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.

Using Wearable Sensors to Measure Goal Achievement in Older Veterans with Dementia.

Aligning treatment with patients' self-determined goals and health priorities is challenging in dementia care. Wearable-based remote health monitoring may facilitate determining the active participation of individuals with dementia towards achieving the determined goals. The present study aimed to demonstrate the feasibility of using wearables to assess healthcare goals set by older adults with cognitive impairment.

Feasibility of Clinicians Aligning Health Care with Patient Priorities in Geriatrics Ambulatory Care.

Background/objectives: Aligning healthcare decisions with patients' priorities may improve care for older adults with multiple chronic conditions (MCCs). We conducted a pilot study to assess the feasibility of identifying patient priorities in routine geriatrics care and to compare clinicians' recommendations for patients who did or did not have their priorities identified.

Design: Retrospective chart review.

Decision-Making in Geriatric Patients with End-Stage Renal Disease: Thinking Beyond Nephrology.

Compared to younger individuals, the prevalence of end-stage renal disease (ESRD) in elders is notably higher. While renal replacement therapy, usually with hemodialysis, is accepted therapy in younger patients with ESRD, decisions regarding the treatment of advanced kidney disease in the elderly population are more complex, secondary to the physiologic changes of aging, concurrent geriatric syndromes, and varying goals of care. Evaluation for possible initiation of dialysis in geriatric patients should be multidisciplinary in nature and patient-focused, including a consideration of physical, cognitive, and social function.

Dementia and Hospital Readmission Rates: A Systematic Review.

Background: Although community-dwelling persons with dementia have an increased risk of hospital readmission, no systematic review has examined the contribution of dementia to readmissions.

Summary: We examined articles in English, with no restrictions on publication dates, from Medline, PubMed, PsycINFO, CINAHL, and EMBASE. Keywords used were , , , , , , , , , , , , , and .

A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia.

Cholinesterase inhibitors (ChEIs) are the primary pharmacological treatment for symptom management of Alzheimer disease (AD), but they carry known risks during long-term use, and do not guarantee clinical effects over time. The balance of risks and benefits may warrant discontinuation at different points during the disease course. Indeed, although there is limited scientific study of deprescribing ChEIs, clinicians routinely face practical decisions about whether to continue or stop medications.

Impact of a Videoconference Educational Intervention on Physical Restraint and Antipsychotic Use in Nursing Homes: Results From the ECHO-AGE Pilot Study.

Objectives: US nursing homes care for increasing numbers of residents with dementia and associated behavioral problems. They often lack access to specialized clinical expertise relevant to managing these problems. Project ECHO-AGE provides this expertise through videoconference sessions between frontline nursing home staff and clinical experts at an academic medical center.

ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues.

Objectives: To design, implement, and assess the pilot phase of an innovative, remote case-based video-consultation program called ECHO-AGE that links experts in the management of behavior disorders in patients with dementia to nursing home care providers.

Design: Pilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes.

Setting: Eleven long-term care sites in Massachusetts and Maine.

A standardized, bundled approach to providing geriatric-focused acute care.

Objectives: To determine whether a bundled intervention can increase detection of delirium and facilitate safer use of high-risk medications.

Design: Pre-post interventional trial.

Setting: Large academic medical center.

Preliminary data from an advanced dementia consult service: integrating research, education, and clinical expertise.

Hospitalized individuals with advanced dementia often receive care that is of limited clinical benefit and inconsistent with preferences. An advanced dementia consultation service was designed, and a pre and post pilot study was conducted in a Boston hospital to evaluate it. Geriatricians and a palliative care nurse practitioner conducted consultations, which consisted of structured consultation, counseling and provision of an information booklet to the family, and postdischarge follow-up with the family and primary care providers.

Aging and ESRD demographics: consequences for the practice of dialysis.

The disproportionate increase in the prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the elderly is now recognized as a national and global reality. Among the major contributing factors are the aging of the population, a growing prevalence of CKD, greater access to care, and increased comorbidities. The utilization of renal replacement therapy in the geriatric population has concomitantly increased.

Identification and management of in-hospital drug-induced delirium in older patients.

Delirium, an acute confusional state with changes in attention and cognition, is a common cause of morbidity and mortality among hospitalized elders. Medications are responsible for up to 39% of delirium cases in the elderly. The incidence of drug-induced delirium is particularly high in this population due to the altered pharmacokinetics and pharmacodynamics of aging, high prevalence of polypharmacy and occurrence of co-morbid disease.