Geriatric Interdisciplinary Team Research Articles

Geriatric Interprofessional Team Transformation for Primary Care overview.

The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.

Medication Management and the Role of the Geriatric Pharmacist in Interdisciplinary Care Teams

Rural areas have a higher proportion of older adults aging in place. Rural areas also face structural barriers to supporting social connectedness among older adults, including transportation barriers, greater geographic distances, and access to technological connectivity. This research aims to discuss rural-specific risks of loneliness and social isolation among older adults, as well as rural/urban differences in loneliness and social isolation among older adults using the national COVID-19 Coping Study. Cross-sectional bivariate analyses highlight rural/urban differences in social activities during the pandemic. For example, rural older adults were more likely to use social media daily, compared with urban older adults (67% vs. 61%, p<0.05), but were less likely to have phone or video calls with others daily (21% vs. 26%, p<0.001). We will also share results of differences within rural older adults in loneliness, isolation, and social activities by socio-demographic characteristics in order to design targeted interventions to improve connectedness.

Effective and Evidence-Based: How the 4Ms Age-Friendly Framework Can Result in Improved Care in a Rural Primary Care Clinic

As healthcare providers struggle to reframe aging, framing Age-Friendly care is also occurring. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve clinical health outcomes of older adults (OA) in primary care settings. As a member of the 2020 Institute for Healthcare Improvement (IHI) Age-Friendly cohort, the AGEC has partnered with ARcare, an AR federally qualified healthcare clinic network, to implement the 4Ms in 4 rural clinics over 3 years. AGEC’s first goal of working with rural primary care clinics is to improve their knowledge of best practices of caring for OA. This was started by providing Geriatric Interdisciplinary Team Training to clinic staff, obtaining baseline data of common health related indicators for OA and starting regular geriatric focused training. Training on the 4Ms (Matters, Medication, Mentation Mobility) framework was next and completed followed by planning and implementation. The process was well received and results are promising. Year 1 data in one clinic show incremental improvements over baseline data in several areas including assessing Mobility with fall screens which has improved over 50% in one year and annual wellness visits (where all 4Ms are reviewed) have increased 30%. However, several areas of opportunities for improvement have also been noted and turned into quality improvement projects (QI). This includes an opportunity to improve depression screens for the clinic’s Mentation measure, which dropped almost 30% in one year. QI projects are ongoing to improve each of the elements of becoming age-friendly.

NARRATIVES ENHANCING TRAINEES’ ATTITUDES TOWARD AGING

We analyzed narratives from graduate students trained in aging themes who then interviewed older hospitalized adults about their life experiences. Three Discovery Fellows given a 90-minute training on open-ended interviewing, the medical care system, empathy, and aging themes derived from the Reframing Aging Program performed semi-structured interviews of 30-90 minutes. Subjects were hospitalized older veterans receiving care by an interdisciplinary geriatric rehabilitation team. Narratives were composed following the interviews and electronically uploaded to a secure site. Qualitative analysis was performed with each statement treated as a separate quote using a hierarchical coding system. A total of 774 codes were used to describe the themes present in 582 quotes. A conceptual framework from the narrative themes emerged with 5 groupings: 1) personal experience, 2) people important in life, 3) self-reflection, 4) medical condition, and 5) health maintenance. Concepts displayed included openness, compassion, and morality, as components of wisdom.

Evaluation of pharmacist interventions and commonly used medications in the geriatric ward of a teaching hospital in Turkey: a retrospective study.

PurposeAging increases the prevalence of diseases. The elderly population is consequently often exposed to complex medication regimens. Increased drug use is one of the main reasons for drug-related problems (DRPs). The primary objective of this study was to define and classify DRPs, pharmacist interventions, and frequently prescribed medications in relation to possible DRPs in patients admitted to the geriatric ward of a teaching hospital in Turkey.Patients and methodsPharmacist medication review reports for 200 orders of 91 patients (mean age: 80.33±0.46) were analyzed retrospectively.ResultsA total of 1,632 medications were assessed and 329 interventions were proposed for possible DRPs in 156 orders. A total of 87.5% of the patients used five or more drugs (mean: 8.17±0.23). The number of DRPs per order was higher when polypharmacy was present (1.04±0.15 vs 1.66±0.11, P<0.05). In 71.31% of the cases, adverse drug events were recognized as the problem. The principal cause of possible DRPs was determined as drug interactions (40.12%). Only 22 potentially inappropriate medications were prescribed. The most common interventions included monitoring drug therapy (31.0%), stopping the drug (20.06%), and changing dosage (13.98%). The acceptance rate of pharmacist interventions by treating geriatrician was 85.41%. The most frequently prescribed drugs were for the nervous system, alimentary tract and metabolism, and cardiovascular system (n=358, 314, and 304, respectively). The pharmaceutical forms of 23 drugs were deemed inappropriate by pharmacists.ConclusionClinical pharmacy services are still not properly implemented in Turkey. The study highlights ways in which clinical pharmacy services can be instrumental in a geriatric ward. The high acceptance rates of pharmacist recommendations concerning a wide variety of DRPs and different classes of drugs indicate that advanced collaboration among geriatricians and pharmacists is possible in interdisciplinary geriatric assessment teams in Turkey.

BRIGHTEN Heart intervention for depression in minority older adults: Randomized controlled trial.

Assess the effectiveness of an interdisciplinary geriatric team intervention in decreasing symptoms of depression among urban minority older adults in primary care. Secondary outcomes included cardiometabolic syndrome and trauma. 250 African American and Hispanic older adults with PHQ-9 scores ≥ 8 and BMI ≥ 25 were recruited from 6 underserved urban primary care clinics. Intervention arm participants received the BRIGHTEN Heart team intervention plus membership in Generations, an older adult educational activity program; comparison participants received only Generations. Both arms demonstrated clinically significant improvements in PHQ-9 scores at 6 months (-5 points, intervention and comparison) and 12 months (-7 points intervention, -6.5 points comparison); there was no significant difference in change scores between groups on depression or cardiometabolic syndrome at 6 months; there was a small difference in depression trajectory at 12 months (p < .001). More participants in the treatment group (70.7%) had greater than 50% reduction in PHQ-9 scores than the comparison group (56.3%; p = .036). For those with higher PTSD symptoms (PCL-C6), improvement in depression was significantly better in the intervention arm than the comparison arm, regardless of baseline PHQ-9 (p = .001). In mixed models, those with higher PTSD symptoms (β = -0.012, p = < 0.001) in the intervention arm showed greater depression improvement than those with lower PTSD symptoms (β = -0.004, p = .001). The BRIGHTEN Heart intervention may be effective in reducing depression for urban minority older adults. Further research on team care interventions and screening for PTSD symptoms in primary care is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Chronic Obstructive Pulmonary Disease in Older Adults: Part II: Considerations for Inhaler Selection.

Inhaler administration for patients with chronic obstructive pulmonary disease (COPD) can be challenging, as it requires correct recall and execution of multiple steps. Older adults may have a higher risk of incorrectly administering inhalers versus the general population due to age-related visual, cognitive, and functional impairments. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report states that in addition to advanced age, use of multiple inhalers and lack of previous inhaler education can negatively impact technique. Improper inhaler use can lead to poor disease control, increased acute care utilization, and reduced quality of life. Therefore, regular evaluation of technique is emphasized by the GOLD guidelines to improve patient outcomes. Health care professionals on geriatric interdisciplinary teams can work together to achieve proper technique and evaluate for age-related limitations that may guide the choice of inhalers in older adults with COPD. [Journal of Gerontological Nursing, 44(10), 10-15.].

Commentary on State of the Science: Interprofessional Approaches to Aging, Dementia, and Mental Health.

It is expected that, by 2050, there will be 83.7 million adults aged 65 and older in the United States1 and 1.6 billion world-wide.2 Already there exists an unrecognized crisis in dementia and mental health care for this rapidly growing population.3 Further, the workforce with expertise in aging, dementia, and mental health/substance use (MH/SU) continues to decline, contributing to health disparities.3 As noted by both the Institute of Medicine (IOM)4 and the World Health Organization (WHO),5 interprofessional teams can play an important role in the improvement of population health outcomes for older adults. Interprofessional teams are not new to geriatrics and gerontology.6 Over the past decade, emerging strategies and models of care for interprofessional education and collaboration have built on foundations laid by several organizations.4 For example, the WHO generated the widely accepted definition and framework for interprofessional education and collaboration.5 For over 50 years, the IOM4,7–8 has supported interprofessional education and collaboration and raised awareness of workforce needs for older adults with MH/SU.3 The National Center for Interprofessional Practice and Education9 has partnered with the Robert Wood Johnson Foundation,10 the Josiah Macy Jr. Foundation,9 the John A. Hartford Foundation,9,11 and the Gordon and Betty Moore Foundation,9 to further the work of the Geriatric Interdisciplinary Team Training and Geriatric Interdisciplinary Teams in Practice programs.6,9,11 The Partnership for Health and Aging (PHA)12 developed competencies for geriatrics and gerontology. Finally, the PHA and the American Geriatrics Society13 published a position statement to support team training. Yet, despite longstanding and broad support for interprofessional education and collaboration in the care of older adults, physical and mental health disparities persist. In this supplement, Farrell et al.14 recommend a unified effort to integrate geriatric and gerontology competencies, content and principles into interprofessional curricula that are aligned with objectives for health systems science.15 Those objectives aim to transform curricula to improve population health, team-based care, high-value care, leadership, quality improvement, patient safety and health policy.15 Farrell et al.14 posit that an intentional, systematic approach by health science educators, health care systems leaders and clinicians is essential to advancing innovation for positive outcomes around aging, dementia and MH/SU. Guided by the Interprofessional Learning Continuum (IPLC) model4 (see Farrell et al.,14 Figure 1), this Commentary reinforces and extends the Farrell et al.14 recommendations by highlighting national and international innovations in interprofessional geriatrics and gerontology, especially related to dementia and mental health. The comprehensive IPLC model grew out of recognition in the IOM’s “Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes”4 that curriculum reform and collaborative practice redesign are prerequisite to improving health and system outcomes.16 In that context, this Commentary provides a discussion of curriculum reform, collaborative practice redesign and their linkages to health and systems outcomes15,16 and concludes with a brief global perspective17 on interprofessional education and practice as they relate to aging, dementia and MH/SU in older adults. Innovation exemplars in interprofessional education aim to challenge and stimulate leadership in interprofessional geriatrics and gerontology.

노년내과와 정형외과의 협진 여부에 따른 노인의 고관절 골절수술 후 합병증 발생 위험 요인분석

노년내과와 정형외과의 협진 여부에 따른 노인의 고관절 골절수술 후 합병증 발생 위험 요인분석

P.3.d.051 - From discharge and beyond revisited: what happens after discharge of a psychiatric ward for first psychotic episode

Interdisciplinary geriatric consultation teams are implemented in the acute hospital setting in several high-income countries to provide comprehensive geriatric assessment for the increasing numbers of older patients with a geriatric profile hospitalized on non-geriatric units. Given the inconclusive evidence on this care model's effectiveness to improve patient outcomes, health care policy and practice oriented recommendations to redesign the structure and process of care provided by interdisciplinary geriatric consultation teams are needed. A scoping review was conducted to explore the structure and processes of interdisciplinary geriatric consultation teams in an international context. As nurses are considered key members of these teams, their roles and responsibilities were specifically explored.The revised scoping methodology framework of Arksey and O’Malley was applied.An electronic database search in Ovid MEDLINE, CINAHL and EMBASE and a hand search were performed for the identification of descriptive and experimental studies published in English, French or Dutch until April 2014.Thematic reporting with descriptive statistics was performed and study findings were validated through interdisciplinary expert meetings.Forty-six papers reporting on 25 distinct interdisciplinary geriatric consultation teams in eight countries across three continents were included. Eight of the 12 teams (67%) reporting on their composition, stated that nurses and physicians were the main core members with head counts varying from 1 to 4 members per profession. In 80% of these teams nurses were required to have completed training in geriatrics. Advanced practice nurses were integrated in eleven out of fourteen interdisciplinary geriatric consultation teams from the USA. Only 32% of teams used formal screening to identify patients most likely to benefit from their intervention, using heterogeneous screening methods, and scarcely providing information on the responsibilities of nurses. Nurses were involved in the medical, functional, psychological and social assessment of patients in 68% of teams, either in a leading role or in collaboration with other professions. Responsibilities of interdisciplinary geriatric consultation teams’ nurses regarding in-hospital follow-up or transitional care at hospital discharge were infrequently specified (16% of teams).This scoping review identified that the structure and processes of care provided to geriatric patients by interdisciplinary geriatric consultation teams are highly heterogeneous. Despite nurses being key team members, only limited information on their specific roles and responsibilities was identified. More research in this area is required in order to inform health care policy and to formulate practice oriented recommendations to redesign the interdisciplinary geriatric consultation team care model aiming to improve its effectiveness.

Which parameters affect long-term mortality in older adults: is comprehensive geriatric assessment a predictor of mortality?

Determining predictors of mortality among older adults might help identify high-risk patients and enable timely intervention. The aim of the study was to identify which variables predict geriatric outpatient mortality, using routine geriatric assessment tools. We analyzed the data of 1141 patients who were admitted to the geriatric medicine outpatient clinic between 2001 and 2004. Comprehensive geriatric assessment was performed by an interdisciplinary geriatric team. Mortality rate was determined in 2015. The parameters predicting survival were examined. Median age of the patients (415 male, 726 female) was 71.7years (53-95years). Mean survival time was 12.2years (95% CI; 12-12.4years). In multivariate analysis, age (OR: 1.16, 95% CI: 1.09-1.23, p<0.001), smoking (OR: 2.51, 95% CI: 1.18-5.35, p=0.017) and metabolic syndrome (OR: 2.20, 95% CI: 1.05-4.64, p=0.038) were found to be independent risk factors for mortality. MNA-SF scores (OR: 0.84, 95% CI: 0.71-1.00, p=0.050) and free T3 levels (OR: 0.70, 95% CI: 0.49-1.00, p=0.052) had borderline significance. The present study showed that the risk conferred by metabolic syndrome is beyond its individual components. Our findings confirm previous studies on the prognostic role of nutritional status, as reflected by MNA-SF. Serum fT3, a simple laboratory test, may also be used in geriatric outpatient clinics to identify individuals at risk. The results of the study demonstrated the need for addressing modifiable risk factors such as smoking, metabolic syndrome, and undernutrition in older adults.

P-20 Information and technical support centre for promotion of end of life care with enhanced advanced care planning at home and local communities in the super-aged society, Japan

Background Integrated Community Care System (ICCS) is constructed under lead of Ministry of Health, Labour and Welfare (MHLW) for the elderly to continue living in hometown to end-of-life (EOL) with sense of security in unprecedented aged society, Japan. For assurance of sense of security, provision of high-quality EOL care (EOLC) with promotion of advance care planning (ACP) is essential. MHLW has established 105 of Regional Bridgeheads to Promote Co-operation between Medical and Long-term Care (RBPCMLC) with geriatric interdisciplinary team through In-Home/Long-Term Care 2012 project. Aim To support RBPCMLCs for establishment of own ICCS at their communities. Methods MHLW entrusted Information and Technical Support Centre (ITSC) for RBCMLCs to Division of Home Care Promotion (DHCP), National Centre for Geriatrics and Gerontology (NCGG) since 2012. In ITSC at DHCP, NCGG, information about activities of RBCMLCs was gathered and analysed. Results With leadership by ITSC according to MHLW policy, medical sectors, especially Japanese Medical Association, has started to collaborate with long-term care sectors for creation of local health-conscious communities under co-operation with local administrations and neighbourhood associations. However, supplies of medical care, especially EOLC, still run short and promotion of ACP is underway. From 2013, numbers of RBCMLCs were increased to 350 and construction of ICCS was continued with regular budget of local governments. Conclusion Acts for Securing Comprehensive Medical and Long-Term Care in the Community in 2014 was major achievements of RBCMLCs activities and promotion in ACP for high-quality EOLC at community hospitals is entrusted to DHCP, NCGG by MHLW.

COMPREHENSIVE GERIATRIC ASSESSMENT (CGA): IS IT NECESSARY FOR TREATMENT OF CANCER PATIENTS? INTERDISCIPLINARY EFFORTS AND IMPORTANCE OF ITS IMPLEMENTATION IN A CANCER CENTER PROGRAM IN LATIN AMERICA

CGA is gaining importance in treatment of elderly cancer patients, since ageing is a global phenomenon. That shift in demographics has huge impact in healthcare. However, the more reliable validated way to apply CGA in Geriatric Oncology is an open research field so far. The efforts to find the best interdisciplinary approach for conducting CGA in daily clinical practice demand a worldwide multi-institutional collaboration. This presentation will review some topics in Geriatric Oncology, highlighting strategies and difficulties of implementing such a unit. Daily routine of a interdisciplinary Geriatric Oncologic team work will be discussed, to put into the context of a high volume cancer hospital, the daily needs of caring for elderly oncology patients. Attending public will discuss, among other topics: a) epidemiology of aging and cancer around the world; b) efforts to better care in geriatric oncology; c) CGA in cancer patients; d) important points in geriatric oncology in different settings (public or private; acute or intensive care unit, ambulatory, nursery, hospice, home care); e) administrative and financial support for geriatric oncology. In A. C. Camargo Cancer Center, in Sao Paulo, Brazil, we are starting a project hoping for government grant, aiming to: □ Detect predictive factors of complications in oncological treatment □ Propose treatment protocols adapted to functional capacity, to avoid over and under treatment. □ Offer ways to rehabilitation of reversible vulnerability and frailty, with combined interprofessional work. □ Prevent additional common complications in elderly: falls, polypharmacy, undernutrition, depression, sarcopenia, for example. □ Detect early signs of psychological or cognitive alterations that may contribute to additional deficits. □ Offer home, ambulatory and hospital support to all patients, specially for the ones that cannot receive specific cancer treatment. □ Combine assistance to comorbidities with the oncology team. Topics above will be illustrated by our experience, initiated in 2010, in the implementation of a Geriatric Oncology Unit in A. C. Camargo Cancer Center – one of the largest oncology hospitals in Latin America – specially how to apply a time-consuming elderly evaluation in a high volume cancer center for multidisciplinary treatment. In our initial retrospective cohort, the incorporation of CGA in daily practice was feasible and useful to predict needs and complications of systemic cancer treatment, like dose adjustment, ability to complete proposed treatment, and hospitalisation. Next step should be to look for correlations with markers of efficacy, such as survival and quality of life. We believe that the comparison of different approaches in Geriatric Oncology may help to improve their applications in many settings and services, with good ideas being applied with local contextualisation. Those efforts will directly benefit elderly cancer patients. Disclosure of interest: None declared

Developing a geriatric resource interdisciplinary team in geriatric oncology

Developing a geriatric resource interdisciplinary team in geriatric oncology

Providing Mental Health Services within Community Geriatric Interdisciplinary Teams: Challenges and Successes

On Lok Lifeways (On Lok), the original Program of All-inclusive Care for the Elderly (PACE) organization provides comprehensive health care for community dwelling frail seniors in San Francisco and South Bay areas, California. On Lok serves over a thousand participants who speak 30 languages. Prior to 2005, On Lok did not have an on-site mental health component and participants were referred to off-site contracted psychiatrists and psychologists for all mental health services. In 2005 On Lok introduced an on-site Mental and Behavioral Health (MBH) team. Currently the team includes a neuropsychologist, five psychotherapists and two part-time psychiatrists. In addition, a full time chaplain is assisting participants with their spiritual needs. The goal of the MBH program is to increase interdisciplinary team effectiveness in care of frail elders with mental and behavioral health issues and to improve access to mental health services for a vulnerable and diverse senior population. MBH team members are providing various direct and indirect services to On Lok participants and staff. Key responsibilities include assessment of mental and behavioral health needs for applicants or new enrollees; routine reassessment every 6 months for participants with a psychiatric diagnosis; counseling to participants and their family members; administration and interpretation of neuropsychological tests for participants with cognitive impairments; crisis intervention and management; and psychotropic medication management as requested by primary care providers. In addition, mental health clinicians conduct regular trainings for all staff regarding various mental health and spiritual issues. Implementing on-site MBH services resulted in quadrupling of the number of appointments to mental health clinicians. There was a reduction in psychiatric inpatient utilization from 12 admissions/1000 patients/year in 2004, to 3 admissions/1000 patients/year in 2005. This reduction was sustained over the past 8 years. The availability of MBH clinicians who can provide timely consultations significantly increased interdisciplinary team understanding of mental health issues and increased team confidence in dealing with difficult mental health cases in an outpatient setting. Inclusion of mental and behavioral health clinicians on geriatric interdisciplinary care teams increased the complexity of care coordination; however the integration of mental health component into comprehensive geriatric care improved the quality of care by increasing timely access to mental health services, reduced the rate of psychiatric inpatient admissions, and reduced anxiety and stress of interdisciplinary teams caring for frail elders with mental health diagnoses.

Promotion of home care medicine with the seminar on geriatric interdisciplinary team care in Japan

(if average age≥70 and lower age limit≥55). Second, we searched the PubMed database for RCTs specifically designed for the elderly and published between January 2011 and January 2012, based on PubMed age categories and the above-mentioned age criteria.Main trial characteristics were extracted. Results.– From the random sample (n=339), 22 (6%) publications reported on RCTs specifically designed for the elderly. The second search yielded 305 publications on RCTs specifically designed for the elderly. Based on the trial characteristics, RCTs specifically designed for the elderly less frequently excludedparticipants based on upper age limits (P<0.001), more frequently focused on the cardiovascular and nervous system (P<0.001), and were more frequently performed in ahospital (P<0.001),when compared toRCTs not specifically designed for the elderly. Key conclusions.– Only a very small proportion of RCTs is specifically designed for the elderly. This proportion is even smaller than current literature illustrated.

Teambuilding across healthcare professions: The ELDER project

BackgroundThe key to ensuring quality care for older adults is a nursing workforce that collaborates across professions and provider levels (Wright M.C., Phillips-Bute, B.G., Petrusa, E.R., Griffin, K.L., Hobbs, G.W., & Taekman, J.M. (2008). Assessing teamwork in medical education and practice: Relating behavioural teamwork ratings and clinical performance. Med Teach, 29, 1-9). PurposeTo improve communication and teamwork among interprofessional health care providers (HCPs) by using innovative teambuilding activities over three years. MethodsParticipants: 97 multi-disciplinary HCPs from five long term or home care agencies in an underserved region of New England. Participants attended six interactive sessions focused on teambuilding skills through the use of role play, case studies, games, exercises and teambuilding strategies. The J. A. Hartford Foundation's (John A. Hartford Foundation. (2001). The John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) Program. Available at: http://www.nygec.org/index.cfm?section_id=26&sub_section_id=18&page_id=98) Geriatric Interdisciplinary Team Training (GITT) instrument and Interdisciplinary Teamwork IQ test were used to measure changes in knowledge and attitudes. ResultsT tests performed on matched pre/post GITT instruments (n=26) revealed no significant change, although scores improved slightly from pre: (71%) to post test (73.3%) (p=.39). Teamwork IQ scores also improved slightly though not significantly. Qualitative data gathered suggest that teambuilding exercises were helpful in practice and allowed for better understanding of other provider roles. ConclusionsRarely is a variety of health care disciplines invited to participate in educational opportunities together. The interprofessional small group methodology used is a replicable model with potential to overcome barriers in communication and teamwork skills.

Transitions Model: Melding of Psychotherapy and Palliative Care Using Teams

This article explains a hospital palliative model called the Transitions and Palliative Care Therapy (TPCT) and provides data. In addition, the Geriatric Interdisciplinary Team Treatment (GITT) program, using its experience with hospice and research based knowledge, applied key principles of teamwork to enhance the TPCT team approach. GITT was applied to TPCT for 1 year. The TPCT model is a transitions counselors–based model that is a hospital-centered, interdisciplinary consult service, with a focus on the patient and the family. It employs master's level counselors and mid-level providers, with a much smaller group of palliative care physicians who supervise mid-level practitioners and provide medical input and leadership. Outcomes evaluated were hospital cost, family and staff satisfaction, and number of consults that led to de-escalating treatment. In all cases the GITT model was effective; it assisted with improved cost, better satisfaction, and an increased number of consults.

Interdisciplinary Geriatric and Psychiatric Care Reduces Potentially Inappropriate Prescribing in the Hospital: Interventional Study in 150 Acutely Ill Elderly Patients with Mental and Somatic Comorbid Conditions

Potentially inappropriate medications and prescription omissions (PO) are highly prevalent in older patients with mental comorbidities. To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing. Prospective and interventional study. Medical-psychiatric unit in an academic geriatric department. Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition. From admission to discharge, daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team. Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge. Compared with admission, the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 (P < .0001) and incidence rates for potentially inappropriate medications and PO reduced from 77% to 19% (P < .0001) and from 65% to 11% (P < .0001), respectively. Independent predictive factors for PIP at discharge were being a faller (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.43-2.09) and for PO, the increased number of medications (OR 1.54; 95% CI 1.13-1.89) and a Charlson comorbidity index greater than 2 (OR 1.85; 95% CI 1.38 - 2.13). Dementia and/or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge. These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population. Further evaluations are, however, still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes, such as incidence of adverse drug events, rehospitalization, or mortality.

Iatrogenic disease in the elderly: risk factors, consequences, and prevention

The epidemiology of iatrogenic disease in the elderly has not been extensively reported. Risk factors of iatrogenic disease in the elderly are drug-induced iatrogenic disease, multiple chronic diseases, multiple physicians, hospitalization, and medical or surgical procedures. Iatrogenic disease can have a great psychomotor impact and important social consequences. To identify patients at high risk is the first step in prevention as most of the iatrogenic diseases are preventable. Interventions that can prevent iatrogenic complications include specific interventions, the use of a geriatric interdisciplinary team, pharmacist consultation and acute care for the elderly units.