AGS Mission of Interdisciplinary Care Evolves to Meet Complex Eldercare Needs

Established by a group of pioneering physicians committed to improving healthcare for older patients, the American Geriatrics Society (AGS) was originally comprised of physician members only. Nearly 15 years ago the society announced that it would welcome all healthcare providers caring for older adults as members. Given the complexity of the healthcare needs of many older people, the AGS recognized the importance of creating a multidisciplinary organization that would promote interdisciplinary care and engage the entire care team.

“The AGS is a leader in welcoming interdisciplinary members,” says Barbara Resnick, PhD, RN, CRNP, past president and chair of the society. “And that’s essential because belonging to an interdisciplinary society is an advantage. It enables healthcare professionals to learn about the roles of other team members so they can understand and appreciate the skills that each discipline brings to the care of older people. If you don’t know what others’ skills are, you can’t use them optimally.” Complementing this multidisciplinary approach, Dr. Resnick notes, the AGS is also a leader in advancing exemplary education in geriatrics.

The team approach to eldercare is particularly important in long-term care settings, where older residents typically have multiple complex conditions and needs. To meet the needs of these patients, the Centers for Medicare & Medicaid Services requires that all beneficiaries in nursing homes have interdisciplinary care plans designed to optimize their care.

“In long-term care settings residents often have challenging diagnostic and management issues, as well as social needs,” so an interdisciplinary approach is needed, says Dr. Resnick. “But it’s important that whichever member of the interdisciplinary team is best suited to meet a given need do so. The team should sit down and say, ‘This is what the patient needs to optimize health, quality of life, and function, and whoever is best suited to meet this need or that need, or help meet this goal or that goal, should.’ It’s when teams truly work together this way that it really works for the benefit of patients and their families.”

Roughly 15% of the AGS membership is now comprised of nurses, pharmacists, social workers, physician assistants, therapists, and other healthcare professionals. The AGS recruits from these fields in a variety of ways. The committee that develops the AGS annual meeting program, for example, promotes contributions from members of all disciplines and programs that incorporate an interdisciplinary perspective and faculty. Likewise, the society ensures that panelists involved in drafting and updating the AGS’ clinical guidelines hail from a range of disciplines. This was the case with the Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, the Guiding Principles for the Care of Older Adults with Multimorbidity, and the recently released Feeding Tubes in Advanced Dementia Position Statement—three recent guidelines particularly relevant to long-term care.

The AGS also ensures that publications have an interdisciplinary perspective whenever appropriate. The society does this by recruiting multidiscipline panels of experts to draft and revise these resources, as well as multidisciplinary and expert commentators and internal reviewers. The Geriatrics Nursing Review Syllabus 3 and new additions to the Doorway Thoughts series—which are relevant to many in long-term care—reflect a strong interdisciplinary approach as well.

At the same time, the AGS continues to invite and encourage interdisciplinary members to get involved in efforts to make the society yet more multidisciplinary.

“Initially, we established a Geriatrics Interdisciplinary Advisory Group to advise us on how to best meet the needs of the team,” recalls Nancy Lundebjerg, MPA, the society’s chief operating officer. “We established discipline-specific sections and special interest groups on topics of interest to all disciplines. We also look to be sure that our board and committees are interdisciplinary.” The 17-member AGS board currently includes three advanced practice nurses and a pharmacist.

Given its pioneering work in advancing interdisciplinary care for older adults, the AGS is now recognized as a national leader in promoting the multidisciplinary approach. In 2008, the society brought together leading organizations in eldercare in a collaborative effort that led to the creation of the Partnership for Health in Aging (PHA). The partnership now includes three-dozen organizations representing all disciplines. AGS past-president Todd Semla, PharmD, led the group’s first workgroup, which created a set of universal geriatrics competencies that all team members should have upon completing entry-level training.

Another PHA workgroup developed a statement and annotated bibliography on interdisciplinary team training that has been widely disseminated (all of the PHA workgroup documents can be found on the AGS website at www.americangeriatrics.org. Also in 2008, Ms. Lundebjerg became co-convener of the Eldercare Workforce Alliance an interdisciplinary organization created to advance the recommendations of the Institute of Medicine’s 2008 Retooling for an Aging America: Building the Health Care Workforce.

“The EWA has been extremely effective in its policy work forcing on building the eldercare workforce and this is in part due to Nancy’s leadership in ensuring the alliance focuses on the team rather than on individual disciplines,” notes Dr. Resnick. Among other things, the alliance has played a key role in protecting federal Title VII and VIII geriatrics healthcare professionals training programs and the National Institute on Aging from proposed budget cuts.

The society has made important strides in fostering a membership and leadership reflecting the geriatrics workforce in its totality. Yet there’s more to be done in this area, Dr. Resnick notes.

“Welcoming interdisciplinary members was a critically important step, and kudos to AGS for recognizing this,” she says. “[Yet, to] continue to build an interdisciplinary geriatrics workforce we need to [continue to] spread the word about the opportunities available in our field to all our colleagues in all disciplines engaged in the geriatrics team.”