The 'aging game': an approach to education in geriatrics

Article Abstract:

The US population has changed dramatically in this century as the total number and proportion of elderly citizens has increased. Since people are living longer, they are encountering a greater degree of chronic illness and disability. While the number of physicians committed to geriatric care must increase in order to meet the needs of the elderly, surveys have found a pervasive negative attitude among physicians towards geriatric medicine. This may stem from the focus in medical schools on curing acute illness rather than managing chronic disease. The "aging game" was developed for use in medical schools to permit students to experience the physical and psychological impact of aging. Participants were told that the object of the game was to protect their independence and identity. They then "experienced" events such as hearing loss (by wearing earplugs) and a fall and injury that led their family to keep them indoors. Players progressed from an independent lifestyle to the dependence of living in a nursing home where their medical concerns were not taken seriously, they received a pureed diet and were scolded for incontinence. Following the game, students and facilitators discussed their reactions. Many players felt frustrated and depressed, and could identify specific problems of the elderly such as sensory deficits and isolation. Students rated the experience as very valuable since it raised their awareness and empathy and brought out their own attitudes towards the elderly and the aging process. The authors conclude that simulation exercises such as the "aging game" are successful educational tools. Players tend to feel relaxed yet stimulated by the competitive aspect. Facilitators can exhibit their enthusiasm for improving geriatric care, thereby serving as positive role models.

Psychological aspects, Aged, Elderly, Research, Analysis, Physician and patient, Physician-patient relations, Geriatrics, Medical education

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Specialists or generalists: on whom should we base the American health care system?

Article Abstract:

The debate continues about whether the American health care system should be based on treatment by highly trained specialists or by more broadly trained general practitioners. Most physicians choose careers in medical subspecialties rather than as general practitioners despite a federal program to recruit more primary care physicians. The Medical Outcomes Study (MOS) is the first large-scale study to examine patient use of the health care system. Patients choose specialists over general practitioners and type of health care organization based on their age and health status. Sick people use more health care services than healthy people. Services of specialists are more expensive than those of general practitioners. Other countries with more general practitioners provide universal health care to their citizens at a lower cost than the US. The US maybe able to decrease health care costs by increasing the use of general practitioners, and of health maintenance organizations and multi-speciality group practices.

Editorial, Usage, Medicine, Family medicine, Medical specialties

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Community hospital transfers to a VA medical center

Article Abstract:

Transfers of patients from community hospitals to a Veterans Administration (VA) medical center were studied. Such transfers accounted for only 4.7 percent of acute care admissions but accounted for 19 percent of deaths in the hospital. The death rate for transferred patients hospitalized in the VA hospital was 12 percent, versus only 2.6 percent for all other admissions to the VA hospital. At the time of transfer, 19 percent of patients were in unstable condition, but only a third of these were cared for en route by a doctor or nurse. The transferred patients stayed in the hospital for an average of 11 days, compared with only 7 days for non-transferred patients.

Transportation, Hospital patients, Veterans, Transport of sick and wounded, Medical transportation

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