Geriatric Experience Research Articles

FUNCTIONAL AND ATTITUDINAL OUTCOMES OF TEACHING FUNCTIONAL ASSESSMENT TO MEDICAL STUDENTS

Teaching geriatric principles to medical students is important because of the increasing geriatric population. Family physicians are in a strategic position to provide this teaching because they provide much of the care for the elderly. The challenge in developing a geriatric curriculum is to determine the content, implement it efficiently, and evaluate its impact. We developed a geriatric assessment experience for third-year medical students. The students were introduced to a geriatric assessment tool and asked to identify a patient, complete the assessment, and record key elements of functional assessment. Student attitudes were measured before and after completing the assessment. The students rated their knowledge, comfort, and experience with a comprehensive geriatric assessment. Students listed approximately seven problems and four recommendations per patient. On average, students identified one functional problem for each patient. There were significant increases in knowledge, comfort, and experience with a comprehensive geriatric assessment. This educational tool met all of our goals. The students identified elderly patients' functional problems, created care plans focused on function and prevention, and reported an increase in positive attitudes about their knowledge, comfort, and experience with geriatric assessment. No outside expertise was needed and faculty time demands were limited.

Geriatrics in Medical Education

Several national organizations have recommended that required clinical geriatrics clerkships be added to the medical school curriculum. Yet, the most recent Association of American Medical Colleges survey data show that only fourteen medical colleges have separate, mandatory geriatric clerkships, while the majority of colleges still only incorporate geriatrics training into existing coursework. This article notes examples of both required and elective geriatric experiences available for undergraduate medical students. Existing models suggest that mandatory geriatrics programs are necessary. Enhancement of geriatrics in medical education is viewed as a health care imperative.

Student Physical Therapists' Attitudes Toward Working with Elderly Patients

Although attitudinal studies of health care providers toward elderly patients have been done in the past, this study is unique in that it simultaneously addresses student physical therapists' attitudes toward the elderly, their attitudes toward working with elderly patients, and their attitudes toward a variety of work environments. Students (n = 190) enrolled in 3 physical therapy programs in one state completed a 4-page questionnaire that consisted of the Kogan Scale, the modified Coren scale, attitudes toward different work environments, and demographic and cur-ricular information. Data were analyzed using descriptive, ANOVA and multiple regression techniques. Taking a class in geriatrics did not result in higher scores on the Kogan or Coren scale. Out of ten possible work environments, a Nursing Home ranked 9th. Students more positively identifying the nursing home as an enjoyable place to work scored higher on the Coren scale and had experienced a predominantly geriatric clinical affiliation per OLS regression. Curricular innovations, including geriatric clinical experiences, may be necessary to graduate students who are both skilled and motivated to provide care to elderly patients in nursing homes and other primarily geriatric settings.

Assessment of Geriatric Training by Medical Students

In this study, classes of second and fourth year medical students rated the importance of 39 geriatrics teaching objectives and rated their self-perceived abilities regarding these objectives. A “needs score” was computed and ranked to indicate priority training objectives which varied over medical school classes. Five geriatric experiences are compared to students' self-perceived abilities. Students rated geriatrics learning objectives as highly important and reported improved abilities in diagnosing and managing diseases in the elderly. Abilities in performing functional assessments, utilizing community resources, diagnosing elder abuse and managing rehabilitation activities did not improve as much as other abilities. Incorporating increased training in functional assessments may be the single most effective method to improve abilities to accomplish multiple geriatrics learning objectives.

Un enseignement innovant, une création réussie: L'european academy for medicine of ageing (eama). le point de vue des enseignants et des étudiants

The origins of the EAMA (European Academy for Medicine of Aging) course are described in this paper by the Scientific Committee of this new post-graduate teaching activity. Innovations are constantly introduced to improve training methodology so as to enable the students to update their knowledge, help them improve their skills in data gathering and in the critical interpretation of information, and exchange geriatric experience and know-how. To reach such goals, an interactive teaching method is implemented by the professors, with world experts being called in to ensure scientific soundness and quality. Evaluations by students and teachers are regularly carried out with the aim of perfectly adjusting their training methodologies and increasing the scientific level of exchanges. If the students progress, so do the teachers....

An Interdisciplinary Service Learning Experience in Geriatrics for Occupational and Physical Therapy Students

An interdisciplinary service learning experience in geriatrics was provided for occupational and physical therapy students and supported by an Allied Health Project Grant. The service learning experience, which was developed by faculty from the Occupational Therapy, Physical Therapy, and Communication Sciences Disorders Programs at the Medical University of South Carolina, functioned as the clinical component of an interdisciplinary geriatrics course. The purposes were to: (1) provide students with an introductory experience in performing evaluation techniques in geriatrics, (2) provide a service to elderly clients by screening them for physical and communications dysfunction, and (3) develop students' ability to interact and work directly with elderly clients. The learning experience was carried out over a nine week period, and provided an opportunity for the students to work directly with elderly subjects in a community based setting. Course evaluations regarding the experience and anecdotal feedback from the students suggested that the experience was worthwhile and constituted an effective design for teaching geriatrics.

Geriatric patient simulations for dental hygiene

The rapidly increasing number of this country's elderly requires that dental hygiene students practice the clinical problem-solving skills of information gathering, assessment, and treatment applied to geriatric patients. Computer-based simulations are purported to provide this experience, but little research has been completed with simulations in the education of dental hygienists. This paper summarizes the process used to design, develop, and evaluate a series of eighteen computer-based geriatric simulated patients. It contains a brief description of the simulations and a description of the design, validation, authoring, and formative evaluation phases. The paper also describes the summative evaluation, provides implementation suggestions, and summarizes future directions. The summative evaluation, conducted at four institutions, suggests that computer-based simulations are an effective instructional method as measured by pre/post-tests. The results suggest that simulations can provide a standardized set of geriatric patient experiences. These simulations may prove especially valuable at institutions that are unable to provide clinical geriatric experiences or lack the expertise to conduct a didactic course in geriatrics.

Lessons from geriatric psychiatry in the long-term care setting.

Of all long-term care settings, the nursing home has served as the most productive laboratory for the study of the mental health problems of late life. Lessons from geriatric psychiatry research and practice in the nursing home have relevance to general psychiatry and to other health care settings, informing us about (a) psychiatric disorders in medically ill and disabled populations; (b) subsyndromes and subtypes of depression; (c) behavioral disturbances in patients with brain injury; (d) the effects of government regulation and education on mental health care; and (e) essential roles for psychiatrists in changing health care systems. Selected areas of knowledge based on geriatric psychiatry research and experience in long term care are reviewed in this paper, and their applications for the field of psychiatry in general are explored.

RECONCILING with God in a New Age Unit

Sylvain Beauregard, RN, BS,is a head nurse at Pavillon Hotel-Dieu in St. Hyacinthe, Quebec, Canada, and besides palliative care, has experience in pediatric psychiatry, geriatrics and short-term care. He is the coordinator of Quebec Nurses Christian Fellowship, French sector, and involved in teaching at his church.

Prescribing policy for antiulcer treatment in the elderly.

In the short and long term treatment of peptic ulcer in the elderly some problems have yet to be resolved, mainly concerning the physiology and pathophysiology of the aging stomach, the pharmacokinetic and pharmacodynamic properties of antiulcer drugs, and the presence of different risk factors compared with young patients. The available data from controlled trials of peptic ulcer in the general population and from the limited experience in geriatrics, show that the clinical efficacy and tolerability of the anti-secretory drugs (e.g. cimetidine, ranitidine and famotidine) and of cytoprotective compounds are similar to that observed in younger patients. However, more data are necessary concerning the optimal dosage in relation to physiological age-related changes of liver and kidney function, the duration of prophylactic treatment, and importantly, the assurance of adequate patient compliance.

Effect of a geriatric educational experience on graduates activities and attitudes

Clinical geriatric dentistry has not been an important part of most dental curricula. However, changes in demographic and patient expectations signify that geriatric oral health care can no longer be equated with supplying dentures for an aging population, but must be understood as treatment of the complex needs of a dentate population. The 1975 to 1985 graduates of the University of Iowa College of Dentistry were surveyed to evaluate the influence on dental practice of a comprehensive geriatric dental curriculum introduced in 1980. The post-1980 graduates were more likely to be practicing in larger population centers and less likely to be treating patients over 75 years of age. The dentists who graduated before 1980 were more likely to be consultants in nursing homes and carrying out examination, emergency care, and/or denture care, whereas the group of dentists who graduated after 1980 and had geriatric clinical experience with frail and functionally dependent older adults were more likely to be carrying out comprehensive care. When given a list of 18 geriatric dental and gerontological topics, few differences were found between cohort groups in terms of knowledge and confidence in carrying out procedures.

An Integrated Geriatric Training Experience for Internal Medicine Residents

An Integrated Geriatric Training Experience for Internal Medicine Residents

Training in geriatrics for future dietitians

Inclusion of geriatric training for future dietitians was assessed through a questionnaire mailed to directors of all internship programs and coordinated undergraduate programs (CUPs) accredited by The American Dietetic Association. All respondents, internship programs (70%) and CUPs (77%), included some exposure to geriatrics. Ninety-six percent of the CUPs included geriatric-related topics in undergraduate courses. Of the 95% internship programs providing class sessions on geriatrics, most included 6 hours or less. Major topics related to nutrition assessment; physical, social, and psychological needs; diet-related diseases; and nutrition programs benefiting the elderly. Fifty-one percent of the CUPs and 23% of the internship programs trained students 3 weeks or more in a geriatric setting, while 45% and 72%, respectively, trained 2 weeks or less. Nursing homes were the primary site of training. The most frequently required activities included identifying specific needs of the elderly in relation to other adults, completing diet histories, and presenting nutrition education to a geriatric population. The question remains as to whether the quantity and type of geriatric experiences currently included are sufficient to keep pace with the increasingly aging population.

Self-assessment of competency in geriatric dentistry.

Senior dental students' self-assessed competence in treating geriatric patients was evaluated before and after a four-week experience on a Geriatric Mobile Dental Program using an evaluation instrument designed to assess this program. Mean pre- and posttest scores for seven specific aspects of providing dental care to geriatric patients were analyzed using t-tests and analysis of covariance. The dental students report feeling significantly more competent in treating geriatric dental patients at the end of their four-week geriatric experience in this program.

Community mental health and the elderly: service and training approaches.

There is a growing gap between needed and available mental health services for older adults. This article discusses the training needs, personnel shortages, and lack of effective service programs and proposes some strategies for dealing with the problems. There is a lack of adequate methods for identifying and referring frail elderly persons in need of mental health services. Services that are currently available to the elderly are identified along with factors that may influence their use by older adults and other service personnel. There are shortages of mental health professionals with special training and experience in gerontology and geriatrics, and clinical geropsychologists. An innovative and practical service model that was developed to coordinate and integrate the identification and treatment of frail, community-dwelling elderly is presented. Various aspects of the program that include outreach and case management approaches, the integration of student volunteer activities with those of special volunteer corps within public housing and specially trained paraprofessionals, telephone reassurance programs, and a system of layered supervision are described. Comparisons are made between this Coordinated Agency Resources for Elderly Services (CARES) model and existing service delivery programs. A three-tiered approach to training and coordinating the activities of trained mental health personnel: (a) paraprofessionals and volunteers, (b) middle-level professionals and (c) supervisory professionals within an integrated system is proposed. Specific roles and functions of personnel at each level are described. The summary discusses the potential of the proposed strategies for dealing with the problems created by the shortage of personnel and services. It suggests some time frames within which the strategies could be operationalized.

Geriatric Experience for Pharmacy Students: Classroom Instruction Applied During Externship

Geriatric Experience for Pharmacy Students: Classroom Instruction Applied During Externship

Problems of the health-impaired elderly: a foundation's experience in geriatrics.

Elderly people, particularly those over age 75, are subject to problems of access to needed health services, of the appropriateness of these services in relation to their needs, and of increasing infirmity, disability and dependency, with loss of their natural support systems. The proportion of health expenditures deployed to deal with the institutionalization and long-term requirements of elderly people is increasing in a national climate characterized by tightening constraints on public expenditures for health care under Medicare and Medicaid. The Robert Wood Johnson Foundation has accepted objectives and roles to find better ways to use what we already know to improve elderly people's access to health care, to improve their functional effectiveness, and to make their health care more affordable. The results of some of the programs it has supported represent innovative approaches and demonstrate ways in which we may accomplish these objectives.

Toward a Comprehensive Geriatric Educational Experience

A description of the goals and the accomplishments of a program in geriatric education and training is presented. Emphasis is laid on the potential role of departments of family and community medicine, even though vast resources may not be available. Such a program is of great importance, but it must be viewed as only the first step in the development of a comprehensive training model for either a school of medicine or a residency program in primary care. Upon graduation in Family Medicine, residents should not only be aware of the specific health needs of the elderly, but also be clinically competent to meet those needs.

Geriatrics program for medical students and family practice residents. I. Establishing attitudes toward the aged.

This report concerns the initiation of required experience in geriatrics for undergraduate medical students and a program of research designed to evaluate that experience. Through the use of questionnaires, an attempt was made to differentiate between attitudes toward the elderly and their rehabilitation potential as stated by medical students, family practice residents, and professional and nonprofessional nursing-home staff members. Important differences were found between professional and nonprofessional groups, but no significant differences among professionals. Implications for the training of professional and nonprofessional staff members are discussed, and further research plans specified.

Welfare emotions and family therapy in geriatrics.

ABSTRACT:This article is a description of a two‐phase approach to family therapy in a geriatric setting. Phase 1 involves separation of the hostile family members. This is easily accomplished, often by placing the patient in a Day Hospital, but does not lead to rehabilitation. Phase 2 involves the working‐through of family conflicts, and is much more difficult to accomplish. However, it can be successful if “welfare emotions” exist in the family, based on a good marriage, work record and retirement adaptation. The resulting rehabilitation and discharge is a valuable experience in geriatrics. Thus permanent or premature admission to an institution often can be avoided.