Geriatric Services Research Articles

Models of clinical care delivery for geriatric oncology in Canada and the United States: A survey of geriatric oncology care providers

BackgroundGeriatric assessment (GA) can help improve patient care and outcomes. There are increasing numbers of centres in Canada and the United States (U.S.) which provide geriatric oncology services, but the distribution and structure of these clinics is unclear. This study sought to identify and describe outpatient geriatric oncology clinics in Canada and the U.S. Materials and MethodsA 30-question survey was administered electronically to clinics identified by the authors, through a search of the internet and from members of geriatric oncology community of practices in Canada and the U.S. Additional clinics were identified via a snowball method. Descriptive statistics were used. An exploratory analysis of factors associated with higher volumes of patients seen was done using a two sample t-test and one-way Analysis of Variance (ANOVA) for categorical variables and simple linear regression for continuous variables. ResultsNineteen clinics (5 in Canada, 14 in U.S.) responded. Median duration in operation was 5 years (range < 1 to 25 years). More than a third (36.8%) were run by a geriatric oncologist alone, 36.8% had input from both geriatrics and oncology, while 21.1% had access to only one of the disciplines. The majority of clinics had nursing, social work and pharmacy involvement, with fewer having physiotherapy and dieticians. Just over half (53%) had an age cut-off for referral to their clinic. Fitness for treatment was the most common reason for referral. Clinics saw a median of 188 consults per year (range 0–1000). Clinics which have been operating longer (p = 0.002), those that took less time to complete a GA (p = 0.03), and those in which individual components of the GA were assessed by each discipline, rather than by one point person (p = 0.02), saw more new consults annually. ConclusionThere has been a growth of geriatric oncology services in Canada and the U.S. within the last five years. The composition and structure of clinics varies widely though the majority have both geriatrics and oncology expertise. Support to build more geriatric oncology services is needed to reach more older adults with cancer. This study provides some insight into ways to structure these clinics.

Outcomes of a Decision-Making Capacity Assessment Model at the Grey Nuns Community Hospital.

BACKGROUND. With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we implemented a DMCA Model that includes a care pathway, worksheets, education, and mentoring. The objective of this study was to assess the impact of the utilization of this patient-centered DMCA model on the need for Capacity Interviews. METHODS. This was a retrospective quality assurance chart review of patients referred for DMCA to the Geriatric Service at the Grey Nuns Community Hospital from 2006–2020. The Geriatric Service is run by Family Physicians with extra training in Care of the Elderly. We extracted patient demographics, elements of the DMCA process, and whether Capacity Interviews were performed. We used descriptive statistics to summarize the data. RESULTS. Eighty-eight patients were referred for DMCAs, with a mean age of 76 years (SD = 10.5). Dementia affected 43.2% (38/88) of patients. Valid reasons for conducting a DMCA were evident in 93% (80/86) of referrals, and DMCAs were performed in 72.6% (61/84). 85.3% (58/68) of referrals identified the need for DMCA in two to four domains, most commonly accommodation, healthcare, and finances. Two to three disciplines, frequently social workers and occupational therapists, were involved in conducting the DMCAs for 67.2% (39/58) of patients. The Capacity Assessment Process Worksheet was used 63.2% of the time. Capacity Interviews were conducted in only 20.7% of referrals. Following the DMCAs, 48.2% (41/85) of those assessed were deemed to lack capacity. CONCLUSION. This study suggests that the DMCA Model implemented has decreased the need for Capacity Interviews while simultaneously respecting patient autonomy. This is an important finding as DMCAs carried out following this process reduced the need for both a Capacity Interview and declarations of incapacity while simultaneously respecting patient autonomy and supporting patients in their decisions in accordance with the legislation.

Factors associated to potentially inappropriate prescribing in older patients according to STOPP/START criteria: MoPIM multicentre cohort study

ObjectivesThe objectives of the present analyses are to estimate the frequency of potentially inappropriate prescribing (PIP) at admission according to STOPP/START criteria version 2 in older patients hospitalised due to chronic disease exacerbation as well as to identify risk factors associated to the most frequent active principles as potentially inappropriate medications (PIMs).MethodsA multicentre, prospective cohort study including older patients (≥65) hospitalized due to chronic disease exacerbation at the internal medicine or geriatric services of 5 hospitals in Spain between September 2016 and December 2018 was conducted. Demographic and clinical data was collected, and a medication review process using STOPP/START criteria version 2 was performed, considering both PIMs and potential prescribing omissions (PPOs). Primary outcome was defined as the presence of any most frequent principles as PIMs, and secondary outcomes were the frequency of any PIM and PPO. Descriptive and bivariate analyses were conducted on all outcomes and multilevel logistic regression analysis, stratified by participating centre, was performed on the primary outcome.ResultsA total of 740 patients were included (mean age 84.1, 53.2% females), 93.8% of them presenting polypharmacy, with a median of 10 chronic prescriptions. Among all, 603 (81.5%) patients presented at least one PIP, 542 (73.2%) any PIM and 263 (35.5%) any PPO. Drugs prescribed without an evidence-based clinical indication were the most frequent PIM (33.8% of patients); vitamin D supplement in older people who are housebound or experiencing falls or with osteopenia was the most frequent PPO (10.3%). The most frequent active principles as PIMs were proton pump inhibitors (PPIs) and benzodiazepines (BZDs), present in 345 (46.6%) patients. This outcome was found significantly associated with age, polypharmacy and essential tremor in an explanatory model with 71% AUC.ConclusionsPIMs at admission are highly prevalent in these patients, especially those involving PPIs or BZDs, which affected almost half of the patients. Therefore, these drugs may be considered as the starting point for medication review and deprescription.Trial registration numberNCT02830425

Acceptance of virtual consultations among older adults and caregivers in Malaysia: a pilot study during the COVID-19 pandemic

ABSTRACT Aim The COVID-19 pandemic has disrupted the delivery of healthcare to vulnerable older adults, prompting the expansion of telemedicine usage. This study surveyed the acceptance of virtual medical consultations among older adults and caregivers within geriatric outpatient services in a tertiary hospital during the pandemic. Methods A cross-sectional survey was conducted among caregivers and patients attending geriatric outpatient services in Kuala Lumpur, Malaysia. The survey measured the availability of equipment for virtual consultations, prior knowledge and experience of telemedicine, and willingness to consult geriatricians through virtual technology, using the Unified Theory of Acceptance and Use of Technology (UTAUT) scale. Results A total of 197 caregivers and 42 older patients with a mean age of 54.28 (±13.22) and 75.62 (±7.32) years, respectively, completed the survey. One hundred and fifty-six (79.2%) of the caregivers were adult children accompanying patients. The mean UTAUT score was 65.97 (±13.71) out of 90, with 66.64 (±13.25) for caregivers and 62.79 (±15.44) for older adults, suggesting a high acceptance of adopting virtual consultations in lieu of face-to-face care. The independent predictors of acceptance of virtual consultation were : possession of an electronic device capable of video-communication, living with someone, living in a care home, weekly online banking usage, and perceived familiarity with virtual platforms. Conclusion Caregivers and patients indicated a high level of acceptance of virtual medical consultations, which is likely facilitated by caregivers such as adult children or spouses at home or staff in care homes. To minimize the transmission of COVID-19 in a highly vulnerable group, virtual consultations are an acceptable alternative to face-to-face consultations for older people and their caregivers in our setting.

Exploring Factors and Strategies to Promote Chinese Elders’ Physical Activity

This study was designed to explore factors and strategies to promote Chinese elders’ physical activity and cultivate healthy lifestyles. We collected the CHARLS survey 2011 baseline data, and selected 2647 cases of the elderly population in China. Based on the social ecosystem theory, the univariate analysis and ordered logistic regression were used. The model was analyzed for multivariate analysis. In the present study, the appropriate IRB approval has been obtained from Peking University. The theory of social ecology believes that individual behavior is influenced individual factors, inter-individual factors, organizational factors, community factors and policy factors. This article used the gender, age, marriage, education, and self-assessment of health status in the survey results as independent variables of individual factors, used whether to provide care for grandchildren, the frequency of participation in social activities as independent variables of inter-individual factors, used whether there are organizations that assist the elderly, the weak, the disabled population and whether there are elderly associations as the independent variables of organizational factors, then uses whether there is geriatric health service center as an independent variable of community factor. In this paper, physical activity participation intensity was used as the dependent variable, and single factor correlation analysis was performed with each independent variable. The other nine chi-square test significant independent variables except for age were included in the multiple regression model. The results showed that compared with other marital status, the physical activity intensity of the elderly population with spouses living together is greater; the elderly population who has better self-rated health scores and has higher social frequency, has stronger physical activity intensity; the elderly population who has geriatric health care service centers in their residence has stronger physical activity intensity. The following suggestions to promote health of Chinese elderly population can be made: the elderly population should establish their own awareness of health care and exercise; the children of the elderly population should strengthen their care for the elderly population; the community pension service organizations should take the initiative to play an active role to care the elderly population; the elderly population residence should strengthen the supporting hardware facilities.

Nursing practices and tasks for collaboration with care workers for the end-of-life care at geriatric health service facilities in A prefecture

Nursing practices and tasks for collaboration with care workers for the end-of-life care at geriatric health service facilities in A prefecture

Naturalistic study of “Adherence to Follow-Up” in the initial 1st year cohort of patients utilizing a tertiary hospital-based geriatric mental health-care service using the “Service Evaluation Framework”

Background: There are very few specialised hospital with quality assurance services catering to the needs of the elderly with mental illness. The concept of 'Appointment adherence' has received little attention in the field of geriatric mental health from India. There is a need to study the pattern of 'drop-out' amongst geriatric patients. Method: An initial cohort of first 105 cases presenting to the clinic were followed up to explore their socio-demographic and clinical variables, overall functioning and satisfaction with the services. Adopting a 'naturalistic approach,' and using the 'service evaluation framework', at the assessment period of about 36 months, tools like socio-clinical profile, Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, WHOQOL-BREF-Hindi version, Patient Satisfaction Scale (PAT-SAT) and 'Service Evaluation (SSS-16 and SSS-10 Practitioner Versions)' were administered. Result: 68 cases were available for assessment of functional outcome and satisfaction parameters were assessed for 78 of the cases. 75% had functional disorders and medical morbidity was present in more than 50% of cases. The mean score for WHOQOL-BREF and GAF were 44.4 (poor quality of life) and 72.91 (slight impairment in socio-occupational functioning) respectively. PAT-SAT score in all the sub-categories were above average. 'Organic' diagnosis patients had lower QoL on certain domains compared to 'functional' patients. Only 30.47% patients were coming for follow-up with 25.71% having died. Of the 32/68 (34.29%) cases who had dropped out, 50% were adherent to treatment in different ways. Additionally, GAF scores were lower in 'drop-out' group. Conclusions: There is a relatively high rate of 'drop-out' over a 3-year period. However, if patients keep coming for follow-up (i.e. do not 'drop-out'), they are more likely to show improvement in their level of social and occupational functioning.

Exploring Care Management for Older Adults with Illnesses as Family Members’ Responsibility : The Need for Social Workers’ Support Services in Nigeria

Introduction: Aging oftentimes comes with health-related issues. Usually, family members are obliged to provide care management for older adults. They must perform this task despite their limited knowledge of their patients’ health conditions. Hence, securing care management for older adults with illnesses becomes a dilemma for consideration. Aims: Older adults require support in managing health conditions. This study hopes to promote the following: First, provide understanding of how family members perceive caregiving. Second, provide insight into family members’ management of health care challenges. Third, explore the need for geriatric support services in providing care for older adults. Methods: The study employed a qualitative research method. Focus Group Discussion was utilized to elicit data from 24 participants admitted to four health care facilities at Enugu-North, Nigeria. Results: Findings indicated that participants perceived care management for the older adults as a filial responsibility that should be provided till their demise. However, the majority experienced difficulties to this effect, other major concerns found include age and the older adult’s attitude, financial challenges, the changing contemporary society, and caregiving stress due to the care recipient’s health status. While many of the participants indicated a preference for traditional medicine as an alternative to rapidly increasing health service charges owing to lagging geriatric support; others were less reliant on the governmental welfare support services. Conclusions: With the government implementing aging and health care policies, Non-Governmental Organizations (NGOs) and Civil Society Organizations (CSOs) in collaboration with geriatric social workers can help develop care-aid programs for older adults’ healthy wellbeing.

Impact of cognitive impairment on activities of daily living among older adults of North India.

Older persons are at risk of developing cognitive impairment, often considered a precursor to more severe conditions, such as dementia or Alzheimer's disease. Cognitive impairment among older adults is one of the most rapidly growing burdens, especially in developing countries. To assess the impact of cognitive impairment on activities of daily living (ADL) among older adults. A cross-sectional descriptive study was conducted among 135 older adults visiting a selected tertiary care centre in Uttarakhand (India) during December 2020, recruited using total enumerative sampling. Data were collected using standardized and validated tools that consisted of socio-demographic information, Hindi Mental Status Examination, and Everyday Abilities Scale for India. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and median) and inferential statistics (Chi-square test, binary logistic regression). The results with pooled analysis have shown that 30% of the older adults had mild cognitive impairment, 9% had moderate cognitive impairment, and 61% had normal cognition. About 16% of the older adults' ADL were affected. The statistically significant predictors for cognitive impairment were age group 80 years [odds ratio (OR) = 36.21; 95% confidence interval (CI) = 6.23-210.59], Muslim religion (OR = 6.26; 95% CI = 1.12-34.93), and middle-class families (OR = 11.95; 95% CI = 1.84-77.78). A considerably large proportion of the older adults had cognitive impairment, which further impacted activities of daily living. There is an urgent need to develop geriatric mental health services across all hospitals in the region.

Prevalence of Non-Communicable Disease Risk Factors among GeriatricPopulation of Hoskote: A Cross Sectional Study

Background Non-communicable diseases NCDs encompass a vast group of conditions such as cardiovascular diseases cancer diabetes hypertension and chronic respiratory diseases. The evolving pandemic of noncommunicable diseases NCDs is generating major health challenges globally. The objective is to study the prevalence of risk factors of non-communicable diseases among geriatric population of Hoskote.Methodology A cross-sectional study was conducted among the geriatric population of Hoskote. A semistructured questionnaire was distributed to all the individuals visiting the geriatric camp which was conducted from Jan 2022 to March 2022. Data was collected through personal interview method. Data was entered in MS Excel and analyzed using SPSS software ver20.0.Results Mean age was found to be 68.53plusmn13.39 years with a gender distribution of 38.93 males and 61.07 females. 46.61 of the participants belonged to lower socioeconomic status. 55.52 of the participants were suffering from one or the other comorbidity. Tobacco smoking chewing was noted among 35.59 of the participants. 36.44 of the subjects exercised regularly.Conclusion Geriatric health care services have to be provided regularly to the geriatric community and special training should be given to the health care providers so that the existing health problems among the elderly can be addressed.nbsp

Public administration strategy of healthcare system for seniors

The goal of the study is to restructure society’s attitude toward the needs of the elderly. The article addresses the methodology of state social policy and possible innovations in funding and economic methods for public administration in the healthcare system for seniors. The novelty of the work is ensured by the concept of managed older age and a start-up proposal to create the State Direct Investment Fund “Senior Generation” functioning as an entity responsible for the development of the organizational foundations for gerontology and geriatrics services. The practical significance of the study lies in the optimization of the modern management model of care for the older generation and a philosophical study of age as a potential in management in both individual and societal regards. This strategy can serve as a basis for public administration of the healthcare system for the elderly accounting for the diversity of seniors as a social stratum.

The depressed frail phenotype as a risk factor for mortality in older adults: A prospective cohort in Peru

IntroductionFrailty and depression can coexist as depressed frail phenotype, useful for the comprehensive evaluation of older adults and prevention of adverse outcomes. The objective of this study was to evaluate the role of the depressed frail phenotype and its components as risk factors for mortality in older adults of the Centro Médico Naval (CEMENA) of Peru during 2010–2015. Material and methodsWe carried out a secondary data analysis of a prospective cohort that included older adults (60 years and older) treated in the Geriatrics service of CEMENA between the years 2010–2015. Frailty was defined as the presence of three or more Fried phenotype criteria and depression was determined using a Yesavage ultrashort scale score of three or more. The presence of both conditions was defined as depressed frail phenotype. In addition, sociodemographic characteristics, medical and personal history, and performance-based measures were included. We employed crude and adjusted Cox regression models to evaluate the association of interest and estimate Hazard Ratios (HR) with their respective 95% confidence intervals (95% CI). Results946 older adults were included in the analysis, with a mean age of 78.0 ± 8.5 years. 559 (59.1%) were male, 148 (15.6%) were found to be frail, 231 (24.4%) had depressive symptoms, 105 (11.1%) had depressed frail phenotype, and 79 (8.3%) participants died during follow-up. The adjusted Cox regression analysis revealed that depressed frail phenotype (HR = 3.53; 95%CI: 2.07–6.00; p < 0.001) was a risk factor for mortality in older adults. ConclusionsThe depressed frail phenotype was associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies that allow estimating this phenotype's impact on mortality and evaluate interventions to improve quality of life and reduce the risk of adverse outcomes.

Another Set of Eyes: Recipients’ Views of the Benefits of Geriatric Specialty Telehealth Services

The aim of GRECC Connect is to increase access to specialty care for medically complex, older, rural patients through e-consultations and telehealth visits. We interviewed 50 outpatient clinic staff and providers as well as 30 patients and caregivers about these services. Overall, the services were considered beneficial. For patients and caregivers, services alleviated the stress and cost of travel, they improved quality of life by increasing their understanding of the progression of an illness and providing treatment and guidance to increase patient functioning and reduce disruptive behaviors, and they eased anxiety associated with not receiving needed care. Having ‘another set of eyes’ on the patients reduced stress and anxiety for providers. Concerns included alignment of telehealth modality with the capabilities of older patients with cognitive problems, hearing loss and/or limited technological abilities and, for some providers, that the referral for and recommendations resulting from the service added to their workload.

Providing Specialty Telehealth Care to Older, Rural Patients: Voices From Field

Older, rural adults have limited access to quality geriatric specialty care for several reasons including relatively few geriatric specialists in rural areas and lack of transportation options or patient ability to travel to more urban centers. GRECC Connect is a promising telehealth-hub and spoke model that provides rural patients access to teams of multidisciplinary geriatric specialists in more urban medical centers primarily by video connection with affiliated community-based outpatient clinics (CBOCs). This model provides a viable option for increasing access to geriatric specialty care for rural patients but is not used to the extent it could be. To date, much of our understanding of this model has come from the experts at the hub medical centers. To learn more about the experience of this model from the field we interviewed CBOC staff and providers as well as Veterans and their caregivers about geriatric specialty telehealth services. In this symposium we will discuss facilitators and barriers to implementing this model from the perspective of the field and then explore more deeply both the context of the CBOC environment and the older patient population served by rural CBOCs to further understand the challenges that are faced in attempting to connect older patients with telehealth services. Finally, we will share the perceived value of the service and alignment with local needs. This deeper understanding of the experience of the ‘spoke’ may help enhance access to much needed geriatric specialty care for rural veterans.

A Strategy Matching Tool for Boosting Implementation of Geriatric Telehealth Services in Rural CBOCs

Fifteen Veterans Administration Medical Centers (VAMCs) offer geriatric specialty care telehealth services through a hub and spoke model to patients at affiliated community-based outpatient clinics (CBOCs). These services are not used to the extent they could be. Through interviews with 50 staff and providers at rural CBOCs we identified several implementation facilitators and barriers. CBOC-level barriers included space constraints, low staffing, internet connection issues, and limited knowledge of services available and referral processes. Patient-level barriers included discomfort with technology, cognitive decline, and inability to travel to the CBOC. We found that champions within the CBOC and iterative, targeted outreach from the hub helped facilitate uptake of services. We entered the identified barriers into the CFIR-ERIC (Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool to help generate targeted strategies that will be used to refine each hub’s implementation approach.

Factors Influencing Retention Intention of Nurses at Long-term Care Hospitals in Korea

Purpose: This study aimed to investigate the levels and correlations of role conflict, nursing professionalism, nursing work environment and retention intention, and the factors influencing retention intention of nurses at long-term care hospitals. Methods: The subjects included 183 nurses at nine long-term care hospitals in one metropolitan city in Korea. A set of self-reported questionnaires was administered to assess general characteristics, role conflict, nursing professionalism, nursing work environment, and retention intention of the subjects. Collected data was analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson correlation coefficients, and multiple linear regression. Results: 183 subjects with a mean (±SD) age of 41.66 (±12.29) years were included in the final analyses. Retention intention had a significant positive correlation with nursing professionalism (r=.39, p<.001) and nursing work environment (r=.51, p<.001). Nursing work environment had a significant negative correlation with role conflict (r=-.30, p<.001) and a significant positive correlation with nursing professionalism (r=.48, p<.001). In the final multiple regression analysis, the factors influencing retention intention of subjects were number of beds (β=-.15 p<.026), nursing professionalism (β=.19, p=.007) and nursing work environment (β=.36, p<.001). The explanatory power of number of beds, nursing professionalism and nursing work environment on retention intention was 34.0% (F=16.66, p<.001). Conclusion: Improving nursing professionalism and nursing work environment of nurses at long-term care hospitals will ultimately enhance their retention intention and positively impact on the quality of gerontological nursing service.

Development and validation of a measure of supervisory best practices in gerontological social work

Agency-based supervision is essential to skilled practice and staff retention, directly impacting the quality of services. The Supervisory Leaders in Aging (SLA) program was designed to strengthen supervision of the aging services workforce. SLA was implemented in four states and trained 134 social work supervisors. The purpose of this study was to develop a novel, comprehensive, and practice-informed measure of supervisory best-practices in gerontological social services. The primary outcome for the SLA program was the Practice Inventory for Supervision in Aging Services (PISAS), which evaluated the frequency of recent use of best practices as identified by the project team and vetted by instructors and an interdisciplinary advisory board. Reliability and confirmatory factor analyses were conducted to examine its psychometric properties. Findings demonstrated the scale had good internal consistency reliability (ɑ = 0.88). Confirmatory factor analyses indicated a three-factor solution, 1) Gerontological Social Work Skills, 2) Program Development Skills, and 3) Supervision and Leadership Skills, accounting for 72% of the variability in the 27 items. Gerontological Social Work Skills captured best practices regarding mental health in late life, heightening awareness of elder abuse, and working with families. Program Development Skills captured assessment, measuring outcomes, and translating evidence into practice. Supervision and Leadership Skills captured individual supervision, group supervision and leadership in interdisciplinary practice. Results indicated that PISAS is a reliable and valid measure of use of best practices in gerontological social work supervision. Further implications and limitations of this measure in assessing outcomes of gerontological education and training programs are discussed.

Uncovering Pet Issues: A Survey of Professionals Working With Older Adults and Care Partners

Pets can play an important role in older adults’ health behaviors and decisions. However, the degree to which these issues are encountered or addressed by professionals working with this population remains unknown. An interdisciplinary (e.g., healthcare, social services) sample of professionals (N=72, 93.05% female, Mage=48.82, SDage=12.57) completed an online survey focused on the pet ownership issues they have encountered while working with older adults, persons with dementia, and care partners. The professionals (n=66) estimated 42.86% of their clients had been pet owners, and 45.58% regularly asked their clients about pets. Issues raised to the professionals varied by type of client. Older adults most often brought up exercising the pet, routine veterinary care, and the financial aspect of ownership (all 37.50%). Persons with dementia most often discussed accessing pet care items (12.50%), exercising the pet (9.72%), and basic pet care (8.33%). Care partners brought up basic pet care (33.33%), planning for the pet due to their care recipients’ housing transition (26.38%), and exercising the pet (25.00%). Professionals reported talking to clients about planning for the pet due to housing transition, concerns about falling, and concerns about the pet’s behavior (all 31.94%). The professionals (n=69) were very favorable toward pet ownership in general (M=4.43, SD=0.78) (1=extremely unfavorable, 5=extremely favorable), less favorable about older adult pet ownership (M=4.15, SD=0.72, p=.002), and even less favorable about persons with dementia owning pets (M=3.51, SD=0.93, p<.001). The results provide evidence that pet ownership issues are likely encountered in geriatric service settings and may shape healthy aging.

Virtual Geriatric Education Preferences of Rural Social Workers

Older adults in rural communities need access to comprehensive healthcare services provided by practitioners equipped with geriatric knowledge and skills. The Geriatric Rural Extension of Expertise through Telegeriatric Service (GREETS) project goal is to use telemedicine and telehealth to expand geriatric service options to underserved Michigan regions. GREETS educational programs train health practitioners to provide geriatric care for vulnerable older adults. To determine gaps in geriatric competencies, the team conducted an online survey of health professionals including behavioral health practitioners. Respondents identified educational topics and preferred virtual delivery methods. Demographic information included respondent’s professional position, practice setting, and county. The respondents were asked to indicate level of educational need using a scale ranging from a low, medium, or high need. Fifty (47%) of 106 total responses were from social workers. We compared the percent of social workers to other practitioners’ responses in our analysis. Four topics emerged for both groups as medium or high educational needs: 1) transitional care when changing residential settings or post-hospitalization; 2) assisting family caregivers cope with caregiving responsibilities; 3) incorporating community-based services into care plans; and 4) and managing frail older adults. Social workers noted higher need than the other respondents for: 1) managing chronic pain; 2) managing care of patients with multiple chronic conditions; 3) having serious illness conversations; 4) diagnosing dementia; and 5) discussing advance care planning. Both social worker and other respondents indicated interactive case-based webinars; published tools, toolkits, tip sheets; and didactic webinars as their top three learning formats.

Standardized Self-Report Tools in Geriatric Medicine Practice: A Quality Improvement Study

Comprehensive geriatric assessment (CGA)—a multidimensional diagnostic process to determine medical, cognitive, and functional capacity—has historically included a narrative history supplemented by use of tools to assess domains such as mood or cognition based on assessor preference. This approach to CGA likely works to assess individuals but with increasing clinical complexity and frailty among older adults, a non-standardized approach may mean that key issues are not assessed, and program quality cannot be determined. The COVID-19 pandemic added to these challenges as social distancing practices meant limited face-to-face appointments and use of phone and video assessments. This quality improvement study implemented the interRAI Check-Up Self-Report instrument through a software platform in a specialized geriatric services practice. The instrument can be used over the phone and summarizes specific health problems and needs as well as information about caregiver status and financial trade-offs. Focus groups were also conducted with specialized geriatric services interprofessional team to explore their experiences with implementation. The descriptive analysis of the self-report data revealed expected geriatric issues, such as cognitive and functional impairment, falls and pain. Clients were also commonly experiencing medical instability, cardiorespiratory symptoms, communication impairments, and elevated risk for emergency department visit. Staff found the self-report tool feasible, easy to use, efficient, and the program-level metrics helpful for program planning. In conclusion, introduction of a standardized self-report enhanced CGA by creating a systematic method to flag, track, and prioritize all areas of need for immediate and future care planning at both the client and program level.