Geriatrics Commons^™

Evaluating Medical Student Geriatric Competency Using A 5ms-Based Assessment Tool, Lauren R. Hersh Md, Amy Cunningham Phd, Mph, Xiya Wu Md

Cooper Rowan Medical Journal

INTRODUCTION

Driven by an aging Baby Boomer generation, the United States is navigating a demographic transformation with far-reaching implications that include increased demand for chronic disease management and long-term care as well as increased stress on both healthcare costs and infrastructure. Generating a workforce competent in the delivery of care to older patients with complex, multimorbid conditions is fundamental to addressing this shift. Recognizing that the development of primary and specialty care physicians skilled in geriatric care begins in medical school, the American Geriatric Society developed minimum competencies grounded in the Geriatric 5Ms (Mind, Mobility, Medication, Multicomplexity, and …

The Geography Of Faces, Faith Abraham

be Still

The Geography of Faces takes its title from the idea that a face, seen across decades, becomes a kind of landscape—something you learn to read not at a glance but through accumulated return visits. For Dr. Vasquez, an older physician who has seen so much, her patients' faces are the territory she has spent a lifetime learning to navigate.

The patients are chosen to represent different dimensions of that longevity. They show affection built on years of small battles, continuity across a family, autonomy that is respected. Together, these patients make the case that primary care is less about problems …

Geriatric Brittle Type 1 Diabetes Mellitus: Case Study And Management Strategies, Saba Irfan, Amanda Cantu

Research Colloquium

“Brittle diabetes” describes a form of diabetes marked by severe, unpredictable fluctuations in blood glucose, often leading to frequent episodes of hypoglycemia and hyperglycemia. Though not formally recognized by major diabetes organizations, the term is clinically useful, especially for vulnerable populations such as older adults with Type 1 Diabetes Mellitus (T1DM). Age-related factors—cognitive impairment, mobility limitations, dexterity issues, sensory decline, inconsistent eating habits, and frailty—make glycemic control particularly challenging and require a personalized, multidisciplinary management approach.

We report the case of a 66-year-old Hispanic female with long-standing T1DM, seizure disorder, and osteoporosis. Despite adherence to a prescribed insulin regimen, her …

Interprofessional Education: A Geriatric Immersion Experiential, Emily J. Balog, Jennifer Degennaro, Lisa Bodenheimer, Stephanie Berdugo-Hernandez, Isabella Berdugo-Hernandez, Matthew Mclaughlin, Kevin Overbeck, Elyse Perweiler

Rowan-Virtua SOM Faculty Teaching & Learning Seminar

The Geriatric Interprofessional Education Immersion (GIPEI) course was developed using a mixed methods design guided by the Knowledge-to-Action (KTA) Framework and embedded data-driven decision-making (DDDM). The eight-week, tri-weekly immersion integrates Experiential and Adult Learning Theories, the 4Ms Framework, IPEC competencies, and TeamSTEPPS to foster age-friendly clinical decision-making. Quantitative and qualitative data, including pre/post-tests, rubrics, observations, and student interviews, inform iterative improvement. The somato-psycho-socio-semiotic model of health further anchors student reflection and care planning. Findings aim to demonstrate improved learner ability to recognize and apply age-friendly care, while supporting evidence-informed curriculum refinement. The course is funded by the geriatric workforce enhancement …

Managing Hypercholesterolemia In Adults Older Than 75 Years Without A History Of Atherosclerotic Cardiovascular Disease: An Expert Clinical Consensus From The National Lipid Association And The American Geriatrics Society, Vera Bittner, Sunny A Linnebur, Dave L Dixon, Daniel E Forman, Ariel R Green, Terry A Jacobson, Ariela R Orkaby, Joseph J Saseen, Salim S Virani

Faculty, Staff and Students Publications

The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated LDL-cholesterol and non-HDL-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. Risk prediction among older individuals is less certain because most current risk calculators lack specificity in those older than 75 years and do not adjust for co-morbidities, functional status, frailty, and cognition which significantly impact prognosis in this age group. Data on the benefits and risks of lowering LDL-cholesterol with statins in older patients without atherosclerotic cardiovascular disease are also limited since most primary prevention trials have included mostly younger patients. Available …

Deprescribing Type 2 Diabetes Mellitus Medications In Older Adults In An Urban Primary Care Setting, Katelyn Koons, Md, Eugenie Hughes, Md, Eunice Choe, Md, Julio Garcia, Md, Munifa King, Md, Emily Lavell, Md, Michael Danielewicz, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Adults 65+ take on average five medications daily
• Polypharmacy increases risks of drug interactions and adverse events
• About 29% adults 65+ in developed countries have type 2 diabetes mellitus (T2DM) and the number of older adults living with these conditions is expected to increase rapidly in the coming decades
• Over-treatment of DM in older adults is common and increases risks of serios adverse outcomes including hypoglycemia
• Older adults with T2DM should have higher A1c goal consistent with ADA guidelines: [See Table on Poster]

Case Report: When Confusion Signals A Crisis: Rethinking The Diagnosis Of Meningitis In Geriatric Sepsis, Asma Zahid

Rowan-Virtua Research Day

We report the case of an 88-year-old female who presented with altered mental status, initially suspected to have urosepsis but ultimately diagnosed with streptococcal meningitis. The patient had a history of lethargy and anorexia over the past few days and was found to have sepsis. Despite initial focus on urosepsis, blood cultures revealed Streptococcus, and cerebrospinal fluid analysis confirmed bacterial meningitis. This case highlights the potential for meningitis to be overlooked in elderly patients with suspected sepsis, underscoring the importance of broad diagnostic considerations and early intervention. This case highlights the importance of considering meningitis in elderly patients presenting with …

Food Allergies And Quality Of Life In Older Adults: Development Of A Food Allergy Questionnaire, Avalon F. Mustafa

UNF Graduate Theses and Dissertations

The United States is experiencing a rapid increase in the number of older adults, yet there is a lack of research on food allergies in this demographic. While there are survey instruments available to study food allergies and quality of life, none of these are tailored to the unique needs of elderly individuals. This study aims to create and validate an on-line survey instrument specifically designed for older adults, focusing on their quality of life in the context of food allergies. The survey will be used to establish a food allergy severity score and a quality-of-life score, enabling comparison between …

Perioperative Outcomes And Mortality In Liver Transplant Patients 65 And Older, Nathaniel S. Pester, Trevor J. Wilke, V K. Shostrom, Cale A. Kassel

Graduate Medical Education Research Journal

Background: The number of patients over the age of 65 awaiting liver transplantation (LT) continues to grow and an increasing number of patients will undergo liver transplantation. While age is not an absolute contraindication to liver transplantation, understanding the risks to older patients remains essential to ensure good outcomes with the limited number of grafts available.

Methods: This retrospective study included patients undergoing LT at the University of Nebraska Medical Center. A total of 421 patients were enrolled and stratified to patients under 65 years old (351 patients) and patients over 65 (70 patients). Geriatric patients were defined as aged …

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 …

Integrating Geriatric House Call Practice Into Paramedic Education: A Novel Educational Approach On Attitudes And Acceptance, Phillip D. Magidson, Mariah L. Robertson, Robby May, Mattan Schuchman, Eric Garfinkel, Matthew J. Levy

Journal of Geriatric Emergency Medicine

Objective: This study aimed to assess the feasibility and acceptance of integrating geriatric house call practice clinical exposure into paramedic education and to explore the impact on attitudes towards older adults among paramedic students.

Methods: Paramedic students from a fire department training program participated in a geriatric house call practice in collaboration with an academic health system. Pre- and post-program surveys were conducted to evaluate changes in attitudes towards older adults using the Ageing Semantic Differential (ASD) scale. Patient feedback on paramedic involvement was collected through post-visit surveys.

Results: Six paramedic students completed 25 house call visits over eight weeks. …

Inclusion Of Caregivers In The Cga: Future Directions For Optimizing Clinical Care, Lora Rhodes, Lcsw, Andrew Chapman, Do, Facp, Fcpp, Kristine Swartz, Md, Caroline Glavin, Msw, Charlotte Zuber, Kuang-Yi Wen, Phd

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

Introduction

As our population continues to age and the number of cancer survivors increases, the physical, emotional, and financial burden on family caregivers will increase exponentially. While burden among cancer caregivers is recognized to impact both caregiver and patient health and quality of life, our current comprehensive geriatric assessments (CGAs) do not routinely include evaluations of caregivers’ distress, burden, or functioning. As we continue to work to better understand the needs of older adults with cancer, it is critical that this circle of concern includes the needs of their caregivers.

Assessing Preparedness, Attitudes, And Knowledge Of Knapp-Utrgv Family Medicine Residents On Geriatric Nursing Home Care: Phase 1 - Creation Of Interactive Modules, Maria M. Ferreira Caceres, Miguel A. Alvarez Silva, Juan C. Lopez-Alvarenga

Research Colloquium

Background: Training in geriatrics and nursing home care are a critical element of medical education. This gap in knowledge becomes increasingly significant given the changing demographics and the need to provide adequate care for an aging population. Improving geriatrics curriculum and implementing nursing home rotations are essential to ensure optimal care for the elderly, thereby fulfilling both educational and healthcare imperatives.

Objective: We aim to analyze and assess the influence of geriatrics training through a survey to collect attitudes, skills, and knowledge of UTRGV Knapp Family Medicine residents. Additionally, the goal is to create interactive modules to boost their skills …

Pragmatism And Feasibility: A Qualitative Study Of Experiences Implementing And Upgrading Care In Geriatric Emergency Departments, Anita Chary, Annika Bhananker, Vivian Ramont, Lauren Southerland, Aanand Naik, Kyler Godwin, Maura Kennedy

Faculty, Staff and Students Publications

OBJECTIVES: Implementation and sustainability of new care processes in emergency departments (EDs) is difficult. We describe experiences of implementing geriatric care processes in EDs that upgraded their accreditation level for the Geriatric Emergency Department Accreditation (GEDA) program. These EDs can provide a model for adopting and sustaining guidelines for evidence-based geriatric care.

METHODS: We performed qualitative interviews with geriatric ED nurse and physician leaders overseeing their ED's geriatric accreditation processes. The interview guide was based on the Consolidated Framework for Implementation Research (CFIR), a framework consisting of a comprehensive set of factors that impact implementation of evidence-based interventions. We used …

Depressive Symptoms Are Associated With C-Reactive Protein In Older Adults With Obesity, Henry D Heisey, Clifford Qualls, Dennis T Villareal, Martha Belen Segoviano-Escobar, Maria Liza Duremdes Nava, Jennifer R Gatchel, Mark E Kunik

Faculty, Staff and Students Publications

OBJECTIVES: To test the hypothesis that depressive symptoms vary with high-sensitivity C-reactive protein (hs-CRP), among older adults with obesity.

METHODS: This was a cross-sectional, secondary analysis of baseline data from two related lifestyle intervention trials. The study sample comprises 148 consecutively recruited, community-dwelling older adults (age >=65 years) without severe psychiatric illness and with body mass index >=30 kg/m

RESULTS: Sample mean GDS score was 2.7 (SD 3.0, range 0 - 14). A significant multivariate model of GDS scores (R

CONCLUSIONS: In older adults with obese BMI, male sex and higher hs-CRP are associated with depression, even in a group …

Preventing Postoperative Cognitive Dysfunction Through Preoperative Exercise, John Andre Socci

Rowan-Virtua Research Day

Introduction: Postoperative cognitive dysfunction (POCD) is a common problem in the elderly population after undergoing anesthesia that results in sometimes irreversible cognitive and physical impairment that can increase mortality and decrease quality of life.

Methods: To see the relationship between preoperative fitness capacity and how this relates to postoperative cognitive ability a literature review was performed. Studies that were included involved populations older than sixty years old that had undergone anesthesia. Additionally, animal studies were included to show inflammatory marker levels and how they increased in relation to physical activity.

Results: Various fitness scales were used such as the Timed …

Geriatric Trauma Triage: Optimizing Systems For Older Adults-A Publication Of The American Association For The Surgery Of Trauma Geriatric Trauma Committee, Tanya Egodage, Vanessa P Ho, Tasce Bongiovanni, Jennifer Knight-Davis, Sasha D Adams, Jody Digiacomo, Elisabeth Swezey, Joseph Posluszny, Nasim Ahmed, Kartik Prabhakaran, Asanthi Ratnasekera, Adin Tyler Putnam, Milad Behbahaninia, Melissa Hornor, Caitlin Cohan, Bellal Joseph

Faculty, Staff and Student Publications

BACKGROUND: Geriatric trauma patients are an increasing population of the United States (US), sustaining a high incidence of falls, and suffer greater morbidity and mortality to their younger counterparts. Significant variation and challenges exist to optimize outcomes for this cohort, while being mindful of available resources. This manuscript provides concise summary of locoregional and national practices, including relevant updates in the triage of geriatric trauma in an effort to synthesize the results and provide guidance for further investigation.

METHODS: We conducted a review of geriatric triage in the United States (US) at multiple stages in the care of the older …

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 …

Describing And Predicting Trajectories Of Healthcare Utilization Among Older Adults Presenting To An Emergency Department Using The Interrai Emergency Department Screener, Matthew B. Downer, Kristina Kokorelias, Andrew P. Costa, Don Melady, Samir K. Sinha

Journal of Geriatric Emergency Medicine

Introduction: Although older adults visit emergency departments (EDs) more than any other age group, the trajectories of healthcare utilization older adults experience post-ED are not well described. Further, whether rapid ED assessment tools can predict trajectories and discharge destinations remains unclear.

Methods: Older adults (≥65 years) who presented to an ED at a large Canadian urban academic hospital were recruited (January 2018-April 2019). The interRAI ED Screener (EDS) was completed on presentation. Patients were categorized by EDS risk score (1/2=low, 3/4=moderate, 5/6=high) and had their discharge destinations tracked. Patients admitted to hospital were tracked until their final discharge destination. …

Acceptability And Use Of An Online Health Priorities Self-Identification Tool For Older Adults: A Qualitative Investigation, Emily L Mroz, Kizzy Hernandez-Bigos, Jessica Esterson, Eliza Kiwak, Aanand Naik, Mary E Tinetti

Faculty, Staff and Student Publications

OBJECTIVE: To examine the use of a web-based, self-directed health priorities identification tool for older adults with multiple chronic conditions (MCCs).

METHODS: We recruited a gender- and racially-diverse, highly educated sample of older adults with MCCs to engage with our My Health Priorities tool, then complete a semi-structured interview. Thematic analysis was used to examine interview transcripts.

RESULTS: Twenty-one participants shared perspectives on the acceptability and use of the tool. Three themes (with eleven subthemes) were generated to describe: website

CONCLUSION: Participants found this tool acceptable and easy to use, describing a variety of benefits of the priorities self-identification process …

Homebound Older Adult, Caregiver, And Provider Perspectives On The Benefits Of Home-Based Primary Care: A Narrative Review, Nila N. Sabetfakhri

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) is a clinical practice that is being increasingly utilized for the homebound older adult population. As the age demographics in the United States shift over time, these programs will need to be expanded to accommodate the growing aging population. This narrative review aims to compile studies on the benefits of HBPC from the perspective of homebound older adult patients, caregivers, and the health care providers who practice HBPC. Studies were identified through PubMed, Web of Science, and Google Scholar, and a total of 10 papers were included in this review. Identified benefits of HBPC for homebound …

Diversity, Equity, And Inclusion: Considerations In The Geriatric Emergency Department Patient, Anita N Chary, Lauren Cameron-Comasco, Kalpana N Shankar, Margaret E Samuels-Kalow

Faculty, Staff and Students Publications

This article introduces core topics in health equity scholarship and provides examples of how diversity, equity, and inclusion impact the aging population and emergency care of older adults. It offers strategies for promoting diversity, equity, and inclusion to both strengthen the patient-clinician therapeutic relationship and to address operations and systems that impact care of the geriatric emergency department patient.

Enhancing The Rates Of Advance Directive Documentation To Improve The Quality Of Patient Care, Sydney Sheppard, Katie Salyers, Carolyn Curtis, Adam Franks Franks, Courtney Wellman

Marshall Journal of Medicine

Introduction

Advance Directives (AD) allow patients to maintain autonomy during incapacitation. Patients and their caregivers benefit from these documents in times of crisis. Overcoming barriers to AD completion and documentation can improve patient care quality.

Methods

A retrospective chart review was performed initially, after consolidation of the electronic health record (EHR) and after alteration of the EHR, to evaluate the availability of a patient’s medical power of attorney (MPOA), living will (LW), and code status.

Results

Baseline documentation of MPOA (7.33%), LW (6.00%), and code status (5.33%) within the outpatient EHR was low. After 2 cycles, this improved to 13.10%, …

Navigating The Healthcare System To Increase Quality Of Life In The Geriatric Population: Case Of An 80-Year Old Male With Blindness, Kelsey Endari, Jessica Flores, Daniel Aragon, Chelsea Chang

Research Symposium

Bilateral retinal artery occlusion (BRAO) is defined as the blockage of blood to the retina in both eyes and can lead to partial or permanent loss of eyesight. This uncommon diagnosis can necessitate lifestyle changes that require supplemental assistance to help with activities of daily living. Navigating the healthcare system in general is formidable. However, doing so as a geriatric patient with limited eyesight and no social support escalates the challenge.

This is the case for an 80-year-old male with history of vision impairment due to BRAO, coronary artery disease, heart failure, atrial fibrillation, chronic kidney disease, basal cell carcinoma …

The Missed And The Misdiagnosed: Geriatric Delirium In The Emergency Department, Christienne Shams, Yashar Eshman, Ronan Factora, Stephen Meldon, Saket Saxena

Journal of Geriatric Emergency Medicine

Background: Older patients with delirium are at increased risk for prolonged hospitalization, poor outcomes, higher costs and a greater risk for institutionalization. By identifying those at risk early, interventions can be implemented to prevent or minimize the severity of the delirium. Per hospital policy, our geriatric emergency department (ED) screens for delirium by performing a 4AT only if changes in mental status are noted by caregivers or healthcare providers familiar with the patient. We hypothesize this approach underestimates the prevalence of delirium on presentation to the ED, particularly among high-risk older patients. The aim of this study is to determine …

Game-Based Intradialytic Non-Weight-Bearing Exercise Training On Gait Speed And Balance In Older Adults With Diabetes: A Single-Blind Randomized Controlled Trial, M G Finco, Bijan Najafi, He Zhou, Abdullah Hamad, Rania Ibrahim, Fadwa Al-Ali

Center on Aging Staff Publications

Older adults with diabetes receiving hemodialysis have impaired gait speed and balance compared to the general population, which have been associated with increased risks of falls and mortality. This study evaluated the effectiveness of a game-based intradialytic exercise training program (iExergame) on improving gait speed and balance. This was a single-blind randomized controlled trial. The intervention group (IG) received iExergame training using real-time audiovisual feedback with wearable inertial sensors. The control group (CG) received conventional training without any technology. Both trainings were intradialytic, non-weight-bearing, and used ankle range of motion. Gait and balance parameters were collected at baseline and 4-week …

Impact Of Geroscience On Therapeutic Strategies For Older Adults With Cardiovascular Disease: Jacc Scientific Statement, Daniel E Forman, George A Kuchel, John C Newman, James L Kirkland, Elena Volpi, George E Taffet, Nir Barzilai, Ambarish Pandey, Dalane W Kitzman, Peter Libby, Luigi Ferrucci

Faculty, Staff and Students Publications

Geroscience posits that cardiovascular disease (CVD) and other chronic diseases result from progressive erosion of the effectiveness of homeostatic mechanisms that oppose age-related accumulation of molecular damage. This hypothetical common root to chronic diseases explains why patients with CVD are often affected by multimorbidity and frailty and why older age negatively affects CVD prognosis and treatment response. Gerotherapeutics enhance resilience mechanisms that counter age-related molecular damage to prevent chronic diseases, frailty, and disability, thereby extending healthspan. Here, we describe the main resilience mechanisms of mammalian aging, with a focus on how they can affect CVD pathophysiology. We next present novel …

Effectiveness Of An Emergency Department-Based Machine Learning Clinical Decision Support Tool To Prevent Outpatient Falls Among Older Adults: Protocol For A Quasi-Experimental Study, Daniel J Hekman, Amy L Cochran, Apoorva P Maru, Hanna J Barton, Manish N Shah, Douglas Wiegmann, Maureen A Smith, Frank Liao, Brian W Patterson

Faculty, Staff and Student Publications

Background

Emergency department (ED) providers are important collaborators in preventing falls for older adults because they are often the first health care providers to see a patient after a fall and because at-home falls are often preceded by previous ED visits. Previous work has shown that ED referrals to falls interventions can reduce the risk of an at-home fall by 38%. Screening patients at risk for a fall can be time-consuming and difficult to implement in the ED setting. Machine learning (ML) and clinical decision support (CDS) offer the potential of automating the screening process. However, it remains unclear whether …

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

Faculty, Staff and Student Publications

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 …

Leveraging The Electronic Health Record To Implement Emergency Department Delirium Screening, Anita N Chary, Elise Brickhouse, Beatrice Torres, Ilianna Santangelo, Christopher R Carpenter, Shan W Liu, Kyler M Godwin, Aanand D Naik, Hardeep Singh, Maura Kennedy

Faculty, Staff and Students Publications

OBJECTIVE: The aim of this study is to understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening.

METHODS: We conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig sociotechnical model, which addresses use of HIT in complex adaptive health care systems. Subsequently, we analyzed data …