Publications by authors named "Gisele Wolf-Klein"
Background: Hospitalized persons living with dementia (PLWD) often experience behavioral symptoms that challenge medical care.
Objective: This study aimed to identify clinical practices and outcomes associated with behavioral symptoms in hospitalized PLWD.
Design: A retrospective cross-sectional study.
Telehealth has emerged as an evolving care management strategy that is playing an increasingly vital role, particularly with the onset of the coronavirus disease 2019 pandemic. A meta-analysis of 20 randomized controlled trials was conducted to test the effectiveness of home telemonitoring (HTM) in patients with type 2 diabetes in reducing A1C, blood pressure, and BMI over a median 180-day study duration. HTM was associated with a significant reduction in A1C by 0.
View Article and Find Full Text PDFObjective: Antipsychotics are frequently used for managing both acute and chronic neuropsychiatric disorders. While antipsychotics are known to be associated with increased mortality due to cardiac arrhythmia, there is a lack of consensus on the timing and frequency of electrocardiogram (ECG) monitoring. The goal of this study was to examine current ECG monitoring practices for adults receiving antipsychotics, specifically during hospital admission.
View Article and Find Full Text PDFBackground: Delirium is a common, devastating, and underrecognized syndrome in the intensive care unit (ICU). The study aimed to describe and evaluate a multicomponent education and training program utilizing a "Train-The-Trainer" (TTT) model, to improve delirium detection across a large health system.
Methods: Fourteen ICUs across nine hospitals participated in a multicomponent delirium program consisting of a 1-day workshop that included: (1) patient testimonials, (2) small group discussions, (3) didactics, and (4) role-playing.
The Centers for Disease Control and Prevention estimates that half of the antibiotic prescriptions for acute respiratory tract infections (ARTIs) in ambulatory care settings are unnecessary. To better understand the quality-of-care implications of prescription patterns for ARTIs, we conducted a retrospective chart review of outpatient ARTI visits, across a large integrated health system, and examined the association of patient characteristics with receiving antimicrobials, as well as the association between receiving antimicrobials and healthcare utilization (outpatient and emergency department visits). We found that 55.
View Article and Find Full Text PDFBackground/objectives: For older adults with acute hip fracture, use of preoperative noninvasive cardiac testing may lead to delays in surgery, thereby contributing to worse outcomes. Our study objective was to evaluate the preoperative use of pharmacologic stress testing and transthoracic echocardiogram (TTE) in older adults hospitalized with hip fracture.
Design: Retrospective chart review.
Background: Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities.
Objective: This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention.
Methods: We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients.
This study examined the prognostic value of the Charlson Comorbidity Index (CCI) in predicting short-term clinical outcomes in hospitalized older adults. We conducted a retrospective cohort study of patients, older than 75 years, admitted to the medicine service at a large tertiary hospital (New York). We used the Enhanced International Classification of Disease, 9th Revision, Clinical Modification adaptation to abstract the CCI from electronic medical records.
View Article and Find Full Text PDFConstant Observation Practices for Hospitalized Persons With Dementia: A Survey Study.
Am J Alzheimers Dis Other Demen
June 2019
Despite substantial staffing and cost implications, the use of constant observation (CO) has been poorly described in the acute care setting. The purpose of this cross-sectional, multicenter, survey study was to assess hospital provider practices regarding the use of CO. Of the 543 surveys distributed, 231 were completed across 5 sites.
View Article and Find Full Text PDFHome Telemonitoring In Heart Failure: A Systematic Review And Meta-Analysis.
Health Aff (Millwood)
December 2018
We conducted a meta-analysis of twenty-six randomized controlled trials that tested the effectiveness of home telemonitoring in patients with heart failure for reducing mortality and hospital use. We used the PICOT framework as a tool to address an important variable not previously studied: the timing or duration of monitoring. Specifically, we found that home telemonitoring decreased the odds of all-cause mortality and heart failure-related mortality at 180 days but not at 365 days.
View Article and Find Full Text PDFAim: We sought to explore the relationship between the number of medications at hospital discharge and 30-day rehospitalization in older adults aged >65 years.
Methods: This was a multicenter cohort study to determine whether an increased number of medications was associated with 30-day rehospitalization in patients aged >65 years. We explored the relationship between rehospitalization and other risk factors.
Background: Older adults account for more than half of all admissions to intensive care units; most remain alive at 1 year, but with long-term sequelae.
Objective: To explore geriatric-focused practices and associated outcomes in older intensive care survivors.
Methods: In a 1-year, retrospective, cohort study of patients admitted to the medical intensive care unit and subsequently transferred to the medicine service, adherence to geriatric-focused practices and associated clinical outcomes during intensive care were determined.
Objectives: To determine whether a multicomponent intervention improves care in hospitalized older adults with cognitive impairment.
Design: One-year retrospective chart review with propensity score matching on critical demographic and clinical variables was used to compare individauls with cognitive impairmenet on intervention and nonintervention units.
Setting: Large tertiary medical center.
Objectives: Hospitalization-associated disability affects up to 60% of older adults; however, standardized measures of function are not routinely used and documented. We sought to determine whether nursing documentation in electronic medical records can be used to determine mobility status and associated clinical outcomes.
Methods: A retrospective study of 2383 medical patients aged 75 years and older was conducted at a large academic tertiary hospital in New York.
Objectives: To explore the effect of the presence and timing of a do-not-resuscitate (DNR) order on short-term clinical outcomes, including mortality.
Design: Retrospective cohort study with propensity score matching to enable direct comparison of DNR and no-DNR groups.
Setting: Large, academic tertiary-care center.
Introduction: Medicare patients account for over 50% of hospital days at a cost of over $1 trillion per year. Yet, hospitalization of older adults often results in poor outcomes. We evaluated the role of geriatrician-hospitalists in the care of older adults.
View Article and Find Full Text PDFBackground/objectives: Whereas opiate prescribing patterns have been well described in outpatient and emergency department settings, they have been less defined in hospitalized older adults. The objective was to describe patterns of opiate prescribing and associated outcomes in hospitalized older adults.
Design: Retrospective cohort study.
Objectives: To evaluate physician knowledge and perceptions about the American Board of Internal Medicine/American Geriatrics Society (ABIM/AGS) Choosing Wisely recommendations regarding percutaneous endoscopic gastrostomy (PEG) in individuals with advanced dementia.
Design: Multicenter, mixed-mode, anonymous questionnaire.
Setting: Three tertiary and four community hospitals in New York.
Background: Medicare patients account for approximately 50% of hospital days. Hospitalization in older adults often results in poor outcomes.
Objective: To test the feasibility and impact of using Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs) as a therapeutic intervention to improve care of hospitalized older adults.
Objectives: Despite the numerous health risks associated with being overweight, the effect of weight loss on health and longevity remains controversial, particularly in older adults. We explored the association among weight changes, health outcomes, and mortality in older residents of a skilled nursing facility.
Methods: A 6-year retrospective chart review of residents of a long-term care facility was conducted, collecting monthly weights in addition to the clinical and demographic data of all residents for at least 1 year.
Objectives: The majority of Americans diagnosed as having cancer are older than 65 years. They are, however, less likely than younger patients to receive chemotherapy. Our study aimed to better understand the specific reasons for acceptance or refusal of chemotherapy in older adults with cancer.
View Article and Find Full Text PDFObjectives: To evaluate knowledge, beliefs, and practices regarding delirium of physicians, nurse practitioners (NPs), and registered nurses (RNs).
Design: Anonymous cross-sectional paper survey.
Setting: New York metropolitan area tertiary care hospital.