Healthy Lifetime (HL): An Internet-Based Behavioral Health Coaching Protocol for Older Adults.

By 2060, the number of Americans 65 years and older will more than double, comprising nearly one-quarter of the population in the United States. While there are many advantages to living longer, a byproduct of aging is also a growing incidence of chronic illness and functional health limitations associated with a concurrent rise in chronic disease and disability that impair independent living in the community. We describe a personalized, behavioral health coaching protocol for early intervention that is delivered online to enhance a participant's independent functioning and to increase their self-care capacity with a goal to maintain independent living throughout aging. The electronic platform provides secure access to fillable surveys, health tracking, "just in time" communication with coaches and scheduling of two-way videos launched from the platform site. The 2-month protocol used two-way video conferencing which allowed high fidelity communication to sustain a complex behavioral intervention. Participants indicate high satisfaction with the intervention, the use of the platform, and the technology. While many health systems across the U.S. have ramped up virtual delivery of care in a proactive manner with now more than 70% of out-patient visits conducted through virtual delivery modes in some health systems, there remains much unevenness in this capability across the U.S. Our approach is to create a stable, interoperable, virtual outreach system for personalized professional health coaching that is complementary to medically oriented services that supports the health and functioning of participants as they age.

Pan American Health Organization/World Health Organization Collaborating Centers in Nursing and Midwifery in Haiti.

OBJECTIVE: To describe partnerships that Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centers in Nursing and Midwifery have in Haiti, and their contribution to promoting universal health coverage in that country. METHODS: In 2017, semistructured interviews were conducted by telephone or email to update the status of activities and collaborations that were mentioned in a 2016 report (which covered efforts prior to early 2016) by the office of the Regional Advisor on Nursing and Allied Health Personnel at PAHO/WHO. Using that information, two of the authors categorized the Collaborating Center activities into focal areas. RESULTS: Six of the nine Collaborating Centers mentioned in the 2016 PAHO/WHO report participated in the 2017 semistructured interviews. The five focal areas identified were: 1) direct care/primary health care, 2) research, 3) workforce development, 4) curriculum development, and 5) shared educational activities. CONCLUSIONS: Current PAHO/WHO Nursing and Midwifery Collaborating Center partnerships in Haiti support universal health access and coverage through direct provision of care with ongoing Haiti-based clinics; research in topics relevant to Haitian partners; assistance with continuing education for nurses; and shared educational activities. These efforts are enhanced through partnerships with Haitian organizations and the Ministry of Public Health and Population. Coordination among PAHO/WHO Collaborating Centers could augment individual schools' efforts to assist health providers and institutions in Haiti to improve health outcomes and support universal health coverage.

Pan American Health Organization/World Health Organization Collaborating Centers in Nursing and Midwifery in Haiti

[ABSTRACT]. Objective. To describe partnerships that Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centers in Nursing and Midwifery have in Haiti, and their contribution to promoting universal health coverage in that country. Methods. In 2017, semistructured interviews were conducted by telephone or email to update the status of activities and collaborations that were mentioned in a 2016 report (which covered efforts prior to early 2016) by the office of the Regional Advisor on Nursing and Allied Health Personnel at PAHO/WHO. Using that information, two of the authors categorized the Collaborating Center activities into focal areas. Results. Six of the nine Collaborating Centers mentioned in the 2016 PAHO/WHO report participated in the 2017 semistructured interviews. The five focal areas identified were: 1) direct care/primary health care, 2) research, 3) workforce development, 4) curriculum development, and 5) shared educational activities. Conclusions. Current PAHO/WHO Nursing and Midwifery Collaborating Center partnerships in Haiti support universal health access and coverage through direct provision of care with ongoing Haiti-based clinics; research in topics relevant to Haitian partners; assistance with continuing education for nurses; and shared educational activities. These efforts are enhanced through partnerships with Haitian organizations and the Ministry of Public Health and Population. Coordination among PAHO/WHO Collaborating Centers could augment individual schools’ efforts to assist health providers and institutions in Haiti to improve health outcomes and support universal health coverage.

[RESUMEN]. Objetivo. Describir las alianzas que tienen los centros colaboradores de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) en enfermería y partería en Haití y su contribución a la promoción de la cobertura universal de salud en ese país. Métodos. En el 2017, se llevaron a cabo entrevistas semiestructuradas por teléfono y por correo electrónico para actualizar el estado de las actividades y colaboraciones mencionadas en un informe del 2016 (que abarcaba esfuerzos previos a los primeros meses del 2016) realizado por la oficina del asesor regional en materia de enfermería y personal paramédico de la OPS/OMS. Con base en esa información, dos de los autores clasificaron las actividades de los centros colaboradores en áreas focales. Resultados. Seis de los nueve centros colaboradores mencionados en el informe de la OPS/OMS del 2016 participaron en las entrevistas semiestructuradas del 2017. Las cinco áreas focales establecidas fueron: 1) atención directa/atención primaria de salud, 2) investigación, 3) desarrollo de la fuerza laboral, 4) elaboración de programas de estudios y 5) actividades educativas compartidas. Conclusiones. Las alianzas actuales de los centros colaboradores de la OPS/OMS en enfermería y partería en Haití brindan apoyo al acceso y la cobertura universales de salud por medio de la prestación directa de atención en los consultorios permanentes establecidos en Haití, investigan sobre temas de importancia para los asociados haitianos, ofrecen asistencia con respecto a la educación continua para enfermeras y realizan actividades educativas compartidas. Estos esfuerzos se optimizan por medio de las alianzas con organizaciones haitianas y el Ministerio de Salud Pública y Población. La coordinación entre los centros colaboradores de la OPS/OMS podría potenciar los esfuerzos individuales de las facultades para ayudar a los prestadores y las instituciones de salud de Haití a mejorar los resultados en materia de salud y brindar apoyo a la cobertura universal de salud.

[RESUMO]. Objetivos. Descrever as parcerias existentes com os Centros Colaboradores da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) para Enfermagem e Obstetrícia no Haiti e como elas contribuem para promover a cobertura universal de saúde no país. Métodos. Em 2017, foi feito um levantamento por meio de entrevistas semiestruturadas por telefone ou email para atualizar a situação das atividades e trabalhos de colaboração descritos em um informe de 2016 (referente aos esforços anteriores a 2016), sob a coordenação do escritório do Assessor Regional de Enfermagem e Pessoal de Saúde Associado da OPAS/OMS. A partir destas informações, dois coordenadores categorizaram as atividades dos centros colaboradores em domínios prioritários. Resultados. Seis dos nove centros colaboradores citados no informe da OPAS/OMS de 2016 participaram das entrevistas semiestruturadas de 2017. Os cinco domínios prioritários identificados foram: 1) atenção direta/atenção primária à saúde, 2) pesquisa, 3) aperfeiçoamento do pessoal, 4) desenvolvimento curricular e 5) atividades educacionais conjuntas. Conclusões. As atuais parcerias dos Centros Colaboradores para Enfermagem e Obstetrícia da OPAS/OMS no Haiti promovem o acesso universal à saúde e a cobertura universal de saúde com a prestação direta de assistência em ambulatórios permanentes no Haiti, pesquisas em tópicos relevantes aos parceiros no Haiti, auxílio com educação continuada para o pessoal de enfermagem e atividades educacionais conjuntas. Esses esforços são fortalecidos com parcerias entre as organizações e o Ministério de Saúde Pública e População do Haiti. Com a coordenação entre os centros colaboradores da OPAS/OMS, poderiam ser ampliados os esforços individuais das escolas a fim de ajudar os prestadores de serviços e instituições de saúde no Haiti a melhorar os desfechos de saúde e promover a cobertura universal de saúde.

Improving care transitions: complex high-utilizing patient experiences guide reform.

OBJECTIVES: Care management has been adopted by many health systems to improve care and decrease costs through coordination of care across levels. At our academic medical center, several care management programs were developed under separate management units, including an inpatient-based program for all patients and an outpatient-based program for complex, high-utilizing patients. To bridge administrative silos between programs, we examined longitudinal care experiences of hospitalized complex patients to identify process and communication gaps, drive organizational change, and improve care. STUDY DESIGN: This descriptive study analyzed the care experiences of 17 high-utilizing patients within the authors' health system. METHODS: Chart audits were conducted for 17 high-utilizing patients with 30-day hospital readmissions during 2013. Clinical and social characteristics were reviewed for patterns of care potentially driving readmissions. RESULTS: Patients had heterogeneous social factors and medical, psychological, and cognitive conditions. Care management interventions apparently associated with improvements in health and reductions in hospitalization utilization included movement to supervised living, depression treatment, and achievement of sobriety. Monthly case management meetings were restructured to include inpatient, outpatient, ambulatory care, and emergency department care managers to improve communication and process. During 2014 and 2015, hospital readmission rates were overall unchanged compared with base year 2013 among a comparable cohort of high-utilizing patients. CONCLUSIONS: Joint review of clinical characteristics and longitudinal care experiences of high-utilizing, complex patients facilitated movement of historically siloed care management programs from their focus along administrative lines to a longitudinal, patient-centered focus. Decreasing readmission rates among complex patients may require direct linkages with social, mental health, and substance use services outside the healthcare system and improved discharge planning.

Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions. 2. Describe the significance of interprofessional collaboration in the delivery of quality health care. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The purpose of the current project was to (a) examine the type of information accompanying patients on transfer from acute care to skilled nursing facilities (SNFs), (b) discuss how these findings meet existing standards, and (c) make recommendations to improve transfer of essential information. The study was a retrospective convenience sample chart audit in one SNF. All patients admitted from an acute care hospital to the SNF were examined. The audit checklist was developed based on recommendations by local and national standards. One hundred fifty-five charts were reviewed. Transferring of physician contact information was missing in 65% of charts. The following information was also missing from charts: medication lists (1%), steroid tapering instructions (42%), antiarrhythmic instructions (38%), duration/indication of anticoagulant medications (25%), and antibiotic medications (22%). Findings support the need for improved transitional care models and better communication of information between care settings. Recommendations include designating accountability and chart audits comparing timeliness, completeness, and accuracy. [Journal of Gerontological Nursing, 43(3), 19-28.].

Physical activity in older adults in a combined functional circuit and walking program.

Our study examined the impact of a 16-week functional circuit/walking program on physical activity (PA) in older adults in independent-living facilities. Exploratory goals included examination of associations among self-efficacy, neighborhood and mobility. Participants (N = 13) were female (M = 77.8, SD = 7.44, range = 65-85 years). One third were African-American; the remainder Caucasian; 1/3 used assistive devices. PA increased from 70 min/week (SD = 35.51) at baseline to 81.31 min/week (SD = 34.21) at 16 weeks. PA was associated with self-efficacy for overcoming neighborhood and facility barriers to walking at all measurement points (baseline r = .73, p < .05 and r = .68, p < .05, respectively). At eight weeks, PA was associated with self-efficacy for walking duration (r = .58, p < .05), self-efficacy for individual (r = .66, p < .05), facility (r = .58, p < .05) and neighborhood (r = .70, p < .05) barriers. At sixteen weeks, physical activity was associated with balance confidence (r = .72, p < .05), and self-efficacy for individual (r = .76, p < .05), facility (r = .71, p < .05), and neighborhood (r = .80, p < .01) barriers. Functional circuit/walking interventions can increase PA in older adults. Further examination of self-efficacy, mobility, neighborhoods and PA is needed.

Trajectories of Outdoor Mobility in Vulnerable Community-Dwelling Elderly: The Role of Individual and Environmental Factors.

OBJECTIVE: Outdoor mobility is critical for healthy aging, yet little is known about the factors influencing mobility in the frail elderly. We investigated the role of individual and community risk factors on trajectories of mobility in a population of vulnerable community-dwelling elderly. METHOD: Using data from 1,188 older adults in Detroit, MI, who qualify for federally funded home care, a latent class growth analysis was used to model the frequency of going outside over a 15-month period. RESULTS: Four latent trajectories were found: those with a low, high, and declining frequency of going outdoors over time, and those who do not go outdoors on a regular basis. Risk factors for membership in the homebound and infrequent mobility groups were older age, more severe mobility impairment, and fear of falling. Barriers at the entry to the home were associated with being homebound. DISCUSSION: Declining health status and functional limitations are risk factors that pose a threat to outdoor mobility in the frail elderly, while housing barriers and community accessibility also merit attention.

The Impact of Weather on Mobility and Participation in Older U.S. Adults.

OBJECTIVES: We examined the impact of weather on the daily lives of US adults to understand which populations are most vulnerable to various weather conditions. METHODS: Data came from a 2013 supplement to the University of Michigan-Thomson Reuters Surveys of Consumers, a nationally representative telephone survey of 502 adults in the contiguous United States. We used logistic regressions to assess the odds of mobility difficulty and participation restriction during different weather conditions, as well as age group differences. RESULTS: Ice was most likely to change the way respondents got around (reported by 47%). In icy conditions, participants had difficulty leaving home (40%) and driving (35%). Facing ice, older adults (≥ 65 years) had twice the odds of having great difficulty leaving home (odds ratio [OR] = 2.22; 95% confidence interval [CI] = 1.12, 4.42) and curtailing work or volunteer activities (OR = 2.01; 95% CI = 1.01, 4.06), and 3 times the odds of difficulty driving (OR = 3.33; 95% CI = 1.62, 6.86) as younger respondents. We also found significant differences in mobility and participation by gender and region of residence. CONCLUSIONS: Weather can affect social isolation, health, well-being, and mortality among older US adults.

Gender differences in neighborhood walking in older adults.

OBJECTIVE: This study examined mobility, self-efficacy, outcome expectations, neighborhood (density, destinations, and design), and neighborhood walking in older men (n = 106, 60-99 years, M = 76.78, SD = 8.12) and women (n = 216, 60-99 years, M = 75.81, SD = 8.46). METHOD/RESULTS: In hierarchical regression, the variables explained 32% of the variance in neighborhood walking in men (p < .001) and 27% of the variance in women (p < .01). Self-efficacy (ß = .49, p < .01), density (ß= .22, p < .05), and design (ß= .21, p = .05) were associated with walking in men. Significant design characteristics included sidewalks (ß= .25, p < .05) and crime (ß= .36, p < .01). In women, self-efficacy (ß= .48, p < .001) and destinations (ß= .15, p < .05) were associated with walking. Walking was associated with self-efficacy for walking despite individual barriers in women (ß= .38, p < .001) and neighborhood barriers in men (ß= .30, p < .05). CONCLUSION: Walking interventions targeting older women should incorporate local destinations. In older men, interventions should consider neighborhood sidewalk design and crime. Walking interventions for all older adults should include enhancement of self-efficacy, but gender differences may exist in the types of self-efficacy on which to focus.

Optimizing mobility in later life: the role of the urban built environment for older adults aging in place.

Hazards in the urban built environment can create barriers to mobility among older adults aging in place. We investigated the relationship between urban built environment characteristics and 15-month trajectories of mobility disability in a sample of 1,188 older adults living in Detroit, MI, a city that has undergone rapid economic and structural decline. Data come from the Michigan Minimum Data Set for Home Care (2001-2008), an enumerative database of older adults in Michigan who qualify for federal or state-funded home and community-based long-term care through a Medicaid waiver program. Standardized assessments are made at intake and every 90 days by case managers. Built environments were assessed with a virtual audit using the "Street View" feature of Google Earth. A summary accessibility score was created for each block based on a count of the number of accessible features (e.g., continuous barrier-free sidewalks and proximity of public transportation). Using growth mixture models, two latent trajectories of outdoor mobility were identified: one capturing occasional outdoor mobility (representing 83 % of the sample) and one capturing almost no mobility outside the home. Controlling for sociodemographic and health risk factors, individuals living in more accessible environments had a 18 % higher odds of being in the more mobile group (OR = 1.18, 95 % CI = 1.01, 1.41). These findings emphasize the importance of the built environment for mobility among urban-dwelling older adults.

Neighborhood factors relevant for walking in older, urban, African American adults.

Focus-group and photo-voice methodology were used to identify the salient factors of the neighborhood environment that encourage or discourage walking in older, urban African Americans. Twenty-one male (n = 2) and female (n = 19) African Americans age 60 years and older (M = 70 +/- 8.7, range = 61-85) were recruited from a large urban senior center. Photographs taken by the participants were used to facilitate focus-group discussions. The most salient factors that emerged included the presence of other people, neighborhood surroundings, and safety from crime, followed by sidewalk and traffic conditions, animals, public walking tracks and trails, and weather. Future walking interventions for older African Americans should include factors that encourage walking, such as the presence of other friendly or active people, attractive or peaceful surroundings, and a sense of safety from crime.