Older adults as simulated participants: a scoping review

AbstractIntroductionSimulated participants (SPs) can support development of competencies associated with person-centred care of older adults. There is limited information and understanding about working with older adult SPs and those who support them to create authentic, safe and effective simulations. This review aimed to review simulation literature focused on the care of older adults to explore and summarize what is known about working with older adults as SPs in healthcare providers’ education.MethodsThis scoping review followed Arksey and O’Malley’s five-stage approach, involving identification, selection, charting, collating, summarizing and reporting on results. Databases searched included MEDLINE, PsychINFO and EBSCO. To capture additional articles, we hand-searched the reference lists of articles selected for inclusion, MedEdPORTAL and Google Scholar.ResultsFrom the initial 816 citations identified, 12 articles were in scope. Articles were either research or educational guides. Findings related to general characteristics of articles, description of SPs, conceptualization of SP role/scenario, SP preparation and scenario implementation.DiscussionOlder adult SPs contribute to healthcare provider training in authentic, engaging, safe and effective ways. This scoping review provides a foundation on which to further develop older adult SP practices by highlighting their well-being and safety (both physical and psychological), promoting ways to increase diversity and inclusion, and emphasizing that the words we use matter. Improved reporting details of articles involving older adult SPs will facilitate the identification of effective practices

Introducing Interprofessional Education and Care Concepts in a Geriatric Multilevel Centre: Development and Introduction of a Toolkit for Staff and Students

Background: Although interprofessional education (IPE) is not new, there has been limited research in IPE focused on the care of older adults. The objective of this study was to develop and implement an interprofessional education and care (IPE/C) toolkit, to help staff and students understand and apply the concepts of IPE/C.Methods and Findings: Focus groups identified staff and students’ understanding of IPE/C and informed development of an IPE/C toolkit comprised of IPE/C tools and resources. Five clinical teams (N = 51) attended workshops that introduced the toolkit and educated teams about IPE/C. Focus group participants had heard of but had limited exposure to IPE/C. Responses to the Attitudes Toward Health Care Teams (ATHT) questionnaire indicated a positive trend on all questions; 2 questions in subscale 1 were statistically significant (p = .01 & p = .005), indicating a positive attitude toward teams and teamwork. Several limitations were identified, including inconsistent attendance at workshops, scheduling challenges, and limited physician participation.Conclusions: This pilot project provided baseline data on staff and students’ understanding of and attitudes toward IPE/C in a multilevel geriatric centre and demonstrated that an IPE/C toolkit delivered via team workshops can enhance healthcare team attitudes. Next steps include expanding the rollout to other teams and introducing the toolkit to all staff and students

Implementation of a Mental Health Guideline in a Long-Term Care Home: A Participatory Action Approach

AbstractBackground: The goal of this pilot study was to implement a Canadian mental health guideline in a long-term care residence in order to improve interprofessional care of clients with mood and behavioural issues.Methods: Using a participatory action approach, this pilot study engaged staff/physicians, residents, and families in identifying key priorities for action related to the goal of improving interprofessional care. This resulted in the implementation of educational interventions, a mandate for non-registered nursing staff to attend interprofessional rounds, and enhanced interprofessional collaboration through unit-based huddles. A staff satisfaction survey and focus groups were conducted to assess perceptions of change.Findings: The staff satisfaction survey revealed statistically significant improvements in perceived job satisfaction, leadership, and workplace resources. Focus group findings indicated improved interprofessional collaboration, teamwork, support, and communication. Staff noted a stronger perception of being valued and increased confidence in their own contributions.Conclusions: Both qualitative and quantitative improvements were noted in staffjob satisfaction. Despite some limitations, these findings suggest that further dissemination of this initiative with rigorous evaluation is warranted

Collaborative framework for working with older simulated participants (SP)

INTRODUCTION: As the global population ages, healthcare providers must prepare for the complexities associated with caring for older adults, defined according to the WHO, as being over the age of 60. Simulation-based education in healthcare allows caregivers to practice and master skills and competencies associated with care of older adults. Simulated patients/participants (SP), well people trained to portray other individuals, are an effective choice when training behavioural skills (eg, communication). When working with older SPs, it is important to recognise unique considerations and requirements related to physiological changes, in physical, cognitive and sensory systems associated with normal ageing. METHOD: SP educators from two different countries, with diverse backgrounds and contexts, collaborated through an iterative, consensus-based process to create a framework for working with older SPs. RESULTS: A practical three-phase framework with specific strategies was developed that synthesised elements of best practices related to simulation methodology with relevant clinical evidence. DISCUSSION: Effective collaboration with older SPs is achievable through investing resources in preparing, training and ensuring their well-being. Through faculty development of healthcare simulation educators, we can ensure that older SPs and simulation communities have the right tools and support to safely and effectively contribute to simulation-based education

Age-related changes in the functional neuroanatomy of overt speech production

Alterations of existing neural networks during healthy aging, resulting in behavioral deficits and changes in brain activity, have been described for cognitive, motor, and sensory functions. To investigate age-related changes in the neural circuitry underlying overt non-lexical speech production, functional MRI was performed in 14 healthy younger (21–32 years) and 14 healthy older individuals (62–84 years). The experimental task involved the acoustically cued overt production of the vowel /a/ and the polysyllabic utterance /pataka/. In younger and older individuals, overt speech production was associated with the activation of a widespread articulo-phonological network, including the primary motor cortex, the supplementary motor area, the cingulate motor areas, and the posterior superior temporal cortex, similar in the /a/ and /pataka/ condition. An analysis of variance with the factors age and condition revealed a significant main effect of age. Irrespective of the experimental condition, significantly greater activation was found in the bilateral posterior superior temporal cortex, the posterior temporal plane, and the transverse temporal gyri in younger compared to older individuals. Significantly greater activation was found in the bilateral middle temporal gyri, medial frontal gyri, middle frontal gyri, and inferior frontal gyri in older vs. younger individuals. The analysis of variance did not reveal a significant main effect of condition and no significant interaction of age and condition. These results suggest a complex reorganization of neural networks dedicated to the production of speech during healthy aging

Clustered functional MRI of overt speech production

To investigate the neural network of overt speech production, eventrelated fMRI was performed in 9 young healthy adult volunteers. A clustered image acquisition technique was chosen to minimize speechrelated movement artifacts. Functional images were acquired during the production of oral movements and of speech of increasing complexity (isolated vowel as well as monosyllabic and trisyllabic utterances). This imaging technique and behavioral task enabled depiction of the articulo-phonologic network of speech production from the supplementary motor area at the cranial end to the red nucleus at the caudal end. Speaking a single vowel and performing simple oral movements involved very similar activation of the corticaland subcortical motor systems. More complex, polysyllabic utterances were associated with additional activation in the bilateral cerebellum,reflecting increased demand on speech motor control, and additional activation in the bilateral temporal cortex, reflecting the stronger involvement of phonologic processing