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The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline's interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

Background: The purpose of this study was to evaluate the rate of and factors associated with attending physicians' adherence to geriatric consultation recommendations in an urban community hospital., Methods: A retrospective review was performed of the charts of 47 patients referred for inpatient geriatric consultation over the previous 1 1/2-year period. Study variables included patient and attending physician demographics, length of stay in hospital before geriatric consultation, status of patient on discharge, level of expertise of consultant, number of diagnoses per patient, and types and number of recommendations per patient made by consultant and acted upon by attending physicians., Results: The recommendations made included medical (23.4%), medication (28.6%), laboratory (15.8%), radiological (2.6%), nutritional (11.7%), psychosocial (7.7%), skin care (1.6%), rehabilitative (6.4%), and other (2.2%). The percentage of total recommendations acted upon was 55.5%. By multivariate analysis, decreasing length of time prior to consultation was statistically associated with referring physician adherence to consultation recommendations (P=.03). Slightly more than 40% of the variability in adherence was explained by this single variable., Conclusions: Inpatient geriatric consultations are aimed at providing a comprehensive assessment for attending physicians. Recommendations are acted upon more than 50% of the time. Physician adherence to recommendations does not appear to be dependent on patient or physician demographic variables, but to some extent, adherence is associated with less time in the hospital prior to consultation. This is a relatively new concept in hospital medicine.

Background: The objective of this study was to evaluate the effect of outpatient geriatric consultation by referring academic physicians and to verify the results of a previous study., Methods: We conducted a retrospective review of charts of 37 patients referred for geriatric consultation during a 7-month period of a university- and community-hospital-affiliated family practice residency clinic in urban northeast Washington, DC. The consultation involved team assessment, which led to formal recommendations to the attending physician. Main outcome measures included total number and category of recommendations made, as well as a total number and category of recommendations adhered to by referring physicians., Results: There were 29 women and 8 men with an average age of 79.1 years; 5 were white and 32 were African-American. For the 23 patients for whom follow-up could be determined, the mean number of total diagnoses per patient was 11.4 (SD 3.5). The mean total number of recommendations made per patient was 18.1 (SD 5.9). The mean total number of recommendations acted upon per patient by referring physicians was 9.5 (SD 4.4). The recommendations fell into the following categories: rehabilitative 64 percent, radiologic 57.1 percent, laboratory 56.9 percent, total medication 55.6 percent, medical 50 percent, health maintenance 47.1 percent, social service 46.2 percent, sensory 33 percent, other 28.6 percent, educational 20 percent, and nutritional 14.3 percent., Conclusions: Multidisciplinary geriatric assessment in an academic outpatient setting provides a comprehensive assessment for faculty and resident physicians in training. Recommendations will be adhered to only 50 to 70 percent of the time, possibly because of the demographic and socioeconomic mix and overall health of the patient population, health care priorities of the referring physician, and costs and availability of various interventions. Physicians in training should be exposed through continuing medical education to various aspects of geriatric assessment.