Fellowship-trained physicians who let their geriatric medicine certification lapse: A national survey.

BACKGROUND: Only 62.6% of fellowship-trained and American Board of Internal Medicine (ABIM)-certified geriatricians maintain their specialty certification in geriatric medicine, the lowest rate among all internal medicine subspecialties and the only subspecialty in which physicians maintain their internal medicine certification at higher rates than their specialty certification. This study aims to better understand underlying issues related to the low rate of maintaining geriatric medicine certification in order to inform geriatric workforce development strategies. METHODS: Eighteen-item online survey of internists who completed a geriatric medicine fellowship, earned initial ABIM certification in geriatric medicine between 1999 and 2009, and maintained certification in internal medicine (and/or another specialty but not geriatric medicine). Survey domains: demographics, issues related to maintaining geriatric medicine certification, professional identity, and current professional duties. RESULTS: 153/723 eligible completed surveys (21.5% response). Top reasons for not maintaining geriatric medicine certification were time (56%), cost of maintenance of certification (MOC) (45%), low Medicare reimbursement for geriatricians' work (32%), and no employer requirement to maintain geriatric medicine certification (31%). Though not maintaining geriatric medicine certification, 68% reported engaging in professional activities related to geriatric medicine. Reflecting on career decisions, 56% would again complete geriatric medicine fellowship, 21% would not, and 23% were unsure. 54% considered recertifying in geriatric medicine. 49% reported flexible MOC assessment options would increase likelihood of maintaining certification. CONCLUSIONS: The value proposition of geriatric medicine certification needs strengthening. Geriatric medicine leaders must develop strategies and tactics to reduce attrition of geriatricians by enhancing the value of geriatric medicine expertise to key stakeholders.

Retooling the Health Care Workforce for an Aging America: A Current Perspective.

A 2008 Institute of Medicine (IoM) report outlined a vision for health care and a workforce capable of addressing health and extended care needs of our aging population. It highlighted dramatic shortages necessitating bold action and outlined recommendations aimed at building a sizable and qualified workforce. This study updates report findings and progress made on its recommendations. Through review of publicly accessible, internet-based literature and government and professional organization websites, current workforce data and recent policy changes are compared to the report's statistics and recommendations. Direct comparisons are limited by changing definitions, context, and data collection and analyses methods. Future workforce-need projections are estimated using reports from various sources. Inability to forecast medical advances, socioeconomic changes, and world events affects the accuracy of these projections. Nonetheless, clear conclusions emerge despite such limitations. Progress toward fulfilling the IoM goals is variable and insufficient. The current and projected numbers for all geriatric health providers remain inadequate compared to estimated 2030 demand. Challenges in meeting estimated needs persist essentially unchanged. The 2008 IoM framework and recommendations remain relevant and constitute an important roadmap to complete unfinished goals. Initial findings from this update provide a platform for developing practice and policy reforms.

Pursuing Age-Friendly University (AFU) principles at a major university: Lessons in grassroots organizing.

Population aging presents challenges and opportunities that Michigan State University (MSU) is now taking on in a strategic way, but it has been a long road to reach a major milestone of establishing a program called AgeAlive. AgeAlive builds on fifty years of advocacy for coordinated aging-related programming and a more current grassroots effort that has led to a commitment to building an aging network connecting research, education, and outreach efforts based on Age-Friendly University principles. This case study describes AgeAlive's path from inception to a recognized program with a clear vision and strategic plan. Concrete goals include a complete inventory of aging-related activity on campus, a virtual hub for networking and information exchange, educational opportunities for students and elders, and building new retirement pathways. The MSU experience may benefit others interested in developing similar programs by offering strategies for moving forward amidst challenges inherent in large-scale, research-intensive institutions.

Improving Patient Experiences and Outcomes Through Personal Care Aide Training.

INTRODUCTION: The rapidly aging US population is resulting in major challenges including delivering quality care at lower costs in the face of a critical health-care workforce shortage. The movement toward home care has dramatically increased the need for qualified, paid personal care aides (PCAs). Adequate PCA training that focuses on skills for person-centered, at home support is an imperative. This study provides evidence that clients of PCAs who have completed a comprehensive, evidence-based PCA training program, titled Building Training…Building Quality (BTBQ), report higher satisfaction and better health outcomes, compared to clients of PCAs with lesser or other training. METHODS: A mixed-methods, quasi-experimental design was used to compare self-reported survey responses from clients of BTBQ-trained PCAs (treatment group) with responses from clients of non-BTBQ-trained PCAs (control group). RESULTS: Clients of BTBQ-trained PCAs had significantly fewer falls and emergency department visits compared to clients whose PCAs had no BTBQ training (P < .05). Conclusion: BTBQ-like PCA training reduces costly adverse events.

A National Survey on the Effect of the Geriatric Academic Career Award in Advancing Academic Geriatric Medicine.

A workforce that understands principles of geriatric medicine is critical to addressing the care needs of the growing elderly population. This will be impossible without a substantial increase in academicians engaged in education and aging research. Limited support of early-career clinician-educators is a major barrier to attaining this goal. The Geriatric Academic Career Award (GACA) was a vital resource that benefitted 222 junior faculty members. GACA availability was interrupted in 2006, followed by permanent discontinuation after the Geriatrics Workforce Education Program (GWEP) subsumed it in 2015, leaving aspiring clinician-educators with no similar alternatives. GACA recipients were surveyed in this cross-sectional, multimethod study to assess the effect of the award on career development, creation and dissemination of educational products, funding discontinuation consequences, and implications of program closure for the future of geriatric health care. Uninterrupted funding resulted in fulfillment of GACA goals (94%) and overall career success (96%). Collectively, awardees reached more than 40,700 learners. Funding interruption led to 55% working additional hours over and above an increased clinical workload to continue their GACA-related research and scholarship. Others terminated GACA projects (36%) or abandoned academic medicine altogether. Of respondents currently at GWEP sites (43%), only 13% report a GWEP budget including GACA-like support. Those with GWEP roles attributed their current standing to experience gained through GACA funding. These consequences are alarming and represent a major setback to academic geriatrics. GACA's singular contribution to the mission of geriatric medicine must prompt vigorous efforts to restore it as a distinct funding opportunity.

Direct Care Workforce Training: Internet Accessibility and Acceptance.

Evidence exists that web-based learning for health care professionals can improve topic-specific knowledge, increase access to training, and lower training costs. However, limited information exists on the value of online education for improving hands-on skills as part of personal care aide (PCA) training. New PCA training programs are emerging that are fully online or hybrid models that blend online with in-person instruction. Such programs require access to a computer and high-speed internet, which could prove difficult for low-income PCAs who are less likely to own a computer. The current study evaluated a PCA training demonstration that examined issues of internet access, use, and acceptability for PCA training. Results show most trainees prefer a hybrid online/in-person model, but there are gaps in access and acceptability, particularly related to reading ability. These findings have implications for health care providers who deliver training programs aimed at developing a qualified PCA workforce capable of providing competent care to older adults. [Journal of Gerontological Nursing, 43(6), 46-52.].

Do Canes or Walkers Make Any Difference? NonUse and Fall Injuries.

Purpose of the Study: Examine patterns of cane and walker use as related to falls and fall injuries. Hypotheses: Among people who fall at home, most do not have an assistive device with them when they fall. Nonusers who fall sustain more severe injuries. Design and Methods: This was a cross-sectional study using a self-administered written survey completed by 262 people aged 60 and older who were community dwelling, cognitively intact, and current cane/walker users with a history of falls. They were recruited through clinical practice sites, churches, and senior housing in central Michigan. Outcomes of interest included patterns of device use, reasons for nonuse, device use at time of fall, and fall-related injuries. Results: Seventy-five percent of respondents who fell were not using their device at the time of fall despite stating that canes help prevent falls. Reasons for nonuse included believing it was not needed, forgetfulness, the device made them feel old, and inaccessibility. Perceived risk was not high enough to engage in self-protective behavior. However, nonuse led to a significantly higher proportion of falls resulting in surgery than among device users. Among respondents requiring surgery, 100% were nonusers. Most respondents never received a home safety evaluation (68%) and only 50% received training on proper device use. Implications: Providers must place increased emphasis on the importance of cane/walker use for injury prevention through patient education to promote personal relevance, proper fitting, and training. New strategies are needed to improve device acceptability and accessibility.

Transformative Theatre: A Promising Educational Tool for Improving Health Encounters With LGBT Older Adults.

Lesbian, gay, bisexual, or transgender (LGBT) older adults are often unaware or fearful of aging services that contribute to greater vulnerability, isolation, and risk when services are needed. In addition, they may perceive or experience bias in health care encounters. Providers may not recognize their own biases or their impact on such encounters. In response, a group of LGBT community activists, aging professionals, researchers, and a theatre ensemble developed an interactive theatre experience, described herein, that portrays challenges faced by LGBT older adults needing services. Goals included raising awareness among LGBT older adults and providers about issues such as the limited legal rights of partners, limited family support, and fear of being mistreated as a result of homophobia. Evaluations and feedback reflected the potential of interactive theatre to engage people in sensitive discussions that can lead to increased awareness, reduced bias, practice change, and ultimately improved care for LGBT older adults.

Family Medicine: Bridge to Life.

Reflecting on the suicide of a close friend, this essay explores what comprises, and inspires a will to live, and how those in Family Medicine can address suicide risk even in the face of debilitating or terminal illness. Research indicates that the will to live is a measurable indicator of general well-being, distinct from depression, and an important predictor of a person's motivation to "hold on to life". As such, understanding what is at the heart of a desire to live should alter clinical practice. This essay offers ideas for ways in which to create bridges for patients that could help sustain life.

Considerations for using the 'brown bag' strategy to reconcile medications during routine outpatient office visits.

BACKGROUND: Among medication reconciliation studies, varying methods are used to determine which medications patients are actually taking. One recommended approach is to ask patients to "brown bag" their medications for routine office visits. AIMS: To determine if 'brown bag' practices performed during routine office visits improve the accuracy of provider-documented medication lists. METHODS: This cross-sectional pilot study was conducted in a university affiliated community geriatric clinic. Forty-six cognitively intact elders who managed their own medications enrolled. Participants self-selected into two groups: 'brown-baggers' (BBs) and 'non-brown-baggers' (NBBs). Three medication lists were compared for each patient: provider-documented in patient's chart (chart list); researcher-generated by post-appointment semistructured interview (point-of-care [POC] list); post-appointment semi-structured telephone interview (telephone list, reference standard). Accuracy of chart and POC lists were compared with reference lists among BBs and NBBs. RESULTS: Thirty-three (72%) patients brought some of their medications to scheduled appointments (BBs); of these, 39% bagged all of their medications. Excluding route as a variable, 35% of provider-documented chart lists were complete; only 6.5% were accurate. Some 76% of chart-documented medication lists contained inclusion, omission and/or dosing instruction discrepancies, with no differences between BBs and NBBs. However, POC lists obtained using a semi-structured interview included fewer inclusion and omission discrepancies among BBs than NBBs (42% v 77%, P = 0.05). In subset analyses by medication type, over-the-counter (OTC) medication documentation was more accurate among BBs than NBBs. Overall, chart lists contained two to three times more discrepancies than lists generated at POC. CONCLUSION: Most BBs do not bag all their medications for office visits. Chart list accuracy is no better among BBs than NBBs, although patients who 'brown bag' their medications for office visits may prompt providers to conduct a more thorough medication history. Lists generated by semistructured interviewing, regardless of BB status, are more accurate than chart lists. Findings challenge benefits of the 'brown bag' unless coupled with in-depth questioning and processes for transferring information to chart lists.

How are the experiences and needs of families of individuals with mental illness reflected in medical education guidelines?

OBJECTIVE: This descriptive study explored the extent that medical education curriculum guidelines contained content about the experiences and needs of family members of people with serious mental illness. METHODS: Key family-focused-literature themes about the experiences and needs of families of individuals with mental illness were drawn from a review of over 6,000 sources in the mental health practice literature that were identified within a systematic search and thematic development process. The study identified the extent and nature of family-focused key literature themes as reflected in medical education curriculum guidelines for psychiatry and primary care practice specialties of family practice, internal medicine, and pediatrics. An iterative process was used to retrieve and analyze text data drawn from the curriculum guidelines of national accrediting organizations for undergraduate, graduate, and continuing medical education. RESULTS: The key family-focused themes, as drawn from the mental health practice research literature, were: mental illness stigma; family caregiver burden; information exchange and referral; family stress, coping, and adaptation; family support; crisis response; and family psychoeducation. Two of these seven themes appeared in medical education curriculum guidelines: information exchange and caregiver burden. The most frequently appearing family-focused key literature theme was information exchange. Psychiatry and undergraduate medical education reflected the most family content. CONCLUSION: It appears that medical education curriculum guidelines have insufficient content about families of people with mental illness. The educational experiences of psychiatrists and primary care physicians may not adequately prepare them for working with family members of their patients. It is recommended that medical education curriculum guidelines incorporate information about family stigma; family/caregiver burden; information exchange; family stress, coping, and adaptation; family support; crisis response; and multiple family group psychoeducation.

An administrator's perspective on mental health in assisted living.

Administrators of 94 assisted living facilities in Michigan completed a 19-item survey about the extent of mental health problems of residents and how such problems were addressed. In 45 facilities more than half of the residents were reported to be cognitively impaired. The two most common problems were dementia and depression. The most common problematic behaviors were resistance to care and wandering. Two-thirds of the facilities conducted some type of mental health evaluation at admission, and two-thirds conducted evaluations as needed. The most common treatment barriers were patient refusal and family refusal. Results of the study suggest that there may be a significant need for mental health services in assisted living facilities.