Gastroenterology

Gastroenterology

Volume 129, Issue 4, October 2005, Pages 1305-1338
Gastroenterology

American Gastroenterological Association
American Gastroenterological Association Future Trends Committee Report: Effects of Aging of the Population on Gastroenterology Practice, Education, and Research

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The AGA Future Trends Committee: Charge and Process

The AGA Future Trends Committee was created in 2004 to

 further the AGA Strategic Plan by identifying and characterizing important trends in clinical practice and scientific-technological developments in the world in general and medicine and gastroenterology in particular that potentially will impact the AGA and/or its members in the coming 3–5 years or beyond and to make strategic recommendations to the Governing Board on how AGA should deal with those trends and developments. These trends and

Number of Older Patients Requiring Gastroenterology Services

A survey conducted by the Lewin group for the AGA3 and published in Gastroenterology4 used data from the National Health Interview Survey, National Hospital Discharge Survey, National Hospital Ambulatory Medical Care Survey, and Medical Expenditure Panel Survey to establish the burden of GI disease in the US population. Seventeen diseases were surveyed, and the total number of people affected was 289 million. Reducing these numbers to avoid overlap results in a burden of approximately 185

General Principles of Aging

As the “baby boom” generation reaches the geriatric threshold, new questions are being raised about the process of aging. Is decline in function inexorable, or can function be maintained throughout one’s life? Is the loss of function related to “normal aging,” or is superimposed disease the culprit? What is “normal aging”? There has been a dramatic increase in research funding available for aging research, primarily due to the fact that the answers to these questions are likely to have a major

Aging of the GI Tract: Specific Issues Affecting Gastroenterology Practice and Research

Age-related changes in GI function will have increasing importance for health care delivery as the number of elderly individuals increases significantly over the next 2–3 decades. The aging process per se has clinically significant effects on oropharyngeal and upper esophageal motility, colonic function, GI immunity, and GI drug metabolism. Although many essential aspects of GI function, such as intestinal secretion, are generally preserved with aging, superimposed effects of chronic diseases

Impact of Common Geriatric Conditions on Gastroenterology Practice

Gastroenterologists who treat older patients (most gastroenterologists other than pediatric gastroenterology specialists will treat geriatric patients) need some understanding of the concept of geriatric care. Geriatric medical care differs from medical care in younger adults in that the focus is often on preservation of function and improving quality of life, rather than on investigating, diagnosing, treating, and “curing” specific diseases. All physicians who treat older patients need to have

Routine consultation and outpatient visits

Given the higher incidence of chronic disease and comorbid illnesses in older patients, it is unlikely that the current gastroenterology practice model of short office visits (5–15 minutes) will remain feasible. Longer visits have been shown to improve outcomes in complex patients with other chronic conditions such as asthma.206 Little data exist in the current literature to guide gastroenterologists in how to address the issue of the increasing complexity of medical care and living

Physician Supply and Waiting Lists

Studies of specialist supply and demand indicate that there will be a substantial shortfall in specialist hours provided by the current training model.229 In 2000, a combined task force of critical care and pulmonary specialists published the results of an analysis of the current and anticipated number of patients requiring pulmonary assessment and critical care, particularly admission to intensive care units, through 2030.230 Based on a detailed workforce assessment, they predicted that after

Gastroenterology Fellowship Programs

Gastroenterology fellows will need training in the unique medical, social, and economic needs of the aging population. Such training has been recommended by the American Geriatrics Society in consultation with the Institute of Medicine and the Association of American Medical Colleges in their published guidelines in “Core Competencies for the Care of Older Patients.”240 The AGA Core Curriculum Committee has recognized this need and added a section concerning geriatric gastroenterology in 2003.

Gastroenterological Research Questions and Needs

Geriatric gastroenterology is a fertile field for research. Numerous questions exist about digestive disease in older patients and the best way to treat these patients. Following are various specific clinical research questions that should be addressed by the gastroenterology clinical research community.

Recommendations

Following are a list of activities that the AGA could undertake that would help its clinician members better serve the needs of an aging population. Additional recommendations pertaining to gastroenterology training programs are found in the Gastroenterology Education section.

  • We suggest that the AGA begin a review of existing funding sources to determine whether adequate funding for geriatric gastroenterology research is present. Targeted requests for proposal for issues such as motility

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    This report was approved by the AGA Future Trends Committee on May 15, 2005.

    Members of the AGA Future Trends Committee include Nicholas F. LaRusso (chair), Juan R. Malagelada, Walter J. McDonald, Pankaj J. Pasricha, Suzanne Rose, and Michael Lee Weinstein.

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