Geriatrics Commons^™

Developing, Implementing, And Evaluating A Clinical Dashboard To Improve The Efficiency And Ease Of Tracking Institute For Healthcare Improvement Ihi Age-Friendly 4ms Framework Data., Margaret Parniawski Nsn, Ne-Bc, Kenneth Forte, Denis Mohess Md, Ray Wauthier Bsn, Erica Zerl Ssa, Edward Ostrowski Msn

Posters

The purpose of this study was to describe a user-centered development, implementation and preliminary evaluation of clinical dashboards to track Age-Friendly 4M Framework Data.

Patterns Of Care Partner Communication For Persons Living With Dementia In The Emergency Department, Adrian D. Haimovich, Aidan Gilson, Evangeline Gao, Ling Chi, Cameron J. Gettel, Mara Schonberg, Ula Hwang, Richard A. Taylor

Journal of Geriatric Emergency Medicine

Abstract

Background:

Nearly half of all persons living with dementia (PLwD) will visit the emergency department (ED) in any given year and ED visits by PLwD are associated with short-term adverse outcomes. Care partner engagement is critical in the care of PLwD, but little is known about their patterns of communication with ED clinicians.

Methods:

We performed a retrospective electronic health record (EHR) review of a random sampling of patients ≥ 65 years with a historical diagnosis code of dementia who visited an ED within a large

regional health network between 1/2014 and 1/2022. ED notes within the EHRs were …

Geriatric Emergency Medicine Fellowship Journal Club: Syncope Risk Stratification & Geriatric-Specific Clinical Decision Rules, Kyle R. Burton Md Mpp, Phillip Magidson

Journal of Geriatric Emergency Medicine

No abstract provided.

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 …

The Geriatric Emergency Department At The University Of California San Francisco: Structures, Roles, And Lessons Learned, Todd James

Journal of Geriatric Emergency Medicine

No abstract provided.

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 …

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

Journal of Geriatric Emergency Medicine

Background

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

Methods

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

Ags And Nia Bench-To Bedside Conference Summary: Cancer And Cardiovascular Disease, Supriya Mohile, Caroline S Blaum, Peter M Abadir, William Dale, Daniel E Forman, Chunkit Fung, Holly M Holmes, Javid Moslehi, Karen M Mustian, Michael W Rich, Heather E Whitson

Faculty, Staff and Student Publications

This report summarizes the presentations, discussions, and recommendations of the most recent American Geriatrics Society and National Institute on Aging research conference, "Cancer and Cardiovascular Disease," on October 18-19, 2021. The purpose of this virtual meeting was to address the interface between cancer and heart disease, which are the two leading causes of death among older Americans. Age-related physiologic changes are implicated in the pathogenesis of both conditions. Emerging data suggest that cancer-related cardiovascular disease (CVD) involves disrupted cell signaling and cellular senescence. The risk factors for CVD are also risk factors for cancer and an increased likelihood of cancer …

Utilization Of Remap Conversation Tool To Improve Advance Care Completion In The Home-Based Palliative Care Community Setting, Gwendolyn Starkey

Doctor of Nursing Practice Projects

Background: The World Health Organization and the American Society of Clinical Oncology guidelines endorses mandatory communication skills training in care goals for seriously ill patients (Back et al., 2019). In one survey of primary care providers (PCP), 68% reported no formal training to discuss advance care planning (Comer et al., 2020). Advance care planning is essential to manage chronic conditions in our growing aging population to provide the best patient care. This manuscript aimed to discuss best practices and techniques in advance care planning and optimize skills to provide patient-centered care conversations that honor patient wishes, reduce unwanted hospitalizations, and …

Evaluation Of The University Of Nebraska Medical Center’S 4ms Geriatric Training Program At Nebraska Medicine Midtown, Holly M. Sesker

Capstone: Master of Health Administration

In 2015, the Health Resources and Services Administration (HRSA) created the Geriatrics Workforce Enhancement Program (GWEP) to address geriatric workforce challenges and improve the health outcomes of older adults. The GWEP redefines care delivery through a movement for age-friendly healthcare guided by evidence-based practices that align with the 4Ms: What Matters, Medication, Mentation, and Mobility. The 4Ms identify the key issues that should drive the decision-making and care for every older adult. 4Ms training sessions were conducted at the Nebraska Medicine Midtown Clinic and evaluated through a cross-sectional survey administered to both residents (trainees) and attendings (trainers). Data was collected …

Evaluation Of The University Of Nebraska Medical Center’S 4ms Geriatric Training Program At Nebraska Medicine Midtown, Holly M. Sesker

Capstone Experience: Master of Public Health

In 2015, the Health Resources and Services Administration (HRSA) created the Geriatrics Workforce Enhancement Program (GWEP) to address geriatric workforce challenges and improve the health outcomes of older adults. The GWEP redefines care delivery through a movement for age-friendly healthcare guided by evidence-based practices that align with the 4Ms: What Matters, Medication, Mentation, and Mobility. The 4Ms identify the key issues that should drive the decision-making and care for every older adult. 4Ms training sessions were conducted at the Nebraska Medicine Midtown Clinic and evaluated through a cross-sectional survey administered to both residents (trainees) and attendings (trainers). Data was collected …

Level Of Comfort In Evaluating Older Patients Amongst Medical Students And Emergency Medicine Residents, Lily L. Berrin, Phraewa Thatphet, Anita N. Chary, Surriya C. Ahmad, Don Melady, Shan W. Liu

Journal of Geriatric Emergency Medicine

Introduction

As the population ages, emergency physicians must be better equipped to manage the complex needs of older patients. While geriatric core competencies have been developed for medical students and emergency medicine (EM) residents, little work has been done to evaluate EM trainees’ comfort with these competencies, or their interest in and barriers to learning more about Geriatric Emergency Medicine (GEM).

Methods

We conducted a cross-sectional study of EM residents and medical students in their clinical years of training with interest in EM. We used an online self-administered survey to evaluate trainees’ self-reported comfort with previously reported geriatric competency domains, …

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 …

A Survey Of Delirium Self-Reported Knowledge And Practices Among Emergency Physicians In The United States, Anita N. Chary, Adriane Lesser, Sharon K. Inouye, Christopher R. Carpenter Md, Msc, Amy R. Stuck, Maura Kennedy

Journal of Geriatric Emergency Medicine

Objective: This study aimed to evaluate United States emergency physicians’ self-reported knowledge and practices regarding the detection, prevention, and management of delirium, a common and deadly syndrome that disproportionately affects older emergency department (ED) patients. Knowledge and practices of the broader emergency physician community about these priority topics in geriatric emergency medicine are understudied.

Design: Electronic self-administered online survey

Setting: United States

Participants: One-hundred ninety-seven emergency physicians of the American College of Emergency Physicians Emergency Medicine Practice Research Network

Measures: Descriptive statistics were generated from survey responses.

Results: Of 734 physicians in the research network who were sent the …

Barriers And Benefits Experienced In Qualitative Geriatric Emergency Care Research During The Covid-19 Era, James D. Van Oppen, Emma Regen, Kay Phelps, Timothy J. Coats, Jose M. Valderas, Simon P. Conroy, Nicola Mackintosh

Journal of Geriatric Emergency Medicine

No abstract provided.

Management Of Fall Patients – What Should Be Done For Emergency Department Fall Patients?, Katherine Selman, Christine Binkley, Katherine Davenport, Shan W. Lliu, Maura Kennedy

Journal of Geriatric Emergency Medicine

Falls are the leading cause of injury-related emergency visits in older adults, translating into an estimated 3 million ED visits and 32,000 deaths from fall-related injuries annually in the United States. Falls subsequently result in diminished functional ability and higher risk for future falls and mortality. Despite this, ED clinicians focus primarily on injuries that result from a fall and often defer the modifiable causes of the fall and future fall prevention to outpatient providers. We review two articles that address the feasibility of performing interventions from the ED and the efficacy of a multifactorial fall intervention program.

Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …

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.

Conference Proceedings: Aurora Scientific Day 2020

Journal of Patient-Centered Research and Reviews

Abstracts published in this supplement were among those presented at the 46th annual Aurora Scientific Day research symposium, held virtually on May 20, 2020. The symposium provides a forum for describing research studies conducted by faculty, fellows, residents, and allied health professionals affiliated with Wisconsin-based Aurora Health Care, a part of the Advocate Aurora Health health system, which publishes the Journal of Patient-Centered Research and Reviews.

Geriatrics In Clinical Practice And Beyond: Brain Health, The Sixth Vital Sign?, Nannette Hoffman

HCA Healthcare Journal of Medicine

Brain health in middle age and geriatric patients will take on greater importance for health care practitioners in our aging society. This article discusses various approaches clinicians can use for their patients to promote and improve brain health. These are generally the same lifestyle adoptions for cerebrovascular disease and cardiovascular disease prevention: weight management, exercise, and blood pressure and cholesterol lowering. Social stimulation and cognitive activities may also be important for the elderly.

Investigating The Impact Of The Nursing Practice Environment (Npe) On Central Line-Associated Bloodstream Infections (Clabsi) Among Older Adults In The Intensive Care Unit (Icu), Kristen A. Cribbs

Dissertations and Theses

Background: Health care–associated infections, resulting from treatment received for medical or surgical conditions in a health care setting, represent a critical public health and patient safety issue, exacting substantial medical, social, and economic costs. The costliest among the leading causes of preventable health care-associated infections is central-line associated bloodstream infections (CLABSI), to which older adults (age 65 years and older) are particularly susceptible, especially during intensive care unit (ICU) stays. A rich body of research has empirically linked the quality of the nursing practice environment (NPE) in hospitals to both positive and negative patient outcomes; yet, surprisingly few studies have …

The Health Benefits Of Visual Art Activities In The Geriatric Population, Melody Au-Yeung, Abraham Avila, Jason Bandong, Hy Ia, Naureen Imam, Kayla Wilcox

San Marcos, Spring 2020

Purpose: The purpose of this poster presentation is to assess the efficacy of visual art therapy on the physical and mental health of the geriatric population.

Description: The potential impact of art therapy on cognition and dementia is a growing field of research in the rehabilitative world. Some researchers have found support for certain mediums, such as ceramic painting, while others have explored multimodal treatment programs that integrate art into physical activities. Combining physical activity with an arts and crafts program could posit a significant impact on ADL function and quality of life in older adults. As a …

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 …

Why I Brought My Mother Home, Barbara L. Gracious

HCA Healthcare Journal of Medicine

According to the Alzheimer’s Association, in the United States more than 16 million adult family members provide care for a relative with Alzheimer’s disease or other dementia. The economic value contributed by unpaid caregivers is $234 billion dollars. Such caregivers are vital to the ability of the U.S. to meet caretaking needs, as the projected number of individuals suffering from dementia will nearly triple over the next 30 years. A meta-analysis found that decisions to provide family caretaking are rooted in long-standing family relationships. This essay explores one family’s decision to move from long-term institutional care back to family-based care …

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.

Academic Service-Learning Experience Embraces The Vincentian Mission In Physician Assistant Education, Alyssa Quinlan, Pamela Gregory-Fernandez, Corinne Alois, Carla Hernandez Goodman

Journal of Vincentian Social Action

Motivated by the belief that health care is a basic human right and driven by a Vincentian mission, St. John’s University Physician Assistant Program incorporates service minded educational experiences created to expose students to the necessity to reach those most in need—“the poor, alienated and the aged.” In Spring 2018, in conjunction with the SJU Academic Service-Learning program, a geriatric service assignment was integrated into the geriatric course curriculum. Working with Selfhelp Virtual Senior Center, local senior centers and nursing homes, students participated in an outreach project to serve senior citizens. Students shared their experiences through reflection and pre- …

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 …