Provider discussion of health goals and psychosocial needs: Comparing older to younger veteran experience.

OBJECTIVE: To examine by age, the veterans' report on whether components of age-friendly health systems were discussed during primary care visits. DATA SOURCES AND STUDY SETTING: Veterans Affairs (VA) Survey of Healthcare Experience of Patients from October 2015 to September 2019. STUDY DESIGN: Cross-sectional survey of VA users by age group (18-44 years, 45-64 years, 65+ years; N = 1,042,318). We used weighted logistic regression models to evaluate disparities in whether veterans discussed with anyone in their provider's office: health goals, depression symptoms, stress, personal problems, and medications. Models were adjusted for socio-demographic characteristics (sex, socioeconomic status, education, rurality) and comorbidity. DATA COLLECTION/EXTRACTION METHOD: Surveys were administered by mail and online. Additional veteran characteristics were extracted from VA administrative data. PRINCIPAL FINDINGS: In unadjusted analyses, VA users age 18-44 had a higher (-8.2%; CI: -9.0, -7.3) and users aged 45 to 64 had lower (4.0%; CI: 3.7, 4.3) predicted, probably discussing health goals compared to age 65+. Fewer VA users age 65+ reported discussing depression symptoms, personal problems, and stress than other age groups, whereas more VA users age 65+ discussed medications. Results were unchanged after adjusting for socio-demographics and comorbidity. CONCLUSIONS: Delivery of goal-concordant care relies on understanding the needs of individual patients. Lower rates of discussing what matters and mood represent potential missed opportunities to deliver age-friendly care for older veterans.

Collaborating toward equity in Pennsylvania: The Age-Friendly Care, PA project.

OBJECTIVE: To collaboratively implement the age-friendly health systems framework, known as the 4Ms: What Matters, Medication, Mentation, and Mobility, at The Primary Health Network (PHN), a federally qualified health center. DATA SOURCES: Data were collected from PHN electronic medical records (EMRs) for individuals over age 65 from December 30, 2019 to December 24, 2021 and from Project ECHO© attendance and evaluation surveys. STUDY DESIGN: The telementoring educational program, Project ECHO©, was used to engage PHN health care professionals working in rural areas of Pennsylvania to incorporate the 4Ms into their practice starting with the annual wellness visit (AWV). Project ECHO© was launched at three primary care sites. After 18 months, it was then disseminated to an additional 18 sites creating pilot and comparison groups. Outcomes included codesigned patient process metrics using EMR data and project ECHO© participant data. DATA COLLECTION METHODS: EMR data were generated by system reports created by PHN's quality assurance program manager. Project ECHO© data were collected and managed using REDCap electronic data capture tools. Outcomes were aggregated, analyzed for trends over time, and compared between groups. PRINCIPAL FINDINGS: All nine process outcomes increased from baseline to follow-up at the three initial sites, ranging from 4% to 43% g. At year two, the three initial sites had higher rates on AWVs (pilot 24%, comparison 12%; p < 0.0001), Advance Care Planning (New on file, pilot 8%, comparison 2%; Discussed with patient, pilot 18%, comparison 13%; Patient declined, pilot 0%, comparison 0%; p = 0.0001), Dementia Screening (pilot 24%, comparison 12%; p < 0.0001), Fall Risk Management (pilot 43%, comparison 10%; p < 0.0001), and Mobility Goal (pilot 19%, comparison 9%; p < 0.0001); and lower rates on High-Risk Medication Elimination (pilot 54%, comparison, 63%, p < 0.02). CONCLUSIONS: Access to high-quality geriatric care for rural older adults can be improved by increasing health care professionals' knowledge of the 4Ms, beginning with its incorporation into the AWV.

Guidance for hospital and community-based health services for older adults: The senior friendly care framework.

To meet the needs of a population of older adults at risk of becoming frail in the context of known limitations to current practice, frameworks have emerged to guide health service development. Typically these frameworks have developed in the hospital sector despite the need for hospital/community sector co-development and adoption. In the present study one such framework - the Senior Friendly Hospital (SFH1) Framework - is examined with an intersectoral lens. The study included a scoping review of literature addressing system-based approaches to improving healthcare of older people as well as a modified Delphi process to incorporate these findings into an expanded framework. Qualitative analysis of the data extracted from the scoping review resulted in the identification of "senior friendly" excerpts that were charted using an apriori matrix provided by the SFH Framework. Researchers conducted thematic analysis of the excerpts to avoid redundancy and wrote statements to optimize thematic clarity. In a modified Delphi process, the statements were subsequently rated for perceived importance, clarity and fit by an intersectoral panel of experts resulting in a refined Senior Friendly Care (sfCare2) Framework comprising 31 statements and 7 guiding principles to consider when implementing improvements in the care of older adults. Finally, a panel of stakeholders were consulted for feedback on the clarity of the framework's intent and its anticipated impact on care. The sfCare Framework is now available to guide hospital and community-based health service development for older adults.

Evaluation of comprehensive care for older adults in primary care services / Avaliação da atenção integral ao idoso em serviços de atenção primária

ABSTRACT OBJECTIVE To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of São Paulo, Brazil. METHODS A total of 157 primary care services from five health regions in midwestern São Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults' care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults' care. CONCLUSIONS The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.

RESUMO OBJETIVO Avaliar o desempenho da atenção integral ao idoso em serviços de atenção primária do Sistema Único de Saúde no estado de São Paulo, Brasi lMÉTODOS Um total de 157 serviços de atenção primária de cinco regiões de saúde do centro-oeste paulista respondeu, de outubro a dezembro de 2014, o instrumento pré-validado Questionário de Avaliação e Monitoramento de Serviços de Atenção Básica 2014. Foram selecionadas 155 questões, com base nas políticas e diretrizes nacionais sobre essa temática. As respostas indicam o desempenho do serviço na atenção ao idoso, agrupadas em três domínios de análise: atenção à saúde para o envelhecimento ativo e saudável (45 indicadores, d1), atenção às doenças crônicas não transmissíveis (89 indicadores, d2) e rede de apoio na atenção ao envelhecimento (21 indicadores, d3). A medida de desempenho foi a soma de respostas positivas (valor 1) ou negativas (valor 0) para cada indicador. Os serviços foram agrupados segundo k-médias dos escores de desempenho de cada um dos domínios. Após a ponderação dos domínios (testes Z), foram estimadas as associações entre os escores de cada domínio e variáveis independentes de gestão (tipologia, planejamento e avaliação dos serviços), por meio de regressão linear simples e múltipla. RESULTADOS A atenção às doenças crônicas não transmissíveis (d2) mostrou, para todos os agrupamentos, melhor desempenho médio (55,7) do que os domínios d1 (35,4) e d3 (39,2). O desempenho do serviço na área geral de planejamento e avaliação esteve associado ao desempenho da atenção ao idoso. CONCLUSÕES Os serviços avaliados apresentaram implementação incipiente da atenção integral ao idoso. O quadro avaliativo pode contribuir para processos de melhoria da qualidade da atenção primária à saúde.

Percepção dos idosos sobre o papel do enfermeiro num centro de convivência / Perception of older peole on the role of nurses in a living center

Introdução: O Centro de Convivência de Idosos (CCI) é um espaço destinado ao bem-estar da pessoa idosa. O acompanhamento de profissionais de saúde, em especial o enfermeiro nesse espaço contribui para promoção da saúde e prevenção de agravos. Objetivo: Compreender a percepção dos idosos quanto a atuação do enfermeiro no Centro de Convivência. Método: Trata-se de uma pesquisa descritiva, exploratória, de abordagem qualitativa realizada em um município da região do Sudoeste do estado de Mato Grosso, com idosos participantes de um CCI. A coleta de dados ocorreu em setembro de 2014, por meio da técnica de entrevista. A quantidade de sujeitos foi definida por saturação dos dados. Os dados foram analisados por meio da análise de conteúdo de Bardin. Resultados: Emergiram duas categorias: "O enfermeiro e o Centro de Convivência" e "O cuidado de enfermagem no Centro de Convivência". Considerações finais: Os idosos relataram que a presença do enfermeiro no CCI facilita os cuidados e intervenções de saúde, além do estabelecimento de ações e práticas voltadas ao envelhecimento saudável.(AU)

Introduction: The Older Adults Living Center (CCI) is a space for the well-being of older people. The monitoring of health professionals, especially nurses in that space, contributes to health promotion and disease prevention. Objective: To understand the perception of older adults regarding the role of nurses in the Community Center. Methods: This is a descriptive, exploratory, qualitative study carried out in a municipality in the Southwest region of the state of Mato Grosso, with older people participating in an ICC. Data collection took place in September 2014, using the interview technique. The number of subjects was defined by data saturation. The data was analyzed using Bardin's content analysis. Results: Two categories emerged: "The nurse and the Living Center" and "Nursing care in the Living Center". Conclusion: The older population reported that the presence of nurses in the ICC facilitates health care and interventions, in addition to establishing actions and practices aimed at healthy aging.(AU)

Advancing the Science of Deprescribing: A Novel Comprehensive Conceptual Framework.

Polypharmacy is common in older adults and associated with inappropriate medication use, adverse drug events, medication nonadherence, higher costs, and increased mortality compared with those without polypharmacy. Deprescribing, the clinically supervised process of stopping or reducing the dose of medications when they cause harm or no longer provide benefit, may improve outcomes. Although potentially beneficial, clinicians struggle to overcome structural, organizational, technological, and cognitive barriers to deprescribing, limiting its use in clinical practice. Deprescribing science would benefit from a unifying conceptual framework to prioritize research. Current deprescribing conceptual frameworks have made important contributions to the field but often with a focus on specific medication classes or aspects of deprescribing. To further this relatively nascent field, we developed a broader deprescribing conceptual framework that builds on prior frameworks and includes patient, prescriber, and system influences; the process of deprescribing; outcomes; and dissemination. Patient factors include patients' biology, experience, values, and preferences. Prescriber factors include rational (eg, based on explicit knowledge) and nonrational (eg, behavioral tendencies, biases, and heuristics) decision making. System factors include resources, incentives, goals, and culture that contribute to deprescribing. The framework separates the deprescribing decision from the deprescribing process. The framework captures the results of deprescribing by examining changes in clinical structures, performance processes, patient experience, health outcomes, and cost. Through testing and refinement, this novel, more comprehensive conceptual framework has the potential to advance deprescribing research by organizing the existing evidence, identifying evidence gaps, and categorizing deprescribing interventions and the settings in which they are applied. J Am Geriatr Soc 67:2018-2022, 2019.

Promoting the autonomy of rural older adults in active aging / Promoción de la autonomía de los ancianos rurales en el envejecimiento activo / Promoção da autonomia de idosos rurais no envelhecimento ativo

ABSTRACT Objective: to understand how the rural older adults promote their autonomy in active aging. Method: qualitative research through the Paulo Freire's research itinerary, consisting of three steps: area of research; encoding and decoding; and critical unveiling. Seventeen older adults living in the rural area of a municipality in Southern Brazil participated in the research. Six culture circles were conducted from July to December 2016. Results: the investigation revealed two generating themes: joint pain and participation in groups. The understanding of autonomy promotion for the active aging of older adults is focused on the physical capacity and independence of activities of daily living. Final considerations: the culture circles have promoted reflection moments for the participants, especially about the advantages and difficulties related to the practice of autonomy in the exercise of citizenship for active aging in the rural area.

RESUMEN Objetivo: comprender como los ancianos rurales promocionan su autonomía en el envejecimiento activo. Método: investigación de abordaje cualitativo por medio del itinerario de investigación de Paulo Freire, que consiste en tres etapas: la investigación temática; la codificación y la descodificación; y el desvelamiento crítico. Participaron de la investigación diecisiete ancianos residentes en la zona rural de un municipio del sur de Brasil. Fueron realizados seis círculos de cultura de julio a diciembre de 2016. Resultados: la investigación reveló dos temas generadores: los dolores articulares y la participación en grupos. Se descubrió también que la comprensión sobre la promoción de la autonomía para el envejecimiento activo de los ancianos está destinada para la capacidad física y la independencia para las actividades cotidianas. Consideraciones finales: los círculos de cultura promocionaron espacios de reflejo de los participantes, especialmente sobre las facilidades y las dificultades relacionadas a la práctica de autonomía en el ejercicio de la ciudadanía para un envejecimiento activo en el área rural.

RESUMO Objetivo: compreender como os idosos rurais promovem sua autonomia no envelhecimento ativo. Método: pesquisa de abordagem qualitativa por meio do itinerário de pesquisa de Paulo Freire, que consiste em três etapas: investigação temática; codificação e descodificação; e desvelamento crítico. Participaram da pesquisa dezessete idosos residentes na zona rural de um município do sul do Brasil. Foram realizados seis círculos de cultura de julho a dezembro de 2016. Resultados: a investigação revelou dois temas geradores: dores articulares e participação em grupos. Descobriu-se também que a compreensão sobre a promoção da autonomia para o envelhecimento ativo dos idosos está voltada para a capacidade física e a independência para as atividades cotidianas. Considerações finais: os círculos de cultura promoveram espaços de reflexão dos participantes, especialmente sobre as facilidades e as dificuldades relacionadas à prática de autonomia no exercício da cidadania para um envelhecimento ativo na área rural.

Educational technology: a facilitating instrument for the elderly care / Tecnología educacional: un instrumento dinamizador del cuidado de ancianos / Tecnologia educacional: um instrumento dinamizador do cuidado com idosos

ABSTRACT Objective: To develop educational technology with caregivers of older people based on the needs, difficulties and concerns related to the elderly care expressed by the caregivers themselves. Method: Research of qualitative nature, with participant observation, based on concepts used by Paulo Freire. Data collection and analysis used the "World Cafe" methodology and the thematic content analysis, respectively. Result: The needs of these caregivers refer to their training and information on aging. The difficulties highlighted are deterrents to quality assistance to older adults, such as: insufficient resources, environmental factor and relationship with the family. The interests are evident in relation to the care and to its more subjective relationship. Final considerations: Educational technologies, printed matter and media, developed along with the caregivers, contribute to orientation and information of caregiver, population and professionals as facilitating instruments, regarding elderly care.

RESUMEN Objetivo: Desarrollar tecnología educacional con los cuidadores de ancianos a partir de las necesidades, dificultades e intereses manifestados por dichos cuidadores, relativos al cuidado de personas ancianas. Método: Investigación de carácter cualitativo, con enfoque participante, orientada por los conceptos de Paulo Freire. Para la recolección y el análisis de los datos se utilizaron las técnicas del «World Café¼ y análisis de Contenido del tipo temático, respectivamente. Resultado: Las necesidades de los cuidadores de ancianos se refieren a su capacitación y a información acerca del envejecimiento. Las dificultades señaladas se encuentran en los impeditivos para asistencia de calidad al anciano, tales como: insuficiencia de recursos, factor ambiental y relación familiar. Los intereses son evidentes respecto a la práctica del cuidado y en su relación más subjetiva. Consideraciones finales: Las tecnologías educacionales, impreso y medios, desarrollados con los cuidadores, contribuye en cuanto instrumento dinamizador para orientación e información del cuidador, población y profesionales, frente al cuidado del anciano.

RESUMO Objetivo: desenvolver tecnologia educacional com cuidadores de idosos a partir de necessidades, dificuldades e interesses manifestados por esses indivíduos quanto ao cuidado com a pessoa idosa. Método: pesquisa de cunho qualitativo, com abordagem participante, orientada por conceitos de Paulo Freire. A coleta e a análise dos dados foram feitas com base nas técnicas do World Café e da análise de conteúdo do tipo temático, respectivamente. Resultado: as necessidades dos cuidadores de idosos se referem a capacitação e informações sobre envelhecimento. As dificuldades apontadas estão nos impeditivos para assistência de qualidade ao idoso, tais como: insuficiência de recursos, fator ambiental e relação com a família. Os interesses são evidentes no tocante à prática do cuidado e em sua relação mais subjetiva. Considerações finais: as tecnologias educacionais, impresso e mídia, desenvolvidas com os cuidadores, contribuem, enquanto instrumentos dinamizadores, para orientação e informação do cuidador, da população e de profissionais sobre o cuidado com o idoso.

Avaliação da indepedência de idosos atendidos por uma estratégia de saúde da família / Evaluation of the independence of older adults attended by a family health strategy / Evaluación de la indepedencia de ancianos atendidos por una estrategia de salud de la familia

Estudo com objetivo de avaliar a independência e sua relação com humor e auto percepção de saúde, por meio de pesquisa transversal com 119 idosos atendidos pela Estratégia Saúde da Família no Município de Pimenta, Minas Gerais, em 2011. Foi utilizado questionário estruturado, aplicado no domicílio dos participantes, contendo questões sociodemográficas, escala de Katz, de Lawton Brody e a escala Geriátrica de Depressão. A maioria dos idosos não apresentou alterações de humor e houve associação (p< 0,05) apenas entre escolaridade e a Escala Geriátrica de Depressão; não houve relação (p> 0,05) entre esta escala e a capacidade funcional; os idosos que demonstraram alteração do humor eram independentes para atividades de vida diárias e atividades instrumentais de vida diárias. Observou-se predomínio da auto percepção positiva da saúde entre idosos independentes. Os idosos apresentaram, predominantemente, preservação de sua independência sem alterações significativas de humor, fatores indispensáveis para o envelhecimento ativo e saudável.

This study aimed to evaluate independence and its relation with mood and self-perception of health, through cross-sectional research with 119 older adults attended by the Family Health Strategy in the Municipality of Pimenta, Minas Gerais, in 2011. A structured questionnaire was used applied in the participants' homes, containing socio-demographic questions, the Katz scale, the Lawton Brody scale and the Geriatric Depression scale. The majority of the older adults did not present mood changes and there was an association (p< 0.05) only between educational level and the Geriatric Depression Scale; there was no relation (p> 0.05) between this scale and functional capacity; the older adults who demonstrated mood change were independent for activities of daily living and instrumental activities of daily living. A predominance of positive self-perception of health was observed among independent older adults. The older adults presented, predominantly, preservation of their independence without significant changes of mood, factors which are indispensable for active and healthy aging.

Estudio que tuvo el objetivo de evaluar la independencia y su relación con el humor y la autopercepción de salud, por medio de investigación transversal con 119 ancianos atendidos por la Estrategia Salud de la Familia en el Municipio de Pimenta, Minas Gerais, en 2011. Fue utilizado cuestionario estructurado, aplicado en domicilio de los participantes, con cuestiones sociodemográficas, escala de Katz, de Lawton Brody y Escala Geriátrica de Depresión. La mayoría de los ancianos no presentó alteraciones de humor y hubo asociación (p< 0,05) solo entre escolaridad y la Escala Geriátrica de Depresión; no hubo relación (p> 0,05) entre esa escala y la capacidad funcional; los ancianos que demostraron alteración de humor eran independientes para actividades de vida diarias y actividades instrumentales de vida diarias. Se observó predominio de la autopercepción positiva de la salud entre ancianos independientes. Los ancianos presentaron, de modo predominante, preservación de su independencia sin alteraciones significativas de humor, factores indispensables para el envejecimiento activo y saludable.