Survey of pharmacy students to assess attitudes toward a career in older adult care.

INTRODUCTION: In the United States, the older adult population is growing faster than the geriatrics-trained healthcare workforce. The primary objective of this study was to determine the top factors that increase or decrease pharmacy student interest in seeking a career in geriatrics. METHODS: A 23-item survey was disseminated to 611 first- through fourth-year pharmacy students. Participants were recruited from two public schools of pharmacy in the United States from February through September 2022. Surveys were administered during class or distributed via email and websites for required courses. Participation was voluntary, and responses were anonymous. Descriptive statistics, independent-samples t-tests, Fisher's exact test, and analysis of variance were used for analysis. RESULTS: A total of 210 responses were received. Respondents were evenly split between somewhat or extremely interested and somewhat or extremely disinterested in geriatrics. Among those interested, the top factors driving interest were past positive experiences with older adults, interest in deprescribing, and perceived need for geriatrics-trained providers. Among those not interested, the top three factors discouraging interest were emotional impact of death and end-of-life care, disinterest in geriatric syndromes, and perception of inadequate exposure to geriatrics within the curriculum. CONCLUSIONS: In order to ensure an adequately trained geriatrics workforce for the aging population, it is crucial to intensify efforts to encourage health profession students to pursue careers in geriatric care. Creating opportunities to increase interest and addressing factors that discourage interest may augment the pipeline of pharmacy students wishing to seek a career specializing in older adult care.

Pharmacy student attitudes towards a career in older adult care.

INTRODUCTION: The United States (US) health care workforce is significantly unprepared to meet the needs of the growing older adult population. The primary purpose of this study is to examine the reasons that current pharmacy students are interested or not interested in pursuing a career or postgraduate training in geriatrics and to evaluate factors that influence this choice. METHODS: This is a qualitative study utilizing focus groups of pharmacy students from the doctor of pharmacy (PharmD) curriculum of one public school of pharmacy in the US. Student pharmacists were invited to participate in the focus groups, and focused interviews were conducted by two postgraduate year two geriatric residents. Each discussion was audio recorded and subsequently transcribed, extracting key factors through open thematic coding. RESULTS: Focus group participants (n = 8) most commonly identified job security, relationship value add, and past positive experiences with older adults as encouraging factors promoting interest, and inadequate geriatric exposure, emotional impact of death and dying, and heightened professional liability as discouraging factors deterring interest in a career in geriatrics. CONCLUSIONS: Enhancing early exposure to geriatric patients and pharmacists, emphasizing common geriatric considerations in the PharmD curriculum, and increasing specialized older adult and end of life content could encourage more student pharmacists to seek careers in geriatrics.

Differential Regulation of Mouse Hippocampal Gene Expression Sex Differences by Chromosomal Content and Gonadal Sex.

Common neurological disorders, like Alzheimer's disease (AD), multiple sclerosis (MS), and autism, display profound sex differences in prevalence and clinical presentation. However, sex differences in the brain with health and disease are often overlooked in experimental models. Sex effects originate, directly or indirectly, from hormonal or sex chromosomal mechanisms. To delineate the contributions of genetic sex (XX v. XY) versus gonadal sex (ovaries v. testes) to the epigenomic regulation of hippocampal sex differences, we used the Four Core Genotypes (FCG) mouse model which uncouples chromosomal and gonadal sex. Transcriptomic and epigenomic analyses of ~ 12-month-old FCG mouse hippocampus, revealed genomic context-specific regulatory effects of genotypic and gonadal sex on X- and autosome-encoded gene expression and DNA modification patterns. X-chromosomal epigenomic patterns, classically associated with X-inactivation, were established almost entirely by genotypic sex, independent of gonadal sex. Differences in X-chromosome methylation were primarily localized to gene regulatory regions including promoters, CpG islands, CTCF binding sites, and active/poised chromatin, with an inverse relationship between methylation and gene expression. Autosomal gene expression demonstrated regulation by both genotypic and gonadal sex, particularly in immune processes. These data demonstrate an important regulatory role of sex chromosomes, independent of gonadal sex, on sex-biased hippocampal transcriptomic and epigenomic profiles. Future studies will need to further interrogate specific CNS cell types, identify the mechanisms by which sex chromosomes regulate autosomes, and differentiate organizational from activational hormonal effects.

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.

Anticholinergic Cognitive Burden in Older People Over Acute Admission.

OBJECTIVE: To evaluate the change of geriatric anticholinergic cognitive burden (ACB) over acute admission for fall, fracture, or altered mental status (AMS) with a secondary endpoint of associated 30-day all-cause readmission.
DESIGN: Retrospective, single-center chart review.
SETTING: An academic, 636-bed level-I trauma and tertiary care hospital in Texas.
PATIENTS, PARTICIPANTS: Participants at least 65 years of age admitted for acute fall, fracture, or AMS between January 1, 2014, and August 31, 2018. A total of 265 participants were included; average age was 83 years, with 56% female.
MAIN OUTCOME MEASURES: Change in ACB of home medications from hospital admission to discharge.
RESULTS: At admission, ACB averaged 2.6 with 43.4% of participants having clinically significant scores, defined as ACB greater than or equal to 3. Overall, ACB decreased by 0.1 by discharge with 63.8% and 13.9% of participants having no change and increases in their ACB over admission, respectively. Clinically significant anticholinergic burden at discharge was significantly associated with 30-day all-cause readmission (P<0.001).
CONCLUSIONS: Anticholinergic burden in older people admitted for fall, fracture, or AMS is not consistently intervened upon in this acute care setting. Strategies to optimize deprescribing in this setting are needed.

Histologic characteristics and mucin immunohistochemistry of cystic fibrosis sinus mucosa.

OBJECTIVES: To evaluate the histologic characteristics of paranasal sinus mucosa of a disease control population and children with chronic rhinosinusitis and cystic fibrosis (CRS/CF) (1) to determine whether goblet cell (GC) hyperplasia and/or submucosal gland (SMG) hyperplasia occur in pediatric CRS/CF and (2) to compare expression and localization of MUC5AC and MUC5B mucins in the sinus mucosa of both cohorts. DESIGN: Histologic and morphometric analyses of paranasal sinus mucosa were used to quantify the number of GCs and mucin-expressing cells. Digital imaging was used to evaluate the SMG area. Immunohistochemistry was performed to identify the cellular localization of MUC5AC and MUC5B mucins, and confocal microscopy was used to determine whether MUC5AC and MUC5B mucins were expressed in the same secretory cells. SETTING: Children's National Medical Center, Washington, DC. PARTICIPANTS: Twenty-one children with CRS/CF who underwent endoscopic sinus surgical procedures and 18 children who underwent craniofacial resection or neurosurgical procedures for abnormalities other than sinusitis. RESULTS: A statistically significant increased area (4.4-fold) of SMGs was detected in the sinus mucosa of patients with CRS/CF compared with the controls (P = .02). Neither GC hyperplasia nor increased expression of MUC5AC was observed in the CRS/CF group. MUC5AC was expressed only in a subpopulation of GCs in both cohorts, and MUC5B was expressed in a subpopulation of GCs as well as in SMGs. There was a positive trend toward increased glandular MUC5B expression in the CRS/CF cohort. Colocalization of MUC5AC and MUC5B expression was observed in a subset of GCs. CONCLUSIONS: Significant SMG hyperplasia and a trend toward increased glandular MUC5B expression exist in children with CRS/CF. This suggests that SMG hyperplasia and glandular MUC5B mucin contribute to mucus overproduction in the sinus mucosa of this population.