GERIATRIC CARE: A FAMILY PHYSICIAN'S PERSPECTIVE

1
GERIATRIC CARE A FAMILY PHYSICIAN'S PERSPECTIVE

• Dr. Grant McKercher
• Seniors Mental Health Program
• North Bay, Ontario

2
INTRODUCTION

• Challenges facing primary care physicians caring
  for the elderly
• Barriers to good medical care for the elderly
• Future directions

3
Challenges Facing Primary Care Physicians Caring
for the Elderly

• Medical
• multiple/complex conditions
• Psychiatric
• increasing prevalence of dementia and other
  psychiatric conditions
• competency
• Social
• caregiver burnout, family dynamics
• placement issues
• community resources

4
Top Ten Problems

• Survey of 134 physicians in Northeastern Ontario
• Drug Reactions/Polypharmacy 53.5
• Functional Decline 50.5
• Complex Medical Problems 49.5
• Competency 47.5
• Atypical Disease Presentation 42.4
• Dizziness 41.4
• Strokes TIAs 41.4
• Dementia 37.4
• Impaired mobility 36.4
• Recurrent falls 36.4

5
Current Advice SourcesFor Difficult Geriatric
Problems

• Internists 39.1
• Journals/Texts 21.8
• Self 10.3
• Colleague 10.3
• Geriatric Psychiatrist 8.1
• CME 3.5
• Family Physician 2.3
• Geriatrician 2.3
• Internet 2.3

6
Barriers to Good Medical Care for the Elderly

• Primary Care Issues
• knowledge/training/attitude
• time constraints
• compensation
• Community/System Resources
• Reduced Home care services
• Underfunding of Long-term care facilities
• Lack of Specialists/multidisciplinary teams
• Poor communication among different sectors (LTC,
  Community agencies, acute care)

7
Future Directions

• Enhance community resources by educating local
  personnel
• family practitioners
• community nurses
• LTC facility personnel
• Long-distance consultations
• Internet/telemedicine
• Alternate payment for geriatric services
• eg salary/sessional fees for LTC work

8
Conclusions

• Primary care physicians have an important role in
  care of the elderly
• Role will increase as population ages
• Need to work more closely with multidisciplinary
  teams to meet the needs of our elderly patients