Geriatric Oncology: A 5-Year Strategic Plan.

The increasing rate of the older adult population across the world over the next 20 years along with significant developments in the treatment of oncology will require a more granular understanding of the older adult population with cancer. The ASCO Geriatric Oncology Community of Practice (COP) herein provides an outline for the field along three fundamental pillars: education, research, and implementation, inspired by ASCO's 5-Year Strategic Plan. Fundamental to improving the understanding of geriatric oncology is research that intentionally includes older adults with clinically meaningful data supported by grants across all career stages. The increased knowledge base that is developed should be conveyed among health care providers through core competencies for trainees and continuing education for practicing oncologists. ASCO's infrastructure can serve as a resource for fellowship programs interested in acquiring geriatric oncology content and provide recommendations on developing training pathways for fellows interested in pursuing formalized training in geriatrics. Incorporating geriatric oncology into everyday practice is challenging as each clinical setting has unique operational workflows with barriers that limit implementation of valuable geriatric tools such as Geriatric Assessment. Partnerships among experts in quality improvement from the ASCO Geriatric Oncology COP, the Cancer and Aging Research Group, and ASCO's Quality Training Program can provide one such venue for implementation of geriatric oncology through a structured support mechanism. The field of geriatric oncology must continue to find innovative strategies using existing resources and partnerships to address the pressing needs of the older adult population with cancer to improve patient outcomes.

[Response to the urgent need to train family doctors in geriatrics : residency in long term care facilities]. / Réponse à l'urgence de former les médecins de famille à la gériatrie : l'assistanat en EMS.

Family doctors have to provide the geriatric cares needed by an aging population. In particular, the increased complexity of care needs in the population living in long term care facilities (LCTF) raises several challenges. One of these challenges is the adequate training of physicians working in LCTF as well as the next generation. Residency programs in LTCFs for future general practioners has demonstrated their value abroad. We describe here the creation of a residency program in LTCF for family doctors in Canton Vaud. Since its beginning in 2020, the program has not only trained young physicians but has also improved interprofessionality and strengthened the training of other healthcare professionals.

La population vieillissante requiert des soins gériatriques spécifiques auxquels le médecin de famille doit répondre. De plus, la complexification des besoins en soins de la population en établissement médicosocial (EMS) soulève de multiples défis. Un de ces défis est la formation adéquate des médecins travaillant en EMS et leur relève. A l'étranger, l'expérience de tournus des médecins de famille dans des structures similaires aux EMS a démontré sa pertinence. Nous illustrons ici le contexte et la mise en place d'une formation postgraduée en EMS pour les médecins de famille sur le canton de Vaud et présentons un aperçu des bénéfices de ce programme depuis sa mise en place en 2020 : au-delà de la formation de jeunes médecins, l'assistanat en EMS améliore la collaboration interprofessionnelle et contribue à la formation d'autres professionnels de la santé.

New horizons in undergraduate geriatric medicine education.

Current projections show that between 2000 and 2050, increasing proportions of older individuals will be cared for by a smaller number of healthcare workers, which will exacerbate the existing challenges faced by those who support this patient demographic. This review of a collection of Age and Ageing papers on the topic in the past 10 years explores (1) what best practice geriatrics education is and (2) how careers in geriatrics could be made more appealing to improve recruitment and retention. Based on these deeper understandings, we consider, as clinician educators, how to close the gap both pragmatically and theoretically. We point out paradigm shifting solutions that include innovations at the Undergraduate level, use of simulation, incorporation of learner and patient perspectives, upskilling professionals outside of Geriatrics and integration of practice across disciplines through Interprofessional Learning. We also identify an education research methodological gap. Specifically, there is an abundance of simple descriptive or justification studies but few clarification education studies; the latter are essential to develop fresh insights into how Undergraduate students can learn more effectively to meet the needs of the global ageing challenge. A case of improving understanding in delirium education is presented as an illustrative example of a new approach to exploring at greater depth education and outlines suggested directions for the future.

Case mapping of geriatrics: Looking beyond age in skills laboratories.

BACKGROUND AND PURPOSE: Development of competencies related to care of older adults is necessary in pharmacy education. Skills laboratories as an essential part of the curriculum represent an important setting to teach geriatrics. The purpose of this research was to describe geriatrics cases in skills/simulation activities of an undergraduate pharmacy program. EDUCATIONAL ACTIVITY AND SETTING: A retrospective review of one academic year of skills laboratories from the pharmacy program at the Faculty of Pharmacy of University of Montreal was performed. Sessions including cases aged ≥65 years were selected. Content was extracted for characteristics relating to the patient, health, medications, and care context. A framework including geriatric considerations such as geriatric syndromes, frailty status, and potentially inappropriate medications was developed for data collection. FINDINGS: In total, 210 patient cases were extracted. Older adults (≥ 65 years) were represented in 51 cases (24%), with 8 cases (4%) aged ≥80 years. Geriatric syndromes were documented in 8%, functional status in 10%, and mobility in 12% of the cases. The median number of comorbidities and medications were 4 and 7, respectively. Regarding polypharmacy, only 10 cases had >10 medications, and none had >15 medications. Potentially inappropriate medications were found in 47% (n = 24) of the cases but were addressed in only 14% (n = 7) cases. SUMMARY: This mapping of skills laboratories highlights gaps in geriatrics content. Inclusion of the oldest patients and geriatrics issues were incorporated in a minority of cases and lacked many characteristics essential for geriatrics care.

The value proposition for geriatrics.

In response to some of the challenges that have been articlulated about the future of Geriatrics, we describe a more positive view and value proposition for the field. Health professionals with specific training in Geriatrics are a natural fit for a variety of roles in value-based care (VBC) programs and health systems. These roles include serving as educators for primary care health professionals and specialists in person-centered care of older adults, serving as consultants on geriatric conditions and syndromes in a co-management model of care, becoming effective leaders in VBC programs and health systems, and conducting quality improvement initiatives to build on the evidence-base for the management of common conditions in the older population. We further recommend that VBC programs and systems support Centers of Excellence or Institutes to implement these strategies within and Age-Friendly, learning system approach.

Using Assisted Living Communities to Enhance Nursing Student Attitudes Toward Older Adults.

PURPOSE: The older adult population continues to increase, resulting in greater use of health care resources. Nurses will be at the forefront of providing competent care to this population, but many nurses do not wish to work with the aged population after graduation. The current study sought to explore whether the addition of a clinical shift at an assisted living community promoted positive attitudes by nursing students toward older adults and exposed them to healthy aging. METHODS: Students (N = 70) in a required undergraduate course at a large university in the West received clinical experience at local assisted living communities in which they independently interviewed a resident and provided an educational session to residents. RESULTS: Students, communities, and clinical instructors had a positive experience in this clinical, finding it rewarding and meaningful and a mechanism for observing healthy aging. CONCLUSION: The incorporation of a clinical experience at an assisted living facility into a stand-alone gerontology course created a positive shift in nursing student attitudes toward older adults, dispelled myths and stereotypes, and was reported to be a meaningful experience. [Journal of Gerontological Nursing, 50(2), 11-15.].

Incentivizing Students to Learn More About Gerontological Practice.

Enticing students to expand their knowledge of aging-related issues and careers can be fraught with challenges. Intrinsic and curricula-related factors associated with pursuit of aging-related careers have been identified, but little evidence exists demonstrating the effectiveness of external factors at motivating students to learn more about gerontological practice. This brief report presents findings from a survey of 214 students enrolled in at a single university in the mid-west to assess how likely they would be motivated to learn more about aging by twelve possible incentives with additional opportunities to write in other thoughts. Credit toward required field work, financial incentives such as stipends, scholarships, tuition waivers, and raffles were the most frequently mentioned incentives. Some variation was noted based on race/ethnicity, age, and program of study. Themes emerging from other suggestions provided by students included curricula enhancements, employment incentives, and the suggestion that nothing could entice some students. Findings can be used by scholars in program development and funding requests.

Geriatric Interprofessional Team Transformation for Primary Care overview.

BACKGROUND: The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. METHODS: Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. RESULTS: Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. CONCLUSIONS: The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.

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.

Training of Doctors at the Geriatric Centre, University College Hospital, Ibadan, Nigeria.

BACKGROUND: The population of older people is increasing exponentially and geriatric care is just evolving in Nigeria. There is a shortage of training opportunities for doctors in Nigeria to care for older people. METHODS: This was an account of the conceptualisation, structure, and outcomes of the annual two-week basic certificate course in geriatric medicine for doctors at the University College Hospital (UCH), Ibadan, Nigeria, between 2016 and 2022. RESULTS: In all, 204 doctors were trained. Their mean age was 40.1 ± 8.5 years, and 105 (51.5%) were females. Majority (80%) worked in public hospitals, especially in the tertiary health sector (62.2%). Annual participation increased from 26 participants in 2016 to 39 participants in 2022. Knowledge acquisition was the main reason for attending the course (56.7%). There were 42 didactic lectures and ten clinical/practical sessions. On average, participants' self-rating in caring for older persons improved significantly after (80.2 ± 12.7%) than before (49.9 ± 16.4%) the course [mean difference = 30.24%, 95%CI (25.91-34.57), p<0.0001]. Similarly, the overall post-course test score in the 20 MCQs (14.08 ± 2.89) was significantly higher than the pre-course test (12.51 ± 2.01) scores [Mean difference = 1.57, 95%CI (0.45-2.69), p = 0.007]. Some participants (37.8%) had commenced special clinics for older persons in 39 institutions across Nigeria. CONCLUSION: Our training programme has yielded a modest increase in the capacity building of doctors for the care of older Nigerians. However, more concerted efforts are needed to train more doctors throughout Nigeria.

CONTEXTE: La population des personnes âgées augmente de façon exponentielle et les soins gériatriques sont en pleine évolution au Nigeria. Les médecins nigérians manquent de possibilités de formation pour s'occuper des personnes âgées. MÉTHODES: Il s'agit d'un compte rendu de la conceptualisation, de la structure et des résultats du cours annuel de certificat de base de deux semaines en médecine gériatrique pour les médecins à l'University College Hospital (UCH), Ibadan, Nigéria, entre 2016 et 2022. RÉSULTATS: Au total, 204 médecins ont été formés. Leur âge moyen était de 40,1±8,5 ans et 105 (51,5%) étaient des femmes. La majorité (80%) travaillait dans des hôpitaux publics, en particulier dans le secteur tertiaire de la santé (62,2%). La participation annuelle a augmenté de 26 participants en 2016 à 39 participants en 2022. L'acquisition de connaissances était la principale raison de participer au cours (56,7 %). Il y a eu 42 conférences didactiques et dix sessions cliniques/pratiques. En moyenne, l'auto-évaluation des participants en matière de soins aux personnes âgées s'est améliorée de manière significative après (80,2±12,7%) qu'avant (49,9±16,4%) le cours [différence moyenne=30,24%, 95%CI (25,91-34,57), p<0,0001]. De même, le score global au test post-cours dans les 20 QCM (14,08±2,89) était significativement plus élevé que le score au test pré-cours (12,51±2,01) [différence moyenne=1,57, 95%CI (0,45- 2,69), p=0,007]. Certains participants (37,8%) ont commencé à travailler dans des cliniques spéciales pour les personnes âgées dans 39 institutions à travers le Nigeria. CONCLUSION: Notre programme de formation a permis une augmentation modeste de la capacité des médecins à soigner les Nigérians âgés. Cependant, des efforts plus concertés sont nécessaires pour former davantage de médecins dans tout le Nigeria. Mots-clés: Main-d'œuvre, Formation, Médecins, Gériatrie, Nigeria.

The Paradoxical Decline of Geriatric Medicine as a Profession.

In this Viewpoint, author Jerry Gurwitz discusses the attrition of geriatric medicine as a profession, attributing it in part to societal attitudes about aging and compounded by the negative effects of lower compensation and lack of career prestige.

Geriatrics Fellows Learning Online And Together (Geri-a-FLOAT): A sustainable model of learning and support.

BACKGROUND: Geriatrics Fellows Learning Online And Together (Geri-a-FLOAT) is a virtual curriculum designed to convene fellows nationwide for learning and peer support. This paper presents the expansion and evaluation of the program from the "Wave 1" pilot to the "Wave 2" year-long curriculum. METHODS: Kern's six-step approach to curriculum development was used to develop the Wave 2 curriculum. Participation was collected via Zoom. Post-session web-based surveys evaluated participant satisfaction regarding speaker, content, and overall session quality; intent-to-change; and a free-response section. A one-year follow-up survey sent to participants with valid e-mail addresses assessed sustained knowledge, skills, and behavior change. RESULTS: Nineteen sessions were held with mean (SD) of 23 (13) participants per session, totaling 182 unique participants. Fifteen of 19 sessions were evaluated with 96 evaluations completed (mean [SD] 6 [4] evaluations per session). Mean (SD) ratings per session that were excellent or above average was 100% (0) for content, 99% (4) for speaker, and 99% (4) overall. Mean (SD) evaluations per session noting intent to change was 90% (14). Respondents reported helpful aspects as sharing resources and examples, perspectives and experiences of others, professional connections, and collaborative discussion. Of 127 participants with valid e-mail addresses, 40 (response rate = 31%) completed the one-year follow-up survey. Mean (SD) respondents reporting some or significant sustained impact was 89% (7) across all learning outcomes. CONCLUSIONS: This virtual, national curriculum for geriatrics fellows was well-received and associated with high rates of self-reported, sustained impact one-year post curriculum. Geri-a-FLOAT may be a model to standardize education and build collaboration and peer support across a discipline.