scholarly journals Creating Age-Friendly Health Systems: Age Matters

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 865-865
Author(s):  
Terry Fulmer
Keyword(s):  
Older Adults ◽  
Social Movement ◽  
Health Systems ◽  
Health Resources ◽  
American Hospital ◽  
American Hospital Association ◽  
Healthcare Improvement ◽  
Health Association ◽  
Common Framework ◽  
Private And Public

Abstract Since 2015, The John A. Hartford Foundation has been funding strategies to create Age-Friendly Health Systems (AFHS). Led by the Institute of Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association, the AFHS movement is rapidly growing, with participation in all 50 states from over 450 sites, including the full continuum of care settings. Partnerships with private and public entities are accelerating the work. As one example, the Health Resources and Services Administration has embedded AFHS principles into the Geriatrics Workforce Enhancement Program. This Kent Lecture will focus on the genesis and trajectory of the AFHS social movement and discuss how the effort will lead to an age-friendly ecosystem that transcends boundaries and cultures and leads to a common framework for the way we approach care, caregiving and communities for optimizing the lives and wellbeing of all older adults.

scholarly journals STRENGTH IN AGE-FRIENDLY HEALTH SYSTEMS: AN INNOVATIVE INTEGRATED INTERPROFESSIONAL MODEL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S829-S829
Author(s):  
Teri Kennedy
Keyword(s):  
Older Adults ◽  
Health System ◽  
Baby Boomers ◽  
Health Systems ◽  
Adult Population ◽  
The United States ◽  
Essential Elements ◽  
Conceptual Approach ◽  
American Hospital ◽  
American Hospital Association

Abstract This paper presents an innovative conceptual approach to health care policy for older adults: the Age-Friendly Health Systems Integrated Interprofessional Model. In 2017, the John A. Hartford Foundation and Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States, advanced the concept of an Age-Friendly Health System. This initiative is designed to respond to the needs of a burgeoning U.S. older adult population, expected to double from 2012 to 2050, largely due to the aging of Baby Boomers and increased life expectancy. These Baby Boomers will demand a well-coordinated, communicative health system responsive to their values and preferences. In an Age-Friendly Health System, all older adults receive the best possible care, without care-related harms, and with satisfaction of care received. Essential elements include what matters, mentation, mobility, and medications, with a focus on patient-directed, family-engaged care. While a solid framework for improving healthcare for older adults, this model is further strengthened by incorporating the essential elements of person-, family-, and community-centered approaches to care; interprofessional team-based competencies, and Quadruple Aim outcomes. This enhanced model, referred to as the Age-Friendly Health System Integrated Interprofessional Model, combines elements essential to quality healthcare within the framework of an Age-Friendly Health System. This paper will present the original Age-Friendly Health System framework, the proposed Age-Friendly Health System Integrated Interprofessional Model, then compare and contrast each model’s essential principles. Implications for adoption of this enhanced model for policy, education, and practice will be explored.

scholarly journals Polypharmacy in Older Adults Hospitalized for Heart Failure

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Ozan Unlu ◽  
Emily B. Levitan ◽  
Evgeniya Reshetnyak ◽  
Jerard Kneifati-Hayek ◽  
Ivan Diaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Racial Differences ◽  
The United States ◽  
Negative Effects ◽  
Real World Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Regards Study

Background: Despite potential harm that can result from polypharmacy, real-world data on polypharmacy in the setting of heart failure (HF) are limited. We sought to address this knowledge gap by studying older adults hospitalized for HF derived from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Methods: We examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. We collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare’s Hospital Compare website. We counted the number of medications taken at hospital admission and discharge; and classified each medication as HF-related, non-HF cardiovascular-related, or noncardiovascular-related. Results: The vast majority of participants (84% at admission and 95% at discharge) took ≥5 medications; and 42% at admission and 55% at discharge took ≥10 medications. The prevalence of taking ≥10 medications (polypharmacy) increased over the study period. As the number of total medications increased, the number of noncardiovascular medications increased more rapidly than the number of HF-related or non-HF cardiovascular medications. Conclusions: Defining polypharmacy as taking ≥10 medications might be more ideal in the HF population as most patients already take ≥5 medications. Polypharmacy is common both at admission and hospital discharge, and its prevalence is rising over time. The majority of medications taken by older adults with HF are noncardiovascular medications. There is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF.

scholarly journals Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

2019 ◽  
Vol 56 ◽  
pp. 004695801881799
Author(s):  
Shivani Gupta ◽  
Ferhat D. Zengul ◽  
Ganisher K. Davlyatov ◽  
Robert Weech-Maldonado
Keyword(s):  
Hospital Readmission ◽  
Fixed Effects ◽  
Skilled Nursing Facility ◽  
Health Resources ◽  
Estimating Equation ◽  
Readmission Rates ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
American Hospital ◽  
American Hospital Association

Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs’ association with hospitals’ readmission rates. This study seeks to examine the association between HBSNFs and hospitals’ readmission rates. Data sources included 2007-2012 American Hospital Association Annual Survey, Area Health Resources Files, the Centers for Medicare and Medicaid Services (CMS) Medicare cost reports, and CMS Hospital Compare. The dependent variables were 30-day risk-adjusted readmission rates for acute myocardial infarction (AMI), congestive heart failure, and pneumonia. The independent variable was the presence of HBSNF in a hospital (1 = yes, 0 = no). Control variables included organizational and market factors that could affect hospitals’ readmission rates. Data were analyzed using generalized estimating equation (GEE) models with state and year fixed effects and standard errors corrected for clustering of hospitals over time. Propensity score weights were used to control for potential selection bias of hospitals having a skilled nursing facility (SNF). GEE models showed that the presence of HBSNFs was associated with lower readmission rates for AMI and pneumonia. Moreover, higher SNFs to hospitals ratio in the county were associated with lower readmission rates. These findings can inform policy makers and hospital administrators in evaluating HBSNFs as a potential strategy to lower hospitals’ readmission rates.

scholarly journals GWEP Successes and Lessons Learned From Making Communities Age Friendly

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 496-496
Author(s):  
Katherine Thompson ◽  
Jennifer Ouellet
Keyword(s):  
Older Adults ◽  
Health System ◽  
Health Systems ◽  
Clinical Decision Making ◽  
Health Resources ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Community Based ◽  
Wide Range ◽  
What Matters

Abstract Geriatrics Workforce Enhancement Programs (GWEPs), funded by the Health Resources and Services Administration have a strong focus on age friendly care and community engagement. With a wide range of populations, locales, and health systems served, GWEPs have significant experience working with a wide variety of communities to implement age friendly care. In this symposium, we present successes and lessons learned from GWEP projects representing diverse populations and approaches to achieving age friendly communities. For instance, one GWEP is utilizing Patient Priorities Care to lay the framework for What Matters in clinical decision-making. Another GWEP is focusing on What Matters by uniquely embedding Area Agencies on Aging care coordinators within primary care settings to invite the participation of aging patients in advance care planning, among other health interventions. A third GWEP is using the 4Ms to educate patients and caregivers in geriatric psychiatry clinics in a population of veterans. Another GWEP is pairing Age Friendly Health System efforts within a health system with community-based efforts to become an age friendly and dementia friendly city. A final GWEP is using multiple educational modalities to create Age-Friendly Communities and assure that health systems, community-based organizations, and older adults and families are educated about the 4Ms. By exploring successes and lessons learned in making communities age friendly, we can improve existing and future programs centered on age friendly care for older adults.

scholarly journals Engaging Isolated and Underserved Older Adults in 4Ms Care: Age-Friendly Care, PA

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 315-315
Author(s):  
Diane Berish ◽  
Terry Fulmer
Keyword(s):  
Older Adults ◽  
Social Services ◽  
Care Delivery ◽  
The United States ◽  
Outcome Data ◽  
Policy Implications ◽  
American Hospital ◽  
American Hospital Association ◽  
Clinician Training ◽  
State College

Abstract Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.

Hospital Isolation and Precaution Guidelines

PEDIATRICS ◽  
1974 ◽  
Vol 53 (5) ◽  
pp. 663-673
Author(s):  
Pierce Gardner ◽  
Sylvia Breton ◽  
Diana G. Carles
Keyword(s):  
Public Health ◽  
New York ◽  
Infectious Diseases ◽  
Medical Center ◽  
Government Printing ◽  
American Public Health Association ◽  
American Hospital ◽  
American Hospital Association ◽  
Isolation Techniques ◽  
Health Association

Infections acquired in hospitals have been recognized as a significant cause of morbidity and mortality since before the era of Semmelweis and Lister. Hospital isolation and precaution procedures have evolved along highly individualistic lines depending on the facilities, patient population and the degree of concern regarding nosocomial infections at a particular hospital. In recent years, a number of valuable manuals which offer details of isolation and precaution techniques as well as recommendations for the hospital control of particular infectious diseases have become available. These include: 1. Public Health Service, U. S. Department of Health, Education and Welfare: Isolation Techniques Used in Hospitals. Washington, D.C.: U.S. Government Printing Office, 1970. 2. Report of the Committee on Infectious Diseases, ed. 16. Evanston, Illinois: American Academy of Pediatrics, 1970. 3. Infection Control in the Hospital, ed. 2. Chicago: American Hospital Association, 1970. 4. Benenson, A. S. (ed.): Control of Communicable Diseases in Man, ed. 11. New York: American Public Health Association, 1970. 5. Top, F. H. (ed.): Control of Infectious Diseases in General Hospitals. New York: American Public Health Association, 1967. In an attempt to synthesize these recommendations into a more easily utilized form, the following alphabetical listing of diseases and conditions has been developed by members of the Infections Control Committee at the Children's Hospital Medical Center. It should be stressed that these are guidelines based on current understanding of the natural history and epidemiology of certain infections. In our hospital, modifications are frequently necessary due to heavy demand for the limited isolation facilities.

scholarly journals Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhong Li ◽  
Sayward E. Harrison ◽  
Xiaoming Li ◽  
Peiyin Hung
Keyword(s):  
Continuity Of Care ◽  
Psychiatric Care ◽  
The United States ◽  
Psychiatric Services ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Promising Alternative ◽  
American Hospital ◽  
American Hospital Association ◽  
Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

scholarly journals Engaging and Educating Older Adults and Caregivers in Age-Friendly Healthcare

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 686-686
Author(s):  
Erin Emery-Tiburcio ◽  
Rani Snyder
Keyword(s):  
Older Adults ◽  
New York ◽  
Health System ◽  
Medical Center ◽  
Health Resources ◽  
Primary Care Providers ◽  
Care Providers ◽  
New York University ◽  
The Us ◽  
Treatment Plans

Abstract As the Age-Friendly Health System initiative moves across the US and around the world, not only do health system staff require education about the 4Ms, but older adults, caregivers, and families need education. Engaging and empowering the community about the 4Ms can improve communication, clarify and improve adherence to treatment plans, and improve patient satisfaction. Many methods for engaging the community in age-friendly care are currently in development. Initiated by Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Programs (GWEPs), Community Catalyst is leading the co-design of Age-Friendly Health System materials with older adults and caregivers. Testing these materials across the country in diverse populations of older adults and caregivers will yield open-source documents for local adaptation. Rush University Medical Center is testing a method for identifying, engaging, educating, and providing health services for family caregivers of older adults. This unique program integrates with the Age-Friendly Health System efforts in addressing all 4Ms for caregivers. The Bronx Health Corps (BHC) was created by the New York University Hartford Institute of Geriatric Nursing to educate older adults in the community about health and health behaviors. BHC developed a method for engaging and educating older adults that is replicable in other communities. Baylor College of Medicine adapted and tested the Patient Priorities Care model to educate primary care providers about how to engage older adults in conversations about What Matters to them. Central to the Age-Friendly movement, John A. Hartford Foundation leadership will discuss the implications of this important work.

scholarly journals Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 704-704
Author(s):  
Yuchi Young ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Systems ◽  
Long Term Care ◽  
The United States ◽  
World Population ◽  
Term Care ◽  
The Usa ◽  
Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

scholarly journals Retirement Without God: Activism and Community Among Secular People Over 60

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 441-441
Author(s):  
Joseph Blankholm
Keyword(s):  
United States ◽  
Older Adults ◽  
Social Movement ◽  
Generational Differences ◽  
Crucial Role ◽  
National Level ◽  
The United States ◽  
Ethnographic Research ◽  
Vast Literature

Abstract There are more than 1,400 nonbeliever communities in the United States and well over a dozen organizations that advocate for secular people on the national level. Together, these local and national groups comprise a social movement that includes atheists, agnostics, humanists, freethinkers, and other kinds of nonbelievers. Despite the fact that retired people over 60 dedicate most of the money and energy needed to run these groups, the increasingly vast literature on secular people and secularism has paid them almost no attention. Relying on more than one hundred interviews (including dozens with people over 60), several years of ethnographic research, and a survey of organized nonbelievers, this paper demonstrates the crucial role that people over 60 play in the American secular movement today. It also considers the reasons older adults are so important to these groups, the challenges they face in trying to recruit younger members and combat stereotypes about aging leadership, and generational differences that structure how various types of nonbeliever groups look and feel. This paper reframes scholarly understandings of very secular Americans by focusing on people over 60 and charts a new path in secular studies.

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