Ethnogeriatric education: a collaborative project of Geriatric Education Centers

Geriatric Education Center (GEC) faculty and staff are committed to teaching health professionals about the impact of culture on the health and health care of elders from ethnically diverse backgrounds. Ethnogeriatrics was highlighted as an important issue in the National Agenda for Geriatric Education during the 1990s. Between 1999 and 2001, the GEC Collaborative on Ethnogeriatric Education developed a Core Curriculum on Ethnogeriatrics and Ethnic Specific Modules. Faculty from 34 GECs wrote, reviewed, revised, expanded, and disseminated the Curriculum in Ethnogeriatrics. The 16-module, web-based Curriculum provides detailed information and teaching resources about important historical and cultural influences on the health care experience of the diverse U.S. population of elders. The Stanford GEC has tracked usage of the ethnogeriatric curriculum and reports favorable responses regarding its effectiveness. Many GECs have used the modules in their continuing education programs. GEC faculty share their teaching methods with others at professional meetings and present training sessions in their own geographical areas.     

New learning programs in cognitive vitality, Alzheimer's disease, and related dementias

As the population continues to age there remains an unmet need in preventing, identifying, treating, and managing mental/behavioral health problems among older adults. The purpose of this paper is to describe educational and training programs offered through three Geriatric Education Centers: (1) the Meharry Consortium Geriatric Education Center, which offers a certificate program on Cognitive Vitality dispelling myths that dementias are part of the normal aging process, (2) the Harvard Upper New England Geriatric Education Center, which offers a self-study web-based learning module on Alzheimer's Disease and related dementias, and (3) the South Carolina Geriatric Education Center, which has developed multi-use and train-the-trainer programs for counseling drivers with dementia and communicating effectively with cognitively impaired older adults. The programs together begin to address the wide range of mental health issues clinicians may encounter in older adult health care delivery and the ways in which Geriatric Education Centers help to prepare an educated workforce.     

Ethnogeriatric Education

Abstract

Geriatric Education Center (GEC) faculty and staff are committed to teaching health professionals about the impact of culture on the health and health care of elders from ethnically diverse backgrounds. Ethnogeriatrics was highlighted as an important issue in the National Agenda for Geriatric Education during the 1990s. Between 1999 and 2001, the GEC Collaborative on Ethnogeriatric Education developed a Core Curriculum on Ethnogeriatrics and Ethnic Specific Modules. Faculty from 34 GECs wrote, reviewed, revised, expanded, and disseminated the Curriculum in Ethnogeriatrics. The 16-module, web-based Curriculum provides detailed information and teaching resources about important historical and cultural influences on the health care experience of the diverse U.S. population of elders. The Stanford GEC has tracked usage of the ethnogeriatric curriculum and reports favorable responses regarding its effectiveness. Many GECs have used the modules in their continuing education programs. GEC faculty share their teaching methods with others at professional meetings and present training sessions in their own geographical areas.     

Harnessing technology and collaboration for an online ethnogeriatric educational resource

The paper describes the development and testing of a Web-based educational resource for usability and acceptability by health care providers who care for ethnic older adults. The work was undertaken as a dissertation project. The purpose of the Website is to provide on-demand ethnogeriatric information to enhance provider-patient interaction. Focus groups of clinicians and ethnic older adults were used in order to identify content relevant to the care of frail ethnic older adults. Collaboration with the Stanford Geriatric Education Center, On Lok SeniorHealth Services, Inc., Pepperdine University Graduate School of Education, and a network of virtual consultants provided support to the project. The site contains information on 15 cultures, 12 religions, and 6 ethnic minority cohort groups. Testing by snowball sampling generated survey data from 96 respondents, consisting of general practitioners (24%), pediatric specialists (20%), and geriatric specialists (18%). The Website was considered useful for provider-patient communication (77%) and would be recommended to others (99%). The Web-based information resource, called "Diversity, Healing, and Healthcare," currently exists as a resource rather than as a defined learning module and can be accessed at http://www.gasi. org/diversity.htm.     

Curricular framework: core competencies in multicultural geriatric care

Strategies to reduce the documented disparities in health and health care for the rapidly growing numbers of older patients from diverse ethnic populations include increased cultural competence of providers. To assist geriatric faculty in medical and other health professional schools develop cultural competence training for their ethnogeriatric programs, the University of California Academic Geriatric Resource Program partnered with the Ethnogeriatric Committee of the American Geriatrics Society to develop a curricular framework. The framework includes core competencies based on the format of the Core Competencies for the Care of Older Patients developed by the Education Committee of the American Geriatrics Society. Competencies in attitudes, knowledge, and skills for medical providers caring for elders from diverse populations are specified. Also included are recommended teaching strategies and resources for faculty to pursue the development of full curricula.     

Responding to Mental Health Needs of the Elderly in Rural Areas:

In Iowa, the percentage of elderly persons in rural areas has increased dramatically in the past decade. Although delivery of mental health services to the rural elderly is a statewide and national priority, at present, too few health professionals are adequately prepared to meet this need. The rural elderly have limited access to psychiatrists and are underserved by Community Mental Health Centers. Therefore, general practitioners, public health nurses, social service workers and other core disciplines who participate in Iowa Geriatric Education Center (IGEC) educational and training programs must be able to understand the mental health needs of this population, provide basic care, and make referrals for needed services. From the inception of the Iowa Geriatric Education Center, an effort was made to incorporate clincial and service delivery into the IGEC curriculum. Through affiliation with the Rural Elderly Outreach Program, participants in IGEC programs have an opportunity to learn more about geriatric mental health and service delvery issues in rural settings.     

Geriatric education across 94 million acres: adapting conference programming in a rural state

Montana, a predominantly rural state, with a unique blend of geography and history, low population density, and cultural diversity represents the challenges for program development and implementation across remote areas. The paper discusses two statewide multidisciplinary geriatric education programs for health professionals offered by the recently established Montana Geriatric Education Center (MTGEC); use of telecommunications technology; collaborations with Geriatric Education Centers (GECs) and the Montana Healthcare Telemedicine Alliance (MHTA); and training outcomes, insights, and implications for continuing education of health professionals who practice in hard-to-reach regions. In addition, data from a statewide needs assessment are presented specific to preferred format. The MTGEC training model that combined traditional classroom and videoconference increased attendance by twofold and may be adapted in other regions to train providers in remote areas of the U.S.     

Determinants of frail elders' lengths of stay in meals on wheels.

Home-delivered meal programs such as Meals on Wheels are low-cost long-term care services that have potential for contributing to the delay of costly institutionalization and to the maintenance of self-sufficiency and quality of life among community-dwelling frail elders. In this study, reasons for elders' termination from a Meals on Wheels program and determinants of their lengths of stay in the program are analyzed. The findings show that the reasons for elders' termination are largely associated with their deteriorating health. But it was also found that a significantly higher proportion of African American elders than White elders discontinued their participation due to their dissatisfaction with the meals offered or their poor appetite. The Cox proportional hazard regression analysis also confirmed that elders' health status, race, and appetite are significantly associated with the hazard of elders' termination. Strategies to improve the acceptability of the services are discussed.     

Ethnic aged discrimination and disparities in health and social care: A question of social justice

Older overseas‐born Australians of diverse cultural and language backgrounds experience significant disparities in their health and social care needs and support systems. Despite being identified as a ‘special needs’ group, the ethnic aged in Australia are generally underserved by local health and social care services, experience unequal burdens of disease and encounter cultural and language barriers to accessing appropriate health and social care compared to the average Australian‐born population. While a range of causes have been suggested to explain these disparities, rarely has the possibility of cultural racism been considered. In this article, it is suggested that cultural racism be named as a possible cause of ethnic aged disparities and disadvantage in health and social care. It is further suggested that unless cultural racism is named as a structural mechanism by which ethnic aged disparities in health and social care have been created and maintained, redressing them will remain difficult.     

An Aging Society:

This article is a reprint of the majority of the report prepared by the authors and members of the National Task Force on Gerontology and Geriatric Care Education in Allied Health which was published in the Speical Issues of the Journal of Allid Health, Volume 16, Number 4, November 1987. This National Task Force was established in 1986 by the American Society of Allied Health Professions (ASAHP). Among its members are gerontological experts nationally recognized within their respective disciplines. The implications for health care needs in an aging society and how these needs impact on allied health education and practice are discussed.     

Toward a Core Curriculum for Interdisciplinary Geriatric Care

This paper describes a core curriculum for interdisciplinary geriatric care that was developed by the faculty of the Hunter/Mount Sinai Geriatric Education Center (GEC). The core curriculum encompasses the knowledge, attitudes and skills held in common by the nine health care disciplines that the GEC faculty represent. Each discipline can use the core as a unified base upon which to develop competencies unique to its own practice role and neccessary for implemntation of an interdisciplinary approach to geriatric care. The core curriculum is a first step in the development of basic, advanced and continuing education programs for interdisciplinary geriatric care.     

A Case Study in Interdisciplinary Education in Geriatric Health Care:

This article reports on the intewllectual, educational and organizational problems encountered in providing interdisciplinary education to professionals in geriatric health care based on the development of a Summer Institute within the University of North Carolina (Chapel Hill) Geriatric Education Center. The quality of individual presentations, the pattern of sessions within a program, the size of the faculty, the number of topics in the curriculum are discussed and recommendations regarding interdisciplinary education programs are given.     

Geriatrics educational outreach: A tale of three GRECCS

Current geriatrics workforce projections indicate that clinicians who care for adults will need basic geriatrics knowledge and skills to address the geriatric syndromes and issues that limit functional independence and complicate medical management. This is most evident for the clinicians caring for veterans in the Department of Veterans Affairs hospitals and clinics nationwide. Geriatric Research, Education and Clinical Centers (GRECCs), whose staff are geriatric-content experts, have developed a number of programs to tackle this daunting educational task. This article introduces three different programs designed and implemented by GRECCs to train currently practicing health care providers in the Veterans Health Administration medical clinics. It also describes the successes and lessons learned from these three programs.     

The Brave New World of GEC Evaluation: The Experience of the Rhode Island Geriatric Education Center

In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics.     

The brave new world of GEC evaluation: the experience of the Rhode Island Geriatric Education Center

In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics.     

Baseline clinical characteristics, antiretroviral therapy use, and viral load suppression among HIV-positive young men of color who have sex with men

Given the continued high incidence of HIV infection in the United States among racial/ethnic minority young men who have sex with men (YMSM), and an appreciation that antiretroviral therapy (ART) can provide personal and public health benefits, attention is needed to enhance the detection of HIV-infected youth and engage them in medical care and support services that encourage sustained HIV treatment and suppression of viremia. Poor retention in clinical care has been associated with higher mortality, an increase in HIV RNA, and decreased CD4 cell count. The goal of the current study was to evaluate the health care utilization and health outcomes of HIV-infected racial/ethnic minority YMSM enrolled in an outreach, linkage, and retention study funded by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB). We hypothesized that among racial/ethnic minority YMSM, baseline CD4 counts and usage of ART are influenced by age, race, drug and alcohol use, and mental health symptoms. Overall, 155 subjects had at least a baseline CD4 count recorded at study entry. There was a low rate of ART use in this population with only one-half of the cohort with CD4 counts ≤ 350 cells/mm(3) being prescribed ART to treat their infection. However, of those youth who were started on ART, the majority (74%) did achieve undetectable viral loads (< 400 copies). Given the continued increase in cases of HIV infection among racial/ethnic minority YMSM, efforts to increase both the provision of ART and support services that encourage adherence in this population are warranted.     

Advancing Geriatric Education: Development of an Interprofessional Program for Health Care Faculty

To improve the health care of older adults, a faculty development program was created to enhance geriatric knowledge. The University of Alabama at Birmingham (UAB) Geriatric Education Center leadership instituted a one-year, 36-hour curriculum focusing on older adults with complex health care needs. Content areas were chosen from the Institute of Medicine Transforming Health Care Quality report and a local needs assessment. Potential preceptors were identified and participant recruitment efforts began by contacting UAB department chairs of health care disciplines. This article describes the development of the program and its implementation over three cohorts of faculty scholars (n = 41) representing 13 disciplines, from nine institutions of higher learning. Formative and summative evaluation showed program success in terms of positive faculty reports of the program, information gained, and expressed intent by each scholar to apply learned content to teaching and/or clinical practice. This article describes the initial framework and strategies guiding the development of a thriving interprofessional geriatric education program.     

Geriatric education utilizing a palliative care framework

ABSTRACT

The dramatic growth of persons older than age 65 and the increased incidence of multiple, chronic illness has resulted in the need for more comprehensive health care. Geriatrics and palliative care are medical specialties pertinent to individuals who are elderly, yet neither completely addresses the needs of older adults with chronic illness. Interprofessional faculty developed Geriatric Education Utilizing a Palliative Care Framework (GEPaC) to teach an integrated approach to care. Interactive online modules use a variety of instructional methods, including case-based interactive questions, audio-visual presentations, reflective questions, and scenario-based tests. Modules are designed for online education and/or traditional classroom and have been approved for Continuing Medical Education. Pre- and posttest scores showed significant improvements in knowledge, attitudes, and skills. Participants were highly satisfied with the coursework’s relevance and usefulness for their practice and believed that GEPaC prepared them to address the needs of older adults for disease and symptom management, communicating goals of care, and supportive/compassionate care.     

Health plan effects on patient assessments of medicaid managed care among racial/ethnic minorities

OBJECTIVE: To examine the extent to which racial/ethnic differences in Consumer Assessment of Health Plans Study (CAHPS) ratings and reports of Medicaid managed care can be attributed to differential treatment by the same health plans (within-plan differences) as opposed to racial/ethnic minorities being disproportionately enrolled in plans with lower quality of care (between-plan differences). DESIGN: Data are from the National CAHPS Benchmarking Database (NCBD) 3.0. Data were analyzed using linear regression models to determine the overall effects, within-plan effects, and between-plan effects of race/ethnicity and language on patient assessments of care. Standard errors were adjusted for nonresponse weights and the clustered nature of the data. PATIENTS/PARTICIPANTS: A total of 49,327 adults enrolled in Medicaid managed care plans in 14 states from 1999 to 2000. MAIN RESULTS: Non-English speakers reported worse experiences compared to those of whites, while Asian non-English speakers had the lowest scores for most reports and ratings of care. An analysis of between-plan effects showed that African Americans, Hispanic-Spanish speakers, American Indian/Whites, and White-Other language were more likely than White-English speakers to be clustered in worse plans as rated by consumers. However, the majority of the observed racial/ethnic differences in CAHPS reports and ratings of care are attributable to within-plan effects. The ratio of between to within variance of racial/ethnic effects ranged from 0.07 (provider communication) to 0.42 (health plan rating). CONCLUSIONS: The observed racial/ethnic differences in CAHPS ratings and reports of care are more a result of different experiences with care for people enrolled in the same plans than a result of racial/ethnic minorities being enrolled in plans with worse experiences. Health care organizations should engage in quality improvement activities to address the observed racial/ethnic disparities in assessments of care.