Caring for older Americans: the future of geriatric medicine.
ABSTRACT In response to the needs and demands of an aging population, geriatric medicine has grown rapidly during the past 3 decades. The discipline has defined its core values as well as the knowledge base and clinical skills needed to improve the health, functioning, and well-being of older persons and to provide appropriate palliative care. Geriatric medicine has developed new models of care, advanced the treatment of common geriatric conditions, and advocated for the health and health care of older persons. Nevertheless, at the beginning of the 21st century, the health care of older persons is at a crossroads. Despite the substantial progress that geriatric medicine has made, much more remains to be done to meet the healthcare needs of our aging population. The clinical, educational, and research approaches of the 20th century are unable to keep pace and require major revisions. Maintaining the status quo will mean falling further and further behind. The healthcare delivery and financing systems need fundamental redesign to improve quality and eliminate waste. The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has identified five goals aimed at optimizing the health of older persons: To ensure that every older person receives high-quality, patient-centered health care; To expand the geriatrics knowledge base; To increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons; To recruit physicians and other healthcare professionals into careers in geriatric medicine; To unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors. Geriatric medicine cannot accomplish these goals alone. Accordingly, the Task Force has articulated a set of recommendations primarily aimed at the government, organizations, agencies, foundations, and other partners whose collaboration will be essential in accomplishing these goals. The vision described in this document and the accompanying recommendations are only the broad outline of an agenda for the future. Geriatric medicine, through its professional organizations and its partners, will need to mobilize resources to identify and implement the specific steps that will make the vision a reality. Doing so will require broad participation, consensus building, creativity, and perseverance. The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician workforce is a recipe for expensive, fragmented health care that does not meet the needs of our older population. By virtue of their unique skills and advocacy for the health of older persons, geriatricians can be key leaders of change to achieve the goals of geriatric medicine and optimize the health of our aging population. Nevertheless, the goals of geriatric medicine will be accomplished only if geriatricians and their partners work in a system that is designed to provide high-quality, efficient care and recognizes the value of geriatrics.
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- "Finally, therapist worries that the older adults might die while in treatment, which could pose a challenge to the therapist's sense of importance. The Lack of Geriatric Healthcare Professionals Besdine et al. (2005) suggest that income is one of the primary reasons keeping many professionals away from entering the field of geriatrics. For example, geriatricians earned $163,000 in 2005, as compared to the potential of $300,000 for dermatologists. "
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- "The biomedical needs of aging patients require responsiveness also to the psychosocial aspects of patient care. Toward that goal, The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has defi ned fi ve goals aimed at improving the health and well-being of older patients (Besdine et al 2005): These are: (1) " to ensure that every older person receives high-quality, patient-centered health care; (2) to expand the geriatrics knowledge base; (3) to increase the number of health care professionals who employ the principles of geriatric medicine in caring for older persons; (4) to recruit physicians and other health care professionals into careers in geriatric medicine; and (5) to unite professional and lay groups in the effort to infl uence public policy to continually improve the health and health care of seniors " (Besdine et al 2005). Multiple chronic conditions, and increasing vulnerabilities and limitations in various realms of functioning, can necessitate complex and multi-faceted treatments for older patients. "
ABSTRACT: There is growing evidence that the outcomes of health care for seniors are dependent not only upon patients' physical health status and the administration of care for their biomedical needs, but also upon care for patients' psychosocial needs and attention to their social, economic, cultural, and psychological vulnerabilities. Even when older patients have appropriate access to medical services, they also need effective and empathic communication as an essential part of their treatment. Older patients who are socially isolated, emotionally vulnerable, and economically disadvantaged are particularly in need of the social, emotional, and practical support that sensitive provider-patient communication can provide. In this review paper, we examine the complexities of communication between physicians and their older patients, and consider some of the particular challenges that manifest in providers' interactions with their older patients, particularly those who are socially isolated, suffering from depression, or of minority status or low income. This review offers guidelines for improved physician-older patient communication in medical practice, and examines interventions to coordinate care for older patients on multiple dimensions of a biopsychosocial model of health care.Clinical Interventions in Aging 02/2007; 2(3):453-67. · 1.82 Impact Factor
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ABSTRACT: This essay is about my transition from family medicine residency into house call/home-based primary care practice. Though some aspects of making home visits have been difficult and uncomfortable, I have found a higher level of satisfaction and sense of purpose than I had as a resident in a traditional outpatient clinic. This enhanced satisfaction is, in part, due to my discovery that a lower-volume, time-intensive house call practice is a more appropriate way than the brief office visit to care for older patients who have multiple morbidities. In light of the aging population, advances in portable medical technology, and changes in Medicare reimbursement, home care could become a key to the future success and ongoing relevance of family medicine.The Annals of Family Medicine 07/2006; 4(4):366-8. DOI:10.1370/afm.550 · 4.57 Impact Factor