Geriatric Psychiatry Fellowship Research Articles

Improving Geriatric Psychiatry Fellowship Recruitment in Underserved Areas of New York State

Improving Geriatric Psychiatry Fellowship Recruitment in Underserved Areas of New York State

P118: The Geriatric Psychiatry Fellowship Program in Mexico

This program was established by Dr. Oscar Ugalde in the year 2000 at the National Institute of Psychiatry of Mexico and was supported by the National Autonomous University of Mexico.Now starting its 23rd year, the 12-month program allows 1 to 4 national or foreign psychiatrist each academic year to develop clinical geriatric psychiatry practice knowledge, as well as academic and research skills to attend to the mental health of the aging population. It provides supervised clinical training in different settings: outpatient geriatric psychiatry clinic, cognition clinic, nursing home setting, geriatrics clinic and neurology clinic. The fellowship also provides the opportunity to learn about thanatology, research methodology, philosophy, spirituality, social work, neuropsychology, dementia, geriatrics, as well as legal, financial and legal issues related to the care of older adults.The over 60 fellowship graduates from Bolivia, Colombia, Ecuador, Peru, and Mexico have established themselves as national and international leaders in the field of old age mental health.The Geriatric Psychiatry Fellowship in Mexico is accredited by de National Autonomous University of Mexico and The National Institute of Psychiatry of Mexico Ramón de la Fuente Muniz at Mexico City is the primary training facility.In this presentation, the assistant professor of the program, Dr. Luis Moncayo, will lay out an overview of the content, structure, and goal of The Geriatric Psychiatry Fellowship Program in Mexico.

Geriatric Psychiatry Fellowship Alumni Networking: Learning the Strengths, Interests, and Goals

Geriatric Psychiatry Fellowship Alumni Networking: Learning the Strengths, Interests, and Goals

Evaluation of the variety and efficacy of internal recruitment strategies at the University of New Mexico Geriatric Psychiatry Fellowship

Evaluation of the variety and efficacy of internal recruitment strategies at the University of New Mexico Geriatric Psychiatry Fellowship

Older Age for Every Training Stage: Confessions of a Geriatric Psychiatrist

The World Health Organization estimates that by 2050, individuals 60 or older will make up 20% of the US population, with about 15% experiencing mental disorders.(1) Unfortunately, the number of geriatric psychiatry fellows has dropped by 55% between 2022 and 2021.(2) Furthermore, the number of Black and Latinx fellows who graduate from a geriatric psychiatry program remains in the single digits.(3) This statistic is concerning given the increasing proportion of aging Black, Latinx, and Asian adults.(4) This session aims to share insights from psychiatrists of varying levels of training on strategies to improve diversity, recruitment, and retention within the field of geriatric psychiatry.Citations1. World Health Organization. (2017, December 12). Mental health of older adults. World Health Organization. Retrieved August 28, 2022, from https://www.who.int/en/news-room/fact-sheets/detail/mental-health-of-older-adults2. Conroy, M. L., Yarns, B. C., Wilkins, K. M., Lane, C. E., Zdanys, K. F., Pietrzak, R. H., Forester, B. P., & Kirwin, P. D. (2021). The AAGP Scholars Program: Predictors of Pursuing Geriatric Psychiatry Fellowship Training. The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry, 29(4), 365–374. https://doi.org/10.1016/j.jagp.2020.07.0123. Accreditation Council for Graduate Medical Education data ... - ACGME. Accreditation Council for Graduate Medical Education. (n.d.). Retrieved August 27, 2022, from https://www.acgme.org/globalassets/pfassets/publicationsbooks/2020-2021_acgme_databook_document.pdf4. U.S. Census Bureau. Race and Ethnicity in the United States: 2010 Census and 2020 Census. Retrieved August 28, 2022 from https://www.census.gov/library/visualizations/interactive/race-and-ethnicity-in-the-united-state-2010-and-2020-census.html

A Survey of Geriatric Psychiatry Fellows and Program Directors: Specialty Choice, Program Choice, and Program Quality.

This study explored factors influencing a physician's choice to pursue geriatric psychiatry fellowship training from fellow and program director perspectives to improve recruitment into this critical need specialty. Questionnaires were sent to the 54 fellows and 79 fellowship program directors of programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) available through the American Association for Geriatric Psychiatry (AAGP) listserv. A 5-point Likert scale (strongly disagree, disagree, neutral-undecided, somewhat agree, strongly agree) was used to score and rank these questionnaires. Thirty-three program directors (42%) on the AAGP listserv and 24 (44%) of all ACGME accredited fellows responded. The clinical quality of the faculty (Fellows 92%, Program Directors 92%) and the fellowship's national reputation (Fellows 75%, Program Directors 88%) were most highly ranked by both. Fellows ranked proximity to family (79%) high (2nd) in their program choice, while ranking workload, salary, and visa issues as low. This study emphasizes that family and cultural/ethnographic considerations, along with the core values of a training program, remain highly valued by trainees, and should inform structural changes to incentivize training, and enhance the inherent quality of fellowship programs.

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.

Palliative Care Training for Geriatric Psychiatry Fellows: A National Survey Project

ObjectivesPalliative care is an essential part of the standard of care for individuals with serious medical illnesses. Integration of palliative care and mental health is important for elderly patients with medical and psychiatric comorbidities. Geriatric psychiatrists are natural stewards of palliative care-mental health integration, however this is contingent on palliative care training. Currently, palliative care training in geriatric psychiatry fellowship programs is uncharacterized. We surveyed geriatric psychiatry fellowship program directors in the United States to assess current palliative care training practices. MethodsWeb-based anonymous survey of geriatric psychiatry fellowship training directors ResultsForty-six percent (28/61) of program directors responded. Seventy one percent (20/28) of programs provide didactics on palliative care. Seventy-seven percent (20/26) of programs provide clinical experiences in palliative care. Sixty-three percent (15/24) have formalized interactions between geriatric psychiatry and palliative care fellows. ConclusionsPalliative care training for geriatric psychiatry fellows is robust but unstandardized. Operationalizing palliative care training for geriatric psychiatrists may improve mental health integration into serious illness care.

Forensics in Geriatric Psychiatry Fellowship: Evolution and Practice Value

There are over 50 million adults aged 65 or older in the United States, representing 15% of the U.S. population (United States Census Bureau, 2018). There are too few geriatric psychiatrists to serve this population. Annually, small numbers of psychiatrists are choosing to pursue careers in Geriatric Psychiatry, with fewer than 60 individuals completing subspecialty training in Geriatric Psychiatry each year (ACGME, 2019). To meet the needs of this diverse population, clinical training in Geriatric Psychiatry must be comprehensive and evolve to ensure trainees graduate with requisite practical competence in areas within their purview. Medicolegal issues arise in the routine care of older individuals across different settings and situations, necessitating a firm understanding, knowledge and assessment skill of relevant medical, psychosocial and cognitive factors that may have legal importance. The teaching of forensic aspects of Geriatric Psychiatry varies across fellowship programs and Forensic Psychiatry fellowships often do not have an elder law component or explicit curriculum addressing the forensic needs of the older adult. Thus, Geriatric Psychiatry fellowship training is the ideal place to educate the future cohort of geriatric psychiatrists serving the older population in forensic matters. UCLA has developed an interdisciplinary curriculum involving integrative encounters combining the education of Geriatric Psychiatry fellows and law students and ending with the practical experience of a mock trial. Participants of this symposium will gain knowledge necessary to develop an integrative educational curriculum for Geriatric Psychiatry fellows that results in procurement of skills to serve as an expert witness, to write expert reports and to testify for probate or conservatorship hearings.

Predictors for Matriculation into Geriatric Psychiatry Fellowship: Data from a 2019-2020 National Survey of U.S. Program Directors.

ObjectiveWith the number of geriatric psychiatry fellows declining from a peak of 106 during 2002–2003 to 48 during 2020–2021, this study aims to investigate characteristics of the geriatric psychiatry training requirement across U.S. psychiatry residency programs and to identify specific factors which may influence residents to pursue geriatric psychiatry subspecialty training.MethodsThe authors queried the American Medical Association’s Fellowship and Residency Electronic Interactive Database Access system to compile a list of program directors from the Accreditation Council for Graduate Medical Education sponsored general adult psychiatry residency programs. Program directors were emailed an anonymous multiple-choice survey to ascertain specific characteristics of their program’s geriatric psychiatry training experiences. This study’s primary outcome was the percentage of residents entering geriatric psychiatry fellowship after completion of general psychiatry training. Linear regression analysis determined which variables may be associated with this primary outcome.ResultsOf 248 surveyed, 60 programs (24%) responded to the survey. Only one of the independent variables revealed a statistically significant association with the percent of residents that became geriatric psychiatry fellows: the number of geriatric psychiatrists at the residents’ home institution (p=0.002).ConclusionsConsistent with previous data, the presence of geriatric psychiatry faculty members is strongly associated with the decision to pursue subspecialty training in geriatric psychiatry.

Residents Interested in Public Sector Career Would Benefit From Geriatric Training

Back to table of contents Previous article Next article ProfessionalFull AccessResidents Interested in Public Sector Career Would Benefit From Geriatric TrainingHana Ali, M.D., Melanie Scharrer, M.D.Hana AliSearch for more papers by this author, M.D., Melanie ScharrerSearch for more papers by this author, M.D.Published Online:3 Mar 2021https://doi.org/10.1176/appi.pn.2021.2.31AbstractThe U.S. population is rapidly aging, and many have serious mental illness. Psychiatry residents should consider geriatric training to augment training in community psychiatry.“Do you like it?” Ms. M asked, fluffing her newly permed hair. It did seem unbelievable that several months ago, she had been referred for hospice care. At the time, the patient rarely spoke or ate during her frequent discharges and readmissions to the state geriatric psychiatric hospital and the university hospital nearby. Slowly, through collaboration among specialists from geriatric psychiatry, palliative care, and geriatric primary care, her multiple comorbid conditions were addressed, and her complex psychotropic medication regime was simplified. She experienced a remarkable recovery and was now ready to go on living.Community psychiatrists constantly use the skills acquired during a geriatric psychiatry fellowship, which can allow them to provide more comprehensive care for aging patients with serious mental illness (SMI), most of whom have multiple psychiatric and medical comorbidities.As the nation’s population ages, so too are individuals living with SMI. These individuals have unique needs that fall at the intersection of the subspecialties of public psychiatry and geriatric psychiatry. Today, many older patients with SMI receive care at public mental health clinics where they are cared for by community psychiatrists and in Assertive Community Treatment programs. However, the shortage of geriatric psychiatrists in this country is well known, and more public-sector psychiatrists with expertise in geriatric psychiatry are needed.In the last decade, fellowship programs in public and community psychiatry have gained popularity among psychiatry residents. A survey of psychiatry trainees found that most had a significant level of interest in public psychiatry. Since 2006 the number of public and community psychiatry fellowship programs in the United States has expanded from two to 21 programs, according to the American Association for Community Psychiatry. These programs equip trainees with skills needed to navigate increasingly complex public mental health infrastructures to provide care for individuals living with SMI. To provide more comprehensive and high-quality care for the rapidly aging population in the United States, trainees who intend to work in public mental health clinics will benefit from geriatric psychiatry training and should consider completing a postgraduate fellowship in geriatric psychiatry.Geriatric psychiatry and public psychiatry already overlap significantly. Geriatric psychiatrists care for patients with complex disease presentations that require collaboration with other medical specialists. They work on interdisciplinary teams to navigate complicated behavioral health and social service systems and are often at the forefront of developing innovative systems of care to meet the needs of our nation’s aging population. In many ways, geriatric training is a natural fit for residents interested in working in the public sector.The challenges that excite individuals interested in public and community psychiatry are the same challenges that exist in the field of geriatric psychiatry: working collaboratively with health care professionals in other disciplines; navigating complex health systems; effectively utilizing local, state, and federal resources; and developing other structural interventions to meet the mental health needs of underserved populations. The overlap is clear. Exposing trainees who have an interest in community and public psychiatry to experiences in geriatric mental health can help alleviate the geriatric workforce shortage and ultimately result in better treatment for our aging SMI population. ■To learn more about geriatric training and other opportunities in the field, please visit the American Association for Geriatric Psychiatry (AAGP) website here.Psychiatry residents and medical students are also encouraged to apply to the AAGP Scholars Program. Both authors are alumni of the AAGP Honors Scholars Program.Hana Ali, M.D., is a PGY-4 psychiatry resident at Yale University.Melanie Scharrer, M.D., is a community psychiatrist who recently completed her geriatric psychiatry fellowship training at the University of Wisconsin School of Medicine and Public Health. ISSUES NewArchived

The AAGP Scholars Program: Predictors of Pursuing Geriatric Psychiatry Fellowship Training

The American Association for Geriatric Psychiatry (AAGP) Scholars Program was developed to recruit trainees into geriatric psychiatry fellowships and is considered a pipeline for fellowship recruitment. Nonetheless, the number of trainees entering geriatric psychiatry fellowship is declining, making it important to identify modifiable factors that may influence trainees' decisions to pursue fellowship. We analyzed survey data from Scholars Program participants to identify demographic characteristics, attitudes toward program components, and behaviors after the program that were independently associated with the decision to pursue fellowship. Web-based surveys were distributed to all 289 former Scholars participants (2010-2018), whether or not they had completed geriatric psychiatry fellowships. We conducted a hierarchical binary logistic regression analysis to examine demographics, program components, and behaviors after the program associated with deciding to pursue geriatric psychiatry fellowship. Sixty-one percent of Scholars decided to pursue geriatric psychiatry fellowship. Attending more than one AAGP annual meeting (relative variance explained [RVE] = 34.2%), maintaining membership in the AAGP (RVE = 28.2%), and rating the Scholars Program as important for meeting potential collaborators (RVE = 26.6%) explained the vast majority of variance in the decision to pursue geriatric psychiatry fellowship. Nearly two-thirds of Scholars Program participants decided to pursue geriatric psychiatry fellowship, suggesting the existing program is an effective fellowship recruitment pipeline. Moreover, greater involvement in the AAGP longitudinally may positively influence Scholars to pursue fellowship. Creative approaches that encourage Scholars to develop collaborations, maintain AAGP membership, and regularly attend AAGP annual meetings may help attract more trainees into geriatric psychiatry.

FORENSICS IN GERIATRIC PSYCHIATRY FELLOWSHIP: EVOLUTION AND PRACTICE VALUE

There are over 50 million adults aged 65 or older in the United States, representing 15% of the U.S. population (United States Census Bureau, 2018). There are too few geriatric psychiatrists to serve this population. Annually, small numbers of psychiatrists are choosing to pursue careers in Geriatric Psychiatry, with fewer than 60 individuals completing subspecialty training in Geriatric Psychiatry each year (ACGME, 2019). To meet the needs of this diverse population, clinical training in Geriatric Psychiatry must be comprehensive and evolve to ensure trainees graduate with requisite practical competence in areas within their purview. Medicolegal issues arise in the routine care of older individuals across different settings and situations, necessitating a firm understanding, knowledge and assessment skill of relevant medical, psychosocial and cognitive factors that may have legal importance. The teaching of forensic aspects of Geriatric Psychiatry varies across fellowship programs and Forensic Psychiatry fellowships often do not have an elder law component or explicit curriculum addressing the forensic needs of the older adult. Thus, Geriatric Psychiatry fellowship training is the ideal place to educate the future cohort of geriatric psychiatrists serving the older population in forensic matters. UCLA has developed an interdisciplinary curriculum involving integrative encounters combining the education of Geriatric Psychiatry fellows and law students and ending with the practical experience of a mock trial. Participants of this symposium will gain knowledge necessary to develop an integrative educational curriculum for Geriatric Psychiatry fellows that results in procurement of skills to serve as an expert witness, to write expert reports and to testify for probate or conservatorship hearings.

A PATHWAY TO GERIATRIC PSYCHIATRY SUBSPECIALTY TRAINING: THE AAGP SCHOLARS PROGRAM

The AAGP Scholars program initially began in 2010 as a member funded training program for medical students and Psychiatry residents with the goal of inspiring interest in the field of Geriatric Psychiatry. Between 2010-2018, 292 former Scholars participants were surveyed, eliciting 98 responses (response rate 33%). Survey responses are currently being collated and included collection of demographic data, and assessment of the following: ongoing involvement in the AAGP, completion of or ongoing interest in geriatric psychiatry fellowship training, board certification status in geriatric psychiatry, and the impact of the program on the career path of the trainees who completed the program.

Advice on How to Choose a Geriatric Psychiatry Fellowship

The population of older adults with mental health and substance use disorders in the United States is increasing at a significant rate. This growth creates a critical need for trained geriatric psychiatrists. Unfortunately, the number of psychiatrists choosing to receive subspecialty training in geriatric psychiatry has not kept pace with the growing needs of society. Many different methods for enhancing the recruitment of physicians interested in subspecialty training are being discussed nationally. One way to improve recruitment is to provide prospective residents a clear understanding of the process by which one may apply to and select a fellowship program. In this article, we discuss the process by which physicians interested in pursuing fellowship training in geriatric psychiatry can make an informed decision to apply to and choose programs that best fit their needs.

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

An Interview With Addiction Psychiatrist Dr. Christoffel Le Roux

AAGP Session to Focus on Evaluation, Treatment of Older Minority Patients

Back to table of contents Next article Annual MeetingFull AccessAAGP Session to Focus on Evaluation, Treatment of Older Minority PatientsShilpa Srinivasan,M.D., , Iqbal “Ike” Ahmed,M.D.Shilpa Srinivasan,Search for more papers by this authorM.D., , Iqbal “Ike” Ahmed,Search for more papers by this authorM.D.Published Online:29 Jan 2018https://doi.org/10.1176/appi.pn.2018.2a26AbstractAs the U.S. population ages, there will be more seniors coming from diverse backgrounds. Psychiatrists need to be prepared to offer culturally sensitive treatment.As the U.S. population ages, the percentage of older adults from diverse backgrounds is increasing. Psychiatrists need to be prepared to provide culturally sensitive care.iStock/a_TaigaThe role of culture and diversity in geriatric psychiatry will be highlighted in a session presented by the American Association for Geriatric Psychiatry (AAGP) at APA’s 2018 Annual Meeting in May. In the session, titled “Culture and Diversity in Geriatric Psychiatry Across the Clinical Continuum,” a panel of geriatric psychiatrists will discuss the growing diversity of the aging U.S. population and the demographic imperative to address diversity and the importance of incorporating patients’ ethno-cultural and sexual identity and orientation in assessment and treatment and as part of the overall approach to the mental health care of older adults. This session is particularly timely and salient, given the evolving landscape of the increasing diversity of the aging population within a rapidly changing health care environment.When we talk about patients’ diversity, we are referring to such demographic characteristics as race, ethnicity, culture, gender, sexual orientation, sexual identity, and immigration status. Currently, 50 million seniors, or 15 percent of the U.S. population, are over the age of 65, and this number is projected to increase to over 80 million, or 24 percent, by 2060, with an accompanying increase in diversity. The United States is also projected to become a majority-minority nation by this time. Ethnic elderly people aged 85 and above comprise the most rapidly growing segment of the U.S. population. Culture and ethnicity have an impact on what are considered normal changes with aging, as well as on psychopathology leading to differences in the prevalence, presentation, and etiology of symptoms and disorders. Culture can also affect therapeutic relationships and attitudes toward treatment as well as contribute to the burden of stigma. Cultural and ethnic differences between patients and health care providers can further exacerbate disparities in health care, such as access and quality of care provided. A framework for culturally informed, aware, and culturally competent care is therefore a critical component of meeting the mental health care needs of the diverse aging population. Among our presenters are current and past AAGP presidents, as well as leaders within AAGP, including Daniel Sewell, M.D., a professor of psychiatry and director of senior behavioral health at UC San Diego School of Medicine; and national experts Maria Llorente, M.D., deputy chief medical officer at the Maryland Veterans Administration Medical Center, and Ladson Hinton, M.D., director of geriatric psychiatry and director of the Latino Aging Research Resource Center at UC Davis.We will present an overview of culture and diversity in aging. Llorente will review the role of cultural psychiatry education and curriculum in training the health care workforce to meet the needs of minority elderly individuals. Sewell will discuss culturally sensitive clinical care of LGBTQ older adults, and Hinton will offer insights on innovative and culturally sensitive approaches incorporating families and caregivers of older adults. ■The preliminary program of APA’s 2018 Annual Meeting can be accessed here.Shilpa Srinivasan, M.D., is the program chair of the American Association for Geriatric Psychiatry (AAGP) 2018 Annual Meeting and program director of the Geriatric Psychiatry Fellowship at the University of South Carolina School of Medicine. Iqbal “Ike” Ahmed, M.D., is the president of AAGP, a faculty psychiatrist at Tripler Army Medical Center, and a clinical professor of psychiatry at the Uniformed Services University of the Health Sciences. ISSUES NewArchived

Session 406 - Forensics in Geriatric Psychiatry Fellowship: Evolution and Value

Abstract: As of 2015, there were approximately 47.8 million adults ages 65 or older in the United States and older adults represented 14.9% of the U.S. population (United States Census Bureau, 2016). Despite this growing population, there are small numbers of psychiatrists choosing to pursue subspecialty careers in geriatric psychiatry, with fewer than 60 individuals completing subspecialty training in geriatric psychiatry (ACGME, 2015). As forensic psychiatry fellowships do not have a geriatric focus, geriatric psychiatry fellowship is the ideal place to educate the future cohort of psychiatrists, who are serving the older population in forensic matters. ACGME has developed geriatric psychiatry milestones which have been designed to evaluate fellows in the context of their participation in their ACGME-accredited fellowship training program. However, individual training programs are left with the task of developing curricula to meet the training needs that will address the topic of forensics within geriatric psychiatry training programs, and as such, the teaching of forensic aspects of geriatric psychiatry varies across fellowship programs. UCLA has been developing a curriculum involving integrative encounters combining the education of geriatric psychiatry fellows with that of law students ending with the practical experience of a mock trial. Participants of this symposium will gain the knowledge necessary to create integrative educational experiences for geriatric psychiatry fellows which will develop the skills necessary to serve as an expert witness or provide testimony for probate conservatorship hearings. Reference: Read S, Kaufman A, Hackman D. Geriatric Forensic Psychiatry Training in Forensic and Geriatric Psychiatry Fellowships. In: Holzer JC, Kohn R, Ellison JM, Recupero PR, Eds. Textbook of Geriatric Forensic Psychiatry. London: Oxford University Press, in press.

The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia

Shilpa Srinivasan is Professor of Clinical Psychiatry and Director of the Geriatric Psychiatry Fellowship Program, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC Rating: 4 stars.

Chaplains Play Important Part in Integrated Palliative Care

Chaplains Play Important Part in Integrated Palliative Care