into one group (65 years and older), and recommendations are often based on studies performed in younger age groups (Nicastri and Fields, 2004). More research is needed on preventive services for older adults, especially for the “oldest old,” and health care professionals need to be aware of the value of these services for all of their older patients.

The activities of professional groups today reflect a growing awareness of the importance of health promotion and disease prevention for older patients. For example, the Geriatrics Section of the American Physical Therapy Association has an interest group on “Health Promotion & Wellness” that aims to improve the education, clinical practice, and research of physical therapists in health and wellness among older adults (APTA, 2007). The American Geriatrics Society lists “health promotion and disease prevention strategies” among the areas of knowledge needed for the successful preparation of internal medicine physicians who care for older adults (AGS, 2004). The American Dietetic Association includes the provision of nutrition care across the lifespan, “infants through geriatrics,” as one of the core competencies for entry-level dietitians and dietetic technicians (ADA, 2008).


Palliative care Within geriatric education and training programs, palliative care skills are especially important since 80 percent of American deaths occur among those over age 65 (Ersek and Ferrell, 2005). Skills that are particularly important include identification and relief of physical and emotional stress, effective communication, interdisciplinary team work, recognition of the signs and symptoms of imminent death, and support of the bereavement process (National Consensus Project for Quality Palliative Care, 2004). The opportunities for exposure to these topics has improved greatly in recent years; almost all medical schools offer some form of end-of-life care education, and 62 percent of pharmacy schools surveyed reported didactic training in end-of-life care (Billings and Block, 1997; Herndon et al., 2003).

Despite such improvements, however, the overall education and training of the health care workforce in palliative care is deficient (Billings and Block, 1997; Ersek and Ferrell, 2005; Holley et al., 2003; IOM, 1997; Paice et al., 2006; Walsh-Burke and Csikai, 2005). In one survey of medical students, residents, and faculty, less than 20 percent reported that they received formal education in end-of-life care, 39 percent felt unprepared to address patient fears, and almost half felt unprepared to deal with their own feelings about death (Sullivan et al., 2003). Another survey showed that less than half of graduating family medicine and internal medicine residents (41 percent and 43 percent, respectively) felt very prepared to counsel patients on end-of-life issues (Blumenthal et al., 2001). In contrast, a 2005 study showed 70 percent of geriatric medicine fellows reported completing rota-



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