With an ageing population worldwide, there is a need for professionals with specialized knowledge and skills in gerontology. Competency- based education (CBE) is a way to assure the development of a workforce that has obtained the know-how to serve older adults. CBE is increasingly recognized as the new pedagogy by accrediting bodies for higher education because of its clear definition of learning goals and accountability for outcomes. In this session, different perspectives on CBE and the consensus and difference in gerontology international competencies are presented. The Association for Gerontology in Higher Education (AGHE) developed a competency framework that can serve as a guideline for developing educational programs in gerontology, which is presented in the first presentation. These competencies, as well as others, are used to a different extent across the world. Educational program development are described and discussed from a European and Pan-American perspective in presentations two and three. Presentation 4 explores the current international job market in gerontology and the competencies required as identified in job postings.

The Association of Gerontology in Higher Education (AGHE) is a global leader in education on aging and has revitalized competencies for gerontology education programs at the Associate, Bachelor’s and Master’s degree levels over a 3-year iterative process. This presentation will review the consensus-building process that used a tiered “circle of influence” method, the foundations and organization of the competencies, and the final set of AGHE gerontology education competencies. This presentation will include examples of utilizing the competencies for curricula development, application of a newly designed curriculum mapping tool and approaches to competency-based outcome evaluation. Discussion will include how the AGHE competencies are now being integrated into the Accreditation of Gerontology Education Council as one international program review criterion for programmatic accreditation of gerontology education programs.

from HCRC focus group conducted with participants from a treatment church were used along with quantitative variables reflecting the qualitative themes analyzed across four phases in the study (baseline, 6, 18 and 24 mo).Key themes identified in the qualitative data included changes in dietary habits (increase in fruit/vegetables [F/V], decrease in foods high in fat and sodium, smaller portion sizes), and changes in physical activity [PA] habits (increase in daily PA).Quantitative items, including daily servings of F/V, fat consumption, daily minutes of PA and perceived health, all improved from baseline to phase 3, with continued improvements shown for fat at phase 4. Both PA and perceived health decreased slightly at phase 4. Implications for use of tracking tool will be discussed.

An increasing number of patients older than 65 years are referred for and have access to organ transplantation, and an increasing number of older adults are donating organs. Although short-term outcomes are similar in older versus younger transplant recipients, older donor or recipient age is associated with inferior long-term outcomes. However, age is often a proxy for other factors that might predict poor outcomes more strongly and better identify patients at risk for adverse events. Approaches to transplantation in older adults vary across programs, but despite recent gains in access and the increased use of marginal organs, older patients remain less likely than other groups to receive a transplant, and those who do are highly selected. Moreover, few studies have addressed geriatric issues in transplant patient selection or management, or the implications on health span and disability when patients age to late life with a transplanted organ. This paper summarizes a recent trans-disciplinary workshop held by ASP, in collaboration with NHLBI, NIA, NIAID, NIDDK and AGS, to address issues related to kidney, liver, lung, or heart transplantation in older adults and to propose a research agenda in these areas.

Similarities and differences among elders in various ethnic groups. The population-based approach of public health to addressing the health of older people emphasizes prevention of disease and disability, and, increasingly, the aging network is reaching out to diverse groups of elders to engage them in health promotion activities. The diversity of the older population is increasing, with elders of color expected to constitute 25 percent of the older population by 2025. By 2050, some 35 percent of elders will be from minority groups (U.S. Department of Commerce, Bureau of the Census, 2000). This demographic reality raises issues that are of particular importance in Los Angeles, where 45 percent of the current older population is composed of minority elders (California State Census Data Center, 2000). The study described here was motivated by the desire to increase the utilization in Los Angeles of a successful community health promotion project, Prevention for the Elderly Program (PEP) (Reuben et al., 1996). To that end, the study was designed to answer a group of questions of particular relevance to service: How do individual older people define health? How does the definition of health vary among groups of ethnic elders? How can an understanding of elders' definitions of health be of use in design of health promotion programs? THE PROBLEM Comparisons of how people rate their own health in diverse age and ethnic populations raise questions about the criteria people are using (Jylha et al., 1998) and show that definitions of personal health can vary considerably and that perceptions of one's own health are necessarily related to other measures of health status (see, e.g., early qualitative research by Kaufman, 1986, and Kerschner, 1994). A better understanding of these definitions and perceptions among minority elders could be used in outreach and health promotion (Wieck, 2000), particularly to improve communication among elders and providers (Sleath et al., 2001). Our research focuses on late-life definitions of health and explores the similarities and differences in the meaning of health for elders from several different ethnic groups. METHODS The initial research activity was conduct of discussions in ten standardized focus groups to explore what healthy means, what participants did to stay healthy, and their views on specific prevention activities. Participants were matched in ethnicity and language; two groups were composed of African American elders, two of Hispanic-American Spanish speakers, two of Mandarin-speaking Chinese, two of Cantonese-speaking Chinese, and two of Eastern European ethnicity and language. All focus groups were held in senior centers or senior housing recreation rooms. The ages of the group members ranged from 59 to 8- years. All African American participants except one were bom in the United States. In contrast, all of the Chinese American participants were immigrants and were the most recent immigrants among these groups, with several having been in the U.S. for five years or less. The Eastern European elders, while all immigrants, had come to the U.S. at fairly young ages. The members of the Spanish-speaking groups had lived in the U.S. a minimum of twenty years, but for many, Spanish was still their primary language. The Eastern European and Mandarin-speaking Chinese elders had the highest educational levels, while the Cantonese-speaking and Hispanic groups (both men and women) had the lowest educational levels. FINDINGS The first question within each focus group was, What docs healthy mean to you? After exhaustive analysis of the transcripts from all groups, a holistic and interlocking diagram of late-life health was constructed based on elders' statements. Figure 1 depicts the three major categories or domains and their characteristics emerging from elders' definitions of health. One older adult would identity an aspect of health as not sick, for example, and another person would add feeling no pain, and yet another would include being content. …

Almost 15 years ago, the John A. Hartford Foundation began its Centers of Excellence (CoE) program. In summer 2002, a quantitative and qualitative evaluation of the CoE program was conducted. The evaluation used previously collected quantitative data from surveys of program directors and graduates of fellowship programs, as well as interviews and surveys of currently funded CoEs.Since its inception, the CoE program has supported 163 geriatrics fellows, of whom 63% entered academic geriatrics. Almost half of these graduating fellows have gone to new academic institutions. CoEs have also supported 222 faculty, including some who were in disciplines other than geriatrics. The vast majority (82%) have remained in academics, and nearly two-thirds are currently in geriatrics. As the priorities and needs of the institutions and geriatrics programs changed, most centers shifted their CoE priorities. These changes predominantly took two forms: a refocus from one activity to another or an expansion of outreach or levels of support.Based upon this formal evaluation, the Hartford-supported CoE program has been successful in strengthening academic geriatrics, particularly in attracting, developing, and retaining geriatrics faculty.

In 1995, the John A. Hartford Foundation launched an initiative to strengthen geriatric interdisciplinary team training (GITT) for advanced practice nursing and masters-level social work students and residents in internal medicine and family practice. As part of the national evaluation of the initiative, case-study and cross-case designs were employed using quantitative and qualitative data to examine the influence of cultures, regulations, and attitudes of individual disciplines on interdisciplinary training efforts at the first eight GITT programs.This evaluation found that attitudinal and cultural traditions of the different health professions faculty and students (disciplinary split) remain as important obstacles to creating an optimal interdisciplinary team-training experience. In general, physician trainees participated least enthusiastically in GITT. In part, this lower level of enthusiasm may have been the result of inconsistent medicine faculty support of the program. At all but one program, physician trainees also had shorter GITT training experiences than other disciplines. In addition, the disparity in level of training by discipline of GITT participants may have contributed to attitudinal barriers to interdisciplinary training. Discipline-specific regulatory and accreditation barriers also impede interdisciplinary training. Nevertheless, GITT experiences at some clinical sites, especially home visits, appeared to promote interdisciplinary training.Some barriers to creating and implementing GITT programs may be best approached at the level of accrediting agencies and certifying organizations. Others will require local and national efforts of leaders in the different disciplines to model and support good team care.

OBJECTIVES:To examine the effect on primary care physicians' implementation and their patients' adherence behaviors of patient-physician concordance about recommended geriatric health care.DESIGN:Case-series, independent interviews of patients and their physicians about their perceptions of the patients' health and the comprehensive geriatric assessment (CGA).SETTING:Community.PARTICIPANTS:Community-dwelling older patients (n = 111) who received consultative outpatient CGA and their primary care physicians.MEASUREMENTS:Concordance variables were generated using physician and patient responses to 10 questions on health- and CGA-related perceptions. An overall concordance score was generated by summing the total number of items on which patients and physicians agreed. Measures of the two dependent variables (physician implementation of and patient adherence to CGA recommendations) were by self-report.RESULTS:In multiple logistic regression analyses, overall concordance between patient and physician proved to be a significant and powerful predictor of physician implementation of (adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6-4.6, P <.001) and patient adherence to (OR = 2.7, 95% CI = 1.7-4.2, P <.001) CGA recommendations, controlling for patient and physician gender and age, patients' functional status, duration of the patient-physician relationship, and frequency of visits in the previous year. Further analysis revealed that mutual patient-physician concordance on health-related perceptions was a significant predictor of these outcomes, whereas individual patient or physician perceptions were not.CONCLUSION:Concordance between older patients and their primary care physicians is a powerful predictor of physician implementation of and patient adherence to outpatient consultative CGA recommendations. Future research should focus on ways physicians can assess and negotiate patient-physician agreement on geriatric healthcare recommendations.

Background. Comprehensive geriatric assessment (CGA) can be effective in inpatient units, but such inpatient settings are prohibitively expensive. If similar benefits could be obtained in outpatient settings, CGA might be a more attractive option. Objectives. To assess the cost-effectiveness (CE) of an outpatient geriatric assessment with an intervention to increase adherence. Subjects. Three hundred fifty-one community-dwelling, elderly subjects with at least one of four geriatric conditions. Measures. In addition to the measures of functioning, we collected data on the costs of the intervention itself and on the use of medical services in the 64 weeks after the intervention. Results. The intervention, which prevented functional decline, cost $273 per participant. The intervention group averaged three more visits than the control group in the first 32 weeks after the intervention, but only 1.2 extra visits in the next 32 weeks. We estimate that the costs of these additional medical services would be $473 for the 5 years after the intervention, leading to a total cost per Quality Adjusted Life Year (QALY) of $10,600. Conclusions. The CE of this program compares favorably with many common medical interventions. Whether investments should be made in health care resources on treatments that lead to modest improvements in the functioning of community-dwelling elderly people remains a societal decision.

BACKGROUND: Although comprehensive geriatric assessment (CGA) has been demonstrated to confer health benefits in some settings, its value in outpatient or office settings is uncertain.OBJECTIVE: To assess the effectiveness of outpatient CGA consultation coupled with an adherence intervention on 15‐month health outcomes.DESIGN: A randomized controlled trial.SETTING: Community‐based sites.PATIENTS: 363 community‐dwelling older persons who had failed a screen for at least one of four conditions (falls, urinary incontinence, depressive symptoms, or functional impairment)INTERVENTION: A single outpatient CGA consultation coupled with an intervention to improve primary care physician and patient adherence with CGA recommendations.MEASUREMENTS: Medical Outcomes Study Short Form‐36 (MOS SF‐36), restricted activity and bed days, Physical Perfomance Test, NIA lower‐extremity battery.RESULTS: In complete case analysis (excluding the five control group subjects who died during the follow‐up period), the adjusted difference in change scores (4.69 points) for physical functioning between treatment and control groups indicated a significant benefit of treatment (P = .021). Similar benefits were demonstrated for number of restricted activity days and MOS SF‐36 energy/fatigue, social functioning, and physical health summary scales. In analyses assigning scores of 0 to those who died, these benefits were greater, and significant benefits for the Physical Performance Test and MOS SF‐36 emotional/well being, pain, and mental health summary scales were also demonstrated.CONCLUSIONS: A single outpatient comprehensive geriatric assessment coupled with an adherence intervention can prevent functional and health‐related quality‐of‐life decline among community‐dwelling older persons who have specific geriatric conditions.

OBJECTIVE: To develop and validate a brief instrument – the Perceived Efficacy in Patient‐Physician Interactions Questionnaire (PEPPI) – to measure older patients' self‐efficacy in obtaining medical information and attention to their medical concerns from physicians. DESIGN: Two consecutive validation surveys. SETTING: Eleven senior multipurpose centers in Los Angeles County California. POPULATION: A convenience sample of 163 community‐dwelling older persons (Survey 1: n = 59, mean age = 77.1 years, 76.3% female; Survey 2: n = 104, mean age = 77.4 years, 57.7% female). MEASURES: The 10‐item PEPPI, subscales of the Patient Satisfaction Questionnaire, the Medical Outcomes Study (MOS) Coping Scale, the Mastery Scale, and global self‐reported health and restricted activity days items. RESULTS: The full 10‐item and a 5‐item short form of PEFPI demonstrated Cronbach's alphas of 0.91 and 0.83, respectively. PEPPI demonstrated discriminant and convergent validity as hypothesized, correlating negatively with avoidant coping ( r = ‐.27, P =.001) and positively with active coping (r =.17, P =.03) and with patient satisfaction with physician interpersonal manner (r =.49, P <.0001) and communication (r =.51, P <.0001) (values from the overall sample). Further, in the second survey, PEPPI correlated positively with self‐reported health (r =.42, P <.0001), education (r =.24, P =.01) and self‐mastery (r =.29, P =.01) and negatively with restricted activity days (r = ‐.25, P =.01). PEPPI‐5 demonstrated correlations similar in magnitude, direction, and statistical significance. CONCLUSION: In either the 5‐ or 10‐item version, PEPPI is a valid and reliable measure of older patients' perceived self‐efficacy in interacting with physicians. This instrument may be useful in measuring the impact of empowerment interventions to increase older patients' personal sense of effectiveness in obtaining needed health care.