Brigham and Women’s Hospital Geriatrician: Physician Residents Need to Learn Hospice Principles, Senior’s Specific Needs

Physicians in training need greater exposure to geriatric training in order to better grasp the needs of older patients, including during transitions to hospice, according to Dr. Julia Lowenthal, a geriatrician from Brigham and Women’s Hospital.

Lowenthal recently presented research at the American Geriatrics Society Meeting in which she found that many residents are unfamiliar with the needs of older patients, despite the large numbers of seniors in need of care.

Hospice News sat down with Lowenthal to discuss the ways in which incoming physicians should prepare to care for the aging population, as well as better coordinate with hospice providers.


What are some of the factors that make a residency program age-friendly?

Internal Medicine residency graduates go on to practice general medicine (e.g., primary care, hospital medicine) or subspecialize in areas like cardiology after graduation.

As you can imagine, these physicians take care of many older patients. Right now there are few Internal Medicine residency programs that offer comprehensive geriatrics, or age-friendly, education. For example, many programs do not include any training in skilled nursing facilities or rehabs, even though they discharge many hospitalized patients to those settings.


There are new training models, like combined internal medicine and geriatrics residency programs, that include more teaching about geriatrics and clinical experiences in settings like the home, assisted living, or skilled nursing facilities. For other programs, they should aspire to hire more geriatricians and include increased education about care of aging patients in their clinical experiences and didactic programs.

Generally, do you think there are differences in how physicians outside the geriatrics specialty care for seniors, compared to younger patients?

We know that older patients who receive care from geriatricians typically have more attention paid to so-called “geriatric syndromes,” or things like dementia, falls, urinary incontinence, and other issues common with aging.

It is important for older people to receive holistic care from an interprofessional team, so not just the physician but also nurses, social workers, physical therapists, and others. I think this is increasingly recognized as an issue regardless of the specialty, but definitely, something that will need more attention as our population continues to age.

What are the most important things medical students or residents need to learn about treating the aging population?

I think reflecting on one’s own feelings about aging is really important. We know that internalized ageism is really detrimental to the health of both patients and also healthcare professionals. If we could work on changing these attitudes and culture about aging it would probably improve a lot of areas of medicine and health.

What are the most important things they need to understand about hospice and palliative care when it comes to the senior population?

Students and residents should be aware of hospice and palliative care, the potential benefits of using these services, and most importantly what is included for patients in these types of services.

I find that learners often know theoretical concepts about hospice and palliative care but they may not know the practical elements or logistics of setting these up. Before going into independent practice after training it is really important to be familiar with the ins and outs of these services.

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