Drivers of Frequent Emergency Department Use in Socioeconomically Disadvantaged Older Adults: A Qualitative Study.

Background: The emergency department (ED) is the safety net for and a common point of healthcare access for socioeconomically disadvantaged older adults. Little is known about socioeconomically disadvantaged older ED patients' perspectives on their health, healthcare access, and ED use. Such insights could guide tailored interventions to address unmet clinical and health-related social needs (HRSN).

Guiding Age-Friendly Care Through "What Matters": Restoring the Whole Person Back into Clinical Practice.

Clinical practice guidelines relying exclusively on evidence from single-disease trials are not designed to meet the needs of older adults with multiple chronic conditions (MCC). Guidelines do not always consider the time to benefit of treatments and often include trials where persons with MCC are excluded. Clinicians can use "what matters" (i.

Effects of cognitive dual-tasking on biomechanics and muscle activity during gait initiation and sit-to-walk in young adults.

The purpose of this study was to investigate the effects of cognitive dual-tasking on gait initiation and sit-to-walk. Twenty-eight healthy young adults performed gait initiation and sit-to-walk under two conditions: while engaging in serial subtraction (dual-task) and without any additional task (single-task). Motion data were collected using a 10-camera optoelectronic motion capture system, synchronized with force plates and surface electromyography.

Identification of Frailty Clusters Using Cross-Sectional Frailty and Frailty Trajectory: Cohort of Heart Failure Veterans.

Background: Frailty is a syndrome associated with increased vulnerability and diminished physiological reserves. Three-quarters (78%) of heart failure (HF) patients are frail. Traditional frailty indices (FIs) assess cross-sectional deficits, while frailty trajectories (FTs) measure changes over time.

From Trials to Practice: Implementing a Clinical Intervention in Community Settings.

Introduction/objectives: Diabetes increases the risk of complications, especially for vulnerable populations. Our previous randomized clinical trial (RCT), TIME (elehealth-supported, ntegrated Community Health Workers (CHWs), edication access, group visit ducation), showed the efficacy of CHW-led diabetes care. This study aimed to gather data on transitioning TIME from clinical trials to practical implementation.

Cognitive Interviews With Emergency Physicians to Understand Disposition Decisions With People With Dementia With Borderline Cases.

People with dementia are often hospitalized from the emergency department (ED) for "borderline cases," where outpatient or inpatient management may be clinically reasonable. We sought to investigate how ED physicians make and communicate about decisions in borderline cases. Through cognitive interviews, we asked attending ED physicians from an academic hospital to share their approach to scenarios representing borderline cases with people with dementia and verbalize communication about ED disposition with patients and care partners.

A Mixed-Methods Usability Pilot of a Value-Goal Elicitation Tool in the Inpatient Setting for Older Adults Anticipating Post-Acute Care.

Age-Friendly Health Systems (AFHS) emphasize aligning care with "What Matters" most to older adults. Hospitalization represents a critical period where value-based goals could shape key decisions about post-acute care transitions. However, few tools designed for eliciting such goals have been adapted for use in the inpatient setting, where the acute nature of care poses unique challenges.

Emergency Nurses' Perspectives on Adopting Geriatric Screenings for Cognitive Impairment: A Qualitative Study.

Introduction: Cognitive impairment in older adults is underrecognized in emergency departments. Despite emergency nurses' central role in facilitating ED screening for clinical and social needs, little is known about their perspectives on implementing delirium and dementia screenings. Nurses can provide insights to promote the uptake of these screenings.

Older Adults' Experiences of Emergency Department Admission Decisions: A Qualitative Study in a Public Safety Net Hospital.

Background: Hospital admission is a significant event in the healthcare trajectory of older adults (age 60 +). Numerous harms such as delirium, falls, and adverse medication events can arise that outweigh the benefits of admission. Little is known about how older adults feel about being hospitalized or what they think admission will achieve for them.

Experiences of the emergency department environment: a qualitative study with caregivers of people with dementia.

ED crowding and boarding adversely impact older patients' care and outcomes. Little is known about how ED crowding impacts persons living with dementia, a vulnerable population. This study sought to explore ED experiences of caregivers of people with dementia during a period of ED crowding and boarding.

Implementation of delirium screening in the emergency department: A qualitative study with early adopters.

Introduction: Delirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one-third of cases. Evidence-based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake.

Needs of family caregivers of hospitalised adults with dementia during care transitions: a qualitative study in a US Department of Veterans Affairs Hospital.

Objective: To identify the needs of caregivers of hospitalised adults with dementia in the hospital and during care transitions.

Design: Pragmatic qualitative inquiry with semi-structured interviews.

Setting: Michael E.

Considerations When Designing and Implementing Pragmatic Clinical Trials That Include Older Hispanics.

Introduction: Pragmatic clinical trials (PCTs) are designed to connect researchers with clinicians to assess the real-world effectiveness and feasibility of interventions, treatments, or health care delivery strategies in routine practice. Within PCTs larger, more representative sampling is possible to improve the external validity of the research. Older adults from underrepresented groups can benefit from PCTs given their historically lower engagement in clinical research.

Improving the Discharge Process at the VA Palo Alto Through Change Management and Implementation of Project Re-Engineered Discharge.

This quality improvement project demonstrates that nursing leadership with Project Re-Engineered Discharge can effect change in the discharge process and improve patient outcomes.

Emergency department communication with diverse caregivers and persons living with dementia: A qualitative study.

Background: Research to date has detailed numerous challenges in emergency department (ED) communication with persons living with dementia (PLWD) and their caregivers. However, little is known about communication experiences of individuals belonging to minoritized racial and ethnic groups, who are disproportionately impacted by dementia and less likely to be included in dementia research.

Methods: We conducted semi-structured interviews with 29 caregivers of PLWD from two urban academic hospital EDs with distinct patient populations.

Implementation of patient priorities-aligned care in a home-based primary care program.

Background: Older adults may be limited in their ability to access care that meets their health goals owing to disease burden, financial instability, and psychosocial barriers. A home-based primary care (HBPC) program established in 2020 within a large family medicine practice uses the Patient Priorities Care (PPC) approach to identify and address patients' health priorities. When incorporated as part of the HBPC model of care, the PPC approach has the potential to enhance person-centered care for older adults in a way that best supports their health goals.

Differential Effects of Type 2 Diabetes Treatment Regimens on Diabetes Distress and Depressive Symptoms in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).

Objective: We evaluated whether adding basal insulin to metformin in adults with early type 2 diabetes mellitus (T2DM) would increase emotional distress relative to other treatments.

Research Design And Methods: The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) of adults with T2DM of <10 years' duration, HbA1c 6.8-8.

Patient Priorities Care Increases Long-Term Service and Support Use: Propensity Match Cohort Study.

Objectives: Patient priorities care (PPC) is an evidence-based approach designed to help patients achieve what matters most to them by identifying their health priorities and working with clinicians to align the care they provide to the patient's priorities. This study examined the impact of the PPC approach on long-term service and support (LTSS) use among veterans.

Design: Quasi-experimental study examining differences in LTSS use between veterans exposed to PPC and propensity-matched controls not exposed to PPC adjusting for covariates.

Patient Priorities-Aligned Care for Older Adults With Multiple Conditions: A Nonrandomized Controlled Trial.

Importance: Older adults with multiple conditions receive health care that may be burdensome, of uncertain benefit, and not focused on what matters to them. Identifying and aligning care with patients' health priorities may improve outcomes.

Objective: To assess the association of receiving patient priorities care (PPC) vs usual care (UC) with relevant clinical outcomes.