ST. LOUIS - Funded by a three-year, $2.5 million grant from the U.S. Department of Health and Human Services, Saint Louis University will lead an initiative to improve the health of older Missourians by training primary care health providers in geriatrics. SLU will receive $843,000 the first year.
SLU has recruited two other universities, a rural hospital, a hospital system, two federally-qualified community health centers, a senior center and a health non-profit to join in an ambitious plan that addresses the significant shortage in underserved urban and rural areas of health care professionals who know how to care for older adults. The project will involve professionals and students in geriatric medicine, geriatric psychiatry, nursing, social work, physical therapy, occupational therapy and interprofessional education.
"Providing the care our older adults deserve is a huge challenge that requires the commitment of many different professionals from many institutions," said John Morley, M.D., director of geriatric medicine at Saint Louis University and the project's director.
"As our state has significant shortages of primary care health professionals and rapidly increasing numbers of older adults, we must act now to train primary care professionals how to conduct screenings, assessments and interventions to improve the health of those who are elderly. I'm energized that so many organizations and people are joining SLU in bringing life to a plan that will improve the quality of life for aging Missourians."
Leading a Team
Collaborative partners include A. T. Still University Osteopathic Medical School/Missouri Area Health Education Center in Kirksville and Perry County Memorial Hospital. University and community partners are Washington University in St. Louis, SSM Health, Myrtle Hilliard Davis and John C. Murphy Health Centers, Northside Youth and Senior Service Center and the St. Louis Alzheimer's Association.
The grant to SLU is funded through the Health Resources and Services Administration (HRSA), the main federal agency in the Department of Health and Human Services charged with improving health care for those who are uninsured, isolated or medically vulnerable.
Slightly more than a quarter of the institutions that submitted applications for federal funding received it. The project is one of 44 Geriatric Workforce Enhancement Programs in the U.S. and one of two in HRSA region VII, which includes Missouri, Iowa, Kansas and Nebraska.
The initiative targets underserved areas: urban north St. Louis city and county and rural Perry County and an eight county region in northeast Missouri, where the impact of the shortage of health care providers who understand the special needs of geriatric patients is amplified.
Graying of Missouri
Older adults comprise a larger proportion of Missouri's population than in the greater United States. In 2011, 14.2 percent of Missourians were older adults, compared to 13 percent of U.S. residents. By 2030, the percentage of elderly Missourians is expected to increase to 21 percent, compared to 19 percent in the U.S.
"To keep pace with the growth of the older adult population who often have multiple health problems and complex conditions that require more medical care, the number of primary care providers needs to increase by 34 percent," said Marla Berg-Weger, Ph.D., LCSW, professor of social work at SLU and co-project director. "With 40 percent of the state's population living in rural areas and only 25 percent of physicians practicing in these areas, the need for a well-trained geriatric workforce is at a crisis point."
Further, because the number of geriatric practitioners is insufficient to care for our growing number of older adults, developing geriatric evaluation teams is essential for the health and quality of life of our aging population.
Tackling from many angles
The project, which is called the Gateway Geriatric Education Center Workforce Enhancement Program, attacks the problem on multiple fronts by:
- Educating about 1,100 health care students and providers on a team-approach that brings together professionals from multiple health disciplines to best care for older adults
Health professions students and those who provide care at the senior center, health centers and rural physician practices will be trained to work in interprofessional teams as they conduct physical and cognitive screenings, assessments and provide interventions. Students and care providers will learn to use screening tools, including many created at Saint Louis University, to detect cognitive impairment, frailty and caregiver stress. They also will learn to deliver cognitive stimulation therapy, which is a non-pharmaceutical intervention for people with dementia that stimulates socialization, conversation and memory; a simple exercise program to restore muscular function; and support and resource information to caregivers of those who have dementia.
Training sites for the first year of the grant include Myrtle Hilliard Davis Comprehensive Health Center, Northside Youth and Senior Service Center and SLU's Health Resource Center, a free clinic run by SLU medical students in north St. Louis; John C. Murphy Health Center in north St. Louis County; A.T. Still University, Truman State University and Missouri Area Health Education Center in northeast Missouri; and Perry County Memorial Hospital in Perry County. Training sites will be expanded to include SSM Health locations in St. Louis, Mexico, Audrain and Maryville the subsequent two years.
- Designating three faculty members from universities in Missouri annually as Geriatric Leadership Scholars who will receive specialized training and mentoring
Scholars will receive salary support and travel funds to attend a national geriatric conference; complete a capstone project that focuses on research, patient care or education; and work with students in the clinical training program.
- Training 5,000 patients, family members and care providers to improve quality of life by becoming healthier
The Geriatric Leadership Scholars and St. Louis Alzheimer's Association will partner to create a lecture series on general geriatric issues, dementia, mild cognitive impairment and caregiver support to be delivered in one-on-one consultations, group sessions and online.
- Teaching 220 health care professionals how to deliver a non-drug treatment for Alzheimer's disease and related disorders called Cognitive Stimulation Therapy
Developed in the U.K., cognitive stimulation therapy is a low-cost, non-pharmaceutical intervention for those who have dementia that has been proven to be effective. The themed seven-week support group engages and stimulates those who have dementia. It will be taught at all training sites that are part of the project and to nursing, social work, occupational therapy, medical, communication disorders and exercise science students.
Building on success
The new project builds on the strengths of SLU's Gateway Geriatric Education Center, which had been funded by HRSA for 22 years to develop cutting edge education for current and future geriatric professionals. The Gateway GEC has trained tens of thousands of public groups, students and professionals across the region and country.
"We know this community very well, and the grant allows us to deepen and extend our previous impact with a new, broader focus," says Berg-Weger. "Through our work in the primary care clinical setting, we will be able to reach a larger number of students, professionals, direct care workers, older adults and their support networks."
Morley said faculty, collaborating and community partners and other universities enthusiastically accepted the invitation to participate in the new initiative.
"They're excited to work with us to deliver quality care for older persons and develop human relationships for care and healing," Morley said. "Our new project presents an opportunity to make transformative change in geriatric care and education."
Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: infectious disease, liver disease, cancer, heart/lung disease, and aging and brain disorders.