tion. That report, as well as several that followed, called for expansion of geriatric training opportunities and offered a number of recommendations for action. Over the past 30 years, opportunities for geriatric training for professionals have expanded. For example, the John A. Hartford Foundation established centers of excellence in geriatric medicine and geriatric psychiatry based on recommendations from a 1987 IOM report, Academic Geriatrics for the Year 2000 (Rowe et al., 1987), and that foundation also devotes significant financial and career support for geriatric nursing and social work (Warshaw and Bragg, 2003). Still, the geriatric discipline has failed to thrive in numbers and stature, and the level of geriatric training among most providers remains too limited. Many recommendations from previous IOM committees and other committees have had limited impact.

What makes this current effort different is the broad nature of the study. It expands the scope of analysis well beyond physicians to consider all formal and informal health care providers for older adults. It focuses not only on the size and skills of the workforce but also on the models of care—that is, on the ways in which health care services are provided to older adults. We have known for decades that as the baby boom generation aged it would challenge the capacity of the health care system (IOM, 1978; NIA, 1987); that time is now upon us.

This current effort also builds upon the IOM’s broader work in the area of quality. The landmark report, Crossing the Quality Chasm (IOM, 2001a), described quality care as being safe, timely, efficient, effective, equitable, and patient centered. However, there are strong indications that the current system of care fails the older adult population in significant ways along all of these dimensions of care. The report specifically noted that a major challenge in transitioning to a twenty-first-century health system will be preparing the workforce to acquire new skills and adopt new ways of relating to patients and each other.

Since that report, the IOM has addressed workforce issues in a number of areas—in emergency care (IOM, 2007b,c,d), public health (IOM, 2007f), pharmacy (IOM, 2007a), mental health and substance abuse (IOM, 2006), cancer care (IOM, 2005a), rural health (IOM, 2005b) and many others. This report addresses workforce needs for older adults comprehensively, across the spectrum of health services.


After reviewing the evidence, the committee concluded the following:

  1. The future health care workforce will be woefully inadequate in its capacity to meet the large demand for health services for older

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