2023-04-10 16:10:39
Doctor Fanny Durig is not the type to wrap her words in wise periphrases. She calls an old man an old man. Nothing pejorative in her mouth: old age, this geriatrician rubs shoulders with it all day long. “During my externship, I realized that I was not very comfortable with young patientsconfides the 30-year-old, at the head of the Association of Young Geriatricians (AJG). With elderly patients, I feel in my place. Caring for them has something extremely gratifying and even galvanizing,” assures the doctor, at the origin of a formula that has flourished on social networks: “Geriatrics is sexy! »
A way of remembering that this specialty does not consist “to hold hands or change nappies in hospices”. Like paediatrics, geriatrics is a medicine centered on a specific population, in this case those aged 75 and over – the theoretical age of entry into old age. “I used to say that it is the most modern medicine because we are dealing with people who did not exist a few years agoand which will become more and more numerous”underlines Gaëtan Gavazzi, professor of geriatrics at the Grenoble University Hospital and member of the French Society of Geriatrics and Gerontology (SFGG).
A recent specialty
Officially, it has only been a medical specialty since 2017, the year in which the diploma of specialized studies (DES) in geriatrics was created. Until then, it was a sub-specialty, an option that could be chosen during the internship and which required an additional year of training, as is still the case for palliative medicine.
Today, around a hundred students choose this route every year after passing the national ranking tests (ECN). We are however far from the plebiscite. In 2022, 33 places for geriatricians remained unfilled, i.e. 17% vacancy. This is one of the highest rates, with public health and medical biology, traditionally neglected.
No wonder in the eyes of Professor Gavazzi, who links this lack of interest to the collective perception of old age. “My aunt wanted me to be a priest. When I told her that I had chosen geriatrics, she replied that it was almost the same. I would be Saint-Gaëtan, at the service of lost causes”, ironically the geriatrician, for whom this anecdote betrays a negative and above all erroneous view of old age.
“Getting old is a blessing”
“Old age remains almost systematically associated with dependency. Ask any audience about the percentage of people over 80 who live alone in their homes and are independent, they will answer you 40%, at best. In fact, this concerns 80% of people! , insists the doctor, who keeps repeating it: “The first cause of dependency is not old age, but serious illnesses. But these occur at any age. »
“As soon as the media talk about old age, we hear Ehpad, dependency, cost for society, burden for families… Not to mention the abandonment of the old age law”, points out Jacques Boddaert, professor of geriatrics at the Pitié-Salpêtrière hospital in Paris, and also a member of the SFGG. «What message does this send to young people? Unless they have been made aware of it by a grandmother or a grandfather, few understand that aging is a chance”, he laments.
The trauma of Covid
For this aging specialist, the choice of geriatrics is first and foremost that of link medicine. “This humanity bias means that the specialty generally attracts beautiful people, with values that are unfortunately not the most rising in our society: solidarity, attention to the most vulnerable…”
“Geriatrics requires an appetite for complexity and for interdisciplinarity, but we see in the choice of specialty that the younger generation is moving more towards technical and therefore simpler medicine”analyzes for his part Gaëtan Gavazzi, for whom awareness of old age should be a compulsory part of the course. “In England, Belgium, the Netherlands or Switzerland, all doctors have training in geriatrics. In France, there is not even an internship planned for general practitioners, while the elderly represent a significant part of their patient base.he points out.
If ageism was already well anchored in people’s minds, the Covid has driven the point home again, according to the doctors. “It has done a lot of damage to our profession and especially to the elderly, said Gaëtan Gavazzi. Imagine, we were instructed not to recommend emergencies to people over 90. But at that age, lots of people are in great shape! », he still chokes.
Georgette and her worries
Beyond this limit, your ticket is no longer valid? For Fanny Durig, health policy itself conveys this idea of renunciation. “The Minister of Health François Braun proposed three preventive medical visits, at 25, 45 and 65 years old. And after ? Nothing. However, at 80, you are not screwed! We can still do prevention or secondary prevention at this age, by preventing the recurrence of a fall, for example. This is our role: to allow people to live as long as possible independently, by examining the medical situation but also their own priorities.», develops the geriatrician, citing the case of a patient over 90 who refuses to treat the cancer from which she suffers. “We will never force her to seek treatment if she does not want it. On the other hand, if her goal is to walk again to be able to go home, we will do everything to help her get there. »
Everyone has their challenges and goals. At 80, some patients are in great shape: they play golf, go to the swimming pool, to the theater, to restaurants; others suffer from severe cognitive disorders and need daily support. “Between the two, there is a whole range of capacities or incapacities, weaknesses or complications that it is up to us to prevent or detect”, explains the geriatrician.
A very underdeveloped liberal sector
It is this diversity of situations that pushed Nathan Bleu to embark on this path. “Unlike specialties centered on a particular organ, we are interested in the patient as a whole. And we touch on everything: cardiology, oncology…”, sums up the president of the National Association of Geriatrics Interns (Anaig), launched in 2019 to promote the new DES. To prove the richness of their discipline, the interns imagined the character of Georgette, a senior embodying several clinical cases to solve, “and not just confusion issues or a fractured femur! Patients sometimes have several pathologies, the difficulty is to treat one without aggravating the other.emphasizes Nathan Bleu.
According to the intern, the mode of exercise of geriatrics also harms its attractiveness. “It is practiced almost only in hospitals, while some young people aspire to settle in liberal. » The reason: consultations that are often very long but undervalued. “In geriatrics, undressing a patient to examine him can take between 5 and 10 minutes, it’s almost the duration of a general medical consultation. But the price is the same, raises Jacques Boddaert. Result, “It is almost only in Paris 16th or Nice that we find geriatricians in town”, summarizes Fanny Durig. Way of saying that only a privileged few have access to these practitioners who compensate for the length of the consultations by exceeding fees. “The nomenclature for acts should be revised, but not before two or three years”, indicates the president of the AJG. In the meantime, the association, which will organize its third annual day on June 9 in Nantes, is working to put an end to received ideas about Georgette and the others.
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10% of French people aged 75 and over
On January 1, 2023, France had 6,849,764 people aged 75 and over, including a majority of women (4,120,459), according to INSEE. This represents nearly 10% of the population.
The number of seniors aged 75 to 84 is expected to nearly double by 2030. Those over 85 are expected to increase from 2 million to 4.8 million by 2050.
According to the DREES, cAmong those aged 75 and over, one in ten people only lives in a residential facility.
France has 2,468 geriatricians in 2022, i.e. 3.6 practitioners per 100,000 adults aged 75 and over.
Predominantly female, the profession has 61% of women. The average age is 51 years old, which corresponds to the national average for doctors.
Nearly three-quarters (74%) of geriatricians practice in hospitals. Only 3% work in liberal, while 23% are in mixed exercise (city and hospital).
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