So I thought I wanted to be a chief

In July 2000, Dr. William Hazzard published an article in the Journal of the American Geriatrics Society entitled “So you think you want to lead an academic geriatric program?” My answer to that question the same month was “Yes,” as I agreed to become the chief of the newly established Section of Geriatrics at the University of Chicago. With about 3.5 years on the job now, I offer a more complete reply to Dr. Hazzard's query. Although his paper covered many important and practical issues to consider in looking at becoming a chief, this article provides a perspective on the academic geriatric leadership position based on a new chief's observations. Topics covered include pressures for and against becoming a chief, changing perspectives on goals and rewards, good help, mentoring, money problems/issues, support for the chief, and communication and relationships. It is hoped that these observations will be of use to geriatricians considering leading an academic geriatrics program and to other newly appointed chiefs.     

Geriatrics for residents in the surgical and medical specialties: implementation of curricula and training experiences

In 1994, under the leadership of the late Dennis Jahnigen, the American Geriatrics Society, with support of the John A. Hartford Foundation, began a project to improve the amount and quality of geriatrics education that surgical and related medical specialty residents receive. The targeted disciplines initially were general surgery, emergency medicine, gynecology, orthopedic surgery, and urology and, later, anesthesiology, ophthalmology, otolaryngology, physical medicine and rehabilitation, and thoracic surgery. A key element of this project was to develop model programs within surgical and related specialty residency education. The Geriatrics Education for Specialty Residents (GESR) program has supported 29 residencies to pilot methods for integration of geriatrics within residency programs, encouraged and inspired development of curricular content, and helped to develop faculty leaders to support these efforts in the long term and at a national level. This paper describes the GESR program, the status of curriculum development, steps for other programs to use in developing a geriatrics education program, and some of the common barriers likely to be encountered during implementation along with solutions to those barriers.     

Development and validation of a geriatrics knowledge test for primary care residents

This study reports the development and preliminary validation of an instrument to measure geriatrics knowledge of primary care residents. A 23-item test was developed using questions selected from the American Geriatrics Society's Geriatrics Review Syllabus. Ninety-six internal medicine and family practice residents, 14 geriatrics fellows, and 11 geriatrics faculty members participated in the study. Findings support the reliability (Cronbach's a 5 0.66) and validity (content and "known groups") of this short test. Predictive validity and sensitivity of the test to changes in knowledge will have to be further explored as residents progress through their training.
KEY WORDS: geriatrics knowledge assessment; evaluation of residency programs; geriatrics education.     

Position Statement on Interdisciplinary Team Training in Geriatrics: An Essential Component of Quality Health Care for Older Adults

Interdisciplinary team training (IDT) is an important component of ensuring quality geriatric care delivery, which can be complex and time intensive, requiring coordination of many medical, psychosocial, and therapeutic interventions and professionals. The Partnership for Health in Aging (PHA), a loose coalition of more than 30 organizations representing healthcare professionals who care for older adults supported by the American Geriatrics Society, identified IDT training in geriatrics as a priority area in addressing the geriatrics workforce shortage described in the 2008 Institute of Medicine report, Retooling for An Aging America: Building the Health Care Workforce. A PHA Workgroup on Interdisciplinary Team Training in Geriatrics was convened to review the literature focused on geriatrics IDT training and to develop a position statement that would inform and influence groups involved in the development and expansion of academic and continuing education programs in IDT training, including professional associations, credentialing and licensing bodies, accreditation organizations, and university administrators. There are significant challenges to expanding the development and implementation of geriatrics IDT training for health professionals, and such training will be successful only with substantial and sustained advocacy from the above professional groups.     

Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area collaboratively created the New York Metropolitan Area Consortium to Strengthen Psychosocial Programming in Geriatrics Fellowships in 2007 to address this shortfall. The goal of the Consortium is to develop model educational programs for geriatrics fellows that highlight psychosocial issues affecting elder care, share interinstitutional resources, and energize fellowship program directors and faculty. In 2008, 2009, and 2010, Consortium faculty collaboratively designed and implemented a psychosocial educational conference for geriatrics fellows. Cumulative participation at the conferences included 146 geriatrics fellows from 20 academic institutions taught by interdisciplinary Consortium faculty. Formal evaluations from the participants indicated that the conference: a) positively affected fellows' knowledge of, interest in, and comfort with psychosocial issues; b) would have a positive impact on the quality of care provided to older patients; and c) encouraged valuable interactions with fellows and faculty from other institutions. The Consortium, as an educational model for psychosocial learning, has a positive impact on geriatrics fellowship training and may be replicable in other localities.     

Building psychosocial programming in geriatrics fellowships: a consortium model

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area collaboratively created the New York Metropolitan Area Consortium to Strengthen Psychosocial Programming in Geriatrics Fellowships in 2007 to address this shortfall. The goal of the Consortium is to develop model educational programs for geriatrics fellows that highlight psychosocial issues affecting elder care, share interinstitutional resources, and energize fellowship program directors and faculty. In 2008, 2009, and 2010, Consortium faculty collaboratively designed and implemented a psychosocial educational conference for geriatrics fellows. Cumulative participation at the conferences included 146 geriatrics fellows from 20 academic institutions taught by interdisciplinary Consortium faculty. Formal evaluations from the participants indicated that the conference: a) positively affected fellows' knowledge of, interest in, and comfort with psychosocial issues; b) would have a positive impact on the quality of care provided to older patients; and c) encouraged valuable interactions with fellows and faculty from other institutions. The Consortium, as an educational model for psychosocial learning, has a positive impact on geriatrics fellowship training and may be replicable in other localities.     

From the standpoint in department of geriatrics in university hospital

Because Japanese society has increasing elderly persons and also has a low birth rate. Medical treatments and benefits will be severely limited in the future because of economic problems. I would like to look back on the history of Japanese Geriatrics Society and the many studies on geriatrics in Japan. The first annual meeting of Japanese Geriatric Society were held in 1959 and the Japanese Gerontology Society meeting was also held in the same year by Geriatric Society and Geriatric Sociology Association. It was held every two years, and now it consists of 6 associations, that is Geriatrics. Geriatric Sociology. Basic Gerontology, Geriatric Dentistry, Geriatric Psychiatry and Care Management Associations. I will introduce the activities of these associations, and also introduce the contribution of departments of geriatrics in Japanese universities. I will also show the system of medical examinations and treatment, the education curriculum for medical students and residency, and research composing of various theme such as basic gene therapy as well as the evaluation of terminal care for the elderly in our Department of Geriatrics, Nagoya University Graduate School of Medicine. Finally, I would like to propose future research plan between departments of geriatrics in Japanese Universities and the National Institute for Longevity Sciences, which will open next March.     

《实用老年医学》引文分析及评价

目的通过评价《实用老年医学》引文情况,旨在揭示我国老年医学期刊领域引文的一般资料,了解和分析著者吸收利用科技文献的实际情况。方法对《实用老年医学》1995～2004年间60期论著引文作文献计量统计分析。结果(1)60期发表的全部论著共2802条引文,平均每篇论著引文6.21条;(2)引文以英文为主,共1554条(55.46%),其次为中文,共1233条(44.00%);(3)引文普赖斯指数为43%,半衰期为5.36年;(4)根据布拉德福定律得出,核心区域期刊中文12种,外文为15种。结论(1)期刊是科技信息的主要载体,具有出版周期短,传递迅速,信息量大等优点,是科技工作者的重要情报来源;(2)《实用老年医学》著者在吸收外文文献时以英文为主,说明我国老年医学工作者主要掌握的外文是英文,而其他语种很少,提示要注意英文以外的其他语种的学习应用;(3)本研究文献老化指标提示,老年医学是一门相对新兴学科,学科发展速度较快;(4)核心区域期刊是老年医学专业的重要信息来源,为加强文献资源的利用,图书情报部门应调整相关期刊的收藏比例,以保证专业人员对文献的要求;(5)本研究提示《实用老年医学》在我国老年医学期刊领域中占有重要的地位。     

When Women Rise,We All Rise: American Geriatrics Society Position Statement on Achieving Gender Equity in Geriatrics

Supporting gender equity for women working in geriatrics is important to the growth of geriatrics across disciplines and is critical in achieving our vision for a future in which we are all able to contribute to our communities and maintain our health, safety, and independence as we age. Discrimination can have a negative impact on public health, particularly with regard to those who care for the health of older Americans and other vulnerable older people. Women working in the field of geriatrics have experienced implicit and explicit discriminatory practices that mirror available data on the entire workforce. In this position article, we outline strategic objectives and accompanying practical recommendations for how geriatrics, as a field, can work together to achieve a future in which the rights of women are guaranteed and women in geriatrics have the opportunity to achieve their full potential. This article represents the official positions of the American Geriatrics Society. J Am Geriatr Soc 67:2447–2454, 2019     

Implementing Models of Geriatric Care—Behind the Scenes

Innovative geriatric clinical programs have proliferated in the 21st century, and many have been highlighted in the Journal of the American Geriatrics Society (JAGS). The Affordable Care Act has supported the accelerated innovation of publicized and unpublicized program development, adaptation, and implementation. Many JAGS articles report work conducted in programs with significant improvements in quality; high satisfaction for patients and providers; and for some, reductions in costs. Despite considerable detail, enabling implementers to attempt to adopt reported programs or adapt them to local environments, much less is typically conveyed about the subtleties of the implementation process that led to a successful outcome. Moreover, where we have been given a window into successful initiatives, far less is known about those that failed and even less about why some succeeded but others failed. With a focus on our shared needs as a geriatrics community, to foster the exchange of more‐comprehensive models of successful and failed implementation, we propose publications that address implementation itself—a second layer of reporting about the “hidden” elements that may have been decisive factors in taking an efficacious test, treatment, or model and putting it into real‐world practice. We propose a new platform for sharing a broader range of healthcare quality improvement initiatives—successes and failures. We include several salient characteristics that could be measured and described in support of dynamic, sustainable, evidence‐based implementation of geriatrics programs.     

Paul B. Beeson career development awards in aging research and U.S. medical schools aging and geriatric medicine programs

Established in 1995, the Paul B. Beeson Career Development program provides faculty development awards to outstanding junior and midcareer faculty committed to academic careers in aging-related research, training, and practice. This study evaluated the effect of 134 Beeson Scholars on their medical schools' aging and geriatric medicine programs and on the field of aging research from 1995 to 2007. Quantitative and qualitative survey data from multiple sources, including the American Geriatrics Society/Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center, National Institutes of Health (NIH) rankings of research funding, and other governmental databases were used to compare 36 medical schools with Beeson Scholars with 34 similar medical schools without Beeson scholars and to examine the influence of Beeson Scholars on the field of geriatrics and aging. Most Beeson Scholars remained at the institution where they trained during their Beeson award, and 89% are still practicing or conducting research in the field of geriatrics and aging. Twenty-six (19.4%) of the scholars have led institutional research mentoring awards, 51 (39%) report leadership roles in institutional program project grants, and 13 (10%) report leadership roles in the Clinical and Translational Science Award programs at their institutions. Beeson Scholars are more likely than a matched sample of non-Beeson NIH K awardees to study important geriatric syndromes such as falls, cognitive impairment, adverse drug events, osteoporosis, and functional recovery from illness. Total Beeson Impact Years (the total number of years all Beeson Scholars have worked at each school) is positively correlated with more geriatrics research faculty, after controlling for NIH funding rank (P=.02). Beeson Scholars have made positive contributions to the development of academic geriatrics research programs at U.S. medical schools.     

Gerontology required core courses and gerontology academic program success

Gerontology, geriatrics, and aging studies (GGA) academic programs are charged to produce competent graduates to work in the field of aging. The Association for Gerontology in Higher Education recommends core courses that are required in GGA academic programs throughout the United States. This article reports findings on the role of the core courses in promoting GGA program success, as defined by graduates' employment status. Objective and subjective measures of the core courses were collected by mail questionnaire from 230 graduates of GGA programs in the largest U.S. public higher education system. Program success was apparent in graduates' timely attainment of employment, employment in aging-related jobs, and job satisfaction. Core courses were evaluated highly by graduates; they were related to program success directly, and indirectly through graduates' subjective evaluations.     

Geriatrics attitudes and knowledge among surgical and medical subspecialty house officers

OBJECTIVES: To examine geriatrics knowledge and attitudes of non-primary care house officers (HOs) before and after a multidisciplinary faculty development program.
DESIGN: Serial cross-sectional surveys.
PARTICIPANTS: HOs.
SETTING: A large midwestern academic medical center.
INTERVENTION: Faculty from seven surgical and six medical subspecialties participated in weekly seminars for 9 months and implemented geriatrics curricula in their HO programs.
MEASUREMENTS: HO geriatrics attitudes and knowledge were measured using the University of California at Los Angeles Geriatrics Attitudes Scale (GAS; 14 items), two scales of the Maxwell Sullivan test (Therapeutic Potential and Time/Energy; six items each; lower scores denote more-favorable attitudes), and the Geriatrics Clinical Knowledge Assessment (20 multiple choice items; range 0–100%). Repeat surveys were administered in seven disciplines after geriatrics curriculum implementation.
RESULTS: Baseline (n=175) geriatrics attitudes were favorable (e.g., 3.7 for GAS; 2.1 for Time/Energy), with more-favorable attitudes among medical subspecialty than surgical HOs (e.g., mean GAS 3.8 and 3.6, respectively; P =.001), and with advanced training. Mean baseline knowledge scores were 65.1% among all HOs. No differences in attitudes or knowledge were observed between the first (n=100) and second (n=90) cohorts in the seven disciplines that administered subsequent tests.
CONCLUSION: Geriatrics attitudes of non-primary care HOs are positive, and knowledge is moderate, suggesting need for and potential effect of geriatrics curricula. Demonstrating effects on learner outcomes of faculty development programs may require more than one faculty member per discipline and measures that are curriculum-specific and detailed rather than general and brief.     

How to Get Better Care with Lower Costs? See the Person,Not the Patient

The U.S. health system perceives people as “patients” almost exclusively as they enter and exit the healthcare system, but with this emphasis on context, have we lost sight of the people who should be in the foreground of care? Does such a view impede care effectiveness and efficiency? How can we shift our frame of reference moving forward? To foster this needed conceptual shift, a group of national thought‐leaders convened by the American Geriatrics Society (AGS) defined “person‐centered care” to reorient the perspective toward individuals remaining in the center of pursuing high‐quality care. This article explores how a person‐centered care approach can improve healthcare effectiveness and efficiency, particularly for older adults with heightened health and daily living needs, and healthcare costs. The process for supporting a person‐centered program is outlined, three critical indicators that define person‐centered quality are highlighted, and several models that embrace the person‐centered paradigm are briefly noted. Although there is no one‐size‐fits‐all schematic, how and why overall success entails fidelity to essential elements of person‐centered programs as the AGS expert panel identified is explained.     

The impact of curricular changes on the geriatrics knowledge, attitudes and skills of medical students

We redesigned our medical school's Problem-Based Learning (PBL) curriculum to include a substantial increase in required geriatrics content. Innovations included new PBL health care problems and standardized patients (SPs) throughout the first three years and a new required four-week, fourth-year rotation. We used data from the AAMC Medical School Graduation Questionnaire, the UCLA Geriatrics Knowledge Test and Attitudes Survey and a Geriatrics SP Examination to measure self-efficacy, geriatrics specific knowledge, attitudes and clinical skills before and after these curricular changes. Positive effects on students' self-efficacy, knowledge and skills were demonstrated. Scores on the attitude scale were high before and after implementation. The demonstration of improved educational outcomes will help to validate our curricular changes and guide their future development.     

Transformation of a Geriatric Department in China

China has the world's largest elderly population, and the oldest‐old population, with a current disability rate greater than 50%, will triple in the next 35 years. The field of geriatrics is young, because almost all geriatric departments were established after 2000, and so faces many challenges. Management of diseases and hospital care is the focus. Senior physicians were trained in other subspecialties, such as pulmonary or cardiology, and junior physicians entered geriatrics departments as masters or doctorate students after medical school. The inadequacy of post‐acute and long‐term care facilities has caused long hospital stays. There are no national systematic geriatric training programs, national board examinations, or qualifications in geriatrics. These challenges were used as a framework for guiding changes in the Department of Geriatrics at West China Hospital, Sichuan University. These changes have included international experiences and collaboration for physicians and nurses, revision of departmental conferences, and special training for a unique group of caregivers called hugong (untrained caregivers hired by families to be at the bedside of hospitalized individuals). The most significant yet challenging part of the transformation has been to develop and modify Western‐based geriatric models of care (e.g., Acute Care of the Elderly unit, delirium prevention and management models, palliative care). Lastly, the department established Tianxia (in the sky) Doctors, an internet‐based platform to connect the department's interdisciplinary team to other hospitals, nursing institutions, home‐based care service stations, community health service centers, and pharmacies throughout the region.     

Geriatrics‐for‐Specialists Initiative: An Eleven‐Specialty Collaboration to Improve Care of Older Adults

In the early 1990s, visionary leaders at the American Geriatrics Society and The John A. Hartford Foundation recognized that the marked and growing shortage of geriatrics healthcare professionals would lead to a U.S. healthcare system ill prepared to provide optimal care for the ever‐increasing number of older Americans. Led by the late Dennis W. Jahnigen, MD, they set forth a plan to address this shortage by collaborating with surgical and related medical specialists to create a series of programs to foster the highest quality care of older adults. Their unique programmatic vision was that every physician, not just geriatricians, would have basic knowledge and skills in geriatric care, because geriatricians cannot and should not meet the need alone.     

Time for geriatric jurisprudence

Geriatrics and law may not be natural bedfellows. Moreover, law and lawyers were not part of the professions that were the 'founding fathers' of the field of geriatrics. In this short viewpoint we invite the readers to consider a new inter-disciplinary research approach that attempts to combine jurisprudence with geriatrics. Geriatric jurisprudence is a special and timely opportunity for doctors and lawyers to come together in a new, different and more united way to jointly conceptualize a medico-legal theory of aging to better serve our shared community: older and aging persons.     

北京协和医院老年医学教育初探

中国的老年医学尚处于起步阶段,缺乏老年医学教育体系,与发达国家的老年医学教育存在很大的差距.本文总结了近2年来北京协和医院老年医学科在继续教育、住院医教育、人员培训、教材编写、社区及患者教育等方面的工作成果.并在普及老年医学理念、完善继续教育途径与方式等方面取得了初步成绩,对于我国老年医学多层次教育形成了初步设想.呼吁中国老年医学教育规范化,建立资格考试和准入制度,完善职业晋升途径.     

A Collaborative National Model to Assess Competencies for Medical Students,Residents, and Other Healthcare Practitioners in Gait and Falls Risk Evaluation

To ensure that the healthcare workforce is adequately prepared to care for the growing population of older adults, minimum competencies in geriatrics have been published for medical students and primary care residents. Approaches to teaching and assessing these competencies are needed to guide medical schools, residencies, and continuing medical education programs. With sponsorship by the Education Committee and Teachers Section of the American Geriatrics Society (AGS), geriatrics educators from multiple institutions collaborated to develop a model to teach and assess a major domain of student and resident competency: Gait and Falls Risk Evaluation. The model was introduced as a workshop at annual meetings of the AGS and the American College of Physicians in 2011 and 2012. Participants included medical students, residents, geriatrics fellows, practicing physicians, and midlevel practitioners. At both national meetings, participants rated the experience highly and reported statistically significant gains in overall competence in gait and falls risk evaluation. The largest gains were observed for medical students, residents, and practicing physicians (P < .001 for all); geriatrics fellows reported a higher level of baseline competence and therefore had a lower magnitude of improvement, albeit still significant (P = .02). Finally, the majority of participants reported intent to disseminate the model in their institutions. This article describes the design, implementation, and evaluation of this collaborative national model. A number of institutions have used the model, and the goal of this article is to aid in further dissemination of this successful approach to teaching and assessing geriatrics competencies.