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OBJECTIVES To describe the Bundled Hospital Elder Life Program (HELP and HELP in Home Care), an adaptation of HELP, and examine the association of 30-day all-cause unplanned hospital readmission risk among older adults discharged to home care with and without Bundled HELP. DESIGN Matched case-control study. SETTING Two medical-surgical units within two midwestern rural hospitals and patient homes (home health). PARTICIPANTS Hospitalized patients, aged 65 years and older, discharged to home healthcare with and without Bundled HELP exposure between January 1, 2015, and September 30, 2017. Each case (Bundled HELP, n = 148) was matched to a control (non-Bundled HELP, n = 148) on Charlson Comorbidity Index, primary hospital diagnosis of orthopedic condition or injury, and cardiovascular disease using propensity score matching. MEASUREMENTS The primary study outcome was 30-day all-cause unplanned hospital readmission. Additional outcomes measured were 30-day emergency department (ED) visit, hospital length of stay (LOS), and total number of skilled home care visits. RESULTS Fewer cases (16.8%) than controls (28.4%) had a 30-day all-cause unplanned hospital readmission. The fully adjusted model showed significantly lower risk of 30-day hospital readmission for case (Bundled HELP) patients (0.41; 95% confidence interval = 0.22-0.77; P

OBJECTIVE The study aimed to assess the prevalence of newly prescribed antipsychotic/benzodiazepine medication, as well as 30-day readmissions, among Hospital Elder Life Program (HELP)-enrolled patients. DESIGN Retrospective case-control study. SETTING HELP intervention took place in eight hospital units. The standard care group was selected from eight additional hospital units. PARTICIPANTS Hospitalized patients, aged 65 years and older, enrolled in HELP during between January 1, 2017 to December 31, 2018 were included in the HELP cohort. Patients hospitalized in eight additional units during the same time frame were part of the standard care group. MEASUREMENTS Antipsychotic/benzodiazepine medications were pulled from the electronic health record. History of chronic mental illnesses were classified by ICD10 codes. Basic descriptive statistics were used to analyze patient characteristics and comorbidities. Chi-squared and t-tests were performed to detect statistical differences as appropriate. RESULTS There were 1411 patients in the HELP group and 10,807 patients in the standard care group. The HELP group was likely to be older, female and to have a shorten length of stay (all p ≤ 0.02). Our study demonstrated that approximately 8.9% (n = 125) of patients enrolled in HELP received an order for antipsychotics during their hospital admission, while 31.5% (n = 3400) from the standard care group (p

In current standard practice, without a structured process for delirium follow up, older individuals and their family caregivers seemed to be lost, as they transitioned from hospital to home. The aim of this study was to pilot test a theoretical post-hospital model of care (DDEFY delirium) to mitigate the complications in patients who had hospital delirium. This is a pilot feasibility randomized controlled trial for patients with hospital delirium. The intervention was carried out by a delirium transitions nurse with personalized interdisciplinary team recommendations. DDEFY delirium intervention encompasses: Diagnose cognitive disorder; review Drugs; Educate patient/family; assess Function; Your health goals. During COVID-19 pandemic a virtual intervention group was created. Thus, three groups were analyzed: control, intervention, and virtual intervention. Among the 35 participants (mean age 80 years (SD10), 40% Black, 46% female), 40% had a diagnosis of dementia, mean Charles Deyo score was 6.4, mean number of medications 11.4 (3.2), and a mean anticholinergic medication burden was 2.4. The intervention group and virtual intervention group rates were: recruitment: 44.6 %vs8.8%, feasibility: 97%vs97%, fidelity:100%vs100%, 30-day readmission 28.6%vs0%, and 30-day ED visits: 0 vs.1. There were no differences in 30-day readmission rates between control vs intervention (p=1.0), control vs virtual intervention (p=.53), nor comparing all 3 groups (p=.49). The results of this pilot study determined that delivering DDEFY intervention to patients with delirium is feasible. Lessons learned from conducting this study will help us design a larger trial with modifications for older patients with delirium who transition from hospital to home.

Older patients in the emergency department (ED) present unique diagnostic and therapeutic challenges. The ED clinicians must simultaneously evaluate and treat older adults along multiple domains: cognitive impairment, atypical presentations, functional impairment, medication management, trauma and falls, and end-of-life care. This article reviews these domains and suggests strategies for a more comprehensive, patient-centered ED approach to older patients. Incorporating assessment of these domains into the ED process improves patient outcomes, provider satisfaction, and ED flow.

Geriatrics models of care : , Geriatrics models of care : , کتابخانه دیجیتال جندی شاپور اهواز

The Acute Care for Elders (ACE) Consult Program is an evidence-based model focused on improving care of hospitalized elders by targeting comprehensive biopsychosocial and functional needs from hospital admission. The four core principles of ACE include a prepared environment, patient-centered care, multidimensional assessment optimizing medication prescribing, and interdisciplinary team rounds linked with early comprehensive discharge planning.