Home delivery--bringing primary care to the housebound elderly.

New England Journal of Medicine 359(23):2409 (2008) PMID 19052122

As baby boomers enter their 60s, their increasing medical needs and a worsening shortage of primary care doctors are expected to fuel a crisis in health care for the elderly. Dr. Susan Okie reports that meeting their medical needs will most likely require increasing reliance on midlevel providers (nurse practitioners and physician's assistants), as well as the use of multidisciplinary teams. Nurse practitioner Gail Metcalf toted her medical bag up the steep stairway of a triple-decker house in Dorchester, a low-income neighborhood of Boston, and greeted her patient, Mrs. E, a Jamaican woman in her mid-80s. Mrs. E, who is legally blind and has chronic obstructive pulmonary disease, hypertension, neuropathy, a thoracic aneurysm, and other medical problems, sank into a lift chair and began describing her symptoms as Metcalf examined her. Her back ached and her arms burned, she said, especially at night: “That's the time when it really comes on. Sometimes, I feel life is leaving me.” Mrs. E's agitation . . .

DOI: 10.1056/NEJMp0808067