Geriatrics Commons^™

Key Healthcare Providers’ Perspectives On The Implementation Of Senior-Friendly Emergency Department Care In Quebec, Deniz Cetin-Sahin, Francine Ducharme, Jane Mccusker, Mona Magalhaes, Nathalie Veillette, Paul-André Lachance, Sylvie Cossette, Alain Vadeboncoeur, Rick Mah, T.T. Minh Vu, Simon Berthelot

Journal of Geriatric Emergency Medicine

Background: Senior-friendly emergency department (ED) care is emerging to address large numbers of older adults in healthcare and implementation is variable.

Objectives: We aimed to explore key healthcare providers’ perspectives on factors affecting implementation of senior-friendly ED care during the first five years of the Senior-Friendly Hospital Initiative in the Province of Quebec, Canada.

Methods: We conducted a descriptive qualitative study of four urban EDs. Key healthcare providers involved in care within the ED or after discharge to the community were purposefully selected. Semi-structured telephone interviews were conducted in participants’ preferred language, English or French. Recorded interviews were transcribed. A …

Cost-Benefit Analysis Of The Cope Program For Persons Living With Dementia: Toward A Payment Model, Laura T Pizzi, Eric Jutkowitz, Katherine M Prioli, Ember Yiwei Lu, Zachary Babcock, Heather Mcabee-Sevick, Dorothy B Wakefield, Julie Robison, Sheila Molony, Catherine V. Piersol, Laura N Gitlin, Richard H Fortinsky

Department of Occupational Therapy Faculty Papers

Background and objectives: There is a critical need for effective interventions to support quality of life for persons living with dementia and their caregivers. Growing evidence supports nonpharmacologic programs that provide care management, disease education, skills training, and support. This cost-benefit analysis examined whether the Care of Persons with Dementia in their Environments (COPE) program achieves cost savings when incorporated into Connecticut's home- and community-based services (HCBS), which are state- and Medicaid-funded.

Research design and methods: Findings are based on a pragmatic trial where persons living with dementia and their caregiver dyads were randomly assigned to COPE with HCBS, or …

Emergency Medicine Provider Comfort With Physician Orders For Life Sustaining Treatment (Polst) Advanced Directive, Katherine Briggie, Kaitlin Sweeney, Shannon Findlay, Hao Wang, Juan Pagan-Ferrer, Dan Miller, Sangil Lee

Journal of Geriatric Emergency Medicine

Background

Emergency departments (ED) across the United States see many patients with advanced disease nearing the end of life. ED providers make many important decisions that impact a patient’s hospital course, including resuscitation decisions. When patients’ preferences are not known, treatment in the ED frequently defaults to maximally aggressive care. The Physician Orders for Life Sustaining Treatment (POLST) form has been shown to lead to more goal-concordant care for these patients by providing detailed instructions regarding end-of-life interventions, made by the patient and/or medical decision maker.

Methods

In this needs assessment study, we aimed to determine the level of awareness …

The Effect Of The Care Transitions Intervention On Ed Revisits And Outpatient Clinic Follow-Up Among Older Adults Who Live Alone, Clara V. Kuranz, Rebecca K. Green, Angela Gifford, Gwen C. Jacobsohn, Thomas V. Caprio, Amy L. Cochran, Jeremy T. Cushman, Courtney M.C. Jones, Amy J. H. Kind, Michael Lohmeier, Manish N. Shah

Journal of Geriatric Emergency Medicine

INTRODUCTION: Older adults frequently return to an emergency department (ED) within 30 days of an initial visit. In this study, we examined the effectiveness of an adapted Care Transitions Intervention (CTI) at reducing risk of ED revisits within 30 days for older adults who live alone. We also explored the interaction between receiving help with healthcare needs and receiving the CTI on the risk of 30-day ED revisits.

METHODS: We conducted a subgroup analysis of community-dwelling older (age≥60 years) ED patients who reported living alone as part of a randomized controlled trial of CTI effectiveness following discharge home from one …

The Intersection Between Toxicology And Aging Research: A Toxic Aging Coin Perspective., John P. Wise Jr.

Faculty Scholarship

We are imminently faced with the challenges of an increasingly aging population and longer lifespans due to improved health care. Concomitantly, we are faced with ubiquitous environmental pollution linked with various health effects and age-related diseases which contribute to increased morbidity with age. Geriatric populations are rarely considered in the development of environmental regulations or in toxicology research. Today, life expectancy is often into one’s 80s or beyond, which means multiple decades living as a geriatric individual. Hence, adverse health effects and late-onset diseases might be due to environmental exposures as a geriatric, and we currently have no way of …

Research To Accelerate Practice Change In Geriatric Emergency Medicine, Susan Hastings

Journal of Geriatric Emergency Medicine

This is the Keynote Address for the First American Geriatrics Society Geriatric Emergency Department Special Interest Group

Dosagem De Colesterol E/Ou Triglicérides Em Pessoas Idosas Do Brasil: Comparação Da Frequência De Exame Nunca Realizado Entre Os Anos 2013 E 2019, Isabella Amanda Weber Zielke, Maria Cristina Gehlen, Carlos Augusto Treviso, Carla Helena Augustin Schwanke

AMNET XX Conferencia Internacional

Objetivo: Descrever e comparar a frequência de não realização de exame de sangue de colesterol e/ou triglicérides em pessoas idosas brasileiras nos anos 2013 e 2019. Métodos: Os dados sobre a frequência e o intervalo de confiança (IC) de “exame de sangue para medir o colesterol e/ou triglicérides nunca realizado” foram obtidos no painel de indicadores de saúde disponível no site da Pesquisa Nacional de Saúde (PNS) do Ministério da Saúde/IBGE. Os filtros utilizados foram faixa etária (pessoas entre 60 e 74 anos e com 75 anos ou mais) e ano (2013 e 2019). Resultados: Em 2013, a frequência de …

How Did The Dietary Habits Of Patients With Chronic Medical Conditions Change During Covid-19?, Sahil K. Patel, Adarsh Gupta

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

CONTEXT: Previous studies have examined the changes in the dietary habits of general populations during the COVID-19 pandemic but have not focused on specific populations such as those with chronic medical conditions (CMCs). Prior to major vaccination efforts, 96.1% of deaths were attributed to patients with preexisting CMCs, thus it is important to examine how this population has endured changes.

OBJECTIVES: The purpose of this study was to identify differences in dietary habits, lifestyle habits, and food attitudes between those with CMCs compared to the populations without chronic medical conditions (non-CMCs) since the beginning of the COVID-19 pandemic.

METHODS: An …

Role Of Sympathetic Pathway In Light-Phase Time-Restricted Feeding-Induced Blood Pressure Circadian Rhythm Alteration, Tianfei Hou, Aaron Chacon, Wen Su, Yuriko Katsumata, Zhenheng Guo, Ming Gong

Sanders-Brown Center on Aging Faculty Publications

Disruption of blood pressure (BP) circadian rhythm, independent of hypertension, is emerging as an index for future target organ damage and is associated with a higher risk of cardiovascular events. Previous studies showed that changing food availability time alters BP rhythm in several mammalian species. However, the underlying mechanisms remain largely unknown. To address this, the current study specifically investigates (1) the relationship between rhythms of food intake and BP in wild-type mice; (2) effects of light-phase time-restricted feeding (TRF, food only available during light-phase) on BP circadian rhythm in wild-type and diabetic db/db mice; (3) the roles of the …

The Trend Of Disruption In The Functional Brain Network Topology Of Alzheimer’S Disease, Alireza Fathian, Yousef Jamali, Mohammad Reza Raoufy, The Alzheimer's Disease Neuroimaging Initiative, Michael W. Weiner, Norbert Schuf, Howard J. Rosen, Bruce L. Miller, Thomas Neylan, Jacqueline Hayess, Shannon Finley, Paul Aisen, Zaven Khachaturian, Ronald G. Thomas, Charles D. Smith, Gregory A. Jicha, Peter A. Hardy, Partha Sinha, Elizabeth Oates, Gary Conrad

Sanders-Brown Center on Aging Faculty Publications

Alzheimer’s disease (AD) is a progressive disorder associated with cognitive dysfunction that alters the brain’s functional connectivity. Assessing these alterations has become a topic of increasing interest. However, a few studies have examined different stages of AD from a complex network perspective that cover different topological scales. This study used resting state fMRI data to analyze the trend of functional connectivity alterations from a cognitively normal (CN) state through early and late mild cognitive impairment (EMCI and LMCI) and to Alzheimer’s disease. The analyses had been done at the local (hubs and activated links and areas), meso (clustering, assortativity, and …

Neuroanatomy In Mild Cognitive Impairment: Relationship To Functional Skills, Treatment Expectancy, And Comorbid Depression, Sara Rushia

Dissertations, Theses, and Capstone Projects

Mild cognitive impairment (MCI) is a neurocognitive disorder defined by cognitive decline in older adults. Although MCI has been studied for decades, there remain important areas to be explored in order to adequately characterize aspects of this disorder that provide information valuable for possible interventions and disease progression to dementia, including a better understanding of the neuroanatomical variables relevant to this disorder. Such neuroanatomical variables include cortical thickness, hippocampal volume, and white matter hyperintensities (WMHs). This dissertation consists of three separate studies aimed at addressing gaps in the literature on MCI in relation to brain morphometrics and under-studied characteristics involved …

Geriatric Emergency Medicine Fellowship Journal Club: Operational Changes For Recognizing Prevalent Delirium And Preventing Incident Delirium, Natalie M. Elder

Journal of Geriatric Emergency Medicine

N/A

Patients’ Attitudes Toward Deprescribing And Their Experiences Communicating With Clinicians And Pharmacists, Kaylee Marie Lukacena, James W. Keck, Patricia R. Freeman, Nancy Grant Harrington, Mark Huffmyer, Daniela C. Moga

Sanders-Brown Center on Aging Faculty Publications

Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients’ beliefs and attitudes and identify facilitators of and barriers to deprescribing.

Methods: As part of a larger study, we recruited patients ⩾18years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and …

Addressing Complex Primary Care Needs For An Older Man Recently Released From Incarceration With Multiple Emergency Department Visits., Saffia Bajwa, Ariba Khan, Michael L. Malone

Journal of Geriatric Emergency Medicine

Purpose: Older prisoners being released into the community need to be placed in a system to help them transition from living in prison to living in a free society. They must adapt in order to find housing, community services, medical, dental and psychiatric care. When the complex social needs of these persons are not fully met, the emergency department is used as a safety net.

Methods and Findings: This paper describes a patient who had multiple emergency department visits which was his routine method of seeking medical care.

Health Care Policy Implications: We believe that public health policy requiring …

Identifying Critical Aging Care Challenges And Opportunities In High-Income Countries: A Cross-Country Comparison Of Denmark, Germany, And The United States, Cassandra Martin

Capstone Collection

Despite the rapid growth in the aging population in the United States, insufficient resources and attention are invested in improving the support systems this population relies on. This discussion explored the question of how the United States as a high-income country fails to operate an aging care support infrastructure that has comparable comprehensiveness, availability, affordability, and overall quality to other high-income countries. Comparing financing structures, long-term care models, and various aging care supports is important for answering this question. This paper approached exploring this question by analyzing specified indicators from publicly available data across the United States, Germany, and Denmark. …

Transportation As A Barrier To Healthcare Access For Older Adults Of Low Socioeconomic Status, Yanira Barajas, Susan Macdermott, Jazminne Orozco Arteaga

Summer 2022 Virtual OTD Capstone Symposium

The older adult population of those in the age group 65+ is one of the fastest growing populations in the following years. This project sought to identify what barriers older adults of low socioeconomic status face when trying to access transportation to healthcare appointments. The project also sought to understand what barriers healthcare professionals saw when their senior clients tried using transportation as well as what opportunities occupational therapists have to address the barriers if any. There was a theme of disconnect which appeared between healthcare professionals and their senior clients across multiple healthcare disciplines. This project was able to …

Supporting Rural Seniors Aging In Place Using Telehealth, Angel Alexander Gomez, Susan Macdermott

Summer 2022 Virtual OTD Capstone Symposium

Background: The United States is witnessing a demographic shift in that the number of Americans aged 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060; the percentage of the 65 and older age group will increase from 16 % to 23 % (Administration for Community Living, 2018). In this ever-growing population, the American Association of Retired Persons (AARP) 2018 survey found that 76% of Americans over the age of 50 would prefer to remain in their current residence and 77% would like to continue living in their community as long as …

Navigating Care Transitions For Older Adults In The Emergency Department When A Social Worker Is Unavailable, Rebecca Weeks, Kathy Sawasky, Adam Perry, Michael Malone

Journal of Geriatric Emergency Medicine

Some Emergency Departments do not have social worker staffing to assess high- risk older adults who have been identified. This is of particular concern in during care transitions for older patients who are at risk for poor health outcomes. We describe triggers for the emergency provider to recognize older patients at high risk and bundles of appropriate services and community supports to mitigate risk.

A Smartwatch Step-Counting App For Older Adults: Development And Evaluation Study, George Boateng, Curtis L. Petersen, David Kotz, Karen L. Fortuna, Rebecca Masutani, John A. Batsis

Dartmouth Scholarship

Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have …

Characterization And Comparison Of Human Glioblastoma Models, Julia A. Schulz, Louis T. Rogers, Richard J. Kryscio, Anika M. S. Hartz, Björn Bauer

Sanders-Brown Center on Aging Faculty Publications

Abstract
Glioblastoma (GBM) is one of the deadliest cancers. Treatment options are limited, and median patient survival is only several months. Translation of new therapies is hindered by a lack of GBM models that fully recapitulate disease heterogeneity. Here, we characterize two human GBM models (U87-luc2, U251-RedFLuc). In vitro, both cell lines express similar levels of luciferase and show comparable sensitivity to temozolomide and lapatinib exposure. In vivo, however, the two GBM models recapitulate diferent aspects of the disease. U87-luc2 cells quickly grow into large, well-demarcated tumors; U251-RedFLuc cells form small, highly invasive tumors. Using a new method to assess …