Advancements in Geriatric Care Training: A Comprehensive Analysis of Strategies, Challenges, and Outcomes

Abstract

The profound demographic shift towards a globally aging population presents an unprecedented imperative for healthcare systems to cultivate a highly competent and empathetic workforce adept at addressing the unique and complex needs of older adults. Recognising this critical gap, recent strategic governmental interventions, most notably the Biden administration’s substantial financial commitment exceeding $200 million towards enhancing geriatric care training for primary care clinicians, underscore the national urgency attributed to this healthcare challenge. This comprehensive report undertakes an in-depth, multifaceted examination of the diverse and evolving strategies currently employed to bolster geriatric care education across the healthcare continuum. It critically evaluates the inherent challenges encountered during the design, implementation, and scaling of these pivotal training initiatives, ranging from resource constraints and institutional resistance to variations in pedagogical quality. Furthermore, the report rigorously assesses the multifaceted, long-term impacts and demonstrable efficacy of these programs on key performance indicators, including the measurable enhancement of clinician competence, tangible improvements in patient outcomes, and the broader systemic capacity of the healthcare infrastructure to deliver equitable, high-quality, and person-centred care to its burgeoning older adult demographic. By synthesising current evidence and identifying future research imperatives, this analysis aims to inform policy, pedagogical approaches, and strategic investments necessary to cultivate a sustainable and geriatric-prepared healthcare workforce for the 21st century.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

1. Introduction

The 21st century is fundamentally defined by a global demographic transformation of historic proportions: the inexorable shift towards an older population. This phenomenon, often termed the ‘graying of the world,’ is characterised by increasing life expectancies and declining birth rates, leading to a significant increase in the proportion of older adults within societies across both developed and developing nations. In the United States, for instance, projections by the U.S. Census Bureau indicate that by 2030, all baby boomers will be older than age 65, meaning that one in every five U.S. residents will be retirement age. By 2034, older adults are projected to outnumber children for the first time in U.S. history. This unprecedented demographic shift profoundly impacts various societal sectors, none more critically than healthcare.

The unique physiological, psychological, and social complexities associated with aging necessitate a highly specialised approach to healthcare delivery. Older adults frequently present with multiple chronic conditions (multimorbidity), polypharmacy, atypical disease presentations, and age-related functional decline, alongside a heightened vulnerability to social isolation and cognitive impairment. Effectively managing these intricate health profiles demands a depth of knowledge and a distinct skill set that transcends conventional medical training. However, the existing healthcare workforce, particularly in the United States, is demonstrably unprepared for this impending surge. Projections consistently highlight a critical and escalating shortage of geriatricians, with some estimates suggesting a deficit of nearly 30,000 specialists by 2025. This shortfall is largely attributable to a confluence of factors, including the relatively low compensation for geriatric specialists compared to other medical fields, a lack of widespread exposure to geriatric medicine during undergraduate and postgraduate medical education, and often, pervasive ageist attitudes that subtly devalue the care of older adults.

To proactively address this looming crisis and bridge the significant gap in specialised geriatric care, the Biden administration has initiated a pivotal strategic investment. This initiative, articulated through an allocation of approximately $206 million, has been directed towards 42 academic institutions across the United States. The primary objective is to significantly bolster and expand comprehensive geriatric care training programmes specifically targeting primary care clinicians. This strategic focus on primary care providers (PCPs) – including general practitioners, family physicians, internists, nurse practitioners, and physician assistants – is critically important. PCPs represent the frontline of healthcare delivery and often serve as the first and most frequent point of contact for older adults within the healthcare system. Equipping these clinicians with enhanced geriatric competencies is not merely about offsetting the geriatrician shortage; it is about embedding fundamental principles of geriatric care into the fabric of routine primary care. This approach aims to empower PCPs to more effectively diagnose, manage, and coordinate care for the majority of older adults, reserving specialist geriatrician input for the most complex or atypical cases. Ultimately, this initiative seeks to cultivate a more geriatric-prepared primary care workforce capable of delivering comprehensive, patient-centred, and high-quality care that genuinely addresses the multifaceted needs of the aging population, thereby enhancing health outcomes, improving quality of life, and fostering a more resilient and responsive healthcare system.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

2. Strategies for Enhancing Geriatric Care Training

Addressing the complex healthcare needs of an aging population requires multifaceted and innovative approaches to clinical education. Effective geriatric care training extends beyond mere knowledge acquisition, encompassing skill development, attitudinal shifts, and the fostering of collaborative practice. Several key strategies have emerged as foundational to this endeavour.

2.1. Comprehensive Geriatric Assessment (CGA)

Comprehensive Geriatric Assessment (CGA) stands as a cornerstone of geriatric medicine, representing a multidimensional, interdisciplinary diagnostic and treatment process. Unlike traditional medical assessments that often focus solely on presenting symptoms or specific diseases, CGA systematically evaluates an older adult’s health from a holistic perspective. This encompasses a broad spectrum of domains: physical health (including medical conditions, polypharmacy, nutrition, and sensory impairments), mental health (cognitive function, depression, anxiety), functional status (activities of daily living (ADLs) such as dressing, bathing, and instrumental activities of daily living (IADLs) like managing finances or preparing meals), social circumstances (social support networks, living arrangements, caregiver burden), and environmental factors (home safety, access to transportation, community resources). The aim is to develop a coordinated, integrated, and individualised care plan that addresses the patient’s multifaceted needs, optimising their health, function, and quality of life.

Training clinicians in CGA is paramount, as it equips them with the structured framework and specific tools necessary to identify often overlooked issues in older adults. For instance, a detailed medication review during CGA can uncover polypharmacy and potential adverse drug reactions, a common and critical issue in older populations. Cognitive screening tools, such as the Mini-Cog or Montreal Cognitive Assessment (MoCA), allow for early detection of cognitive impairment, facilitating timely intervention and support. Functional assessments highlight areas where assistive devices or rehabilitation might improve independence. Numerous studies have demonstrated the tangible benefits of CGA implementation, including improved medical outcomes such as increased survival rates, reduced hospital admissions, decreased readmission rates, and a lower likelihood of nursing home placement. Furthermore, CGA has been associated with improved functional independence and a higher quality of life for older adults. The training typically involves didactic sessions on assessment tools, case-based learning, and supervised clinical practice, often within multidisciplinary teams, to ensure clinicians can effectively integrate and interpret the complex information gathered from various domains.

2.2. Interprofessional Education (IPE) and Team-Based Learning

The complexity of geriatric care often exceeds the scope of any single healthcare discipline, necessitating a collaborative, team-based approach. Interprofessional Education (IPE) is a pedagogical strategy where students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. In the context of geriatrics, IPE fosters a profound understanding of each team member’s unique contributions and perspectives, promoting seamless coordination of care. A geriatric care team might comprise physicians, nurses, social workers, pharmacists, physical therapists, occupational therapists, dietitians, and even chaplains or care managers. Each brings distinct expertise to the assessment and management of an older adult’s health needs.

Programmes like the Geriatrics Champions Program exemplify the efficacy of team-based learning in improving not only knowledge retention but also its practical application in complex clinical settings. By engaging healthcare professionals from diverse disciplines in shared learning experiences, these programmes enhance communication skills, foster mutual respect, and develop a collective problem-solving approach crucial for managing multimorbidity, polypharmacy, and psychosocial challenges inherent in geriatric care. For example, a pharmacist on the team can identify potential drug-drug interactions or recommend medication simplification, while a social worker can address housing insecurity or access to community resources. Nurses often play a central role in coordinating care and educating patients and families. IPE also addresses the systemic challenge of siloed training by preparing future professionals for the realities of collaborative practice. This approach has been shown to reduce medical errors, improve patient satisfaction, and ensure more holistic and patient-centred care for older adults, moving beyond a fragmented, disease-specific model.

2.3. Online and Remote Learning Platforms

The advent of digital technologies has profoundly transformed the landscape of medical education, offering unprecedented opportunities for expanding access to and flexibility in geriatric care training. Online modules, webinars, Massive Open Online Courses (MOOCs), virtual patient simulations, and teleconferencing sessions have become invaluable tools for delivering geriatric education, particularly to healthcare providers in geographically dispersed, rural, or underserved areas where traditional in-person training might be impractical or inaccessible. These platforms offer significant advantages, including scalability, cost-effectiveness, and flexibility, allowing clinicians to engage in continuous professional development without significant disruption to their clinical practice.

Online platforms can provide access to a vast repository of educational resources, including evidence-based guidelines, case studies, interactive quizzes, and expert lectures. Virtual patient simulations, for example, allow trainees to practice diagnostic reasoning and treatment planning in a safe, controlled environment, simulating complex geriatric scenarios such as falls assessment or delirium management. Tele-mentoring programmes, where experienced geriatricians provide guidance and consultation to primary care providers remotely, are also leveraging technology to bridge expertise gaps. While beneficial, it is important to acknowledge the limitations, such as the need for robust internet access and digital literacy, and the potential for a diminished sense of community compared to in-person interactions. However, hybrid models, combining online didactic content with in-person practical sessions or clinical rotations, are increasingly being adopted to maximise the benefits of both approaches and provide a comprehensive learning experience, ensuring that hands-on skills are also developed.

2.4. Curriculum Integration and Experiential Learning

Effective geriatric care training is not merely an add-on; it must be deeply woven into the fabric of medical education from undergraduate to postgraduate levels. This involves integrating geriatric principles across various medical disciplines rather than confining them to a single elective rotation. Longitudinal curricula can introduce geriatric concepts – such as the physiological changes of aging, common geriatric syndromes, and ethical considerations in older adults – early in medical school, reinforcing them through case-based learning, problem-based learning, and interdisciplinary seminars. Dedicated clerkships or rotations in geriatric settings (e.g., outpatient geriatric clinics, nursing homes, palliative care units, home health) provide invaluable experiential learning opportunities. These immersive experiences allow trainees to directly interact with older patients in diverse care environments, observe the nuances of geriatric assessment, and participate in multidisciplinary team discussions. Such exposure helps students appreciate the unique challenges and rewards of caring for older adults, often countering preconceived negative stereotypes. Structured clinical experiences are crucial for developing practical skills in areas such as fall prevention, pain management, end-of-life care discussions, and family conferencing. The opportunity to follow patients over time, observing the progression of chronic conditions and the impact of interventions, is particularly impactful for cultivating a holistic understanding of aging.

2.5. Faculty Development and Mentorship

The quality of geriatric care training is intrinsically linked to the expertise and pedagogical skills of the faculty delivering the education. A critical strategy, therefore, is robust faculty development programmes. These initiatives aim to equip existing and new faculty members with the specific knowledge and teaching methodologies required to effectively convey geriatric principles. This can include training in adult learning theories, simulation-based education techniques, feedback provision, and strategies for fostering interprofessional collaboration. Furthermore, developing a strong cadre of geriatric faculty is essential to serve as role models and mentors for aspiring clinicians. Mentorship programmes, connecting students and residents with experienced geriatricians or geriatric-prepared primary care providers, can significantly influence career choices and foster a deeper commitment to caring for older adults. These programmes help to transmit not only clinical knowledge but also the compassion, patience, and communication skills vital for effective geriatric practice.

2.6. Simulation-Based Training

Simulation-based training, utilising high-fidelity mannequins, standardised patients (actors trained to portray specific patient scenarios), and virtual reality environments, offers a safe and controlled setting for clinicians to practice and refine their geriatric care skills without risk to actual patients. This approach is particularly effective for scenarios that are high-risk, low-frequency, or involve sensitive communication. For instance, simulations can be used to practice recognising and managing delirium, conducting a difficult conversation about advance care planning, performing a comprehensive geriatric assessment, or responding to a sudden decline in functional status. Simulation allows for immediate feedback, debriefing, and repetition, enhancing skill acquisition and confidence. It also provides an opportunity to practice teamwork and communication within an interprofessional context, mirroring real-world clinical challenges. The controlled environment allows for the deliberate practice of complex decision-making processes, leading to improved clinical judgment and patient safety.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

3. Challenges in Implementing Geriatric Care Training

Despite the clear imperative and demonstrated benefits of enhanced geriatric care training, its widespread and effective implementation faces a myriad of significant challenges. These impediments often intersect and compound, requiring comprehensive and sustained efforts to overcome.

3.1. Resource Constraints

One of the most pervasive challenges is the substantial resource investment required for comprehensive geriatric care training programmes. This includes not only direct financial outlays but also considerable commitments of time and highly specialised personnel. Academic institutions and healthcare organisations frequently grapple with limited budgets and competing priorities, where funding for geriatric programmes may be overshadowed by perceived higher-yield or more ‘glamorous’ specialties. Establishing and maintaining dedicated geriatric clinics, staffing them with interdisciplinary teams for experiential learning, developing sophisticated online platforms, and supporting faculty development programmes all incur significant costs. Furthermore, the time commitment for trainees can be substantial, potentially extending residency or fellowship durations or requiring clinicians to take time away from direct patient care, which can be economically punitive for both the individual and the institution. The scarcity of geriatric-trained faculty members, who are essential for effective teaching and mentorship, also represents a critical human resource constraint. In settings with tight budgets or a lack of institutional champions, the variability in resource allocation can directly impact the scope, quality, and sustainability of training initiatives, creating disparities in the preparedness of healthcare providers across different regions or institutions.

3.2. Resistance to Change

Introducing new training programmes, particularly those that necessitate a shift in established clinical practices and mindsets, often encounters resistance from healthcare professionals. This resistance can stem from various sources: ingrained routines, skepticism about the tangible efficacy or relevance of new methods, concerns about increased workload without commensurate compensation, or a perceived lack of immediate applicability to their current patient population. Clinicians accustomed to a disease-specific or acute-care model may find the holistic, complex, and often slower pace of geriatric care less appealing or more challenging to integrate into their busy schedules. Overcoming this resistance requires a multifaceted approach. Clear, compelling communication about the direct benefits of geriatric care training – demonstrating how it enhances patient outcomes, improves clinician satisfaction through better patient management, and prepares them for future demographic realities – is crucial. Providing robust evidence supporting the effectiveness of geriatric interventions, coupled with opportunities for ‘champions’ within the existing workforce to model new behaviours and advocate for the training, can significantly foster buy-in. Incentives, such as continuing medical education credits or professional development opportunities, can also encourage participation.

3.3. Variability in Training Quality

The quality of geriatric care training programmes is far from uniform across institutions and professional disciplines. This variability is influenced by a multitude of factors, including disparate curriculum designs, the level of expertise and experience of instructors, the availability of diverse clinical learning environments (e.g., long-term care facilities, memory clinics, palliative care services), and the extent of institutional commitment and support. Unlike some other medical specialties, there may be less standardisation in geriatric curriculum content and teaching methodologies across different medical schools or residency programmes. This can lead to significant inconsistencies in the competencies acquired by healthcare providers. Some programmes may offer extensive hands-on experience with CGA, while others might provide only theoretical exposure. Without nationally mandated curricula or rigorous accreditation standards specifically focused on geriatric competencies across all primary care training programmes, there is a risk of producing a workforce with uneven levels of preparedness. These disparities in training quality can ultimately translate into variations in the quality of care delivered to older adults, exacerbating existing health inequities.

3.4. Faculty Shortage and Expertise Gap

A critical and often overlooked challenge is the severe shortage of faculty members who are adequately trained and experienced in geriatric medicine. Many academic institutions struggle to recruit and retain geriatricians and other geriatrics-focused specialists to teach, mentor, and supervise trainees. This deficit is partly a consequence of the broader geriatrician shortage itself, as fewer individuals are entering the specialty. Existing faculty may have limited formal geriatric training, necessitating significant investment in their professional development if they are to effectively teach complex geriatric concepts. This expertise gap can limit the depth and breadth of geriatric content offered, hinder the establishment of robust clinical learning environments, and impact the quality of mentorship available to students and residents. Without a sufficient number of knowledgeable and passionate faculty, it becomes exceedingly difficult to sustain and expand high-quality geriatric education programmes.

3.5. Curriculum Overload and Competing Priorities

Medical curricula, both at undergraduate and postgraduate levels, are already densely packed, covering an ever-expanding body of medical knowledge. Integrating substantial new content, such as comprehensive geriatric care, into an already saturated curriculum presents a significant challenge. Programme directors often face intense pressure from various specialties, each vying for dedicated teaching time and clinical rotation slots. Finding adequate space for geriatric-specific modules, longitudinal courses, or dedicated rotations without compromising other essential areas of medical education requires careful negotiation, innovative curriculum design, and a strong institutional commitment to geriatrics. This ‘curriculum overload’ can lead to a superficial treatment of geriatric topics, or their relegation to optional electives, thereby undermining the goal of creating a universally geriatric-prepared primary care workforce.

3.6. Negative Perceptions and Ageism

Subtle yet pervasive negative perceptions of geriatrics, and indeed ageism within society and the medical profession, can significantly impede the successful implementation of geriatric training. Some trainees may view geriatrics as less intellectually stimulating, less financially rewarding, or overly focused on chronic decline rather than acute intervention and cure. There can be a lack of awareness regarding the complexity and intellectual challenge involved in managing multimorbidity and functional decline in older adults. These perceptions can lead to a lack of interest among medical students and residents in pursuing geriatric subspecialisation or even in engaging meaningfully with geriatric content during their general training. Overcoming these entrenched biases requires conscious efforts to highlight the intellectual rigor, humanistic rewards, and societal importance of geriatric care, starting early in medical education, and showcasing positive role models in the field.

3.7. Reimbursement Models and Economic Disincentives

The current healthcare reimbursement landscape often inadvertently disincentivises comprehensive, time-intensive geriatric care. Fee-for-service models tend to reward acute interventions and procedural work over the longitudinal, coordinated, and often lower-reimbursement cognitive work inherent in managing complex chronic conditions in older adults. Time spent on detailed comprehensive geriatric assessments, extensive medication reviews, care coordination, family meetings, and psychosocial support may not be adequately compensated. This economic reality can make geriatric primary care less attractive to clinicians and less financially viable for institutions, indirectly impacting the prioritisation and funding of geriatric training programmes. A shift towards value-based care models, which reward outcomes and comprehensive care rather than volume, is essential to align economic incentives with the goals of high-quality geriatric care and its associated training needs.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

4. Evaluating the Effectiveness of Geriatric Care Training

The ultimate justification for investing substantial resources into geriatric care training lies in its demonstrable effectiveness. Evaluation must encompass not only immediate learning outcomes but also the broader impact on clinical practice, patient health, and healthcare system efficiency. Adopting robust evaluation frameworks, such as Kirkpatrick’s four levels (Reaction, Learning, Behavior, and Results), can provide a comprehensive understanding of program efficacy.

4.1. Impact on Clinician Competence

Assessing the impact on clinician competence is the most direct measure of training effectiveness. Studies consistently demonstrate that targeted geriatric education significantly enhances clinicians’ knowledge, skills, confidence, and attitudes towards managing common geriatric conditions. Metrics used for evaluation include pre- and post-training knowledge assessments (e.g., multiple-choice questions, case-based exams), objective structured clinical examinations (OSCEs) to assess practical skills and communication, self-reported confidence scales, and direct observation of clinical performance. For instance, a postgraduate training course in community geriatrics specifically reported improvements in participants’ communication skills when interacting with elderly patients, their self-efficacy in diagnosing and managing common geriatric problems, and their overall confidence in providing holistic care. Beyond specific conditions, training improves clinicians’ abilities in critical geriatric competencies such as conducting a comprehensive medication reconciliation, assessing for polypharmacy, identifying and managing delirium and dementia, screening for depression, evaluating fall risk, addressing malnutrition, and facilitating advance care planning discussions. The development of critical thinking skills tailored to the often atypical presentations of illness in older adults is also a key outcome. Furthermore, qualitative feedback from trainees often highlights a reduction in ageist biases and an increased appreciation for the complexities and rewards of geriatric care, indicating a positive attitudinal shift.

4.2. Patient Outcomes

The true test of training effectiveness lies in its translation to improved patient outcomes. This is where the long-term, systemic benefits become apparent. Effective geriatric care training has been linked to a broad spectrum of positive patient-level impacts. These include, but are not limited to, reduced hospital admissions and readmission rates, fewer emergency department visits, improved functional status (e.g., increased mobility, greater independence in ADLs/IADLs), better management of chronic diseases, reduced incidence of adverse drug events, enhanced quality of life, and increased patient and family satisfaction with care. Programmes like Nurses Improving Care for Healthsystem Elders (NICHE), which systematically embed geriatric principles into nursing care within hospitals, have demonstrated measurable improvements in care processes for hospitalized older patients, leading to better outcomes such as reduced incidence of pressure injuries, falls, and delirium. The logic is straightforward: clinicians who are better equipped to identify and manage geriatric syndromes, conduct thorough assessments, and coordinate care are more likely to prevent complications, ensure appropriate medication use, and facilitate timely interventions that keep older adults healthier and out of acute care settings. Longitudinal studies employing robust methodologies, such as randomised controlled trials or quasi-experimental designs, are essential to rigorously quantify these patient-level benefits, often employing specific outcome measures like the Barthel Index for functional status, Mini-Mental State Examination (MMSE) or MoCA for cognition, or specific scales for pain and depression.

4.3. Healthcare System Impact

Beyond individual clinician competence and patient outcomes, effective geriatric care training has profound implications for the broader healthcare system. By enhancing the geriatric capabilities of primary care providers, such training has the potential to alleviate the significant burden on specialised geriatric services, which are already in short supply. This leads to a more efficient and appropriate use of healthcare resources, as PCPs can manage common geriatric conditions effectively, referring to specialists only when truly necessary. This ‘right care, right place, right time’ approach can reduce wait times for specialist appointments and ensure that highly specialised geriatricians can focus on the most complex and challenging cases. Furthermore, by preventing complications, reducing unnecessary hospital admissions and readmissions, and promoting proactive, preventative care, well-trained clinicians can contribute to substantial reductions in overall healthcare costs. Programmes that integrate geriatric principles into primary care, such as Guided Care models, have shown promise in improving care coordination, reducing hospital utilisation, and lowering overall healthcare expenditures by focusing on patient self-management, caregiver support, and proactive monitoring of chronic conditions. This integrated approach can also lead to improved patient satisfaction due to continuity of care and a perception of more holistic support, fostering greater trust in the healthcare system. Ultimately, by empowering the primary care workforce, health systems can become more resilient, cost-effective, and better positioned to meet the growing demands of an aging demographic while simultaneously improving health equity and access to quality care.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

5. Long-Term Impacts and Sustainability

The long-term success and sustainability of geriatric care training initiatives hinge upon their integration into broader healthcare policy, continuous workforce development, and ongoing research. These elements collectively ensure that the healthcare system can adapt and thrive in response to the evolving needs of an aging population.

5.1. Workforce Development

Sustaining and expanding geriatric care training programmes is fundamental to the continuous development of a healthcare workforce that is genuinely adept at addressing the unique and complex needs of an aging population. This involves not only initial training but also continuous professional development (CPD) and lifelong learning for all healthcare professionals. As medical knowledge evolves and the demographics of older adults shift (e.g., increasing prevalence of specific conditions, changes in cultural backgrounds), clinicians must have accessible pathways to update their geriatric competencies. This can involve mandatory geriatric-focused CME credits, online modules for specific geriatric syndromes, or advanced certification programmes. Furthermore, cultivating a ‘geriatric-prepared’ workforce extends beyond just medical doctors; it encompasses nurses, pharmacists, social workers, rehabilitation therapists, and allied health professionals. Establishing clear career pathways for those interested in geriatrics, alongside mentorship programmes and leadership development, is crucial for fostering a cadre of dedicated professionals. The goal is to embed geriatric principles into the core competencies of all healthcare disciplines, ensuring that every interaction with an older adult is informed by an understanding of age-related changes and complexities. This holistic workforce development approach builds institutional capacity and resilience, preparing healthcare systems for future demographic realities.

5.2. Policy Implications

Government investments, such as the significant funding provided by the Biden administration, serve as pivotal catalysts for integrating and prioritising geriatric care training within healthcare systems. However, sustained policy support must extend beyond one-off funding injections. It requires a comprehensive policy framework that incentivises geriatric education, practice, and research. This can include:

• Funding Mechanisms: Continued allocation of federal and state funds for Geriatric Education Centers (GECs), Geriatric Workforce Enhancement Programs (GWEPs), and other initiatives that support interprofessional geriatric education. This ensures that academic institutions have the resources to develop and deliver high-quality training.
• Accreditation Standards: Mandating stronger geriatric content and experiential learning requirements within the accreditation standards for medical schools, residency programmes (especially in primary care specialties), nursing schools, and other allied health professions. This elevates geriatrics from an optional add-on to a core competency.
• Reimbursement Reform: Adjusting reimbursement models (e.g., within Medicare and Medicaid) to adequately compensate for the time and complexity involved in comprehensive geriatric assessment, care coordination, chronic disease management, and preventative care for older adults. This includes fair compensation for non-procedural cognitive work.
• Loan Forgiveness and Scholarships: Establishing or expanding loan forgiveness programmes and scholarships specifically for healthcare professionals who pursue careers in geriatric medicine or commit to serving older adult populations in underserved areas. This addresses the financial disincentives that often deter promising clinicians from entering the field.
• Research Funding: Prioritising and increasing funding for research into best practices in geriatric education, workforce development, and the effectiveness of geriatric interventions. Policy decisions that embed these considerations within the broader healthcare agenda are essential for fostering environments that genuinely value, support, and facilitate the comprehensive care of older adults, shifting from a reactive ‘sick care’ model to a proactive ‘health care’ model for the aging population.

5.3. Future Research Directions

While significant progress has been made, ongoing and rigorous research is absolutely essential to continually refine and advance the field of geriatric care training. Key future research directions include:

• Optimal Pedagogical Methodologies: Investigating the most effective and efficient training methodologies for different professional groups and learning contexts. This includes comparing the effectiveness of traditional didactic teaching versus simulation-based training, interprofessional learning, virtual reality, and blended learning approaches. Research should identify the ideal balance between theoretical knowledge and practical, hands-on clinical experience.
• Long-Term Outcome Measures: Conducting longitudinal studies to robustly assess the long-term impact of specific training interventions on not only clinician behaviour but also on patient-centric outcomes (e.g., functional independence, quality of life, patient satisfaction) and system-level outcomes (e.g., cost-effectiveness, reduction in healthcare disparities). This requires robust data collection and analytical frameworks.
• Addressing Health Disparities: Research must focus on how geriatric care training can be tailored to address specific health disparities experienced by diverse older adult populations, including racial, ethnic, socioeconomic, and geographic disparities. This involves developing culturally competent training materials and evaluating their effectiveness in improving care for vulnerable older adults.
• Cost-Effectiveness Analysis: Rigorously evaluating the cost-effectiveness of different training programmes and their associated returns on investment for healthcare systems and society. This economic analysis is crucial for advocating for sustained policy and institutional funding.
• Impact of Technology and AI: Exploring how emerging technologies, including artificial intelligence (AI), machine learning, and advanced telehealth platforms, can be integrated into geriatric care training to enhance learning, support clinical decision-making, and expand access to expertise. This includes research on ethical implications and effective implementation strategies.
• Mental Health Integration: Investigating how training can better equip primary care clinicians to address the often-underdiagnosed and undertreated mental health conditions in older adults, such as depression, anxiety, and the early stages of dementia, and how to effectively integrate mental health services into routine geriatric primary care.
• Caregiver Support and Training: Researching the best methods to train healthcare professionals in supporting informal caregivers of older adults, including identifying caregiver burden, providing educational resources, and connecting caregivers with support networks. This extends the impact of training beyond the patient to their crucial support system.

Collaborative efforts among academic institutions, healthcare organisations, governmental bodies, and policymakers are paramount to facilitate this research agenda, ensuring that training programmes remain responsive to the evolving needs of the aging global population and the dynamic healthcare landscape.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

6. Conclusion

The demographic imperative of an aging global population unequivocally positions the enhancement of geriatric care training as a critical and indispensable priority for contemporary healthcare systems. This comprehensive review has illuminated the diverse and innovative strategies currently being deployed to cultivate a more geriatric-prepared workforce, including the foundational principles of Comprehensive Geriatric Assessment, the collaborative power of Interprofessional Education, the widespread accessibility offered by online learning platforms, the immersive value of curriculum integration and experiential learning, the crucial role of faculty development, and the utility of simulation-based training. Each strategy contributes uniquely to equipping healthcare providers with the nuanced knowledge, specialised skills, and empathetic attitudes necessary to deliver high-quality, person-centred care to older adults.

Despite the clear and compelling rationale, the path to widespread implementation and sustained impact is fraught with significant challenges. These impediments, encompassing pervasive resource constraints, inherent institutional and individual resistance to change, the problematic variability in training quality, acute faculty shortages, curriculum overload, underlying ageist perceptions within the profession, and misaligned reimbursement models, collectively necessitate a concerted and multifaceted approach to overcome. However, compelling evidence consistently supports the transformative effectiveness of these training initiatives, demonstrably improving clinician competence, leading to tangible enhancements in patient outcomes such (as reduced hospitalisations and improved functional status), and fostering a more efficient and equitable healthcare system through optimised resource utilisation.

Looking ahead, continued strategic investment, robust and targeted research, and sustained, visionary policy support are not merely desirable but absolutely essential. Financial commitments from governmental bodies, such as the Biden administration’s significant allocation, play a vital role in catalysing change, but must be complemented by systemic reforms in accreditation standards, reimbursement policies, and incentives for geriatric practice and research. Future research must rigorously evaluate pedagogical effectiveness, quantify long-term patient and system outcomes, address health disparities, explore the integration of emerging technologies like AI, and focus on holistic care that includes mental health and caregiver support. By addressing these complexities and embracing these opportunities, healthcare systems globally can progressively build a resilient, compassionate, and highly competent workforce capable of not only meeting but exceeding the evolving needs of an increasingly older society, ensuring that aging is met with dignity, vitality, and comprehensive, high-quality care.

Many thanks to our sponsor Esdebe who helped us prepare this research report.

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