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September/October 2019
Geriatric Education Today & Tomorrow — Who Are the Providers? “I wish that I knew what I know now, when I was younger. I wish that I knew what I know now, when I was stronger.” When considering who needs geriatric education, the answer that first jumps to mind, of course, is primary care professionals (PCPs). The PCP cohort requires a significant level of education in geriatric medicine in order to successfully diagnose and treat the ever-growing number of geriatric patients. However, the cohort that’s most in need of education is geriatric patients and their caregivers—the population with the most limited health literacy (LHL) of all age groups. LHL is defined by the Institute of Medicine “as a limited capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” This LHL extends to the geriatric patient and family caregivers, such as spouses and children, and pertains to such concerns as diagnosis, treatment, health insurance, appropriate placement such as a nursing home, personal care, day care, and medications. As certified geriatric care managers, we’ve witnessed geriatric patients taking medications incorrectly—too much, too little, too soon, too late—as well as splitting their capsules. Additionally, patients frequently do not comprehend their rehabilitation interventions, as evidenced when they ascend and descend steps incorrectly after knee or hip replacement surgery, incorrectly use mobility devices such as canes or walkers, and discontinue rehabilitation therapy before the full benefit can be gained. Geriatric patients often fail to understand the terminology used by PCPs, such as DNR. Similarly, when a care manager uses the word “oncologist,” a 95-year-old who cares for a wife with terminal cancer may not understand that the term means cancer doctor. It’s been estimated that approximately one-half of the US adult population has LHL. Many of these individuals and their caregivers are older adults, who have LHL in many medical situations. LHL has been associated with poor health outcomes, contributes to health disparities, can lead to increased morbidity and rehospitalization, and adds to the cost of care.1 Furthermore, providing patient education requires more of the PCP’s time, which is already constrained. Health care expenditures associated with LHL are estimated at $50 to $73 billion annually.1 Therefore, improving the literacy of geriatric patients and their caregivers would also result in a substantial cost savings for the country. PCPs and their office staffs lack both the time and the resources to provide adequate geriatric patient education to improve patient literacy. To remedy the problem, who should or could provide the education required for geriatric patients and their caregivers? The geriatric care manager, geriatric social worker, and geriatric nurse can and do provide education to families and their loved ones on an ongoing basis. If PCP offices (with the patients’ consent) provide information about diagnosis, treatment, and test results to geriatric care managers, nurses, and social workers, they could deliver the required education to the patients and their caregivers. However, they would be furnishing education to a relatively small cohort, since, with limited exceptions, they interact with only one patient at a time. Also, as that education would have to be billed as a fee for service, patients and caregivers with limited resources would be excluded. Patient Navigation A certified patient navigator must have a strong foundation in gerontology from a college or university. Many colleges and universities offer gerontology certifications and degrees. The role of the navigator requires the use of communication skills and strategies specific to older patients and their caregivers—for example, sitting directly in front of patients, asking open-ended questions, and using varied communication aids such as pictures and written materials. Additional techniques for effective communication include speaking to patients slowly, using simple and specific language, and limiting the amount of information covered so as not to overwhelm them. Before patients leave the office, the patient navigator does a “teach back,” asking the patients to tell the PCP what they’re going to share with their family members about the day’s discussion.3 Patient navigation also requires knowledge of assessment and patient resources; the ability to identify literacy issues affecting older patients, such as impaired hearing; and the development an education plan for individual patients or groups of patients. Patient navigators now work in many different medical settings, such as hospitals, clinics, and PCP offices, with patients who have illnesses such as cancer, diabetes, cardiovascular disease, or asthma. They help patients overcome communication, educational, and cultural barriers to increase health literacy.2 They readily can provide the education necessary to increase health literacy for patients and caregivers to improve clinical outcomes and increase medication compliance. Navigators can work with patients individually or provide more economical group education. For example, they can offer instruction and answer questions for a group of patients scheduled for knee replacement rather than educating each on a one-to-one basis, which would be less efficient and more costly. Because older adults may not understand technical or scientific jargon and may not have the computer skills to appropriately navigate search engines or determine whether results are reliable, patient navigators also can help them with computer issues, medical terminology, and determining the quality of search results.4 Patient participation in medical, psychiatric, or rehabilitation educational groups is by far the most economical method to increase older patients’ literacy. A group is a collection of patients who have a relationship with one another including but not limited to having a shared diagnosis of a specific disease or condition such as diabetes, heart disease, or neurocognitive disorders or being similarly involved in a rehab program following, for example, knee or hip replacement. A group may also share common goals such as understanding how to take or administer medication correctly or how to manage difficult behavior in a person with a neurocognitive disorder. Other goals may be to learn about available services and programs and how to apply for them effectively. These and other goals can be accomplished with the patient navigator in a group setting. Ultimately, the short answer to the question, “Who are the providers who will increase health literacy by teaching geriatric patients and their caregivers?” is PCPs, patient navigators, occupational therapists, physical therapists, rehab specialists, and other health care professionals the patients and caregivers encounter. The long answer is that everyone, as they develop and age, should be exposed to gerontology and geriatric principles. Although everyone does not need a degree or certification, everyone needs a basic understanding of what’s entailed in aging and what they as individuals can do to maintain their health and quality of life as they age. According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, the average age of a male in 1900 was approximately 47 years and the average age of a female was 49 years.5 In fact, many women in 1900 never experienced menopause. Today, US men can anticipate a life span of approximately 77.5 years, and women 82 years. The population of the United States has increased dramatically since 1990. People did not understand, nor did they need to understand, aging since many died before age 50. In contrast, people today are living well into their 70s, 80s, and 90s, yet still have no understanding of the aging process. Aging Education for All The goal would be to prepare youth for the future and teach them about normal and abnormal aging. Eventually, young students will age to the point of retirement. What should they be thinking about and doing between age 18 and 65 to get ready? How can they prepare for retirement? Is it just about saving enough money (which few of today’s older adults have accomplished) or are there psychosocial issues that need to be addressed, and what might they be? Is aging something to fear? Does it change one’s sex life? Is losing one’s memory inevitable? Are they prepared to relate to a grandparent or a parent experiencing a neurocognitive disorder or who is at risk for a fall? Unlike in the 1900s, these are now common issues. These and many more questions should be addressed through education to inform and augment individuals’ aging and health literacy. As a society, we can do a much better job of educating our youth and fostering the skills necessary for successful aging, such as recreational and social skills. There’s little evidence that as an aging society we’re preparing our youth to age, let alone to age successfully. The goal of aging is to have our life spans equal our health spans and our health spans to equal our brain spans. It should not be based on the luck of the draw. Without education that provides knowledge about how to age successfully and prevent health deterioration, many individuals will be doomed to becoming increasingly frail, possibly bedridden, and unable to perform basic functions of life, such as eating and dressing. Successful aging can be defined as the ability to maintain low risk of disease or disability, high mental and physical function, and active engagement with life.6 Roger Bacon, a Franciscan friar who lived circa 1214–1294, wrote a book (translated as The Cure of Old Age and Preservation of Youth) in which he suggested that “aging can be mitigated by means of a controlled diet, proper rest, exercise, a moderate lifestyle, [and] good hygiene,” which, if followed, would increase ones’ likelihood of aging successfully.7 Disease prevention skills and healthy lifestyle behaviors should be taught and encouraged by all heath care professionals. Today, geriatric patients and their caregivers need education to improve patient outcomes. The PCPs, geriatric-trained occupational therapists, physical therapists, nurses, social workers, and patient navigators are vital providers of geriatric education to increase patient health and geriatric literacy. Today and tomorrow, the sheer volume of geriatric patients will make this challenging as diagnosis and treatment consume the majority of allotted time for them. Going forward, reliance on the aforementioned providers, education that prepares students to geriatricians, and secondary and elementary education on aging for the general population can play a pivotal role in advancing successful aging. — James Siberski, MS, CMC, is an assistant professor of gerontology and the director of the geriatric care management graduate certificate program at Misericordia University in Dallas, Pennsylvania. He is also an adjunct faculty member at University of Scranton. — Carol Siberski, MS, CRmT, C-GCM, is a geriatric care manager in private practice and participates in research in geriatrics and intellectual disabilities in Pennsylvania.
References 2. Smith J, Teague M. Patient Navigation: A Resource Guide for Navigators and Care Coordinators. North Charleston, SC: CreateSpace Independent Publishing Platform; 2015. 3. Oates DJ, Zitnay RM. Health literacy’s critical importance. Aging Well. 2012;5(3):34. 4. Centers for Disease Control and Prevention. Improving health literacy for older adults: expert panel report 2009. https://www.cdc.gov/healthliteracy/pdf/olderadults-508.pdf. Published 2009. 5. 1900-2000: changes in life expectancy in the United States. SeniorLiving.org website. https://www.seniorliving.org/history/1900-2000-changes-life-expectancy-united-states 6. Rowe JW, Kahn RL. Successful aging. Gerontologist. 1997;37(4):433-440. 7. Busse AL, Filho WJ. History and prospects of geriatrics. Rev Med (São Paulo). 2016;95(Special Issue 2):22-26. |
