Geriatric Care Models Research Articles

Home-based geriatric oncology care: A feasibility study.

62 Background: The Comprehensive Geriatric Assessment (CGA) improves the outcomes of older patients with cancer, and by identifying of geriatric impairments the CGA can guide the development of supportive interventions. However, the implementation of these interventions in a real-world setting can be burdensome for patients, particularly when additional visits are required in an often frail population. Therefore, our team developed a collaborative model for home-based delivery of CGA-guided interventions. Methods: We performed a retrospective review of community-dwelling patients aged ≥ 70 years with an active cancer diagnosis who were deemed to be frail by a CGA and who received home-based CGA-guided supportive interventions under a collaborative care model established by the geriatric oncology and the palliative home care teams at Hartford HealthCare Cancer Institute between October 2020 and April 2022. The collaboration is based on multidisciplinary discussion of the CGA results / interventions and weekly rounds to discuss patient’s progress and emerging needs. Results: A total of 182 patients received a CGA during the study period, 54% (n = 99) were determined to be frail based on impairment in ≥ 7 geriatric domains. Among all eligible patients, 19 patients (19%) were included in the collaborative model. The median age of enrolled patients was 84 years (74-90), 12/19 (63%) had metastatic cancer, 7/19 (37%) received systemic treatment, and 8/19 (42%) received radiation. The average number of geriatric impairments per patients was 9.5 (7-12). Geriatric impairments addressed at home were skilled nursing (19/19), physical therapy (18/19), occupational therapy (12/19), speech-language-pathology (2/19), nutrition (5/19), or social worker (11/19) support at home. The average number of unplanned hospitalizations was 1.16 per patient (range 0-4), and the average unplanned emergency room visit was 0.89 per person (range 0-4) during study time. Transition to hospice occurred in 8/19 patients (42%), the median time to transition to hospice was 33.5 days (15-167). Conclusions: This study demonstrates the feasibility of a collaborative model for home-based geriatric oncology care in a real-world setting to help reduce the burden of care on patients and ensure patient-centered delivery of CGA-guided interventions. Findings underscore the need for future work to evaluate the impact of this novel geriatric oncology care model on patient outcomes.

Perceived benefits of geriatric specialty telemedicine among rural patients and caregivers.

Explore the perceived benefits of a Veterans Health Administration (VHA) geriatric specialty telemedicine service (GRECC Connect) among rural, older patients and caregivers to contribute to an assessment of its quality and value. In Spring 2021, we interviewed a geographically diverse sample of rural, older patients and their caregivers who participated in GRECC Connect telemedicine visits. A cross-sectional qualitative study focused on patient and caregiver experiences with telemedicine, including perceived benefits and challenges. We conducted 30 semi-structured qualitative interviews with rural, older (≥65) patients enrolled in the VHA and their caregivers via videoconference or phone. Interviews were recorded, transcribed, and analyzed using a rapid qualitative analysis approach. Participants described geriatric specialty telemedicine visits focused on cognitive assessments, tailored physical therapy, medication management, education on disease progression, support for managing multiple comorbidities, and suggestions to improve physical functioning. Participants reported that, in addition to prescribing medications and ordering tests, clinicians expedited referrals, coordinated care, and listened to and validated both patient and caregiver concerns. Perceived benefits included improved patient health; increased patient and caregiver understanding and confidence around symptom management; and greater feelings of empowerment, hopefulness, and support. Challenges included difficulty accessing some recommended programs and services, uncertainty related to instructions or follow-up, and not receiving as much information or treatment as desired. The content of visits was well aligned with the domains of the Age-Friendly Health Systems and Geriatric 5Ms frameworks (Medication, Mentation, Mobility, what Matters most, and Multi-complexity). Alignment of patient and caregiver experiences with widely-used models of comprehensive geriatric care indicates that high-quality geriatric care can be provided through virtual modalities. Additional work is needed to develop strategies to address challenges and optimize and expand access to geriatric specialty telemedicine.

A systematic review and qualitative analysis of geriatric models of care for rural and remote populations.

Much is known about the healthcare needs of rural and remote communities; however, understanding how to best deliver geriatric models of care in these settings has received less attention. The purpose of this systematic review was to identify necessary key components of existing models of geriatric care serving rural or remote populations. A systematic literature review was conducted using MEDLINE, CINAHL and EMBASE databases to identify articles that described models of geriatric care serving rural or remote populations. A qualitative case study and key component analysis approach was used to identify necessary model components. Eight articles were included. We identified eight distinct components that may improve the successful delivery of models of geriatric care serving rural or remote populations. Environmental assessments were done in six of eight models. Model integration with the local healthcare system, local provider leadership, and local provider education in geriatrics were present in five of eight models. Three of eight models used high-risk screening principles and included geriatrician consultation. One model described active community engagement, and one used telemedicine. Future geriatric care delivery models designed to serve rural or remote populations are encouraged to use an evidence-based framework based on eight distinct model characteristics found in the literature that aim to support the ideal provision of effective and accessible geriatric medical care.

Understanding the need of Geriatric Medicine in Pakistan

Aim: To determine the common problems of advancing age and their plausible solutions. Study design: Prospective Observational Study. Setting: Pakistan Airforce Hospital Sargodha Duration of study: One year from 1st January 2020 till 31st December 2020. Methods: All elderly citizens both male and female were interviewed regarding the common difficulties faced by them in their day to day life to quantify the magnitude of the problem and consequently help finding easy plausible solutions . Results: All senior citizens approachable in person or on phone over the age of sixty five both males and females were interviewed. Interviews were carried out by using a specially designed short , crisp and easy to understand questionnaire. Common difficulties faced in this age group were listed and their magnitude was estimated so that strategies can be defined to help resolve those. Common difficulties were related to social life, relationships, self care , mobility, psychological and emotional health. In the wake of interviews we found majority of people highlighted that with advancing age the quality of care imparted to them diminishes although the demands made are minimized due to lack of reassurance and uncertainty. This instills a lack of confidence in them. Moreover the monotony over days, weeks and years causes a loss of self worth and self esteem. Conclusion: As an evolving society of a developed country we have the advantage of utilizing models of Geriatric Care already in place in the developed world. Whereby Geriatric Medicine is a specialty for addressing the needs of advancing age and Hospice looks after the terminally ill patients of any age in a nonhospital environment. Many solutions can be offered and exercised without a big resource may it be human, material or financial. Keywords: Geriatric Care, Senior Citizen, Home and Hospice

Geri Models of Care (MOC): An Immersive Preclerkship Curriculum Fostering Student Exploration of Residential Geriatric Models of Care.

Many older adults live in a community-based residential geriatric model of care (MOC; e.g., senior apartments, long-term care nursing facilities). While existing curricula focus on patient transitions to such care, none focus explicitly on MOC features, which are essential for creating effective care plans. We developed the Geriatric Models of Care (Geri MOC) curriculum to guide preclerkship medical students in comparing features of five MOCs. On day 1 of the 2-day session, all second-year medical students spent half a day at different sites, interviewing administrators and touring facilities. On day 2, students debriefed and peer taught in small groups with peers who had visited different care models. Students applied their new knowledge to complex patient cases. Students completed retrospective pre/post self-assessments and offered qualitative feedback on the experience. A summative exam essay question assessed student knowledge application. From 2017 to 2019, 267 students gave the site visit experience a mean rating of 4.6 on a 5-point Likert scale (1 = poor, 5 = excellent). Students' perceived confidence increased significantly (p < .001) for all four evaluated objectives. On the summative exam question, 89% of students passed. Students commented that the curriculum was a unique and effective learning approach, and 13 sites indicated a strong interest in ongoing annual participation. Community MOC visits were instructive and engaging for students and sites. The curricular materials are novel, adaptable for all levels of medical and health professions trainees, and adaptable for a virtual experience.

Which features of ambulatory healthcare are preferred by people aged 80 and over? Findings from a systematic review of qualitative studies and appraisal of confidence using GRADE-CERQual

BackgroundDespite healthcare providers’ goal of patient-centeredness, current models for the ambulatory (i.e., outpatient) care of older people have not as yet systematically incorporated their views. Moreover, there is no systematic overview of the preferable features of ambulatory care from the perspective of people aged 80 and over. Therefore, the aim of this study was to summarize their specific wishes and preferences regarding ambulatory care from qualitative studies.MethodsThe study was based on qualitative studies identified in a prior systematic review. Firstly, the findings of the qualitative studies were meta-summarized, following Sandelowski and Barroso. Secondly, a list of preferred features of care from the perspective of older people was derived from the included studies’ findings through inductive coding. Thirdly, the review findings were appraised using the GRADE-CERQual tool to determine the level of confidence in the qualitative evidence. The appraisal comprised four domains: methodological limitations, coherence, data adequacy, and data relevance. Two reviewers independently evaluated every review finding in each domain. The final appraisals were discussed and ultimately summarized for the respective review finding (high, moderate, low, or very low confidence).ResultsThe 22 qualitative studies included in the systematic review were mainly conducted in Northern and Western Europe (n = 15). In total, the studies comprised a sample of 330 participants (n = 5 to n = 42) with a mean or median age of 80 and over. From the studies’ findings, 23 preferred features of ambulatory care were identified. Eight features concerned care relationships (e.g., “Older people wish to receive personal attention”), and 15 features concerned healthcare structures (e.g., “Older want more time for their care”). The findings emphasized that older people wish to build strong relationships with their care providers. The majority of the review findings reached a moderate or high confidence appraisal.ConclusionsWhile the listed features of healthcare structures are common elements of care models for older people (e.g., Geriatric Care Model), aspects of care relationships are somewhat underrepresented or are not addressed explicitly at all. Future research should further explore the identified preferred features and their impact on patient and care outcomes.

Geriatric conditions and healthcare utilisation in older adults living with HIV.

older HIV-positive adults experience a significant burden of geriatric conditions. However, little is known about the association between geriatric conditions and healthcare utilisation in this population. outpatient safety-net HIV clinic in San Francisco. in 2013, HIV-positive adults ≥50years of age underwent geriatric assessment including functional impairment, fall(s)in past year, cognitive impairment (MOCA <26) and low social support (Lubben social network scale ≤12). We reviewed medical records from 2013 through 2017 to capture healthcare utilisation (emergency room (ER) visits and hospitalisations) and used Poisson models to examine the association between geriatric conditions and utilisation events over 4years. among 192 participants, 81% were male, 51% were white, the median age was 56 (range 50-74), and the median CD4 count was 508 (IQR 338-688) cells/mm3. Sixteen percent of participants had ≥1 activities of daily living (ADL) dependency, 58% had ≥1 instrumental activities of daily living IADL dependency, 43% reported ≥1 falls, 31% had cognitive impairment, and 58% had low social support. Over 4years, 90 participants (46%) had ≥1 ER visit (total of 289 ER visits), 39 (20%) had ≥1 hospitalisation (total of 68 hospitalisations), and 15 (8%) died. In unadjusted and adjusted analyses, IADL dependency and falls were associated with healthcare utilisation (adjusted incidence rate ratios IADL (95%CI): 1.73 (1.33-2.25); falls: 1.51 (1.21-1.87)). IADL dependency and history of falls were associated with healthcare utilisation among older HIV-positive adults. Although our results are limited by sample size, improved understanding of the association between geriatric conditions and healthcare utilisation could build support for geriatric HIV care models.

Remaining Agile in the COVID-19 pandemic healthcare landscape – How we adopted a hybrid telemedicine Geriatric Oncology care model in an academic tertiary cancer center

IntroductionThe COVID-19 pandemic has impacted healthcare on an unprecedented scale, with healthcare resources being channeled into managing the devastating effects of the outbreak. Healthcare provision for vulnerable older adults has also been affected by lockdowns and suspension of selected medical services worldwide. In our tertiary cancer center, the National University Cancer Institute, Singapore (NCIS), our Geriatric Oncology (GO) service for older adults with cancer was halted for five months. In this paper, we describe the adoption of a hybrid telemedicine model by our GO service to continue care provision for older adults in the midst of the pandemic. Materials and MethodsComprehensive geriatric assessments (CGA) were done via telemedicine and virtual multidisciplinary discussions were held prior to the patients' clinic visits. A hybrid telemedicine consultation allowed geriatricians and oncologists, segregated in different sites during the pandemic, to provide a hybrid physical and video geriatric oncology consultation. Scheduled phone follow ups by GO nurses helped to monitor patients for treatment-related toxicities and geriatric syndromes. ResultsTwo hundred fifty patients were enrolled in the program from July 2020 to August 2021. All were assessed with a CGA, with 240 receiving interventions in the one-stop clinic.The average amount of time spent per visit was shortened from four hours to two and a half hours with an average of three interventions on the same day, versus one previously.Of the patients who received interventions, 84.8% were satisfied with the hybrid telemedicine model and 80.8% of them had reported a maintained or improved quality of life after being enrolled in the program. DiscussionTelemedicine has been widely adopted during the pandemic, but older adults with limited digital literacy may find it a challenge. Our hybrid telemedicine model has allowed us to continue to provide cancer care, identify issues brought about by social isolation, and render timely assistance. It has become imperative to adapt, prepare and plan for the challenges we may face amid the ongoing COVID-19 pandemic and similar future outbreaks. Only by doing so can we remain agile and resilient, to continue providing quality care to our older patients with cancer.

Changing Hospital Care For Older Adults: The Case for Geriatric Hospitals in the United States.

Hospital care of frail older adults is far from optimal. Although some geriatric models of care have been shown to improve outcomes, the effect size is small and models are difficult to fully implement, sustain and replicate. The two root causes for these shortcomings are competing interests (high revenue generating diseases, procedures and surgeries) and current hospital cultures (for example a culture of safety that emphasizes bed alarms and immobility rather than frequent ambulation). Geriatric hospitals would be hospitals completely dedicated to the care of frail older patients, a group which is most vulnerable to the negative consequences of a hospitalization. They would differ from a typical adult hospital because they could implement evidence based principles of successful geriatric models of care on a hospital wide basis, which would make them sustainable and allow for scaling up of proven outcomes. Innovative structural designs, unachievable in a typical adult hospital, would enhance mobility while maintaining safety. Financial viability and stability would be a challenge but should be feasible, likely through affiliation with larger health care systems with other hospitals because of cost savings associated with geriatric models of care (decreased length of stay, increased likelihood of discharge home, without increasing costs).

Midlevel Providers Focusing on Geriatrics Improve Care and Outcomes of Fall-Related Injuries Among the Elderly.

A rural level 1 trauma center underwent a consolidation to level III status in a new trauma network system. A dedicated group of midlevel practitioners emphasizing early mobilization, a geriatric care model, and fall prevention replaced surgical residents in the level 3 center. We hypothesized that outcomes of elderly fall-related injuries may be enhanced with midlevel providers using a geriatric-focused care model. An IRB-approved trauma registry review of patients over 65years of age with a fall-related injury admitted to a rural trauma center 1year prior to and 1year following a trauma center consolidation from level 1 to level III designation evaluated demographics, anticoagulant use, comorbidities, and clinical outcomes. Statistical analysis included t-test and regression analysis. 327 patients injured by falls were seen over a 2-year study period. The number of patients admitted with a fall-related injury and the injury severity were similar over the study period. Increasing age and anticoagulant use increased length of stay and mortality (both with P < .05). Mortality rates and patient level of independence on discharge were improved in the later period involving midlevel practitioners (both with P < .05). Trauma centers and trauma system networks face increasing challenges to provide resources and providers of care for patients injured by falls, especially for the growing elderly population. Midlevel providers focusing on geriatric clinical issues and goals may enhance care and outcomes of elderly fall-related injuries.

Implementing a multidisciplinary rapid geriatric observation unit for non-critical older patients referred to hospital: observational study on real-world data

Geriatric rapid observation units may represent an alternative to hospitalization in older patients with non-critical acute illness. To describe the characteristics and outcomes of patients admitted to a geriatric observation unit called URGe (Unità Geriatrica Rapida), implemented in an Italian hospital and characterized by multidisciplinary medical staff with geriatric expertise, fast-track access to diagnostic resources, regular use of point-of-care ultrasound and predicted length of stay (LOS) < 72h. The medical records of patients admitted to URGe during a 3-month period (452 subjects, 247 F and 205M, median age 82years, IQR 77-87) were retrospectively examined. The primary study endpoint was transferral from URGe to regular wards. Baseline covariates included demographics, comprehensive geriatric assessment, acute illnesses, comorbidities, vital signs and routine laboratory tests. Despite elevated burden of multimorbidity (median number of chronic diseases 4, IQR 2-5) and frailty (median Rockwood Clinical Frailty Scale score 4, IQR 3-6), only 137 patients (30.3%) required transferral from URGe to regular wards. The main factors positively associated with this outcome were Rockwood score, fever, cancer and red cell distribution width (P < 0.05 on multivariate logistic regression model). The rate of complications (mortality, delirium, and falls) during URGe stay was low (0.5%, 7% and 2%, respectively). Overall duration of hospital stay was lower than that of a group of historical controls matched by age, sex, main diagnosis, multimorbidity and frailty. The URGe model of acute geriatric care is feasible, safe and has the potential of reducing unnecessary hospitalizations of older patients.

Linking hospital and residential aged care: a nurse-led vascular-geriatric model of care

The interplay of frailty, multimorbidity and polypharmacy in the older person results in complex care needs. Monitoring and proactive management of chronic diseases in this context can be challenging. Early identification of deterioration reduces the risk of hospitalisation in older people, particularly in residential care, where the person can be particularly vulnerable. Deterioration of a resident often results in an expectation of in-hospital care, which especially where there are life-limiting conditions, may not align to the wishes of the person and their family. However, links between tertiary hospital services with the expertise to upskill and mentor those providing the more complex care to residents of aged care facilities need to be developed. Current models of care need to be adapted to incorporate the provision of specialist nursing within residential facilities to support higher-level care delivered in the person’s familiar environment, improve the person and family experience, and reduce the costs and potential for iatrogenic problems associated with hospitalisation. Vascular dysfunction is common in aged care and results in impaired healing and complex wounds. We developed a Vascular and Geriatric (VaG) model of care to support specialist care for aged care residents with vascular dysfunction. The VaG model enhances existing links between hospital and residential care settings and builds workforce capacity in residential care facilities by the use of clinical consultation, peer learning and networking to increase the vascular skill set initially of the hospital outreach nurse and then modelled to residential care clinicians. This paper reports the development and implementation of the VaG model as part of the Aged Care Outreach Service.

A 6-year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder.

IntroductionDepressive disorder has been conceptualised as a condition of accelerated biological ageing. We operationalised a frailty index (FI) as marker for biological ageing aimed to explore the bidirectional, longitudinal association between frailty and either depressive symptoms or depressive disorder.MethodsA cohort study with 6‐year follow‐up including 377 older (≥60 years) outpatients with a DSM‐IV‐defined depressive disorder and 132 never‐depressed controls. Site visits at baseline, 2 and 6‐year follow‐up were conducted and included the CIDI 2.0 to assess depressive disorder and relevant covariates. Depressive symptom severity and mortality were assessed every 6 months by mail and telephone. A 41‐item FI was operationalised and validated against the 6‐year morality rate by Cox regression (HRFI = 1.04 [95% CI: 1.02–1.06]).ResultsCox regression showed that a higher FI was associated with a lower chance of remission among depressed patients (HRFI = 0.98 [95% CI: 0.97–0.99]). Nonetheless, this latter effect disappeared after adjustment for baseline depressive symptom severity. Linear mixed models showed that the FI increased over time in the whole sample (B[SE] = 0.94 (0.12), p < .001) with a differential impact of depressive symptom severity and depressive disorder. Higher baseline depressive symptom severity was associated with an attenuated and depressive disorder with an accelerated increase of the FI over time.ConclusionsThe sum score of depression rating scales is likely confounded by frailty. Depressive disorder, according to DSM‐IV criteria, is associated with accelerated biological ageing. This argues for the development of multidisciplinary geriatric care models incorporating frailty to improve the overall outcome of late‐life depression.

Developing eHealth tools for diverse older adults: Lessons learned from the PREPARE for Your Care Program.

Electronic Health (eHealth) tools offer opportunities for people to access health information online; yet, most tools are not designed to meet the unique needs of diverse older adults, leading to health disparities. Our goal was to provide guidance for the development of eHealth tools for diverse older populations for use in geriatric care models. Guidance for eHealth tools was compiled from user design resources and eHealth design literature. Pragmatic examples were provided from an evidenced-based eHealth tool called PREPAREforYourCare.org (PREPARE). We used quantitative feasibility data from PREPARE research studies and qualitative analysis of PREPARE focus groups, cognitive interviews, and feedback from randomized trials to further inform our recommendations. Guidance and lessons learned include: (1) define clear objectives and a conceptual framework; (2) co-create with the target population; (3) optimize the design and layout for accessibility and ease of use, such as text at the 5th grade reading level, closed captioning, etc.; (4) use simple, standardized navigation design; (5) use actionable information to enhance behavior change, such as modeling of behaviors; (6) align accompanying written materials with the eHealth tool; and (7) create tracking mechanisms for ongoing user feedback. PREPARE is used as a case example to provide pragmatic illustrations for how the guidance may be operationalized. eHealth tools can be tailored to the unique characteristics, preferences, and needs of diverse older populations. Following the "lessons learned" may help decrease health disparities among diverse older adults and ensure eHealth tools are readily accessible and culturally appropriate.

Models of care for people with dementia applied in practice

Abstract Aim. The study highlights the different concepts of dementia care models which are used in different care settings and determine the effectiveness and contribute to a better quality of life for people with dementia. Methods. This literature review use PRISMA process for data collection and analysis. Scientific and professional publications in English were searched through international specialized databases; EBSCO HOST, CINAHL, MEDLINE, PubMed and Wiley Online Library. The review results were founded by key words and then selected according to the publication time frame and other shaped criteria. Results. In total 1998 references were identified for the thematic content analysis, in the final review we included 29 studies. Two thematic areas were identified according to the keywords and literature search strategy: dementia care models and geriatric models of care. Further, we formed four concepts highlighted in models that reflect the specific characteristics and principles of care: biopsychosocial approach, person-centred care practice, environment of care, and Montessori for dementia care. Conclusions. Most of featured models advocated the implementation of comprehensive, integrated and person-centred care, focused to honour and integrate an individual’s life story with their needs into daily care as much as possible in an appropriate and customized environment. Currently the most innovative model is based on implementation of Montessori approach into person’s daily activities.

Effects of comprehensive geriatric care models on postoperative outcomes in geriatric surgical patients: a systematic review and meta-analysis

BackgroundThe elderly population is highly susceptible to develop post-operative complications after major surgeries. It is not clear whether the comprehensive geriatric care models are effective in reducing adverse events. The objective of this systematic review and meta-analysis is to determine whether the comprehensive geriatric care models improved clinical outcomes, particularly in decreasing the prevalence of delirium and length of hospital stay (LOS) in elderly surgical patients.MethodWe searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Emcare Nursing, Web of Science, Scopus, CINAHL, ClinicalTrials. Gov, and ICTRP between 2009 to January 23, 2020. We included studies on geriatric care models in elderly patients (≥60 years) undergoing elective, non-cardiac high-risk surgery. The outcomes were the prevalence of delirium, LOS, rates of 30-days readmission, and 30-days mortality. We used the Cochrane Review Manager Version 5.3. to estimate the pooled Odds Ratio (OR) and Mean Difference (MD) using random effect model analysis.ResultsEleven studies were included with 2672 patients [Randomized Controlled Trials (RCTs): 4; Non-Randomized Controlled Trials (Non-RCTs): 7]. Data pooled from six studies showed that there was no significant difference in the prevalence of delirium between the intervention and control groups: 13.8% vs 15.9% (OR: 0.76; 95% CI: 0.30–1.96; p = 0.57). Similarly, there were no significant differences in the LOS (MD: -0.55; 95% CI: − 2.28, 1.18; p = 0.53), 30-day readmission (12.1% vs. 14.3%; OR: 1.09; 95% CI: 0.67–1.77; p = 0.73), and 30-day mortality (3.2% vs. 2.1%; OR: 1.34; 95% CI: 0.66–2.69; p = 0.42). The quality of evidence was very low.ConclusionsThe geriatric care models involved pre-operative comprehensive geriatric assessment, and intervention tools to address cognition, frailty, and functional status. In non-cardiac high-risk surgeries, these care models did not show any significant difference in the prevalence of delirium, LOS, 30-days readmission rates, and 30-day mortality in geriatric patients. Further RCTs are warranted to evaluate these models on the postoperative outcomes.Trial registrationPROSPERO registration number - CRD42020181779.

The Cancer and Aging Research Group (CARG) infrastructure: The clinical implementation core

The need for high quality care-delivery for older adults with cancer is evident by the growing number of multi-disciplinary geriatric oncology care models. Geriatric Assessments (GA) are established to enhance communication, improve morbidity, mortality and hospital utilization [1–4]. The aging population, and increased cancer incidence among older adults, has created an unmet need for health care delivery infrastructure. Academic institutions, private practices, and cancer centers have recognized the unique needs of older adults with cancer and the ability to deliver high-caliber care in the context of routine oncology care.

Care of Older People in Surgery for general surgery: a single centre experience.

Older patients undergoing emergency surgery experience higher mortality and morbidity. 'Care of Older People in Surgery' (COPS) is a comprehensive geriatric care model developed for acute surgical units (ASU) to improve clinical outcomes in older general surgical patients. This study aimed to evaluate the impact of COPS on clinical and health service outcomes in an Australian hospital. The before-and-after study was conducted in the ASU, at Nepean Hospital. Data from patients ≥75 years admitted for >24 h into the ASU during the intervention period between April 2017 and March 2018 were compared to patients admitted in the previous year (April 2016 to March 2017) prior to the COPS intervention (n=212). Health service outcomes measured include the average stay length, medical emergency team response, unplanned intensive care unit admission and 28-day readmission rates. The COPS group (n=214) suffered significantly fewer medical complications, including less acute kidney injuries, arrhythmias and urinary tract infections compared to the pre-intervention cohort (n=212). Medical emergency team activation was significantly reduced after COPS model implementation and the average length of stay decreased. However, the incidence of postoperative delirium and acute coronary syndrome were higher in COPS cohort. Our study demonstrated that comprehensive geriatric assessment and care delivered through a shared model of care in older general surgical patients improved clinical outcome and patient safety measures.

The Efficacy of the Geriatric Model of Care in Emergency Housing Programs for Homeless Veterans.

The aging homeless population currently makes up half the general homeless population. However, there are few homeless emergency shelters that can address their needs. This results in an overutilization of inpatient admissions and emergency room services. Homeless service staff from VA Palo Alto Health Care System partnered with a local homeless emergency housing provider, Compassion Residio Services Inc., to implement this new model of care for aging, medically fragile homeless Veterans. This emergency housing model utilizes practices done in geriatric settings. This model aimed to help decrease the utilization of emergency departments and inpatient admissions. The average cost of emergency department visits and inpatient admissions was $127,314 per Veteran 6 months before admission. Six months after discharge, the average cost of treatment from emergency department visits and inpatient admissions was roughly $59,546 after discharge, a 53% decrease. Emergency department visits decreased from an average of 5.6 visits per Veteran 6 months before admission to 2.65 visits after 6 months discharge. The number of inpatient nights decreased from an average of 15 days per admission in the 6 months before the program to 13 days. Total admissions decreased by nearly half from 48 the previous 6 months to 25 after 6 months. Overall, as residents settled into stable environments tailored around geriatric care, the utilization of emergency department visits and inpatient services decreased. Furthermore, the complexity (eg, cost per encounter) also decreased.

Preventive geriatric care model: A dire necessity in recent times!

A holistic concept of providing regular health check-up, reinforcing their intent to a healthy and happy living, taking care of them with a day care center and communicating to their family members both in station and outstation every fortnight regarding their health status is the aim of the project. A benefit to community and forming a strong self-sustaining wise peer group who will turn into an asset than a liability for a community is the sole motto of the project. In the aforesaid context to create a geriatric-friendly society, this preventive geriatric care model was envisaged.