Geriatrics

Editorial

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2 pages, 156 KiB

Open AccessEditorial

Geriatric Care Models

by James S. Powers

Geriatrics 2021, 6(1), 6; https://doi.org/10.3390/geriatrics6010006 - 12 Jan 2021

Cited by 2 | Viewed by 3122

Abstract

This Special Issue on geriatric care models features 18 papers highlighting the evolving nature of healthcare delivery and the leadership and quality enhancement research provided by geriatric care models [...] Full article

(This article belongs to the Special Issue Geriatric Care Models)

2 pages, 126 KiB

Open AccessEditorial

The Importance of Geriatric Care Models

by James S. Powers

Geriatrics 2019, 4(1), 5; https://doi.org/10.3390/geriatrics4010005 - 27 Dec 2018

Cited by 1 | Viewed by 6843

Abstract

I am delighted to edit this Special Issue of Geriatrics focusing on Geriatric Care Models. [...] Full article

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3 pages, 144 KiB

Open AccessEditorial

Strategies to Promote Broad-Based Implementation of Acute Care for Elders (ACE) Units

by Roger Y. Wong

Geriatrics 2018, 3(3), 58; https://doi.org/10.3390/geriatrics3030058 - 6 Sep 2018

Cited by 7 | Viewed by 5036

Abstract

n/a Full article

(This article belongs to the Special Issue Geriatric Care Models)

Research

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12 pages, 706 KiB

Open AccessArticle

Walking All over COVID-19: The Rapid Development of STRIDE in Your Room, an Innovative Approach to Enhance a Hospital-Based Walking Program during the Pandemic

by Jaime M. Hughes, John T. Bartle, Ashley L. Choate, Elizabeth P. Mahanna, Cassie L. Meyer, Matthew C. Tucker, Virginia Wang, Kelli D. Allen, Courtney H. Van Houtven and Susan Nicole Hastings

Geriatrics 2021, 6(4), 109; https://doi.org/10.3390/geriatrics6040109 - 10 Nov 2021

Viewed by 3215

Abstract

Hospitalization is common among older adults. Prolonged time in bed during hospitalization can lead to deconditioning and functional impairments. Our team is currently working with Department of Veterans Affairs (VA) medical centers across the United States to implement STRIDE (assiSTed eaRly mobIlity for [...] Read more.

Hospitalization is common among older adults. Prolonged time in bed during hospitalization can lead to deconditioning and functional impairments. Our team is currently working with Department of Veterans Affairs (VA) medical centers across the United States to implement STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans), a hospital-based walking program designed to mitigate the risks of immobility during hospitalization. However, the COVID-19 pandemic made in-person, or face-to-face, walking challenging due to social distancing recommendations and infection control concerns. In response, our team applied principles of implementation science, including stakeholder engagement, prototype development and refinement, and rapid dissemination and feedback, to create STRIDE in Your Room (SiYR). Consisting of self-guided exercises, light exercise equipment (e.g., TheraBands, stress ball, foam blocks, pedometer), the SiYR program provided safe alternative activities when face-to-face walking was not available during the pandemic. We describe the methods used in developing the SiYR program; present feedback from participating sites; and share initial implementation experiences, lessons learned, and future directions. Full article

(This article belongs to the Special Issue Responding to the Pandemic: Geriatric Care Models)

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12 pages, 213 KiB

Open AccessFeature PaperArticle

Dementia Caregiver Virtual Support—An Implementation Evaluation of Two Pragmatic Models during COVID-19

by Jacy A. Weems, Shana Rhodes and James S. Powers

Geriatrics 2021, 6(3), 80; https://doi.org/10.3390/geriatrics6030080 - 19 Aug 2021

Cited by 9 | Viewed by 3183

Abstract

Caregivers of people with Alzheimer’s and related dementias (ADRD) require support. Organizations have pivoted from traditional in-person support groups to virtual care in the face of the COVID-19 pandemic. We describe two model programs and their pragmatic implementation of virtual care platforms for [...] Read more.

Caregivers of people with Alzheimer’s and related dementias (ADRD) require support. Organizations have pivoted from traditional in-person support groups to virtual care in the face of the COVID-19 pandemic. We describe two model programs and their pragmatic implementation of virtual care platforms for ADRD caregiver support. A mixed methods analysis of quantitative outcomes as well as a thematic analysis from semi-structured interviews of facilitators was performed as part of a pragmatic quality improvement project to enhance delivery of virtual support services for ADRD caregivers. Implementation differed among individual organizations but was well received by facilitators and caregivers. While virtual platforms can present challenges, older adults appreciated the strength of group facilitators and reported enhanced connectedness related to virtual support. Barriers to success include the limitations of virtual programming, including technological issues and distractions from program delivery. Virtual support can extend outreach, addressing access and providing safe care during a pandemic. Implementation differs among organizations; however, some elements of virtual support may be long-lasting. Full article

(This article belongs to the Special Issue Responding to the Pandemic: Geriatric Care Models)

17 pages, 1818 KiB

Open AccessArticle

Leveraging National Nursing Home Huddles for Rapid COVID-19 Response

by Rebecca Brandes, Elias Miranda, Alice Bonner, Joelle Baehrend, Terry Fulmer and Jennifer Lenoci-Edwards

Geriatrics 2021, 6(2), 62; https://doi.org/10.3390/geriatrics6020062 - 17 Jun 2021

Cited by 1 | Viewed by 6320

Abstract

A disproportionate number of older adult residents of U.S. nursing homes have died during the COVID-19 pandemic. The novelty of the virus spurred frequently changing guidance as nursing facilities navigated response efforts. In May 2020, the 6-month COVID-19 Rapid Response Network for Nursing [...] Read more.

A disproportionate number of older adult residents of U.S. nursing homes have died during the COVID-19 pandemic. The novelty of the virus spurred frequently changing guidance as nursing facilities navigated response efforts. In May 2020, the 6-month COVID-19 Rapid Response Network for Nursing Homes (RRN) was launched to leverage the concept of huddles across U.S. nursing homes to reduce COVID-19-related morbidity, mortality, and transmission by identifying best practices to rapidly implement, fostering connections between nursing homes, and refocusing the national narrative on optimism for nursing home care response efforts. Daily 20-min huddles transitioned to twice weekly in the program’s final two months. A total of 93 huddles featured 103 speakers with 1960 participants engaging in both live huddles and asynchronous learning. 90.33% of participants said they learned at least two new ideas by participating and 89.17% strongly agreed or agreed that participating improved their ability to lead change in their organization. Qualitative data echoed gratitude for a centralized source of information and best practices and the sense of positivity and community the RRN provided. Leveraging nursing home huddles at the national, regional, local, system, or facility level may serve as a guidepost for future pandemics or work where guidance is new or quickly evolving. Full article

(This article belongs to the Special Issue Responding to the Pandemic: Geriatric Care Models)

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5 pages, 175 KiB

Open AccessCommunication

The GeriPACT Initiative to Prevent All-Cause 30-Day Readmission in High Risk Elderly

by James S. Powers, Lovely Abraham, Ralph Parker, Nkechi Azubike and Ralf Habermann

Geriatrics 2021, 6(1), 4; https://doi.org/10.3390/geriatrics6010004 - 6 Jan 2021

Cited by 2 | Viewed by 3323

Abstract

Background: Suboptimal care transitions increases the risk of adverse events resulting from poor care coordination among providers and healthcare facilities. The National Transition of Care Coalition recommends shifting the discharge paradigm from discharge from the hospital, to transfer with continuous management. The patient [...] Read more.

Background: Suboptimal care transitions increases the risk of adverse events resulting from poor care coordination among providers and healthcare facilities. The National Transition of Care Coalition recommends shifting the discharge paradigm from discharge from the hospital, to transfer with continuous management. The patient centered medical home is a promising model, which improves care coordination and may reduce hospital readmissions. Methods: This is a quality improvement report, the geriatric patient-aligned care team (GeriPACT) at Tennessee Valley Healthcare System (TVHS) participated in ongoing quality improvement (Plan, Do, Study, Act (PDSA)) cycles during teamlet meetings. Post home discharge follow-up for GeriPACT patients was provided by proactive telehealth communication by the Registered Nurse (RN) care manager and nurse practitioner. Periodic operations data obtained from the Data and Statistical Services (DSS) coordinator informed the PDSA cycles and teamlet meetings. Results: at baseline (July 2018–June 2019) the 30-day all-cause readmission for GeriPACT was 21%. From July to December 2019, 30-day all-cause readmissions were 13%. From January to June 2020, 30-day all-cause readmissions were 15%. Conclusion: PDSA cycles with sharing of operations data during GeriPACT teamlet meetings and fostering a shared responsibility for managing high-risk patients contributes to improved outcomes in 30-day all-cause readmissions. Full article

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12 pages, 860 KiB

Open AccessArticle

Improving Care Transitions for Hospitalized Veterans Discharged to Skilled Nursing Facilities: A Focus on Polypharmacy and Geriatric Syndromes

by Amanda S. Mixon, Vivian M. Yeh, Sandra Simmons, James Powers, Eugene Wesley Ely, John Schnelle and Eduard E. Vasilevskis

Geriatrics 2019, 4(1), 19; https://doi.org/10.3390/geriatrics4010019 - 9 Feb 2019

Cited by 5 | Viewed by 7636

Abstract

Geriatric syndromes and polypharmacy are common in older patients discharged to skilled nursing facilities (SNFs) and increase 30-day readmission risk. In a U.S.A. Department of Veterans Affairs (VA)-funded Quality Improvement study to improve care transitions from the VA hospital to area SNFs, Veterans [...] Read more.

Geriatric syndromes and polypharmacy are common in older patients discharged to skilled nursing facilities (SNFs) and increase 30-day readmission risk. In a U.S.A. Department of Veterans Affairs (VA)-funded Quality Improvement study to improve care transitions from the VA hospital to area SNFs, Veterans (N = 134) were assessed for geriatric syndromes using standardized instruments as well as polypharmacy, defined as five or more medications. Warm handoffs were used to facilitate the transfer of this information. This paper describes the prevalence of geriatric syndromes, polypharmacy, and readmission rates. Veterans were prescribed an average of 14.7 medications at hospital discharge. Moreover, 75% of Veterans had more than two geriatric syndromes, some of which began during hospitalization. While this effort did not reduce 30-day readmissions, the high prevalence of geriatric syndromes and polypharmacy suggests that future efforts targeting these issues may be necessary to reduce readmissions among Veterans discharged to SNF. Full article

(This article belongs to the Special Issue Geriatric Care Models)

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9 pages, 969 KiB

Open AccessArticle

Geriatrics Evaluation and Management in the Veterans Administration—An Historical Perspective

by James S. Powers and Kathryn J. Eubank

Geriatrics 2018, 3(4), 84; https://doi.org/10.3390/geriatrics3040084 - 25 Nov 2018

Cited by 4 | Viewed by 5937

Abstract

Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care. Since the 1970s, the US Department of Veterans Affairs (VA) has encouraged the development of geriatric [...] Read more.

Comprehensive geriatric assessment, defined as an interdisciplinary assessment and development of an overall plan of treatment and follow-up, has become a fundamental part of clinical geriatric care. Since the 1970s, the US Department of Veterans Affairs (VA) has encouraged the development of geriatric evaluation and management programs. Evolution of geriatric evaluation and management has occurred over time and many VA medical centers have transferred inpatient geriatric evaluation programs to long-term care Community Living Centers, home, and outpatient settings. Availability of geriatric resources and trained personnel across the continuum of care as well as administrative collaboration between care components are critical to the successful implementation of geriatric services. Facilities may need to prioritize their resources and utilize the most effective and relevant elements of geriatric evaluation and management according to patient population needs, available space, resources, and institutional priorities. New risk assessment tools derived from the VA’s experience in geriatric evaluation may be useful for targeting services for other high-risk populations. Full article

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9 pages, 196 KiB

Open AccessArticle

Early Mobility in the Hospital: Lessons Learned from the STRIDE Program

by Susan Nicole Hastings, Ashley L. Choate, Elizabeth P. Mahanna, Theresa A. Floegel, Kelli D. Allen, Courtney H. Van Houtven and Virginia Wang

Geriatrics 2018, 3(4), 61; https://doi.org/10.3390/geriatrics3040061 - 26 Sep 2018

Cited by 28 | Viewed by 12324

Abstract

Immobility during hospitalization is widely recognized as a contributor to deconditioning, functional loss, and increased need for institutional post-acute care. Several studies have demonstrated that inpatient walking programs can mitigate some of these negative outcomes, yet hospital mobility programs are not widely available [...] Read more.

Immobility during hospitalization is widely recognized as a contributor to deconditioning, functional loss, and increased need for institutional post-acute care. Several studies have demonstrated that inpatient walking programs can mitigate some of these negative outcomes, yet hospital mobility programs are not widely available in U.S. hospitals. STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) is a supervised walking program for hospitalized older adults that fills this important gap in clinical care. This paper describes how STRIDE works and how it is being disseminated to other hospitals using the Replicating Effective Programs (REP) framework. Guided by REP, we define core components of the program and areas where the program can be tailored to better fit the needs and local conditions of its new context (hospital). We describe key adaptations made by four hospitals who have implemented the STRIDE program and discuss lessons learned for successful implementation of hospital mobility programs. Full article

(This article belongs to the Special Issue Geriatric Care Models)

5 pages, 468 KiB

Open AccessFeature PaperCommunication

A Healthcare Pathway to Nirvana? The SNF Transition to Home

by Wayne S. Saltsman

Geriatrics 2018, 3(3), 54; https://doi.org/10.3390/geriatrics3030054 - 24 Aug 2018

Cited by 2 | Viewed by 5552

Abstract

While the majority of attention and the literature has focused on transitional models out of the acute care setting, transitions from the post-acute setting—especially from the skilled nursing facility (SNF)—are not well understood. What are the ‘best practices’, or thoughtful considerations, for a [...] Read more.

While the majority of attention and the literature has focused on transitional models out of the acute care setting, transitions from the post-acute setting—especially from the skilled nursing facility (SNF)—are not well understood. What are the ‘best practices’, or thoughtful considerations, for a successful transition back to home and the community? Facilitation of a smooth and seamless transition relies on the abilities of the SNF and primary care teams, as well as community agencies, to coordinate care in a patient-centered manner together. This article will focus on this specific transition within the healthcare continuum. Full article

(This article belongs to the Special Issue Geriatric Care Models)

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10 pages, 215 KiB

Open AccessArticle

Geriatric Patient-Aligned Care Teams in Department of Veterans Affairs: How Are They Structured?

by Jennifer L. Sullivan, Marlena H. Shin, Omonyêlé L. Adjognon, Kenneth Shay, Kimberly Harvey, Orna Intrator, Enzo Yaksic, Jennifer Moye and Samantha Solimeo

Geriatrics 2018, 3(3), 46; https://doi.org/10.3390/geriatrics3030046 - 1 Aug 2018

Cited by 7 | Viewed by 6110

Abstract

Geriatric Patient-Aligned Care Teams (GeriPACT) were implemented in the Department of Veterans Affairs (VA) (i.e., Patient-Centered Medical Homes for older adults) to provide high quality coordinated care to older adults with more risk of negative health and psychosocial outcomes. The objectives of this [...] Read more.

Geriatric Patient-Aligned Care Teams (GeriPACT) were implemented in the Department of Veterans Affairs (VA) (i.e., Patient-Centered Medical Homes for older adults) to provide high quality coordinated care to older adults with more risk of negative health and psychosocial outcomes. The objectives of this paper are: (1) to present data on GeriPACT structural characteristics; and (2) to examine a composite measure of GeriPACT model consistency. We utilized a web survey targeting 71 physician leads resulting in a 62% response rate. We found GeriPACTs employed a range of staffing, empanelment, clinic space, and patient assignment practices. The mean value of the GeriPACT consistency measure was 2.03 (range: 1–4) and 6.3% of facilities were considered consistent to the GeriPACT model. We observed large variation in GeriPACT structure and in model consistency. More research is needed to understand how these variations are related to processes and outcomes of care. Full article

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10 pages, 410 KiB

Open AccessArticle

Use of Clinical Video Telehealth as a Tool for Optimizing Medications for Rural Older Veterans with Dementia

by Woody Chang, Marcia Homer and Michelle I. Rossi

Geriatrics 2018, 3(3), 44; https://doi.org/10.3390/geriatrics3030044 - 30 Jul 2018

Cited by 19 | Viewed by 6710

Abstract

Community-Based Outpatient Clinics (CBOCs) allow delivery of primary care to rural veterans who are far from a main Veterans Affairs (VA) campus. However, CBOCs often do not have physicians with geriatric training. We used a clinical video telehealth (CVT) dementia service (Teledementia clinic) [...] Read more.

Community-Based Outpatient Clinics (CBOCs) allow delivery of primary care to rural veterans who are far from a main Veterans Affairs (VA) campus. However, CBOCs often do not have physicians with geriatric training. We used a clinical video telehealth (CVT) dementia service (Teledementia clinic) based in the Pittsburgh VA Healthcare System to optimize dementia patients’ medications and potentially inappropriate medications (PIMs). We analyzed 199 CVT patient encounters from 1 January 2016 to 31 December 2016 and compared different medication changes per encounter between the initial CVT consults and the follow-up visits for all medications and PIMs as listed in the 2015 Beers Criteria, to see if there was a decrease of each kind of change, which is being used as a surrogate for optimization. We found that initial CVT consults, compared to follow-up visits, had greater medications added (0.731 vs. 0.434, p = 0.0092), total overall medications changes (1.769 vs. 1.130, p = 0.0078), and the stopping of 2015 Beers Criteria PIMs (0.208 vs. 0.072, p = 0.0255) per encounter. The fewer PIMs discontinued and fewer medication additions in follow-ups implies that our patients’ medications tend to stay optimized between visits. The teledementia service represents a novel way to provide geriatric assistance to CBOC VA primary care physicians for rural veterans with dementia. Full article

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20 pages, 722 KiB

Open AccessArticle

Frailty Screening and Case-Finding for Complex Chronic Conditions in Older Adults in Primary Care

by Linda Lee, Tejal Patel, Loretta M. Hillier, Jason Locklin, James Milligan, John Pefanis, Andrew Costa, Joseph Lee, Karen Slonim, Lora Giangregorio, Susan Hunter, Heather Keller and Veronique Boscart

Geriatrics 2018, 3(3), 39; https://doi.org/10.3390/geriatrics3030039 - 7 Jul 2018

Cited by 13 | Viewed by 7063

Abstract

With the aging population, escalating demand for seniors’ care and limited specialist resources, new care delivery models are needed to improve capacity for primary health care for older adults. This paper describes the “C5-75” (Case-finding for Complex Chronic Conditions in Seniors 75+) program, [...] Read more.

With the aging population, escalating demand for seniors’ care and limited specialist resources, new care delivery models are needed to improve capacity for primary health care for older adults. This paper describes the “C5-75” (Case-finding for Complex Chronic Conditions in Seniors 75+) program, an innovative care model aimed at identifying frailty and commonly associated geriatric conditions among older adults within a Canadian family practice setting and targeting interventions for identified conditions using a feasible, systematic, evidence-informed multi-disciplinary approach. We screen annually for frailty using gait speed and handgrip strength, screen for previously undiagnosed comorbid conditions, and offer frail older adults multi-faceted interventions that identify and address unrecognized medical and psychosocial needs. To date, we have assessed 965 older adults through this program; 14% were identified as frail based on gait speed alone, and 5% identified as frail based on gait speed with grip strength. The C5-75 program aims to re-conceptualize care from reactive interventions post-diagnosis for single disease states to a more proactive approach aimed at identifying older adults who are at highest risk of poor health outcomes, case-finding for unrecognized co-existing conditions, and targeting interventions to maintain health and well-being and potentially reduce vulnerability and health destabilization. Full article

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7 pages, 580 KiB

Open AccessArticle

Reaching Out to Rural Caregivers and Veterans with Dementia Utilizing Clinical Video-Telehealth

by James S. Powers and Jennifer Buckner

Geriatrics 2018, 3(2), 29; https://doi.org/10.3390/geriatrics3020029 - 9 Jun 2018

Cited by 20 | Viewed by 9062

Abstract

Context: A clinical video telehealth (CVT) program was implemented to improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five [...] Read more.

Context: A clinical video telehealth (CVT) program was implemented to improve access and quality of dementia care to patients and their caregivers in rural areas. The program was offered as part of an established dementia clinic/geriatric primary care clinic in collaboration with five community-based outpatient clinics (CBOC’s) affiliated with the Tennessee Valley Healthcare System (TVHS) in middle Tennessee. Telehealth support was provided by a physician–social worker team visit. Methods: Telehealth training and equipment were provided to clinic personnel, functioning part-time with other collateral clinical duties. Patients and caregivers were referred by primary care providers and had an average of one to two CVT encounters originating at their local CBOC lasting 20 to 30 min. Clinical characteristics and outcomes of patients and caregivers receiving CVT support were collected by retrospective electronic medical record (EMR) review. Results: Over a 3-year period 45 CVT encounters were performed on patient–caregiver dyads, followed for a mean of 15 (1–36) months. Some 80% patients had dementia confirmed and 89% of these had serious medical comorbidities, took an average of eight medications, and resided at a distance of 103 (76–148) miles from the medical center. Dementia patients included 33% with late stage dementia, 25% received additional care from a mental health provider, 23% took antipsychotic medications, 19% transitioned to a higher level of care, and 19% expired an average of 10.2 months following consultation. Significant caregiver distress was present in 47% of family members. Consult recommendations included 64% community-based long-term care services and supports (LTSS), 36% medications, and 22% further diagnostic testing. Acceptance of the CVT encounter was 98%, with 8770 travel miles saved. Conclusions: CVT is well received and may be helpful in providing dementia care and supporting dementia caregivers to obtain LTSS for high-need older adults in rural areas. Full article

(This article belongs to the Special Issue Geriatric Care Models)

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11 pages, 193 KiB

Open AccessArticle

A Statewide Model for Assisting Nursing Home Residents to Transition Successfully to the Community

by Darci Buttke, Valerie Cooke, Kathleen Abrahamson, Tetyana Shippee, Heather Davila, Rosalie Kane and Greg Arling

Geriatrics 2018, 3(2), 18; https://doi.org/10.3390/geriatrics3020018 - 10 Apr 2018

Cited by 7 | Viewed by 5400

Abstract

Minnesota’s Return to Community Initiative (RTCI) is a novel, statewide initiative to assist private paying nursing home residents to return to the community and to remain in that setting without converting to Medicaid. The objective of this manuscript is to describe in detail [...] Read more.

Minnesota’s Return to Community Initiative (RTCI) is a novel, statewide initiative to assist private paying nursing home residents to return to the community and to remain in that setting without converting to Medicaid. The objective of this manuscript is to describe in detail RTCI’s development and design, its key operational components, and characteristics of its clients and their care outcomes. Data on client characteristics and outcomes come from the Minimum Data Set, staff assessments of clients and caregivers, and Medicaid eligibility files. Most clients transitioned by the RTCI had entered the nursing facility from a hospital. Clients overwhelmingly wanted to return to the community and fit a health and functional profile making them good candidates for community discharge. Most clients went to a private residence, living alone or with a spouse; yet, adult children were the most frequent caregivers. At one year of follow-up 76% of individuals were alive and living in the community and only a small percentage (8.2%) had converted to Medicaid. The RTCI holds promise as a successful model for states to adopt in assisting individuals who are at risk to become long stay nursing home residents instead to return to the community. Full article

(This article belongs to the Special Issue Geriatric Care Models)

Review

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15 pages, 496 KiB

Open AccessReview

COVID-19 Era Social Isolation among Older Adults

by Stephanie MacLeod, Rifky Tkatch, Sandra Kraemer, Annette Fellows, Michael McGinn, James Schaeffer and Charlotte S. Yeh

Geriatrics 2021, 6(2), 52; https://doi.org/10.3390/geriatrics6020052 - 18 May 2021

Cited by 59 | Viewed by 8188

Abstract

Risk of COVID-19 exposure and more severe illness are serious concerns for older adults. Social distancing has worsened existing social isolation, with severe impacts on connectedness among seniors. The pandemic is threatening to cause an extended health crisis, with impacts including serious health [...] Read more.

Risk of COVID-19 exposure and more severe illness are serious concerns for older adults. Social distancing has worsened existing social isolation, with severe impacts on connectedness among seniors. The pandemic is threatening to cause an extended health crisis, with impacts including serious health consequences. Our primary purpose is to summarize emerging research describing the impacts of the pandemic on social isolation among older adults. A streamlined search was conducted to fit the scope of this literature review. Common research databases and mainstream resources and websites were utilized to identify research published or released in 2020 to align with the pandemic. Early research indicates that the pandemic has worsened social isolation among older adults. Social isolation has become urgent, as seniors have lost their usual connections due to social distancing. While safety measures are critical to prevent virus exposure, this approach must be balanced with maintaining social connectedness. The pandemic highlights the importance of social connections, with significant impacts on both community-living older adults and those in nursing facilities. Safety protocols have created a paradox of reduced risk along with greater harm. Consequently, adapted approaches are urgently needed to address the consequences of a long-term social recession. Full article

(This article belongs to the Special Issue Responding to the Pandemic: Geriatric Care Models)

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6 pages, 216 KiB

Open AccessReview

Orthogeriatrics and Hip Fracture Care in the UK: Factors Driving Change to More Integrated Models of Care

by Mark Middleton

Geriatrics 2018, 3(3), 55; https://doi.org/10.3390/geriatrics3030055 - 28 Aug 2018

Cited by 20 | Viewed by 7709

Abstract

In the United Kingdom (UK), approximately 80,000 hip fractures each year result in an estimated annual cost of two billion pounds in direct healthcare costs alone. Various models of care exist for collaboration between orthopaedic surgeons and geriatricians in response to the complex [...] Read more.

In the United Kingdom (UK), approximately 80,000 hip fractures each year result in an estimated annual cost of two billion pounds in direct healthcare costs alone. Various models of care exist for collaboration between orthopaedic surgeons and geriatricians in response to the complex medical, rehabilitation, and social needs of this patient group. Mounting evidence suggests that more integrated models of orthogeriatric care result in superior quality of care indicators and clinical outcomes. Clinical governance through national guidelines, audit through the National Hip Fracture Database (NHFD), and financial incentives through the Best Practice Tariff (providing a £1335 bonus for each patient) have driven hip fracture care in the UK forward. The demanded improvement in quality indicators has increased the popularity of collaborative care models and particularly integrated orthogeriatric services. A significant fall in 30-day mortality has resulted nationally. Ongoing data collection by the NHFD will lead to greater understanding of the impact of all elements of hip fracture care including models of orthogeriatrics. Full article

(This article belongs to the Special Issue Geriatric Care Models)

14 pages, 763 KiB

Open AccessReview

Acute Care for Elders (ACE) Team Model of Care: A Clinical Overview

by Kellie L. Flood, Katrina Booth, Jasmine Vickers, Emily Simmons, David H. James, Shari Biswal, Jill Deaver, Marjorie Lee White and Ella H. Bowman

Geriatrics 2018, 3(3), 50; https://doi.org/10.3390/geriatrics3030050 - 6 Aug 2018

Cited by 28 | Viewed by 8816

Abstract

The Institute of Medicine (IOM) Reports of To Err is Human and Crossing the Quality Chasm have called for more interprofessional and coordinated hospital care. For over 20 years, Acute Care for Elders (ACE) Units and models of care that disseminate ACE principles [...] Read more.

The Institute of Medicine (IOM) Reports of To Err is Human and Crossing the Quality Chasm have called for more interprofessional and coordinated hospital care. For over 20 years, Acute Care for Elders (ACE) Units and models of care that disseminate ACE principles have demonstrated outcomes in-line with the IOM goals. The objective of this overview is to provide a concise summary of studies that describe outcomes of ACE models of care published in 1995 or later. Twenty-two studies met the inclusion. Of these, 19 studies were from ACE Units and three were evaluations of ACE Services, or teams that cared for patients on more than one hospital unit. Outcomes from these studies included increased adherence to evidence-based geriatric care processes, improved patient functional status at time of hospital discharge, and reductions in length of stay and costs in patients admitted to ACE models compared to usual care. These outcomes represent value-based care. As interprofessional team models are adopted, training in successful team functioning will also be needed. Full article

(This article belongs to the Special Issue Geriatric Care Models)

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10 pages, 184 KiB

Open AccessReview

The Resurgence of Home-Based Primary Care Models in the United States

by Mattan Schuchman, Mindy Fain and Thomas Cornwell

Geriatrics 2018, 3(3), 41; https://doi.org/10.3390/geriatrics3030041 - 16 Jul 2018

Cited by 54 | Viewed by 10064

Abstract

This article describes the forces behind the resurgence of home-based primary care (HBPC) in the United States and then details different HBPC models. Factors leading to the resurgence include an aging society, improved technology, an increased emphasis on home and community services, higher [...] Read more.

This article describes the forces behind the resurgence of home-based primary care (HBPC) in the United States and then details different HBPC models. Factors leading to the resurgence include an aging society, improved technology, an increased emphasis on home and community services, higher fee-for-service payments, and health care reform that rewards value over volume. The cost savings come principally from reduced institutional care in hospitals and skilled nursing facilities. HBPC targets the most complex and costliest patients in society. An interdisciplinary team best serves this high-need population. This remarkable care model provides immense provider satisfaction. HBPC models differ based on their mission, target population, geography, and revenue structure. Different missions include improved care, reduced costs, reduced readmissions, and teaching. Various payment structures include fee-for-service and value-based contracts such as Medicare Shared Savings Programs, Medicare capitation programs, or at-risk contracts. Future directions include home-based services such as hospital at home and the expansion of the home-based workforce. HBPC is an area that will continue to expand. In conclusion, HBPC has been shown to improve the quality of life of home-limited patients and their caregivers while reducing health care costs. Full article

(This article belongs to the Special Issue Geriatric Care Models)

Other

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11 pages, 292 KiB

Open AccessCommentary

Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19

by David G Smithard, Nadir Abdelhameed, Thwe Han and Angelo Pieris

Geriatrics 2021, 6(2), 36; https://doi.org/10.3390/geriatrics6020036 - 1 Apr 2021

Cited by 7 | Viewed by 3372

Abstract

Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation [...] Read more.

Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation are not appropriate for all. Who decides and how? This paper discusses the issues, biases, and potential harms involved in decision-making. The basis of decision making requires fairness in the distribution of resources/healthcare (distributive justice), yet much of the printed guidance has taken a utilitarian approach (getting the most from the resource provided). The challenge is to provide a balance between justice for the individual and population justice. Full article

(This article belongs to the Special Issue Responding to the Pandemic: Geriatric Care Models)

13 pages, 820 KiB

Open AccessConcept Paper

ACE Model for Older Adults in ED

by Martine Sanon, Ula Hwang, Gallane Abraham, Suzanne Goldhirsch, Lynne D. Richardson and GEDI WISE Investigators

Geriatrics 2019, 4(1), 24; https://doi.org/10.3390/geriatrics4010024 - 21 Feb 2019

Cited by 12 | Viewed by 13638

Abstract

The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department [...] Read more.

The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department (GED) replicated an Acute Care for Elderly (ACE) model, with focused assessments on common geriatric syndromes and daily comprehensive interdisciplinary team (IDT) meetings for high-risk patients. The IDT, comprised of an emergency physician, geriatrician, transitional care nurse (TCN) or geriatric nurse practitioner (NP), ED nurse, social worker (SW), pharmacist (RX), and physical therapist (PT), developed comprehensive care plans for vulnerable older adults at high risk for morbidity, ED revisit, functional decline, or potentially avoidable hospital admission. Patients were identified using the Identification of Seniors at Risk (ISAR) screen, followed by geriatric assessments to assist in the evaluation of elders in the ED. On average, 38 patients per day were evaluated by the IDT with approximately 30% of these patients formally discussed during IDT rounds. Input from the IDT about functional and cognitive, psychosocial, home safety, and pharmacological assessments influenced decisions on hospital admission, care transitions, access to community based resources, and medication management. This paper describes the role of a Geriatric Emergency Medicine interdisciplinary team as an innovative ACE model of care for older adults who present to the ED. Full article

(This article belongs to the Special Issue Geriatric Care Models)

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16 pages, 973 KiB

Open AccessFeature PaperCommentary

The Acute Care for Elders Unit Model of Care

by Robert M. Palmer

Geriatrics 2018, 3(3), 59; https://doi.org/10.3390/geriatrics3030059 - 11 Sep 2018

Cited by 68 | Viewed by 14985

Abstract

Older patients are at risk for loss of self-care abilities during the course of an acute medical illness that results in hospitalization. The Acute Care for Elders (ACE) Unit is a continuous quality improvement model of care designed to prevent the patient’s loss [...] Read more.

Older patients are at risk for loss of self-care abilities during the course of an acute medical illness that results in hospitalization. The Acute Care for Elders (ACE) Unit is a continuous quality improvement model of care designed to prevent the patient’s loss of independence from admission to discharge in the performance of activities of daily living (hospital-associated disability). The ACE unit intervention includes principles of a prepared environment that encourages safe patient self-care, a set of clinical guidelines for bedside care by nurses and other health professionals to prevent patient disability and restore self-care lost by the acute illness, and planning for transitions of care and medical care. By applying a structured process, an interdisciplinary team completes a geriatric assessment, follows clinical guidelines, and initiates plans for care transitions in concert with the patient and family. Three randomized clinical trials and systematic reviews of ACE or related interventions demonstrate reduced functional disability among patients, reduced risk of nursing home admission, and lower costs of hospitalization. ACE principles could improve elderly care in any acute setting. The aim of this commentary is to describe the ACE model and the basis of its effectiveness. Full article

(This article belongs to the Special Issue Geriatric Care Models)

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11 pages, 1113 KiB

Open AccessFeature PaperCase Report

Vet Connect: A Quality Improvement Program to Provide Telehealth Subspecialty Care for Veterans Residing in VA-Contracted Community Nursing Homes

by Anne Hale, Leah M. Haverhals, Chelsea Manheim and Cari Levy

Geriatrics 2018, 3(3), 57; https://doi.org/10.3390/geriatrics3030057 - 5 Sep 2018

Cited by 15 | Viewed by 6779

Abstract

Veterans residing in Veterans Health Administration (VA) contracted Community Nursing Homes (CNHs) receive primary care from the CNH they reside in, but often travel to Veterans Affairs Medical Centers (VAMCs) for specialty care services. The Vet Connect project is a quality improvement project [...] Read more.

Veterans residing in Veterans Health Administration (VA) contracted Community Nursing Homes (CNHs) receive primary care from the CNH they reside in, but often travel to Veterans Affairs Medical Centers (VAMCs) for specialty care services. The Vet Connect project is a quality improvement project aiming to implement video technology to support access to specialty care. Methods: Eight Denver VAMC specialty care providers and three project nurses underwent telehealth training and obtained appropriate equipment. To identify in-person visits eligible for substitution of video visits, project nurses review charts of CNH Veterans, consult directly with Veterans, and obtain recommendations from staff. Project nurses serve as tele-presenters within the CNHs, while VA specialists provide care from the VAMC. After each visit, team nurses coordinate care with and deliver specialty care recommendations to CNH staff. Results: We assessed clinical, business, and technical domains of the Vet Connect project, and utilized process mapping to identify barriers and facilitators to implementation. Clinically, starting on 26 June 2017 through 1 June 2018, N = 203 video visits have been conducted with 11 different CNHs in three subspecialties: geriatrics, palliative care, and mental health. These visits generated 49 referrals for 37 Veterans. Fiscally, cost analyses indicate that per visit, the health care system saves an estimated $310. Technologically, the success rate was 83%. Process mapping helped identify facilitators and barriers to implementation of the telehealth program, including cultivating buy-in from key stakeholders (i.e., medical and mental health providers, telehealth staff, and CNH staff), communication allowing for ongoing program adaptation, and building relationships. Conclusion: Subspecialty care delivery to nursing homes using video visit technology in the Vet Connect program is feasible using centralized organization to coordinate complex clinical, business and technical processes. Vet Connect has proved sustainable and has potential to expand within and outside of the VA. Full article

(This article belongs to the Special Issue Geriatric Care Models)

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