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Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree

Developed with support from the American Geriatrics Society

Domain #1: Health Promotion and Safety

  1. Advocate to older adults and their caregivers interventions and behaviors that promote physical and mental health, nutrition, function, safety, social interactions, independence, and quality of life. 
     
  2.  Identify and inform older adults and their caregivers about evidence-based approaches to screening, immunizations, health promotion, and disease prevention. 

  3. Assess specific risks and barriers to older adult safety, including falls, elder mistreatment, and other risks in community, home, and care environments. 

  4. Recognize the principles and practices of safe, appropriate, and effective medication use in older adults. 

  5. Apply knowledge of the indications and contraindications for, risks of, and alternatives to the use of physical and pharmacological restraints with older adults. 

Domain #2: Evaluation and Assessment 

  1. Define the purpose and components of an interdisciplinary, comprehensive geriatric assessment and the roles individual disciplines play in conducting and interpreting a comprehensive geriatric assessment. 

  2. Apply knowledge of the biological, physical, cognitive, psychological, and social changes commonly associated with aging. 

  3. Choose, administer, and interpret a validated and reliable tool/instrument appropriate for use with a given older adult to assess: a) cognition, b) mood, c) physical function, d) nutrition, and e) pain. 

  4. Demonstrate knowledge of the signs and symptoms of delirium and whom to notify if an older adult exhibits these signs and symptoms. 

  5. Develop verbal and nonverbal communication strategies to overcome potential sensory, language, and cognitive limitations in older adults. 

Domain #3:  Care Planning and Coordination Across the Care Spectrum (Including End-of-Life Care)

  1. Develop treatment plans based on best evidence and on person-centered and directed care goals.  

  2. Evaluate clinical situations where standard treatment recommendations, based on best evidence, should be modified with regard to older adults’ preferences and treatment/care goals, life expectancy, co-morbid conditions, and/or functional status. 

  3. Develop advanced care plans based on older adults’ preferences and treatment/care goals, and their physical, psychological, social, and spiritual needs.  

  4. Recognize the need for continuity of treatment and communication across the spectrum of services and during transitions between care settings, utilizing information technology where appropriate and available. 

Domain #4:  Interdisciplinary and Team Care

  1. Distinguish among, refer to, and/or consult with any of the multiple healthcare professionals who work with older adults, to achieve positive outcomes. 

  2. Communicate and collaborate with older adults, their caregivers, healthcare professionals, and direct-care workers to incorporate discipline-specific information into overall team care planning and implementation. 

Domain #5:  Caregiver Support 

  1. Assess caregiver knowledge and expectations of the impact of advanced age and disease on health needs, risks, and the unique manifestations and treatment of health conditions. 

  2. Assist caregivers to identify, access, and utilize specialized products, professional services, and support groups that can assist with care-giving responsibilities and reduce caregiver burden. 

  3. Know how to access and explain the availability and effectiveness of resources for older adults and caregivers that help them meet personal goals, maximize function, maintain independence, and live in their preferred and/or least restrictive environment. 

  4. Evaluate the continued appropriateness of care plans and services based on older adults’ and caregivers’ changes in age, health status, and function; assist caregivers in altering plans and actions as needed. 

Domain #6:  Healthcare Systems and Benefits

  1. Serve as an advocate for older adults and caregivers within various healthcare systems and settings. 

  2. Know how to access, and share with older adults and their caregivers, information about the healthcare benefits of programs such as Medicare, Medicaid, Veterans’ services, Social Security, and other public programs. 

  3. Provide information to older adults and their caregivers about the continuum of long-term care services and supports – such as community resources, home care, assisted living facilities, hospitals, nursing facilities, sub-acute care facilities, and hospice care. 

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