Geriatrics Commons^™

Implementation Of A Provider-Focused Multimodal Educational Initiative To Address Polypharmacy And High-Risk Medication Use In A Home And Community Medicare Advantage Setting, Jennifer Butler-Rickard, Kellie Olsen, Eileen Stuart-Shor, Craig Drew

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Community-dwelling adults are at risk for adverse drug events such as falls, hospitalizations, cognitive decline, drug-to-drug interactions, and mortality related to high-risk medication use and polypharmacy, often defined as concurrent use of five or more different medications. Lack of provider knowledge of polypharmacy and high-risk medication use as well as suboptimal communication with primary care providers can lead to gaps in medication management in this vulnerable population.

LOCAL PROBLEM: Patients seen by the Comprehensive Annual Health Assessment Program advanced practice clinicians (APCs) at the project Medicare Advantage insurer organization often experience polypharmacy. Given the lack of provider knowledge of …

Difference Between Postural Sway, Functional Fitness, And Behavioral Measures In Older Adult Fallers & Non-Fallers, Olivia Maus, Rebecca Brandhorst, Andrea Geisenhof, Kyle Reason

InnovateHER Meeting 2026

BACKGROUND: Falls are among the leading causes of injury, hospitalization, and loss of independence among older adults. There is not enough research to determine how body composition, fitness, and postural sway affect balance.

METHODS: Participants completed surveys measuring behaviors around fall risk, assessment of body composition, postural sway, and functional fitness.

RESULTS: There was a significant difference between OF and ONF on the FES-I (p=0.05; d=-0.41) and the ABC-6 (p=0.008; d=0.57). There was significance on condition three of the mCTSIB (p=0.007; d=-.58), and composite score (p=0.04; d=-0.43).Significance between groups was approached on condition one of the mCTSIB (p=0.06; d=-0.39).

CONCLUSIONS: …

Golden Steps: A Dance-Based Program To Improve Balance In Older Adults — A Feasibility And Acceptability Study, Ramyr Bognot, Sophia Botelho, Nolan Caberto, Lauren Valerio, Joshua Yu, Jason Zeidman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background

Falls are a leading cause of injury and loss of independence among older adults. Evidence-based programs such as Otago and Tai Ji Quan reduce fall risk, yet barriers to access and adherence remain. Dance-based interventions may offer a practical, enjoyable approach to engage older adults in balance training.

Purpose

This formative pilot study aimed to develop four dance routines grounded in evidence- based balance principles and evaluate their feasibility and acceptability among older adults, including factors influencing enjoyment and willingness to continue participation, to inform future clinical and community implementation.

Methods

Four routines (Polka, Country, Rockabilly, Salsa) were developed …

Social Disparities, Delirium Occurrence, And Related Outcomes Among Hospitalized Older Adults, Alan P Pan, Kathryn Agarwal, Thomas Potter, Karim Borei, Sara Nowakowski, Courtenay R Bruce, George E Taffet, Farhaan S Vahidy

Faculty, Staff and Students Publications

Background: Underlying socio-economic and health burden may variably impact delirium presentation among older adults. We characterized differences in patient factors related to social marginalization and studied their effects on delirium occurrence and hospital outcomes.

Methods: We conducted a 7-year retrospective analysis of older adults (aged ≥ 70 years) who systematically underwent screening for delirium at an 8-hospital healthcare system. Our primary exposure included patient characteristics related to demographics and social marginalization. Multivariable logistic regression models were built to identify factors associated with increased odds of delirium occurrence, either (1) present-on-admission (D-POA) or (2) hospital-acquired (HAD). Secondary outcomes included hospital length …

Incorporation Of The 4ms, With A Focus On Mentation, Into The H&P For Older Adults Hospitalized With A Hip Fracture And Its Effect On Delirium Documentation, Emily Custer, Do, Kristine Swartz, Md, Lily Ackermann, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Delirium affects 15% to over 50% of patients with hip fractures during their hospital stay (1) and is associated with increased mortality, increased length of hospital stay, poorer functional outcomes, and higher risk of nursing home placement (1,2). However, at Thomas Jefferson University Hospital, the prevalence of documented delirium post-hip fracture is only 5.22%, suggesting potential under recognition. Additionally, at the end of 2025, a new CMS inpatient quality metric will require public reporting on a hospital's capability to provide age-appropriate care for older adults, which can be done by utilizing the 4M framework of age-friendly health care. The …

A Preliminary Report Of The Carotenoid Assessment In Adults 50 Years Of Age And Older In Louisiana, Mary-Catherine Feazell

Master's Theses

Fruits and vegetables are at the core of a healthy, balanced diet. They assist in preventing the development of chronic diseases such as hypertension, diabetes, cardiovascular disease, and cancer (Fadnes, et al., 2022). Aging is a natural biological process followed by disease, cognitive impairment, and a natural decline of the body’s ability to perform at its best. The older adult population is currently the fastest-growing population globally (El-Shebiney et al., 2022). Vitamin A is crucial for several parts of the body to function correctly. Despite the positive effects of Vitamin A on the body, the recommended dietary intake is not …

Access To And Utilization Of Dental Care Services By Older Adults In Nigeria: Barriers And Facilitators, Sunkanmi Folorunsho, Victor Ajayi, Munirat Sanmori, Medinah Suleiman, Raji Abdullateef, Abdulazeez Abdulganiyu

Department of Sociology: Faculty Publications

Aims: Nigeria’s rapidly aging population presents urgent challenges for the healthcare system, particularly in oral health, which remains an overlooked aspect of well-being. While older adults are especially vulnerable to dental issues such as tooth loss, periodontal disease, and oral pain, access to care remains limited due to systemic, economic, and cultural barriers. This qualitative study explored the lived experiences of older Nigerians in accessing and utilizing dental care, with the goal of identifying key barriers, facilitators, and policy-relevant insights.

Methods: Fifteen participants aged 50–83 years were purposively selected from urban and peri-urban areas of Ilorin, North- Central …

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 …

Implementing The Brief Confusion Assessment Method (Bcam) Delirium Screening Tool In An Emergency Department, Carolina Van Dalen

Master's Projects and Capstones

Problem: Persons with delirium have an elevated risk of falls. Thus, falls and delirium are inextricably linked. Both should be routinely screened for older adults.

Context: A 40-bed Emergency Department (ED) in the East San Francisco Bay area of Northern California and the first site among all acute care hospitals in the organization to implement the Brief Confusion Assessment Method (bCAM) delirium scoring tool within the Electronic Health Record (EHR).

Interventions: An EHR toolkit for delirium screening using bCAM was developed, tested, and implemented in the ED.

Measures: The outcome measure was the percentage of patients with a reported fall …

Delirium Screening Practices For Older Adults In Emergency Departments Across United States: A Scoping Review, Azmat Sidhu, Joy K. Luzingu, Sheneil Agyemang, Arushi M. Chalke, Grace M. Leito, Joseph A. Molina, Zhao Chen, Deborah Jean Mcclelland, Nimit Agarwal, Leah Steckler, Angela Wu

Journal of Geriatric Emergency Medicine

Delirium is commonly missed among older patients in the Emergency Department (ED). Identifying and managing patients with delirium in ED is critical to help improve health outcomes and prevent falls and readmission. There are several validated delirium screening tools but their utilization for assessing delirium in emergency department settings are still under investigation. The overall purpose of this review was to summarize information on current screening practices for delirium among older adults (65 or older) in EDs across United States and to identify current gaps in knowledge and evidence to help inform future research and practice. A comprehensive literature search …

A Multifactorial Fall Prevention Program, Virale Patel, Zeida Gutierrez

Fall 2024 OTD Capstone Symposium

Falls among older adults are a pressing public health concern, leading to significant physical, psychological, and economic consequences. This capstone project aimed to design and implement a multifactorial fall prevention program to address unmet occupational needs and enhance safety and occupational participation among long-term care residents at a skilled nursing facility. The six-week program included targeted weekly sessions focusing on behavior modification, footwear safety, adaptive equipment training, strength and balance exercises, toileting strategies, and environmental modifications. Pre- and post-program assessments utilized the Fall Efficacy Scale International (FES-I) and participant surveys to evaluate changes in confidence, fear of falling, and satisfaction …

Understanding The Perceptions Of Technology In Homes For Aging In Place, Jinelle Abugan, Amy Lyons-Brown Ms, Otd, Otr/L, Molly Wuebker Otd, Otr/L, Actcp

Fall 2024 OTD Capstone Symposium

The purpose of this study is to understand the thoughts and experiences of technology in homes and the use of technology-based home modifications to help individuals with participation and performance in daily activities. The education of perceptions of culture in homes will be supported by faculty, OTs, professional designers, about the need to explore culture in technology for home modifications aging in place.

An Innovative Approach To Aligning Healthcare With What Matters Most To Patients: A Hybrid Type 1 Trial Protocol Of Patient Priorities Care For Older Adults With Multiple Chronic Conditions, Aanand D Naik, Mackenzie L Shanahan, Lilian Dindo, Marcia C Mecca, Jennifer Arney, Amber B Amspoker, Sheena Wydermyer, Jack Banks, Richard L Street, Lea Kiefer, Maria Zenoni, Tracey Rosen, Raquel D Gonzalez, Angela Catic, Terri R Fried

Faculty, Staff and Students Publications

Background: Providing healthcare for older adults with multiple chronic conditions (MCC) is challenging. Polypharmacy and complex treatment plans can lead to high treatment burden and risk for adverse events. For clinicians, managing the complexities of patients with MCC leaves little room to identify what matters and align care options with patients' health priorities. New care approaches are needed to navigate these challenges. In this clinical trial, we evaluate implementation and effectiveness outcomes of an innovative, structured, patient-centered care approach (Patient Priorities Care; PPC) for reducing treatment burden and aligning health care decisions with the health priorities of older adults with …

Maggot Debridement Therapy Vs. Negative Pressure Wound Therapy And Their Effectiveness On Tissue Healing On Older Adults, Angelica L. Funes

Soaring: A Journal of Undergraduate Research

Chronic ulcers, particularly prevalent in older adults, significantly impact patients' quality of life, leading to prolonged hospital stays and increased healthcare costs. This study explores the efficacy of two common therapies, Negative Pressure Wound Therapy (NPWT) and Maggot Debridement Therapy (MDT), in promoting tissue healing for chronic ulcers in adults aged 60 and older. A methodical search was conducted using databases such as CINAHL, PubMed, EBSCO, and ProQuest, employing specific search strategies and inclusion/exclusion criteria. Four high-quality Level 1 randomized controlled trials were selected for analysis, comparing NPWT and MDT in various settings. The results indicate that MDT exhibits superior …

Multifactorial Exercise Intervention Decreases Falls Risk In High-Risk And Low-Risk Older Adults, Amanda Estep, Steven Morrison, Shane V. Caswell, Jatin P. Ambegaonkar, João R. Vaz, Nelson Cortes

Rehabilitation Sciences Faculty Publications

Background: Each year, 1 in 4 people over the age of 65 years of age will experience a fall. It is important to identify and address modifiable risk factors that are associated with falls in adults at high and low risk for falls.

Hypothesis: Falls risk improves in both high-risk and low-risk participants with the implementation of Stay Active and Independent for Life (SAIL).

Study Design: Cohort study.

Level of Evidence: Level 3.

Methods: Seventy-eight older adults (age, 70.9 ± 5.1 years) were included in this study and categorized into high risk and low risk for falling based on the …

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. …

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 …

Tuberculosis Presentation And Outcomes In Older Hispanic Adults From Tamaulipas, Mexico, Belinda A Medrano, Miryoung Lee, Gretchen Gemeinhardt, Javier E Rodríguez-Herrera, Moncerrato García-Viveros, Blanca I Restrepo

Faculty, Staff and Student Publications

Older people are at high risk of developing and dying from pulmonary infections like tuberculosis (TB), but there are few studies among them, particularly in Hispanics. To address these gaps, we sought to identify host factors associated with TB and adverse treatment outcomes in older Hispanics by conducting a cross-sectional study of TB surveillance data from Tamaulipas, Mexico (2006-2013; n = 8381). Multivariable logistic regressions were assessed for older adults (OA ≥65 years) when compared to young (YA, 18-39 years) and middle-aged adults (40-64 years). We found that the OA had features associated with a less complicated TB (e.g., lower …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Clinical Outcomes Of Immunotherapy Continued Beyond Radiographic Disease Progression In Older Adult Patients With Advanced Non-Small Cell Lung Cancer, Eric K Singhi, Frank Mott, Michelle Worst, Cheuk Hong Leung, J Jack Lee, Brett Carter, Carolyn J Presley, John V Heymach, Mehmet Altan

Faculty, Staff and Student Publications

Immunotherapy is an effective and generally well-tolerated treatment strategy for older adult patients (aged ≥70 years) with advanced non-small cell lung cancer (NSCLC). Unfortunately, most patients who receive immunotherapy eventually exhibit disease progression during treatment. The present study reports on a subset of older adult patients with advanced NSCLC who could effectively continue immunotherapy beyond radiographic disease progression due to perceived clinical benefit. Local consolidative radiotherapy may be used in select older adult patients to prolong the duration of immunotherapy they receive, with a particular consideration of their preexisting co-morbidities, performance status and tolerance of potential toxicities associated with combined …

Effects Of Meditation On Chronic Pain Management Among Older Adults, Katelyn R. Forsell

Doctor of Nursing Practice

The older adult population is expected to continue to grow. This population is more susceptible to facing chronic health conditions that often contribute to pain. Pain affects many aspects of an individual's life and can be debilitating, affecting physical and mental wellbeing. Chronic pain among older adults is often not well managed. Mindfulness meditation is a holistic healing modality that literature supports for pain mitigation (Creswell & Khoury, 2019). This scholarly project provided mindfulness meditation sessions to older adults in an independent and assisted living facility setting to help educate and guide them in reducing chronic pain. Pain reduction scores …

Patient Frailty: A Review, Lakshmi Sailaja Kodavati

Dissertations and Theses

According to Geriator (2011), frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes such as falls, incident disability, hospitalization, and mortality. An operational definition of frailty is the existence of at least three out of five observable criteria indicating compromised energetics: low grip strength; low energy; slowed walking speed; low physical activity; and unintentional weight loss (Fried, et al. 2001).

According to Dubois and Charpillet (2017), most transitions into frailty are due to unintentional weight loss which, in turn, impacts gait performance and subsequent general mobility. In this literature review, the …

Pre-Hospital Conditions Affecting The Hospitalization Risk In Older Adults At The Emergency Department, Karin Erwander, Kjell Ivarsson, Mona Landin-Olsson, Björn Agvall

Journal of Geriatric Emergency Medicine

BACKGROUND: The Emergency Department (ED) is a common route to hospitalization for critically ill and older adults. Older patients are admitted to hospital at a higher rate and have longer length of stay (LOS) when hospitalized. To be able to confront an increasing aging population, meet their medical needs and influence rising costs of health care, there is a need to focus on the older population. In Scandinavia, few studies are made that focus on the geriatric population at the ED. It is essential to early identify risk factors for hospitalization at the ED to improve the medical care for …

The Association Of Gabapentin Initiation And Neurocognitive Changes In Older Adults With Normal Cognition, Gyeon Oh, Daniela Claudia Moga, David W. Fardo, Erin L. Abner

Sanders-Brown Center on Aging Faculty Publications

Background: Gabapentin is increasingly prescribed to older adults, which raises concerns about its potential to cause neurocognitive changes. Therefore, we aimed to examine the association of gabapentin use with neurocognitive changes (i.e., cognitive decline, functional status decline, and motor function change) in older adults.

Methods: We conducted a retrospective cohort study using the National Alzheimer’s Coordinating Center Uniform Data Set (UDS; September 2005-March 2021 data freeze). From the eligible sample (≥age 65 years), we identified cognitively normal new-users of gabapentin and the visit they initiated gabapentin (i.e., index visit). Initiators were matched to randomly selected nonusers on year …

The Effect Of The Care Transitions Intervention On Ed Revisits And Outpatient Clinic Follow-Up Among Older Adults Who Live Alone, Clara V. Kuranz, Rebecca K. Green, Angela Gifford, Gwen C. Jacobsohn, Thomas V. Caprio, Amy L. Cochran, Jeremy T. Cushman, Courtney M.C. Jones, Amy J. H. Kind, Michael Lohmeier, Manish N. Shah

Journal of Geriatric Emergency Medicine

INTRODUCTION: Older adults frequently return to an emergency department (ED) within 30 days of an initial visit. In this study, we examined the effectiveness of an adapted Care Transitions Intervention (CTI) at reducing risk of ED revisits within 30 days for older adults who live alone. We also explored the interaction between receiving help with healthcare needs and receiving the CTI on the risk of 30-day ED revisits.

METHODS: We conducted a subgroup analysis of community-dwelling older (age≥60 years) ED patients who reported living alone as part of a randomized controlled trial of CTI effectiveness following discharge home from one …

Association Between Fall History And Gait, Balance, Physical Activity, Depression, Fear Of Falling, And Motor Capacity: A 6-Month Follow-Up Study, Catherine Park, Md Moin Uddin Atique, Ramkinker Mishra, Bijan Najafi

Center on Aging Staff Publications

Maintaining function in older adults is key to the quality of life and longevity. This study examined the potential impact of falls on accelerating further deterioration over time in gait, balance, physical activity, depression, fear of falling, and motor capacity in older adults. 163 ambulatory older adults (age = 76.5 ± 7.7 years) participated and were followed for 6 months. They were classified into fallers or non-fallers based on a history of falling within the past year. At baseline and 6 months, all participants were objectively assessed for gait, balance, and physical activity using wearable sensors. Additional assessments included psychosocial …

Addressing Complex Primary Care Needs For An Older Man Recently Released From Incarceration With Multiple Emergency Department Visits., Saffia Bajwa, Ariba Khan, Michael L. Malone

Journal of Geriatric Emergency Medicine

Purpose: Older prisoners being released into the community need to be placed in a system to help them transition from living in prison to living in a free society. They must adapt in order to find housing, community services, medical, dental and psychiatric care. When the complex social needs of these persons are not fully met, the emergency department is used as a safety net.

Methods and Findings: This paper describes a patient who had multiple emergency department visits which was his routine method of seeking medical care.

Health Care Policy Implications: We believe that public health policy requiring …

Supporting Rural Seniors Aging In Place Using Telehealth, Angel Alexander Gomez, Susan Macdermott

Summer 2022 Virtual OTD Capstone Symposium

Background: The United States is witnessing a demographic shift in that the number of Americans aged 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060; the percentage of the 65 and older age group will increase from 16 % to 23 % (Administration for Community Living, 2018). In this ever-growing population, the American Association of Retired Persons (AARP) 2018 survey found that 76% of Americans over the age of 50 would prefer to remain in their current residence and 77% would like to continue living in their community as long as …

Transportation As A Barrier To Healthcare Access For Older Adults Of Low Socioeconomic Status, Yanira Barajas, Susan Macdermott, Jazminne Orozco Arteaga

Summer 2022 Virtual OTD Capstone Symposium

The older adult population of those in the age group 65+ is one of the fastest growing populations in the following years. This project sought to identify what barriers older adults of low socioeconomic status face when trying to access transportation to healthcare appointments. The project also sought to understand what barriers healthcare professionals saw when their senior clients tried using transportation as well as what opportunities occupational therapists have to address the barriers if any. There was a theme of disconnect which appeared between healthcare professionals and their senior clients across multiple healthcare disciplines. This project was able to …

A Smartwatch Step-Counting App For Older Adults: Development And Evaluation Study, George Boateng, Curtis L. Petersen, David Kotz, Karen L. Fortuna, Rebecca Masutani, John A. Batsis

Dartmouth Scholarship

Background: Older adults who engage in physical activity can reduce their risk of mobility impairment and disability. Short amounts of walking can improve quality of life, physical function, and cardiovascular health. Various programs have been implemented to encourage older adults to engage in physical activity, but sustaining their motivation continues to be a challenge. Ubiquitous devices, such as mobile phones and smartwatches, coupled with machine-learning algorithms, can potentially encourage older adults to be more physically active. Current algorithms that are deployed in consumer devices (eg, Fitbit) are proprietary, often are not tailored to the movements of older adults, and have …