By Bonnie Adams
Westborough – As the country's boomer population ages and people live longer than ever, Dr. Gary Moak feels there will soon be a “massive crisis.”
Moak, a geriatric psychiatrist who is also the medical director of the Moak Center for Healthy Aging in Westborough, is concerned that there will not be enough health professionals qualified to take care of the unique needs of an increasing elderly population.
Geriatric psychiatry, he explained, is a medical sub-specialty at the intersection of primary care, neurology and psychiatry.
In fact, it is such a sub-specialty that there are only approximately 1,600 doctors currently in the United States practicing in the field. And Moak is the only geriatric psychiatrist located between Newton and Springfield. As such, his office had over 5,000 patient appointments last year.
By 2030 it is estimated that there will be 70 million older Americans, he said, with approximately 15 million of those who will have some sort of mental health problem.
“There is a critical shortage of professionals in this field now – not just doctors but also nurses,” he said. “By 2030 it will be twice as bad.
Geriatric usually refers to those who are age 65-plus, he said, and who are frail older people. Most of his patients are in the age range of 80 to 90 years old, but he has also treated some who are 100 or older.
“Older people are good to work with,” he said. “Once you help them get over their reticence to accept help, they are very grateful. But they have complicated needs. And many times they feel written off by not only society but also medicine.”
People who come to see him are desperate, he said, often “at the end of their options to get help.”
Often the patient may be suffering from depression, Alzheimer's disease, dementia or a host of other illnesses.
Eighty percent of mental health problems are caused by other health issues such as cancer or emphysema, he said.
“They are survivors,” he said of the patients he treats. “It's their bodies that have let them down.”
Moak also tries to involve a patient's family in the treatment process as much as possible.
“When an elderly person is suffering, it affects the whole family,” he said. “It is truly a “family illness.” Children worry about their parents and how to help to help them.”
The majority of his referrals come from primary care doctors. Those doctors often don's have the time or necessarily the expertise to deal with the particular mental challenges that elders face, he added.
Compounding the problem, he said, is the insurance pay structure. Recent health care reform initiatives mainly address the private health care sector and issues related to younger people. But elderly people usually have Medicare or Medicaid rather than private insurance. For decades, Medicare used to require 50 percent for co-payments, but now changes are slowly being phased in, Moak said, so that by 2014 those co-payments will be reduced to 20 percent.
Moak has been practicing in the field since 1986. He is also an associate professor of Clinical Psychiatry at the University of Massachusetts Medical School and sits on the Medicare Carrier Advisory Committee, representing the Massachusetts Psychiatric Society. He is a past-president of the American Association for Geriatric Psychiatry (AAGP) and in March, he received the AAGP Clinician of the Year Award.
“What keeps people from entering this field is that it is hard to make a living at it,” he said. “It's longer care, with less payment.”
“But it's a stimulating rewarding field,” he said of geriatric psychiatry. “It requires a wide range of skills. You need to deal with traditional counseling, have to understand social systems, end of life issues, ethical concerns, etc.”
For more information, visit the website www.moakgeriatricpsychiatry or call 508-366-2106.