About the Advanced Concepts Curriculum

Concepts in Geriatric Care is a series of self-administered online modules designed to expand the knowledge of advanced practice nurses concerning the growing population of "over 65" persons in the U.S and their primary health care needs. The modules focus on the unique characteristics that underlie needs of the elderly, as well as lessons in problem-solving for nurse practitioners and other nurses who provide primary care for our older adults.

The modules present demographic data describing our elderly population, relevant psychosocial and cultural characteristics, financial aspects of health care affecting the aging society, health assessment specific to older adults, ethical issues related to elders, interdisciplinary approaches to the provision of health care for elderly clients, and clinical management of selected common health problems of older adults. In addition to presenting key concepts in these areas, the modules utilize scenarios of elderly clients to illustrate the application of these concepts and engage learners. Online references, periodic self-assessment quizzes, and guided problem-solving are also included to enrich the learning process. Each module concludes with a post-test that may be submitted in order to receive Continuing Education Units for successful completion of that component.

Objectives:
Completion of the modules in the Advanced Geriatric Concepts for Primary Care curriculum will enable the advanced practice nurse to:

1. Apply to health care decisions current and projected demographic and socio-cultural characteristics of older individuals and the geriatric population.
2. Analyze how the increasing older population influences health care systems and nursing practice.
3. Demonstrate relevant health care decisions based on knowledge of current health care policies and their influence on access to health care resources.
4. Adapt health assessment of older adults to meet their needs and to identify special pertinent findings characteristic of this population.
   1. Analyze common normal age changes and pathology.
   2. Identify own prejudices, as well as myths of aging commonly related to senior care and their families.
   3. Utilize established tools to assess the functional status (physical, cognitive, psychosocial) of older adults.
5. Identify competencies needed by Advanced Practice Nurses as a member of an interdisciplinary team providing effective primary care.
6. Plan, and evaluate effective primary care approaches for older adults.
   1. Apply knowledge of common geriatric syndromes and their effect on health care decisions.
   2. Modify primary care decisions to recognize that changes occurring with aging influence the presentation of acute and chronic problems as well as treatment modalities.
   3. Adapt teaching strategies to meet the needs of older adults, based on an understanding of the physical, cognitive, and psychosocial changes that occur with age.
   4. Incorporate into patient care the support needed by families and others who are caretakers of dependent seniors
   5. Apply research findings regarding geriatric primary care to patient decisions.
7. Apply ethical principles to patient situations involving dilemmas about decisions needing principled consideration.

Continuing Education (CE) credit will be offered for completion of this self-paced online curriculum.

Curricular Modules

Eight modules are included the Advanced Concepts Curriculum:

Growing Needs of the Geriatric Population: See the Module 1 Overview
Provision of effective health care necessarily depends on knowledge about the individual client and his or her relevant needs. Elderly persons in this country have the same basic needs as other members of the populace, but have distinctive requirements for health care which differ in end goals, as well as quantity and type of health problems experienced.

This introductory module provides foundational concepts and information for a broad understanding of the geriatric population:

• Highlights demographic and socio-cultural characteristics;
• Includes statistics on longevity and disease/disability patterns relative to primary health;
• Delineates the most common health conditions experienced by older adults;
• Explains social theories of aging and their relevance to the provision of primary health care of older patients;
• Analyzes special health care needs of older adults;
• Describes unique health assessment needs; physiologic changes associated with aging and the associated health risks, as well and the impact of these changes on health assessment and interpretation of assessment results; and,
• Provides selected tools for functional assessment: when and how to use the tools;

Short appraisals throughout the module assist the learner with self-evaluation.

Financing Health Care for the Elderly: See the Module 2 Overview
As a nurse, you are expected to help your elderly clients achieve their health care goals through the provision of high quality, cost-effective health care. To achieve this goal, it is necessary to have a basic understanding of health care economics and health care finance, and more specifically, with the unique health care resources available to and accessible by the elderly in this country.

This module presents a range of information about health care economics and finance in four parts.

• The first portion provides an overview of healthcare economics; how health care is financed in this country and basic fiduciary concepts related to insurance and reimbursement;
• The second segment examines how the elderly pay for health care in this country with special attention given to Medicare, Medicaid, and managed care insurance options. Gaps and overlaps in coverage are examined;
• The third area examines the settings in which elderly receive long term health care in this country with special attention given to skilled nursing facilities, community care settings, and care within the home; and,
• The final section examines current health care policies and proposed legislation affecting elderly individual's access to and consumption of health care resources. Issues related to reimbursement for advanced practice nurses are examined.

A patient scenario is discussed, illustrating common patient financial problems in relation to health care.

Ethical Practice in Eldercare See the Module 3 Overview
All nurses, and particularly those who are advanced practice nurses, are on the frontline of patient care issues. This is especially true when we speak of eldercare. However, one area in which nurses may not be well prepared is how to cope with the ethical concerns that arise as they care for their patients, and special issues and decisions that are imperative for our older clients.

The purpose of this module is to provide the advanced practice nurse, and all professional nurses, with a basic knowledge of ethical theories and principles as well as resources available to assist when ethical concerns arise in their practice with the elder patient. The unit includes:

• Terminology and concepts of ethics in order to give you the necessary vocabulary and knowledge to take part in ethical discussions;
• Basic ways of thinking about health care ethics;
• The role of the nurse in ethical conflicts;
• Guidelines and models for approaching ethical concerns;
• Resources on ethical issues; and,
• Case studies that will provide practice with ethical concerns.

The Development and Support of Interdisciplinary Teams See the Module 4 Overview
The development and support of interdisciplinary health care teams has received growing attention over the past two decades. It has become increasingly evident that "no one discipline possesses all the skills and knowledge necessary for providing care that patients require in a multifaceted system serving complex health care problems" (Lewis et al., 1998, p. 89). Interdisciplinary teams have been found to be particularly effective in dealing with the management of complex chronic illness, and therefore have become extremely common in geriatric health care (Fulmer & Abraham, 1998; Powers et al, 2000).

This module identifies the following interdisciplinary competencies that are needed for effective interdisciplinary team functioning:

• Understanding the value of interdisciplinary teams (IDT) in the care of older adults;
• Ability to analyze team dynamics and the roles of team members;
• Interpersonal strategies for working with an interdisciplinary team effectively;
• Awareness of the roles of Advanced Practice Nurses in IDT care;
• Ability to adapt the team to individual patient needs by appropriate selection of team members and referrals; and,
• Ability to formulate an IDT care plan.

Scenarios of actual team meetings are incorporated into the module to provide role modeling of concepts.

Management of the Elderly Patient, 4 Modules See the Module 5 Overview (Module 5 is the first of the 4 Health Management Modules)
These four modules use a case-based approach to care of older clients with common diagnoses. Each module presents a client problem for student guided problem-solving. The cases integrate and apply the following clinical information to the solution of the geriatric health problems:

• Epidemiology/Risk Factors;
• Pathophysiology;
• Presenting signs and symptoms;
• Differential diagnosis;
• Diagnostic Approaches and their rationale;
• Management-inclusive of pharmacologic and non pharmacologic intervention strategies; guidelines for consultation and referral; appropriate utilization of available community resources, selection of therapeutic interventions based on life-style values and economic abilities of pt/family without compromising quality of care.
• And, Patient/family education approaches.

Case scenario(s) will guide the learner through the clinical reasoning process, while emphasizing the variances arising from the aging process.