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.

Older Adults with Metabolic Syndrome May be More Resistant to Depression Treatments

JAGS graphicJournal of the American Geriatrics Society Research Summary

Researchers suspect that having Metabolic Syndrome makes it harder for older adults to respond to therapies for depression. (Metabolic Syndrome is a mix of conditions like increased blood pressure, high blood sugar levels, excess body fat around the waist, and abnormal cholesterol levels). In a new, first of its kind study, published in the Journal of the American Geriatrics Society, researchers examined whether Metabolic Syndrome in depressed older adults affects their response to antidepressant treatment.

Older adults who have major depressive disorder (MDD, also known as depression) are at higher risk for having problems thinking and making decisions. They are more likely to have trouble performing their regular daily activities and managing their personal care. These problems can lead to poorer health in general and a higher risk of death compared to older adults who are not depressed. Continue reading

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

Poor Dental Health Increases Risks of Frailty in Older Men

JAGS graphicJournal of the American Geriatrics Society Research Summary

Oral health issues are common among older adults. These issues include tooth loss, gum disease, tooth decay, and dry mouth. These conditions can also affect an older adult’s well-being because they may make it harder to eat, swallow, speak, get adequate nutrition, and even smile.

Oral health issues like tooth loss and gum disease are also linked to increased risks of frailty. Frailty is the medical term for becoming more vulnerable to declining health or the inability to perform the activities of daily living. Frailty is a major healthcare challenge for older adults and caregivers. Someone who is frail can be weak, have less endurance, and be less able to function well. Frailty increases the risk for falls, disability, and even death.

Over a three-year period, researchers from the United Kingdom examined the relationship between poor oral health and older adults’ risks for becoming frail. They published their findings in the Journal of the American Geriatrics Society.

The researchers studied information from the British Regional Heart Study. This study included 7,735 British men. They were first examined in 1978 to 1980 when they were 40- to 59-years-old. In 2010 to 2012, researchers invited 1,722 surviving participants to be re-examined. During that time period, the participants were 71- to 92-years-old.

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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