Geriatrics Commons^™

The Interrai Ed Tool For Screening Older Patients In The Emergency Department: “What Am I Supposed To Do With This?”, Michael L. Malone

Journal of Geriatric Emergency Medicine

not applicable for Collective Wisdom/ Editorial per JGEM author guidelines.

Boarding Of Older Adults: A Concerning Trend In The Emergency Department, Julie Van Baardwijk, Eric Tharmathurai, Ariba Khan

Journal of Geriatric Emergency Medicine

Emergency department (ED) boarding (EDB) is the practice of holding admitted patients in the ED due to a lack of hospital beds. We identified one ED in our health system with a high rate of EDB. We sought to identify factors associated with EDB in this hospital by comparing it to a similar hospital in our health care system.

Methods: We conducted a retrospective study comparing two community hospitals in our healthcare system. Boarding was defined as a patient waiting ≥8 hours in ED for disposition. One hospital, located in a rural area with 55beds was chosen as it was …

Comparing Cognitive Tests And Smartphone-Based Assessment In 2 Us Community-Based Cohorts., Ileana De Anda-Duran, Preeti Sunderaraman, Edward Searls, Shirine Moukaled, Xuanyi Jin, Zachary Popp, Cody Karjadi, Phillip H Hwang, Huitong Ding, Sherral Devine, Ludy C Shih, Spencer Low, Honghuang Lin, Vijaya B Kolachalama, Lydia Bazzano, David J Libon, Rhoda Au

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

BACKGROUND: Smartphone-based cognitive assessments have emerged as promising tools, bridging gaps in accessibility and reducing bias in Alzheimer disease and related dementia research. However, their congruence with traditional neuropsychological tests and usefulness in diverse cohorts remain underexplored.

METHODS AND RESULTS: A total of 406 FHS (Framingham Heart Study) and 59 BHS (Bogalusa Heart Study) participants with traditional neuropsychological tests and digital assessments using the Defense Automated Neurocognitive Assessment (DANA) smartphone protocol were included. Regression models investigated associations between DANA task digital measures and a neuropsychological global cognitive

CONCLUSIONS: Our findings demonstrate that smartphone-based cognitive assessments exhibit concurrent validity with a …

Digital Clock Drawing As An Alzheimer's Disease Susceptibility Biomarker: Associations With Genetic Risk Score And Apoe In Older Adults, L I Thompson, M Cummings, S Emrani, David J. Libon, A Ang, C Karjadi, R Au, C Liu

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

BACKGROUND: Alzheimer's disease (AD) is the leading cause of dementia in older adults, but most people are not diagnosed until significant neuronal loss has likely occurred along with a decline in cognition. Non-invasive and cost-effective digital biomarkers for AD have the potential to improve early detection.

OBJECTIVE: We examined the validity of DCTclockTM (a digitized clock drawing task) as an AD susceptibility biomarker.

DESIGN: We used two primary independent variables, Apolipoprotein E (APOE) ε4 allele carrier status and polygenic risk score (PRS). We examined APOE and PRS associations with DCTclockTM composite scores as dependent measures.

SETTING: We used existing data …

On The Discontinuation Of Enteral Feeding In Head And Neck Cancer: A Case Report, Kyle Fisk, Ana Sanchez

HCA Healthcare Journal of Medicine

Introduction

The goal of palliative care is to preserve the quality of life or patient “comfort” in patients with serious diseases. Palliative care providers serve a wide range of patients: from those who seek curative treatment to those who are actively dying. Given this range, palliative care must mirror the dynamic goals of the patient at different stages of life and treatment. Throughout these stages, a goal of the palliative care provider would be to avoid hastening death; however, this often leads to clinical decisions that directly pit the patient’s comfort against the patient’s life span. This is most salient …

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 …

The Pharmacological Deprescription In Elderly Patients, Chelsey Ali, Daniel Huang, Charlene Tugwete, Stefano Del Canale, Vittorio Maio

College of Population Health Faculty Papers

No abstract provided.

Experiential Learning Final Report: Ase Leadership And Usri, Lauren Cowell

SASAH 4th Year Capstone and Other Projects: Publications

This reflective journey encapsulates the profound impact of my SASAH experiential learning, encompassing roles as an ASE Transition Leader and a USRI intern during my undergraduate years. From fostering academic growth to developing practical skills applicable in professional settings, this program provided unique opportunities for multidimensional learning. Collaboration emerged as a cornerstone, teaching adaptability, resilience, and the nuances of teamwork. Engaging with professionals contributed to workplace insights and personal growth. The roles undertaken enriched my skill set, from refining public speaking to engaging in collaborative research. The CliftonStrengths framework played a pivotal role, guiding me through challenges and leveraging collective …

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. …

Evaluation Of A Community Based Teaching Hospital’S Geriatric Emergency Medicine Initiative, Josette Hartnett, Isabel Muronzi-Belfon, Suzanne J. Rose

Journal of Geriatric Emergency Medicine

INTRODUCTION: To accommodate the complex healthcare needs of the rising geriatric population, Stamford Hospital’s (SH) emergency department (ED) began a Geriatric Emergency Medicine Initiative (GEMI) in 2018 to improve our ED environment, practices, and focused assessments for our community-dwelling older adults.

METHODS: This retrospective program evaluation describes SH’s novel ED processes for at-risk older adults and compares GEMI and non-GEMI assessed patient outcomes using aggregate frequencies on throughput metrics such as length of stay (LOS), 72 hour and 30-day re-admission rates, and other outcomes of interest. Chi-square tests and group t-tests were used for all analyses with a p-value of …

Providing Optimal Resident Sleep Hygiene In Assisted Living Communities; Opportunities For Design And Operation Teams To Collaborate And Share Their Unique Knowledge, Beverly Bj Miller

Architecture Masters of Science Program: Theses

Research is emerging relating sleep hygiene to disease pathogenesis including Parkinson's, dementia, Alzheimer’s disease and increased cardiovascular risk. The application of circadian science as it relates to human wellness has intensified as a result. The quality of sleep significantly impacts the wellness of residents living in long term care, however sleep hygiene research is lacking in assisted living (AL) communities.

The thesis question inquires; How can operation and design teams collaborate to optimize sleep health for residents in assisted living communities? The research methodology utilized a two-phase process. Phase I identified three AL communities as test sites, providing case studies …

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 …

Assessing Medication Self-Management Challenges And Self-Efficacy During Emergency Department Medication Reconciliation: An Evidence-Based Quality Improvement Project, Mitchel Erickson, Jyu-Lin Chen, Yoonmee Joo, Stephanie Rogers, Thomas Hoffman, Claire Bainbridge

Journal of Geriatric Emergency Medicine

Abstract

Background

Older adult patients (≥65) accessing emergency departments (ED) represent a significant demographic. Recidivism secondary to adverse drug events (ADE) ranges between 6-24% and levels of prescribed medication non-adherence is common among older adults. The ED pharmacist medication reconciliation workflow may mitigate self-management challenges in real time and reduce medication-related harm while potentially impacting recidivism, medication adherence, and patient self-efficacy. The purposes of this evidence-based project were to (1) evaluate the impact of a modified Medication Management for Deficiencies in the Elderly (MedMalDE) intervention on Self-Efficacy for Appropriate Medication Use (SEAMS) and 30-day return to care and (2) identify …

Depression And Anxiety Of Care Partners During The Emergency Department Visit Of Older Adults With Cognitive Impairment, Nancy Glober, Anthony Perkins, Joshua Chodosh, Karen Connor, Sujuan Gao, Frank Messina, Malaz Boustani, Soo Borson, Nicole R. Fowler

Journal of Geriatric Emergency Medicine

Background: Older adults with cognitive impairment (CI) are more likely to visit the emergency department (ED) than those without CI. They are also more likely to suffer poor outcomes after an ED visit. Family and friends who serve as care partners contribute significant time and resources to the care of these patients and may need particular attention to their emotional needs during and after the ED encounter. In this study, we examined the association between patient and care partner characteristics on care partner depression and anxiety at the time of the ED visit.

Methods: Baseline data from 640 patient-care partner …

Primary Care Intervention: Medication Reconciliation Reduces Rehospitalizations, Dianna Twombly

Student Scholarly Projects

Practice Problem: Patients are put at risk for adverse medications events when diligent care is not taken by healthcare staff. Medication discrepancies and oversights from medical personal can lead to severe illness or even death of a patient.

PICOT: The PICOT question for this project is: For patients 65 years and older (P) does a review of a hard copy of discharge instructions (I)compared to current practice during a visit, (C) impact the number of hospital readmission (O)in eight weeks (T)?

Evidence: Medication reconciliation at each point of care, patient education on medication management, and involving patients in their own …

Meaningful Engagement Of Patients And Families In A Complex Trial Of Advance Care Planning In Primary Care, Angela K. Combe, Deborah L. Dokken, Mary M. Minniti, Annette M. Totten

Patient Experience Journal

Engagement of Patient and Family Advisors (PFAs) is increasingly recommended as best practice in research. During the design and conduct of a large trial of advance care planning (ACP) in primary care, we expanded on the funder’s (Patient-Centered Outcomes Research Institute®) requirement for an engagement plan and sought to develop an innovative approach to fostering and sustaining meaningful engagement of PFAs throughout all phases of the trial. Structures were developed that integrated PFAs into planning and provided the foundation for their ongoing participation. A continuous quality improvement approach became the framework for ongoing engagement. This involved setting goals; collecting data …

Coxarthrosis Etiology Influences The Patients’ Quality Of Life In The Preoperative And Postoperative Phase Of Total Hip Arthroplasty, Madalin Bulzan, Simona Cavalu, Amir Mohamed Abdelhamid, Calin Tudor Hozan, Florica Voiţă-Mekeres

Journal of Mind and Medical Sciences

Background. In orthopedics, the patients’ quality of life relative to the preoperative and postoperative phase is referred with a low impact compared to other branches of medicine. In this context, our interest focused on assessing the quality of life in patients with traumatic and non-traumatic coxarthrosis by longitudinally following the evolution of the patients. Materials and Methods. The well-established instrument Short Form Survey SF-36 was applied in a retrospective study, conducted on a cohort of 203 participants who underwent THA (Total Hip Arthroplasty). Statistical analysis was generated using GraphPad Prism (version 9.5.1). Results. In the pre-operative phase, physical functioning was …

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%, …

Gericared: Feasibility Of A Pilot Program Of A Geriatric Personal Care Attendant Addressing Mentation, Mobility And Matters Most In An Emergency Department Observation Unit, Ilianna Santangelo, Anne Marie Thompson, Aileen Tubridy, Kendra Cull, Bridget Conly, Benjamin A. White, Maura Kennedy

Journal of Geriatric Emergency Medicine

The aging of the population has a significant impact on the health care system, as older adults have higher rates of emergency department (ED) visits and hospitalization, different care needs, and are at higher risk of iatrogenic harm in the hospital setting. In addition, there has recently been a rapid growth in ED observation units (EDOUs), to which older adults are frequently admitted. Recognizing the specific needs of older adults, our EDOU implemented an ‘Up by 10’ program which incorporates key components of delirium prevention programs. We took an iterative approach to the implementation of this program, resulting in a …

A Rare Case Of Takotsubo Cardiomyopathy In An Elderly Lady During Hospital Stay, Himabindu Kolli, Ashika A. Chacko, Pooja Maknoor, Nazish Khan, Timothy Heath

Research Colloquium

Introduction: Takotsubo Cardiomyopathy (TTC) is an acute, reversible form of left ventricular systolic dysfunction, most often triggered by a sudden physical, or less commonly emotional event. Here, we describe a patient who developed Takotsubo Cardiomyopathy during her hospital stay.

Case Description: 74-year-old Hispanic lady, a nursing home resident presented to the ED with altered mental status. She was admitted for septic shock due to UTI. Echocardiogram demonstrated normal systolic function, with 60-65% LV ejection fraction. After initiation of antibiotic therapy, she showed clinical improvement with resolution of shock.

On day 8 of hospitalization, patient became emotionally upset and her clinical …