that these competencies be incorporated into educational programs. Some of these competencies include

• ability to distinguish between illness and normal aging;

• assessment of geriatric syndromes;

• identification of changes in mental status;

• education of patients and their families about prevention and end-of-life care;

• assessment of cultural and spiritual concerns; and

• collaboration with other health care professionals.

Little is known about on-the-job opportunities for APRNs to gain knowledge and skill in geriatric nursing care.

The oral health needs of older adults are significantly different from the needs of younger people, and older adults face a variety of challenges in meeting these needs. One of the barriers facing older adults who need oral-health services is lack of access to care. This lack of access is often due to the lack of coverage under Medicare for routine services, but it is also the case that many oral-health professionals are reluctant to travel to alternative sites of care (such as community-based settings) or to manage the complicated social and medical challenges associated with older patients. Even though the delivery of basic oral-health services to nursing home patients is supported by government regulation, less than 20 percent of residents of government-certified institutions received dental services in 1997 (MacEntee et al., 2005). In 1987 the National Institute on Aging (NIA) predicted a need for 1,500 geriatric dental academicians and 7,500 dental practitioners with training in geriatric dentistry by the year 2000 (NIA, 1987). By the mid-1990s, however, only about 100 dentists in total had completed advanced training in geriatrics (HRSA, 1995), and little has changed since then.

The availability of geriatric training for dentists has improved over the past few decades. In 1976, only 5 percent of dental schools offered courses in geriatric dentistry and, at that time, more than half of the programs (52 percent) did not foresee geriatric dentistry as part of their future curricula (Mohammad et al., 2003). However, by 1981 about half of all schools had developed geriatric dentistry programs, and an additional 25 percent planned to add geriatric curricula in the near future. As of 2001, all dental schools reported having some curricula related to geriatric dentistry, and almost one-third operated a geriatric clinic (Mohammad et al., 2003). The geriatric content varies greatly among schools. A school may offer