Optimizing delirium care in the era of Age-Friendly Health System.

Delirium is a significant geriatric condition associated with adverse clinical and economic outcomes. The cause of delirium is usually multifactorial, and person-centered multicomponent approaches for proper delirium management are required. In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) launched a national initiative, Age-Friendly Health System (AFHS), promoting the use of a framework called 4Ms (what matters, medication, mentation, and mobility). The 4Ms framework's primary goal is to provide comprehensive and practical person-centered care for older adults and it aligns with the core concepts of optimal delirium management. In this special article, we demonstrate how a traditional delirium prevention and management model can be assessed from the perspective of AFHS. An example is the crosswalk with the Hospital Elder Life Program (HELP) Core Interventions and the 4MS, which demonstrates alignment in delirium management. We also introduce useful tools to create an AFHS environment in delirium management. Although much has been written about delirium management, there is a need to identify the critical steps in advancing the overall delirium care in the context of the AFHS. In this article, we suggest future directions, including the need for more prospective and comprehensive research to assess the impact of AFHS on delirium care, the need for more innovative and sustainable education platforms, fundamental changes in the healthcare payment system for proper adoption of AFHS in any healthcare setting, and application of AFHS in the community for continuity of care for older adults with delirium.

Age-Friendly Nursing Homes: Opportunity for Nurses to Lead.

Age-Friendly Health Systems is a movement to ensure that all care and support for and with older adults across all settings is age-friendly care. Age-Friendly Health Systems provide staff, leadership, and care partner education based on the 4M Framework (What Matters, Medications, Mentation, Mobility). Nursing homes and other settings are often left out of local, state, or federal strategic plans on aging. In addition, limited quality and quantity of nursing home staff impact new program implementation. We consider how programs and services to support older adults can create and sustain an Age-Friendly Ecosystem, including a meaningful role for nursing homes.

Elder Mistreatment Prevention Rounds in Nursing Homes.

This new prevention paradigm could benefit all.

Advancing clinical trials in nursing homes: A proposed roadmap to success.

An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.

Drivers and restrainers to adoption and spread of evidence-based health service delivery interventions: The case of CAPABLE.

CONTEXT: Very few programs improve physical function among older adults and those that do should achieve farther reach. METHODS: We used Force Field Analysis to examine drivers and restrainers for the CAPABLE program to impact the function of older adults throughout the United States. FINDINGS: We found 19 distinct drivers for CAPABLE. These include robust research findings demonstrating clinical and economic utility, expansion from an evidence-based program, grounding in theory, high value to older adults themselves, and common sense approach. A major policy environment shifting towards value-based payment and payer flexibility to experiment with social determinants significantly changed the perception of the program's value by key stakeholders. We found 8 distinct restrainers. CONCLUSIONS: Factors which drive and restrain CAPABLE provide lessons for other programs to move from research to sustainability. Policymakers, payers, and communities should look to proven programs as solutions to improve function for older adults and society.

Advancing Clinical Trials in Nursing Homes: A Proposed Roadmap to Success.

An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.

Advancing Clinical Trials in Nursing Homes: A Proposed Roadmap to Success.

An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.

Leveraging National Nursing Home Huddles for Rapid COVID-19 Response.

A disproportionate number of older adult residents of U.S. nursing homes have died during the COVID-19 pandemic. The novelty of the virus spurred frequently changing guidance as nursing facilities navigated response efforts. In May 2020, the 6-month COVID-19 Rapid Response Network for Nursing Homes (RRN) was launched to leverage the concept of huddles across U.S. nursing homes to reduce COVID-19-related morbidity, mortality, and transmission by identifying best practices to rapidly implement, fostering connections between nursing homes, and refocusing the national narrative on optimism for nursing home care response efforts. Daily 20-min huddles transitioned to twice weekly in the program's final two months. A total of 93 huddles featured 103 speakers with 1960 participants engaging in both live huddles and asynchronous learning. 90.33% of participants said they learned at least two new ideas by participating and 89.17% strongly agreed or agreed that participating improved their ability to lead change in their organization. Qualitative data echoed gratitude for a centralized source of information and best practices and the sense of positivity and community the RRN provided. Leveraging nursing home huddles at the national, regional, local, system, or facility level may serve as a guidepost for future pandemics or work where guidance is new or quickly evolving.

Advancing Gerontological Nursing at the Intersection of Age-Friendly Communities, Health Systems, and Public Health.

Mounting efforts to improve care and promote healthy aging throughout society and across the care continuum have created unique opportunities for gerontological nursing practice. Population aging has invoked a multitude of responses among all levels of international and national organizations, foundations, health care, and government to meet the needs and promote preferences of older adults. Large-scale programs by the World Health Organization, The John A. Hartford Foundation, Institute for Health-care Improvement, and Trust for America's Health have galvanized to advance the momentum of age-friendly communities, health care, and public health. Gerontological nurses can leverage this growing interest in aging by enhancing their knowledge about age-friendly movements, influencing these movements with their expertise in evidence-based practices, and advancing their own competencies in caring for older adults in any setting. [Journal of Gerontological Nursing, 47(3), 13-17.].

Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum.

Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms-what matters, medication, mentation, and mobility-in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework's positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers' criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.

Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey.

OBJECTIVE: To measure US hospitals' adoption of electronic health record (EHR) functions that support care for older adults, focusing on structured documentation of the 4Ms (What Matters, Medication, Mentation, and Mobility) and electronic health information exchange/communication with patients, caregivers, and long-term care providers. MATERIALS AND METHODS: In an online survey of a national, random sample of 797 US acute-care hospitals in 2018-2019, 479 (60.1%) responded. We calculated nationally representative measures of the percentages of hospitals with EHRs that include structured documentation of the 4Ms and exchange/communications functions. RESULTS: Structured EHR documentation of the 4Ms was fully implemented in at least 1 unit in 64.0% of hospitals and across all units in 41.5% of hospitals. Of the 4Ms, structured documentation was the highest for medications (91.3% in at least 1 unit) and the lowest for mentation (70.3% in at least 1 unit). All exchange/communication functions had been implemented in at least 1 unit in 16.2% of facilities and across all units in 7.6% of hospitals. Less than half of the hospitals had an EHR portal for long-term care facilities to access hospital information (45.4% in at least 1 unit), sent information electronically to long-term care facilities (44.6%), and had training for adults/caregivers on the patient portal (32.1%). DISCUSSION: Despite significant national investment in EHRs, hospital EHRs do not yet include key documentation, exchange, and communication functions needed to support evidence-based care for the older adults who comprise the majority of the inpatient population. Additional policy efforts are likely needed to promote the expansion of EHR capabilities into these high-value domains. CONCLUSIONS: US acute-care hospital EHRs are lacking key functions that support care for older adults.

Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed.

BACKGROUND: Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones. OBJECTIVE: To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation. DESIGN: Systematic review. SETTING: Ovid MEDLINE, Ovid EMBASE, Cochrane Library, PsycINFO Elton B. Stephens Co. (EBSCO), AgeLine, CINAHL. MEASUREMENTS: We abstracted key information about each program and categorized programs into 14 types and 9 subtypes. For programs that reported an impact evaluation, we systematically assessed the study quality. We also systematically examined the potential for programs to be successfully implemented in environments with limited resources available. RESULTS: We found 116 articles describing 115 elder mistreatment programs. Of these articles, 43% focused on improving prevention, 50% focused on identification, and 95% focused on intervention, with 66% having multiple foci. The most common types of program were: educational (53%), multidisciplinary team (MDT) (21%), psychoeducation/therapy/counseling (15%), and legal services/support (8%). Of the programs, 13% integrated an acute-care hospital, 43% had high potential to work in low-resource environments, and 57% reported an attempt to evaluate program impact, but only 2% used a high-quality study design. CONCLUSION: Many programs to combat elder mistreatment have been developed and implemented, with the majority focusing on education and MDT development. Though more than half reported evaluation of program impact, few used high-quality study design. Many have the potential to work in low-resource environments. Acute-care hospitals were infrequently integrated into programs.