Geriatric Curriculum Research Articles

Integrating Humanities and Arts Into Gerontology and Geriatrics Curricula

Humanities, Arts and Cultural Gerontology (HACG) has been an integral element of GSA for over 4 decades, and is included as a notable feature of AGHE guidelines on curricula for gerontology and geriatrics. However, as with many interdisciplinary areas, the degree to which HACG has been successfully inserted into curricula, the extent to which this has involved engagement of faculty in arts and humanities, and the facilitators and barriers of such deeper joint working are unknown. The HACG Advisory Panel and AGHE would like to convene a round-table/symposium at the 2021 Phoenix GSA Meeting to consider the range of experiences of educators of programs in gerontology/geriatrics, from those who can relate success stories in integrating HACG into their curricula, to those who can give insights into challenges and opportunities in attempts to develop such elements in their curricula. Co-convened by Des O'Neill, Chair HACG AP and Dana Burr Bradley AGHE Program Chair, we invite lively discussion which we consider will aid in the development of a road map towards substantive and rewarding initiatives in incorporating scholarship and education in HACG in gerontology and geriatrics educational program

Lessons for Humanities and Arts in Gerontology and Geriatrics Curricula From the Medical and Health Humanities

The role of Humanities, Arts and Cultural Gerontology in gerontology and geriatrics curricula finds a metaphor in the rapidly evolving field of medical and health humanities, with which this author has been involved for three decades. Behind the call for increasing humanities and arts scholarship in the pedagogy of both fields lies the challenge of establishing an interdisciplinary nexus of scholarship that avoids the challenges of dilettantism and gestures such as providing lists of novels and movies. This presentation draws on the presenter's bibliometric research in the medical and health humanities which indicates authorship in the majority to be either solely from the humanities or from healthcare, with little indication of joint working in either authorship or acknowledgements (the scholar's courtesy), and explores the background issues of academic culture with a view to proposing solutions to elevate the inclusion of humanities and arts as a significant element of gerontology education.

(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.

The COVID-19 Geropsychiatry Rounds: A Curriculum for Healthcare Providers

Older adults’ mental health needs significantly increased during the COVID-19 pandemic. Geriatric psychiatry is an area of extreme workforce shortage globally. A novel curriculum was developed to educate healthcare providers on COVID-19-related geriatric and geropsychiatry topics. Monthly lectures were presented from November 2020 to June 2021. Evaluations were collected after each lecture via an anonymous survey. Overall lecture quality and relevance for the participants’ clinical practices were rated on a 1-3 Likert-type scale. 217 participants attended lectures; 72 evaluations were collected (33% response rate). Overall lecture rating score was 2.82 ± 0.38 and relevance score was 2.77 ± 0.45. The curriculum was well received and relevant to participants. Future studies should collect more details regarding participants’ clinical practices. To our knowledge, this is the first COVID-19-related geriatric psychiatry curriculum developed to educate healthcare providers and empower them to care for older adults during the pandemic.

Teaching medicine interns minimum geriatrics competencies within a "4 + 2" schedule.

The increased ambulatory training time in an "X + Y" (inpatient + ambulatory) residency schedule affords more opportunities to teach geriatrics principles of care. We describe our internal medicine (IM) residency program's experience in teaching the IM-family medicine (FM) minimum geriatrics competencies (MGC) during a longitudinal geriatrics rotation embedded within interns' yearlong "4 + 2" schedule. Interns spend 1day of the ambulatory block in a geriatrics outpatient setting (Program of All-Inclusive Care for the Elderly, house calls, nursing home), during which geriatrics division faculty members give core didactic seminars. We revamped core seminars to address MGC related to medication management, cognitive health, complex chronic illnesses, end of life care, and ambulatory care. Three consecutive intern cohorts completed anonymous surveys pre- and postrotation, rating their confidence level in MGC addressed by the curriculum on a 5-point Likert scale. On postrotation surveys, they also rated the curriculum's contribution to geriatrics skills enhancement. Interns who completed both surveys (N=22, 92%) reported statistically significant improved confidence ratings on all items, with the greatest point gains seen in performance of functional assessment (1.56), practice of optimal geriatric pharmacotherapy (1.78), and identification of older patients eligible for skilled (1.71) and unskilled home-based services (1.65). They rated geriatrics curricular components as being more helpful than other rotations and conferences in enhancing their geriatric skills. In conclusion, we developed a longitudinal geriatrics curriculum within the context of our "4 + 2" immersion schedule which other programs can easily adapt. Aligning curricular content with the MGC has resulted in interns' improved confidence in several important geriatrics skills.

Beyond longevity: healthy longevity

Beyond longevity: healthy longevity

A mixed methods evaluation of a 4-week geriatrics curriculum in strengthening knowledge and comfort among orthopaedic surgery residents

BackgroundIn 2014, the University of Toronto Faculty of Medicine implemented a 4-week “Orthogeriatrics” rotation for orthopaedic surgery residents. We sought to assess the rotation’s impact on trainees’ knowledge, attitudes, and behaviours toward caring for older adults, and explore areas for improvement.MethodsWe used a mixed methods concurrent triangulation design. The Geriatrics Clinical Decision-Making Assessment (GCDMA) and Geriatric Attitudes Scale (GAS) compared knowledge, attitudes, and behaviours between trainees who were or were not exposed to the curriculum. Rotation evaluations and semi-structured interviews with trainees and key informants explored learning experiences and the curriculum’s impact on resident physician growth and development in geriatric competencies.ResultsAmong trainees who completed the GCDMA (n = 19), those exposed to the rotation scored higher in knowledge compared to the unexposed cohort (14.4 ± 2.1 vs. 11.3 ± 2.0, p < 0.01). The following themes emerged from the qualitative analysis of 29 stakeholders: Increased awareness and comfort regarding geriatric medicine competencies, appreciation of the value of orthogeriatric collaboration, and suggestions for curriculum improvement.ConclusionsThese results suggest that the Orthogeriatrics curriculum strengthens knowledge, behaviour, and comfort towards caring for older adults. Our study aims to inform further curriculum development and facilitate dissemination of geriatric education in surgical training programs across Canada and the world.

71 Developing A Portfolio for Advanced Practitioners Working with Older People

Abstract Introduction Advanced Nurse Practitioners (ANP’s) have a professional responsibility to ensure that they maintain professional competence (Whiteing, N. in Hinchcliffe and Rogers Eds pp192–219, 2008). The aim of the portfolio is to assist ANP’s in developing evidence demonstrating continued advanced level practice. At the time of the study, there was a dearth of evidence relating to competencies for qualified ANP’s, working with older people. The aim was to move away from the traditional confines of “nurse does this, doctor does this”, and to embrace the concept of developing skills to meet the clinical demands of service provision for our older people. Methods Participatory action research methodology was adopted—using the Review, Plan and act cycle (Edwards and Talbot, p63 1999; Holloway &amp; Wheeler p155–156, 1996). Review A literature search and review of competencies relating to advanced practice and older people was undertaken. Plan A portfolio of knowledge and skills was collated utilising the information from the review. A matrix was created incorporating four Pillars of Advanced Practice (SGHD 2008), the Nursing and Midwifery Code (NMC, 2015) and modified competencies for Joint Royal Colleges of Physicians Training Board Geriatric curriculum (JRCPTB), (2010, amended 2013 and 2015). The portfolio was sent out to existing team members, and local Consultant Geriatricians based in the Acute Trust and local University for comment and amendments were made. Act The portfolio was used by staff as a trial and evaluated. Written feedback was obtained through questionnaires. Results The portfolio was well evaluated by staff using it, including recommendations for improvement. Portfolio has been shared at national groups and via social media and has been well received. Conclusions An Advanced Practice Portfolio of capabilities is being used, based on action research cycles, enhancing the level of care received by older people.

Attitudes of dental students towards treating elderly patients. Dental students’ attitudes on geriatric patients

The purpose of this questionnaire-based survey was to evaluate the attitudes of the undergraduate dental students towards elders. The 14-item Geriatric attitudes scale (GAS) questionnaire, along with a 9-item questionnaire with specific questions on the current geriatric dental curriculum, confidence, and preference in treating the elderly patients were administered to the undergraduate dental students (3rd bachelor, 1st master, and 2nd master) in the four Swiss university dental schools. Mean GAS scores were calculated and inter- and intra-group differences were analyzed with ANOVA and post hoc tests (level of significance set at α=0.05). Responses to the 9-item questionnaire were reported descriptively. Further analyses were performed to evaluate the effect of demographic factors on the GAS scores. 305 students (meanage: 25.8±4.0y) participated in this study. The mean overall GAS score of the students was 3.5±0.4. There were no significant differences in the GAS scores between the centers [F(3, 300)=2.266, p=0.081] or between the year of training [F(2, 301)=1.884, p=0.154]. Demographic factors did not influence the GAS scores. Students considered geriatric dentistry as an important part of their dental undergraduate education. The current geriatric curriculum was perceived to be on an adequate level. Hands-on experience in treating geriatric patients in the undergraduate curriculum was positively opinionated, and mobile dental services for elders with limited access to care was considered a good solution. In conclusion, the attitudes of the Swiss undergraduate dental students towards an elderly patient seem acceptable but could still be improved.

Survey on the attitudes of dental hygiene students towards treating elderly patients.

This questionnaire-based survey assessed the attitudes of dental hygiene students towards treating elderly patients. The 14-item UCLA 14-item Geriatrics Attitudes Scale (GAS-14) questionnaire was used in this survey. A further set of nine questions evaluated the opinions of the students towards the existing geriatric curriculum in their respective institutions. Students from five dental hygiene schools from three countries (Switzerland, Belgium and Canada) participated in this survey. General demographic information from the participants was collected. Mean GAS-14 scores were calculated; ANOVA and Bonferroni's tests were used for statistical analyses (p<0.05). Three hundred eighty-five students (Switzerland: n=157, mean age=25.38±4.6years; Belgium: n=82, mean age=27.58±12.8years; Canada: n=146, mean age=25.95±12.3years) completed the survey for a response rate of 86.3%. The overall GAS-14 scores for Switzerland, Belgium and Canada were 3.61±0.42, 3.24±0.37 and 3.32±0.36, respectively. Switzerland scored significantly higher than Belgium and Canada (p<0.0001). Overall scores revealed a significant effect of progressive training (p=0.010). The GAS-14 score was influenced by the nationality of the participants (p<0.0001), but not influenced by sex, age, origin, religion, or marital and accommodation statuses. Majority of the students (75.8%) agreed that geriatric dentistry was an important part of their education. 77.4% agreed that they would like hands on experience in treating the elderly patient during their education. 85.1% of the participants considered mobile dental clinics as a good solution for the provision of dental care to the institutionalized elders. The general attitudes of DH students towards treating the elderly patients are on an acceptable level and improved as they progressed through their dental hygiene academic programmes.

Qualitative Analysis of an Inter-Professional, In-Home, Community Geriatric Educational Training Program

This study describes and provides qualitative analysis of an innovative, inter-professional (IP) geriatrics curriculum focused on team-based care with healthy older adults in a home-based community setting. The curriculum consisted of five, four-hour didactic and experiential sessions over one academic year. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams led by IP faculty from each health professional school. Teams met with a community-dwelling older adult three times. At the program’s conclusion, students responded to the reflective question “What is the most important learning experience you expect to take away from the geriatric inter-professional training? A qualitative analysis of student responses revealed four common themes from all five professions aligning with curricular goals: (1) health professional roles/scope of practice, (2) geriatric care and health outcomes, (3) team communication/collaboration, and (4) advocating for one’s own profession. As sites for institutional clinical training become scarcer for health professions’ trainees, this study offers both a novel, IP, geriatrics curriculum with didactic/experiential learning through community partnerships in a home-based setting and a reflective evaluation.

ESPO/ Academy for Gerontology in Higher Education Section Symposium: Bridging the Gap: Shifting Population Dynamics and Opportunities to Inform and Educate Communities

This symposium is intended to highlight population-shifts and their impact on the individual, family, institution, and community levels. Currently, increases in diversity among individuals under age 18 continue to outpace those of individuals age 65-and-older, creating a substantial racial/ethnic diversity gap between generations. As it relates to education-level, individuals age 65-and-older who have earned at least a bachelor’s degree has increased from 5 percent in 1965 to 29 percent in 2018 (Population Reference Bureau, 2020). Population-shifts could be mitigated or better supported through enhancements to gerontology/geriatric education and training. This symposium will highlight the biopsychosocial aspects of these shifts and will link each aspect to the development of gerontology and geriatric curriculum. To start, presenter one will describe projects focused on community-based intergenerational programs to reduce social isolation and loneliness among rural older adults (Jill). Next, presenter two will describe findings from a university-based study, using surveys of aging and ageist attitudes to foster intergenerational connections between undergraduate students and older adult community members (Giselle). Presenter three will discuss a program to support the development of aging ministries to educate and support both caregivers and older adults in community settings (Lauren). Finally, presenter four will discuss findings from one-on-one interviews conducted with Chinese caregivers and Chinese geriatric social workers in efforts to develop and evaluate an end-of-life manual designed for Chinese immigrant caregivers (Mandong). The discussant will link the presenters’ findings to implications for future gerontology and geriatric education and training while identifying key topics to inform and engage communities.

Assessing the learning needs of physical medicine and rehabilitation residents to develop a geriatric medicine and rehabilitation curriculum

ABSTRACT Background Older adults with functional impairment are cared for by physiatrists in rehabilitation, but physiatrist training in geriatric-related competencies remains suboptimal. To develop a geriatric rehabilitation (GR) curriculum and explore opportunities for improvement, a needs assessment of stakeholders was conducted to understand physical medicine and rehabilitation (PMR) residents’ comfort levels and learning needs in geriatrics. Methods A mixed-methods design was employed. PMR residents (n = 18) and practicing physiatrists (n = 40) completed a questionnaire; and PMR residents, physiatrists and key informants (n = 9; n = 4; n = 6) participated in focus groups and semi-structured interviews to explore geriatric experiences of trainees and educational needs in geriatrics and rehabilitation. Data were qualitatively analyzed using constructivist-grounded theory. Results Residents and physiatrists highlighted similar topics as areas of low comfort in knowledge. Interviews prioritized critical geriatric topics (gait assessment, falls, cognitive impairment, movement disorders, and polypharmacy) and highlighted disposition planning and end-of-life care as areas needing further curriculum support. Challenges in delivering geriatric education were also identified. Conclusion What emerged from the needs assessment was a series of critical geriatric educational priorities for the development of a GR curriculum for physiatry trainees – arising at an opportune time given the shift toward competency-based residency education.

Interprofessional, older adult, team-based home visits: A 6-year prospective analysis

ABSTRACT This 6-year prospective study describes the impact on student attitudes of an innovative, interprofessional geriatrics curriculum (IPGC) focused on team-based care with older adults in a home-based community setting. Dental, medical, occupational therapy, pharmacy, physical therapy, and physician assistant students were placed into teams each led by faculty members from all of the professions. The curriculum consisted of five, four-hour sessions over one academic year. Teams met with a community-dwelling older adult three times. Students completed the Geriatric Assessment Scale (GAS) before and after the IPGC experience. At the conclusion, improvements in attitudes toward older adults in the GAS and its four domains – social value, medical care, compassion, and societal resources–were observed across a wide spectrum of students. Students with the lowest initial attitudes improved the most, as did the scores of the youngest students. Older students improved more than younger students in the social value domain (i.e., the perceived social value of older adults). Among disciplines, occupational therapy and social work students improved the most in the social value domain. This study demonstrates improvement in attitudes toward older adults from student involvement in IPGC that combines didactic and experiential learning through community partnerships in a home-based setting.

A Novel Interprofessional Palliative Care and Geriatrics Curriculum for Nephrology Teams.

The population of older adults with chronic kidney disease (CKD) is increasing and nephrologists need education on the principles of geriatrics and palliative care to effectively care for this population. Our objective was to develop and deliver a curriculum to interprofessional clinicians caring for older adults with CKD. The aim of this curriculum would be to improve knowledge of the principles of geriatrics and palliative care. We have previously developed a curriculum on geriatrics and palliative care targeted toward primary care teams. In this project, we used an interdisciplinary steering committee to modify the curriculum for nephrology teams. This curriculum was delivered in a live grand rounds setting and was recorded and made available via online platform for virtual learning. The 6-session curriculum was delivered to 611 live and online learners between January 2018 and April 2019, with more than half of the participants (n = 317) completing more than 1 session. Participants came from a variety of disciplines including medicine, nursing, pharmacy, and social work. Participants had a high rate of agreement with the statement that the curriculum met learning objectives, with live participants having stronger agreement. Participants reported that the activity would change their practice behavior by calling palliative care earlier, as well as improving their communication skills. Interprofessional collaboration can result in improved learning around the management of patients with CKD or end-stage kidney disease.

Analysis of educational needs for improving the geriatric dental hygiene curriculum

Analysis of educational needs for improving the geriatric dental hygiene curriculum

CAPTURING IMPACT ON STUDENTS PARTICIPATING IN AGING IN PLACE: A PROGRAM TO ENHANCE GERIATRIC EDUCATION

Curricula to enhance healthcare students’ geriatric training has been lacking. Therefore, we developed AIP, an interprofessional (IP) community-based curriculum, in which IP student teams visit community-dwelling older adults. Using established instruments did not capture personal and professional changes experienced by students. Thus, an additional method using qualitative analyses of students’ six post-visit reflections over 15 weeks was employed to evaluate students ‘experiential learning. A grounded theory approach was used to describe students’ growth in geriatric proficiencies related to participation in the January-April 2017 AIP program . By program completion, 21 students had submitted 111 reflective essays. An interdisciplinary panel reviewed a sample of reflections and developed an initial coding system, which was then systematically applied to the whole via QSR-NVivo. Seventy-three distinct codes across 111 student essays generated 2515 occurrences. Prevalent themes, revealed by frequency analysis, and themes with remarkable trendlines yielded fifteen central themes. Students became attuned to their client’s life-world (n=185) as demonstrated by four central themes: 1) isolation, loneliness, and depression (n=44); 2) risks of fall (n=19); 3) loss of function/control (n=98); and, 4) importance of socializing in care (n=24). This attunement informed interactional intentionality (n=284), which shaped interactions with their client (n=207). From these authentic encounters, students described learning about 1) myself; 2) current and future practice; 3) team dynamics; and 4) my client as an older person. Systematic analysis of student reflections revealed student growth attributable to AIP. This evaluation approach should be further assessed in geriatric curricula.

Evaluation of the geriatric curriculum implemented at Shiraz University of Medical Sciences, Iran, since 2017: A qualitative study

Background:Recently, there has been an increase in life expectancy due to improvements in nutrition, health, and sanitation. The aim of this study was to evaluate the geriatric curriculum in the field of general medicine at Shiraz University of Medical Sciences (SUMS), Iran to improve the quality of services provided to this population in the community.Methods:This was a qualitative study­­. Six educational hospitals and ambulatory centers of Shiraz University of Medical Sciences participated in this study. Within these centers, 15 medical education faculty members and educational experts, 6 medical students, 6 elderly patients and 6 nurses working in the university related to the geriatric field were selected using purposive sampling. Data were gathered through semi-structured interviews, focus group discussion and field observations in the teaching hospital and ambulatory setting of SUMS from June 2017 to May 2018. Based on the qualitative research, the data underwent conventional content analysis and the main themes were developed from this.Results:Three main themes were extracted from the data: effective clinical education, geriatrics curriculum challenges and promotion strategies for geriatric medicine. Subcategories that emerged were a competent curriculum teacher, a challenging program, management of resources, promotion of the program, and the revision required in the curriculum, which were related to other concepts and described in the real-world situation of the geriatric curriculum in the university, as observed in field observations.Conclusions:This study identified three concepts as main themes that can be used to explain how to implement a geriatric curriculum in a medical university. The main contributing factor to different views of the participants was identified as the revision required to the curriculum for integrative care in a geriatric patient. This should be taken into consideration while planning any programs and decisions aimed at education of medical students on this topic.

Landscape of education and clinical practice in geriatric oncology: a Japanese nationwide survey.

The aim of this survey was to describe how geriatric oncology is integrated in undergraduate teaching and graduate training as well as in daily clinical oncology practice in Japan. All schools of medicine in Japan are allied with graduate schools of medicine. We conducted a survey of all Japanese medical and graduate schools (n=81), and designated cancer hospitals (n=437) from July 2018 to August 2018. The survey of the schools asked about existence of geriatrics division and geriatric oncology service and if an education curriculum in geriatrics and geriatric oncology was used. The survey of designated cancer hospitals requested general hospital information and the current practice patterns of general geriatric and cancer patients. Forty-eight medical schools (59%) participated in this survey, and teaching in geriatrics and geriatric oncology was implemented in 23 schools and 1 school, respectively. Forty-two graduate schools of medicine (52%) responded; five had an education curriculum in geriatrics, but none provided geriatric oncology training. Among 151 participating hospitals (35%), 5 had a geriatrics division and 20 hospitals employed geriatricians. There was no geriatric oncology service or geriatric oncology specialists in any of the 151 hospitals. Seventy percent of the hospitals reported performing a geriatric assessment for at least some older adults with cancer. This survey provides information on the current state of Japanese education and clinical practice in geriatric oncology. In Japan, a nation with among the largest population of older citizens in the world, education and training greatly need to be promoted to disseminate a core set of geriatrics knowledge and skills to students, trainees and healthcare professionals.