Training In Geriatric Psychiatry Research Articles

Developing a Diverse, Equitable, and Inclusive Curriculum for Trainees

The importance of diversity in medical education has become increasingly clear with strong evidence showing its benefits in helping to reduce healthcare disparities and mortality, increase access to medical care, increase the number of clinicians practicing in medically underserved and rural communities, increased patient trust, improvement in patient-physician relationships, and better financial outcomes for health systems. As leaders in graduate medical education, the Teaching and Training Committee of the American Association for Geriatric Psychiatry (AAGP) proposed the creation and development of a curriculum that fosters an inclusive learning environment for our fellows, promotes open dialogue among everyone involved in the clinical process, and establishes anti-bias principles as integral parts of geriatric psychiatry education. The AAGP Diversity, Equity, and Inclusion (DEI) Curriculum Development subcommittee was established to carry out this task. Themes to be explored include ageism, racism and bias, social determinants of health, cultural humility, ethics of decision making in older adults, substance use, neurobiology of stress, the mental health of minoritized older adults, psychosocial and cultural aspects of aging, and laws that impact this population.This session details the process of establishing this important curricular thread as a template or framework that can be used in Geriatric Psychiatry training programs throughout the country and, in acknowledgement of the importance of the workforce that cares for older adults, ensures that it is practical and applicable to clinicians in non-academic settings. The panelists will highlight DEI curricular development in one fellowship program from the view of a trainee, the impact on recruiting a more representative workforce, and how to improve trainee and faculty engagement within and across programs.This presentation is sponsored by the Teaching and Training Committee.

Trainee doctors' preparedness for clinical work in geriatric psychiatry: A survey on 18 preliminary entrustable professional activities.

Research concerning transitions from one rotation to another during medical specialist training is scarce. This study examined trainee doctors' perceived preparedness for core clinical activities, trainee doctors' preparedness levels, and general perceptions of medical specialist training in geriatric psychiatry. Swiss trainee doctors in geriatric psychiatry were surveyed about their perceived preparedness for 18 preliminary entrustable professional activities (EPAs), curricular support, and general perceptions of their medical specialist training. Closed questions were analysed using descriptive statistics, while open questions were subjected to content analysis. The participants comprised 48 trainee doctors (30.4% response rate) who differed in their educational experience (years of residency and specialism) and clinical subspecialisation goals. Trainee doctors felt adequately prepared for most EPAs but less prepared for some, including electroconvulsive therapy, psychotherapy, and treating older adults in the home environment or residential facilities. Despite the trainee doctors' diversity, they did not differ significantly in perceived preparedness for most EPAs. The most often offered suggestions for improving geriatric psychiatry training were intensified clinical supervision and a structured induction programme. Trainee doctors reported that they felt sufficiently prepared for most EPAs, regardless of their backgrounds and professional goals. However, several professional activities in geriatric psychiatry warrant further training. Our findings indicate the need for a higher intensity of clinical supervision (e.g. more direct observation and specific feedback), the introduction of structured induction programmes (e.g. orientation week), and specific teachings (e.g. on neurocognitive assessment).

Diverse Geriatric Workforce Education History, Needs, and Opportunities: Focus on Psychiatric Advanced Practice Nurses

Primary TopicAdvanced Practice Nursing History and Current State of Education Update Secondary TopicExploration of opportunities for filling educational gaps for subspecialty geriatric psychiatry training in Diverse WorkforceThis symposium is sponsored by the AAGP IDEA Committee.Advanced practice nurses are continuing to grow as partners of care for the geriatric psychiatry patient population. With increasing specialty workplace shortages across acute, ambulatory, and long-term care settings and growing numbers of geriatric psychiatrists retiring and less coming into the field, there is need to increase interprofessional collaboration with advanced practice nurses. The variety of advanced practice nurses practicing in the field has led to understandable confusion surrounding educational standards and experience from physician colleagues.Advanced nursing education has evolved over decades adapting to the needs of the ever-changing healthcare system and patient needs. Advanced practice nurses came in existence to assist in providing care to the underserved and often rural populations that struggled to maintain physician employment. The first advanced practice nurse specializing in the field of psychiatry was the certified nurse specialist. This role originally encompassed a larger focus on psychotherapy. Over decades and changes in healthcare, there was a larger call for psychiatric prescribers due to psychiatrist shortage, leading to the development of the psychiatric nurse practitioner role. Psychiatric nurse practitioners are board certified to provide psychiatric healthcare across the lifespan but are considered generalists until provided experience and training in specialty areas. Psychiatric nurse practitioners specializing in geriatric psychiatry do not currently have any additional academic institution driven training, but become specialists through mentorship from geriatric psychiatrists, nurse practitioners, or physician assistants within depth knowledge in geriatric mental healthcare. They also engage with continuing medical education, professional organization involvement, and gain clinical experience at bedside and in advanced practice nursing. Some advanced practice psychiatric nurses come into geriatric psychiatry practice from a calling and passion for this population, while others find their career gravitates towards this population as a response to a call from the community in need of care. There is desire and need for increased standardized educational opportunities for advanced practice nurses who are passionate about caring for the mental health needs of older people, and a hope that geriatric psychiatrists may offer assistance and guidance with the interprofessional united goal to improve access to quality care to our geriatric patients.

Psychiatric Resident Perceptions of Competency in the Management of Social Isolation and Grief in Geriatric Patients

Introduction The proposed research is an examination of resident experiences and preparedness in providing psychiatric care to geriatric patients in an adult outpatient clinic setting. During the SARS COV-2 pandemic, psychiatry residents were called upon to help older patients cope with increased social isolation, loss of loved ones, and fears about their own safety. The goal of the study is to assess the educational needs of residents in caring for this population, to provide a brief educational intervention targeting relevant clinical skills and knowledge, and to evaluate resident attitudes and feelings of competence before and after the intervention. The geriatric population presents with distinct clinical challenges and needs when it comes to psychiatric management. Although this population might be best served by subspecialty services, there is a relative shortage of geriatric psychiatrists, and most older psychiatric patients receive care from general psychiatrists or primary care physicians. While one month of training in geriatric psychiatry is a requirement of ACGME-accredited psychiatry residency programs, there is very little research examining general psychiatry residents’ perceptions of their ability to address the specific needs and psychosocial challenges of this population. Minimal research exists that examines the geriatric curricula in adult psychiatry residency programs. Furthermore, there is no research that addresses psychiatry resident competence in managing key psychosocial factors affecting geriatric psychiatric patients, including social isolation, loneliness, and bereavement. Experiences of loneliness and loss are fundamental lifecycle concerns, with social isolation being a particular issue among aging urban populations (1). The COVID-19 pandemic has greatly exacerbated issues of social isolation and bereavement among geriatric patients, bringing attention to their role as key social determinants of physical and mental health (2). The psychological impact of the pandemic on older adults is an area of active study. However, little attention has been paid to how psychiatric trainees are engaging with these issues in their care of older patients. Methods Study participants were drawn from all four class years of the psychiatry residency program at LAC+USC Medical Center between March and June of 2021. Participants completed a 15-question survey to evaluate their subjective feelings of preparedness and competency in caring for elderly patients. The survey also evaluated residents’ perspectives about the relative importance of addressing different psychosocial issues when caring for elderly patients. Results A total of 34 respondents across four levels of training completed the pre-intervention survey. Among first- and second-year residents, 84% did not feel prepared to address issues of loneliness and 76% did not feel prepared to address issues of grief in older patients. Among third- and fourth-year residents, 31% of respondents did not feel prepared to address either of these two issues, despite having completed a 1-month geriatric psychiatry rotation. Very few senior residents felt “very well prepared” to address issues of grief or loneliness in their patients (13% and 6% respectively), with the majority feeling “somewhat prepared.” Respondents across all four class years indicated a strong level of interest in additional training in the management of grief and social isolation/loneliness. Conclusions The results of the survey suggest that although, self-perceived competence in the management of geriatric psychosocial issues increases over the course of training, many residents do not feel adequately prepared to meet certain needs in the geriatric population. These results will be used to create an educational intervention. The educational intervention will be provided to the current 3rd year class as part of the outpatient didactic curriculum. A post-intervention survey will be used to assess residents’ feelings of preparedness and comfort in providing care for elderly patients and to evaluate the perceived value of the educational intervention. A final survey will be given to the 3rd year class at the end of the 2022 academic year and will be compared to the survey results of the 2022 and 2021 graduating classes. Study data will be primarily qualitative, with a limited amount of quantitative date derived from pre- and post-intervention surveys. A paired t-test will be used to compare the results of the pre- and post-intervention surveys. Citations: 1.Courtin, E., & Knapp, M. (2017). Social isolation, loneliness and health in old age: a scoping review. Health & social care in the community, 25(3), 799-812. 2.Smith, M. L., Steinman, L. E., & Casey, E. A. (2020). Combatting social isolation among older adults in a time of physical distancing: the COVID-19 social connectivity paradox. Frontiers in public health, 8, 403. This research was funded by None The proposed research is an examination of resident experiences and preparedness in providing psychiatric care to geriatric patients in an adult outpatient clinic setting. During the SARS COV-2 pandemic, psychiatry residents were called upon to help older patients cope with increased social isolation, loss of loved ones, and fears about their own safety. The goal of the study is to assess the educational needs of residents in caring for this population, to provide a brief educational intervention targeting relevant clinical skills and knowledge, and to evaluate resident attitudes and feelings of competence before and after the intervention. The geriatric population presents with distinct clinical challenges and needs when it comes to psychiatric management. Although this population might be best served by subspecialty services, there is a relative shortage of geriatric psychiatrists, and most older psychiatric patients receive care from general psychiatrists or primary care physicians. While one month of training in geriatric psychiatry is a requirement of ACGME-accredited psychiatry residency programs, there is very little research examining general psychiatry residents’ perceptions of their ability to address the specific needs and psychosocial challenges of this population. Minimal research exists that examines the geriatric curricula in adult psychiatry residency programs. Furthermore, there is no research that addresses psychiatry resident competence in managing key psychosocial factors affecting geriatric psychiatric patients, including social isolation, loneliness, and bereavement. Experiences of loneliness and loss are fundamental lifecycle concerns, with social isolation being a particular issue among aging urban populations (1). The COVID-19 pandemic has greatly exacerbated issues of social isolation and bereavement among geriatric patients, bringing attention to their role as key social determinants of physical and mental health (2). The psychological impact of the pandemic on older adults is an area of active study. However, little attention has been paid to how psychiatric trainees are engaging with these issues in their care of older patients. Study participants were drawn from all four class years of the psychiatry residency program at LAC+USC Medical Center between March and June of 2021. Participants completed a 15-question survey to evaluate their subjective feelings of preparedness and competency in caring for elderly patients. The survey also evaluated residents’ perspectives about the relative importance of addressing different psychosocial issues when caring for elderly patients. A total of 34 respondents across four levels of training completed the pre-intervention survey. Among first- and second-year residents, 84% did not feel prepared to address issues of loneliness and 76% did not feel prepared to address issues of grief in older patients. Among third- and fourth-year residents, 31% of respondents did not feel prepared to address either of these two issues, despite having completed a 1-month geriatric psychiatry rotation. Very few senior residents felt “very well prepared” to address issues of grief or loneliness in their patients (13% and 6% respectively), with the majority feeling “somewhat prepared.” Respondents across all four class years indicated a strong level of interest in additional training in the management of grief and social isolation/loneliness. The results of the survey suggest that although, self-perceived competence in the management of geriatric psychosocial issues increases over the course of training, many residents do not feel adequately prepared to meet certain needs in the geriatric population. These results will be used to create an educational intervention. The educational intervention will be provided to the current 3rd year class as part of the outpatient didactic curriculum. A post-intervention survey will be used to assess residents’ feelings of preparedness and comfort in providing care for elderly patients and to evaluate the perceived value of the educational intervention. A final survey will be given to the 3rd year class at the end of the 2022 academic year and will be compared to the survey results of the 2022 and 2021 graduating classes. Study data will be primarily qualitative, with a limited amount of quantitative date derived from pre- and post-intervention surveys. A paired t-test will be used to compare the results of the pre- and post-intervention surveys.

Forensics in Geriatric Psychiatry Fellowship: Evolution and Practice Value

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

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

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

Residents Interested in Public Sector Career Would Benefit From Geriatric Training

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

FORENSICS IN GERIATRIC PSYCHIATRY FELLOWSHIP: EVOLUTION AND PRACTICE VALUE

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

The generalizability of Older Adult Self-Report (OASR) syndromes of psychopathology across 20 societies.

As the world population ages, psychiatrists will increasingly need instruments for measuring constructs of psychopathology that are generalizable to diverse elders. The study tested whether syndromes of co-occurring problems derived from self-ratings of psychopathology by US elders would fit self-ratings by elders in 19 other societies. The Older Adult Self-Report (OASR) was completed by 12 826 adults who were 60 to 102 years old in 19 societies from North and South America, Asia, and Eastern, Northern, Southern, and Western Europe, plus the United States. Individual and multigroup confirmatory factor analyses (CFAs) tested the fit of the seven-syndrome OASR model, consisting of the Anxious/Depressed, Worries, Somatic Complaints, Functional Impairment, Memory/Cognition Problems, Thought Problems, and Irritable/Disinhibited syndromes. In individual CFAs, the primary model fit index showed good fit for all societies, while the secondary model fit indices showed acceptable to good fit. The items loaded strongly on their respective factors, with a median item loading of .63 across 20 societies, and 98.7% of the loadings were statistically significant. In multigroup CFAs, 98% of items demonstrated approximate or full metric invariance. Fifteen percent of items demonstrated approximate or full scalar invariance, and another 59% demonstrated scalar invariance across more than half of societies. The findings supported the generalizability of OASR syndromes across societies. The seven syndromes offer empirically based clinical constructs that are relevant for elders of different backgrounds. They can be used to assess diverse elders and as a taxonomic framework to facilitate communication, services, research, and training in geriatric psychiatry.

Geriatric Psychiatry Teaching in Canadian Medical Schools: a Cross-Sectional Study.

With a growing geriatric population and limited geriatric psychiatrists in Canada, it is crucial to provide sufficient training in geriatric psychiatry during medical school. The authors examined how geriatric psychiatry education is delivered in Canadian medical schools during clerkship. Factors that could be associated with increased geriatric psychiatry teaching in medical schools were examined. The authors were also interested in comparing Canadian to US findings. A cross-sectional survey was distributed to the psychiatry medical education representatives attending the Canadian Organization of Undergraduate Psychiatry Educators (COUPE) semi-annual meeting in September 2017. All 17 (100%) medical schools completed the survey. Fifteen of the 17 schools (88%) have geriatric psychiatry-specific learning objectives. Five schools (29%) offer a clinical component in geriatric psychiatry. One school has an award for clerks (6%), and no awards exist for faculty. The number of lecture hours in geriatric psychiatry is moderately correlated with the presence of a geriatric component to psychiatry clerkship (Spearman's rho = 0.67, p = 0.003) and the length of the geriatric portion of clerkship (Spearman's rho = 0.64, p value = 0.006). Lecture hours are also moderately correlated with the presence of a geriatric fellowship (Spearman's rho = 0.68, p value = 0.003). Geriatric psychiatry clerkship education is inconsistent in Canada. There is virtually no recognition of excellence in teaching or undergraduate performance in this area in clerkship. Geriatric psychiatry may receive more frequent attention in Canadian medical schools than in US medical schools.

THE STATE OF GERIATRIC PSYCHIATRY TRAINING IN GENERAL PSYCHIATRY RESIDENCY: DATA FROM A NATIONAL SURVEY OF U.S. PROGRAM DIRECTORS

Introduction The 2012 Institute of Medicine (IOM) report identified a staggering increase in older adults with anticipated need for mental health and substance use treatment (1). By 2030, the United States population of elderly adults is anticipated to increase from 40.3 to 72.1 million, with 14-20% of this population estimated to have a mental health or substance use disorder ( 1 ). However, the IOM report cautions that the projected workforce remains inadequate to meet these pressing needs. Geriatric psychiatrists play a critical role providing subspecialty care to elderly patients with mental health, substance use, and neurocognitive disorders. Since 2010, the total number of geriatric psychiatry fellows has plummeted by 31% ( 4 , 5 , 6 ); this decrease in numbers ( 2 ) is a substantial concern. This study aims to investigate geriatric psychiatry training opportunities in general adult psychiatry residency programs and specific educational factors which may be associated with residents pursuing geriatric psychiatry subspecialty training. Methods The American Medical Association's Fellowship and Residency Electronic Interactive Database Access (FREIDA) was queried to compile a contact list of program directors from Accreditation Council on Graduate Medical Education (ACGME) accredited general adult psychiatry residency programs ( 3 ). The program directors were emailed an anonymous multiple choice survey using Qualtrics software to ascertain the nature of their program's geriatric psychiatry training experiences. The survey's domains of inquiry included the following: the quantity and quality of geriatric clinical and didactic experiences, the settings of training in geriatric psychiatry, the number of faculty with geriatric psychiatry specialization, and the number of graduates who pursued geriatric fellowships. Program directors were also asked about their familiarity with the American Association for Geriatric Psychiatry (AAGP) Scholars Program. Data analysis will be performed on survey responses. Results The authors will present survey data and compare results to previously published literature. Conclusions This work will contribute to the field by describing the current state of geriatric training in general psychiatry residency and examining whether these educational factors correlate to residents pursuing geriatric psychiatry fellowships. This research was funded by No funding sources supported this work.

Advice on How to Choose a Geriatric Psychiatry Fellowship

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

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

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

Critical Association Between Mental Health Disorders and Medical Status: Depression Intervention Use Indicates a Two-Fold Risk for Subsequent Medical Events in Older American Home Health Care Patients.

The current study examined longitudinal associations between mental disorders and all-cause subsequent medical events in a 5% random sample of records in the 2010 national Outcome and Assessment Information Set. Records of older adults (N = 28,475) receiving home health care (HHC) services were examined with respect to mental disorders and medical events, including acute care hospitalization, emergency department admission, and 30-day rehospitalization. Predominant mental disorders were depression and anxiety identified by formal diagnoses, symptom clusters, and/or prescription of related mental health services. Depression intervention use was the strongest risk factor for all three types of medical events. However, 61.6% of patients receiving depression interventions did not screen positive at admission using the Patient Health Questionnaire-2. Moving forward, nurses must closely monitor high-risk older adults throughout the HHC stay using sensitive depression screening tools, as well as receive targeted training in geriatric psychiatry. [Journal of Gerontological Nursing, 42(10), 42-55.].

Training in old age psychiatry: The 30 countries’ perspective

To improve the care of older people with mental health problems it is necessary to have a highly skilled workforce who is very well-trained in the diagnosis and management of the range of the psychiatric problems affecting older people including the dementias. Key to this is the need to have an adequate number of specialists in geriatric psychiatry and a wider recognition of geriatric psychiatry training across Europe including a broad agreement on training requirements. In 2012 the European Association of Geriatric Psychiatry (Toot et al.) published the results of a Europe wide survey on geriatric psychiatry training to scope current practice and develop recommendations to begin a debate on harmonization. Representatives from 30 out of 38 (79%) representatives responded including many from countries where old age psychiatry was not formally a specialty. Training programs and duration varied between countries. Eleven countries reported that they had geriatric psychiatry training programs and most of these required geriatric psychiatry trainees to complete mandatory training for two years within old age psychiatry. Representatives from ten countries reported having specific Continuing Professional Development (CPD) for old age psychiatrists at consultant level.The recognition of geriatric psychiatry as a specialist discipline in Europe is on the rise. The training procedures and processes in place vary considerably between and sometimes within countries. There are several options for harmonizing old age psychiatry training across Europe with advantages to each. However, support is required from national old age psychiatry bodies across Europe and an agreement needs to be reached on a training strategy that encompasses supervision, development, and appraisal of the knowledge and skills sets of old age psychiatrists. This workshop will look at options for harmonization and take first steps towards a consensus.Disclosure of interestThe author has not supplied his declaration of competing interest.

Harmonization of European training

Mental health disorders, especially dementia, mood- and anxiety disorders, are among the most prevalent diseases in later life. Due to a greying European society, numbers are expected to increase over the next decades. Consequently, there is a pressing need for well-trained specialists in geriatric psychiatry across Europe in order to meet the mental health needs and to deliver a high standard of care to the aging population. In the past decades, some countries have set up specific training programs for specializing in geriatric psychiatry, whereas others did not. In order to stimulate the development of high-quality services, harmonizing specialty training across Europe will be a first step forward.The EU stresses the need for standardizing qualifications of medical professionals to enable them to work across the EU. This workshop aims to work towards a consensus on the minimum training level required for geriatric psychiatry. We state that being able to work as an old age psychiatrist requires specific training in geriatric psychiatry and old age over and above general training in psychiatry. Therefore, discussion of opportunities to develop minimal criteria for training and practice across Europe is crucial. Taken the differences between countries into account (many countries do not provide specific training in old age psychiatry), we should finally agree on the minimal level of education and supervision, the minimum level of work experience and finally the minimal level of supervision in peer groups as a starting point.Disclosure of interestThe author has not supplied his declaration of competing interest.

Integrated and Collaborative Training for Psychiatrists and Nurse Practitioners

By 2030, estimated 72.1 million will be over the age of 65 (more than 19% of the total population) (1). In 2010, there were estimated 1738 geriatric psychiatrists in the United States and this represented 0.9 geriatric psychiatrists per 10,000 population aged 75 years (2). Recently number of general psychiatrists entering advanced fellowship training in geriatric psychiatry has been decreasing. Approximately 55-60 fellowship slots are being filled each year and this is woefully inadequate to meet the overall demands (3).

Comorbid Mental Health Disorders in Hospice Consultation in Geriatric Psychiatry Training: A Retrospective Review

Comorbid Mental Health Disorders in Hospice Consultation in Geriatric Psychiatry Training: A Retrospective Review

Improving the focus on Consultation- Liaison Psychiatry in postgraduate training: Can this be useful in improving the training in geriatric psychiatry too?

Improving the focus on Consultation- Liaison Psychiatry in postgraduate training: Can this be useful in improving the training in geriatric psychiatry too?

[Specialized training in geriatric psychiatry during residency in France].

Aging of the population is a growing concern in developed countries. Therefore, geriatric psychiatry has gradually emerged from general psychiatry. Many names have been proposed to term this sub-specialty: old age psychiatry (OAP), psychogeriatrics, geropsychiatry. A working group of the French federation of psychiatric trainees (AFFEP) set up an inventory of the theoretical instruction and clinical practice of OAP during the training of psychiatrists in France. Methods. A survey of both academic teaching and practical training for OAP was carried out in the 28 local AFFEP representatives of every French medical residency district, including overseas. We assessed the supply of general courses and seminars devoted to OAP during the training of French residents in psychiatry, and the offer of university or inter-university degrees as well as the possibility of specialized internship in every residency district. Results. 96% of French medical residency districts offered general courses of OAP with a mean volume of 11.5 hours along the four years of psychiatric training in France. Fifty percent of medical residency districts proposed at least one seminar devoted to OAP. Half of medical residency districts also offer a specialized university or inter-university degree. Concerning clinical practice, 86% of medical residency districts had one internship dedicated to OAP, in 39% of cases in teaching hospitals. Conclusion. Nationwide, there is an overall effort to make OAP available to French psychiatric residents by general courses and internship, but some disparity appeared in academic teaching (i.e. offering seminars and university/inter-university degrees) according to various residency districts.