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1
Empleo-Frazier, Ophelia, Ami Marshall, Margaret Doyle, Andrea Rink, Noelle Gallant, Barry Wu, and Richard Marottoli. "AN AGE-FRIENDLY COURSE ADOPTING THE 4M GERIATRIC MODEL IN A PRIMARY CARE NURSE PRACTITIONER PROGRAM." Innovation in Aging 6, Supplement_1 (November 1, 2022): 755. http://dx.doi.org/10.1093/geroni/igac059.2741.
Повний текст джерелаАнотація:
Abstract Training nurse practitioners to assume an expanded role in management of geriatric patients is key to addressing the care needs of a growing older adult population. To that end, the Yale School of Nursing revised geriatric coursework required of family nurse practitioner (FNP) and adult geriatric nurse practitioners (AGNP) to ensure the curriculum was sufficiently in-depth, engaging, and inclusive. Revisions included a new course, “Advanced Primary Care of the Older Adult” which focuses on the role of the nurse practitioner in the assessment, diagnosis, and management of primary geriatric syndromes. The 4M model (Medications, Mentation, Mobility, and what Matters most) provided the framework. Additionally, faculty added expert speakers, interactive dementia animated videos, book and movie discussions and a geriatric telehealth simulation component. Content was guided by training needs data collected from prior nurse practitioner students. At the end of each course, students were surveyed to assess attitudes towards geriatric care and satisfaction with the course. We compared survey responses pre (academic year 2019–2020, Nf18, response rate=53%) and post (academic years 2020–2021 and 2021–2022, Nf28, response rate=44%) rollout. In multivariate regression analyses adjusted for differences in age, gender, race, program (AGNP and FNP) and previous geriatric experience, we found significant improvement in measures of both confidence in providing geriatric care and satisfaction with course content. Analysis of qualitative data confirmed student satisfaction with the new course. Future work will include expansion and more rigorous evaluation of the program, including measures of student knowledge of best practices and increasing survey participation rates.
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Martin-Plank, Lori. "Advocacy as an Academic and Nurse Practitioner." Innovation in Aging 4, Supplement_1 (December 1, 2020): 683. http://dx.doi.org/10.1093/geroni/igaa057.2383.
Повний текст джерелаАнотація:
Abstract The first speaker is Dr. Lori Martin-Plank, an established academic at the University of Arizona, College of Nursing. Dr. Martin-Plank will provide her experiences in advocating for older adults in Pennsylvania and nationally through professional organizations, meeting with coalition partners to promote access to care for vulnerable older adults in rural areas by promoting full practice authority for nurse practitioners, and advocating for full home health authority for nurse practitioners. Dr. Martin-Plank will share how she is active in advocacy and policy at the local, state and federal levels, and how to build a presence and relationship with legislators on The Hill and State Capitol. Dr. Martin-Plank is a family, gerontological, and mental health nurse practitioner, practicing in Pennsylvania, New Jersey, and Arizona.
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McGilton, Katherine. "THE LONG-TERM CARE STAFFING CRISIS AND COVID-19: ROLE OF THE NURSE PRACTITIONER." Innovation in Aging 6, Supplement_1 (November 1, 2022): 186. http://dx.doi.org/10.1093/geroni/igac059.743.
Повний текст джерелаАнотація:
Abstract The residential long-term care sector has historically suffered from seemingly intractable staffing challenges in terms of ensuring adequate clinical expertise and a supportive work environment to address the complex health care needs of residents. Considerable evidence has demonstrated the devastating effect of COVID-19 on this fragile residential long-term care staffing structure, resulting in adverse outcomes among staff and residents alike, with the potential for permanent devastation without directed intervention. Drawing upon data from an Ontario-based study of nurse practitioner deployment during COVID-19, this talk will share an emergent approach to re-shaping expertise and capacity in Ontario, Canada through embedding nurse practitioners in residential long-term care homes. Results of this work helped to inform health policy action in the province to scale-up the use of nurse practitioners in long-term care homes, in order to enhance staff expertise and tackle the significant inequities of access to care among nursing home residents.
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Kennedy-Malone, Laurie. "Simulating Treating in Place in Long-Term Care: Interprofessional Team Care Video Case for Nurse Practitioners." Innovation in Aging 5, Supplement_1 (December 1, 2021): 755. http://dx.doi.org/10.1093/geroni/igab046.2801.
Повний текст джерелаАнотація:
Abstract As a means of enhancing clinical simulation opportunities for adult-gerontology nurse practitioner students, a series of video simulations were created for use for nurse practitioner education. With funding through the Health Resources and Service Administration (HRSA) Advanced Nursing Education Workforce grant and partnering with nurse practitioner clinical educators from Optum Health Care, a video simulation focused on the concept of treating an older veteran within a long-term care facility rather than transferring to the acute care setting was developed. The case Treating in Place: Nurse Practitioner-Led Team Management of a Long-Term Care Patient Video involved a nurse practitioner collaborating with a physician, a registered nurse, a social worker, and a family member. The interactive simulation video was developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face-to-face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. A faculty handbook that describes the case scenario with the interactive questions and suggested discussion questions is available. The adult-gerontology primary care nurse practitioner competencies addressed for this case are identified in the faculty handbook. These videos have been widely disseminated and are being included in nurse practitioner curriculum across the country. A QR code with access to direct viewing of the video will be included in the presentation.
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Picella, David, and Diana Woods. "Clinical Geriatrics as a Team Sport: Fostering Interprofessional Experiences in the Community." Innovation in Aging 5, Supplement_1 (December 1, 2021): 820. http://dx.doi.org/10.1093/geroni/igab046.3010.
Повний текст джерелаАнотація:
Abstract Team-based care is necessary to provide better healthcare outcomes for the complex needs of older adults. Shared clinical learning experiences prepare practitioners to work in collaborative partnership to achieve optimal outcomes. To promote collaborative partnership, we established interprofessional community based clinical experiences with older adults at home, in assisted living and in skilled nursing facilities. One nurse practitioner faculty member was paired with 2 students for each clinical experience day. Initially these were face-to-face encounters, however, with the onset of COVID-19, all high-risk encounters were converted to a virtual modality. The clinical encounters focused on the Age Friendly Model (4M). Post clinical discussions and recommendations focused on interprofessional treatment plans. A REDCap(TM) survey was completed by all student participants for program evaluation. Of the 14 surveys sent, 11 were completed; 10 (77%) females; 3 (23%) males; 7 (50%) family practitioner students; 7 (50%) adult-gerontology nurse practitioner students. Four had previous home health experience (14%), and 10 had none (86%). 4M Likert scale (1-5) means were “what matters” = 4.27, medications = 4.18, mentation = 4.09, and mobility = 4.09. Students found the overall experience valuable (mean = 4.27). Of 11 students, 3 (27%) were involved telehealth experiences. Students found real community based clinical experiences to be very enlightening, offering a different perspective, and altering their appreciation for the everyday life of the older adult. Future plans include adding social work and physical therapy students to these clinical experiences to enhance interprofessional education.
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Fortinsky, Richard, and Shawn Ladda. "DEMENTIA CARE IN NURSE PRACTITIONER-LED CARE MANAGEMENT FOR COGNITIVELY VULNERABLE OLDER ADULTS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 254. http://dx.doi.org/10.1093/geroni/igac059.1008.
Повний текст джерелаАнотація:
Abstract Care management approaches are being widely tested in the Medicare-eligible population to manage chronic conditions, but few have focused on cognitive vulnerability as the pathway to optimizing independence in the community-dwelling older population. Cognitive vulnerability refers to living with dementia, depression, and/or a history of delirium. This presentation features a nurse practitioner-led team care management model (3D Team) to address cognitive vulnerability, tested in an ongoing clinical trial with older adults in a Medicare Advantage population. For older adults with dementia and their families served by the 3D Team, the nurse practitioner works closely with occupational therapists (OTs) delivering a nonpharmacological dementia care intervention. Preliminary results presented will include: characteristics of dyads that have received the dementia care intervention (N=70 dyads to date), how the nurse practitioner and OTs communicate, how the nurse practitioner reinforces dementia care skill-building strategies introduced by OTs, and process evaluation results to date.
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Pariseault, Christine, Nancy Sharts-Hopko, and Elizabeth Blunt. "Nurse Practitioners’ Experiences of Polypharmacy in Community-Dwelling Older Adults." Innovation in Aging 4, Supplement_1 (December 1, 2020): 207. http://dx.doi.org/10.1093/geroni/igaa057.670.
Повний текст джерелаАнотація:
Abstract Numerous studies exist that define polypharmacy and its impact on health. Additionally, the literature is rich in studies documenting the benefits of care provided by nurse practitioners. A gap in research exists at the intersection of the value of nurse practitioners in caring for older adults and their management of polypharmacy. Coinciding with a growth of America’s older adult population and the need for adequate care, the purpose of this study was to explore the experiences of nurse practitioners caring for older adults experiencing polypharmacy. A qualitative descriptive study was conducted using a purposive sampling of nurse practitioners who care for older adults. Interviews were conducted and data was analyzed for themes. Four themes emerged: defining polypharmacy, communicating and collaborating, clinical judgement of nurse practitioners in relation to polypharmacy, and medication issues of older adults. Major themes emerged that depict the complexity of medication management in older adults as well as the important role of NPs in providing care to older adults. The significance of the study findings to future practice includes improving communication and collaboration of prescribing health care providers, better identification and management of polypharmacy, and improving the health care delivered to older adults. Safe and effective prescribing for older adults requires NPs consider the unique needs of each older adult while utilizing technology to support collaboration and decision making.
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Obuchon, Kathleen. "Nurse Practitioner’s Role as 3D Team Leader." Innovation in Aging 4, Supplement_1 (December 1, 2020): 745. http://dx.doi.org/10.1093/geroni/igaa057.2679.
Повний текст джерелаАнотація:
Abstract The nurse practitioner’s (NP) clinical activities during the 12-month intervention period include 4 monthly in-home visits and 8 monthly telephone contacts. This presentation will detail the clinical assessments and activities conducted during the initial home visit, and how subsequent home visit activities and interventions are structured for older adults and their informal caregivers depending on whether older adults have dementia, depression, and/or recent delirium. Because the potential for medication-related problems is a critical concern for older adults with cognitive vulnerability, this presentation also will detail how the NP works with the 3D Team pharmacist to determine potential inappropriate medications through a review and reconciliation process, and how the NP and pharmacist summarize these results and correspond accordingly with the older adult’s primary care physician. Finally, this presentation will explain how the NP manages communication among members of the 3D Team who provide interventions to the same older adult and caregiver.
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Kim, Jennifer, Kanah Lewallen, and Taylor Boll. "Teaching Nurse Practitioner Students About Polypharmacy Through a Lived Experience." Innovation in Aging 4, Supplement_1 (December 1, 2020): 209–10. http://dx.doi.org/10.1093/geroni/igaa057.677.
Повний текст джерелаАнотація:
Abstract Polypharmacy (typically defined as the concomitant use of 5 or more medications) affects 40-50% of older adults in the U.S., and is associated with geriatric syndromes, a higher risk of medication non-adherence, and adverse drug events. Medication non-adherence is a common frustrating clinical issue for clinicians who provide care for older adult patients. Simultaneously, patients often find medication regimens to be complicated and confusing. This may contribute to medication non-adherence, which may further lead to adverse drug events and/or negative health outcomes. The more medications a patient is taking, the higher the risk for non-adherence. Thirty-eight students enrolled in an adult-gerontology primary care nurse practitioner program were given a bag of five mock medications that are commonly prescribed for older adults. Students were instructed to follow the directions on each of the bottles for approximately one month. A private messaging system was available for students if refills were needed or if they had questions about their medications. A debriefing session for this month-long, ungraded simulation was held, at which time students returned medication bottles. Pill counts were not analyzed, but all returned bottles contained mock medications. Approximately 52.6% of students estimated adhering to the medication regimen 0-24% of the time, whereas 26.3% reported an adherence rate of 25-50%. The most commonly cited barrier to adherence (55.3%) was “forgetfulness”. Nearly all students (89.5%) reported that the exercise “very much” increased their awareness of challenges patients face when managing medications, and 97% cited an increased awareness of ways to improve medication adherence.
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Christian, Thomas J., Joan Teno, Pedro L. Gozalo, and Michael Plotzke. "HOSPICE VISIT INTENSITY BY PHYSICIANS AND NURSE PRACTITIONERS ON THE GENERAL INPATIENT LEVEL OF CARE." Innovation in Aging 3, Supplement_1 (November 2019): S7. http://dx.doi.org/10.1093/geroni/igz038.021.
Повний текст джерелаАнотація:
Abstract The Medicare Hospice Benefit’s General Inpatient (GIP) level of care provides short-term services for pain and symptom management in an inpatient facility that cannot be managed in the patient’s home. Relatively little is known about how beneficiaries utilize services during GIP care. Among a cohort of Medicare hospice beneficiaries utilizing GIP during Federal Fiscal Year 2014 (FY2014), we used 100% Medicare hospice and Part B claims to identify physician and nurse practitioner services concurrent with GIP dates. We estimated logistic regression models to determine the likelihood a beneficiary never receives physician or nurse practitioner services. We found that among the 1.5 million GIP days serviced in FY2014, more than half (52.4%) lacked any recorded physician or nurse practitioner services. Absence rates for these services were particularly high among hospice GIP days provided in inpatient facilities (69.1% missing services), long-term care hospitals (84.3% missing services), and skilled nursing facilities (85.3% missing services). Moreover, one in five hospice episodes having at least three sequential GIP days lacked any physician or nurse practitioner services. Relative to hospice inpatient units, rates of absence were higher among episodes beginning in long-term care hospitals [59.3% long-term care hospital vs. 11.5% hospice inpatient units; AOR 9.65 95% CI 7.47-12.46] and skilled nursing facilities [51.3% skilled nursing facility vs. 11.5% hospice inpatient units; AOR 5.98, 95% CI 5.63-6.36]. More in depth research and monitoring is needed to further understand dimensions of GIP care provision, to ensure that hospice beneficiaries are receiving adequate services regardless of their inpatient setting.
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McGilton, Katherine, Alexandra Krassikova, Aria Wills, Margaret Keatings, Jennifer Bethell, Veronique Boscart, and Souraya Sidani. "NURSE PRACTITIONER–LED IMPLEMENTATION OF HUDDLES TO SUPPORT STAFF IN LONG-TERM CARE HOMES." Innovation in Aging 6, Supplement_1 (November 1, 2022): 536. http://dx.doi.org/10.1093/geroni/igac059.2039.
Повний текст джерелаАнотація:
Abstract Staff working in long-term care (LTC) homes frequently report experiencing moral distress related to lack of autonomy and not being able to provide quality care. Huddles have been used as a communication tool for many years in acute care settings to improve collaboration and safety culture. In LTC homes, huddles are implemented less often, despite evidence of their benefits in improving support and teamwork. In this pre-test post-test implementation study, huddles led by a nurse practitioner (NP) were introduced in a privately-owned not-for-profit LTC home with < 150 beds, located in a medium urban centre in Ontario, Canada. Objectives of the study were to 1) examine fidelity of huddle implementation; 2) examine the extent to which the huddles improved staff’ outcomes of moral distress, job satisfaction, and support provided by the NP estimated with Bayesian proportional odds model. A total of 48 huddles were carried out by the NP over 15 weeks. Huddles were most commonly attended by personal support workers (98%) and registered practical nurses (96%), with an average of 7 individuals per huddle. Topics most often addressed at huddles were related to resident care (46%) and staff concerns (34%). Strong statistical evidence of a reduction in overall moral distress was evident for staff attending the huddles, when compared to staff who did not (posterior probability =.9933). No changes in job satisfaction and support provided by the NP were observed. Introducing huddles in LTC homes may be effective at reducing moral distress experienced by staff.
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Massimo, Lauren, Lauren Hunt, and Kathleen Buckwalter. "THE GEROPSYCHIATRIC NURSING COLLABORATIVE: ADDRESSING BEHAVIORAL NEEDS OF PERSONS WITH DEMENTIA." Innovation in Aging 6, Supplement_1 (November 1, 2022): 253. http://dx.doi.org/10.1093/geroni/igac059.1005.
Повний текст джерелаАнотація:
Abstract Over the last decade, the Geropsychiatric Nursing Collaborative (GPNC) has sought to improve care of older adults with mental health needs such as those with dementia. Geropsychiatric nurses are well-poised to deliver person-centered care to address the psychosocial needs of persons with dementia, which may include behavioral expressions. In this interdisciplinary symposium, we will highlight approaches members of the GPNC are taking to address mood and behavior in persons with dementia. The first session will describe how persons with mild-cognitive impairment draw upon their inner strength after they receive a diagnosis. The second session will discuss how common behavioral expressions such as anxiety, depression and apathy contribute to difficulty with everyday functional activities in persons with Alzheimer’s disease. The third session will describe an interprofessional communication tool to improve communication of behavioral expression in the nursing home setting. The last session will share findings from a nurse practitioner-led team care management model to address cognitive vulnerability in older adults with dementia, depression, and/or delirium. Together, these presentations describe how geropsychiatric nurses are investigating mood and behavioral symptoms in persons with dementia and addressing their mental health needs with innovative person-centered interventions.
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Kane, R. A., R. L. Kane, S. Arnold, J. Garrard, S. McDermott, and L. Kepferle. "Geriatric Nurse Practitioners as Nursing Home Employees: Implementing the Role." Gerontologist 28, no. 4 (August 1, 1988): 469–77. http://dx.doi.org/10.1093/geront/28.4.469.
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Castle, Nicholas G. "Measuring Caregiver Retention in Nursing Homes." Gerontologist 61, no. 4 (February 1, 2021): e118-e128. http://dx.doi.org/10.1093/geront/gnab012.
Повний текст джерелаАнотація:
Abstract Background and Objectives Retention of nursing home caregivers is examined. This represents the concept of continuously employing the same caregivers in the same facility for a defined period of time. In this research, several measures of caregiver retention are examined and the utility of these measures for practitioners and policy makers is discussed. Research Design and Methods A survey of nursing home administrators conducted in 2016 was used to collect staffing data from 2,898 facilities. This was matched with Nursing Home Compare and the Certification and Survey Provider Enhanced Reporting data. The association of four measures of retention for each of three types of caregivers with six quality indicators was examined. Results The descriptive statistics show rates of retention at 5 years for nurse aides (NAs), registered nurses (RNs), and licensed practical nurses to be low. The regression estimates show some support for the relationship that high caregiver retention is associated with better overall quality. The relationship was strongest for NAs and RNs. Support was also found for the notion that different measures of retention were more/less associated with quality. The 3- and 5-year retention measures had the strongest associations with the quality indicators. Discussion and Implications The findings presented provide some evidence that caregiver retention may be an important metric that can be used as a means of improving quality of care in nursing homes. However, the findings also show practitioners and policy makers should be more nuanced in the use of caregiver retention metrics.
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Halpin, Sean, Kathleen Len, and Michael Konomos. "Talking about Complimentary and Alternative Medicine: A Conversation Analysis Study." Innovation in Aging 5, Supplement_1 (December 1, 2021): 833–34. http://dx.doi.org/10.1093/geroni/igab046.3053.
Повний текст джерелаАнотація:
Abstract Multiple Myeloma (MM) is a clonal plasma cell malignancy characterized by low blood counts and increased risk of infection, and primarily afflicts older adults. Although MM is incurable, advances in treatment, including autologous stem cell transplant (ASCT) has improved the lifespan of patients. MM patients commonly use over-the-counter complementary and alternative medicines (CAM) alongside conventional cancer therapies which, often without recognition by health care practitioners, may impact their treatment. Using data from an 18-month ethnographic study, we applied conversation analysis to examine 1180 minutes of audio-recordings to describe how patients and nurses interacted about CAM during ASCT education visits. Patients (n=12) had a median age of 62 years (IQR= 54-73), were mostly white (n=12, 75%), male (n=9, 56%), and had a moderate score on the FACT-G7 of 15 (IQR= 10-20). All patients had a caregiver present during their visit. Nurses (n=3) were aged 39 (IQR= 29-49) all with at least five years providing care to patients with blood cancers. Results suggested that nurses rarely provided direct feedback about CAM modalities, instead providing brief responses, and moving on to other topics. Excerpts were categorized into three groups, (1) demonstration of implicit epistemic authority, (2) demonstration of deferred epistemic authority in patient-initiated conversations, and (3) demonstration of deferred epistemic authority in nurse-initiated conversations. Understanding how conversations surrounding CAM are navigated can provide insights into patient-communication in general, and methods for improving ASCT education.
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Kaufman, Brystana, Diane Holland, Catherine Vanderboom, Cory Ingram, Alice Chun, Erica Langan, Henry Baer-Benson, and Joan Griffin. "EVALUATING IMPLEMENTATION COSTS FOR A TRANSITIONAL PALLIATIVE CARE INTERVENTION TO SUPPORT RURAL CAREGIVERS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 213. http://dx.doi.org/10.1093/geroni/igac059.850.
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Abstract Compared to urban caregivers, rural caregivers experience greater burdens accessing coordinated care for their loved ones during and after hospital discharge. The impact of technology-enhanced transitional palliative care (TPC) on patient and caregiver outcomes is currently being evaluated in a randomized control trial. This study evaluates resource use and health system costs of this caregiver-focused TPC intervention. Rural caregivers of hospitalized patients in Minnesota, Wisconsin, and Iowa were enrolled in an 8-week intervention consisting of video visits, conducted by a registered nurse, supplemented with phone calls and texts (n=207). Labor costs were estimated using the Bureau for Labor Statistics median hourly rate for a registered nurse and compared to a scenario analysis using a nurse practitioner or social worker wages. Hours spent conducting the visits and charting were calculated using study data. A one-way sensitivity analysis estimated resource use over a range of visits per caregiver and time per visit. Caregivers received 8.8 visits on average over the study period at 45 minutes per visit. In the base case, TPC cost $330 per caregiver facilitated by a registered nurse, compared to $281 and $489 if facilitated by a social worker or nurse practitioner, respectively. The number of visits had the greatest influence on total costs of the intervention (low of $198, high of $463). TPC is a feasible, low cost strategy to enhance caregiver support in rural areas. These results pose an opportunity to consider reimbursement mechanisms to evaluate the sustainability of transitional palliative care interventions to support caregivers.
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Grando, Victoria, and Roy Grando. "Teaching Family Nurse Practitioner Students to Provide Mental Health Care to Older Adults." Innovation in Aging 4, Supplement_1 (December 1, 2020): 10–11. http://dx.doi.org/10.1093/geroni/igaa057.034.
Повний текст джерелаАнотація:
Abstract In recent years, FNPs have been challenged to deliver mental health services in the primary care setting. Over half of mental health services are provided in primary care, and one-quarter of all primary care patients have a mental disorder. Moreover, 20% of older adults have a mental or neurological disorder often not diagnosed. Nationally, it is estimated that 17% of older adults commit suicide, 15% have a mental condition, 11% have dementia, and 5% have a serious mental condition. There is a paucity of adequately prepared primary care providers trained in geropsychiatric treatment. A didactic course was developed to instruct FNP students in the skills needed to provide mental health treatment in primary care. We discuss mental illness in the context of culture to ensure that treatment is congruent with a patient’s unique cultural background and experiences. This shapes the patients’ beliefs and behaviors that influence the way they view their condition and what they perceive as acceptable solutions. We then go into detail about the common mental conditions that older adults exhibit. Through the case study method, students learn to identify the presenting problem, protocols for analyzing the case, which includes making differential diagnoses and a treatment plan including initial medications, non-medical treatments, and referral. Students are introduced to the DMS-5 to learn the criteria for mental health diagnosis with an emphasis on suicide, depressive disorders, anxiety disorders, bipolar disorders, substance use disorders, and neurocognitive disorders. We have found that students most often misdiagnose neurocognitive disorders.
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Picella, David, and Diana Lynn Woods. "CHANGING AGING MYTHS AND READINESS FOR INTERPROFESSIONAL EDUCATION IN FAMILY NURSE PRACTITIONER STUDENTS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 859–60. http://dx.doi.org/10.1093/geroni/igac059.3075.
Повний текст джерелаАнотація:
Abstract The preparation of Family Nurse Practitioner (FNP) students caring for the older adult population is inadequate. The design was a quasi-experimental pilot study (N = 30) to assess change in myths about aging and readiness for interprofessional education (IPE) in FNP students near graduation. The Woolf Aging Quiz (WAQ) containing 24 true-false myths about older adults, and the Readiness for Interprofessional Learning Scale (RIPLS) containing 19 items rated on a 5-point Likert scale (high score indicates more readiness), were completed at baseline and post-intervention. The intervention consisted of 4-weeks of education on normal aging, agism, age friendly healthcare, and IPE using online weekly brief video presentations and peer discussion. Thirty FNP students, mean age 43.5 years, 80.6% (N = 25) female, 19.4% (N = 6) male. A paired t-test showed no significant pre-post difference in the WAQ (t = -1.388, p < .05). McNemar crosstab analysis of the WAQ items indicated 14 aging myths where students chose the wrong answer pre and post intervention. In addition, the RIPLS showed no significant change (t = .793, p < .05) from pre-intervention (mean = 35.87) to post-intervention (mean = 34.42). FNP students near graduation held strong ageist beliefs, reflected in the WAQ, and were unprepared for IPE. Both of these results were resistant to change. The data suggests that FNP programs need to address aging and IPE content earlier and provide students with exposure to older adults that addresses myths about aging affords both theoretical and practical opportunities for interprofessional learning.
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Kennedy-Malone, Laurie M., Karen Amirehsani, Rachel Zimmer, and Joshua Borders. "PROGRESSIVE CARE OF AN AGING WOMAN: INTERACTIVE VIDEO SIMULATION CASES SPANNING 15 YEARS." Innovation in Aging 3, Supplement_1 (November 2019): S974. http://dx.doi.org/10.1093/geroni/igz038.3530.
Повний текст джерелаАнотація:
Abstract As a means of enhancing experiential educational opportunities for adult-gerontology nurse practitioner students who are prepared to manage the complex care of older adults, interactive simulation videos were developed using the eLearning authoring tool H5P to create learning experiences for students that can be used either in face to face classroom experiences or embedded in learning management systems. H5P is a web-based authoring tool that helps faculty build interactive course content. H5P activities provide instant feedback to students, allowing them to self-assess their understanding of the dynamic video simulation case. With funding through the Health Resources and Service Administration Advanced Nursing Education Workforce grant, four video simulation cases were developed that address emerging chronic care conditions in an older women who aged 15 years presenting initially with signs of hypothyroidism, progressed to early frailty, through moderate dementia and eventually along with her daughter face end of life health care issues. Partnering with the university instructional design experts, nurse practitioner faculty created questions that were inserted throughout the video as a means of keeping students engaged in problem-solving and decision making. A faculty handbook that described the case scenario with the interactive questions with suggested discussion questions was developed for each video simulation. The adult-gerontology primary care nurse practitioner competencies addressed in each case are identified in the handbook. Recommendations for the interactive question format will be presented and QR codes with access to direct viewing of the videos will be presented on the poster.
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Ferdows, Nasim B., and Amit Kumar. "NURSE PRACTITIONERS’ PRESCRIPTIVE AUTHORITY AND THE RURAL URBAN DISPARITY IN MORTALITY RATES." Innovation in Aging 3, Supplement_1 (November 2019): S564. http://dx.doi.org/10.1093/geroni/igz038.2084.
Повний текст джерелаАнотація:
Abstract Although nurse practitioners (NPs) might be the main providers of primary care to some communities, different states pursue different regulations for NP’s practice authority. This study compared the trends in mortality rates and supply of physicians in states with different policies, using AHRF and CMF data. We categorized states based on their restrictive policies into: full, reduced, and restricted practice. We compared the trends in age-adjusted mortality rate and physician supply in rural and urban areas, and examined within-state changes in rural-urban difference in physician supply and mortality. Our results indicate that as the level of restrictive policy increased the rural-urban mortality gap increased while physician supply declined. Furthermore, regardless of increase or decrease in physicians supply disparity, rural-urban mortality disparity declined in full practice states, with a negative association between a decline in rural-urban physician supply disparity and decline in rural-urban mortality disparity in full or reduced practice states.
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Intrator, O., Z. Feng, V. Mor, D. Gifford, M. Bourbonniere, and J. Zinn. "The Employment of Nurse Practitioners and Physician Assistants in U.S. Nursing Homes." Gerontologist 45, no. 4 (August 1, 2005): 486–95. http://dx.doi.org/10.1093/geront/45.4.486.
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Pradhan, R., R. Weech-Maldonado, S. Gupta, and N. Dayama. "THE IMPACT OF NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS ON NURSING HOME QUALITY." Innovation in Aging 1, suppl_1 (June 30, 2017): 841. http://dx.doi.org/10.1093/geroni/igx004.3029.
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Ladda, Shawn. "Nurse Practitioner’s Clinical Triggers for Referral to Other 3D Team Members." Innovation in Aging 4, Supplement_1 (December 1, 2020): 745. http://dx.doi.org/10.1093/geroni/igaa057.2680.
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Abstract This presentation features how 3D Team nurse practitioners (NP) use results of clinical assessments to determine whether older adults and caregivers enrolled in the study are referred to other Team members; these assessment results are called “clinical triggers”. Other team members who receive referrals based on NP-generated clinical triggers include: Licensed Clinical Social Workers, who deliver Problem Solving Therapy to older adults with significant depressive symptoms; Occupational Therapists, who deliver an evidence-based dementia care intervention; Physical Therapists, who deliver an adapted Otago exercise program; Registered Dietician, who provides nutrition and dietary instruction; and Community Health Educator, who provides community resource information to address social determinants of health. All clinical triggers will be detailed in this presentation, along with a description of each intervention delivered by other team members except the Community Health Educator. Case studies will be presented to illustrate how study participants receive multiple interventions from the 3D Team.
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Nikpour, Jacqueline, Heather Brom, Aleigha Mason, Jesse Chittams, Lusine Poghosyan, and Margo Brooks Carthon. "BETTER NP PRACTICE ENVIRONMENTS REDUCE HOSPITALIZATION DISPARITIES AMONG DUALLY ENROLLED PATIENTS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 64–65. http://dx.doi.org/10.1093/geroni/igac059.257.
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Abstract Adults dually-enrolled in Medicare and Medicaid experience twice as many hospitalizations and higher rates of ambulatory care-sensitive conditions (ACSCs) – such as coronary artery disease [CAD] and diabetes, compared to Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address care needs of dually-eligible patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and disparities in all-cause hospitalizations between dually-eligible and Medicare-only patients with ACSCs. Using linked secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ) and Medicare claims files, we examined 189,420 patients with CAD and/or diabetes (19.1% dually-eligible, 80.9% Medicare-only), cared for in 470 practices employing NPs across four states (PA, NJ, CA, FL) in 2015. After adjusting for patient and practice characteristics, dually-eligible patients in poor practice environments had the highest odds of being hospitalized compared to their Medicare-only counterparts (OR 1.60, CI: 1.49-1.71). In mixed practice environments, dually-eligible patients had approximately 48% higher odds of a hospitalization (OR 1.48, CI 1.31-1.68), while in the best practice environments, dually-eligible patients had approximately 37% higher odds (OR 1.37, CI 1.21-1.57, p < .001). As policymakers look to improve outcomes and reduce costs among dually-eligible patients, addressing a modifiable aspect of care delivery in NPs’ clinical practice environment is a key opportunity to reduce hospitalization disparities. Yet further efforts are needed to address remaining disparities by meeting patients’ health-related social needs, such as poverty and access to care.
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Fortinsky, Richard, and Caroline Stephens. "3D Team Care Management Trial for Cognitively Vulnerable Older Adults: Who Participates and How Does the Team Work?" Innovation in Aging 4, Supplement_1 (December 1, 2020): 744. http://dx.doi.org/10.1093/geroni/igaa057.2677.
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Abstract Community-dwelling older adults often experience cognitive symptoms, and three common conditions that contribute to changes in cognition are dementia, depression and delirium. Despite the clinical inter-connectedness among these medical conditions, hereafter referred to collectively as cognitive vulnerability, little is known about the potential for success of clinical interventions that simultaneously address these conditions. From the perspective of older adults with cognitive vulnerability and their families, hospital admissions and emergency department (ED) visits are disorienting and often lead to declines in functional capacity and well-being, and significant family distress, threatening continued independent living. In this Symposium, we present details about an ongoing clinical trial testing a novel in-home, multidisciplinary team care management intervention for older adults with cognitive vulnerability and their families. This care management intervention led by nurse practitioners, called the3D Team care model, aims to help reduce ED visits and hospitalizations and achieve other health-related outcomes. The first presentation will provide study background and design features as well as characteristics of study participants. The next two presentations by the3D Team nurse practitioners will provide details about how the multidisciplinary team works, and how each team member provides interventions intended to address risk factors for adverse health outcomes. The fourth presentation by the3D Team community health educator will explain how needs related to social determinants of health are addressed. The Discussant will place this clinical trial within the broader context of multidisciplinary team care for older adults with cognitive vulnerability led by nurse practitioners trained in geropsychiatry.
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Treston, Carole. "Older Adults Aging With HIV: A Growing Population Experiencing Comorbidities and Social Isolation." Innovation in Aging 4, Supplement_1 (December 1, 2020): 221–22. http://dx.doi.org/10.1093/geroni/igaa057.715.
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Abstract Significantly more than half of people living with HIV in the United States are over age 50 and at least half of that number are over 70 years old. Advances in antiretroviral treatments continue to extend the lifespan of people with HIV. However, people aging with HIV, particularly those diagnosed earlier in the epidemic, known as “long term survivors” are likely to face a myriad of challenges: clinical, psychosocial, financial, and logistical. Aging with HIV is a complex mix of long-term treatment effects, early onset of general aging, comorbidities and other confounding factors including mental health and psycho-social factors that affect quality of life. Older persons living with HIV have experienced tremendous loss, stigma and discrimination, including within the healthcare system. Now, renewed losses amplified by the emergence of multiple comorbidities including cardiovascular and metabolic disease, HIV associated neurocognitive disease, other neurological disability, diminished bone health and frailty and other conditions can impair quality of life significantly. A review of the common comorbidities experienced by people aging with HIV and the intersection with social isolation, stigma and loss will be presented. Strength based, holistic care that focuses on resilience, and includes advocacy, social networks and care coordination delivered by nurses and nurse practitioners as part of a collaborative inter-professional education program at the Association of Nurses in AIDS Care to address the unique challenges experienced by PLWH will be described.
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Bakerjian, D., and M. Dharmar. "IMPACT OF NURSE PRACTITIONER CARE OF NURSING HOME RESIDENTS ON EMERGENCY ROOM USE AND HOSPITALIZATIONS." Innovation in Aging 1, suppl_1 (June 30, 2017): 703. http://dx.doi.org/10.1093/geroni/igx004.2517.
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Goldberg, S., A. Blundell, J. Cooper, A. Gordon, T. Masud, and R. Moorchilot. "DEVELOPMENT OF THE ROLE OF AN ADVANCED NURSE PRACTITIONER IN GERIATRIC MEDICINE IN THE UK." Innovation in Aging 1, suppl_1 (June 30, 2017): 1374. http://dx.doi.org/10.1093/geroni/igx004.5057.
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Murphy-Boucher, Michele, and Diana Lynn Woods. "USING STORYTELLING TO ASSESS NURSE’S KNOWLEDGE IN CARING FOR OLDER ADULTS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 877. http://dx.doi.org/10.1093/geroni/igac059.3131.
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Abstract Continuing education, knowledge acquisition, and competence is required of all professional Registered Nurses. Remaining current in care delivery trends based on evidence practice is the responsibility of nurses supported by professional development specialists and educators. This project was conducted as a quality improvement project, using the evidence-based teaching modality of storytelling to educate practitioners in caring for older adults. This project addresses the question: For leaders of professional development and education focused on acute care and ambulatory practice, who have not had specialty geriatric training, how does using case-based/story-telling education for the care of patients 65 years and older affect confidence levels of the 4 M’s (mentation, mobility, what matters and medication) of elder care? A convenience sample of 12 Directors of Professional Development participated, and a validated comparison of responses to the Gerontological Nursing Competence Questionnaire (GNCQ) and the Facts on Aging (2015 version) (FAQ) were used for collecting data of pre intervention and post intervention. An eight-minute video was the educational intervention. GNCQ responses for confidence in knowledge and confidence in teaching were statistically significant. Although an increase in the mean score for interest in additional training, it was not statistically significant. The FAQ showed no statistical significance for the pre and post results. Findings indicate that storytelling is a viable teaching modality for increasing nurse’s knowledge of caring for older adults based on the concepts of the 4 Ms of age-friendly care. Keywords: storytelling, case studies, nurse education, professional development, narratives, and adult learning.
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Bosco, Elliott, Andrew Zullo, Kevin McConeghy, Patience Moyo, Robertus van Aalst, Ayman Chit, Vincent Mor, and Stefan Gravenstein. "LONG-TERM CARE FACILITY VARIATION IN THE INCIDENCE OF PNEUMONIA AND INFLUENZA HOSPITALIZATIONS." Innovation in Aging 3, Supplement_1 (November 2019): S821—S822. http://dx.doi.org/10.1093/geroni/igz038.3029.
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Abstract Pneumonia and influenza (P&I) increase morbidity and mortality among older adults, especially those residing in long-term care facilities (LTCFs). Facility-level characteristics may affect P&I risk beyond resident-level determinants. However, the relationship between facility characteristics and P&I is poorly understood. We therefore identified potentially modifiable facility-level characteristics that might influence the incidence of P&I across LTCFs. We conducted a retrospective cohort study using 100% of 2013-2015 Medicare claims linked to Minimum Data Set 3.0 and LTCF-level data. Short-stay (<100 days) and long-stay (≥100 days) LTCF residents aged ≥65 were followed for the first occurrence of hospitalization, LTCF discharge, Medicare disenrollment, or death. We calculated LTCF risk-standardized incidence rates (RSIRs) per 100 person-years for P&I hospitalizations by adjusting for over 30 resident-level demographic and clinical covariates using hierarchical logistic regression. The final study cohorts included 1,767,241 short-stay (13,683 LTCFs) and 922,863 long-stay residents (14,495 LTCFs). LTCFs with lower RSIRs had more Physician Extenders (Nurse Practitioners or Physician’s Assistants) among short-stay (44.9% vs. 41.6%, p<0.001) and long-stay residents (47.4% vs. 37.9%, p<0.001), higher Registered Nurse hours/resident/day among short-stay and long-stay residents (Mean (SD): 0.5 (0.7) vs. 0.4 (0.4), p<0.001), and fewer residents prescribed antipsychotics among short-stay (21.4% (11.6) vs. 23.6% (13.2), p<0.001) and long-stay residents (22.2% (14.3) vs. 25.5% (15.0), p<0.001). LTCF characteristics may play an important role in preventing P&I hospitalizations. Hiring more Registered Nurses and Physician Extenders, increasing staffing hours, and reducing antipsychotic use may be modifiable means of reducing P&I in LTCFs. Funding provided by Sanofi Pasteur.
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Jablonski, Rita, Vicki Winstead, and David Geldmacher. "Perspectives of Family Caregivers Confronted With Care-Resistant Behavior From Persons With Dementia." Innovation in Aging 4, Supplement_1 (December 1, 2020): 253. http://dx.doi.org/10.1093/geroni/igaa057.813.
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Abstract Problem: Care-resistant behavior is often bundled with other behavioral symptoms of dementia, but it is a unique behavior requiring targeted interventions. Purpose: To describe the experiences of caregivers receiving online coaching to manage care-resistant behaviors exhibited by persons with dementia. Design: Qualitative. Sample & Procedure: 20 caregivers (12 female, 8 male) were recruited from Memory Disorders and Geriatrics clinics to participate in 6 weeks of online coaching sessions delivered by a doctorally prepared nurse practitioner. Coaching sessions were recorded and transcribed. NVivo12 software was used to manage the thematic analyses. Results: Caregivers followed a general trajectory. They initially reported feelings of anger, frustration, and guilt. They believed that the person with dementia was purposefully “being stubborn and mean.” As the coaching sessions progressed, these negative emotions and the attributions of intent altered. By the conclusion of the six weeks, caregivers expressed feelings of success and ingenuity in applying coaching strategies. Conclusion: Online coaching is an effective way to individualize strategies that enable the caregiver to manage and reduce care-resistant behavior. Implications: The use of a doctorally-prepared nurse practitioner to deliver coaching, while effective, is not sustainable. Next steps include developing a coaching training program that could be embedded into existing community resources for community-dwelling caregivers. Limitations: Participants were limited to referrals from two clinics in the same institution.
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McGilton, Katherine S., Alexandra Krassikova, Veronique Boscart, Souraya Sidani, Andrea Iaboni, Shirin Vellani, and Astrid Escrig-Pinol. "Nurse Practitioners Rising to the Challenge During the Coronavirus Disease 2019 Pandemic in Long-Term Care Homes." Gerontologist 61, no. 4 (February 28, 2021): 615–23. http://dx.doi.org/10.1093/geront/gnab030.
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Abstract Background and Objectives There is an urgency to respond to the longstanding deficiencies in health human resources in the long-term care (LTC) home sector, which have been laid bare by the coronavirus disease 2019 (COVID-19) pandemic. Nurse practitioners (NPs) represent an efficient solution to human resource challenges. During the current pandemic, many Medical Directors in LTC homes worked virtually to reduce the risk of transmission. In contrast, NPs were present for in-person care. This study aims to understand the NPs’ roles in optimizing resident care and supporting LTC staff during the pandemic. Research Design and Methods This exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes in Ontario, Canada, was recruited. Data were generated using semistructured interviews and examined using thematic analysis. Results Four categories relating to the NPs’ practices and experiences during the pandemic were identified: (a) containing the spread of COVID-19, (b) stepping in where needed, (c) supporting staff and families, and (d) establishing links between fragmented systems of care by acting as a liaison. Discussion and Implications The findings suggest that innovative models of care that include NPs in LTC homes are required moving forward. NPs embraced a multitude of roles in LTC homes, but the need to mitigate the spread of COVID-19 was central to how they prioritized their days. The pandemic clearly accentuated that NPs have a unique scope of practice, which positions them well to act as leaders and build capacity in LTC homes.
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Gorbenko, Ksenia, Emily Franzosa, Abraham Brody, Bruce Leff, Christine Ritchie, Bruce Kinosian, Alex Federman, and Katherine Ornstein. "Provider Perceptions of Video Telehealth in Home-Based Primary Care During COVID-19." Innovation in Aging 5, Supplement_1 (December 1, 2021): 535. http://dx.doi.org/10.1093/geroni/igab046.2059.
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Abstract The COVID-19 pandemic accelerated the adoption of virtual care. In this qualitative study, we sought to determine provider perceptions of video telehealth during the first wave of COVID-19 in NYC to inform practice for home-based primary care providers nationwide. We conducted semi-structured interviews with clinical directors, program managers, nurse practitioners, nurse managers, and social workers at 6 NYC practices (N=13) in spring 2020. We used combined open and focused coding to identify themes. Participants employed both hospital-supported and commercial technological platforms to maintain care during COVID-19. Benefits of video telehealth included improved efficiency, capacity and collaboration between providers. Barriers included patients’ physical, cognitive or technological abilities, dependence on caregivers and aides to facilitate video visits, challenges establishing trust with new patients and addressing sensitive topics over video, and concerns over missing important patient information. Considering patient, clinical, and technological conditions can help optimize telehealth implementation among older homebound adults.
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Ingle, Pilar, Evan Plys, Danielle Kline, Emma Stark, and Jennifer Dickman Portz. "EXPERIENCES WITH APATHY AND MHEALTH PREFERENCES AMONG ADULTS WITH MILD COGNITIVE IMPAIRMENT." Innovation in Aging 6, Supplement_1 (November 1, 2022): 375. http://dx.doi.org/10.1093/geroni/igac059.1480.
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Abstract Apathy is common early in dementia, often increases in severity as illness progresses, and is one of the most pervasive neuropsychiatric symptoms associated with Alzheimer’s Disease and related dementias (ADRDs). This study explored experiences of apathy and preferences for dyadic-communication via mobile health (mHealth) among adults with mild cognitive impairment (MCI) and their care-partners. Semi-structured interviews were conducted with 10 ADRD-related health providers (5 behavioral neurologists, 2 nurse practitioners, 2 geriatricians, 1 nurse, 1 social worker), 9 patients with MCI (5 male, mean age = 73), and 6 of their care-partners. Participants expressed interest in the development of mHealth dyadic communication tools targeting apathy symptom monitoring, dyadic understanding of apathy, spiritual and religious coping, sharing ADRD health information, and resources for addressing burdensome behavioral symptoms of MCI. This research provides preliminary insight to the development of apathy specific mHealth communication strategies that may improve patient and care-partner quality of life.
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Zúñiga, Franziska, Lori Popejoy, and Amy Vogelsmeier. "The Importance of Redefining Geriatric Expertise in Nursing Homes to Reduce Unnecessary Hospitalizations." Innovation in Aging 5, Supplement_1 (December 1, 2021): 552. http://dx.doi.org/10.1093/geroni/igab046.2121.
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Abstract Unplanned transfers from nursing homes (NHs) are burdensome, associated with adverse outcomes for residents and costly for health care systems. Internationally, NHs are facing similar issues whereby a lack of geriatric expertise combined with a shortage of NH general practitioners require innovative and adaptable models of care tailored to the organizational context. In this symposium, we will present studies from the MOQI project from the United States, which successfully reduced unnecessary hospitalizations by embedding advanced practice registered nurses (APRN) in 16 US NHs over a 6-year period. We will discuss the influence of race on multiple hospital transfers and present possible interventions to reduce transfers. Next, we will present finding from a study with MOQI APRNs that highlighted their contributions to the COVID-19 pandemic response in NHs and discuss the broader implication or infection control practices. In addition, we will present the INTERCARE project which successfully reduced unplanned hospitalizations in 11 Swiss NHs, by implementing a registered nurse with an expanded role, to compensate for the very limited access to APRNs; which is the case for many European countries. Both MOQI and INTERCARE pinpoint the importance of strategies to support the introduction of a new role in NHs. Both projects will give examples of different models of care which can be feasibly implemented to sustainably decrease unnecessary hospitalizations, in different contexts and with different resources. Finally, data from the INTERCARE study will address the issue of potentially avoidable fall-related transfers and which resources are deemed appropriate to mitigate these.
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Powers, Becky, and Jeanette Ross. "IMPROVING GERIATRIC CARE OF INTERPROFESSIONAL PRACTICING PROVIDERS." Innovation in Aging 3, Supplement_1 (November 2019): S273. http://dx.doi.org/10.1093/geroni/igz038.1013.
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Abstract Practicing providers often struggle with the care of older adults due to knowledge, skill, and attitude barriers. In an attempt to improve employee engagement in the care of older adults, the Geri-EMPOWER (Empowering Medical Providers and Older adults With strategies to Escape Readmission) program was initiated. In this program, case managers and visiting VA rural geriatric scholars participated in a two days of intensive educational sessions including lectures, shadowing inpatient teams and clinic providers, a dementia simulation learning exercise, and an Observed Structured Clinical Exam (OSCE) with standardized patient encounters. The 15 initial participating trainees came from a variety of medical backgrounds including physicians, nurse practitioners, nurses, social workers, and psychologists. A 10 item knowledge based pretest and posttest was constructed using the learning objectives of the course. Skills of attendees were directly observed during 4 OSCE stations. Attitudes towards older adults were measured before and after the intervention using the Caroline Opinions on Care of Older Adults (COCOA) scale. Geriatric and palliative care knowledge improved with average knowledge test scores improving from 63% to 86% before and after the course. Participants obtained all minimum competencies during their OSCE exam, and rated this session very highly in their course feedback. Attitudes towards older adults were also found to improve with an average COCOA score increase of 9 points before and after the educational sessions. This innovative course based in adult-learning theory demonstrates that employed interprofessional providers can quickly improve knowledge, skills, and attitudes towards older adults.
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Reuben, David, and Katie Maslow. "RECRUITMENT FOR A MULTISITE PRAGMATIC TRIAL OF DEMENTIA CARE STRATEGIES: BARRIERS AND SUCCESS DURING COVID-19." Innovation in Aging 6, Supplement_1 (November 1, 2022): 305. http://dx.doi.org/10.1093/geroni/igac059.1207.
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Abstract With 2176 participants recruited, D-CARE is the largest pragmatic clinical trial of dementia care strategies, to date. At four clinical trial sites (CTS), D-CARE will compare the effectiveness of three dementia care strategies over 18 months: 1) by nurse practitioners or physician assistants within a health care system, 2) by social workers or nurses at community-based service organizations (CBO), or 3) usual care. Primary outcomes include person with dementia (PWD) behavioral symptoms and caregiver strain. Other outcomes include the PWD quality of life and ability to reach personal goals, and caregiver self-efficacy, distress, and depressive symptoms. Recruitment began in June 2019 with a basic protocol in which participating providers reviewed lists generated from the electronic health records (EHR) of patients who had a diagnosis of dementia, allowing the removal of patients who should not be contacted and giving an opportunity to provide information about the family caregiver. Some practices gave “blanket” referral allowing research staff to recruit participants directly. Other practices provided direct referrals via EHR communications to the research team. Self-referrals triggered by public postings in clinics and CBOs, social media, and media coverage were also accepted if a dementia diagnosis was confirmed in the EHR. By March 16, 2020, all in-person recruitment visits were suspended due to COVID-19. In response, informed consent was switched to telephone with verbal consent as permitted by State and Institutional regulations. This symposium describes the creative approaches employed by CTS’ to respond to these challenges and reach the recruitment goal in January 2022.
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Rossi, Michelle, Lauren Jost, Ina Engel, Carol Dolbee, and Keisha Ward. "Integrating Caregiver Education and Support into Multidisciplinary Video Visits." Innovation in Aging 4, Supplement_1 (December 1, 2020): 661. http://dx.doi.org/10.1093/geroni/igaa057.2286.
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Abstract The TeleDementia Clinic is an interdisciplinary longitudinal telehealth dementia clinic providing care to rural Veterans in Western Pennsylvania with cognitive decline. The TeleDementia Caregiver Support group uses telehealth to provide caregiver support and education to those caregivers with the highest levels of caregiver burden in this population. The support group has caregivers participating in the session at different rural clinics while a multidisciplinary team of professional (geropsychologist, geriatrician, nurse practitioner and others) are located at an urban VA medical center. All can interact via video telehealth connection. Each session provides a short educational session on caregiving topics that then provides a springboard for caregiver discussion about their own experiences. The multidisciplinary clinician team lend their expertise to the education and support of caregivers. Both quantitative and qualitative analysis of effectiveness of this model will be discussed.
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Wiese, Lisa K., Christine Williams, James E. Galvin, Debra Hain, and David Newman. "LEARNING FROM IN-DEPTH COGNITIVE ASSESSMENTS CONDUCTED IN RURAL INDEPENDENT LIVING FACILITIES." Innovation in Aging 3, Supplement_1 (November 2019): S553—S554. http://dx.doi.org/10.1093/geroni/igz038.2040.
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Abstract Despite benefits to earlier Alzheimer’s disease interventions, efforts to increase dementia detection and treatment in high-risk rural areas are lacking. Barriers include lack of resources, including limited time for providers to conduct in-depth cognitive assessments. A pilot program tested the effectiveness of a home-based approach for increasing rates of AD detection and treatment in a rural retired farmworker community. Depression and cognitive screenings of 139 residents conducted by community health workers were followed up with in-depth geriatric-focused assessments, including the Moca-B, by experienced, culturally diverse adult gerontological nurse practitioners (AGNPs). Their findings were forwarded to primary providers. This approach was evaluated for effectiveness using correlations, regressions, and Chi-square analyses of variables on rates of ADRD screening, referrals, and ADRD diagnosis.
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Lee, Jung-Ah, Lisa Gibbs, Julie Rousseau, Sonia Sehgal, and Neika Saville. "Bridging Digital Divides: GWEP Pivots to Support Telehealth for Clinical Care and Education." Innovation in Aging 5, Supplement_1 (December 1, 2021): 474. http://dx.doi.org/10.1093/geroni/igab046.1835.
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Abstract Early in the pandemic, the University of California, Irvine (UCI), GWEP pivoted to focus on building telehealth and remote patient monitoring, while supporting team-based interdisciplinary learners. Our Health Assessment Program for Seniors (HAPS) adapted to provide hybrid remote/in-person evaluations with our Geriatric Fellows and Doctor of Nurse Practitioner (DNP) students working alongside our multi-disciplinary team. Learner teams innovatively bridged the digital divide through weekly DNP support phone calls, and the Fellows delivered family conferences through Zoom. In ASSIST, medical students and nursing students gained digital competencies through a phone support system for isolated older adults with friendly weekly check-ins providing referrals to community resources. Another IRB-approved pilot, Healing at Home, diverted patients from the Emergency Room and In-Patient care with a team of ED, Hospitalists, Geriatricians teaching DNP and Fellows telehealth management. GWEP successfully piloted symbiotic learning for both older adults and health profession students through new virtual formats.
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Greenberg, Sherry, Lilia Pino, Mary McCormack, Evelyn Duffy, Elizabeth Zimmermann, Robin Hughes, Anne Pohnert, and Mary Dolansky. "Embedding Age-Friendly Care using the 4Ms Framework in the Convenient Care Setting." Innovation in Aging 4, Supplement_1 (December 1, 2020): 902. http://dx.doi.org/10.1093/geroni/igaa057.3320.
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Abstract This late-breaker presentation highlights the implementation science plan for Age-Friendly care in CVS Health MinuteClinic’s convenient care clinics. This project, a partnership between MinuteClinic, Case Western Reserve University Frances Payne Bolton School of Nursing, and the Institute for Healthcare Improvement, funded by The John A. Hartford Foundation, increases the number of care providers trained in the provision of Age-Friendly care using the 4Ms Framework: What Matters, Medication, Mentation, and Mobility. The implementation team learned the MinuteClinic usual processes, then developed strategies for successful Age-Friendly care implementation. Data from 21 nurse practitioner, 5 patient interviews, educator focus groups and 14 site visits revealed time, resources, and perceived value as barriers to implementation. Most reported increased knowledge and willingness to change practice. Based on the Plan-Do-Study-Act change process data, the implementation team developed solutions that addressed gaps leading to the development of practice-based tools for successful Age-Friendly care project adoption and implementation.
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Gorbenko, Ksenia, Emily Franzosa, Sybil Masse, Abraham Brody, Jonathan Ripp, Katherine Ornstein, and Alex Federman. "The Psychological Impact of COVID-19 on Home Based Primary Care Providers in New York: A Qualitative Study." Innovation in Aging 5, Supplement_1 (December 1, 2021): 380–81. http://dx.doi.org/10.1093/geroni/igab046.1477.
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Abstract Research on professional burnout during the pandemic has focused on hospital-based health care workers. This study examined the psychological impact of the pandemic on home-based primary care (HBPC) providers. We interviewed 13 participants from six HBPC practices in the New York including medical/clinical directors, program managers, nurse practitioners, and social workers and analyzed the transcripts using inductive qualitative analysis approach. HBPC providers experienced emotional exhaustion and a sense of reduced personal accomplishment. They reported experiencing grief of losing many patients at once and pressure to adapt to changing circumstances quickly. They also reported feeling guilty for failing to protect their patients and reduced confidence in their professional expertise. Strategies to combat burnout included shorter on-call, regular condolence meetings to acknowledge patient deaths, and peer support calls. Our study identifies potential resources to improve the well-being and reduce the risk of burnout among HBPC providers.
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Cohen-Mansfield, J., B. Jensen, B. Resnick, and M. Norris. "Knowledge of and Attitudes Toward Nonpharmacological Interventions for Treatment of Behavior Symptoms Associated With Dementia: A Comparison of Physicians, Psychologists, and Nurse Practitioners." Gerontologist 52, no. 1 (November 9, 2011): 34–45. http://dx.doi.org/10.1093/geront/gnr081.
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Harris, John, Steven Handler, Alison Trinkoff, David Wolf, and Nicholas Castle. "Qualitative Assessment of Resident Obesity in Nursing Homes by Medical Providers." Innovation in Aging 4, Supplement_1 (December 1, 2020): 241. http://dx.doi.org/10.1093/geroni/igaa057.778.
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Abstract We present qualitative themes from an ongoing five-year AHRQ-funded project (R01HS026943) examining the various ways nursing homes provide care for residents with obesity to determine the most effective way to prevent adverse safety events for residents with obesity. Obesity is a common diagnosis among short- and long-stay residents, and in the past, nursing home administrators have reported concerns from admissions issues to negative resident outcomes. No studies have examined the medical provider’s perspective on health of residents with obesity. In this abstract, we present three emergent themes from semi-structured interviews of medical providers (n=6) (nursing home medical directors, staff physicians, nurse practitioners) across the U.S. First, residents with obesity often have several complex and challenging medical conditions that require more services and health monitoring than most residents. Significant medical issues include diabetes, hypertension, cardiovascular disease, arthritis, and sleep apnea. Second, medical providers observe that it is difficult to provide daily custodial and nursing care, but the actual medical harm from substandard care is hard to quantify. Third, medical providers would like to help residents with obesity to lose weight and live healthier lives. There is, however, not an easy way to facilitate weight loss, due to limited resident physical activity, concerns about unhealthy weight loss, and difficulty changing established dietary habits of residents. These findings are limited by sample size, though themes have been consistent within the current participants. Comparing and contrasting these themes with other stakeholder groups (residents, nurse aides, administrators) interviews in the future will strengthen these findings.
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Mengelers, Angela, Michel Bleijlevens, Hilde Verbeek, Vincent Moermans, Elizabeth Capezuti, and Jan Hamers. "Prevention and Reduction of Care Against Someone’s Will in Cognitively Impaired People at Home: A Feasibility Study." Innovation in Aging 4, Supplement_1 (December 1, 2020): 665. http://dx.doi.org/10.1093/geroni/igaa057.2302.
Повний текст джерелаАнотація:
Abstract Sometimes care is provided to a cognitively impaired person against the person’s will, referred to as involuntary treatment. An intervention (PRITAH) was developed to prevent and reduce involuntary treatment comprising 4 components: client-centered care policy, workshops, coaching on the job by a specialized nurse and the use of alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.
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Fortinsky, Richard. "3D Team Care Management Trial: Study Design Features and Participant Characteristics." Innovation in Aging 4, Supplement_1 (December 1, 2020): 744–45. http://dx.doi.org/10.1093/geroni/igaa057.2678.
Повний текст джерелаАнотація:
Abstract This clinical trial was designed in partnership with a Medicare Advantage (MA) plan, with the goal of comparing two care management approaches for its MA policyholders age >65 living with cognitive vulnerability. To test the efficacy of the 3D Team, we are using a randomized design, with the comparison group receiving telephonic care management currently offered to MA members. In this presentation, detailed aspects of the study design, characteristics of the study population, and patterns of 3D team referrals will be explained. To date, 390 older adults and 306 informal caregivers are enrolled in the trial toward a recruitment goal of 576 older adults and 380 caregivers. Among older adults, 40% have depression only, 23% have dementia only, and the rest have more than one of these conditions and/or delirium. Most common referrals by 3D Team nurse practitioners are to the community health educator and to physical and occupational therapy.
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Santiago, Alba. "Community Health Educator’s Role on the 3D Team." Innovation in Aging 4, Supplement_1 (December 1, 2020): 745. http://dx.doi.org/10.1093/geroni/igaa057.2681.
Повний текст джерелаАнотація:
Abstract As a member of the 3D Team, the bilingual, bicultural Community Health Educator (CHE) addresses needs expressed by study participants related to social determinants of health. Clinical triggers generated by nurse practitioners (NPs) that lead to CHE referral include: social isolation and loneliness; lack of transportation access; lack of resources to sustain nutritional adequacy, purchase medications, and purchase assistive devices; and cultural and linguistic barriers that lead to lack of knowledge about community resources. To date, 50% of study participants randomized to receive 3D Team care have triggered referral to the CHE. In this presentation, the team CHE will provide details on the frequency of different needs expressed by study participants, how she utilizes an ever-growing community resource directory, and specific types of information and guidance she provides to address their expressed needs. Case studies will help illustrate ways in which CHE services have successfully provided assistance to study participants.
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White, Elizabeth, Cyrus Kosar, and Momotazur Rahman. "Advanced Practice Clinicians Providing an Increased Share of Primary Care in Skilled Nursing Facilities, 2008-2016." Innovation in Aging 4, Supplement_1 (December 1, 2020): 87. http://dx.doi.org/10.1093/geroni/igaa057.287.
Повний текст джерелаАнотація:
Abstract Rising care complexity in skilled nursing facilities (SNFs), coupled with growing shortages of geriatricians and other primary care physicians able to see SNF patients, have increased demand for nurse practitioners and physician assistants (NP/PAs). We used 2008-2016 Medicare Part A and B claims and nursing home assessment data to describe longitudinal trends in NP/PA practice in SNFs. We identified 8,877,094 SNF post-acute primary care visits for 1,494,113 Medicare beneficiaries. The total number of visits increased from 850,285 in 2008 to 1,189,553 in 2016. The share of visits by NP/PAs rose significantly over time, from 24% of visits in 2008 to 43% in 2016. 71% of SNFs (n=10,139) used NP/PAs in 2016, up from 46% (n=6,696) in 2008. The number of NP/PAs practicing in SNFs more than doubled, from 4,472 clinicians in 2008 to 10,000 in 2016. The number of physicians practicing in SNFs declined from 26,297 in 2008 to 19,745 in 2016. NP/PAs represented 14% of all SNF medical providers in 2008 and 34% of providers in 2016. In 2016, 48% of NP/PAs were SNFists (i.e. >90% of visits billed in SNF), vs. only 11% of physicians. SNFs with NP/PAs are on average larger, more likely urban, for profit, and care for larger populations of racial minorities, than SNFs without NP/PAs. SNFs with NP/PAs also have more short-stay Medicare residents, more admissions, higher nurse and rehab staffing levels, and higher case mix. These findings show that NP/PAs are taking on increasingly prominent roles as medical providers in SNFs.
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Bergen, Gwen, Ankita Henry, and Yara Haddad. "Comparison of Older Adult and Healthcare Provider Beliefs About Fall Prevention Strategies." Innovation in Aging 5, Supplement_1 (December 1, 2021): 932. http://dx.doi.org/10.1093/geroni/igab046.3372.
Повний текст джерелаАнотація:
Abstract Older adults reported about 36 million falls in 2018. Although effective strategies are available to minimize fall risk, little is known about older adults’ and healthcare providers’ awareness of these strategies. This study describes and compares older adults’ and healthcare providers’ beliefs about fall prevention strategies. Demographic and fall-related data for older adults were obtained from the 2019 fall cohort of Porter Novelli ConsumerStyles. Similar data from primary care practitioners, nurse practitioners, and physician assistants, were gathered from the 2019 cohort of DocStyles. Percentages and 95% confidence intervals were calculated to compare older adults and providers. Most providers (91.3%) and older adults (85.1%) believed falls can be prevented. High percentages of providers and older adults identified strength and balance exercises (90.7% and 82.8% respectively) and making homes safer (90.5% and 79.9% respectively) as strategies that help prevent falls. More providers reported that Tai Chi (45.7%) and managing medications (84.2%) can prevent falls compared to older adults (21.7% and 24.0% respectively; p<0.0001). Sizable percentages of providers and older adults endorsed less evidence-based strategies including aerobic exercise (70.7% and 58.4% respectively) and being more careful (69.3% and 81.6% respectively). Among older adults, lower endorsement of evidence-based strategies (e.g., Tai Chi, medication management) coupled with higher endorsement of limited evidence-based strategies (e.g., being careful, aerobic exercise) suggest some older adults lack awareness of effective fall prevention interventions. Increased patient and provider communication can increase awareness about the benefits of evidence-based strategies for fall prevention.
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Fortinsky, Richard, Kristen Annis-Brayne, Marie Smith, Kathleen Obuchon, Julie Robison, George Kuchel, and Shawn Ladda. "Referral Processes and Dispositions in a Multidisciplinary Team for Older Adults With Cognitive Vulnerability." Innovation in Aging 5, Supplement_1 (December 1, 2021): 324–25. http://dx.doi.org/10.1093/geroni/igab046.1262.
Повний текст джерелаАнотація:
Abstract Multidisciplinary team care for community-dwelling older adults with multiple chronic conditions has proven value. Older adults receiving team care experience better outcomes than by solo practitioners alone, and teams are being established as outgrowths of primary care and other clinical settings. Yet little is known about the inner workings of multidisciplinary teams, both in terms of how referral patterns among team members are established and the extent to which older adults and their families accept referrals from team leaders to other clinical disciplines within teams. In this presentation, we provide details about referral patterns and rates of acceptance by study participants in an ongoing clinical trial testing a multidisciplinary team designed to provide care management to older adults (age >65) with cognitive vulnerability due to dementia, depression, and/or delirium (3D Team). Nurse practitioners lead the 3D Team, conduct in-home clinical assessments and make referrals to other team members based on study protocols specifying participants’ eligibility for each 3D Team member. Results are based on the first 209 older adults randomized to the 3D Team. Pharmacist: all 209 members accepted having their medications reviewed and reconciled. Registered Dietician: of 134 referrals, 52 (38.8%) accepted. Occupational Therapist, of 117 referrals, 65 (55.6%) accepted. Physical Therapist: of 109 referrals, 92 (84.4%) accepted. Community Health Educator: of 106 referrals, 101 (95%) accepted. LCSW for depression-related problem solving therapy: of 76 referrals, 55 (72.4%) accepted. Criteria for referrals and interpretations of variations in referral acceptance rates by older adults and their families will be discussed.