Medicine and Health Sciences Commons^™

A Systematic Review Of Dementia Research Priorities, Manonita Ghosh, Pelden Chejor, Melanie Baker, Davina Porock

Research outputs 2022 to 2026

Introduction: Patient involvement is a critical component of dementia research priority-setting exercises to ensure that research benefits are relevant and acceptable to those who need the most. This systematic review synthesises research priorities and preferences identified by people living with dementia and their caregivers. Methods: Guided by Joanna Briggs Institute methodology, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, we conducted a systematic search in five electronic databases: CINAHL, Medline, PsycINFO, Web of Science and Scopus. The reference lists of the included studies were also manually searched. We combined quantitative and qualitative data for synthesis and descriptive thematic …

Case Report And Literature Review Of An Atypical Polymyalgia Rheumatica And Its Management, Saad Bilal Ahmed, Saara Ahmad, Hanmei Pan

Department of Biological & Biomedical Sciences

Polymyalgia rheumatica (PMR) is a systemic inflammatory disease of the elderly population that increases in incidence as age advances. It is characterised by the sudden or sub-acute onset of symptoms affecting the shoulder and pelvic girdles, often accompanied by constitutional symptoms. Due to the lack of consensual diagnostic criteria and specific laboratory or radiological investigations for PMR, its diagnosis can be very challenging, particularly because it can be mimicked or masked by other geriatric syndromes. PMR responds well to glucocorticoid treatment, but if left untreated, can lead to morbidity and poor quality of life. We present the case of an …

Frailty And Pain In An Acute Private Hospital: An Observational Point Prevalence Study, Rosemary Saunders, Kate Crookes, Karla Seaman, Seng Giap Marcus Ang, Caroline Bulsara, Max K. Bulsara, Beverley Ewens, Olivia Gallagher, Renée Graham, Karen Gullick, Sue Haydon, Jeff Hughes, Kim-Huong Nguyen, Bev O’Connell, Debra Scaini, Christopher Etherton-Beer

Research outputs 2022 to 2026

Frailty and pain in hospitalised patients are associated with adverse clinical outcomes. However, there is limited data on the associations between frailty and pain in this group of patients. Understanding the prevalence, distribution and interaction of frailty and pain in hospitals will help to determine the magnitude of this association and assist health care professionals to target interventions and develop resources to improve patient outcomes. This study reports the point prevalence concurrence of frailty and pain in adult patients in an acute hospital. A point prevalence, observational study of frailty and pain was conducted. All adult inpatients (excluding high dependency …

Guiding Post-Hospital Recovery By 'What Matters:' Implementation Of Patient Priorities Identification In A Va Community Living Center, Katherine C Ritchey, Laurence M Solberg, Sandra Wolfe Citty, Lea Kiefer, Erica Martinez, Caroline Gray, Aanand D Naik

Journal Articles

BACKGROUND: Patient priorities care (PPC) is an effective age-friendly health systems (AFHS) approach to aligning care with goals derived from 'what matters'. The purpose of this quality improvement program was to evaluate the fidelity and feasibility of the health priorities identification (HPI) process in VA Community Living Centers (CLC).

METHODS: PPC experts worked with local CLC staff to guide the integration of HPI into the CLC and utilized a Plan-Do-Study-Act (PDSA) model for this quality improvement project. PPC experts reviewed health priorities identification (HPI) encounters and interdisciplinary team (IDT) meetings for fidelity to the HPI process of PPC. Qualitative interviews …

Chronic Venous Insufficiency With Emphasis On The Geriatric Population., Harvey N. Mayrovitz, Kawaiola C. Aoki, Jessica Colon

HPD Articles

The underpinning of Chronic Venous Insufficiency (CVI) is valvular dysfunction, which manifests on a spectrum depending on the severity of insufficiency and duration of the disease. The mainstay of treatment relies on compression therapy of a proper type and intensity. In older adults, special consideration must be taken during the patient encounter to account for age-related factors. This review discusses the clinical presentation, diagnosis, and mimicking of CVI, focusing mainly on older adults. The epidemiology, risk factors, disease burden, and grave complications -- such as thrombosis and ulceration, are reviewed. The physiological impacts of CVI are described, providing the background …

Study Protocol: Type Iii Hybrid Effectiveness-Implementation Study Implementing Age-Friendly Evidence-Based Practices In The Va To Improve Outcomes In Older Adults, Kirstin Manges Piazza, Laura Ellen Ashcraft, Liam Rose, Daniel E. Hall, Rebecca T. Brown, Mary Elizabeth (Libby) Bowen, Shahrzad Mavandadi, Alison C. Brecher, Shimrit Keddem, Bruce Kiosian, Judith A. Long, Rachel M. Werner, Robert E. Burke

College of Population Health Faculty Papers

Background

Unmet care needs among older adults accelerate cognitive and functional decline and increase medical harms, leading to poorer quality of life, more frequent hospitalizations, and premature nursing home admission. The Department of Veterans Affairs (VA) is invested in becoming an “Age-Friendly Health System” to better address four tenets associated with reduced harm and improved outcomes among the 4 million Veterans aged 65 and over receiving VA care. These four tenets focus on “4Ms” that are fundamental to the care of older adults, including (1) what Matters (ensuring that care is consistent with each person’s goals and preferences); (2) …

Physical Therapy Consultation In The Emergency Department For Older Adults With Falls: A Qualitative Study, Anita Chary, Elise Brickhouse, Beatrice Torres, Lauren Cameron-Comasco, Sangil Lee, Brittany Punches, Rachel M Skains, Aanand D Naik, Catherine C Quatman-Yates, Maura Kennedy, Lauren T Southerland, Shan Liu

Journal Articles

OBJECTIVES: Little is known about current practices in consulting physical therapy (PT) in the emergency department (ED) for older adults with falls, a practice that can reduce fall-related ED revisits. This qualitative study aimed to understand perspectives of ED staff about ED PT consultation for older adults with falls and fall-related complaints, specifically regarding perceived value and associated challenges and strategies.

METHODS: We performed focus groups and key informant interviews with emergency physicians, advanced practice clinicians, nurses, physical therapists, occupational therapists, and technicians who perform ED geriatric screenings. We used rapid qualitative analysis to identify common themes related to decisions …

A Co-Designed Health Information System Implementation Into Residential Aged Care: A Mixed-Method Evaluation, Kasia Bail, Eamon Merrick, Diane Gibson, Alicia Hind, Karen Strickland, Bernice Redley

Research outputs 2022 to 2026

Introduction: Internationally, the adoption of technology into residential aged care settings has been slow and fraught with multiple challenges for residents, staff and service providers. The aim of this study was to evaluate the acceptability, efficiency, and quality of health information system implementation into aged care. Methods: Three-stage, mixed-methods participatory action research, concurrent with the natural experiment of a co-designed health information system implementation into a 169-bed aged care home in Australia. Data were collected pre-, during, and post implementation between 2019 and 2021. Qualitative data included focus groups, interviews, and observations. Quantitative data included work observations, pedometers, record audits, …

How Help Provided The Pathway To Become Age-Friendly, Chesley Ferris, Anna Pleet, Emily Carter

MaineHealth Maine Medical Center

In assessing how the 4Ms framework applies to the Hospital Elder Life Program, we were able to target specific ways to deliver more Age-Friendly care to those enrolled in the program.

Ensuring A Knowledgeable Geriatric Workforce: Interdisciplinary Education In Long-Term Services And Supports, Gina Tucker-Roghi

Occupational Therapy | Faculty Scholarship

In this symposium, we describe five interdisciplinary educational programs to enhance the geriatric workforce in long-term services and supports (LTSS): Skilled nursing facilities (SNFs), assisted living, and home health and hospice. The interdisciplinary teams that came together to offer the programs leveraged technology to maximize access to experts in both the curriculum development process and the delivery of the educational programs for a wide range of target learners. The first program, an interdisciplinary telementoring series on dementia care for therapists in SNFs, was developed by a team of experts from occupational, physical and speech therapy. The program included asynchronous online …

Interdisciplinary Telementoring For Therapists In Snfs To Improve Dementia Care Knowledge And Skills, Gina Tucker-Roghi

Occupational Therapy | Faculty Scholarship

Occupational, physical, and speech therapists possess knowledge and skills that have the potential to reduce the burden of care and improve the quality of life of skilled nursing facility (SNF) residents living with dementia. Despite this opportunity to impact the well-being of residents with dementia, many therapy practitioners lack specialized training on the management of dementia. Therapy practitioners (n=31) from 22 SNFs participated in eight weekly interdisciplinary educational sessions using the Project ECHO (Extension for Community Health Outcomes) tele-mentoring model. An interdisciplinary team of therapy experts collaborated on the development of the curriculum, which included didactic content on dementia-care best …

Examining The Effects Of Formal Education Level On The Montreal Cognitive Assessment, Renee S. White, Justin M. Barber, Jordan P. Harp, Gregory A. Jicha

Sanders-Brown Center on Aging Faculty Publications

Background: Brief, global assessments such as the Montreal Cognitive Assessment (MoCA) are widely used in primary care for assessing cognition in older adults. Like other neuropsychological instruments, lower formal education can influence MoCA interpretation.

Methods: Data from 2 large studies of cognitive aging were used—Alzheimer’s Disease Neuroimaging Initiative (ADNI) and National Alzheimer’s Coordinating Center (NACC). Both use comprehensive examinations to determine cognitive status and have brain amyloid status for many participants. Mixed models were used to account for random variation due to data source.

Results: Cognitively intact participants with lower education (≤12 years) were more likely than …

Persistent Polypharmacy And Fall Injury Risk: The Health, Aging And Body Composition Study, Lingshu Xue, Robert M. Boudreau, Julie M. Donohue, Janice C. Zgibor, Zachary A. Marcum, Tina Costacou, Anne B. Newman, Teresa M. Waters, Elsa S. Strotmeyer

Health Management and Policy Faculty Publications

Background

Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults.

Methods

The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in …

Prevalence Of Chronic Disease In Older Adults In Multitier Eye-Care Facilities In South India: Electronic Medical Records-Driven Big Data Analytics Report, Umesh Chandra Behera, Brooke Salzman, Anthony Vipin Das, Gumpili Sai Prashanthi, Parth Lalakia, Richard Derman, Bharat Panigrahy

Department of Family & Community Medicine Faculty Papers

Purpose: To study the prevalence of systemic conditions in older adults, either self-reported or discovered during routine eye examinations, at multitier eye-care facilities over the past decade, and to explore their association with vision and common ocular disorders, including cataract, glaucoma, and retinopathy.

Methods: Retrospective review of a large data set compiled from the electronic medical records of patients older than 60 years who presented to an eye facility of a multitier ophthalmology network located in 200 different geographical locations that included urban and rural eye-care centers spread across four states in India over a 10-year period.

Results: 618,096 subjects …

Use Of Smartphone Technology To Promote Knowledge Of Home Safety, Bonnie L. Rogulj

Physical Therapy Collection

This brief article describes the use of smartphone panoramic 360-degree imaging technology to educate patients on home safety. By positioning "hot spots" on images of the home environment, a visual tool for patient education was created to illustrate safety hazards in the home.

Data From Emergency Medicine Palliative Care Access (Empalla): A Randomized Controlled Trial Comparing The Effectiveness Of Specialty Outpatient Versus Telephonic Palliative Care Of Older Adults With Advanced Illness Presenting To The Emergency Department., Abigail M. Schmucker, Mara Flannery, Jeanne Cho, Keith S. Goldfeld, Corita Grudzen, Empalla Investigators

Student Papers, Posters & Projects

BACKGROUND: The Emergency Medicine Palliative Care Access (EMPallA) trial is a large, multicenter, parallel, two-arm randomized controlled trial in emergency department (ED) patients comparing two models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. This report aims to: 1) report baseline demographic and quality of life (QOL) data for the EMPallA cohort, 2) identify the association between illness type and baseline QOL while controlling for other factors, and 3) explore baseline relationships between illness type, symptom burden, and loneliness.

METHODS: Patients aged 50+ years with advanced cancer (metastatic solid tumor) or end-stage organ failure (New York …

Spreading Encouragement To Seniors In A Pandemic, Bonnie L. Rogulj, Lashia Hicks

Physical Therapy Collection

This brief note describes a "virtual calendar" project created by students of the University of St. Augustine for Health Sciences. The calendar of images and poetry was shared with older adult community members to reduce loneliness and increase mental health and wellness in this population during the COVID-19 pandemic.

Improving Health Care Accessibility Among Geriatric Patients In Rural Communities, Capriana Calvachi

Honors Projects

The following literature review and analysis compiles information regarding ways to improve rural geriatric healthcare accessibility through the use of interprofessional care and outreach. I also wish to bring to light the various deficiencies often seen in this realm of care, and the reasons behind the inadequate rural physician retention rates. Using this background information, I compiled various collaborative approaches which seek to ease the strain faced by the healthcare system and its elderly patients.

Improving healthcare accessibility through the use of interprofessional care and outreach is an essential facet in geriatric medicine. By exploring the deficiencies of geriactric healthcare …

Sleeping Time Is Associated With Functional Limitations In A National Sample Of Older Americans, Brenda M. Vincent, Nathaniel Johnson, Grant R. Tomkinson, Ryan Mcgrath, Brian C. Clark, Bong-Jin Choi

Education, Health & Behavior Studies Faculty Publications

Background: Engaging in healthy behaviors may help to preserve function during aging; however, it is not well understood how sleeping time is associated with functional capacity in older adults.

Aims: We sought to determine the association of sleeping time on functional limitation in a national sample of older Americans.

Methods: The analytical sample included 6,020 adults aged at least 65 years who participated in the 2007-2016 waves of the National Health and Nutrition Examination Survey. Respondents indicated their hours of sleep/week night and were categorized as <5, 5-6.5, 7-8, 8.5-9, and >9 hours of sleep/week night. Ability to complete 19 functional tasks …

Creating Covid-19 Work-Arounds For Vulnerable Older Adults, Edward F. Ansello

Director's Editorials from Age in Action

In response to disruptions in care due to the COVID-19 pandemic, the Geriatrics Workforce Enhancement Program (GWEP) has decided to focus energies on vulnerable populations, specifically: low income older adults in the Richmond Health and Wellness Program (RHWP), which delivers healthcare coordination at rental assistance housing complexes in Richmond, who had been receiving regular in-person help from interprofessional teams of faculty and students; residents with dementia and staffs of long-term care facilities who’d been intended to participate on-site in a non-pharmacological dementia care intervention called TimeSlips, as well as family caregivers of individuals in the community with dementia; and older …

The Agony Of Da Feet: Reexamining The Foundation To Fitness, Amanda M. Lutter, Christopher B. Stewart

Case Studies from Age in Action

Educational Objectives

1. Explain the role of podiatry in helping older adults maintain wellbeing.

2. Provide an overview of common foot and ankle conditions that older adults should be concerned about.

3. Discuss newer services and techniques provided by podiatrists.

4. Review several cases in which podiatry supported patients’ health through early interventions.

Increasing Advanced Care Planning In An Ambulatory Care Setting, Jennifer Aronson, Elizabeth Eisenhardt, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operations Transformation

Maine is experiencing an increasing percentage of its population being over 65 years old. Advanced Care Planning (ACP) is an important part of this aging population medical care so those ends of life preferences are known well in advance. An adult internal medicine clinic in a large academic tertiary medical center decided to create a performance improvement project that addressed ACP with embedded workflows.

The goal of this project was to have a minimum of 40% of patients 65 or older have an Advanced Care Directive or Serious Illness Conversation documented in EPIC.

Baseline metrics demonstrated that ACP discussion rates …

The Benefits And Accessibility Of Integrative Exercise In Geriatric Populations, Elizabeth Nisper

Honors Projects

There are many physical and mental benefits of conventional exercise and they have been well-studied. However, integrative exercise practices aim to encompass more than physical fitness. There is also a spiritual/ethical component when taking into account aspects such as meditation and mindfulness. By examining a number of different health domains, we can study whether the benefits of yoga and tai chi extend beyond the benefits of exercise more broadly. While the short-term physical fitness benefits of other cardio and strength training may exceed those of integrative practices, yoga and tai chi appear to be equally as beneficial in the long …

Dietary Nitrate Intake Is Associated With Muscle Function In Older Women, Marc Sim, Joshua R. Lewis, Lauren C. Blekkenhorst, Catherine P. Bondonno, Amanda Devine, Kun Zhu, Peter Peeling, Richard L. Prince, Jonathan M. Hodgson

Research outputs 2014 to 2021

Background

In younger individuals, dietary nitrate supplementation has been shown to improve short‐term vascular and muscle function. The role of higher habitual nitrate intake as part of a typical diet on muscle function in ageing has not been investigated. A cross‐sectional study of relationships between dietary nitrate and measures of muscle function in older community‐dwelling Australian women (n = 1420, ≥70 years) was undertaken.

Methods

Participants completed a semi‐quantitative food frequency questionnaire assessing dietary intake over the previous year. Total nitrate from vegetables and non‐vegetable sources was calculated from a validated instrument that quantified the nitrate content of food …

Periodontitis And The Elderly: An Overview Of The Disease And Its Impact On An Aging Population, Nicole Grace Weissenfluh

Senior Honors Theses

Periodontitis affects millions of Americans each year, and is especially prevalent among the elderly. Since periodontitis is a chronic, progressive condition, uninterrupted disease progression leads to irreversible oral damage; therefore, periodontitis often reduces the oral health-related quality of life. Furthermore, research strongly suggests a correlation between periodontitis and other systemic diseases (e.g., cardiovascular disease and diabetes mellitus), highlighting the importance of understanding, treating, and preventing periodontitis. This thesis explores the pathology and etiology of periodontitis, with special focus given to the prevalence and impact of the disease in the elderly population. Additionally, the connection between periodontitis and other systemic diseases …

A Review Of The Pharmacological And Clinical Profile Of Newer Atypical Antipsychotics As Treatments For Bipolar Disorder: Considerations For Use In Older Patients., Akshya Vasudev, Sumit Chaudhari, Rickinder Sethi, Rachel Fu, Rachel M Sandieson, Brent P Forester

Psychiatry Publications

Bipolar disorder prevalence rates vary in the older adult population (defined as age ≥ 65 years), ranging from 1% in community dwellers to as high as 8-10% in hospital inpatients. Although older agents, including lithium and valproic acid, offer significant antimanic efficacy, as supported by a recent randomized controlled trial (RCT), there is growing interest in using atypical antipsychotics to treat bipolar disorder in older adults. Newer atypical antipsychotics are of interest based on their tolerability and efficacy in the general adult bipolar population. The aim of this review was to systematically examine efficacy and tolerability of newer atypical antipsychotics …

Physical Therapy Considerations For Chronic Kidney Disease And Secondary Sarcopenia, Michael O. Harris-Love, Haniel J. Hernandez, Gideon Obamwonyi

Exercise and Nutrition Sciences Faculty Publications

Chronic kidney disease (CKD) is a progressive condition that may negatively affect musculoskeletal health. These comorbidities may include malnutrition, osteoporosis, and decreased lean body mass. Secondary sarcopenia due to CKD may be associated with mobility limitations and elevated fall risk. Physical therapists are well-positioned among the health care team to screen for secondary sarcopenia in those with CKD and for the treatment of musculoskeletal comorbid conditions that may affect functional performance. Given the consequences of both low muscle mass and low bone mineral density, appropriate and timely physical therapy is important for fall risk assessment and intervention to minimize the …

Fighting Frailty With The Mediterranean Diet, Edward F. Ansello

Director's Editorials from Age in Action

It’s appropriate for each of us to examine our eating habits, not just our nutrition intake. The various aspects of the Mediterranean Diet hold potential benefits beyond the important feature of helping to reduce frailty.

Our Anniversary, Edward F. Ansello

Director's Editorials from Age in Action

The Virginia Center on Aging celebrates 40 years.

Into The Elder Law Trenches At Wake Forest University School Of Law, Kate Mewhinney

Case Studies from Age in Action

Educational Objectives:

1. Examine the benefits of a medical-legal partnership for training law students how to represent older clients.

2. Review common legal issues in the field of elder law.

3. Explore broader policy concerns facing an aging population.