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.