scholarly journals An Age- Friendly Campus Partnership for Hospitalized Older Adults in the COVID Era and Beyond

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 387-387
Author(s):  
Heavner Mojdeh ◽  
Marjorie Fass ◽  
Christina Cafeo ◽  
Giora Netzer ◽  
Mangla Gulati ◽  
...  
Keyword(s):  
Older Adults ◽  
Critical Illness ◽  
Medical Center ◽  
University Of Maryland ◽  
Intergenerational Programs ◽  
Contagious Disease ◽  
Hospitalized Older Adults ◽  
What Matters

Abstract As hospitals isolate COVID-19 patients to prevent the spread of this highly contagious disease, patients and family are separated during times of critical illness. For many older adults inflicted with coronavirus it is not the fear of dying that matters the most, it is the fear of dying alone. Utilizing the 4Ms approach, University of Maryland, Baltimore (UMB) and University of Maryland Medical Center (UMMC) responded with several initiatives including intergenerational programs designed to shape and inform the development of future healthcare clinicians in addressing what matters the most to patients and leveraging technology to connect them with families, provide mobility opportunities, monitor medications, and reduce errors.

scholarly journals Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care

2018 ◽  
Vol 9 (9) ◽  
pp. 523-533 ◽  
Author(s):  
Alec W. Petersen ◽  
Avantika S. Shah ◽  
Sandra F. Simmons ◽  
Matthew S. Shotwell ◽  
J. Mary Lou Jacobsen ◽  
...  
Keyword(s):  
Older Adults ◽  
Usual Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Patient Centered ◽  
Convenience Sample ◽  
Point Reduction ◽  
Significant Difference ◽  
Hospitalized Older Adults

Background: Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results. Methods: This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications. A deprescribing protocol (Shed-MEDS) was implemented among 20 intervention and 20 usual care control patients during their hospital stay. The primary outcome was the total number of medications deprescribed from hospital enrollment. Deprescribed was defined as medication termination or dose reduction. Enrollment medications reflected all prehospital medications and active in-hospital medications. Baseline characteristics and outcomes were compared between the intervention and usual care groups using simple logistic or linear regression for categorical and continuous measures, respectively. Results: There was no significant difference between groups in mean age, sex or Charlson comorbidity index. The intervention and control groups had a comparable number of medications at enrollment, 25.2 (±6.3) and 23.4 (±3.8), respectively. The number of prehospital medications in each group was 13.3 (±4.6) and 15.3 (±4.6), respectively. The Shed-MEDS protocol compared with usual care significantly increased the mean number of deprescribed medications at hospital discharge and reduced the total medication burden by 11.6 versus 9.1 ( p = 0.032) medications. The deprescribing intervention was associated with a difference of 4.6 [95% confidence interval (CI) 2.5–6.7, p < 0.001] in deprescribed medications and a 0.5 point reduction (95% CI −0.01 to 1.1) in the drug burden index. Conclusions: A hospital-based, patient-centered deprescribing intervention is feasible and may reduce the medication burden in older adults.

scholarly journals AGE-FRIENDLY CARE AND MOBILITY IN HOSPITALIZED OLDER ADULTS WITH COGNITIVE IMPAIRMENT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S446-S446
Author(s):  
Jasmine K Vickers ◽  
Richard E Kennedy ◽  
Shari Biswal ◽  
David James ◽  
Katrina Booth ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Patient Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Adverse Outcomes ◽  
Care Needs ◽  
Post Discharge ◽  
Before And After ◽  
Hospitalized Older Adults

Abstract Hospitalization of older adults with cognitive impairment (CI) has been associated with higher risk for adverse outcomes. Acute Care for Elders (ACE) Units were developed to meet the unique hospital care needs of older adults and have been associated with reductions in functional decline and readmissions. The Virtual ACE intervention was developed to disseminate ACE principles across hospital units. Virtual ACE included training interprofessional providers to utilize screens and care protocols to optimize care for older adults on eight units at a large academic medical center. We conducted a preliminary analysis of mobility and patient outcomes before and after Virtual ACE among 192 older adults with CI on hospital admission. Chi-Square tests were used to examine the associations between Virtual ACE and patient outcomes. There were statistically significant pre vs. post improvements in patients’ mobility from bed to chair (30% vs. 51%, p=0.011) and on the unit hallway (12% vs. 27%, p=0.046). Although not statistically significant, there were also improvements in hospital room mobility (39% vs. 50%, p=0.214) and documentation of activities of daily living (ADL) screens (70% vs. 80%, p=0.196). There were non-significant reductions in pressure ulcer prevalence (26% vs. 22%) and restraint use (5% vs. 0%) during the hospital stay. Pain was similar before and after Virtual ACE. Virtual ACE was associated with increased mobility and slight reductions in adverse outcomes. As increased hospital mobility improves patient functioning post-discharge, Virtual ACE has the potential to maintain function and enhance outcomes in hospitalized older adults with CI.

scholarly journals Asking What Matters Is What Matters to Hospitalized Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 581-582
Author(s):  
Vikki Rompala ◽  
Erin Emery-Tiburcio ◽  
Carline Guerrier
Keyword(s):  
Older Adults ◽  
Qualitative Data ◽  
First Year ◽  
Compassionate Care ◽  
Patient Room ◽  
Optimal Care ◽  
White Boards ◽  
Hospitalized Older Adults ◽  
What Matters

Abstract The 4Ms of an Age-Friendly Health System place What Matters at the center of optimal care for older adults. Nurses at Rush have asked every medical inpatient What Matters early in their hospital stay since May, 2018. Responses were recorded in tablet software and on patient room white boards. What Matters responses recorded electronically were stratified by age and ethnicity. Qualitative data analysis of responses (n=660) was conducted using In-Vivo software by three raters. Themes in responses include: going home; comfort, including pain control and breathing more easily; effective staff/patient communication; compassionate care; and mobility. Patient satisfaction data for the first year showed an average 2.6% increase in satisfaction in nurses listening to the patient, and average 3.6% increase in satisfaction in nurses explaining things in an understandable way. Both increases were statistically significant. Implications of this practice for health systems improving age-friendly care will be discussed.

scholarly journals Diverse Approaches to Assessing What Matters to Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 581-581
Author(s):  
Erin Emery-Tiburcio ◽  
Robyn Golden
Keyword(s):  
Older Adults ◽  
Health System ◽  
Health Systems ◽  
Medical Center ◽  
Simulated Patients ◽  
Care Plans ◽  
Health Community ◽  
Diverse Backgrounds ◽  
Real Patients ◽  
What Matters

Abstract Asking older adults What Matters to them and assuring that care plans are aligned with these preferences is the cornerstone of an Age-Friendly Health System (AFHS). Health systems have struggled to identify clear ways to ask this question and meaningfully utilize the responses. Both simple and complex options for addressing this challenge have been developed at Rush University Medical Center. At Rush, nurses began asking every inpatient What Matters and placing the response on the white board in the patient’s room. Results of this practice include increased awareness of staff and significant increases in patient satisfaction. Qualitative analysis of responses yields increased awareness of patterns that the hospital can more systematically address. The Rush Center for Excellence in Aging hosts Schaalman Senior Voices, in which older adults from diverse backgrounds are given the unique opportunity to offer their perspectives on life, health and aging related to “What Matters” to them. The films have been used effectively to stimulate conversations among older adults and families in the community and in health professions courses, and with health systems executives. The Rush College of Medicine has integrated AFHS training into communication skills for medical students. Faculty introduce the 4Ms and demonstrate methods for having What Matters (WM) conversations. Students then practice WM conversations with simulated patients; some have had the opportunity to practice with real patients in preceptorships. Implications for the health system and community will be discussed as Rush builds an Age-Friendly Health Community.

scholarly journals Religion and Spirituality in Surrogate Decision Making for Hospitalized Older Adults

2015 ◽  
Vol 55 (3) ◽  
pp. 765-777 ◽  
Author(s):  
Kristin N. Geros-Willfond ◽  
Steven S. Ivy ◽  
Kianna Montz ◽  
Sara E. Bohan ◽  
Alexia M. Torke
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Surrogate Decision Making ◽  
Religion And Spirituality ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

scholarly journals Beyond survival: identifying what matters to survivors of critical illness

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Somnath Bose ◽  
Benjamin Hoenig ◽  
Maria Karamourtopoulos ◽  
Valerie Banner-Goodspeed ◽  
Samuel Brown
Keyword(s):  
Critical Illness ◽  
What Matters

scholarly journals Influenza Vaccine Effectiveness and Waning Effect in Hospitalized Older Adults. Valencia Region, Spain, 2018/2019 Season

2021 ◽  
Vol 18 (3) ◽  
pp. 1129
Author(s):  
Ainara Mira-Iglesias ◽  
F. Xavier López-Labrador ◽  
Javier García-Rubio ◽  
Beatriz Mengual-Chuliá ◽  
Miguel Tortajada-Girbés ◽  
...  
Keyword(s):  
Older Adults ◽  
Influenza Vaccine ◽  
Influenza A ◽  
Vaccine Effectiveness ◽  
Surveillance Network ◽  
Adjuvanted Vaccine ◽  
Clinical Registries ◽  
Populations At Risk ◽  
Influenza A H1n1 ◽  
Hospitalized Older Adults

Influenza vaccination is annually recommended for specific populations at risk, such as older adults. We estimated the 2018/2019 influenza vaccine effectiveness (IVE) overall, by influenza subtype, type of vaccine, and by time elapsed since vaccination among subjects 65 years old or over in a multicenter prospective study in the Valencia Hospital Surveillance Network for the Study of Influenza and other Respiratory Viruses (VAHNSI, Spain). Information about potential confounders was obtained from clinical registries and/or by interviewing patients and vaccination details were only ascertained by registries. A test-negative design was performed in order to estimate IVE. As a result, IVE was estimated at 46% (95% confidence interval (CI): (16%, 66%)), 41% (95% CI: (−34%, 74%)), and 45% (95% CI: (7%, 67%)) against overall influenza, A(H1N1)pdm09 and A(H3N2), respectively. An intra-seasonal not relevant waning effect was detected. The IVE for the adjuvanted vaccine in ≥75 years old was 45% (2%, 69%) and for the non-adjuvanted vaccine in 65–74 years old was 59% (−16%, 86%). Thus, our data revealed moderate vaccine effectiveness against influenza A(H3N2) and not significant against A(H1N1)pdm09. Significant protection was conferred by the adjuvanted vaccine to patients ≥75 years old. Moreover, an intra-seasonal not relevant waning effect was detected, and a not significant IVE decreasing trend was observed over time.

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