A Strong Partnership Promoting Gerontological Nursing.

The practice development section of this particular edition of International Journal of Older People Nursing focuses on the importance of place in older people nursing. The papers develop the argument that, rather than being a trivial or abstract phenomenon, place matters to nurses, their practices and importantly patients. Moreover, they demonstrate how place can be recognized, operationalized and hence, brought to the fore in gerontological nursing research. Notably, in doing this, the practice development section also brings together and progresses, two significant fields of research, ‘geographical gerontology’ (otherwise known as geographies of ageing) and an emerging ‘geographies of nursing’ in the consideration of the potential geographies located in nursing work. For over three decades, geographical gerontology has provided a range of valuable ‘contextual’ information to clinical and professionally focused gerontological research. Much, but not all, of this has been focused on the design of ageing environments, the interactions between older people and their environments, demographic trends and population movement. Consequently, even if readers do not recognize the specific disciplinary title, many will be familiar with these subjects. More recently however, changing perspectives, including the greater use of qualitative methods and a more frequent focus on more intimate spatial scales such as homes, institutions and inter-personal relationships, have meant that the interests of geographical gerontology and nursing research increasingly coincide (see Andrews & Phillips, 2005). The focus of the three papers presented here augments this particular disciplinary convergence by making some clear connections to professional practice debates. The result, it is hoped, is that the papers demonstrate the potential for geographical gerontology to provide critical and direct evidence for practice. Geographies of nursing, however, are a relatively recent body of work in the wider field of nursing research, the common feature of these studies being their central conceptual emphasis on space and/or place (see Andrews, 2006) and some re-readings and extensions of the meta-paradigm of nursing environment (see Andrews & Moon, 2005). Because this field of research is in its relative infancy, commentators have yet to debate the particular contributions of a geographical perspective in nursing research to specific specialties of nursing work. Moreover, neither have they addressed connections to the fundamental concepts that underpin professional caring practices. The papers in this section thus begin to address these issues with respect to gerontological nursing, coaxing the ‘spatial turn’ in nursing research to its next logical stage. Most importantly, of course, is the contribution of these disciplinary movements to gerontological nursing and research. It would be naive to think that these papers might revolutionalize research and practice in the care of older people. However, we would like to think that some of the suggested directions for research are followed up by researchers, if only that a focus on place might help them look at their existing problems and issues in a slightly different light, perhaps ‘tweaking’ their research foci and questions if a conceptual emphasis on place provides them with fresh insights. In this sense then, we hope that these papers provide some useful leads into the relevant geographical literatures, debates, concepts and theories. To make these disciplinary progressions and connections, we have assembled a truly multidisciplinary team. Janine Wiles, who works in a geography department, is one of a new generation of ‘critical’ geographical gerontologists/health geographers. Through a broad-based review, her paper defines and introduces place and its varied roles and meanings for older people. The next paper sharpens the focus on practice and specifically how place is located in the concepts and locales of gerontological nursing practice. In order to get to the heart of nursing practice concerns, a team approach was taken in the production of this more lengthy piece. The co-authors include two health geographers – Blake Poland and Gavin Andrews – based in nursing and public health departments respectively; two sociologists – Pascale Lehoux and Karen-Lee Miller – based in health administration and public health departments; two gerontological nurses – Dorothy Pringle and Katherine McGilton – based in nursing departments and David Holmes a nurse and critical sociologist also based in nursing. Having made these arguments, the final ‘visionary’ paper sets the wide-ranging research agenda for research on place and older peoples’ nursing care. It is written by Malcolm Cutchin, a health geographer and gerontologist, currently based in a department of occupational science. We hope that the ideas presented prove to be useful to readers and although they might appear to be novel or new, it is certainly worth remembering that ideas about places and their role in healing and health care can be traced to Nightingale and even earlier (Andrews, 2003; Gesler, 2003). In this sense then, the papers provide a contemporary spin on what might be considered to be a fundamental and core issue in nursing and health professional work.

Background This study aimed to conduct a literature search to determine research hotspots in the field of gerontological care education in China and abroad. A knowledge of the focus of research conducted abroad may assist Chinese educators in determining the shape of gerontological care education in the future. Methods The “Web of Science Core Collection” and “CNKI” databases were searched for literature on gerontological care education published from 2010 to 2020. CiteSpace software was used to display the knowledge map of co-occurrence of keywords, and an evolution trend map of research hotspots in recent 10 years was constructed. Results From 2010 to 2020, the focus of foreign gerontological nursing education research was on the training of gerontological nursing personnel; the development of elderly care services; and education and training in dealing with patients with senile delirium and dementia. The focus of gerontological nursing education research in China was primary care education, training of senior elderly nursing personnel, talent training mode reform, training of nursing staff, and career development paths for geriatric nursing staff. Conclusions Foreign geriatric nursing education research focuses on cultivating talents, mental health services for the elderly, innovating the mode of pension, and the care of patients with disorders such as dementia and delirium, while in China, the emphasis remains on gerontological nursing personnel training. Attention to research developments in other countries may assist Chinese educators to promote the development of geriatric nursing education in our country.

Nursing Programs Could Sharpen LTC Focus

It is commonly believed that older adults are often ill and therefore high users of health services. A pilot study involving adults 60 and older living in the Canadian province of Alberta was conducted to (a) raise interest in the concepts of lifelong health and health services use; (b) develop a lifelong health data collection tool; (c) obtain information about lifelong and recent health services use, and self-perceived lifelong and current health; and (d) reveal links (if any) between perceived health and lifelong health services use. A questionnaire was developed, pilot tested, and posted for completion by 100 volunteers. Most older adults reported good or very good current and lifelong health. Comorbidities and low finances were associated with higher health services use. These findings suggest community-dwelling older adults may be healthy currently and throughout their lives. Gerontological nursing research, practice, and advocacy are needed because myths about aging must be addressed to refocus attention on the importance of lifelong health promotion for older adults. [Journal of Gerontological Nursing, 43(2), 28-32.].

DESPITE THE GROWING NEED FOR NURSES TO WORK WITH THE OLDER ADULT POPULATION, THE TEACHING OF GERONTOLOGICAL NURSING PRESENTS MANY CHALLENGES TO NURSING EDUCATION, Multiple factors, including the faculty shortage, a lack of faculty expertise, and the need to develop sites for clinical placements (Ironside, Tagliareni, McLaughlin, King, & Mengel, 2010; Mueller, Goering, Talley, & Zaccagnini, 2011; Thornlow, Latimer, Kingsborough, & Arietti, 2006), affect the ability of schools of nursing to educate the nurses needed to ensure that older adults maintain functional ability to age well in the community and manage the care needs for older adults in acute care and rehabilitation settings. With the population of people over the age of 60 expected to double worldwide between 2000 and 2050, from 600 million to 2 billion (World Health Organization, 2012), the need for nurses trained in gerontology is greater now than ever before. Gerontology content varies in schools of nursing, with some programs having a single gerontology course and others integrating content across the curriculum. Either way, schools must prepare graduates with the competencies required to manage care for older adults across a diversity of health care settings. This article describes how the creation of a geriatric nurse instructor position maximized educational benefits and enhanced the academic-practice partnership between a community college in Maine and local nursing homes. Implications for those interested in designing, funding, or implementing such a position are presented. Background First-level nursing students in the associate degree nursing program traditionally received initial clinical experiences at local nursing homes (Ironside et al., 2010). A faculty shortage, combined with lack of expertise in gerontological nursing, led to an inefficient learning experience for students, one that did not meet the program's expected learning outcomes. With nursing homes in the area struggling to recruit and retain new graduate nurses, the nursing leadership of a rural geriatric health agency, which partnered with five nursing homes, met with the chair of the nursing department at the community college, to explore barriers to the use of nursing homes as clinical sites and as potential employers for new graduate nurses. These discussions led to a proposal to create a geriatric nurse service instructor position with a threefold purpose: a) to address gaps in gerontology nursing in the curriculum and help with the nursing faculty shortage, b) to increase the effectiveness of clinical experiences for students at two of the nursing homes, and c) to provide mentorship opportunities for students and new graduate nurses. A grant proposal was submitted to a foundation to help with initial funding for the position's salary. The community college also supports the position with funding, and the agency contributes administrative, human resources, and technology support for the position. The instructor maintains an office at the geriatric health agency and divides her time equally between the community college and the agency, with flexibility to offer additional time at either site as needed. (In the fall, the ratio is 60/40, with more time spent at the community college.) With four organizations helping to fund the position, financial sustainability is supported. As envisioned, the position called for, at a minimum, a master's prepared, certified gerontology nurse with academic experience at the undergraduate level. Additional skills in interdisciplinary communication, leadership and management concepts, and collaboration were identified as essential requirements for success in the position, and the ability to use technology to deliver educational programs such as web-based, online training program modules was preferred. Support of Nursing Students A first step for the geriatric nurse service instructor was the completion of a curriculum review of the associate degree program to identify gaps in gerontological nursing education. …

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There was a projected growth of up to 80% between 1990 and 2025 in an older adult of Nigeria above 60 years of age. This projected growth assumes an increased workload for almost every healthcare provider to ensure optimal geriatric care. This study aimed to assess preventive geriatrics as a way of geriatric health care. Self-administered questionnaires were distributed among elderly people (60 years and above) residing in the Akure South Local Government Area for at least a year. The survey included several sections to assess multiple aspects such as sociodemographic information, assessment of primary preventive geriatrics, secondary preventive geriatrics as well as tertiary preventive geriatrics as methods of receiving geriatric health care. The response rate was around 96% of the respondents. The mean (± standard deviation) age of the cohort was 72.3 (±8.4) years. The primary (χ² =39.498, df = 12 p-value=0.000), secondary (χ² =58.5003, df = 12, p-value=0.000), and tertiary (χ² =35.8994, df = 12, p-value=0.000) preventive geriatrics were shown to be a way of geriatric health care. Geriatric health care should focus on prevention, medication use, personalized health management, fall prevention, and vaccination uptake. The study thus recommends that institutions in geriatric care provide educational programs, gratuitous medical evaluations, and social support strategies that can reduce the burden of preventive geriatric care for Nigerian elderly.

As the global aging population grows, addressing the mental health challenges of older adults has become increasingly important. Depression, anxiety, cognitive decline, and existential distress are prevalent among geriatric individuals, often exacerbated by social isolation, chronic illness, and end-of-life concerns. Religious and spiritual counseling has emerged as a significant intervention in geriatric mental health care, providing emotional support, resilience, and a sense of purpose for elderly individuals. This review explores the impact of religious and spiritual counseling on mental health outcomes in geriatric care, emphasizing its role in enhancing psychological well-being and overall quality of life. Spiritual counseling interventions, including chaplaincy services, faith-based group therapy, and individualized pastoral care, have been shown to alleviate depression, reduce anxiety, and improve emotional resilience. By offering comfort through religious rituals, prayer, meditation, and spiritual discussions, these interventions help aging individuals navigate the complexities of later life with greater peace and acceptance. Furthermore, spiritual support fosters social engagement, strengthening the sense of belonging and reducing feelings of loneliness among older adults in long-term care facilities and community settings. This also examines the challenges of integrating religious and spiritual counseling into geriatric mental health care, including ethical concerns, religious diversity, and institutional barriers. Strategies for effective implementation, such as interdisciplinary collaboration, culturally inclusive spiritual care models, and the use of digital technology for remote counseling, are discussed. By highlighting the benefits and best practices of religious and spiritual counseling in geriatric care, this review advocates for the recognition of spirituality as a crucial component of holistic elder care. Implementing structured spiritual support in healthcare systems can significantly improve mental health outcomes, enhance emotional well-being, and promote dignity and hope among aging populations.

Hot Topics in Geriatrics Draw Funding

The objective of this project was to describe geriatric care provided under Medicare-risk contracts in HMOs with established Medicare programs. These findings provided the basis for an invitational workshop, sponsored by the National Institute on Aging and the Robert Wood Johnson Foundation, to formulate a research agenda for geriatric care in HMOs. The case study method involved site visits to seven HMOs by a physician with expertise in geriatrics, a managed care specialist, and a program development specialist. Representatives from the HMOs included senior executive officials, physicians recognized for providing and promoting geriatric care, research and program development staff, and various clinical staff including pharmacists, geriatric nurse practitioners, nurses, and social workers. The most frequently encountered geriatric care programs were categorized by the following six objectives: (1) identifying high risk patients, (2) assessing multi-problem patients, (3) treating multi-problem patients, (4) rehabilitating patients following acute events, (5) reducing medication problems, and (6) providing long-term care and home health care. Unique programs identified from these site visits included screening methods for new enrollees, approaches to comprehensive geriatric assessment, use of skilled nursing facilities for intensive rehabilitation and postacute care, and drug profiling and review. Utilization of geriatric nurse specialists and programs aimed at coordination with social services were pervasive in many of these HMOs. Workshop participants proposed several research and demonstration projects in all six areas. Overall consensus emerged that HMOs with Medicare-risk contracts provide a valuable setting for experimentation in geriatric care. Given the current health policy emphasis on managed care and capitated payment methodologies, geriatric care research in HMOs should be a high priority.

Overview of the Geriatrics Curriculum In recent years, we have developed and strengthened the geriatrics curriculum through a deliberate process of specifying learning outcomes, identifying existing geriatrics content, designing and implementing new learning activities and resources, and assessing students’ geriatrics-related knowledge, skills, and attitudes. Further, recent changes in the curriculum governance structure ensure ongoing assessment and improvement of the geriatrics curriculum. The geriatrics curriculum now is fully integrated in required courses across all four years of the curriculum, providing a coherent and comprehensive program that prepares students to care effectively and compassionately for older adults. A unique feature of our curriculum is its focus on preparing students to improve the health of the state’s population, which includes a growing number of citizens over the age of 65. Approximately 40% of clinical teaching takes place in communities throughout the state, where students learn about caring for diverse populations in a variety of communities and health care settings. Curriculum Management and Governance Structure (see Figure 1)FIGURE 1. Governance StructureIn January 2002, the Curriculum Management and Policy Committee (CMPC) was established as the central body responsible for curriculum management and governance. The CMPC is chaired by the executive associate dean for medical education, who reports to the dean, and its members are the co-chairs of the three course directors’ committees and the associate deans for admission, student affairs, and educational development. The following committees report to and advise the CMPC and are the avenue by which the geriatrics curriculum has been integrated in the overall curriculum: Three course directors’ committees, one each for the first and second year, and one for the third and fourth years combined, are responsible for overseeing, coordinating, and improving the individual courses and overall curriculum for each year. The co-chairs of these committees are appointed by the executive associate dean for medical education. Each committee is composed of all of the course directors for the respective year(s). Ex-officio members include staff from the Office of Medical Education and student representatives. The director of the Program on Aging, as a second-year course director, is a member of that committee and also attends the first-, third- and fourth-year committee meetings. The Curriculum Advisory Board convenes quarterly to serve as a forum for all constituencies and stakeholders involved with the educational program for the MD degree, to share ideas about the curriculum, and discuss current practice, concerns, and plans. The director of the Program on Aging is a member of this committee. Two additional committees report to the CMPC and have supported the development of the geriatrics curriculum: The Faculty Advisory Committee on Educational Technology advises the executive associate dean for medical education on matters regarding effective selection and use of educational technology and information systems. Much of the computer-assisted geriatrics instruction has been facilitated by this group. The Whitehead Curriculum Committee, an arm of the Whitehead Medical Society (the student government), works to improve individual courses and the overall curriculum and serves as the liaison among students, student government, and the Curriculum Management and Policy Committee. Each year the two second-year students who are elected co-vice presidents for curriculum of the Whitehead Medical Society serve as co-chairs of the committee, which is composed of student representatives from each class, the co-chairs of the course directors’ committees, the executive associate dean for medical education, and the associate deans for student affairs and educational development. Whitehead representatives attend meetings of the course directors’ committees and Curriculum Advisory Board. The new governance structure has permitted organizational and administrative flexibility to manage and coordinate the curriculum and to react to a rapidly changing academic medical center environment to facilitate change if and when it is deemed necessary. The strengthening of the geriatrics curriculum has been and continues to be a critical focus. In addition to the overall curriculum governance structure of the medical school, the Geriatrics Curriculum Committee (GCC), centered in the Program on Aging, serves as a major force in the development of the geriatrics curriculum. The seven-member interdisciplinary GCC, chaired by the director of the Program on Aging, was created to remedy gaps in the geriatrics curriculum. The group’s accomplishments include: development of a comprehensive syllabus outlining geriatrics learning objectives and content that all medical students should master prior to graduation; thiswas done through surveying practicing physicians to determine the skills needed to work effectively with elders in the community and following guidelines from the American Geriatrics Society (“Areas of Basic Competency for the Care of Older Patients for Medical and Osteopathic Schools,” 1998); evaluation of existing geriatrics content and learning activities to assess where and how well these topics are taught in the curriculum; and implementation of educationally sound methods to address geriatrics components that may not be fully incorporated into the medical curriculum. Plans developed by the GCC are shared with the three course directors’ committees and the Curriculum Advisory Board via the Program on Aging representative. THE AAMC/HARTFORD GERIATRICS CURRICULUM PROGRAM Institutional Involvement in Curricular Change The John A. Hartford Foundation grant received through the AAMC in June 2000 provided the resources that allowed us to strengthen and build the geriatrics curriculum across all four years, expand our outreach to students interested in geriatrics medicine, and document those areas in the curriculum where geriatrics knowledge and skills were inadequate or lacking. Specifically, our goals were to increase (1) the exposure of all students to core geriatrics content to help ensure a sound knowledge base for practice, (2) the number of opportunities for student exposure to older adults to support empathic practice, based upon an appreciation of normal and successful aging as well as its challenges, and (3) educational experiences to engage students in applying their knowledge and skills to solve complex problems in geriatrics medicine. These efforts were well received by faculty and students and resulted in increased visibility throughout the School of Medicine and increased awareness of the importance of geriatric medicine as an inherent component of core competencies. Both before and midway through the grant period, institutional involvement in curriculum change permitted even greater achievements in enhancing the geriatrics program. Prior to this, the Program on Aging had limited opportunities to make formal recommendations regarding medical school curriculum design and content, with virtually no active, authoritative role in the decision-making process. In 1999, the large and unwieldy First- and Second-Year Course Directors’ Committee was divided in two, so that each committee could focus exclusively on a single year’s curriculum. This promoted more intense and focused work on analyzing the curriculum and determining ways to strengthen it. In 2001, the dean appointed the Leadership Task Force on the Outcomes of the Medical School Curriculum, composed of nine department chairs representing both basic and clinical sciences. This committee was charged with describing the core competencies (learning objectives) to be achieved by graduating medical students and with revising the curriculum governance structure to promote efficient and effective decision making. The subsequent establishment of a set of core competencies and the reconfiguration of the governance structure (described above) resulted in major curriculum changes, with significant implications for expanding the depth and breath of geriatrics content throughout the four-year curriculum. The Second-Year Course Directors’ Committee transformed the second-year curriculum from separate courses generated by each department into integrated block courses focusing on organ systems. The committee also established both an introductory and a capstone block to begin and end the year, with each of these blocks using case-based learning with a strong geriatrics focus. Theme for the Geriatrics Curriculum The teaching mission of the Division of Geriatric Medicine and the Program on Aging is to build the capacity of UNC to prepare health care providers at all levels for evidence-based, outcomes-oriented health care for older adults and ultimately, to improve or preserve their level of function and quality of life. The major theme for the geriatrics dimension of the UNC medical school curriculum is twofold, to ensure (1) that the geriatrics curriculum is a recognizable and integral component throughout all four years of the medical curriculum; and (2) that students, faculty, and administrators recognize that the mastery of geriatrics competencies is most effectively achieved within an interdisciplinary system of care delivery that recognizes the interdependence of education; research; primary, subspecialty, and ancillary care; and public policy and regulation. The questions that must be addressed for each curricular activity are “How does this intervention affect the student’s acquisition of identifiable geriatric core competencies?” and “How does this intervention increase the student’s understanding and implementation of interdisciplinary team skills?” An additional theme is the commitment to recognize and encourage those students who have a particular interest in geriatrics and the potential to be leaders in the field, regardless of their subspecialty interest. Learning Outcomes for the Geriatrics Curriculum After completion of the enhanced four-year geriatrics curriculum, students will be able to describe age-related physiological changes, differentiate between normal aging and disease processes, demonstrate the problem-solving ability necessary to provide care to older persons, exhibit the professional qualities of integrity, compassion, thoroughness, responsibility, and commitment to caring for older persons, identify political, financial, and social factors that affect delivery of care, and recognize their own potential and that of their patients for subscribing to aging stereotypes. Special Programs Community partnerships Community partnerships play an essential role in fulfilling the university’s commitment to prepare professionals to meet the health care needs of North Carolina’s citizens. The Program on Aging facilitates student involvement in two partnerships that offer a variety of opportunities for work with older adults across the spectrum of geriatrics issues: The Program on Aging enjoys a strong and longstanding relationship with the North Carolina Area Health Education Centers (AHEC) program, a nationally recognized model for interdisciplinary education and training of health care providers. Several regional AHECs collaborate with us on innovative projects to ensure that there are community clinical training sites with well-qualified preceptors available to teach geriatrics knowledge and clinical skills. The Education for Lifelong Service (ELS) Program provides students with community service opportunities, complemented by a curriculum designed to foster leadership skills in service delivery. ELS has responsibility for the newly established Office of Community Service and sponsors courses on the care of underserved and vulnerable populations, including activities that emphasize services to older adults. Program on Aging representatives participate on the ELS leadership team. Standardized geriatric patients The UNC School of Medicine Standardized Patient (SP) Program, administered by the Office of Educational Development, gives students opportunities to practice communication and diagnostic and examination skills before they encounter patients in the actual clinical setting. In addition, the program provides a mechanism to assess these same skills in a standardized format. The program maintains an active database of SPs, including those who are suitable for presentation of geriatric illnesses and situations. Simulated case presentations using geriatric standardized patients are frequently requested for classroom learning, most notably in the first- and second-year Introduction to Clinical Medicine course, in second- year integrated cases, and as part of the fourth-year Clinical Performance Examination, which students must pass in order to graduate. Faculty development The Office of Educational Development provides several faculty development programs and activities in which geriatrics faculty participate and that help to strengthen the geriatrics curriculum. The Expert Preceptor Program, designed for practitioners in community-based clinical settings, is available in an online, interactive format known as the Expert Preceptor Interactive Curriculum. This is a self-paced program comprising modules that can be used individually as information resources or collectively as a complete curriculum. Each module focuses on a skill related to clinical teaching in the community practice setting or on strategies for teaching contemporary health issues. The Teaching Scholars Program is a year-long series of monthly seminars designed to promote expertise and scholarship in medical education for fellows and faculty. In addition, participants choose a specific area of educational interest to pursue in depth and present their results to colleagues at a symposium at the conclusion of the program. Completion of the program confers recognition as a scholar in medical education, and graduates are targeted for positions of leadership in the curriculum. Each year, ten teaching scholars are chosen from faculty nominated by their department chairs, with at least one participant from the Program on Aging. The Excellence in Teaching Series consists of monthly seminars and workshops focused on innovative approaches that enhance learning and instruction in medical education. These sessions provide a forum for participants to discuss practical approaches that facilitate and maximize student learning. The series is designed for faculty and residents who have responsibility for teaching in the classroom, lab, and/or clinical setting. Consultations on teaching and curriculum development issues are provided for individuals or groups of faculty as needed. Faculty and staff from the Office of Educational Development work closely with the Program on Aging to provide ongoing support for efforts to enhance the geriatrics curriculum. Student interest group The UNC Student Chapter of the American Geriatrics Society is a student-led organization for physicians-in-training who have an interest in geriatrics medicine regardless of intended area of specialty. The group focuses on ways to enhance the visibility of geriatrics issues at the UNC School of Medicine and to provide educational programs on geriatric medicine. For those students specifically interested in careers in geriatrics, the chapter seeks to develop leadership skills in geriatrics medicine by sponsoring interdisciplinary educational programs, encouraging research participation, and creating geriatrics-related community service opportunities. The leaders of this student group have initiated a one-hour orientation to geriatric patient care for first year students prior to their community week experience. (See the discussion of “Students’ Clinical Experiences” below.) Palliative care and end-of-life issues In the first year, the required Medicine and Society course provides multiple opportunities for exploration of the social aspects of aging in our society and in politics, as well as the economic factors affecting geriatrics health care. Students discuss various medical-ethical issues found most often among the elderly, e.g., palliative care and end-of-life decisions. In the second year, up to 20 students may select the seminar entitled The Good Death or the Good Fight: Ethnical, Legal, and Policy Issues in Medical Choices as their required humanities and social sciences seminar. A fourth-year elective course sponsored by the Department of Medicine specifically addresses palliative care and end-of-life issues. Palliative Medicine is a six semester-hour, interdisciplinary course taught by faculty from the Departments of Medicine (including a certified geriatrician) and Psychiatry; the Schools of Social Work, Pharmacy, and Nursing; and the Hospital Chaplaincy Office. Resulting Pedagogical Changes Program on Aging faculty promote the importance of teaching methods that encourage students’ active engagement in learning processes that are both self-directed and collaborative. One approach that has proven particularly effective is a merger of evidence-based and problem-based methods. Students are given a clinical vignette in which a patient presents with symptoms and complaints (a problem-based case). Students work in teams to define the problem and set priorities for self-directed (evidence-based) study. This approach is especially appropriate where students must understand the unique and complex presentation of common illnesses among older adults. Specific curricular enhancements include: The Introduction to Clinical Medicine course for first-year students (ICM-1), which devotes time for more in-depth presentations of topics that traditionally have not been an inherent component of the medical curriculum. When these “special topics” were introduced into the curriculum in 1998, geriatrics medicine was included as a three-hour roundtable discussion. Today, the day-long seminar on aging is a firmly established component of ICM-1. Through the AAMC-Hartford program, we further developed this activity to include a lecture and exercise on ageism and aging stereotypes. Strengthened geriatrics content in the following targeted first- and second-year courses: Psychiatry, Gross Anatomy, Immunology, Cardiovascular System, and Respiratory System. The success of this collaborative effort with individual course directors led to an invitation to participate in the design and implementation of the new second-year integrated curriculum. Other regularly scheduled, geriatrics-specific teaching opportunities for required first- and second-year courses. These include geriatrics assessment interviews with standardized patients, a polypharmacy component for the pharmacy course, a geriatrics problem-based case that addresses end-of-life issues, and geriatrics case exercises; they were developed for use in the new introductory and capstone block courses in the second-year curriculum. An interactive, Web-based geriatrics case exercise for the first-year Introduction to Clinical Medicine (ICM) course, which was developed, integrated, and titled “Meet Mrs. Jefferson.” A problem-based case, “Robert Waters,” was developed for the second-year ICM course. A “patient bank” of geriatric subjects for student interviews for the required first-year Medicine and Society course. Students are assigned two patients to interview in teams (two to three students per team). The assignment required recruitment of a significant number of patient-volunteers. Geriatricians from the Program on Aging assisted with recruitment, providing an additional opportunity to ensure a geriatrics component in course content. Additions of geriatrics content to the third-year family medicine, internal medicine, psychiatry, and obstetrics - gynecology (See “Students’ Clinical in below.) of the required fourth-year care to include two additional care geriatrics These two sites are in communities with the growing populations in the In addition to the required courses and activities the Program on Aging sponsors the following elective For years, the Program on Aging has sponsored a elective course, known as designed to provide first- and second-year students with clinical care of older patients in and care and opportunities for The Program the by groups of students to an geriatrics to make to older patients and to patients over an Geriatric Education Consultations provide a forum for students to with a master geriatrics clinical team to community-based sites for interdisciplinary with practitioners regarding complex geriatric patient issues. Students who are based in the community are often in with patients or family members and responsibility for case presentations and on geriatrics are through the Departments of Medicine and including in in Geriatric Health and and An to of Technology The School of Medicine that all first-year medical students a and that are specifically to ensure that all students have and to all resources needed for the medical school curriculum. Each student has a at or assigned and each lecture has as resources are and begin with the course that serve as the for course The first-year course students how to and research and build The Educational Technology provides faculty and staff with and to for curricular course directors with and provide expertise necessary to teaching resources to the classroom, the lab, and the clinical setting. This strong learning environment our commitment to evidence-based practice and learning, as in Pedagogical of the ways in which technology the geriatrics curriculum include use of an geriatrics case-based exercise in the Introduction to Clinical Medicine course, and providing students with the appropriate information resources needed to complete the case-based in the introductory and capstone block courses in the second year. Clinical in Geriatrics One and Two the first two years of the medical curriculum focus on students a in the basic the Introduction to Clinical Medicine course provides clinical experiences as Students are introduced to basic clinical skills on in sessions with faculty In addition, they in community-based care Students learn the complete and in the of a approach to care. Both in the classroom and their clinical in the students are to the spectrum of care, from to The Student Chapter of the American Geriatrics Society has initiated a one-hour week seminar for first-year students focusing on basic care issues common to older the internal medicine at least one of the required patient must focus on a patient or the obstetrics and gynecology each student is required to complete two of and two of and attend of and two of which address issues often in geriatric patients, e.g., and Students are responsible for case one of which must be of a patient age or The Geriatric and Management on the service is one of six students can choose to meet the This geriatrics clinical is available for six the academic year and can six students per Through the students learn clinical skills in the of among geriatric geriatrics content the family medicine among overall at least of patients by students are age or and on geriatrics issues are throughout the The required care has two newly established geriatrics-specific sites where students have clinical preceptors who are certified In the academic year students received geriatrics clinical training at these provide additional opportunities for fourth-year students to complete clinical geriatric One is a where the student is assigned to a variety of clinical to work with certified The second is a where the student works with a certified geriatrics to provide comprehensive and for specifically assigned In both the students are to focus on a specific area of interest. The and An clinical examination is used to assess students in the Introduction to Clinical Medicine course, faculty to and how well students specific clinical skills and Students through a series of patient For each the student is to a and a faculty the student’s using a assessment Standardized geriatrics patients are included in this of geriatrics content that is in the courses and is by including appropriate on the various and In with the and Course Directors’ Committee, the Office of Educational Development the Clinical Performance a assessment required of all fourth-year to patient in North the a patient that and medical problems most frequently in care in this geriatrics one to one third of the The is designed to ensure that relationship and communication skills, examination skills, skills, and management and assessment skills are across to Students a that provides a of each case, for each case, overall and skill In with the students are given a case-based geriatrics developed by the Program on Aging. For both the and the the Program on Aging works with the Office of Educational Development to ensure that core geriatrics competencies are included in the to the Program a of the success we have in geriatrics needs to the we are now with the for ongoing faculty teaching time and significant staff and expand our educational programs in all we must engage new faculty as well as who can a geriatrics component to the training they offer in their respective The success of the John A. grant has the for a comprehensive approach to geriatrics education. must to new ways to address the needs of at to assess the of new and to rapidly new information and methods to our Outcomes The recent of the second-year curriculum from courses to integrated blocks us an opportunity to more fully develop the geriatrics curriculum. The provides an for case-based learning the AAMC-Hartford had given new to geriatrics content, we were able to for additional case-based geriatrics The introductory block with a evidence-based case using a geriatric The case provided an opportunity to demonstrate how diagnostic information is used in patient care, to emphasize the of geriatrics care, and to students’ awareness regarding the of health care issues by this rapidly growing of the The capstone block focuses on two patient cases, one of which an Both are designed to multiple aspects of medical care that were addressed in Students work in groups to the including and and The of the curriculum governance system allowed for more Program on Aging involvement in curriculum Through committee the Program on Aging continues to new and from faculty to in and implementing geriatrics teaching resources and of The Program on Aging has achieved an level of visibility and within the School of Medicine and throughout all the and programs in the UNC Division of Health is a relationship with the Office of Medical Education and with individual course a commitment to ensure that geriatrics content and an integral component of required courses. available between 2000 and the staff time needed to collaborate with course directors and offer geriatrics-specific classroom and learning the two years, these course have and the Program on Aging has on all course directors’ committees and in curriculum design and The by the AAMC-Hartford allowed us to for additional from the is us both further expand the medical student curriculum and also build educational programs for and faculty, including community-based For further at

Mary Harper: Nurse/politician extraordinaire

Older patients who live in rural areas often have limited access to specialty geriatric care, which can help in identifying and managing geriatric conditions associated with functional decline. Implementation of geriatric-focused practices among rural primary care providers has been limited, because rural providers often lack access to training in geriatrics and to geriatricians for consultation. To bridge this gap, four Geriatric Research, Education, and Clinical Centers, which are centers of excellence across the nation for geriatric care within the Veteran health system, have developed a program utilizing telemedicine to connect with rural providers to improve access to specialized geriatric interdisciplinary care. In addition, case-based education via teleconferencing using cases brought by rural providers was developed to complement the clinical implementation efforts. In this article, the authors review these educational approaches in the implementation of the clinical interventions and discuss the potential advantages in improving implementation efforts.

BackgroundIndividuals receiving geriatric care are often frail and afflicted with multiple chronic conditions demanding care from several medical disciplines, and from several different care providing units across the health systems.ObjectiveTo explore the six-month service utilization and direct costs attributed to individuals receiving geriatric inpatient care.MethodsHealth care utilization– in terms of inpatient care, outpatient visits with different health care professions– and social care utilization– in terms of social services, and stay at residential care facility (RCF)– were quantified based on registry data, for a cohort admitted to geriatric inpatient care in Stockholm, Sweden during 2016.ResultsOn average, individuals admitted to geriatric inpatient care in Stockholm had 12.8 inpatient care days, 32.1 visits in outpatient care, 432 h of home care and 28.8 days of staying at RCF, during the first six months after discharge. This amounted to an average cost of 722 thousand Swedish kronor (SEK), € 64 900, in 2023 monetary value. Costs were on average 37% attributable to inpatient care including the initial inpatient stay, 12% to outpatient visits, 38% to social services at home, and 13% to stay at residential care facility (whereof 11% short-term, 89% long-term). Total costs differed significantly between groups based on function, age and main diagnosis.ConclusionCosts of care for individuals treated at geriatric department are substantial. The variation of cost is also significant; higher age and lower function were associated with higher health care and social care costs. Major cost buckets were inpatient health care (region-financed) and social care at home (municipality-financed).

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Music Therapy Training for Undergraduate Nursing Students: A Modality to Foster Interest in Gerontological Nursing" found on pages 25-31, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until May 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Identify the worldwide shortage of nurses specializing in gerontological nursing. 2. Describe the results of using music therapy to create positive attitudes toward older adults. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Nursing students generally have a negative attitude toward older adults. Preparing nurses to meet the care needs of an expanding aging population is a challenge for nursing educators. The purpose of the current study was to explore whether incorporating music therapy into a practical geriatric nursing course at a nursing home cultivates positive attitudes toward older adults, raises students' willingness to work with older adults, and increases their interest in specializing in gerontological nursing after graduation. Focus groups were conducted to collect data from three participant groups (N = 20). Verbatim transcripts of audiorecorded interviews were analyzed using content analysis, which revealed four themes: (a) better appreciation and understanding of music therapy, (b) role modeling instructors' successful experience and positive attitude toward older adults, (c) changing attitudes toward older adults, and (d) improving interaction skills with older adults. Results suggested music can be integrated into a gerontological nursing course to enhance students' motivation to learn, empathize, and approach older adults. [Journal of Gerontological Nursing, 42(6), 25-31.].