Geriatric Program Research Articles

Implantación de un programa de Geriatría de enlace coordinado con Atención Primaria en 60 centros sociosanitarios del área asistencial noroeste de la Comunidad de Madrid

ObjectiveTo describe interventions included in the implementation of a multidisciplinary Geriatrics Program that gives support to nursing homes, in coordination with Primary Care and Public Health, in collaboration with other hospital departments. MethodsAn observational descriptive study was conducted in an area that includes 60 nursing homes with nearly 4600 residents from June 1 st, 2020 to October 1 st, 2021. The program consists of different interventions including Telemedicine and support of a Geriatric Consultation Liaison Team. An estimation of avoided costs through these interventions was carried out. ResultsThe activity recorded was 11502 telephone calls, 2247 e-mails, 313 visits to these centres in where 4085 patients underwent comprehensive geriatric assessment. During this period of time 442 patients received intravenous therapy in their nursing homes, including 7541 different types of medication which 5850 of them were antibiotics. According to the Diagnosis-related-Group (DRG) of the patients that received intravenous treatment in their nursing homes, was estimated a cost reduction of 1,500,00€ and a total of 2800 days of hospital stay avoided. In the group of 198 patients that received video consultation was estimated reduction of costs of 37,026€. A hospital multidisciplinary care team focused on the nursing home patients was created. ConclusionsThis program improves continuity of nursing homes patients care and to enhance communication and coordination among Primary Care, Hospitals and Public Health services and secondarily, reducing hospital costs.

Correlation analysis of physical fitness and its impact on falls in 2130 community- dwelling older adults: a retrospective cross-sectional study

BackgroundAs the community-dwelling population ages in Taiwan, concerns regarding long-term care have grown more urgent. Physical fitness plays a key role in enabling community-dwelling older adults to independently complete daily tasks and avoid falling accidents. However, the effect of physical fitness on falls and other fitness-related factors remains poorly understood.MethodsIn this retrospective cross-sectional study, 2130 community-dwelling older adults were recruited from a rural region of Taiwan. Each of these participants completed a demographics interview and frailty questionnaire and reported their history of falls. We evaluated each participant’s height and body weight measurements, calf circumference, bone mass density, and results on the grip strength, single-leg standing, chair sit-and-reach, 8-ft up-and-go, 30-second chair stand, 2-minute step, 30-second arm curl, 6-m walk, and back scratch tests to determine their overall physical fitness, which consisted of their body composition, muscular strength and endurance, flexibility, and cardiopulmonary fitness.ResultsThe prevalence of falls in the preceding year among the older adults surveyed was 20.8%, and the resultant hospitalization rate was 10.9%. The older adults who were more physically active in the past week, had regular exercise habits, lived with family, and had no history of hospitalization due to falls, exhibited greater performance on the physical fitness tests. Three time fallers exhibited lower levels of overall physical fitness than did those who had not fallen. The nonfallers outperformed the fallers in grip strength (participants who had not fallen and those who had fallen once, twice, or three times in the preceding year: 24.66 ± 0.19 vs. 23.66 ± 0.35 vs. 20.62 ± 0.71 vs. 22.20 ± 0.90 kg) and single-leg standing duration (19.38 ± 0.39 vs. 16.33 ± 0.78 vs. 13.95 ± 1.67 vs. 12.34 ± 1.82 seconds).ConclusionsExercise habits, living status, hospitalization due to falls, and amount of exercise were all associated with physical fitness in community-dwelling older adults. The results of all of the assessments indicated that the participants who had fallen three times exhibited lower levels of physical fitness than did those who had not fallen in the previous year. Physical measurements, including grip strength and single-leg standing duration, are associated with an individual’s risk of falling, which indicates that they should be considered in the development of geriatric physical fitness and fall-prevention programs.

Transforming an Orthopaedic Unit Into an "Age-Friendly" Unit Through Implementation of the American Geriatrics Society's CoCare: Ortho Program.

To transform an inpatient orthopaedic unit into an age-friendly unit for geriatric fracture center (GFC) patients. Pragmatic dissemination study of a continuous quality improvement intervention with episodic data review. Large quaternary care university hospital with no on-site geriatrics program and no dedicated geriatric inpatient unit. Individuals 60 years of age and older with fragility fracture of the native proximal femur hospitalized from July 2017 to June 2020. A hospital medicine-orthopaedics comanagement model for a GFC was developed using processes, tools, and education provided by the American Geriatrics Society's AGS CoCare: Ortho program to support the age-friendly 4Ms principles: mentation, mobility, medications, and what matters. Delirium reduction strategies included minimizing sleep interruption through changes in blood draw times, order sets for pain management, and nursing education. Mobility specialists were incorporated to improve early mobilization on the orthopaedic unit. Frequency of weight-bearing on postoperative day 1 and frequency of delirium among GFC patients on the orthopaedic unit were compared with those among concurrent GFC patients on other units. Frequency of delirium was 26% among patients on the orthopaedic unit versus 35% among those on other units (P = 0.055). Frequency of weight-bearing on post-operative day 1 was 84% among patients on the orthopaedic unit versus 72% among those on other units (P = 0.003). AGS CoCare: Ortho is an effective dissemination program for establishing a hospital medicine-orthopaedics comanagement program and making an orthopaedic unit age-friendly in a hospital without onsite geriatricians or a dedicated geriatrics unit. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Prehabilitation and perioperative geriatric care in patients aged over 80 years with colorectal cancer: Results of a cross-speciality geriatrics program

ObjectivesTo describe a perioperative cross-speciality geriatrics program for patients aged >80 years with colorectal cancer (CRC), aimed to detect and manage frailty and to understand its influence on clinical outcomes. Materials and methodsPatients aged >80 years with CRC and proposed for surgery were included from October 2018 to March 2020. Comprehensive geriatric assessments (CGA) were performed. Patients were classified according to the estimated physiological reserve, from fit, frail patients and even the disabled: CGA-1, CGA-2, CGA-3, and CGA-4. Individualised treatment was adapted to each patient's situation. Patients who underwent surgery were followed up by a geriatrician. The presence of complications, length of stay, hospital readmissions at 30 days, and short- and long-term mortality were recorded. ResultsSeventy-four patients were included. The mean age was 84.5 ± 4.5 years. 55.4% patients were classified as CGA-1, 24.3% as CGA-2, 16.2% as CGA-3, and 4.1% as CGA-4. No CGA-4 patient was operated on. Frail (CGA-2 and CGA-3) patients had higher medical complications (50% vs 21.2%, p < 0.05) and delirium (30% vs 9.1%, p < 0.05) than fit patients (CGA-1). They also had higher rates of surgical complications (20% vs 15.2%), longer hospital stay (10 ± 6.2 vs 8.4 ± 4.2 days), 30-day readmissions (15% vs 6.3%), and mortality at six (10% vs 3%) and twelve months (20% vs 6.1%), although it was not statistically significant. ConclusionCGA and prehabilitation can classify patients according to their frailty status, support clinicians in decision-making to achieve tailored treatment, and detect clinical conditions for intervention in multiple domains of health in the perioperative period.

Effect of a Community Gerontology Program on the Control of Metabolic Syndrome in Mexican Older Adults.

Background: Metabolic syndrome (MS) is highly prevalent in older adults; it constitutes a risk factor for cognitive deterioration, frailty, and Alzheimer’s disease. For this reason, the WHO has pointed out the importance of the implementation of community programs for the training of healthy aging. The aim of this study was to evaluate the effect of a community gerontology program framed in active aging on the control of metabolic syndrome in older adults. Methods: An experimental study was carried out in a convenience sample of 80 older adults diagnosed with MS according to the ATPIII criteria, comprising (1) experimental group (EG), n = 40; (2) control group (CG), n = 40. During a 6-month period, the EG participated in a supervised community gerontology program, and the CG was assessed monthly. Results: A statistically significant decrease was observed in the number of components for the diagnosis of MS. In this regard, of the total of participants with a diagnosis of MS in EG, only 28% maintained the diagnosis of MS (ATPIII ≥ 3 criteria), in contrast to 83% of the CG participants (p < 0.0001). Conclusions: Our findings suggest that health self-care training within the framework of active aging is effective for the control of MS in older adults.

Gender and Racial Trends among Geriatric Psychiatry Fellows in the USA: A Call to Action.

The United States (USA) is a culturally and ethnically diverse country with an estimated 5.6 to 8 million elderly population living with psychiatric and substance use disorders and a dwindling geriatric psychiatry workforce.In this study, we explored the gender and racial trends in USA geriatrics psychiatry fellowship programs from 2007-20, and forecasted the 2030 geriatric psychiatry workforce to identify the gaps and provide recommendations. This retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) data included trainees in geriatric psychiatry fellowship programs in the USA from 2007-20. Races were classified as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black (Non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was categorized as Male, Female, and Not Reported. Amongst the geriatric psychiatry fellowship trainees, there was an overall decrease in the representation of all races from 2011-20. There was a relative decrease of 16%, 8.6% and 2.3% for White (Non-Hispanic), Asian/Pacific Islander, and Black (Non-Hispanics) respectively whereas the Hispanic and Native American/Alaskan trainees remained unchanged. Women relatively increased 28.4% from 2007-20 while men relatively decreased 27.1%. Our projections suggest that without changes in the current health professional recruitment trendsand the shortage of geriatric psychiatrists will persist with a shortfall of 1,080 (9.7%) by 2030. There are critical gaps in racial and gender representation in geriatric psychiatry fellowship programs in the USA. An inclusive workforce is required to address diverse communities and bridge gaps in physician workforce gender and racial disparities.

Recommendations for promoting university wide gerontological education: findings from an exploratory study

ABSTRACT The importance of gerontology-focused classroom and field education has been emphasized heavily in social work education for decades as the population of older adults continues to expand, as does the need to provide services to support the health and well-being of older adults. Although the need for social workers and other professionals who possess competency in relevant aging issues is paramount, various challenges still exist in regard to curricular infusion of gerontological education and generating student and faculty interest in this area of study. This exploratory study highlights empirical findings from faculty and students at a growing metropolitan university with no current gerontology program or gerontology certificate program. The present study employed cross-sectional, quantitative survey research to identify experience, interest, preparedness, and barriers expressed by university faculty and students in regard to addressing a rapidly aging society. Findings contribute to preexisting literature and offer new insight and feasible recommendations for faculty in all university departments to expand gerontological education opportunities.

EFFECT OF GERIATRIC COMMUNITY PROGRAM ON ACHIEVING SUSTAINABLE DEVELOPMENT GOALS AND UNIVERSAL HEALTH COVERAGE AMONG OLDER PERSONS IN AFRICA; A NIGERIA PROJECT PLAN

Population of older person are growing globally, in Africa and Nigeria. The WHO stated that this demographic change has implications on health care systems and on achieving sustainable development goals (SDGs) and universal health coverage (UHC). However, programs to adjust to population aging is still lacking in countries like Nigeria. This project proposal aims to implement and evaluate, with goal of scaling up, community geriatric program on achieving SDGs and UHC among older persons in Nigeria. Intervention approach will include home based management of older persons through seven geriatric case management processes, service provisions by trained case managers across four intervention domains, instituting and supporting health geriatric clinics and drug banks, enrollment of beneficiaries into national health insurance program and supporting system strengthening (on geriatric care) for service providers and hospitals. Data collection and entry will be done using expert data capturing tools and geriatric data management information system (GDMIS), while data analysis will be done through comparison of pre and post intervention indices. Review of literatures and anecdotal data show paucity of geriatric projects for care of older persons whose population is exponentially increasing in Africa. This project proposal that aims to implement and evaluate effect of a novel and innovative community health programs on achieving SDGs and UHC goals among older persons in Nigeria will share its result, conclusion, and recommendations, which will be disseminated for adaption and adoption for geriatric programing in the African context.

Dance practices as a component of geriatric preventive programs

Dance practices as a component of geriatric preventive programs

(Re)Introducing the Gerontology and Geriatrics Curricular Standards and Guidelines in Higher Education

The lecture will be given by the 2020 recipient, Sara Czaja, PhD, FGSA of Weill Cornell Medicine. The 2021 M. Powell Lawton Award recipient is David Roth, Phd, FGSA, of Johns Hopkins University. The M. Powell Lawton Award is presented annually to an individual who has made outstanding contributions from applied research that has benefited older people and their care. The Lawton Award is generously funded by the Polisher Research Institute of Abramson Senior Care.

(Re)Introducing the Gerontology and Geriatrics Curricular Standards and Guidelines in Higher Education

The Academy for Gerontology in Higher Education (AGHE), the education member group of GSA, is the only national institutional membership organization devoted primarily to gerontology and geriatrics education. Its mission provides for development and sponsorship of initiatives to advance the field of aging through its focus on education in gerontology/geriatrics. AGHE first published the Gerontology and Geriatrics Curricular Standards over three decades ago – a document that has been an integral resource for implementing/revising programs in liberal arts, the sciences, and more recently, health professions. To meet the needs in the field for increased breadth and depth of content, the new 7th edition of the educational guidelines fully embraces competency-based education for gerontology, as the health professions programs have for years. Our first presenter will provide an overview of the new edition. The second presenter will focus on associate degree programs in gerontology and their unique contribution to higher education. The third will present on undergraduate programs in gerontology explaining how these programs give students an edge in today’s job market. The fourth presenter will address graduate programs in gerontology, describing master’s degree programs and doctoral degree programs in gerontology and aging studies. The fifth presenter will discuss health professions programs including geriatrics curricula for osteopathic medical education, gerontology/geriatrics curricula for health-related programs and the doctor of pharmacy degree programs. Presentations will provide expert recommendations for program development through mapping AGHE’s Gerontology Competencies for Undergraduate and Graduate Education to programs in higher education. Nina Silverstein will serve as discussant.

Standards and Guidelines for Associate's Degree Programs in Gerontology

Associate degree programs in gerontology occupy a unique space in higher education. They must prepare students for a wide variety of careers and opportunities from technical and vocational training to preparation for further gerontology education at a four-year college. It is widely known that there is great variability among the numerous associate degree programs in gerontology; this presentation gives an overview of the revised standards and guidelines for associate degree programs. Associate degree programs will vary based on the faculty, the leadership, the program, and institutional support, this presentation discusses best practices for a variety of program types paying particular attention to competency-based educational strategies.

Standards and Guidelines for Graduate Programs in Gerontology and Geriatrics

Graduate programs in gerontology prepare students for advanced academic and/or applied careers in aging. Programs at this level offer greater depth, breadth, and increased emphasis on theory and research. Persons completing a master’s and/or doctoral degree in gerontology or aging studies have reached the level of “gerontologist” whereby they have completed the necessary coursework in the physical, psychological, social and built environment in order to understand the unique opportunities and challenges of aging in a scholarly manner. While the depth of treatment of each topic will vary across programs, each of the AGHE Core Competencies should be mastered at a level of “analyzation and evaluation” or higher on Bloom’s Taxonomy of Educational Objectives. The current presentation addresses how the AGHE Standards and Guidelines for graduate programs in gerontology were updated as a competency-based curriculum that includes coursework, practicum, and a culminating project (e.g., thesis, comprehensive exam, and/or dissertation).

Generating Community Engaged Learning in Gerontology Courses During the COVID-19 Pandemic

This presentation describes the core traits of a community-engaged learning (CEL course), how one gerontology program incorporated a theoretical framework to continue to provide students opportunities during the COVID-19 pandemic, and how generalizable this is across gerontology programs. Caregiving and Aging Families, a gerontology course enrolling both undergraduate and graduate students, champions community-engaged learning in two critical ways: students attend caregiver support groups in the community, and students form a partnership with a caregiver mentor in the community. This partnership allows students an intimate look at the caregiver's role and burden while enlisting the student to prepare a service care plan and compendium of resources for the caregiver. Ensuring the safety of older adults during the COVID-19 pandemic placed restrictive parameters on these experiences. While students typically attend support groups and identify and partner with a caregiver mentor in person, this needed modification during the pandemic. This was created through the application of Baltes' Theory of Selection, Optimization, and Compensation (SOC model), aided by a CEL teaching assistant, funded through the campus Community Service Center. This allowed for identifying, coordinating, and communicating with community partners throughout the semester and provided ongoing communication, technical assistance, and problem-solving for both partners and students. Caregiver groups with a robust online, synchronous presence were identified and approached. The gerontology program communities of interest disseminated a call for community caregivers with basic technological familiarity. The caregiver mentor-student partnerships were founded and maintained, with additional benefits stemming from a shared pandemic experience.

Alternative Pathways: The Use Of Field-Specific Micro-Credentials in Aging Services

The rise of formal academic programs in gerontology at colleges and universities has been well documented over the last fifty years. Organizations such as AGHE and AGEC have been established to provide guidance, foster consistency, and advance formal gerontology education programs. Broadly, the purpose of these programs has been to develop a pipeline of trained gerontologists for the aging services workforce. What has been less documented is the rise of alternative pathways to gerontology and gerontological competence, including micro-credentialing. Micro-credentials are intended to provide quick-to-complete competency-based education around specific topics to demonstrate relevant skills to employers. To date, little is known about the prevalence of micro-credentialing in gerontology. Still, it may be that micro-credentials are sought in place of formal academic preparation due to their reduced cost, ease of completion, recognizability, and opportunity to quickly train employees in specific skills. To address this gap, we conducted a review of existing gerontological micro-credentialing opportunities. We identified a total of 51 micro-credentials with an explicit aging-focus and searched for associated competencies for these micro-credentials. In this poster, we describe findings on the emphases of micro-credentials, including dementia and care coordination, and review the programs' scope and nature of competencies. We argue that micro-credentialing can offer value for employees unable or unwilling to pursue formal academic training but should be differentiated from such training. Moving forward, it is critical to ensure alignment between gerontological micro-credentials and established gerontological competencies and standards and to differentiate micro-credentials from formal academic programs.

Policy Series: Building Momentum for Diversity, Equity, and Inclusion in Geriatrics and Gerontology Education

With an increasingly multicultural and diverse older adult population, health care professionals must be prepared to serve older adults from varied backgrounds and marginalized communities; address health determinants and disparities; and promote diversity, equity, inclusion, and empathy within systems of care. The National Association for Geriatrics Education (NAGE) is a non-profit organization representing geriatric and gerontology education and training programs, including Health Services and Resource Administration (HRSA) funded Geriatric Workforce Enhancement Programs (GWEPs), and Geriatric Academic Career Awardees (GACAs). The 44 GWEPs focus on improving health outcomes for older adults by enhancing geriatrics and primary care training of the healthcare workforce. The 26 GACA awards support leaders in Age-Friendly health care transformation and interprofessional clinical geriatrics training. This symposium examines the role both programs have in reducing racial health disparities in older adults by promoting increased diversity of the geriatrics/gerontology workforce and advancing public policies for racial equity and inclusion. First, presenters will introduce the NAGE Diversity and Racial Equity Workgroup that supports a broader and unified effort across GWEPs and GACAs for equity and inclusion in geriatrics and gerontology education. Presenters will then share strategies to mobilize system-level changes within their institutions. Finally, examples of progress showcase individual GWEP and GACA projects and partnerships aimed at reducing racial health disparities within a multidimensional and local context. Presenters discuss strategies and opportunities to disrupt and transform health professions education at multiple levels and implications for policies supporting optimal aging for all older adults.

Answering the Call for Diversity and Racial Equity: The National Association for Geriatric Education

The National Association for Geriatric Education (NAGE) is a non-profit organization representing geriatric and gerontology programs, including Health Services and Resource Administration funded Geriatric Workforce Enhancement Programs (GWEPs), and Geriatric Academic Career Awardees (GACAs). NAGE responded to the renewed call to address systemic racism and racial inequities by forming a Diversity and Racial Equity Workgroup. The Workgroup explored ways to disseminate educational resources, support members to address racial inequities among older adults, promote increased diversity of the geriatrics/gerontology workforce, and support public policy initiatives that address racism and health disparities. Initial outputs include creating a Diversity and Racial Equity resource page, identifying liaisons to the Workgroup from each NAGE Committee to ensure impact across the organization, and organizing collaborations across GWEPs and GACAs to share successful initiatives. Future plans include education and advocacy with members and collaborating organizations to address systemic racism and racial health inequities impacting older adults.

Refining the Loop of Continuous Improvement

Academic assessment of student competency is essential to measure learning within a gerontology program. In its self-evaluation, a program must assess its student learning outcomes. JoAnn Damron-Rodriguez et al. (2019, p. 423) proposed a systematic approach that has several levels. The key is to utilize a competency-based education model. Moreover, to satisfy workforce goals the gerontology program must adopt the AGHE competencies that reflect the knowledge, skills, and attitudes necessary to serve older adults at an acceptable level of care. The next step involves generating well-articulated quantitative or qualitative measures of student learning outcomes (SLOs) consistent with the program’s mission statement that include twelve competency domains. SLO measures include test grades, assignments, projects, portfolios, field experiences, essay questions, multiple choice items, and so on. The program’s enhancement loop requires the evaluation of SLOs, faculty discussion of them, and a continuous modification cycle "closing the loop" to reach the program’s goals.

Community College Gerontology Programs: Revisiting and Re-Visioning Workforce, Career Pathways, and Transfer

The session will focus on new and existing innovative ways that Community Colleges are effectively addressing workforce needs resulting from a rapidly aging population; the ever-expanding career pathways available to students in the field of gerontology; as well as the continuing higher education needs of students transferring to bachelor’s and graduate-level gerontology programs. A panel of Community College and University gerontology professionals, representing both the GSA Community College and Aging Workforce Interest Groups, will share the innovative ways that they are working to address the three focus areas of this symposium. We will also include opportunities for discussion with participants about their experiences with and ideas for addressing these issues.

The Impact of Declining Enrollment and Re-Careering on Community College Gerontology Programs

Abstract According to Inside Higher Ed (2020), community college enrollment declined by 10.1% during the fall 2020 semester and this decline in enrollment continued into the spring 2021 semester for many community colleges. Gerontology programs within community colleges were among curriculums impacted by this downswing in enrollment. This presentation will discuss what this means for community college Gerontology programs across the United States in a time when the older adult population is rapidly increasing, and a qualified workforce is needed to fill the multiple fields serving this aging population. One area of discussion will be the number of returning adults who are re-careering into Gerontology, some because of the impact of a family caregiving situation while others are motivated to change careers because of their interest in the numerous career pathways available in the field of aging. Suggestions for encouraging and supporting these newly returning adults will be discussed.