Dr. David Eibling Q&A: Geriatric Otolaryngology

Geriatric ENT Health – March 2009

AAO-HNS Member Expert Q & A –
When Baby Boomers Become Senior Boomers

A Q&A with David E. Eibling, MD, Chair of AAO-HNS’ Geriatric Otolaryngology Committee, on the challenges that face both patients and physicians as the age group known as the “baby boomers” become seniors.

Q. You’re the chair of the Academy’s Geriatric Otolaryngology committee. Are you prepared for the large number of baby boomers who will be entering their senior years soon?

A. The members of the Geriatric Otolaryngology committee have been thinking about this impending challenge for some years now. Under the leadership of Ara Chalian, MD, and others, the committee has built relationships with the American Geriatric Society and the Hartford Foundation to develop materials that can prepare otolaryngologists to manage the elderly. Nevertheless, I don’t think that I could claim that we are “ready.”  The numbers of patients who will be seeking our care will stress the entire care system, from our bricks-and-mortar infrastructure, to our workforce, and to our nation’s ability to fund the care that these aging boomers will need. We will need to “think outside of the box,” probably in ways we can’t even imagine in 2009. Every specialty will need to participate in effecting these changes, and none are really ready.

Q. What are some of the most pressing concerns these new seniors will face?

A. I think it is reasonable to predict that disorders of hearing, balance, and swallowing will be among the primary concerns of the aging population. Practices that treat the elderly already commonly encounter patients with these disorders. Over the next decade the need for otolaryngologists to take an increasing role in early diagnosis, management, and rehabilitation will only increase. One example will be the need to develop new strategies to address cerumen (earwax) management for the large numbers of patients who will be wearing hearing aids.

Q. The baby boomers were the first age group to attend loud rock concerts and other noisy events. Are you seeing the impact of this cultural shift?

A. Without question, all of us are encountering patients who present with the early development of significant high frequency hearing loss, but without a history of work-related noise exposure. Another recent concern is the number of young veterans who served in Iraq and Afghanistan developing moderate-to-severe high-frequency hearing loss in their 20s and 30s. Despite our nation’s shift away from an economy based on heavy industry, and the success of government hearing conservation programs, I fear that our nation is facing an epidemic of hearing loss for which it is unprepared.

Q. People these days are living longer. Any tips to improve their chances of avoiding these ear, nose, throat, head, and neck health concerns?

A. There are really no secrets here. Eat right, don’t smoke, get plenty of exercise, and protect yourself from things that might hurt you by wearing your seat belts, driving conservatively, wearing a helmet when you ride two-wheeled vehicles, and protecting your hearing. I predict that over the next several years we will hear much more on the value of balance training to maintain high levels of independence and reduce the risk of falls.

Q. Are otolaryngologists ready for this influx of new patients?

A.  With the exception of those who practice only pediatric ENT, essentially all of us in otolaryngology will face new challenges as these aging baby boomers appear at our doors. It is unlikely that we, or any segment of the healthcare system, are really ready.  Predicting the future is always a risky proposition, but the Academy has anticipated these impending demographic changes. We have been helping our members prepare for this eventuality for some time through the development of teaching materials such as the online edition of Textbook of Geriatrics. There will be some unique challenges to meet the needs and expectations of this group, such as increased need for care coordination with other providers, as well as the need to take specialty care out to patients where they reside. In its April 2008 report “Retooling America’s Workforce,” the Institute of Medicine makes a number of recommendations. Key in these recommendations is the need for active teaching of the primary caregivers. As specialists we are charged with alerting the workforce to some of the unique problems elderly people face, to ensure they are referred for optimal management.