Currently, 16% of the United States population is 65 and older, and is expected to increase to 21% by 2040[1]. This population will live with chronic conditions that will require specialized geriatric healthcare. Despite this, the number of healthcare providers qualified to care for elderly patients in the U.S. continues to shrink even as the need increases. However, academic programs and hospitals can use simulation-based training to help combat the shortfall of geriatric care providers by training and upskilling more healthcare professionals before it is too late.

The geriatrician shortage will negatively impact patient care

The population of the United States is rapidly aging. By 2060, nearly one in four Americans will be 65 years and older, meaning they will outnumber children for the first time in U.S. history[2]. Additionally, the growing elderly population will require more healthcare services as an estimated 80% of elderly Americans live with one chronic illness, and 68% live with two or more[3]. The most common chronic conditions affecting older adults include hypertension, heart disease, and COPD, which require extensive treatment and specialized care.

In addition, older adults deal with unique health concerns, including end-of-life issues and cognitive decline. Geriatricians complete additional training to effectively handle the specific medical, psychological, and social needs of older people. However, the U.S. is experiencing a shortage of geriatricians, which means some geriatric patients will receive inadequate healthcare.

The American Geriatrics Society expects about 30% of older Americans to require care from these specialists. About 30,000 geriatricians will be needed by 2030 to meet the needs of the growing elderly population[4]. Otherwise, older people will have to compete for access to primary care physicians (PCP) with the non-geriatric population. Patients will have to wait longer to see their physician, potentially delaying a diagnosis and treatment for chronic illness.

An early diagnosis is key to preventing or delaying functional decline in older people from a chronic illness[5]. Without these regular PCP visits, many older people could needlessly die from their ailments. While some might seek care at hospitals or clinics, these facilities do not guarantee faster service. Many hospitals across the country are dealing with widespread staffing shortages, leading to longer wait times and worse care as providers struggle to keep up with the demand for healthcare.

The COVID-19 pandemic caused many providers to leave the profession, which, coupled with preexisting provider shortages, has increased patient-provider ratios in hospitals across the country. Research has shown that large patient workloads adversely affect patient safety and the quality of patient care[6]. Clinicians have less time to spend with patients, and the stress from overwork decreases their ability to work effectively. This increases the risk of mistakes and patients dying from preventable causes.

A balanced patient-provider ratio allows clinicians to offer personalized care and avoid errors. In turn, patients are more likely to trust and adhere to the treatment plan set by the clinician. This is especially important when managing chronic illness, as inadequate adherence to treatment may reduce its efficacy, leading to a greater risk of hospital readmission and worse outcomes.

The clinician shortage could deprive many elderly patients of routine geriatric care.

Using simulation to train clinicians prepared for geriatric care

Despite ample research indicating that the U.S. healthcare system is unprepared to meet the needs of an increasing elder population, there is still little policy to address this issue. Some policy experts recommend training primary care and other specialty physicians in the care of older adults[7]. This will help prepare physicians of all specialties to meet the specific needs of the elderly population.

The Association of American Medical Colleges (AAMC) has endorsed training medical students in geriatric competencies even if they do not plan to specialize in that field[8]. Thus, training programs should provide students with hands-on experiences practicing geriatric care guidelines in their curriculum. Simulation-based training can help facilitate these experiences, so students have a safe environment to develop the skills needed to provide effective care to older patients.

However, some programs face challenges in expanding their curriculum, such as finding the space and budget dollars to allocate for a geriatric simulator. There might also be downtime as the educator learns to operate the new technology. While these factors can prevent some programs from expanding their curriculum, integrating geriatric care can be easy and cost-effective.

Gaumard’s geriatric appearance accessory changes the appearance of a SUSIE®, CHLOE®, or Code Blue® patient simulator to that of a geriatric patient. The accessory helps immerse students into the scenario as greater realism helps them suspend disbelief and improves the training experience. Students can practice and hone essential geriatric care skills on the simulators, including CPR, airway management, and catheterization.

Thus, programs may not necessarily need to purchase a new simulator; instead, they can use their existing resources, saving money and time. Educators can quickly establish a framework in their curriculum for teaching geriatric care that provides both didactic and hands-on, experiential learning opportunities. Learning is active, and students see the consequences of their actions reflected in the simulator’s vitals and physical condition in real-time.

Therefore, the educator can provide feedback when a mistake is made or reinforce positive actions. Unlike in traditional clinical hours, students can repeatedly practice a procedure or skill until they achieve mastery, ensuring they are prepared to meet the needs of the growing elderly population. As these clinicians enter the workforce, they will fill critical roles created by the geriatrician shortage.

Simulation-based training offers participants opportunities to gain experience working with geriatric patients.

Simulation helps develop patient-provider communication skills

While practicing and honing clinical skills is essential, communication skills also play a significant role in patient care. Effective communication skills build a connection and trust between the patient and their clinician, and this helps the patient feel less anxious and understand their treatment. Ultimately, empathetic communication with the patient leads to better medication adherence, decreased malpractice cases, fewer mistakes, and increased patient satisfaction[9].

However, patient-provider communication skills are difficult to practice during traditional clinical hours as the focus is mainly on practicing hands-on clinical skills rather than communication skills. Moreover, time with patients is limited and conducted in a large group, so it is difficult to develop a one-on-one connection with them.

Patient-provider communication skills are essential when working with older patients. Many older people are affected by cognitive decline or hearing loss; therefore, they are slower to articulate their needs and have trouble processing information or following along with speech. So, it can be difficult for providers with increasingly greater patient loads to give them the extra time to express themselves clearly.

Therefore, incorporating geriatric care scenarios into the curriculum helps students develop a better understanding and empathy for these patients. This allows them to manage their stress and effectively acquire complete information from the patient. Also, students can practice discussing a difficult diagnosis clearly and empathetically and develop the ability to accept the patient’s attitudes without showing a negative reaction.

Throughout the scenario, the students use communication skills to accomplish several tasks, including getting a patient history, gathering information to formulate a diagnosis, and calming the patient to comply with treatment. Thus, the students enter the workforce prepared to communicate with elderly patients and can handle their own emotions during challenging interactions.

Conclusion

The growing elder population will create far more demand for healthcare services, but the U.S. is not producing enough geriatricians to meet their needs. The healthcare system must adopt strategies for filling these gaps to avoid poorer health outcomes for older patients. Simulation-based training can help clinicians learn how to manage and treat these patients’ specific healthcare needs effectively so that even non-geriatric specialty clinicians can provide care for them. Providing older adults with appropriate care is essential to avoid health disparities and address their needs.

[1] “2020 Profile of Older Americans.” Administration for Community Living, May 2021, https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2020ProfileOlderAmericans.Final_.pdf.

[2] Vespa, Jonathan. “The U.S. Joins Other Countries With Large Aging Populations.” United States Census Bureau, https://www.census.gov/library/stories/2018/03/graying-america.html. Accessed 23 Aug. 2022.

[3] “The Top 10 Most Common Chronic Conditions in Older Adults.” National Council of Aging, 23 April 2021, https://www.ncoa.org/article/the-top-10-most-common-chronic-conditions-in-older-adults.

[4] Castellucci, Maria. “Geriatrics still failing to attract new doctors.” Modern Healthcare, https://www.modernhealthcare.com/article/20180227/NEWS/180229926/geriatrics-still-failing-to-attract-new-doctors. Accessed 23 Aug. 2022.

[5] Jansen, Maria WJ, et al. ” Early detection of health problems in potentially frail community-dwelling older people by general practices – project [G]OLD: design of a longitudinal, quasi-experimental study.” BMC Geriatrics, vol. 13, no. 7, 2013, pp. 1-10.

[6] Stephenson, Jo. “Excessive nurse workload linked to higher patient safety risk.” Nursing Times, https://www.nursingtimes.net/news/workforce/excessive-nurse-workload-linked-to-higher-patient-safety-risk-04-05-2018/. Accessed 8 Sept. 2022.

[7] Bragg, Elizabeth, et al. “Refocusing Geriatricians’ Role in Training to Improve Care for Older Adults.” American Academy of Family Physicians, https://www.aafp.org/pubs/afp/issues/2012/0101/p59.html. Accessed 24 Aug. 2022.

[8] Brown, Shilpa P, et al. ” Integrating an Interprofessional Geriatric Active Learning Workshop Into Undergraduate Medical Curriculum.” Journal of Medical Education and Curricular Development, vol. 7, no. 1, 2020, pp. 1-6.

[9] Killam, Kasley. “Building Empathy in Healthcare.” The Greater Good Science Center at the University of California, Berkeley, https://greatergood.berkeley.edu/article/item/building_empathy_in_healthcare. Accessed 25 Aug. 2022.