Geriatrics Commons^™

Primary Care Providers' Attitudes And Practices Regarding Cancer Screening In Older Adults., Randa Sifri, Brooke Salzman, Amy Cunningham, Alexis Silverio, Madalene Zale, Christine Talerico

Department of Family & Community Medicine Faculty Papers

Introduction: Cancer-screening decisions for older adults should be individualized. However, conducting such complex shared decisions may be challenging for primary care providers (PCPs). Additionally, there is little information on how PCPs make these decisions. This study consisted of a provider survey and chart review to assess current PCP approaches to breast and colorectal cancer (CRC) screening with patients age ≥75.

Methods: PCP survey questions: panel age, comfort with discussion of screening harms and benefits, screening decision-making process, and discussion style. One Hundred charts were chosen from a random sample of male and female patients ≥75 with a recent office …

Implementation Of A Volunteer Based Hospital Visitation Program For Older Adults, Mariana R. Kuperman, Md, Mph, Kristine Swartz, Md, Elizabeth Collins, Md, Jennifer Kim, Bs

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

Hospital Elder Life Program (HELP)¹: a multi faceted, volunteer led, hospital based program has been shown to:

• Reduce the incidence of delirium
• Decrease length of stay
• Reduce hospital costs

Implementation of such a program requires upfront investment.

A smaller, volunteer based visitation program for older adults was started to provide support for the allocation of hospital resources in delirium prevention and establishment of HELP in this institution.

This research aims to investigate the program’s implementation and impact on delirium specific outcomes.

Depressive Symptoms In People With Vision Impairment: A Cross-Sectional Study To Identify Who Is Most At Risk, Claire Nollett, Barbara Ryan, Nathan Bray, Catey Bunce, Robin J. Casten, Rhiannon Tudor Edwards, David Gillespie, Daniel J. Smith, Miles Stanford, Tom H. Margrain

Department of Psychiatry and Human Behavior Faculty Papers

Objective To identify the risk factors for significant depressive symptoms in people with visual impairment in England and Wales to provide information on who is most at risk and to whom support services could be targeted in future. Design A cross-sectional study using baseline data from a pragmatic randomised controlled trial. Setting and participants 990 participants aged 18 or over attending 1 of 14 low-vision rehabilitation primary care optometry-based clinics in South Wales or two hospital clinics in London. Outcome measure A score of ≥6 on the Geriatric Depression Scale-15 was classed as clinically significant depressive symptoms. Results In a …

A Social Dance Intervention To Nourish Sustainable Quality Of Life Outlook In Geriatric Oncology Patients, Luis Alberto Aguilar Montalva

Phase 1

Importance: Social support is a major determinant of health for geriatric oncology patients. Nevertheless, no DMT program utilizes community building as an explicit focus of intervention.

Objective: To design a DMT that fosters a therapeutic approach which relies as much on the interpersonal relationships as on the intrapersonal journey. Design, setting, participants: 12 weeks observational trial of participants, from TJUH geriatric oncology patient population, as they progressed through two series of social dance workshops. The first series of six workshops happened on a weekly basis, with participants filling out a FACT-G survey pre and post involvement. The second series of …

Immersive Virtual Reality For The Management Of Pain In Community-Dwelling Older Adults., Sara Benham, Minhee Kang, Namrata Grampurohit

Department of Occupational Therapy Faculty Papers

Immersive virtual reality (VR) can provide a high level of engagement and distraction analgesia to address pain. However, community-based applications of this technology for older adults have not been studied. The objective of this study was to examine the applicability and effectiveness of an immersive VR intervention for pain, depression, and quality of life (QOL) in older adults. This pretest–posttest, mixed-methods design included senior center members (n = 12) with pain that interfered with daily functioning. The outcomes included the Numeric Pain Rating Scale, Patient-Reported Outcomes Measurement Information System (PROMIS^®) depression scale, World Health Organization Quality of Life …

Optimizing Psychosocial Care Of Older Adults With Cancer: An Early Assessment And Intervention Model, Lora Rhodes, Lcsw, Andrew Chapman, Do, Facp

Department of Medical Oncology Posters

Background

Jefferson Multidisciplinary Senior Adult Oncology Center

History

• Established September 2010
• First multidisciplinary geriatric oncology evaluation center in the tristate area

Demographics

• 890 patients evaluated to date
• All tumor types
• Age 70 and above & Pre-transplant (Bone Marrow) evaluation age 65 and above

Format

• Consultative service
• Two sessions weekly
• Average evaluation time: two hours

Multidisciplinary Team

• Navigator, Medical Oncologist, Geriatrician, Pharmacist, Nutritionist, Social Worker
• As needed: Psychiatry, Rehab Medicine, Radiation Oncology, Surgery

The Conceptual Relevance Of Assessment Measures In Patients With Mild/Mild-Moderate Alzheimer's Disease, Ann Hartry, Natalie V.J. Aldhouse, Tamara Al-Zubeidi, Myrlene Sanon, Richard G. Stefanacci, Sarah L. Knight

College of Population Health Faculty Papers

Introduction: This study aims to evaluate the conceptual relevance of four measures of disease activity in patients with mild/mild-moderate Alzheimer's disease (AD): (1) the Alzheimer's Disease Assessment Scale–Cognitive Subscale; (2) the Alzheimer's Disease Cooperative Study–Activities of Daily Living Inventory; (3) the Neuropsychiatry Inventory; and (4) the Dependence Scale. Methods: A conceptual model depicting patient experience of mild AD was developed via literature review; concepts were compared with the items of the four measures. Relevance of the concepts included in the four measures was evaluated by patients with mild AD in a survey and follow-up interviews. Results: The four measures assessed …

Implementation Of A Volunteer-Based Hospital Program For Older Adults, Elizabeth Collins, Md, Kristine Swartz, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• A multi-faceted, volunteer-led, hospital-based program1has been shown to: •Reduce the incidence of delirium •Decrease hospital length of stay •Reduce hospital costs.
• Implementation of such a program requires upfront investment.
• A smaller, volunteer-based visitation program for older adults may provide support for the allocation of more hospital resources in delirium prevention and establishment of a formal Hospital Elder Life Program1in this institution.
• This research aims to investigate: •If the implementation of a visitation program is feasible at this hospital •Volunteer experience with the program.

Role Of A Plausible Nuisance Contributor In The Declining Obesity-Mortality Risks Over Time., Tapan Mehta, Nicholas M. Pajewski, Scott W. Keith, Kevin Fontaine, David B. Allison

Department of Pharmacology and Experimental Therapeutics Faculty Papers

CONTEXT: Recent analyses of epidemiological data including the National Health and Nutrition Examination Survey (NHANES) have suggested that the harmful effects of obesity may have decreased over calendar time. The shifting BMI distribution over time coupled with the application of fixed broad BMI categories in these analyses could be a plausible "nuisance contributor" to this observed change in the obesity-associated mortality over calendar time.

OBJECTIVE: To evaluate the extent to which observed temporal changes in the obesity-mortality association may be due to a shifting population distribution for body mass index (BMI), coupled with analyses based on static, broad BMI categories. …

Evaluation Of Patient Perceptions Of Team Based Care In A Geriatric Oncology Clinic, Kristine Swartz, Md, Andrew Chapman, Do, Lauren Collins, Md, Shoshana Sicks, Med, Abigail Sherburne, Bsn

JCIPE Conference

Purpose: To measure patient perceptions of collaborative practice in an interprofessional team providing geriatric oncology assessments to older patients with cancer.

Background: The Senior Adult Oncology Clinic (SAOC) at Thomas Jefferson University’s Kimmel Cancer Center utilizes an interprofessional team approach to provide comprehensive geriatric oncology assessments and treatment plans for older patients with cancer. The importance of team-based healthcare delivery is well documented, however, experts agree that there is a need for more tools to assess the skills required to become a high-functioning team and a need to study the impact of collaborative practice on patient reported outcomes …

Polypharmacy And Potentially Inappropriate Medication Use In Geriatric Oncology., Manvi Sharma, Kah Poh Loh, Ginah Nightingale Pharmd, Bcop, Supriya G. Mohile, Holly M. Holmes

College of Pharmacy Faculty Papers

Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. …

Utilization Of Exercise Prescriptions For Older Adults, David Jeong, Md, Caqsm, Cep, Rmsk, Brooke Salzman, Md, Jeremy Close, Md

Department of Family & Community Medicine Posters

Objective

This study was conducted to investigate

1) Providers` knowledge and physician attitude about Exercise and Physical activity (PA) recommendations for Older Adults (OA)

2) Frequency of utilizing written exercise prescriptions

3) Barriers to using exercise prescriptions in primary care practice

4) Providers’ interest in learning about and utilizing exercise prescriptions

Recurrent Siadh After Switching Citalopram To Very Low Dose Duloxetine In The Elderly, David Jeong, Md, Caqsm, Cep, Rmsk, Patrick Doggett, Md, Kristine Swartz, Md, Lauren Hersh, Md, Brooke Salzman, Md

Department of Family & Community Medicine Posters

Objective

• Duloxetine-induced SIADH has been seldom reported
• This case study emphasizes the importance of suspecting rare adverse effects of recurrent SIADH after switching an SSRI to duloxetine in older adults

Preserving Cognition In Older African Americans With Mild Cognitive Impairment., Barry W. Rovner, Robin J. Casten

Department of Psychiatry and Human Behavior Faculty Papers

No abstract provided.

Pharmacists On The Front Lines Of Polypharmacy: The Individualized Medication Assessment And Planning (Imap) Project To Improve Medication Use In Senior Adults With Cancer, Ginah Nightingale Pharmd, Bcop, Laura T. Pizzi Pharmd, Mph, Emily Hajjar Pharmd, Bcps, Bcacp, Cgp, Elizabeth Pigott, Margaret Wang, Shannon Doherty, Kristine Swartz Md, Andrew Chapman Do, Facp

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Personality And Functional Vision In Older Adults With Age-Related Macular Degeneration, Barry W. Rovner, R. J. Casten, Mark T. Hegel, Robert W. Massof, Benjamin E. Leiby, Allen C. Ho, William S. Tasman

Department of Psychiatry and Human Behavior Faculty Papers

Introduction: The purpose of the study was to determine whether personality traits influence self-reported functional vision in patients with age-related macular degeneration (AMD). Methods: This is a prospective cross-sectional analysis of baseline data from the Low Vision Depression Prevention Trial. Participants (N = 182) over age 65 with bilateral AMD, visual acuity worse than 20/70 in the better-seeing eye, and subthreshold depression were recruited from the Wills Eye Hospital retina practice. Assessments included visual acuity, contrast sensitivity, National Eye Institute Visual Function Questionnaire-25 plus Supplement (NEI VFQ-25) near and distance subscales, depression, and personality testing. Structural equation models were used …

A Community-Integrated Home Based Depression Intervention For Older African Americans: Descripton Of The Beat The Blues Randomized Trial And Intervention Costs., Laura N Gitlin, Lynn Fields Harris, Megan Mccoy, Nancy L Chernett, Eric Jutkowitz, Laura T Pizzi

Center for Applied Research on Aging and Health Research Papers

ABSTRACT: BACKGROUND: Primary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness. METHODS/DESIGN: Beat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to …

Cost Effectiveness Of A Home-Based Intervention That Helps Functionally Vulnerable Older Adults Age In Place At Home., Eric Jutkowitz, Laura N Gitlin, Laura T. Pizzi, Edward Lee, Marie P Dennis

College of Population Health Faculty Papers

Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE), previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety. Incremental cost-effectiveness ratio (ICER), expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were …

Persistent Nodular Rash In An Elderly Patient, Daniel Dejoseph, Md, James Studdiford, Md, Amber Stonehouse, Md, Beth Careyva, Md

Department of Family & Community Medicine Faculty Papers

A 62yo white male presented to same day clinic with an erythematous nodular rash. He was initially treated with antibiotics for a furunculosis, but the rash worsened and he was eventually found to have secondary syphilis. He is an MSM who had a prior history of syphilis, putting him at high risk for STI’s and HIV, and should have been undergoing annual screening. He was found to be HIV positive. The rates of STI’s and HIV are increasing in older Americans. Despite this, physicians do not regularly screen this population for unsafe sexual behavior. This case emphasizes the importance of …

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CenterPieces

Download the PDF of the Full Issue of CenterPieces, Fall 2007, Volume 2, Issue 1.

We Are Seeking Participants For The Following Studies

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All participants in our research projects receive compensation for participating in study interviews. For further information about these and other studies, please visit our website at www.jefferson.edu/jchp/carah or call 215-503-2897 to speak to a member of our staff.

Coping Tips For Caregivers

CenterPieces

Educate yourself about the disease your family member is facing and how it may affect his or her behavior, pain level or quality of life.

Find sources of help for caregiver tasks. Contact family, friends, neighbors, church/synagogue, workplace, Area Agency on Aging or other organizations.

Protect your personal time for something you enjoy or something you need to get done.

Helping Caregivers To Cope

CenterPieces

When Deb Lacktman promised her dying father that she would care for her mother, Margaret Rimato, after he passed, she wasn’t prepared for the challenges to come. Shortly after he passed, Margaret became increasingly forgetful and delusional. Deb attributed her mother’s memory loss to the stress of losing her husband. With time, however, Margaret’s condition worsened and she was diagnosed with Alzheimer’s disease.

As the primary caregiver of a parent with Alzheimer’s, Deb dealt with various complications beyond the memory loss. Her mother continually roamed the house in the middle of the night, for no apparent reason. It turned out …

Speaking With Barry Rovner, Md

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Q: What Alzheimer’s related studies are you involved in currently at the Farber Institute for Neurosciences?

Dr. Rovner: We are evaluating three exciting new disease-modifying drug treatments that may slow down the course of Alzheimer’s disease. I am also a Principal Investigator of Jefferson’s Center for Excellence in Neurodegenerative Diseases funded by the Pennsylvania Department of Health Tobacco Settlement grant. We are testing innovative screening methods to identify dementia in community-based agencies serving older adults, as well as testing in-home skills training services to delay nursing home placement and reduce stress for a racially diverse group of family caregivers. This …

Message From Dr. Laura Gitlin, Director Of Carah, Laura N. Gitlin

CenterPieces

Welcome to the second issue of CenterPieces, the newsletter of the Center for Applied Research on Aging and Health. We dedicate this issue to the topic of dementia and family caregiving, a critical public health issue. There are 26 million individuals with dementia worldwide, and approximately 5 million individuals with the diagnosis in the US. This number may exceed 16 million in 2050.

For the past 15 years, CARAH has been in the forefront of developing and testing innovative approaches to supporting families in their heroic care efforts and enhancing the quality of life of affected individuals. CARAH’s current research …

Intracerebral Hemorrhage For The Palliative Care Provider: What You Need To Know., B Brent Simmons, Susan M Parks

Department of Family & Community Medicine Faculty Papers

Intracerebral hemorrhage (ICH) makes up 10%-30% of all strokes. Palliative care providers are often asked to get involved with ICH cases to aid with development of short-term and long-term goals. Prognosis can be calculated using the ICH score (based on Glasgow Coma Score score, ICH volume, presence of intraventricular hemorrhage, age, and location of origin) or the Essen score (based on age, NIH Stroke Scale [NIHSS], and level of consciousness). Do-not-resuscitate (DNR) status is important to discuss with families. Expert consensus states DNR is appropriate if the patient has two of the following: severe stroke, life-threatening brain damage, or significant …

A New Age In Dementia Care: Turning Evidence Into Practice

Center for Applied Research on Aging and Health Conferences

A New Age in Dementia Care: Turning Evidence into Practice Come celebrate the opening of the new Living Laboratory for Elder Care.

September 17, 2008 7:30 am - 4:30 pm Thomas Jefferson University, Dorrance H. Hamilton Building 1001 Locust St., Philadelphia, PA 19107

Speakers Include:
Christine Arenson, MD Associate Professor Director, Division of Geriatric Medicine Department of Family and Community Medicine Jefferson Medical College Director, Eastern-Pennsylvania Delaware Geriatric Education Center Co-Director Jefferson InterProfessional Education Center Thomas Jefferson University

Louis D. Burgio, PhD Harold R. Johnson Endowed Chair in Gerontology, Professor of Social Work Research Professor, Institute of Gerontology School …

A Non-Pharmacological Intervention To Manage Behavioral And Psychological Symptoms Of Dementia And Reduce Caregiver Distress: Design And Methods Of Project Act3., Laura N Gitlin, Laraine Winter, Marie P Dennis, Walter W Hauck

Center for Applied Research on Aging and Health Research Papers

Project ACT is a randomized controlled trial designed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia (BPSD) and caregiver distress. The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances. All participants are interviewed at baseline, 4-months (main trial endpoint), and 6-months (maintenance). The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers (communication style, environmental clutter) contributing to behaviors, and instruct in strategies to reduce caregiver …

Carah's Bookshelf

CenterPieces

Occupational Therapy and Dementia Care: The Home Environmental Skills-Building Program for Individuals and Families

by Laura N. Gitlin, PhD and Mary Corcoran, PhD, OTR/L with contributors, published by AOTA Press, the American Occupational Therapy Association, Inc.

ISBN: 1569002037

Based on over 15 years of research, the book presents the Home Environmental Skill-building Program (ESP), an evidence-based intervention to support families and persons with dementia and enhance quality of life. The book provides the theoretical and empirical evidence for the program and describes its protocols in depth.

Physical Function in Older Adults: A Comprehensive Guide to Its Meaning and Measurement

by …

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