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For three consecutive years, the Age-Friendly Design Committee (AFDC) of the Academy for Gerontology in Higher Education (AGHE) used AGHE's annual meeting as a platform to conduct community-based service-learning workshops focusing on age-friendly design. These workshops assembled local stakeholders, conference attendees from multiple disciplines, and landscape and architectural designers to discuss age-friendly design issues and solutions for local environments. Each workshop provided hands-on design experience and the opportunity for AGHE participants to contribute to conference host communities by using their gerontological expertise to translate knowledge into practice. Local stakeholders learned the value of gerontological input when considering design issues. We describe the process of incorporating service-learning into the conference experience through age-friendly design workshops and how these bring together students, faculty, and design professionals from different backgrounds and disciplines to address local age-friendly design issues.

Physical activity has many benefits for the optimal health of older adults (e.g., lowering risk of cardiovascular disease, depression, dementia and falls). However, less than one in four Americans meets guidelines for physical activity and evidence suggests inactivity increases with age. A growing number of unhealthy older adults will strain resources. Masters athletes are one segment of the population that some promote as exemplary because of their remarkable physical functioning. Swimming is a global, fast-growing sport in Masters athletics. This qualitative study explored the motivations and barriers of older adult (60+ years of age) members of a Masters swim club in Southern California. The researcher used purposive sampling to diversify the sample by selecting male and female participants (N=18) from multiple geographical areas. Guided by a primary research question: Why do Masters swimmers choose swim late in life, when most of their age cohort are becoming less physically active, the researcher conducted semi-structured interviews to delve into the lived experiences of the participants, solicited peer feedback and employed Interpretive Phenomenological Analysis. Four main themes emerged: Masters swimming provided an enjoyable way to slow physical decline; participants felt camaraderie; working out with a group provided challenge and achievement that reinforced their identity as swimmers; and their practice greatly reduced stress. A formidable barrier was revealed when most of the participants expressed longing and regret that they could not swim due to COVID risk and safety guidelines. These findings can be used to design community programs to promote lifelong physical activity participation.

Informal caregivers form a shadow workforce projected to become even more essential as the U.S. population ages. Most are untrained in the role and manage caregiving with competing life demands that compound burden and threaten the welfare of the older adults in their care. The 12-item Zarit Burden Interview measure was employed to investigate differences in subjective burden before and during the Covid-19 pandemic among adult children who are primary informal caregivers of a parent. Additionally, this study explored family composition to determine if the presence of siblings or dependent children affected burden scores. A convenience sample ( N = 77) reported significantly more burden since the onset of the Covid-19 pandemic when compared to pre-pandemic burden. Since the pandemic began, those with living siblings reported less burden than those without siblings, while there was no difference in burden between sandwich generation caregivers and those providing care only for a parent. This study’s results point to the role family plays in resilience during a crisis and emphasizes the need to promote efficient supports and networks to alleviate caregiver burden.

Background: Historically, older adults have been disproportionately affected by disasters. In particular, homebound adults are especially at risk. As one facet of bolstering community resilience, home health agencies have been tasked with improving their patients’ disaster preparedness. However, home health practitioners often lack the information necessary to fulfill these requirements. Providing resources about disaster preparedness will allow these practitioners, often seen as trusted advisors, to better prepare their patients. Objective: This study explores the utility of implementing a checklist-style assessment tool to guide Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) practitioners in disaster preparedness assessments of their patients. Methods: The HBPC Patient Assessment Tool for Disaster Planning (“Tool”) was fielded by practitioners at 10 VHA HBPC programs with all patients seen over the course of a 3-week period. Descriptive statistics and bivariate analysis of the data collected via the Tool were used to understand the baseline levels of preparedness education provided by practitioners to their patients. Data from a follow-up survey and follow-up interviews with Program Managers were analyzed, the latter using content analysis methods. Results: 754 surveys were returned for analysis. We examined how frequently practitioners reviewed the included preparedness items with their patients. Of those patients on oxygen, adherence ranged from 67 to 94% for practitioners covering a discussion about smoking materials/open flame, despite strong efforts to achieve high compliance on this measure as reported by several program managers. Of those items applicable to the general population, certain items were more frequently discussed than others. How to activate 911 services was most frequently reviewed (87%). Providing information about emergency shelter registration and specialty transport was the item least frequently reviewed (44%). Strengths about the Tool included its ease of use, flow, comprehensiveness, and that it fits on one page. Conclusion: Home-based care programs, such as the VHA HBPC program, are tasked with supporting the emergency preparedness of their patients, but often do not have the expertise to do so. This study shows that the checklist-like structure of an assessment tool can assist with this role by encouraging practitioners to cover key points with patients and their caregivers.

Objective:The aim of this study is to determine the response of home-based primary care programs to the fall 2017 Atlantic hurricane season.Methods:This study examines the experiences of 9 Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs in their responses to Hurricanes Harvey, Irma, and Maria. Thirty-four phone interviews with HBPC leadership and staff were conducted from April to July 2018.Results:The total census of impacted HBPC programs was 3118. No program reported loss of life due to these hurricanes. Early preparedness was key to an effective program response. Response included prompt tracking of the patients. In the most affected areas, respondents noted limited resources to support basic patient needs.Conclusions:Medically complex patients served by programs such as the VHA’s HBPC program represent a subset of the population, yet they have an outsized impact on health care resources that could be exacerbated by inadequate disaster preparedness. HBPC programs serve a unique role in supporting the “older old.” They are tasked with supporting disaster preparedness activities of patients. Understanding what is involved in actualizing their requirements shows communities how to effectively engage with these programs.

An increasing number of older adults are turning to educational institutions to provide career training, intellectual stimulation and social interaction. Response to the educational needs and interests of this emerging population calls for new opportunities and innovative practices of teaching, research, and community engagement that colleges and universities are poised to offer. In Summer 2018, CSULB became the third university in California to be designated an Age-Friendly University. This study aimed to identify strengths and opportunities for growth at CSULB as related to each of the 10 Age-Friendly University principles. This study is part of a larger, national study conducted by researchers from UMass, Boston. Interviewees were asked to indicate on the Campus Inventory survey tool the activities and programs offered by the university. Data were collected from CSULB administrators through email after a phone introduction and entered into an Excel document for analysis using qualitative methods. Results provided a clear overview of the types of activities and programs available to older adult students and guided the identification of gaps in services, from the perspective of administrators on campus. The results of this CSULB survey will be compared with results from several AFU campuses across the United States. Additionally, results will be compared with a future Campus Climate survey, which will assess the age-friendliness of CSULB from the perspectives of faculty, students and community members.

ObjectiveHealth agencies working with the homebound play a vital role in bolstering a community’s resiliency by improving the preparedness of this vulnerable population. Nevertheless, this role is one for which agencies lack training and resources, which leaves many homebound at heightened risk. This study examined the utility of an evidence-based Disaster Preparedness Toolkit in Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs.MethodsWe conducted an online survey of all VHA HBPC program managers (N=77/146; 53% response rate).ResultsRespondents with fewer years with the HBPC program rated the toolkit as being more helpful (PPConclusionThis toolkit helps support programs as they fulfill their preparedness requirements, especially practitioners who are new to their position in HBPC. Programs that implement disaster protocols infrequently may require additional efforts to increase understanding of the toolkit’s utility. Engaging all members of the team with their diverse clinical expertise could strengthen a patient’s personal preparedness plan. (Disaster Med Public Health Preparedness. 2017;11:56–63)

IntroductionHome health agencies have been tasked to improve their patients’ disaster preparedness. Few studies have evaluated the robustness of tools to support preparedness in home health. Through evaluation of the Home-Based Primary Care (HBPC) Patient Assessment Tool, we conducted a survey to identify strengths and challenges in supporting the preparedness of patients served by home health programs such as the Veterans Health Administration’s HBPC program.MethodsPractitioners from 10 HBPC programs fielded the Patient Assessment Tool with all patients during a 3-week period. Logistic regression and bivariate analyses were used to identify patient characteristics associated with the delivery of preparedness education.ResultsA total of 754 Patient Assessment Tools were returned. The educational item most likely to be covered was how to activate 911 services (87%). The item least likely to be discussed was information on emergency shelter registration and emergency specialty transportation (44%). When compared to the low risk group, HBPC patients in the high/medium risk group were more likely to receive preparedness education materials for 6 of the 9 educational preparedness items (P values less than 0.05).DiscussionPractitioners are relaying preparedness education to their most vulnerable patients, suggesting that home health agencies can provide disaster preparedness in the home. Nonetheless, there is room for improvement. (Disaster Med Public Health Preparedness. 2019;13:547-554)

Individuals receiving care in the home are vulnerable during disasters due to high rates of chronic disease, cognitive impairment, functional limitations, and physical disabilities as well as dependence on life-saving treatments and equipment. Increasing disaster preparedness among home health care recipients decreases the likelihood of adverse health outcomes and lessens the burden on community hospitals and emergency responders. A literature review examined existing home health organization policies and procedures, lessons learned in the field, and expert recommendations for improving home-based patient disaster preparedness. This review addressed preparedness on three levels: organization, provider, and patient. The results (1) indicate gaps between established and recommended tools and policies and adopted policies, and (2) demonstrate marked differences in approaches to evaluation, classification, education, and triage between organizations.

The Department of Veterans Affairs (VA) is a key player in emergency management for both veterans and civilians. Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of article characteristics include methodology, phase of emergency management addressed in the research, and study design. Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to generate suggestions for future research. Keywords: Veterans Affairs, veterans, disaster, emergency

Introduction The Veterans Health Administration (VHA), the largest integrated healthcare delivery system in the United States, is charged with ensuring timely access to high-quality care for veterans during disasters, and supporting national, state, local, and tribal emergency management and homeland security efforts. In 2008, the VHA Office of Public Health (OPH) sponsored the first VHA Emergency Management Research Agenda-setting conference to develop research priorities that address the needs of veterans and to position VHA as a national leader in emergency management by having VHA serve as a "laboratory" for the development of evidence-based emergency management practices. Methods We focused on four steps: #1: Appraising the emergency management research portfolio of VHA-based researchers; #2: Obtaining systematic information on VHA's role in emergency management and the healthcare needs of veterans during disasters; #3: Based upon gaps between the current research portfolio and the existing evidence base, identifying strategic priorities using a research agenda-setting conference; and #4: Laying the groundwork to foster the conduct of emergency management research within VHA. Results Identified research priorities included how to prevent and treat behavioral health problems related to a disaster, the efficacy of training programs, crisis communication strategies, workforce resilience, and evacuating veterans from health care facilities. Conclusion: VHA is uniquely situated to answer research questions that cannot be readily addressed in other settings. VHA should partner with other governmental and private entities to build on existing work and establish shared research priorities.

The Association for Gerontology in Higher Education (AGHE) fosters the commitment of higher education to the field of aging through education, research, and public service. As part of AGHE’s last three annual conferences from 2016–2018 – in Long Beach, CA, Miami, FL, and Atlanta, GA – the Age-friendly Design Committee (AFDC) coordinated design charrette workshops with local partners (e.g., universities, public agencies) that led to design recommendations for advancing each conference host community’s age friendliness. We will highlight the evolution of partnerships with local universities, conference attendees, and community stakeholders. Local university partners included California State University Long Beach (CSULB), Florida International University (FIU), and Georgia Gwinnett College (GGC). In Long Beach, 2016, the AFDC worked with a CSULB gerontology faculty member, student, and operator of a residential care facility for older adults, recommending improvements for the home’s social and physical environments. In Miami, 2017, the AFDC worked with an FIU landscape architecture class utilizing PhotoVoice methods to incorporate older adult perspectives into the design of the Underline, an urban linear park under construction. In Atlanta, 2018, the AFDC offered a pre-conference workshop focused on age-friendly design concepts, curricula, and community-based research and service approaches. The AFDC worked with GGC faculty and sociology students to assess age-friendly features and barriers of Atlanta’s BeltLine, a network of parks, trails, and community service access points. These charrettes enabled AGHE conference members to collaborate with local community stakeholders to move toward more age-friendly environments.

An editorial is presented which addresses the authors' views about the efforts of health care practitioners to educate older patients about emergency preparedness, and it mentions responses to large-scale disasters, America's aging population, and patient resiliency. The U.S. Veterans Health Administration's Home Based Primacy care program is examined, along with patient assessments, disaster planning, and the roles of home health agencies.

Obesity, cardiovascular disease, and vulnerability among older adults highlight a critical need for a careful consideration of effective and preventive dietary interventions. Consuming flaxseed, along with a well-balanced diet, has been shown to significantly improve weight, waist circumference, blood pressure, serum lipids, plasma glucose levels, and inflammatory biomarkers. Although flaxseed exhibits anti-inflammatory and antioxidant properties, little is known regarding its consumer acceptability among older adults. The objective of this study was to investigate the acceptability of a bagel with 23% flaxseed in individuals 50 years and older using a 9-point Hedonic rating scale, Paired Preference test, and Food Action (FACT) rating scale. There were no significant differences between the control and flaxseed bagel in sensory attributes and FACT ratings in 20 participants (69.0 ± 6.3 years old). Age was significantly associated with the overall acceptability of the flaxseed bagel (p = 0.004). Appearance, color, flavor, and texture were strongly correlated (p < 0.01) to overall acceptability in both bagels. Further exploration of consumer acceptance of flaxseed products among older adults is needed; clinical trials may also shed light on potential health impacts of regular flax consumption.

Individualizing care in nursing homes can be difficult and complex. The purpose of this study is to characterize the meaning of and experiences with individualized care from the perspectives of both nursing aides and nursing-home residents. Eight focus groups of nursing aides (N =17) and residents (N=15) from two nursing homes generated four dialectical themes related to communication strategies: (a) getting to know versus maintaining a protective distance, (b) mutual respect versus disrespect, (c) avoiding versus addressing conflict, and (d) equity versus perceived favoritism. These findings suggest dialectics in how interpersonal communication affects individualized care from the perspectives of both nursing aides and residents.

Increasing use in the past decade has created pressure for hospital emergency rooms (ERs). Healthcare provided through an ER is expensive and is not designed to meet the complex needs of an older, chronically-ill population. ER visits are presented as the outcome of a decision-making process. Thirty veterans who had visited the ER in the previous year were asked about their decisions to use the ER. Their responses reflected four distinct approaches to ER use, which are characterized by frequency (frequent/infrequent) and risk for social isolation (low/high). Appropriate interventions by social work personnel might reduce inappropriate use of the ER and enhance the care of this vulnerable population.

Background: Hurricanes Katrina and Rita exposed significant flaws in US preparedness for catastrophic events and the nation’s capacity to respond to them. These flaws were especially evident in the affected disaster areas’ nursing homes, which house a particularly vulnerable population of frail older adults. Although evacuation of a healthcare facility is a key preparedness activity, there is limited research on factors that lead to effective evacuation. Objective: Our review of the literature on evacuation is focused on developing a conceptual framework to study future evacuations rather than as a comprehensive assessment of prior work. Methods: This paper summarizes what is known thus far about disaster response activities of nursing homes following natural and human-caused disasters, describes a conceptual model to guide future inquiry regarding this topic, and suggests future areas of research to further understand the decision-making process of nursing home facilitators regarding evacuating nursing home residents. To demonstrate the utility of the conceptual model and to provide guidance about effective practices and procedures, this paper focuses on the responses of Veterans Health Administration (VHA) nursing homes to the 2 hurricanes. Results: Quarantelli’s conceptual framework, as modified by Perry and Mushkatel, is useful in guiding the development of central hypotheses related to the decision-making that occurred in VA nursing homes and other healthcare facilities following Hurricanes Katrina and Rita. However, we define evacuation somewhat differently to account for the fact that evacuation may, in some instances, be permanent. Thus, we propose modifying this framework to improve its applicability beyond preventive evacuation. Conclusions: We need to better understand how disaster plans can be adapted to meet the needs of frail elders and other residents in nursing homes. Moreover, we must address identified gaps in the scientific literature with respect to health outcomes by tracking outcomes over time. Information on health outcomes would allow administrators and others to more appropriately weigh the balance of risks and benefits associated with evacuation. Without this understanding of the relationship between evacuation and health outcomes, it is not possible to develop effective response plans that are tailored to meet the needs of nursing home residents.

Why do some older veterans visit the emergency room (ER) frequently? This study expands an existing decision-making model that describes how ER users recognize symptoms of a health problem, decide to seek medical care for the health problem, and decide to visit the ER specifically for the medical care. The focus of this inquiry is the role of older veterans’ social support networks in decisions to visit the ER. Data were collected through in-depth, semistructured, in-person interviews with 30 community-dwelling, high-functioning veterans aged 65 years and older who had visited the ER frequently (3 or more times) in the previous year. We found that the older veteran study participants, regardless of the availability of social support, preferred to make decisions independently, relied heavily on formal social support network members, and received various types of assistance to visit the ER from informal social support networks.

IntroductionVeterans served by Veterans Health Administration (VHA) home-based primary care (HBPC) are an especially vulnerable population due to high rates of physical, functional, and psychological limitations. Home-bound patients tend to be an older population dealing with normal changes that accompany old age, but may not adequately be prepared for the increased risk that often occurs during disasters. Home health programs are in an advantageous position to address patient preparedness as they may be one of the few outside resources that reach community-dwelling adults.ProblemThis study further explores issues previously identified from an exploratory study of a single VHA HBPC program regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients, including patient education activities.MethodsThis project involved semi-structured interviews with 31 practitioners and leadership at five VHA HBPC programs; three urban and two rural. Transcripts of the interviews were analyzed using content analysis techniques.ResultsPractitioners reported a need for further training regarding how to assess properly patient disaster preparedness and patient willingness to prepare. Four themes emerged, validating themes identified in a prior exploratory project and identifying additional issues regarding patient disaster preparedness: (1) individual HBPC programs generally are tasked with developing their disaster preparedness policies; (2) practitioners receive limited training about HBPC program preparedness; (3) practitioners receive limited training about how to prepare their patients for a disaster; and (4) the role of HBPC programs is focused on fostering patient self-sufficiency rather than presenting practitioners as first responders. There was significant variability across the five sites in terms of which staff have responsibility for preparedness policies and training.ConclusionVariability across and within sites regarding how patient needs are addressed by preparedness policies, and in terms of preparedness training for HBPC providers, could place patients at heightened risk of morbidity or mortality following a disaster. Despite the diversity and uniqueness of HBPC programs and the communities they serve, there are basic aspects of preparedness that should be addressed by these programs. The incorporation of resources in assessment and preparedness activities, accompanied by increased communication among directors of HBPC programs across the country, may improve HBPC programs’ abilities to assist their patients and their caregivers in preparing for a disaster.ClaverML, Wyte-LakeT, DobalianA. Disaster preparedness in home-based primary care: policy and training. Prehosp Disaster Med. 2015;30(4):17.

Background: Chronic conditions paired with normal aging put home-bound individuals at risk of harm during a disaster. Because of their high rate of comorbidities, veterans receiving care from the Veterans Health Administration (VHA)'s home-based primary care (HBPC) program are especially vulnerable, which may prevent them from being prepared for disaster. With intimate knowledge of their patients' home environments, medical needs, resources, and limitations, HBPC practitioners are uniquely positioned to assess and improve disaster preparedness of patients. Objective: This study explored issues regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support routine assessment of disaster preparedness for patients as well as patient education activities. Methods: This project involved 32 semi-structured interviews with practitioners and leadership at 5 VHA HBPC programs - 3 urban and 2 rural. Transcripts of the interviews were analyzed using content analysis techniques. Results: Three themes emerged regarding the assessment of a patient's disaster preparedness: (1) assessment tools are rudimentary and, in some cases, individually developed by practitioners; (2) comprehension of criteria for assigning risk categories varies among practitioners, and (3) patients' cognitive impairment, limited resources, and out-of-date or inaccessible materials are the primary challenges to their preparedness. A fourth additional theme emerged as well: (4) the interdisciplinary nature of the HBPC team allows for unique innovative practices, such as a central focus on caregiver support and personal safety, as it relates to assessment and preparedness of the patient. Conclusion: Health and functional limitations may prevent home-bound patients from being adequately prepared for disasters. Standardized strategies and tools concerning disaster preparedness assessment for HBPC patients, which allow flexibility in consideration of factors such as local hazards, could assist in creating more comprehensive planning approaches and, in turn, more prepared persons. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

Despite an ever-growing need for social workers trained to address the needs of older adults, social work baccalaureate and masters programs have been slow to offer gerontology-focused foundation c...

Background: Veterans receiving home-based primary care (HBPC) are an especially vulnerable population served by the Veterans Health Administration (VHA) due to high rates of physical, functional, and psychological limitations. These vulnerabilities may prevent these persons from being adequately prepared for disasters. HBPC providers connect the community-dwelling population with their regional health care system and thus are appropriate partners for assessing preparedness. The limited literature on this topic suggests that there are issues with the development and implementation of emergency management plans, dissemination to staff, and inconsistencies with preparedness strategies across agencies. Objective: To further explore identified issues regarding emergency management planning for patients receiving medical care in their home, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients. Methods: This exploratory pilot project, carried out in a single VHA HBPC program located in an urban area, involved seven 15- to 25-min semistructured interviews with practitioners and leadership. Transcripts of the interviews were analyzed using content analysis techniques to develop themes to describe information obtained through the interviews. Results: Six themes emerged from the data: (1) a national policy regarding the inclusion of disaster preparedness assessment in routine HBPC assessment exists in only a skeletal manner and individual HBPC programs are tasked with developing their own policies; (2) the tools used at the initial assessment were rudimentary and, in some cases, individually developed by providers; (3) the comprehension of criteria for assigning risk categories (i.e. acuity levels) varied among providers; (4) the primary challenges identified by respondents to patient engagement in emergency preparedness activities included cognitive impairments, patients' willingness to invest in preparedness activities, and limited resources; (5) providers received limited formal training on how to prepare their patients for a disaster, and (6) provider recommendations included training to focus on better strategies to get patients to participate, more consistent time spent on patient education, formalization of the initial assessment, and having emergency preparedness be formally addressed on a more consistent basis. Conclusion: Formal standardized strategies regarding disaster preparedness assessment for HBPC patients, which leave room for flexibility in consideration of local factors, could assist in creating more comprehensive emergency management planning agendas and community collaboration.

A key concept driving the field of both clinical and applied gerontology is that of personal control. Seminal work conducted in the late 1970s to early 1980s by Ellen Langer and Judith Rodin, who examined the effect of choice and enhanced responsibility on older adults, not only contributed to the discussion of the relevance of control in contemporary theories and practices of aging but also aided in the development of today's philosophy of how to serve and care for older adults in ways that are passionate, humanistic, and empowering. In their early research, residents at a nursing home were randomly assigned to 2 groups: 1 group was told they could arrange their furniture as they wanted, go where they wanted, spend time with whom they wanted, and so forth and were given a plant to care for; the other group was told that the staff was there to take care of and help them, including watering a plant given to each of them. During this study, and 18 months later, residents who were given control and personal responsibility had improved health; among those for whom control had not changed, a greater proportion had died. Since these original studies, research has continued to support the need for personal control as we age. This paper presents a brief overview of literature informed by Langer and Rodin's seminal findings, as well as the role of control to theory, policy, and practice.

Despite problematic evacuation and sheltering of nursing home residents during Hurricanes Katrina and Rita, an exploration of the experiences of Veterans Health Administration (VHA) nursing homes (VANHs) is necessary for a comprehensive examination of the healthcare community's response to these disasters. VANH evacuations during these hurricanes have not been widely studied. This exploratory project aimed to provide information about the evacuation experiences and characteristics of vulnerable nursing home residents. Interviews with key informants from VHA facilities with nursing home staff and representatives revealed that physical harm, psychological distress, cognitive decline and increased social isolation were areas that deserved special attention for this vulnerable population. Moreover, physical, psychological and social needs were interconnected in that each influenced the others. Findings contribute to the general conversation about meeting the biopsychosocial needs of nursing home residents in an integrated healthcare delivery system and more broadly, the role of long-term care facilities in general in planning for future disasters.

Health care in the United States is rarely delivered in a coordinated manner. Current methods to share patient information are inefficient and may lead to medical errors, higher readmission rates, and delays in the delivery of needed health services. This qualitative study describes lessons learned concerning the early implementation of one Nationwide Health Information Network (NHIN) site in Long Beach, CA during its first year of operation. The Long Beach Network for Health (LBNH) focused on an incremental effort to exchange health information. Despite a limited concentration on emergency department care, virtually all respondents noted concerns regarding the sustainability, or business case, for the exchange of health information. Nevertheless, respondents were encouraged by progress on technological challenges and user requirements during this first year. The early gains in this process may, in turn, have laid the groundwork for future efforts to expand beyond the emergency department.

International audience

International audience

International audience; Dans un article paru en 1938, Georges Duhamel examine la menace de la guerre qui pèse sur la civilisation et en parle en termes de “guerre d'expropriation” et de “guerre d'extermination”: “Il ne suffit pas, pour vivre, écrit-il, de vouloir vivre à tout prix. Il faut en avoir la place” (Destinée des peuples vassaux). La présente communication vise à interroger les textes des écrivains français qui face à la menace de l'idéologie nazie abordent la question d'une nouvelle géographie d'exclusion. La question que pose Duhamel à l’Allemagne hitlérienne de la fin des années trente - “Que voulez-vous faire des Juifs?” (Entreprise vouée à l'échec), est sans doute l'une des plus importante. Au même moment, dans L'Enfance d'un chef, Sartre aborde, lui aussi, le problème d'exclusion territoriale et spatiale. Lucien, le protagoniste qui arrive à forger sa place dans la société par le biais de sa conversion à l'antisémitisme virulent, est celui qui “ne peut souffrir les Juifs” à l'intérieur du même espace où il se trouve. Il ne faut pas que l'espace soit partagé et celui qui a les “cheveux roux” est contraint à l'éviction du lieu commun. Il s'agit en fin de compte du nettoyage du territoire de “l'élément Juif” qui est en même temps considéré comme souillure, comme atteinte à l'hygiène, avant de devenir une “tentation d'expulser les Juifs du genre humain à partir d'un projet de remodelage 'biologico-racial' de l'Europe” (Enzo Traverso, Entretien).