College of Medicine

Older Americans are steadily becoming more dominant in the population, and nowhere is the pace increasing faster than in Florida. By 2040, the Sunshine State is expected to have almost 7 million older adults, with more than 1.2 million of those age 85 or older.
 
The Department of Geriatrics at the Florida State University College of Medicine continues to lead efforts to reshape health care to serve older patients’ unique needs. It was recently awarded a five-year, $5 million grant from the federal Health Resources and Services Administration (HRSA).

HRSA’s Geriatrics Workforce Enhancement Program (GWEP) funds only two programs in Florida, and this is the third grant for the FSU-based North and Central Florida GWEP (NCF-GWEP) since its inception in 2015. Florida has the highest percentage of older adults of any state in the U.S., and the number of older adults moving to Florida from other states continues to increase.

“Nationally, geriatrics experts have been putting their heads together, knowing there will never be enough geriatricians to go around, to find out ‘What are we asking all health care services to do related to care of older adults?’” said Professor Lisa Granville, M.D., a nationally renowned geriatrician, chair of the College of Medicine’s Department of Geriatrics and principal investigator.

What resulted was the concept of an age-friendly health system, of which a key component is incorporating the 4M’s: What Matters Most to older adults; Medication; Mobility; and Mentation, or mind health.

Through partnerships across the health care professions as well as with community, state and national organizations, GWEP specifically focuses on developing age-friendly health systems and dementia-friendly communities by training the geriatrics workforce and community to better meet the needs of older adults. The Geriatrics Department in the College of Medicine is uniquely positioned to coordinate and lead this effort; part of the college’s mission is to train exemplary physicians to provide patient-centered care for the underserved, particularly elder, rural and minority residents.

“When you agree to be age-friendly, you put into place systems where you are diligent about addressing all four of those M’s,” Granville said. “You may have screening systems in place where you are routinely asking older adults, ‘Have you fallen in the last year or since our last visit?’”

Falling is the fifth leading cause of death for older adults, she said. “Many people don’t realize that half of older adults who fall can’t get back up by themselves, and it’s not because they were injured necessarily; it can be limited strength and flexibility that existed before the fall.”

Other processes may screen for cognitive impairment, depression, identify opportunities to reduce medications and other ways to improve quality of life. A goal is to avoid health care related harms an older patient may be more vulnerable to.
 
The most recent grant is funding four projects, which among them have about a dozen programs and partnerships:

•    Dementia outreach expansion and supportive care worker training through statewide partnerships with state agency initiatives. Individual programs include dementia sensitivity training for transportation providers, rural-focused planning for dementia-friendly programming, family care partner education and outreach, and training opportunities for health care professionals.
•    Career advancement for supportive care workers and nurses. Programs include specialized training for certified nursing assistants (CNAs), medical assistants and undergraduate nursing students in health care issues of older patients, developing a geriatrics certificate pathway for hospice CNAs, creating a 4Ms geriatrics care curriculum for nursing students and medical assistants, and developing a post-baccalaureate geriatrics nursing certificate.
•    The next phase of transforming federally qualified health centers into age-friendly health systems, which was started with previous HRSA grant cycles beginning in 2015. Programs emphasize the 4Ms of geriatric patient-centered care across all levels of staff with environmental enhancements. Data collection identifies care gaps and monitors improvements, trainings focus on evolving needs of longer-lived populations, and specific quality improvement initiatives will occur. Another goal is to connect partnering clinics with outside resources to increase access to services and supports for older adults. 
•    Enhanced longitudinal geriatrics training for physician assistant (PA) students, family medicine residents and post-doctoral psychology fellows during their formative training, to ensure they have the skills to help fill the gap of trained clinicians to care for geriatric patients over the continuum of care and respond accordingly.
 
The FSU College of Nursing is one of the partners in the project to train nurses. Assistant Dean Steven J. Palazzo, Ph.D., agreed that Florida faces an urgent need for skilled geriatric care.

"By integrating 4M's geriatric training into Bachelor of Science Nursing programs, we can equip future nurses to provide high-quality, compassionate care to older adults,” he said. “A post-baccalaureate certificate in geriatrics will further empower students with specialized skills, positioning them as leaders in transforming long-term care systems for seniors across the state."

One of the community-based partners is PanCare of Florida, a non-profit with 16 Federally Qualified Health Center locations in North Florida, 12 of which are primary care medical clinics. The College of Medicine team will work with PanCare to transform its clinics into age-friendly sites, beginning with its largest clinic, located in Panama City, and eventually reaching all of them.
 
“It’s really beyond training,” said Nicolette Castagna, LMHC, MPH, CDP NCF-GWEP community engagement and health systems manager within the Department of Geriatrics. “We’re building relationships with their leadership and getting to know their providers and staff, and together we’re basically looking at what is the experience of the older patient. We’re helping their staff to see that a little more clearly.”
 
The work funded by the grant is being coordinated under the umbrella of Resources & Education for Aging, Community and Health (REACH). For more information, visit its website at reach.med.fsu.edu.

Contact Audrey Post at audrey.post@med.fsu.edu

Photo Caption: The Geriatrics Grant Oversight Team, from left, Professor Lisa Granville, M.D., principal investigator; Nicolette Cartagna, LMHC, MPH, CDP, NCF-GWEP community engagement and health systems manager; Professor Paul Katz, M.D., co-principal investigator; and Tiffany Holcomb, MSW, GWEP coordinator. Not pictured, LaVon Goodwin, M.S. program manager.