Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

Decreasing Caregiver Stress

Stress is both critical and personal experience and has significant effects on caregivers’ physical, mental, and social well-being. The nature of caregiving and the responsibility to work and serve individuals at their illness conditions are very personal encounters that often result in adverse effects on the health and well-being of caregivers (Frederick, 2016). A decrease in stress experience can lead to the satisfaction of caregiver roles and improvement of patient’s quality of life (Choi, Jisun & Boyle, Diane, 2013; Yada, Nagata, & Inagaki, 2014). This scholarly project determined that evidence-based stress management interventions have decreased the perceived stress in caregivers. The scholarly project identified low levels of stress among research participants, and how evidence-based interventions decreased caregiver stress by increasing their knowledge and awareness of evidence-based stress management interventions. The results of this scholarly project agree with the literature that caregiver stress experience can be decreased through the implementation of evidence-based stress management interventions (Blom, Zarit, Groot Zwaaftink, Cuijpers, & Pot, 2013). It is significant to implement evidence-based stress management interventions to decrease perceived stress among caregivers

Falls Free 2015 National Falls Prevention Action Plan

The 2015 Falls Free® National Action Plan is a blueprint describing what should be done to reduce the growing number of falls and fall-related injuries among older adults. This updated plan builds on the original Falls Free® National Action Plan, released in 2005, and is the product of key recommendations and strategies collected during the Falls Prevention Summit, a White House Conference on Aging event held in April 2015

Community-Dwelling Older Adult Fall Prevention Improvement Project

Abstract Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk. Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also reduces resource utilization at the acute care hospital microsystem of care level, reduces organizational operating costs and optimizes trauma patient flow from a broader, systems-based approach. Intervention: This project improved the screening, referral, and enrollment of at-risk community-dwelling older adults into an evidence-based fall prevention program from a baseline of zero persons to ten persons per month by August 2021. The project occurred in three phases; (1) adult family medicine physician (AFMP) training and education on the existence of a quality gap, (2) AFMP education and training to address upstream, pre-fall determinants of health in older persons using the Centers for Disease Control and Prevention\u27s Stop Elderly Accidents, Deaths and Injuries (STEADI) Fall Risk Factors Checklist (2020), and (3) enrollment of the target population into an online fall prevention program, A Matter of Balance (AMOB), in the Spring of 2021. Measures: Process measures included self-reported or observed improvement in participants health status, fall-related confidence, or functional ability. Outcome measures included the percent of persons aged 60 years and older screened and referred by AFMP’s. Balancing measures included; (1) the percent of health plan members in the target population that had an eye exam in the last two years, and (2) fall prevention trainer fidelity to the AMOB program curriculum. Results: This project saw a 65% attrition rate prior to program commencement secondary to technology limitations of participants. The remaining participant\u27s self-reported and observed health status, fall-related confidence, and functional ability were evaluated at baseline and completion of the virtual program. At AMOB conclusion, 100% of participants reported a decreased fear of falling, 97.5% made environmental hazard reduction changes, 99.5% increased their physical activity and planned to continue exercising, and 100% would recommend the program to other older adults. Conclusion: Reducing falls will improve upstream determinants of health, reduce resource utilization at the hospital microsystem of care level, reduce hospital operational costs, and optimize trauma patient flow from a broader, systems-based approach. Keywords: Aging, exercise, fall prevention, falls, injury prevention, older adult

Medication Non-Adherence in Community Dwelling Older Adults with Dementia: An Educational Intervention for Family Caregivers

Older adults with neurocognitive disorders are at high risk for medication non-adherence, while being vulnerable to great injury from regimen deviations. Informal caregivers often aid in healthcare management for these individuals. The current study compared the efficacy of two online health education interventions designed to increase caregiver health related knowledge for use with care recipients. Women (N=35) assisting a cognitively impaired older person with medications were randomly assigned to one of two online health education conditions (1) written materials and narrative vignettes depicting actors encountering common medication challenges or (2) written materials and didactic video clips of information from medical experts. It was hypothesized that narrative group participants would show greater improvements in several domains of functioning when compared to didactic group participants. Results showed equivalent participant satisfaction between groups; caregivers did not improve differentially between condition, over time, in the domains of medication hassles, patient-provider communication, medication management adherence, or self-efficacy. There was no main effect of time on caregiver reported hassles, patient- provider communication or medication adherence. There was a significant main effect of time on caregiver self-efficacy for controlling upsetting thoughts about the caregiving situation F (1, 33) = 8.07, p \u3c .001, p = .20, achieved power = .79. Secondary analyses revealed that caregivers in the narrative vignette condition showed significant increases in overall self-efficacy for controlling upsetting thoughts, from pre-treatment (M = 62.95, SD = 33.55), to post treatment (M = 72.38, SD = 31.27), t(17) = -2.53, p =.02. Future directions include introducing a no-treatment control, inclusion of additional post-intervention assessment points to investigate intervention effects over time, and expansion of the study to include older adults in the care dyad

Use of Medicines by Community Dwelling Elderly in Ontario

OBJECTIVE: Prescription medicine use by the elderly is of growing concern as indicated by a large literature focused on rising costs, patient compliance and the appropriateness of use. However, prescriptions account for only a portion of medicines used by the elderly, who have increasing access to non-prescription medicines and natural health products. The objective of this paper is to describe overall medicine use among the elderly in Ontario. METHODS: Using the National Population Health Survey (1996/97), we describe self-reported use of prescription, non-prescription and alternative medicines among elderly Ontarians aged 65+, and we compare use among four age sub-groups and by gender. Analysis is focused on the prevalence of, and the relative balance of use of different types of medicines. RESULTS: About one quarter of the respondents reported using no prescription or non-prescription medicines in the two days prior to being surveyed; a large majority reported using two or fewer medicines only, and use of non- prescription medicines was reported more often than prescription medicines (56% vs 48%). Use of natural health products by seniors is relatively low, but we observe a trend toward increased use in younger age groups. DISCUSSION: The findings place the consumption of prescription medicines by the elderly into a broader context that reveals that much of medicine use by the elderly involves non-prescribed products. We highlight the need to better understand seniors' decision-making regarding the different types of medicines available, and the financial costs and health risks of the medicine regimes of elderly persons.elderly, medicine-use, prescription medicines, over-the-counter medicines, natural health products, NPHS

Family Caregivers’ Knowledge of Delirium and Preferred Modalities for Receipt of Information

Delirium is a life-threatening, frequently reversible condition that is often a sign of an underlying health problem. In-hospital mortality alone for older adults with delirium ranges from 25% to 33%. Early recognition of delirium is critical because prolonged duration poses a greater risk of poor functional outcomes for older adults. Family caregivers, who are familiar with the older adult’s usual behaviors, are most likely to recognize delirium symptoms but might dismiss them as due to aging. It is important to learn what family caregivers know about delirium to ascertain their need for education. The aims of this study were to describe family caregivers’ knowledge of delirium and preferred modalities for receipt of information about delirium. A cross-sectional design was used for this study and a survey distributed to family caregivers for older adults. Analysis of 134 usable surveys indicated that family caregivers need and want information about delirium. The preferred modalities for receipt of information included Internet, in-person classes, and newsletters

Factors and Outcomes Associated With Potentially Inappropriate Medication Use in Rural Community-Dwelling Older Adults

Potentially inappropriate medications (PIMs) use in older adults is a significant public health concern. The use of PIMs to avoid may lead to negative outcomes such as adverse drug events. Prior conceptual analysis of PIMs use and observation of health-related factors in rural adults led to the design of this dissertation study. A sample was recruited from a population of rural community-dwelling older adults to examine the following specific aims: 1) Describe the use of PIMs to avoid, 2) Explore individual demographic characteristics (age, gender, income, education, and rural home location), health experience (comorbidity, number of medications and health providers), and health status factors (physical and mental function, sleep disturbance, sleep quality, and 24 hours sleep-wake patterns) as predictors of use of PIMs to avoid, 3) Examine individual demographic characteristics, health experience, health status, and the use of PIMs to avoid as predictors of patient-reported adverse drug events (ADEs). One-on-one reviews of all prescribed and over-the-counter medications (OTC), vitamins, and supplements were performed on participants (N=138). The 2012 Beers Criteria were used to identify and record PIMs to avoid. Data were collected on: participant’s demographics, subjective physical and mental health and sleep; objective sleep-wake patterns, and patient-reported ADEs. Almost half (49%) of the sample of rural community-dwelling older adults used both prescribed and OTC PIMs to avoid. The most frequently used PIMs to avoid taken by participants were prescribed and OTC non-steroidal anti-inflammatory drugs (33%), prescribed and OTC anticholinergic medications (28%), and prescribed short-acting benzodiazepines (18%). The use of PIMs to avoid was associated with higher number of medications taken and medical providers (both

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar