Broader View Urged for Seniors' CV Care

Geriatric Knowledge among Emergency Nurses | Aging In Action

by JOHN DAVY on APRIL 8, 2011

Adults age 65 and older make up at least 15% of emergency department visits, and have longer lengths of emergency department stay, as well as poorer post-discharge outcomes, than the general population. At the same time, most nursing baccalaureate programs do not require coursework in geriatric care. Does this imply a gap between training and practice, or are emergency nurses equipped with the knowledge to work with older adults? The Journal of Emergency Nursing published an article that surveyed nurses at one large California hospital (Roethler et al 2011) on geriatric knowledge and self-perception of nurse ability to work with older adults, which suggests that there may in fact be a knowledge gap.

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Peace Accord Reached Between Geriatrics and Palliative Care Professional Societies | GeriPal - Geriatrics and Palliative Care Blog

by: Wikileaks

Boards for the major professional societies for geriatrics (AGS) and hospice and palliative medicine (AAHPM) have reached an agreement on collaborative efforts. The agreement was drafted following a conference in New York.

Here is the joint statement:

BACKGROUND

The Geri-Pal Workgroup has focused its collaborative efforts between the disciplines of geriatrics and palliative medicine in the following five areas: Workforce, Research, Education, Policy and Membership Communication. The following summaries provide specific recommendations in each area for the AAHPM Board to consider.

Workforce
Due to the continued growth of advanced and serious illness among older adults, it is imperative that aggressive steps be taken to increase the workforce with training in advanced and complex illness care. It is likely that both for the field of geriatrics and palliative medicine that workforce will be inadequate to address population needs. The Geri-Pal workgroup recommends

1) ongoing dialogue between both specialties on ways to train mid-career physicians (since fellowship training won’t meet workforce need);

2) better understanding of current workforce issues in palliative medicine and geriatrics through incorporation of questions into the AGS annual workforce study (See appendix) and the proposed academic palliative medicine survey and communication of these findings to both organizations;

3) identification of areas of resistance to collaboration between both specialties;

4) delineation of unique and overlapping competencies for both specialties; and

5) support by both organizations/disciplines for Geriatric Academic Career Awards and Palliative Academic Career Awards.

Research
Very little research addresses advanced illness/multimorbidity/symptom management in older adults. Despite the large number of people affected, funding for these areas are also thin. The Geri-Pal workgroup recommends

1) joint advocacy for research in these areas;

2) increased communication to relevant stakeholders regarding the research vacuum in geri-pal research;

3) initiation of a joint strategic initiative to increase funding in these areas through State of the Art conferences, an Institute of Medicine conference for targeted topics, and interaction by the Geri-Pal workgroup and other AGS/AAHPM leaders with key research and policy stakeholders.

Education
Based on the identified overlap of shared goals in the care for older adults with advanced illness and a cross-over of more than 300 members, a pilot exercise to educate each organization’s membership during their Annual Meetings was viewed as successful. Both organizations completed the following activities in 2009/2010:

• an exhibit booth exchange allowing each organization to have a presence at the other’s annual conference;

• development of a pre-conference session offered at both the 2010 AGS conference and the 2011 AAHPM conference.

Based on high evaluation scores and good attendance for the pre-conferences and notable interest at the exhibit booths, continued inclusion of exhibit booths and sessions is being sought for the 2011 and 2012 annual meetings of AGS and AAHPM respectively. The AGS Annual Meeting Program Committee has considered this request and approved moving forward with a pre-conference at the AGS 2011 Annual Meeting. AAHPM will consider this for its 2012 planning committee meeting.

In addition, AGS and AAHPM have continued the exchange of products. AGS is providing Geriatrics at Your Fingertips to AAHPM at its member price and AAHPM is providing the Primer at the AAHPM member price during certain time periods throughout the year.

Policy
Given the important issues confronting providers working in geriatrics and palliative medicine, especially in the coming decade as health reform is implemented, it will be crucial to speak with one voice, synergistically, on matters relevant to medical care of persons of advance age, and those nearing the end of life. To that end, the Geri-Pal workgroup recommends to the leadership and membership of the AAHPM and AGS to:

1) Concur on matters of mutual clinical and policy import;

2) Share policy and advocacy initiatives regularly to highlight areas of mutual interest and emphasis;

3) Share “talking points” related to (2);

4) Prepare statements and political approaches to “hot button” issues, including but not limited to - rationing, health care reform, end of life care, Medicare cost-cutting initiatives, and

5) Share mechanisms of mobilizing membership to accomplish shared goals of the AAHPM and AGS.

Communication to memberships
To demonstrate the growing collaboration between the two fields of geriatrics and palliative medicine, the Geri-Pal workgroup recommends ongoing communicating to both organizations’ memberships regarding activities of the workgroup and two organizations that highlight this collaboration. The Geri-Pal workgroup recommends:

1) Regular updates in the AGS newsletter (sent quarterly), the AGS Week in Review (weekly), and the AAHPM newsletter (sent quarterly) and 

2) Development of a joint position statement and issue brief addressing the need for integration of geriatric and palliative medicine, the importance of funding the care provided, and the need for training programs that facilitate training at the intersection of the fields and are not barriers to training in both areas.

Workgroup members:
Chair, Christine Ritchie, University of Alabama at Birmingham
Bob Arnold, University of Pittsburgh
Jean Kutner, University of Colorado Denver HSC
Seth Landefeld, University of California at San Francisco
Bruce Leff, John Hopkins University
Wayne McCormick, University of Washington
Greg Sachs, Indiana University

RECOMMENDATION
The Membership and Communities SCC has reviewed the proposal as submitted by the Geri-Pal Workgroup and recommends ongoing collaboration between the disciplines of geriatrics and palliative medicine to focus on the areas/issues noted above.
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Understanding Frailty: | GeriPal - Geriatrics and Palliative Care Blog

Frailty is a central concept of Geriatrics. It would only be a slight stretch to claim that the clinical practice of Geriatrics is the management of frailty.

So, if frailty is so important, you would think all Gerontologists would have the same definition on the tip of their tongue. But frailty is surprisingly hard to define. And then is not general agreement on any one definition. The definition remains a matter of debate in the field.

It is certainly a challenge teaching Geriatrics when you can't give a coherent definition for such a central concept. There are many who argue that the Justice Oliver Wendell Holmes definition, "I know it when I see it" is actually the best approach. This is not unreasonable---after all, this accounts for the inordinate amount of stuff that happens with aging that collectively causes frailty. Perhaps clinical judgment is better than any diagnostic algorithm. On the other hand, when a Geriatrician is trying to teach a medical student, who does not "know it when they see it", this can be a totally unhelpful approach.

Others have worked to define frailty as a specific clinical syndrome marked by easily definable characteristics. A very popular definition was established by Dr. Linda Fried, which defines fraily as the presence of 3 of the following 5 phenomena: involuntary weight loss, weakness, slow walking speed, exhaustion, low physical activity. The definition has the significant advantage of being reproducible. If we use this definition, we are all talking about the same thing when we talk about frailty. On the other hand, proponents of the Justice Holmes approach might argue that this definition does not account for the vast milieu of problems that can cause frailty.
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Betsy Stanford to turn 107

Image via WikipediaBy Ann Scott Tyson Washington Post Staff Writer

Betsy Stanford turns 107 years young on Tuesday, and the spunky matriarch from the District has no shortage of longevity advice - from dietary to spiritual to downright racy.

What to eat? Anything and everything. "Juicy steaks . . . pork chops - as much as you want!" Stanford exclaims. "Everything they say not to eat, I've been eating it since I was 45 years old."

These days, she admits to a particular fondness for a smoothie made of Guinness stout mixed with the nutritional supplement Ensure, a drop of vanilla flavoring and a sprinkle of nutmeg "if [the stout] is too bitter."

"I drink stout. It's good for you, baby!" Stanford said as she held forth with a group of relatives and fellow worshipers at her 107th birthday celebration Sunday at the Wesley United Methodist Church in Northwest.

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New Resource for Geriatric Pain Management

The Geriatric Pain Website

The purpose of this  Web resource is to share best practice tools and resources with nurses responsible for pain care in older adults who reside in nursing homes.

Why was the Geriatric Pain Web site created?

• To provide nurses working in long-term care environments access to resources, a new Web site — www.geriatricpain.org — has been developed. This site, a one-stop resource, shares free best-practice tools and resources that support recommendations for good pain assessment and management in older adults, including implementation of quality improvement processes focused on pain management.
• Up to 80 percent of older persons living in long-term care facilities suffer from pain problems. Although aging contributes to the likelihood of pain conditions, effective assessment and management can ensure good quality of life.
• The Web site is easy to access and user friendly. It’s organized into categories of emphasis, including pain assessment, pain management, education, quality improvement, guidelines and resources.

Who was Geriatric Pain Web site developed for?

• The tools available are for nurses and administrators in nursing homes and long-term care facilities to help them improve pain outcomes for residents, change organizational standards for pain outcomes and save time identifying and evaluating quality tools.

Is there a cost to access the resources

• The Geriatric Pain Web site resources are free to registered users. Registration is quick, easy and requires only your e-mail address, password, name and zip code. 

JAMA Launches New Series On Caring Of The Aging Patient

To assist physicians in caring for a patient demographic that is rapidly growing in size, JAMA is launching a new series, "Care of the Aging Patient: From Evidence to Action."

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Management of long term conditions

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Policy developments strengthening primary care provide the specialty of geriatric medicine an opportunity to review and strengthen its partnership with primary care. The Department of Health has promulgated a three level model for the management of long term conditions: self management, disease management and case management for those with complex and multiple conditions. It is this latter group that geriatricians have most to offer, backed up by the evidence-based practice of comprehensive geriatric assessment.

The British Geriatrics Society Primary and Continuing Care SIG offer a model of care for frail older people, and this is intended to be useful for the effective implementation of services for such people, including case management
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• Researchers at Boston University School of Medicine incorporate multisite geriatric clerkship (scienceblog.com)
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• Accountable Care Organizations (ACOs): A 'Blue Ocean' for the Disease Management Industry? (diseasemanagementcareblog.blogspot.com)

Geriatric Nursing Education

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The Geriatric Nursing Education Wiki

The purpose of this Wiki is to share resources and tools to improve gerontological and geriatric nursing education. The Wiki was created as a result of the Knowledge Exchange Institute for Geriatric Nursing Education, held at Brock University May 6-8, 2009. The Knowledge Exchange Institute was sponsored by the National Initiative for Care of the Elderly (NICE) and the Canadian Institutes for Health Research (CIHR) and organized by Lynn McCleary (Brock University), Kathy McGilton (Toronto Rehab and University of Toronto), Abram Oudshoorn (University of Western Ontario), Veronique Boscart (University of Toronto), and Lynn McDonald (NICE and University of Toronto). The Knowledge Exchange Institute was part of NICE's work to enhance gerontological nursing education.

The Wiki is a way for participants in the Knowledge Exchange Institute to continue to share knowledge, resources, and tools and for others to join in the process of knowledge exchange with us.

The Wiki will start off with uploaded files and links to resources that were shared with the Knowledge Exchange Institute participants. Feel free to add new information.

Main Page - Geriatric Nursing Education

AMNews: Sept. 1, 2009. Warnings issued about bogus board certifications ... American Medical News

Connecticut's attorney general is investigating a complaint about mail-order geriatrics certifications. Schemes have also involved other medical specialties.
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Best Geriatric Care Hospitals - US News and World Report

More than 1,450 hospitals are listed in Geriatric Care. The top 50 are ranked and the rest are listed alphabetically. Use the expanded search to locate services related to this specialty at more than 5,000 U.S. hospitals. Read More

Treating an Illness Is One Thing. What About a Patient With Many?

New York Times People with multiple health problems — a condition known as multimorbidity — are largely overlooked both in medical research and in the nation’s clinics and hospitals. The default position is to treat complicated patients as collections of malfunctioning body parts rather than as whole human beings.

“Very often, there is nobody looking at the big picture or recognizing that what is best for the disease may not be best for the patient,” said Dr. Mary E. Tinetti, a geriatrician at the Yale School of Medicine.

And treating one disease in isolation, she added, can make another disease worse. In controlling diabetes, for example, doctors often seek to reduce levels of a blood-sugar marker called hemoglobin A1C. “But we know that for some people with complicated diseases, that’s not always the best move,” Dr. Tinetti said.

Cognitive Impairment in Older Persons Linked to Vitamin D Deficiency

By Kristina Fiore, Staff Writer, MedPage Today Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. A low level of vitamin D in older patients is associated with a higher risk of cognitive impairment, researchers here said.

Those with the lowest levels were more than twice as likely to have cognitive impairment (P<0.001),>Journal of Geriatric Psychology and Neurology.

"Our results suggest that high levels of serum 25-hydroxyvitamin D are associated with lower odds of cognitive impairment," the researchers said.

As patients age, however, the capacity of their skin to absorb vitamin D from sunlight decreases, often requiring they obtain it from other sources, they said.

Evidence from in vitro and animal studies suggests vitamin D may be neuroprotective, but there is a "paucity of reliable evidence" from clinical and population studies, the researchers said.

So to examine the association between serum vitamin D and cognitive impairment, the researchers conducted a cross-sectional study of 1,766 persons 65 and older in the Health Survey for England 2000.

The researchers found that vitamin D levels were higher in those with normal cognition than in those who were cognitively impaired.

About half of patients with cognitive impairment had the lowest serum levels of the vitamin.

In a multivariate analysis, those with the lowest levels of vitamin D were 2.3-fold more likely to be cognitively impaired than those with the highest levels (95% CI 1.4 to 3.8, P=0.001).

In that analysis, the association was stronger in men, which may be attributable to differences in BMI, the researchers said.

Organization Design for Geriatrics: An Evidence Based Approach

From the Regional Geriatric Programs of Ontario, this newly released handbook is aimed at providing an evidence-based approach to service delivery for the elderly patient in core specialized geriatric services. Core services include:

• geriatric rehabilitation
• assessment and consultation
• geriatric outreach
• outpatient clinics
• geriatric day hospitals
• condition-specific units
• innovative areas of care

Each chapter follows the same general layout:

• executive summary
• definition and description of the service
• description of information sources used
• recommendations from the literature

Healthcare Professional Training: A Comparison of Geriatric Competencies

Authors: Mathy Mezey, Ed.D., R.N., Ethel Mitty, Ed.D., R.N., Sarah G. Burger, M.P.H., R.N., and Philip McCallion, Ph.D.Journal: Journal of the American Geriatrics Society, September 2008 56(9):1724–29 Synopsis A comparison of geriatric competency domains across five health care disciplines—dentistry, medicine, nursing, pharmacy, and social work—reveals striking similarities. Based on these commonalities, it may be possible to improve interdisciplinary collaboration in the education and clinical training of health care professionals specializing in geriatrics. The Issue Health care professionals who are knowledgeable about the aging process and are skilled in managing the complex needs of older adults are an important but scarce resource. Geriatric specialists may be able to better serve the complex needs of older adults through education and training that incorporates common themes among health care disciplines and emphasizes collaboration among providers. Development of interdisciplinary geriatric training programs is hampered by the fact that, until this study, little has been known about the overlap between competencies specified in the training and certification documents used in different health care disciplines. Key Findings

• Findings from this study reflect striking similarities in geriatric competencies across the five disciplines, as reflected in their training and certification documents.
• The dentistry documents addressed all domains except psychosocial elements and managing and negotiating health delivery systems.
• The pharmacy documents included all domains except the pharmacist's teaching–coaching role as a team member.
• In medicine, the documents for geriatric fellows did not include evaluation of the plan of care, the teaching–coaching role, or cultural competence.
• The documents for geriatric social workers differed the most. The materials did not address risk assessment and health promotion, environmental issues, chronic health problems and functional status, or teaching–coaching role as a team member. They did, however, include domains not found in other disciplines, such as values clarification, interventions, and program development.
• Findings suggest the benefit of including disciplines such as dentistry and pharmacy in coordinated geriatric initiatives.

Addressing the Problem

Most educators, health care professionals, administrators, and policy bodies agree that interdisciplinary collaboration has the potential to improve quality and lower health care costs for older adults. Despite widespread support, few geriatric health care specialists are trained to work on care teams. Health care professionals with limited exposure to interdisciplinary teams in academic and training programs may be less likely to perceive the benefits of teamwork. Barriers to developing interdisciplinary academic programs include difficulties in scheduling courses and clinical rotations, few faculty with interdisciplinary skills or interest in teaching interdisciplinary courses, and language differences in competency documents. Significantly overlapping geriatric competencies across health care disciplines could further the development and testing of a core curriculum in geriatrics that includes interdisciplinary classes and clinical rotations.

About the Study

The study identified geriatric competency source documents from the geriatric-certifying bodies of five health care professions: dentistry, medicine, nursing, pharmacy, and social work. These documents were used to develop a geriatric competency grid that consisted of eight domains: assessment, diagnostic, plan of care and implementation, evaluation, professional role, teaching and coaching, cultural competence, and managing and negotiating health care systems.

The Bottom Line

Significant overlap in the geriatric competencies of a variety of health care disciplines could form the basis of an interdisciplinary program that maximizes the potential of a small number of geriatric specialists to better serve the needs of older adults.

Geriatrics and Gerontology Advisory Committee; Notice of Meeting

The Department of Veterans Affairs (VA) gives notice under Public Law 92-463 (Federal Advisory Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September 18-19, 2008, in Room 630, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC. On September 18, the session will begin at 8:30 a.m. and end at 5 p.m. On September 19, the session will begin at 8 a.m. and end at 12 noon. This meeting is open to the public. The meeting will feature presentations and discussion on:

• VA's aging research activities,
• update on VA's geriatric workforce (to include training, recruitment and retention approaches),
• Veterans Health Administration (VHA) Geriatric Primary Care,
• VHA strategic planning activities in geriatrics and extended care,
• recent VHA efforts regarding dementia and long term care needs of recently returning veterans,
• program advances in Community Living Centers and palliative care, and
• policy guidance and performance oversight of the VA Geriatric Research, Education, and Clinical Centers.

No time will be allocated at this meeting for receiving oral presentations from the public. Interested parties should provide written comments for review by the Committee not less than ten days in advance of the meeting to Mrs. Marcia Holt-Delaney, Office of Geriatrics and Extended Care (114), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420.

Individuals who wish to attend the meeting should contact Mrs. Holt-Delaney, Program Analyst, at (202) 461-6769.

Prognosis: Low-Tech Clues to Future Illness

Vital Signs Prognosis: Low-Tech Clues to Future Illness By ERIC NAGOURNEY Published: July 1, 2008 - New York Times Minor neurological weaknesses may offer doctors an opportunity to see which older patients are at higher risk of illness and begin treatment, researchers have found. Related Link Journal of Internal Medicine Abstract Subtle Neurological Abnormalities as Risk Factors for Cognitive and Functional Decline, Cerebrovascular Events, and Mortality in Older Community-Dwelling Adults