Geriatric Program Research Articles

An Integrative Approach to Promoting Wellness in Older Adults: An Online Undergraduate Course

As gerontology and geriatric programs look to grow their connections with health and allied health areas, examining emerging health care areas is important. Thus, this session will present key concepts and pedagogical strategies from an innovative online undergraduate course, An Integrative Approach to Promoting Wellness in Older Adults, that is taught in the Erickson School at the University of Maryland at Baltimore County. The course brings together a conventional western allopathic approach and a holistic, patient-centered, integrative approach which includes complementary therapies, to promote wellness in older adults. Specifically, the session will present a comparison of the philosophical premises of conventional western and integrative approaches to health promotion. It will present a holistic model of health, an overview of the effectiveness and safety of different complementary therapies, and examples of how an integrative approach with conventional western and complementary therapies can be used in to promote health in older adults with particular chronic conditions. Also, a discussion of the incorporation of diversity content in the course, an integrative approach to health promotion for underserved populations, and specific pedagogical strategies used to facilitate learning in synchronous and asynchronous online learning environments are included. Session presentation techniques include a PowerPoint presentation, demonstration of examples of conventional western and integrative approaches to health promotion in older adults through case studies, and audience participation.

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

Development and validation of a measure of supervisory best practices in gerontological social work

Agency-based supervision is essential to skilled practice and staff retention, directly impacting the quality of services. The Supervisory Leaders in Aging (SLA) program was designed to strengthen supervision of the aging services workforce. SLA was implemented in four states and trained 134 social work supervisors. The purpose of this study was to develop a novel, comprehensive, and practice-informed measure of supervisory best-practices in gerontological social services. The primary outcome for the SLA program was the Practice Inventory for Supervision in Aging Services (PISAS), which evaluated the frequency of recent use of best practices as identified by the project team and vetted by instructors and an interdisciplinary advisory board. Reliability and confirmatory factor analyses were conducted to examine its psychometric properties. Findings demonstrated the scale had good internal consistency reliability (ɑ = 0.88). Confirmatory factor analyses indicated a three-factor solution, 1) Gerontological Social Work Skills, 2) Program Development Skills, and 3) Supervision and Leadership Skills, accounting for 72% of the variability in the 27 items. Gerontological Social Work Skills captured best practices regarding mental health in late life, heightening awareness of elder abuse, and working with families. Program Development Skills captured assessment, measuring outcomes, and translating evidence into practice. Supervision and Leadership Skills captured individual supervision, group supervision and leadership in interdisciplinary practice. Results indicated that PISAS is a reliable and valid measure of use of best practices in gerontological social work supervision. Further implications and limitations of this measure in assessing outcomes of gerontological education and training programs are discussed.

Engaging Isolated and Underserved Older Adults in 4Ms Care: Age-Friendly Care, PA

Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.

An Inter-University Virtual Geriatric Case Competition to Build Interprofessional Collaboration Skills

Developing positive learning experiences in team-based geriatric care is challenging. This presentation will highlight an inter-University geriatric case competition for developing interprofessional competencies in health professional students sponsored by the Geriatric Workforce Enhancement Programs at Saint Louis University and the University of Minnesota. The virtual competition involved teams of 4-5 undergraduate and graduate students from multiple health professions who designed a comprehensive care plan using a simulated complex geriatric patient case. Students were assigned to an interprofessional team with a faculty or community expert coach, attended an orientation, and developed a 20-minute recorded presentation. A panel of judges rated team presentations using a scoring rubric based on the Core Competencies for Interprofessional Collaborative Practice. Local competitions included a first and semi-final round, with the winning teams presenting at the inter-university competition held via live videoconferencing that involved a question-and-answer session. Prizes were given to the top teams. Students, coaches, and judges completed evaluation surveys focused on satisfaction with the competition format/procedures and achievement of interprofessional competencies. Twenty-one teams and 117 students from 12 disciplines participated. Team scores ranged from 2.2 to 4.3 (overall mean 3.1) on a 1-5 scale. Judge, coach, and student evaluations were positive, indicating students learned valuable lessons in group dynamics, team-based care, and geriatric care. Most students (82%) preferred the virtual competition format or had no preference on format. The virtual case competition provided a positive, engaging experience to introduce health professional students to geriatric team-based care and develop their readiness for collaborative practice.

A Model to Transform Communities Toward Becoming Dementia Inclusive

As the US population ages, the prevalence of people living with dementia will also increase. It is estimated that by 2050, 13.8 million American’s 65 and older will be diagnosed with dementia, and currently only 40% of those living with dementia receive an official diagnosis. 70% of people living with dementia live in the community. In order to optimize quality of life and extend each person’s ability to remain living in their homes for as long as possible, it is important for communities to educate consumers and providers alike about Alzheimer’s Disease and related dementias, focusing on behaviors and interventions. This education must cross multiple sectors to effectively increase awareness, decrease stigma, and enable participation in community living for people living with dementia and their caregivers. Dementia Friends USA offers a framework for implementation of dementia friendly inclusive community initiatives that spans professions and incorporates patient and caregiver perspectives. The four symposia will 1) lead us through the evidence that supports the Dementia Friends USA approach, 2) demonstrate how this approach can be operationalized in a truly integrated fashion at the community level using HRSA’s Geriatric Workforce Enhancement Program (GWEP), 3) provide step-by-step instructions for implementing Dementia Friends Community sessions, focusing on one sector at a time (in this case the Developmental Disability population), and 4) discuss the individual and community level outcomes of Dementia Friends implementation.

Innovations in Workforce Education for Family Caregiving

The number of adults providing care to a family member in the US is estimated at more than 50 million, with nearly half of those individuals providing complex care. National organizations, such as AARP, and federal programs, such as the Geriatric Workforce Enhancement Program, have identified the family caregiver as an integral member of the health care team, yet there is a paucity of clinical workforce education programs for how best to partner and support family caregivers. A virtual summit was held in September 2020 to highlight existing educational programs designed to prepare undergraduate and graduate health professional students or practicing clinicians in their efforts to support family caregivers. The meeting consisted of a keynote, 6 podium presentations and 12 poster presentations. Primary themes emerged around target learners, curricula topics, and outcomes. Programs targeted learners from across the workforce, from undergraduate students to continuing professional education programs, with the majority targeting graduate (masters and doctoral) learners. Several programs were interprofessional in development, delivery and target learner. Curricula topics varied across programs and included caregiver assessments, multicultural considerations, communication, care plan development and risk screening. Education outcomes primarily focused on assessment of participants’ confidence and knowledge. The summit highlighted that the topic of family caregiving is included in clinical education inconsistently, if at all. The summit helped identify gaps in education, curriculum development, and the need for common learning outcomes to strengthen a clinician’s ability to support family caregivers as part of the care team.

Going Virtual When The Doors Close: Addressing Geriatric Workforce Training Needs During A Pandemic

The focus of our Geriatric Workforce Enhancement Program (GWEP) is to enhance long-term services and support (LTSS) and primary care healthcare workforce capacity through interprofessional education (IPE) and to increase patient, family, and caregiver engagement. When it became evident that LTSS settings, schools, and communities were going to be adversely impacted by the COVID-19 pandemic for the unforeseeable future, our GWEP quickly pivoted to address new challenges and initiate technology to continue our programs. In this symposium, we describe four programs implemented or revised during the COVID-19 pandemic. We utilized CARES (Coronavirus Aid, Relief and Economic Security) funding to develop a 3-part Project ECHO on utilizing telehealth in LTSS settings. We pivoted quarterly Fireside Chats – community-based educational programs held at partnering LTSS settings for older adults and caregivers – to bi-weekly and now monthly webinars addressing topics relevant to COVID-19 and combatting social isolation. Because students could no longer attend an in-person IPE course introducing them to long-term care, we revised the course to be online with a partnering nursing home participating in an interactive mock care conference. Finally, a 2-semester undergraduate Honors College project-based course introducing students to successful aging utilized virtual activities to expose students to the challenges of hospice care during a pandemic. With these adaptations, as well as activities that advocated for, and supported, LTSS settings and older adults, our GWEP program was able to continue to provide education and support to the setting and individuals most impacted by COVID-19.

Leveraging ACL Funding to Implement an Evidence-Based Falls Prevention Program in Three GWEPs

Primary care practices have a robust capacity to screen older adults for falls risk and refer them to evidence-based falls prevention programs delivered by Community Based Organizations (CBOs). However, due to a difference in the culture and nature of the work done in these two systems of care, there is often a lack of coordination and communication. Dartmouth has worked to bridge this gap for the past five years through our Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Program (GWEP). GWEP goals include the promotion of Age-Friendly Health Systems by focusing on the 4 Ms: What Matters Most, Medication, Mentation and Mobility. GWEPs commonly operationalize the Mobility component via falls risk screening and prevention programs. Though CBOs are well suited to deliver falls prevention programs, implementing, disseminating and sustaining community-based falls prevention programs in an environment of cost containment, limited funds for community-based services and workforce issues is challenging. Previous Administration for Community Living (ACL) grant funding enabled us to develop the Dartmouth Falls Prevention Training Center (D-TC) using our expertise in training and community-based implementation of evidence-based interventions. The D-TC offers training and implementation support to primary care and CBOs on screening, referring and capacity-building for falls prevention programs. We will discuss challenges and successes implementing the Dartmouth falls prevention model with two additional GWEP grantees, Baystate and the University of Rhode Island. Benefits of leveraging ACL and HRSA funding to achieve synergistic goals to reduce falls in older adults will be explored.

Strategies for Developing an Inclusive Geriatric Physician Workforce for Older Adults in the U.S.

The “geriatric imperative” has been part of the aging discourse for more than 30 years but neither geriatric practice nor older adults are homogenous. As the U.S. population ages, elders will become more racially and ethnically diverse; and, their health outcomes will be shaped by lifetime experiences with systemic discrimination and racism. Already, COVID-19 has made clear that older adults and non-Whites, particularly African Americans and Hispanics, disproportionately bear the burden of disease and illness. Research suggests health disparities will continue unless there is change within the health care system. The Institute of Medicine (2001) reported on the problematic nature of the stark contrast between the diversity of patients and the physicians caring for them, including issues with patient trust and communication, yet no significant movement has been made to diversify the physician workforce. Despite being 13% and 16% of the U.S. population, respectively, African Americans and Hispanics make up just 5% and 6% of the practicing physician workforce. Further, practicing geriatricians represent less than 1% of physicians with very few physicians of color. There is a need for more African American and Hispanic geriatricians. In this systematic review, we examine recruitment and retention efforts targeting students of color, and curricula of geriatric medical programs in the U.S. We offer recommendations toward incentivizing physicians of color to enter geriatrics, strategies to support decolonization of geriatric medical curricula in undergraduate medical education programs, and the development of mentorship and pipeline programs to increase diversity in the geriatric physician workforce.

Factors Driving High-Need High-Risk Vulnerable Veterans Use of Outpatient Healthcare

Loneliness and social isolation are serious public health concerns associated with higher risks of clinical depression, suicidal ideation, coronary artery disease, stroke, functional decline, an increased risk of developing dementia and cancer mortality. Recent reports indicate the prevalence and dangers of loneliness and social isolation have increased as a result of the COVID-19 pandemic, especially among older populations. In order to address these concerns among residents living at Northgate II (NGII), a 302-unit affordable housing development in Camden, NJ, Fair Share Support Services, Inc. (FSSS), the non-profit arm of Fair Share Housing Development, collaborated with the New Jersey Institute for Successful Aging (NJISA) and the DHHS-funded Geriatric Workforce Enhancement Program (GWEP) to develop a loneliness/social isolation survey using two evidenced-based tools, the UCLA Loneliness Scale and the Steptoe Social Isolation Index. FSSS piloted the loneliness and social isolation survey with 192 low-income minority older adults residing at NGII. Results indicate that 49% of the NGII residents surveyed fall into 5 "at-risk" categories: 1) lonely and isolated (9%), 2) lonely/somewhat isolated (8%), 3 ) lonely/not isolated (9%), 4) isolated/somewhat lonely (9%), and 5) isolated/not lonely (14%). FSSS, will utilize survey results and follow-up interviews to tailor social service/other interventions to meet the needs and preferences of residents with the goal of preventing serious health problems associated with loneliness and social isolation, allowing residents to age in place.

Adaptive Care and Remote Training: Models of Resilience for GWEPs During a Pandemic

Service and training are interconnected for GWEP’s, whose dual missions are to advance training as well as service delivery to improve the care of older adults. The COVID-19 pandemic has necessitated a pivoting from in-person to remote delivery of program content and services. As a result, older adults and their families require the continuity of services with their providers due to the barriers that the pandemic has created. Additionally, universities and organizations have adapted virtually to teach learners how to work with older adults around different health initiatives. The pandemic required these programs to develop immediate services that provided an alternative to remote delivery services. This collection of GWEP programs utilized students and trainees in their older adult services and initiatives. The goal of this symposium is to demonstrate new models of educational and program delivery to enhance and extend training and service to new audiences. The symposium centers on best practices including technological tools to promote GWEP aims and will allow a discussion of challenges and outcomes faced. The session will be comprised of presentations from five university-based, Geriatric Workforce Enhancement Programs (approximately 12 minutes each), a 20 minute discussion and sharing of best practices, and a 10 minute question/answer session. Individual presentations will address areas that include: 1.) group interventions for dementia and caregivers, 2.) teaching interdisciplinary interns in conducting telehealth visits, 3.) adapting geriatrics regional conferences to reach older adults virtually, and 4.) Developing new programs and services for underserved and underrepresented older adult populations.

Addressing the New Normal in Health Care Using an Interprofessional Model of Care Coordination

There has been significant discourse surrounding the widespread system failures within healthcare during COVID-19. Older, frailer, and poorer persons across the United States have been the most impacted by the pandemic. Given this, our FlourishCare team, received funding through the COVID Cares Act, as part of our Geriatric Workforce Enhancement Program (GWEP) grant, to create innovative programming for individuals that were the most impacted by the pandemic. Remote patient monitoring (RPM) is one intervention been shown as an effective way to assist persons in managing their conditions. Patients from our Optimal Aging Clinic were identified as struggling with hypertension, diabetes and/or COPD. Interprofessional teams of nursing and social work learners were assigned to work with patients. The kits contain all of the necessary technology and a virtual app platform that allows a patient to check their heart rate, blood pressure, oxygen levels, and glucose levels. This information was then disseminated to the team coordinating the patient’s care. The sample was mostly female (88%), African American (64%) and retired (70%). The mean age was 60 (SD=4), and 40% had less than a high school diploma. After 3 months in the program, we saw a significant improvement across all determinants of health, with a particular overall change in access to health services and individual health behaviors. This study showed the importance of providing patients with access to technology and the support of an interprofessional team can improve patient outcomes, lead to improvements in individual health behaviors and improve health literacy.

But How Will We Measure It? Co-Creating Assessments of Outcomes in Age-Friendly Care, PA

Moving from concept to quantitative measurement can be complex. There were several challenges in co-designing measures to assess the impact of Age-Friendly Care, PA, a geriatric workforce enhancement program. First as a FQHC, our clinical partner had not captured the metrics of interest. Second, the co-developed operational definitions for our metrics should be feasible, relevant, and useful for all project members. Third, funder reporting requirements must also be addressed. Working within this context, we co-created 11 outcome indicators structured around the 4Ms (IHI) now with 9 months of data. EMR changes to make data reportable included measuring opioid misuse mitigation, high-risk medication elimination, cognitive assessment and dementia care management, advanced care planning, care partner presence, annual wellness visit completion, pneumonia vaccination rates, colorectal screening rates, mobility goal tracking, and presence of a caregiver. Work continues around formulating themes to create a reportable mechanism for assessing What Matters.

Dementia-Friendly America Recognition: Strategies for Urban, African American Communities

Dementia-Friendly America is a network of communities across the United States who have committed to a process to support people living with dementia and their caregivers. Through technical support from Dementia Friendly Illinois, CATCH-ON, a HRSA Geriatric Workforce Engagement Program, has identified key characteristics for the 17 communities in Illinois achieving national recognition and for communities that have engaged but not yet achieved national recognition. In addition to communities in rural regions, urban communities with a large number of African Americans residents have necessitated more grassroots engagement than other communities. Partnerships are vital for providing information and education about the movement and for supporting multi-sectoral engagement. This presentation highlights barriers and facilitators in diverse communities, particularly urban African American communities, becoming recognized by Dementia Friendly America.

Age-Friendly Care, PA: A Geriatric Workforce Enhancement Program

Age-Friendly Care, PA is co-led by Primary Health Network, the largest Federally Qualified Health Center in Pennsylvania, and Penn State College of Nursing that aims to bring reliable, high-quality, age-friendly care to all older adults living in rural PA. Sponsored by HRSA through its Geriatric Workforce Enhancement Program, Age-Friendly Care, PA utilizes the ECHO, all-teach-all-learn, platform to engage isolated rural providers in incorporating the 4Ms (IHI) into their practice. Age-Friendly Care, PA reaches out directly to rural older adults and their care partners to co-design education and support. We have hosted 28+ events and reached 450+ individuals. Results include tracking and improvement in quality indicators assessed including support for individuals living with dementia and their care partners (NA-66.7%), risk for opioid misuse (NA-78%), high-risk medication management (NA-47.8%), fall-risk management (NA-9.4%), and advanced care planning (NA-8.9%). We will discuss the creation, co-development, implementation, lessons learned, and future of Age-Friendly Care, PA.

Strengthening Collaborations for Geriatrics Knowledge: Twitter Journal Club for Geriatric Fellows

The pandemic has challenged training programs in numerous ways, specifically in the ability to conduct group based teaching sessions. To overcome this challenge Twitter was examined as a vehicle for engaging Geriatric Fellows in education about critical appraisal of clinical research. A secondary objective was to develop educational synergy among university-based programs. To achieve these aims, 5 Midwestern Geriatric and Palliative Medicine Fellowship programs agreed to enroll their fellows into a monthly Geriatrics Twitter Journal Club, that commences on Twitter Tuesday and lasts a week. Each month, an assigned fellow selects an article to discuss and creates a short video to introduce it. A Twitter meister deliveres structured questions to guide fellows’ collective input on the article being critiqued. Over a 3 month roll out of @GeriatricJC, the twitter account of the journal club has gained 144 followers that includes 20 fellows, 63 geriatricians/geriatric faculty, 28 organizational accounts, 5 students and around 28 other providers and experts. From December 2020- February 2021, account generated tweets resulted in an average of 397 impressions/day with 2548 visits to the account profile per month. Videos posted have averaged 73 views/video. Discussion in journal club using #GeriJC has garnered 178 tweets from participants. This project shows that Twitter is a feasible platform for a fellowship journal club among several training programs, thus expanding expertise in evidence-based medicine while lowering the administrative burden of preparing journal club within a single program and increasing both faculty and trainee convenience of learning.

Experiential Service Learning: Promoting Competency-based Education for Gerontology Students

Service-learning is an effective pedagogical approach meant to deepen learners understanding of course content by linking scholarship and social action when structurally organized based on attainment of professional core competencies. The recent COVID-19 pandemic caused a rethinking of the way service learning practicum is delivered, especially as it relates to training health professionals who engage collaboratively with older persons (individuals aged 65 years and older). This poster examines the challenges faced by gerontology students as they transitioned to fully virtual learning and practicum format, the lessons learned, and how to close the gap between theory and practice for better programmatic processes. The data used to gather students experiences include; student reflective journals, class discussions and survey questions to students (n=44). The analytic framework utilized is the Social Cognitive Theory, (SCT)- which explains how individuals can master concepts through verbal and physical persuasion, including peer modelling. The goal is to promote leaners self- regulatory skills to achieve the course learning objectives, as obtained from the SCT six strategies for setting achievable goals, through: Feedback, self-instruction, self-monitoring, use of support and goal setting. Some of the lessons learned suggest students benefit more from service learning when they receive continuous feedback about how to develop intergenerational relationships with older adult partners assigned to in the community (68%), than from goal setting strategies (24%). The implication for practice is: there is a need to develop structured service-learning guidelines for undergraduate students in gerontology program to be prepared to better serve older adults.

Considerations in Curriculum Design for Teaching About Race and Racism in Gerontology

The recognition of structural racism as a public health crisis has enlarged the breadth and depth of discussions of the unique “Isms” in higher education classrooms. A significant number of undergraduate or graduate level gerontology programs participate in the delivery of training through instruction on the topics of aging, gerontology, or long-term care administration to future labor market participants. Absent from these classroom conversations, however, has been an analysis of how syntax, the analytical vocabulary, and other framing of such conversations can impact learners. While these educational programs provide highly critical information on disease, illness and injury prevention, self-care, population health, and other topics, professors can also introduce perspectives on race, racism, and how they may be related to the delivering of care to the aging population. Specifically, this session will introduce an example of curricular design for the identification of structural racism in the operation of long-term care institutions.

The Long and Winding Road: Early Years of the Accreditation for Gerontology Education Council

The long road of establishing an accreditation entity began in August 2010 when the AGHE Accreditation Task Force was convened. After numerous meetings complete with loud and vigorous debates, AGEC, the Accreditation for Gerontology Education Council emerged in 2016. Over the subsequent years, the Standards hit the hard road of reality leading to various revisions to the Handbook. The symposium’s first presentation concerns the history of AGEC and its further development into an independent entity. The key purpose of AGEC is assuring gerontology programs educational quality and enhancement governed by the principle of self-evaluation and peer review that engenders trust. The next presentation discusses the marketing aspect of AGEC built on getting feedback from the public. One of the outcomes of conducting focus groups and surveying the public is the discovery that prospective students really see the value of accreditation. The penultimate presentation focuses on refinements to procedures alluded to in the first presentation in response to the feedback received in meeting with institutions and faculty about what accreditation offers to students, stake-holders, and ultimately the older adults served by the graduates in the work force. The key goal is to clarify the expectations and simplify the application process. On no other issue has more time been spent than on the assessment of students’ competency. Our last presentation explains competency-based education consisting of well-articulated student learning outcome measures that are consonant with the program’s mission that lead to "closing the loop" of continuous and durable improvements in the learning environment.