Care Model For Older Adults Research Articles

Innovative Model of Care for Older Adults in Taiwan: Implementation of Intergenerational Learning for Older Adults and Young Children

In intergenerational learning, older adults experience benefits such as improved well-being, cognitive engagement, and social interaction. IGL also improves the ability of older adults to address age-specific developmental concerns, including generativity and identity formation. Older individuals can benefit from engaging in learning activities with young children. This article introduces an innovative care model for older adults in Taiwan, and the model focuses on the implementation of IGL for older adults and young children. In addition, it is hoped that this study will give preschool teachers a greater understanding of the essence of IGL to become better educators, and effectively implementing intergenerational learning courses so that older adults and young children can develop a healthy body and mind in the future. To effectively implement IGL for older adults and young children, preschools should develop thematic, interactive IGL curricula, and increase preschool teachers’ awareness of IGL and train professionals in this educational approach. Preschools should also utilize available resources and funds to systematically promote IGL, and they should invite parents to participate in activities that can counter misconceptions regarding the capabilities of older adults. Preschools should establish a team of experts to provide assistance and consultations for institutions, and they should develop effective models for promoting IGL.

Co-design of an integrated home-based primary care model for older adults living with frailty in Ontario, Canada

Background: The demand for home care is predicted to increase with increasing senior population and the aging-at-home phenomenon. Countries world-wide are preparing for this growing demand by making changes to their health care and social care systems. This change is much needed given that, globally, evidence shows that seniors are experiencing fragmented care particularly when they are living with frailty. To address this problem, the Central West Ontario Health Team in Canada is creating an integrated home-based primary care model for individuals 65+ who are living with frailty. At the ICIC23 Conference, I plan to share our research findings, design of the program, learnings from every phase of our co-design and change management approach, and findings from the evaluation of the pilot program. 
 Methods: The program is being co-designed (using Experienced Based Co-Design) in collaboration with patients, caregivers, primary care, hospitals, the municipality, mental health organizations, social workers, home and community care, and other community groups. To date, the co-design team has worked together in partnership to share experiences, segment the population, conduct an environmental scan of documents, and conduct quantitative and qualitative research. First, the team performed descriptive data analysis of hospitalization and community data, and then, three separate focus groups were held with local organizations, service providers, and patients and caregivers (n=60). The data that emerged from the focus groups was then thematically analyzed. The co-design team is now finalizing the program as it is set to be piloted in January 2023, at which point, the program will be evaluated (on measures such as emergency department (ED) diversion and patient experience), updated, and scaled up appropriately.
 Results: Research showed that 80% of Alternate-Level-of-Care days in the Region are among those who are 65+. A cohort of the older adult population are also high users of the ED who are being discharged home each time. Reported reasons for high ED use include isolation, confusion about the health care system, caregiver burnout, and not receiving proper care in the community in a timely manner. Our research also identified frail older adults to be particularly vulnerable. The program I will describe in the presentation will aim to address these issues. It is novel to Ontario, Canada, and will consist of a screening process to identify “at risk” older adults presenting to the ED, a comprehensive assessment, and ongoing access to an intraprofessional team (consisting of physicians, nurses, physiotherapists, nutritionists, pharmacists, and mental health professionals) that will work together on a shared care plan for each patient. All the tools are being adapted to meet a multi-faceted definition of frailty as well as local needs given that the Central West Region is one of the most ethnically diverse regions in the province. By co-designing, the aim is to implement an integrated program that matches the preferences of patients and their family-members and caregivers.
 Discussion: The learnings will be helpful to the many groups world-wide who are also planning on creating integrated co-designed primary-care based programs for diverse older adults experiencing frailty.

Transitional care model for older adults with multiple chronic conditions: An evaluation of benefits utilising an umbrella review.

To synthesise and describe the combined evidence from systematic reviews of interventions using elements from the Transitional Care Model, on the content and timeframe of the interventions and the related improvement of outcomes for older patients with multiple chronic conditions. The population of older patients with multiple chronic conditions is increasing worldwide and trajectories are often complicated by risk factors. The Transitional Care Model may contain elements to support transitions between hospital and home. An umbrella review. A comprehensive search in five electronic databases was performed in April 2021 based on the search terms: 'Patients ≥60 years,' 'multi-morbidity,' 'Transitional care model,' 'Transitional care,' and 'Systematic review.' PRISMA guidelines was used. Five systematic reviews published from 2011 to 2020 comprising 62 intervention studies (59 randomised controlled trials and three quasi-experimental trials) were included in the review. The synthesis predominantly revealed significant improvements in decreasing re-admissions and financial costs and increasing patients' quality of life and satisfaction during discharge. The results of the review indicate that multiple elements from the Transitional Care Model have achieved significant improvements in older patients' transitions from hospital to home. Especially a combination of coordination, communication, collaboration and continuity of care in transitions, organised information and education for patients and pre-arranged structured post-discharge follow-ups. The transition from hospital to home is a complex process for older patients with multiple chronic conditions. A specific focus on coordination, continuity, and patient education should be implemented in the discharge process. Nurses with specialised knowledge in transitional care are needed to ensure safe transitions. The umbrella review is part of a larger research program which involved a patient expert advisory board, which participated in discussing the relevance of the elements within the umbrella review.

1446-P: Success of a Hybrid Care Model to Maintain Glycemic Control in Older Adults with Type 1 Diabetes (T1D)

Aim: During the COVID-19 pandemic, a hybrid care (in-office and telemedicine) model was urgently implemented. Impact of this hybrid model on clinical visit frequency and glycemic outcomes in older adults with T1D warrants study. Methods: Demographics, clinical characteristics, and clinical visits of older adults (aged ≥65 years) with T1D were retrieved from electronic medical records covering 2 time periods, before the pandemic (pre-pandemic: April 1, 2019-March 1, 2020) and during the pandemic (pandemic: September 1, 2020 to August 31, 2021) periods, with adjustment for length of follow-up. Results: 661 (45% male) unique older adults with T1D received care and had HbA1c measurements in both periods at a tertiary diabetes center. Mean age was 72±5 years; 59% were CGM users, 38% were pump users. Clinic visits in the pre-pandemic period were almost all in-person, averaging 4.2 visits/person/year (CI 3.9-4.4), with <2% as phone visits. During the pandemic period, the mean number of visits was significantly greater than in the pre-pandemic period, at 6.3 visits/person/year (CI 5.7-6.9), with 30% in-office, 38% by video, and 32% by phone. HbA1c values were similar between periods (pre-pandemic: 7.6% (CI 7.5-7.8) vs pandemic: 7.4% (CI 7.3-7.6)). However, there was a significant, favorable shift in HbA1c distribution <7%, 7-8%, >8% when using hybrid care model: pre-pandemic period 21, 42, 37%, respectively; pandemic period 35, 36, 29%, respectively (pre-pandemic vs pandemic period p<.0.001). Conclusion: Compared with the pre-pandemic care model, the hybrid care model during pandemic for older adults with T1D allowed for increased visit frequency and preserved HbA1c values while favorably increasing the proportion with HbA1c <7% and decreasing proportion at the higher end of the distribution. This data support ongoing use of a hybrid care model for older adults with T1D. Disclosure A.Adam: None. M.Munshi: Consultant; Sanofi. R.Hurlbert: None. C.Slyne: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. E.Toschi: Advisory Panel; Eli Lilly and Company. Funding Thomas J. Beatson, Jr. Foundation

Health care network model for older adults: a co-creation and participatory action research approach

Objective: To develop a collaborative, multidisciplinary care model for older adults that improves interdisciplinary teamwork and increases access to specialized services for frail patients, helping solve management problems in the Brazilian Unified Health System. In the state of Bahia, the health care network for older adults requires better interaction and integration with the Unified Health System and the Unified System of Social Assistance to improve patient flow in the network. Methods: We used a co-creation and participatory action research approach based on reflection, data collection, interaction, and feedback with participants and stakeholders. Data was collected from health professionals, representatives of health agencies, and older adults through collective and individual interviews, reflective diaries, and direct communication. Results: An action plan involving members of the older adult care network was developed to put the new model into practice. A pilot study with a multidisciplinary team allowed adjustments and implementation of the model at our institution. Conclusions: The new model improved both the internal management of the State Reference Center for Older Adult Health Care (Centro de Referência Estadual de Atenção à Saúde do Idoso - CREASI) and its interaction with primary care, optimizing patient flow and establishing rules for shared management between CREASI and primary care institutions. In view of this, restructuring the care model reorganized relations between the agencies, expanding CREASI’s role in the management and systematization of older adult health.

Impact of an orthogeriatric collaborative care model for older adults with hip fracture in a community hospital setting

BackgroundStudies have shown that the incidence of postoperative delirium, the hospital length of stay and time to surgery are reduced when older adults with a hip fracture are cared for by a multidisciplinary team providing comprehensive geriatric assessments. Most of these studies have been conducted in academic centres. We sought to determine if implementation of an orthogeriatric collaborative care model would improve key quality of care metrics in a community hospital setting.MethodsThis retrospective pre- and postintervention single-site study was conducted in a community hospital in Ontario, Canada. We included consecutive patients aged 65 years or older who were admitted for a hip fracture between June 2015 and June 2017. In the intervention period, a new postoperative order set included a referral to a geriatrician for comprehensive geriatric assessment, with direct implementation of recommendations. Primary outcomes were the incidence of postoperative delirium and length of stay. Secondary outcomes included Health Quality Ontario’s quality standards for hip fracture.ResultsA total of 212 consecutive patients (95 in the preintervention group and 117 in the postintervention group) were included in the study. The incidence of postoperative delirium (26.3% v. 26.5%, p = 0.98) and length of stay (interquartile range 4–10 v. 5–10 d, p = 0.32) were similar in the preintervention and postintervention groups. There were improvements (p < 0.001) in the rates of asssessment of mental status, falls and bone health; identification of delirium prevention strategies; prescription of vitamin D or calcium or both; and recommendations for antiresorptive therapy. Despite systemic implementation of the orthogeriatric model, only 74.4% of patients in the postintervention group were seen by a geriatric medicine consultant.ConclusionAlthough the implementation of an orthogeriatric collaborative care model for older adults with a hip fracture did not reduce the incidence of postoperative delirium or length of stay, there were improvements in the rates at which several other key quality standards for hip fracture care were met. Earlier proactive, comprehensive geriatric assessment in a community hospital setting will be the target for further quality improvement initiatives.

Perceptions of a Transitional Care Model for Older Adults With Multimorbidity and Depressive Symptoms

Transitioning from hospital to home is an important healthcare system priority. This paper reports on the qualitative findings from a larger mixed methods study designed to examine the implementation and effectiveness of a new transitional care intervention (Community Assets Supporting Transitions [CAST]). The goal of the CAST intervention is to improve the quality and experience of hospital-to-home transitions for older adults (≥ 65 years) with depressive symptoms and multimorbidity. Semi-structured interviews were completed with a sub-set of intervention group trial participants including 11 older adult participants and 1 caregiver, as well as 4 intervention nurses. A qualitative descriptive design was used to explore the perceived impacts of the CAST intervention on participants and their caregivers. Audio-recorded interviews were transcribed verbatim, with descriptive codes and themes generated using conventional content analysis. Patient participants indicated that the intervention resulted in improved access to information (e.g., medication review) and services (e.g., care coordination) that enhanced their self-management. Participants felt that the home visits and phone visits were valuable and helped to improve their mental health. Intervention nurses described advocating for patients to help achieve their needs. For example, nurses advocated for physiotherapy services to provide additional education to support patient mobility. Understanding patient, caregiver, and provider perceptions of the impact of the CAST intervention will help to identify how to improve the delivery of this transitional care intervention, to bridge the gap between hospital and community care, and to positively impact patient health outcomes.

Challenges in measuring integrated care models: International knowledge and the case of Québec

Introduction The implementation of integrated care models requires significant efforts, especially due to institutional and organisational inertial forces that characterize health and social care systems of developed countries. It is therefore crucial to deploy strategies that promote continuous adjustment to these barriers so as to improve the benefits of integrating care. Measuring the implementation and effects of integrated care models are key component of these strategies. However, measuring integrated care also faces major challenges. This study aims to identify and characterise integrated care measurement challenges. Methods A review of reviews on the measurement of integrated care identified 12 papers. A thematic analysis was conducted to identify and categorize measurement challenges. Document analysis was done on the measurement of an integrated care model for older adults in Québec. Results Eight categories of measurement challenges were identified. These challenges include difficulties in measuring structures, processes, and effects of models; conceptual ambiguity and heterogeneity of organisational forms; involving multiple actors in the measurement strategy; and including multiple data sources, amongst others. These challenges revealed and explained potential gaps in the measurement of integrated care for older adults in Québec. For instance, the Québec measurement strategy did not include effects indicators. Conclusion Although the measurement of integrated care is a complex endeavour, there is a need for adequate measurement strategies that allow to appreciate important elements of integrate care. The findings of this study could be used as a reflexive tool in advancing research and practice of measuring integrated care.

A contemporary and innovative care model for older adults

Abstract The population aging that has arisen from Brazil’s new demographic and epidemiological reality, a relatively recent phenomenon, requires innovative and efficient responses. This article presents a care model for the older population with the most contemporary comprehensive care and an excellent cost-benefit ratio. The proposal is aimed at health promotion, disease prevention and the coordination of care, with an emphasis on low complexity instances of care. The integrated models seek to solve the problem of fragmented and poorly coordinated care in current health systems. For this reason, we propose a low complexity care unit, an epidemiological assessment, a social center and a team formed by a pair of medical and nursing professionals, with the support of gerontologists. There will also be medical records that cover clinical and social aspects, as well as a quality information system - all involving advanced technology, accessible by doctors and clients at any time via cloud technology and a cell phone app. The more the healthcare professional knows their patient’s history, the better the results. The concepts and structure that underlie this model, which aims to reduce waste, offering greater quality at reduced cost, are set out. It is our contribution to benefit - be it in the public or supplementary sector - health care aimed at the fastest growing age group in Brazil.

Multiple Perspectives Analysis of the Implementation of an Integrated Care Model for Older Adults in Quebec.

Introduction:Integrated care models for older adults are increasingly utilised in healthcare systems to overcome fragmentations. Several groups of stakeholders are involved in the implementation of integrated care. The aim of this study is to identify the main concerns, convergences and divergences in perspectives of stakeholders involved in the implementation of a centralised system-wide integrated care model for older adults in Quebec.Theory and methods:Qualitative multiple-case study. Semi-structured interviews of key stakeholders: policymakers (n = 11), providers (n = 29), managers (n = 34), older adult patients (n = 14) and caregivers (n = 9), including document analysis. Thematic analysis of the views of stakeholders along the lines of the six dimensions of the Rainbow Model of Integrated Care.Results:While patients/caregivers were mostly concerned by their unmet individual needs, policymakers, managers and providers were concerned by structural barriers to integrating care. Stakeholders’ diverse perspectives indicated implementation gaps in a top-down implementation context.Conclusion:Mandated system-wide integration appears to have structural, organizational, functional, and normative transformations, but its clinical changes are more uncertain in view of the observed divergent perspectives of actors. It will be interesting to explore if the systemic changes are precursors of clinical changes or, on the contrary, explains the lack of clinical changes.

IMPLEMENTING A NEW MODEL IN PRIMARY CARE FOR OLDER CANADIANS LIVING WITH FRAILTY

Primary care may be the best place within the health system to coordinate care for older persons, but at present, it is poorly equipped to do so. Effective models for complex patients require appropriate targeting, patient/caregiver engagement, and care coordination. A large national project aims to co-design and implement a model in primary care that includes risk-stratification, patient engagement and care coordination techniques for older adults. This presentation focuses on the process of implementation in primary care. Grounded in the Consolidated Framework for Implementation Research, researchers worked with nine primary care sites in three Canadian provinces. Project implementation was completed in two phases. Pre-implementation: Interviews with providers (n=25) and older adults (n=8) were conducted to understand current practices and plan for implementation. Implementation: Researchers worked with sites to train staff and support implementation. Monitoring of the implementation process included Interviews with providers (n=20) and field notes. Data were analyzed using directed coding, following the framework. A number of learnings emerged: buy-in was required from the entire team, teams provided meaningful information to guide implementation, contributing to a sense of ownership, and it was important that intervention components were tailored to the needs at each site. Ongoing and frequent discussions with the team was necessary. Scheduling meetings and training sessions for providers was challenging due to the length of time away from direct patient care. A new primary care model for older adults living with frailty was implemented. Lessons from this project will be used to guide future implementation and spread.

A contemporary care model for older adults should seek coordinated care, greater quality and the reduction of costs

A contemporary care model for older adults should seek coordinated care greater quality and the reduction of costs

Multiple perspectives analysis of the implementation of an integrated care model for older adults in Quebec

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Continuity of Care Model for Older Adults

In 2000, the world population of people over 60 was 600 million and the projection for 2050 is 2,000 million. This means the consequent increase in chronic, degenerative, debilitating and, therefore, the increase in consultations and hospitalizations for this population. It is important that the elderly dependent suffer numerous hospital admissions that may lead to return to his home in different conditions that he entered. It is therefore necessary to emphasize something important for nurses: the continuity of care. Sometimes there is good communication between hospital, primary care or nursing homes and if this transition between hospital-old homes is not insured incur a decline in the quality of care.

Self-Supporting Care Model for Older Adults

Self-supporting care is an emerging concept in the geriatric care system of Taiwan. The traditional care model tends to prioritize aspects such as "safety" and "convenient and effective". For older adult patients, this situation has led to excessive restrictions, enforced bedrest, and the use of adult diapers, which seriously deteriorate quality of life. The present article introduces the development and current status of self-supporting care and international empirical research results from the perspective of holistic care for older adults as well as describes the intervention strategies that are currently used in Taiwan. We look forward to the caregivers of older adults being able to apply self-supporting care in their care settings, which is expected to enhance quality of life and dignity for older adults.

Lessons Learned from Implementing a Pilot RCT of Transitional Care Model for Individuals with Serious Mental Illness

We adapted an evidence-based transitional care model for older adults being released from acute care hospitals for patients with serious mental illness and medical co-morbidities being discharged from two psychiatric units of an acute care hospital (TCare) and evaluated implementation issues. An advisory group (AG) of community stakeholders assessed barriers and facilitators of a 90-dayT-Care intervention delivered by a psychiatric nurse practitioner (NP) in the context of conducting a pilot randomized controlled trial. Minutes of AG and case narratives by NP of 20 intervention participants were content analyzed. Patients with immediate and pressing physical health problems were most receptive and actively utilized the service. Provider barriers consisted of communication and privacy issues making it difficult to contact patients in mental health facilities. In contrast, the NP was accepted and valued in the physical health arena. Psychosocial needs and relationship issues were demanding, and we recommend a team approach for TCare with the addition of a social worker, peer provider, and consulting psychiatrist for severely mentally ill patients being released from an acute physical health hospitalization.

Evaluation of a patient-reported continuity of care model for older adults

Although continuity of care (CoC) is a cornerstone of many health policies, there is no theoretically driven model of CoC that incorporates the experiences of older adults. We evaluated such a model in data collected for another purpose. We used data on 2,620 Medicare beneficiaries who completed all of the necessary components of the 2004 National Health and Health Services Use Questionnaire (NHHSUQ). The NHHSUQ solicited information on usual primary provider, place of care, and the quality and duration of the patient-provider relationship. We used confirmatory factor analysis to evaluate the patient-reported CoC model and examined factorial invariance across sex, race/ethnicity, Medicare plan type, and perceived health status. Our thirteen-item CoC model consisted of longitudinal (care site and provider duration) and interpersonal (instrumental and affective) domains. Although the overall chi-square goodness-of-fit statistic was significant (χ(2) = 1,091.8, df = 57, p < .001), model fit was good based on standard indices (GFI = 0.94, NFI = 0.96, CFI = 0.96, RMSEA = 0.08). Cronbach's alpha for the longitudinal care site (two items) and provider duration (three items) scales was 0.88 and 0.75, respectively, while the instrumental and affective relationship scales (four items each) were 0.88 and 0.87, respectively. Factorial invariance between sexes was observed, with relatively minor variance across race/ethnicity, Medicare plan type, and perceived health. We evaluated a theoretically derived model of CoC in older adults and found that the assessment of CoC should include the patient experience of both the longitudinal and the interpersonal dimensions of CoC.