Skip to main content

The “Silver Tsunami” is coming. What am I doing to prepare?


Everyone involved in geriatric care has heard the news: The “Silver Tsunami” is coming and the U.S. healthcare system is not prepared.

According to the Eldercare Workforce Alliance (EWA), the current health care system is already overwhelmed by demands for geriatric care and those specializing in the care of older adults cannot meet the current demand let alone the projected needs. EWA outlines the critical workforce shortage in detail. There are only 7,029 certified geriatricians practicing in the U.S., roughly half the number currently needed, and falling.

I remember first reading this and feeling somewhat saddened and overwhelmed. What could I do to address this shortage other than start taking an antidepressant and continue working with a population that I love? It occurred to me that I could make a difference by helping others prepare. My question changed from “how can I make a difference?” to “how can I help my non-geriatrics trained colleagues prepare to meet this need?”

Interestingly, my contribution to a possible small part of the solution began to unfold back in 2009, before I was even really aware of the workforce shortage problem at all. In 2009, I was a geriatric medicine fellow studying for my Boards exam by using the Geriatric Review Syllabus (GRS) and Geriatrics at Your Fingertips (GAYF) and making notes in an “H&P” format. I thought it might be helpful to share my notes with the residents on their geriatrics rotation. I contacted the American Geriatrics Society (AGS) to see if this would be possible and the response was incredibly positive and supportive. After a slew of emails, calls, meetings and drafts, the project morphed into a new AGS product series entitled Geriatric Evaluation and Management (GEM). An editorial subcommittee of the AGS Education Committee was formed last year so this would be a product of consensus. Eleven tools covering different topics were created over the past year using the “H&P” format and drawing from GRS and GAYF materials.

The GEM tools are clinical templates that follow an “H&P” format. They can be utilized as a quick consult for those with more experience in geriatric care, a reminder checklist for providers with less experience, and a teaching tool for medical students, residents, and fellows. Currently there are 11 tools with more in the works.

The GEM tools cover the following topics:

  • Appropriate Prescribing 
  • Benign Prostatic Hyperplasia 
  • Behavioral Problems in Dementia 
  • Delirium · Depression 
  • Dementia 
  • Falls 
  • Incontinence 
  • Osteoporosis 
  • Pressure Ulcers 
  • Depression
  • Insomnia

The tools are available to download on the AGS website and currently require AGS membership to enter the site. I am working together with AGS to investigate wider access to the tools for non-AGS members and a possible smart-phone application. My hope is that my geriatric colleagues may find these tools useful as they also strive to educate their non-geriatrician colleagues in the care of older adults. http://www.americangeriatrics.org/membership/resources/gemtools

 by: Shaida Talebreza Brandon

Comments

james.condon said…
Tantalizing but unavailable to a non-AGS member: all the links in your article are "dead links" to me. Sigh.

JK Condon

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…

Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block

Nursing homes are a tough place to do palliative care.  There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice.  So what can we do to improve the palliative care outlook in nursing homes?

On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week.  Lieve led a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries.  Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes.  I struggle with just trying to improve palliative care in one site!

We discuss with Lieve the results of the study, her take on why they got…