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

As an educational resource, the Pepper Centers are educating
and encouraging older adults by sharing free health promotion
information that addresses ways to improve their health and better
their lives. Originally, 3 Pepper Centers were funded and in 2001 there
were 9 funded centers (See Appendix C for a list of current centers.)
The total budget for these centers increased from $3,860,000 in 1991
to $13,074,000 in 2001 (Figure 3.2).
Alzheimer’s Disease Centers
The NIA began funding Alzheimer’s Disease Centers (ADCs) in 1984
and currently funds 29 centers at major U.S. medical institutions. (See
Appendix D for a list of current centers.) Researchers at these centers
are working to translate research advances into improved diagnosis
and treatment for Alzheimer’s Disease (AD) patients while, at the same
time, focusing on the program’s long-term goal of finding a way to
cure and possibly prevent AD. Areas of investigation range from the
basic mechanisms of AD to managing symptoms and helping families
cope with effects of the disease.
Center staff conduct basic, clinical, and behavioral research,
and train scientists and health care providers new to AD research.
Although each center has its own unique area of emphasis, a common
goal of the ADCs is to enhance research on AD by providing a network
for sharing new ideas and research results. The National Alzheimer’s
Coordinating Center in Seattle, under the direction of Walter Kukull,
PhD, coordinates data collection and fosters collaborative research
among the ADCs. Many ADCs have satellite facilities that offer
diagnostic and treatment services and collect research data in
underserved, rural, and minority communities. The funding history
of these Centers is presented in Figure 3.2
Nathan Shock and
Edward R. Roybal Centers
The NIA began the Nathan Shock Centers for Excellence in Basic
Biology of Aging in 1995. The goal of this center grant program is to
enhance already well-developed institutional programs in basic
research on aging. Current funded centers are established at Harvard,
the University of Texas at San Antonio, the University of Michigan, the
University of Washington, and at the Lankenau Medical Research
Center/Jefferson Health System in Philadelphia. The NIA began the
Edward R. Roybal Centers (named for the former U.S. congressman
from Los Angeles) for Research on Applied Gerontology in 1993.
Funded by the NIA’s Behavioral and Social Research Program, the goal
of these centers is to conduct applied research utilizing existing basic
knowledge about cognitive and psychosocial aging. Current funded
centers are established at Boston University, Cornell University, the
University of Alabama at Birmingham, the University of Illinois at
Chicago, the University of Michigan, and the University of Miami.
Recent Initiatives
Two new educational initiatives hold promise for the near future. The
Association of American Medical Colleges (AAMC), with funding from
the Hartford Foundation, is supporting 40 U.S. medical schools’ efforts
to enhance the quality and quantity of their medical student geriatric
medicine curricula. The central goal of this effort is initiating a
required geriatric medicine curriculum for each student in all four
years of medical school training. In addition, the Donald W. Reynolds
Foundation of Las Vegas recently funded ten medical schools
(approximately $2 million per school over 4 years) to build
comprehensive geriatric medical education programs for medical
students, residents, and practicing physicians. The Foundation
currently anticipates funding 20 additional schools under this initiative
over the next five years, for a total commitment of $60 million. Efforts
are also well underway to develop the next generation of academic
leaders. Research career awards through the NIA, VHA, the American
Geriatrics Society, and the American Federation for Aging Research are
supporting numerous young investigators, and ADGAP recently
announced a new program to identify and support young leaders (see
Chapter 5).
Challenges for the Future
In addition to the need to continue developing the next generation of
academic leaders, researchers, and educators, the field of geriatric
medicine will face challenges related to Medicare over the coming
decade. These include the need to promote careful use of Medicare
dollars. Medicare expenditures are heavily invested in reactive and
highly expensive technical hospital care. Critical components of care
such as preventive medicine, primary care, prescription medication
benefits, psychiatric services, and long-term care services are
arguably either un-funded or under-funded.
In summary, geriatric medicine remains a young discipline. Over
the past 25 years academic geriatric medicine programs have been
implemented at most U.S. medical and osteopathic schools, and
thousands of practicing geriatricians have been certified. This is a
significant accomplishment, yet much remains to be done. Academic
programs at many American medical colleges are still small and
fragile. Time to insure that our health system will be able to respond
effectively to an aging America is limited. Although recent research
has documented a trend toward declining disability in the elderly
(Cutler, 2001), without major changes in the health status of our
older population, health care costs will escalate rapidly (Schneider &
Guralnik, 1990). Further investment in basic and clinical research
and in training all physicians in the care of the aged remains a
critical priority.
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