Journal of the American Geriatrics Society最新文献

{"title":"Responding to a nursing mandate in long-term care: A multi-modal pilot curriculum for bachelor of science in nursing students","authors":"Glenda R. Westmoreland MD, Kathryn I. Frank RN, PhD, Emilie L. Garrison BA, Qing Tang MS, Julia Loubeau MSN, AGPCNP-C, Julie Krieger MSN, AGPCNP-BC, Sarah Hartman NP, Sarah Roth MHA, MPH, PMP, CCRP, Debra K. Litzelman MA, MD, MACP","doi":"10.1111/jgs.19089","DOIUrl":"10.1111/jgs.19089","url":null,"abstract":"<p>On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) released new guidelines for staffing long-term care (LTC) in the U.S. responding to the Executive order from President Biden. The order requires improvement in the quality of care for 1.2 million residents of LTC facilities, most of whom are older adults.<span><sup>1</sup></span> These guidelines mandate in-facility presence of registered nurses round-the-clock, seven-days-a-week and enhanced presence of nurse's aides who have training to meet the complex care needs of LTC residents.<span><sup>1</sup></span> Expanding the currently inadequate nursing workforce in LTC is critical. Comprehensive review of the literature found that including geriatrics and LTC content in undergraduate nursing students' curriculum through clinical placements effectively enhanced their competence in these content areas.<span><sup>2</sup></span></p><p>We developed a new geriatrics curriculum for Bachelor of Nursing Students (BSN) that included content as the 4Ms of Age Friendly Care coupled with LTC content.<span><sup>3</sup></span> Learners completed the multi-modal curriculum, which included an online component, at their own pace. In the absence of real patients through clinical placements, interacting with standardized patients (SPs) is another actionable teaching model. Research by the National Council for the State Boards of Nursing found that replacing traditional clinical hours with high-fidelity simulated experiences are effective in nursing curriculum.<span><sup>4</sup></span> After completing our multi-modal curriculum, learners applied the content using virtual SPs. Our program is the first of its kind where use of “virtual SPs” means the SPs were live, but students were interacting with them through a virtual platform. After the interaction students received feedback from the SP and a faculty member who was also observing the interaction through Zoom.</p><p>Our new curriculum used multiple modalities including locally and nationally developed web modules on geriatrics topics, myths of aging, advanced care planning, and LTC and videos on dementia and the 4Ms. Students completed the roughly 10-h curriculum at their own pace. Our objectives focused on students defining the 4Ms, applying them to a LTC population, and having exposure to LTC as a potential new career option.</p><p>Student evaluation included: (1) pre- and post-knowledge assessment (using the Alzheimer's Disease Knowledge Scale and web-based module questions); (2) attitude assessment (using the Kogan's Attitude Toward Older People Scale and the Four-Domain Sense of Competence in Dementia Care Staff); and (3) skills using four virtual standardized patient scenarios developed by the investigators. Investigators trained SPs on the scenarios. Training was repeated until 80% agreement on checklist completion between the SP and the investigator was achieved. Students were given 20 min to interact with the SPs per scenario, fol","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 S3","pages":"S109-S112"},"PeriodicalIF":4.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting serious illness conversations in primary care through telehealth among persons living with cognitive impairment","authors":"Jennifer L. Gabbard MD,&nbsp;Gretchen A. Brenes PhD,&nbsp;Kathryn E. Callahan MD, MS,&nbsp;Ajay Dharod MD,&nbsp;Richa Bundy MPH,&nbsp;Kristie L. Foley PhD, MS,&nbsp;Adam Moses MHA,&nbsp;Jeff D. Williamson MD, MHS,&nbsp;Nicholas M. Pajewski PhD","doi":"10.1111/jgs.19100","DOIUrl":"10.1111/jgs.19100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes</h3>\u0000 \u0000 <p>Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (<i>n</i> = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3022-3034"},"PeriodicalIF":4.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between pre-hip fracture depression and days at home after fracture and assessing sex differences","authors":"Rhea Mehta MHS,&nbsp;Denise L. Orwig PhD,&nbsp;Chixiang Chen PhD,&nbsp;Yu Dong MD, PhD,&nbsp;Michelle D. Shardell PhD,&nbsp;Takashi Yamashita PhD, MPH,&nbsp;Jason R. Falvey PT, DPT, PhD","doi":"10.1111/jgs.19096","DOIUrl":"10.1111/jgs.19096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hip fracture and depression are important public health issues among older adults, but how pre-fracture depression impacts recovery after hip fracture is unknown, especially among males who often experience greater depression severity. Days at home (DAH), or the days spent outside a hospital or healthcare facility, is a novel, patient-centered outcome that can capture meaningful aspects of fracture recovery. How pre-fracture depression impacts DAH after fracture, and related sex differences, remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants included 63,618 Medicare fee-for-service beneficiaries aged 65+ years, with a hospitalization claim for hip fracture surgery between 2010 and 2017. The primary exposure was a diagnosis of depression at hospital admission, and the primary outcome was total DAH over 12 months post-discharge. Longitudinal associations between pre-fracture depression and the count of DAH among beneficiaries were estimated using Poisson regression models after adjustment for covariates; sex-by-depression interactions were also assessed. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) reflecting relative differences were estimated from these models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, beneficiaries with depression were younger, White females, and spent 11 fewer average DAH compared to counterparts without depression when demographic factors (age and sex) (IRR = 0.91; 95% CI = 0.90, 0.92; <i>p</i> &lt; 0.0001) and social determinants of health (race, Medicaid dual eligibility, and poverty) were adjusted for (IRR = 0.92; 95% CI = 0.91, 0.93; <i>p</i> &lt; 0.0001), but this association attenuated after adjusting for medical complexities (IRR = 0.99; 95% CI = 0.98, 1.01; <i>p</i> = 0.41) and facility and geographical factors (IRR = 1.0037; 95% CI = 0.99, 1.02; <i>p</i> = 0.66). There was no evidence of effect modification by sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The comorbidity burden of preexisting depression may impact DAH among both male and female Medicare beneficiaries with hip fracture. Results suggest a holistic health approach and secondary prevention of depressive symptoms after hip fracture.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3109-3118"},"PeriodicalIF":4.3,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations in Geriatric Medicine Training on Hearing Loss","authors":"Katherine Runkel MD,&nbsp;Prajakta Shanbhag Dr PH,&nbsp;Steven Huart AuD,&nbsp;Janna Hardland MD,&nbsp;Hillary D. Lum MD, PhD","doi":"10.1111/jgs.19095","DOIUrl":"10.1111/jgs.19095","url":null,"abstract":"","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3601-3603"},"PeriodicalIF":4.3,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing the 4Ms framework to create a structure and process to support voluntary health assessments in affordable housing","authors":"Elyse Perweiler MA, MPP, RN,&nbsp;Jennifer DeGennaro MA,&nbsp;Sherry Pomerantz PhD,&nbsp;Marilyn Mock MSW,&nbsp;Margaret Avallone DNP, RN,&nbsp;Aaron Truchil MS,&nbsp;Stephen Singer MCP","doi":"10.1111/jgs.19092","DOIUrl":"10.1111/jgs.19092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A growing number of older adults live in senior affordable housing, many with limited support systems and representing underserved or disadvantaged populations. Staff in these buildings are in a unique position to identify and address the healthcare and biopsychosocial needs of their residents and link them to services and supports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Staff in four affordable housing sites received training on the 4Ms approach to caring for older adults and conducting resident health assessments. They learned to collect comprehensive health information using a 4Ms Resident Health Risk Assessment (4Ms-RHRA) and results are entered into a customized electronic database. Embedded flags identify potential risk factors and initiate a follow-up process for documenting interventions and tracking referrals to healthcare and supportive services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-one percent of the 221 4Ms-RHRAs completed with residents (63% female, mean age 71.1 years, 73% live alone) were flagged for at least one concern (Mean = 2.2 flags). Items addressing What Matters were most frequently flagged: resident's “most important health issue” (55%) and Advance Care Planning (ACP: 48%). In response, staff provided Advance Directive forms and Five Wishes pamphlets to interested residents and reminded residents to review ACP documents annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Training affordable housing staff, precepting faculty, and students to conduct health assessments based on the 4Ms framework and longitudinally track interventions related to resident-centered needs and manage long-term service and supports is a first step in creating an interprofessional workforce capable of addressing the complex needs of older individuals in affordable housing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 S3","pages":"S113-S121"},"PeriodicalIF":4.3,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living art and Giving art in Alzheimer disease","authors":"Michael Tran Duong MD, PhD","doi":"10.1111/jgs.19101","DOIUrl":"10.1111/jgs.19101","url":null,"abstract":"&lt;p&gt;My grandfather taught me my first lessons in the art of giving care. While Grandpa was not a professional in healthcare or art, his time as site manager at a French pharmaceutical company in Vietnam inspired his personal hobby of illustrating human anatomy and nature. This knack reflected in his later drawings while living with Alzheimer disease. We repeated the same conversations and drew the same pictures as our time-honored script and art, though Grandpa still had new lessons to give on the art of living with Alzheimer disease.&lt;/p&gt;&lt;p&gt;One spring afternoon, I came home from school to find a gift on my desk: Grandpa's illustrated anatomy of his heart (2006). He signed on the back, “For Michael.” I ran to thank him and we added it to our art collection.&lt;/p&gt;&lt;p&gt;Five years later, after months of misplacing hats and forgetting appointments, Grandpa was diagnosed with mild cognitive impairment. Neuropsychologic testing demonstrated deficits in episodic memory and logical reasoning. Magnetic resonance imaging revealed atrophy of limbic and retrosplenial regions, supportive of the diagnosis of Alzheimer disease (2011). Our family rallied together, extending our minds to support his.&lt;/p&gt;&lt;p&gt;The years passed and as expected, Grandpa's cognitive impairment progressed. Seven years from his initial diagnosis, Grandpa required substantial assistance in his activities of daily living, but he still enjoyed drawing. One weekend, I asked Grandpa what he wanted to do. He assembled pencils and crayons so I asked him what he wanted to draw. He pointed to his chest and declared, “Draw a heart!” Midway through, Grandpa dropped his red pencil and exclaimed, “Why am I drawing this? This is ugly!” I said this was lovely. He stood up and thrashed. “Why am I drawing this?!” he shouted. I said this drawing was for him. He looked at me, expressing remorse. “Not for me. This is for you.” he replied. Grandpa steadily sat down, picked up a crayon, and continued drawing his heart (2018b).&lt;/p&gt;&lt;p&gt;Two years later, on New Year's day, our family gathered but Grandpa seemed isolated. I invited him to draw one of his favorites, his brain. He nodded. Pencil and paper in hand, we sat. Minutes later, Grandpa dropped his pencil and asked, “What am I drawing?!” I said it's a fine brain. “Why am I drawing this?!” he hollered. I said he liked to draw. “No, I don't like to. Stop asking me!” he responded. I said this drawing was for him. “No,” he accused, “this drawing is for YOU!” He picked up the pencil and yelled, “Now THIS is for you!” slashing graphite lacerations over his paper cortex (2020a).&lt;/p&gt;&lt;p&gt;Grandpa made me reconsider our art and script. If someone no longer enjoys an art, what can their caregiver do? If a patient no longer appreciates a script, what can their provider do?… Patients, caregivers, and providers must adapt to evolving needs. As Grandpa met drawing with indifference and frustration, we found new activities. We chatted. We listened to music. We sat silently. We smiled","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3588-3589"},"PeriodicalIF":4.3,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing drug evaluation in diverse populations and older adults: National Academies of Sciences, Engineering, and Medicine considerations","authors":"Jonathan H. Watanabe PharmD, MS, PhD","doi":"10.1111/jgs.19075","DOIUrl":"10.1111/jgs.19075","url":null,"abstract":"&lt;p&gt;The total value to society of eliminating all life expectancy disparities attributable to the underrepresentation of minorities for the three common conditions of diabetes, heart disease, and hypertension was approximately $11 trillion based on a commissioned analysis that applied the Future Elderly Model for the National Academies of Sciences, Engineering, and Medicine (NASEM) Committee on Improving the Representation of Women and Underrepresented Minorities in Clinical Trials and Research.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While older adults experience higher rates of these comorbidities&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and polypharmacy&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; than the general population and are the major utilizers of medications,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; they are considerably underrepresented in clinical trials and clinical research overall.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; The prioritization of COVID-19 vaccines for older adults as part of phase 1 by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices was a prominent example of the importance of studying older adults and, particularly, older adults with chronic disease in clinical trials.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;To address the societally pressing challenge of the lack of older adults, women, and minorities in clinical trials and medical research in general, NASEM hosted a virtual workshop titled “Drug Research and Development for Adults Across the Older Age Span” in 2020. The following year through 2022, NASEM performed a Congressionally mandated consensus study with culminating report titled “Improving Representation in Clinical Trials and Research: Building Research Equity for Women and Underrepresented Groups.” The goal of these NASEM activities was to examine and shed light on the challenges and opportunities in drug research and development for older adults, women, and underrepresented groups and explore hurdles that impair clinical studies in these populations. The NASEM events described the array of consequences due to the underrepresentation of women and minoritized populations as well as the salient conclusions based on the evidence (Table 1).&lt;/p&gt;&lt;p&gt;Barriers to the necessary representation of underrepresented and excluded populations in clinical research in the current research system have reduced participation by a diverse population in clinical trials and clinical research at multiple levels. Individual research studies, the institutions that conduct research, funders of studies, institutional review boards (IRBs), medical journals, and the broader landscape of national policies and practices that govern research all contribute to barriers of populations historically excluded from clinical research.&lt;/p&gt;&lt;p&gt;At the level of an individual research study, the factors and problems that lead to the underrepresentation and exclusion of certain populations in clinical trials and research begin with and follow the life cycle of a project. Understanding and res","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2912-2920"},"PeriodicalIF":4.3,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of education initiatives to increase delivery of age-friendly care in retail clinics","authors":"Nicholas K. Schiltz PhD,&nbsp;Grace Q. Armstrong MPH,&nbsp;Megan A. Foradori MSN, RN,&nbsp;Sarah Ball MSN, RN, APRN, FNP-BC,&nbsp;Evelyn G. Duffy DNP, AGPCNP-BC, FAANP,&nbsp;Mary E. McCormack MSN, MPH, RN, APNC,&nbsp;Lilia Pino PhD, RN, FNP-C,&nbsp;Anne M. Pohnert DNP, RN, FNP-BC,&nbsp;Mary A. Dolansky PhD, RN, FAAN","doi":"10.1111/jgs.19081","DOIUrl":"10.1111/jgs.19081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Age-Friendly Health Systems model, encompassing four key elements (4Ms)—What Matters, Medication, Mentation, Mobility—is integral to delivering high-quality care to older adult patients. In May 2020, the MinuteClinic at CVS implemented the 4Ms model in all 1100+ store locations nationwide. To prepare healthcare providers to deliver 4Ms care, educational modules were developed to provide an understanding of the gerontology principles that support the 4Ms model of care. Our goal was to evaluate the effectiveness of these education modules on improving reliable 4Ms delivery during retail clinic visits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Educational modules were provided to nurse practitioners and physician associates to complete in a self-directed manner. These included an orientation module with scenarios comparing usual care and 4Ms care, 12 monthly grand rounds focusing on 4Ms case studies, and 10 video vignettes on 4Ms integration. We examined the association between number of education modules completed with the average number of Ms delivered per visit (M-Score) using descriptive statistics and a generalized linear mixed-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over 70% of 2783 providers completed at least one education module. Rates of 4Ms care delivery were 1.37 (1.36–1.39, <i>p</i> &lt; 0.001) times higher among those that completed an orientation course compared to those that did not. Higher uptake of education exhibited a dose–response relationship with rate ratios between 1.77 (1.74–1.80, <i>p</i> &lt; 0.001) for 1–2 modules beyond orientation, up to 2.94 (2.90–2.99, <i>p</i> &lt; 0.001) for eight or more modules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The self-directed learning environment (e.g., providers self-select the number and type of courses) reflects real-world variation in engagement. Despite this variation, significant improvements in 4Ms delivery were observed at any level of educational exposure, underscoring the value of prioritizing education time with quality improvement initiatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3046-3054"},"PeriodicalIF":4.3,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community health worker training on older adults: A qualitative needs assessment","authors":"Nora Spadoni BA,&nbsp;Aliza Baron AM,&nbsp;Elizabeth Zavala MD,&nbsp;Maureen Burns BA,&nbsp;Kandis Draw BA,&nbsp;Wandy Hernandez BA,&nbsp;Jenil Bennett BECE,&nbsp;Lauren J. Gleason MD, MPH, AGSF,&nbsp;Stacie Levine MD","doi":"10.1111/jgs.19077","DOIUrl":"10.1111/jgs.19077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Community health workers (CHWs) are frontline public health personnel who serve as liaisons between vulnerable patient populations and the healthcare system. They are instrumental in health promotion and education for urban-dwelling older adults. However, no research exists on training that CHWs receive on age-friendly health care. This article explores CHW education on the 4Ms of an Age-Friendly Health System and identifies areas where additional training may be necessary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>As part of a two-pronged qualitative needs assessment, four focus groups were held with a total of 17 CHWs and semistructured interviews were conducted with 10 clinicians, including both healthcare providers and social workers. Focus group and interview transcripts were then analyzed for major themes in Dedoose, a qualitative coding software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinicians most often identified Mentation and Mobility as areas where CHWs can have the greatest impact. Correspondingly, CHWs felt under-equipped to assist patients in these areas and expressed strong interest in additional training. In general, CHWs and clinicians agreed that Medications and What Matters do not fall under CHW scope of practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings confirm the critical role that CHWs can play in promoting the health and well-being of urban-dwelling older adults. However, we also demonstrate that many CHWs lack adequate training in age-friendly care. To meet the social and medical needs of a rapidly aging US population, there is a pertinent need to develop a novel community health worker training curriculum on Mentation and Mobility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 9","pages":"2825-2833"},"PeriodicalIF":4.3,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Travels with Bob, my favorite octogenarian","authors":"Dalane W. Kitzman MD","doi":"10.1111/jgs.19090","DOIUrl":"10.1111/jgs.19090","url":null,"abstract":"&lt;p&gt;My great fortune was that my father-in-law became my best friend. For over three decades, I enjoyed his company, learned from his wisdom and example, and observed and assisted this member of the Greatest Generation as he aged gracefully despite humble circumstances and multiple severe morbidities. We bonded quickly after my future wife brought me home to meet her parents. However, it started out awkwardly. Bob was a tall, burly, gregarious dockworker. I was a short, slight, introverted medical student. Nevertheless, within minutes, his cheerful smile and hearty welcome put me at ease. In many ways, he became the father I never had. I affectionately called him “Dad.” Over the years, we became so close and spent so much time together that members of his own family may even have become a little jealous.&lt;/p&gt;&lt;p&gt;Two dramatic events made it unlikely that Bob would live to age 88. First, during WWII as a 22-year-old infantryman, his stubborn refusals to wear his helmet pushed his commanding officer to teach him a lesson about the importance of head protection in an active combat zone. At dusk, he and his equally stubborn compatriot were given a heavy radio set and ordered to cross behind enemy lines and serve as the forward observers for the night. Several times they encountered enemy soldiers, dodged volleys of bullets and their own side's mortars, and narrowly escaped into nearby brush cover. After finally receiving permission to return near dawn, they stumbled into camp, muddy and exhausted. In the dim light, Bob laughed nervously as he pointed to a bullet hole in the radio set his partner carried. But they both paled when his partner then pointed to the fresh bullet dent in Bob's helmet. Later, when they were unable to find their foxhole where they would have slept that night had they not been afield, they were informed that an incoming mortar blast had obliterated it.&lt;/p&gt;&lt;p&gt;Second, at age 52 while on vacation, Bob had a massive heart attack. He spent 6 weeks recovering in a small rural hospital. At Johns Hopkins, he was found to have severe, inoperable ischemic dilated cardiomyopathy. My father-in-law undertook several behavioral changes that I believe contributed to becoming a rare 36-year cardiomyopathy survivor: smoking cessation, regular physical activity, an optimistic, cheerful outlook, generously helping others, crossword puzzles, and regular afternoon naps. He also participated in the first clinical trial of beta-blockers, which became the most potent survival-improving drug.&lt;/p&gt;&lt;p&gt;Bob loved to travel. However, his wife, recalling his multiple out-of-hospital cardiac arrests, wanted him to stay close to home. However, after I joined the family, she allowed him to accompany her cardiologist son-in-law on business trips, opening up a world of adventure and deepening our friendship.&lt;/p&gt;&lt;p&gt;Our trips together took us to three different countries and eight different US states. In Germany, we visited the Berlin wall and Checkpoint Charlie where ","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 10","pages":"3239-3241"},"PeriodicalIF":4.3,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141622018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}