Are geriatric medicine fellows prepared for the important skills of hospice and palliative care?

Many geriatricians care for terminally ill and dying patients, but it is unclear whether the current geriatric medicine fellows receive sufficient training in hospice and palliative care (H&PC). A national cross-sectional survey was conducted between March and June 2011 to determine fellows' experience and perceived competency with H&PC. Fellows (143 of 298, 48%) and program directors (PDs; 69 of 150, 46%) answered the surveys on paper or online. Three-fourths of the fellows planned to practice H&PC; however, only 35% fellows versus 42% PDs believed that fellows were well prepared in this area. Factors associated with fellows' self-reported better preparation included completion of an H&PC rotation, experiences with an inpatient hospice facility, inpatient palliative care consulting service, and the presence of a formal H&PC curriculum.

Embracing the ecology of geriatrics to improve family medicine education.

Family physicians currently provide almost half of the primary care for older patients in the United States. This proportion is expected to increase as the "baby boomers" age. Current care of older patients is characterized by poor recognition of mental status deficits, high use of inappropriate medications, inadequate recognition and treatment of geriatric syndromes, problems with quality of transitional care, and the need to incorporate new relevant bodies of knowledge, such as hospice and palliative care. Current family medicine training requirements do not address these needs, and training needs to be improved. Analysis of the medical ecology of geriatrics reveals extensive use of continuum-of-care services and institutions where large numbers of older patients receive care outside of the traditional teaching sites of hospitals and clinics. These continuum-of-care services and institutions, with their multidisciplinary teams and the patients in them, are ideal for family medicine resident education in many aspects of geriatrics. Family medicine can address these concerns by requiring a block rotation immersion experience around these themes that is integrated with the continuum of care.

Health care disparities in postmenopausal women referred for DXA screening.

BACKGROUND: Racial disparities have been identified in a number of areas in clinical medicine. Limited data are available on osteoporosis screening rates between races. We assessed the racial distribution in Dual Energy X-ray Absorptiometry (DXA) screening rates among African American and Caucasian women referred from our primary care clinics. METHODS: We obtained DXA results during the years 1998-2002 for all 546 women ages >50 years referred for bone mineral density (BMD) testing from a primary care population. We compared the DXA screening rates between African American and Caucasian women with the racial demographics of the referring primary care clinic population. RESULTS: African American women represented 45.9% and Caucasian women 51.7% of our primary care clinic population. Yet, only 14.5% (n=79) of the DXA screened women were African American, while 82.8% (n=452) were Caucasian. Age and recognized risk factors only explained a small portion of this difference. In women 65 years and older with universal screening recommendations, 19.4% (n=46) of the screened women were African American, and 80.6% (n=191) were Caucasian. The prevalence of osteoporosis was similar in both populations, 21.5% and 20.1% for African American and Caucasian women, respectively. CONCLUSIONS: Significantly fewer African American women had BMD screening even though national guidelines do not differentiate by race. The large disparity between the proportion of African American and Caucasian women screened calls for more equitable BMD screening among races.