Health and Aging Curriculum in Accredited Public Health Programs

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Health and Aging Curriculum in Accredited Public
Health Programs

• L. Cricel Molina, MPH
• Steven P. Wallace, PhD
• Doctoral Roundtable
• May 15, 2006

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Presentation Outline

• Background and Significance
• History of Public Health and Aging
• Methods
• Results
• Discussion
• Future Directions

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Background and Significance
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Background and SignificanceNumber of Older
Adults

• 36 million older adults (65) in the U.S. in
  2003, accounting for 12 of total population
• Growth from 3 million to 35 million over the 20th
  century
• Projection of 71.5 million older adults by 2030,
  accounting for 20 of population

U.S. Census Bureau, Population Estimates and
Projections, 2004
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Background and Significance Ethnic Diversity of
Older Adults
Population Age 65 and Over, by Race and Hispanic
Origin, 2003 and Projected 2050
U.S. Census Bureau, Population Estimates and
Projections, 2004
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Background and Significance Life Expectancy
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Background and Significance Chronic Conditions
Among Older Adults
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Background and Significance

• With a growing older adult population, of
  diverse ethnic backgrounds, that are living
  longer and reporting high prevalence of chronic
  conditions, it is important to have a public
  health workforce with training in gerontology.

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History of Public Health and Aging
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History of Public Health and Aging

• Education and research in the public health of
  older adults
• APHA founded in 1872, while Gerontological
  Society of America (GSA) not founded until 1945
  and the Gerontological Health Section (GHS) of
  APHA formed in 1982.

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History of Public Health and AgingResearch
Studies

• 1984 ASPH Survey
• 63 courses offered in 17 schools
• All but 4 SPHs offered at least 1 course in PH
  and aging
• Recommended that SPHs recognize significance of
  and necessity of training and curricula in aging
• Urged federal funding agencies to provide
  resources for development of student and faculty
  training programs.

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History of Public Health and AgingResearch
Studies

• 1992 study by Prohaska
• 96 courses offered by 23 public health schools
  (52 increase since 1984)
• 2 schools offered degree programs specifically in
  aging
• 9 offered a track, concentration, or
  specialization
• 4 offered continuing education
• 4 offered certificates programs in gerontology
• Recommended that schools share curriculum and
  syllabi materials to strengthen the core of aging
  curriculum and that schools with strong aging
  programs serve as a resource for those trying to
  strengthen their aging programs

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History of Public Health and AgingResearch
Studies

• 1992 Review of Syllabi Study by Wallace
• Telephone survey to accredited Schools of Public
  Health (n24) and graduate programs in Public
  Health (n22)
• 14 schools and 6 programs offered courses in
  aging covering health problems and health
  services, practice issues, special populations,
  disease prevention/health promotion, and policy
  issues
• While a wide variety of coursework existed, most
  content assumed limited knowledge or experience
  in gerontology.

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History of Public Health and AgingResearch
Studies

• 1994 U.S. Bureau of Health Professions Survey by
  Wallace
• 92 courses offered by 43 public health
  schools/departments
• Found lower prevalence of coursework than
  Prohaska
• Examined coursework as well as barriers, program
  resources, grants, and students
• Most common barrier to PH and aging curriculum
  development is financial concerns
• PH and aging courses are indeed offered at almost
  all schools, but graduate programs in PH did not
  frequently offer PH and aging courses

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Methods

• 2005 Bureau of Health Professions (BHP) Study
• Education on Health and Aging in Public Health
  Degree Programs

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Methods

• Web-based survey
• Pre-administration
• Built upon first BHP survey
• Advisory Board of 4 SPHs and 1 PHP
• Pilot testing
• Revisions

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Methods

• Survey Administration
• Email to Deans and Program Directors
• Follow-up
• Email
• Mail
• Telephone
• Strategic Techniques
• Time of emails
• Use of personal contacts

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Sample Characteristics

• Total n99
• 36 accredited graduate Schools of Public Health
  (SPH)
• 63 accredited graduate Public Health Programs
  (PHP)
• Excluded Tulane and Louisiana State MPH Program

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Results
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Results

• Response rate for SPHs 72 (26/36)
• Response rate for PHPs 32 (20/63)
• The remainder of the results section will focus
  only on data from Schools of Public Health

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ResultsCurriculum

• 79 have any aging content
• 77 offer 1 or more courses in aging
• Those with any courses have a median of 3 or
  fewer offerings
• About three-quarters of the courses are scheduled
  once a year, mostly by tenure-track faculty, with
  an average enrollment of 12 students

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ResultsCurriculum cont

• 79 have field placements with aging content
• 69 reported offering a concentration,
  specialization, or certification in aging
• 40 have a faculty member designated to
  coordinate gerontological curriculum

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ResultsFaculty and Other Resources

• About 3/4 of respondents had faculty with aging
  interests in their units
• There were a median of 4 faculty with aging
  interests, half of whom had aging issues as their
  primary interest
• There were more faculty involved in aging-related
  research than teaching.
• About 1/3 reported somewhat greater faculty
  effort in aging issues than five years ago and
  about 1/3 reported similar effort

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ResultsStudents

• There are an estimated 20 unduplicated masters
  and 4 doctoral students enrolled in aging classes
  each year
• About ½ of schools take a students aging
  interests into account in admissions
• Only 25 have fellowship funding to support
  students in health and aging research
  assistantships on aging projects are more common
  and are available at 1/3 of schools

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ResultsTrends and Factors in PH and Aging
Education

• Programs/schools were more likely to report
  increased versus decreased effort in the past
  five years on all PH and aging dimensions
• Most most common response was no change
• The 1 barrier to adequate PH and aging
  curriculum is funding

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Results Trends and Factors in PH and Aging
Education cont

• More than half of schools reported a major or
  moderate obstacle was lack of trained faculty and
  that aging is not a priority of the school. A
  lack of aging-related jobs was the least likely
  to be reported as an obstacle.
• Only 30 ranked faculty expertise as extremely or
  very strong. Funding was rated as not strong at
  all by nearly 60, and somewhat strong by the
  rest.

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Discussion
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Discussion

• The number and variety of courses is promising,
  but the generally low enrollments mean that they
  have a limited impact.
• There appears to be an untapped reservoir of
  gerontological expertise in SPHs that could be
  offering training in health and aging.

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Discussion cont

• It is unclear whether enrollment is low because
  of the quality of PH and aging courses or if
  there needs to be active recruitment of PH
  professionals to the field of aging.
• Financial constraints are issues for curriculum
  development and affect incentives for students to
  pursue studies in the field of PH and aging.

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Future Directions

• Continued follow-up, particularly with graduate
  PHP
• Need information on why schools and departments
  do not offer PH and aging courses
• Have to understand the political and bureaucratic
  context for which PH and aging is or is not a
  priority
• Bivariate analysis looking at trends of course
  offerings and other resource, institutional, and
  political issues

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Thanks!

• lcmolina_at_ucla.edu