The development of a geriatric postgraduate education assessment instrument using a modified Delphi procedure

There is currently wide variation in the structure and content of higher medical training in geriatric medicine across Europe and no common framework within which existing efforts can be compared. We set out to develop an audit tool to compare training between countries. An initial review of indexed and grey literature was used to develop an audit tool which was used as the basis of an Internet-based modified Delphi process incorporating the views of 14 expert geriatricians from across Europe. Items in the audit tool were included or excluded when supported by ≥75% or <50% of respondents, respectively. Items supported by 50–74% of respondents were carried forward with additional suggestions and modifications included following Round 1. Thirteen experts representing 12 countries responded to both rounds. 40/45 items were supported at Round 1. Five items were carried forward. A further 13 elements were introduced for consideration at Round 2. Consensus was gained after the second round. The final tool describes 52 items across four domains: general considerations, topics referring to knowledge in patient care, different roles that should be considered in medical training and topics regarding assessment. The resulting tool can be used as a basis for comparing higher medical training programmes in geriatric medicine between countries. Individual countries can use this to audit current practice. At an European Union level, the insights gained through such audit will form the basis of future work to develop an agreed postgraduate curriculum in the specialty

Development and initial evaluation of a point-of-care educational app on medical topics in orthogeriatrics

INTRODUCTION: Research by AOTrauma's orthogeriatrics education taskforce identified ongoing educational needs for surgeons and trainees worldwide regarding the medical management of older adults with a fracture. To address practicing surgeons' preference for increased use of mobile learning, a point-of-care educational app was planned by a committee of experienced faculty. The goals were to deliver the app to surgeons, trainees, and other healthcare professionals, to measure usage, and to evaluate the impact on patient care. MATERIALS AND METHODS: The committee of geriatricians and surgeons designed and developed four modules on osteoporosis, delirium, anticoagulation, and pain based on published evidence and the content was programmed into mobile app formats. A registration form was integrated and a 14-question online evaluation survey was administered to users. RESULTS: The AOTrauma Orthogeriatrics app was installed by 17,839 users worldwide between September 2014 and October 2015: Android smartphones (44%), iPhones (32%), iPads (15%), Android tablets (9%). 920 users registered and 100 completed the online evaluation: orthopedic/trauma surgeons (67%), residents/fellows (20%), and other professionals (13%). Ratings for all aspects were 4 or higher on a 1-5 Likert scale (5 = Excellent). 80% of evaluation respondents found the answer to their question or educational need on their last visit, and 26 of 55 respondents (47%) reported making a change in an aspect of their management of patients as a result of their learning from the app. CONCLUSION: The orthogeriatrics app reached its intended audiences and was rated highly as a method of providing education to help improve patient care. Content input by experienced faculty and app improvements based on user feedback were key contributors to successful implementation

European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique

Introduction: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. Methods: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. Results: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. Discussion: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europ

Correlation between Age, Emergency Department Length of Stay and Hospital Admission Rate in Emergency Department Patients Aged ≥70 Years

Background: Interdisciplinary emergency departments (EDs) are confronted with trauma and nontrauma patients of any age group. Length of stay (LOS) and admission rates reflect both disease complexity and severity. Objective: To evaluate LOS and admission rates in different age groups according to traumatic and nontraumatic etiologies. Patients and Methods: During May 2011 a total of 4,653 adult patients (defined as ≥18 years old) seen in the ED of our municipal hospital were evaluated for their primary problem, Emergency Severity Index, LOS and admission rate. 1,841 trauma patients (mean age: 51.9 years; SD 22.5 years) and 2,812 nontrauma patients (mean age: 60.0 years; SD 20.4 years) were included. Results: Median LOS in the ED was 1:41 h (trauma) and 1:52 h (nontrauma). Trauma patients aged ≥70 years spent more time in the ED than nontrauma patients of this age group (patients aged ≥70 years median: 2:08 vs. 1:56 h; p < 0.0001). However, no significant difference was found in patients aged <70 years (1:33 vs. 1:48 h; p = 0.64). Comparing older with younger patients, median LOS within the ED was about 8 min longer in nontrauma patients aged ≥70 years (p = 0.22) and about 35 min longer in trauma patients aged ≥70 years (p < 0.00001). Conclusions: The correlation between age and LOS is stronger for trauma patients, which might indicate a special need for geriatric expertise in elderly trauma ED patients. Thus an interdisciplinary approach including surgical and geriatric expertise may be advantageous

Palliative care competencies for geriatricians across Europe : a Delphi consensus study

Key summary points Aim to develop a set of specific palliative care competencies to be recommended for training at a postgraduate level of geriatricians across Europe. Findings A list of 35 palliative care competencies for geriatricians is now available for implementation in the different European countries. Message Future action are needed to support implementation and evaluation of the recommendations based upon key performance indicators within different health care systems. Purpose Integration of palliative care competencies with geriatric medicine is important for quality of care for older people, especially in the last years of their life. Therefore, knowledge and skills about palliative care for older people should be mandatory for geriatricians. The European Geriatric Medicine Society (EuGMS) has launched a postgraduate curriculum for geriatric medicine recently. Aim Based on this work, the Special Interest Group (SIG) on Palliative care in collaboration with the SIG in Education and Training aimed to develop a set of specific palliative care competencies to be recommended for training at a postgraduate level. Methods Competencies were defined using a modified Delphi technique based upon a Likert like rating scale. A template to kick off the first round and including 46 items was developed based on pre-existing competencies developed in Switzerland and Belgium. Results Three Delphi rounds were necessary to achieve full consensus. Experts came from 12 EU countries. In the first round, the wording of 13 competencies and the content of 10 competencies were modified. We deleted or merged ten competencies, mainly because they were not specific enough. At the end of the 2nd round, one competence was deleted and for three questions the wordings were modified. These modifications had the agreement of the participants during the last round. Conclusion A list of 35 palliative care competencies for geriatricians is now available for implementation in European countries

Effectiveness of multi-professional educational interventions to train Comprehensive Geriatric Assessment (CGA) – a Systematic Review

Introduction: As the world population ages, health and social care professionals are increasingly confronted with patients with chronic long-term conditions and multimorbidity, requiring an extensive assessment and integrated care management strategy. The aim of this paper was to systematically collect and assess evidence of interprofessional education and training strategies for Comprehensive Geriatric Assessment (CGA) to build a competent health workforce. Methods: A systematic review was conducted according to PRISMA guidelines and the databases Medline, CINAHL, Cochrane and Embase were searched for studies illustrating effectiveness of educational interventions for teaching and training CGA in an interprofessional context. Results: Based on 21 identified studies, a great variability and heterogeneity in duration, setting and design of the interventions was identified. Promising results were found in the domains analysed, ranging from knowledge and skills; practices and behaviour; patient health outcomes; attitudes and perceptions to collaboration and quality of care. Discussion: Education and training of transversal skills within a continuous learning approach is key to equip the health care workforce for successful CGA performance in an interprofessional environment. Conclusion: Further research in this field is recommended to strengthen the evidence-base towards development of a resilient and integrated health care workforce for an ageing population. Kurzfassung Hintergrund: Aufgrund der zunehmenden Alterung der Weltbevölkerung sehen sich Fachkräfte des Gesundheits- und Sozialwesens immer häufiger mit Patient*innen mit chronischen Erkrankungen (bzw. Langzeiterkrankungen) und Multimorbidität, welche eine umfassende Beurteilung und eine integrierte Versorgungsmanagementstrategie erfordern, konfrontiert. Ziel der vorliegenden Arbeit war es, systematisch Evidenz für interprofessionelle Aus- und Weiterbildungsstrategien für ein Comprehensive Geriatric Assessment (CGA) zu sammeln und zu bewerten, um Kompetenz im Gesundheits- und Sozialwesen zu generieren. Methodik: Es wurde eine systematische Übersichtsarbeit gemäß den PRISMA-Richtlinien durchgeführt und die Datenbanken Medline, CINAHL, Cochrane und Embase im Zuge dessen nach Studien durchsucht, welche die Wirksamkeit von Bildungsmaßnahmen zur Vermittlung und Ausbildung von CGA in einem interprofessionellen Kontext belegen. Ergebnisse: Basierend auf 21 identifizierten Studien wurde eine große Variabilität und Heterogenität in Bezug auf Dauer, Setting und Design der Interventionen festgestellt. Vielversprechende Ergebnisse wurden in den analysierten Bereichen gefunden, welche von Wissen und Fähigkeiten, Praktiken und Verhalten, gesundheitlichen Ergebnissen für Patient*innen, Einstellungen und Wahrnehmungen bis hin zu Zusammenarbeit und Qualität der Versorgung reichen. Diskussion: Die Aus- und Weiterbildung von transversalen Fähigkeiten im Rahmen eines kontinuierlichen Lernansatzes ist der Schlüssel dazu, Angehörige der Gesundheits- und Sozialprofessionen mit entsprechendem Werkzeug auszustatten, um geriatrische Assessments (CGA) erfolgreich im interprofessionellen Umfeld durchführen zu können. Schlussfolgerung: Es besteht der Bedarf für weitere Forschungsvorhaben in diesem Bereich, um die Evidenzbasis für die Entwicklung eines zuverlässigen, integrierten Gesundheitspersonals für eine alternde Bevölkerung zu stärken. Schlüsselwörter: Integrierte Versorgung; Comprehensive Geriatric Assessment; Ausund Weiterbildung; interprofessionelle Bildung; Alterun

Teaching geriatric medicine through gamification: a tool for enhancing postgraduate education in geriatric medicine

Background Polypharmacy is becoming increasingly common and all doctors must be prepared to manage it competently. Aims The aim of this project is to evaluate the feasibility and use of a novel gamification-based teaching intervention on polypharmacy among doctors undergoing advanced geriatric training. Among others, one of the learning goals for the students was to be able to describe the adherence to medication. Methods Electronic questionnaire sent to students of the third session “evidence-based medicine in geriatrics” of advanced postgraduate course in geriatrics of the European Academy for Medicine of Ageing. Results Most students reported issues with forgetting doses and remembering sufficiently to establish a medication routine due to busy schedules as well as social influences around medication taking. Reflecting on the challenges of the game, most students reported that their own prescribing practice was likely to change. Discussion and conclusion The current model of learning appears to be a feasible approach for postgraduate medical education or in other areas of healthcare such as nursing or physiotherapy. Learning through action and reflection promotes deeper thinking and can lead to behavioral change, in this case thus enhancing the attitudes and understanding regarding pharmacological issues associated with ageing. Recommendations for future research in medical education about medication adherence are outlined.publishedVersio

A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods

Purpose The world’s population is ageing. Therefore, every doctor should receive geriatric medicine training during their undergraduate education. This review aims to summarise recent developments in geriatric medicine that will potentially inform developments and updating of undergraduate medical curricula for geriatric content. Methods We systematically searched the electronic databases Ovid Medline, Ovid Embase and Pubmed, from 1st January 2009 to 18th May 2021. We included studies related to (1) undergraduate medical students and (2) geriatric medicine or ageing or older adults and (3) curriculum or curriculum topics or learning objectives or competencies or teaching methods or students’ attitudes and (4) published in a scientific journal. No language restrictions were applied. Results We identified 2503 records and assessed the full texts of 393 records for eligibility with 367 records included in the thematic analysis. Six major themes emerged: curriculum, topics, teaching methods, teaching settings, medical students’ skills and medical students’ attitudes. New curricula focussed on minimum Geriatrics Competencies, Geriatric Psychiatry and Comprehensive Geriatric Assessment; vertical integration of Geriatric Medicine into the curriculum has been advocated. Emerging or evolving topics included delirium, pharmacotherapeutics, healthy ageing and health promotion, and Telemedicine. Teaching methods emphasised interprofessional education, senior mentor programmes and intergenerational contact, student journaling and reflective writing, simulation, clinical placements and e-learning. Nursing homes featured among new teaching settings. Communication skills, empathy and professionalism were highlighted as essential skills for interacting with older adults. Conclusion We recommend that future undergraduate medical curricula in Geriatric Medicine should take into account recent developments described in this paper. In addition to including newly emerged topics and advances in existing topics, different teaching settings and methods should also be considered. Employing vertical integration throughout the undergraduate course can usefully supplement learning achieved in a dedicated Geriatric Medicine undergraduate course. Interprofessional education can improve understanding of the roles of other professionals and improve team-working skills. A focus on improving communication skills and empathy should particularly enable better interaction with older patients. Embedding expected levels of Geriatric competencies should ensure that medical students have acquired the skills necessary to effectively treat older patients

COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021

Purpose We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. Methods The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. Results There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. Conclusion Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.Peer reviewe

COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021

Purpose We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. Methods The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. Results There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. Conclusion Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.Peer reviewe