Training In Geriatric Mental Health Research Articles

OVERVIEW OF THE NEBRASKA GERIATRIC BEHAVIORAL HEALTH WORKFORCE SURVEY

Abstract According to the US Census, more than 16% of Nebraska’s population is 65 and older. Many older Nebraskans reside in rural communities. Although clinicians in existing state-wide workforce surveys endorse working with older adults, it is unclear how frequently they are involved in geriatric mental health. To identify the needs of those who are providing mental health services to older Nebraskans, the Behavioral Health Education Center of Nebraska (BHECN) conducted an online survey of eligible licensed practitioners from August to December 2022. This presentation highlights the background characteristics of 193 respondents, nearly 40% of whom came from rural areas. Two-thirds identified either as licensed mental health therapists (38%), licensed clinical social workers (26%), or licensed psychologists (14%). More than a quarter did not provide direct clinical services to older adults. On average, respondents estimated devoting 18% of their time working with older adults. Respondents listed insurance restrictions, lower reimbursement rates, and limited specialized geriatric mental health training opportunities as major reasons that had kept them from serving older clients more frequently. These findings support BHECN’s ongoing efforts to further develop training and support, and advocate for potential policy changes to enhance the state’s geriatric behavioral and mental health workforce.

DEVELOPMENT OF PODCAST IN SERVICE OF THE NEXT GENERATION OF GEROPSYCHOLOGISTS

Abstract The current geropsychology workforce falls woefully short of meeting the mental healthcare needs of older adults, with only 3% of licensed psychologists identifying Geropsychology as their primary or secondary specialty. Formal training in geriatric mental health is extremely limited. Out of the over 400 APA-accredited doctorate-level psychology programs in the U.S., only five provide specialty training in Geropsychology. Consequently, the vast majority of psychologists who treat older adults have never received formal education or training in geriatrics. It is imperative that evidence-based geropsychology education is disseminated to a wide audience of mental health providers across all levels of training and career development. The Geropsychology Podcast was developed to address this gap as a novel pedagogical resource commensurate with educational competencies established by the ‘Pikes Peak Model for Professional Geropsychology.’ Topics include geriatric assessment methods, intervention, consultation, and foundational knowledge on adult development and aging. The feasibility and acceptability of the podcast was evaluated with a two-year pilot study from 2019 to 2021. During this time, eleven episodes were published across multiple podcast platforms. Preliminary results found the episodes were downloaded by over 1,500 unique listeners across 34 countries. These results indicate that The Geropsychology Podcast is scalable, acceptable, and potentially fulfilling an educational need that people are actively seeking. This poster describes the podcast’s model of curriculum development and ongoing quality metrics and impact analysis. Future work holds that this podcast will continue to be a vital resource for the field.

Addressing Disparities in Geropsychiatry Education: Lessons Learned from 2020

With the onset of the Covid-19 pandemic in 2020, numerous disparities in both geriatric mental health care and geriatric mental health education emerged as challenges for medical educators. Many of these disparities were known prior to the onset of pandemic, including unequal access to geriatric psychiatry educators and clinical experts across the country, as well as limited opportunities for clinical experiences in geriatric psychiatry for medical students and residents. Indeed, the Institute of Medicine Report of 2012, “In Whose Hands: The Mental Health and Substance Use Workforce for Older Adults”, had identified the current and projected gaps in geriatric mental health training to meet the needs of an aging population. Since 2020, additional gaps and disparities have been recognized that adversely affect the ability to adequately develop and train the next generation of geriatric psychiatrists, as well as geriatrics-informed general psychiatrists and primary care physicians. The year 2020 also brought to the fore, issues of racism and ageism, both of which may not have been adequately addressed before in geropsychiatry education. Yet, racism and ageism are both now more clearly understood as key factors affecting the lives of elders and adding to disparities in geriatric mental health care. At the same time, the challenges of the pandemic led to new innovations in both the delivery of geropsychiatry education and the content of the education strategies that will help to mitigate disparities for patients and trainees. This symposium will address 3 key areas related to disparities in geropsychiatric education and will share important insights that should inform future approaches to geropsychiatry education.Dr. Susan W. Lehmann will present on: “’In Whose Hands?’: Where are we today?” In her talk, Dr. Lehmann will discuss the 2012 Institute of Medicine Report that described the deficiencies and disparities in geriatric mental health education identified in 2012, and she will provide an update 10 years later about what has changed since the report, and what remains to be done. She will specifically talk about geographic disparities in opportunities for training and the impact of these disparities on the mental health care of older adults. Dr. Lehmann will discuss the need for professional organizations to focus on national approaches to advocacy and change.Dr. Kirsten Wilkins will present on: “Challenges and Opportunities: Preparing the Next Generation of Geropsychiatry Trainees”. In her talk, Dr. Wilkins will discuss disparities in health care that were exposed by the Covid-19 pandemic and which negatively impact geropsychiatry education. She will address the clinical care training challenges presented by unequal access to telemedicine for elders, as well as the challenges of incorporating virtual care into the geropsychiatry curriculum for trainees. Dr. Wilkins will also address the national reckoning on race and racism that emerged during 2020 and its impact on older adults and the learning environment for geropsychiatry trainees. She will discuss the implications for geropsychiatry educators in preparing trainees to be leaders in eliminating the deleterious effects of racism and ageism for older adults.Dr. Michelle Conroy will present on: “Innovations and opportunities within geriatric psychiatry education: lessons learned from the COVID-19” pandemic. She will discuss innovations in geropsychiatry education that were developed during the Covid-19 pandemic in response to identified disparities, and lessons learned for educators that should continue into the future. In particular, she will describe a number of successful new outreach programs, didactics, and educational products developed by geropsychiatry educators in AAGP.

Life skill training workshop in geriatric mental health for postgraduate students: An appraisal

Background: Management of mentally ill elderly is a challenging task. Due to the lack of awareness, training opportunities in the course curriculum, and nil to negligible knowledge/ understanding/ exposures, allied mental health professionals are hardly available in geriatric mental health (GMH). Awareness generating orientation/ skill development workshops/ seminars/ webinars/ conferences may develop the interest in the young generations, which further may help in generating human resources in the subject. The present article aims to provide a snapshot of the Life Skill Training (LST) workshop developed for psychology students and discusses its effectiveness. Materials and Methods: The authors had an opportunity to organize and facilitate orientation workshop named as “life skill training in GMH“ for the students of psychology in Varanasi. A total of 86 students had participated in two independent workshops. All participants' self-rated appraisal was obtained on a five-point scale (ranging from very poor to very good) for all ten core life skills as laid out by the World Health Organization. The workshop was conducted by applying the tools such as imagination, reflection, communication, presentation, problem-solving, critical thinking, and sharing. The pre-post assessment was done, and qualitative feedback was received from the participants. Results: The results reveal that participants observed betterment in self on each life skill as the obtained value of mean scores after the workshop was found to be slightly more on each of the core life skills. Conclusion: The orientation workshop sensitizes the students regarding the issues related to the field, which may allow them to pursue the subject further.

Geropsychology and psychogeriatrics in Portugal: research, education and clinical training

In response to the global challenges of population aging in Portugal, it is crucial to improve research, education and clinical training in old age in order to meet the growing demands placed on psychogeriatric care services. An overview is provided on the status of old age psychology and psychiatry as part of the multidisciplinary care delivery system for the elderly in Portugal. Available educational offerings and clinical training in geriatric mental health at both undergraduate and postgraduate level are described, as well as primary research associations and initiatives within Portugal. Important issues raised include the need for more educational and clinical training programs for specialists, a broader commitment to aging research and the need to increase interest in working with older adults among students across disciplines. The recent movement towards multidisciplinary work conducted by researchers, psychiatrists, psychologist and other health professionals in Portugal points to the urgent need for specialist education for all health professionals working in geriatrics. This educational initiative must focus not only on the transmission of knowledge on aging-related topics, but also on the training of specific skills and competencies. Improving geriatric mental health service delivery and connecting research with clinical practice constitute other significant steps forward. An effective intervention in psychogeriatrics should involve a strategy with the participation of a multidimensional network that includes the commitment of researchers, educators, clinicians, health policy-makers and older adults. Several recommendations to improve late life mental health care are presented.

Career Development and Training in Geriatric Mental Health: Report of an NIMH Workshop

At a National Institute of Mental Health (NIMH)-sponsored meeting, the participants discussed means of increasing the pool of late-life mental-illness researchers. Approaches identified included encouraging retention of junior scientists through greater mentoring and support; creation of research postdoctoral programs by investigators and institutions that lack late-life emphasis; earlier commitment to late-life research with predoctoral training mechanisms; recruitment of ethnic and racial minority scholars into late-life research; and recruitment of newly established researchers through postdoctoral training mechanisms. Federal, public, and private mechanisms need to be better leveraged to grow late-life mental-illness research infrastructure and meet increasing demand and scientific opportunities.

The Challenge and Promise of Geriatric Mental Health Training

The Challenge and Promise of Geriatric Mental Health Training

Career Development and Training in Geriatric Mental Health: Report of an NIMH Workshop

At a National Institute of Mental Health (NIMH)-sponsored meeting, the participants discussed means of increasing the pool of late-life mental-illness researchers. Approaches identified included encouraging retention of junior scientists through greater mentoring and support; creation of research postdoctoral programs by investigators and institutions that lack late-life emphasis; earlier commitment to late-life research with predoctoral training mechanisms; recruitment of ethnic and racial minority scholars into late-life research; and recruitment of newly established researchers through postdoctoral training mechanisms. Federal, public, and private mechanisms need to be better leveraged to grow late-life mental-illness research infrastructure and meet increasing demand and scientific opportunities.

Confidence of primary care physicians in assessing the suicidality of geriatric patients.

This study examined the confidence levels of physicians in assessing the risk of suicide among older adults in clinical settings. Of the 300 physicians who were selected from a population of 4980 family practice, internal medicine, and geriatric physicians in Illinois, 63% responded to the mail survey. Several categorical items inquired about specific assessment and treatment approaches, referral resources used, barriers to meeting the mental health needs of older patients, and sources of training in suicide risk assessment. All the training items (suicide assessment in medical school, residency, and CME courses; rating of medical school training; and insufficient training in geriatric mental health) were significantly (p < 0.01) associated with confidence in assessing suicidality. The overall model consisting of six variables explained 57% of the variation in confidence scores [F (6, 130) = 28.48, p < 0.001]. Three variables accounted for 50% of the explained variance: confidence in diagnosing depression, residency training in the assessment of suicide risk, and assessment of the intentional misuse of medication. Confidence in diagnosing depression (beta = 0.38, p < 0.001) was the strongest predictor. More effective mental health care will require specific preparation in treating geriatric patients through the full spectrum of medical training, including medical school, residency, and CME courses. Improved prevention of elderly suicide hinges on the enhancement of clinical skills in diagnosing and treating geriatric depression.

Caring for depressed and suicidal older patients: a survey of physicians and nurse practitioners.

This study sought to describe patterns of mental health care for depressed and suicidal geriatric patients by primary care physicians (MDs) and nurse practitioners (NPs). A probability sample of 300 Illinois MDs from the AMA Physician Masterfile and a national sample of 595 NPs from the American Academy of Nurse Practitioners were surveyed. Sixty-three percent of MDs and 61 percent of NPs responded regarding their approaches to assessing, treating, and referring older adult patients who were depressed or suicidal. Respondents rated their confidence in assessing and treating depression and suicidality and identified barriers to mental health treatment in a primary care setting. Both similarities and differences were found among MDs and NPs in their patterns of managing depressed and suicidal older adults. NPs used more varied approaches in assessing, treating, and referring their geriatric patients with mental health problems. MDs relied more heavily on psychotropic medications for the treatment of depression and on psychiatrists when referring suicidal older patients. NPs were more likely than MDs to note lack of training and referral resources as barriers to treating depression of older patients. NPs rated their training in geriatric mental health more favorably than MDs. In terms of assessment of depression, preferred treatment approaches, the use of referral resources, and perceived barriers to mental health care, there appears to be a greater orientation towards a psychosocial approach among NPs. Primary care MDs and NPs often have different perspectives that in combination could enhance the mental health care of geriatric patients.

Training in geriatric mental health: needs and strategies.

This paper examines current numbers of U.S. mental health care professionals in psychiatry, psychology, social work, and nursing who are trained to treat late-life mental disorders and presents estimates of the increased numbers that will be needed by 2010. Strategies that may be effective in increasing the supply of geriatric mental health specialists are expanding incentives, such as fellowship stipends, loan forgiveness programs, and clinical reimbursement, to attract more clinicians to the field; encouraging professional organizations to offer certification in aging to highlight increased knowledge among professionals; and increasing core curricula in late-life mental disorders, or at least in aging, in all health professions. Other strategies are to diversify the range of training opportunities available by establishing short-term training initiatives to meet specific demands; use new technology to provide education to both professionals and the public; and establish "centers of excellence" to advance research training and clinical care in late-life mental disorders.

Introduction: preparing for the future.

The United Nations has declared 1999 the International Year of Older Persons, which should come as no surprise. The past century has witnessed a greater increase in average longevity than any other period in the history of mankind. The average life span grew from 20 years in ancient Greece to 30 years in medieval Europe to 47 years in the United States in 1900. Today, the average life span in the U.S. is more than 75 years (1). The rest of the world is also experiencing a phenomenal rise in the number of elderly persons. Thus, between the years 1985 and 2025, the number of individuals over age 65 will increase by 238 percent in China and by 264 percent in India (2). As the overall number of elderly persons in the population at large increases, the number of elderly persons with mental illnesses will increase. Moreover, individuals with psychiatric disorders such as dementia, schizophrenia, and mood disorders, which have long been associated with reduced longevity, should be able to have relatively normal life spans in the future, thanks to the expected advances in pharmacological and other treatments. The anticipated explosion in the number of elderly persons with chronic mental illness has major implications. The country will face an unprecedented growth in expenditures for the care of these patients. Critical issues of quality of life and quality of care for elderly psychiatric patients and their caregivers must be addressed. As a preliminary step toward addressing issues pertinent to the future of mental health and aging, we organized a closed workshop in San Diego on March 11 and 12, 1998. The invited participants came from academic institutions, professional organizations, advocacy groups, government agencies, and the pharmaceutical industry. The formal scientific presentations were followed by a broad-ranging discussion. A consensus statement based on those deliberations is being published elsewhere (3). This special section of Psychiatric Services includes eight of the individual papers presented at the workshop, which have been peer reviewed for publication. The papers address topics ranging from major psychiatric disorders such as dementia, depression, schizophrenia, and substance use disorders to broader issues such as epidemiology, psychotherapeutic and behavioral interventions, health care services delivery, and training in geriatric mental health. These topics represent only a portion of the overall field of mental health and aging. For example, no papers on anxiety disorders or personality disorders in elderly persons are included. The effort represented here should be viewed as one step in a long process. Multipronged efforts on various fronts, including an increase in public education, reforms in health care financing, expansion of the research portfolio, and improvement in training at all levels, are urgently needed. ♦

Geropsychiatric nursing consultation as an adjunct to training in long-term care facilities: the indirect approach.

Creative, collaborative approaches between sub-specialties in nursing are needed to improve the quality of care and, hence, the quality of life for mentally ill and behaviorally impaired older adults living in long-term care (LTC) facilities. Results of a consultation survey collected as part of a larger geriatric mental health training project, and described in this article, support the position that consultee-centered geropsychiatric nursing consultation services are an important adjunct to training. However, this indirect approach to service enhancement may not be well understood and, as a result, not well utilized by LTC nurses. Methods to facilitate understanding and utilization of "indirect" mental health assistance to LTC residents and staff are explored within the context of building productive liaisons among nurses.

Evaluation of a geriatric mental health training program for nursing personnel in rural long-term care facilities.

Although mental illness among elderly living in nursing homes is a substantial and growing concern, the behavioral problems associated with mental illness or threats to mental health are not well understood, tolerated, or effectively managed by nursing home staff. As a result, resident care and quality of life, and staff morale often suffer. The need for geriatric mental health training in long-term care settings has become increasingly apparent. Psychiatric/mental health nurses are in an advantageous position to address this current need and future challenge through the development, implementation, and evaluation of geriatric mental health education and training programs in long-term care settings. This article describes one such innovative training effort, designed to improve the quality of psychosocial care provided by nursing personnel in rural long-term care settings, and highlights evaluation outcomes related to participant satisfaction, staff knowledge, and attitudes.

Training in Geriatric Mental Health:

The author briefly reviews previous research on educational programs which have been effective in improving students' attitudes toward mentally ill elderly, then describes two model outpatient programs which have been successfully used as training sites. Geriatric and Family Services is a University based, family oriented clinic specializing in the diagnosis and management of Alzheimer's Disease. The other program described in the paper is the Geriatric Evaluation Team, a community based crisis intervention outreach service. Current training activities must be greatly expanded if the needs of mentally ill elderly are to be met adequately.

Increasing the Emphasis on Health Care and the Environment in Geriatric Mental Health Training

Geriatric mental health training programs would benefit from increased emphasis in two areas: the role of the general health care system in meeting the mental health needs of the elderly; and, the assessment and modification of environments to promote the mental health of the elderly. These two areas are discussed and suggestions are made for including them in the curriculum.