Is there a geriatrician in the house? Geriatric care approaches in hospitalist programs.

BACKGROUND

The rapid growth of the hospitalist movement presents an opportunity to reconsider paradigms of care for hospitalized older patients.

METHODS

To determine the impact of the hospitalist movement on acute care geriatrics, we conducted a cross-sectional survey of the hospitalist community in 2003 and 2004.

RESULTS

We identified innovations in geriatric hospital care in only 11 hospitalist programs. These innovations varied widely in complexity, goals, structure, and staffing. The majority targeted patients using age as a criterion and incorporated geriatrics training for nurses or physicians. Several innovations had one or more of the following features: geriatrician-hospitalists or gerontology nurse-practitioners, perioperative management for complex older patients, specialized geriatric services such as skilled nursing units or acute care for elders units, and quality improvement initiatives targeted to the older patient. A case study of the Hospital Internal Medicine group at the Mayo Clinic is presented as an example of a complex innovation highlighting several of these features.

CONCLUSIONS

The scarcity of geriatric care approaches among hospitalist groups highlights the need for collaboration between hospitalists and geriatricians, with the goals of rethinking staffing models and organization of care and focusing on quality-improvement activities. In particular, perioperative care and postdischarge care are two clinical areas where innovation in hospital care may particularly benefit older patients. Significant opportunities remain for collaboration, coordination, and research to improve the care of acutely ill older patients at the intersection of geriatric and hospital medicine.