Providing Dementia Consultations to Veterans Using Clinical Video Telehealth: Results from a Clinical Demonstration Project.

PURPOSE: Veterans with dementia and their caregivers in remote areas may not have access to specialists to provide diagnosis, treatment, and education. The purpose of this clinical demonstration project was to examine the feasibility, acceptability, and impact of a video consultations clinic for veterans with dementia or memory complaints and their caregivers. METHODS: The dementia clinical video telehealth (CVT) consultation clinic was established to identify, diagnose, and treat dementia in veterans at sites distant from the main medical center. A geriatrician at the main facility provided video consultation to patients and caregivers at seven satellite facilities. Diagnoses made and services provided were recorded after the initial consultation. Patient and caregiver satisfaction with the CVT clinic were assessed. FINDINGS: Ninety-four patients were evaluated in the CVT dementia clinic (average age = 74.7; average Mini-Mental State Exam = 24.4). Forty patients had a prior dementia diagnosis, 15 received a new dementia diagnosis, and 20 a new mild cognitive impairment diagnosis. Of the remaining patients evaluated for memory complaints, seven were found to have depression, three had hearing loss, and three had traumatic brain injury. After CVT consultation, common referrals included social work (n = 43), neuropsychology (n = 36), and brain imaging (n = 26). Patients and caregivers expressed high satisfaction with the video consultation and 90% of caregivers indicated they would rather use CVT than travel to see the specialist in person. CONCLUSIONS: Video consultation was well accepted by both dementia patients and caregivers. CVT may facilitate timely diagnosis and management and provide support for rural dementia patients and caregivers.

Mental Health for LGBTQIA+ Older Adults.

LGBTQIA+ older adults share a unique set of risk factors that impact mental health. This article provides an overview of the minority stress and allostatic load models and how they can lead to worse physical and mental health outcomes. The article also describes unique epidemiologic and psychosocial context for various aspects of mental health among LGBTQIA+ older adults. Within each section are suggestions for health care providers when addressing these mental health issues and caring for LGBTQIA+ older adults in all settings.

Sexual and gender minority health-related content in geriatric fellowships.

INTRODUCTION: Despite a growing number of older lesbian, gay, bisexual transgender, and queer (LGBTQ) adults in the United States, education on care for this vulnerable population has historically been inadequate across all levels of training. This research assessed the extent of LGBTQ education in geriatric medicine fellowship curricula across the United States. METHODS: We designed a survey to anonymously collect information from geriatric medicine fellowship programs on LGBTQ curricular content. Eligible participants included all 160 fellowship directors on record with the American Geriatrics Society. The survey addressed demographics of the fellowship program, current state of inclusion of LGBTQ content in didactic curricula and in clinical settings, and other available training opportunities. RESULTS: Out of those contacted, 80 (50%) completed the survey. Of the programs surveyed, 60 (75%) were housed in internal medicine, 19 (24%) were in family medicine, and one was in their own department. Forty-seven fellowships (59%) reported some formal didactic session (e.g., lecture or case based), with the majority of these programs (72%) featuring 1-2 h of formal instruction. Forty-five programs (56%) reported offering no formal clinical experiences. There was less than 50% coverage for all surveyed topics in the required curriculum (range 46% for discrimination to 9% for gender affirming care). Time and lack of expertise were cited as the main barriers to content inclusion. CONCLUSIONS: Curricular content regarding care for LGBTQ older adults is inadequate in geriatric medicine fellowships. Faculty development of current educators and providing standardized guidelines and curricula are steps toward addressing this deficit.

The Fallacy of Teaching and the Illusion of Learning: Improving Articulation of Basic Science in the Medical School Curriculum.

Despite calls from educators to re-engineer how faculty deliver medical student curricula with integrated basic science concepts, this content is still frequently disarticulated from other curricular components. We renewed our curriculum using evidence-based pedagogical and cognitive learning strategies to interleave basic science across the 4-year curriculum.

Computer-based animations and static graphics as medical student aids in learning home safety assessment: a randomized controlled trial.

BACKGROUND: Although animations may intuitively seem more effective than static graphics for teaching, there is no clear-cut evidence for the superiority of simple computer-based animations in medical education. AIMS: We investigated whether simple animations are better than static graphics as an aid to medical students in learning home safety assessment, an important part of geriatric curriculum. METHODS: We used two versions of an interactive online module, one that depicted common home safety issues in static graphics and the other in animations. We randomized first-year medical students who agreed to participate into two groups. After the module, students completed a cognitive burden scale and a standardized competency assessment test in which they had to identify the salient home safety issues and give recommendations based on the hazards. We also captured time spent on task. RESULTS AND CONCLUSIONS: We found no significant differences between the groups in the cognitive burden level, competency assessment scores, and time spent on task. The much cheaper-to-produce static graphics were equally effective as simple animations in this medical education scenario.

A competency-based medical student curriculum: taking the medication history in older adults.

Older adults are the largest consumers of prescription medications. Taking multiple medications, which interact with medical, psychological, and socioeconomic factors, increases a person's risk of nonadherence and adverse events. A curriculum was developed to train medical students to identify these risks and make recommendations for improving medication safety. The curriculum, consisting of a self-study computer tutorial, a small-group simulated-patient (SP) experience, and an online competency assessment, was implemented in the students' second year of training. Groups (N = 28) of five to seven students interviewed the SP and were assessed on their ability to identify medication concerns (N = 18) and make recommendations (N = 18) on improving medication safety. On average, student groups identified 16.1 concerns and made 15.4 recommendations. On the competency assessment several months later, students were given a case scenario and again asked to identify concerns (N = 7) and make recommendations (N = 7). Students (N = 176) were required to achieve a preset performance standard on the assessment. A high percentage (97.2%) of students achieved the standard (a score of 8/14) on their first attempt; the remainder achieved the standard on their second attempt. Student evaluations indicated high levels of satisfaction with the curriculum. The learning objectives, competency assessment, and instructional activities were closely aligned. Instructional activities provided students with an opportunity to practice the competency in a nonthreatening environment. The SP session materials are available through MedEdPORTAL and can readily be incorporated by other institutions into existing curricula.

A fourth-year medical school clerkship that addressed negative attitudes toward geriatric medicine.

Despite extensive educational efforts, many medical students still have negative attitudes toward the field of geriatric medicine and the care of older adult patients. This article describes a fourth-year geriatric clerkship that addressed this issue by providing opportunities for students to actively discuss many of the negative stereotypes that exist regarding geriatric medicine. Emphasis was also placed on personalizing the course content to show the relevance of geriatric medicine to all medical students. During the 2008/09 academic year, 150 students completed the rotation. Although no students expressed an interest in pursuing a career as a geriatrician, they expressed a highly favorable evaluation of this personalized geriatric clerkship and voted this clerkship "the most outstanding clinical course" at the medical school.

A competency-based medical student curriculum targeting key geriatric syndromes.

The University of Miami Miller School of Medicine (UMMSM) has developed and implemented a competency-based undergraduate medical education (UME) curriculum that targets 61 learning objectives for three geriatric syndromes: dementia, falls, and delirium. This curriculum redesign changed the educational focus from what is taught to what is learned. Students complete 13 different competency assessments throughout their four years of training and are required to meet specific performance standards. Documentation of competency is now provided for 600 students annually. This paper describes the design, development, implementation, and evaluation of this curriculum, reviews our data-driven curriculum quality improvement efforts, and discusses the challenges to translating student competency into routine practice.

An interactive e-learning tutorial for medical students on how to conduct the performance-oriented mobility assessment.

We evaluated the effectiveness of an e-learning tutorial (iPOMA) as a supplement to traditional teaching of the Performance-Oriented Mobility Assessment. Second-year medical students (137) completed the iPOMA, in preparation for a session on fall risk assessment consisting of a lecture, practice with elder volunteers and small group debriefing. Before and after the tutorial, students completed online questionnaires, a quiz on POMA scoring immediately after the tutorial and competency assessments on POMA performance 1 month later. Self-efficacy in using the POMA increased and post-tutorial quiz scores were significantly correlated with self-efficacy. Students who completed the tutorial performed significantly better on the verbal instructions portion of the POMA. The iPOMA is an effective instructional modality.

The educational impact of a computer-based training tutorial on dementia in long term care for licensed practice nursing students.

The purpose of this study was to examine whether training with a multimedia tutorial would have an impact on LPN students' knowledge of dementia care, attitudes toward dementia care, and self-efficacy ratings. A total of 38 nursing students participated. Pre-post comparisons of outcome measures revealed significant improvements in knowledge, attitudes, and self-efficacy ratings. Results of post-training satisfaction and usability questionnaires indicate that participants found the tutorials easy to understand and easy to use. These data support the effectiveness of the dementia tutorial and the use of computer-based training in educating our long-term care workforce.

HUMANS: An English and Spanish neuropsychological test battery for assessing HIV-1-infected individuals--initial report.

A neuropsychological battery for testing HIV-1-infected individuals in Spanish was developed. We refer to this battery as the HIV/University of Miami Annotated Neuropsychological test battery in Spanish (HUMANS). The HUMANS battery includes recommendations of the National Institute of Mental Health Neuropsychology Workgroup on HIV-1 infection and measures processes in the following 7 cognitive domains: attention, verbal and visual memory, information processing speed, abstraction and executive functioning, language, visuospatial and visuoconstructive, and motor. Administration requires approximately 3 to 4 hr. The English version of the battery is sensitive to HIV-1 serostatus and Centers for Disease Control clinical disease stage. We report on the test selection, translation, and adaptation of this parallel English battery into Spanish using methods to eliminate linguistically and culturally biased items in some tests. The importance of standardized neuropsychological instruments equivalent in different languages to test HIV-1-positive individuals for impairment is emphasized. Validation and reliability studies are in progress.

Cognitive functioning in younger and older HIV-1-infected adults.

In young adults, a major neurologic complication of HIV-1 infection is cognitive motor impairment. Epidemiologic findings suggest that increasing age is a significant risk factor for HIV-1-associated dementia as the AIDS-defining illness. Findings from the few studies that have directly measured cognition in younger and older HIV-1-infected adults, however, have been mixed, in part, because of small sample sizes and other methodologic differences between studies. The authors present preliminary findings on cognitive functioning in symptomatic HIV-1-infected younger (aged 20-39 years) and older (aged 50 years or older) adults. Independent of age, HIV-1 infection was accompanied by learning and memory retrieval deficits, which were significantly associated with high plasma viral loads in the young adults. Relative to the younger and older HIV-1-negative (HIV-1-) groups, only the younger HIV-1-positive (HIV-1+) group had significantly longer reaction times (RTs). Within the older HIV-1+ group, however, longer simple and choice RTs were significantly correlated with higher viral loads and lower CD4 cell counts. Although HIV-1 infection affects cognition independent of age, longitudinal studies involving large numbers of older individuals are needed to determine whether there are age differences in the prevalence, nature, and severity of HIV-1-associated cognitive dysfunction.