Geriatric Medicine Training and Practice in the United States at the ...

2
Project Background
Introduction
The percentage of Americans over age 65 has more than tripled,
increasing from 3.1 million (4.1% of the population) in 1900 to 35.0
million (12.4% of the population) in 2000. By 2030 that number is
expected to increase to 70 million (20.6% of the population)
(Administration on Aging, 2001). This dramatic increase is due to the
fact that baby boomers, individuals born between 1946 and 1964, will
begin turning 65 in 2011.
The older population itself is also living longer. Comparing
statistics from 1900 to 2000, the 65-74 age group was eight times
larger in 2000 (18.4 million) than in 1900. The 75-84 age group was
16 times larger (12.4 million), and the 85+ group was 34 times larger
(4.2 million) (Administration on Aging, 2001). Along with the increased
numbers of older Americans, the elder population is becoming
increasingly diverse. By the year 2030, one in four people over the
age of 65 will be from a racial or ethnic minority (AHRQ Task Force on
Aging, 2001).
Although Americans are living longer, they are also experiencing
increased chronic diseases, such as arthritis, atherosclerotic vascular
disease, cancer, hearing and visual loss, and dementia. While not
always immediately life threatening, these illnesses can impair
function and require ongoing expert management for optimal
outcomes. Consequently, the elderly population utilizes the health
care system more than younger populations. In 1997 people age 65
and over averaged more annual contacts with doctors than persons
under 65 (11.7 contacts per year compared to 4.9 contacts) (Duncker
& Greenberg, 2001).
At present no health care profession has the minimum projected
number of trained personnel necessary to meet the unique health care
needs of older adults. The Institute of Medicine (IOM) has conducted
several studies of medical education related to aging. In 1993 and
1994 the John A. Hartford Foundation sponsored the two most recent
reports from the IOM. The Bureau of Health Professions has also
sponsored studies of geriatric education; the most recent was
published in 1995. These studies have resulted in federal, state, and
foundation initiatives to increase the quality and quantity of training
of health professionals in the care of older adults.
The 1993 IOM report with its 1994 background report also
emphasized other trends that will affect the development of a high
quality care system for older people: 1) the need for growth in
available resources (including geriatric nurse practitioners and
medical social workers), cost containment, and managed care; 2)
changes in the funding and organization of graduate medical
education; and 3) the interdisciplinary nature of geriatric practice.
Existing efforts to document and track the status of past, current,
and future geriatrics training are fragmented, and many data sets are
not limited to geriatrics training. Survey efforts specific to geriatrics
have not been coordinated, and, in many cases, the collected data
have become outdated. Further, most of those conducting these
studies have no plans for future updates. There is no central database
of information about training needs in geriatric medicine. A
comprehensive project to develop a database of information relative
to the growth and development of geriatric education efforts, seriously
needed for several years, is now underway and is the subject of
this report.
Project Goal
The overall goal of this project is to build a comprehensive database
containing information about the growth and development of geriatrics
training and clinical practice. This database will allow for analysis and
dissemination of information about these issues. This report contains
a summary and analysis of data collected from fall 2000 through
spring 2002.
Project Objectives
• To provide high-quality, up-to-date information about the status
of geriatric medical education
• To provide information that can lead to increased recognition of
the importance of geriatric research and training programs
• To establish benchmarks for the field of geriatric medicine and
enable measurement of the impact of current and future
strategies for developing academic geriatric medicine
The database currently provides reliable data on the current
physician workforce and available resources to train clinicians,
teachers, and researchers. In the future, as the database is updated,
it will provide a means of measuring the impact of programs that
are developing academic geriatric medicine, supporting faculty
development, and increasing the quality and quantity of geriatrics
training. When combined with demographic and health care utilization
data, the database will help geriatric medicine policy advisors identify
gaps in geriatric education and manpower. Analyses of the database
will also help provide direction for future initiatives by federal and
state governments and private foundations.
14