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Interdisciplinary Emergency Department/hospital-based teams represent a promising care model to improve identification of and intervention for elder mistreatment. Two institutions, Weill Cornell Medicine/NewYork-Presbyterian Hospital and the University of Colorado Anschutz Medical Campus have launched such programs and are exploring multiple strategies for effective dissemination. These strategies include: (1) program evaluation research, (2) framing as a new model of geriatric care, (3) understanding the existing incentives of health systems, EDs, and hospitals to align with them, (4) connecting to ongoing ED/hospital initiatives, (5) identifying and collaborating with communities with strong elder mistreatment response that want to integrate the ED/hospital, (6) developing and making easily accessible high-quality, comprehensive protocols and training materials, (7) offering technical assistance and support, (8) communications outreach to raise awareness, and (9) using an existing framework to inform implementation in new hospitals and health systems. [ABSTRACT FROM AUTHOR]

The emergency department and hospital provide a unique and important opportunity to identify elder mistreatment and offer intervention. To help manage these complex cases, multi-disciplinary response teams have been launched. In developing these teams, it quickly became clear that social workers play a critical role in responding to elder mistreatment. Their unique skillset allows them to establish close connections with community resources, collaborate with various hospital stakeholders, support patients/families/caregivers through challenging situations, navigate the legal and protective systems, and balance patient safety and quality of life in disposition decision-making. The role of the social worker on these multi-faceted teams includes conducting a comprehensive biopsychosocial assessment, helping to develop a safe discharge plan, and making appropriate referrals, among other responsibilities. Any institution considering developing a multi-disciplinary program should recognize the critical importance of social work. [ABSTRACT FROM AUTHOR]

Background, Lower limb muscle power impairments are modifiable factors underlying mobility limitations in older adults. This study examined relationships between upper and lower limb muscle power and their role in predicting mobility performance among community-dwelling older adults. Methods. A cross-sectional analysis was conducted. Participants included 37 mobility-limited adults (24 women, 13 men), aged 65 to 93 years. Measures included upper (elbow extension) and lower limb (double leg press) one repetition maximum (IRM), and muscle power at both 40% and 70% one repetition maximum. Physical performance measures included stair climb time, the Short Physical Performance Battery, and 4-meter walk time. Factors commonly mediating the relationship between impairments and physical performance were analyzed as covariates. Results. Participants had a mean age of 76 years, had five chronic medical conditions, and manifested moderate mobility limitations. Although the associations between the upper and lower limbs were strong (p < .001), the magnitude of association was greater for power (r = .88-.89) as compared to strength (r = .69). Multivariate regression analyses revealed consistently strong relationships between limb muscle power and mobility performance measures. Substituting upper for lower limb power within these models did not materially weaken the relationships. Conclusion. Muscle power appears to be a more generalized attribute between the upper and lower limbs than is muscle strength, suggesting that mechanisms underlying velocity of movement, as opposed to force production, may be important factors underlying muscle power in elderly persons. Additionally, upper limb muscle power measures may serve as a useful surrogate measure of limb power having implications for clinicians and researchers.

Background. The 6-minute walk (6mw) is a well-established measure of aerobic capacity in elders with cardiorespiratory and peripheral vascular disease and may be an accurate measure of functional performance in healthy elders. In mobility-limited elders, a population at risk for disability, impairments in strength and power are predictive of performance-based measures of function. Though commonly utilized as an outcome measure among otherwise healthy mobility-limited elders, it is not clear whether the 6mw best represents a measure of functional limitation, aerobic capacity, or both. Methods. We hypothesized that the 6mw would be strongly representative of performance-based measures of function being determined by impairments in muscle strength and power. We performed a cross-sectional analysis of 45 community-dwelling elders with mild to moderate mobility limitations. Results. The 6mw was strongly associated with established functional measures (r = .61-.83; p < .001), but was poorly associated with indirect measures of aerobic capacity (r < .25; p > .05). Multivariate linear regression models demonstrated that impairments in leg strength and power, especially those at the knee and ankle, were predictive of 6mw performance. Conclusions. These findings emphasize the 6mw as a measure of functional limitation among mobility-limited elders without cardiorespiratory or peripheral vascular disease.

In the article, the author discusses the enrollment process, development of individualized care plans and electronic triage early notification system in super-high utilizer programs (SHUP) and their effects on emergency department (ED) and inpatient hospital utilization. Other topics include the common patients using emergency services like patients with chronic diseases, substance abuse and psychiatric disorders, and the use of individualized patient-centered care plans in patients.

Objectives/hypothesis: Few studies have specifically addressed auditory complaints in patients with nonblast mild traumatic brain injury (mTBI). Herein, we aimed to investigate auditory symptoms in patients following mTBI using patient-reported outcome measures.Study Design: Retrospective analysis of prospectively collected data in a tertiary-care hospital.Methods: The patients included those with mTBI (cases) and those without mTBI (controls). Individuals (≥18 years old) with and without mTBI were screened. Exclusion criteria included history of otologic disorders, blast injury, or occupational noise exposure. Primary outcomes included the Hearing Handicap Inventory for Adults (HHIA), Tinnitus Handicap Inventory (THI), and Hyperacusis Questionnaire (HQ). Secondary outcomes included subjective auditory complaints.Results: From September 2017 to September 2018, 52 patients with mTBI and 55 controls met inclusion and exclusion criteria. The mean time between mTBI and survey intake was 70.6 months. The mean age and gender were 51.5 years old and 73% female in the mTBI group, and 46.1 years old and 56.3% female in the control group (P = .112 and P = .105, respectively). Patients with mTBI reported hyperacusis (67.3% of all mTBI patients), hearing loss (61.5%), and tinnitus (61.5%), compared to 8.3%, 12.7%, and 16.4%, respectively, for control subjects (P < .0001). The mean HHIA score in the mTBI group was 38.3 versus 8.5 in controls (P = .002). The mean THI score was 27.4 in the mTBI group and 3.1 in controls (P < .0001). The mean HQ score was 26.5 in mTBI group and 7.3 in controls (P = .001).Conclusions: Auditory symptoms and associated handicap were common in patients with nonblast mTBI compared to age-matched controls. Findings have implications for the pathophysiology and management of symptoms in this patient population.Level Of Evidence: 3 Laryngoscope, 130:761-767, 2020. [ABSTRACT FROM AUTHOR]

1. Viewers are able to articulate key factors for the successful implementation of the My Life, My Story or other type of narrative medicine program at their institution. 2. Participants may apply described strategies to assist in designing and implementing My Life, My Story or other type of narrative medicine program at their institution. While the benefits of MLMS have been previously demonstrated, the implementation roadblocks could be further explored. Outlining how to lower the barrier of entry to starting and sustaining MLMS could allow more systems to add this valuable care dimension. These techniques and pitfalls can be generalizable in launching other dignity or legacy work through narrative medicine programs. The MLMS project is a dignity intervention that focuses on the personal stories of Veterans beyond their medical diagnoses. Veterans and providers alike agree that MLMS enhances therapeutic relationships, leading to quality care that better aligns with patients' goals(1). MLMS allows trainees of various disciplines to improve empathy skills, mitigate burnout and deeply understand patients; impact is sustained even many years after exposure(2-4). The aim of this project is to share successful strategies for launching MLMS within a timeframe of a few months. MLMS starts with an initial interview, where Veterans share personal stories, followed by a second meeting to review and edit the written narrative. The final document is then entered into the electronic health record, with personal copies made available. Weekly meetings address integration challenges, engage stakeholders, and troubleshoot barriers. Through experiential learning, we gained valuable insight during the implementation of MLMS. Success hinged on identifying a core team as interviewers and trainers, addressing challenges in consent and referral processes, prioritizing interviews for patients with shorter prognoses, program advocacy, and establishing partnerships with other MLMS facilities. A qualitative analysis of Veterans' perceptions improved the process. Pitfalls included relying solely on impermanent interviewers, over-planning before launch, lack of structure for training and debriefing, and misalignment with the institution's vision. These lessons may be readily applicable to launching MLMS or other types of legacy work and narrative medicine programs. Challenges revolved around capturing and serving appropriate Veterans, allocating resources, navigating organizational workflow, and obtaining institutional buy-in. Successful MLMS implementation facilitates a holistic and personalized approach to care, leading to improved healthcare experiences and outcomes for patients. Existential / Humanities / Spirituality / ReligionManaging Suffering and Distress [ABSTRACT FROM AUTHOR]

Objectives: To evaluate weighted stair climbing exercise (SCE) as a means of increasing lower extremity muscle power in mobility-limited older people., Design: Single-blinded, randomized controlled pilot study., Setting: Human physiology laboratory of a metropolitan university., Participants: Forty-five community-dwelling people aged 65 and older who had baseline mobility limitations manifested by scores of 11 or lower on the Short Physical Performance Battery (SPPB)., Interventions: Subjects were randomized into one of two 12-week exercise programs. The intervention group (SCE) (n = 23) ascended and descended stairs, at a set pace, while wearing a weighted vest. The control group (WALK) (n = 22) participated in a standardized walking program., Measurements: Primary and secondary outcomes included measures of muscle power and strength, submaximal aerobic capacity, and physical performance., Results: SCE produced 17% improvement in double leg press peak power in comparison with WALK (P =.013) and significant improvement in stair climbing power from baseline (12%). Improvement in submaximal aerobic performance was equivalent for both groups. Although not statistically significant, effect size estimates suggest that SCE can potentially influence knee extension power and strength. Stair climb time was improved in both groups, whereas SCE produced significant improvements from baseline SPPB score in a subcohort of participants., Conclusions: These findings suggest that SCE maybe a useful component of a home exercise program designed to enhance lower extremity muscle power, aerobic capacity, and functional performance. Further investigation is needed involving larger sample sizes and direct comparisons with other forms of resistance training.