The Silver Tsunami: One Educational Strategy for Preparing to Meet America's Next Great Wave of Underserved

Silver tsunami is the compelling phrase coined by the authors of a 2001 Pew Report that considered the possible consequences of baby boomers approaching retirement.¹ Many health professionals, including those of us at the University of New England, believe the phrase is an apt description for the swell of older people, gaining momentum, and surging toward the health care system over the next twenty years. Like the actual tsunami originating around Indonesia in 2004, leaving unbelievable devastation in its wake, this swelling tide of America's elderly threatens to overwhelm our health care system. We are unprepared to care for what will soon be the largest, and in many ways, most challenging segment of our population.

According to 2000 Census data,² people over the age of 65 currently constitute approximately 13% of the population. Close to 28% of those folks live alone, and that percentage approaches 39% for those 85 and over; women outnumber men in this latter category by a margin of three-to-one. Approximately 10% of elders live in poverty. This is less than the U.S. adult percentage, but it is significant to note that more women than men are affected, and that without the continued stability of Social Security income, nearly one of every two elders, regardless of gender, would have an income level below the poverty line.³ Geographically, about one-fourth of the total elderly population resides in non-metropolitan and rural areas; overall, these elders face greater poverty, have less education, and generally report poorer health than their more urban counterparts. They also face disadvantages in health systems' accessibility, resources, transportation, and work force availability.⁴ Most projections estimate that, by 2020, the proportion of the total population that is 65 and over will have risen to approximately 20%, or one-in-five.

These are sobering statistics, especially in combination with the complex, multifaceted health issues associated with aging. Most elders acknowledge one or more physical, sensory, or self-care disabilities, and have at least one chronic illness.² It is not just matters of medical/physical health that cause concern; indeed both oral health and mental health stand at the vanguard of needs. As noted in the Surgeon General's Report of 1999, ". . . more than any other area of health and medicine, the mental health field is plagued by disparities, particularly as they relate to the elderly."

Over the past decade, calls for a health care workforce more adequately prepared to care for elders have been raised within the health care system as well as by patients and clients. Since the early 1990s, The American Geriatric Society (AGS) has been encouraging a proactive response to the impending, dual crises of insufficient numbers within the workforce, and inadequate education about care of older patients by that workforce. In 2002, there was a call for increased numbers of specialty-trained geriatricians, and for general practice physicians to obtain additional education and certifications in geriatrics.⁵ The AGS reissued its set of basic competencies for care of older patients, for medical education,⁶ as did several other specialty and health professional groups. There was strong encouragement to all health professions to increase their educational content in geriatric care. In 2006, AGS reframed their guidelines for care of elders, and suggested that, aside from nursing home residents, only a small subset of the nation's community dwelling elders required geriatric specialty care (perhaps 15%—those with multiple, complex, chronic conditions). The AGS described interdisciplinary team function as the benchmark practice for this level of care. They also acknowledged that peer-reviewed literature supported innovative care delivery systems, including the use of geriatric assessment, care coordination, multidisciplinary teams, and a holistic approach to patient care that involved clinical, psychosocial, and environmental follow-up.⁷ The overall response to the pleas of health and policy groups for action can kindly be described, so far, as underwhelming.

The final distressing contributors to this quandary are the reports discussing the aging/approaching retirement of the existing health care workforce, and the variety of...