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  • 1
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    Online Resource
    Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool
    Wiley ; 2023
    In:  Academic Emergency Medicine Vol. 30, No. 4 ( 2023-04), p. 428-436
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 30, No. 4 ( 2023-04), p. 428-436
    Abstract: Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high‐risk population for EA. VHA emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs; former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non‐VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM‐SART) to pilot in the Louis Stokes Cleveland VA Medical Center geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high‐risk older Veterans for geriatric syndromes and unmet needs. The adapted EM‐SART was integrated into the electronic health record and GED workflow in December 2020. By July 2022, a total of 251 Veterans were screened with nine (3.6%) positive on the prescreen and five (2%) positive on the comprehensive screen. Based on the first‐year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM‐SART for wider use in VHA, including embedding flexibility for both licensed and nonlicensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence‐based approach to EA assessment in the largest integrated health system in the United States.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.v30.4
    DOI: 10.1111/acem.14646
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2029751-8
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  • 2
    Online Resource
    Online Resource
    Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures
    Oxford University Press (OUP) ; 2022
    In:  Innovation in Aging Vol. 6, No. 5 ( 2022-07-01)
    Details
    In: Innovation in Aging, Oxford University Press (OUP), Vol. 6, No. 5 ( 2022-07-01)
    Abstract: Delirium is a common disorder among older adults following hospitalization or major surgery. Whereas many studies examine the risk of proximate exposures and comorbidities, little is known about pathways linking childhood exposures to later-life delirium. In this study, we explored the association between paternal occupation and delirium risk. Research Design and Methods A prospective observational cohort study of 528 older adults undergoing elective surgery at two academic medical centers. Paternal occupation group (white collar vs. blue collar) served as our independent variable. Delirium incidence was assessed using the Confusion Assessment Method (CAM) supplemented by medical chart review. Delirium severity was measured using the peak CAM-Severity score (CAM-S Peak), the highest value of CAM-S observed throughout the hospital stay. Results Blue-collar paternal occupation was significantly associated with a higher rate of incident delirium (91/234, 39%) compared with white-collar paternal occupation (84/294, 29%), adjusted odds ratio OR (95% confidence interval [CI]) = 1.6 (1.1, 2.3). All analyses were adjusted for participant age, race, gender, and Charlson Comorbidity Index. Blue-collar paternal occupation was also associated with greater delirium severity, with a mean score (SD) of 4.4 (3.3), compared with white-collar paternal occupation with a mean score (SD) of 3.5 (2.8). Among participants reporting blue-collar paternal occupation, we observed an adjusted mean difference of 0.86 (95% CI = 0.4, 1.4) additional severity units. Discussion and Implications Blue-collar paternal occupation is associated with greater delirium incidence and severity, after adjustment for covariates. These findings support the application of a life-course framework to evaluate the risk of later-life delirium and delirium severity. Our results also demonstrate the importance of considering childhood exposures, which may be consequential even decades later.
    Type of Medium: Online Resource
    ISSN: 2399-5300
    URL: Article
    DOI: 10.1093/geroni/igac050
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2905697-4
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  • 3
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    Medical and Social Factors Associated With Referral for Elder Abuse Services in a National Health Care System
    Oxford University Press (OUP) ; 2022
    In:  The Journals of Gerontology: Series A Vol. 77, No. 8 ( 2022-08-12), p. 1706-1714
    Details
    In: The Journals of Gerontology: Series A, Oxford University Press (OUP), Vol. 77, No. 8 ( 2022-08-12), p. 1706-1714
    Abstract: Elder abuse (EA) is common and has devastating health consequences yet is not systematically assessed or documented in most health systems, limiting efforts to target health care-based interventions. Our objective was to examine sociodemographic and medical characteristics associated with documented referrals for EA assessment or services in a national U.S. health care system. Methods We conducted a national case–control study in U.S. Veterans Health Administration facilities of primary care (PC)-engaged Veterans age ≥60 years who were evaluated by social work (SW) for EA-related concerns between 2010 and 2018. Cases were matched 1:5 to controls with a PC visit within 60 days of the matched case SW encounter. We examined the association of patient sociodemographic and health factors with receipt of EA services in unadjusted and adjusted models. Results Of 5 567 664 Veterans meeting eligibility criteria during the study period, 15 752 (0.3%) received services for EA (cases). Cases were mean age 74, and 54% unmarried. In adjusted logistic regression models (adjusted odds ratio; 95% confidence interval), age ≥ 85 (3.56 vs age 60–64; 3.24–3.91), female sex (1.96; 1.76–2.21), child as next-of-kin (1.70 vs spouse; 1.57–1.85), lower neighborhood socioeconomic status (1.18 per higher quartile; 1.15–1.21), dementia diagnosis (3.01; 2.77–3.28), and receiving a VA pension (1.34; 1.23–1.46) were associated with receiving EA services. Conclusion In the largest cohort of patients receiving EA-related health care services studied to date, this study identified novel factors associated with clinical suspicion of EA that can be used to inform improvements in health care-based EA surveillance and detection.
    Type of Medium: Online Resource
    ISSN: 1079-5006 , 1758-535X
    URL: Article
    DOI: 10.1093/gerona/glab354
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2043927-1
    SSG: 12
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  • 4
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    Online Resource
    Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system—Results from a case–control study
    Wiley ; 2023
    In:  Journal of the American Geriatrics Society Vol. 71, No. 6 ( 2023-06), p. 1724-1734
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 71, No. 6 ( 2023-06), p. 1724-1734
    Abstract: Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system. Methods We conducted a case–control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 ( n  = 14,723) and controls receiving VA primary care services in the same 60‐day window ( n  = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model. Results The sample ( n  = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant ( p   〈  0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre‐frailty (aOR vs. robust 1.7; 95% CI 1.5–1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3–3.9) were independently associated with referral for EA evaluation. Conclusions A claims‐based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under‐recognized phenomenon.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.v71.6
    DOI: 10.1111/jgs.18245
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2040494-3
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  • 5
    Online Resource
    Online Resource
    Diagnostic Coding of Elder Mistreatment: Results From a National Database of Medicare Advantage and Private Insurance Patients, 2011–2017
    SAGE Publications ; 2022
    In:  Journal of Applied Gerontology Vol. 41, No. 4 ( 2022-04), p. 918-927
    Details
    In: Journal of Applied Gerontology, SAGE Publications, Vol. 41, No. 4 ( 2022-04), p. 918-927
    Abstract: Health care providers may play an important role in detection of elder mistreatment, which is common but underrecognized. We used the Health Care Cost Institute insurance claims database to describe elder mistreatment diagnosis among Medicare Advantage (MA) and private insurance patients in the United States from 2011 to 2017. We used International Classification of Diseases (ICD) coding to identify cases, examining the impact of transition from ICD-9 (Ninth Revision) to ICD-10 (Tenth Revision), which occurred in October 2015 and added 14 new codes for “suspected” mistreatment. 8,127 patients (0.051% of all aged ≥ 65), including 6,304 with MA (0.058%) and 1,823 with private insurance (0.026%) received elder mistreatment diagnosis. Transition from ICD-9 to ICD-10 was associated with a small increase in diagnosis rate, with “suspected” codes used in 45.3% of ICD-10 versus 9.7% of ICD-9 cases. Overall rates remained low. Rates, settings, and types of diagnosis differed between MA and private insurance patients.
    Type of Medium: Online Resource
    ISSN: 0733-4648 , 1552-4523
    URL: Article
    DOI: 10.1177/07334648211018530
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2089028-X
    detail.hit.zdb_id: 155897-3
    SSG: 5,2
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  • 6
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    Online Resource
    Mobile Integrated Health Interventions for Older Adults: A Systematic Review
    Oxford University Press (OUP) ; 2023
    In:  Innovation in Aging Vol. 7, No. 3 ( 2023-04-01)
    Details
    In: Innovation in Aging, Oxford University Press (OUP), Vol. 7, No. 3 ( 2023-04-01)
    Abstract: Mobile integrated health (MIH) interventions have not been well described in older adult populations. The objective of this systematic review was to evaluate the characteristics and effectiveness of MIH programs on health-related outcomes among older adults. Research Design and Methods We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, Social Work Abstracts, and The Cochrane Library through June 2021 for randomized controlled trials or cohort studies evaluating MIH among adults aged 65 and older in the general community. Studies were screened for eligibility against predefined inclusion/exclusion criteria. Using at least 2 independent reviewers, quality was appraised using the Downs and Black checklist and study characteristics and findings were synthesized and evaluated for potential bias. Results Screening of 2,160 records identified 15 studies. The mean age of participants was 67 years. The MIH interventions varied in their focus, community paramedic training, types of assessments and interventions delivered, physician oversight, use of telemedicine, and post-visit follow-up. Studies reported significant reductions in emergency call volume (5 studies) and immediate emergency department (ED) transports (3 studies). The 3 studies examining subsequent ED visits and 4 studies examining readmission rates reported mixed results. Studies reported low adverse event rates (5 studies), high patient and provider satisfaction (5 studies), and costs equivalent to or less than usual paramedic care (3 studies). Discussion and Implications There is wide variability in MIH provider training, program coordination, and quality-based metrics, creating heterogeneity that make definitive conclusions challenging. Nonetheless, studies suggest MIH reduces emergency call volume and ED transport rates while improving patient experience and reducing overall health care costs.
    Type of Medium: Online Resource
    ISSN: 2399-5300
    URL: Article
    DOI: 10.1093/geroni/igad017
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2905697-4
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  • 7
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    Online Resource
    Wealth-Associated Disparities in Death and Disability in the United States and England
    American Medical Association (AMA) ; 2017
    In:  JAMA Internal Medicine Vol. 177, No. 12 ( 2017-12-01), p. 1745-
    Details
    In: JAMA Internal Medicine, American Medical Association (AMA), Vol. 177, No. 12 ( 2017-12-01), p. 1745-
    Type of Medium: Online Resource
    ISSN: 2168-6106
    URL: Article
    DOI: 10.1001/jamainternmed.2017.3903
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2017
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  • 8
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    Challenges Of Measuring Quality Of Community-Based Programs For Seriously Ill Individuals And Their Families
    Health Affairs (Project Hope) ; 2017
    In:  Health Affairs Vol. 36, No. 7 ( 2017-07), p. 1227-1233
    Details
    In: Health Affairs, Health Affairs (Project Hope), Vol. 36, No. 7 ( 2017-07), p. 1227-1233
    Type of Medium: Online Resource
    ISSN: 0278-2715 , 1544-5208
    URL: Article
    DOI: 10.1377/hlthaff.2017.0161
    Language: English
    Publisher: Health Affairs (Project Hope)
    Publication Date: 2017
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  • 9
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    Changes in Elder Abuse Risk Factors Reported by Caregivers of Older Adults during the COVID ‐19 Pandemic
    Wiley ; 2021
    In:  Journal of the American Geriatrics Society Vol. 69, No. 3 ( 2021-03), p. 602-603
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 69, No. 3 ( 2021-03), p. 602-603
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.v69.3
    DOI: 10.1111/jgs.17009
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2040494-3
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  • 10
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    Late Transitions and Bereaved Family Member Perceptions of Quality of End‐of‐Life Care
    Wiley ; 2018
    In:  Journal of the American Geriatrics Society Vol. 66, No. 9 ( 2018-09), p. 1730-1736
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 66, No. 9 ( 2018-09), p. 1730-1736
    Abstract: To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC). Design National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees aged 65 and older. Setting United States, all sites of death. Participants Family members and close friends of decedents from NHATS Rounds 2 through 6 (N=1,653; weighted 6.0 million Medicare deaths). Measurements Multivariable logistic regression with survey weights was used to examine the association between having a late transition and reports of perceived unmet needs for symptom management, spiritual support, concerns with communication, and overall QOC. Results Seventeen percent of decedents had a late transition. Bereaved respondents for decedents experiencing late transitions were more likely to report that the decedent was treated without respect (21.3% vs 15.6%; adjusted odds ratio (AOR)=1.59, 95% confidence interval (CI)=1.09–2.33), had more unmet needs for spiritual support (67.4% v 55.2%; AOR=1.48, 95% CI=1.03–2.13), and were more likely to report they were not kept informed about the person's condition (31.0% vs 20.9%; AOR=1.54, 95% CI=1.07–2.23). Bereaved respondents were less likely to rate QOC as excellent when there was a late transition (43.6% vs 48.2%; AOR=0.79, 95% CI=0.58–1.06). Subgroup analyses of those experiencing a transition between a nursing home and hospital (13% of all late transitions) revealed such transitions to be associated with even worse QOC. Conclusion Transitions in the last 3 days of life are associated with more unmet needs, higher rate of concerns, and lower rating of QOC than when such late transitions are absent, especially when that transition is between a nursing home and hospital.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2018.66.issue-9
    DOI: 10.1111/jgs.15455
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2040494-3
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