Med school grants aim to strengthen geriatric care

Nearly $10 million in grant funding to 10 U.S. medical schools means that physicians, students and other health care workers will be better equipped to handle care delivery differences in older patients, said the organization awarding the money.

Under the initiative called Next Steps in Physicians' Training in Geriatrics, the Donald W. Reynolds Foundation announced the awards in June. Aimed at strengthening physicians' geriatrics training, the grants fill what the foundation and geriatric advocates say is a rapidly growing need for geriatric care. “As we all know, America is aging, and we may be ill-prepared to deal with this increase of older patients,” said Cathy Alessi, MD, president of the American Geriatric Society. “Enhancing geriatric competence is an important goal.

“Every health care professional should have knowledge and training in the care of older adults,” she said.

The health care work force receives little geriatric training, according to the Institute of Medicine. “Compared to when I was in training, geriatric training is increasing,” Dr. Alessi said. “Unfortunately, knowledge and integration of geriatric concepts hasn't made it into mainstream care.”

Beginning July 1, award recipient Warren Alpert Medical School of Brown University Center for Gerontology and Health Care Research in Providence, R.I., will teach hundreds of specialty and subspecialty residents, fellows and hospitalists about aging to improve care and outcomes further. The award builds upon an earlier Reynolds grant aimed at training medical students, said Renee Shield, PhD, clinical professor and project coordinator of the Reynolds grant.

Clinical intervention key component

Commonly, there is a consultative relationship with geriatricians, said Lynn McNicoll, MD, director of education for the Division of Geriatrics. What makes the Brown program unique is the clinical intervention aspect of care. Geriatricians will partner with faculty from the specialty to train them as geriatrics educators, co-manage patients and execute care plans.

In a collaborative team approach, they will round together daily. “In the consultative model, the geriatricians come in as needed,” Dr. McNicoll said. “Here there will be more ongoing contact with the geriatrician.”

With an emphasis on patient safety and improved outcomes, Brown's program will focus on seven specialties; hospitalists at their two major teaching hospitals and nearly 200 residents in orthopedics, surgery, emergency medicine, psychiatry, neurology and neurosurgery. “Hip fracture is a good model,” Dr. McNicoll said. “This is a high-risk, high-morbidity event where a patient is likely to die or come out at a much lower functioning. … The longer it takes the elderly patient in the ER to get to the OR, the worse the outcome.”

Previously, Brown researchers identified barriers to getting older hip fracture patients to the operating room in less than 48 hours and streamlined the process. Now elderly hip fracture patients get to the OR in 24 hours.

It is this type of clinical intervention that will help physicians better understand the differences in care. “We are hoping to give them the knowledge to become geriatric champions,” Dr. McNicoll said. “This is a much more integrated model we are hoping will lead to better outcomes for older patients. It will become sustainable.”