ElderWeb

By Dr. David Lansdale, PhD

This month, Dr. Lansdale interviews Dr. Robert Roush of Baylor College of Medicine in Houston, Texas, who recently completed three years serving as president of the National Association of Geriatric Education Centers. Dr. Roush is an Associate Professor of Medicine and Director of the Texas Consortium of Geriatric Education Centers (TCGEC) headquartered at the Huffington Center on Aging at Baylor College of Medicine. Dr. Roush works with Geriatrics Fellows on being better teachers, conducts research on personal response systems, and promotes use of the Internet as a means to improve health care for older people.

Q: Let?s begin with the history of the GECs? How were they started?

A: GECs are federally funded programs of the Health Resources and Services Administration Bureau of Health Professions. They were first funded in 1984 at four schools, now referred to as the "forefathers:" SUNY Buffalo, Michigan, Harvard, and USC. In 1985, an additional 16 ? the "sweet 16" -- were funded, including the TCGEC I direct. A total of 45 GECs exist today, of which 35 are fully funded. Approximately 10 years ago, the GECs formed an independent organization to conduct policy education for our local, state, and national representatives. The National Association of GECs (NAGEC) is organized with a nine-member Council elected annually at the GSA meeting. At our meeting held on November 17, 2000, three new Council members were elected, as was a wonderful new president, Dr. Andrea Sherman of the Consortium of New York GECs headquartered at NYU. I?m honored to have been asked to serve another two years as the immediate past president.

Q. What is the mission of the GECs?

A: Since their inception over 15 years ago, the mission of GECs remains the same ? i.e., offer professional development opportunities to health professions educators and practitioners to increase their funds of knowledge in geriatrics that helps them teach students and provide health care for older people. With a national health workforce better trained in the interdisciplinary care of their older patients, older Americans should have better health and, consequently, a better old age. NAGEC is also a founding member institution of the Health Professions and Nursing Education Coalition. HPNEC maintains a constant vigil over national health issues and makes clarion calls for more funding for all Human Resources and Services Administration (HRSA) health professions programs to ensure a well-trained national health workforce capable of caring for the very young, the very poor, and the very old.

Q. What is the GEC?s strategy for addressing the opportunities and challenges that lie ahead as a result of significant gains in longevity, both in the United States and abroad?

A: We recognize two very important factors:

We have a burgeoning aging society in the US ? over 35 million older Americans today with 77 million baby boomers turning age 50 at a rate of over 10,000 per day ? in a world aging at the rate of 1,000,000 new 60 year olds per month and soon to have many Western countries with over 20% of their citizens being older ones; and
There are not enough health care providers with sufficient training in geriatrics available to care for them.
Thus, our basic strategy is twofold:

Continue to educate today?s and tomorrow?s health care providers on those special areas of caring for the elderly that they need; and
Keep calling for better health care for all older Americans ? a rapidly growing diverse group of persons with respect to socioeconomic and ethnographic characteristics ? via a better trained national health workforce.
We believe the federal government will need to ensure that all older Americans have access to adequately trained health professionals by having fully funded GECs covering all 50 states, whereas presently we have only 35 funded GECs covering slightly over 40 states and territories. And more health professions programs in our colleges and in our academic health centers will need to increase their emphasis on the training for their students in this vital area.

Q. What role do you see the Internet playing for our aging population, and in helping the GECs accomplish its goals?

A: The Internet holds great promise to link us ? young and old alike ? as we can all become ?electronically proximal? with e-mail and e-learning via Web sites. The only problem is the vastness of the number of sites themselves ? going from the first Web site on Christmas Day 1990 to over 13 million this past March to over 22 million today. The Internet seems to double every six months or so, and the number of Web sites in health and in aging have also increased to the point that the average, busy health care provider simply can?t keep up with those that have good information. Thus, we need to start training older people and their caregivers on how to judge the quality of a Web site so they know that it has up-to-date, valid health information. Likewise, we need to start training health care professionals to write ?information prescriptions? ? literally an Rx for www.something.edu/gov/org/com that he or she can reliably recommend that their older patients browse and discuss with them via e-mail.

Q. How might ElderWeb help the GECs, both locally and nationally, achieve its mission?

A: One way ElderWeb can play an important information-dissemination role is to apprise your readers that they can logon to http://www.hcoa.org/nagec to contact the GEC nearest them or to simply follow our activities posted on the Web site I maintain at Baylor. Another opportunity might be to regularly feature a unique GEC program ? e.g., the GEC-pioneered field of Ethnogeriatrics, which takes an ethnographic view of the older person and his/her caregivers. Furthermore, the field of geroethics is an integral part of the broad training we provide clinical educators and community practitioners. Your readers should also know that GECs produce a tremendous amount of curricular materials; many of which are available as printed modules and many are computer-based -- such as CD-ROMs on common geriatric problems and Web-based e-learning opportunities. HRSAhas a new site that lists materials alphabetically by topic and by GEC that developed them. These can be downloaded in PDF format at http://bhpr.hrsa.gov/dadphp/gec.htm.

Dr. David Lansdale, founder of the Linking Ages program which connects older adults to the Internet, will be conducting a series of interviews for the ElderWeb newsletter. He will speak to representatives of key organizations that serve consumers, professionals, legislators, and others interested in aging and eldercare.

In the current issue of the Annuls of Internal Medicine, Christine K. Cassel, MD, makes a case for the development of more Geriatric departments in medical schools. She states, "I am writing to argue the case for departments of geriatric medicine as institutional structures that can advance research, improve teaching, and improve patient care -- three goals that are at the core of academic medicine. I do so from my experience over the past 4 years as chair of the first U.S. department of geriatrics and as someone who came to the position skeptical of this model."

"Separate departments of geriatrics offer many advantages," she concludes, "Leaders in geriatrics have a presence at the senior leadership level, which allows them to best represent the broad field of geriatrics and research in aging and to effectively communicate the issues concerning the elderly population. A larger proportion of medical training efforts is focused on a department of geriatrics, which helps produce well-trained geriatricians who are able to meet the needs of older patients much more effectively and efficiently. A department also houses enough faculty to provide adequate teaching throughout the other departments and the medical school. The existence of a critical base for scholarship and investigation creates an advantage in seeking external grant funding and allows researchers to focus their efforts and further the knowledge of geriatrics. The improved training provided by a department of geriatrics benefits its institution by expanding the patient population and providing comprehensive, seamless care while emphasizing preventive measures that reduce hospital utilization and improve outcomes. Our students and trainees who see this model in action from the bench to the community will be inspired to seek careers in this expanding and rewarding field."