Background/Objectives
Telephone calls after discharge from the emergency department (ED) are increasingly used to reduce 30‐day rates of return or readmission, but their effectiveness is not ...established. The objective was to determine whether a scripted telephone intervention by registered nurses from a hospital‐based call center would decrease 30‐day rates of return to the ED or hospital or of death.
Design
Randomized, controlled trial from 2013 to 2016.
Setting
Large, academic medical center in the southeast United States.
Participants
Individuals aged 65 and older discharged from the ED were enrolled and randomized into intervention and control groups (N = 2,000).
Intervention
Intervention included a telephone call from a nurse using a scripted questionnaire to identify obstacles to elements of successful care transitions: medication acquisition, postdischarge instructions, and obtaining physician follow‐up. Control subjects received a satisfaction survey only.
Measurements
Primary outcome was return to the ED, hospitalization, or death within 30 days of discharge from the ED.
Results
Rate of return to the ED or hospital or death within 30 days was 15.5% (95% confidence interval (CI) = 13.2–17.8%) in the intervention group and 15.2% (95% CI = 12.9–17.5%) in the control group (P = .86). Death was uncommon (intervention group, 0; control group, 5 (0.51%), 95% CI = 0.06–0.96%); 12.2% of intervention subjects (95% CI = 10.1–14.3%) and 12.5% of control subjects (95% CI = 10.4–14.6%) returned to the ED, and 9% of intervention subjects (95% CI = 7.2–10.8%) and 7.4% of control subjects (95% CI = 5.8–9.0%) were hospitalized within 30 days.
Conclusion
A scripted telephone call from a trained nurse to an older adult after discharge from the ED did not reduce ED or hospital return rates or death within 30 days. Clinicaltrials.gov identifier: NCT01893931z.
See related editorial by Hwang et al.
We characterized real-world prescribing patterns of opioids and benzodiazepines (BZDs) for older adults to explore potential disparities by race and sex and to characterize patterns of ...co-prescribing.
A retrospective evaluation was conducted using electronic health data for adults ≥65 years old who presented to one of 15 primary care practices between 2019 and 2020 (n = 25,141). Chronic opioid and BZD users had ≥4 prescriptions in the year prior, with at least one in the last 90 or 180 days, respectively. We compared demographic characteristics between all older adults versus chronic opioid and BZD users. We used logistic regression to identify characteristics (age, sex, race, Medicaid use, fall history) associated with opioid and BZD co-prescribing.
We identified 833 (3.3%) chronic opioid and 959 chronic BZD users (3.8%) among all older adults seen in these practices. Chronic opioid users were less likely to be Black (12.7% vs. 14.3%) or other non-White race (1.4% vs. 4.3%), but more likely to be women (66.8% vs. 61.3%). A similar trend was observed for BZD users, with less prescribing among Black (5.4% vs. 14.3%) and other races (2.2% vs. 4.3%) older adults and greater prescribing among women (73.6% vs. 61.3%). Co-prescribing was observed among 15% of opioid users and 13% of BZD users. Co-prescribing was largely driven by the presence of relevant co-morbid conditions including chronic pain, anxiety, and insomnia rather than demographic characteristics.
We observed notable disparities in opioid and BZD prescribing by sex and race among older adults in primary care. Future research should explore if such patterns reflect appropriate prescribing or are due to disparities in prescribing driven by biases related to perceived risks for misuse.
Background
Little is known about changes in gastrointestinal symptoms compatible with disorders of gut‐brain interaction (DGBI) with increasing age at the population level. The objective of this ...study was to describe the patterns of DGBI in individuals 65 years of age and above and contrasting them with those of younger adults.
Methods
A community sample of 6300 individuals ages 18 and older in the US, UK, and Canada completed an online survey. Quota‐based sampling was used to ensure equal proportion of sex and age groups (40% aged 18–39, 40% aged 40–64, 20% aged 65+) across countries, and to control education distributions. The survey included the Rome IV Diagnostic Questionnaire for DGBI, demographic questions, questionnaires measuring overall somatic symptom severity and quality of life, and questions on healthcare utilization, medications, and surgical history.
Results
We included 5926 individuals in our analyses; 4700 were 18–64 years of age and 1226 were ages 65+. Symptoms compatible with at least one DGBI were less prevalent in participants ages 65+ vs. ages 18–64 years (34.1% vs. 41.3%, p < 0.0001). For symptoms compatible with upper GI DGBI, lower prevalence for most disorders was noted in the 65+ group. For lower GI DGBI, a different pattern was seen. Prevalence was lower in ages 65+ for irritable bowel syndrome and anorectal pain, but no differences from younger participants for the disorders defined by abnormal bowel habits (constipation and/or diarrhea) were seen. Fecal incontinence was the only DGBI that was more common in ages 65+. Having a DGBI was associated with reduced quality of life, more severe non‐GI somatic symptoms, and increased healthcare seeking, both in younger and older participants.
Conclusion
Symptoms compatible with DGBI are common, but most of these decrease in older adults at the population level, with the exception of fecal incontinence which increases. This pattern needs to be taken into account when planning GI health care for the growing population of older adults.
OBJECTIVES
To evaluate the effects of a community pharmacy‐based fall prevention intervention (STEADI‐Rx) on the risk of falling and use of medications associated with an increased risk of falling.
...DESIGN
Randomized controlled trial.
SETTING
A total of 65 community pharmacies in North Carolina (NC).
PARTICIPANTS
Adults (age ≥65 years) using either four or more chronic medications or one or more medications associated with an increased risk of falling (n = 10,565).
INTERVENTION
Pharmacy staff screened patients for fall risk using questions from the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. Patients who screened positive were eligible to receive a pharmacist‐conducted medication review, with recommendations sent to patients' healthcare providers following the review.
MEASUREMENTS
At intervention pharmacies, pharmacy staff used standardized forms to record participant responses to screening questions and information concerning the medication reviews. For participants with continuous Medicare Part D/NC Medicaid coverage (n = 3,212), the Drug Burden Index (DBI) was used to assess exposure to high‐risk medications, and insurance claims records for emergency department visits and hospitalizations were used to assess falls.
RESULTS
Among intervention group participants (n = 4,719), 73% (n = 3,437) were screened for fall risk. Among those who screened positive (n = 1,901), 72% (n = 1,373) received a medication review; and 27% (n = 521) had at least one medication‐related recommendation communicated to their healthcare provider(s) following the review. A total of 716 specific medication recommendations were made. DBI scores decreased from the pre‐ to postintervention period in both the control and the intervention group. However, the amount of change over time did not differ between these two groups (P = .66). Risk of falling did not change between the pre‐ to postintervention period or differ between groups (P = .58).
CONCLUSION
We successfully implemented STEADI‐Rx in the community pharmacy setting. However, we found no differences in fall risk or the use of medications associated with increased risk of falling between the intervention and control groups. J Am Geriatr Soc 68:1778‐1786, 2020.
Introduction
There is a growing number of older adults (≥65 years) who live with type 1 diabetes. We qualitatively explored experiences and perspectives regarding type 1 diabetes self‐management and ...treatment decisions among older adults, focusing on adopting care advances such as continuous glucose monitoring (CGM).
Methods
Among a clinic‐based sample of older adults ≥65 years with type 1 diabetes, we conducted a series of literature and expert informed focus groups with structured discussion activities. Groups were transcribed followed by inductive coding, theme identification, and inference verification. Medical records and surveys added clinical information.
Results
Twenty nine older adults (age 73.4 ± 4.5 years; 86% CGM users) and four caregivers (age 73.3 ± 2.9 years) participated. Participants were 58% female and 82% non‐Hispanic White. Analysis revealed themes related to attitudes, behaviours, and experiences, as well as interpersonal and contextual factors that shape self‐management and outcomes. These factors and their interactions drive variability in diabetes outcomes and optimal treatment strategies between individuals as well as within individuals over time (i.e. with ageing). Participants proposed strategies to address these factors: regular, holistic needs assessments to match people with effective self‐care approaches and adapt them over the lifespan; longitudinal support (e.g., education, tactical help, sharing and validating experiences); tailored education and skills training; and leveraging of caregivers, family, and peers as resources.
Conclusions
Our study of what influences self‐management decisions and technology adoption among older adults with type 1 diabetes underscores the importance of ongoing assessments to address dynamic age‐specific needs, as well as individualized multi‐faceted support that integrates peers and caregivers.
Acute coronary syndrome in the older adults Dai, Xuming; Busby-Whitehead, Jan; Alexander, Karen P
Journal of geriatric cardiology : JGC,
02/2016, Letnik:
13, Številka:
2
Journal Article
Odprti dostop
Coronary heart disease remains the leading cause of death in the developed world. Advanced age is the single strongest risk factor for coronary artery disease （CAD） and independent predictor for poor ...outcomes following an acute coronary syndrome （ACS）. ACS refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction due to various degrees of reduction in co- ronary blood flow as a result of plaque rupture/erosion and thrombosis formation or supply and demand mismatch.
Abstract
Acute Care for Elders (ACE) units reduce hospital‐associated delirium, functional decline, and lengths of stay. However, establishing and sustaining such units have proven difficult. There ...are only 43 ACE units among the >3500 hospitals in the United States. This study describes an iterative quality improvement process, which allowed us to establish and sustain an ACE unit care model in a modern academic hospital. This continuous process was centered on implementing the key principles of the ACE unit model of care: patient‐centered care assessments, medical care review, specialized prepared environment, early mobilization, physical therapy, and early planning for discharge to home. Quality of care and patient outcomes data for older adults admitted to our ACE unit includes mortality index (observed/expected) consistently <1 (FY22 = 0.86), 30‐day readmission rate of <10% (FY22 9.31%), and length of stay index of ~1 (FY22 1.07). We describe how work on our ACE unit has led to hospital‐wide initiatives, including dementia‐friendly hospital certification. Our hope is that others can use this process to enhance the dissemination of the ACE unit model of care.
Older adults are characterized by profound clinical heterogeneity. When designing and delivering interventions, there exist multiple approaches to account for heterogeneity. We present the results of ...a systematic review of data‐driven, personalized interventions in older adults, which serves as a use case to distinguish the conceptual and methodologic differences between individualized intervention delivery and precision health‐derived interventions. We define individualized interventions as those where all participants received the same parent intervention, modified on a case‐by‐case basis and using an evidence‐based protocol, supplemented by clinical judgment as appropriate, while precision health‐derived interventions are those that tailor care to individuals whereby the strategy for how to tailor care was determined through data‐driven, precision health analytics. We discuss how their integration may offer new opportunities for analytics‐based geriatric medicine that accommodates individual heterogeneity but allows for more flexible and resource‐efficient population‐level scaling.
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