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AGS Member Volunteer Spokesperson Survey

Name:
Degree:
Position/Title:
Institution:
Phone:
Fax:
Email:


1. Have you had any formal media training in the past?
       Yes      No

If yes, please describe type of training and when you took part in it

 

2. Please indicate the areas of the media which you have experience with
     (check all that apply)

National TV
National Radio
National Print
National Other   
N/A
Local TV
Local Radio
Local Print
Local Other   
   


3. Please indicate the types of interviews that you are willing to participate in with the media
     (check all that apply)

TV
Radio
Email/Written Correspondence
Webcast
Telephone

4. Have you served as an AGS Spokesperson before?
       Yes      No

If yes, please explain

5. Do you presently serve as a spokesperson for any other organizations?
       Yes      No

If yes, which?

 

6. Please indicate the topics which you feel comfortable with serving as an AGS Spokesperson for.
(check all that apply)

General Principles of Aging

demography of aging
biology of aging
psychosocial aspects of aging
pharmacology
legal and ethical issues
health care finance

Approach to the Older Patient

hospital-based and community-based geriatric care
nursing home care
geriatric assessment
preventive geriatrics
physical activity
rehabilitation
palliative care
complementary and alternative medicine

Geriatric Syndromes

Dementia
Delirium
urinary incontinence
hearing loss
vision impairment
malnutrition
eating and feeding problems
osteoporosis and osteomalacia
falls and gait disturbances
dizziness and syncope
pressure ulcers
sleep disorders

Geriatric Psychiatry

depression and other mood disorders
anxiety disorders
psychotic disorders
personality/somatoform disorders
substance abuse
mental retardation

Common Geriatric Diseases, Disorders, and Health Care Concerns

cardiovascular diseases/disorders
hypertension
musculoskeletal diseases/disorders
back pain
diseases/disorders of the foot
neurologic diseases/disorders
infectious diseases
respiratory diseases/disorders
oral diseases/disorders
gastrointestinal diseases/disorders
endocrine/metabolic disorders
diabetes
hormone replacement therapy
gynecologic diseases/disorders
disorders of sexual function
hematologic diseases/disorders
oncology
renal diseases/disorders
prostate disease
dermatologic diseases/disorders

7. Many times media requests are not only for an expert on a particular subject, but also for a patient/caregiver story as well. Please indicate if you have patients or caregivers who you think would be willing to assist us .
(we will follow up with you for further information if you answer yes to this question)
       Yes      No