Aging, the Medical Subspecialties, and Career Development: Where We Were, Where We Are Going

Arti Hurria, MD; Kevin P. High, MD, MS; Lona Mody, MD; Frances McFarland Horne, PhD, MA; Marcus Escobedo, MPA; Jeffrey Halter, MD; William Hazzard, MD; Kenneth Schmader, MD; Heidi Klepin, MD, MS; Sei Lee, MD, MAS; Una E. Makris, MD, MSCS; Michael W. Rich, MD; Stephanie Rogers, MD; Jocelyn Wiggins, BM, BCh; Rachael Watman, MSW; Jennifer Choi, BS; Nancy Lundebjerg, MPA; Susan Zieman, MD, PhD

Disclosures

J Am Geriatr Soc. 2017;65(4):680-687. 

In This Article

Progress in Integrating Geriatrics Into the Medical Subspecialties

American Academy of Allergy, Asthma, and Immunology

In 2007, the American Academy of Allergy, Asthma, and Immunology (AAAAI) formed a task force to explore care of older adults with asthma. This task force has become a standing committee that promotes clinical care, education, and research on asthma and allergy in older adults. Other accomplishments include symposia at the annual AAAAI meeting, development of a teaching slide set, a wide range of articles on asthma and allergic rhinitis in older adults, inclusion of geriatrics questions on fellowship in-training examinations, and an education brochure targeted to older adults with asthma. With support from an ASP Small Project Grant, AAAAI has developed an online curriculum on allergy and immunology in older adults, piloted implementation of the curriculum in select fellowship programs, and released a final version to all fellowship programs in allergy and immunology.

American College of Cardiology

The American College of Cardiology (ACC) has established a Geriatric Cardiology Section (GCS) that now includes approximately 2000 members and more than 400 fellows. The GCS has several working groups focused on advocacy and public policy, palliative care, communications, education, international activities, early-career physicians (including fellows in training), and research related to geriatrics and cardiology. These groups participate in monthly calls with the GCS Leadership Council and hold face-to-face meetings at the annual conferences of the ACC and American Heart Association. ASP supported a cardiology fellows' retreat that led to the establishment of a Fellows-in-Training Working Group, a clinical care project that allows fellows to gain experience in conducting online assessments of older adults with cardiovascular disease and the development of a pilot study designed to set the stage for a future geriatric cardiology research network. In addition, with support from the JAHF, the GCS and ACC have developed a curriculum, Essentials of Cardiovascular Care for Older Adults, which is available on the ACC website (www.acc.org/eccoa) and is being translated into Chinese. The GCS published two seminal papers in the ACC's flagship journal, the Journal of the American College of Cardiology.[16,17] In collaboration with AGS and supported by a collaborative conference grant from the NIA (U13 AG047008), the GCS developed a conference series addressing geriatric cardiology. Members of the GCS Leadership Committee are also working to incorporate training in geriatric cardiology into the ACC's Core Cardiovascular Training Statement.

American College of Rheumatology

With support from an ASP Small Project Award, the American College of Rheumatology (ACR) has developed and disseminated self-assessment questions focused on geriatric conditions in musculoskeletal health. These questions, which are available online, are widely used and have become part of a set of self-assessment and preparatory tools. To reinvigorate its Geriatrics Rheumatology Special Interest Group, a proposal has been developed focusing on evaluating gaps in clinical practice and research, understanding and addressing barriers to achieving successful careers in aging and rheumatology, and planning symposia to bring in speakers who normally do not attend meetings on rheumatology. ACR also has a committee on research that includes a subcommittee focused on early careers, and it is working to increase awareness of its activities to integrate geriatrics and rheumatology. ACR invited an NIA representative, Dr. Susan Zieman, to its Rheumatology Research Workshop, which served to promote GEMSSTAR and focus on career development for junior faculty.

American Diabetes Association

Unlike many other professional societies, the American Diabetes Association (ADA) is a large, diverse organization that includes professionals, individuals with diabetes mellitus, and their families. The Older Adults Working Group of ADA, which has been in place for several years, has promoted the acceleration of several activities. Among these is an ADA consensus conference, organized by ADA and supported by a JAHF ASP Small Project Grant. That conference led to the joint publication of clinical recommendations for improving care of older adults.[18] These recommendations have been incorporated into the ADA's annual update: Standards of Medical Care in Diabetes. A workshop supported by ADA and NIA on diabetes mellitus and cardiovascular disease in older adults led to a 2014 publication in Diabetes.[19] The Older Adults Working Group is also developing a position statement on diabetes mellitus in long-term care, given the many challenges for individuals in this setting, who often are transferred from acute hospitals with complex insulin regimens. In addition, the ADA Academy, a series of Grand Rounds programs focused on the latest evidence-based research related to diabetes mellitus prevention and management, includes Diabetes in Older Adults as one of five current topics. ADA has also developed the Diabetes and the Older Adults Self-Assessment Program, targeted to the diverse group of health professionals who work with older adults.

American Society of Clinical Oncology

The American Society of Clinical Oncology (ASCO) began its integration of aging components with the development of geriatric oncology fellowships in collaboration with the JAHF. This collaboration spurred the development of programmatic integration throughout the ASCO's annual meeting, with inclusion of geriatric oncology in all tracks, a clinical science symposium dedicated to geriatrics research, an extended education session focused on integrating geriatric oncology into practice, and the B.J. Kennedy Award and Lecture for scientific excellence in geriatric oncology. Additional educational resources are available through ASCO University, ASCO's online learning platform, which features a curriculum in geriatric oncology, and in ASCO's publications, including the Special Series on Geriatrics in the Journal of Clinical Oncology and a monthly geriatric oncology section in the ASCO Post. The ASCO Geriatric Oncology Special Interest Group supports broad-based efforts across ASCO and is undertaking a project to digitize and centralize geriatric oncology tools and educational resources. In addition, ASCO's patient website, Cancer.Net, has a section dedicated to geriatric oncology. ASCO advocates for advancement of research benefitting older adults with cancer, including a recently published manuscript, "Advancing the Evidence Base for Treating Older Adults with Cancer." Outside of ASCO, the Cancer and Aging Research Group provides a forum for mentoring and collaboration and holds NIA-supported meetings on research methodology. The Journal of Geriatric Oncology is in its sixth year, and its influence is growing.

American Society of Hematology

Until recently, there has been little formal activity to integrate geriatrics and aging research into hematology, but the Special Interest Group on Hematology and Aging of the American Society of Hematology (ASH) lobbied the ASH Executive Committee to promote attention to aging-related topics at ASH, with an emphasis on the missions of research and education. With encouragement from the Executive Committee, the special interest group successfully applied to hold a scientific workshop focused on hematology and aging. Held in December 2014, this workshop convened more than 300 participants and explored new research related to stem cells, aging, and disease pathogenesis; preclinical models and clinical implications of the biology of aging; aging phenotypes linking clinical observations with biologic mechanisms; and funding opportunities from NIA and the National Heart, Lung, and Blood Institute. This workshop and other interest group efforts have stimulated further interest in aging and hematology and the inclusion of aging experts in several ASH committees. Several of these experts have been recipients of the GEMSSTAR, TFWS awards, or Paul B. Beeson Career Development Awards in aging research.

American Society of Nephrology

In 2008, the American Society of Nephrology (ASN) offered a 2-day course in geriatric nephrology for its membership that has become a standard offering at the ASN's annual meeting. In 2009, the ASN approved the formation of the Geriatric Nephrology Advisory Group, which has spearheaded a number of initiatives to integrate geriatrics into the field of nephrology. In addition to updating the ASN's Geriatric Nephrology Pre-Course, ASP-supported initiatives of this group include the development and maintenance of an online geriatric nephrology curriculum accessible through the ASN website; collaboration with other professional societies to conduct a landmark workshop on supportive care for individuals with kidney disease; conducting a workshop to support teaching of communication skills needed for advance care planning for junior faculty members in nephrology; development of an online video series titled "Nephrology Rounds" focusing on the relevance of geriatrics to the care of individuals with kidney disease; and establishment of visiting professor and small grants programs to support clinical care, teaching, and research in geriatric nephrology. The Nephrology Self-Assessment Program also has a dedicated geriatric edition.

Infectious Diseases Society of America

The field of infectious diseases has had the highest number of TFWS Scholars (14) of all subspecialties and a number of additional GEMSSTAR recipients. Examples of areas in which these scholars have made critical discoveries include immune senescence,[20] influenza vaccine efficacy,[7] antibiotic stewardship,[8] and infections in older adults, including nursing home residents.[13,21,22] Since 2003, the Infectious Diseases Society of America (IDSA) has held an annual interest group meeting on infection in older adults and has included aging and infection as a topic at Fellows Day symposia during its annual meetings. IDSA has also developed and updated guidelines on fever and infection in long-term care residents (https://cid.oxfordjournals.org/content/48/2/149.full.pdf+html) and has received small grants from the JAHF to hold a fellowship survey and symposium and to develop a website on nursing home infections. TFWS awardees have developed guidelines to revolutionize the approach to infection control and prevention in long-term care settings and to develop surveillance criteria to define infections within these settings.[23,24]

Society of General Internal Medicine

ASP support has had tremendous influence in catalyzing and sustaining geriatric initiatives in the Society of General Internal Medicine (SGIM). The most visible and enduring accomplishment is the ongoing Distinguished Professor of Geriatrics series, which is now in its twelfth year and that other groups in general medicine have copied, including those focused on women's health and cancer research. ASP support has also allowed SGIM to offer travel awards to trainees focused on geriatrics and to support walk rounds for posters focused on geriatrics at every annual meeting. With ASP support, SGIM held a retreat in 2012 to generate a research agenda focused on geriatric topics in general medicine. SGIM also held a geriatrics symposium in 2014, leading to the publication of six articles in the Journal of General Internal Medicine on topics related to the interface between general medicine and geriatrics. ASP support has also enables the development of educational tools to assess competencies in geriatric medicine among general medicine residents and the broad dissemination of this toolkit to improve patient care and obtain feedback data. SGIM has focused on care transitions between nursing homes and ambulatory providers with a retreat focused on developing a checklist and an educational guide of best practices for care transitions.

Society of Hospital Medicine

Since 2011, the Society of Hospital Medicine (SHM) has facilitated career development for hospitalists interested in geriatrics by supporting early-career aging research through the GEMSSTAR and TFWS programs. SHM has also supported efforts to improve end-of-life care, for example through collaboration with the Hastings Center to develop educational resources, including user tool kits, implementation guides, and research support, and has focused on patient care through its Acute Care for Older Persons project, a series of interviews with 17 stakeholder organizations to identify unanswered questions and research priorities. This project, which has led to publications in the Journal of General Internal Medicine and the Journal of Hospital Medicine, has identified priorities in the areas of advanced care planning, care transition, dementia, depression, medical management, physical function, surgery, medical care, and geriatrics training. Results from the project were presented at the 2014 meetings of SHM, AGS, and the Gerontological Society of America.

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