Older Patients: A Growing Concern for Surgeons and Related Specialists
Surgeons and related medical specialists are increasingly required to address the unique needs of older adults. While people over the age of 65 account for only 12% of the U.S. population, they undergo almost 40% of surgical procedures. They are also more likely to suffer a wide range of post-operative complications. In the future, the provision of high quality, “gero-sensitive” care will become an even more critical issue in the surgical and related specialties.

The demographic realities driving this phenomenon are well documented. As the baby boom ages, conservative estimates suggest that the population of Americans 65 and older will more than double from 35 million today to more than 78 million in 2050. The group 85 and over will quadruple to 18.2 million; and if current trends in life expectancy continue, this number may be closer to 30 million.

Along with these trends, striking skill and technology improvements in everything from cardiac catheterization to knee replacements to liver transplants are enlarging the proportion of older adults (particularly the very old) who are candidates for surgery and other non-primary care interventions. As a result, surgeons and related medical specialists-whether in training or in practice-will likely spend a significant proportion of their careers providing care to older patients.

The Need for More Training in Geriatrics
Unfortunately, too few surgeons and specialists receive specific training in geriatric principles, strategies and tactics during their residency or through continuing education. A national and growing shortage of certified geriatricians means that in practice, the expertise needed to “pull older patients through” traumatic events and avoid (often preventable) post-operative problems is often unavailable. Surgical and medical specialists, therefore, carry-and will continue to carry-considerable responsibility for older adults and the complexities of their care.

The Geriatric for Specialists Project: Improving geriatric training and care through the specialties
To respond to this need for better geriatric training, the American Geriatrics Society (AGS), with funding from the John A. Hartford Foundation, established the Geriatrics for Specialists Project. Launched in 1994, the project is expanding geriatrics expertise in 10 surgical and related medical specialties by:

• Improving the amount and quality of geriatric education medical and surgical residents receive;
• Developing faculty leaders who promote geriatric training and research within their disciplines; and
• Enabling professional certifying bodies and societies to build the capacity of their members to provide better care of older adults.

Infusing Geriatrics Through the Specialties
Before the AGS launched the Geriatrics for Specialists Project-initially called “Increasing Geriatrics in the Surgical and Related Medical Specialties”-in 1994, most efforts to increase the supply of physicians with special skills in the care of older adults focused on family practice, internal medicine, neurology, and psychiatry. At the same time, many national organizations, including emergency medicine and orthopaedic surgery advocated the importance of including geriatrics training in all specialty areas. In planning the project, the AGS, along with The John A. Hartford Foundation, believed that the best way to help all surgical and related medical specialists do a better job caring for older patients was to avoid further fragmentation of the target specialties. Therefore, we decided against a substantial effort aimed at creating more geriatric sub-specialists. Instead, the project sought to “infuse” geriatrics throughout each of the participating specialties with a multi-faceted approach aimed at a broad range of new and established faculty.
This work began by developing grass-roots networks between and within each of the participating specialties, learning the culture of each specialty and its respective professional societies, and testing a variety of efforts aimed at spreading interest in and knowledge of the geriatric aspects of the specialties.

Developing Interdisciplinary Leadership
Since the initiative’s inception, the leadership of the Geriatrics for Specialists Project has been a collaborative effort between AGS and the specialties themselves. In 1998, this collaboration was formalized when key faculty and staff from professional societies representing each of the participating specialties, along with members of AGS, formed an Interdisciplinary Leadership Group (ILG) to provide guidance to the Project and spearhead activities within their own specialties.

In 2000, the ILG issued a Statement of Principles: Toward Improved Care of Older Patients in Surgical and Medical Specialties. This has been published in the Journal of the American Geriatrics Society and in the journals of several of the specialties. This Statement of Principles lays out the rationale for the Geriatrics for Specialists Project, a set of common objectives specialists and geriatricians should seek to achieve, and a series of concrete recommendations that would increase the geriatrics expertise of surgeons and related medical specialists.

In 2002, the ILG officially became the Council of the Section for Enhancing Geriatric Understanding and Expertise among Surgical and Medical Specialists (SEGUE) in the AGS. The Section runs an annual educational and research meeting in collaboration with the AGS, facilitates the exchange of information between specialists and geriatricians, and provides direction to the Project as a whole.
An important contribution of the Section was the development of a Geriatrics Syllabus for Specialists (GSS), a short, useful guide geared toward providing vital information for surgeons caring for older patients.