Geriatric pharmacy education: a strategic plan for the future

Patient Interaction Involving Older Adults: Provider vs. Caregiver Expectations

This paper presents a study of the interaction between healthcare providers (HCPs) and older patients and their caregivers. The paper first presents results from a rapid review and narrative synthesis using PubMed and Google Scholar of HCP/patient/caregiver interactions involving older patients; these results then informed the design of a survey administered to HCPs and caregivers using a range of scenarios and their ratings of appropriateness of different responses, to explore where expectations align or differ between HCPs and caregivers. In analyzing ratings, the research found HCPs and caregivers generally approach the older adult encounter with similar expectations, but differences for specific situations are informative. HCPs appear to better recognize when there is a need to show empathy, as when a patient is frustrated or anxious. HCPs, overall, offer more calming responses, especially in embarrassing, upsetting, or worrying situations. For older patients of advanced age, HCPs value engagement with patients more than caregivers, but HCPs are more aligned with caregivers in their ratings of how to engage caregivers. Compared to caregivers, HCPs focus more on simplifying the description of treatment rather than using thorough explanations when a patient expresses hesitancy or avoidance. The results from this work suggest that having a fuller understanding of the different participants’ expectations may improve communication and identify potential pitfalls. A better understanding may also lead to changes in how students in the healthcare fields are trained; having better insight into this relationship will prepare them for interacting with older patients while addressing the needs of caregivers.

The current state of geriatric pharmacy education in the United States - A cross-sectional survey

INTRODUCTION

Concerns exist that the current health care workforce is underprepared to meet the needs of the aging American population. This study evaluated the current emphasis on geriatrics in doctor of pharmacy curricula.

METHODS

A 61-item web-based survey was distributed to associate deans with oversight of pharmacy curricula at all United States (US) schools and colleges of pharmacy (S/COP). Information collected included school demographics, employment of geriatrics faculty, geriatric education (required, elective, and experiential courses), co-curricular geriatric experiences, postgraduate residency training in geriatrics, student interest in geriatrics, and perception of preparedness of the profession to care for older adults.

RESULTS

Of responding S/COP, 35% required a course in geriatrics while 63% offered a geriatrics elective. An advanced pharmacy practice experience (APPE) in geriatrics was required by 14%, and 79% offered an elective APPE. Insufficient curricular emphasis on geriatrics was noted by 44% of responding schools, and 33% lacked confidence that the profession of pharmacy is adequately prepared to care for the aging population.

CONCLUSIONS

According to the survey respondents, most pharmacy schools do not have a required didactic course or APPE in geriatrics. Additional emphasis on foundational principles of medication management for older adults in pharmacy curricula is warranted to meet the health care needs of the rapidly aging US population.

Knowledge and Attitude of Pharmacy Students Regarding Geriatric Care: Questionnaire-Based Analysis in Malaysia

INTRODUCTION

There is a predicted growth of up to 17% in an older adult of Malaysian above 60 years of age by 2040. This will increase the workload of almost every healthcare provider to ensure optimal geriatric care.

PURPOSE

This study aimed to assess pharmacy students' knowledge and attitudes towards geriatric pharmacy education and older patients to determine their preparation in delivering appropriate medical care to the geriatric population.

METHODS

Self-administered questionnaires were distributed among pharmacy students in different Malaysian universities. The survey included several sections to assess multiple aspects such as sociodemographic information, assessment of knowledge using a validated 28-item Geriatric Knowledge Assessment Scale (GKAS), and attitudes towards geriatrics education.

RESULTS

The response rate was around 70% of the respondents. The mean (± standard deviation) age of the cohort was 22.28 (±1.12) years. Despite around 78% of pharmacy students claiming that their knowledge of geriatric care is adequate, their GKAS score showed that only around 20% have high geriatric knowledge. Around 80% of them showed a positive attitude on the importance of taking courses focused on geriatric care and demonstrated interest to further knowledge and training in geriatric care. However, more than half of the students were uncertain of their answers towards their attitudes regarding older patients.

CONCLUSION

Given the growing role of pharmacists in the ageing population, this study highlights the importance of geriatric care education among potential pharmacists. Therefore, we urge the need to improve/develop geriatrics education and training into the pharmacy curriculum to ensure sufficient preparation for actual practice after graduation.

Engaging Older Adults With Cancer and Their Caregivers to Set Research Priorities Through Cancer and Aging Research Discussion Sessions

PURPOSE

To report on the perspectives of older adults (aged older than 65 years) with cancer and their caregivers who participated in patient-oriented research priority-setting activities called the Cancer and Aging Research Discussion Sessions.

PARTICIPANTS & SETTING

35 older adults and caregivers participated in three public meetings and follow-up interviews.

METHODOLOGIC APPROACH

Qualitative descriptive.

FINDINGS

There was clear consensus from participants on research priorities related to two key areas.

IMPLICATIONS FOR NURSING

Future research should focus on addressing age-related disparities in cancer care communication and support. By capitalizing on older adults' interest in research engagement, effective solutions can be cocreated to improve cancer experiences for older adults and their caregivers.

Changes in student pharmacists' confidence in attaining geriatrics competencies and attitudes toward older adults across the Doctor of Pharmacy curriculum

To determine if student pharmacists' confidence in their knowledge and skills, and their attitudes toward older adults improved throughout pharmacy school with an integrated geriatrics didactic curriculum (years 1-3) and a final year of clinical training including a required advanced pharmacy practice experience (APPE) in geriatrics (year 4). A two-part voluntary anonymous survey was administered at three different time points to two large cohorts of student pharmacists. The first part of the survey assessed students' confidence in attaining geriatrics competencies. The second part of the survey used the UCLA Geriatrics Attitudes Scale to assess students' attitudes. Of the 286 students who were emailed the survey, 236 student pharmacists completed it at the first assessment. Student pharmacists showed an increase in confidence in achieving geriatrics competencies from their first year to their third year, and further increase after their clinical training. Most students also held a generally positive attitude toward older adults from P1 to P4 year. Integration of geriatrics throughout the didactic and experiential curriculum made an impact on student pharmacists' confidence in their competency toward caring for older adults, while maintaining a positive attitude toward older adults throughout pharmacy school.

Knowledge and Attitudes of Student Pharmacists Regarding Polypharmacy and Deprescribing: A Cross-Sectional Study

Pharmacists play a key role in deprescribing medications. Incorporation of this concept into pharmacy school curricula is important in ensuring that graduates can address the complex needs of an aging population. The aims of this study were to assess if and how student pharmacists were exposed to deprescribing within their curriculum, to assess students’ perceptions regarding their attitudes, ability and confidence in deprescribing, and to assess if reported curricular exposure to this topic resulted in improved perceptions or objective knowledge assessment scores. An electronic survey was distributed to third- and fourth-year pharmacy students at 132 schools of pharmacy. The survey included three sections including: (i) demographics and questions on their exposure to deprescribing and other experiences within their curriculum; (ii) questions regarding their attitudes, ability, and confidence regarding deprescribing on a 5-point Likert-scale; (iii) a knowledge assessment on polypharmacy and deprescribing in the form of 12 multiple-choice questions. Likert-scale questions were analyzed as scales utilizing the mean score for items measuring student perceptions regarding deprescribing attitudes, ability, and confidence. Comparisons were made on each variable between students with and without curricular exposure to deprescribing using t-tests. Ninety-one responses were included in the analysis. Only 59.3% of respondents reported exposure to deprescribing in their didactic coursework. The mean scores on the polypharmacy and deprescribing knowledge assessments were 61.0% and 64.5%, respectively. Those with exposure to deprescribing concepts within their curriculum were more likely to agree that their school’s curriculum prepared them to deprescribe in clinical practice (t(89) = −2.26, p = 0.03). Pharmacy schools should evaluate their curricula and consider the addition of specific deprescribing objectives and outcome measures for didactic and experiential training.

Impact of geriatrics elective courses at three colleges of pharmacy: Attitudes toward aging and eldercare

INTRODUCTION

One in five Americans will be 65 years and older by 2030. Training student pharmacists to provide quality eldercare as healthcare professionals is essential. The objective of the study was to assess pharmacy students' attitudes toward aging and eldercare before and after a geriatrics-focused elective course.

METHODS

The University of Arizona Aging and Health Care (UA AHC) survey was modified for pharmacy and administered pre and post to students enrolled in a geriatrics elective course at three United States (US) colleges of pharmacy. Pre and post means were calculated to examine attitudinal changes after course participation. Factor analysis was performed to examine construct validity by identifying the dimensions being measured.

RESULTS

Sixteen of 37 questions differed significantly from pre-course to post-course demonstrating improved attitudes after course participation. Students also reported an awareness of how older adults are viewed and treated. Factor analysis identified seven factors with a range of behaviors, skills, training, and attitudes perceived to be important in geriatric care. Two factors, importance of learning about geriatric care and experience/comfort with older adults, showed significant changes confirming positive impact of the course.

CONCLUSIONS

Geriatrics-focused elective courses in three colleges of pharmacy had a positive impact on students' perceived importance of learning about geriatric care and experience/comfort with elders. Further research to adapt and validate the UA AHC survey to pharmacy education is needed. The identification of the skills and attitudes necessary to meet the growing needs of older adults is necessary for pharmacy curriculum implementation and practice.

Continuing pharmacy education practices in geriatric care among pharmacists in the Upper Midwest

OBJECTIVES

To summarize select continuing pharmacy education (CPE) topics and hours related to geriatric care completed by community, hospital/clinic, and long-term care (LTC)/consultant pharmacists in the previous 12 months, whether pharmacy workplace influenced topic selection or completion, and to describe CPE sources used by community versus hospital/clinic pharmacists.

DESIGN

Cross-sectional survey (2017).

SETTING AND PARTICIPANTS

Licensed pharmacists in North Dakota, South Dakota, Minnesota, Iowa, and Nebraska with primary practice settings in community pharmacies, hospitals, or clinics or those practicing as consultant pharmacists.

MAIN OUTCOME MEASURES

CPE on geriatric-related topics and hours completed in the previous 12 months, CPE providers and sources used, and differences in CPE topic completion and CPE providers and sources by primary pharmacy practice setting.

RESULTS

Pharmacists' response rates for states ranged from 10.5% to 17.1%. Pharmacists (n = 1082) reported limited completion of geriatric-related topics. Almost one-third completed CPE credit in Alzheimer disease (AD) but fewer than 20% of pharmacists in selected age-related chronic diseases (e.g., Parkinson disease, dementia with Lewy bodies, epilepsy, vascular dementia, geriatric syndrome). LTC/consultant pharmacists completed significantly more hours in geriatric-related topics compared with other pharmacists. In contrast, diabetes mellitus, hypertension, asthma, and heart failure were completed by 34% to 64% of the pharmacists. Pharmacist's Letter (57.2%), Power-Pak CE (42.4%), conferences, conventions, and symposia (32.5%), and Pharmacy Times (21.8%), were the most used CPE sources. Other sources were used by fewer than 18% of the pharmacists. Online CPE providers used by high numbers of study participants offered limited AD- or dementia-related topics and hours.

CONCLUSION

Findings revealed modest to minimal CPE completion in select geriatric care topics among pharmacists in the Upper Midwest. Completion rates were higher for LTC pharmacists compared with hospital, clinic, and community pharmacists. Only a few CPE sources were heavily used, and those offered minimal CPE in AD/dementia-related care. Given current findings and previous research, current CPE use habits and CPE offerings from major providers and sources seem insufficient for ensuring continued high-quality patient-centered care for growing U.S. aging populations.

Health care providers' roles and responsibilities in management of polypharmacy: Results of a modified Delphi

BACKGROUND

Little is known about the roles that allow interprofessional teams to effectively manage older patients experiencing polypharmacy.

OBJECTIVES

To identify and examine the consensus on salient interprofessional roles, responsibilities and competencies required in managing polypharmacy.

METHODS

Four focus groups with 35 team members practising in geriatrics were generated to inform survey development. The sessions generated 63 competencies, roles or responsibilities, which were categorized into 4 domains defined by the Canadian Interprofessional Health Collaborative. The resulting survey was administered nationally to geriatric health care professionals who were asked to rate the importance of each item in managing polypharmacy; we sought agreement within and across professions using a confirmatory 2-round Delphi method.

RESULTS

Round 1 was completed by 98 survey respondents and round 2 by 72. There was high intra-professional and interprofessional consensus regarding the importance of competencies among physicians, nurses and pharmacists; though pharmacists rated fewer competencies as important. Less consensus was observed among other health care professionals or they indicated the nonimportance of competencies despite focus group discussion to the contrary.

DISCUSSION

Although there is a strong consensus of polypharmacy management competencies across team members who have been more traditionally involved in medication management, there continue to be health care providers with differing understandings of competencies that may contribute to reduced reliance on medication. Lower importance ratings suggest pharmacists may not acknowledge or recognize their own potential roles in interprofessional polypharmacy management.

CONCLUSION

Further exploration to understand the underutilization of professional expertise in managing polypharmacy will contribute to refining role clarity and translating competencies in practical settings, as well as guiding educators regarding curricular content.

Geriatric education in schools of pharmacy: Students' and educators' perspectives in Qatar and Canada

INTRODUCTION

Older adults constitute the largest population admitted to hospitals due to chronic diseases, which requires appropriate prescribing of medications and comprehensive pharmaceutical care. The views and perspectives of students and educators can inform curriculum review in geriatric education in pharmacy schools.

METHODS

A cross sectional online survey containing 34 questions covering the areas of curriculum content and perceived needs for geriatric education was administered to students, faculty members, and preceptors. Data analysis included descriptive and inferential statistics.

RESULTS

The majority of participants indicated that their pharmacy school offered geriatric education. Pharmacokinetic/Pharmacodynamic Considerations in the Elderly was the topic most frequently reported to be covered in the geriatric curricula. Significantly more use of small groups discussions for delivering the geriatric curriculum was reported by respondents in Qatar than in Canada. Experiential geriatric education was available in both countries, although duration of rotations were reported to be longer in Canada than in Qatar. The majority of respondents perceived that students were moderately prepared for providing geriatric care.

DISCUSSION

This is the first study conducted to explore the current state of geriatric education in a pharmacy school in the Middle East in comparison with a well-established Canadian pharmacy curricula.

CONCLUSION

Both pharmacy schools studied offer a compulsory course on special populations that includes a similar geriatric curriculum. Future surveys should investigate how geriatric content in the pharmacy curricula is being evaluated.

Incorporating age-related special populations into a pharmacy skills laboratory course sequence

BACKGROUND AND PURPOSE

The purpose was this study was to evaluate the incorporation of geriatric and pediatric therapeutic concepts into a pharmacy skills laboratory (PSL) course sequence. Secondary outcomes were to describe the incorporation and evaluate the assessment effectiveness of these topics. Educational activity and setting Teaching materials and assessment data from the PSL course were evaluated for inclusion of content regarding age-related special populations.

FINDINGS

Materials reviewed from 205 PSL sessions held over four years demonstrated 89 (41.5%) sessions incorporated age-related topics using a variety of methods. Quiz and exam item performance was acceptable with an average difficulty index of 77.2% ± 21.3 and 85.8% ± 12.8, respectively. The average objective structured clinical exam (OSCE) score was also satisfactory at 83.2% ± 3.

DISCUSSION AND CONCLUSIONS

Age-related topics were included in several PSL sessions. These incorporation strategies were deemed to be effective as students performed well on written assessments and OSCEs. Additional PSL sessions were identified as potential targets for incorporating age-related special populations into future PSL offerings.

Use of a health screening and education event to change student attitudes toward the elderly

BACKGROUND

While many schools have incorporated geriatric pharmacy education into their curricula, questions remain as to how these experiences shape student perceptions of the geriatric population. The objective of this study was to assess student comfort levels and perceptions toward the geriatric patient population before and after participation in a single health screening and education event.

METHODS

Student perceptions about the elderly (measured via the Geriatrics Attitude Survey) and comfort levels in caring for geriatric patients were assessed before and after an event.

RESULTS

Twenty-two students completed pre-event and post-event surveys. Students were primarily female (73%), and half were completing their second year of pharmacy school (50%). Global student perceptions of geriatric patients positively changed from baseline following event participation (p = 0.023). Results reveal significant increases from baseline in student comfort levels with communicating, screening, and counseling elderly patients (p < 0.001, 0.01, and 0.001, respectively).

CONCLUSION

The Geriatrics Attitude Survey is a useful tool in assessing the value of a geriatric experience. Participation in this geriatric experience caused a statistically significant positive change in global perception scores. Additionally, survey results indicate that interactions with geriatric patients at a single event increased student comfort in communication, screening, and counseling.

The need for redesigned pharmacy practice courses in Pakistan: the perspectives of senior pharmacy students

PURPOSE

In Pakistan, courses in pharmacy practice, which are an essential component of the PharmD curriculum, were launched with the aim of strengthening pharmacy practice overall and enabling pharmacy students to cope with the challenges involved in meeting real-world healthcare needs. Since very little research has assessed the efficacy of such courses, we aimed to evaluate students' perceptions of pharmacy practice courses and their opinions about whether their current knowledge of the topics covered in pharmacy practice courses is adequate for future practice.

METHODS

A cross-sectional study was conducted over two months among the senior pharmacy students of two pharmacy colleges. A content- and face-validated questionnaire was used to collect data, which were then analysed using SPSS version 20. Descriptive analysis and logistic regression were performed.

RESULTS

Research in pharmacy practice (30.2%), applied drug information (34.4%), health policy (38.1%), public health and epidemiology (39.5%), pharmacovigilance (45.6%), and pharmacoeconomics (47.9%) were the major courses that were covered to the least extent in the PharmD curriculum. However, hospital pharmacy practice (94.4%), pharmacotherapeutics (88.8%), and community pharmacy practice (82.8%) were covered well. Although 94% of students considered these courses important, only 37.2% considered themselves to be competent in the corresponding topics. Of the participants, 87.9% agreed that the pharmacy courses in the present curriculum should be redesigned.

CONCLUSION

Our results showed that the pharmacy practice courses in the current PharmD curriculum do not encompass some important core subjects. A nationwide study is warranted to further establish the necessity for remodelling pharmacy practice courses in Pakistan.

A comparison of pharmacy students' and active older adults' perceptions regarding geriatric quality of life

OBJECTIVES

To measure perceptions of quality of life (QOL) in an active geriatric population and compare their responses with pharmacy students' perceptions of older adult QOL.

METHODS

Pharmacy students and active older adults completed the modified and standard version of a validated health survey instrument, respectively, and their responses were compared.

RESULTS

Eighty-six students and 20 active older adults participated. Student perceptions of geriatric QOL were significantly lower in all domains except health change compared to older adult perceptions (p<0.001 for all domains). Interest in a geriatric pharmacy career (p=0.04) and previously having taken the Perspectives in Geriatrics course and laboratory (p=0.05 and 0.02, respectively) were significantly associated with higher student scores on the physical component portion of the survey.

CONCLUSION

Stronger emphasis on geriatric QOL within pharmacy curricula may improve pharmacy students' perceptions regarding outcomes related to healthy older adults.

Validation of an empathy scale in pharmacy and nursing students

OBJECTIVE

To validate an empathy scale to measure empathy in pharmacy and nursing students.

METHODS

A 15-item instrument comprised of the cognitive and affective empathy domains, was created. Each item was rated using a 7-point Likert scale, ranging from strongly disagree to strongly agree. Concurrent validity was demonstrated with the Jefferson Scale of Empathy - Health Professional Students (JSE-HPS).

RESULTS

Reliability analysis of data from 216 students (pharmacy, N=158; nursing, N=58) showed that scores on the empathy scale were positively associated with JSE-HPS scores (p<0.001). Factor analysis confirmed that 14 of the 15 items were significantly associated with their respective domain, but the overall instrument had limited goodness of fit.

CONCLUSIONS

Results of this study demonstrate the reliability and validity of a new scale for evaluating student empathy. Further testing of the scale at other universities is needed to establish validity.

Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

The rate of medication errors is high, and these errors can cause adverse drug reactions. Elderly individuals are most vulnerable to adverse drug reactions. One cause of medication errors is the lack of drug knowledge on the part of different health professionals. Medical curricula have changed in recent years, resulting in less education in the basic sciences, such as pharmacology.

WHAT THIS STUDY ADDS

Our study shows that little curricular time is devoted to geriatric pharmacology and that educational programmes in geriatric pharmacology have not been thoroughly evaluated. While interest in pharmacology education has increased recently, this is not the case for geriatric pharmacology education. Education on geriatric pharmacology should have more attention in the curricula of health professionals, given the often complex pharmacotherapy in elderly patients. Educational topics should be related to the known risk factors of medication errors, such as polypharmacy, dose adjustments in organ dysfunction and psychopharmacotherapeutics.

AIMS

Given the reported high rates of medication errors, especially in elderly patients, we hypothesized that current curricula do not devote enough time to the teaching of geriatric pharmacology. This review explores the quantity and nature of geriatric pharmacology education in undergraduate and postgraduate curricula for health professionals.

METHODS

Pubmed, Embase and PsycINFO databases were searched (from 1 January 2000 to 11 January 2011), using the terms 'pharmacology' and 'education' in combination. Articles describing content or evaluation of pharmacology education for health professionals were included. Education in general and geriatric pharmacology was compared.

RESULTS

Articles on general pharmacology education (252) and geriatric pharmacology education (39) were included. The number of publications on education in general pharmacology, but not geriatric pharmacology, has increased over the last 10 years. Articles on undergraduate and postgraduate education for 12 different health disciplines were identified. A median of 24 h (from 15 min to 4956 h) devoted to pharmacology education and 2 h (1-935 h) devoted to geriatric pharmacology were reported. Of the articles on education in geriatric pharmacology, 61.5% evaluated the teaching provided, mostly student satisfaction with the course. The strength of findings was low. Similar educational interventions were not identified, and evaluation studies were not replicated.

CONCLUSIONS

Recently, interest in pharmacology education has increased, possibly because of the high rate of medication errors and the recognized importance of evidence-based medical education. Nevertheless, courses on geriatric pharmacology have not been evaluated thoroughly and none can be recommended for use in training programmes. Suggestions for improvements in education in general and geriatric pharmacology are given.

An introprofessional geriatric medication activity within a senior mentor program

Objective. To determine whether a required interprofessional geriatric medication activity within a senior mentor program changed pharmacy and medical students' attitudes regarding interprofessional collaboration.Design. Interprofessional teams, consisting of 1 third-year pharmacy student and 2 second-year medical students, conducted an in-home interview and medication history with a senior mentor (geriatric patient). The team members then collaboratively analyzed and discussed the patient's medication use and wrote an essay in which they identified the patient's medication problems and reflected on the interprofessional experience.Assessment. Students completed a validated survey instrument to measure pharmacist-physician attitudes about interprofessional collaboration before and after the experience. Pharmacy and medical students' already generally positive attitudes regarding interprofessional relationships were maintained and, in some instances, significantly improved. Students found the activity enhanced their geriatric training and increased their understanding of an interprofessional team.Conclusion. Incorporation of a geriatric medication activity within a senior mentor program maintained or improved pharmacy and medical students' positive attitudes about interprofessional collaboration and enhanced geriatric training within the curriculum.

Effect of an introductory pharmacy practice experience geriatric rotation on pharmacy students' learning outcomes: a qualitative study

OBJECTIVE

All second-year pharmacy students at Appalachian College of Pharmacy (ACP) undertake the early pharmacy practice experiences (EPPE) II. EPPE II is an introductory pharmacy practice experience (IPPE) geriatric course/rotation that occurs over two semesters during the second year. During the course, students are introduced to long-term care/geriatric patients through visits with their assigned patient for an hour each week for 24 weeks. The aim of this study is to evaluate the effect of the EPPE II rotation on students' attitudes toward nursing facility patients (mostly geriatric) and long-term care.

STUDY DESIGN

Cross-sectional study.

SETTING

Academic site.

PARTICIPANTS

Fifty-five second-year Doctor of Pharmacy students at ACP.

INTERVENTIONS

All ACP students enrolled in the EPPE II course are required to write a one- to two-page reflective essay during the spring term in which they describe the development of their relationship with their patient over time. Students were asked to submit their essays to faculty investigators for use in this study after completing the course. These essays were independently analyzed for content and categorized into themes by two faculty raters.

MAIN OUTCOME MEASURES

Student learning outcomes.

RESULTS

A total of 55 students voluntarily submitted their reflective essays for inclusion in the study. Most students had positive opinions about the rotation. Overall, students felt that the rotation was rewarding, valuable, worthwhile, and life-changing. Students cited many aspects that they learned from the course: life lessons, what real patient care involves, how to build patient relationships, and disease states and drugs, among others. Most students indicated that they developed a close relationship with their patients and enjoyed visiting with them in the nursing facility.

CONCLUSION

Many students enjoyed visiting with their nursing facility patients and developed a personal relationship with them. Students also learned many aspects as individuals and as future pharmacists.

Geriatric education in the health professions: are we making progress?

PURPOSE

Relative to the overall population, older adults consume a disproportionally large percentage of health care resources. Despite advocacy and efforts initiated more than 30 years ago, the number of providers with specialized training in geriatrics is still not commensurate with the growing population of older adults. This contribution provides a contemporary update on the status of geriatric education and explores how geriatric coverage is valued, how geriatric competence is defined, and how students are evaluated for geriatric competencies.

DESIGN AND METHODS

Semi-structured interviews were conducted with curriculum representatives from 7 health profession disciplines in a case study of one academic medical center.

FINDINGS

Geriatric training varies across health professions' disciplines. Although participants recognized the unique needs of older patients and valued geriatric coverage, they identified shortage of time in packed curricula, lack of geriatrics-trained educators, absence of financial incentive, and low student demand (resulting from limited exposure to older adults and gerontological stereotyping) as barriers to improving geriatric training.

IMPLICATIONS

Progress in including geriatric training within curricula across the health professions continues to lag behind need as a result of the continuing presence of barriers identified several decades ago. There remains an urgent need for institutional commitment to enhance geriatric education as a component of health professions curricula.

Impact of the geriatric medication game on pharmacy students' attitudes toward older adults

OBJECTIVE

To examine the impact of participation in the Geriatric Medication Game on pharmacy students' perceptions of and attitudes toward older adults and familiarity with common disabilities that affect them and the process of seeking health care.

DESIGN

In the game, first-year pharmacy students "became" older adults during a 3-hour pharmacy practice laboratory. They were given aging-related challenges (eg, impaired vision or mobility) and participated as patients in simulated healthcare scenarios, such as a visit to a physician's office and a pharmacy.

ASSESSMENT

After playing the game, students completed a 5-question reflection about their experiences and attitudes toward older adults. Content analysis was performed to identify themes from 4 years of student (n = 625) reflections. Predominant themes included: improved attitudes toward older adults, better understanding of patient experiences, and increased willingness to provide assistance.

CONCLUSIONS

Incorporating the Geriatric Medication Game into the pharmacy curriculum may facilitate students' understanding of the challenges that older adults face and improve future interactions.

Geriatric care as an introductory pharmacy practice experience

OBJECTIVE

To describe the design, delivery, and impact of a geriatric introductory pharmacy practice experience (IPPE) to develop students' skills related to consultant pharmacists' roles and patient care responsibilities.

DESIGN

A required 2-unit geriatric IPPE, involving 40 hours in a geriatric-care facility, 5 reflection hours, and 12 classroom-discussion hours, was developed for first- and second-year pharmacy students. Students interviewed patients and caregivers, reviewed patient charts, triaged patient needs, prepared care plans, and performed quality-assurance functions.

ASSESSMENT

After completing the IPPE, students' geriatric- and patient-care abilities were enhanced, based on review of their interactions, care plans, reflections, and examinations, and they demonstrated cognitive, affective, and psychomotor-domain learning skills. Students' care plans and quality assurance activities revealed positive patient outcomes, opportunities for measurable patient health improvement, and a positive impact on quality assurance activities. Student evaluations and feedback from health workers at the facilities also were positive.

CONCLUSIONS

This geriatric IPPE in which students cared for a specific patient and interacted with other health care providers is an innovative approach to enhancing students' abilities to serve the growing geriatric population.

An active-learning course model to teach pharmacotherapy in geriatrics

OBJECTIVE

To describe the development, implementation, and assessment of a geriatric pharmacotherapy elective course emphasizing a patient-centered approach and active, self-directed learning strategies.

DESIGN

The course content included fundamental concepts in aging, geriatric syndromes, activities involving assessment of medically complex older adults, presentation of controversies in clinical geriatrics, book and film clubs, an Adopt-a-Patient project, and scientific and reflective writing. Students participated in site visits to interview and interact with older adults.

ASSESSMENT

Student evaluation of the course was assessed with the teaching evaluation tool, an end-of-semester survey, a follow-up P4 survey, and reflective writings. Students strongly agreed that course goals were achieved. Learning how to communicate with older adults and assess complex medication regimens were the areas of highest importance to students. P4 students strongly agreed that skills learned in the course were important to their success in advanced pharmacy practice experiences (APPEs).

CONCLUSION

A pharmacotherapy course emphasizing active and self-directed learning in geriatrics through innovative teaching was adaptable to doctor of pharmacy (PharmD) students at various stages of their training and improved students' perceptions of aging.

Implications for Pharmacy from the Institute of Medicine's Report on Health Care Workforce and an Aging America

The Institute of Medicine's report “Retooling for an Aging America: Building the Health Care Workforce” concluded that the US health care workforce will require significant overhaul to care for the estimated 70 million adults 65 years and older by 2030. No profession trains the numbers of geriatric specialists needed to maintain the current provider to patient ratio. Pharmacy is no exception; currently less than 1% of pharmacists are certified or have specialty training in geriatrics. Schools of pharmacy, accrediting and professional organizations, and boards of pharmacy will need to collaborate to ensure that pharmacists have the core competencies to care for older adults.