Caring for a growing older adult population with one or more chronic conditions requires a comprehensive approach from both the medical and public health communities. This includes providing education, support and services that, much like a bridge, span not only the distance between the clinical and community settings, but provide a connection between the two as well. It is also important that we extend these efforts to educate and train individuals from a variety of fields as well as provide support and education for informal caregivers such as family and friends who are often relied on to provide care in the home – the preferred care setting for most older adults.

Compared to previous generations, older adults currently experience better health outcomes and lower disability rates. This is great news; however, as individuals get older they are more likely to develop chronic diseases and conditions such as arthritis, diabetes and heart disease, as well as disabilities that result from injuries such as falls.1 Additionally, as they continue to age, older adults are more likely to experience more than one chronic condition.

Related to this, it is imperative to reach older adults in rural areas. The aging rural population is increasingly underserved and more diverse, creating a critical need for leadership in geriatric training. In Iowa alone, roughly 40% of residents over age 65 and one-third over age 85 live in rural settings, and 79% of Iowa's counties are rural.2 Key challenges face the rural healthcare workforce, including a grave shortage of health professionals trained in geriatrics, an inadequate infrastructure for training to meet the growing need, and insufficient patient access to geriatric care expertise. Health disparities in rural states such as Iowa are common and widening. Rural residents tend to be older and sicker than urban residents.3 According to the CDC, rural residents have higher rates of poverty, less access to health care and lower quality of health care.4 With 15% of the U.S. population living in rural areas, it is crucial to close this gap.

Currently, the United States is experiencing a shortage of people trained in geriatric care including geriatricians, nurses and other direct care providers5 as well as public health, in-home care, and a variety of community-based workers. Additionally, older adults often have complex needs that require an interdisciplinary team approach. The interdisciplinary team often includes formal caregivers such as physicians, nurses, social workers, psychiatrists, pharmacists, physical and occupational therapists, direct care workers, and others. The person being cared for and their family members or informal caregivers are to be included in the team approach as well. With the large number of elders residing in rural areas and lack of specialist care available in rural settings, it is imperative that rural providers have access to quality education and clinical tools to assist them in providing optimal care to older adults, and to their family care partners, who shoulder the burden of daily caregiving.

In response to the need to educate and train providers, the Iowa Geriatric Education Center (IGEC) has developed a variety of print and web-based trainings and materials on caring for older adults within clinical and community settings. This includes a new Family Involvement in Care training directed at family members providing care at home to loved ones. Additionally, the IGEC's reach in the rural setting is ideally suited to promote interprofessional team care delivery and integration of geriatric training into the primary care system. Special emphases on mental health, frailty, delirium, substance use, and dementia care are optimally suited for primary care practices where the evaluation and treatment of mental health conditions most often occurs in rural settings.

While the health of the aging population can be improved and the prevalence of chronic diseases can be reduced through prevention efforts, it is also imperative to increase efforts to provide the needed training to practitioners and informal caregivers that allow older adults the opportunity to remain at home, have a voice in the care they receive, and maintain the best quality of life possible.

 

References

1. Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2013.

2. 2010 United States Census.

3. Rosenthal M. Rural Americans: Older and sicker than their urban counterparts. Pain Medicine News. January 19, 2017. Accessed at http://www.painmedicinenews.com/Web-Only/Article/01-17/Rural-Americans-O...

4. Moy E, Garcia MC, Bastian B, et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas – United States, 1999–2014. MMWR Surveill Summ. 2017;66(SS-1):1-8.

5. Fineberg HV. Retooling for an aging America. Medscape J Medicine. 2008;10(8):188.