Geriatric content in physical therapist education programs in the United States

Journal of Physical Therapy Education, Summer 2001 by Wong, Rita, Stayeas, Christina, Eury, James, Ros, Christina

Background and Purpose. It has been a decade since the last national survey examining geriatric content within physical therapist education programs in the United States. The primary purpose of this descriptive study was to obtain current data related to the extent to which geriatrics is included in the professional preparation of physical therapists. Method. In 1999, a survey instrument was mailed to all physical therapist education programs in the United States for completion by the program director or a faculty member responsible for geriatric content within the curriculum. The survey tool had four sections: demographics, knowledge base, examination skills, and intervention skills. Ninety respondents (42% response rate) indicated their level of agreement with survey statements related to knowledge base, examination skills, and intervention skills related to geriatrics. Results. For 64% of the knowledgebase items, at least 75% of the respondents agreed that the items were optimally covered

in their curriculum. For 79% of the examination items and 50% of the intervention items, at least 75% of the respondents agreed that the items were well covered in their curriculum. Conclusion. This study suggests that faculty at responding physical therapist education programs in the United States perceive that the majority of geriatric-related knowledge-base content and patient examination skills are well covered within their curriculums.

INTRODUCTION

The elderly population has become and will continue to be a major client base for physical therapists.1,2 Each day in the United States more than 5,500 people-or more than 2 million each year-celebrate their 65th birthday. The death rate for those over 65 years is less than 1.7 million annually. This means that the US population 65 years or over increases by approximately 900 people each day or 325,000 each year.3 The US Census Bureau estimates that by the year 2010 those over age 65 years will number almost 40 million and that in 2030 that number will increase to almost 70 million.3 This is an increase of approximately 75% from today's figures.

Physical therapists play a significant role in assisting older adults in maintaining their physical independence and enhancing their quality of life. Physical therapy services are delivered in a wide variety of settings and for a broad range of health conditions, for those who are critically ill to the well elderly.4 Involvement of physical therapists in geriatrics is fairly recent. As with many health fields, the development of physical therapy clinical practice has been driven by the primary health problems it has been asked to address. The profession's early roots were closely linked to the rehabilitation of injured war veterans and the care of children with poliomyelitis.5 As the benefits and unique skills of physical therapists gained recognition, the capacity of the field for involvement across a broad variety of patients was identified.

In the early 1970s, the rapid increase in the older adult population was predicted and concerns about the lack of preparation of health care practitioners to care for this population were raised.6-8 1980, the first publication. appeared dealing directly with the extent to which physical therapist educational curricula addressed geriatrics. In that study, Jackson9 reported that the typical physical therapist curriculum included only 4 to 10 hours of geriatric-related instruction. In 1981, Strasburg,10 using a national panel of experts, identified 14 geriatric-focused topic areas essential to preparing physical therapists for professional (entry-level) practice. Using these topic areas as a guide, Strasburg developed an ideal geriatric physical therapist curriculum and identified four criteria against which each topic area was measured. She then compared this "ideal curriculum" with the actual curriculum reported by physical therapist program directors. Only one program met all criteria, and 45% met none of the criteria. On average, she found that 16 clock hours of didactic course time were spent on geriatric topics.

A few years later, Granick et al2 reported on a 1984-1985 survey instrument sent to the directors of all physical therapist programs in the United States. The purpose of that study was to establish baseline data regarding the status of geriatric content in physical therapist education programs. Granick et al reported that approximately 10 to 15 hours of didactic course work was spent on geriatrics and that most program directors believed there was a need for greater geriatric content. Granick et al concluded that, although improvements had occurred since the 1970s, geriatric curriculums remained inadequate. Solon and Kilpatrick,11 in a study conducted in 1984, reported findings that were very similar to those of Granick et ale and Strasburg.10

In 1988, as part of a grant from the Administration on Aging, the Department of Accreditation of the American Physical Therapy Association (APTA) surveyed physical therapist program directors to examine curriculum progression efforts related to geriatrics since the early 1980s.12 The results of the survey indicated that, although the geriatric-related curriculums had improved substantially since the early 1980s, they remained essentially inadequate.12 This grant not only identified important content areas for professional education but provided a resource manual that included specific strategies, examples of courses, course modules, educational activities, and case study vignettes giving concrete suggestions for enhancing curriculum activities in geriatrics. This grant also supported the development of a cadre of physical therapist educators who could assess the geriatric content of academic programs and provide consultation regarding methods to enhance infusion of geriatrics within a given curriculum.