Ellen Roberts

Medical self-care education for elders: a controlled trial to evaluate impact.

We conducted a trial to evaluate the impact of medical self-care education on 330 elders whose average age was 71. The test group participated in a 13-session educational intervention with training in clinical medicine, life-style, and use of health services. The comparison group received a two-hour lecture-demonstration. Both groups were assessed pre-intervention, post-intervention, and one year after entry. The results indicate medical self-care instruction: produces substantial improvements, that were sustained for one year, in health knowledge, skills performance, and skills confidence; stimulates many attempts to improve life-style; and generates improvements in life quality. The program had little influence on utilization of medical care or health status.

Reliability and validity issues for two common measures of medical students' attitudes toward older adults

Results are reported from 2 common measures of medical student attitudes toward older adults: Maxwell-Sullivan Attitude Survey (MSAS); and UCLA Geriatrics Attitude Survey (GAS), with students entering the University of South Carolina School of Medicine (USCSM) in the period 2000–2005. A reliability analysis incorporating item means, Cronbachs alpha, item correlation matrix, and, Spearman-Brown prediction for positively and negatively worded items was conducted. Internal consistency results were unacceptable, revealing reliability and validity problems in this sample of medical students. Reconsideration of the use of these common measures, and a reframing of attitudes of medical students toward older adults seem appropriate.

Preparing medical students to care for older adults: the impact of a Senior Mentor Program.

Purpose To provide alternative training experiences for medical students to improve the competencies needed to provide care for older adults. Method Part of a comprehensive approach to integrating geriatric content at the University of South Carolina (USC) School of Medicine, the Senior Mentor Program (SMP) was launched in 2000. The SMP links pairs of students with older community volunteers in the spring of the first year. Students visit their mentors throughout medical school, and execute assignments that complement materials covered in the traditional curriculum. To evaluate the feasibility and efficacy of the SMP, the authors describe the program’s operation and outputs, the extent to which undergraduate medical education at USC and the SMP meet the core competencies for care of older adults promulgated by the American Geriatrics Society (AGS), and analyze the coverage of geriatrics content from 2000 to 2005 at USC, as indicated by responses to the Medical School Graduation Questionnaire. Results From 2000 to 2005, 379 students enrolled in the SMP; 133 graduates of the classes of 2004 and 2005 have completed the SMP. Students and mentors indicated high acceptance and enthusiasm. The program has been maintained with minimal administrative burden. USC covered only half of AGS competencies before the SMP, but now covers 100%, with nearly a third met specifically through the SMP. USC graduates reporting inclusion of geriatrics throughout their four years of training rose from 66% in 2002 to 96% in 2004–05. Conclusions The SMP has had a substantial impact on students’ preparation for dealing with an aging patient population.

Translation of the otago exercise program for adoption and implementation in the United States.

Background The Otago Exercise Program (OEP) is an evidence-based fall prevention program developed, evaluated, and disseminated in New Zealand. The program was designed for delivery in the home by physical therapists (PTs). It was not known if American PTs would require additional training and resources to adopt the OEP. This article describes the process of translating the OEP for dissemination in the US. Processes included reviewing and piloting the New Zealand training materials to identify implementation challenges, updating training materials to be consistent with American physical therapy practices, piloting the updated training materials in an online format, and determining if the online format reached the target PT audience. Methods – Process Activities The New Zealand manual was reviewed by expert American PTs and a training webinar was piloted with 56 American PTs. Feedback suggested that the program itself was understood by PTs, but training materials required modification related to documentation and reimbursement policies. Additional content was developed and integrated into an online training module. The online training was piloted and then deemed adequate by seven PT subject matter experts. The online training was launched in March 2013. Demographic and practice data were collected to characterize the PTs attending the online training as well as perceived barriers and facilitators to implementation (n = 522). Perceived facilitators include the effectiveness of the OEP to facilitate adoption, but the lack of agency support, billing and reimbursement challenges pose a significant barrier to OEP implementation. Conclusion The OEP required additional information to facilitate adoption by American PTs. Online training that specifically targets PTs appears to effectively reach the target audience and be well received by participants. More research is required to determine the impact of online training on a PT’s adoption and implementation of this material into their practice.

Health care professionals' perceptions and use of the medical orders for scope of treatment (MOST) form in North Carolina nursing homes.

OBJECTIVES To characterize the self-reported practices and opinions of nursing home (NH) health care professionals using the North Carolina Medical Orders for Scope of Treatment (MOST) form, an adaptation of the Physician Orders for Life-Sustaining Treatment (POLST) paradigm. DESIGN A cross-sectional survey and semistructured interviews. PARTICIPANTS AND SETTING Six physicians, 3 nurse practitioners, and 2 social workers from 2 NHs in North Carolina. MEASUREMENTS Survey items covered timing and appropriateness of form completion, review criteria, barriers, and concerns about using the form. Interviews clarified survey responses and elicited descriptions of how subjects explain the scope of medical interventions to patients/families. RESULTS NH admission and routine care plan meetings were considered the most important times to complete the MOST form. Treatment options on the form were often introduced in the context of patient preferences for hospitalization; however, there were considerable differences in how health care professionals explained and interpreted the scope of medical interventions. Nearly all health care professionals (10/11) believed that the form improves communication between physicians and patients/families. Only 3 of 11 respondents were aware of all of the MOST forms review requirements. Time was the most commonly cited barrier to use of the form. Respondents were concerned about forms getting lost or not being honored outside of the NH. CONCLUSION Health care professionals generally viewed the MOST form as a useful tool for communicating patient treatment preferences in the NH. However, they may need specific strategies for explaining and interpreting the scope of medical interventions section and for meeting the forms review requirements.

An innovative home-based interdisciplinary service-learning experience.

Abstract The University of North Carolina Mobile Student Health Action Coalition (UNC MSHAC) at Chapel Hill, North Carolina is a voluntary service-learning program in which interdisciplinary teams of graduate level health professional students provide monthly home visits to isolated, community-dwelling elders with complex medical and social issues. Students are mentored by UNC clinical faculty and retirees from the local community. Together, mentors and students generate action plans to improve the health and well-being of the participating elders. We report here the qualitative and quantitative results from our program evaluation demonstrating UNC MSHAC as an effective, service-learning model that compliments curricula, is satisfactory to students, and is a vehicle for academic institutions to serve elders in the local community.

Evaluation of the Staying Healthy After Fifty Educational Program: Impact on Course Participants

A study to evaluate the impact of a medical self-care program on older adults was conducted. The test group (n=161) participated in an 11-session educational interven tion with training in clinical skills, lifestyle, and the use of health services. The compar ison group (n=164) received no intervention. The test group was assessed pre-interven tion, post-intervention, and six months post-intervention and the comparison group was assessed at corresponding intervals. The results indicated that medical self-care instruction produces substantial improvements in health-related knowledge, health skills performance, and health actions. This study produced no evidence, however, that medical self-care instruction has any effect on health status, the utilization of medical care, or other aspects of life quality.

COCOA: A New Validated Instrument to Assess Medical Students' Attitudes Towards Older Adults

This study tested the reliability and validity of the Carolina Opinions on Care of Older Adults (COCOA) survey compared with the Geriatric Assessment Survey (GAS). Participants were first year medical students (n = 160). A Linear Structural Relations (LISREL) measurement model for COCOA had a moderately strong fit that was significantly better than the null model (GFI = 0.81, TLI = 0.90) and the GAS (GFI = 0.76). A reduced, 24-item COCOA performed well (GFI = 0.90, TLI = 1.00) with R 2 = .595 on five factors. The COCOA and GAS represent complementary instruments for assessing attitudes towards older adults.

EVALUATING A TELECOURSE ON AGING

Growing Old in a New Age is a 13‐hr telecourse in gerontology produced by the University of Hawaii at Manoa in 1993. The telecourse producers at the university have been teaching the course for several years, and this article reports on findings from evaluation efforts. In a first study, students taking the television and classroom‐based versions of the course in 1993‐1994 were compared on a number of outcomes (e.g., completion of assignments, improvements in knowledge and attitudes toward older adults, grades, satisfaction with the course, and access to the instructor). Findings suggested that telecourse students completed more of the readings and rated the videos and readings as more helpful than did the in‐class students, but that in‐class students reported better access to the instructor. Upon posttest, both groups showed similar improvements in attitude, but only the classroom group reported a significant increase in knowledge as measured by the Palmore Facts on Aging quizzes. Both groups reported en...

Development of an Introductory Gerontology Telecourse.

The development and uses of a gerontology telecourse entitled Growing Old in a New Age are described. Produced by the Center on Aging at the University of Hawaii at Manoa under a grant from the Annenberg ICPB Project of Washington, DC, the telecourse involves an instructional design with three essential components: television programs, printed support materials, and local faculty participation. The methodology for creating the telecourse included grant writing, instructional design, content and video treatment development, interviewing, narration and scriptwriting, student and faculty guide development, expert reviews, formative evaluations, pretesting of video and guide elements, studio production, and promotion skills. The usefulness of formative evaluation and pretesting in telecourse development is highlighted, and a methodology is outlined that can serve as a model for the planning and implementation of telecourse projects.