Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions

David B. Reuben

and

John C. Beck

A Background Paper Prepared for the Committee on Strengthening the Geriatric Content of Medical Education

Division of Health Care Services

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C. 1994



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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions David B. Reuben and John C. Beck A Background Paper Prepared for the Committee on Strengthening the Geriatric Content of Medical Education Division of Health Care Services INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1994

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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions National Academy Press 2101 Constitution Avenue, NW, Washington, DC 20418 The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this project was provided by The John A. Hartford Foundation under Grant No. 93146-G. Additional copies of this background paper are available from: Division of Health Care Services Institute of Medicine 2101 Constitution Avenue, N.W. Washington, DC 20418 Copyright 1994 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions COMMITTEE ON STRENGTHENING THE GERIATRIC CONTENT OF MEDICAL TRAINING JOHN A. BENSON, Jr., * Chair, President Emeritus, American Board of Internal Medicine, Portland, Oregon GENE D. COHEN, deputy director, National Institute on Aging, National Institutes of Health, Bethesda, Maryland LEO M. COONEY, Jr., Humana Foundation Professor of Geriatric Medicine, Yale University School of Medicine, and Yale-New Haven Hospital BERNICE C. HARPER, medical care adviser and acting director, Office of Professional and Business Affairs, Health Care Financing Administration, U.S. Department of Health and Human Services, Washington, D.C. WILLIAM R. HAZZARD, * professor and chair, Department of Internal Medicine, The Bowman Gray School of Medicine, Wake Forest University LISSY F. JARVIK, professor of psychiatry and biobehavioral science, Neuropsychiatric Institute, University of California at Los Angeles School of Medicine, and distinguished physician, West Los Angeles Veterans Affairs Medical Center MARY O. MUNDINGER, dean, School of Nursing, Columbia University DAVID B. REUBEN, associate professor of medicine, Department of Medicine, Multicampus Program in Geriatric Medicine and Gerontology, University of California, Los Angeles JOANNE G. SCHWARTZBERG, director, Department of Geriatric Health, American Medical Association, Chicago Staff JOSEPH S. CASSELLS, study director JO HARRIS-WEHLING, senior program officer MARY JAY BALL, senior project assistant NINA H. SPRUILL, financial associate KARL D. YORDY, director (until 10/1/93) KATHLEEN N. LOHR, director (as of 10/1/93) TOM BURROUGHS, consultant JOHN C. BECK, consultant * Member, Institute of Medicine

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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions Acknowledgments The authors thank the following individuals who provided unpublished data for this paper: Brownell Anderson, Association American of Medical Colleges Linda L. Blank, American Board of Internal Medicine Wendy Colquitt, Association American of Medical Colleges W. F. Dube, U.S. Department of Veterans Affairs Jeffrey Foster, American Association for Geriatric Psychiatry Carol Gleich, Council on Graduate Medical Education Marsha Goodwin, U.S. Department of Veterans Affairs Central Office Robert Haynes, Association of American Medical Colleges Gail Jacoby, National Institute on Aging Paul Jolly, Association of American Medical Colleges Ann Kahl, Bureau of Health Professions Susan Klein, Bureau of Health Professions Sheila Kopic, University of California, Los Angeles, Medical Center Jerome Kowal, Association of Directors of Geriatric Academic Programs Karen Lambert, Accreditation Council for Graduate Medical Education Anita Landry, Boston University Stephanie Lederman, American Federation for Aging Research, Inc. Angie Legaspi, American Geriatrics Society David Lipshitz, Association of Directors of Geriatric Academic Programs Chris Lyttle, National Study of Internal Medicine Manpower John Morley, St. Louis University School of Medicine Donna Regenstreif, The John A. Hartford Foundation Patricia Reineman, University of Michigan Laura Robbins, The John A. Hartford Foundation Joanne Schwartzberg, American Medical Association Melissa Silvestri, American Geriatrics Society Brooke Whiting, Association of American Medical Colleges David Woodwell, National Ambulatory Medical Care Survey Tom Yoshikawa, U.S. Department of Veterans Affairs Central Office

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Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions Foreword In December 1993, the Institute of Medicine (IOM) released the report Strengthening Training in Geriatrics for Physicians, which was the product of a nine-member Committee on Strengthening the Geriatric Content of Medical Training. The work of that committee was enhanced by a background paper authored by committee member David B. Reuben and John C. Beck. Their paper, Training Physicians to Care for Older Americans: Progress, Obstacles, and Future Directions, is published in this volume. In this paper the authors address the progress in geriatric and gerontological education that has been made throughout the educational continuum for physicians. The interpretations and conclusions expressed are their own, and do not necessarily reflect the views of the IOM Council, the committee, or IOM staff. Because this publication postdates the release of Strengthening Training in Geriatrics for Physicians, the authors have added a chapter that summarizes the committee's recommendations found in that report. The IOM committee's work and the publication of both its report and this background paper were supported by The John A. Hartford Foundation. We are particularly grateful to the Foundation's senior program officer, Donna Regenstreif, and program officer, Laura Robbins, for the encouragement they provided for publishing the paper. In addition, Mary Jay Ball, IOM project assistant, played an essential role in preparing this manuscript for publication; we appreciate her quality work. John A. Benson, Jr., Chair Committee on Strengthening the Geriatric Content of Medical Training

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