Gerontology competencies: Construction, consensus and contribution.

The Academy for Gerontology in Higher Education (AGHE) in 2014 approved the first integrative "Gerontology Competencies for Undergraduate and Graduate Education"©. This article describes the background, thought development, guiding framework and consensus process for its construction. A modified Delphi method utilizing seven review rounds within three developmental cycles, with gerontology educators from 30 institutions, achieved input and consensus. The comprehensive framework has ten major domains, employs three categories each including multiple selective competencies. Six Category I competencies are essential orientations to gerontology. Four Category II competencies are "interactional" processes of knowing and doing across the field. Category III provides eight selective competencies for sectors where gerontologists may work. From educators' feedback, gerontology characteristics emerged: multi-system approaches; interdisciplinary; communication of older adults' "voices" and strengths; research utilization. The discussion includes the contribution of competency-based gerontology to students and aging workforce development as well as next steps, outcome measurement, levelling and accreditation.

Older Californians and the Mental Health Services Act: Is an Older Adult System of Care Supported?

This policy brief summarizes findings from the first study to evaluate how California's public mental health delivery system has served older adults (60 years of age and over) since the passage of the Mental Health Services Act (MHSA) in 2004. Study findings indicate that there are unmet needs among older adults with mental illness in the public mental health delivery system. There are deficits in the involvement of older adults in the required MHSA planning processes and in outreach and service delivery, workforce development, and outcomes measurement and reporting. There is also evidence of promising programs and strategies that counties have advanced to address these deficits. Recommendations for improving mental health services for older adults include designating a distinct administrative and leadership structure for older adult services in each county; enhancing older adult outreach and documentation of unmet need; promoting standardized geriatric training of providers; instituting standardized data-reporting requirements; and increasing service integration efforts, especially between medical, behavioral health, aging, and substance use disorder services.

Mental Health Services for Older Adults: Creating a System That Tells the Story.

In 2004, voters in California approved Proposition 63 for passage of the Mental Health Services Act (MHSA). From that time until 2014, over $13 billion in the state's tax revenue was allocated for public mental health services. There is very little information available to answer critical questions such as these: How much of this amount was spent in the interests of older adult mental health? What benefits were gained from services delivered to older adults? This policy brief promotes recommendations for specific age-relevant indicator utilization and for an expanded system of uniform and transparent data for all types of MHSA-funded programs. These two policy directions are necessary in order to document the older adult mental health care services provided and to track outcomes at the state level for MHSA programs. A third recommendation centers on assuring that the mental health workforce is prepared to utilize and report age-relevant data indicators.

Competencies in European gerontological higher education. An explorative study on core elements.

This study explores whether there is a common core of competencies in European gerontology education programs by doing a cross-comparison of five undergraduate-level programs. Content analysis of competency profile documents at the five European educational programs were studied using thematic analysis. Study results document that there indeed is a common core of elements in gerontological educational programs. Three clusters which included a total of 15 categories were identified. The clusters were labeled professional attitude, communication skills, and service provision. Clusters and categories varied across the five programs. One program in particular included fewer clusters and categories. This may reflect a difference in focus in the program but could also reflect a less elaborately formulated competency profile document. The results of this study show that, at least at the level of formulating competencies, there is a strong agreement on the major components that are important for a gerontologist at the undergraduate level.

Team-Based Interprofessional Competency Training for Dementia Screening and Management.

As many as 50% of people satisfying diagnostic criteria for dementia are undiagnosed. A team-based training program for dementia screening and management was developed targeting four professions (medicine, nursing, pharmacy, social work) whose scope of practice involves dementia care. An interprofessional group of 10 faculty members was trained to facilitate four interactive competency stations on dementia screening, differential diagnoses, dementia management and team care planning, and screening for and managing caregiver stress. Registrants were organized into teams of five members, with at least one member of each profession per team. The teams rotated through all stations, completing assigned tasks through interprofessional collaboration. A total of 117 professionals (51 physicians, 11 nurses, 20 pharmacists, 24 social workers, 11 others) successfully completed the program. Change scores showed significant improvements in overall competence in dementia assessment and intervention (very low = 1; very high = 5; average change 1.12, P < .001), awareness of importance of dementia screening (average change 0.85, P < .001), and confidence in managing medication (average change 0.86, P < .001). Eighty-seven participants (82.9%) reported feeling confident or very confident using the dementia toolkit at their home institution. In a survey administered 3 months after the session, 48 respondents reported that they had changed their approach to administering the Mini-Cog test (78%), differential diagnosis (49%), assessment of caregiver stress (74%), and accessing community support and services (69%). In conclusion, team-based interprofessional competency training is a team teaching model that can be used to enhance competency in dementia screening and management in medical, nursing, pharmacy, and social work practitioners.

A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care-Preliminary Data.

Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6-month intervention with five components: facilitated collection of MDS 3.0 nine-item Patient Health Questionnaire (PHQ-9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ-9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self-appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self-ratings improved on four depression care measures (P = .05 to <.001). Mentors observed improvement in team process and enthusiasm during team meetings. For 336 residents with PHQ-9 and medication data, depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH-prevalent syndromes is possible.

Preparing the workforce for healthy aging programs: the Skills for Healthy Aging Resources and Programs (SHARP) model.

Current public health and aging service agency personnel have little training in gerontology, and virtually no training in evidence-based health promotion and disease management programs for older adults. These programs are rapidly becoming the future of our community-based long-term care support system. The purpose of this project was to develop and test a model community college career technical education program, Skills for Healthy Aging Resources and Programs (SHARP), for undergraduate college students, current personnel in aging service and community organizations, and others interested in retraining. A multidisciplinary cross-sector team from disciplines of public health, sociology, gerontology and nursing developed four competency-based courses that focus on healthy aging, behavior change strategies, program management, an internship, and an option for leader training in the Chronic Disease Self-Management Program. To enhance implementation and fidelity, intensive faculty development training was provided to all instructors and community agency partners. Baseline and postprogram evaluation of competencies for faculty and students was conducted. Process evaluation for both groups focused on satisfaction with the curricula and suggestions for program improvement. SHARP has been piloted five times at two community colleges. Trainees (n = 113) were primarily community college students (n = 108) and current aging service personnel (n = 5). Statistically significant improvements in all competencies were found for both faculty and students. Process evaluation outcomes identified the needed logical and component adaptations to enhance the feasibility of program implementation, dissemination, and student satisfaction. The SHARP program provides a well-tested, evidence-based effective model for addressing workforce preparation in support of healthy aging service program expansion and delivery.

Social work knowledge of community-based services for older adults: an educational model for social work students.

Social workers are often the key link between older adults, their families and community-based services. Thus, knowledge about older adults and community-based care is imperative for social work practice. Evaluation data are provided on a national multisite effort (N = 353) from 35 schools to assure graduate social work student's competency related to community services for older adults. Results suggest that the educational model as described in this article sets forth positive outcomes in the education of aging savvy social workers. Ongoing social work education is needed to meet the burgeoning needs of the geriatric population.

Geriatric social work career tracking: graduates of the Hartford Partnership Program for Aging Education (HPPAE).

Despite a growing need for geriatric social workers, there is a question as to whether MSW graduates who are gerontologically prepared actually enter the workforce to serve older adults. By tracking MSW graduates who had special training in aging, this study aims to explore their job search and career experience. Findings show that most graduates located aging-related jobs 4 months postgraduation and remained committed to the field 1 to 2 years later. The majority were working in direct service provision in clinical settings. Their salaries compare favorably with those of generic social workers. Implications for geriatric social work education are discussed.

Innovations in student-centered interdisciplinary teaching for general education in aging.

The University of California-Los Angeles (UCLA) General Education "Clusters" are innovations in student-centered undergraduate education focused on complex phenomena that require an interdisciplinary perspective. UCLA gerontology and geriatric faculty recognized the opportunity to introduce freshmen to the field of aging through this new initiative. In 2000, with support of the College of Letters and Science, the School of Medicine Multicampus Program in Geriatric Medicine and Gerontology created "Frontiers in Human Aging: Biomedical, Social and Policy Perspectives". The active and cooperative student-centered teaching of aging that is integral to this course has successfully contributed to the development of intellectual skills needed for academic and life success in over 1,200 freshman honors students.

Strengthening field education in aging through university-community agency partnership: the Practicum Partnership Program.

The Practicum Partnership Program (PPP), an innovative field education model developed and implemented by six demonstration sites over four years (2000-2004), uses a structured university-community partnership, or consortium, as the foundation for designing, implementing, and evaluating internships for graduate social work students specializing in aging. This paper describes the site consortia and PPP programs, presents evaluation findings, and identifies future directions for the PPP. Student learning outcomes were positive and both students and consortia agencies reported positive PPP experiences. The PPP model underscores the value of the community agencies as equal partners in educating future geriatric social workers.

Developing geriatric social work competencies for field education.

Preparing social workers to effectively practice with the growing older population requires the identification of geriatric competencies for the profession. The John A. Hartford Geriatric Social Work Initiative provided the impetus and direction for a national strategy to improve the quality of preparation of geriatric social workers. The Geriatric Social Work Practicum Partnership Program (PPP) is the project with the Hartford Initiative that emphasizes field education. The Geriatric Social Work Education Consortium (GSWEC), one of the PPP programs, initiated the development of competencies for work with older adults. GSWEC utilized Geriatric Social Work White Papers and the pioneering work of the Council on Social Work Education's (CSWE) Strengthening Aging and Gerontology Education for Social Work's (SAGE-SW) comprehensive competency list as well as conducted focus groups locally to delineate key competencies for field education. The Coordinating Center for the PPP, located at the New York Academy of Medicine, led in collaboratively developing knowledge based skill competencies for geriatric social work across all 6 demonstration sites (11 universities). The competencies adopted across sites include skills in the following five major domains: values and ethics; assessment (individuals and families, aging services, programs and policies); practice and interventions (theory and knowledge in practice, individual and family, aging services, programs and practice) interdisciplinary collaboration; and evaluation and research. The identified competencies have proven effective in evaluating students (n = 190) pre- and post PPP field education. The implications for further development of competency driven education for geriatric social work are discussed.

Racial/ethnic variations in veterans' ambulatory care use.

OBJECTIVES: We assessed racial/ethnic variations in patterns of ambulatory care use among Department of Veterans Affairs (VA) health care-eligible veterans to determine if racial/ethnic differences in health care use persist in equal-access systems. METHODS: We surveyed 3227 male veterans about their health and ambulatory care use. RESULTS: Thirty-eight percent of respondents had not had a health care visit in the previous 12 months. Black (odds ratio [OR] = 0.5), Hispanic (OR = 0.4), and Asian/Pacific Islander veterans (OR=0.4) were less likely than White veterans to report any ambulatory care use. Alternately, Whites (OR=2.2) were more likely than other groups to report ambulatory care use. Being White was a greater predictor of health care use than was having fair or poor health (OR=1.4) or functional limitations (OR=1.5). In non-VA settings, racial/ethnic minorities were less likely to have a usual provider of health care. There was no VA racial/ethnic variation in this parameter. CONCLUSIONS: Racial/ethnic disparities in health and health care use are present among VA health care-eligible veterans. Although the VA plays an important role in health care delivery to ethnic minority veterans, barriers to VA ambulatory care use and additional facilitators for reducing unmet need still need to be investigated.

Undergraduate knowledge of aging: a comparative study of biopsychosocial content.

This study assesses undergraduate knowledge of aging, distinguishing between types of deficits (ignorance vs. misinformation) and content areas as delineated by a biopsychosocial framework. Knowledge is examined as an outcome of taking an aging elective, while accounting for course rating and knowledge retention. A diverse body of UCLA undergraduate students who took an aging course (n = 349) and a stratified random comparison group (n = 430) took Palmore's Facts on Aging Quiz and scored 14 and 12 items correct, respectively. Undergraduates (n = 779) showed a good knowledge of aging in the psychological- cognitive domain, but consistent with previous findings, they exhibited deficits primarily in the social-demographic realm. Taking an aging course was significantly related to better overall knowledge of aging (correct) (p

Accessibility and acceptability of the Department of Veteran Affairs health care: diverse veterans' perspectives.

OBJECTIVES: Diverse veteran's perspectives on the accessibility and acceptability of the Department of Veteran Affairs (VA) health services are presented. METHODS: The qualitative methodology uses 16 focus groups (N = 178) stratified by war cohort (World War II and Korean Conflict versus Vietnam War and Persian Gulf War) and four ethnic/racial categories (African American, Asian American, European American, Hispanic American). RESULTS: Five themes emerged regarding veterans' health care expectations: (1) better information regarding available services, (2) sense of deserved benefits, (3) concern about welfare stigma, (4) importance of physician attentiveness, and (5) staff respect for patients as veterans. Although veterans' ethnic/racial backgrounds differentiated their military experiences, it was the informants' veteran identity that framed what they expected of VA health services. CONCLUSIONS: Accessibility and acceptability of VA health care is related to veterans' perspectives of the nature of their entitlement to service. Provider education and customer service strategies should consider the identified factors to increase access to VA as well as improve veterans' acceptance of the care.

An international approach to community health care for older adults.

Worldwide population ageing, concomitant increases in disability rates, and changes in family health care systems require an examination of current service delivery to optimize use of societal resources in the future. This article examines a community health care approach suggested by research conducted by the World Health Organization Kobe Centre for Health Development (WKC). The WKC approach, which uses a cross-national perspective, envisions a community health care system that integrates health and social services and spans health promotion, primary care, and long-term care. Prototypical approaches for organizing community health care include communal, marketplace, case management, and managed care. The ramifications of these approaches are examined from the perspectives of the older adult, the family, and formal service providers.

The health and functional status of US veterans aged 65+: implications for VA health programs serving an elderly, diverse veteran population.

As the US population is aging, so too is the US veteran population. Chief among the challenges facing the Department of Veterans Affairs (VA) is developing health programs and services that mesh with the needs of an aging veteran population and therefore improve the health status of elderly veterans. Meeting this challenge requires an understanding of the health needs of the older veteran population, including health disparities that exist across racial ethnic populations. This study examines the self-rated health and functioning of a national sample of veterans aged 65+ participating in the National Survey of Veterans. The results show that over one half of elderly veterans report difficulty in functioning and rate their health status as fair or poor. Additionally, elderly African American and Hispanic veterans report worse health than non-Hispanic white veterans across the majority of health indicators. Given the health profile of older veterans found in this study, it would seem necessary that programs serving older veterans be adept at the ongoing medical management of chronic disease and the provision of long-term care services.

Health and functioning among four war eras of U.S. veterans: examining the impact of war cohort membership, socioeconomic status, mental health, and disease prevalence.

This analysis examines the self-rated health and functioning of World War II, Vietnam era, Korean Conflict, and Persian Gulf War veterans participating in the Veteran Identity Program Survey 2001. The results indicate that although World War II veterans are more likely to report poor health status and functioning, Vietnam-era veterans report more difficulty with specific activities of daily living and instrumental activities of daily living than any other era of veterans. These relationships remain when controlling for race/ethnicity, socioeconomic status, disease prevalence, and mental health status. These findings suggest that there are characteristics unique to the Vietnam experience that negatively affect this cohort of veterans. We suggest that further analysis examine the specific pathways through which the experience of being a Vietnam veteran affects health. In the meantime, health and social service planning within the Department of Veterans Affairs should explore the services that should be developed and targeted to this cohort of veterans so that they may remain independent in the community.

Community-based strategies for focus group recruitment of minority veterans.

Minority recruitment is crucial to successful clinical research and associated community-based outreach programs. Reaching and retaining a diverse sample is particularly challenging when research targets not only ethnic or racial minorities but also subcultural groups such as veterans of different war periods. We describe various strategies that address the special challenges of minority recruitment through our experience engaging an ethnically diverse sample of 258 veterans as part of an evaluation of ambulatory care services at Department of Veterans Affairs health care facilities. Most veterans were recruited by liaison with the community center, which accounted for 29% of the total sample. Other strategies included on-site recruitment (21%), word of mouth (21%), mailings to veterans' organizations (12%), and newspaper advertisements (7%). Strategies varied in their effectiveness at reaching specific racial or ethnic groups and veterans from different cohorts of war service.