Geriatrics Commons^™

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Falling Star Program: A Visual Cue Intervention To Reduce Falls In Long-Term Care, Maggie Shanahan

Evidence-Based Practice Project Reports

Falls among older adults in skilled nursing and long-term care settings remain a leading cause of injury, functional decline, and increased healthcare utilization, contributing significantly to morbidity and mortality in this population (Centers for Disease Control and Prevention [CDC], 2023; Agency for Healthcare Research and Quality [AHRQ], 2022). The primary purpose of this project aimed to implement and evaluate a structured visual cue–based fall prevention intervention to reduce fall rates among high-risk residents in a long-term care facility in Northwest Indiana. The project included 23 participants aged 65 years and older who were identified as high risk for falls. Using …

Improving Anesthesia Provider Confidence In The Identification, Management, And Treatment Of Postoperative Delirium, Brittany M. Whistle, Charles Dustin Phelps

Scholars Week

Purpose: Postoperative Delirium (POD) is a potentially devastating complication of anesthesia that is poorly understood by clinical staff leading to poor outcomes for surgical patients. This study is meant to determine if a focused knowledge presentation accompanied by visual aids could increase anesthesia providers confidence in identifying, diagnosing, and treating Postoperative Delirium.

Methodology: Utilizing a statistical model to analyze respondents results on a standardized test administered before and after an informational presentation with visual aids on the topic of Postoperative Delirium.

Results: Results indicated a statistically significant difference between pretest and posttest scores, with a p-value of .002, t(11) = …

Tezepelumab's Effects On Patient-Reported Symptoms In Severe Asthma, Overall And With History Of Comorbid Chronic Rhinosinusitis With Nasal Polyps (Crswnp), Njira L. Lugogo, Joseph K. Han, Anju T. Peters, Stella E. Lee, Monica Kraft, Mary Kay Margolis, Sonia F. Shenoy, Nicole Martin, Shradha Chandarana, Christopher S. Ambrose

Department of Otolaryngology (ENT) Faculty Publications

Background

Tezepelumab (an anti-thymic stromal lymphopoietin monoclonal antibody) treatment resulted in reduced exacerbations and improved sino-nasal symptoms and health-related quality of life in patients with severe uncontrolled asthma (SUA) and chronic rhinosinusitis with nasal polyps (CRSwNP) in the NAVIGATOR study.

Objective

To evaluate the effect of tezepelumab versus placebo on sleep disturbances, activity levels, and physical exertion tolerance in NAVIGATOR patients with SUA overall and in those with past medical history of comorbid CRSwNP.

Methods

Patients (12-80 years old) with SUA were randomized to receive tezepelumab 210 mg or placebo subcutaneously every 4 weeks for 52 weeks. Patient responses to …

Estetrol (E4) For The Treatment Of Moderate To Severe Vasomotor Symptoms In Postmenopausal Women - Efficacy And Safety Results From The Phase 3 E4comfort I Multicenter, Placebo-Controlled Study, Tommaso Simoncini, Céline Bouchard, Marie Cloes, Mélanie Taziaux, Santiago Palacios, Sebastião Freitas De Medeiros, Valeriu Vrabii, David F. Archer, Nick Panay

Department of Obstetrics & Gynecology Faculty Publications

Objective

To evaluate the efficacy and safety of estetrol in reducing moderate to severe vasomotor symptoms in postmenopausal women.

Methods

Multicenter, randomized, parallel group (1:1:1), placebo-controlled, double-blind, phase 3 study in hysterectomized and non-hysterectomized participants aged 40-65 years. A total of 640 participants with seven or more moderate to severe hot flashes daily or 50 weekly received estetrol 15 mg, estetrol 20 mg, or placebo for 12 weeks. Co-primary endpoints were the change in frequency and severity of moderate to severe vasomotor symptoms from baseline to weeks 4 and 12. Comparisons versus placebo were made using a mixed-effects model for …

Violence Between Residents In Nursing Homes Is An Enduring Problem. The Agencies, Nursing Homes, And Residents Are Playing Hot Potato With The Responsibility, Cindy Marchionda, Rafael Escalara Montoto

Capstones

Resident-to-resident aggression in nursing homes is a persistent issue, far more common than the general public realizes. While many of these violent situations can be managed, some tragically escalate to fatal outcomes, leaving families mourning the loss of their loved ones at the hands of a facility that was meant to provide safety and care during their final years. Experts agree that this issue is largely driven by chronic understaffing and insufficient training for employees on how to manage patients with dementia and aggression issues.

Quality Of Life And Mental Health: A Qualitative Exploration Of Perceived Factors That Impact Older Adults, Chasiti Herring

All-Inclusive List of Electronic Theses and Dissertations

Enhancing quality of life and well-being is a universal phenomenon across the lifespan. As the population ages, older adults are in great need of supportive services to enhance quality of life and their ability to manage their mental health. The purpose of this study is to examine the quality of life (QoL) of older adults. This study aimed to provide valuable research in the area of QoL through the exploration of perceived factors that impact the older adult population. This exploratory qualitative research study consisted of 10 older adult participants between the ages of 65 and 95. Research recruitment prioritized …

Best Practice Recommendations For Anesthesia Providers In Preventing Postoperative Delirium In The Geriatric Population Undergoing Non-Cardiac Surgery, Ana Primeaux, Ashanti Reed

Doctoral Projects

Postoperative delirium (POD) is a significant and preventable complication in geriatric patients undergoing non-cardiac surgery. Such complication is associated with foreseeable consequences, such as prolonged hospitalization, long-term cognitive decline, increased morbidity and mortality, and increased costs. Despite the emerging awareness of evidence-based nonpharmacologic and pharmacologic interventional strategies, POD still represents a clinical challenge for anesthesia providers.

Currently, there is a lack of clinical guidelines to guide formalized education and evidence-based interventions on POD prevention across anesthesia practice settings. Consequently, there is a critical need to raise awareness that the lack of clinical guidelines and the high incidence of POD may …

Net Effects Of Correlated Determinants Of Health Among U.S. Older Adults, Haomiao Jia, E I. Lubetkin

Publications and Research

Background

The health effect produced by a contributing factor alone may be different from the effect when other interacting factors are present. The effects of a set of contributors, estimated by regression coefficients, may be invalid or inappropriate if some of the predictors are correlated or the model has interaction and nonlinear terms. The net effect (NE) of a given contributing factor is the effect produced by the factor alone, not by other factors due to their correlations with the factor of interest. This study estimated NE of selected determinants of health for U.S. older adults.

Methods

Participants, aged ≥ …

Association Of Area Deprivation Index With Perinatal And Covid-19 Outcomes During The Early Pandemic: A Secondary Analysis Of A Prospective Cohort Study, Abigail Bell, Megan Foeller, Candice Woolfolk, Emily Diveley, Fan Zhang, Amy Scheffer, Ruizhi Huang, Daniel Jackson, Nandini Raghuraman, Ebony Carter, Indira U Mysorekar, Jeannie C Kelly

Center on Aging Staff Publications

Objective: We sought to evaluate the relationship between neighborhood-level deprivation and perinatal outcomes, particularly preterm birth, as well as COVID-19 outcomes among pregnant patients during the early pandemic.

Methods: We performed a secondary analysis of a prospective longitudinal cohort study that investigated the impact of prenatal COVID-19 exposure on perinatal outcomes. Pregnant patients were recruited 12/23/20-7/18/22 and serially assessed for COVID-19 exposure during pregnancy, with serum antibody testing, electronic medical record review, and patient report. For this secondary analysis, address at the time of delivery was used to categorize patients into low ADI (≤50th percentile Area Deprivation Index, indicating low …

Giant Cell Arteritis After Mrna Covid Vaccines: Concerning Or A False Alarm?-A Retrospective Cohort Study, Syed M. F. Zabiullah, Rutwik Pradeep Sharma, Roshan Subedi, Viqarunnisa Faaiza Zahid, Yasir Loai, Sarathlal Mannumbethlal, Aatifa Aatifa

Advances in Clinical Medical Research and Healthcare Delivery

Background: The coronavirus disease (COVID-19) pandemic led to the first large-scale rapid deployment of novel messenger RNA (mRNA) vaccines. Although the effectiveness and safety of these vaccines were rigorously studied, post-vaccination adverse events such as giant cell arteritis (GCA) continue to be reported. More than two hundred and sixty three cases of new-onset GCA occurring after mRNA vaccine administration are listed in the Vaccine Adverse Events Reporting System as of October 2024. We aimed to explore the incidence of GCA after mRNA vaccines among patients in our health system and study their characteristics and outcomes.

Methods: We conducted a …

Long-Term Care Services And Support In The Mountain West, 2023, Taylor Volk, Ivan Sun, Miguel Soriano Ralston, Kristian Thymianos, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data from the American Association of Retired Persons (AARP) report, “Long-Term Services and Supports 2023 State Scorecard Report,” comparing Long-Term Services and Supports (LTSS) systems across multiple dimensions of performance for older adults, people with physical disabilities, and family caregivers for all 50 states. This fact sheet focuses on state-level LTSS system data for the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah.

Enhancing The Eden Alternative Model With Well Standards: A Case Study Analysis, Mariah Stoner

Architecture Masters of Science Program: Theses

This thesis investigates the potential for improving the Eden Alternative Model, a person-centered approach to elder care that emphasizes creating a homelike environment and meaningful relationships, using WELL Standards, a building certification system focused on enhancing human health and well-being through improvements in environmental quality. Through a mixed-methods approach involving quantitative data analysis and qualitative case studies, this research examines how WELL Standards, which cover aspects such as air quality, water quality, lighting, and thermal comfort, can improve environmental quality and resident satisfaction within the Eden Alternative Model. This research introduces a tailored approach to elder care by combining these …

Clinical Outcomes For Patients With Ventilator-Associated Pneumonia In Octogenarians, Nonagenarians, And Centenarians: A Population-Based Study, Tony Elias, Fady Beshara, Daniel Basta, Mena Elmalh, Matthew Ebrahim, Taha Syed, Olga Sarah, Abdallah Hussein

Rowan-Virtua Research Day

We sought to examine the national inpatient sample data-base to describe in-hospital outcomes among patients over seventy who acquire ventilator-associated pneumonia after being on the ventilator for over 48 hours.

Analysis Of Blood Pressure, Blood Glucose, And Cholesterol Screening Results Collected During Street Outreach Events In Atlantic County, New Jersey, As Part Of A Mobile Community Health Worker Program To Identify Residents At High Risk For Severe Covid-19, Kenneth W. Stagliano, Richard T. Jermyn, Alexander E. Abbott, Donato F. Tassoni, Amy Palen, Frank Carozza, Nicole M. Miller

Rowan-Virtua Research Day

Background: This study seeks to evaluate the status of random blood pressure, cholesterol, and blood glucose screening results in Atlantic County, NJ. This study also aims to identify the rates of hyperlipidemia, hyperglycemia, and hypertension within the target population, and potential differences between surveyed age demographics.

Methods: Medical students participating in the COVID-19 CHW Service Corps collected blood pressure, cholesterol, and blood glucose screenings at multiple screening events in Atlantic County, NJ during a two-year period. This data was analyzed retrospectively using ANOVA, non-parametric Kruskal Walis Test, and Tukey's pairwise comparisons.

Results: Senior adults had significantly higher SBP than …

On Death And Disease: How Physicians’ Perspectives Compare Across Specialties Through Written Work, Stephanie Anne C. Alkonga

Honors Capstones

Narrative medicine is a tool that the medical field is increasingly utilizing to cultivate patient-centered and culturally competent doctors and to reflect on lived experiences through texts that focus on psychosocial best practices. This study aims to examine the language used in physician-written works that address how physicians in different medical specialties treat the aging and the terminally ill, and how they view the deceased. Qualitative data guided by thematic questions will primarily be used in the analysis and comparison of these texts’ tone, rhetoric, diction, and similar literary devices to uncover if certain patterns arise across such specialties. Findings …

The Havcr1-Centric Host Factor Network Drives Zika Virus Vertical Transmission, Wenzhe Yu, Jun Tao, Hongmin Cao, Wanshan Zheng, Beiang Zhang, Yue Zhang, Peiqun Xu, Yiwei Zhang, Xuan Liu, Yinan Wang, Han Cai, Gang Liu, Fan Liu, Haibin Wang, Haiyan Zhao, Indira U Mysorekar, Xiaoqian Hu, Bin Cao

Center on Aging Staff Publications

Zika virus (ZIKV) vertical transmission results in devastating congenital malformations and pregnancy complications; however, the specific receptor and host factors facilitating ZIKV maternal-fetal transmission remain elusive. Here, we employ a genome-wide CRISPR screening and identify multiple placenta-intrinsic factors modulating ZIKV infection. Our study unveils that hepatitis A virus cellular receptor 1 (HAVCR1) serves as a primary receptor governing ZIKV entry in placental trophoblasts. The GATA3-HAVCR1 axis regulates heterogeneous cell tropism in the placenta. Notably, placenta-specific Havcr1 deletion in mice significantly impairs ZIKV transplacental transmission and associated adverse pregnancy outcomes. Mechanistically, the immunoglobulin variable-like domain of HAVCR1 binds to ZIKV via …

Incident Hearing Loss And Subsequent Risk Of Dementia: The Health And Retirement Study 2010-2018, Jingkai Wei, Youngran Kim, Yike Li, Donglan Zhang, Casey Crump

Faculty, Staff and Student Publications

Background and Objectives

Research Design and Methods

Management Of Pulmonary Arterial Hypertension: Current Strategies And Future Prospects, Munish Sharma, Vivek Paudyal, Saifullah Khalid Syed, Rubi Thapa, Nadeem Kassam, Salim Surani

Internal Medicine, East Africa

Primary pulmonary hypertension (PPH), now known as pulmonary arterial hypertension (PAH), has induced significant treatment breakthroughs in the past decade. Treatment has focused on improving patient survival and quality of life, and delaying disease progression. Current therapies are categorized based on targeting different pathways known to contribute to PAH, including endothelin receptor antagonists (ERAs), phosphodiesterase-5 inhibitors (PDE-5 inhibitors), prostacyclin analogs, soluble guanylate cyclase stimulators, and activin signaling inhibitors such as Sotatercept. The latest addition to treatment options is soluble guanylate cyclase stimulators, such as Riociguat, which directly stimulates the nitric oxide pathway, facilitating vasodilation. Looking to the future, advancements in …

Acute Care For Elders Unit Implementation At Banner Health: A Quality Improvement Analysis, Jacob Lahti, Tony Gaidici, Shreya Bharath, Esha Saraswat, Nimit Agarwal

Annual Research Symposium

There is an increasing need to optimize hospital care for older adults as Age Friendly Health Systems (AFHS) become increasingly popular. Geriatric patients may often be subject to extended hospital stays, which can result in functional decline, increases in hospital-acquired injury, infections, and neurocognitive deterioration. Early acute inpatient rehabilitation (IRF) is known to improve functional optimization of older adults as compared to therapy in a skilled nursing facility (SNF). In this study we demonstrate the effect of a structured program based on the 4Ms of AFHS in our newly established Acute Care for Elders (ACE) unit, a first in Arizona. …

An Evaluation Of Nhmrc Funded Dementia And Diabetes Research, Etienne Vignola-Gagné Phd, Dmitrii Malkov, Elisabeth Browning, Jörg Hellwig Phd, Luigi Rocco Phd, Henrique Pinheiro, Alexandre Bédard-Vallée

Public Reports

This report, commissioned by the National Health and Medical Research Council (NHMRC), provides comprehensive insights into the research outputs, outcomes, and impacts of NHMRC-funded health and medical research in the areas of dementia and diabetes to support NHMRC's mission of ‘building a healthy Australia.’

A Quality Improvement Approach To Reducing Post-Surgical Acute Care Falls, Tiffany C. Mitchell

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Inpatient falls remain one of the most preventable adverse events in hospitals. Falls result in serious injuries and increasing healthcare costs. This quality improvement project evaluates the implementation of Fall TIPS to reduce fall incidence and promote sustainable safety practices.

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer’S Disease Detection And Monitoring, Melissa E. Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah E. Pape, Juan Fortea, Nicholas J. Ashton, Chinedu Udeh-Momoh, Sid E. O’Bryant, Dwight German, Florin Despa, Mark Mapstone, Henrik Zetterberg

Neurology Faculty Publications

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer’s Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

Bundled Approach To Improve Colorectal Cancer In Primary Care, Elizabeth Reddiar

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, despite being preventable through timely screening. National guidelines recommend regular screening for adults aged 45 to 75; (American cancer Society (ACS), 2025) however, screening rates remain suboptimal, particularly in primary care settings serving diverse and high-volume populations. Local Problem: At the project site, a community-oriented primary care clinic in North Texas, baseline data revealed CRC screening completion rates were below benchmarks set by the organization. Barriers included limited patient awareness, inconsistent provider reminders, and workflow challenges in distributing and tracking fecal immunochemical test …

The Role Of Social Isolation In Shaping Health Outcomes In Older Adults: A Regional Analysis, Vince Falco, Lynn Wiles, Jonathan Romero, Leorey Saligan

Ellmer School of Nursing Faculty Publications

Social isolation is a critical public health concern in older adults and is linked to a range of adverse health outcomes across diverse sociodemographic groups. This study investigated the associations between social isolation with physical and mental health of older adults residing in Hampton Roads, a racially diverse region in Southeastern Virginia, home to a large population of senior military veterans. Secondarily, the study explored how social determinants of health (SDoH) and comorbid medical conditions influenced the relationship of social isolation with physical and mental health of these seniors. Physical and mental health were measured using the Patient-Reported Outcomes Measurement …

Financial Health Literacy Of Community-Dwelling Older Adults: A Qualitative Research Study, Kimberly Davis

Theses and Dissertations

Background: Financial health literacy (FHL) is an emerging concept with unique application to older adults. Multiple complexities converge in older age that create increased financial vulnerability (e.g., retirement, chronic disease). However, low financial and health literacy are common in older adults, impacting their ability to self-manage. The AWV’s focus on prevention offers an opportunity to incorporate a proactive approach to financial-related assessment. This study will explore the perceived value of assessing FHL in primary care settings and the financial-related barriers and facilitators to implementing the personalized prevention plan.

Methods: The conceptual framework was guided by the Individual and Family Self-Management …

Dental Care Trajectories Among Formerly Incarcerated Older Adults In The United States, Alexander Testa, Luis Mijares, Mateus Renno Santos, Vahed Maroufy, Dylan B Jackson, Rafael Samper-Ternent, Rahma Mungia, Ana C Neumann

Faculty, Staff and Student Publications

A growing body of research has documented an association between prior incarceration and lower dental care use, yet the longitudinal impact of prior incarceration on dental care patterns over time among older adults remains unexplored. This study aims to investigate whether prior incarceration is associated with differing trajectories of dental care use among older adults in the United States. Data were drawn from the 2012-2020 waves of the Health and Retirement Study (HRS), a nationally representative longitudinal survey of older adults in the United States (n =  5,893). Group-based trajectory modeling was used to estimate dental care use patterns over …

Multisociety Guidance For Infection Prevention And Control In Nursing Homes, Lona Mody, Sonali D. Advani, Muhammad Salman Ashraf, Allison H. Bartlett, Suzanne F. Bradley, Deborah P. Burdsall, Jennifer A. Hanrahan, Susan S. Huang, Robert L.P. Jump, Lindsay Nicolle, Mary-Claire Roghmann, Patricia Stone, Rekha K. Murthy

Department of Medicine Faculty Publications

This multisociety guidance was endorsed by SHEA, APIC, IDSA, PALTmed, and AGS. It provides recommendations for infection prevention and control (IPC) in the context of the complexity of nursing home care in the United States: increased medical acuity of residents, the spread of multidrug-resistant organisms, and the threat of emerging pathogens. Recommendations and implementation suggestions address IPC leadership, staffing, and resources, healthcare personnel and residents‘ adherence to precautions and effective hand hygiene, outbreak preparedness, training, occupational health, cleaning and disinfection in the care environment, and the involvement of IPC in the facility. The guidance also addresses the challenges of maintaining …

The Doing, Being, Becoming, And Belonging Of Intergenerational Collective Occupations, Gladys Garcia, Jazminne Orozco-Arteaga

Fall 2024 OTD Capstone Symposium

Background: Older adults have been globally recognized as a vulnerable population. Literature has indicated that intergenerational engagement can decrease social isolation for older adults, but there is a gap in understanding intergenerational co-occupational engagement and how these engagements can improve quality of life and fulfillment of self-identity. The purpose of this qualitative research study was to generate knowledge of how relationships and occupations performed with individuals from a younger generation impacted sense of well-being. Through the lens of Doing, Being, Becoming and Belonging (Wilcock, 2006), the study sought to increase understanding of this lived experience to promote intergenerational practice within …

After-Hours, Severity, And Distance Are Associated With Non-Vha Emergency Department Use For Older Veterans: Insights From A Regional Health Information Exchange, Elina Kurkurina, Kimberly M. Judon, Ula Hwang, Kenneth S. Boockvar, Juan Wisnivesky, Matthew R. Augustine

Journal of Geriatric Emergency Medicine

Background: Older adults treated in emergency departments (EDs) are at higher risk for adverse outcomes. Using multiple facilities can worsen this issue through service duplication and poor care transitions. Veterans with dual insurance coverage can access both Veterans Health Administration (VHA) and non-VHA EDs. This study aimed to identify factors associated with non-VHA ED use among veterans.

Methods: We conducted a retrospective observational study of patients aged ≥ 65 who had primary care at the James J Peters VA Medical Center and at least one VHA or non-VHA ED visit between October 2017 and February 2020. Data were collected from …