More and more frail elderly live in the Netherlands. The Social Cultural Planning Office has calculated that their number will increase to 1 million people by 2030. These are people with complex care needs who rely on various facets of medical care. They live in small-scale housing, in a nursing home or – increasingly often – at home. Nearly every doctor will have to deal with this target group (more) in the coming years.
It is very important to pre-sort for the aging population. Knowledge of geriatric medicine and multidisciplinary collaboration is essential for this. The geriatric medicine specialist works for the most frail elderly. With a growing number of vulnerable people, a growing number of geriatric specialists is needed. Professional association Verenso is committed to this. The geriatric specialist treats and guides vulnerable elderly patients with complex care problems. He not only looks at the clinical picture, but also how vulnerable elderly people have the best possible quality of life in daily life.
Quality of life
Contributing to the quality of life and to the patient’s self-reliance and autonomy are the most important principles in the work of the geriatric specialist. He offers a listening ear, provides expert advice and respects the wishes of the patient.
Together with the patient and family, the geriatric medicine specialist examines what the most appropriate medical care is, regardless of where the patient is staying. He works closely with other healthcare providers. The geriatric specialist works together in a multidisciplinary team, regardless of the walls of the nursing home. In primary care, he can also act as a co-practitioner or as a consultant alongside the general practitioner. In order to be able to offer the patient the most optimal care and treatment, multidisciplinary teams often work together in which the geriatric specialist is in charge.
‘After a week I was done: I wanted to work as a geriatric specialist’
Unknown makes unloved
During their medical studies, students currently do not automatically come into contact with geriatric medicine through education and/or internships. This is partly because medical education is based on the clinical setting and students are obliged to do almost all internships in a (academic) hospital. However, the geriatric medicine specialist can be found in nursing homes, small-scale housing and at the home of the elderly.
In the basic curriculum
Recently, De Medicine Student, Verenso and VASON, the association for doctors in training to specialize in geriatric medicine, have therefore urged academic medicine courses to include geriatric medicine in the basic curriculum of the courses. So that students get acquainted with it at an early stage and can experience the different sides of the multifaceted specialism in practice during their studies.
Important for all doctors
Every doctor will have to deal with elderly patients in the future. That is also why it is extremely important that geriatric medicine is integrated into the entire medical education. This ties in seamlessly with the vision of the Framework Plan for Doctors’ Training 2020, which states that the developments surrounding the increasing number of people aged 75 and over, chronic diseases and multimorbidity require integrated, multidimensional care. Precisely these matters are central to geriatric medicine and are therefore relevant for every young doctor. Which specialization he or she will ultimately choose.
Senior resident in geriatric medicine Fleur Stoevelaar initially planned to do general practice training after completing her medical studies. She was not yet familiar with the geriatric medicine specialization.
The hospital didn’t appeal to me at all. I then worked for a while in a general practice, but I wanted to broaden my horizons. Then I was put on the trail of the nursing home. After a week I was done: I wanted to work as a specialist in geriatric medicine.’
She immediately registered for the geriatric medicine specialization. Fleur: ‘I find it inspiring to think about complex medical problems within a multidisciplinary team and how we can improve the quality of life of the elderly together. And not only with other doctors, but also together with, for example, the carers, activity counselors and paramedics.’
Another beautiful facet of geriatric medicine is the space that is available to talk to clients and family. ‘You often spend a long time together with a client and his family and often you really build a bond. This is perhaps also reinforced by the topics that are discussed, such as the wishes and ideas people have about the end of life, or problem behavior in dementia.’
Fleur finds it very unfortunate that medical students are not put on the track of geriatric medicine during their studies. ‘There are quite a lot of students who don’t want to work as a doctor in a hospital, but have never heard of the possibilities within a nursing home, small-scale housing or for the vulnerable at home. They think, so to speak, that the elderly are just sitting there waiting for death. But as a geriatric medicine specialist you can do a lot for vulnerable elderly people with complex problems in order to offer them the best possible quality of life in their final phase of life. It’s a wonderful profession.’
Medical specialists who want to switch to geriatric medicine can start from 1 March next year with an adapted, shortened training program for doctors who have already completed further training. On the basis of previously acquired competences, these doctors are trained to become highly qualified specialists in geriatric medicine. Important principles here are that the quality of the training remains high and that the intake increases.
During the committee debate ‘Labour market and care’ on 6 July, attention was also paid to the need for more geriatric medicine specialists. As a result of this debate, Liane den Haan of Fractie Den Haan submitted a motion on 7 July, co-signed by MPs from VVD, CDA, SGP and GroenLinks. The House of Representatives then voted on the motion and it was passed.
In the motion, the government is requested: ‘…to work together with the Minister of Education, Culture and Science to draw attention to geriatric residencies in the study of medicine, so that medical students can become acquainted with this field and more specialists in geriatric medicine are trained and about this. to enter into discussions with the management of the medical education programmes.’
Every doctor will have to deal with older patients in the future
Conversation with minister
In this context, a conversation took place last month between Conny Helder, Minister of Long-term Care and Sport (LZS), Verenso and SOON (Cooperative training for specialist geriatric medicine in the Netherlands). Minister Helder sees the need for a permanent internship within the study of medicine and indicates that he is positive about the new shortened training program for the second career of medical specialists. Together with the field, she will work to increase the intake for the training to become a specialist in geriatric medicine. Important steps to be ready for a future in which more specialists in geriatric medicine are desperately needed to continue to offer appropriate care to our vulnerable elderly.