scholarly journals GERI-VET: A PROGRAM FOR OLDER VETERANS SEEN IN THE EMERGENCY ROOM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S146-S146
Author(s):  
Denise M Kresevic ◽  
Albert Lee ◽  
Mustafa Ascha ◽  
Todd Smith
Keyword(s):  
Older Adults ◽  
Emergency Room ◽  
Hospital Admissions ◽  
Social Issues ◽  
Functional Decline ◽  
Care Staff ◽  
Caregiver Support ◽  
Avoidable Hospitalizations ◽  
One Year ◽  
Family Caregiver Burden

Abstract Older adults made over 21 million Emergency Room (ER) visits accounting for nearly 46% of all ER hospital admissions in 2015. The ER setting provides not only a unique opportunity to assess patients’ health, functional status and social issues, but also provide recommendations to help coordinate care. Geriatric ER assessments have been associated with reduced avoidable hospitalizations, functional decline, and institutionalization. However, few ER clinicians including physicians, nurses and technicians have received adequate training to perform geriatric screenings and implement timely referrals. In 2014 American College of Emergency physicians and American Geriatric Society published guidelines for care. Based on these guidelines A” Geri-Vet Bootcamp” Program was developed and piloted at the Northeast Ohio VAMC. This program included: simulation emphasizing standardized screenings, and the use of decision support aides for management and referrals for older adults seen in the ER. Following this multi-modal education program, 91% clinicians reported greater ability to apply knowledge learned, 82% clinicians were able to more accurately identify geriatric syndromes, and 86% were able to identify additional resources. Of the patients screened over one year, 73% of patients were identified as being at high risk for falls, 32% had high family caregiver burden, 15% had moderate to severe dementia, and 14% had positive delirium screens. Those veterans screened by Geri Vet trained Staff received significantly more referrals than usual care staff, home care 28.7% vs.15.6%, geriatric clinic 20.5% vs. 11.7% and caregiver support 5.0% vs. 1.3%. Data show hospital admissions have decreased 5-7%. Education and dissemination continues

Functional Decline in Emergency Department Patients with Dyspnea; a Register-Based Cohort

2021 ◽  
Author(s):  
Karoline Stentoft Rybjerg Larsen ◽  
Marianne Lisby ◽  
Hans Kirkegaard ◽  
Annemette Krintel Petersen
Keyword(s):  
Emergency Department ◽  
Electronic Patient Record ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Patient Characteristics ◽  
Risk Of Death ◽  
Record Data ◽  
Emergency Department Patients ◽  
One Year ◽  
Historic Cohort

Abstract Background Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably patients acutely admitted to hospital with dyspnea have a high risk of functional decline. The aim of this study was to describe patient characteristics, hospital trajectory, and use of physiotherapy services of dyspneic patients in an emergency department. Furthermore, to compare readmission and death among patients with and without a functional decline, and to identify predictors of functional decline. Methods Historic cohort study of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients that due to dyspnea in 2015 were treated at the emergency department (ED). The main outcome measures were readmission, death, and functional decline. Results In total 2,048 dyspneic emergency treatments were registered. Within 30 days after discharge 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, p<0.001) and mortality (9.3% vs. 3.6%, p=0.009) as well as mortality within one year (36.1% vs. 13.4%, p<0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. Conclusion Patients suffering from acute dyspnea are seen at the ED at all hours. In total one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seems to be particularly vulnerable.

scholarly journals HIV pada Geriatri HIV in Geriatrics

2017 ◽  
Vol 3 (2) ◽  
pp. 106
Author(s):  
Nur Ainun ◽  
Evy Yunihastuti ◽  
Arya Govinda Roosheroe
Keyword(s):  
Older Adults ◽  
Patient Group ◽  
Social Issues ◽  
Functional Decline ◽  
Prolonged Survival ◽  
Ageing Process ◽  
Complex Patient

Jumlah pasien HIV yang berusia lanjut semakin bertambah dikarenakan angka kesintasan pasien yang meningkat dan infeksi HIV pada pasien usia lanjut. Populasi pasien tersebut membutuhkan penatalaksaan tersendiri dikarenakan terdapat sejumlah komorbid baik yang berhubungan dengan HIV maupun tidak, polifarmasi, penurunan kapasitas fungsional dan isu sosial.Kata kunci: geriatri, HIV, komorbid, kronik, penuaanHIV in GeriatricsThrough both prolonged survival and late acquisition of the disease, numbers of older adults with HIV are climbing. Along with ageing process is an accumulation of HIV-associated non-AIDS related comorbidities, creating a complex patient group affected by multi-morbidity along with polypharmacy, functional decline and social issues. Keywords: ageing, chronic, comorbidity, geriatrics, HIV

scholarly journals The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

2020 ◽  
Author(s):  
Anne Griffin ◽  
Aoife O´Neill ◽  
Margaret O´Connor ◽  
Damien Ryan ◽  
Audrey Tierney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Ability ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Secondary Analysis ◽  
Adverse Outcomes ◽  
Nutrition Status

Abstract BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. MethodsSecondary analysis of data collected from a randomised trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from baseline to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD=7.0); 59.2% (n=209) female) the prevalence of malnutrition was 7.6% (n=27) and ‘risk of malnutrition’ was 28% (n=99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. At 6-months, a reported further decline in functional ability was more likely among those who were malnourished compared to those who had normal nutritional status. ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to long-term care at 30 days. Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515

One-year predictors of turnover among personal-care workers for older adults living at home in Italy

2010 ◽  
Vol 31 (4) ◽  
pp. 611-624 ◽  
Author(s):  
CLAUDIO BILOTTA ◽  
PAOLA NICOLINI ◽  
CARLO VERGANI
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Multivariate Logistic Regression Analysis ◽  
Community Dwelling ◽  
Care Staff ◽  
Personal Care ◽  
Care Workers ◽  
Informal Carers ◽  
One Year ◽  
At Home

ABSTRACTThis paper reports a study that aimed to identify the predictors of the turnover of privately-employed personal-care staff that provide community-dwelling older adults in Italy with assistance in the activities of daily living. The prospective cohort study enrolled 121 older adults (mean age 85.6 years) living at home, along with their personal-care workers and 107 informal carers. The older participants underwent a comprehensive geriatric assessment. At a one-year follow-up between May 2006 and June 2008, 12 of the older participants had been placed in a nursing home and 26 had died. Of the 83 still living at home, 22 had changed their personal-care staff (26.5% turnover). Multivariate logistic regression analysis identified one characteristic of the personal-care staff, living far away from their families (odds ratio (OR) 16.30, p=0.01), and two characteristics of the elders, namely being widowed (OR 0.09, p=0.01) and having cognitive impairment (OR 0.10, p=0.01), as one-year predictors of turnover and of the retention of personal-care workers, respectively. Further studies are needed both to evaluate whether immigration politics that enable family reconjunction would reduce the turnover of personal-care workers, and to investigate the lower turnover among personal-care staff caring for widowed elders and older adults with cognitive impairment.

scholarly journals The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anne Griffin ◽  
Aoife O’Neill ◽  
Margaret O’Connor ◽  
Damien Ryan ◽  
Audrey Tierney ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Functional Ability ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Secondary Analysis ◽  
Adverse Outcomes ◽  
Nutrition Status

Abstract Background Malnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. Methods Secondary analysis of data collected from a randomised controlled trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit to 30-days and 6-month follow-up were used for statistical analysis. Results Among 353 older adults (mean age 79.6 years (SD = 7.0); 59.2% (n = 209) female) the prevalence of malnutrition was 7.6% (n = 27) and ‘risk of malnutrition’ was 28% (n = 99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant. Conclusion Over one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to a nursing home at 30 days. Trial registration Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018.

scholarly journals Carer Café in Taiwan: An Innovative Model Providing Caregiver Support for Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 487-487
Author(s):  
Tsuann Kuo ◽  
Su-I Hou
Keyword(s):  
Older Adults ◽  
Family Caregivers ◽  
Social Infrastructure ◽  
Community Based ◽  
Term Care ◽  
Caregiver Support ◽  
Pilot Survey ◽  
One Year ◽  
Coffee Shops

Abstract Physical places and environments play critical roles in shaping how people interact. This paper introduces an innovative Carer Café model in Taiwan with social infrastructure support and services for family caregivers caring for older adults. Carer cafés are community-based initiatives of Taiwan Association of Family Caregivers (TAFC), aiming to help carers recognizing their own needs and increase awareness of long-term care resources available. Through partnerships with local coffee shops, respite-focused services are provided. The “free coffee for two” campaign encourages family members and friends taking a caregiver out for a “respite coffee”. Carer Café has also become an important “third place” hosting respite programs and the “a shop within a shop” style creating designated space to build a sense of community. Pilot survey (n=375) showed 77% perceived reduced stress, 83% appreciated services provided, and 250% increased referrals within one year. Implications on impact and future opportunities will be discussed.

scholarly journals Risk factors for functional decline and institutionalisation among community-dwelling older adults with mild to severe Alzheimer’s disease: one year of follow-up

2006 ◽  
Vol 35 (3) ◽  
pp. 308-310 ◽  
Author(s):  
Maria E. Soto ◽  
Sandrine Andrieu ◽  
Sophie Gillette-Guyonnet ◽  
Christelle Cantet ◽  
Fati Nourhashemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Functional Decline ◽  
Community Dwelling ◽  
One Year ◽  
Community Dwelling Older Adults

scholarly journals AGING IN PLACE: EFFECTIVE INTERPROFESSIONAL COLLABORATION AND ENGAGEMENT WITH OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S134-S134
Author(s):  
Elizabeth Fine-Smilovich ◽  
Diana L Morris ◽  
David M Rosenberg ◽  
Elizabeth O’Toole ◽  
Cynthia Booth-Lord ◽  
...  
Keyword(s):  
Older Adults ◽  
Experiential Learning ◽  
Social Issues ◽  
Interprofessional Collaboration ◽  
Community Setting ◽  
Attitude Scale ◽  
Learning Goals ◽  
Learning Program ◽  
Early Health ◽  
One Year

Abstract Background: An innovative educational program addresses two gaps in health professions education: lack of an emerging workforce comfortable caring for older adults and proficiency in working in an interprofessional (IP) setting. We sought to explore whether AIP provides grounding in pillars of IPE and geriatric competencies through experiential learning in IP teams with older adults in a community setting. Methods: Early health profession students n=37 (MD, MSN, PA, SW), working in teams of 3, made monthly visits to older adults’ residences over a one-year period. Workshops on core geriatric and IPE principles defined expected learning goals for client visits. Visits were followed by: 1) written field notes; 2) reflections based on pre-determined learning prompts; and 3) debriefing sessions with faculty members. Students completed pre and post program questionnaires including Attitudes Towards Social Issues in Medicine, Geriatrics Attitude Scale, ICCAS, and RIPLS. Pre-post results were analyzed using t-tests and qualitative analysis of comments. Results: 25 (68%) students completed pre-post questionnaires. Responses on the interprofessional collaboration scale significantly increased following the program (t=2.09; p = 0.047) and 94% responded that they could “well” or “very well” describe issues that impact older adults’ health, quality of life, and convey appreciation toward older adults. Discussion: Students, engaging with older adults longitudinally in a community setting learned pillars of IPE, geriatric care competencies, and gained insights into this population. An interprofessional, experiential learning program is feasible and effective way to increase interest and self-efficacy in working with older adult populations.

HIV and ageing: what the geriatrician needs to know

2013 ◽  
Vol 24 (1) ◽  
pp. 10-24 ◽  
Author(s):  
T Levett ◽  
J Wright ◽  
M Fisher
Keyword(s):  
Older Adults ◽  
Human Immunodeficiency Virus ◽  
Patient Group ◽  
Social Issues ◽  
Functional Decline ◽  
People Living With Hiv ◽  
Fatal Disease ◽  
Complex Patient ◽  
Immunodeficiency Virus ◽  
Living With Hiv

SummaryThe transformation of human immunodeficiency virus (HIV) from a rapidly fatal disease to a chronic manageable illness has resulted in annual increases in the numbers of people living with HIV. The HIV cohort is therefore ageing, with numbers of older adults with HIV climbing, through both prolonged survival and late acquisition of the disease. Associated with ageing is an accumulation of HIV-associated non-AIDS related co-morbidities, creating a complex patient group affected by multi-morbidity along with polypharmacy, functional decline and complex social issues. With this in mind, this review seeks to explore areas where HIV (diagnosed or undetected) may impact on the work of clinical geriatricians.

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