General skills and competencies for all care providers
Care of the acutely ill or injured older person takes place over a wide spectrum of settings from in-home community-based care, to in-hospital acute or intensive care, and back.
In some cases, gaining competency will require general enhancements of pre-employment training and education. However, competency will more likely be achieved through additional field-based, ‘real-life’ on-the-job training. Ultimately every provider continually refines their knowledge and skills to reach expertise, the ability to provide care at the time and in the place where it offers the best care option available for each patient.
It is a common observation that, in most health care education systems, there is little focused education in the specific skills needed to assess, treat, and work with older people. Although older people often make up the bulk of patients seen by health care workers, education in many international systems, treats older people as though they were exceptions or outliers to usual care. It is critical to educate students, trainees, and workers about both general and specific skills needed in older adult care. This chapter will guide educational enhancements to close that competency gap.
To develop competency, it is necessary to develop across three domains – skills, knowledge, and attitudes.
Skills: ‘Hard’ skills which require the appropriate completion of a physical task (e.g. how to transfer a person from wheelchair to bed, how to perform an ultrasound-guided femoral nerve block); and ‘soft’ skills such as facial expressions and touch and body posture (e.g. how non-verbal cues can help to gather information from a person with hearing or cognitive impairment).
Knowledge: This relates to knowing a fact and how to interpret it (e.g. what the normal blood pressure range is for older patients and what it means when abnormal; or the right height for a walker and how to fit one; or what indications for transfer to a higher level of care may be). Other areas of knowledge enhancement include a familiarity with the ways in which older people are different from the general population whether socially, functionally, physiologically, or anatomically. Competent providers have an awareness of community services and resources that others can provide, which may benefit the older person. Additionally all must develop clinical reasoning and assessment skills which might be as basic as identifying when someone ’just isn’t right’.
Attitudes: This relates to feelings or emotions and opinion development, such as changing the way you think or feel about care of older persons resulting in a more positive behaviour. This attitude would manifest as a willingness to spend more time; or an openness to collaborate more intensively with family members or interdisciplinary colleagues. It is the perspective that an older person is an intrinsically valuable and important member of society. Maintaining a positive attitude that one’s own actions, however minimal, have the potential to improve the older person’s life. Excellent providers identify and avoid ageist attitudes which devalue, categorise, or dismiss older people and their issues.
These issues of skills, knowledge, and attitude development exist for all providers across the entire spectrum of care provision for an ill or injured older person, from personal support workers to geriatricians; from doctor’s offices to intensive care units.260
Communication skills
Probably the greatest area of skills enhancement specific to care of older people is communication.
Effective communication skills (the ability to clearly and consistently communicate empathy, compassion, respect, patience and build rapport with patients, families, and caregivers) is another skill set essential at every point along the care continuum.
