A Clinical Service Learning Program Promotes Mastery of Essential Competencies in Geriatric Physical Therapy

Abstract

BACKGROUND AND PURPOSEIn 2010 there were 40 million older adults, defined as those 65 years of age and older, in United States. This number is predicted to more than double by year 2030.1,2 By 2050, individuals 65 years of age and older will make up approximately 20% of US population.2,3Older adults are a heterogeneous group ranging from those who are frail elders to elite athletes. Brummel-Smith4 defined optimal aging as the capacity to function across many domains-physical, functional, cognitive, emotional, social, and spiritual-to one's satisfaction and in spite of one's medical conditions. A large majority of older adults fail to live into this ideal. The slippery slope of aging described by Schwartz5(P3) depicts a general decline in physiological and functional ability that has been observed with increasing age. Approximately 80% of older adults report living with at least 1 chronic medical condition and 50% have 2 or more.6 Obesity, arthritis, diabetes, osteoporosis, hypertension, heart disease, stroke, depression, injuries related to falls, and hearing and vision impairments often co-occur with typical multisystem changes associated with aging.7'9 Age-related decline in physical performance in conjunction with additional pathologic conditions often results in loss of functional ability. Approximately 36% of older adults report a disability of some kind, with 23% reporting limitations in walking and 8% reporting some dependence in self-care.10Physical therapists must be able to identify variable needs of older adults and provide care that is commensurate with those needs in order to promote optimal aging and quality of life. Physical therapist education programs must prepare future PTs to address health promotion, safety, mobility, and physical performance issues of older adults. Students need to recognize normal changes that occur with aging, understand common pathologies associated with older adults, and then discern among effects of new pathology, normal effects of aging, or a combination of two in order to direct care appropriately. They must be able to engage in interprofessional collaboration and caregiver training in order to provide competent care to older adults across health care continuum and in community.The American Physical Therapy Association Section on Geriatrics (now known as Academy of Geriatric Physical Therapy) developed Essential Competencies in Care of Older Adults at Completion of Entry-level Physical Therapist Professional Program of Study (see page 91 of this issue)11 to identify skills necessary to provide competent care to this older adult population. The essential competencies11 are organized into following 6 domains: Health Promotion and Safety, Evaluation and Assessment, Care Planning and Coordination Across Care Spectrum, Interdisciplinary and Team Care, Caregiver Support, and Healthcare Systems and Benefits. Within each of these 6 domains,11 cognitive, psychomotor, and affective skills essential to providing physical therapy care to older adults are identified. A variety of pedagogical approaches may help to ensure that academic programs in physical therapy foster student development of these skills in order to serve aging population.Service learning and other experiential learning opportunities may help enhance academic coursework that prepares students to fulfill essential competencies.11 Service learning combines community service with academic coursework for purposes of satisfying explicit academic objectives.12,13 Experiential learning can also be accomplished through student participation in provision of volunteer services, which are often provided free of charge.14'16 In both cases, students have opportunity to apply classroom knowledge to real-world scenarios and develop cognitive, psychomotor, and affective skills relevant to physical therapist practice, including practice with older adults. …