Geriatricians Must Refine Their Focus On Frailest Elderly With Primary Care Physicians Caring For Healthier Elders

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Series Published In JAGS
Main Category: Seniors / Aging
Article Date: 10 Oct 2008 – 1:00 PDT
Two converging trends – rapid growth in the population of older Americans and declining numbers of geriatricians practicing in the U.S. – are forcing the field of geriatrics to refine its scope, according to a series of articles on the future of the field in October’s Journal of the American Geriatrics Society (JAGS). Over the next two decades, the number of older Americans will nearly double, to 70 million. But the number of geriatricians, physicians who have advanced training to meet the unique health care needs of older patients, in the U.S. is expected, at best, to stay steady at roughly 7,500.

“As the recent Institute of Medicine (IOM) report, Retooling for an Aging America, confirms, there won’t be nearly enough geriatricians to care for the growing number of older Americans,” says the University of South Carolina Medical School’s Paul Eleazer, M.D., President of the Association of Directors of Geriatric Academic Programs (ADGAP). “These articles offer guidance for making the most effective use of our limited supply of geriatricians.”

The JAGS series includes a report on a recent survey that asked the directors of all U.S. geriatric academic programs what role geriatricians should play in health care. Their answer: Geriatricians should focus on the most complex and most vulnerable older patients. “The consensus among the nation’s geriatric academic program directors appears to be that the best way to deploy the geriatricians we have is to have them focus on the frailest, most vulnerable older patients,” says the University of Cincinnati College of Medicine’s Gregg Warshaw, M.D., project director for ADGAP’s longitudinal geriatrics workforce study. “These findings from our survey offer the beginning of a consensus statement as to the role of geriatricians in the continuum of American medical care.” The longitudinal study is funded by the Donald W. Reynolds and John A. Hartford Foundation.

Having geriatricians focus on the frailest, most complex older patients is likely to result in improved outcomes, a companion study in the JAGS series suggests. That study finds that the care provided by geriatricians and generalists differs, with geriatricians assessing patients for complex geriatric syndromes and taking steps to avoid improper prescribing slightly more often than generalists.

An accompanying editorial by Dean of the Columbia University School of Public Health Linda Fried, M.D., and William Hall, M.D., of the University of Rochester School of Medicine, recommends next steps. First, the health care system should target training efforts to prepare “adequate numbers” of geriatricians to care for the 25 to 30 percent of older adults who are frail and have multiple, complex health problems. At the same time, it should ensure that the primary care physicians who will be responsible for caring for healthier and better functioning older patients are taught basic geriatrics principles and “when and how to involve a subspecialist geriatrician in care.”

In addition to utilizing geriatricians in the most effective way possible – by focusing their efforts on the most vulnerable older adults – our nation also needs to address the underlying causes of the growing shortage of geriatricians, many leaders in the field argue. “As the IOM report noted, one of the central contributors to the shortage of geriatricians in this country is financial – inadequate Medicare reimbursement and other strong financial disincentives discourage physicians from entering geriatrics practice,” says Dr. Eleazer. “Until these financial disincentives are addressed, we will never be able to recruit adequate numbers of geriatricians — even if the scope of practice focuses on frail, vulnerable older adults.”

About the Association of Directors of Geriatric Academic Programs

For the past 15 years, the Association of Directors of Geriatric Academic Programs (ADGAP) has been committed to advancing academic geriatrics programs and supporting academic geriatrics program directors in order to benefit and aid patient care, research, and teaching programs in geriatric medicine within accredited medical schools located in the United States. ADGAP has built and fostered new methods of facilitating the development of leadership skills among academic geriatricians and has provided an ongoing forum for Program Directors and leaders in academic geriatrics to discuss the wide variety of issues that they encounter.

American Geriatrics Society

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