Sue Nyberg, MHS, PA- C, DFAAPA Wichita State University Gina Berg, PhD Univ. of Kansas School of Medicine Ashley Hervey, MEd Univ.

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1 Sue Nyberg, MHS, PA- C, DFAAPA Wichita State University Gina Berg, PhD Univ. of Kansas School of Medicine Ashley Hervey, MEd Univ. of Kansas School of Medicine

2 Increasing population of older adults by % of population > age 65 adults > 85 fastest growing age group older adults consume > 50% of health care resources avg 4 5 chronic conditions avg 5 medications on a daily basis greater number of outpatient visits hospitalized 2 x s more, inpatient stays are twice as long

3 Geriatric population is underserved In the US geriatrics established as a medical specialty only since 1970 s prior to 1978 no trained geriatricians and no geriatrics faculty no recognition by American Board of Internal Medicine as a specialty Considerable curriculum growth in past 3 decades medical schools and PA schools John A. Hartford Foundation

4 Shortage of providers interested in care for older adults geriatric specialty stereotyped as lower status typically lower salary 2010 AAPA Annual Census prior surveys indicate majority of PAs report seeing pts > age 65 only < 3% of PAs report geriatrics as a specialty (2010)

5 Woolsey LJ. Geriatric medicine and the future of the physician assistant profession. Perspective on Physician Assistant Education 2005;16(1): PA profession created to serve the underserved and provide primary care PAs effectively provide many primary care services trained to provide patient education and manage chronic disease older adults satisfied with care provided by PAs PAs integrated into NH results in cost- savings

6 Currently wide variety of exposures across programs Woolsey and other researchers note: students more likely to choose geriatrics if they have exposure to well elderly during training curriculum that emphasizes normal of aging has been shown to improve student attitudes provide opportunities for positive experiences with older adults interdisciplinary approach emphasize communication skills

7 you can t teach an old dog new tricks older people can t take care of themselves older people are grumpy old people are senile

8 Institute of Medicine Report on Health Professions and Training Call to Action training in communication is important for clinicians and the healthcare team similar to other healthcare procedures, communication skills can be learned improvement in communication skills requires commitment and practice Stewart MA. Effective physician- patient communication and health outcomes: a review. CMAJ 1995;152(9): positive correlation between effective physician- patient communication and improved patient health outcomes Research suggests that clinician s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes. ~ Institute for Healthcare Communication

9 Primarily medical school environments Outcomes varied but overall positive No ongoing programs documented in PA education Objectives provide opportunity for students to interact with well older adult in non- clinical setting increase student awareness of issues related to aging stimulate interest in geriatric medicine

10 Class of 2014 (March June) Student/faculty research project (100% participation) initial student support provided by WSU Regional Institute on Aging no requirement for service learning Class of 2015 (January June) continuing research project added as optional service learning activity (86% participation) Class of 2016 (October June) optional service learning activity

11 Students required to participate in activities across 4 categories for degree completion: Service learning Senior Mentor Program, fluoride varnish clinics Interprofessional learning homeless healthcare clinic, international rotation Professional development class officer, Kansas Career Opportunities Research journal club, presentation at national conference

12 Start during first year of PA Program Didactic content on communication strategies with older adults Relationship with local assisted living facility 3 required activities COCOA (Carolina Opinions on Care of Older Adults) administered pre- and post- intervention Students allowed to arrange times to meet with mentor Reflection paper required

13 Meet and greet to get acquainted Life History (not a medical history) Review fall prevention strategies Activity of choice playing cards/games, go for a walk, visit

14 Basketball watch party Student talent show Holiday party Volunteer recognition dinner

15 Does participation in a senior mentor program during the first year of PA school improve student attitude toward aging/older adults? change the likelihood of student willingness to consider a future career in geriatric medicine?

16 Carolina Opinions on Care of Older Adults Developed by Univ of North Carolina School of Medicine 42 item Likert scale 6 domains early interest in geriatrics empathy/compassion attitudes towards geriatrics career ageism clinical and social services for older adults social value of older adults

17 YEAR 1: CLASS OF participated; 100% N = 48 completed data % Recommend to continue the Program Yes 39.6% No 6.3% Maybe 54.2% YEAR 2: CLASS OF participated; 96% N = 38 completed data % Recommend to continue the Program Yes 84.3% No 0% Maybe 15.7%

18 % Change Sig % Change Sig I do not mind providing healthcare to older patients (A) 2.1% 13.2%.021 I always take time to listen to what older adults have to say (A) I would stop what I was doing and immediately help and older pt. who had an accident involving daily bodily functions (A) - 2.0% - 5.7% 6.3% 10.5% It is depressing to care for older adults (D) 4.1% - 5.1% Note: % reflects change in response; negative reflects movement from desired response Combined classes PRIOR to Intervention: 88% agreed that I do not mind providing healthcare to older adults. 93% agreed that I always take time to listen to older adults. 85% disagreed with It is depressing to care for older adults.

19 % Change Sig % Change Sig Caring for patients in their home would be rewarding (A) % 2.6% My friends would think I am smart to consider geriatrics as a career(a) Working in geriatrics might limit lifestyle/career goals more than other specialties (D) 29.1% % - 4.2% 0.3% Caring for patients in nursing homes would be rewarding (A) - 6.3% 2.6% Choosing a career in geriatrics would be a good decision (A) 4.2% 5.3% Geriatrics is a desirable healthcare specialty for my career goals (A) 6.2% 7.9% Working in geriatrics would be rewarding (A) % % I am interested in working with and treating older adults (A) - 4.2% 0.0% Note: % reflects change in response; negative reflects movement from desired response Combined classes PRIOR to Intervention: 48.9% agree that Geriatrics is a desirable healthcare specialty 67.5% agree that I am interested in working with and treating older adults. 79% agree that Working in geriatrics would be rewarding.

20 % Change Sig % Change I have experience working with older adults (A) 2.1% 0.0% I have spent time caring for an older friend or family member (A) 4.2% - 7.3% Note: % reflects change in response; negative reflects movement from desired response Sig Combined classes PRIOR to Intervention: 84% had experience working with older adults prior to intervention 75% had spent time caring for an older friend or family member

21 % Change Sig % Change Sig Older adult s bodies generally are unattractive (D) - 4.2% 0.0% It is probably not fruitful to encourage a change to poor health habits, since any damage to body has already occurred (D) Older adults participate in same recreational activities as younger adults (A) It is not necessary to aggressively treat serious conditions since they have few yrs left and have already lived a good life (D) - 4.2% 7.9% 8.3% 10.5% - 6.2% 5.3% Older adults tend to lose interest in sex (D) - 4.2% 0.0% It is reasonable there should be a mandatory retirement age for most professions (D) 10.4% 0.4% Most older adults are relatively inactive and stay close to home (D) 4.2% 5.2% Note: % reflects change in response; negative reflects movement from desired response Combined classes PRIOR to Intervention: 54.7% agree that Older adults participate in same recreational activities as younger adults. 65% agree that Most older adults are relatively inactive and stay close to home % disagree with It is prob not fruitful to encourage a change to poor health habits

22 Small sample size Self- report Relatively positive attitudes at onset

23 Students and mentors often involved their respective families all generations enjoyed interaction Unexpected marketing for PA Program, PA profession and university many were not familiar with PA profession or WSU Program many of the mentors/family were WSU alumni

24 I have gained more respect for this generation. As a PA, it will be very important to listen to our older patients and give them the opportunity to fully discuss their concerns. I realized that I need to make every effort to include my older age patient in the decision making process. It was a good experience in being able to communicate with older adults, which will be important in our future careers.

25 I now have a better understanding of how important it is to let older adults speak and give them the time to feel respected and appreciate everything they have done with their life. I was hesitant and I know that others in my generation share these same misconceptions. Until I worked with them I had no idea how fun and full of life many of them are. This event reminded me that this generation still loves to have fun and enjoys community!

26 10 respondents 90% would recommend to a friend Considered the following to be student strengths: compassionate, knowledgeable, friendly, energetic, open Majority believed the amount of activities was just enough

27 Tight curriculum No funds or administrative support available PD/Faculty buy- in is important Scheduling difficulties student vs older adult communication preferences senior mentor illness

28 Recruit community dwelling older adults Expand nursing home experience for students develop additional observation and clinical rotation experiences Continue development of classroom geriatric curriculum Portal of Online Geriatric Education Enhance recruitment of older adults for simulated patients

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