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WHY GERIATRICS? During the past several years, a major demographic trend has come into focus. The number and proportion of elderly Americans is increasing at a rapid pace. This shift in our population will have significant implications for the practicing physician. The number of Americans over age 65 has grown twice as fast as the overall population since 1950. Currently, the fastest growing segment of the U.S. population is persons 85 years of age and older. This trend of increasing numbers of older adults is expected to continue until the year 2030, when it is estimated that the 65+ population will have more than doubled to 65.6 million since 1980. By the year 2030, there will be proportionately more elderly than young people in the population; 22% of the population will be 65 + (in contrast to the current 12.5 % of the total population), and 21 % will be under age 18 (Aging America, 1991). The changing composition of our population represents, in part, a victory of science and technology over many of the diseases related to the shorter life spans that were characteristic of previous eras. But this victory has presented new challenges in meeting the social, economic, and health care needs of the increasing number of elderly within our society. Meeting these health care needs is a growing concern for the medical community. As the proportion of elderly within our society grows, physicians will be spending a greater percentage of time treating elderly patients. This will affect every specialty and subspecialty in medicine, with the exception of pediatrics. In general, the elderly tend to require more medical services than younger adults. The demand for physician services for older adults will increase 22 % by the year 2000, and 1 15 % by 2030. In addition, people age 65 + will account for more than one-third of the country's total personal health care expenditures (Aging America, 1991). Clearly, there will be a great demand for physicians trained and skilled in treating older patients. The impact will be greatest on today's medical students, as they will be practicing the majority of their careers in the twenty-first century. How are today's medical students being prepared to provide care for the elderly? A study on geriatric training programs published in the Journal of medical Education showed that two-thirds of United States medical schools did offer some instruction in geriatrics (Robbins, 1982). Most of these courses were elective with few students enrolled and less than 1 0 % of the courses were a regular part of the curriculum. A 1988 report in the Journal of Medical Education noted that overall integration of geriatrics into the first two years (basic science years) of medical school was low. Pharmacology and psychiatry courses were found to have the highest content, while microbiology, biochemistry, and neuroanatomy were found to have the least. In the Report on Education and Training in Geriatrics and Gerontology (1984) the National Institute on Aging cited intense competition for curriculum time as one of the problems faced by medical schools in expanding education in geriatrics. Perhaps this explains why the bulk of instruction in geriatrics is offered in elective courses. The usefulness of these courses is clearly an issue when few students are interested in enrolling in them. Encouraging and maintaining interest in geriatrics among medical students is the focus of this guide. It is a collection of ideas and strategies to assist faculty and students in expanding educational opportunities in geriatrics within their own institutions. The University of Colorado School of Medicine is used as an example of how faculty and students can influence education in geriatrics; other schools throughout the country have had similar experiences. The results of a student survey at the University of Colorado School of Medicine indicated that a group of students were interested in pursuing educational opportunities in geriatrics. With encouragement from full-time and clinical faculty, they met in October of 1982 to form a student organization devoted to geriatrics at which time a committee structure was established. The group included students, the chief of geriatrics at the local Veterans Administration, the assistant dean of the medical school, and a clinical faculty member. The group was loosely affiliated with the American Geriatrics Society and it defined its purposes and goals as the following:
Since its formation, the group has sponsored annual educational programs which are widely attended by employees of the medical center and the local community. The students participate as a group in a variety of activities, both social and academic, that are related to their interest in geriatrics. The group was instrumental in the development of the first elective course in geriatrics at the medical school, and since then has served as a catalyst in the development of additional electives. Enrollment in these courses has remained high. |