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 Ecosystems: Expert Voices from the Field.

(1) Background: With the growth of the age-friendly movement, age-friendly ecosystems (AFE) garnered more attention. The successful development of an AFE is contingent on unified efforts across different stakeholders; however, limited efforts were made to help create a common understanding of the necessary components of an AFE. (2) Methodology: In response, The John A. Hartford Foundation and The Age-Friendly Institute hosted a series of convenings of international experts to identify a working definition of the characteristics composing an AFE. The goal of these convenings was to provide a foundation on which to unite cross-sector age-friendly work. (3) Results: This paper discussed the findings of the convenings and provided a framework from which future age-friendly work must draw upon. (4) Conclusions: This paper presented a necessary change in how we conceive AFEs.

The Faculty Nurse Attending Model at the Mount Sinai Hospital.

The ongoing nursing shortage and the ravages of the COVID-19 pandemic have further challenged nursing staff with devastating shortages. This article describes the Faculty Nurse Attending Model, an innovative approach incorporating nursing faculty into staffing and the ongoing interdisciplinary rounds at the Mount Sinai Hospital in New York City. The Mount Sinai Phillips School of Nursing faculty actively participates in the pilot unit to support nursing practice and ensure that the curricula address contemporary practice.

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.

Clinician knowledge and behaviors related to the 4Ms framework of Age-Friendly Health Systems.

BACKGROUND: The Age-Friendly Health Systems (AFHS) aims to improve the experience of care for adults aged 65 years and older through the 4Ms framework, an evidence-based approach to care planning that emphasizes what matters most to the older person, mentation, mobility, and medication. The aim of this study was to examine clinicians' attitudes, knowledge, and practices concerning AFHS and the 4Ms. METHODS: We surveyed U.S.-based health care providers randomly identified from the Medscape database. The sample was weighted based on sex, U.S. Census region, and ethnic diversity of health occupations. We examined the differences between cohorts using proportions tests and logistic regression models. RESULTS: More than 90% of clinicians (n = 1684) agreed that "older patients require a different approach to care than younger patients." Fifty percent of clinicians "always" take the age of their patient into consideration when determining care. A majority of clinicians said they discuss each of the 4Ms with older patients and/or their family caregivers. Screening for depression and review of high-risk medication use are among the leading types of age-friendly care that clinicians provide to older patients. A minority of clinicians are asking older adults about and aligning the care plan with What Matters. CONCLUSIONS: A majority of clinicians acknowledged the benefits of providing care via AFHS but reported limited knowledge of the specificities of the 4Ms framework and are not necessarily taking the age of their patients into consideration when determining the best form of care. Health care settings that have implemented the 4Ms framework appear to be doing so in an incomplete way. Our study reinforces the case for training primary care providers on how to adopt the evidence-based 4Ms framework in clinical practice effectively and consistently.

When Family Caregivers Meet Health Care Institutions.

Nurses have the opportunity to make a difference for caregivers.

Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital emergency departments.

Hospital emergency departments (EDs) lack the tools and processes required to facilitate consistent screening and intervention in cases of elder abuse and neglect. To address this need, the National Collaboratory to Address Elder Mistreatment has developed a clinical care model that ED's can implement to improve screening, referral, and linkage to coordinated care and support services for older adults who are at risk of mistreatment. To gauge ED readiness to change and facilitate adoption of the care model, we developed an organizational assessment tool, the Elder Mistreatment Emergency Department Assessment Profile (EM-EDAP). Development included a phased approach in which we reviewed evidence on best practice; consulted with multidisciplinary experts; and sought input from ED staff. Based on this formative research, we developed a tool that can be used to guide EDs in focusing on practice improvements for addressing elder mistreatment that are most responsive to local needs and opportunities.

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.

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.