November 27, 2009 By The Associated Press JEFF HANSEN (The Birmingham News)
Quick Summary
Growing older population causes UAB to add elder care to medical school curriculum
BIRMINGHAM, Ala. - BIRMINGHAM, Ala. (AP) — With a ballooning population of older people, the UAB School of Medicine is changing its curriculum to ensure every medical student learns about caring for the elderly.
Historically, the University of Alabama at Birmingham and other medical schools have failed to give broad training in geriatrics, the area of medicine that focuses on diagnosing and treating diseases and problems particular to older people.
UAB has now joined 39 other medical schools to correct that, with the help of $80 million of funding from the Donald Reynolds Foundation. Reynolds was a media tycoon who built a fortune in newspapers, radio, television and outdoor advertising.
UAB got its $2 million, four-year grant last year and is spending it to improve education for its 875 medical students, as well as for 350 residents and numerous faculty and community physicians.
"There has been a huge gap in geriatrics training," said Dr. Christine Ritchie, director of palliative and supportive care in the UAB Division of Gerontology, Geriatrics and Palliative Care, and director of the new program.
Some parts of the new Alabama Reynolds Program for Care of the Complex Older Adult are under way.
Internal medicine residents are now required to spend one month in geriatrics training in settings that include acute hospital care for the elderly, a long-term care facility, outpatient clinics and home care visits.
Medical students have started a senior mentoring program in which older people from the community talk to the students. Other parts of the program will be added over the next two years.
Ritchie and others are systematically working to increase geriatric education in all four years of the medical school curriculum.
They are also developing interactive, online training modules with 10 different virtual patients. In one, an older man and his adult daughter come to see the doctor, with the daughter explaining that her dad has become very withdrawn. The modules will be tested in collaboration with the University of South Carolina, the University of Arizona, Emory University and Vanderbilt University.
Ritchie and other physicians are also developing special geriatrics training for residents in internal medicine, family medicine, emergency medicine and pediatrics.
"Why pediatrics?" said Ritchie. "What we're seeing is multigenerational caregivers, where a grandparent is the caregiver."
She has one simulation in which a young child comes in after overdosing on his grandmother's blood pressure medicine. "The pediatrician has to figure out what's going on with the grandparents - what do you have to be aware of when you have an older caregiver?" Ritchie said.
Geriatrics presents some special problems.
One great danger that older patients face is transitions, when they move from one care setting, say a hospital, to another, such as home or a nursing home.
"It's very hazardous for patients, because balls get dropped," said Ritchie.
One study in the New England Journal of Medicine this year found that 30 percent of Medicare patients who had been hospitalized for a medical condition were readmitted to the hospital within 60 days. The cost of those potentially preventable hospitalizations may be as high as $12 billion a year.
To avoid transition problems, doctors have to make sure medications are managed properly during the change, that a follow-up outpatient appointment has been set, and that patients and caregivers know the "red flags" of their illnesses that require quick attention. Patients and families also have to be able to take charge of the health care plan.
Older patients can face multiple chronic conditions.
Dr. John Burton, a geriatrics expert at Johns Hopkins University, has said the average adult has two to three chronic medical conditions by age 75, and some have as many as 10 or 12 conditions. And he has said that just as doctors do not treat a child and a middle-aged adult the same way, there are remarkable differences in the medical treatment of a 50-year-old and an 85-year-old.
Geriatric doctors also have to understand the patient's family system and the culture they come from.
"People's caregiver support is highly variable," Ritchie said. "In the past it was sort of 'don't ask, don't tell.'"
This improved training at UAB comes at a point when people 85 and older are the fastest-growing group in the United States. It also comes just as the baby boomer generation starts to reach Medicare age. The demand for geriatric care will only increase.
Dr. Mustafa Ahmed, an internal medicine resident who went through medical school in England, will finish his UAB geriatrics rotation next week. Ahmed said he was surprised by the lack of geriatrics training in America - especially since so many of the patients that internists see are older.
"In England, there is a heavy emphasis on geriatrics training," he said. "It's essential for our training."
Ritchie believes the UAB changes will improve the quality of medical care that patients and families receive.
"I hope it means that the future care of them or their loved one is more clued in to the various complex issues that surround the care of older adults," she said.
Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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