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Closing the Knowledge Gap: Toward the Creation of a Health Education Model

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ILC-USA Report

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INTERNATIONAL

LONGEVITY CENTER–USA

60 East 86th StreetNew York, NY 10028212 288 1468 Tel212 288 3132 Fax [email protected]

An Affiliate of Mount Sinai School of Medicine

An Interdisciplinary Consensus Conference of theInternational Longevity Center - USA

Thursday April 16th 2009

With support from Pfizer, Inc.

The International Longevity Center-USA gratefully acknowledges Pfizer Inc. for sponsoring the consensusconference upon which this report is based. Dr. Everette Dennis at the ILC-USA served as moderator for the conference and was involved with the writing of the report. The project was managed by Heather Sutton,the ILC’s director of development and corporate relations. James Nyberg served as rapporteur and drafted thisaction-oriented report. Finally, our gratitude to the panelists who generously brought their considerable knowl-edge and judgment to bear on this report.

Acknowledgements

WWOORRKKSSHHOOPP RREEPPOORRTT

Closing the Knowledge Gap: Toward the Creation of a Health Education Model

for Professionals

An Interdisciplinary Consensus Conference of theInternational Longevity Center - USA

Thursday April 16th 2009

With support from Pfizer, Inc.

ILC Workshop Report – Closing the Knowledge Gap: Toward the Creation of a Health Education Model for Professionals

CONFERENCE LEADER:

Robert N. Butler, MDFounding President and CEO, The International Longevity Center

MODERATOR:

Everette E. Dennis, Ph.D.Executive Director and COO, The International Longevity Center

Liz Capezuti, Ph.D., DN, FAANDr. John W. Rowe Professor in Successful Agingand Co-Director, Hartford Institute for GeriatricNursing, New York University College of Nursing

Rosanne Leipzig, MDVice-Chair for Education and Gerald and May Ellen Ritter Professor of Geriatrics in theBrookdale Department of Geriatrics and AdultDevelopment, Mount Sinai Medical Center

Howard Fillit, MDFounding Executive Director, The Institute for the Study of Aging

Jeanette Takamura, Ph.D., MSWDean, Columbia School of Social Work

Steven DawsonPresident, PHI (formerly ParaprofessionalHealthcare Institute)

Nancy LundebjergDeputy Executive Vice President of the American Geriatrics Society

Harrison Bloom, MDSenior Associate, The International LongevityCenter and Director of the International GeriatricsClinical Education Consultation Service

Daniel Weisz, MDResearch Associate, The International LongevityCenter – The World Cities Project

David Hamerman, MDConsultant, The International Longevity Center

Rapporteur: James NybergDirector, Rhode Island Association of Facilities and Services for the Aging

Workshop Participants

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Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

• Robert Butler, M.D., President and CEO, International Longevity Center-USA

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

• Everette E. Dennis, Executive Director and COO, International Longevity Center -USA

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Innovation and Education in Geriatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Barriers to Bridging the Knowledge Gap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Approaches to Bridge the Knowledge Gap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Action Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

The International Longevity Center-USA Board Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Table of Contents

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Sharing information is a hallmark of the digital era,a time when interactivity and social networkingallows for easy access to information of all kinds, butit requires dedication and effort. That said, the flowof knowledge in medicine and other health fieldsoften doesn’t travel very far. Information publishedin peer reviewed journals may attract media atten-tion with provocative or controversial findings, butthat doesn’t guarantee that this knowledge or thebest practices of one discipline or field will be widelyadopted by others with like minded interests.Certainly this is true in gerontology and geriatricswhere the flow of new knowledge sometimes lurksbehind disciplinary and professional barriers or issimply cut short by time and motivation.

For that reason, the International LongevityCenter with the support of Pfizer, Inc. organized a Knowledge Gap Project in 2008 and 2009 toaddress this problem and find solutions. Throughbackground research and a scientific consensusconference, reported here, we have engaged 10experts from several fields to share their knowl-edge-transfer experience with us so that we couldbegin to pursue their important questions and cir-cumstances that affect the transfer and dissemina-tion of health care information for older people.

The conference yielded many important proposals,some involving policy, some more focused on prac-tical applications. One that struck me as exceptionaland powerful was the suggestion that the Center for

Medicare and Medicaid Services (CMS), the pri-mary payer for heath care and long term care, play a more active role in promoting an integratedapproach to care—from shared knowledge acrossthe various disciplines to better linkage betweengraduate education in medicine, nursing, socialwork and other fields. No organization is betterpoised for leadership in closing the knowledge gap.

We are indebted to several individuals at Pfizer,Inc. for being part of this effort and supporting itsfunding, allowing us complete independence in theprocess. Thanks to Joseph Feczko, M.D., Pfizer’schief medical officer and a member of our ILCBoard of Directors and Jack Watters, M.D. whofirst believed in and championed this project.

Also our gratitude to Michael Hodin, Ph.D., also of Pfizer, whose longstanding interest in the ILCand its work is much appreciated. My thanks too to all those who took part in this project and espe-cially to Everette E. Dennis, Ph.D, who conceivedthe project and chaired the conference, to HeatherSutton, MBA, of the ILC staff who managed thiseffort and to James Nyberg of the Rhode IslandAssociation of Facilities and Services for the Aging(RIAFSA) who served as our rapporteur andauthored this report.

Robert N. Butler, M.DPresident and CEOInternational Longevity Center

Preface

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For decades, health care professionals who special-ize in the care and treatment of older persons havegenerated knowledge both through clinical experi-ence and in systematic research. Recognizing thatthe medical and health needs of older persons aredifferent from those of other generations, notablythe young and middle aged, these professionalsdraw on that knowledge to do their work servingtheir patients and clients. Concurrently generalistsand other professionals are also engaged with per-sons from all age cohorts and are also accumulatingand using new knowledge, based on experience andresearch as well.

Although there are academic and professionalmeetings as well as journals where knowledge isdisseminated and shared, just how much geriatric-specific information goes to physicians, nurses,social workers and other health professionals notspecifically trained in geriatrics and gerontology isnot known. What research there is, as well as con-siderable impressionistic evidence, suggests thatthese busy healthcare professionals and workers

don’t share much. There may be many reasons forthis—sheer time itself, status issues and percep-tions of professional hierarchies, lack of easy accessto the requisite information and knowledge—andother barriers, real or perceived.

At the same time, there is mounting evidence ofmutual respect between and among these persons,bound together by a common concern for thehealth status of older persons, which is not neces-sarily on the agenda of everyone who works in thehealth care field. Interdisciplinary and multidisci-plinary approaches in education are now more invogue, so the climate for such interaction, learning,and knowledge sharing is perhaps improving, espe-cially (and ironically) among younger professionals,who have more open and fluid attitudes in a non-hierarchical world where social networks of allkinds are valued and appreciated.

Everette E. DennisExecutive Director and COO, International Longevity Center -USA

Overview

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The lack of education and training in geriatrics forall health care providers has been an issue of greatconcern to the ILC. There is a well-documentedshortage of academic geriatricians and related fac-ulty in the nursing and social work fields, as well aspractitioners who specialize in the unique needs ofolder people. Various reports, including the recentInstitute of Medicine (IOM) report “Retooling foran Aging America: Building the Health CareWorkforce” in 2008, highlighted how almost allhealth care providers treat older individuals at somepoint in their career, yet they lack the skills neces-sary to effectively care for older people. Moreover,as the field of geriatrics gains new knowledge andstandards of practice through the work of its geri-atric physicians, nurses, and social workers, the disconnect between those who possess such spe-cialized information and those who provide themajority of care to older individuals grows.

In order to highlight and address this disconnect,the ILC hosted a consensus conference on “Closingthe Knowledge Gap – Creating a Health EducationModel for Professionals,” which brought togetherexperts from various fields and disciplines to assess

the state of knowledge about the specific medicaland health needs of older people, and discuss howto address the gap between the trained geriatricexperts who possess such knowledge and thosehealth care workers who routinely care for olderindividuals. Partial funding for the conference wasgenerously provided by Pfizer, Inc.

As a solutions-oriented research and educationcenter, the ILC was committed to avoid conveninga ‘banquet of complaints,” during which expertslament that front line workers “don’t know what we know.” Rather, the conference reviewed thereasons for the current disconnect in knowledgeand practice, and spent the majority of the timeexploring solutions that could bridge the knowl-edge gap and ensure that all health care workers,from primary care physicians to nurses aides, arebetter prepared to provide quality and effective care to older people. This report distills thethoughts, perspectives, and suggestions of the participants on a wide range of issues - clinical,policy, and social – and lays out a series of recom-mendations that outline how to close the knowl-edge gap on healthy aging.

Introduction

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Require medical, nursing, and social work students to rotate throughthe continuum of care for

aging patients.

Integrate geriatrics intoevery subject in medical,nursing, and social work

school curricula.

Geriatrics Training and Development:

What America Needs to Do

Create a cadre of academic geriatricians toeducate all doctors in thecare of older adults.

Create a cadre of academic geriatricians toeducate all doctors in thecare of older adults.

Train all primary care and specialty physicians

in geriatrics.

Develop/support special centers of

excellence in geriatrics to advance research and knowledge.

FIGURE 1: GERIATRICS KNOWLEDGE TRANSFER: WHAT AMERICA NEEDS TO DO

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The field of geriatrics has grown remarkably inthe last few decades. Much has been learnedabout the unique health-related issues and needsin the older individual, as well as effective treat-ments for numerous conditions. This is largelythe work of expert geriatricians and gerontologistswho have conducted the research and educationnecessary to advance the field. Although still lim-ited in number, there are now full-fledged depart-ments of geriatrics scattered throughout theUnited States. Foundations such as the John A.Hartford Foundation, the Donald W. ReynoldsFoundation, the Brookdale Foundation, andAtlantic Philanthropies have made significantinvestments in the field, promoting geriatrics inmedical schools, nursing programs, and schools of social work.

This relatively specialized information on how tobetter care for older people and promote healthyaging needs to be transmitted to the wider healthcare community and beyond. An important devel-opment in the field, noted at the outset of theworkshop, has been the recent efforts to create a setof geriatric competencies for health care providers -basic knowledge and skills that need to be pos-sessed and can be taught in an interdisciplinaryway. These competencies are an effective tool todisseminate the progress that has been made ingeriatrics and gerontology, and the ongoing workin this area is critical to promoting interest andknowledge in the field. An example of MinimumGeriatric Competencies is in Figure 2.

Innovation and Education in Geriatrics

FIGURE 2: SAMPLE OF MINIMUM GERIATRIC COMPETENCIES

Medication Management• Explain the impact of age-related changes on drug selec-tion and dose based on knowledge of age-relatedchanges in renal and hepatic function, body composition,and Central Nervous System sensitivity.

Cognitive and Behavioral Disorders• Compare and contrast among the clinical presentations of delirium, dementia, and depression.

Self Care Capacity • Develop a preliminary management plan for patientspresenting with functional deficits, including adaptiveinterventions and involvement of interdisciplinary teammembers from appropriate disciplines, such as socialwork, nursing, rehabilitation, nutrition, and pharmacy.

Falls, Balance, Gait Disorders• Ask all patients >65 y.o., or their caregivers, about falls inthe last year, watch the patient rise from a chair and walk(or transfer), then record and interpret the findings.

Health Care Planning and Promotion (HCP)• Accurately identify clinical situations where life expectancy,functional status, patient preference or goals of careshould override standard recommendations for screeningtests in older adults.

Palliative Care• Present palliative care (including hospice) as a positive,active treatment option for a patient with advanced disease.

Hospital Care for Elders• Identify potential hazards of hospitalization for all olderpatients (including immobility, delirium, medication sideeffects, malnutrition, pressure ulcers, procedures, periand post operative periods, transient urinary inconti-nence, and hospital acquired infections) and identifypotential prevention strategies.

Available at the Portal of On-Line Geriatric Educationwww.pogoe.org/node/697

Published: Leipzig RM, Granville L, Simpson D, BrownellAnderson M, SauvigneK, Soriano RP. Keeping granny safeon July 1: consensus on minimum geriatric competenciesfor graduating medical students. Acad Med.2009;84:604–610

The participants noted that the progress beingmade in geriatrics reinforces the need to effectivelyconvey such knowledge to students, as well as thoseindividuals working in the field. It was noted thatthe need to teach these students is huge, and thereare efforts to teach them well, but there is a greatdeal of competition in terms of curriculum,resources, and time. Many students are more inter-ested in children, or in the case of social work inparticular, interested in social development issues.Aging issues often get subsumed under other cate-gories. In addition, the current curriculum at manyschools is jam-packed, with no time to add addi-tional training topics, such as geriatrics. Lastly,given the low numbers of individuals who pursuethe field, many schools have difficulty in justifyingthe investment in a geriatrics program, which thenperpetuates the lack of training.

On a related note, the army of health care workerscalled personal care assistants, nurses aides, or cer-tified nursing assistants (CNAs) who work mostintensively with older people, are undertrained ingeneral, and certainly undertrained in geriatricknowledge and skills. The curricula for trainingthese individuals varies greatly state-by-state asthere are no established national standards forsuch training. An example of the lack of focus ongeriatrics can be found in a recent review of care-giver curricula by the ILC, which found little tono mention of why and how older people mayreact differently to prescription drugs nor how toidentify possible side-effects and other harmfulinteractions in this population. This is despite the

fact that older people consume 40% of all medica-tions and take four, five, or more medications atany given time. Moreover, these workers are oftenoverlooked in terms of communicating geriatricknowledge from nurse supervisors and otherhealth care professionals.

Underlying societal attitudes towards aging andolder people, which can be ambivalent at best andageist at worst, are also an impediment. This candeter physicians, nurses, and social workers frompursuing a career in the field. It certainly hasstymied the development of academic geriatrics,which has been extensively noted. Geriatrics andthe care of older people is simply not seen as inter-esting or effective, which those with experience inthe field know is certainly not the case.

Barriers to Bridging theKnowledge Gap

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FIGURE 3: ATTITUDES TOWARD GERIATRICS

Medical students are frequently given the messagethrough their mentors that medical care of geriatricpatients is futile and that their prognoses aredepressing. Stereotypes, fears and irrational prejudices about the aging process can harm the very people physicians are trying to help.

• Physicians are often negative toward their frail olderpatients and dismissive of their symptoms.

• Physicians may reinforce the misconceptions that age-related diseases such as arthritis, confusion, sexual dysfunction and incontinence are inevitable.

• Physicians frequently discriminate against peoplebecause they are old in ways that are similar toracism and sexism.

• Older people are generally categorized as senile, depressing, and hopeless. Epithets such as “crock” and “vegetable” are common and acceptable.

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Barriers between types of health care providers isanother impediment. For example, a team-basedapproach to geriatric care is acknowledged to be an effective way to share knowledge and developeffective interventions, but such interventions arelimited by both practice boundaries (e.g. “I do this,you do that”) and by payment systems. Indeed,health care payment systems, with Medicare being the obvious example, pay according to theservice being provided, which limits collaborationand cooperation.

Indeed, the discussion highlighted Medicare,which provides health insurance for the older population, as a missed opportunity. As a payer of health care, it does little to promote effectiveand coordinated geriatric care. As one conferenceparticipant noted, “there is Medicare A, B, C, andD. But D does not care what B does and viceversa.” Moreover, even though it is the primarypayer of graduate medical education for physi-cians, it does little to promote education andtraining in geriatrics.

Moreover, practicing physicians and other healthcare providers often do not have the time given thesize of their patient loads to effectively treat frailolder individuals. A participant observed in lessthan an eight-minute office visit precludes effectivegeriatric care, which in turn reduces the perceivedneed for such knowledge.

One participant noted that there are two types ofhealth care workers that go into geriatrics: those thatreceive specific training in the field to become geri-atric providers and/or researchers, and those who, bysimple virtue of health care demographics, provide agreat deal of care to older patients. This lattergroup, which comprises the vast majority, does notreceive any formal training in geriatrics. Given thegrowing number of old people coupled with ongoingincreases in life expectancy, an effective way to trans-mit knowledge and best practices to these varioushealth care professionals is critical and was the focusof discussions on bridging the knowledge gap.

The participants discussed a number of ideas andapproaches to bridging the knowledge gap. Therecommendations fall into three broad areas:Clinical; Policy; and Social.

CLINICAL APPROACHESOne initial area of agreement was to establish a setof core competencies that all health care providersshould have in geriatrics. A prominent example ofthis effort is the Partnership for Health in Aging,which is a loose coalition of health care organiza-tions focused on developing core geriatrics compe-tencies. Given the lack of time that health careproviders have, these competencies, with a focus onthe critical knowledge about conditions as well aspreventive measures and interventions, will be anessential tool. Their dissemination and applicationwill be critical to promoting knowledge transferand utilization in the health care community.

It was noted that specific factoids which demon-strate the difference in caring for a 75 year old ver-sus a 45 year old can be an effective teaching tool,especially for physicians. For example, 60 percentof individuals age 80 and over with myocardialinfarction (MI) present without chest pain. Suchfactoids, which can be conveyed as a ‘pop quiz’ helpstudents, and even providers, recognize their ownknowledge gap. The goal is to get people to ‘wantto know,” so that, as one geriatrician at the work-shop noted, “when I am 80, I want to see a doctorwho ‘gets this stuff.’” A brief handout or flyer thatsummarizes some of the more unique issues associ-ated with presentation and treatment of illnesses inolder people would be a useful teaching tool acrossthe spectrum.

The discussion also reviewed ways to incorporate or integrate geriatrics into medical education andtraining. One approach was dubbed “stealth geri-atrics” and refers to having excellent geriatriciansand gerontologists serve as instructors, and byextension as role models to encourage students toexplore the field. Another important interventionis community placement of students, whether theyare medical students, nurses, or social workers. Inthe past, students used to be placed only in nursinghomes, but now, in some schools, they rotatethrough placements in facilities and in community-settings. This mixture of experiences highlights thediversity of the aging population, and increases theenthusiasm of students in pursuing the field. TheChief Resident Immersion Training (CRIT) pro-gram was also highlighted as an example, in which

Approaches to Bridge theKnowledge Gap

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Chief Residents, who play a significant role inpatient care and medical student and resident train-ing, undergo a brief immersion in geriatrics. Thishas been an effective tool to stimulate interest in thefield and disseminate key knowledge to providers.

A significant focus of the discussion was on thedirect care workforce, such as nurses’ aides. Thedevelopment of national standards for educationand training, with a strong geriatrics component, isimportant. The size of this workforce is significant,at least 3 million caregivers and growing, but under-utilized. These individuals, particularly in homecare, have hours of interaction with older individu-als, as opposed to the aforementioned eight-minuteoffice visit. The proper dissemination of geriatricknowledge to improve the skills and attitudes ofthese workers will play a pivotal and cost-effectiverole in improving care, since the services of theseindividuals are already being reimbursed by publicprograms such as Medicare and Medicaid. Anotherway to foster dissemination of geriatric knowledgein the field is to train the supervising nurses, whogenerally have more experience and education inthe care of older people, to better communicatewith aides in the field. The lack of training fornurses in the areas of communication and supervi-sion undermines knowledge transfer. Another is touse the caregiving workforce as a delivery system foroverall health education by better training them onknowledge dissemination.

The growing use of electronic medical recordspresents an opportunity to trigger certain informa-tion and interventions related to older people. Ifthis software could be “geriatricized” as one partici-pant observed, it would enhance efforts to increaseknowledge and awareness among providers. Thesystem could trigger certain information related togeriatric care, such as medication-related issues, orwhat certain symptoms could mean. This would

improve care and also help avoid unnecessary andcostly tests, if the system guides the providertoward a lower-cost intervention.

POLICY APPROACHESAnother issue that was explored involved the needfor practitioners to have a better understanding ofsystems of care, not just knowledge about geriatriccare. The current health and long term care systemis fragmented and difficult for providers and con-sumers to navigate. A comprehensive approachthat includes physical, psychosocial, and environ-mental needs is important to caring for a frail, at-risk older person. For example, a basic eightminute office visit is not effective for an in-depthassessment nor for a discussion about various pro-grams and services that may be available. In addi-tion, physicians often do not know how to refer toa geriatric social worker to help address a patient’spsychosocial needs.

One possibility is that the Centers for Medicareand Medicaid Services (CMS) which is the pri-mary payer of health care and long term care viaMedicare and Medicaid respectively, be moreinvolved in promoting a more integrated approachto care. The perspective that Medicare is just apayer of care is no longer practical. New approach-es in reimbursement, such as a mechanism for ateam-based effort, or a geriatric medical home,need to be explored.

Indeed, the concept of a medical home, in whichan individual has a primary care physician who isresponsible for coordinating care from a wide rangeof health care professionals, is gaining prominence.This concept should be ‘geriatricized’ underMedicare to facilitate communication and coordi-nation between providers and ultimately promotemore seamless care for older individuals. On arelated note, the need for greater communication

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and collaboration among various agencies, includ-ing the Administration on Aging (AoA), theAgency for Health Quality and Research(AHQR), and the National Institute on Aging(NIA), to promote geriatric care was also empha-sized during the discussion.

On a related note, the participants noted that eachprofession tends to seek to expand its scope ofpractice, but that this precludes more integratedapproaches. An internal initiative among profes-sional groups and disciplines to review scopes ofpractice and identify cross-over areas will facilitatemore collaboration and perhaps revitalize a team-based approach to care. Many of the foundationsthat are involved in geriatrics education for physi-cians, nurses, social workers, and others could facilitate this change.

Another promising development in the policyarena involves legislation in the U.S. Congress“The Retooling the Healthcare Workforce for anAging America Act,” which includes several provi-sions to promote academic geriatrics across variousdisciplines and at various career stages (medicine,nursing, social work, and other allied health profes-sionals), as well as expanding training in geriatricsfor nurses, direct care workers, and family care-givers. The enactment of this legislation will be animportant step in helping close the knowledge gap.

SOCIAL APPROACHESIt was noted that the need for a form of social mar-keting to promote health across the life span andcombat stereotypes and misperceptions about agingwill not only benefit society, but will help promotegeriatric care, as individuals and health careproviders are more informed. A breakthroughevent or individual, especially in this era of sponta-neous awareness through various media platformssuch as YouTube (e.g. Susan Boyle’s skyrocket to

fame based on her appearances on Britain’s “YouGot Talent” show) would be instrumental and pos-sibly lead to a successful public health campaign.The key is to identify a potential individual orevent to help bring about a societal transformationand push up the level of knowledge about agingand the embrace of older people in our society.

A related need is to raise awareness of the life-course perspective, that many diseases of old agehave their genesis throughout an individual’s life.A proper understanding of health throughout life, by health care providers and individuals, willmitigate the perception that geriatrics is just aboutcaring for older people. Indeed, geriatric care isintertwined with all aspects of health care. Forexample, a television show or other popular medi-um on how caring for children can relate to theirhealth status later in life will help raise awarenessof geriatrics, both in society and by extension inhealth care. The linkage of geriatrics to healththroughout life is critical.

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The following are some key action steps distilledfrom the workshop discussions in order to beginclosing the geriatric knowledge gap. This gap pres-ents an opportunity for both private funders andpublic entities to leverage existing knowledge andresources to improve care for the older populationnow and in the future.

1. A coordinated and comprehensive effort todevelop and disseminate core competencies ingeriatrics for all health care providers. A pub-lic-private initiative to integrate these compe-tencies across the health care provider spectrumwill provide the necessary size and scope tounify the current efforts and mainstream thisimportant development.

2. The establishment of a system to replicate bestpractices in expanding and enhancing geriatricseducation and training in all health care educa-tion programs, including:

a. Promoting effective use of geriatric instruc-tors to inspire the next generation;

b. Publicizing successful efforts such as the Chief Resident Immersion Training program; and

c. Incorporating successful community rota-tions programs so students experience thefull range of geriatric needs

3. The harnessing of the large direct care work-force to promote geriatric care and to transmitknowledge about health and aging by incorpo-rating geriatric principles into national trainingstandards for this vital workforce.

4. Advancement of federal policies and initiativesto promote geriatric knowledge and utilizationof systems of care.

a. Revamp payment systems to promote cross-discipline collaborations, such as establishinggeriatric medical homes.

b. Foster interagency coordination (e.g. CMS,NIA, AHRQ) to strengthen the connectionbetween research, practice, and payment systems.

5. Collaboration between professional groups andsocieties to review their respective scopes of prac-tice to identify ways to better coordinate care.

6. Enactment of the Retooling the HealthcareWorkforce for an Aging America Act, whichcontains a variety of initiatives to promote geriatrics education and training for studentsand current health care professionals.

Action Steps

With greater access to information of all kinds, it is natural that those concerned with older personswould want to benefit from the understandings thatcome from different kinds of knowledge from thosewho embrace what social scientists call “differentways of knowing.” In the aging and longevity field,geriatric physicians, nurses and social workers forexample, have different disciplinary perspectives—and often different takes on the same issue or prob-lem. Some are more attentive to one phenomenon,while others are focused on a different concern. Ina postindustrial society, this is as it should be, forknowledge itself is the dominant feature.

Scholars concerned with this have posited theoriesabout knowledge transfer between public and privatedomains where information, once a rare commodityheld by an empowered class, is now transmitted toand shared with the public. Knowledge transfer isvalued and methods for accomplishing it are many.At the same time, there is considerable scholarshipon the so-called knowledge gap hypothesis thatdivides the information rich and the informationpoor. Here the disparities between the most andleast knowledgeable are linked to educational attain-ment and socio-economic status. Thus there may belimited motivation for a high status professional likea geriatric physician with specialized knowledge toshare much with a less well educated home careworker, for example, though this may be changing.

Add to this the notion of diffusion of innovationswherein the nature of change itself can be enhancedor blocked, depending on various factors and motiva-tions of people who foster new ideas, methods andprocedures. The diffusion of innovations theory actu-ally offers a research-based explanation for process by

which individuals learn about and ultimately adoptnew ideas and practices. Much of the interface ofthose who pay attention to these three arenas—knowledge transfer, knowledge gaps and dissemina-tion or diffusion of innovations has been severelychallenged by the digital age, which has expandedaccess to information on the Internet and WorldWide Web in extraordinary ways. At the same time,social networking media and other interactive media,such as search engines, have made information trans-fer, access and utilization much easier.

While the complexities of the digital age suggestmany methods for bridging the knowledge gap,which is happening continuously, there are manyimportant if conventional means of doing thisincluding mentoring, work shadowing, guidedexperience, work simulations, establishing commu-nities of practice and others. The goal of this work-shop was to download what a roomful of expertsknow about geriatric care and to craft guidelinesand action steps recommended for bridging thegeriatric knowledge gap, including conventional andnonconventional means. Some interventions maybe targeted, focused on better integrating geriatricsinto education and training, while other interven-tions require a re-thinking of our systems of careand professional practice boundaries, or even a soci-etal change in perspectives towards older people.Since everyone has a vested interest in closing thegeriatric knowledge gap, health care professionals,health care payers, and of course health care con-sumers, such efforts should be a priority. The ILCwill continue to highlight this issue and advance therecommendations that were developed during thisworkshop, and looks forward to working with col-leagues and partners on this important endeavor.

Conclusion

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Leipzig RM, Granville L, Simpson D, BrownellAnderson M, Sauvigne K, Soriano RP. Keepinggranny safe on July 1: consensus on minimum geriatric competencies for graduating medical students. Acad Med. 2009;84:604–610.

Institute of Medicine. Retooling for an AgingAmerica : Building the Health Care Workforce.Washington DC. (2008)

International Longevity Center – USA. Ageism in America. New York, NY. (2006)

International Longevity Center – USA. Preparing for an Aging Nation: The Need for Academic Geriatricians. (2002)

International Longevity Center – USA. Caregiver Education Module on the Managementof Concurrent Drug Treatments in Older Patients.New York, NY (2009)

International Longevity Center – USA. A National Crisis: The Need for Geriatrics FacultyTraining and Development. New York, NY (2000)

References


15


CONSENSUS CONFERENCE:

“Closing the Knowledge Gap—Creating a Health EducationModel for Professionals.”

Thursday, April 16th 2009 9:30am-12:00pm

The International Longevity Center60 East 86th St. New York, NY 10028

(Call 212-517-1307 with any questions)

AGENDA

Purpose: To assess the state of new knowledge about the specific medical and health needs of older people,often confounded by a paucity of trained geriatric physicians, nurses, social workers and other health careprofessionals. In the face of those personnel shortages,the need to close the knowledge gap on healthy agingwith other health professionals is urgent.

Schedule:9:30am All participants meet in the

2nd floor conference room.

9:40am Welcome by Dr. Butler.

10:00am Group discussion led by Dr. Butler and Dr. Everette Dennis, Executive Directorand COO of the ILC (see guiding ques-tions below). Input and perspectives fromall participants are encouraged.

11:30am Lunch is served; discussion continues.

11:45am Final thoughts and consensus points; wrapup by Dr. Dennis.

12:00pm Session concludes.

Appendix

16

Lloyd Frank, ChairLloyd Frank is of counsel at the law firm TroutmanSanders LLP in New York, NY.

Edward M. Berube is CEO and President ofFUTURITY FIRST Insurance Group.

Cory A. Booker is the Mayor of Newark, New Jersey.

Robert N. Butler, M.D., President and CEO ofthe International Longevity Center-USA, is aworld leader in gerontology and geriatrics. As thefirst director of the National Institute on Aging,Dr. Butler helped educate the nation about thedangers of Alzheimer’s disease and worked to makeresearch a priority.

John J. Creedon is the former President & ChiefExecutive Officer of Metropolitan Life Insurance Co.

Everette E. Dennis, Ph.D. the ILC's chief operat-ing officer and executive director (ex-officio) wasfounding president of the American Academy inBerlin and founding executive director of theMedia Studies Center at Columbia University.

Susan W. Dryfoos - Vice Chair Ms. Dryfoos is an award-winning independentfilmmaker and author. She formerly served as the Director of The New York Times HistoryProductions..

Joe Feczko, M.D. is president for worldwidedevelopment at Pfizer. He brings together allaspects of clinical development in both PfizerGlobal Research and Development and PPGIndustries into a single functioning role.

Robert W. Fogel is the Charles R. WalgreenDistinguished Service Professor of AmericanInstitutions, and Director of the Center forPopulation Economics, Graduate School ofBusiness, at the University of Chicago.

Paul M. Gilbert is co-founder of MedAvante, a pharmaceutical services organization.

Annie Glenn has had a life-long interest in pro-grams for children, the elderly and handicapped.She is a member of the Advisory Board for theNational First Ladies' Library.

Senator John Glenn is the first popularly electedSenator from Ohio to win four consecutive terms.Before retiring at the end of the 105th Congress,he was the Ranking Minority Member of both the Governmental Affairs Committee and theSubcommittee on Airland Forces in the SenateArmed Services Committee.

Lawrence K. Grossman is Founder and Co-Chairof the Digital Promise Project, a public interest ini-tiative focused on the development and use of theadvanced information technologies. He is formerpresident of NBC News and PBS.

The International LongevityCenter-USA Board of Directors

ILC Policy Report – The Future of Living: Independently

Andrew D. Heineman, a retired attorney fromProskauer Rose LLP, is a board member of The Mount Sinai Medical Center and Williams College.

Karen K. C. Hsu is a civic leader in education,conservation and natural history. She currentlyserves as Trustee of The Nature Conservatory New York State Board.

Linda P. Lambert, Oklahoma City, is President of LASSO Corp., an investment corporation specializing in oil and gas development and PetreeValley Farms.

Naomi Levine is senior advisor to NYU presidentJohn Sexton and Chair and executive director,NYU George H. Heyman, Jr. Center forPhilanthropy and Fundraising .

William C. Martin was the co-founder of RagingBull, a leading online financial community.

David O. Meltzer, M.D., Ph.D is an AssociateProfessor, Department of Medicine and the Harris School of Public Policy at the University of Chicago.

Evelyn Stefansson Nef is a writer, authority on thePolar regions, psychotherapist, and philanthropist.She has served on the board of the CorcoranGallery of Art, the National Symphony, theWashington Opera, the Paget Foundation, and theLourie Center for Infants and Young Children.

Regina S. Peruggi, Ed.D., is the president ofKingsborough Community College of the CityUniversity of New York.

Stanley B. Prusiner, M.D., is the 1997 NobelPrize winner in physiology/medicine.

Albert Siu, M.D. is the Ellen and Howard C.Katz Chairman's Chair of the BrookdaleDepartment of Geriatrics and Adult Development.

Joseph E. Smith served in various positions withWarner-Lambert Company from 1989 until hisretirement in 1997. He was Corporate VicePresident and served as a member of the Office of the Chairman and the firm's ManagementCommittee.

Jackson T. "Steve" Stephens is chairman andCEO of ExOxEmis, Inc., a biotechnology firm inLittle Rock, Arkansas.

Catharine R. Stimpson, Ph.D. is Dean of NYU'sGraduate School of Arts and Science and aUniversity Professor.

Humphrey Taylor is the chairman of the HarrisPoll, a service of Harris Interactive.

William D. Zabel is a trusts and estate lawyer withSchulte Roth & Zabel LLP, a firm he co-foundedin 1969.

John F. Zweig is Non-Executive Chairman ofSpecialist Communications for the WPP Group.

17

ILC Policy Report – The Future of Living: Independently

Copyright © 2009 INTERNATIONAL LONGEVITY CENTER-USA, Ltd. All rights reserved.

The International Longevity Center-USA is a research policyorganization in New York City and has sister centers in Europe,Asia, Latin America, Africa and Israel. Led by Dr. Robert N.Butler, a world renowned physician specializing in geriatrics, theCenter is a non-for-profit, non-partisan organization with a staffof economists, medical and health researchers, demographers andothers who study the impact of population aging on society. TheILC-USA focuses on combating ageism, healthy aging, productiveengagement and the financing of old age. The ILC-USA is anindependent affiliate of Mount Sinai School of Medicine and isincorporated as a tax-exempt 501(c) (3) entity. More informationon the ILC-USA can be found at www.ilcusa.org.

Pfizer is the world's largest research-based biomedical and phar-maceutical company. Founded in 1849, it is dedicated to betterhealth and greater access to health care for people and their valuedanimals. Every day, approximately 81,900 colleagues in more than150 countries work to discover, develop, manufacture and deliverquality, safe and effective prescription medicines to patients.Pfizer’s key priorities are finding cures and treatments, investing inhealth and strengthening patient safety. Its aim is to demonstratethe results of our commitment to collaborate with and providemore value to stakeholders. More information about Pfizer Inc.can be found at www.pfizer.com.

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INTERNATIONAL LONGEVITY CENTER–USA

60 East 86th StreetNew York, NY 10028212 288 1468 Tel212 288 3132 [email protected]

An Affiliate of Mount Sinai School of Medicine

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