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Background: Advance care planning (ACP) is the process of having conversations with patients to ensure preferences are known and support patient healthcare goals. ACP and the Age‐Friendly Health Systems (AFHS) Initiative's, "What Matters," are synergistic approaches to patient‐centered conversations. Implementation and measurement of ACP in primary care (PC) are variables in quality and consistency. We examined whether participation in an ACP learning collaborative (LC) would improve knowledge and ability to conduct ACP discussions and increase the frequency of documented ACP in participating practices. Methods: The WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) region Practice and Research Network (WPRN) and the Northwest Geriatrics Workforce Enhancement Center collaboratively organized a 9‐month virtual LC. It consisted of 4 synchronous, 1.5‐h sessions, technical support, and a panel of ACP experts. A Wilcoxon rank sum test assessed differences in knowledge from a pre–post survey. Documentation of ACP in the EHR was collected after at least one plan–do–study–act cycle. Results: We enrolled 17 participants from 6 PC practices (3 hospital‐affiliated; 3 Federally Qualified Health Centers) from the WPRN. Two practices did not complete all LC activities. There was a trend toward increased ACP knowledge and skills overall especially in having discussions patients and families (pre‐mean 2.9 [SD = 0.7]/post‐mean 4.0[SD = 1.1], p < 0.05). 4/6 practices observed an increase in EHR documentation post‐collaborative (median 16.3%, IQR 1.3%–36.9%). Conclusions: The LC increased PC providers knowledge and skills of ACP and AFHS's What Matters, reported ACP EHR documentation, and contributed to practice change. [ABSTRACT FROM AUTHOR]

Background: Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration‐funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age‐friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP. Methods: A survey of GWEPs was conducted to measure the reach, foci, evaluation methods, and other characteristics of ECHO networks. Results: All 48 (100%) GWEPs responded to the survey, and 30 (63%) reported using ECHO. GWEP ECHOs have both rural and urban‐underserved reach across the United States, and their hub teams include many health professions. Age‐friendly care is incorporated through multiple methods and is taught across foci including primary care, dementia, long term care, and novel topics. GWEP ECHOs have many academic and community partners including Area Agencies on Aging, and reach varied health professions, trainees, and caregivers. Geriatrics ECHOs collect outcomes across the evidence continuum including the community‐level outcome of Age‐Friendly Health System designation. Conclusions: The ECHO model has been widely adopted by GWEPs as a key approach for workforce training in age‐friendly care. Project ECHO is a valuable tool to expand interprofessional training for the geriatrics workforce, particularly for interprofessional teams in rural and underserved areas. [ABSTRACT FROM AUTHOR]

The article discusses research which explored the preparedness and needs of program directors (PD) in geriatric medicine. Cited are the topics included in an anonymous, voluntary electronic survey of participants asking for input on PD transition experiences, how the respondents rate the quality of their transition experience, and the perception of PD with handoffs.

Background and Hypothesis Risk-taking in specific contexts can be beneficial, leading to rewarding outcomes. Schizophrenia is associated with disadvantageous decision-making, as subjects pursue uncertain risky rewards less than controls. However, it is unclear whether this behavior is associated with more risk sensitivity or less reward incentivization. Matching on demographics and intelligence quotient (IQ), we determined whether risk-taking was more associated with brain activation in regions affiliated with risk evaluation or reward processing. Study Design Subjects (30 schizophrenia/schizoaffective disorder, 30 controls) completed a modified, fMRI Balloon Analogue Risk Task. Brain activation was modeled during decisions to pursue risky rewards and parametrically modeled according to risk level. Study Results The schizophrenia group exhibited less risky-reward pursuit despite previous adverse outcomes (Average Explosions; F (1,59) = 4.06, P =.048) but the comparable point at which risk-taking was volitionally discontinued (Adjusted Pumps; F (1,59) = 2.65, P =.11). Less activation was found in schizophrenia via whole brain and region of interest (ROI) analyses in the right (F (1,59) = 14.91, P < 0.001) and left (F (1,59) = 16.34, P < 0.001) nucleus accumbens (NAcc) during decisions to pursue rewards relative to riskiness. Risk-taking correlated with IQ in schizophrenia, but not controls. Path analyses of average ROI activation revealed less statistically determined influence of anterior insula upon dorsal anterior cingulate bilaterally (left: χ 2 = 12.73, P <.001; right: χ 2 = 9.54, P =.002) during risky reward pursuit in schizophrenia. Conclusions NAcc activation in schizophrenia varied less according to the relative riskiness of uncertain rewards compared to controls, suggesting aberrations in reward processing. The lack of activation differences in other regions suggests similar risk evaluation. Less insular influence on the anterior cingulate may relate to attenuated salience attribution or inability for risk-related brain region collaboration to sufficiently perceive situational risk. [ABSTRACT FROM AUTHOR]

Background: Older adults are more susceptible to adverse events when administered certain medications at doses appropriate for younger adults. Objective: The aim of this study was to investigate the effect of default geriatric dosing on computerized physician order entry (CPOE) templates on the subsequent administration of recommended starting doses of opioids, benzodiazepines (BZDs) and non-steroidal anti-inflammatory drugs (NSAIDs) to older adults in the emergency department (ED). Methods: This was a before-after comparison of the frequency of the recommended starting doses of high-risk medications to adults aged 65 years and older. Computerized records were queried for the administration of the above medication classes in two academic EDs over two similar 4-month periods in 2015 and 2016. Between study periods, the doses of high-risk medications on ED CPOE templates were adjusted for older adults based on established pharmacy guidelines and expert consensus. Results: There was a significant improvement in the rate of recommended dose administration of all medications of interest (27.3 vs. 32.5%, p < 0.001). Not surprisingly, the medications that were maximally impacted were also those most frequently prescribed, with a significant increase in the recommended dosing of opioids (29.0 vs. 35.2%, p < 0.001) accounting for the majority of the change. Although there were no differences in BZDs as a group, there were significant differences in selected BZDs such as midazolam and diazepam. Changes in the recommended dosing of NSAIDs could not be determined due to low numbers of administered doses in both phases of the study. Conclusion: Simple changes in the CPOE template resulted in increased administration of the recommended starting doses of high-risk medications to older adults in the ED. [ABSTRACT FROM AUTHOR]