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Gerontology and Geriatrics Education and Training in the Global Context: The Need for Standards and

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Title: Gerontology and Geriatrics Education and Training in the Global Context: The Need for Standards and


1
Gerontology and Geriatrics Education and Training
in the Global Context The Need for Standards and
Guidelines
  • Gloria M. Gutman, PhD, OBC
  • Founding Director and Professor Emerita,
    Gerontology Department,
  • Simon Fraser University, Vancouver, Canada
  • Presentation in the symposium Addressing the
    challenges of population ageing through capacity
    building and training, 19th World Congress,
    International Assn. of Gerontology and
    Geriatrics, Paris, France July 5-9, 2009

2
Introduction
  • Population ageing is occurring to an
    unprecedented extent throughout the world. What
    was once a developed world phenomenon, is
    occurring and at a more rapid rate, in less
    developed countries lacking the infrastructure
    and resources to guarantee even minimum quality
    of life and quality of care for their older
    citizens.
  • Simultaneous with population ageing, urbanization
    and migration are also taking place on a global
    scale.
  • These three trends have created labour market
    conditions and training issues with respect to
    individuals who provide health and social care to
    frail older persons on a scale not heretofore
    encountered or anticipated by local, national and
    regional governments or by the gerontological
    community.

3
The Issues
  • Demand for and supply of appropriately trained
    workers in a variety of disciplines who provide
    service in a variety of settings ranging from
  • the older persons private residence (home care),
    to units in collective dwelling units (e.g.
    assisted living, licensed care facilities) to
    acute and chronic hospitals
  • community based settings in which seniors engage
    in social and recreational activities (e.g.
    community senior centres adult day care
    centres)
  • Primary care centres and offices, pharmacies,
    legal clinics, banks, libraries, police and
    justice-related units (e.g. Public Guardian
    Trustee)
  • On the demand side recognizing the need for
    training
  • On the supply side meeting the need

4
Recognizing the need includes understanding that
implementation of evidence-based policy
practice depends on having an educated workforce
  • As Rejean Hebert (2002), first direction of the
    Canadian Institute on Aging , points out
  • translation of research findings into new
    policies and interventions is essential for
    improving the supply and appropriate use of
    services (p.6) . He notes , however that Such
    translation can occur at the clinical level only
    if the workers have appropriate professional
    training for interpreting and integrating the
    knowledge springing from the research (p.7).

5
Recognizing the need also includes recognizing
the dangers of occupational drift
  • some research has shown that tasks normally
    performed by professionals are being carried out
    inappropriately by untrained personnel,
    particularly in peoples homes and in certain
    residential institutions out of a desire to
    economize (Hebert et al 2001).
  • This shifting of responsibility for care has
    impacts not only on the quality of services, but
    also on these alternative providers ability to
    apply recent scientific findings.
  • Adequate training of all professional and
    non-professional providers in the care of
    seniors, is the most effective way to reverse
    this trend.

6
The development of practice and training standards
  • In 1969, the American Nursing Association
    published its first practice standards for
    geriatric nursing. By the mid-1970s, the term
    gerontological nursing came to be the preferred
    designation for nurses specializing in care of
    the elderly.
  • The American Nurses Credentialing Center offered
    the first certificate in gerontological nursing
    in 1974.
  • In the USA, in the mid- 1980s, the Bureau of
    Health Professions began funding Geriatric
    Education Centres (GECs) in health science
    schools in order to develop and expand clinical
    training in geriatrics. Model gerontology and
    geriatrics curricula for the health professions
    were developed during this period (Bureau of
    Health Professions, 1986 Wood Davis, 1988).
  • Programs for physicians trained in internal
    medicine, family practice and psychiatry who
    wished to specialize in care of the elderly also
    began to proliferate.
  • In North American, Europe and other parts of the
    world articles began to appear in medical
    journals describing recommended content.
  • In parallel, training programs were being
    developed for individuals outside the standard
    health care disciplines who wished to conduct
    research on individual or population ageing , or
    who were being employed to provide housing, adult
    day care and other community-based social and
    recreational services. To guide their
    development, in the late 1970s, the Association
    for Gerontology in Higher Education published its
    first Standards and Guidelines for Gerontology
    Programs, now in its 4th edition.

7
Development of practice and training standards
contd
  • By the late 1990s health professions such as
    pharmacy were developing their own curriculum
    guides . For example, In 1997 The American
    Association of Colleges of Pharmacy (AACP) in
    collaboration with the American Society of
    Consultant Pharmacists (ASCP) published Geriatric
    Curricular Resources. This was followed in 2002
    with a Geriatric Pharmacy Curriculum Guide
    published by ASCP . A revised version of this
    guide, which provides a framework for development
    of a standardized gerontology and geriatrics
    curriculum for pharmacists was published in 2007.
  • It is notable that the competencies for
    geriatrics education that are articulated by the
    pharmacists are similar to those articulated by
    The American Geriatrics Society (Eleazer, McRae,
    Knebl et al 2000) and the American Association of
    Colleges of Nursing (AACN 2000). These can be
    broadly defined into 3 categories Knowledge,
    Skills and Attitudes

8
Competency in Geriatrics (Odegard et al, 2007)
9
International Trends in Graduate Training in
Gerontology
  • Common feature
  • multidiscipinary

10
2004 IAGG Survey (n90)
  • 60 in USA
  • 30 in other countries
  • Argentina (1), Australia (1), Brazil (1),
    Canada (4), China (1), Colombia (1), Czech
    Republic (1) Finland (1), Germany (1), Hong Kong
    (2) Ireland (1), Israel (2), Malta (1),
    Netherlands (1), New Zealand (1), Puerto Rico
    (1), Spain (3), and the UK (6).
  • 80 Masters 10 PhD

11
Master of Arts 32/80
12
Master of Science 43/80
13
Other 5/80
14
PhD
15
Other areas of diversity
  • Time to degree completion (Range 1- 4.5 years)
  • Prerequisites other admission requirements
  • Opportunities for specialization
  • Research vs. Policy vs. Practice emphasis
  • Courses only, courses thesis or project,
    courses thesis/project practicum, research
    only
  • Targeted students, marketing strategies
  • Mode of Delivery
  • Single university vs. consortium approach (e.g.
    European Masters Nordic Collaboration)

16
Compliance with Guidelines Standards
  • Studies are few and far between

17
Extent of compliance with standards and
guidelines for education in gerontology and
geriatrics
  • Research training in gerontology
  • Magnum (1992) examined the correspondence
    between credit hours allocated for research
    methods and statistics courses in a sample of US
    Gerontology programs and the recommended hours
    proposed by the AGHE Standards Committee. Only
    28 of the Bachelors degree programs and 65 of
    the Masters programs met the standards for
    research methods courses less than 50 of the
    Masters programs met the standards for
    statistics courses.

18
Student ratings of core courses
  • Gilford, Gibson and Newton (2005) report that
    core courses recommended by AGHE were evaluated
    highly by 230 graduates of US gerontology,
    geriatrics and aging studies programs. Program
    success, as defined by graduates employment
    status, was correlated with graduates ratings
    of the core courses.

19
Gerontological Competencies
  • Janet Frank, in an article in the Fall 2007 AGHE
    Newsletter, asked the question Is Gerontology
    lagging behind in developing relevant
    competencies?
  • She presents data from a study that reviewed the
    comparability and differences in published
    compentencies for social work, nursing and
    gerontology. 12 broad competency areas were
    identified as relevant to all three. As shown in
    the following table, there are some gaps for both
    social work and gerontology.

20
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21
  • Franks asks why are there no health related
    competencies in gerontology? As she notes
    Perhaps this reflects the orientation of
    gerontology programs in the early 1990s, but it
    doesnt seem to fit into todays realities. We
    assume that gerontology students learn a lot
    about health issues in most, if not all
    programs. She suggests perhaps it is time to
    revisit AGHE competency standards.

22
An additional Recommendation Competency
Assessment in Geriatrics Gerontology
  • Odegard et al (2007) note that contemporary
    pharmacy education is moving towards
    performance-based (ability-based) assessment and
    that this approach may be applicable to
    geriatrics education where competent knowledge,
    skills, attitudes and values are essential for
    care provision.

23
  • An ability-based outcome is described as a
    statement of student performance that describes
    what the student should be able to do or
    perform.
  • Performance is defined as a demonstration of the
    ability rather than response to proxy measures of
    ability
  • I would argue that this approach should be taken
    with respect to evaluation of gerontology
    education as well.

24
References
  • AGHE Standards Committee, J. R. Connelly T.A.
    Rich (First Eds.) (2005). Standards and
    guidelines for gerontology programs (4th
    Edition). Washington, D.C. Association for
    Gerontology in Higher Education.
  • American Association of Colleges of Nursing
    (2000). Older Adults Recommended Baccalaureate
    Competencies and Curricular Guidelines for
    Geriatric Nursing Care. Washington, DC American
    Association of Colleges of Nursing.
  • Bureau of Health Professions (1986). The
    conference report on geriatric education new
    knowledge, new settings, new curricula. June
    2-4., 1986 Rockville, MD Health Resources and
    Services Administration, US Department of Health
    and Human Services.
  • Eleazer, G.P., McRae, T., Knebl, J. et al.
    American Geriatrics Society (2000). Core
    competencies for care of older patients
    Recommendations of the American Geriatrics
    Society. Academic Medicine, 75, 252-255.
  • Frank, J.C. (2007). Is gerontology lagging behind
    in developing relevant competencies? AGHE
    Exchange, 31 (1), p. 1, 11).
  • Gilford, R., Gibson, L. Newton, R. (2005).
    Gerontology required core courses and gerontology
    academic program success. Gerontology
    Geriatrics Education, 25(3), 31-48.
  • Hebert, R. (2002, May 28). Research on aging
    providing evidence for rescuing the Canadian
    health care system. Submission to the Romanow
    Commission.
  • Hebert, R. et al (2001). Resources and costs
    associated with disabilities of elderly persons
    living at home and in institutions. Canadian
    Journal on Aging, 20 (1), 1-22.
  • Magnum, W.P. (1992). Research methods and related
    courses in multilevel degree programs in
    Gerontology Standards, practices and proposals.
    Gerontology Geriatrics Education, 12(2), 7-18.
  • Miller, C.A. (2008). Nursing for wellness in
    older adults Theory and practice (5th Edition).
    Philadephia Lippincott, Williams and Wilkins. 
  • Odegard, P.S., Breslow, R.M., Koronkowski, M.J.,
    Williams, B.R. Hudgins, G.A. (2007). Geriatric
    pharmacy education A strategic plan for the
    future. American Journal of Pharmaceutical
    Education, 71(3), Article 47.  
  • UN Department of Economic and Social Affairs
    (2007). Overview World Economic and Social
    Survey 2007 Development in an ageing world.
    New York UNDESA. Full publication available
    from http//www.un.org/esa/policy/wess/index.html
  •  Williams, B.R. (1988). Geropharmacy. In G.J.
    Wood L.J. David (Eds.). Gerontology and
    Geriatrics for Health Professions. Guidelines for
    multidisciplinary curriculum development. Los
    Angeles Pacific Geriatrics Education Center,
    106-17.

25
Resources
  • Visit the IAGG website and click on Education for
    a current worldwide listing of post-graduate
    degree programs (Masters, PhD) in
    Gerontology/Geriatrics.
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