This policy paper presents workforce development recommendations for research, clinical care and public stakeholders as they plan future research activities to strengthen the workforce to support the healthcare and social needs of persons living with dementia and their families and caregivers. To create these recommendations, the 2020 National Research Summit on Care, Services and Supports for Persons with Dementia and Their Caregivers (2020 Summit) convened a Workforce Development Stakeholder Workgroup. The Stakeholder Workgroup consisted of an interprofessional team of health professionals from academia, professional organizations, and the federal government with expertise in dementia workforce development. The resulting ten workforce development recommendations represent four themes: (1) Accountability by addressing progress towards implementing the 2017 Research Summit on Care, Services, and Supports for Persons with Dementia and their Caregivers (2017 Summit) workforce recommendations; (2) Improving recruitment, retention, and job quality for direct care workers; (3) Creating a tech-savvy and culturally competent workforce; and (4) Developing educational core competencies, domains and milestones. These recommendations will positively impact the ability of persons living with dementia and their caregivers to access person- and family-centred dementia care that promotes independence and quality of life among those navigating their dementia journey.

The training of clinicians in geriatrics-gerontology care is not keeping up with demand for these services. Workforce training goals for an aging population are recruitment and training of geriatrics-gerontology specialists to lead care programs, systems, and education programs; and ensuring all health profession students and providers have the skills to provide older adults with evidence-based, individualized, and coordinated team-based care that prioritizes patients' goals, function, and quality of life. Without an immediate and significant commitment to address these goals, many older adults will receive inadequate care. By extension, their children will be burdened with extraordinarily challenging responsibilities.

Summer training in aging research for medical students is a strategy for improving the pipeline of medical students into research careers in aging and clinical care of older adults. Johns Hopkins University has been offering medical students a summer experience of mentored research, research training, and clinical shadowing since 1994. Long-term outcomes of this program have not been described. The authors surveyed all 191 participants who had been in the program from 1994–2010 (60% female and 27% underrepresented minorities) and received a 65.8% (N = 125) response rate. The authors also conducted Google and other online searches to supplement study findings. Thirty-seven percent of those who have completed training are now in academic medicine, and program participants have authored or coauthored 582 manuscripts. Among survey respondents, 95.1% reported that participation in the Medical Student Training in Aging Research program increased their sensitivity to the needs of older adults. This program may help to build commitment among medical students to choose careers in aging.

The exciting news is that people living to age 65 in the United States will have an average life expectancy of an additional twenty years (Administration for Community Living, 2013). Less exciting is that even if remaining independent and living at home, seven out of ten of us will likely need assistance for three of those years (Redfoot, Feinberg, and Houser, 2013; Lynn, 2013). This assistance would include help with everyday activities such as bathing, dressing, preparing meals, or paying bills.n our current structure of healthcare delivery, there are not enough trained caregivers (family or paid professionals) for older adults. However, there is another, perhaps more efficient system where we partner with patients, and, coupled with the use of evolving technology, we can focus on factors that most influence the health of a population to deliver care more effectively. We need not only to be informed of the current limits of Medicare coverage, but also to embrace a new framework that enables solutions for the best, safest, and most economical care. Tweaking current solutions will be insufficient. This article explores the current landscape of healthcare delivery: the lack of preparedness and capacity of the current workforce for an aging society.The Personal Side of AgingParticularly as we enter our seventies, eighties, and nineties, questions related to aging begin to take prominence. Who will we ask to honor our wishes and goals as well as to advocate for us so that we live with dignity, meaning, and security? How do we receive the best care that addresses our symptoms, perhaps through palliative care instead of unwanted medical and surgical interventions?How many family members or friends might be willing and able to help provide care as we age? Marriage is the most important predictor of having someone to help, as partners and adult children often arrange or provide the care (Redfoot, Feinberg, and Houser, 2013). But what if you are single, childless, or have just one child who lives in another state and has a full-time job? If no one is available, might we consider a robot caregiver or another emerging smart technology?Most older adults plan to remain in their own homes until death (National Conference of State Legislatures and AARP Public Policy Institute, 2011). For those of us who are or who have been caregivers, we have wondered who will be there to help us. Can we afford to pay for help? Many people still are surprised that Medicare does not pay for many services we might need to help us stay in our home. On average, annual home health aide services (at $20 per hour, twenty hours per week) cost almost $21,000, and adult daycare (at $70 per day, five days per week) costs about $18,000 (Kaiser Commission on Medicaid and the Uninsured, 2013).Multi-Fold Challenges for the WorkforceIn the current configuration, there are not enough trained workers. There is another configuration wherein partnering with patients and other disciplines, along with the use of evolving technology, can lead to aligned care solutions. We must embrace a framework that enables the best, safest, and most economical care, whether we are discussing the health of an aggregate population or more customized care for the growing number of older adults with complex care needs. It is especially important to consider those who are older than age 85-the fastest growing population in the country-who will likely experience a 50 percent chance of having dementia (Alzheimer's Association, 2014).Background on the aging demographicThe current aging of the population means a growing number of older adults with high levels of disability living in community. Thirtyseven percent of adults who are ages 65 and older (14 million individuals) have a disability (Rich et al., 2012). The number of frail older people (older than age 65 with any disability) is projected to increase from 11 million in 2010 to 18 million in 2030 (Redfoot, Feinberg, and Houser, 2013), due to 10,000 Americans turning age 65 every day from 2011 to 2029 (Rousseau, Firth, and Jankiewicz, 2013). …

In the United States, one in nine people ages sixty-five and older and one-third of people ages eighty-five and older have Alzheimer's disease. The number of cases of Alzheimer's disease is projected to triple by 2050, from 5.0 million in 2013 to 13.8 million. This will challenge the health care workforce, which is already inadequate in both size and training. We assessed what is likely to be an increasing shortage of physicians, nurses, and social workers with specialized training in geriatrics and, more specifically, in the care of people with dementia. We highlight the limited training of health care professionals in best practices of dementia care and chronic disease management. To address these shortfalls, we recommend the dissemination of team-based models of care that integrate health and social services; expansion of education loan forgiveness and faculty development programs to attract students into clinician-educator careers focusing on Alzheimer's disease; inclusion of curricula specific to the disease in all health professions training; expansion of federal programs to train existing workers; and increased compensation for the direct care workforce.

The current number of geriatricians cannot keep up with the health care needs of the growing number of older adults. To fill the gap, more geriatricians should focus on training primary care and other specialty physicians to care for older adults.

Purpose Most U.S. medical schools and training programs lack sufficient faculty expertise in geriatrics to train future physicians to care for the growing population of older adults. Thus, to reach clinician–educators at institutions and programs that have limited resources for enhancing geriatrics curricula, the Donald W. Reynolds Foundation launched the Faculty Development to Advance Geriatrics Education (FD~AGE) program. This consortium of four medical schools disseminates expertise in geriatrics education through support and training of clinician–educators. The authors conducted this study to measure the effects of FD~AGE. Method Program leaders developed a three-pronged strategy to meet program goals: FD~AGE offers (1) advanced fellowships in clinical education for geriatricians who have completed clinical training, (2) mini-fellowships and intensive courses for faculty in geriatrics, teaching skills, and curriculum development, and (3) on-site consultations to assist institutions with reviewing and redesigning geriatrics education programs. FD~AGE evaluators tracked the number and type of participants and conducted interviews and follow-up surveys to gauge effects on learners and institutions. Results Over six years (2004–2010), FD~AGE trained 82 fellows as clinician–educators, hosted 899 faculty scholars in mini-fellowships and intensive courses, and conducted 65 site visits. Participants taught thousands of students, developed innovative curricula, and assumed leadership roles. Participants cited as especially important to program success expanded knowledge, improved teaching skills, mentoring, and advocacy. Conclusions The FD~AGE program represents a unique model for extending concentrated expertise in geriatrics education to a broad group of faculty and institutions to accelerate progress in training future physicians.

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article updates the progress made by U.S. medical schools from 2005 to 2010 in developing these programs. Academic leaders in geriatrics in accredited allopathic and osteopathic medical schools were surveyed in the winter of 2010 (60% response rate), and results were compared with findings from a similar 2005 survey (68% response rate). Physician faculty in geriatrics increased from 9.6 (mean) full‐time equivalents (FTEs) in 2005 to 11.2 by 2010. In 2010, faculty and staff effort was mostly devoted to clinical practice (mean = 37%) and education (mean = 33%), with only seven responding schools devoting more than 40% of faculty effort to research. Schools that have been designated as Centers of Excellence had a median 20 FTE physician faculty, compared with seven at the other schools (P < .001). In 2010, 27% of medical schools required a geriatrics clerkship, and 87% (n = 83) had an elective geriatric clerkship. In summary, more fellows and faculty were recruited and trained in 2010 than in 2005, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, but few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. New approaches to training the entire physician workforce to care for older adults will be required to ensure adequate medical care for aging Americans.

OBJECTIVE:: To document the development of geriatric psychiatry (GP) fellowship training in the United States through 2008. METHODS:: A cross-sectional survey of the 56 U.S. GP fellowship programs was conducted in summer 2007. Longitudinal data from the American Medical Association and the Association of American Medical Colleges' National Graduate Medical Education Census and data from the Accreditation Council for Graduate Medical Education were also analyzed. RESULTS:: Thirty-seven (66%) of 56 program directors responded. The number of fellowship programs has decreased over the past 7 years. During 2006/07, 72 fellows were in training, as compared with 94 fellows in 2001/02. Application rates declined significantly with a mean of 4.3 applications per program in 2006/07 as compared with the mean of 10 applications per program in 2001/02. The fill rate for first-year GP fellowship positions dropped from 61% in 2001/02 to 48% in 2006/07. During 2006/07, 67% of programs reported having two or fewer first-year fellows and 16% had no first-year fellows. Seventeen programs reported having no United States medical school graduates as first-year fellows. CONCLUSION:: The number of GP fellows in training has declined by 23% from 2001/02 to 2006/07. This decline has occurred at the same time when the number of older adults continues to expand rapidly. It is critical that an adequate number of geriatric psychiatrists be trained to support and educate general psychiatrists in the care of the elderly. Specific strategies need to be developed urgently to stimulate interest in careers in clinical and academic GP.

PurposeMost U. S. medical schools and training programs lack sufficient faculty expertise in geriatrics to train future physicians to care for the growing population of older adults. Thus, to reach clinician-educators at institutions and programs that have limited resources for enhancing geriatrics curricula, the Donald W. Reynolds Foundation launched the Faculty Development to Advance Geriatrics Education (FD similar to AGE) program. This consortium of four medical schools disseminates expertise in geriatrics education through support and training of clinician-educators. The authors conducted this study to measure the effects of FD similar to AGE.MethodProgram leaders developed a three-pronged strategy to meet program goals: FD similar to AGE offers (1) advanced fellowships in clinical education for geriatricians who have completed clinical training, (2) mini-fellowships and intensive courses for faculty in geriatrics, teaching skills, and curriculum development, and (3) on-site consultations to assist institutions with reviewing and redesigning geriatrics education programs. FD similar to AGE evaluators tracked the number and type of participants and conducted interviews and follow-up surveys to gauge effects on learners and institutions.ResultsOver six years (2004-2010), FD similar to AGE trained 82 fellows as clinician-educators, hosted 899 faculty scholars in mini-fellowships and intensive courses, and conducted 65 site visits. Participants taught thousands of students, developed innovative curricula, and assumed leadership roles. Participants cited as especially important to program success expanded knowledge, improved teaching skills, mentoring, and advocacy.ConclusionsThe FD similar to AGE program represents a unique model for extending concentrated expertise in geriatrics education to a broad group of faculty and institutions to accelerate progress in training future physicians.

The education mission of the Department of Veterans Affairs (VA) is to train health professionals to benefit VA and the United States. One approach for achieving that mission, along with VA's research and clinical missions, was the establishment of Geriatric Research, Education and Clinical Centers (GRECCs) in 1975. These were developed at VA hospital sites that had existing strong partnerships with schools of medicine already engaged in research on aging. GRECCs were funded to enhance those research enterprises, to expand health professions education in geriatrics, to expand interest in geriatrics among medical faculty and to support them to become more expert in geriatrics, to develop new approaches to care of the aging, and to disseminate the lessons learned within VA and beyond. Using 2001 and 2008 data from two surveys of U.S. medical schools' geriatrics programs, this article explores the impact of GRECCs on geriatric programs at their affiliated schools of medicine. It demonstrates how VA's academic mission through GRECCs has benefited VA and its affiliates and how it has benefited the nation through the growth of geriatric medicine as an academic enterprise and a legitimate clinical specialty.

Established in 1995, the Paul B. Beeson Career Development program provides faculty development awards to outstanding junior and midcareer faculty committed to academic careers in aging‐related research, training, and practice. This study evaluated the effect of 134 Beeson Scholars on their medical schools' aging and geriatric medicine programs and on the field of aging research from 1995 to 2007. Quantitative and qualitative survey data from multiple sources, including the American Geriatrics Society/Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center, National Institutes of Health (NIH) rankings of research funding, and other governmental databases were used to compare 36 medical schools with Beeson Scholars with 34 similar medical schools without Beeson scholars and to examine the influence of Beeson Scholars on the field of geriatrics and aging. Most Beeson Scholars remained at the institution where they trained during their Beeson award, and 89% are still practicing or conducting research in the field of geriatrics and aging. Twenty‐six (19.4%) of the scholars have led institutional research mentoring awards, 51 (39%) report leadership roles in institutional program project grants, and 13 (10%) report leadership roles in the Clinical and Translational Science Award programs at their institutions. Beeson Scholars are more likely than a matched sample of non‐Beeson NIH K awardees to study important geriatric syndromes such as falls, cognitive impairment, adverse drug events, osteoporosis, and functional recovery from illness. Total Beeson Impact Years (the total number of years all Beeson Scholars have worked at each school) is positively correlated with more geriatrics research faculty, after controlling for NIH funding rank (P=.02). Beeson Scholars have made positive contributions to the development of academic geriatrics research programs at U.S. medical schools.

OBJECTIVES: To determine the distribution of geriatricians across the rural–urban continuum from 2000 to 2008 and to compare with primary care physicians in 2008. DESIGN: County‐level analysis of physician data from the American Medical Association Physician Masterfile for 2000, 2004, and 2008 merged with U.S. Census data on the number of older (≥65) county residents. Descriptive statistics for each year were stratified according to 2003 Rural Urban Continuum Codes (RUCCs). SETTING: United States. PARTICIPANTS: Physicians in the United States. MEASUREMENTS: Number of physicians per county elderly population. RESULTS: The number of self‐identified geriatricians nationwide increased from 5,157 to 7,412 from 2000 to 2008. The number of geriatricians increased in each RUCC level, with nearly 90% of geriatricians residing in urban areas in all years. In 2008, the number of geriatricians per 10,000 older adults declined as rurality increased (from 1.48 in the most‐urban areas to 0.80 in the most rural). General internal medicine physicians are more plentiful in urban counties and declined as rurality increased (from 27.29 to 3.85 per 10,000 older adults in 2008). In contrast, family physicians were more evenly distributed with the elderly population across the rural–urban continuum (22.02 to 14.27 per 10,000 older adults in 2008). CONCLUSION: Small numbers of geriatricians combined with a growing elderly population poses a challenge and an opportunity. Healthcare systems and policy‐makers will need to modify care models to better use the skill of geriatricians in concert with other providers to provide quality care for older rural and urban Americans.

OBJECTIVE:The authors describe the current characteristics of geriatrics training within general psychiatry training programs.METHODS:In the fall of 2006, a survey was mailed and made available online to all U.S. psychiatric residency program directors (N=181).RESULTS:The response rate was 54% (n=97). Of the responding psychiatry programs, 96% (n=93) required a clinical experience in geriatrics, with a mean of 54.9 half days of required clinical training. The predominant training sites were inpatient geriatric psychiatry acute care units, ambulatory care experiences precepted by one or more geriatric psychiatrists, and outpatient geriatric psychiatry assessment centers. The mean number of physician faculty per residency program available to teach geriatrics was 2.8 full-time equivalents, and the mean number of physicians certified in geriatric psychiatry was 3.2 per program. Conflicting time demands with other curricula was ranked as the most significant barrier to expanding geriatrics training.CONCLUSION:Variability in the amount of time devoted to geriatrics training exists across general psychiatric residency programs. Some residents spend very little time in specific required geriatric psychiatry clinical experiences and have limited exposure to well-trained geriatric psychiatrists. Therefore, some psychiatrists who will take care of older patients in the future may be ill prepared to do so.

Aging of the U.S. population raises numerous public policy issues about which gerontological researchers, policy experts, and practitioners have much to contribute. However, the means by which aging-related public policy is influenced are not always apparent. Drawing on experience working in the U.S. Senate and other settings as Health and Aging Policy Fellows, the authors outline the formal and informal processes by which public policy is shaped in the U.S. Congress. Many who seek to influence public policy do so by telling legislators what they want. A less obvious path to policy influence is for gerontologists to offer their expertise to legislators and their staff. The authors provide specific recommendations for how gerontologists can establish productive and ongoing relationships with key legislative players. The authors also emphasize the importance of collaboration with advocacy groups and with local and state stakeholders to advance aging-related public policy to improve the lives of older Americans.

Existing totals of practitioners across all specialties who focus on geriatrics show that our educational system must shift focus in order to provide better care for elders. To improve the health, independence, and quality of life of all older people, every older American should receive high-quality, patientcentered care (American Geriatrics Society, 2010). Currently disconnects exist between the expanding healthcare needs of older adults, the educational institutions responsible for training healthcare providers, and the entities paying for the training (U.S. Department of Health and Human Services Council on Graduate Medical Education [COGME], 2010; Kovner, Mezey, and Harrington, 2002). Older adults with multiple chronic health problems frequently receive care from multiple healthcare providers with minimal, if any, contact between providers. This lack of coordination can result in adverse or simply unpleasant side effects for the older person, as treatment for one condition aggravates or leads to another problem. With appropriate coordinated medical care and social support, older Americans are more likely to remain safely in their own homes as they age, as well as to maintain their social activities. Appropriate care optimizes functional autonomy and quality of life (Boult, 2010). However, the current healthcare system fails to provide well-coordinated, highquality chronic care (Institute of Medicine, 2008; Salsberg and Grover, 2006; Eleazer and Brummel-Smith, 2009). In addition, many healthcare professionals do not see older adults as having needs distinct from younger adults (Holtzen et al., 1993). The professional healthcare workforce required to care for an aging America is an interdisciplinary workforce made up of physicians, nurses, social workers, pharmacists, psychologists, psychiatrists, nutritionists, dentists, dietitians, and physical therapists. This article reviews several health professions' current state of readiness to address the care of a rapidly expanding older population. Physicians Geriatricians and geriatric psychiatrists There are currently 7,029 geriatricians certified by the American Board of Family Medicine and the American Board of Internal Medicine, and 418 certified by the American Osteopathic Board of Family Medicine and Internal Medicine (American Geriatrics Society and the Association of Directors of Academic Geriatric Center's Geriatric Workforce Policy Studies Center [GWPSC], 2010). In the United States, the mean number of geriatricians per 10,000 adults ages 75 and older is only 3.7 (GWPSC, 2010). As of December 2009, 2,732 physician directors have received the certified medical director (CMD) designation from the American Medical Directors Association. Among CMDs, 1,101 also are board certified in geriatric medicine (personal communication, Alicia Willey, American Medical Directors Certification Program). There are currently 148 geriatric medicine fellowship training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). These programs are training 296 fellows annually; 273 first-year and twenty-three advanced fellows, of which 66 percent are medical students who graduated from schools outside of the United States. In 2009, there were 216 (44 percent) unfilled training slots in these training programs (Brotherton and Etzel, 2010). In 2007-2008 the American Osteopathic Association recognized seven programs (Freeman and Lischka, 2009). These programs trained only three fellows. There are currently 1,705 certified geriatric psychiatrists. In the United States, the mean number of geriatric psychiatrists per 10,000 adults ages 75 and older is only 0.9 (GWPSC, 2010). There are currently fifty-eight geriatric psychiatry ACGME fellowship programs training fifty-five fellows. Fifty-six percent of the fellows are graduates of foreign medical schools. In 2009, sixty-six geriatric psychiatry fellowship slots went unfilled (Brotherton and Etzel, 2010). …

This article documents the development of geriatric medicine fellowship training in the United States through 2009. Results from a national cross‐sectional survey of all geriatric medicine fellowship training programs conducted in 2007 is compared with results from a similar survey in 2002. Secondary data sources were used to supplement the survey results. The 2007 survey response rate was 71%. Sixty‐seven percent of responding programs directors have completed formal geriatric medicine fellowship training and are board certified in geriatrics, and 29% are board certified through the practice pathway. The number of Accreditation Council for Graduate Medical Education–accredited fellowship programs has slowly increased, from 120 (23 family medicine (FM) and 97 internal medicine (IM)) in 2001/02 to 145 in 2008/09 (40 FM and 105 IM), resulting in a 21% increase in fellowship programs and a 13% increase in the number of first‐year fellows (259 to 293). In 2008/09, the growth in programs and first‐year slots, combined with the weak demand for geriatrics training, resulted in more than one‐third of first‐year fellow positions being unfilled. The number of advanced fellows decreased slightly from 72 in 2001/00 to 65 in 2006/07. In 2006/07, 55% of the advanced fellows were enrolled at four training programs. In 2008/09, 66% of fellows were international medical school graduates. The small numbers of graduating geriatric medicine fellows are insufficient to care for the expanding population of older frail patients, train other disciples in the care of complex older adults, conduct research in aging, and be leaders in the field.

Purpose To describe geriatric training initiatives implemented as a result of Reynolds Foundation grants awarded in 2001 (and concluding in 2005) and evaluate the resulting structure, process, and outcome changes. Method Cross-sectional survey of program directors at 10 academic institutions augmented by review of reports and secondary analyses of existing databases to identify structural and process measures of curriculum implementation, participation rates, and students' responses to Association of American Medical Colleges Medical School Graduation Questionnaires about geriatrics training. Results All 10 institutions reported structural changes, including newly developed or revised geriatric rotations or courses for their trainees. Most used online Internet educational materials, sent students to new training venues, incorporated geriatric case discussions, implemented standardized patients, and used digital media. On average, each institution trained more than 1,000 medical students, 500 residents, 100 faculty, and 700 nonfaculty community physicians during the award period. Reynolds institutions also provided geriatrics training across 22 non-primary-care disciplines. Eight schools implemented formal faculty development programs. By 2005, students at Reynolds-supported schools reported higher levels of geriatrics/gerontology education and more exposure to expert geriatric care by the attending faculty compared with students at non-Reynolds schools. Innovations and products were disseminated via journal publications, conference presentations, and the Portal of Geriatric Online Education. Conclusions The investment of extramural and institutional funds in geriatrics education has substantially influenced undergraduate, graduate, and practicing physician education at Reynolds-supported schools. The full impact of these programs on care of older persons will not be known until these trainees enter practice and educational careers.