conditions with which older patients present in practice (Adelman et al 1992). Finally, a variety of medical training programs have placed increasing emphasis on training physicians in the communication and interpersonal skills that increase their cultural awareness and sensitivity (often called “cultural competence”) (van Ryn et al 2006). A culturally-competent health care setting can be facilitated by the inclusion of a culturally diverse staff that reﬂects the community served, including physicians or translators who are proﬁcient in the languages with which patients are most comfortable, physician training in understanding the cultural norms and language of patients, and signs and instructional pamphlets in patients’ primary languages (Anderson et al 2003). Even when patients’ native language is English, cultural barriers may still need to be understood and overcome in order to provide the best possible care to older patients. Training physicians in methods for involving their patients in care, especially within culture-speciﬁc contexts, would work to encourage a medical interaction based on partnership, which is an essential ingredient of optimal treatment and outcomes. Similarly, patients should be made aware of the important role that they play in communication during the medical encounter. If feasible, training older patients to be active participants (with particular emphasis on helping those who are most vulnerable, and those who may be initially reluc- tant to assert their views) can be an important component of successful care. Patients who are trained to be effective com- municators and partners in their care are often more compli- ant with treatment recommendations and have better clinical outcomes than those who are not trained (Greenﬁeld et al 1985; Kaplan et al 1989; Cegala et al 2000). Interventions to train patients can be quite practical and readily administered. In one study, for example, older patients were assigned to a communication skills training intervention which con- sisted of providing them with a training booklet before their appointment and then conducting 30 minute face-to-face training just prior to their visit with their physician. Trained patients both sought, and provided, more information to their physicians, asked more questions about medically related topics, and were more involved in their care. Training thus enhanced patients’ participation in their care and increased the potential to improve their health (Cegala et al 2001). Given the opportunity to express “ownership” in the health care process, patients engage in more self-care behaviors and demonstrate greater adherence to medical recommendations (Adelman et al 2000; Cegala et al 2001). Clinical Interventions in Aging 2007:2(3) Physician-patient communication Formal programs The biomedical needs of aging patients require responsive- ness also to the psychosocial aspects of patient care. Toward that goal, The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has deﬁned ﬁve goals aimed at improving the health and well-being of older patients (Besdine et al 2005): These are: (1) “to ensure that every older person receives high-quality, patient-centered health care; (2) to expand the geriatrics knowledge base; (3) to increase the number of health care professionals who employ the principles of geriatric medicine in caring for older persons; (4) to recruit physicians and other health care professionals into careers in geriatric medicine; and (5) to unite professional and lay groups in the effort to inﬂuence public policy to continually improve the health and health care of seniors” (Besdine et al 2005). Multiple chronic conditions, and increasing vulnerabilities and limitations in various realms of functioning, can necessitate complex and multi-faceted treatments for older patients. There is great need for programs that address the psychosocial and biomedical needs of elderly patients and for the incorporation of the successful elements of such programs into physician- patient communication at all levels of care. Comprehensive geriatric assessment Comprehensive Geriatric Assessment (CGA) is a process of care for older patients based on multidimensional and multidisciplinary approaches to addressing the medical, functional, and psychosocial problems of elderly patients by teams of health care professionals (Williamson et al 1964). The goals are to evaluate and solve problems of older patients in the physical, mental, social, economic, functional, and environmental domains (Rubenstein 1987; Reuben et al 1995; Maly et al 2002). Accomplished through the implementation of teamwork- based care for older patients, CGA includes not only the patient’s primary care physician but also a geriatrician, a geriatric nurse practitioner, a social worker, and other medical team members as needed. With CGA, primary care practitioners are assisted by assessment teams that monitor patients for short-term or long-term care needs, and develop individualized comprehensive treatment plans for care and follow-up. CGA programs are especially beneficial for patients who have multiple hospital, ER, and urgent-care visits, because the focus of their care can be shifted toward better preventive efforts. Such programs are also conducted on an outpatient basis (such as in the UCSD Seniors Only CARE (SOCARE) program) which is especially effective 463