Inpatient Geriatric Unit Research Articles

PERSONALIZED MUSIC PLAYLISTS FOR HOSPITALIZED OLDER ADULTS: CREATING AND REVISING VOLUNTEER WORKFLOW

Abstract Personalized music has been shown to decrease the incidence of neuropsychiatric symptoms among hospitalized older adults. As part of the “Creativity in Aging” project at Yale Geriatrics, this quality improvement study aims to evaluate the process and feasibility of a personalized music program in an inpatient geriatrics unit. We collaborated with the hospital volunteer department to credential and train five undergraduate volunteers in building personalized music playlists for hospitalized older adults to listen to during their stay. From October 2023 to February 2024, 88 patients were referred to the program by hospital staff, and 57 patients participated. Here we describe the process of developing and revising the pilot. Following “test” sessions led by a medical student and resident physician familiar with the unit, an initial protocol was developed. Volunteers used REDCap and paper spreadsheets to organize HIPAA-secure patient data including referrals, linkage to personalized playlists stored on iPads, and brief pre- and post-listening surveys. Volunteers filled out feedback forms after each weekly shift to identify workflow issues and suggest improvements. Challenges included 1) identification of appropriate patients and 2) hand-off of patient referrals, notes, and next steps between shifts. Consultation with multiple stakeholders including volunteers, nursing managers, and attending physicians, led to solutions: 1) recruitment of nursing staff and creation of resident physician training module, after which nurses and resident physicians became key patient referral sources, and 2) remodeling of REDCap to manage volunteer “hand-off” communication, replacing the physical note-keeping system. We aim to make this a sustainable volunteer program.

Enhancing validity through cognitive interviewing: A methodological example using the registered nursing forecasting nurse survey

PurposeSystemic anti-cancer therapy (SACT) nurses are facing increasing workload challenges against the backdrop of increased treatment complexity and patient caseload, coupled with a lack of policy guidance or research about the required composition of SACT workforce to ensure optimal care and outcomes. The Registered Nursing Forecasting (RN4CAST) study is an international research initiative designed to model what happens to the quality of patient care and care outcomes when components of the workforce change in acute and geriatric inpatient units. The insights from the RN4CAST have not been applied to the oncology setting. Therefore, the purpose of the study is to amend and test the RN4CAST nurse survey to ensure draft Registered Nursing Forecasting SACT day unit (RN4CAST-SACT-D) survey items are relevant, unambiguous/straightforward and the design/format is usable. MethodsThis study adopted cognitive interviewing (CI), it combed two analytical approaches (reparative approach and descriptive approach) while Question Appraisal System (QAS) and cognitive theory were adopted. ResultsTotally, 12 interviews were conducted within two rounds, 48 items remained unchanged, 20 items underwent rephrasing for enhanced clarity, 20 new items were incorporated to address test content gaps, and adjustments were made to the provided answers to 5 questions. ConclusionThis study refined the RN4CAST survey for SACT day units through cognitive interviewing, addressing comprehension, retrieval, judgment, and response.issues. Adjustments in wording improved clarity and relevance, aligning the survey with nurses' experiences.

The prevalence and experience of loneliness in persons with cognitive impairment on an Inpatient Geriatric Unit

AbstractBackgroundOlder adults who experience loneliness are at a heightened risk for mortality. There are two distinct types of loneliness: social, in which social interactions and networks are reduced, as can result from social isolation and lack of social integration; and emotional, in which a meaningful attachment bond with another is absent. We examined the prevalence and experience of loneliness in cognitively impaired older adults receiving treatment in a mental healthcare facility.MethodFourteen participants with mild cognitive impairment or mild/moderate dementia (mean MoCA 17, range 12‐22; mean age 76, range 65‐92) completed a demographic survey, DeJong Gierveld 6‐Item Loneliness Scale, Montreal Cognitive Assessment (MoCA), and a semi‐structured interview. Basic thematic analysis was used to extract major themes from the interview data. Differences in the prevalence of loneliness between low (MOCA 18 or greater) and high (MOCA 17 or less) cognitive impairment groups and correlations between cognitive impairment and loneliness were examined.ResultParticipants experienced moderate or severe loneliness (86%), emotional (79%) and social (57%) loneliness. Themes emerging from interviews included limited social networks, lack of connection or social engagement, loss of role, need for meaningful activities, missing families, dependency, and stigma. No significant differences were found in loneliness between low vs. high cognitive impairment groups. Correlational analysis suggested a negative association between social loneliness and cognitive impairment, with individuals with lower cognitive impairment scoring higher on social loneliness (r = , p = ).ConclusionLoneliness is prevalent and multifactorial in individuals with cognitive impairment receiving care in a mental health care facility.

Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project

BackgroundNHS staff recruitment and retention have failed to keep pace with service demands and workforce burn-out is of significant concern. This quality improvement project (QIP) aimed to increase staff time...

Is there a relationship between ‘getting up and dressed’ and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study

Objectives To evaluate the physical and functional outcomes of the ‘Ending Pyjama Paralysis’ intervention in an inpatient geriatric rehabilitation unit. Design Quasi-experimental mixed-methods design nested within the ‘REStORing health of acutely unwell adulTs’ (RESORT) prospective, observational, longitudinal cohort of geriatric rehabilitation inpatients study. Setting Geriatric rehabilitation wards in a major metropolitan public hospital between June 2019 and March 2020. Intervention The ‘Ending Pyjama Paralysis’ movement originated in the UK. Its aim was to encourage patients to ‘Get up, Get dressed and Get moving’ to reduce hospital-associated functional decline. However, the physical and functional benefits of this campaign have not yet been evaluated. The ‘Ending Pyjama Paralysis’ was adopted as an integrated intervention on two out of four geriatric rehabilitation wards. The two control wards received usual care. Main Measures Physical measures included the Short Physical Performance Battery, and functional measures included the Katz Index of Independence in Activities of Daily Living and Lawton and Brody’s Instrumental Activities of Daily Living, which were completed on admission and discharge. A linear mixed-effects model was used to analyse the results. Results A total of 833 admissions were included in this study. Of these, 512 patients were in the control group, and 321 were in the intervention group. There were no significant differences in both physical and functional measures between the intervention and control groups. Conclusion The ‘Ending Pyjama Paralysis’ campaign did not result in enhanced functional or physical benefits in geriatric rehabilitation inpatients in this setting when applied in addition to usual care.

Comprehensive evaluation of older patients with suspected malignancy: 5-year experience of a tertiary geriatric inpatient unit

Objective Geriatric cancer population is growing. Both cancer and geriatric conditions are associated with some degree of inflammatory burden. To comprehensively present our five years of experience in patients with suspicion of a malignancy, signs and symptoms that are more prominent as indicator of malignancies, conditions that cause malignancy-like symptoms, and common malignancies and newly diagnosed malignancies in geriatric patients with a history of cancer. Methods Patients hospitalized with suspected malignancy in a geriatric inpatient unit were included. Demographic data, hospitalization symptoms, clinical findings, smoking history, laboratory and further examinations, comprehensive geriatric assessment scores, length of hospital stay and discharge diagnoses were examined. Endoscopy and colonoscopy findings were also recorded. Results Of the 1,104 patients hospitalized for various reasons in the five-year period, 197 (106 women) were suspected of having a malignancy. Mean age was 78.22 ± 7.27. A total of 65 (33%) patients were diagnosed with a malignancy. Amount of smoking (pack/year) and geriatric depression scale (GDS) scores were significantly higher in malignant group (p = .009; p < .001; respectively). Of the hospitalization symptoms, frequency of lumbar-hip-back pain was significantly higher in the malignant group (p = .043). The three most common cancers were hematologic (32%), lung (15%), and gastrointestinal cancers (15%). Gastritis was the most common pathological finding from gastroscopies (58%), and adenoma from colonoscopies (24%). Malignancies were detected in 40% of patients with a history of malignancy, and 55% of the newly detected malignancies were new primaries. Immunoglobulin G4-related disease was one of the detected interested benign conditions. Conclusion The frequency and presentation patterns of malignancies may differ in older adults. Depressive symptoms are common in geriatric cancer patients. Geriatric patients with a history of malignancy should be evaluated in detail for new primary malignancies.

Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography.

Patient safety for people experiencing dementia in acute hospitals is a global priority. Despite national strategies as well as safety and quality guidelines, how safety practices are enacted within the complexities of everyday work are poorly understood and articulated. Using video reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people experiencing dementia and/or delirium in Australia. Patients, family members, and staff members participated by: allowing researchers to document fieldwork notes and video-record their practices and/or accounts thereof; and/or interpreting video-recordings with researchers to co-analyse and make sense of the data. Safe care for people experiencing advanced dementia involved: negotiating risk via leadership, teamwork, and transparency; practice-based learning through situated adaptation; managing personhood versus protocols by doing the 'right' thing; joyful and meaningful work; as well as incorporating patient and family voices to do safety together. Patient safety for people experiencing dementia requires continuous responsiveness and prioritising in the context of multiple risks by a staff collective with a shared purpose. Ongoing research to better understand how the nuances of patient safety unfold in everyday complex clinical realities in diverse contexts and with key stakeholders is required.

Utilizing IADL Score to Improve Community Service Referrals at Discharge From an Inpatient Geriatric Psychiatric Unit

Utilizing IADL Score to Improve Community Service Referrals at Discharge From an Inpatient Geriatric Psychiatric Unit

Challenges of Agitation in Dementia: A Plea for Early Discussion.

Behavioral and psychological symptoms of dementia (BPSD) occur frequently among people with dementia and are known precipitants for placement in care facilities. Despite the social, financial, and psychological impact on dementia care, education and discussions on BPSD have not been routinely included in advance care planning (ACP). As a result, families can face great challenges in making complex medical decisions when their loved ones are admitted to the geriatric psychiatric inpatient unit with refractory BPSD. We present the case of an 83-year-old gentleman with BPSD to illustrate universal struggles in dementia care experienced by many families, which could have been alleviated by education and discussions around BPSD earlier in the patient's dementia course. A literature search did not yield any articles that mention discussions of BPSD in ACP. The lack of literature referencing BPSD in ACP supports our clinical experiences with the case and highlights the need for improvement in current dementia care. We propose a guideline for providers to facilitate conversations around BPSD as an integral part of ACP, including discussions of four key points related to the progressive nature of dementia, the commonality of BPSD, the lack of FDA-approved treatment for BPSD, and the difficulty in balancing agitation and sedation to allow safe placement. We firmly believe it is important to start discussion on BPSD as part of ACP as early as possible. Early education and discussion will help to facilitate meaningful care decisions as patients and families navigate the challenges associated with this progressive disease.

The impact of COVID-19 pandemic on the geriatric inpatient unit

Objective We aimed to determine the effects of the pandemic on the inpatients in the geriatric unit by comparing the demographic and clinical characteristics, reasons for hospitalization, morbidity, and mortality of the patients before and during the pandemic. Methods The population of this retrospective, cross-sectional study consisted of inpatients in the geriatric unit for two years (11 March 2019–10 March 2021). The patients were separated into two groups according to the hospitalization time as pre-COVID-19 and COVID-19 period. Hospitalization types, reasons for hospitalization, length of stay, demographic data, chronic diseases, drugs, developed morbidities, discharge, and 1-year mortality status of the patients were recorded. Results Three hundred and fifty patients were included in our study. The mean age was 80.4 ± 8.02. It was observed that the number of hospitalized patients decreased by ∼50% in the COVID-19 period. However, there was a significant decrease in hospitalization due to the control of chronic diseases during the COVID-19 period (p = .008). The number of inpatients from the emergency department was found to be higher during the COVID-19 period (p < .001). Regarding the presence of geriatric syndromes, polypharmacy (p = .011) and delirium (p = .035) were found to be significantly less in the pre-COVID-19 period. The percentage of malnutrition was also detected as lower, but it was not statistically significant. In terms of 1-year mortality, although not statistically significant, the all-cause mortality rate was higher during the COVID-19 period (p = .08). Conclusions Pandemic has greatly affected the geriatric unit. The prognosis of the patients has worsened and mortality rates have increased. Physiological and psychological deterioration caused by quarantine measures, worsening chronic diseases, and immunosenescence affected the prognosis of geriatric patients. This adds to the previous literature by proving the fact that older individuals are the most vulnerable group in the pandemic.

Effect of a geriatric unit in the outcomes of hospitalized older Mexican adults with cancer: A case-control study

IntroductionGeriatric interventions may improve the care of hospitalized older adults with cancer, but information regarding their effect on geriatric-specific outcomes is lacking. We studied the effect of a specialized geriatrician-led inpatient geriatric management unit compared with a conventional internal medicine ward on the outcomes of hospitalized older adults with cancer in Mexico. Materials and MethodsCase-control study including persons aged ≥65 years with solid malignancies who had a cancer-related hospitalization at a university-affiliated hospital in Mexico City. Patients hospitalized in a geriatric unit (cases) were paired 1:2 with those in internal medicine wards (controls). Matching criteria included: age (+/− five years), tumor type (according to International Classification of Diseases [ICD]-10 code), and admission date (+/− three months). The association between being hospitalized in the geriatric unit on various outcomes was determined using conditional logistic regression models. ResultsOne hundred cases and 200 controls were included. Mean age was 75.3 years (standard deviation 6.4 years) and 53% had gastrointestinal tumors. No difference in median length-of-stay was found between cases and controls (9.0 days, vs. 9.5 days, p = 0.34). Hospitalization in the geriatric unit was associated with a reduced risk of delirium (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.04–0.80). Being hospitalized in the geriatric unit was not associated with an effect on hospital-acquired complications (OR 0.83, 95% CI 0.47–1.45) or in-hospital mortality (OR 1.82, 95% CI 0.32–10.18). DiscussionAmong older Mexican adults hospitalized for a cancer-related diagnosis, receiving care in a geriatric management unit was associated to a decreased risk of delirium, without influencing other outcomes.

Transforming an Orthopaedic Unit Into an "Age-Friendly" Unit Through Implementation of the American Geriatrics Society's CoCare: Ortho Program.

To transform an inpatient orthopaedic unit into an age-friendly unit for geriatric fracture center (GFC) patients. Pragmatic dissemination study of a continuous quality improvement intervention with episodic data review. Large quaternary care university hospital with no on-site geriatrics program and no dedicated geriatric inpatient unit. Individuals 60 years of age and older with fragility fracture of the native proximal femur hospitalized from July 2017 to June 2020. A hospital medicine-orthopaedics comanagement model for a GFC was developed using processes, tools, and education provided by the American Geriatrics Society's AGS CoCare: Ortho program to support the age-friendly 4Ms principles: mentation, mobility, medications, and what matters. Delirium reduction strategies included minimizing sleep interruption through changes in blood draw times, order sets for pain management, and nursing education. Mobility specialists were incorporated to improve early mobilization on the orthopaedic unit. Frequency of weight-bearing on postoperative day 1 and frequency of delirium among GFC patients on the orthopaedic unit were compared with those among concurrent GFC patients on other units. Frequency of delirium was 26% among patients on the orthopaedic unit versus 35% among those on other units (P = 0.055). Frequency of weight-bearing on post-operative day 1 was 84% among patients on the orthopaedic unit versus 72% among those on other units (P = 0.003). AGS CoCare: Ortho is an effective dissemination program for establishing a hospital medicine-orthopaedics comanagement program and making an orthopaedic unit age-friendly in a hospital without onsite geriatricians or a dedicated geriatrics unit. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol

BackgroundGeriatric hospital wards are highly medicalised environments with limited opportunities for choice and control, and can be distressing for older survivors of psychological trauma. While trauma-informed models of care (TIC) are effectively applied across mental health and other settings, the utility of these models in aged care settings has not been assessed. The objective of this study was to examine whether TIC can reduce responsive behaviour, chemical restraint, and improve staff skills and patient experiences in inpatient geriatric settings.MethodsFour wards participated in this type I hybrid implementation-effectiveness study across southern Adelaide, Australia, including 79 beds. Using a co-design method, the principles of TIC were transformed into an implementation strategy including staff training, establishment of highly trained ‘champions’ on each ward, screening for trauma-related needs, and amending ward policies and procedures. Primary outcomes will be examined using an interrupted time-series design and are monthly incidence of responsive behaviour incidents and use of chemical restraint. Process evaluation will be used to examine secondary, implementation outcomes including the acceptability, feasibility, and fidelity to the implementation strategy.DiscussionTrauma-informed care has potential to improve the safety and accessibility of hospital wards for older people who have survived psychologically traumatic events and has an extensive evidence base supporting its effectiveness in other settings. Identifying trauma-related needs and amending care to reduce the risk of re-traumatisation and distress may also reduce the incidence of responsive behaviour change, which has a significant impact on the quality of life of hospital patients and staff and is very costly. The inclusion of a process evaluation will allow us to identify and report changes made on each ward and make recommendations for future implementation efforts.

Effect of a geriatric management unit on the outcomes of hospitalized older adults with cancer in Mexico.

12039 Background: Geriatric assessments and interventions improve the outcomes of hospitalized older adults with cancer, but their implementation in developing countries is limited. We studied the effect of a specialized geriatrician-led inpatient geriatric management unit compared with a conventional internal medicine ward on the outcomes of hospitalized Mexican older adults with cancer. Methods: This retrospective study included patients aged ≥65 with solid tumors who had a cancer-related hospitalization at a public academic center in Mexico City between March 2015 and October 2018. Patients hospitalized in the geriatric management unit (cases) were paired in a 1:2 fashion with those in internal medicine wards (controls). Pairing was done by age (+/- 5 years), tumor type, and admission date (+/- 3 months). We studied the effect of being hospitalized in the geriatric management unit on length of stay (LOS), incidence of delirium, hospital-acquired complications, and in-hospital mortality. Multivariate logistic regression models for each outcome were created using variables which were significant on univariate analysis. Results: 300 patients (100 cases, 200 controls, median age 75) were included. The most common tumors were gastrointestinal (GI) (53%) and genitourinary (25%). Both groups were comparable regarding baseline comorbidities (Charlson index 8.5 vs. 7.7, p = 0.99) and illness severity at admission (NEWS2 score 2.6 vs. 2.3, p = 0.82). No difference in median LOS was found between cases and controls (9.1 vs. 9.5 days, p = 0.34). Diagnosis of a GI tumor (OR 3.4, 95% CI 1.3-5.5), hospital-acquired complications (OR 4.9, 95% CI 2.5-7.3), and delirium (OR 5.5, 95% CI 2.3-8.7) were associated with longer LOS. 14% of patients in both groups had delirium. Hospitalization in the geriatric management unit reduced the risk of delirium (OR 0.35, 95% CI 0.1-0.9), while a higher Charlson index (OR 1.2, 95% CI 1.0-1.4), NEWS2 score (OR 1.2, 95% CI 1.1-1.4), and hospital-acquired complications (OR 7.3, 95% CI 2.9-18.5) increased it. 34% of patients developed hospital-acquired complications. Diagnosis of a GI tumor (OR 1.9, 95% CI 1.1-3.3) and higher NEWS2 score (OR 1.2, 95% CI 1.1-1.4) increased the risk of hospital-acquired complications. No differences in in-hospital mortality were seen between cases and controls (12% vs. 10%, p = 0.59). A higher NEWS2 score at admission (OR 1.4, 95% CI 1.2-1.7) and delirium (OR 10.7, 95% CI 3.2-36.3) increased the risk of death. Conclusions: Among older Mexican adults hospitalized for a cancer-related diagnosis, receiving care in a geriatric management unit led to a significant decrease in the risk of delirium. No improvements were seen in LOS, complications, or in-hospital mortality, which were associated with tumor and patient-related characteristics. Geriatric co-management can lead to improved geriatric outcomes in developing countries with limited resources.

Electroconvulsive Treatment(ECT) in the presence of titanium cochlear implant: a case report

<h3>Introduction</h3> Several questions remain regarding the safety of ECT in the presence of cranial metallic objects. Foreign objects may lead to electrical field disruptions resulting in ineffective treatment and complications. Few reports of cases describe the safety of ECT with cranial foreign objects like cerebral clipping systems, coils and other foreign bodies. For some of these cases the placement of ECT electrodes had to be modified. <h3>Methods</h3> Review of a case seen and treated on our geriatric inpatient unit <h3>Results</h3> We present the case of a 67 year old man who presented to our inpatient unit with severe depression with psychotic features. He poorly responded to treatment with an antidepressant and anti psychotic at target doses. He had a congenital right ear deformity with hearing loss for which he had a titanium cochlear implant placed many years ago. Patient received 11 sessions of right unilateral ECT. The electrode placement was not modified. He had good and appropriate seizures. He reported only minor discomfort with reports of mild muscle ache around the right jaw. His symptoms remitted. There was no objective evidence of cognitive impairment from ECT; weekly MOCA were between 25-30/30 and he did not report confusion, headache, or amnesia post ECT. <h3>Conclusions</h3> The presence of a foreign object may not be an absolute contraindication to ECT. Each case should be considered and assessed to ensure safety. <h3>Funding</h3> Not applicable

Considerations for delirium screening in response to a case of COVID-19 on an inpatient geriatric psychiatric unit

IntroductionWhile the COVID-19 pandemic caused by the SARS-CoV2 virus has challenged healthcare systems across the country, inpatient psychiatric hospitals struggle with a unique challenge. Psychiatric patients participate in therapy groups and eat meals together on milieus. It is difficult to enforce mask use or self-isolation practices in the setting of psychosis or mania.Additionally, neuropsychiatric disorders such as new onset psychosis, delirium, and affective disorders have all been documented following a SARS-CoV2 infection. A surveillance study from the UK found that primary psychiatric diagnoses were most common in younger patients and encephalopathy was more common in older adults following a SARS-CoV2 infection. A multicenter cohort study looking specifically at older adults found that 226 (28%) of 817 geriatric patients with COVID-19 had delirium at ED presentation. Delirium was the sixth most common of all presenting symptoms of COVID-19. Of patients with delirium, 16% had delirium as a primary presenting complaint and 37% had no fever or shortness of breath.Our psychiatric hospital has a geriatric psychiatry service, which has generated further challenges during the pandemic. The hospital requires COVID-19 testing prior to admission, but false negatives are possible. We continue to adapt our procedures to best serve this vulnerable population as we learn more about COVID-19 and atypical presentations. We provide a case report of a geriatric psychiatry patient who presented with delirium secondary to COVID-19 and the subsequent consideration in our admission process.MethodsA case report of a patient who was admitted to the geriatric psychiatry inpatient service and was found to have delirium as a presenting COVID-19 symptom. A review of neuropsychiatric manifestations of COVID-19 will be presented.ResultsMs. A is an 80-year-old woman with history of major depressive disorder, recent non-ST-elevation myocardial infarction, aortic stenosis, ischemic cardiomyopathy, and hypertension. She was originally admitted to the inpatient psychiatry from the ED for suicidal ideation and worsening depression but was found to be inattentive and disoriented. She had multiple falls in the several days leading up to admission, but no respiratory symptoms or fever. The geriatric psychiatry service determined she was delirious and started medical work up for etiology. Her rapid COVID-19 test at an outside facility was negative. Her medical work up was remarkable for a leukocytosis of 11 ×109 per liter, and an acute kidney injury (AKI) with BUN 20 mg/dL and Creatinine 1.31 mg/dL increased acutely from baseline of 0.9. Urinalysis was negative for infection. She was transferred to the emergency room for encephalopathy and declining oral intake. There, she tested positive for COVID-19 by PCR and was admitted to medicine for delirium of likely multiple etiologies including COVID-19. Her EEG showed generalized slowing and her head CT was negative for hemorrhage or infarction. The consult liaison psychiatry service continued to follow Mrs. A during her three-week hospitalization, during which she required Olanzapine 2.5 mg as needed for agitation related to her hyperactive delirium. Her AKI resolved with intravenous fluids and avoidance of nephrotoxic agents. She was discharged into the care of family on psychiatric medications fluoxetine 40 mg and mirtazapine 45 mg after her delirium gradually resolved with supportive care including physical and occupational therapy.ConclusionsThe diverse clinical presentation, often multifactorial etiology and the waxing and waning course of delirium makes it difficult to diagnose in an emergency room setting even for experienced physicians. Delirium can present with depressive, cognitive, and psychotic symptoms. It is not uncommon for delirious geriatric patients to be admitted to our inpatient unit for agitation, psychosis or depression, as was the case with Ms. A. Delirium can be a presenting symptom of COVID-19. Given this and our unique circumstances on a psychiatric milieu, we need to take greater consideration when assessing for delirium and other possible neuropsychiatric symptoms of SARS-CoV2 infection prior to admission. Grossman et al. developed a modified confusion assessment method for the emergency department (mCAM-ED) that requires 3 to 5 minutes to complete the whole instrument. However, despite having this and other tools, formal assessment tools for delirium are rarely used in the ED.It is important that geriatric patients are triaged to the appropriate level of care so proper medical treatment can be initiated without delay, as prolonged encephalopathy can lead to permanent decline in cognitive function, worse outcomes, and increased mortality. This case reinforces the clinical importance of including delirium on checklists of presenting symptoms of COVID-19, specifically for geriatric patients, that guide standardized screening, evaluation, and treatment.FundingThe authors received no financial support for the research, authorship, and/or publication of this article.

Improving the assessment and documentation of patient mobility using a quality improvement framework

ObjectiveTo implement a system for assessing and documenting patient mobility in an inpatient geriatric unit using a quality improvement framework. MethodsWhiteboards incorporating the Johns Hopkins Highest Level of Mobility scale were placed on each door of the unit. Staff were trained to assess and document patient mobility, and documentation compliance was measured. Nurses were surveyed to assess perceived burden of the system. Fall rates were calculated and analyzed for change from baseline. ResultsMedian daily documentation rates reached 79% by the end of the project. Surveys indicated a low perceived burden of the system. Fall rates did not increase when compared to the previous year baseline (p = 0.80) and the analogous time frames during the previous two years (p = 0.84). ConclusionA quality improvement framework may be used to improve mobility assessment and documentation in a geriatric unit without increasing patient falls or nursing burden.

Improving Communications With Patients and Families in Geriatric Care. The How, When, and What.

There has been little published literature examining the unique communication challenges older adults pose for health care providers. Using an explanatory mixed-methods design, this study explored patients’ and their family/caregivers’ experiences communicating with health care providers on a Canadian tertiary care, inpatient Geriatric unit between March and September 2018. In part 1, the modified patient–health care provider communication scale was used and responses scored using a 5-point scale. In part 2, one-on-one telephone interviews were conducted and responses transcribed, coded, and thematically analyzed. Thirteen patients and 7 family/caregivers completed part 1. Both groups scored items pertaining to adequacy of information sharing and involvement in decision-making in the lowest 25th percentile. Two patients and 4 family/caregivers participated in telephone interviews in part 2. Interview transcript analysis resulted in key themes that fit into the “How, When, and What” framework outlining the aspects of communication most important to the participants. Patients and family/caregivers identified strategic use of written information and predischarge family meetings as potentially valuable tools to improve communication and shared decision-making.

Retrospective Analysis of Demographic, Psychiatric, and Physical Characteristics That Impact Length of Stay on an Inpatient Geriatric Psychiatric Unit

Currently, the aging adult population is rising fast and presenting multiple challenges for the US healthcare system. Older adults present unique challenges in their care of medical and psychiatric conditions. This study retrospectively examined characteristics that are associated with length of stay on an inpatient geriatric psychiatric unit in an urban located psychiatric hospital. A sample of 74 individuals was examined. Factors that influenced length of stay included commitment status and discharge to a different level of care. Reducing the length of stay for geriatric patients can help reduce costs and improve health outcomes.

302 - The Effectiveness and Safety of Electroconvulsive Therapy for Treatment Refractory Agitation or Aggression in Major Neurocognitive Disorder

Introduction:Fifty to ninety percent of individuals with Major Neurocognitive Disorder (MNCD) have Neuropsychiatric Symptoms (NPS)1. Agitation and aggression are amongst the most persistent and treatment-refractory symptom clusters. Patients with these NPS are associated with increased risk of institutionalization, psychotropic medication use, caregiver burden, and mortality2.Safe and effective treatments for NPS are lacking. Consensus guidelines emphasize the initial use of non-pharmacologic approaches though supportive evidence is limited3.Extensive research has established the safety and efficacy of ECT in elderly patients with depression and other psychiatric conditions6. Clinical experience suggests that ECT is a valuable treatment option in MNCD-related treatment refractory NPS cases7-10. However, data supporting the efficacy and safety of this practice is scant.Materials and Method:Patients admitted to the geriatric psychiatry inpatient units who meet the inclusion criteria, were recruited from 2 Vancouver sites and 3 unit at Ontario Shores. These patients had an anesthesia consultation to evaluate their safety of going through ECT. Consent was obtained from their substitute decision makers. All patients enrolled are already on psychotropic medications.