SPEAK. A mnemonic tool for addressing health literacy concerns in geriatric clinical encounters.

Healthcare providers can enhance the effectiveness and efficiency of the care they provide by recognizing their patients' health literacy. Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." It is a measure of the clarity of the communication between the healthcare system and the patient. The consequences that can occur when the patients' health literacy is not addressed include: poorer health status, high rates of health services use, compromised patient safety, and increased health care costs. The mnemonic SPEAK (Speech, Perception, Education, Access, and Knowledge) provides a simple framework that healthcare providers can use to enhance their own awareness of health literacy components during patient care. Case examples show how the mnemonic can be used in everyday practice.

The prevalence of undiagnosed geriatric health conditions among adult protective service clients.

PURPOSE: We sought to determine the prevalence of remediable health conditions from in-home geriatric assessments of referred adult protective service (APS) clients suffering elder mistreatment. DESIGN AND METHODS: We used a retrospective cohort study of 211 APS clients (74% female; age, M = 77 years) in two central New Jersey counties. RESULTS: Dementia was the most frequent diagnosis (62% prevalence) and was positively correlated with occurrences of financial exploitation (R =.199; p =.01) and caregiver neglect (R =.174; p =.03) among female APS clients. Depression (37% prevalence), hypertension (36%), involuntary weight loss (34%), pain (32%), and falling (26%) all appeared equally distributed, though urinary incontinence (23% prevalence) was strongly correlated with circumstances of caregiver neglect (R =.31; p =.003). IMPLICATIONS: This new effort to link APS workers with geriatric clinicians conducting in-home health assessments proved effective for identifying a high prevalence of remediable health conditions among APS clients suffering various manifestations of elder mistreatment.

Interventions from home-based geriatric assessments of adult protective service clients suffering elder mistreatment.

OBJECTIVES: To describe the interventions for adult protective service (APS) clients referred for geriatric assessment. DESIGN: Retrospective cohort study. SETTING: In-home geriatric assessments conducted in two New Jersey counties. PARTICIPANTS: Two hundred eleven APS clients; 74% female; mean age 77. MEASUREMENTS: Cognition, affect, nutrition, prevalence of selected medical diagnoses and functional conditions, and categories of interventions. RESULTS: Home health agency services were initiated for 46% of APS clients suffering from all forms of mistreatment. Institutional placements (36%) and guardianship interventions (36%) were correlated with caregiver neglect, especially in female APS clients and those diagnosed with dementia. Urgent medications (25%) were prescribed across all mistreatment classifications, and acute hospitalization (20%) was correlated with circumstances of physical abuse. CONCLUSION: An in-home geriatric assessment service was able to contribute at least one relevant intervention for 81% of referred APS clients to collaboratively help mitigate elder mistreatment circumstances.

Hospice use for the patient with advanced Alzheimer's disease: the role of the geriatric psychiatrist.

Advanced Alzheimer's disease (AD) can place an immense burden on caregivers as they struggle to provide end-of-life (EOL) care for the patient. Palliative care, as delivered by hospice, provides a viable solution. Hospice maintains the patient's quality of life (QOL) and helps the family during the grieving process. However, many providers are not familiar with hospice and its care for advanced AD patients. Geriatric psychiatrists can be central in implementing hospice, and they can remain an important part of the care once it is in place. A principal clinical challenge is establishing the six-month prognosis for such patients, which is a prerequisite for initiating hospice admission.

Hospice use for the patient with advanced Alzheimer's disease: the role of the geriatric psychiatrist.

Advanced Alzheimer's disease (AD) can place an immense burden on caregivers as they struggle to provide end-of-life (EOL) care for the patient. Palliative care, as delivered by hospice, provides a viable solution. Hospice maintains the patient's quality of life (QOL) and helps the family during the grieving process. However, many providers are not familiar with hospice and its care for advanced AD patients. Geriatric psychiatrists can be central in implementing hospice, and they can remain an important part of the care once it is in place. A principal clinical challenge is establishing the six-month prognosis for such patients, which is a prerequisite for initiating hospice admission.

Four models of medical education about elder mistreatment.

The authors describe four models of incorporating elder-mistreatment curricular content and collaboration with adult protective service (APS) community service agencies into geriatrics medical education. Geriatrics education programs at four academic health centers-the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; the University of California, Irvine College of Medicine; Hennepin County Medical Center, Minneapolis, Minnesota; and Baylor College of Medicine Geriatrics Program at the Harris County Hospital District, Houston, Texas-were surveyed and information collated. All programs incorporated direct interactions between learners and APS workers into their teaching programs. Learners were fellows, residents, and medical students. While two programs provided direct patient care, two others restricted learners to consultant roles, supporting the APS service providers with medical input. In addition to directly meeting curricular training needs of elder abuse and neglect, clinical cases provided valued learning experiences in applied clinical ethics, the role of physicians with community-based programs, the interaction between the medical and legal professions in cases of financial exploitation, and assessment of elder individuals' decision-making capacity. In two programs APS workers also contribute to the assessment of trainees' humanistic competencies. The authors conclude that APS community service agencies can successfully be incorporated into medical training programs to address a wide range of curricular goals.

The ETHNIC(S) mnemonic: a clinical tool for ethnogeriatric education.

Geriatrics healthcare providers need to be aware of the effect that culture has on establishing treatment priorities, influencing adherence, and addressing end-of-life care issues for older patients and their caregivers. The mnemonic ETHNIC(S) (Explanation, Treatment, Healers, Negotiate, Intervention, Collaborate, Spirituality/Seniors) presented in this article provides a framework that practitioners can use in providing culturally appropriate geriatric care. ETHNIC(S) can serve as a clinically applicable tool for eliciting and negotiating cultural issues during healthcare encounters and as a new instructional strategy to be incorporated into ethnogeriatric curricula for all healthcare disciplines.

Prescribing exercise for frail elders.

BACKGROUND: Frail elders often have chronic illnesses, such as osteoarthritis, hypertension, diabetes, and peripheral vascular disease, for which exercise is a proven means of achieving nonpharmacologic benefits, even at advanced age. Exercise has been shown to enhance the quality of life for these elders. METHODS: A literature search of exercise literature applied to older adults and lifestyle modifications was conducted, summarized, and then reviewed with practicing colleagues. RESULTS AND CONCLUSIONS: Exercise continues to be an underused therapeutic intervention for frail elders as a result of barriers created by patients themselves, their caregivers, and their health care providers. Family physicians can overcome these barriers by prescribing appropriate exercises and by tailoring the exercise to the functional needs and preferences of their patients. An exercise prescription for frail elders is based on a pragmatic strategy that makes therapeutic exercise both sustainable and safe. Such a strategy incorporates motivational elements and knowledge of achievable benefits.