Agreed: More Geriatric Training Needed!

Early in my career my focus was on developing home and community based services for seniors to help prevent premature admission to nursing homes. I noticed while doing this work how little health care professionals, particularly physicians, knew about dealing with seniors. Amazingly enough, with early baby boomers on the cusp of retirement, calls for geriatric training for health care professionals are still being made. From HealthLeaders:

The Partnership for Health in Aging—a coalition of more than 20 organizations representing eldercare professionals—released today a set of 23 geriatrics core competencies that it says all healthcare providers should have to better care for elderly patients.

The coalition developed the competencies in response to the Institute of Medicine's 2008 report Retooling for an Aging America: Building the Healthcare Workforce, which recommended that "licensure, certification, and maintenance of certification for healthcare professionals should include demonstration of competence in the care of older adults as a criterion."

Geriatric specialists are already in short supply and training more may not be feasible given the lack of interest and growing demands of an aging population. Some experts think training all doctors, dentists, nurses, physician therapists, social workers, and other providers in basic elder care may be the best way to prepare the nation for the "silver tsunami."

"The ultimate goal is to have universal geriatrics competencies that can enhance the capacity of the entire workforce in caring for older adults," said Todd Semla, MS, PharmD, who chairs the workgroup. The final competencies cover six domains:

• Health promotion and safety. These competencies include promoting mental and physical health behaviors, assessing risks like falls and elder mistreatment, and recognizing evidence-based treatments for older adults.
• Evaluation and assessment. Example competencies include, "Apply knowledge of the biological, physical, cognitive, psychological, and social changes commonly associated with aging," and, "Demonstrate knowledge of the signs and symptoms of delirium."
• Care planning and coordination across the care spectrum. Emphasis was placed on ensuring person-centered and -directed care across the continuum, including end-of-life care.
• Interdisciplinary and team care. The competencies encourage providers to refer to and consult with any of the multiple healthcare professionals who work with older adults and incorporate discipline-specific information into the overall care plan.
• Caregiver support. The competencies call for providers to: "Assess caregiver knowledge and expectations of the impact of advanced age and disease on health needs," and take other steps to involve and work with caregivers.
• Healthcare systems and benefits. One major challenge for providers would be to know how to assess and share with patients information about Medicare, Medicaid, Veterans' Services, Social Security, and other public programs.

The authors of the competencies intentionally left them broad, and expect each discipline to determine how to incorporate them into their training programs. However, the workgroup believes the competencies can apply to all entry-level professionals.

"There will be variations in how the competencies apply to each discipline, and each discipline will need to determine how the competencies will be utilized within their own curriculum development and credentialing processes. We see this as an iterative process as other disciplines build upon the work that we have started," said Semla.

I raised this issue at a geriatric conference I attended in 1982! It amazes that this type of training has yet to be implemented across the board.