Older Adult-Friendly Emergency Department Staff Help Reduce Hospital Admissions

JAGS graphicJournal of the American Geriatrics Society Research Summary

When older adults arrive at a hospital’s emergency department (ED), they may face unexpected challenges. For example, they may become less able to function independently. They may develop difficulties thinking and making decisions during or following a visit to the ED. This makes transitions in care to and from the ED an important area for improvement in our health care as we age.

To address these challenges, geriatrics experts have developed special programs such as the “Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements” (GEDI WISE) program. GEDI WISE is an award-winning program that serves as a model for excellence in emergency care for older adults in three large urban hospitals: Mount Sinai Medical Center in New York, NY; St. Joseph’s Regional Medical Center in Paterson, NJ, and Northwestern Memorial Hospital in Chicago, IL.

One piece of the GEDI WISE program includes an ED-based geriatrics transition care nurse (TCN). The TCN identifies patients who have health needs specific to older adults. This nurse works to help people transition to their homes so that they can avoid hospital admission whenever possible.

A team of researchers designed a study to learn how effective the GEDI WISE TCNs were for reducing hospital admissions, later admissions, and revisits to the ED. They published their findings in the Journal of the American Geriatrics Society.

The study took place in 2013-2015 in all three hospitals in the GEDI WISE program. They studied more than 57,000 people aged 65 or older who made more than 120,000 visits to the three participating hospitals’ EDs.

The TCN nurses gave the older adults several different screenings, including tests for:

Informed by these screenings, the TCN used various geriatrics resources to help patients. Some people required only a little support, while others needed extensive help.

Older adults who saw the TCN at least once during the study period were included in the “intervention group.” Older adults who didn’t see the TCN during the study period were included in the “control group.”

Compared to the control group, people who saw the TCN had lower rates of inpatient (hospital or healthcare facility) admissions over 30 days at two of the three hospitals.

The researchers concluded that programs focusing on improving care transitions for older people seen in the ED may help reduce the risk for hospital admission.

This summary is from “Geriatric Emergency Department (ED) Innovations: ED transitional care nurses & hospital utilization.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Ula Hwang, MD, MPH; Scott M. Dresden, MD; Mark S. Rosenberg, DO, MBA; Melissa M. Garrido, PhD; George Loo, DrPh; Jeremy Sze, BS; Stephanie Gravenor, MBA; D. Mark Courtney, MD; Raymond Kang, MA; Carolyn Zhu, PhD; Carmen Vargas-Torres, MS; Corita R. Grudzen, MD, MSHS; Lynne D. Richardson, MD; and the GEDI WISE Investigators.

Measured with Fitness Trackers, Light Intensity Physical Activity Linked to Lower Mortality in Women 63 to 99

JAGS graphicJournal of the American Geriatrics Society Research Summary

Experts say that a lack of physical activity leads to age-related weakness and poor health in older adults. Official guidelines suggest that healthy older adults spend at least 2.5 hours every week doing moderate activity (such as brisk walking), or at least 1.25 hours per week doing vigorous exercise (such as jogging or running).

Unfortunately, many older adults are not physically able to perform either moderate or vigorous intensity exercise. Researchers created a study to learn more about how much exercise older adults are able to perform, and how that exercise affects their health.

The research team studied 6,489 female participants aged 63 to 99 years old. The researchers published their findings in the Journal of the American Geriatrics Society.

The participants agreed to take in-home exams, answer health questionnaires, and wear accelerometers (devices similar to fitness trackers). The participants also kept sleep logs.

The study was conducted between 2012 and 2013. The researchers reviewed death certificates as of September 2016 to learn how many participants had died. Continue reading

Home-Based Activity Program Reduces Severity and Frequency of Behavioral Symptoms and Maintains Function for Older Veterans with Dementia

JAGS graphicJournal of the American Geriatrics Society Research Summary

People with dementia often have behavioral symptoms. These include problems with memory, language, and decision-making abilities. People with dementia can also experience changes in mood, such as increased irritability, depression, and anxiety. They often need assistance with their daily activities, such as feeding, dressing, using the toilet, and bathing themselves. These symptoms are often troubling for people with dementia, as well as for their caregivers.

These dementia symptoms can reduce quality of life for people as they age. This can make them dependent on other people, which can lead to caregivers feeling distressed. It may also lead to people with dementia being hospitalized or placed in a nursing home, even if it is not what they would prefer for their care.

There are no effective drug treatments for dementia or its symptoms. Therefore, researchers have been exploring treatment options to improve symptoms that don’t involve using medication. A team of researchers studied one of those programs, called the Tailored Activity Program (TAP). TAP matches activities to the interests and abilities of people with dementia. Then it teaches caregivers how to use those activities daily.

The researchers initially reported positive results in a small study of 60 people. They then studied TAP in a larger group of veterans living with dementia. They reported their results in the Journal of the American Geriatrics Society. Continue reading

Hospital Elder Life Program (HELP) Lowers 30-Day Readmission Rates

JAGS graphicJournal of the American Geriatrics Society Research Summary

The Hospital Elder Life Program, or HELP, is an evidence-based treatment plan developed in the 1990s to prevent hospitalized older adults from developing delirium (the medical term for sudden confusion).  Delirium can cause people to be either aggressive and agitated or sleepy and inactive—sometimes even a combination of the two. Delirium is also the most common complication older adults experience after surgery.

Delirium has many causes, including infection, excess time in bed, and an imbalance in electrolytes (important minerals dissolved in bodily fluids). Older adults with delirium have longer hospital stays, higher care costs, and increased rates of death and institutionalization.

 In a new study published in the Journal of the American Geriatrics Society, researchers examined the HELP program. They wanted to learn how effective it was at preventing older people from being readmitted to the hospital within 30 days, which is often harmful for patients and costly for hospitals. Continue reading

For Older Adults with Diabetes, Losing Weight through Diet and Exercise Can Improve Blood Circulation in the Brain

JAGS graphicJournal of the American Geriatrics Society Research Summary

Type 2 diabetes affects blood circulation. The disease stiffens blood vessels and reduces the amount of oxygen that circulates throughout your body. This includes your brain. When blood flow in the brain is impaired, it can affect the way we think and make decisions.

People who have type 2 diabetes are often overweight or obese. These are conditions that may also be linked to cognitive problems (problems with thinking abilities). Lowering calorie intake and increasing physical activity are known to reduce the negative effects of type 2 diabetes on the body. However, the effects of these interventions on cognition and the brain are not clear.

Recently, researchers examined information from a 10-year-long study called Action for Health in Diabetes (Look AHEAD). In this study, participants learned how to adopt healthy, long-term behavior changes. In their new study, the researchers focused on whether participants with type 2 diabetes who lowered calories in their diet and increased physical activity had better blood flow to the brain. The researchers published their findings in the Journal of the American Geriatrics Society. Continue reading