July/August 2020

Education: Reopening the Book on Geriatric Education
By David Hage, MSW, LCSW, ACSW, C-ASWCM
Today’s Geriatric Medicine
Vol. 13 No. 4 P. 6

“Responsibility for learning belongs to the student, regardless of age.” — Robert Martin

On March 13, 2018, the US Census Bureau published a correction to previously projected infant mortality rates, indicating errors that skewed the estimated overall number of deaths. When these errors were detected and calculations were appropriately revised, it became clearer that older adults are projected to outnumber children for the first time in US history. Moreover, baby boomers will all be older than 65 by 2030, at which point 1 in 5 US residents will be at retirement age.1

Challenges for Geriatrics Education
In a systematic literature review, Meiboom and colleagues evaluated 20 studies looking at medical students’ preferences about which patient populations they wished to work with upon graduation. The data indicated medical students typically preferred working with younger patients who have “acute and somatic diseases that can be cured.” This was correlated with perceived complexities associated with geriatric medicine, lower status among peers, and financial disadvantages, which made choices to work with this population further less likely.2 However, exposure to an older adult patient population in preclinical and clinical experiences was positively correlated to pursuing a career in geriatrics.

You may have had a positive preclinical experience or clinical exposure to working with older adult populations. Perhaps your mentor was a geriatrician, primary care provider, or a clinician in another specialty or discipline with an interest in providing high-quality medical care to older adults. Despite your good work and passion, while “the demand for doctors specialized in the medical care of elderly patients is increasing, the interest among medical students for a career in geriatrics is lagging behind.”2 According to the American Geriatrics Society, as many as 30% of older adults need care from a geriatrician. The society further notes that even if each currently practicing geriatrician cared for 700 patients, there would still be an estimated 45% increase in need for geriatricians between 2013 and 2025. Even more concerning is that this 45% increase in demand for geriatricians is expected to occur five years before all baby boomers will hit age 65 in 2030.3

Helping Students Discover a Passion for Geriatrics
A lack of geriatrics clinicians remains a significant problem for an already overburdened health care system and for individual practitioners who manage high patient caseloads of medically complex older adults. This becomes increasingly pronounced when time allotted to see patients continues to shrink rapidly to meet corporate and regulatory expectations of productivity and achievement metrics, which may at times function in opposition to patient preferences and best possible outcomes.

Meiboom and colleagues also developed a concept map that identified a lack of geriatricians entering and maintaining practice and what could be done to remedy this problem. This concept map includes the following categories of focus that can influence medical students to choose geriatrics as a profession4:

• “a patient-centered medical curriculum”;
• “a curriculum representative of patient population (substantial amount of geriatric patients)”;
• “geriatrics presented as intellectually challenging and emotionally appealing”;
• “senior-friendly role models”; and
• “future professional perspectives are clearly provided.”4

Given these five approaches, how can the cause of geriatric education be promoted to create more interest among students in health care education and for those already in practice? Educators might do well to modify health care educational curricula to focus on a truly patient-centered approach attentive to the needs of older adult patients and their family members.3 In light of a rapidly aging society, a representative sample of educational material must include greater amounts of geriatric content.4

Inside the walls of the academy and the medical practice environment alike, educators and geriatric clinicians should collaborate on developing effective methods that make geriatrics intellectually stimulating while simultaneously fostering a humane and “emotionally appealing” environment. When mentoring students and new practitioners, experienced geriatric educators and clinicians can point students to positive geriatric career perspectives and financial potential within the field of geriatric medicine and help them identify the type of health care providers they want to be. This is critical to increasing the number of geriatric clinicians needed to meet increasing societal aging needs.4 These activities might be integrated into in-class activities, clinical supervision time, structured interprofessional simulations, and continued education offerings, for example. Examples of grant opportunities that could support curricular development from the Health Resources & Services Administration include the Geriatric Academic Career Award and the Geriatrics Workforce Enhancement Program.5

Final Thoughts
As we write the next chapters in the book of geriatric education, the needs of a rapidly aging society are clear. So too is the shortage of geriatric clinicians to meet those needs. Numerous barriers exist to developing increased interest in becoming a geriatric clinician, including perceptions of status, financial deterrents, and a lack of meaningful and positive preclinical and clinical exposure to geriatrics and connections to valuable mentorship by established geriatric clinicians.2 However, restructuring medical education opportunities can help bridge these barriers and counterbalance the challenges.6,7 Continued leadership from professional geriatrics organizations, educational institutions and educators, geriatrics clinicians, and researchers remain vital to the future of geriatrics.

— David Hage, MSW, LCSW, ACSW, C-ASWCM, is an assistant professor of social work and gerontology at Misericordia University in Dallas, Pennsylvania. He is also the cofounder and a practicing Aging Life Care Professional and consultant at Pathway Senior Care Associates, LLC.

Geriatrics Educational Resources for Educators
• American Geriatrics Society: a nationwide, not-for-profit society of geriatrics health care professionals dedicated to improving the health, independence, and quality of life of older people.

• Academy for Gerontology Education in Higher Education: offers education, training, curricular innovations, and research programs in the field of aging.

• Consult Geri: a clinical education resource including courses, podcasts, webinars, tools, and other resources focused on the care of older adults provided by the Hartford Institute for Geriatric Nursing.

• American Federation of Aging Research: a research organization focused on aging issues that also lists established Geriatric Centers for Excellence.

• National Association of Geriatric Education: an educational organization dedicated to improving the education/training, supply, distribution, diversity, and quality of health care professionals, ultimately to improve the quality of health care for all elderly individuals, including underserved and minority groups.

Geriatrics Educational Resources for Health Care Providers
• Gerontological Society of America: the oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging by promoting the study of aging and disseminating information to scientists, decision makers, and the general public.

• American Academy of Family Physicians Geriatric Toolbox: clinical resources for family physicians working with older adults.

• American Geriatrics Society Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine, 10th Edition: a comprehensive reference containing the latest developments in the field of geriatric medicine.

• Consult Geri: a clinical education resource including courses, podcasts, webinars, tools, and other resources focused on the care of older adults provided by the Hartford Institute for Geriatric Nursing.

References
1. Older people projected to outnumber children for first time in U.S. history. United States Census Bureau website. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html. Updated October 8, 2019. Accessed April 9, 2020.

2. Meiboom AA, de Vries H, Hertogh CM, Scheele F. Why medical students do not choose a career in geriatrics: a systematic review. BMC Med Edu. 2015;15:101.

3. Geriatrics workforce by the numbers. American Geriatrics Society website. https://www.americangeriatrics.org/geriatrics-profession/about-geriatrics/geriatrics-workforce-numbers. Accessed April 10, 2020.

4. Meiboom AA, Vries HD, Scheele F, Hertogh CMPM. Raising enthusiasm for the medical care of elderly patients: a concept mapping study to find elements for an elderly friendly medical curriculum. BMC Med Edu. 2018;18(1):283.

5. Grants. Health Resources & Services Administration website. https://www.hrsa.gov/grants/index.html. Published November 27, 2017. Accessed April 10, 2020.

6. Piedra L, Howe M, Ridings J, et al. Re-conceptualizing positive aging: researcher and practitioner perspectives. Innov Aging. 2018;2(Suppl 1):397-398.

7. Hahn RA, Truman BI. Education improves public health and promotes health equity. Int J Health Serv. 2015;45(4):657-678.