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Purpose: Individuals identified as high fall risk are expected to have high concern about falling. However, perception and individual factors that influence concern about falling have yet to be thoroughly studied. We aimed to understand factors that influence concern about falling among older adults with increased risk for falling. Patients and Methods: This was a secondary analysis of a clinical trial among community-dwelling older adults (age ≥ 65 years old) at high risk for falls (n = 178). Descriptive and regression analyses were used. We analyzed the relationship between participants' baseline concern about falling – categorized into three groups: low (7– 8), moderate (9– 13), and high (≥ 14) – and factors that may impact their concern. Exploratory factors included age, sex, self-reported health status and confidence to address fall risks, fall risk scores, and physical performance measures. Results: Among these individuals, 15.2% reported low concern about falling. On average, individuals in higher concern about falling groups had higher fall risk scores (low [5.7], moderate [6.4], and high [8.0]; p < 0.001). Our regression model showed that the odds of being in a higher concern group increased by 21% for every one unit increase in fall risk score and increased by 67% for every one unit increase toward poorer health rating. Conversely, for every one unit increase in self-reported confidence, the odds of being in a higher concern group decreased by 27.5%. Conclusion: Knowledge of older adults' fall risk, health status, and concerns about falling can be used to assist in the personalization of fall prevention interventions for a more holistic approach. [ABSTRACT FROM AUTHOR]

Falls are a major cause of preventable death, injury, and reduced independence in adults aged 65 years and older. The American Geriatrics Society and British Geriatrics Society (AGS/BGS) published a guideline in 2001, revised in 2011, addressing common risk factors for falls and providing recommendations to reduce fall risk in community‐dwelling older adults. In 2022, the World Falls Guidelines (WFG) Task Force created updated, globally oriented fall prevention risk stratification, assessment, management, and interventions for older adults. Our objective was to briefly summarize the new WFG, compare them to the AGS/BGS guideline, and offer suggestions for implementation in the United States. We reviewed 11 of the 12 WFG topics related to community‐dwelling older adults and agree with several additions to the prior AGS/BGS guideline, including assessment and intervention for hearing impairment and concern for falling, assessment and individualized exercises for older adults with cognitive impairment, and performing a standardized assessment such as STOPPFall before prescribing a medication that could potentially increase fall risk. Notable areas of difference include: (1) AGS continues to recommend screening all patients aged 65+ annually for falls, rather than just those with a history of falls or through opportunistic case finding; (2) AGS recommends continued use of the Timed Up and Go as a gait assessment, rather than relying on gait speed; and (3) AGS recommends clinical judgment on whether or not to check an ECG for those at risk for falling. Our review and translation of the WFG for a US audience offers guidance for healthcare and other providers and teams to reduce fall risk in older adults. [ABSTRACT FROM AUTHOR]

Background: Adverse drug events (ADEs) during hospitalization are a serious, yet preventable concern for older adults. Our institution designed a Geriatric Prescribing Context (GPC) to adjust doses for the older adult population but its impact on ADEs was unknown. The goal of this study was to assess any differences in rates of ADEs before and after its implementation in July 2017. Methods: We used relevant ICD‐10 codes followed by confirmatory chart review to identify dose‐related ADEs from 10 commonly used medications at our institution. We assessed differences in the number of admissions with an ADE before and after the GPC implementation using a test of binomial proportions. The pre‐period was from July 2016 through June 2017 and the post‐period was from August 2017 through July 2018. We compared the rate of ADEs per 1000 patient days between periods with a Poisson rate test and further examined any differences in harm categories using a Fisher's exact test. Results: The proportion of admissions with any dose‐related ADEs significantly decreased from 0.0082 to 0.0037 after the GPC (p = 0.04). The rate of dose‐related ADEs also declined from 2.5 per 1000 patient days to 1.1 per 1000 patient days (p = 0.001). Harm categories did not change significantly between time points (p = 0.30). Conclusions: Based on our list of relevant ICD‐10 codes, the GPC was associated with lower dose‐related ADEs for our selected medications among hospitalized older adults. [ABSTRACT FROM AUTHOR]

Older adults have a high burden of chronic diseases but are underrepresented in research. Researchers with geriatric or gerontology expertise have developed frameworks to recruit and retain older adults but these have not been widely adopted by the broader research community. We developed or adapted seven Age-Friendly research tools and invited research team members with no aging training to pilot test them. We consented 21 research team members and asked them to share strengths, limitations, and areas for improvement for each tool for up to 4 months via REDCap surveys. Sixteen participants (76%) completed at least one survey. The communication guide and Age-Friendly research checklist were the most utilized tools among participants. Key barriers to implementation were lack of time and lack of age-appropriate populations. Facilitators of tool implementation were accessibility and ease of use, webinar training, and supportive teams. Participants found the tools valuable to encourage Age-Friendly research studies. Adoption of Age-Friendly research tools could improve the experience for research team members and older adults alike. [ABSTRACT FROM AUTHOR]

Potentially inappropriate medication (PIM) use increases the risk of adverse drug events in older adults and deprescribing has been shown to reduce these outcomes. This study assessed the feasibility of a provider-driven approach to deprescribe PIMs in an internal medicine clinic. Providers received education on the risks of select medications and benefits of deprescribing at an all-staff meeting in April 2021. Providers were asked to choose a deprescribing intervention. Chart reviews were completed at 3 and 6 months to evaluate changes in medication. Tests of binomial proportions were used to determine any significant differences. Thirty-two providers participated and interventions resulted in a 41.6% reduction in the reviewed PIMs (tapered or discontinued). A provider-driven approach may be a feasible and effective method of deprescribing PIMs in older adults. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on how healthcare providers can understand the experiences of patients having serious illness conversation (SIC) about their end-of-life preferences. Topics mentioned include the impact of SIC on patients' relationship with their healthcare provider, a list of themes and representative quotes from thematic analysis, and some confusion of patients about the term, goal, when discussing their preferences for their care.

Background: The Age-Friendly Health Systems (AFHS) initiative uses a 4Ms framework-What Matters, Mentation, Medication, and Mobility-to encourage patient-centered care for older adults. Many health systems have implemented the core elements of AFHS with the goal to uniformly apply them to all patients 65 years and older. However, equity in AFHS delivery has not yet been examined.Methods: Five health equity factors-gender, race, ethnicity, preferred language, and electronic patient portal (MyChart) activation-were cross-sectionally analyzed against the 4Ms framework for patients in an academic internal medicine clinic seen between April 2020 and April 2021 (N = 3 370). Bivariate analysis and multiple logistic regression models analyzed the relationship of health equity variables to the 4Ms metrics and were represented with odds ratios and 95% confidence intervals.Results: Preferred language, gender, and MyChart activation yielded significant 4M metric pairings. Females were 1.22 times more likely than males, and English-speaking patients were 2.27 times more likely than non-English-speaking patients to receive advance care planning (p < .01). Females and patients with MyChart activation were about 2 times more likely to have a high-risk medication on their medication list compared to males and patients without MyChart activation (p < .01). Patients with MyChart activation were 2.08 times more likely than patients without MyChart activation to get cognitive screening (p < .001).Conclusion: This study, the first to incorporate demographic data into AFHS outcomes, suggests a need to develop best practices for equitable Age-Friendly care at the clinical team and institutional policy levels. [ABSTRACT FROM AUTHOR]

Background: The medication‐related death of a hospitalized older adult elucidated the inappropriateness of medication default doses in our electronic health record (EHR) for older adults. In response, we created and implemented the Geriatric Prescribing Context (GPC), an EHR‐based set of age‐specific dose and frequency defaults for patients 75 years and older, in July 2017. Inpatient medication orders aligned with GPC defaults and showed significant dose decreases at one year for nine of ten most commonly used medications. This follow‐up investigation examined GPC alignment of dose and frequency over the 42‐month time period after its implementation. Methods: Order data for the ten most commonly used medications at OHSU Hospital were collected retrospectively from July 2016 through December 2020. We used Statistical Process Control charts to assess the proportion of medication orders aligning with the GPC's recommendations. Signals of special cause were evaluated to identify time periods when shifts in process averages likely occurred and suspected shifts were assessed using binomial proportion tests. We used RStudio (RStudio, Inc., version 1.2.5001) and Microsoft Excel (2016) to perform statistical analyses and control charts, respectively. Results: The preimplementation phase of all medications displayed no special causes. After significant initial improvement in 2017, control charts revealed three different patterns of performance. Eight medications maintained the initial improvement with one medication displaying a second significant improvement at a later date. Two medications showed a subsequent decline in performance not statistically different from baseline. Overall, eight of the ten medications were prescribed at more age‐friendly doses and frequencies compared to baseline after 42 months. Conclusions: The GPC is an effective method to support safer prescribing for hospitalized older patients, but long‐term impacts may be medication‐specific. Further investigation is needed to ensure appropriate prescribing across drug classes and understand the GPC's impact on patient outcomes like adverse drug events. [ABSTRACT FROM AUTHOR]

The impact of a novel Geriatric Prescribing Context (GPC) on hospital clinicians' prescribing workflows is still unknown. A cross-sectional survey was distributed to 346 inpatient pharmacists, physicians, and advance practice providers employed at three pilot site hospitals affected by the GPC to assess awareness and impact to usual workflow. The GPC, a set of medication default doses and frequencies for patients 75 years and older, was unnoticed by 74% of survey respondents (n = 119) with pharmacists more likely to be aware of the context than prescribers. The impact of the GPC on clinicians' workflow differed by setting, with academic respondents reporting no change or decreased time to write or verify orders, and community respondents reporting no change or increased time to write or verify orders. The GPC has smoothly integrated into usual prescribing workflows for both prescribers and pharmacists and both overall reported positive responses to the implementation. [ABSTRACT FROM AUTHOR]

This document is an abstract from the Journal of Clinical & Translational Science. It includes three separate studies. The first study examines the impact of benevolent sexism on the well-being of Latinx women, specifically how hostile and benevolent sexist attitudes moderate the link between experiences of benevolent sexism, self-doubt, and life satisfaction. The second study focuses on the development and testing of age-friendly research tools to enhance the inclusion of older adults in research. The tools were found to be user-friendly and valuable among non-aging-trained research team members. The third study discusses a workshop aimed at promoting LGBTQ+ inclusivity in research, providing learners with a space to discuss the history of the LGBTQ+ community in medical and public health research and apply frameworks for inclusivity. The workshop was well-received, and plans are in place to offer it to a wider audience. [Extracted from the article]

BACKGROUND/OBJECTIVES Hospitalized older adults are at risk of receiving potentially inappropriate medication (PIM) doses, driven in part by age‐independent dose defaults used by electronic health records (EHRs), leading providers to prescribe for older adults as they do for younger adults. We studied whether an automated EHR‐based medication support tool would reduce PIM dosing for hospitalized older adults. DESIGN Pre‐post study design. SETTING Tertiary care, level 1 trauma, academic medical center in Oregon. PARTICIPANTS Hospitalized adults 75 years and older in the inpatient, nonemergency setting prescribed medications with geriatric‐specific dose considerations. INTERVENTION An EHR‐based, automated set of evidence‐based, age‐specific dose and frequency defaults called the Geriatric Prescribing Context (GPC). MEASUREMENTS The process measure is percentage of orders consistent with geriatric dose recommendations, and outcome measures are average dose (AD) in milligrams and total daily dose (TDD) in milligrams in the 12 months before and after implementation. RESULTS: Use of recommended geriatric doses with the context improved for all 10 of the most commonly ordered medications. In the year after implementation, there was a trend toward decreasing TDD and AD across all drug classes. CONCLUSION: The GPC is a simple, elegant, and effective means to align prescribing practices with safety standards for older adults, improving prescribing safety for all. It works within the current prescriber workflow without triggering alert fatigue and requires minimal resources for development and maintenance. [ABSTRACT FROM AUTHOR]

Introduction: Older adults have a high disease burden but are often underrepresented in research studies due to recruitment and retention obstacles, among others. Geriatric research specialists have identified solutions to these challenges and designed frameworks to help other researchers. Our team utilized three frameworks to create an interactive webinar series aimed to educate research team members on Age-Friendly practices., Methods: We recruited 40 non-aging-trained research team members to participate in a six-session, real-time webinar series from October to November 2022. Sessions were comprised of 20-30 minute didactics and 30-40 minute group discussions. Participants completed pre- and post-program surveys, commitment to change forms, and post-webinar session surveys. Responses were examined for strengths and areas for improvement. Wilcoxon signed-rank tests assessed differences in confidence scores., Results: Self-reported confidence scores improved after the webinar series. Most participants provided positive feedback and high likeliness to use what they learned and recommend the webinar to others. The strengths were practical tips, applicable tools, and real-world examples. The major area for improvement was information on industry-sponsored trials. The commitment to change responses varied from pledging to use more inclusive language to adapting materials to improve the consent process., Conclusion: This interactive Age-Friendly Research webinar series was feasible and well received by participants. We created an Age-Friendly Research community fostering commitment to change clinical and translational research to be more inclusive of older adults. Future work will include more information on industry-sponsored trials and expand to other research centers., Competing Interests: The authors have no conflicts of interest to report., (© The Author(s) 2023.)

Skilled conversations regarding end-of-life (EOL) care reduce emotional suffering and increase goal-concordant care. The Ariadne Labs Serious Illness Conversation (SIC) framework is an effective tool for improving EOL communication, but research is lacking on use with resident physicians. This study led by internal medicine residents tested the feasibility and acceptability of training peers in SIC. In 2021, three resident project leaders recruited first and second year internal medicine residents at a single tertiary academic center to receive extracurricular training on the Ariadne Labs SIC Guide. Baseline and post-training surveys were conducted to determine attitudes, barriers, and confidence related to EOL discussions. Initial recruitment efforts were unsuccessful but participation increased from zero to seven after residency administrators approved protected time for SIC training. Six residents (85.7%) completed baseline and post-training surveys. Residents identified lack of time as the key barrier to initiating SIC. Self-reported comfort discussing EOL care and documenting the conversations improved after training. Both resident researchers and participants reported SIC training was valuable and successful. Institutional support with dedicated buy-in, strong faculty mentorship, and committed resident leaders all contribute to successfully implementing a resident-led project.

Background: Many diseases are highly prevalent in older adults, yet older adults are often underrepresented in corresponding trials. Our objectives were to (1) determine alignment between Institutional Review Board (IRB) protocol age ranges and enrollment demographics to disease demographics pre- and post-implementation of the 2019 National Institutes of Health (NIH) Lifespan Policy and (2) raise awareness about inclusive recruitment to principal investigators (PIs)., Methods: This was a pre-post study. We reviewed investigator-initiated studies meeting eligibility criteria at Oregon Health & Science University from 2017 to 2018 to determine baseline alignment. Alignment was defined by the level of matching between protocol/enrollment age and disease demographics: 2 points for full match, 1 point for partial match, and 0 points for mismatch. After the NIH policy implementation, we reviewed new studies for alignment. When a mismatch was determined, we contacted PIs (either at initial IRB protocol submission or during ongoing recruitment) to raise awareness and provide strategies to expand inclusion of older adults in their trials., Results: Studies that matched IRB protocol ages to disease demographics significantly improved from 78% pre-implementation to 91.2% post-implementation. Similarly, study enrollment ages matching disease demographics increased by 13.4% following the implementation (74.5%-87.9%). Out of 18 post-implementation mismatched studies, 7 PIs accepted a meeting and 3 subsequently changed their protocol age ranges., Conclusion: This study highlights strategies that translational institutes and academic institutions could use to identify research studies whose participants do not align with disease demographics, offering opportunities for researcher awareness and training to enhance inclusion., Competing Interests: The authors have no conflicts of interest to declare., (© The Author(s) 2023.)

Introduction: Adverse drug events (ADEs) among hospitalised older adults are common yet often preventable. Efforts to recognise ADEs using pharmacist review and electronic health record adaptations have had mixed results. Our health system developed and implemented a geriatric prescribing context designed to offer age-friendly dose and frequency defaults for hospitalised patients 75 years and older. The impact of this context on ADEs remains unknown. To measure its impact, our team created a list of ADE-related International Classification of Diseases (ICD) codes specific to 10 commonly used medications at our institution. This protocol paper presents the process of designing a screening tool for ADEs, validating the tool with manual chart reviews and measuring the impact of the context on ADEs., Methods and Analysis: This retrospective cross-sectional study will assess our list of ICD-10 codes against manual chart review to determine its accuracy. An electronic health record report for patients aged 75 years and older admitted to the hospital for a minimum of two nights was generated to identify 100 test positives and 100 test negatives. Test positives need at least one code from each level of our ICD-10 code list. The first level of codes identifies any possible ADEs while the second level is more symptom based. Test negatives must not have any code from the list. Two physicians blinded to test status will complete a structured chart review to determine if a patient had an ADE during their hospitalisation. Acceptable inter-rater reliability will need to be met before proceeding with independent chart review. Positive predictive value and negative predictive value will be calculated once all the chart reviews are completed., Ethics and Dissemination: The Oregon Health & Science University Institutional Review Board approved this study (#21385). The results of the study will be disseminated in peer-reviewed journals and conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)