The increasing proportion of elderly to working age adults is indicating the future need for geriatrics-trained health professionals. However, consensus on required training to produce competency in geriatric care is lacking. More data are needed on the number and types of patients requiring geriatrics specialists versus generalists. Governments, licensing and accreditation bodies could: (a) require increased geriatric content and clinical experience for licensure of professionals and accreditation of facilities; (b) provide financial incentives to encourage organizations to provide geriatrics-specific care; (c) provide scholarships for geriatrics specialization; and (d) provide support for research on effectiveness of geriatrics training programs and geriatrics patient care.

Background: Treatment by geriatrics-trained health care professionals improves physical, functional and psychosocial status among older adults without increasing costs. While mortality rates are not affected by geriatrics-specific treatment, patients in geriatrics units do show sizable improvement in mental health and reduction in functional decline. Elderly patients cared for by geriatric nurses have fewer hospital readmissions, and are less likely to be physically restrained or inappropriately transferred from nursing homes to hospitals. Despite this evidence, the percentage of RNs employed in geriatrics nursing facilities is decreasing. Several reports have recommended increased RN staffing, use of geriatrics-trained nurse practitioners, increased nursing hours per patient, and greater use of RNs over assistants in facilities treating older adults.

Methods: Researchers reviewed the current supply of geriatrics-certified US health professionals (physicians, nurse practitioners, clinical nurse specialists, and others) and the capacity of US training programs to produce sufficient and competent geriatrics-certified practitioners.

Findings:Nurses: While all US nursing and medicine programs require a paediatrics rotation, there is no similar commitment to geriatrics. Close to 60% of baccalaureate nursing programs were without geriatrics-certified faculty. Only 4% met the criteria for geriatrics education; 23% required a geriatrics course; and only 14% provided geriatrics as an elective. Less than 1% of practicing RNs in the US are certified in geriatrics.
Physicians: Geriatrics preparation rates are even lower for physicians. 2% of US medical schools have a geriatrics department, and only 10% require a geriatrics course. Less than 1% of the medical faculty are geriatrics specialists. Of the 650,000 licensed physicians currently practicing in the US, less than 9,000 (1.4%) have met qualifying criteria in geriatrics. Some researchers estimate that 20,000 geriatrics-trained physicians are needed to meet current demand and 36,000 will be needed by 2030.
Other Workers: Of 200,000 US pharmacists, only 720 have geriatrics certification. Less than 0.3% of physical therapists are certified in geriatrics.

Conclusions: The increasing proportion of elderly to working age adults is indicating the future need for geriatrics-trained health professionals. However, consensus on required training to produce competency in geriatric care is lacking. More data are needed on the number and types of patients requiring geriatrics specialists versus generalists. Governments, licensing and accreditation bodies could: (a) require increased geriatric content and clinical experience for licensure of professionals and accreditation of facilities (b) provide financial incentives to encourage organizations to provide geriatrics-specific care (c) provide scholarships for geriatrics specialization, and (d) provide support for research on effectiveness of geriatrics training programs and geriatrics patient care.

Reference: Tassone Kovner C, Mezey M, Harrington C. Who cares for older adults? Workforce implications of an aging society. Health Affairs 2002; 21 (5): 78-89.

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