Integration of Geriatrics Specialty Care in Family Medicine Ian M Deutchki, MD Assistant Professor of Family Medicine and Geriatrics Kristen Thornton, MD Assistant Professor of Family Medicine and Geriatrics

Objectives After this session participants will be able to: – Describe the challenges to primary care presented by the aging population – Discuss how integration of Geriatric specialty care within a Family Medicine practice enhances patient care

Older and Complex 43% of current Medicare recipients have 3 or more chronic medical conditions (Federal Interagency Form on Age Related Statistics, 2010) Over 40% of adults over age 65 have a functional limitation 1 in 9 people over 65 have Alzheimer’s Dementia (AD) A full third of individuals over 85 have AD

Older adults account for a disproportionate share of healthcare services: Older adults make up ~13 % of the population – 26% of all physician office visits; – 35% of all hospital stays; – 34% of all prescriptions; – 38% of all emergency medical responses; and – 90% of all nursing home use.

Not Enough Geriatricians ~7,500 certified geriatricians in 2012 (about 1 for every 5,000 people over age 65) approximately 30% of the 65 plus patient population needs to be cared for by a geriatrician and each geriatrician can care for a patient panel of 700 older adults Therefore, today we need 17,000 geriatricians By 2030 we are projected to need 30,000

IOM Recommendation 2008 IOM Report “Retooling for an Aging America: Building the Health care Workforce” – Enhance the geriatric competency of the entire workforce – health care professionals should be required to demonstrate their competence in the care of older adults as a criterion of licensure and certification 1993 IOM Report: “Strengthening Training in Geriatrics for Physicians” – Recommended 6 months of geriatric training for primary care specialties by 1996 and 9 months by 1999

Current RRC Requirements Residents must be primarily responsible for a panel of continuity patients, integrating each patient’s care across all settings,including the home, long-term care facilities, the FMP site, specialty care facilities,and inpatient care facilities – Long-term care experiences must occur over a minimum of 24 months Residents must provide care for a minimum of 1650 in-person patient encounters in the FMP site – One hundred sixty-five of the FMP site patient encounters must be with patients 60 years of age or older.

Current RRC Requirements Residents must have at least 100 hours (or one month) or 125 patient encounters dedicated to the care of the older patient – The experience must include functional assessment, disease prevention and health promotion, and management of patients with multiple chronic diseases – The experience should incorporate care of older patients across a continuum of sites

U of R Geriatrics Training Resources – 2 Geriatricians on faculty – Active Geriatrics fellowship – 566 bed nursing facility with a long tradition of teaching

U of R Geriatrics Aspects of curriculum – 4 week rotation during 3 rd year of residency – 2 year longitudinal long-term care experience – Area of concentration – Within practice consultations – Didactic sessions

1) US Agency on Aging website downloaded : 2) Redfoot, D, Feinberg, L, Houser A (2014). Baby boom and the growing care gap, AARP website downloaded : /the-aging-of-the-baby-boom-and-the-growing-care-gap-AARP-ppi-ltc.htmlhttp:// 2013/the-aging-of-the-baby-boom-and-the-growing-care-gap-AARP-ppi-ltc.html 3) Besdine, R., Boult, C., Brangman, S., Coleman, E. A., Fried, L. P, Gerety, M.,... American Geriatrics Society Task Force on the Future of Geriatric Medicine. (2005). Caring for older Americans: The future of geriatric medicine. Journal of the American Geriatrics Society, 53(6), S245–256. 4) Warshaw G, et al. Geriatric Medicine Training for Family Practice Residents in the 21 st Century: A Report from the Residency Assistance Program/Hartford Geriatrcis Initiative. Family Medicine (2003) 35(1),