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PubMed1984

Implementation and evaluation of a model geriatrics curriculum.

An evaluation of a case-based, problem-oriented, modular curriculum in geriatrics for medical students was designed by the authors to investigate (a) whether students would demonstrate cognitive knowledge gain in geriatrics, (b) whether students' attitudes toward the elderly would change favorably, (c) whether suggested learning activities in geriatrics would positively influence students' ratings of these activities in geriatrics, and (d) which institutional characteristics facilitate implementation of the new curriculum. The results indicated that using the modules did produce statistically significant gains in students' cognitive knowledge of geriatrics. Using the modules did not, however, influence the students' attitudes toward the elderly. Clinical or related learning activities involving elderly persons were rated positively by students; however, only two of the participating medical schools in the evaluation provided such experiences. Data from questionnaires and site visits identified several factors which may be helpful in the implementation of geriatrics or other new curricular material into existing curricular structures.

Aged↗
PubMed1986

Responses of fourth-year medical students to a required clerkship in geriatrics.

Fourth-year medical students at the Mount Sinai School of Medicine of the City University of New York taking a required four-week clinical clerkship in geriatrics were surveyed before and after the clerkship on their knowledge of geriatrics, attitudes toward the elderly, and evaluation of the rotation. The students showed a significant improvement in their knowledge of geriatrics and gave a mildly favorable evaluation of geriatrics as a required clerkship. Their attitudes toward the elderly did not change, however. This latter finding may be related to favorable attitudes before the clerkship, some factor inherent to the clerkship, or the previously demonstrated lack of correlation between measured attitudes and behavior. The present authors suggest that educators, in establishing clinical clerkships in geriatrics, should focus on imparting knowledge in geriatrics, should assess students' acceptance of the clerkship carefully, and should not use changes in attitudes toward the elderly as the sole measure of the effectiveness of such a clerkship.

Attitude of Health Personnel↗
PubMed1993

Increasing knowledge about the older population: the role of geriatric curriculum in optometry.

Education in the area of geriatrics/gerontology alleviates misconceptions about the elderly and lessens ageism. Ageism, negative feelings toward the elderly, represents a substantial obstacle to the delivery of quality health care to older adults. As future primary health care professionals, optometry students will encounter a large segment of the older population. This study looks at the effect that a didactic course and a clinical rotation in geriatrics have on the knowledge and attitude of optometry students toward older adults. Palmore's Facts on Aging Quiz: Part 1 was administered to two classes of optometry students. One class experienced a geriatric course and clinic concurrently; the other class experienced the geriatric clinic before the course. Scores increased significantly post-test for both classes. Exposure to geriatric patients before didactic instruction did not improve pretest scores; however, the number of patient exposures was significant at post-test. Antiage bias scores also improved with intervention of a didactic course and clinical rotation in geriatrics. The results of this study indicate that ageism in optometrists may be ameliorated by providing formal instruction in geriatrics in the optometric curriculum.

Aged↗
PubMed2002

United Kingdom national survey of the views of geriatric psychiatrists on the administration of electroconvulsive therapy to patients with fractures.

Traditionally, psychiatrists have been cautious in administering electroconvulsive therapy (ECT) to patients with recent fractures. Drawing on the collective experience of geriatric psychiatrists in the United Kingdom may allow a better understanding of the use of ECT in fractures. The opinions of UK consultant geriatric psychiatrists on the use of ECT in the presence of recent fracture were acquired by a detailed questionnaire survey. Questionnaires were sent to 551 geriatric psychiatrists, and 306 (56%) usable responses were received. Twelve percent of geriatric psychiatrists had used ECT in fractures, and 55% would be prepared to administer ECT in the presence of fractures. They would seek specialist advice from anesthetists and orthopedic surgeons before, during, and after the administration of ECT. Geriatric psychiatrists generally did not seek advice from specialist ECT consultants. The researchers concluded that geriatric psychiatrists are prepared to administer ECT in the presence of fractures after seeking specialist advice from anesthetists and orthopedic surgeons.

Aged↗
PubMed2006

The effect of geriatrics evaluation and management on nursing home use and health care costs: results from a randomized trial.

BACKGROUND: The Geriatric Evaluation and Management study was developed to assess the impact of a comprehensive geriatric assessment service on the care of the elderly. OBJECTIVES: We sought to evaluate the cost and clinical impact of inpatient units and outpatient clinics for geriatric evaluation and management. RESEARCH DESIGN: We undertook a prospective, randomized, controlled trial using a 2x2 factorial design, with 1-year follow-up. SUBJECTS: A total of 1388 participants hospitalized on either a medical or surgical ward at 11 participating Veterans Affairs medical centers were randomized to receive either inpatient geriatric unit (GEMU) or usual inpatient care (UCIP), followed by either outpatient care from a geriatric clinic (GEMC) versus usual outpatient care (UCOP). MEASURES: We measured health care utilization and costs. RESULTS: Patients assigned to the GEMU had a significantly decreased rate of nursing home placement (odds ratio=0.65; P=0.001). Neither the GEMU nor GEMC had any statistically significant improvement effects on survival and only modest effects on health status. There were statistically insignificant mean cost savings of $1027 (P=0.29) per patient for the GEMU and $1665 (P=0.69) per patient for the GEMC. CONCLUSIONS: Inpatient or outpatient geriatric evaluation and management units didn't increase the costs of care. Although there was no effect on survival and only modest effects on SF-36 scores at 1-year follow-up, there was a statistically significant reduction in nursing home admissions for patients treated in the GEMU.

Aged↗
PubMed1991

Geriatrics faculty in the United States: who are they and what are they doing?

Despite increases in geriatrics training at all levels of medical education, there is a nationwide shortage of geriatrics faculty. This shortage may be due in part to demands for clinical responsibilities that preclude adequate time for teaching and research. To learn about the professional activities of geriatrics faculty, we conducted a national survey of a 50% sample of all medical schools and their affiliated residency programs that focused on physician and non-physician geriatrics faculty in internal medicine, family practice, psychiatry, neurology, and physical medicine and rehabilitation. Although we found minor differences across specialties, in general, approximately one-third of physician faculty time is spent in teaching, the majority of which is clinical teaching. Less than 15% of physician faculty time is spent in research, and fewer than 10% of physician geriatrics faculty devote over half of their time to research. The percentage of time that non-physician faculty (other than "Research Only" faculty) spend in research is only slightly higher. These findings suggest that efforts to increase geriatrics education at all levels and promote research advances will be limited unless geriatricians devote substantially more of their time to these responsibilities.

Clinical Medicine↗
PubMed2004

Development and validation of a geriatric knowledge test for medical students.

OBJECTIVES: To assesses the reliability and validity of a geriatrics knowledge test designed for medical students. DESIGN: Cross-sectional studies. SETTING: An academic medical center. PARTICIPANTS: A total of 343 (86% of those sampled) medical students participated in the initial study, including 137 (76%) first-year, 163 (96%) third-year, and 43 (86% of those sampled) fourth-year students in the 2000-2001 academic year. To cross-validate the instrument, another 165 (92%) third-year and 137 (76%) first-year students participated in the study in the 2001-2002 academic year. MEASUREMENTS: An 18-item geriatrics knowledge test was developed. The items were selected from a pool of 23 items. An established instrument assessing the clinical skills of medical students was included in the validation procedure. RESULTS: The instrument demonstrated good reliability (Cronbach alpha=0.80) and known-groups and concurrent validity. Geriatrics knowledge scores increased progressively with the higher level of medical training (mean percentage correct=31.3, 65.3, and 66.5 for the first-year, third-year, and fourth-year classes, respectively, P<.001). A significant (P<.01) relationship was found between the third-year students' geriatrics knowledge and their clinical skills. Similar results, except the relationship between knowledge and clinical skills, were found in the cross-validation study, supporting the reliability and known-groups validity of the test. CONCLUSION: The 18-item geriatrics knowledge test demonstrated sound reliability and validity. The average scores of the student groups indicated substantial room for growth. The relationship between geriatrics knowledge and overall clinical skills needs further investigation.

Education, Medical, Undergraduate↗
PubMed2005

Emergency medicine management of the geriatric patient: an educational program for medical students.

This article describes the experience of fourth-year medical students participating in a geriatric education program integrated into a 4-week emergency medicine student clerkship. Between July 2002 and April 2003, all students in this required clerkship participated in a geriatric educational program consisting of a small group discussion of medical and psychosocial issues of older adult emergency department (ED) patients. Students used learned skills to evaluate older adult ED patients for medical and psychosocial issues and later followed up with these patients by telephoning them at their homes or visiting them in the hospital. Students tracked their evaluations of the medical problems, functional abilities, and social supports of patients in the ED. Students also noted when their assessments resulted in the acquisition of new skills or knowledge and when their evaluation of geriatric syndromes resulted in a change of the patient care plan. Seventy-seven students evaluated 217 patients in the ED, of whom 167 (77%) received a follow-up visit or phone call. Students documented learning new skills while caring for 80 (48%) of the older adult patients. Qualitative survey responses from students indicated that students had increased understanding of the importance of assessing functional status and social supports and providing interdisciplinary care. Integrating geriatric education modules into existing emergency medicine clerkships is an effective method to expand the geriatric curriculum in medical schools and to emphasize the importance of geriatric assessment and syndromes in emergency care.

Adult↗
PubMed2006

. . . But does it stick? Evaluating the durability of improved knowledge following an undergraduate experiential geriatrics learning session.

Canada's aging population, fewer medical students training in geriatric medicine, and inadequate geriatric curricula require that medical schools immediately address how future physicians will be able to care for older people effectively. The medical literature suggests that experiential learning strategies improve undergraduate medical students' knowledge of and interest in less-popular subjects, but the durability of improvements resulting from these resource-intensive learning approaches remains unclear. In October 2001, a convenience sample of all University of Western Ontario medical students attending the geriatric component of their first year was randomized to attend one 3-hour didactic lecture or 3-hour experiential learning session. Approximately 1 year later, students completed a follow-up knowledge and attitudes survey that was matched to their first-year surveys using date-of-birth data. Of 100 completed follow-up surveys, 42 were used in formal analysis. Although initially the experiential group demonstrated a better knowledge score, at 1-year follow-up, there was no significant difference in knowledge, attitudes toward older people, or interest in geriatric medicine between the didactic (n=17) and experiential (n=25) groups. Nevertheless, these students (n=42) demonstrated better attitude scores than those (n=22) who had not attended either educational intervention. This study challenges the belief that an experiential approach is a superior training method to a didactic approach. One year after an educational intervention, there was no difference in geriatric knowledge, attitude scores, or interest in geriatric medicine between students who underwent a didactic lecture or a participatory, experiential learning session.

Analysis of Variance↗
PubMed2006

Geriatric Resources for Assessment and Care of Elders (GRACE): a new model of primary care for low-income seniors.

The majority of older adults receive health care in primary care settings, yet many fail to receive the recommended standard of care for preventive services, chronic disease management, and geriatric syndromes. The Geriatric Resources for Assessment and Care of Elders (GRACE) model of primary care for low-income seniors and their primary care physicians (PCPs) was developed to improve the quality of geriatric care so as to optimize health and functional status, decrease excess healthcare use, and prevent long-term nursing home placement. The catalyst for the GRACE intervention is the GRACE support team, consisting of a nurse practitioner and a social worker. Upon enrollment, the GRACE support team meets with the patient in the home to conduct an initial comprehensive geriatric assessment. The support team then meets with the larger GRACE interdisciplinary team (including a geriatrician, pharmacist, physical therapist, mental health social worker, and community-based services liaison) to develop an individualized care plan including activation of GRACE protocols for evaluating and managing common geriatric conditions. The GRACE support team then meets with the patient's PCP to discuss and modify the plan. Collaborating with the PCP, and consistent with the patient's goals, the support team then implements the plan. With the support of an electronic medical record and longitudinal tracking system, the GRACE support team provides ongoing care management and coordination of care across multiple geriatric syndromes, providers, and sites of care. The effectiveness of the GRACE intervention is being evaluated in a randomized, controlled trial.

Aged↗
PubMed2006

Geriatric dentistry in Brazilian universities.

OBJECTIVE: The purpose of this study was to investigate the teaching of geriatric dentistry in Brazilian universities. MATERIALS AND METHODS: This study consisted of questionaires regarding the training in geriatric dentistry in 104 dental schools included in the National Institute of Education Research (INEP) in 2001. In order to calculate the sample (a random stratified one), the confidence interval was set at 99% and a maximum permitted error of 3% was adopted. Pearson's chi-square test was used in the inferential analysis. RESULTS: From the 64 dental courses which were studied, only 25 included geriatric dentistry in the curriculum. From 1857 students who were involved in the study, 41% sought knowledge outside the dental school and 98% considered that it was important that this subject should be included in the curriculum. There was statistical significance between geriatric dentistry teaching and the students' preference as well as the prospect of working with this group of the population. Geriatric dentistry as an individual subject was absent from the curriculum in two-thirds of the dental courses investigated. Knowledge was often transmitted as part of dental prosthetics and most of the students stated that they would want to be able to treat elderly people. It was relevant to note that senior students expected to work in this field. CONCLUSION: Dental students in Brazil do not have adequate training in geriatric dentistry.

Brazil↗
PubMed2005

Cognitive impairment is the major risk factor for development of geriatric syndromes during hospitalization: results from the GIFA study.

OBJECTIVE: To detect the main factors associated with the occurrence of specific geriatric syndromes (namely pressure sores, fecal incontinence, urinary incontinence and falls) in elderly patients during hospitalization. DESIGN: Observational prospective study. SETTING: Eighty-one community and university hospitals throughout Italy. PARTICIPANTS: 13,729 patients aged 65 years and more, consecutively admitted to medical or geriatric acute wards during 20 months in the period between 1991 and 1998. MEASUREMENTS: Occurrence of pressure sores, fecal incontinence, urinary incontinence and falls during the stay in hospital. RESULTS: Pressure sores were already present in 3% of hospitalized subjects, fecal incontinence in 7.3%, while urinary incontinence, evaluated on a subgroup of total population (4,268 subjects), had a prevalence of 22.3%. During hospitalization (mean stay of 15 days), 74 subjects developed new pressure sores, 55 became fecal and 35 urinary incontinent, and 279 subjects had at least one episode of fall. In multivariate analyses, cognitive impairment, advanced age (85+ years), length of stay (more than 3 weeks) and severe disability were the main independent predictors of development of the four geriatric syndromes, with cognitive impairment as the most significant risk factor for all the four outcomes (OR 4.9, 95% CI 2.4-9.9 for pressure sores; OR 6.3, 95% CI 3.0-13.0 for fecal incontinence; OR 5.3, 95% CI 2.3-12.0 for urinary incontinence; OR 1.6, 95% CI 1.2-2.3 for falls). CONCLUSION: Very old people have a significant increased risk of several geriatric syndromes during the stay in hospital, particularly if it is long and they are cognitively impaired. A standardized comprehensive geriatric evaluation at admission could be helpful in detecting all subjects at risk and preventing the development of hospital-acquired geriatric syndromes.

Accidental Falls↗
PubMed2002

Canadian geriatric psychiatrists: why do they do it? A Delphi study.

OBJECTIVE: To generate hypotheses regarding influential factors that have contributed to the practice of geriatric psychiatry by geriatric psychiatrists. METHOD: Using the Delphi technique, designed to generate ideas and consensus, a sample of members of the Canadian Academy of Geriatric Psychiatry (CAGP) was asked to provide ideas on what factors were influential in their decision to devote a significant part of their practice to geriatric patients. These items were then synthesized into a questionnaire and rated for their degree of influence by the same group of psychiatrists. RESULTS: A total of 41 items were rated according to their degree of influence. The most influential items were related to geriatric psychiatry residency training experiences that were perceived to be positive or adequate. Supervision characteristics and interest in the medical psychiatric nature of the field were also deemed influential. CONCLUSIONS: This study generates the hypothesis that the nature of the educational experience during psychiatry residency has a significant influence on the practice of geriatric psychiatry.

Adult↗
PubMed2004

Geriatric medical education in Israel.

In this article we will focus on geriatric medical education in Israel and will review our experience in this field. A coordinated effort of the Ministry of Health and the Israeli Medical Association led to the establishment of a modern geriatric system and to the recognition of geriatrics as a medical specialty in the early 1980s. All four Israeli medical schools joined this effort by introducing geriatrics in the undergraduate studies. Several innovative models for teaching geriatrics to medical students and for postgraduate training have been developed and implemented. The growing body of skills and knowledge available, and their application for competent care of the elderly, constitute a compelling impetus for the further development of a high-quality geriatric medical education.

Aged↗
PubMed2004

Web-based framework for improving geriatric education.

Despite the growth in the elderly population, physicians with special geriatric training and certification number only 9,000 out of 650,000 doctors in the United States. The flexibility and increasing availability of the Internet makes it an ideal avenue for addressing the educational needs of health care providers to improve the health and care of older adults. We performed an Internet search using popular search engines. This yielded between 321 and 358,000 websites about geriatrics and 164 to 175,000 about geriatric education. This paper reviews popular health and medical Web sites to determine geriatric educational content and proposes a structure for an "ideal" geriatric Web site that would provide resources and enhance training for allied health professionals, physicians in training and community doctors in practice. We also propose a framework addressing the design and content for developing a geriatric specific website. We use this framework to propose a prototype resource on falls and gait instability.

Aged↗
PubMed2006

Do geriatricians stay in geriatrics?.

To evaluate whether formally trained geriatricians remain in the field of Geriatrics, and to determine their job satisfaction and perceived quality of life, we surveyed the 107 fellows trained over the last 25 years in one accredited geriatric program. Of the 88 physicians who consented to participate, 75% devoted at least half of their practice to the care of the elderly. On an academic level, 89.5% had, or planned to pursue, recertification in geriatric medicine. Ninety-five percent of these geriatricians felt that the impact of a formal geriatric fellowship was positive on their medical career and satisfaction index. Sixty-four percent had yearly incomes between $100 and $200k, and 25.6% had income greater than $200k. Eighty-seven percent would recommend pursuing geriatric fellowship training. We need to further explore how recruitment process and job opportunities are presented to potential geriatric fellows.

Adult↗
PubMed1989

Effects of a geriatric nurse practitioner on process and outcome of nursing home care.

We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.

Activities of Daily Living↗
PubMed2005

Isolation followed by integration: a model for development of a separate geriatric course.

Because of the growing population of older adults in America, nursing faculty throughout the United States have been consistently challenged during the past decade to use the most appropriate methods to strengthen geriatric content in baccalaureate nursing programs. The question of whether to integrate content throughout the curriculum or offer a stand-alone geriatric nursing course has been explored extensively, but no ultimate conclusion has been found. With the support of a grant for geriatric curriculum integration from the John A. Hartford Foundation, one university began the journey to integrate geriatric nursing curriculum throughout all baccalaureate nursing courses. However, at a curriculum evaluation meeting held halfway through the grant period, faculty expressed the need to have concentrated content earlier in the program that could serve as a foundation on which to build geriatric knowledge. Faculty unanimously voted to create a geriatric nursing course to be offered to students during their second year of baccalaureate study.

Accreditation↗