Growth and impact of Project ECHO for workforce development in age-friendly care.

BACKGROUND: Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration-funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age-friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP. METHODS: A survey of GWEPs was conducted to measure the reach, foci, evaluation methods, and other characteristics of ECHO networks. RESULTS: All 48 (100%) GWEPs responded to the survey, and 30 (63%) reported using ECHO. GWEP ECHOs have both rural and urban-underserved reach across the United States, and their hub teams include many health professions. Age-friendly care is incorporated through multiple methods and is taught across foci including primary care, dementia, long term care, and novel topics. GWEP ECHOs have many academic and community partners including Area Agencies on Aging, and reach varied health professions, trainees, and caregivers. Geriatrics ECHOs collect outcomes across the evidence continuum including the community-level outcome of Age-Friendly Health System designation. CONCLUSIONS: The ECHO model has been widely adopted by GWEPs as a key approach for workforce training in age-friendly care. Project ECHO is a valuable tool to expand interprofessional training for the geriatrics workforce, particularly for interprofessional teams in rural and underserved areas.

Special Focus Facilities vs Special Focus Facility Candidates: What is the Difference?

OBJECTIVES: This study compares Special Focus Facilities (SFFs) and Special Focus Facility Candidate Facilities (SFFcs) on organizational traits and quality outcomes to evaluate the effectiveness of the SFF program as a quality improvement intervention and inform potential areas for program reform. DESIGN: This is a retrospective analysis. SETTINGS AND PARTICIPANTS: Using data from the Centers for Medicare and Medicaid Services archives for 2020, this retrospective study analyzed 247 nursing facilities (50 SFFs and 197 SFFcs). METHODS: Variables of interest were staffing, profit status, facility size, certification status, number of residents, and complaint citations: t tests, χ2, Fisher's Exact test, and multivariate analysis of variance were used to compare the 2 groups. RESULTS: From an organizational perspective, SFFs and SFFcs are minimally different. Both groups had similar facility size, profit status, hospital affiliation, continuing care retirement community status, and Medicare/Medicaid certification. Large and for-profit facilities were overrepresented in both groups. SFFs and SFFcs exhibited statistical differences in the number of complaint deficiencies. The groups had no significant difference in staffing levels, category, severity of complaints, or incident reports. CONCLUSIONS AND IMPLICATION: The study's findings suggest that the SFF program, while resource-intensive, is minimally impactful. The similarities between SFFs and SFFcs raise questions about the program's effectiveness in improving nursing facility care. Previous adjustments to the program may not have successfully achieved the desired quality improvements. This research highlights the need to further evaluate the SFF program's effectiveness as a quality improvement intervention. It also underscores the importance of addressing biases and subjectivity in state survey agency processes, which affect the enrollment of nursing facilities. The study underscores the flaws within the nursing home monitoring system and the 5-star quality rating system, especially when comparing small samples between states.

Cultivating Relationships as a Community-Based Recruitment Strategy in Transdisciplinary Aging Research: Lessons From an Academic-Community Partnership.

Participation of Black American older adults in community-engaged research remains challenging in health sciences. The objectives of this study were to describe the specific efforts, successes, and challenges in recruiting Black American older adults in research led by the Health and Wellness in Aging Across the Lifespan core, part of the Virginia Commonwealth University Institute for Inclusion, Inquiry, and Innovation (iCubed). We conducted a cross-case analysis of 6 community-engaged research projects using the community-engaged research continuum model. Successful recruitment strategies comprised a multifaceted approach to community-based collaboration, including a wellness program with a long standing relationship with the community, engaging key stakeholders and a community advisory board, and building a community-based coalition of stakeholders. Posting flyers and modest monetary compensation remain standard recruitment strategies. The cross-case analysis offered critical lessons on the community's nature and level of engagement in research. Relationship building based on trust and respect is essential to solving complex aging issues in the community.

Beyond knowledge and confidence: a mixed methods evaluation of a Project ECHO course on dementia for primary care.

Primary care clinicians have an important role in the management of dementia and have expressed interest in continuing education. The authors describe a model they used for providing dementia education in primary care, Project ECHO (Extension for Community Healthcare Outcomes), and an overview of its major features. A partnership including academic institutions and a national healthcare association is then outlined, including the unique features of the ECHO model developed through this partnership. A mixed-methods methodology was used for programmatic evaluation. This use of mixed methods adds vital new knowledge and learner perspectives that are key to planning subsequent ECHO courses related to dementia and primary care. The discussion includes an exploration of the significance of these findings for understanding the motivations of primary care providers for participation in the educational program, as well as the limitations of the current study. A final section explores the next steps in the continued development of the model and its implications for geriatrics education in dementia care, especially the supportive role that ECHO courses can play in meeting the challenges of dementia care.

An interprofessional geriatrics faculty development program: exploration of the barriers and facilitators of capstone projects.

Faculty development programs (FDPs) are an effective, evidence-based method of promoting knowledge, skills and self-efficacy of faculty. However, implementation and sustainability of curricular capstone projects developed by faculty as part of these programs are rarely reported. Challenges to sustaining programmatic implementation of interprofessional FDP curricular content into academic and clinical settings over time were not found in peer-reviewed literature. To better understand the sustained impact of our geriatrics-focused FDP, we explored barriers and facilitators to implementation and sustainability of capstone projects designed by faculty Scholars in our FDP. Thematic analysis of virtual interviews with 17 Scholars revealed several key factors that impacted the implementation and Dynamic sustainability of curricular projects. Three major themes and sub-themes were identified: Project Implementation (Supportive Factors, Hindering Factors and Filling in Gaps in the Field); Pedagogical Development (Enhancement of Skills and Culture Change); and Sustainability Impact (Project Sustainability, Career Development and Passing the Torch). Results suggest it is important to ensure logistical support, dedicated time, and organizational or institutional support. Implementation of geriatrics-focused FDPs provides an evidence-based approach to sustainability. Further study of the ongoing barriers and facilitators to sustainability is encouraged.

"I like being young, active, alive": first-year medical students' attitudes to their own aging.

BACKGROUND AND OBJECTIVES: Senior Mentoring programs have been developed to expose students to older adults, increase knowledge of geriatrics, and prepare them to provide patient-centered care. However, even while participating in a senior mentoring program, health professions students demonstrate discriminatory language toward older adults and the aging process. In fact, research suggests ageist practices occur, intentionally or not, among all health professionals and within all healthcare settings. Senior mentoring programs have primarily focused on improving attitudes about older people. The current study evaluated a different approach to anti-ageism by examining medical students' perceptions of their own aging. RESEARCH DESIGN AND METHODS: This qualitative, descriptive study explored medical students' beliefs about their own aging at the beginning of their medical education using an open-ended prompt immediately before beginning a Senior Mentoring program. RESULTS: Thematic analysis identified six themes: Biological, Psychological, Social, Spiritual, Neutrality and Ageism. Responses suggest that students enter medical school with a complex view of aging that goes beyond biological considerations. DISCUSSION AND IMPLICATIONS: Understanding that students enter medical school with a multi-faceted view of aging provides an opportunity for future work to explore senior mentoring programs as a way to tap into this complex view of aging by changing the way students think not just about older patients but about aging more broadly, and specifically about themselves as aging individuals.

Creating structural community cohesion: Addressing racial equity in older adult homelessness.

Older adults and racial minorities are overrepresented in homeless populations. Shelter and housing options for homeless older adults who have complex health and social needs are necessary, but not readily available. Older homeless adults that require, but do not receive, health-sensitive, age-sensitive, and racial equity housing, remain vulnerable to poor outcomes and premature mortality. Accordingly, this study examines the development of a coalition to better address older adult homelessness within a racial equity framework. A community coalition was established to better address older adult homelessness within the lens of age-sensitivity and racial equity, due to a disconnect between healthcare and senior housing placement programs, creating unaddressed multifaceted health issues/complications. The community coalition development is described, including the coalition process, activities, and outcomes. Local rehoused older adults are also interviewed and described to better understand their central life circumstances.

Creating Interprofessional Readiness to Advance Age-Friendly U.S. Healthcare.

A successful interprofessional faculty development program was transformed into a more clinically focused professional development opportunity for both faculty and clinicians. Discipline-specific geriatric competencies and the Interprofessional Education Collaborative (IPEC) competencies were aligned to the 4Ms framework. The goal of the resulting program, Creating Interprofessional Readiness for Complex and Aging Adults (CIRCAA), was to advance an age-friendly practice using evidence-based strategies to support wellness and improve health outcomes while also addressing the social determinants of health (SDOH). An interprofessional team employed a multidimensional approach to create age-friendly, person-centered practitioners. In this mixed methods study, questionnaires were disseminated and focus groups were conducted with two cohorts of CIRCAA scholars to determine their ability to incorporate learned evidence-based strategies into their own practice environments. Themes and patterns were identified among transcribed interview recordings. Multiple coders were used to identify themes and patterns and inter-coder reliability was assessed. The findings indicate that participants successfully incorporated age-friendly principles and best practices into their own work environments and escaped the silos of their disciplines through the implementation of their capstone projects. Quantitative data supported qualitative themes and revealed gains in knowledge of critical components of age-friendly healthcare and perceptions of interprofessional collaborative care. These results are discussed within a new conceptual framework for studying the multidimensional complexity of what it means to be age-friendly. Our findings suggest that programs such as CIRCAA have the potential to improve older adults' health by addressing SDOH, advancing age-friendly and patient-centered care, and promoting an interprofessional model of evidence-based practice.

"It's just a constant concern in the back of my mind": Lived experiences of college food insecurity.

Objective: Food insecurity is a growing concern to the health and wellbeing of college students. This study aims to examine the lived experiences of students at-risk of food insecurity and associated challenges in a public urban campus. Participants: The study recruited 21 college students at risk of food insecurity using purposive sampling. Methods: We performed qualitative interviews with three focus groups and conducted a thematic analysis to explore themes that emerged from participant discussions. Results: Three central themes emerged from our qualitative analysis: (a) barriers to accessing stable and healthy food; (b) impacts of food insecurity on academic performance and physical and mental health; and (c) coping strategies for navigating food insecurity. Conclusions: The study highlights the distinct natures of food hardship and responses specific to urban public college students. Suggestions for academics and college administrators to mitigate college food insecurity are discussed.

COVID in Context: The Lived Experience of Richmond's Low-Income Older Adults.

Taking a phenomenological approach, this qualitative study describes the lived experiences of low-income older adults during the COVID-19 pandemic. A socio-ecological model was used to organize the five identified themes describing the lived experience: socio-economic context, Black Lives Matter and the politics of race, COVID and polarized views of COVID, interpersonal context (social connections), and individual context (feelings, beliefs, and behaviors). Study findings illustrate the intersectionality of contextual influences on the experience of low-income older adults. Study participants demonstrated remarkable resilience and coping strategies developed in response to the challenges they experienced throughout their lifetime which benefited them when faced with the pandemic, social unrest, and political events that took place in 2020. This study highlights the importance of understanding the larger context of COVID-19 which has significant implications for policy makers and public health leaders.

Socioeconomic Effects on Psychosocial Factors Among Low-Income Older Adults.

OBJECTIVES: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to determine the socioeconomic effects on psychosocial factors among low-income independent-living older adults, in an urban setting, during the COVID-pandemic. METHODS: Participants were recruited through Virginia Commonwealth University's Richmond Health and Wellness Program. Telephone surveys (n=100) were conducted using the Epidemic - Pandemic Impacts Inventory Geriatric with the Racial/Ethnic Discrimination addendum. Responses were analyzed for income and education effects across seven domains: home life, social activities/isolation, economic, emotional health-wellbeing, physical health, COVID-infection history, and positive change behaviors/experiences. RESULTS: The sample population was between 51 and 87 years of age, 88% were Black, 57% reported incomes of $10,000/year or less, and 60% reported a high-school education or less. There were income effects for social activities/isolation (f = 3.69, p<.05) and positive change (f = 8.40, p<.01), and education effects for COVID History (f = 4.20, p <.04). DISCUSSION: Overall results highlight the social patterns for a diverse sample of low-income urban older adults; education and income are identified as risk factors for social losses, COVID-infection experiences, racial/ethnic discrimination during the COVID-pandemic, and positive change behaviors.

Bringing Transdisciplinary Aging Research From Theory to Practice.

There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science is unclear. In this forum, we illustrate our team's experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, interprofessional blind spots, group function, and group dynamics. This work resulted in the creation of the team's Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes is integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team science initiatives on aging communities.

Geriatric Opioid Harm Reduction: Interprofessional Student Learning Outcomes.

Objective: Opioid harm reduction is increasingly important in the care of the older adults, who are at higher risk for negative opioid-related outcomes due to high prevalence of pain, multimorbidity, polypharmacy, and age-changes in metabolism. Our project aims to develop, implement, and evaluate an interprofessional opioid harm reduction service training. Method: This evaluation occurs in context of the Richmond Health and Wellness Program (RHWP), a community-based interprofessional wellness care coordination equity initiative, within buildings designated for low-income and disabled older adults. The geriatric opioid harm reduction training was delivered online and inperson, and followed up with case-discussions and practice. Findings: Pre (n = 69)/post (n = 62) student assessments indicated that after the training, there was an increase in knowledge. At follow-up, 60% recognized tramadol as an opioid, 50% at baseline. About 97% correctly indicated that MME represents morphine milligram equivalent, 80% at baseline. About 93% indicated that 50 MME level greatly increases opioid overdose risk, 62% at baseline. Only 20%, change from 60% at baseline, reported not being able to calculate MME at post assessment. Conclusion: Findings indicate that geriatric opioid harm reduction training within community-based wellness care coordination is feasible. Future works need to explore the impact on student practice in clinical settings and resident health.

Physical and Occupational Therapy Practice Improvement Following Interprofessional Evidence-Based Falls Prevention Training.

AIMS: Evaluate changes in physical therapy (PT) and occupational therapy (OT) practice following evidence-based practice (EBP) interprofessional modules that teach assessments and interventions to reduce falls in community-dwelling older adults. METHODS: Medical records of post-fall patients in three Programs of All-Inclusive Care for the Elderly (PACE) sites were analyzed to assess differences in documented falls and the OT and PT use of EBP assessment and interventions implemented following fall prevention training. RESULTS: In training year 1, PT demonstrated a 34.6% practice improvement in risk assessments performed (z=3.0, p<0.005). In training year 2, PT demonstrated a 66.7% practice change in the implementation of EBP interventions (z=2.1, p<0.05) and OT demonstrated a 22.2% practice improvement in the implementation of recommended EBP interventions (z=2.0, p<0.05). In training year 3, OT achieved a 6.8% increase in the execution of home environment modifications (z=2.0, p<0.05), and PT demonstrated a 23.3% practice improvement in the implementation of recommended EBP interventions (z=3.1, p<0.005). CONCLUSION: The delivery of EBP assessment and intervention training modules for falls prevention resulted in PT and OT practice changes and improved adherence to published guidelines.