Assessing Educational Needs in Geriatric Care in Ophthalmology: A Single Academic Institution Study

Abstract

Purpose The purpose of this study was to assess the educational needs in geriatric care among practicing and training eye care providers at a single academic institution, the Flaum Eye Institute, at the University of Rochester Medical Center.

Methods Data were collected using a voluntary and anonymous electronic survey that was distributed to 35 training and practicing eye care providers.

Results Of the 35 distributed surveys, 27 (77%) were returned. Respondents included 6 residents-in-training and 17 practicing providers, based on those who reported demographics. Overall, respondents reported that most of their patients were older than 65 years (mean, 66.4%). Notably, 63% of providers felt they received very little to no prior education in geriatric care. Only 46.4% reported having a moderate level of interest in geriatric issues. While respondents reported high confidence levels in many geriatric domains, they reported moderate to low confidence levels in several others, including conducting cognitive and functional assessments, assessing and reducing the risk for falls and driving accidents, recognizing depression, and understanding the roles of long-term care and home services, social supports, and geriatric rehabilitation. Differences were also observed in confidence levels between residents-in-training and practicing providers in several geriatric domains.

Conclusion At this single academic institution, current practicing and training ophthalmologists reported having limited prior education in geriatric care and identified many opportunities for geriatric education. While larger-scale studies need to be conducted to produce more generalizable results, this pilot study serves as a guide to augment geriatric education and training of ophthalmologists and improve the quality of eye care for the rapidly growing aging U.S. population.

Keywords

geriatric education - continuing medical education - ophthalmology resident education

• References

• 1 Werner CA. U.S. Bureau of the Census 2010 Census Briefs. The older population: 2010. November 2011. Available at: http://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf
• 2 Day JC. U.S. Bureau of the Census, Current Population Reports P25–1130. Population Projections of the United States by Age, Sex, Race and Hispanic Origin: 1995 to 2050. Washington, DC: U.S. Government Printing Office; 1996. Available at: http://www.census.gov/prod/1/pop/p25-1130.pdf
• 3 O'Neill G, Barry PP. Training physicians in geriatric care: responding to critical need. Public Policy and Aging Report 2000; 13: 17-21
• 4 Lee AG, Liesegang T. Increasing geriatrics expertise in ophthalmology. Ophthalmology 2002; 109 (4) 635-636
• 5 Centers for Disease Control. National Ambulatory Medical Care Survey Factsheet: Ophthalmology. Available at: http://www.cdc.gov/nchs/data/ahcd/NAMCS_2010_factsheet_ophthalmology.pdf
• 6 Lee AG, Coleman AL. Research agenda-setting program for geriatric ophthalmology. J Am Geriatr Soc 2004; 52 (3) 453-458
• 7 Friedman DS, Lee A. Geriatric ophthalmology. In: LoCicero III J, Rosenthal RA, Katlic MR, Pompei P, eds. A Supplement to New Frontiers in Geriatrics Research: An Agenda for Surgical and Related Medical Specialties. New York, NY: American Geriatrics Society; 2007: 161-180
• 8 Lee AG, Beaver HA. Geriatric ophthalmology. In: Rosenthal RA, Zenilman ME, Katlic MR, eds. Principles and Practice of Geriatric Surgery. New York, NY: Springer-Verlag; 2011: 513-523
• 9 Rosenthal BP. Ophthalmology. Screening and treatment of age-related and pathologic vision changes. Geriatrics 2001; 56 (12) 27-31 , quiz 32
• 10 National Eye Institute. Statistics and Data. Available at: https://www.nei.nih.gov/eyedata
• 11 Congdon N, O'Colmain B, Klaver CC , et al; Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004; 122 (4) 477-485
• 12 Massof RW. A model of the prevalence and incidence of low vision and blindness among adults in the U.S. Optom Vis Sci 2002; 79 (1) 31-38
• 13 International Council of Ophthalmology. International Council of Ophthalmology Residency Curriculum, Low Vision Rehabilitation. 2012. Available at: http://www.icoph.org/dynamic/attachments/curriculum_documents/pdf_doc/updated-ico-residency-curriculum.pdf
• 14 Friedman SM, Gillespie SM, Medina-Walpole AM, Caprio TV, Karuza J, McCann RM. “Geriatricizing” hospitalists: identifying educational opportunities. Gerontol Geriatr Educ 2013; 34 (4) 409-420
• 15 Cantor JC, Baker LC, Hughes RG. Preparedness for practice. Young physicians' views of their professional education. JAMA 1993; 270 (9) 1035-1040
• 16 Blumenthal D, Gokhale M, Campbell EG, Weissman JS. Preparedness for clinical practice: reports of graduating residents at academic health centers. JAMA 2001; 286 (9) 1027-1034
• 17 Drickamer MA, Levy B, Irwin KS, Rohrbaugh RM. Perceived needs for geriatric education by medical students, internal medicine residents and faculty. J Gen Intern Med 2006; 21 (12) 1230-1234
• 18 Hong T, Mitchell P, Burlutsky G, Samarawickrama C, Wang JJ. Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 2014; 55 (11) 7589-7593
• 19 Covinsky KE, Palmer RM, Fortinsky RH , et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003; 51 (4) 451-458
• 20 Klein R, Klein BE, Linton KL, De Mets DL. The beaver eye dam study: visual acuity. Ophthalmology 1991; 98 (8) 1310-1315
• 21 Lord SR, Menz HB. Visual contributions to postural stability in older adults. Gerontology 2000; 46 (6) 306-310
• 22 Lord SR, Dayhew J. Visual risk factors for falls in older people. J Am Geriatr Soc 2001; 49 (5) 508-515
• 23 Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013; 75 (1) 51-61
• 24 Campbell AJ, Robertson MC, La Grow SJ , et al. Randomised controlled trial of prevention of falls in people aged > or =75 with severe visual impairment: the VIP trial. BMJ 2005; 331 (7520) 817
• 25 Sandlin D, McGwin Jr G, Owsley C. Association between vision impairment and driving exposure in older adults aged 70 years and over: a population-based examination. Acta Ophthalmol (Copenh) 2014; 92 (3) e207-e212
• 26 Huisingh C, McGwin Jr G, Wood J, Owsley C. The driving visual field and a history of motor vehicle collision involvement in older drivers: a population-based examination. Invest Ophthalmol Vis Sci 2015; 56 (1) 132-138
• 27 Kempen GI, Ballemans J, Ranchor AV, van Rens GH, Zijlstra GA. The impact of low vision on activities of daily living, symptoms of depression, feelings of anxiety and social support in community-living older adults seeking vision rehabilitation services. Qual Life Res 2012; 21 (8) 1405-1411
• 28 Uhlmann RF, Larson EB, Koepsell TD, Rees TS, Duckert LG. Visual impairment and cognitive dysfunction in Alzheimer's disease. J Gen Intern Med 1991; 6 (2) 126-132
• 29 Potter JF, Burton JR, Drach GW, Eisner J, Lundebjerg NE, Solomon DH. Geriatrics for residents in the surgical and medical specialties: implementation of curricula and training experiences. J Am Geriatr Soc 2005; 53 (3) 511-515
• 30 Lee AG, Chen Y. Structured curricula and curriculum development in ophthalmology residency. Middle East Afr J Ophthalmol 2014; 21 (2) 103-108
• 31 Lee AG, Arnold AC. The AGCME milestone project in ophthalmology. Surv Ophthalmol 2013; 58 (4) 359-369
• 32 Tso MO, Goldberg MF, Lee AG, Selvarajah S, Parrish II RK, Zagorski Z. An international strategic plan to preserve and restore vision: four curricula of ophthalmic education. Am J Ophthalmol 2007; 143 (5) 859-865
• 33 Scott IU, Smiddy WE, Schiffman J, Feuer WJ, Pappas CJ. Quality of life of low-vision patients and the impact of low-vision services. Am J Ophthalmol 1999; 128 (1) 54-62
• 34 The American Geriatrics Society. Existing Formal Geriatrics Competencies and Milestones. Available at: http://www.americangeriatrics.org/health_care_professionals/education/curriculum_guidelines_competencies/existing_formal_geriatrics_competencies
• 35 Reuben DB, Bachrach PS, McCreath H , et al. Changing the course of geriatrics education: an evaluation of the first cohort of Reynolds geriatrics education programs. Acad Med 2009; 84 (5) 619-626
• 36 Christmas C, Park E, Schmaltz H, Gozu A, Durso SC. A model intensive course in geriatric teaching for non-geriatrician educators. J Gen Intern Med 2008; 23 (7) 1048-1052