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Background: With changing cognitive abilities, individuals with mild cognitive impairment (MCI) and dementia face challenges in successfully managing multidrug regimens. We sought to understand how individuals with MCI or dementia and their family caregivers manage multidrug regimens and better understand patient‐to‐caregiver transitions in medication management responsibilities. Methods: We conducted qualitative interviews among patient–caregiver dyads. Eligibility included: patients with a diagnosis of MCI, mild or moderate dementia, managing ≥3 chronic conditions, ≥5 prescription medications, who also had a family caregiver ≥18 years old. Semi‐structured interview guides, informed by the Medication Self‐Management model, ascertained roles and responsibilities for medication management and patient‐to‐caregiver transitions in medication responsibilities. Results: We interviewed 32 patient–caregiver dyads. Older adults and caregivers favored older adult autonomy in medication management, and individuals with MCI and mild dementia largely managed their medications independently using multiple strategies (e.g., establishing daily routines, using pillboxes). Among individuals with moderate dementia, caregivers assumed all medication‐related responsibilities except when living separately. In those scenarios, caregivers set up organizers and made reminder calls, but did not observe family members taking medications. Patient‐to‐caregiver transitions in medication responsibilities frequently occurred after caregivers observed older adults making errors with medications. As caregivers sought to assume greater responsibilities with family members' medicines, they faced multiple barriers. Most barriers were dyadic; they affected both the older adult and the caregiver and/or the relationship. Some barriers were specific to caregivers; these included caregivers' competing responsibilities or inaccurate perceptions of dementia, while other barriers were related to the healthcare system. Conclusions: To ease medication management transitions, balance must be sought between preservation of older adult autonomy and early family caregiver involvement. Clinicians should work to initiate conversations with family caregivers and individuals living with MCI or dementia about transitioning medication responsibilities as memory loss progresses, simplify regimens, and deprescribe, as appropriate. [ABSTRACT FROM AUTHOR]

Background: Long‐term care services are funded primarily by Medicaid long‐term services and support in the United States, where eligibility is based on care needs of the individual with intellectual and developmental disability alone. Impact of Medicaid waiver services on self‐reported caregiver needs is not well understood. Method: Caregivers (n = 405) of individuals with intellectual and developmental disabilities across four states (NY, OH, TX, and PA) completed an online survey. Results: Caregivers reported a moderate degree of burden and susceptibility of stress‐induced health breakdown. Despite controlling for the activities of daily living of the care recipient, caregivers of individuals with Medicaid Waiver services reported greater difficulty managing medications (p =.013) and finding paid help (p <.001) than caregivers of individuals without services. [ABSTRACT FROM AUTHOR]

Background: Community‐dwelling older adults often serve as caregivers despite having their own health concerns and disabilities, yet little is known about their care needs. Methods: Cross‐sectional analysis including community‐dwelling U.S. adults over age 60 years who self‐identified as caregivers in the National Social Life, Health, and Aging Project in 2015–2016. Caregiving was defined by self‐reported assistance of another adult with day‐to‐day activities due to age or disability; overlapping care‐receiving was defined by simultaneous receipt of help for at least one activity of daily living (ADL) or independent ADL (IADL). Multivariable logistic regression models examined attributes associated with overlapping care‐receiving among older caregivers, adjusted for caregiver characteristics (age, gender, spousal caregiving, self‐reported physical and mental health, cognitive function, and household assets). Results: Among the 444 caregivers, the mean age was 67.8 (SD 0.29) years, 55.8% were women, 78.1% were non‐Hispanic White, 54.7% self‐identified as primary caregivers, and 30.7% were caring for a spouse. Thirty‐two percent of older caregivers were caregiving while themselves receiving assistance with at least one ADL or IADL. Thirty‐four percent of caregivers reported <$50,000 in household assets and 10% did not answer the question. Given prior research that supports that most nonrespondents fall into the low‐income group, subjects were combined. Analyses with and without nonrespondents did not substantially change the results. Compared to caregivers who were not simultaneously receiving care, caregivers reporting overlapping care‐receiving had greater odds of being older (AOR 1.30, 95% confidence interval [CI] [1.14, 1.48] per each 5‐year age increase), caregiving for a spouse (AOR 1.93, 95% CI [1.20, 3.13]), having limited household assets (AOR 2.10, 95% CI [1.17, 3.80], for <$50,000 compared to ≥$50,000), and having poor or fair self‐reported physical health (AOR 2.94, 95% CI [1.43, 6.02]). Conclusions: Over 30% of older adult caregivers report simultaneously receiving care for their own daily activities. Older caregivers who receive care are more likely to be older, spousal caregivers, and have limited assets and worse physical health. Targeted strategies are needed to support older caregivers who are uniquely vulnerable due to their overlapping care needs. [ABSTRACT FROM AUTHOR]

The article discusses a study on older adults' conflict experiences on their living arrangements and the frequency of interest-right-power (IRP) statements as of September 2024. Topics covered include conflict types and content coding into 6 themes, and results which show older adults' family conflicts on moving from their homes into long-term care communities, and their making of mostly interest-based statements. Also noted are healthcare providers' possible help in resolving disagreements.

Background: Family caregivers of people with Alzheimer's disease experience conflicts as they navigate health care but lack training to resolve these disputes. We sought to develop and pilot test an artificial‐intelligence negotiation training program, NegotiAge, for family caregivers. Methods: We convened negotiation experts, a geriatrician, a social worker, and community‐based family caregivers. Content matter experts created short videos to teach negotiation skills. Caregivers generated dialogue surrounding conflicts. Computer scientists utilized the dialogue with the Interactive Arbitration Guide Online (IAGO) platform to develop avatar‐based agents (e.g., sibling, older adult, physician) for caregivers to practice negotiating. Pilot testing was conducted with family caregivers to assess usability (USE) and satisfaction (open‐ended questions with thematic analysis). Results: Development: With NegotiAge, caregivers progress through didactic material, then receive scenarios to negotiate (e.g., physician recommends gastric tube, sibling disagrees with home support, older adult refusing support). Caregivers negotiate in real‐time with avatars who are designed to act like humans, including emotional tactics and irrational behaviors. Caregivers send/receive offers, using tactics until either mutual agreement or time expires. Immediate feedback is generated for the user to improve skills training. Pilot testing: Family caregivers (n = 12) completed the program and survey. USE questionnaire (Likert scale 1–7) subset scores revealed: (1) Useful—Mean 5.69 (SD 0.76); (2) Ease—Mean 5.24 (SD 0.96); (3) Learn—Mean 5.69 (SD 0.74); (4) Satisfy—Mean 5.62 (SD 1.10). Items that received over 80% agreements were: It helps me be more effective; It helps me be more productive; It is useful; It gives me more control over the activities in my life; It makes the things I want to accomplish easier to get done. Participants were highly satisfied and found NegotiAge fun to use (91.7%), with 100% who would recommend it to a friend. Conclusion: NegotiAge is an Artificial‐Intelligent Caregiver Negotiation Program, that is usable and feasible for family caregivers to become familiar with negotiating conflicts commonly seen in health care. [ABSTRACT FROM AUTHOR]

Background: Long‐term care planning (LTCP) is critical for individuals with intellectual/developmental disabilities. Objectives of this study were to investigate progression through LTCP, and associations between social support and: (1) LTCP and (2) burden among family caregivers. Methods: A cross‐sectional survey was distributed to caregivers of individuals with intellectual/developmental disabilities in NY, OH, PA, and TX, exploring demographics, supports, burden, and LTCP behaviours. Bivariate and linear multiple regression analyses were used to investigate study objectives. Results: Caregivers (n = 405) were predominantly parents, female, non‐Hispanic, and in the 'learning to plan' stage of LTCP. Caregiver‐identified social support was associated with further progression in LTCP (p =.020) and lower caregiver burden (p <.001). Conclusion: Social support was associated with further progression in LTCP, and associated with less burden, however fewer than 40% of caregivers reported having social support. Ongoing exploration of emotional/social needs of caregivers is necessary to better support these families. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the subjective cognitive decline (SCD) and missed aging-in-place (AIP)/long-term care (LTC) planning for older people.l Also cited are the claims that SCD is a precursor to the development of Alzheimer's disease (AD), and the issue of whether self-reports of SCD is linked to increased AIP/LTC planning and older adult perceptions of SCD.

The article presents a study which sought to better understand the aging-related content and backgrounds of experts portrayed by a leading national online lecture, TED Talks. Topics discussed include major themes revealed by thematic analysis, TED speaker background themes and examples, and importance that geriatricians are encouraged to have a strong presence in popular media.

Background: Geriatrics research generally cumulates in academic journal publications, with variable diffusion to patients and communities. PlanYourLifespan.org is a free, evidence‐based tool that assists older adults, and their loved ones, to better understand and plan for their long‐term support needs. There is a need to effectively disseminate geriatrics research, such as PlanYourLifespan.org, to communities that may directly benefit from this research. Objective: To leverage community‐based stakeholder leaders, utilizing a train‐the‐trainer program, to disseminate PlanYourLifespan.org and evaluate the extent of the dissemination. Methods: Using a train‐the‐trainer strategy, community stakeholder leaders from the original study paired up with newly recruited community stakeholder leaders. New community stakeholder leaders were trained on dissemination, using a "how‐to‐disseminate" web‐based toolkit—developed as part of this project. Newly trained community stakeholder leaders subsequently trained additional community stakeholder leaders who conducted and tracked dissemination activities in their communities. Google Analytics tracked newly created PlanYourLifespan.org accounts, login sessions, and daily website visitors. Results: Five newly trained community stakeholder leaders disseminated PlanYourLifespan.org over a three‐month period. Cumulatively, on the day of the dissemination activity, there were 11,361 PlanYourLifespan.org log‐ins (average: 378.7 log‐ins/activity day), 89,068 log‐ins (average: 2969 log‐ins/activity week) one‐week after the activity, and 319,154 log‐ins (average: 10,638 log‐ins/activity month) one month after the dissemination activity. Approximately 9.4 new PlanYourLifespan.org accounts were created one‐week post dissemination activity and over 1100 new accounts in the one‐month period thereafter. Conclusions: Wide dissemination of PlanYourLifespan.org occurred by leveraging a train‐the‐trainer approach with community stakeholder leaders. Researchers should consider collaborating early on with community stakeholders to meaningfully disseminate results. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the evaluation of the impact of COVID-19 pandemic on the self-efficacy of older adults. Topics mentioned include the use of Patient-Reported Outcomes Measurement Information System to evaluate general self-efficacy and self-efficacy for managing chronic conditions, the sociodemographic characteristics of older adults before and during the pandemic, and the challenges of isolated aging-in-place faced by older adults.

Background: Older adults frequently defer decisions about their aging‐in‐place/long‐term care (AIP‐LTC) needs. As a result, when older adults experience worsening Alzheimer's disease, family members/friends become surrogate decision makers. We sought to understand what aspects of cognition impact older adult AIP‐LTC planning. Methods: As part of the PlanYourLifespan (PYL)‐LitCog study, we longitudinally examined AIP‐LTC decision‐making among a cohort (LitCog) of community‐based older adults (65 years and older) recruited from hospital‐associated primary care clinics in Chicago, Illinois, with extensive cognitive testing. PlanYourLifespan.org (PYL) is an evidence‐based online intervention that facilitates AIP‐LTC planning. Subjects underwent baseline testing, received the PYL online intervention, and then were surveyed at 1, 6, and 12 months about AIP‐LTC decision‐making. Cross‐sectional logistic regression analysis was conducted examining cognitive variables that impacted AIP‐LTC decision‐making. Results: Of the 293 older adults interviewed (mean age 73.0 years, 40.4% non‐White), subjects were more likely to have made AIP‐LTC decisions if they had adequate inductive reasoning (ETS letter sets total—OR = 1.14 (95% CI = 1.03–1.27; p < 0.05)) and adequate working memory (size judgment span total—OR = 1.76 (95% CI = 1.13–2.73; p < 0.05)). There were no differences in decision‐making observed in verbal abilities, long‐term memory, or processing speed. All analyses were adjusted for participant gender, race, age, and decision‐making response at baseline. Conclusion: Inductive reasoning and working memory are critical to AIP‐LTC decision‐making. Screening routinely for these specific cognitive domains is important in targeting and helping older adults prepare in time for their future AIP‐LTC needs. [ABSTRACT FROM AUTHOR]

The article discusses the findings of a telephone survey conducted between January-June 2022 which aimed to characterize what matters most to older adults in the postacute or skilled nursing facility setting. Topics covered include how responses were separated into 48 statements and grouped into three overarching categories, several themes revealed by each category, and staff competence and professionalism as the most prevalent themes that mattered most to older patients and their caregivers.

Introduction: Social isolation is a major public health concern, as isolated individuals are at increased risk of poor overall health, as well as at increased risk of unhealthy behaviors. During the COVID‐19 pandemic, social distancing strategies have led to increased rates of loneliness and social isolation. There is a clear need for strategies to mitigate the effects of social isolation and loneliness on the mental and physical health of older adults. In this study, we sought to better understand how voice‐controlled intelligent personal assistants (VIPAs) could be leveraged to reduce loneliness and social isolation among home‐bound older adults. Methods: Patients and geriatric experts were recruited to use VIPA devices (Google Home) in their homes for 4 weeks and then provide feedback. No prior training was provided. Geriatric experts were recruited via email solicitation from the Northwestern Medicine Geriatrics Clinic, and patients were solicited directly from geriatric primary care physicians. The investigators used qualitative analysis to identify codes and overarching themes. Results: A total of 288 comments were received from 16 participants. Eight major themes were identified: Administrative, Companionship, Home Control, Education, Emergencies, Entertainment, Health and Well‐Being, and Reminders. Discussion: Results demonstrate that VIPAs can be useful across multiple domains and potentially play a role in providing physical, social, and cognitive stimulation to home‐bound older adults. VIPAs have a wide range of functionality, many of which could be implemented to focus on common geriatric syndromes and may ultimately be a tool to help mitigate social isolation and the consequential loneliness. [ABSTRACT FROM AUTHOR]

The article highlights the use of livestreaming platform Twitter Spaces during the 2022 American Geriatrics Society Annual Scientific Meeting held in Orlando, Florida on May 24, 2022. Topics mentioned include the three themes of the livestreaming content, the response of participants about the event, and the advantages of using livestreaming.

Background: Older adult delirium is often unrecognized in the emergency department (ED), yet the most compelling research questions to overcome knowledge‐to‐practice deficits remain undefined. The Geriatric Emergency care Applied Research (GEAR) Network was organized to identify and prioritize delirium clinical questions. Methods: GEAR identified and engaged 49 transdisciplinary stakeholders including emergency physicians, geriatricians, nurses, social workers, pharmacists, and patient advocates. Adhering to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews, clinical questions were derived, medical librarian electronic searches were conducted, and applicable research evidence was synthesized for ED delirium detection, prevention, and management. The scoping review served as the foundation for a consensus conference to identify the highest priority research foci. Results: In the scoping review, 27 delirium detection "instruments" were described in 48 ED studies and used variable criterion standards with the result of delirium prevalence ranging from 6% to 38%. Clinician gestalt was the most common "instrument" evaluated with sensitivity ranging from 0% to 81% and specificity from 65% to 100%. For delirium management, 15 relevant studies were identified, including one randomized controlled trial. Some intervention studies targeted clinicians via education and others used clinical pathways. Three medications were evaluated to reduce or prevent ED delirium. No intervention consistently prevented or treated delirium. After reviewing the scoping review results, the GEAR stakeholders identified ED delirium prevention interventions not reliant on additional nurse or physician effort as the highest priority research. Conclusions: Transdisciplinary stakeholders prioritize ED delirium prevention studies that are not reliant on health care worker tasks instead of alternative research directions such as defining etiologic delirium phenotypes to target prevention or intervention strategies. [ABSTRACT FROM AUTHOR]

The article focuses on emergency department (ED) visits each year increasing ED use by older adults is projected to exceed the capacity of the U.S. EDs. Topics include the traditional ED model of care is ill-equipped to address the many complex care needs of older adults, and the evolution of emergency care has developed as evidenced by consensus geriatric ED (GED) guidelines and the American College of Emergency Medicine's Geriatric Emergency Department Accreditation program.

BACKGROUND Healthcare providers may not offer patient portal (PP) access to electronic health records (EHRs) to their patients older than 85 years, due to the false impression that they do not utilize technology. It is imperative that older adults be given equal opportunity to use technology in regard to their healthcare. OBJECTIVE To characterize the content and frequency of use of PP messaging tethered to EHRs by older adults, aged 85 years and older, and their caregivers. DESIGN, SETTING, AND PARTICIPANTS User‐initiated communications from electronic PPs (MyChart) tethered to an EHR (Epic) for patients who were 85 years and older, receiving care at outpatient internal medicine and geriatric clinics at an academic health center from July 1, 2016, to December 31, 2016, were reviewed retrospectively and analyzed with mixed methods. RESULTS: A total of 1254 user‐initiated messages, sent by 62 patients aged 85 years and older (mean age = 87.9 years; n = 576 messages; mean = 9.9 messages per person) and 82 caregivers (n = 678 messages; mean = 7.8 messages per person), were analyzed. Qualitative analysis revealed 12 main themes: clinical issues, medication/vaccine questions, medication refills, laboratory orders/results, therapy/durable medical equipment, care coordination, care transitions, scheduling, appreciation/thank you, administrative/billing, telephone requests, and death notification. Caregivers significantly initiated messages more for care transitions (P <.001). Patients significantly initiated messages more for scheduling (P =.04) and medication refills (P =.04). Patients who had heart failure, coronary artery disease, or Alzheimerʼs disease were significantly more likely to have caregivers using the PP as their proxy (30.7% vs 21.6%; P =.01). CONCLUSIONS: Adults, aged 85 years and older, and their caregivers utilize PPs tethered to EHRs. Healthcare providers should ensure inclusivity and offer access to EHRs to older adult populations, especially those aged 85 years and older. J Am Geriatr Soc 68:1078–1082, 2020 [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Many older adults wish to age in place, and voice‐controlled intelligent personal assistants (VIPAs; eg, Amazon Echo and Google Home) potentially could support unmet home needs. No prior studies have researched the real‐world use of VIPAs among older adults. We sought to explore how older adults and caregivers utilize VIPAs. DESIGN/MEASUREMENT: Retrospective review of all verified purchase reviews of the Amazon Echo posted on Amazon.com between January 2015 and January 2018, with filtering for health‐related older adult key words. Open‐ended reviews were qualitatively analyzed to identify relevant themes. RESULTS: On retrieval, there were 73 549 reviews; and with subsequent key word filtering, 125 total reviews were subsequently analyzed. Five major themes were identified: (1) entertainment ("For two very senior citizens...we have really had fun with Echo. She tells us jokes, answers questions, plays music.); (2) companionship ("A senior living alone...I now have Alex to talk to."); (3) home control; (4) reminders ("I needed something that would provide me with information I couldn't remember well, such as the date, day, or my schedule...I highly recommend for anyone with memory challenges"); and (5) emergency communication. Several felt it reduced burdening caregivers. "...You also feel guilt from fear of overburdening your caregivers. Alexa has alleviated much of this." Specifically, caregivers found that: "By making playlists of songs from her youth whoever is providing care, family or professional caregiver, can simply request the right song for the moment in order to sooth, redirect, or distract Mom." Alternatively, negative reviewers felt the VIPA misunderstood them or could not adequately respond to specific health questions. CONCLUSION: VIPAs are a low‐cost artificial intelligence that can support older adults in the home and potentially reduce caregiver burden. This study is the first to explore VIPA use among older adults, and further studies are needed to examine the direct benefits of VIPAs in supporting aging in place. J Am Geriatr Soc 68:176–179, 2019 [ABSTRACT FROM AUTHOR]

Dissemination of cutting‐edge geriatrics‐focused research is essential for academic geriatrics researchers, clinicians, and older adults and their caregivers. Social media channels, such as Twitter, provide a means of quickly reaching a wide array of users, globally. Besides standard tweets with links to research articles, visual abstracts are a means of delivering research results visually to end users succinctly. We compared the use of a standard tweet with a linked article with a tweet that held an added visual abstract, for a recent Journal of the American Geriatrics Society article. While the standard tweet received 24 984 impressions with 17 retweets and 36 likes over 8 days, the visual abstract inclusive tweet received 168 447 impressions with 81 retweets and 100 likes in 4 days. To assist researchers on future visual abstract development, we provide a framework and real‐world guide on translation of research abstracts into visual abstracts. We hope that by providing evidence and the means to create visual abstracts, researchers in geriatrics may be empowered to disseminate their research through this method and potentially advance the care of older adults worldwide. See related editorial by Eric Widera et al. in this issue. [ABSTRACT FROM AUTHOR]

Objectives: To understand older adult perceptions about accepting help at home, in particular fears related to potential loss of independence. Design: Qualitative focus groups. Setting: Rural, suburban, and urban areas of Fort Wayne, Indiana, and Chicago, Illinois. Participants: Community‐dwelling adults aged 65 and older (N=68). Measurements: Participants discussed decision‐making, reluctance to accept home‐based care, barriers, and resources that might affect remaining in the home. Three independent coders used constant comparative analysis to interpret results. Results: Analysis revealed that reluctance to accept home‐based support was associated with concerns over inability to complete tasks, perceptions of being burdensome to others, lack of trust in others, and lack of control. To overcome these concerns, some participants reframed the concept of independence to be “interdependence,” with people continually depending on each other throughout their lives. Subjects noted that, even if one becomes more limited over time, the recognition that one is still contributing something meaningful to society is important to overcoming refusal of home assistance. Another strategy presented to overcome negative perceptions of accepting assistance in the home was the recognition that helping someone who is in need may engender positive emotions in those providing the help. Conclusion: Older adults perceived multiple reasons for refusing home‐based assistance and offered potential strategies to overcome this reluctance. Addressing the reasons and promoting strategies to accept home‐based support may lead older adults to have fewer unmet home‐based needs, enabling them to remain safely in their homes. [ABSTRACT FROM AUTHOR]

Kidney transplantation is a good option for adults aged 65 and older with end-stage renal disease because it has been shown to reduce morbidity and mortality, improve quality of life, and is more cost-effective than other renal replacement options. However, older age has been a deterrent to access to the deceased donor waiting list, and individuals aged 65 and older have a lower probability of being referred to and listed for transplantation compared to younger adults. Because the deceased organ supply is limited, living donor kidney transplantation offers an effective alternative for older adults facing long waiting times for cadaveric organs. This article describes the evolution of living kidney donation and transplantation in older adults over 15 years using the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients database. Between 1997 and 2011, 28,034 kidney transplantations were performed in adults aged 65 and older. Living-donor and cadaveric kidney transplantation increased in older adults over the 15-year period. Offspring are the most common living donors in this age group, followed by unrelated donors (e.g., friends), whereas the most common donors in younger transplant recipients are spouses, siblings, and parents. The number of living kidney donors aged 65 and older is slowly increasing, although the total number of transplants in this age group remains low. The expansion of living-donor kidney transplantation in the aging population may offer a solution for organ shortage and thereby improve the quality of life of older adults. More research is needed to understand the older donor-recipient relationship and barriers to transplantation in this population. [ABSTRACT FROM AUTHOR]

Objectives To evaluate whether age is independently associated with greater rate of unanticipated hospital admission within 30 days of ambulatory surgery. Design Retrospective database study. Setting The 2012 National Surgical Quality Improvement Project data set. Participants All individuals with 'outpatient' recorded as their status in the data set. Measurements The primary outcome of interest was all-cause hospital admission in the 30-day period after surgery. Multivariate models were constructed to control for covariate bias. Assessment of interactions of terms in the final model was performed using a conditional tree analysis. Results The final analysis included 53,667 ambulatory surgical cases. There were 1,370 (2.5%, 99% confidence interval ( CI) = 2.4-2.7%) hospital admissions among the cases evaluated. After adjusting for potential confounders, age (<70 vs ≥70) was independently associated with hospital admission (odds ratio = 1.54, 99% CI = 1.29-1.84). A classification tree analysis of the cases without postoperative morbidity identified age (<60 vs ≥60) as an important decision point leading to greater likelihood of admission ( P < .001) within 30 days after ambulatory surgery. Conclusion Even after adjusting for comorbidities, older adults are at greater risk of unanticipated hospital admission within 30 days of ambulatory surgery. Renal failure, chronic obstructive pulmonary disease, current cancer treatment, diabetes mellitus, and history of amputation or revascularization were also associated with greater likelihood of hospital admission. Interventions to improve transitions of care for older adults after ambulatory surgery are needed. [ABSTRACT FROM AUTHOR]

Older adults account for a large and growing segment of the emergency department ( ED) population. They are often admitted to the hospital for nonurgent conditions such as dementia, impaired functional status, and gait instability. The aims of this geriatric ED innovations ( GEDI) project were to develop GEDI nurse liaisons by training ED nurses in geriatric assessment and care coordination skills, describe characteristics of patients that these GEDI nurse liaisons see, and measure the admission rate of these patients. Four ED nurses participated in the GEDI training program, which consisted of 82 hours of clinical rotations in geriatrics and palliative medicine, 82 hours of didactics, and a pilot phase for refinement of the GEDI consultation process. Individuals were eligible for GEDI consultation if they had an Identification of Seniors At Risk ( ISAR) score greater than 2 or at ED clinician request. GEDI consultation was available Monday through Friday from 9:00 a.m. to 8:00 p.m. An extensive database was set up to collect clinical outcomes data for all older adults in the ED before and after GEDI implementation. The liaisons underwent training from January through March 2013. From April through August 2013, 408 GEDI consultations were performed in 7,213 total older adults in the ED (5.7%, 95% confidence interval ( CI) = 5.2-6.2%), 2,124 of whom were eligible for GEDI consultation (19.2%, 95% CI = 17.6-20.9%); 34.6% (95% CI = 30.1-39.3%) received social work consultation, 43.9% (95% CI = 39.1-48.7) received pharmacy consultation, and more than 90% received telephone follow-up. The admission rate for GEDI patients was 44.9% (95% CI = 40.1-49.7), compared with 60.0% (95% CI = 58.8-61.2) non- GEDI. ED nurses undergoing a 3-month training program can develop geriatric-specific assessment skills. Implementation of these skills in the ED may be associated with fewer admissions of older adults. [ABSTRACT FROM AUTHOR]

Objectives To assess what screening practices agencies use in hiring caregivers and how caregiver competency is measured before assigning responsibilities in caring for older adults. Design One-to-one phone interviews in which interviewers posed as prospective clients seeking a caregiver for an older adult relative. Setting Cross-sectional cohort of agencies supplying paid caregivers to older adults in Illinois, California, Florida, Colorado, Arizona, Wisconsin, and Indiana. Participants Four hundred sixty-two home care agencies were contacted, of which 84 were no longer in service, 165 offered only nursing care, and 33 were excluded; 180 agencies completed interviews. Measurements Agencies were surveyed about their hiring methods, screening measures, training practices, skill competencies assessments, and supervision. Two coders qualitatively analyzed open-ended responses. Results To recruit caregivers, agencies primarily used print and Internet (e.g., ) advertising (n = 69, 39.2%) and word-of-mouth referrals (n = 49, 27.8%). In hiring, agencies required prior 'life experiences' (n = 121, 68.8%) few of which (n = 33, 27.2%) were specific to caregiving. Screening measures included federal criminal background checks (n = 96, 55.8%) and drug testing (n = 56, 31.8%). Agencies stated that the paid caregiver could perform skills, such as medication reminding (n = 169, 96.0%). Skill competency was assessed according to caregiver self-report (n = 103, 58.5%), testing (n = 62, 35.2%), and client feedback (n = 62, 35.2%). General caregiver training length ranged from 0 to 7 days. Supervision ranged from none to weekly and included home visits, telephone calls, and caregivers visiting the central office. Conclusion Using an agency to hire paid caregivers may give older adults and their families a false sense of security regarding the background and skill set of the caregiver. [ABSTRACT FROM AUTHOR]

Options for elderly patients who can no longer remain independent are limited. Most choices involve assisted living facilities, 24-hour caregivers, or nursing homes. State and federal assistance for payment for individual care is limited, and seniors usually pay for most costs out of pocket. For those patients who have the means to afford assisted living centers or nursing homes,“cruise ship care” is proposed. Traveling alongside traditional tourists, groups of seniors would live on cruise ships for extended periods of time. Cruise ships are similar to assisted living centers in the amenities provided, costs per month, and many other areas. This article begins with an examination of the needs of seniors in assisted living facilities and then explores the feasibility of cruise ship care in answering those needs. Similarities between cruise ship travel and assisted living care, as well as the monetary costs of both options, are defined. A decision tree with selections for nonindependent care for seniors was created including cruise ship care as an alternative. Using a Markov model over 20 years, a representative cost-effectiveness analysis was performed that showed that cruises were priced similarly to assisted living centers and were more efficacious. Proposed ways that cruise ship companies could further accommodate the needs of seniors interested in this option are also suggested. Implementation for cruise ship care on the individual basis is also presented. Ultimately, it is wished to introduce a feasible and possibly more desirable option to seniors who can no longer remain independent. [ABSTRACT FROM AUTHOR]