Clinical Geriatrics

Practicing physicians and other healthcare professionals seeking to improve the care they provide to their older patients should benefit from a number of recent projects and programs developed by academic centers through the generous support of the Donald W. Reynolds Foundation.

Six years ago, the Foundation began offering grants to academic health centers to support efforts to develop comprehensive projects that improve geriatrics training for medical students, residents—and practicing clinicians. It has since awarded 30 leading academic centers the four-year grants, which total roughly $2 million each.

Recipients of the grants met in Las Vegas last month for the Foundation’s sixth annual meeting to share and disseminate the more than 70 projects, materials, initiatives, and ideas for enhancing geriatrics training that they’ve developed with the Foundation’s support. Many of the projects aim to improve the clinical care practicing physicians and healthcare professionals provide.

Among the promising initiatives of interest to clinicians was the University of Utah School of Medicine’s “Advancing Geriatric Education through Quality Improvement” (AGE QI) project, which aims to help primary care physicians in that state provide higher quality care for their older patients. Through the onsite educational program, a University of Utah School of Medicine geriatrics faculty member and a geriatrics educator work with the entire staff in a given practice—physicians, physician assistants, nurses, medical assistants, and clerks, alike—offering them an intensive geriatrics review, then helping the staff develop, complete, and analyze the outcomes of a quality improvement project focused on a common geriatric condition. The school is now using AGE QI, which is based on an initiative originally developed through the Michigan Geriatric Education Center and introduced in practices in Michigan and Ohio, to help more than two dozen clinical practices in Utah improve care for their aging patients.

Another project introduced during the October meeting was Harvard Medical School’s series of Web-based modules on key geriatrics topics. Harvard’s Advancement of Geriatrics Education Project has completed three of the modules (on pain management, delirium, and dementia) and is in the process of producing three more (on syncope and falls, osteoporosis, and end-of-life and ethical issues). The modules specifically target practicing physicians who need brief, interactive, and evidence-based information on these geriatrics subjects. The medical school intends to make all of the modules accessible via the Internet.

Some of the clinician-focused materials developed with Reynolds Foundation support are already available on the Web. The University of Arizona College of Medicine, for example, has posted four fact sheets from its “Elder Care: A Resource for Providers” project at http://geriatrics.medicine.arizona.edu/azreynolds/. The concise, one-page fact sheets for primary care physicians cover the problems of falls, delirium, hypertension, and urinary incontinence. Arizona’s Geriatrics Section developed the fact sheets with the help of the Indian Health Service and tribes such as the Hopi and Navajo so that the information would be culturally appropriate for older Native American patients. It’s also appropriate for other seniors.

Reynolds grantee materials ready for dissemination are posted to the Portal of Geriatric Online Education at www.POGOe.org, a free, online clearinghouse that offers access to high-quality training and related materials. As clinicians, we can greatly benefit from this dissemination of new ideas and models for our practices.

Dr. Spivack is Associate Clinical Professor of Medicine, Columbia University, New York, NY, Consultant in Geriatric Medicine, Greenwich Hospital, Greenwich, CT, and Medical Director, LifeCare, Inc., Westport, CT.