Robert E. Roush

Bioterrorism and Emergency Preparedness in Aging (BTEPA): HRSA-Funded GEC Collaboration for Curricula and Training

Abstract Frail elders living alone or in long-term care settings are particularly vulnerable to bioterrorism and other emergencies due to their complex physical, social and psychological needs. This paper provides an overview of the recent literature on bioterrorism and emergency preparedness in aging (BTEPA); discusses federal initiatives by the health resources and services administration (HRSA) to address BTEPA; describes the collaborative efforts of six HRSA-funded geriatric education centers (GECS) to develop BTEPA geriatric curricula and training; and offers recommendations for BTEPA education and training, clinical practices, policy, and research. The GEC/BTEPA collaboration has produced model curricula, including emergency planning for diverse groups of older persons; enhanced networking among stakeholders in a fast paced environment of information sharing and changing policies; and developed interdisciplinary educational resources and approaches to address emergency preparedness for various settings in the elder care continuum.

Reduced Hospitalization Rates of Two Sets of Community-Residing Older Adults After Use of a Personal Response System

This study replicated, in a United States setting, an earlier study conducted in Canada to determine whether use of a 24-hour personal response system (PRS) affected selected hospital utilization rates among community-residing users. Utilization rates of 106 Canadian patients were reviewed for 1 year before and 1 year after enrollment in the PRS: These were compared with a similar set of 101 U.S. patients using the same PRS program. Self-paired analyses were conducted on number of emergency department (ED) visits and number of inpatient days. During the 1-year follow-up periods, both sets of subscribers using the Lifeline system experienced a statistically significant decrease (p < 0.05) in per person inpatient days (mean reduction = 6.5 days). No significant differences occurred in ED visits. When indicated, a PRS may be an appropriate environmental prescription.

Faculty appointments, promotions, and tenure policies in the allied health professions.

The number of patients with cancer and the number of patients with bone metastases are increasing recently. Patients with bone metastases frequently develop skeletal related events (SREs; i.e.,pathological fracture, surgery to bone, and paralysis). SREs have been associated with Activities of daily living (ADL) and Quality of life (QOL). When the ADL decrease, chemotherapy cannot be administered in some patients. Then, the ADL are associated with the prognosis. Various interventions are required in order to improve the ADL of patients with bone metastases. In this study, we describe the way to evaluate the pathologic fracture risk before the start of rehabilitation, the team approach in medical care, exercise therapy, patient education, and environment and adjustment to improve the ADL and the QOL of patients with bone metastases.

An Educational Program to Assist Clinicians in Identifying Elder Investment Fraud and Financial Exploitation

Due to age-related factors and illnesses, older adults may become vulnerable to elder investment fraud and financial exploitation (EIFFE). The authors describe the development and preliminary evaluation of an educational program to raise awareness and assist clinicians in identifying older adults at risk. Participants (n = 127) gave high ratings for the program, which includes a presentation, clinician pocket guide, and patient education brochure. Thirty-five respondents returned a completed questionnaire at the 6-month follow-up, with 69% (n = 24) of those indicating use of the program materials in practice and also reporting having identified 25 patients they felt were vulnerable to EIFFE. These findings demonstrate the value of providing education and practical tools to enhance clinic-based screening of this underappreciated but prevalent problem.

Expanding the Technology Safety Envelope for Older Adults to Include Disaster Resilience

The concept of resilience is central to understanding how technology might have a role to play in reducing the disproportionate vulnerability of older adults in natural and human-made disasters. Resilience has been defined in various ways by different theorists and researchers, but the common thread is the idea of adaptive capacity and the ability to recover from adversity (Norris, Stevens, Pfefferbaum, Wyche, & Pfefferbaum, 2008). Resilience is not simply a personality style or a characteristic of individuals but a product of the interplay among various determinants of population health: income and social status, social support, education, employment, social and physical environments, health practices and coping skills, developmental factors, biological and genetic endowment, health services, gender, and culture (Public Health Agency of Canada [PHAC], 2003). Disasters are large-scale disturbances or sources of adversity that tax the resilience not only of individuals but of whole communities and broader societies. All members of a population can be at risk depending on the nature of the crisis (InterInter-Agency Standing Committee [IASC], 2006). As would be expected given the multiple interacting determinants that come into play, the pathways from risk vulnerability to disaster resilience are complex (International Federation of Red Cross and Red Crescent Societies [IFRC], 2004). Similar to other population health challenges, the availability of appropriate resources, effectively implemented, is likely to contribute to more desirable outcomes for individuals and groups who are responding to and attempting to recover from disasters (Lindsay, 2003). Disaster resilience is increasingly in the public eye as the number of catastrophic natural and human-made events continues to rise. This chapter examines the potential for technology to promote disaster resilience among older adults. They are a population subgroup with increased vulnerability in emergencies not because of age per se, but because they are more likely to live with a constellation of risk factors for increased vulnerability, including health problems, dependence on healthcare and social services, lower socioeconomic status, and restricted social networks. In addition, with increasing age, higher proportions of older adults are women, a population subgroup with heightened vulnerability across the life course (Powell, 2009).

The Evolution of Academic-Based Geriatric Emergency Preparedness and Response (GEPR) Training for Medicine, Health, and Behavioral Sciences

This chapter provides a historical perspective of the evolution of policy, funding, training, and resources to address the age-appropriate needs of older persons and the healthcare workforce that serves them in planning, response, and recovery from disasters. The collaborative efforts are described of six U.S. Department of Health and Human Services, Health Resources Services Administration (USDHHS/HRSA) funded Geriatrics Education Centers that have made a significant impact on training for health professionals, the continuum of geriatric care services, and the ability to leverage financial support. Academic courses, faculty development, clinical and practice training, and continuing education programs are described. Focused programs on mental health, acute care settings, community-based long-term care and populations with functional, access, and unique needs are included so they can be replicated in other settings to enhance academic and community disaster planning and response. Strategies are recommended to support and advance the national goals of preparedness for older adults and their families from mainstream communities as well as from culturally and functionally diverse communities. Lessons learned, unmet needs, and evolving trends are included that have significant implications for future education and resource development for geriatric emergency preparedness and response.

Outcomes of Academic-Based Geriatric Emergency Preparedness and Response (GEPR) Training for Medicine, Health, and Behavioral Professions

The progression of evaluation approaches shifting from counting training activities to measuring outcomes from evidence-based training is documented for six U.S. Health Resources and Services Administration-funded Geriatric Education Centers that have collaborated on geriatric emergency preparedness and response (GEPR) training and evaluation initiatives. The Kirkpatrick’s chain of impact evaluation model is used as the framework for describing modalities and outcomes at the reaction, learning, behavior, and results levels. The chapter provides examples of GEPR Collaborative training programs and resources that provide insight into evaluation approaches and their impact on the healthcare workforce, changes in geriatric/gerontological services, the ability to leverage support, development, and use of new resources and the provision of care for older persons. Outcomes are described that lead to lessons learned and recommendations for enhancing evaluation efforts. The importance of legislative and policy directives are explored relative to the creation of a national standard for culturally proficient preparedness and response to “all-hazards” disaster and governmental and community resilience as 17 million people with multiple chronic conditions (MCC) steadily grow with the aging baby boomer generation. In addition, the next generations and populations with culture-based survival and safety needs are aging as well. A case is made for using multimodal evaluation strategies to create standardized tools to measure GEPR training outcomes to meet Healthy People 2020 objectives and to strengthen preparedness and response skills of healthcare provider networks and populations of older adults from diverse communities across the nation.

Screening Older Patients for Risk Factors Associated with Financial Exploitation

Due to a variety of conditions, especially Mild Cognitive Impairment and dementia, many older people are defrauded of money they need to pay for routine living expenses and for out-of-pocket healthcare costs. Since most older persons do not have the time to recoup their losses, they must often make the difficult choice of foregoing expenses for needed health care. Not receiving those health services and perhaps eating less nutritious food can hasten a downward spiral, exacerbating often frail conditions that clinicians must manage. In this chapter, the authors present an overview of the medical literature on risk factors associated with increasing an elder’s vulnerability to being financially exploited. They also describe a national continuing medical education program to raise clinicians’ awareness of the issue and what healthcare professionals can do to help prevent the adverse consequences of the loss of their patients’ wherewithal to have a good old age.

Being "on stage": improving platform presentation skills with microteaching exercises and feedback.

ABSTRACT In just over 20 years, all 78 million baby boomers will have reached their “coming of age.” When this demographic milestone occurs, one in every five Americans will be at least 65 years old; millions will have comorbid and chronic conditions requiring better prepared health care providers and markedly improved services than are presently available. Thus, geroeducators must teach current and future practitioners what they need to know to help their patients have the best possible old age. To ensure that this outcome occurs, teachers must observe students and practitioners demonstrating their ability to perform taught skills competently. Using microteaching and feedback can help clinical educators be those better teachers of the caregivers of older people.ABSTRACT In just over 20 years, all 78 million baby boomers will have reached their “coming of age.” When this demographic milestone occurs, one in every five Americans will be at least 65 years old; millions will have comorbid and chronic conditions requiring better prepared health care providers and markedly improved services than are presently available. Thus, geroeducators must teach current and future practitioners what they need to know to help their patients have the best possible old age. To ensure that this outcome occurs, teachers must observe students and practitioners demonstrating their ability to perform taught skills competently. Using microteaching and feedback can help clinical educators be those better teachers of the caregivers of older people.In just over 20 years, all 78 million baby boomers will have reached their “coming of age.” When this demographic milestone occurs, one in every five Americans will be at least 65 years old; millions will have comorbid and chronic conditions requiring better prepared health care providers and markedly improved services than are presently available. Thus, geroeducators must teach current and future practitioners what they need to know to help their patients have the best possible old age. To ensure that this outcome occurs, teachers must observe students and practitioners demonstrating their ability to perform taught skills competently. Using microteaching and feedback can help clinical educators be those better teachers of the caregivers of older people.