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The authors present a method for estimating the value and cost effectiveness of the U.S. government initiative known as the American Jobs Plan, particularly regarding the program's allocation of funds targeted toward the expansion of access to home and community-based services (HCBS) for older citizens with disabilities.

Background: Community health centers (CHCs) are federally funded safety‐net clinics that provide care to low income and medically underserved persons. The proportion of CHC patients aged ≥65 doubled in the last ten years, yet little is known about this population. We aim to describe the demographic and clinical characteristics of the older adult CHC population. Design: Cross sectional analysis. Setting: The nationally representative 2014 Health Center Patient Survey. Participants: CHC patients ≥55 years. Measures: We used descriptive statistics to characterize older adults across demographic and clinical variables. To determine differences by age, we stratified into three groups (55–64, 65–74, 75+ years). We used t‐tests and chi‐squared to calculate p values and survey weights to make national estimates. Results: We included 1875 older adults ≥55 years, representing over 4.2 million people. Older adults were mostly aged 55–64 (60%), female (51%), and white (60%). The majority (73%) had Medicare or Medicaid and 47% reported fair or poor health. Regardless of age, older adults had an average of three chronic conditions and 0.6 impairments in activities of daily living (ADL). Healthcare utilization was not significantly different across age groups with most taking ≥5 prescription medications (54%) and one in five reporting ≥2 emergency department visits or ≥1 hospitalization in the last year. Conclusions: Adults 55–64 who attend CHCs have similar disease burden as adults ≥65. As the population of older adults who access CHCs grow, our findings highlight the opportunity to enhance focus on key principles of geriatric medicine, such as measurement of functional impairment for those who are <65 while also addressing underlying health disparities. [ABSTRACT FROM AUTHOR]

Background/Objectives: The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW‐delivered interventions in older adults. Design: We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English‐language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. Setting: Any U.S. or international setting, including clinical and community‐based settings. Participants: Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high‐utilization. Interventions: Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. Measurements: Pre‐defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. Results: Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi‐experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low‐to‐moderate methodological quality. Outcomes included mood, functional status and disability, social support, well‐being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high‐quality RCT, while others noted no significant intervention effects on outcomes. Conclusion: CHW‐led interventions may have benefit for older adults with complex health needs, but additional high‐quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence‐based interventions and improve clinical outcomes in complex older adults. See related editorial by Thompson et al. [ABSTRACT FROM AUTHOR]

Objective: Patients with multiple medical conditions and complex social issues are at risk for high utilization and poor outcomes. The Connecting Provider to Home program deployed teams of a social worker and a community health worker (CHW) to support patients with social issues and access to primary care. Our objectives were to examine the impact of the program on utilization and satisfaction with care among older adults with complex social and medical issues. Design: Retrospective quasi‐experimental observational study with matched comparator group. Setting: Community‐based program in Southern California. Participants: Four hundred twenty community dwelling adults. Intervention: Community‐based healthcare program delivered by a social worker and CHW team for older adults with complex medical and social needs. Measurements: Acute hospitalization and emergency department (ED) visits in the 12 months preceding and following enrollment in the pilot program. A "difference‐in‐difference" analysis using a matched comparator group was conducted. Comparator group data of patients receiving usual care were obtained. Surveys were conducted to assess patient satisfaction and experiences with the program. Results: The mean age of patients was 74 years, and the program demonstrated statistically significant reductions in acute hospitalizations and ED use compared with 700 comparator patients. Pre/post‐acute hospitalizations and ED visits were reduced in the intervention group. The average per patient per year reduction in acute hospitalizations was −0.66, whereas the average per patient reduction in ED use was −0.57. Patients enrolled in the program reported high levels of satisfaction and rated the program favorably. Conclusions: A care model with a social worker and CHW can be linked to primary care to address patient social needs and potentially reduce utilization of healthcare services and enhance patient experiences with care. See related editorial by Danto‐Nocton et al. and article by Robinson et al. in this issue. [ABSTRACT FROM AUTHOR]

Background: Community-based interventions that incorporate resistance training (RT) and dietary changes have not been extensively studied in overweight and obese older adults. The purpose of this investigation was to determine the effects of a community-based RT and dietary intervention on physical function and body composition in overweight and obese older adults. Methods: Ninety-five overweight and obese (BMI = 33.4 ± 4.0 kg/m²) older adults aged 55-80 years completed an 8-week RT and dietary intervention at 4 Rhode Island senior centers. Participants performed RT twice-weekly using resistance tubing, dumbbells, and ankle weights. Participants also attended 1 weekly dietary counseling session on a modified Dietary Approaches to Stop Hypertension diet. Outcome measurements included anthropometrics, body composition, and physical function. Results: There were small changes in body mass (-1.0 ± 1.8 kg, P < .001 ), waist circumference (-5.2 ± 3.8 cm, P < .001 ), and percent body fat (-0.5 ± 1.4%, P < .001 ). In addition, significant improvements were observed in knee extensor torque (+7.9 ± 19.1 N-m, P < .001), handgrip strength (+1.2 ± 2.5 kg, P < .001), and 8-foot up-and-go test time (-0.56 ± 0.89 s, P < .001). Conclusion: Community-based RT and dietary modifications can improve body composition, muscle strength, and physical function in overweight and obese older adults. Future investigations should determine if this intervention is effective for long-term changes. [ABSTRACT FROM AUTHOR]

Background: This study was designed to develop an evidence- and community- based falls prevention program--Tai Chi: Moving for Better Balance. Methods: A mixed qualitative and quantitative approach was used to develop a package of materials for program implementation and evaluation. The developmental work was conducted in 2 communities in the Pacific Northwest. Participants included a panel of experts, senior service program managers or activity coordinators, and older adults. Outcome measures involved program feasibility and satisfaction. Results: Through an iterative process, a program package was developed. The package contained an implementation plan and class training materials (ie, instructor's manual, videotape, and user's guidebook). Pilot testing of program materials showed that the content was appropriate for the targeted users (community-living older adults) and providers (local senior service organizations). A feasibility survey indicated interest and support from users and providers for program implementation. A 2-week pilot evaluation showed that the program implementation was feasible and evidenced good class attendance, high participant satisfaction, and interest in continuing Tai Chi. Conclusions: The package of materials developed in this study provides a solid foundation for larger scale implementation and evaluation of the program in community settings. [ABSTRACT FROM AUTHOR]

The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older was designed to develop a national strategy for the promotion of physically active lifestyles among the mid-life and older adult population. The Blueprint identifies barriers to physical activity in the areas of research, home and community programs, medical systems, public policy and advocacy, and marketing and communications.ÊIn addition, the Blueprint proposes a number of concrete strategies that could be employed in order to overcome the barriers to physical activity in society at large. This paper summarizes and reviews progress achieved in advancing each of the 18 strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: The Centers for Disease Control and Prevention recommends that patients at risk of falling engage in evidence‐based community fall prevention programs (EBCFPPs). EBCFPPs are often delivered in senior centers (SCs). This is the first independent assessment of availability of EBCFPPs in SCs. DESIGN: Cross‐sectional study of four types of EBCFPPs in the 25‐mile radius of 10 US academic centers (ACs). SETTING: SCs. PARTICIPANTS: SCs. INTERVENTION: None. MEASUREMENTS: Number and types of EBCFPPs offered at SCs. RESULTS: Across the 10 ACs, 249 SCs were sampled. Of the SCs, 35% offered zero, 54% offered at least one, 9% offered at least two, and 2% offered at least three EBCFPPs. Tai Chi of any type was offered in 59.8%, A Matter of Balance was offered in 8.9%, Stepping On was offered in 8.0%, and Staying Active and Independent for Life was offered in 1.2% of SCs sampled. SCs near Columbia University offered all four of the programs, while those near the University of Utah, Johns Hopkins University, and Seattle University only offered three of the programs. In univariate analysis, the number of local SCs was significantly associated with quantity of EBCFPPs (odds ratio [OR] = 2.2; 95% confidence interval [CI] = 1.9‐2.6; P < .001), but not with diversity of EBCFPPs (OR = 1.0; 95% CI = 1.0‐1.1; P =.13). In multivariate regression, city, sex distribution, and average household income did not correlate with the overall number or the diversity of EBCFPPs, whereas locales with more SCs offered more EBCFPPs (OR = 2.2; 95% CI = 1.7‐2.9; P < .001). CONCLUSIONS: A significant number of SCs still do not offer any EBCFPPs. From those that do, few offer a diversity of these programs. Opportunities exist to increase access to EBCFPPs in SCs. [ABSTRACT FROM AUTHOR]

Background: Ghana is experiencing an epidemiological shift in public health issues toward non-communicable diseases that are underpinned by modifiable health behaviors. Physical activity rates have decreased, especially among older adults, coinciding with urbanization and an increase in sedentary work. Community-based physical activity programs are a recommended method of increasing physical activity levels; however, none currently exist in Ghana. The aim of this exploratory study was to determine older Ghanaian adults' perceptions of physical activity and asses fit and feasibility of adapting and delivering a physical activity program for this population.Methods: Through a concurrent exploratory mixed-methods design, data were gathered from Ghanaian older adults (N = 123) during focus groups (N = 10) conducted at one diabetes clinic and nine churches across three urban areas. Qualitative data were collected using a semi-structured script that prompted for responses related to physical activity perceptions and the fit and feasibility of physical activity program characteristics. Quantitative data were collected through a questionnaire assessing participant demographics, physical activity levels, and health rating as well as physical activity knowledge and self-efficacy.Results: Findings indicate that older adults in Ghana have a need for and an interest in physical activity promotion. Participants had positive perceptions of being physically active, but were unaware of physical activity guidelines and how to meet them. Peer influence and health care providers' recommendations were motivating factors for physical activity participation. As for desired physical activity program characteristics, participants expressed interest in group-based activities and becoming peer leaders and preference for a church-based program.Conclusions: The results suggest that a group-based physical activity program encouraged by health care providers and delivered at churches through a train-the-trainer model would be well received by aging adults from three urban areas of Ghana. In addition, education on physical activity types is needed, along with better dissemination and education on Ministry of Health physical activity guidelines. This exploratory work highlights preliminary support for a group- and community-based physical activity program for the aging population in Ghana. Beginning with the end in mind, these program characteristics should be considered when adopting, adapting, and implementing an intervention with this population. [ABSTRACT FROM AUTHOR]

Background: Several outcome measures can be utilised to measure social participation and Quality of Life (QoL) in research and clinical practice. However there have been few large-scale trials of these tools in community care to identify their value to clients and providers. This study aims to evaluate the implementation of the Australian Community Participation Questionnaire (ACPQ) and the ICEpop CAPability measure for Older people (ICECAP-O) as tools to measure social participation and QoL for clients receiving community aged care services. The specific research questions focus on determining: (1) the levels and predictors of social participation and QoL among older adults using community aged care services; (2) the acceptability and feasibility of implementation of ACPQ and ICECAP-O tools into routine community aged care assessments; (3) if implementation of the tools change service provision and outcomes for older adults receiving community aged care services.Methods: A mixed method design will be used to collect data from a large Australian aged care provider. Community aged care clients' ACPQ and ICECAP-O scores, as well as other key outcomes (e.g. services used, hospitalisation and admission to permanent residential care), will be examined at baseline and 12-monthly follow-up assessments. Interviews and focus groups with community aged care clients and staff who administer the tools will also be completed. Descriptive statistics and multiple linear regression will be used to examine the levels and predictors of social participation and QoL. Thematic analysis of interviews and focus groups will be used to determine the acceptability and feasibility of implementing the ACPQ and ICECAP-O into routine needs assessments in community aged care. Case-controlled analyses will be used to determine whether the implementation of the ACPQ and ICECAP-O changes service use and outcomes.Discussion: The novel use of the ACPQ and the ICECAP-O tools as part of routine needs assessments for community aged care clients has the potential to improve the quality and effectiveness of community aged care services and outcomes.Trial Registration: Australian and New Zealand clinical trial registry number: ACTRN12617001212347 . Registered 18/08/2017. [ABSTRACT FROM AUTHOR]

Background: A first step to offer community-dwelling older persons proactive care is to identify those at risk of functional decline within a year. This study investigates the predictive value of registered information, questionnaire and GP-opinion on functional decline.Methods: In this cohort study, embedded within the ISCOPE-trial, participants (≥75 years) completed the ISCOPE-screening questionnaire on four health domains. GPs gave their opinion on vulnerability of participants. Functional status was measured at baseline and 12 months (Groningen Activities Restriction Scale [GARS]). The outcome was functional decline (death, nursing home admission, 10% with greatest functional decline). The predictive value of pre-selected variables (age, sex, polypharmacy, multimorbidity, living situation; GPs' opinion on vulnerability, number of domains with problems [ISCOPE-score]) was compared with the area under the curves (AUC) for logistic regression models.Results: 2018 of the 2211 participants (median age 82.1 years [IQR 78.8-86.5], 68.0% female, median GARS 31 [IQR 24-41]) were visited at 12 months (median GARS 34 [IQR 26-44]). 394 participants (17.8%) had functional decline (148 died, 45 nursing home admissions, 201 with greatest functional decline). The AUC for age and sex was 0.602, increasing to 0.620 (p = 0.029) with polypharmacy, multimorbidity and living situation. The GPs' opinion added more (AUC 0.672, p < 0.001) than the ISCOPE-score (AUC 0.649, p = 0.007). AUC with all variables was 0.686 (p = 0.016), and 0.643 for GPs' opinion alone.Conclusions: The GPs' opinion and ISCOPE-score improve this prediction model for functional decline based on readily available variables. GPs could identify older patients for further assessment with their clinical judgement.Trial Registration: Netherlands trial register, NTR1946 . Registered 10 August 2009. [ABSTRACT FROM AUTHOR]

Background: Geriatric syndromes (GSs) are common in older adults and have a significant effect on their quality of life, disability, and use of health care resources. Few studies have assessed the prevalence of GSs in Russia. The aim of this study is to assess the prevalence of GSs among older adults living in the community in Moscow. Methods: A cross-sectional study was conducted in four community clinics in Moscow. A total of 1,220 patients completed a screening questionnaire, and 356 of them also underwent a comprehensive geriatric assessment (CGA). Results: The mean age of the 1,220 participants was 74.9±6.1 years; 75.5% were women. Based on the questionnaire, 58.3% reported visual or hearing impairment, 58.2% cognitive impairment, 46% mood disorder, 42% difficulty walking, 28.3% urinary incontinence, 21.3% traumatic falls (over the previous year), and 12.2% weight loss. The mean number of GSs per patient was 2.9±1.5. Based on CGA, a decline in Instrumental Activity of Daily Living score was identified in 34.8% of the patients, a risk of malnutrition (Mini-Nutritional Assessment score, 17-23.5) in 25.8%, probable cognitive impairment (Mini-Mental State Examination score <25) in 8.6%, and symptoms of depression (15-item Geriatric Depression Scale score .5) in 36.2%. On the whole, patients demonstrated good mobility (average walking speed, 1±0.2 m/s) and hand grip strength (23.9±6.4 kg in women and 39.1±8.3 kg in men), but poor balance (only 39.4% were able to maintain their balance on one leg for 10 s or more). Conclusion: The results of this study demonstrate a high prevalence of GSs among communitydwelling people aged 65 years and older in Moscow. The results provide a better understanding of the needs of older adults in Russia and can facilitate planning for medical and social assistance for this population. [ABSTRACT FROM AUTHOR]

Background: A million older people living in Australia receive community care services each year due to experiencing functional or mental health difficulties. This group may be at greater risk of falling than similar-aged people not receiving services. However, there is limited falls prevention research for this population. Purpose: The aim of this study was to identify the falls prevalence rates of older people from 10 Australian community care organizations and compare current falls prevention data to a study 10 years prior that utilized the same 10 organizations. This study also identified factors associated with falling for this population. Patients and methods: This is a cross-sectional descriptive study, in which 5,338 questionnaires were mailed to a random sample of community care recipients aged $65 years. Results: A total of 1,991 questionnaires were returned (37.3%), with 47.7% of respondents having fallen in the previous year, and 32.7% in the month prior to completing the questionnaire, similar to 10 years prior. Community care clients had a 50% higher falls rate than that reported for similar-aged people not receiving services, and this remained unchanged over the last 10 years. Eighty-six per cent of fallers had fallen once or twice, and 60% reported being injured. Thirty-six per cent of respondents reported not being able to get up independently, and only 27.4% of fallers were referred to a falls prevention program (significantly fewer than 10 years ago; 95% CI: 0.821-6.366, p=0.01). Balance issues (odds ratio [OR]: 2.06, 95% CI: 1.288-3.290, p=0.003) and perceived risk of falling in the future being "definite" (OR: 6.42, 95% CI: 1.890-21.808, p=0.003) or "unsure" (OR: 3.31, 95% CI: 1.144-9.544, p=0.027) were risk factors associated with falling. In contrast, individuals referred to a falls prevention intervention had a 47% reduced likelihood of having fallen (95% CI: 0.281-0.988, p=0.046). Conclusion: Community care clients should have their falls risk routinely assessed, and at-risk individuals be offered falls prevention advice and referral to fall prevention programs. [ABSTRACT FROM AUTHOR]

Background: Despite knowing better how to screen older adults, understanding how frailty progression might be modified is unclear. We explored effects of modifiable and non-modifiable factors on changes in frailty in community-dwelling adults aged 50+ years who participated in the Canadian Multicentre Osteoporosis Study (CaMos).Methods: Rates of change in frailty over 10 years were examined using the 30-item CaMos Frailty Index (CFI). Incident and prevalent low-trauma fractures were categorized by fracture site into hip, clinical vertebral and non-hip-non-vertebral fractures. Multivariable generalized estimating equation models accounted for the time of frailty assessment (baseline, 5 and 10 years), sex, age, body mass index (BMI, kg/m2), physical activity, bone mineral density, antiresorptive therapy, health-related quality of life (HRQL), cognitive status, and other factors for frailty or fractures. Multiple imputation and scenario analyses addressed bias due to attrition or missing data.Results: The cohort included 5566 women (mean ± standard deviation: 66.8 ± 9.3 years) and 2187 men (66.3 ± 9.5 years) with the mean baseline CFI scores of 0.15 ± 0.11 and 0.12 ± 0.10, respectively. Incident fractures and obesity most strongly predicted frailty progression in multivariable analyses. The impact of fractures differed between the sexes. With each incident hip fracture, the adjusted mean CFI accelerated per 5 years by 0.07 in women (95% confidence interval [CI]: 0.03 to 0.11) and by 0.12 in men (95% CI: 0.08 to 0.16). An incident vertebral fracture increased frailty in women (0.05, 95% CI: 0.02 to 0.08) but not in men (0.01, 95% CI: -0.07 to 0.09). Irrespective of sex and prevalent fractures, baseline obesity was associated with faster frailty progression: a 5-year increase in the adjusted mean CFI ranged from 0.01 in overweight (BMI: 25.0 to 29.9 kg/m2) to 0.10 in obese individuals (BMI: ≥ 40 kg/m2). Greater physical activity and better HRQL decreased frailty over time. The results remained robust in scenario analyses.Conclusions: Older women and men with new vertebral fractures, hip fractures or obesity represent high-risk groups that should be considered for frailty interventions. [ABSTRACT FROM AUTHOR]

Diabetes is a common long-term condition affecting many people many of whom require support with their insulin injections at home. These injections are often carried out by community nurses if individuals are unable to self-manage their condition. This paper describes a pilot project where health care support workers were trained to administer insulin at home for suitable patients. Four patients took part in the pilot study and two support workers were trained to give the insulin injections. The project was evaluated well by all those who took part. It freed up 80 hours of nursing time while also providing the support workers with an extended scope of practice and associated increased in job satisfaction. No untoward medication errors were reported as a result of this initiative. This project will now be rolled out to the wider nursing teams with a staggered approach to the delivery of the training to ensure there is not a detrimental effect on patient care. [ABSTRACT FROM AUTHOR]

The number of older Europeans 80+ is projected to increase from 27.7 million in 2016 to 65.2 million in 2070. The goal of these cohorts is to stay independent and autonomous in the community as long as possible, but a large share of this population resides in improperly built dwellings. They face a dangerous environment in surrounding of their dwelling which influences their decision to prematurely move to nursing home, which is decreasing their quality of life and increasing public expenditures. To prevent premature departure to a nursing home and make long-term care system, more sustainable Member States need to develop a proper Health and Social Infrastructure including long-term care services and assisted living facilities suitable for older adults with declining functional capacities that are dependent on the help of others. For the development of this infrastructure, the financial sources should be structured properly. Therefore, the objective of this paper is to introduce the decision model for planning and financing of Health and Social Infrastructure including long-term care services and dwelling units suitable for the older population. The model is based on a multiple decrement approach. As a novelty, we have developed a scheme of long-term care insurance where disbursement of benefits depends on functional capacities of older adults and type of dwelling, where they are living. Actuarial present value of long-term care LTCa x is subject of criterion function of suitability of the social infrastructure. Local authorities can use the model for supporting decisions regarding investment in social infrastructure for elderly. [ABSTRACT FROM AUTHOR]

A path-breaking example of the interplay between geriatrics and learning healthcare systems is the Veterans Health Administration's ( VHA's) planned roll-out of a program for providing participant-directed home- and community-based services to veterans with cognitive and functional limitations. We describe the design of a large-scale, stepped-wedge, cluster-randomized trial of the Veteran-Directed Home- and Community-Based Services ( VD- HCBS) program. From March 2017 through December 2019, up to 77 Veterans Affairs Medical Centers will be randomized to times to begin offering VD- HCBS to veterans at risk of nursing home placement. Services will be provided to community-dwelling participants with support from Aging and Disability Network Agencies. The VHA Partnered Evidence-based Policy Resource Center ( PEPReC) is coordinating the evaluation, which includes collaboration from operational stakeholders from the VHA and Administration for Community Living and interdisciplinary researchers from the Center of Innovation in Long-Term Services and Supports and the Center for Health Services Research in Primary Care. For older veterans with functional limitations who are eligible for VD- HCBS, we will evaluate health outcomes (hospitalizations, emergency department visits, nursing home admissions, days at home) and healthcare costs associated with VD- HCBS availability. Learning healthcare systems facilitate diffusion of innovation while enabling rigorous evaluation of effects on patient outcomes. The VHA's randomized rollout of VD- HCBS to veterans at risk of nursing home placement is an example of how to achieve these goals simultaneously. PEPReC's experience designing an evaluation with researchers and operations stakeholders may serve as a framework for others seeking to develop rapid, rigorous, large-scale evaluations of delivery system innovations targeted to older adults. [ABSTRACT FROM AUTHOR]

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This study examined the effects on attitudes and lifestyle behavior of Jog your Mind, a multi-factorial community-based program promoting cognitive vitality among seniors with no known cognitive impairment. A quasi-experimental study was conducted. Twenty-three community organizations were assigned either to the experimental group (offering the program) or to the control group (creating a waiting list). They recruited 294 community-dwelling seniors. The aims of the study were to verify the effects of the program on attitudes and behaviors related to cognitive vitality and to explore its effects on cognitive vitality. Data was collected at baseline and after the program. Regression analyses revealed that, following their participation in the program, experimental group participants reported: (i) in terms of attitudes, having a greater feeling of control concerning their cognitive capacities, (ii) in terms of behaviors, using significantly more memory strategies and practicing more physical activity and stimulating activities than control group participants. However, the program had no significant effects on measures of cognitive vitality. This study supports the fact that a multi-factorial community-based program can have significant effects on seniors' attitudes and lifestyle behaviors related to cognitive vitality but at short term, no effects on cognitive vitality it-self were found. [ABSTRACT FROM AUTHOR]

Objectives To examine whether a novel videoconference that connects an interdisciplinary hospital-based team with clinicians at postacute care sites improves interprofessional communication and reduces medication errors. Design Prospective cohort. Setting One tertiary care medical center and eight postacute care sites. Participants Hospital-based providers (hospitalists, geriatricians, pharmacists, social workers, medical trainees, and subspecialists) and postacute care clinicians. Intervention All patients discharged to eight postacute care sites were discussed in a weekly videoconference. Measurement Preliminary data including demographic characteristics of the patients discussed, postacute care provider satisfaction survey results, and data on medication errors are reported. Results Over 2 years, 907 patients were discussed; 84.6% were discussed with staff at subacute skilled nursing facilities and the remainder with clinicians at one long-term acute care facility. They had an average hospital length of stay of 6.8 days. Postacute care providers felt that the videoconference enhanced communication and provided much-needed access to information and hospital staff. Of the 106 pharmacy discrepancies identified, 16% involved an omission of a medication. Conclusion As increasing numbers of older adults are discharged to postacute care facilities, they face high-risk care transitions. Extension for Community Healthcare Outcomes-Care Transitions ( ECHO- CT) facilitates interdisciplinary communication between hospital and postacute care providers, who normally have minimal interaction. Preliminary data suggests that ECHO- CT may improve the transitions of care processes between these sites. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to develop a community-based oral healthcare model for Thai dependent older people in Tambon Tha Pla Duk, Amphur Mae Tha, Lamphun Province, in the north of Thailand.Materials and Methods: Participatory action research was conducted, taking an interdisciplinary approach. Data were collected through focus group discussions with key stakeholders in health care of older people in Amphur Mae Tha. Supplementary data were also collected with the stakeholders through a triangulation of in-depth interviews, a self-administered questionnaire, participant observations with field notes and a literature review. The model was subsequently refined and checked by the stakeholders. The data from all processes were coded, grouped, interpreted and thematically analysed for emerging themes and patterns, independently by the researcher (TP).Results: This model consists of two key components: (i) primary care and (ii) other related factors. Primary care: This model provides a strong linkage between home, community and healthcare services to foster strong collaborations with dependent older people. This is the central focus of the model. Other related factors consist of the following: (i) Thai social norms and culture, (ii) the need for equity, (iii) the need for effectiveness, (iv) the need for efficiency and (v) the need for quality (that is, holistic, integrated and continuous). Finally, interdisciplinary collaboration was a strategy used to achieve improved quality of oral health care.Conclusion: A community-based care model to enhance oral health of dependent older people was developed for potential implementation and submitted to the stakeholders at the location of the study. [ABSTRACT FROM AUTHOR]