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Over the next 25 years, the number of American adults 65 and older will double, topping 71.5 million. Yet sufficient numbers of professionals to deliver their healthcare is far from assured.

A study last year by the American Geriatrics Society concluded that the current shortage of geriatricians and other healthcare professionals trained to care for older adults could reach "crisis proportions" during those same 25 years. Meanwhile, Congress has slashed federal funding to help train the next generation of geriatricians.

"Geriatrics, just like pediatrics, has a special information set that addresses the problems that are not existent in younger individuals and become increasingly prevalent as people grow older," explains Dr. Jane F. Potter, the new AGS president. Professor and chief of geriatrics at the University of Nebraska Medical Center, Potter says geriatrics has been recognized by the medical community as a certified specialty since 1988.

The 2005 AGS report "Caring for Older Americans: The Future of Geriatric Medicine" warns that by 2030 there will be only one geriatrician for every 7,665 older adults unless substantial measures are taken to lure medical students to the field. One disincentive is inequitable Medicare reimbursement policies, the report says. The study also documents the need for more geriatrics research.

Potter says geriatricians bring to the table knowledge and skills to treat a variety of chronic maladies simultaneously, a scenario that's often the case in older adults. Called the "geriatric syndromes," these health problems may include urinary and fecal incontinence, dementia, pressure ulcers, instability and falls, diabetes, depression, heart disease, sensory impairment and malnutrition. "These are the things that rob older folks of their independence," Potter says.

"Sometimes we refer to geriatrics as being the specialty of complex illness," she adds. "If you followed all the guidelines to treat a patient who has diabetes, heart disease and hypertension, you could easily have that patient on 12 medications. When is too much medicine too much? When do the side effects from medications outweigh the benefits to an individual? When do risk factors and treatment recommendations need to be modified? How does the patient view their quality of life? That's really what geriatrics is all about."

Potter calls her career "enormously satisfying," so she's particularly troubled by recent Title VII federal funding cuts. Congress created Title VII funding about two decades ago to increase the number of professionals in specific areas of healthcare. Geriatrics was included. In December 2005, Title VII funding across the board was either reduced or eliminated, and funding for geriatrics, about $31.5 million, was abolished altogether. "Compared to what we expend on Medicare, which is into the billions, it's a drop in the bucket," Potter says. "And these are the people who care for the Medicare population and teach others to do good care."

The Title VII funding for geriatrics supported three initiatives:

1. Nearly 90 faculty fellowships to train physicians, dentists, and behavioral and mental health professionals, who then teach geriatric medicine, dentistry and psychiatry.

2. The nation's 50 Geriatric Education Centers, which bring physicians and other healthcare professionals up to speed on the unique needs of older adults. The center also trains medical professionals to be faculty "preceptors," meaning they teach in a clinical setting. For example, a preceptor in geriatrics in a rural location might welcome a student to work alongside him or her to get hands-on experience and try the discipline on for size. The centers also develop training programs for people who provide care in nursing homes.

3. The Geriatric Academic Career Awards, which support geriatric physicians and other healthcare professionals who pursue academic medicine and then go on to train geriatricians. The five-year awards afford these professionals opportunities "to develop themselves as teachers," Potter explains.

In Potter's department at the University of Nebraska, the funding loss is already taking a toll. "[The loss] leaves 98 health providers without the means to complete the mini-fellowships in which they enrolled and also eliminates our programs to reach rural providers and direct-care providers in nursing homes," she says.

Thus, a coalition of medical organizations, including the AGS, is fighting to restore the Title VII geriatrics funding. Potter says the Senate recently made a move to reinstate the money, but the House doesn't appear to be "in any mood" to do the same.

"There were some positive signs, but it doesn't look good now," she says. "It's very likely that when it goes to conference committee, we're going to lose again. We're expecting a battle that will go into October, so the sooner people contact their congressional representatives to encourage restoration of the funding at the 2005 levels the better."

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