Geriatrics Commons^™

Using A Checklist To Guide Discussion In Level Of Care Meetings At The Hill At Whitemarsh, Grant Schultheis, Nicholas Safian, Sopuru Ezeonu, Austin Klein, Danielle Snyderman, Md

Phase 1

Background: The Hill at Whitemarsh is a retirement facility in Lafayette Hill, Pennsylvania which has three bundles of services for residents termed levels of care (LOC). Meeting are held routinely by medical and administrative staff to determine if an individual needs to move to a different LOC to improve her/his quality of life and safety. These meetings require integration of medical, functional, cognitive, social, and subjective factors often requiring input from several staff members. In this project, we seek a checklist for staff members at the Hill to use at the LOC meetings to ensure important points of discussion for …

Mechanical Thrombectomy In Acute Ischemic Stroke Patients Greater Than 90 Years Of Age Experience In 26 Patients In A Large Tertiary Care Center: Outcome Comparison With Younger Patients, Nicholas Elmer, Ahmad Sweid, Md, Joshua H. Weinberg, Vivian Xu, Kavya Shivashankar, Tyler D. Alexander, Ms, Jane Khalife, Md, Michael R. Gooch, Md, Nabeel Herial, Md, Nohra Chalouhi, Md, Pascal Jabbour, Md, Robert H. Rosenwasswer Md, Stavropoula Tjoumakaris, Md

Phase 1

Introduction: Several independent randomized control trials have shown the superior efficacy of mechanical thrombectomy for acute ischemic stroke (AIS). However, the elderly has been underrepresented or excluded in these trials. In this study, we investigated the feasibility and safety of mechanical thrombectomy in patients with AIS aged 90 years or greater.

Methods: A retrospective review of patients age 90 years or older presenting with AIS who underwent mechanical thrombectomy between 2010 and 2018.

Results: Of total 453 patients with AIS, 5.74 % (26) were aged 90 or older, and 69.32 % (314) ranged from 60-89 years of age. Of …

Ageism In Consent? In A Decision-Making Capable Geriatric Orthopaedic Trauma Patient Population, Does Increased Age Impact Who Physicians Consent For Surgical Fixation?, Madeline M. Mcgovern, Michael F. Mctague, Mph, Marilyn Heng, Md, Mph, Frcsc

Phase 1

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Our study examines the consenting process in an orthogeriatric trauma patient population to determine if there is a relationship between increased age at presentation and utilization of health care proxies (HCPs) for surgical procedure consent.

Methods: We retrospectively reviewed medical records of patients aged 65 and older admitted for an operative fracture between 2013 and 2016. Patients were considered decision-making capable if there was absence of history of cognitive impairment prior to surgical consent and if the patients screened negative in …

Asthma-Copd Overlap: Economic Burden And Medication Adherence, Mona Nili

Graduate Theses, Dissertations, and Problem Reports (ETD)

In many older adults, asthma and chronic obstructive pulmonary disease (COPD) coexist as “Asthma-COPD overlap” (ACO). This dissertation pursued three Aims: 1) estimate the economic burden of ACO and its contributory factors; 2) evaluate the association of ACO to “cost-related medication nonadherence” (CRN); and 3) identify adherence trajectory patterns and examine the impact of initial maintenance therapies (IMT) type (inhaled corticosteroids monotherapy (ICS) vs. fixed-dose combination of ICS and long-acting beta agonist (ICS/LABA)) on adherence trajectory patterns among older adults Medicare Beneficiaries. The first and second Aims were cross-sectional studies by using Medicare Current Beneficiary Survey data. For the third …

Home Health Care Resource Binder: A User-Friendly Guide For Crossroads Hospice And Palliative Care, Deanna Eder

Williams Honors College, Honors Research Projects

Patients and families searching for home health care need accurate information regarding the community resources available to them to promote aging in place and to maintain their quality of life. In connection to the social workers at Crossroads Hospice and Palliative Care, the researcher identified a need for a centralized source of up-to-date information regarding local home health care agencies due to the current resource deficit. Social workers and other health care professionals are expected to benefit from a concise list of resources readily available to provide their patients and families with adequate support to make informed decisions about a …

Helping Continuing Care Retirement Communities Determine The Best Level Of Care For Each Patient, Sopuru Ezeonu, Nicholas Safian, Grant Schultheis, Austin Klein, Danielle Snyderman, Md

Phase 1

Background: Continuing Care Retirement Communities (CCRCs) consists of various neighborhoods and care spaces for senior adults. The neighborhoods are organized and residents are housed based on “levels of care” (LOC), Independent, Assisted, and Nursing. During scheduled interprofessional meetings, the CCRC leadership has the critical task of understanding the residents’ needs and assigning them to the appropriate LOC. Currently, the process of completing this task lacks the necessary structure, which engenders challenges in making recommendations in a systematic way. This project seeks to offer the CCRC interprofessional team a structured approach to determine which LOC and its resources would best serve …

Renal Mass Ablation In The Octogenarian And Nonagenarian Population, Callum Hamilton, Amanda Smolock, Md, Colette Shaw, Md, Conor Mckee, Md

Phase 1

Introduction: The gold standard for the management of T1a and T1b renal tumors is partial nephrectomy. This study aims to analyze the outcomes of renal mass thermal ablations as an alternative therapy in the octogenarian and nonagenarian patient population, specifically.

Methods: Departmental database of all percutaneous renal ablations performed between February 2008 and August 2019 was reviewed. 34 tumors were ablated in 19 males and 15 females with a mean age of 84.1 ± 3.1 years (range 80-92 years). Patient demographics, procedural and postprocedural data were evaluated.

Results: Ten microwave and 24 cryoablations were performed, all ablations …

Effects Of Medications On Cognitive Function And Falls In Older African Americans With Diabetes, Diana Alnemri, Robin J. Casten

Phase 1

Introduction: Potentially-inappropriate medications (PIMs) are medications that have increased rates of adverse drug events in older adults. Medications with anticholinergic activity are classified as PIMs since they can lead to cognitive dysfunction and increased fall risk. PIM use is higher among African Americans (AA) than Whites.

Methods: This study explored relationships among cognitive function, falls, and PIMs in AAs with diabetes. This study recruited AAs with diabetes (n=99, age ≥60yrs) who were seen in the Emergency Department (ED), and were enrolled in a trial of a behavioral intervention to improve diabetes management. PIMs were based on the Beer’s criteria …

Understanding The Context And Social Processes That Shape Person- And Family-Centered Culture In Long-Term Care: The Pivotal Role Of Personal Support Workers, Ellen Helena Melis

Antioch University Dissertations & Theses

This single, exemplar case study explored the context and social processes that shape person-and family-centered culture in a long-term care (LTC) home, using grounded theory and situational analysis for the data collection and analysis. Findings revealed one core dimension: needing to be heard, valued, and understood, and five key roles: personal support workers (PSWs), executive director (ED), senior leadership, nurse managers, and residents and families, which informed five dimensions, each focused on enhancing care for residents: (a) attending to residents’ daily care needs (PSWs), (b) advocating strategically (ED), (c) translating vision into programs and policies (senior leadership), (d) ensuring quality …

Association Of Common Chronic Pain Conditions To Incident Alzheimer’S Disease And Related Dementias In Two Cohorts Of Older Medicare Beneficiaries, Sumaira Khalid

Graduate Theses, Dissertations, and Problem Reports (ETD)

Objective: The purpose of this research was to study the collective and incremental association of common non-cancer chronic pain conditions (NCPC) to risk for Alzheimer’s disease and related dementias (ADRD); to explore the potential mediating influence of mood and sleep disorders; and to assess the potential synergistic effects of NCPC’s and multimorbidity on ADRD risk. This research also aimed to study the contribution of NCPC to ADRD risk in poor, rural, underserved United States populations who suffer a disproportionate burden of ADRD risk factors. To achieve these goals, this dissertation pursued three specific aims: 1) assess the association of …

Intervention For Cognitive Reserve Enhancement In Delaying The Onset Of Alzheimer's Symptomatic Expression (Increase), A Randomized Controlled Trial: Rationale, Study Design, And Protocol, Daniela C. Moga, Brooke F. Beech, Erin L. Abner, Frederick A. Schmitt, Riham H. El Khouli, Ashley I. Martinez, Lynne Eckmann, Mark Huffmyer, Rosmy George, Gregory A. Jicha

Pharmacy Practice and Science Faculty Publications

BACKGROUND: The course of Alzheimer's disease (AD) includes a 10-20-year preclinical period with progressive accumulation of amyloid β (Aβ) plaques and neurofibrillary tangles in the absence of symptomatic cognitive or functional decline. The duration of this preclinical stage in part depends on the rate of pathologic progression, which is offset by compensatory mechanisms, referred to as cognitive reserve (CR). Comorbid medical conditions, psychosocial stressors, and inappropriate medication use may lower CR, hastening the onset of symptomatic AD. Here, we describe a randomized controlled trial (RCT) designed to test the efficacy of a medication therapy management (MTM) intervention to reduce inappropriate …

Chapter 14: Hospice And End-Of-Life Care, Sally Pelon, Brandon Youker, M. Paola Leon

Books and Contributions to Books

This chapter explores end-of-life issues and concerns as well as the hospice movement’s role in assisting terminally ill individuals. Specific social work assessment and interventions tools are offered considered as well as controversial issues in end-of-life care.

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- …

Treatment And Outcome Improvement With Implementation Of A System-Wide Comprehensive Plan Of Care For Management Of Isolated Hip Fractures, C. Michael Lecroy, Adam Kaufman, Christina Mcquiston, Harold Michael Frisch, Martha Hoskyns, Sean Snyder, Terrie Smith, Jaclyn Gosnell, Michael J. Schurr, William Shillinglaw

Orthopedic Surgery

No abstract provided.

Interleukin 1 Alpha Administration Is Neuroprotective And Neuro-Restorative Following Experimental Ischemic Stroke, Kathleen E. Salmeron, Michael E. Maniskas, Danielle N. Edwards, Raymond Wong, Ivana Rajkovic, Amanda L. Trout, Abir A. Rahman, Samantha Hamilton, Justin F. Fraser, Emmanuel Pinteaux, Gregory J. Bix

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: Stroke remains a leading cause of death and disability worldwide despite recent treatment breakthroughs. A primary event in stroke pathogenesis is the development of a potent and deleterious local and peripheral inflammatory response regulated by the pro-inflammatory cytokine interleukin-1 (IL-1). While the role of IL-1β (main released isoform) has been well studied in stroke, the role of the IL-1α isoform remains largely unknown. With increasing utilization of intravenous tissue plasminogen activator (t-PA) or thrombectomy to pharmacologically or mechanically remove ischemic stroke causing blood clots, respectively, there is interest in pairing successful cerebrovascular recanalization with neurotherapeutic pharmacological interventions (Fraser et …

Post-Acquisition Processing Confounds In Brain Volumetric Quantification Of White Matter Hyperintensities, Ahmed A. Bahrani, Omar M. Al-Janabi, Erin L. Abner, Shoshana H. Bardach, Richard J. Kryscio, Donna M. Wilcock, Charles D. Smith, Gregory A. Jicha

Neurology Faculty Publications

BACKGROUND: Disparate research sites using identical or near-identical magnetic resonance imaging (MRI) acquisition techniques often produce results that demonstrate significant variability regarding volumetric quantification of white matter hyperintensities (WMH) in the aging population. The sources of such variability have not previously been fully explored.

NEW METHOD: 3D FLAIR sequences from a group of randomly selected aged subjects were analyzed to identify sources-of-variability in post-acquisition processing that can be problematic when comparing WMH volumetric data across disparate sites. The methods developed focused on standardizing post-acquisition protocol processing methods to develop a protocol with less than 0.5% inter-rater variance.

RESULTS: A series …

I Live Alone But Don't Feel Alone: Social Isolation And Loneliness From The Patient Perspective, Julia Bedard-Thomas, Christian Gausvik, Jonathan Wessels, Saundra Regan, Keesha Goodnow, Anna Goroncy

Journal of Patient-Centered Research and Reviews

A growing homebound population may be at risk for social isolation and loneliness. Health-related social needs play a contributing role in these conditions. Research shows social isolation and loneliness are drivers of health outcomes. This pilot feasibility study seeks to explore patient-centered insight into perceptions of social isolation and loneliness in a homebound population. Eight participants were recruited from a home-based primary care practice within a family medicine residency program. One 30-minute semi-structured interview was completed in participants’ homes. The interview focused on loneliness and social isolation, using the 6-item De Jong Gerveld loneliness scale. Three qualitative analysts open-coded transcriptions …

Pain Management In Dementia Patients In Nursing Homes, Tiffany Kneuss, Kelsey Weisenburger, Hannah Stewart, Kelly Reilly Kroustos

Pharmacy and Wellness Review

Pain in the elderly, especially those with dementia, is often undertreated and misdiagnosed by health care professionals in the long-term care setting. Communication barriers in patients with cognitive impairment force pain assessment to rely heavily on subjective interpretation of behavioral factors due to the inability of patients to self-report pain symptoms. It is important for clinicians to develop a standard method of identifying and assessing signs of pain in patients with dementia in order to appropriately treat those experiencing discomfort. Patients with dementia who present with a sudden onset of behavioral changes should receive a comprehensive evaluation that includes a …

The Effects Of Long-Term Benzodiazepine Use And Withdrawal In The Elderly, Lydia Suchecki, Hannah Granger, Jamie Kellner, Mary Ellen Hethcox

Pharmacy and Wellness Review

Benzodiazepines remain a commonly prescribed medication in the United States, and the high usage of this drug class is especially a concern in the elderly population for several reasons. First, elderly patients metabolize drugs differently, leading to varying responses. Age-related changes also have a significant impact on the effects of benzodiazepines. Second, elderly patients are more likely to be taking multiple centrally-acting drugs, which can further exacerbate negative effects. In regard to long-term benzodiazepine use, elderly patients experience an increased risk of cognitive impairment, motor vehicle accidents, decline in physical performance, falls and subsequent fractures, and sleep disturbances. Withdrawal is …

Boomers And Fraudsters: A Closer Look At The Financial Elder Abuse Cycle In America, Ryan E. Brown

Marriott Student Review

In 2011, a landmark study was published by the Metlife Mature Market Institute claiming that nearly $3 billion disappears from the wallets and bank accounts of senior citizens annually. More surprising is that a similar study reported that figure could be as high as $36 billion. Because so many seniors let incidents of fraud or financial deceit go unreported, there is a huge discrepancy in annual reporting. This contributes to the overall lack of understanding we have of elder financial abuse, or why seniors continue to lose to fraudsters and scam artists. In a brief overview of financial elder abuse …

Hospitalization-Associated Change In Gait Speed And Risk Of Functional Limitations For Older Adults, Wei Duan-Porter, Tien N. Vo, Kristen Ullman, Lisa Langsetmo, Elsa S. Strotmeyer, Brent C. Taylor, Adam J. Santanasto, Peggy M. Cawthon, Anne B. Newman, Eleanor M. Simonsick, Teresa M. Waters, Kristine E. Ensrud

Health Management and Policy Faculty Publications

BACKGROUND: Hospitalization-associated functional decline is a common problem for older adults, but it is unclear how hospitalizations affect physical performance measures such as gait speed. We sought to determine hospitalization-associated change in gait speed and likelihood of new limitations in mobility and activities of daily living (ADLs).

METHODS: We used longitudinal data over 5 years from the Health, Aging and Body Composition Study, a prospective cohort of black and white community-dwelling men and women, aged 70-79 years, who had no limitations in mobility (difficulty walking 1/4 mile or climbing 10 steps) or ADLs (transferring, bathing, dressing, and eating) at baseline. …

La Ciudad Versus El Campo: La Calidad De Vida De Los Adultos Mayores Aymara Entre Arica Y Putre, Clare Rogowski

Independent Study Project (ISP) Collection

The elderly population in Chile is increasing rapidly. In indigenous villages in the interior of Chile, like Putre, the younger generation is leaving to pursue education and employment opportunities in cities, in this case Arica. In many cases no one stays to take care of the elders. As the elderly begin to grow older and require greater support, the younger generation seeks to move their family members to the city so that they can care for them. While this provides for greater connection to family and access to medical care for the elderly relatives, the elderly loses their connection to …

An Animal-Assisted Intervention Study In The Nursing Home: Lessons Learned, Lonneke G. J. A. Schuurmans, Inge Noback, Jos M. G. A. Schols, Marie-Jose Enders-Slegers

People and Animals: The International Journal of Research and Practice

AAI studies in the nursing home pose a specific set of challenges. In this article the practical and ethical issues encountered during a Dutch psychogeriatric nursing home AAI study are addressed with the aim of sharing our experiences for future researchers as well as AAI practitioners in general.

In our study we compared three groups of clients with dementia who participated in group sessions of either visiting dog teams, visiting FurReal Friend robot animals, or visiting students (control group) and monitored the effect on social interaction and neuropsychiatric symptoms through video analysis and questionnaires. We encountered the following four categories …

Association Of Fish Oil And Physical Activity On Mobility Disability In Older Adults, Anoop T. Balachandran

Publications and Research

Purpose: This study aimed to examine whether long-term fish oil (FO) supplementation is associated with a lower risk of mobility disability and enhances benefits of physical activity (PA). Methods: A total of 1635 sedentary adults age 70 to 89 yr from the Lifestyle Interventions and Independence for Elders single-blinded randomized,multicenter clinical trial, which compared a structured PA program to a health education program. Primary outcome was incident major mobility disability (MMD), defined by loss of ability to walk 400 m, measured every 6 months for an average of 2.6 yr. Secondary outcomes included persistent mobility disability, Short Physical Performance Battery, …

Assessing General Cognitive And Adaptive Abilities In Adults With Down Syndrome: A Systematic Review, Sarah Hamburg, Bryony Lowe, Carla Marie Startin, Concepcion Padilla, Antonia Coppus, Wayne Silverman, Juan Fortea, Shahid Zaman, Elizabeth Head, Benjamin L. Handen, Ira Lott, Weihong Song, André Strydom

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: Measures of general cognitive and adaptive ability in adults with Down syndrome (DS) used by previous studies vary substantially. This review summarises the different ability measures used previously, focusing on tests of intelligence quotient (IQ) and adaptive behaviour (AB), and where possible examines floor effects and differences between DS subpopulations. We aimed to use information regarding existing measures to provide recommendations for individual researchers and the DS research community.

RESULTS: Nineteen studies reporting IQ test data met inclusion for this review, with 17 different IQ tests used. Twelve of these IQ tests were used in only one study while …

Effects Of Obesity And Fall Risk On Gait And Posture Of Community-Dwelling Older Adults, Thurmon E. Lockhart, Christopher W. Frames, Rahul Soangra, Abraham Lieberman

Physical Therapy Faculty Articles and Research

Epidemiological studies link increased fall risk to obesity in older adults, but the mechanism through which obesity increases falls and fall risks is unknown. This study investigates if obesity (Body Mass Index: BMI>30 kg/m2) influenced gait and standing postural characteristics of community dwelling older adults leading to increased risk of falls. One hundred healthy older adults (age 74.0±7.6 years, range of 56-90 years) living independently in a community participated in this study. Participants’ history of falls over the previous two years was recorded, with emphasis on frequency and characteristics of falls. Participants with at least two falls in the …

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 …

House Calls Are Reaching The Tipping Point — Now We Need The Workforce, Thomas Cornwell

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better …

White Matter Hyperintensity Regression: Comparison Of Brain Atrophy And Cognitive Profiles With Progression And Stable Groups, Omar M. Al-Janabi, Christopher E. Bauer, Larry B. Goldstein, Richard R. Murphy, Ahmed A. Bahrani, Charles D. Smith, Donna M. Wilcock, Brian T. Gold, Gregory A. Jicha

Sanders-Brown Center on Aging Faculty Publications

Subcortical white matter hyperintensities (WMHs) in the aging population frequently represent vascular injury that may lead to cognitive impairment. WMH progression is well described, but the factors underlying WMH regression remain poorly understood. A sample of 351 participants from the Alzheimer’s Disease Neuroimaging Initiative 2 (ADNI2) was explored who had WMH volumetric quantification, structural brain measures, and cognitive measures (memory and executive function) at baseline and after approximately 2 years. Selected participants were categorized into three groups based on WMH change over time, including those that demonstrated regression (n = 96; 25.5%), stability (n = 72; 19.1%), and …

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 …