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In gerontology and geriatrics, learning often requires both the acquisition of new facts and a change in attitude towards elderly persons. Games, in addition to stimulating a desire to learn, are powerful instruments to change attitudes. This paper introduces games currently being used by the Gateway Geriatric Education Center to teach gerontological and geriatric principles to healthcare providers. It summarizes assessments that have been used to measure the effectiveness of those games to promote learning. Arguments are made that more rigorous methodologies of evaluation for games should be adopted in order to demonstrate the effects of that learning on improved patient outcomes. [ABSTRACT FROM AUTHOR]

Frail elders living alone or in long-term care settings are particularly vulnerable to bioterrorism and other emergencies due to their complex physical, social and psychological needs. This paper provides an overview of the recent literature on bioterrorism and emergency preparedness in aging (BTEPA); discusses federal initiatives by the health resources and services administration (HRSA) to address BTEPA; describes the collaborative efforts of six HRSA-funded geriatric education centers (GECS) to develop BTEPA geriatric curricula and training; and offers recommendations for BTEPA education and training, clinical practices, policy, and research. The GEC/BTEPA collaboration has produced model curricula, including emergency planning for diverse groups of older persons; enhanced networking among stakeholders in a fast paced environment of information sharing and changing policies; and developed interdisciplinary educational resources and approaches to address emergency preparedness for various settings in the elder care continuum. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic disproportionately affected populations served by Federally Qualified Health Centers (FQHCs), with high morbidity and mortality rates in ethnic minority older adults. In response to this pandemic, academic geriatric medicine teams through federally funded Geriatric Workforce Enhancement Program (GWEP) with FQHC partnership implemented new initiatives to improve the care for vulnerable older adults. Objectives: To describe how four FQHC/GWEP teams collaborated in caring for diverse communities of older adults during the pandemic. Methods: Four GWEPs have addressed pandemic response efforts with their respective FQHC partners. These collaborations to meet the increasing numbers of older adults seeking services, and the rising disparities exacerbated during the pandemic are delineated. Results: FQHC/GWEP partnerships enabled access to care, whether in-person or virtually to serve unmet needs of underserved older adults during the pandemic. Partnerships promoted COVID-19 education, testing, and vaccinations. Most FQHCs faced severe staffing shortages, and the digital divide challenged patients with barriers. GWEPs provided direct care, created educational materials, and developed telehealth programs. These partnerships addressed social determinants of health gaps caused by the pandemic. Conclusion: The findings demonstrate that strong partnerships between GWEPs and FQHCs mitigate health inequities for vulnerable ethnic minority and rural older adults during pandemic crises., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

The US Department of Health and Human Services and the Foundation for the National Institutes of Health, through private sector support, sponsored the National Research Summit on Dementia Care: Building Evidence for Services and Supports (Summit) in 2017. Various workgroups were asked to address topics of interest in dementia care and develop recommendations addressing the goals of the Summit. Workforce education and training was identified to be a key issue. As a result, a Workforce Development Workgroup (the Workgroup) was created and addressed two of the Summit's goals. The first goal is to improve the quality of care and support provided to persons living with dementia and those who care for them. The second goal is to accelerate the development, evaluation, translation, implementation, and scaling-up of evidence-based and evidence-informed services for persons living with dementia, their families, and caregivers. In this article, the Workgroup identified gaps in educating and training a dementia-capable workforce. The Workgroup consisted of an interprofessional team with expertise in dementia workforce development from academia, professional organizations, and the federal government. Four recommendations are presented concerning research topics that will advance the education and training of a dementia-capable workforce, which includes health professions students, faculty, practitioners, direct care workers, persons living with dementia, and those who care for them. J Am Geriatr Soc 68:625-629, 2020., (© 2020 The American Geriatrics Society.)

In the July 2016 issue of this journal, Dr. Mary Tinetti proposed that geriatric medicine abandon attempts to increase the numbers of board-certified geriatricians and change focus to the development of a "small elite workforce." What would be gained and what sacrificed by accepting this challenge? We agree that the best clinical use of a scarce resource, specialty trained geriatricians, is to care for frail, complex, severely ill elderly adults and to help design and study novel interventions in research, education, and care models to improve the care of all older adults, but for this to happen, all other providers must attain specific competency in the care of older adults. This article responds and discusses alternative pathways for teaching geriatrics care, training specialists, and geriatrics fellows., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Reciprocal relationships based on mutual goals, respect and trust are key to maintaining working relationships and getting reliable research results. Yet relationship building is not a concept taught in academia. These skills are often learned the hard way, with singular solutions found for case-by-case scenarios. Several journeys to identify the components, barriers and rewards of reciprocal relationships are discussed.

A support group, focused on sports memories, provided a nonpharmalogic intervention to help maintain cognitive function and improve quality of life for patients with dementia and depression., Competing Interests: Author disclosures The author reports no actual or potential conflicts of interest with regard to this article.

Objective: The Veterans Affairs Saint Louis University Mental Status (SLUMS) examination is a screening tool that has the sensitivity to detect mild neurocognitive impairment and dementia. This study explores patients' cognitive impairment trajectories based on the SLUMS examination score changes after 7.5 years., Design: Retrospective chart review., Setting: The Geriatric Research, Education, and Clinical Center at the Department of Veterans Affairs Medical Center (VAMC), St Louis, MO., Participants: A review of 533 charts indicated that 357 patients who had participated in the SLUMS examination validation study in 2003 were still alive., Measurement: Charts were screened for indicators of cognitive status in both 2003 and 2010 and interventions after baseline evaluation., Results: The mean age of the 357 individuals in 2003 was 74, all were men, and 73% had a high school education or more. A total of 223 (62%) of the 357 completed the SLUMS examination at baseline and at the 7.5-year follow-up visit; of those, 33 (15%) progressed to mild cognitive deficit, 20 (9%) progressed to severe cognitive deficit, and 53 (24%) improved or reverted back to normal. Further exploration revealed that at least one reversible cause was identified for most (n = 36/53, 68%) of the reversions. The primary interventions that differentiated reversers from nonreversers were correction of visual loss (P = .005) and discontinuation of anticholinergic medications (P = .002)., Conclusion: Cognitive improvement (reversion) as indicated by the SLUMS examination after 7.5 years was associated with the correction of some reversible causes. This stresses the importance of early detection and exclusion of reversible causes for persons screened for cognitive dysfunction using the SLUMS examination., (Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.)

Objectives: To compare the ability of the Veterans Affairs Saint Louis University Mental Status (SLUMS) examination to detect mild cognitive impairment (MCI) and dementia according to the Clinical Dementia Rating Scale (CDR) with that of two other well-known screening instruments, the Montreal Cognitive Assessment (MoCA) and the Short Test of Mental Status (STMS)., Design: Cross-sectional validation study., Setting: Saint Louis Veterans Affairs Medical Center Geriatric Research Education and Clinical Center., Participants: Veterans aged 60 and older (median 78.5) with a high school education or more (n = 136)., Measurements: Participants were administered the SLUMS examination, the MoCA, and the STMS in random order. A blinded test administrator administered the CDR in a separate session. Receiver operating characteristic (ROC) curves were used to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SLUMS examination, the MoCA, and the STMS for MCI, dementia, and MCI or dementia. ROC contrasts were used to statistically compare the area under the ROC curve (AUC) for the screening tests' ability to detect cognitive dysfunction according to the CDR., Results: ROC contrasts demonstrated that the AUCs for detecting MCI (SLUMS examination 0.74, MoCA 0.77, STMS 0.77), dementia (SLUMS examination 0.98, MoCA 0.96, STMS 0.97), and MCI or dementia (SLUMS examination 0.82, MoCA 0.83, STMS 0.84) were equivalent. Sensitivity, specificity, PPV, and NPV were similar across measures of MCI, dementia, and MCI or dementia according to the CDR., Conclusion: The SLUMS examination has validity similar to that of the MoCA and STMS for the detection of MCI, dementia, and MCI or dementia according to the CDR., (© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.)

Reminiscence therapy for persons with dementia improves socialization and quality of life. Herein we report the development of reminiscence groups based around memories of professional baseball. Preliminary feedback suggests that this can be a successful approach to enhancing quality of life for persons with mild to moderate dementia., (Copyright © 2014 American Medical Directors Association, Inc. All rights reserved.)

The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics and gerontology and in quality improvement (QI) and support to implement a local QI project; in addition, elective options include webinars, audio conferences, clinical practica, and mentoring. The program is effective in improving core competencies in geriatrics and in improving clinical care for older Veterans who receive health care in rural clinics.

The scope of geriatrics-related educational offerings in large health care systems, in either the target audiences or topics covered, has not previously been analyzed or reported in the professional literature. The authors reviewed the geriatrics-related educational sessions that were provided between 1999 and 2009 by the Geriatrics Research, Education, and Clinical Centers (GRECCs) and the Employee Education System (EES) of the United States' largest integrated health care system, the Veterans Health Administration (VHA). Using records of attendance and content at local training events and regional and national conferences, the authors estimated the number of attendees in different health disciplines and the number and types of lectures. During the past 11 years, GRECCs and EES provided geriatric-related educational sessions to about one third of a million attendees, most of them nurses and physicians, in about 15,000 lectures. About three-fourths of the educational events occurred through local, rather than regional or national, events. Lectures covered a wide variety of topics, with a particular emphasis on dementia and other mental health topics. A comparison of the number of potential learners in VHA with the number of geriatric-related educational presentations over this time period yields an average of one offering per VHA provider every 3 years; most providers likely never received any. Since 1999 the GRECCs have been the dominant source for geriatrics-related education for VHA health professionals, but given that about one half of VHA patients are older than age 65, there is still a large unmet need to provide geriatric education to VHA providers. Examination of the GRECC resources that have been put to use in the past to develop and deliver the face-to-face education experiences described sheds light on the magnitude of resources that might be required to address remaining unmet need in the future, and supports the prediction that there will need to be increasing reliance on distance learning and other alternatives to face-to-face educational modalities.

Clinicians experience great pressures to provide timely, effective, and evidence-based medical care. Educators can aid these clinicians through the development of new tools that can facilitate timely completion of clinical tasks. These tools should summarize evidence-based information in a convenient format that allows easy use. This article describes one process in which a group of Geriatric Research, Education, and Clinical Center educators identified an area where important new information accrued, their development of a new clinical and teaching tool for imparting the new information, the initial dissemination of the tool to a preliminary target audience, and the initial evaluation of the new tool to determine how to improve its distribution and use beyond the original target audience.

Gerontology and geriatrics are interdisciplinary professions. The quality of the care and services provided by the members of these professions depends upon the strength and integrity of the partnerships between the professionals working together. This article summarizes the partnerships created by the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers. This myriad of partners has formed the basis of successful programming to improve clinical care, to expand research projects, and most specifically, to produce educational opportunities in geriatrics and gerontology that have the potential to improve the quality of life for older Veterans.

Elderly diabetic persons are 1.5 times more likely than age-matched nondiabetic persons to develop vision loss and blindness. Annually, between 12,000 and 24,000 diabetic patients in the United States become legally blind because of complications caused by diabetic retinopathy. Even more diabetic persons experience vision loss caused by comorbid ocular and periocular conditions such as dry eye syndrome, cataracts, macular degeneration, and glaucoma. This article discusses the synergy between these conditions and diabetes. Standards of care that slow the progression of vision loss and exciting new research on new strategies of care that may reverse vision loss are presented.

Context: The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to detect dementia. However, it performs poorly in identifying persons with mild neurocognitive disorder. The Saint Louis University Mental Status (SLUMS) examination is a 30-point screening questionnaire that tests for orientation, memory, attention, and executive functions., Objective: The objective of this study was to compare SLUMS and the MMSE for detecting dementia and mild neurocognitive disorder (MNCD) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria., Methods: Patients at the Veterans' Affairs Geriatric Research, Education and Clinical Center, St. Louis, MO (N = 702) were clinically classified as having normal cognitive functioning, MNCD, or dementia based on DSM-IV criteria. The SLUMS and MMSE were administered for comparison., Results: Mean age was 75.3 years (standard deviation: 5.5). Regarding education, 62.4% of the sample had at least completed high school and 30.6% had not. Sensitivity and specificity were calculated and receiver operator curves (ROCs) generated for SLUMS and MMSE as a function of diagnosis (MCND versus dementia) and education. Both the SLUMS and MMSE produced acceptable ROCs for the diagnosis of dementia, but the ROCs for SLUMS were better than the MMSE for the diagnosis of MNCD in both education groups., Conclusion: These results suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. Although the definition of MNCD is controversial, the authors believe that the SLUMS is possibly better at detecting mild neurocognitive disorder, which the MMSE failed to detect, but this needs to be further investigated.

Goodhill (1993) has recently suggested that the spacing of ocularity domains in visual cortex is not solely an intrinsic property of cortex, but is determined, at least in part, by the degree of correlation in the activity of the two eyes. In support of this model, Löwel (1994) has shown that strabismus, which decorrelates the activity of the two eyes, increases the spacing of ocular dominance columns in area 17, but not area 18, of the cat. As a further test of Goodhill's model, in this paper we examine the effects of another rearing procedure that decorrelates the activity of the two eyes, namely alternating monocular exposure (AME). Cats were reared either normally (9 cats) or with AME (21 cats). We labeled their ocularity domains by one of three methods: ocular dominance columns by 2-deoxyglucose (14 cats), and ocular dominance patches by transneuronal transport (14 cats), or by injections of tracer into single layers of the lateral geniculate nucleus (LGN; 2 cats). The spacing of ocular dominance was 11% greater in the AME cats than in the normal cats (0.976 vs. 0.877 mm). These results are similar to those previously reported for strabismic cats, although the effect is less striking. We thus confirm that decorrelating the activity of the two eyes increases the spacing of cortical ocularity domains. Our results further suggest that the degree of decorrelation affects the extent of that increase.

The antibody H386F revealed microglia in the retinae of several species: owl monkey, slow loris, galago, ferret, raccoon, and tree shrew. The shape, size, and density of labeled microglia were identical to those labeled by OX-42 and OX-41, two antibodies specific for microglia, in both galago and owl monkey. The labeled microglia varied little in retinal location. There was remarkably little variability in density, shape, number, and size of the labeled microglia between species. All labeled microglia were evenly distributed across, but restricted to, the nerve fiber layer. Possible reasons for this restriction in location are discussed.

This paper describes changes in the appearance and distribution of microglia in postnatal cat retina as demonstrated by a new antibody, H386F. This fractionated IgM antibody was created via an intrasplenic immunization of a single BALB/C mouse with about 2-3 x 10(5) large, whole cells isolated from 46 minced cat retinae. To confirm that the labeled cells are microglia, the staining properties of H386F were compared with those of four commercially available antibodies, OX-33, OX-41, OX-42, and ED-1, that have been used by others to distinguish between microglia and other cells in rat brain. These experiments show that H386F is the only antibody of the five to label only microglia in both the cat retina and hippocampus.

The present study tested the hypothesis that nondominant-eye influences on lateral geniculate nucleus (LGN) neurons affect the processing of spatial and contrast information from the dominant eye. To do this, we determined the effects of stimulating the nondominant eye at its optimal spatial frequency on the responses of LGN cells to sine-wave gratings of different spatial frequency and contrast presented to the dominant eye. Detailed testing was carried out on 49 cells that had statistically significant responses to stimulation of the nondominant eye alone. Spatial-frequency response functions to nondominant-eye stimulation indicated that the responses were spatially tuned, as reported previously (Guido et al., 1989). Optimal spatial frequencies through the nondominant eye were significantly correlated with the optimal spatial frequencies through the dominant eye (r = 0.54; P less than 0.0001), and the optimal spatial frequencies were fairly similar for the two eyes. Nondominant-eye stimulation changed the maximal amplitude of the fundamental (F1) response to dominant-eye stimulation for only about 45% (22 of 49) of the cells that responded to nondominant-eye stimulation alone. The response vs. contrast function through the dominant eye was altered for 73% of the cells (51% independent of spatial frequency). Three types of effects were observed: a change in the initial slope of the response vs. contrast function (contrast gain), a change in the response amplitude at which saturation occurred, or an overall change in response at all contrasts. The incidence of these changes was similar for X and Y cells in LGN layers A, A1, and C (only four W cells were tested). Nondominant-eye stimulation had little or no effect on the sizes or sensitivities of the receptive-field centers or surrounds for the dominant eye. In addition, nondominant-eye stimulation had little or no effect on optimal spatial frequency, spatial resolution, or the bandwidth of spatial-frequency contrast sensitivity curves for the dominant eye. Possible functions of binocular interactions in the LGN are considered. The present results suggest a role in interocular contrast-gain control. Interocular contrast differences can occur before the acquisition of binocular fusion, when the two eyes are viewing different aspects of a visual stimulus. Psychophysical and physiological studies suggest that an interocular mechanism exists to maintain relatively constant binocular interactions despite differences in interocular contrast. The present results suggest that at least part of this mechanism occurs in the LGN.