Meeting the Geriatric Care Needs of an Aging Population: Older Adult, Family Caregiver, and Provider Perspectives

Abstract

There is a critical need to ensure the provision of high-quality health care for a growing population of adults age 65 and older (older adults). Recent policy initiatives emphasize the need for a health care workforce that is well equipped to support older adults who may require health care from multiple providers while navigating other social and economic transitions. Older adults are also increasingly supported by family caregivers who may be involved in daily activities and medical decision-making. Simultaneously, primary care physicians are overwhelmed with increasing patient panels and policy pressures, resulting in insufficient attention to the unique needs of older patients. Geriatric care was developed as a health service specifically for the care of older adults; yet, there is a significant geriatrics workforce shortage. Further, utilization of geriatric care is low although demand is expected to increase in the future. Geriatrics practitioners have suggested that clarifying the value of geriatrics may be required to move the subspecialty forward and ultimately meet the needs of an aging population. In this dissertation, I examine geriatric care from the perspectives of older adults, family caregivers, and medical trainees. First, I conduct focus groups with older adults and family caregivers to learn about their experiences with the health care system and characteristics of health care that they value as they think about their aging experience. Thematic analysis reveals that older adults’ and family caregivers’ experiences with the health care system are related to perceived needs related to characteristics of providers, care delivery, and the health system.

In my second study, I use analyses from focus groups to develop and field a survey to a sample of over 300 older adults and family caregivers. This study seeks to understand how experiences with providers, care delivery, and the health system—along with clinical and social circumstances—are related to perceived value of geriatric care. I find that among older adults and family caregivers, clinical complexity and perceiving higher technical quality of current provider are each associated with higher perceived value of geriatric care while awareness of geriatrics is associated with lower perceived value. Older adults with a caregiver perceive greater value in geriatric care while caregivers living in the same household as their older relative perceive lower value. In my third study, I conduct qualitative interviews with internal medicine residents and geriatrics fellows across three prestigious medical institutions to understand how personal background, social and peer support, and institutional characteristics may be related to professional identity and interest in geriatrics. I find that institutional characteristics such as the proximity to geriatricians and geriatrics clinics and conceptualizations of prestige in medicine are important to trainees as they think about their professional identity and consider geriatric medicine as a subspecialty. Building institutional capacity to train geriatricians and promote geriatrics may be as important as financial incentives. Geriatric medicine has the potential to ensure the provision of high-quality care to older adults, and my findings suggest that older adults and family caregivers perceive value in the field. Incorporating the needs and preferences of family caregivers may make for more robust decision-making. There is a need for raising awareness of geriatrics, and for medical training institutions to broaden the meaning of medicine and to involve geriatricians further in leadership and mentorship positions.