Building the Geropsychology Workforce: A National Survey and Virtual Conference Define Critical Obstacles and Steps Forward.

The number of psychologists prepared to work with older adults falls far short of the demand. In the face of perceptions of a worsening geriatric workforce shortage, we describe the process of developing and implementing a national virtual conference aimed at generating solutions. A preconference survey (n = 174) found fewer applicants than desirable for aging-targeted graduate student, trainee, clinician, or academic positions (58.6%) and decreased student interest in aging (43.7%), with downstream consequences of filling age-targeted positions by those without aging backgrounds (32.3%), difficulty securing funding for aging-related positions (28.7%), and loss of aging-related positions (27.0%). Two fifths (40.7%) felt these problems have worsened as compared to 5 years ago. Qualitative responses provide detailed perspectives on these barriers and strategies generally and in particular as relates to racial and ethnic diversity and academic geropsychology. During a 2-day conference, attendees developed and prioritized strategies. Following a postconference survey to ascertain interest in volunteering, seven work groups were formed that have made progress on these issues. A virtual conference provides an inclusive, cost-effective, and fruitful opportunity to discuss workforce concerns in geropsychology and to generate numerous ideas to promote positive change.

Development and evaluation of a national careers in aging webinar series for psychology trainees.

Trainees may be interested in careers in aging but unfamiliar with career options, leading to a shortage in the geriatric workforce. In response to needs identified at a national geropsychology training conference, a multisite faculty group developed a six-session webinar series about careers in geropsychology, detailing career options in six unique settings. Each webinar session featured a moderated discussion with a panel of four professionals currently employed in the career of interest. The webinar was advertised to clinical and counseling psychology trainees with a potential interest in age-related careers, with evaluation of the series primarily including trainees from graduate programs, clinical internships, and postdoctoral fellowships. Participants rated their attitudes and beliefs about each career option at pre- and post-discussion. On average, each webinar session was attended by 48 individuals (SD = 12, range = 33-60). At baseline, attendees reported significantly more interest in careers in clinical practice compared to other careers, and interest in university settings increased from pre- to post-discussion. Across all six sessions, participants reported increased understanding of training experiences that would be helpful in pursuing that specific career. Findings point to the feasibility and utility of webinars for enhancing interest and confidence in pursuing careers in aging.

Situating the Pandemic in the Life-Course: Older Adults' Perspectives on the Challenges and Positives of the COVID-19 Pandemic.

Older adults experienced the highest rates of infections and deaths and significant social isolation during the COVID-19 pandemic. While these negative impacts are important to address, the positive outcomes among older adults during the pandemic are equally important. A survey was distributed to adults aged 65 or older living in St. Louis, Missouri from August 2020 through March 2021 to characterize the challenges and positives they found during the pandemic. A total of 103 older adults participated. Compared to previous times in their lives, a majority of participants felt the pandemic had been more disruptive (62%) and more confusing (78%) and a majority were more worried (58%) and more afraid of dying (53%) during the pandemic. The most common positives were increased emotional well-being (23% of responses) and stronger personal connections (20% of responses). This ability to identify positive outcomes of the pandemic demonstrates the resilience of older adults and counters the ageist narrative that dominated the dialogue early in the pandemic, which depicted older adults as weak, vulnerable, and dispensable. As the pandemic evolves, nurturing and leveraging these positives will be key to combatting the cycle of fear and restrictions that the pandemic could bring.

The Association Between Patterns of Social Engagement and Conversion From Mild Cognitive Impairment to Dementia: Evidence From the Health and Retirement Study.

OBJECTIVES: This study examined the association between patterns of social engagement and conversion from cognitive impairment, no dementia (CIND) to dementia. It also tested whether social engagement is associated with conversion independently from physical and cognitive engagements. METHOD: Data from 2 waves (2010 and 2014) of the Health and Retirement Study (HRS) were used. The sample consisted of 1227 people who had CIND in 2010. To identify the heterogeneity of social engagement, latent class analysis was utilized. Multinomial logistic regression analysis was utilized to investigate the association between patterns of social engagement and probability of conversion to dementia and death or dropout. RESULTS: The result showed that patterns of social engagement that represent higher level and more variety of social engagement were associated with lower probabilities of conversion to dementia in 4 years but not with probabilities of death or dropout. The relationship held after controlling for physical and cognitive engagements. DISCUSSION: Findings implied that promoting social engagement may be protective against developing dementia even for the high-risk group of people with CIND. Future studies should investigate the mechanism behind the relationship between patterns of social engagement and lower probabilities of conversion to dementia.

House Hunters, Gerontology Style: a problem-based learning classroom activity for undergraduate students.

Problem-based learning is an evidence-based, pedagogical approach that invites students to solve complex, real-life problems using knowledge learned in the classroom. Effective use of problem-based learning in undergraduate gerontology courses, specifically, is likely to deepen students' knowledge about course content related to aging and may also promote students' long-term interest in gerontology. House Hunters: Gerontology Style is a problem-based learning activity that can be used in small-group discussions to facilitate students' understanding of issues related to relocation and homebuying in older adulthood. In this activity - based on the popular television show - students act as real estate agents for a fictional older couple relocating closer to adult children. Assignment features can be tailored easily by the instructor to optimize specific learning objectives. In an evaluation of the activity, students who completed this activity reported that it was engaging, that it enabled them to apply material from the class, and that it facilitated their application of course material to a "real world" problem. Suggestions for modifications to future iterations of this assignment may include a more pointed focus on budgetary constraints on homebuying in older adulthood, approaching homebuying from a life course lens, and considering the role of disparities in the home buying process.

Reliability and Validity of the Polish Version of the Alzheimer's Disease Knowledge Scale.

INTRODUCTION: In the context of increasing numbers of older adults and an increased prevalence of neurodegenerative diseases, the early diagnosis of dementia has become an important issue. Poland's population is aging, and the growing number of individuals with Alzheimer's disease (AD) may pose challenges for families and the health-care system. While creating effective psychoeducational interventions aiming at increasing caregivers' knowledge may be beneficial, Poland lacks a standardized measurement for assessing knowledge about AD or a related form of dementia. METHODS: The aim of our study was to translate and evaluate the Alzheimer's Disease Knowledge Scale (ADKS) among Polish individuals. RESULTS: The Polish ADKS was developed through a translation-back translation method. Psychometric evaluation was done with a sample of 942 individuals (caregivers, health-care professionals, and general population) who completed the questionnaire. DISCUSSION: The results indicate that the scale produces acceptable psychometric properties and can be used to evaluate the effectiveness of educational interventions among caregivers, health-care professionals, and the general population.

Frontotemporal Dementia Knowledge Scale: Development and Preliminary Psychometric Properties.

OBJECTIVE: Frontotemporal dementia (FTD) accounts for ∼10% of dementia cases and is the most common cause of early-onset dementia. However, no well-validated instrument currently exists to measure knowledge about FTD. In this study, we used systematic scale development procedures to create a scale to measure knowledge of FTD based on a contemporary understanding of the disease. METHODS: Standard scale development methods were used to create items and evaluate their psychometric properties. A total of 72 health care professionals and 102 caregivers of people with FTD responded to items measuring FTD knowledge, general dementia knowledge, crystallized intelligence, experience with FTD, and demographic information. RESULTS: The Frontotemporal Dementia Knowledge Scale (FTDKS) contains 18 items that cover key, basic knowledge about FTD in the domains of risk factors, symptoms, course, caregiving, and treatment. The scale uses a 4-point True/False format with a Don't Know option and takes ∼5 minutes to complete. In the current sample the FTDKS had good psychometric properties in terms of reliability and validity. IMPLICATIONS: The FTDKS can be used with health care professionals and caregivers of people with FTD to assess their knowledge about the disease. The scale may be useful to evaluate knowledge in clinical care and educational program contexts.

Motion Preservation in Hallux Rigidus After Failure of Hydrogel Implantation: Treatment Considerations and a Report of 2 Cases.

Hallux rigidus is a common condition treated daily by surgeons worldwide. During the past decade, the standard treatment algorithm has been questioned by both patients and surgeons seeking alternatives to arthrodesis, which was previously considered the gold standard for advanced disease. Patients are living longer, and many have a more active lifestyle; thus, recreating and improving range of motion and achieving pain relief are increasingly desirable. The treatment spectrum and implant options for motion-preserving techniques in the metatarsophalangeal joint has been widened with the recent US Food and Drug Administration approval of a polyvinyl-alcohol hydrogel implant. In the controlled US Food and Drug Administration trial, the 2-year revision rate was 9.2% and all failures were revised to a first metatarsophalangeal arthrodesis. Outcomes comparison of these revisions to primary fusions showed less predictable pain relief and may warrant alternative treatment considerations, preferably those that allow for continuation of motion preservation. Revision of failed hydrogel implants to arthrodesis can be performed through various first metatarsophalangeal fusion techniques or, as introduced in this review, with a fourth-generation threaded hemiarthroplasty. Excellent 10-year results with primary hemiarthroplasty supported its use as revision procedure in 2 failed polyvinyl-alcohol implantations, preserving arthrodesis for future salvage if necessary. The purpose of this report was to outline a motion-preserving technique after failed hydrogel implants and describe preoperative, intraoperative, and postoperative considerations for optimized outcomes.

The Podiatric Medical Profession: A Gender Comparison.

The number of women in podiatric medicine and surgery has increased steadily over the past 4 decades; however, there appears to be a large and continued gender gap with respect to representation in academic medicine and other positions of power. National and state level organizational data were obtained from multiple podiatry professional societies to evaluate the rate at which women achieved leadership roles within the podiatric profession over time. A secondary questionnaire was also developed and electronically mailed to 8684 doctors of podiatric medicine to help capture additional leadership information and to provide further insight into the trends observed. The response rate was 26% (2276/8684). Female representation in academia, research/publications, most leadership positions, and board certifications has increased over time, but at a slower rate than the number of women entering the profession. We observed a decreasing trend of females completing fellowships, speaking at national meetings, becoming residency directors, and receiving American College of Foot and Ankle Surgeons- and American Podiatric Medical Association-sponsored grants/awards. Based on the survey results, female podiatric physicians were more likely to be single, have fewer children, spend more time in a clinical setting, be less satisfied with work, and experience higher work stress levels than their male colleagues. Of the female respondents, 73% described experiencing gender discrimination at some point in their career, and 42% reported experiencing sexual harassment, compared with only 6% and 5% of men, respectively. There continues to be a gender gap in leadership roles, which may be explained partially by work/life balance issues, gender discrimination, and other issues.

The Wilms' tumor suppressor protein WT1 is processed by the serine protease HtrA2/Omi.

The Wilms' tumor suppressor protein WT1 functions as a transcriptional regulator of genes controlling growth, apoptosis, and differentiation. It has become clear that WT1 can act as an oncogene in many tumors, primarily through the inhibition of apoptosis. Here, we identify the serine protease HtrA2 as a WT1 binding partner and find that it cleaves WT1 at multiple sites following the treatment of cells with cytotoxic drugs. Ablation of HtrA2 activity either by chemical inhibitor or by siRNA prevents the proteolysis of WT1 under apoptotic conditions. Moreover, the apoptosis-dependent cleavage of WT1 is defective in HtrA2 knockout cells. Proteolysis of WT1 by HtrA2 causes the removal of WT1 from its binding sites at gene promoters, leading to alterations in gene regulation that enhance apoptosis. Our findings provide insights into the function of HtrA2 in the regulation of apoptosis and the oncogenic activities of WT1.

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain.

Adult acquired inferior calcaneal heel pain is a common pathology seen in a foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options are presented. Various diagnostic and treatment modalities are available to the practitioner. It is prudent to combine appropriate history and physical examination findings with patient-specific treatment modalities for optimum success. We present the most common diagnostic tools and treatment options, followed by a discussion of the appropriateness of each based on the published data and experience of the expert panel.

When I'm 64: Effects of an interdisciplinary gerontology course on first-year undergraduates' perceptions of aging.

One challenge for gerontology is getting more students interested in aging at an earlier point in their academic career. This study evaluated the impact of an interdisciplinary course on aging designed for first-year undergraduate students. The course aimed to expand students' appreciation of the personal and professional relevance of aging issues, with the goal of expanding their aging-related curricular and career interests. Main outcome variables of the study included knowledge of older adults and aging, attitudes toward older adults, and anxiety about personal aging. Participants included an intervention group enrolled in the course and a control group not enrolled in the course. Compared to baseline, at the end of the semester students in the class had more knowledge about aging and more positive explicit attitudes toward older adults, but their implicit attitudes toward older adults and anxiety about aging did not change. Control students showed no changes. These findings suggest that objective knowledge of aging and explicit attitudes improve with curricular intervention, but implicit attitudes and anxiety might be more difficult to change. Gerontology education is a complex undertaking whose diverse goals must be clearly articulated in order to guide curricular interventions and incite curiosity among young undergraduate students.

Come, join, lead: Attracting students to careers in aging and promoting involvement in gerontological societies.

Geriatric educators face the challenge of attracting more clinicians, scientists, and educators into geriatrics and gerontology, and promoting involvement in gerontological societies. A survey of psychologists (N = 100) examined factors that attract students in clinical/counseling psychology to practice with older adults, as well as experiences in organizational service. For 58%, interest in aging began at the undergraduate level, but for others interest developed later. About one half cited academic exposure such as mentorship (51%), research (47%), or coursework (45%) as sparking interest, along with family (68%) or work experience (61%). Involvement in professional organizations lags (58%), in part owing to misperceptions about what those activities require. A continued targeted effort at the undergraduate and graduate level is essential to attract students to careers in aging. To preserve vital professional organizations, enhanced outreach may be useful to dispel myths about service and encourage engagement.

Words Matter.

Palliative care consultation teams (PCCTs) provide input to other health-care providers working with patients who have life-limiting disease. This study examines whether the diction and phrasing of consultation recommendations in the electronic health record influence their implementation. We reviewed 288 verbatim PCCT recommendations that were made for 111 unique patients in a Veterans Affairs hospital and available in the electronic health record. Recommendations were coded for linguistic features, such as the presence of conditionals (e.g., "could") and tentative phrasing (e.g., "would suggest"). Each patient's subsequent treatment was followed in the medical record to determine whether PCCT recommendations were implemented. Only 57% of the consultation recommendations were eventually implemented. Recommendations that included a conditional word or phrase were significantly less likely to be implemented. In particular, recommendations that included the words "could" and "consider" were less likely to be implemented. PCCTs may enhance their effectiveness by attending to the subtle pragmatics of how they communicate with other health-care providers, particularly in electronic communication where nonverbal features of communication are unavailable.

Development and validation of the Palliative Care Knowledge Scale (PaCKS).

OBJECTIVE: The purpose of this study was to develop a reliable and valid scale that broadly measures knowledge about palliative care among non-healthcare professionals. METHOD: An initial item pool of 38 true/false questions was developed based on extensive qualitative and quantitative pilot research. The preliminary items were tested with a community sample of 614 adults aged 18-89 years as well as 30 palliative care professionals. The factor structure, reliability, stability, internal consistency, and validity of the 13-item Palliative Care Knowledge Scale (PaCKS) were assessed. RESULTS: The results of our study indicate that the PaCKS meets or exceeds the standards for psychometric scale development. SIGNIFICANCE OF RESULTS: Prior to this study, there were no psychometrically evaluated scales with which to assess knowledge of palliative care. Our study developed the PaCKS, which is valid for assessing knowledge about palliative services in the general population. With the successful development of this instrument, new research exploring how knowledge about palliative care influences access and utilization of the service is possible. Prior research in palliative care access and utilization has not assessed knowledge of palliative care, though many studies have suggested that knowledge deficits contribute to underutilization of these services. Creating a scale that measures knowledge about palliative care is a critical first step toward understanding and combating potential barriers to access and utilization of this life-improving service.

Ten-Year Follow-Up of Metatarsal Head Resurfacing Implants for Treatment of Hallux Rigidus.

Controversy remains regarding the use of arthroplasty versus arthrodesis in the surgical treatment of late-stage hallux rigidus. The purpose of our retrospective study was to report the long-term follow-up results of the metatarsal head resurfacing implant used for hemiarthroplasty. The patient assessments were conducted using the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal clinical rating system and a satisfaction questionnaire. A total of 59 consecutive implantations were performed from January 2005 to December 2009 at our institution. Of the 59 patients, 2 had died and 12 were lost to follow-up, for a 76.3% follow-up rate (45 of 59 procedures) at a mean of 117.67 (range 96 to 143) months. The mean overall AOFAS scale score was 90.6 ± 7.6. The AOFAS pain scale score was 37.78 ± 4.71. One implant was removed, and all remaining patients were happy with their outcome and would repeat the procedure on their other foot, if needed. A subset of patients from a previous mid-term study at our institution showed no significant change in the AOFAS scale scores. Of these 32 patients, 30 (93.75%) were available for follow-up examination at a mean of 122.62 (range 96 to 143) months. We were able to obtain long-term results for 32 implants (30 patients), resulting in a 10-year follow-up rate of 93.7%. With the minimal resection required for this implant, salvage arthrodesis remains a viable option if revision is needed. The surgical treatment of late-stage hallux rigidus with metatarsal head resurfacing allows for low-risk and excellent outcomes at long-term follow-up point.

Transitioning From a Level II to Level I Trauma Center Increases Resident Patient Exposure.

Increased patient exposure has been shown to improve residency training as determined by better patient outcomes. The transition of John Peter Smith Hospital from a level II to a level I trauma center in 2009 provided a unique opportunity to investigate the direct effects of increased patient exposure on residency training in a relatively controlled setting. We evaluated the effect of the transition to a level I trauma center on residency training. In 2014, we examined the annual facility reports and separated the data into 2 groups: level II (2001 to 2008) and level I (2010 to 2013). The primary outcome measures were patient volume, surgical volume, patient acuity, and scholarly activity by the residents. The patient volume in all units increased significantly (p < .05 for all) after the transition to a level I center. The surgical volume increased significantly for the general surgery, orthopedics, and podiatry departments (p < .05 for all) but remained unchanged in the gynecology and oral maxillofacial surgery departments. The volume measures were performed on all 98 residents (100%). Patient acuity and scholarly activity increased by 17% and 52%, respectively; however, the differences in these data were not statistically significant. The scholarly activity per resident was measured for the orthopedic and podiatry departments. For those departments, the total number of residents was 30, and scholarly activity was measured for 100% of them. Overall, resident education improved when the hospital transitioned to a level I trauma center, although certain subspecialties benefited more than did others from this transition.

Interposition Ankle Arthroplasty Using Acellular Dermal Matrix: A Small Series.

Although ankle arthrodesis is the reference standard for end-stage ankle arthritis, loss of mobility and adjacent joint arthritis are consequences that alternatives to arthrodesis attempt to avoid. The purpose of the present study was to report the clinical results of interpositional arthroplasty using acellular dermal matrix in 4 patients (age 32 to 42 years) for the treatment of advanced ankle osteoarthritis. The primary findings included relief of pain, with improvement in tibiotalar joint range of motion from a mean of 16.5° (range 0° to 24°) preoperatively to a mean of 31° (range 25° to 40°) postoperatively. All 4 patients underwent open arthrotomy of the anterior and posterior tibiotalar capsule with plafond exostectomy and debridement of all deleterious tissue within the ankle capsule. The articular surface of the talar dome was denuded down to smooth subchondral bone, and microfracture was performed. Autologous calcaneal bone marrow aspirate was applied, and talar resurfacing was achieved using an acellular dermal matrix. Knotless anchors placed medially and laterally within the anterior and posterior dome were used to affix the dermal matrix. The follow-up period ranged from 12 to 18 (mean 14) months. The mean pre- and 12-month postoperative Association of Orthopaedic Foot and Ankle Society hindfoot-ankle scale scores were 35 and 88.5, respectively. These outcomes suggest that interpositional tibiotalar arthroplasty using an acellular dermal matrix is successful in improving function and range of motion and decreasing pain. As an alternative to tibiotalar arthrodesis, interpositional tibiotalar arthroplasty might be the procedure of choice for young patients with end-stage ankle arthritis. Longer follow-up periods, histologic testing, and arthroscopic evaluations would be advantageous to further assess the durability of this procedure.

Training for Research and Teaching in Geropsychology: Preparing the Next Generation of Scholars and Educators.

For geropsychology to flourish in the years ahead, we need scientists to advance knowledge and teachers to draw new professionals into the field. In this project the authors surveyed 100 geropsychologists who completed a doctoral degree in clinical or counseling psychology about their experience with training for research and teaching. The majority were currently conducting some degree of research (38%) and some form of teaching (45%). The majority of ratings for components of research training were in the "very good to excellent" range, whereas elements of teacher training were rated in the "poor to good" range, though there was variability among persons and components. Qualitative comments revealed enthusiasm for research and teaching roles and a need to enhance our training of geropsychologists as educators. The authors provide several suggestions that could enhance research and teacher training for current and future students of professional geropsychology.

The influence of cerebrospinal fluid (CSF) biomarkers on clinical dementia evaluations.

BACKGROUND: Cerebrospinal fluid (CSF) proteins have become accepted biomarkers of Alzheimer's disease (AD) in research settings. The extent of their use, perceived utility, and influence on decision making in clinical settings, however, are less well studied. METHODS: Clinicians who evaluate older adults (N = 193) were randomized to view normal, borderline, AD-consistent, or no CSF information in two vignettes portraying patients with borderline and mild AD symptoms. Clinicians also reported on the use and perceived utility of CSF biomarkers. RESULTS: Although clinicians reported infrequent use and low perceived utility of CSF biomarkers, viewing AD-consistent CSF values made clinicians more likely to make an AD-related diagnosis, increased diagnostic confidence, and led clinicians to initiate treatment more often than clinicians who had no CSF information. CONCLUSIONS: CSF biomarkers influence decision making depending on the extent to which biomarkers reflect AD pathology, consistency between clinical-pathologic information, and the ambiguity of protein values.