to the rural aging population (Henry and Hooker, 2007). Among the challenges in recruiting any type of professional to rural areas are professional isolation, heavy call schedules, and few job opportunities for the spouses of the health care professionals. The best strategies for recruitment and retention may be those that focus on the training of existing rural providers in geriatric skills via distance education in conjunction with the use of remote technologies to increase the availability of outside geriatric experts for rural elderly populations.

THE CURRENT STATE OF GERIATRIC EDUCATION AND TRAINING

For more than 30 years the IOM (IOM, 1978, 1993) and others (LaMascus et al., 2005; Olson et al., 2003) have called for improvements in the geriatric education and training of virtually all types of health care providers. While progress is evident, many formal training programs still do not include robust coursework in geriatrics (Berman et al., 2005; Eleazer et al., 2005; Linnebur et al., 2005; Scharlach et al., 2000). Among the barriers to increased education and training in geriatrics for all professions are the lack of faculty, lack of funding, lack of time in already-busy curricula, and the lack of recognition of the importance of geriatric training (Bragg et al., 2006; Hash et al., 2007; Hazzard, 2003; Rubin et al., 2003; Simon et al., 2003; Thomas et al., 2003; Warshaw et al., 2006). Furthermore, very little is known about the best methods to improve the knowledge and skills of professionals in caring for older adults (Gill, 2005).

It is not possible to discuss every profession in detail, as virtually every professional cares for older patients to some degree. In the following section, several professions instrumental to the care of older adults are examined. (See Table 4-3 for an overview.) Specifically, the status of geriatric education and training within each profession is discussed. While some professions are discussed more extensively than others, the committee does not intend for this to imply any conclusion about their importance to the care of older adults. Rather, this is a reflection of the amount of data available and the extensiveness of the existing education and training programs in geriatrics. Overall, the breadth and depth of geriatric education and training remains inadequate to prepare all professionals for the health care needs of the future elderly population.

Physicians

Older Americans account for a disproportionate share of physician services, but a 2002 survey of primary care physicians showed that only half of these physicians believed that their colleagues could adequately treat



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