Gerontological Knowledge Research Articles

Balancing safety and harm for older adults with dementia in rural emergency departments: healthcare professionals' perspectives.

The emergency department (ED) is a potentially harmful environment for older adults with dementia, and rural EDs face unique challenges in providing care to this population. The purpose of this study was to understand safety and harm in rural ED transitional care for community dwelling older adults with dementia from the perspective of healthcare professionals (HCPs). An interpretive, descriptive exploratory design from a social ecological perspective was used. Using purposive and snowball sampling, HCPs were recruited from two rural hospital EDs in two Canadian provinces. Data collection involved participant interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed, transcripts coded, and themes identified using constant comparative analysis with thematic coding. A total of 12 HCPs, seven from one province and five from the other, participated in the study. HCPs worked directly in the ED or consulted in the ED from hospital-based social work, rehabilitation and community liaison services. Three themes were identified: physical environment (space, design and equipment), work environment (pressure to perform) and practice environment (family, knowledge and processes). A conceptual model was developed to illustrate how HCPs worked to balance safety and harm for older patients with dementia within a milieu created by the overlapping and synergistically interacting environments. HCPs in rural EDs working at the interface of hospital and community constantly attempt to balance promoting safety and avoiding harm for older adults with dementia. Participants perceived safety broadly, understanding that the consequences of the milieu were created through an interaction between physical, work and practice environments. These consequences related to the physical, cognitive and emotional wellbeing of older adults with dementia and their caregivers. Within the practice environment, participants identified a 'rural advantage' that was tied to their knowledge of community and the people with dementia and their caregivers who sought care in the participating EDs. However, familiarity can be a double-edged sword and to minimize potential harm healthcare professionals must seek input from caregivers regarding altered functional status, and policies to change triage to include gerontological knowledge and create elder-friendly rural ED environments are needed.

Agency and Social Forces in the Life Course: The Case of Gender Transitions in Later Life.

In order to bolster gerontology's knowledge base about transgender issues and advance conceptualizations of agency and social forces in life course scholarship, this study explores the conditions under which people contemplate or pursue a gender transition in later life. In-depth interviews were conducted with male-to-female identified persons (N = 22) who have seriously contemplated or pursued a gender transition after the age of 50 years. Participant observation was also carried out at three national transgender conferences (N = 170 hours). Interpretive analyses utilized open and focused coding, analytical memo writing, and an iterative process of theory development. Participants in this study faced unrelenting social pressures to conform to normative gender expectations throughout their lives, which were often internalized and experienced as part of themselves. Confronting these internalized forces often took the form of a "dam bursting," an intense emotional process through which participants asserted agency in the face of constraining social forces in order to pursue a gender transition in later life. The findings in this paper are used to extend the life course concept of agency within structure, which has implications for future life course research in aging, especially with respect to socially marginalized and oppressed minority groups.

Extensão para inclusão no NETI - Núcleo de Estudos da Terceira Idade: previdência e cidadania

The study aims to evaluate the contribution of the Senior Center of Study (SCS) of the Federal University of Santa Catarina (UFSC), to the university extension by highlighting the project on Social Security and Citizenship. The Center aims at development, organization, socialization and broadening of knowledge in gerontology. The Project on Social Security and Citizenship was accompanied, since the beginning, by materials development and taught classes. It is possible to conclude that continuous education through university extension is a very challenging job in methodological, organizational and operational dimensions.

Social Work Gerontological Practice: The Need for Faculty Development in the New Millennium

ABSTRACTThere is a pressing need to upgrade the gerontological knowledge and skills of practicing social workers. Geriatrics and gerontology, as specialized fields of knowledge, have not been sufficiently integrated into formal academic training programs. There are major trends in the health care environment which impact on social work education, including technological advances, a shift from inpatient to outpatient and community care settings, increasing diversity of the older population, and client and family participation in decisionmaking. These trends necessitate social work education to emphasize new content areas in gerontology and the development of new skills in clinical, case management, care coordination, and teamwork. A significant obstacle to the preparation of future social workers to deliver the complex services needed by older adults and their families is a serious shortage of social work faculty in gerontology. Sustained and broad initiatives, such as the John A. Hartford Foundation funded Geriatric Social Work Faculty Scholars Program, are needed to develop academic and practice-based faculty in gerontology. This is crucial if social work is to maintain an important service role in the new millennium.

Educação continuada em gerontologia para agentes comunitários de saúde

Objetivo: avaliar o efeito de um Programa de Educação em Gerontologia desenvolvido à Agentes Comunitários de Saúde. Métodos: estudo de intervenção (comparação antes e depois) com participação de 111 agentes comunitários, com perda de 25 (22,5%), atuantes nas 12 unidades de saúde da família de um município do interior paulista, em 2012. Os dados foram coletados por meio de questionário sociodemográfico, instrumento de avaliação do contato dos agentes comunitários com idosos e questionário para avaliação de conhecimentos gerontológicos (Questionário Palmore-Neri-Cachioni). Foi desenvolvido um Programa de Educação em Gerontologia junto aos agentes comunitários, no período de 5 dias: encontros com duração de 90 minutos cada um, abordando temas relacionados à velhice e envelhecimento. Para análise dos dados, foi utilizado o programa SAS versão 9.2 para Windows. Resultados: prevaleceram entre os agentes os adultos jovens, do sexo feminino, casados, com ensino médio completo e inseridos na atividade há mais de dois anos e meio. A maioria dos agentes expôs sempre ter contato com idosos, cultivado em âmbito do trabalho e intrafamiliar e relatou experiência com a população dessa faixa etária, mais da metade referiu ter participado de educação gerontológica. O maior número de acertos ao questionário de avaliação sobre conhecimentos gerontológicos, aplicado antes, imediatamente após e depois de três meses ao desenvolvimento do Programa de Educação em Gerontologia, demonstrou melhor desempenho dos agentes na segunda e terceira aplicações desse instrumento realizadas após o programa, tornando evidente a importância de educação em gerontologia para esse público. Conclusão: promover educação em gerontologia para agentes comunitários de saúde é fundamental, pois providos de conhecimentos podem reforçar seu papel mediante a equipe de saúde e população, dentre ela, os idosos.

The construction of the indicators of professional competence for exercise instructors of the elderly.

The purpose of this study was to construct the quality indicators of professional competence for exercise instructors of the elderly, and then to rank the importance among those indicators. This study used the Delphi technique to integrate the opinions of 11 experts to construct the indicators, and then adopts the analytic hierarchy process (AHP) to calculate the relative rank among each individual indicator. Results revealed that the experts identified 3 first-degree indicators (professional attitude, professional skills, and professional knowledge), 10 second-degree indicators (teaching attitude, exercise knowledge, professional growth, exercise safety, personal characteristics, exercise instructor, gerontology knowledge, communicative competence, curriculum design, and motor skill), and 72 third-degree indicators. In the indicator weighting system, professional attitude was the most important among all other first-degree indicators, and the teaching attitude was the most important among all other second-degree indicators. The results provided will help in planning the curriculums of training, professional growth and evaluation. The results also provide a reference for future research.

The construction of the indicators of professional competence for exercise instructors of the elderly.

The purpose of this study was to construct the quality indicators of professional competence for exercise instructors of the elderly, and then to rank the importance among those indicators. This study used the Delphi technique to integrate the opinions of 11 experts to construct the indicators, and then adopts the analytic hierarchy process (AHP) to calculate the relative rank among each individual indicator. Results revealed that the experts identified 3 first-degree indicators (professional attitude, professional skills, and professional knowledge), 10 second-degree indicators (teaching attitude, exercise knowledge, professional growth, exercise safety, personal characteristics, exercise instructor, gerontology knowledge, communicative competence, curriculum design, and motor skill), and 72 third-degree indicators. In the indicator weighting system, professional attitude was the most important among all other first-degree indicators, and the teaching attitude was the most important among all other second-degree indicators. The results provided will help in planning the curriculums of training, professional growth and evaluation. The results also provide a reference for future research.

De-standardising ageing? Shifting regimes of age measurement

ABSTRACTDeparting from the proposition that, in the sociological debate about whether there has been a shift towards a de-standardised lifecourse in advanced economies, little attention has been devoted to the infrastructural arrangements that would support such a transition, this paper explores the changing role of standards in the governance of ageing societies. In it, I outline a sociological theory of age standard substitution which suggests that contradictory rationalities used in the implementation of chronological age fuelled the emergence of a critique of chronological age within the diverse strands of gerontological knowledge during the 20th century. The paper analyses how these critiques were linked to a proliferation of substitute, ‘personalised’ age standards that aimed to conjoin individuals’ unique capacities or needs to roles or services. The paper suggests that this configuration of age standards’ production, characterised by uncertainty and an opening of moral and epistemic possibilities, has been shrouded by another, more recent formation where institutional responses to decentred processes of standardisation moved research and political investment towards an emphasis on biological age measurement.

The Effect of an Interprofessional Gerontology Course on Student Knowledge and Interest

ABSTRACTAims: This study investigated occupational and physical therapy students’ knowledge of gerontology and self-reported interest in working with the geriatric population before and after an inter-professional course in gerontology. Methods: This retrospective analysis used a single-group pretest–posttest design. Participants included 204 occupational and physical therapy students who took a graduate course in gerontology. Results: Increased student knowledge of gerontology was indicated by course content pre- and post-test scores. There was a post-test correlation between subjective knowledge and course content knowledge. Increased content knowledge did not lead to increased interest. The primary factor influencing a change in interest was the course project. Students who did group projects were more likely to report increased interest in working with older adults. Conclusions: An inter-professional course in gerontology positively influenced OT and PT student knowledge of gerontology. Group activities involving interaction with older adults may enhance interest in geriatrics.

Gerontology in Five Images.

In his Kent Award lecture, Scott Bass called for a greater coherence of gerontology. This article proposes that the teaching of gerontology is one way to address the centrifugal tendencies of the field and economize its disciplinary sprawl. The instructional strategy is to concentrate attention to a limited number of focal visuals from which the exposition of gerontological knowledge can radiate out and to which it can circle back. The 5 images selected here synthesize numerous ideas about life course; senescence, development, and interventions in these processes; the long gestation of relative health and illness; the succession of cohorts and social change; and the question of preparing for and managing the uncertainties of adult life. The 5 pictures and charts show some common features, such as lifelong flows of time and a recurring arc-like shape that is used to depict them. A sixth image is suggested in order to counter the impression that aging is a process of diminishment. Most knowledge about aging is rooted in a core discipline, but the teaching of that knowledge beyond the discipline can integrate content in fruitful ways.

What's the Point of Aging? Does Philosophy Make a Difference?

Jan Baars is the premier philosopher of aging, working in Europe and the United States today. Actually, to call him a philosopher of aging is to diminish the range of his thought and his accomplishments. Baars, who writes in Dutch and in English and whose work has been translated into several languages, recently “retired” as Professor of Interpretive Gerontology at the University of Humanistic Studies in Utrecht, where he retains a part-time appointment and continues to extend and publish his remarkable body of work. It is difficult for American readers and gerontologists to appreciate the breadth of Baars’s work—partly because of its density and also because it emerges from his dual training, both in the social sciences and in the European tradition of Continental philosophy. We rarely encounter a scholar whose thought ranges across conceptual analysis, historical interpretation of texts, social theory, critical gerontology, and existential issues. Baars, however, began his career far from the concerns of aging. In 1975, he organized a major conference at the Free University of Amsterdam on “Theory and Praxis in Sociological Theory,” where he brought critical theorists and phenomenological sociologists into philosophical conversation with Dutch sociology, which he found too limited in its uncritical integration into the social life of the country. In 1987, Baars’s philosophy dissertation on the Frankfurt School theorists Horkheimer and Adorno led him to embrace Habermas’s view of communicative discourse as a means of analyzing problems of social justice, interpreting the meaning of human existence, and understanding the disparate spheres of politics, science, and everyday life. Baars then turned his attention to gerontology, just at the time when the author organized the first conference on Critical Gerontology at the University of Texas Medical Branch (1991), leading to the volume Voices and Visions of Aging: Toward a Critical Gerontology (Cole, Achenbaum, Jakobi, & Kastenbaum, 1993), in which Harry (Rick) Moody first articulated the concept of critical gerontology. In Moody’s formulation, critical gerontology unsettled mainstream gerontology by introducing interpretive and emancipatory philosophical questions, beginning with the realization that instrumental knowledge about aging carried the possibilities of social control of older people and undermined the possibilities of emancipatory social change. Baars, too, had come to the view that science did not produce “objective” knowledge but functioned as a means of legitimating and regulating social processes and forms of domination. This view was first fully exemplified in gerontology by Steven Katz’s Disciplining Old Age: The Formation of Gerontological Knowledge (1996). Since then, Baars, in collaboration with European and American colleagues, has turned out a significant body of work that links his interests in the social, the existential, and the political. His most recent publication along these lines is the coedited collection Ageing, Meaning and Social Structure: Connecting Critical and Humanistic Gerontology (Baars, Dohmen, Grenier, & Phillipson, 2013). The book under review, Aging and the Art of Living, flows from Baars’s more purely philosophical meditations though critical gerontology and social theory are deftly woven into the arguments put forward. With this landmark book, Baars takes his place among the very few serious

Different Cultures but Similar Positive Attitudes: A Comparison between Thai and Swedish Nursing Students' Attitudes toward Older People

The proportion of elderly people in the world's population is growing. Thailand and Sweden have disparate cultural traditions of caring for older people, though both countries are facing a larger population of older people. Sweden and Thailand are involved in several cooperative projects and exchange programs for nursing students in this area, raising the questions of if and how the different cultures of gerontological care influence students’ attitudes in the issue. The aim of the study was to compare Swedish and Thai nursing students’ attitudes towards older people. A convenience sample of 241 Thai nursing students and 299 Swedish nursing students participated in the study. The Kogan's Old People Scale, a 34-item questionnaire, was used in this research. The questionnaire consists of 17 positive (OP+) statements and 17 negative (OP-) statements and uses a Likert scale. Concerning attitudes towards older people, there was no significant difference in Swedish and Thai students’ positive scores in the distribution across the groups. In contrast, these students did differ on negative scores across countries (p = .001). This was understood to be related to age; the Swedish students’ higher age was positively associated with their positive attitudes; as the age increased, the students’ scores were also higher. Attitudes towards older people are not only influenced by cultural values, norms, and social structures, they also have a foundation in gerontological knowledge and experiences. Education addressing cultural awareness of negative ageism should be incorporated into all aspects of education, not just gerontological courses.

Educational Strategies to Promote Professional Nursing in Long-Term Care: An Integrative Review

This integrative review investigates various strategies in professional nursing education that facilitate positive attitudes toward working with older adults in long-term care (LTC) environments, including nursing homes. Nine studies contained strategies that increased positive attitudes of nurses towards older adults. The barrier most frequently identified is lack of gerontological knowledge by faculty and students, suggesting increased knowledge in faculty may ensure that older adults receive quality care. Early introduction of students to people who are aging successfully may dispel bias against older adults. Lack of current nursing role models in LTC settings may reinforce negative stereotypes.

Am I a Gerontologist or Geriatrician?

Am I a Gerontologist or Geriatrician?

Using Simulation Pedagogy to Enhance Teamwork and Communication in the Care of Older Adults: The ELDER Project

The Expanded Learning and Dedication to Elders in the Region (ELDER) project addressed the needs of under-served older adults by educating health care providers in home health and long-term care facilities. Four agencies in a health professional shortage/medically underserved area participated. Focus groups were held to determine agency-specific educational needs. Curricula from the John A. Hartford Foundation were adapted to design unique curricula for each agency and level of personnel during the first 2 years. The focus of this report is the case-based simulation learning approach used in year 3 to validate application of knowledge and facilitate teamwork and interprofessional communication. Three simulation sessions on varying topics were conducted at each site. Postsimulation surveys and qualitative interviews with hired evaluators showed that participants found simulations helpful to their practice. Tailored on-site education incorporating mid-fidelity simulation was an effective model for translating gerontological knowledge into practice and encouraging communication and teamwork in these settings.

Students' Knowledge of Aging and Career Preferences

The increased number of older adults attributes to a rising need for future professionals to work in gerontology. Understanding the influence of students' career choices is important. A qualitative study was conducted after students' taking a gerontology course to explore students' knowledge and career preference in gerontology. The results were that students reported higher competency in that their knowledge was higher. Although increased knowledge did not necessarily encourage students to choose careers in gerontology, it may have made students more amenable toward accepting working with the aging population in the future. The study offers suggestions on how to increase students' competency level in practice.

The ELDER Project: Educational Model and Three-Year Outcomes of a Community-Based Geriatric Education Initiative

The purpose of the ELDER (Expanded Learning and Dedication to Elders in the Region) Project was to address the needs of underserved older adults by providing worksite education to individuals who provide nursing care to older adults in community health centers, home health agencies, and long-term care facilities. Four agencies located in a Health Professional Shortage and Medically Underserved Area participated. Project staff conducted separate focus groups with administrators and staff at each agency to determine educational needs and preferences. Curricula from the Hartford Institute, End-of-Life Nursing Education Consortium, and Geriatric Education Centers were adapted to design unique curricula for each agency and level of personnel (licensed nurse or unlicensed caregiver). Activities included focus group meetings to tailor content to the needs of each agency, on-site educational sessions, and identification of an agency champion to sustain the program after the funding ended. A case-based simulation-learning approach was used in the final year to validate application of knowledge and to facilitate teamwork and interprofessional communication. Over 100 nurses and nursing assistants and eight administrators and allied health professionals participated over the three-year period of the project. Retention over this period, independent evaluations, and simulations demonstrated participants' ability to integrate best practices into typical clinical scenarios and revealed improved communication among care providers. Tailored on-site education incorporating simulation was an effective model for translating gerontological knowledge into practice and improving the care of older adults in these multiple settings.

Geriatric Emergency Nurses: Addressing the Needs of an Aging Population

Older adults account for up to 14.5% of ED visits. Presentation of older adults can differ from younger adults. Emergency visits by older adults that are characterized by comorbidity, cognitive and functional impairment, and complex social issues. In addition, older adults present with subtle, atypical symptoms making diagnosis and discharge more challenging. The purpose of this study was to describe an innovative geriatric emergency nurse role that has been implemented to address the unique needs of older adults in the emergency department. This was an exploratory, descriptive study. The study sample was comprised of two groups: Geriatric Emergency Nurses (N=5) and key informants (N=15). The study was based at a tertiary hospital in Vancouver, Canada. Data was collected using semi-structured interviews. Data were analyzed using thematic analysis. The findings are organized into three sections: defining the role and its functions; a collaborative relationship: fitting in to the larger emergency department; and recommendations for future role development. Findings from the study have led to further considerations about the role in relation to communication about older patients both within the emergency department and with community stakeholders. We also discuss the importance of this role in relation to the continuum of care and recognizing the central role of the emergency department as a place for intervention. Lastly, we consider the need for further integration of gerontological knowledge and expertise within the emergency department beyond a specialized role.

Ethical Imperatives for Intervention with Elder Families

This article discusses the ethical dilemmas common to counseling practice with elder families and describes virtue ethics, rule ethics, and principle ethics in their application to the unique challenges of the life stage of diverse adults 60 years and older. The Five P Model of Ethical Decision Making of Gamino and Ritter is examined as a process for conceptualizing the ethics of care in complex situations like those of elder families. The authors challenge family counselors to expand their gerontological knowledge, including that of end-of-life care and bereavement, and to use a developmental lens when taking perspective on issues of aging clients and their families.

Maggie Kuhn: social theorist of radical gerontology

PurposeThe purpose of this article is to explore Maggie Kuhn's theoretical and analytical contributions to social gerontology and more broadly to the advancement of critical and public sociology.Design/methodology/approachThis paper is an theoretical exploration of ageing. Maggie Kuhn's and the Gray Panthers theoretical contributions include analyses of, and related to: identity politics, intersectionality, cultural and media studies and the cognitive sciences, the forces and factors in the developing political economy of ageing including critiques of the ageing enterprise and the medical industrial complex, the sociology of knowledge of gerontology and globalization and world imperialism. The concluding section argues that the post‐retirement career of Maggie Kuhn was one of a Public Sociologist.FindingsMaggie Kuhn fulfils the promise of the Project of Public Sociology, which “is to make visible the invisible, to make the private public, to validate these organic connections as part of our sociological life”. Maggie Kuhn's example moved forward the work of multiple generations of scholars. She lived and produced critical social analyses in pursuit of emancipatory knowledges. Her work is one of the earliest forms, if not the first, of critical pedagogy in gerontology; she promoted and advanced discourses of resistance. Maggie Kuhn was an engaged and outraged, practicing organic intellectual – the epitome of what bell hooks means by “teaching to transgress” and “education as the practice of freedom”. In the 24 years after her involuntary retirement, this was Maggie Kuhn's full‐time transformational agenda.Originality/valueThe paper looks at how the biography of Maggie Kuhn helped to engender the rise of radical social gerontology.