Geriatric Health Is the Missing Link in Medical Education

Abstract

Recently, due to the advancement of nutrition, health, and treatment, the human lifespan has become much longer than before, and the number of people who are considered as elderly people is increasing day by day owing to the physiological changes that occur with aging. It is evident that the elderly are more susceptible to diseases than the young. In addition, it has been observed that at least 90% of the elderly are suffering from chronic diseases; however, despite such problems, they need more extensive care (1, 2). Around the world, the number of average trained geriatric doctors per country is very different, and it is seen that in many countries, including Iran geriatrics specialty is still in its early stages (3). Due to the aging of the population and the complexity of the medical care of the elderly, basic geriatric health (GH) training should be received by every doctor while being educated to gain knowledge, skills, and attitudes connected to the elderly (4). Effective GH care management, with an emphasis on the care of healthy and functional elderly patients, is recommended to be used as a comprehensive health screening. Physicians can identify and improve specific problems that are common in the elderly by using simple facilities for assessment and also turn to preventive care and preventive medical management instead of disease intervention (5). A collection of 26 minimum geriatrics competencies was developed by Leipzig et al in 2009 for all graduating medical students, which was approved by the Association of American Medical Colleges (AAMC). These competencies were placed in eight content areas, including medication management, self-care capacity, falls, balance, and gait disorders, hospital care, cognitive and behavioral disorders, unusual manifestations of the disease, health care planning and promotion, and palliative care (6). On top of that, according to the basic framework of AAMC regarding geriatric minimum competencies, six areas of geriatric mental health were recommended by Lehmann et al such as normal aging, mental health assessment, psychopharmacology, delirium, dementia, and depression to teach medical students (7). Instead of confining it to a single GH course, GH can be proposed to medical students in the pre-clinical and clinical courses. Therefore, training can be strengthened and developed through rapid and regular exposure to the core principles which are determining the caring and welfare of older people. The Alpert Medical School of Brown University successfully introduced GH-related learning outcomes in a year-long course for all students as part of a comprehensive curriculum redesign (8). In addition, several researchers advocated and carried out a vertical integration of GH into the curricula. To begin with, a few topics are common in multiple disciplines: late-life depression in psychiatry and delirium and dementia in neurology. Second, this vertical integration may mirror the actual reality of the older population who are found in all clinical settings. Finally, frequent exposure to GH may reinforce teaching; however, this should be done in a non-GH setting. It may also help to change medical students’ negative attitudes toward older people (9). One drawback of vertical integration is that it may dilute GH compared to other disciplines, and its training may rely on non-geriatric specialists. However, organizational training can be implemented by both geriatric and nongeriatric professionals, thus promoting high-quality, multidisciplinary training (9). It is seen that the use of simulators and gamification (electronic and non-electronic) has created a positive attitude in students toward the elderly and increased the