Academic Geriatric Medicine Research Articles

Spotlight on the academic multidisciplinary team: proposals from the 3rd NIHR Newcastle BRC Academic Geriatric Medicine Workshop.

High-quality care for older people is best delivered by multidisciplinary teams involving a range of professions. Similarly, if research evidence is to effectively inform practice, it needs to be designed and executed by teams that are both multidisciplinary and multiprofessional. Here, we summarise the discussions from a 1-day workshop convened by the National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre in Spring 2021, which focussed on multidisciplinary academic teams. Barriers to success include small numbers of clinical academic researchers across all professions focussing on older people, and lack of career pathways, role models and support for non-medical clinical researchers. The workshop identified strengths in the tradition of multidisciplinary working in the care of older people, research questions that lend themselves naturally to multidisciplinary working, increasing interest from funders in multidisciplinary research, and untapped opportunities for greater commercial engagement. Initiatives to improve engagement of students and trainees, mentorship, career pathways, networking across research centres and possibly developing a national School of Older People's Care Research are all ways that we can ensure the growth of multidisciplinary research to best serve older people's health and social care in the future.

Development of a UK core dataset for geriatric medicine research: a position statement and results from a Delphi consensus process

BackgroundThere is lack of standardisation in assessment tools used in geriatric medicine research, which makes pooling of data and cross-study comparisons difficult.MethodsWe conducted a modified Delphi process to establish measures to be included within core and extended datasets for geriatric medicine research in the United Kingdom (UK). This included three complete questionnaire rounds, and one consensus meeting. Participants were selected from attendance at the NIHR Newcastle Biomedical Research Centre meeting, May 2019, and academic geriatric medicine e-mailing lists. Literature review was used to develop the initial questionnaire, with all responses then included in the second questionnaire. The third questionnaire used refined options from the second questionnaire with response ranking.ResultsNinety-eight responses were obtained across all questionnaire rounds (Initial: 19, Second: 21, Third: 58) from experienced and early career researchers in geriatric medicine. The initial questionnaire included 18 questions with short text responses, including one question for responders to suggest additional items. Twenty-six questions were included in the second questionnaire, with 108 within category options. The third questionnaire included three ranking, seven final agreement, and four binary option questions. Results were discussed at the consensus meeting. In our position statement, the final consensus dataset includes six core domains: demographics (age, gender, ethnicity, socioeconomic status), specified morbidities, functional ability (Barthel and/or Nottingham Extended Activities of Daily Living), Clinical Frailty Scale (CFS), cognition, and patient-reported outcome measures (dependent on research question). We also propose how additional variables should be measured within an extended dataset.ConclusionsOur core and extended datasets represent current consensus opinion of academic geriatric medicine clinicians across the UK. We consider the development and further use of these datasets will strengthen collaboration between researchers and academic institutions.

Pioneering COVID-19 Pandemic Partnerships: Federally Qualified Health Centers and Geriatric Workforce Enhancement Programs Work Together to Care for Diverse Underserved Older Adults.

Background: The COVID-19 pandemic disproportionately affected populations served by Federally Qualified Health Centers (FQHCs), with high morbidity and mortality rates in ethnic minority older adults. In response to this pandemic, academic geriatric medicine teams through federally funded Geriatric Workforce Enhancement Program (GWEP) with FQHC partnership implemented new initiatives to improve the care for vulnerable older adults. Objectives: To describe how four FQHC/GWEP teams collaborated in caring for diverse communities of older adults during the pandemic. Methods: Four GWEPs have addressed pandemic response efforts with their respective FQHC partners. These collaborations to meet the increasing numbers of older adults seeking services, and the rising disparities exacerbated during the pandemic are delineated. Results: FQHC/GWEP partnerships enabled access to care, whether in-person or virtually to serve unmet needs of underserved older adults during the pandemic. Partnerships promoted COVID-19 education, testing, and vaccinations. Most FQHCs faced severe staffing shortages, and the digital divide challenged patients with barriers. GWEPs provided direct care, created educational materials, and developed telehealth programs. These partnerships addressed social determinants of health gaps caused by the pandemic. Conclusion: The findings demonstrate that strong partnerships between GWEPs and FQHCs mitigate health inequities for vulnerable ethnic minority and rural older adults during pandemic crises.

Neurogeriatrics-avision for improved care and research for geriatric patients with predominating neurological disabilities.

Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson’s disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly frequent in old subjects. As knowledge about these age-associated conditions and disabilities is steadily increasing, the integral implementation of neurogeriatric knowledge in geriatric medicine and specific neurogeriatric research is essential to develop the field. This article discusses how neurological know-how could be integrated in academic geriatric medicine to improve care of neurogeriatric patients, to foster neurogeriatric research and training concepts and to provide innovative care concepts for geriatric patients with predominant neurological conditions and disabilities.

Growing research in geriatric medicine

Academic geriatric medicine activity lags behind the scale of clinical activity in the specialty. A meeting of UK academic geriatricians was convened in March 2018 to consider causes and solutions to this problem. The meeting highlighted a lack of research-active clinicians, a perception that research is not central to the practice of geriatric medicine and a failure to translate discovery science to clinical studies. Solutions proposed included better support for early-career clinical researchers, schemes to encourage non-University clinicians to be research-active, wider collaboration with organ specialists to broaden the funding envelope, and the need to co-produce research programmes with end-users. Solutions to grow academic geriatric medicine are essential if we are to provide the best care for the growing older population.

A National Survey on the Effect of the Geriatric Academic Career Award in Advancing Academic Geriatric Medicine.

A workforce that understands principles of geriatric medicine is critical to addressing the care needs of the growing elderly population. This will be impossible without a substantial increase in academicians engaged in education and aging research. Limited support of early-career clinician-educators is a major barrier to attaining this goal. The Geriatric Academic Career Award (GACA) was a vital resource that benefitted 222 junior faculty members. GACA availability was interrupted in 2006, followed by permanent discontinuation after the Geriatrics Workforce Education Program (GWEP) subsumed it in 2015, leaving aspiring clinician-educators with no similar alternatives. GACA recipients were surveyed in this cross-sectional, multimethod study to assess the effect of the award on career development, creation and dissemination of educational products, funding discontinuation consequences, and implications of program closure for the future of geriatric health care. Uninterrupted funding resulted in fulfillment of GACA goals (94%) and overall career success (96%). Collectively, awardees reached more than 40,700 learners. Funding interruption led to 55% working additional hours over and above an increased clinical workload to continue their GACA-related research and scholarship. Others terminated GACA projects (36%) or abandoned academic medicine altogether. Of respondents currently at GWEP sites (43%), only 13% report a GWEP budget including GACA-like support. Those with GWEP roles attributed their current standing to experience gained through GACA funding. These consequences are alarming and represent a major setback to academic geriatrics. GACA's singular contribution to the mission of geriatric medicine must prompt vigorous efforts to restore it as a distinct funding opportunity.

Current Federal Budget Issues and the Impact on Academic Geriatricians

As part of his State of the Union address delivered on February 12, 2013, President Obama reported to Congress that the “state of our union is stronger.” Stronger, of course, is a relative term. He noted the nation's progress with respect to its military exposure and on the economic front. Even so, President Obama acknowledged that there is a lot of work to be done. He stressed that our attention must focus on making decisions regarding the country's budget and singled out medical research as one of the national priorities that would be devastated should the sudden, harsh, and arbitrary budget cuts take place in the form of “sequestration.” Understandably, academic geriatricians are particularly anxious to see the uncertainty surrounding the federal budget resolved in a manner that avoids crippling the National Institutes of Health (NIH), part of the U.S. Department of Health and Human Services. A recent study reported on the development of academic geriatric medicine in the United States.1 The study reported on the period from 2005 to 2010 and had an interesting finding.1 Although medical students are now more exposed to a geriatrics curriculum than in the past, this trend has not translated into more academic geriatricians pursuing research careers.1 One reason that may explain this unfortunate trend is the fierce competition for NIH dollars and the low success rates for grant mechanisms that have followed. The upcoming 2013 American Geriatrics Society Annual Scientific Meeting, to be held in Grapevine, Texas, this May, is a prime example of how many of our colleagues the potential drastic cuts to the NIH budget will affect. These large forums represent an efficient manner by which investigators come together and present the latest information on clinical care, research on aging, and innovative models of care delivery. Academic geriatricians often fund their research projects directly or indirectly from the NIH. These research dollars are becoming harder to obtain, and as a result, many significant and innovative applications fall by the wayside. It is worri-some to think what would become of the advancement of science should significant cuts to the NIH budget be implemented. It is equally worrisome to think what would become of the pure academic geriatrician should funding dollars dry up. It is important for the geriatrics community to become familiar with and engaged in the budget process that will take place in the next few months. The Congressional Budget Office (CBO) is a nonpartisan entity that provides analysis to the U.S. Congress. In its February 2013 report, the CBO lists three budget matters that our leaders in Washington, District of Columbia, will need to address.2 The first is the automatic spending cuts as part of the sequestration scheduled to be implemented in the beginning of March; if this happens, funding for many government activities will be reduced by 5% or more. The second is the expiration of a continuing resolution in late March; if no additional appropriations are provided for, nonessential functions of the government will be at risk. The third is the statutory limit on the federal debt that will go into effect in mid-May; to avoid default on government obligations, the debt limit will need to be addressed.2 It is an interesting time for our country. Normally, it may seem that the work in Washington has little influence on your personal life. The purpose of this letter is to communicate the contrary. It is important for individuals in the geriatrics community to be actively engaged with their lawmakers and voice their concerns regarding the above-mentioned budget challenges. Federal support for the NIH is at issue, and so might be the future of the academic geriatrician. Speak now. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Both authors contributed significantly to the research and writing of this paper. Sponsor's Role: None.

The Development of Academic Geriatric Medicine in the United States 2005 to 2010: An Essential Resource for Improving the Medical Care of Older Adults

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article updates the progress made by U.S. medical schools from 2005 to 2010 in developing these programs. Academic leaders in geriatrics in accredited allopathic and osteopathic medical schools were surveyed in the winter of 2010 (60% response rate), and results were compared with findings from a similar 2005 survey (68% response rate). Physician faculty in geriatrics increased from 9.6 (mean) full-time equivalents (FTEs) in 2005 to 11.2 by 2010. In 2010, faculty and staff effort was mostly devoted to clinical practice (mean = 37%) and education (mean = 33%), with only seven responding schools devoting more than 40% of faculty effort to research. Schools that have been designated as Centers of Excellence had a median 20 FTE physician faculty, compared with seven at the other schools (P < .001). In 2010, 27% of medical schools required a geriatrics clerkship, and 87% (n = 83) had an elective geriatric clerkship. In summary, more fellows and faculty were recruited and trained in 2010 than in 2005, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, but few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. New approaches to training the entire physician workforce to care for older adults will be required to ensure adequate medical care for aging Americans.

The Effect of Geriatric and Palliative Medicine Education on the Knowledge and Attitudes of Internal Medicine Residents

A recent Institute of Medicine report on geriatric work force issues recommends training residents in settings with geriatric patients and increasing certification requirements to include competence in the care of older adults. Although the number of internal medicine programs with a geriatric curriculum has increased, the scope and effectiveness of these programs vary. The purpose of this study was to evaluate the effect of a new academic geriatric and palliative medicine curriculum on the knowledge and attitudes of third-year internal medicine and fourth-year medicine and pediatrics residents. The study was conducted at The University of Texas Medical School at Houston. A new Division of Geriatric and Palliative medicine was created that offered inpatient, consultation, ambulatory, and home visit experiences in addition to didactic lectures. The University of Michigan Geriatrics Clinical Decision Making Assessment and the University of California at Los Angeles Geriatric Attitude Test was used to evaluate pre- and post-rotation knowledge and attitudes. Residents' knowledge improved after completing the rotation, as shown by a 6.9-point increase in posttest scores (P<.001). There was also a 10-point improvement in pretest scores over the course of the year (P=.03). Fifty-seven percent of residents had an improvement in attitude. This study shows that an increase in geriatric and palliative teaching opportunities provided by the establishment of a geriatric and palliative medicine division improves residents' knowledge significantly.

The Development of Academic Geriatric Medicine: Progress Toward Preparing the Nation's Physicians to Care for an Aging Population

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article describes the progress made by medical schools in developing these programs. Academic leaders in geriatrics at all 145 accredited allopathic and osteopathic medical schools in the United States were surveyed in the winter of 2005 (68% response rate) and results compared with findings from a similar 2001 survey. Physician faculty in geriatrics at U.S. medical schools increased from 7.5 (mean) full-time equivalents (FTEs) in 2001 to 9.6 FTEs in 2005. Faculty and staff effort is mostly devoted to clinical practice (mean 36.9%) and education (mean 34.6%). A small number of programs focus on research; only six responding schools devote more than 40% of faculty effort to research. Seventy-one percent reported that their medical school required a geriatrics medical student clerkship or that their geriatric training was integrated into a required clinical rotation. In summary, from 2001 to 2005, more fellows and faculty have been recruited and trained, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, although few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. An expanded investment in training the physician workforce to care for older adults will be required to ensure adequate care for aging Americans.

How Much Time Do Physicians Spend Providing Care Outside of Office Visits?

People with chronic illness require care outside of office visits, much of which is not reimbursed under current Medicare guidelines. To describe the amount of time geriatricians spend and the nature of care they provide outside of office visits. Cross-sectional study on the time spent by physicians in clinical interactions outside of patient visits during 3 randomly sampled, 1-week periods. An academic geriatric medicine ambulatory practice. 16 physicians. Information on the method, content, outcome, and participants in clinical interactions outside of office visits was collected on a structured form. There were 472 discrete interactions, representing 296 episodes of care for 226 patients. Fifty-four percent of interactions were linked as multistep episodes, whose mean duration (range; 25th, 75th percentiles) was 18.9 minutes (3 to 70 minutes; 9, 21 minutes). Thirty-six percent of episodes involving a new medical symptom resulted in medication use, 27% resulted in an office visit, and 9% resulted in a referral to another physician. Mean time spent per physician per week was 112.2 minutes (range, 36 to 260 minutes), which represents an additional 6.7 minutes (range, 1.7 to 13.8) of care provided outside of office visits for every 30 minutes of time spent scheduled to see ambulatory patients. For a full-time physician scheduled to see 14 patients per day in 30-minute visits over a 5-day workweek, this would represent an extra 7.8 hours of clinical work per week. Data were self-reported and were limited to an academic geriatric medicine practice. Physicians spend a considerable amount of time providing care outside of office visits for patients with chronic illness. This study suggests that collecting empirical data on the amount and nature of nonreimbursed care activities is feasible and should be done in more generalizable settings to inform debates about reimbursement reform.

Beneath the surface: discovering the unvoiced concerns of older adults with Type 2 diabetes mellitus

Emerging clinical guidelines recommend shared decision making to individualize drug regimens for older adults with Type 2 diabetes mellitus. While the current health education campaign for diabetes in the United States recommends physician-initiated medication-related discussions about adherence and side effects, little emphasis is placed on soliciting patient concerns. This study's aim was to explore the concerns of older adults with diabetes about the complexity of their drug regimens and to determine whether they discussed medication-related concerns with their physician. Twenty-two patients with Type 2 diabetes age 65 years and older who used five or more medications were selected from an urban academic geriatric medicine practice in the United States. In-depth semi-structured interviews were conducted to uncover participants' perceptions of multiple medication use and related discussions with providers. The predominant theme that emerged was the variability in medication-related topics that patients perceived they could discuss with their physician. While most participants described physician-initiated discussions about adherence and side effects, many did not bring up concerns about medication cost or their desire to reduce medication burden. In order to encourage greater patient involvement in medication decision making for diabetes treatment, educational messages promoting patient-physician dialogue need to take more account of patient concerns.

Geriatric Medicine and Geriatric Psychiatry Clinical Services Affiliated with U.S. Academic Medical Centers

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).

Academic geriatric programs in US allopathic and osteopathic medical schools.

By 2030, 20% of the US population will be older than 65 years compared with 12.4% in 2000. The development of geriatric medicine research and training programs to prepare for this increasing number of older individuals is largely dependent on the successful establishment of academic geriatric medicine programs in medical schools. To assess the structure, resources, and activities of academic geriatric medicine programs in US allopathic and osteopathic schools of medicine. Survey distributed to the academic geriatric medicine leaders of the 144 US allopathic and osteopathic medical schools in March 2001. Organizational structure, program information, curriculum, budgetary issues, and characteristics of academic geriatric medicine leaders. A total of 121 program directors (84%) responded. Most schools (87%) had an identifiable academic geriatric program structure, with 67% established after 1984. The greatest proportion of faculty and staff time (40%) was spent in clinical practice, followed by research and scholarship (12%), residency and fellowship education (10% each), and medical student education (7.8%). Clinical practice accounted for the greatest portion (27%) of revenue, and 25.7% of the programs had total annual budgets of less than $250,000, while 11% had budgets of greater than $5 million. The largest obstacles to achieving the goals of an academic geriatric medicine program were a lack of research faculty and fellows and poor clinical reimbursement. Most US medical schools have an identifiable academic geriatric medicine program; most have been established within the last 15 years. Resources are needed to train faculty for roles as teachers and researchers and to develop medical school geriatric programs of the size and scope equivalent to other academic disciplines.

MAXIMIZING RESOURCES IN GERIATRIC EDUCATION THROUGH COOPERATION: THE METROPOLITAN AREA GERIATRICS SOCIETY EXPERIENCE

The role of the New York Metropolitan Area Geriatrics Society (MAGS), an affiliate of the American Geriatrics Society, in supporting educational activities in the 11 academic geriatric medicine fellowship programs in the metropolitan area is described. A 1991 survey of each program's educational resources revealed a striking disparity in the self‐perceived quality of the various program components at each site and a unanimous interest in sharing and complementing existing activities. Whereas all programs were positive about the strength of their conferences and grand rounds and the interest of their teaching faculty, they were generally concerned about their home care component; clinical research; and, most of all, the time availability of their teaching faculty. Through MAGS, a number of activities have been developed to help support the fellowship programs. Opportunity for intersite exchange of geriatric fellows is being actively pursued. This cooperative effort may be a model for similar activity in ot...

Bladder Problems in Elderly Patients

Excerpt To the editor: By your selection of the article by Williams and Pannill (1) for publication, I assume that academic geriatric medicine has arrived. Although I agree with their final recom...