Healthcare professional training: a comparison of geriatric competencies

Health professionals specializing in geriatrics are a unique but scarce resource who nevertheless play a critical role in shaping the care of older adults. An interdisciplinary didactic and clinical training milieu would have the potential to maximize training opportunities for geriatric healthcare professionals. The fact that little is known about the concordance between discipline-specific geriatric competencies hampers the creation of interdisciplinary geriatric training opportunities. Discipline-specific geriatric experts compared the geriatric competencies specified by geriatric-certifying bodies of five healthcare professions: dentistry, medicine, nursing, pharmacy, and social work. Overlap and differences in geriatric competencies across disciplines are presented, and opportunities and barriers to interdisciplinary geriatric education are discussed.     

住院患者老年综合评估规范及初步效果分析

目的：探讨在老年住院患者中进行老年综合评估（CGA）对于老年人全面综合管理的作用。方法制定标准的CGA流程,采用标准流程对北京协和医院老年病房2013年9月至2014年9月连续入院的≥65岁患者进行CGA,分析其筛查老年综合征的效果。结果标准化的评估流程便于临床使用,接受评估的179例患者中,年龄（72.5±8.1）岁。通过CGA发现,视力异常患者占62.0%,睡眠障碍41.3%,听力异常40.8%,慢性疼痛34.6%,跌倒25.7%,多重用药23.5%,便秘21.8%,抑郁焦虑18.4%,尿失禁16.2%,谵妄10.6%。以不同主诉入院的15例患者最终诊断为老年综合征,占8.4%。结论老年综合征在老年患者中普遍存在,运用标准化的CGA方法可以进行有效筛查,有利于老年患者的全人管理。     

Geriatrics training and education for nongeriatrician faculty: the Dean's Faculty Scholars in Aging Program

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty-six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross-departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third-year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.     

The current state of geriatric medicine: a national survey of fellowship-trained geriatricians, 1990 to 1998

The rapid growth of the older population has focused national attention on the need for physicians trained in geriatric medicine. To gain insight into the evolving status of the field, with particular focus on career decision-making and academic career development of trainees, we conducted a survey of physicians recently completing geriatric fellowships. The 107 accredited extant geriatric fellowship programs in the United States and Puerto Rico were contacted to identify trainees from 1990 to 1998. A mailed survey addressed relevant career development and training issues. Four hundred ninety out of 787 (62%) physicians responded; 20% completed 1 year and 80% 2 or more years of training. Half made the decision to pursue a career in geriatrics during residency, 27% decided before/during medical school, and a mentor influenced 48%. Currently, 80% have a Certificate of Added Qualifications in geriatric medicine, 69% hold academic appointments, 78% teach, 39% participate in research, and 44% author publications. Most are doing predominantly clinical work in multiple settings. Further analysis of the 1996-to-1998 cohort revealed that those completing fellowships of 2 or more years are more likely to identify all geriatrics as their professional focus, conduct and author research, work with multidisciplinary teams, and participate in professional geriatric societies. This national survey documents career decision-making and the academic and clinical profiles of physicians completing geriatric fellowship training in the past decade. Longer fellowship training is associated with academic career development. Although there is a national need to train clinical geriatricians, the additional need to train and fund future geriatric academic leaders requires increased attention.     

老年住院患者的综合管理

衰老、共病、老年综合征、老年问题等多方面因素共同作用,影响老年人的健康情况和功能状态,需要进行全面的老年综合评估来发现老年住院患者各个方面的问题,针对可以处理、能够逆转的问题进行个体化的干预,才能使老年患者真正获益。除了针对入院疾病的诊疗之外,还要重视相关的老年问题,采取跨学科团队干预,可以有效地处理其健康问题,改善老年患者的功能状态、提高生活质量。     

A National Survey on the Effect of the Geriatric Academic Career Award in Advancing Academic Geriatric Medicine

A workforce that understands principles of geriatric medicine is critical to addressing the care needs of the growing elderly population. This will be impossible without a substantial increase in academicians engaged in education and aging research. Limited support of early‐career clinician–educators is a major barrier to attaining this goal. The Geriatric Academic Career Award (GACA) was a vital resource that benefitted 222 junior faculty members. GACA availability was interrupted in 2006, followed by permanent discontinuation after the Geriatrics Workforce Education Program (GWEP) subsumed it in 2015, leaving aspiring clinician–educators with no similar alternatives. GACA recipients were surveyed in this cross‐sectional, multimethod study to assess the effect of the award on career development, creation and dissemination of educational products, funding discontinuation consequences, and implications of program closure for the future of geriatric health care. Uninterrupted funding resulted in fulfillment of GACA goals (94%) and overall career success (96%). Collectively, awardees reached more than 40,700 learners. Funding interruption led to 55% working additional hours over and above an increased clinical workload to continue their GACA‐related research and scholarship. Others terminated GACA projects (36%) or abandoned academic medicine altogether. Of respondents currently at GWEP sites (43%), only 13% report a GWEP budget including GACA‐like support. Those with GWEP roles attributed their current standing to experience gained through GACA funding. These consequences are alarming and represent a major setback to academic geriatrics. GACA's singular contribution to the mission of geriatric medicine must prompt vigorous efforts to restore it as a distinct funding opportunity.     

老年综合评估及多学科团队服务在老年共病干预中的应用

目的 探讨住院老年患者通过老年综合评估(CGA)及多学科团队服务(GITS)进行多维度诊疗,为老年患者提供科学、合理的个性化诊疗模式,有效改善共病诊疗效果及生活质量。方法 选取年龄≥60岁的老年科共病患者,分为观察组和对照组。使用自主开发的“老年综合评估软件V2.0”对210例老年患者入院7天内进行老年综合评估,随后观察组根据评估结果给予共病、老年综合征、心理、认知及生活方式等全面综合干预,对照组仅给予共病干预。干预3个月后行第2次老年综合评估,比较观察组与对照组共病及生活质量改善情况。结果 (1)观察组比对照组血压、血糖控制效果更好(P<0.05),观察组比对照组慢性心衰急性加重、慢性阻塞性肺疾病急性加重发生人数减少(P<0.05)。(2)老年综合征及生活质量：观察组比对照组Barthel指数得分及MMSE得分显著提高(P<0.05),观察组比对照组营养、抑郁、焦虑、跌倒、衰弱均有显著改善(P<0.05),因促眠药物的应用观察组与对照组睡眠障碍均有改善,改善程度无显著差异(P>0.05)。结论 老年患者住院期间进行老年综合评估并结合多学科团队服务,可以及...     

Geriatric medicine and geriatric psychiatry clinical services affiliated with U.S. academic medical centers

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).     

National survey of geriatric medicine fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs Geriatrics Workforce Policy Studies Center

This article documents the development of geriatric medicine fellowship training in the United States through 2009. Results from a national cross-sectional survey of all geriatric medicine fellowship training programs conducted in 2007 is compared with results from a similar survey in 2002. Secondary data sources were used to supplement the survey results. The 2007 survey response rate was 71%. Sixty-seven percent of responding programs directors have completed formal geriatric medicine fellowship training and are board certified in geriatrics, and 29% are board certified through the practice pathway. The number of Accreditation Council for Graduate Medical Education-accredited fellowship programs has slowly increased, from 120 (23 family medicine (FM) and 97 internal medicine (IM)) in 2001/02 to 145 in 2008/09 (40 FM and 105 IM), resulting in a 21% increase in fellowship programs and a 13% increase in the number of first-year fellows (259 to 293). In 2008/09, the growth in programs and first-year slots, combined with the weak demand for geriatrics training, resulted in more than one-third of first-year fellow positions being unfilled. The number of advanced fellows decreased slightly from 72 in 2001/00 to 65 in 2006/07. In 2006/07, 55% of the advanced fellows were enrolled at four training programs. In 2008/09, 66% of fellows were international medical school graduates. The small numbers of graduating geriatric medicine fellows are insufficient to care for the expanding population of older frail patients, train other disciples in the care of complex older adults, conduct research in aging, and be leaders in the field.     

Community Physicians' Knowledge on Basic Health Care for Elderly Persons in Israel: Comparing Findings From 2006 to 1996

Community physicians should be knowledgeable of basic geriatrics to cope with the challenges posed by the growing number of older patients and their complex needs. A survey of knowledge in basic health care for elderly persons, carried out by our team in 1996, revealed that it was insufficient. The authors repeated this survey in 2006, by using the same methodology, namely, a mailed questionnaire sent to 500 randomly sampled community physicians. No significant changes were found after this 10-year period. Likewise, no difference was evidenced between physicians that participated in geriatric training of any kind and those who did not. This lack of change requires health system leaders to coordinate their efforts and develop efficient teaching programs to prevent similar findings 10 years from now.     

通过老年综合评估分析北京市社区老年人的营养状况

目的通过包括微型营养评定简表(MNA-SF)、慢病、生活方式以及其他老年问题的老年综合评估(CGA),了解北京市老年人营养状况及其影响因素。方法对北京市朝阳区4个社区941例≥65岁、同意接受调查的老年人进行面对面调查。结果 4个社区老人年龄(75.8±7.0)岁,中位年龄76岁;体质量指数(BMI)(23.8±4.2)kg/m~2。MNA-SF提示营养不良(0~7分)34例,占3.6%,营养不良风险(8~11分)407例,占43.3%,营养问题总计441例(46.9%)。营养问题的风险因素有:≥85岁(χ~2=9.65,P=0.002)、女性(χ~2=6.82,P=0.01)、单身(χ~2=5.63,P=0.02)、仍工作(χ~2=4.36,P=0.04)、合并≥3种慢病(χ~2=3.71,P=0.05)及患慢性肺病(χ~2=5.21,P=0.02)。结论营养问题是社区常见的老年问题,建议加强教育,将营养筛查与评估纳入常规健康查体,尤其应关注高龄及共病老人。     

The importance of physical function as a clinical outcome: Assessment and enhancement

The burgeoning population of older adults is intrinsically prone to cardiovascular disease (CVD) in a context of multimorbidity and geriatric syndromes. Risks include high susceptibility to functional decline, with many older adults tipping towards patterns of sedentary behavior and to downstream effects of frailty, falls, disability, poor quality of life, as well as increased morbidity and mortality even if the incident CVD was treated perfectly. While physical activity has been shown to moderate these patterns both as primary or secondary preventive medical care, the majority of older adults fail to meet physical activity recommendations. Clinicians of all specialities, including CVD medicine, can benefit from greater proficiency in functional assessments for their older adults, as well as from insights how to initiate effective functional enhancing approaches even in older adults who may be frail, deconditioned, and medically complex. Pertinent functional assessments include traditional cardiovascular metrics of cardiorespiratory fitness, as well as strength and balance. This review summarizes the components of a wide-ranging functional assessment that can be used to enhance care for older adults with CVD, as well as interventions to improve physical function.     

城市社区健康状态较差老年人的状况评估及分析

目的了解社区健康状态较差的老年人的需求,为合理干预提供依据。方法 2013年2月至2013年5月对北京市部分社区≥65(79.2±8.3)岁、健康状态较差的209位老年人进行老年综合评估。结果巴氏日常生活活动能力(Barthel-ADL)正常者50例(23.9%),功能受损者159例(76.1%);所有老年人均有≥2个多种慢性状况(MCC),受调查者有老年综合征3.9[4(3,5)]个,高于平均慢性疾病数3.5[3(2,4)]个,功能受损组老人慢性疾病及老年综合征数均高于功能正常组(P=0.007,P=0.05)。需要他人照顾者占79.9%,其中照顾者为配偶者占50.3%。每年规律接种流感疫苗者仅占8.1%,规律体检者占14.8%。结论老年综合征对该人群影响更大,应予以重视;社区针对失能老年人的医学照护模式、照顾者负担等问题仍需关注。     

四川7家医院住院老年肿瘤患者综合评估结果分析

目的分析四川7家医院住院老年肿瘤患者综合评估结果及预后。方法 2012年7月到2014年1月间对四川省7家医院488例年龄≥65岁的住院老年肿瘤(肺癌、前列腺癌、结直肠癌和恶性淋巴瘤)患者进行综合评估,分析老年综合征情况并比较不同功能组患者随访1年的预后情况。应用SPSS 22. 0统计软件对数据进行分析。组间比较用χ2检验。结果 488例患者中严重合并症占76. 4%(373/488),工具性日常生活能力(IADL)受损占68. 6%(335/488),视力障碍占68. 2%(333/488),跌倒高危人群占51. 0%(249/488),社会支持不足占10. 0%(49/488)。65~75岁组患者营养不良风险和营养不良患者比例高于76~85岁和 85岁组患者,差异有统计学意义(P 0. 001)。37. 5%(183/488)的老年肿瘤患者随访期内发生肿瘤恶化进展/复发,功能障碍组患者恶化进展/复发率(41. 5%,92/222)高于功能独立组(16. 7%,4/24)和失能组(36. 0%,87/242),差异具有统计学意义(P 0. 05)。患者的1年死亡率为11. 9%(58/488),功能独立组无死亡,失能组死亡率(21. 1%,51/242)高于功能障碍组(3. 4%,7/222),差异具有统计学意义(P 0. 001)。接受化疗的273例患者中76. 9%(210/273)未完成预计治疗疗程,失能组未完成预计治疗疗程的比例为100. 0%(96/96),高于功能障碍组(67. 1%,110/164)和功能独立组(30. 8%,4/13),差异具有统计学意义(P 0. 001); 79. 9%(218/273)的患者发生不同程度的放/化疗副反应,其中≥3级副反应率为19. 0%(52/273),不同功能组间的副反应发生率差异无统计学意义(P=0. 108)。结论老年综合征在住院老年肿瘤人群中普遍存在,其中合并症和IADL受损最常见,部分功能障碍患者易发生肿瘤恶化进展/复发,失能患者未完成预计治疗疗程的比例和1年死亡率高。     

The development of academic geriatric medicine in the United States 2005 to 2010: an essential resource for improving the medical care of older adults

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article updates the progress made by U.S. medical schools from 2005 to 2010 in developing these programs. Academic leaders in geriatrics in accredited allopathic and osteopathic medical schools were surveyed in the winter of 2010 (60% response rate), and results were compared with findings from a similar 2005 survey (68% response rate). Physician faculty in geriatrics increased from 9.6 (mean) full‐time equivalents (FTEs) in 2005 to 11.2 by 2010. In 2010, faculty and staff effort was mostly devoted to clinical practice (mean = 37%) and education (mean = 33%), with only seven responding schools devoting more than 40% of faculty effort to research. Schools that have been designated as Centers of Excellence had a median 20 FTE physician faculty, compared with seven at the other schools (P < .001). In 2010, 27% of medical schools required a geriatrics clerkship, and 87% (n = 83) had an elective geriatric clerkship. In summary, more fellows and faculty were recruited and trained in 2010 than in 2005, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, but few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. New approaches to training the entire physician workforce to care for older adults will be required to ensure adequate medical care for aging Americans.     

The development of academic geriatric medicine: progress toward preparing the nation's physicians to care for an aging population

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article describes the progress made by medical schools in developing these programs. Academic leaders in geriatrics at all 145 accredited allopathic and osteopathic medical schools in the United States were surveyed in the winter of 2005 (68% response rate) and results compared with findings from a similar 2001 survey. Physician faculty in geriatrics at U.S. medical schools increased from 7.5 (mean) full-time equivalents (FTEs) in 2001 to 9.6 FTEs in 2005. Faculty and staff effort is mostly devoted to clinical practice (mean 36.9%) and education (mean 34.6%). A small number of programs focus on research; only six responding schools devote more than 40% of faculty effort to research. Seventy-one percent reported that their medical school required a geriatrics medical student clerkship or that their geriatric training was integrated into a required clinical rotation. In summary, from 2001 to 2005, more fellows and faculty have been recruited and trained, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, although few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. An expanded investment in training the physician workforce to care for older adults will be required to ensure adequate care for aging Americans.     

Academic Detailing to Teach Aging and Geriatrics

Geriatric education is a required component of internal medicine training. Work hour rules and hectic schedules have challenged residency training programs to develop and utilize innovative teaching methods. In this study, the authors examined the use of academic detailing as a teaching intervention in their residents’ clinic and on the general medicine inpatient wards to improve clinical knowledge and skills in geriatric care. The authors found that this teaching method enables efficient, directed education without disrupting patient care. We were able to show improvements in medical knowledge as well as self-efficacy across multiple geriatric topics.     

52例老年哮喘临床分析

目的：提高临床对老年哮喘的诊治水平。方法：对1999年6月～2004年3月本院诊治的老年哮喘52例临床资料进行回顾性分析。结果：经我院综合救治好转43例(82．7％)；放弃治疗5例(9．6％)；死亡4例(7．7％)。讨论：老年哮喘多属晚发哮喘，以中重度发作居多，病情复杂，及时正确的诊断治疗有利于改善其预后。     

住院糖尿病患者的老年综合征调查

目的：探讨住院老年糖尿病患者的老年综合征罹患情况。方法对北京协和医院内科老年病房2012年7月至2014年9月收治的213例≥65岁老年糖尿病患者进行老年综合评估,评估患者的认知、情绪、睡眠障碍、跌倒、尿失禁、营养风险和日常生活能力。结果入组患者年龄（74.7±6.6）岁,糖尿病病程（12.4±8.9）年（中位数为10年）,共病3～27种,平均患老年综合征数3.3±1.7。60%存在多重用药,40%～50%存在日常生活能力下降;认知损害、情绪障碍、慢性疼痛和跌倒高风险的发生率分别为39.0%,29.0%,31.9%和43.0%。病程长的患者跌倒风险发生率较高[54.8%（病程＞10年组） vs 37.9%（病程≤10年组）];血糖控制较差组（HbA1c＞7.5%）糖尿病平均病程较长[（17.7±10.5） vs （10.9±7.7）年],跌倒高风险的发生率（61.7% vs 38.5%）和睡眠障碍发生率（51.1%vs 34.9%）均较高,但认知功能损害发生率较低（27.6%vs 44.8%）,且差异均有统计学意义（P＜0.05）。结论老年糖尿病患者的认知损害、情绪障碍、慢性疼痛、跌倒高风险等老年综合征发生率高,需要进行老年综合征评估和个体化的管理。     

Principles of Gerontology for Osteopathic Medical Students

This paper describes the implementation of a course to provide medical students with opportunities to understand the phenomenon of aging and to develop a comprehensive view of the unique needs and problems of the elderly. A team of faculty members representing various academic disciplines related to the study of aging or long-term care lead the students in discussing topics such as the biological, psychological and sociological aspects of aging; functional assessment; health promotion for the elderly; community perspectives in long-term care; and clinical considerations of care to the elderly. A key feature of the course is an assigned visit to an elderly individual at home. Through observing and assessing the elderly in their own home environment, students obtain a more realistic and complete comprehension of the interrelatedness of the many factors that must be considered in caring for the elderly.