Novel Electronic Health Record Strategies to Identify Frailty Among Hospitalized Older Adults with Multiple Chronic Conditions.

A growing number of aging adults are living with multiple chronic conditions (MCC). Older adults living with MCC are predisposed to developing frailty, a state of decreased physiologic reserve that increases risk for geriatric syndromes and associated morbidity and mortality. The electronic frailty index (eFI) is computed passively using structured EHR data and can aid in prospective screening.

Frailty integration in medical specialties: Current evidence and suggested strategies from the Clin-STAR frailty interest group.

Frailty is a syndrome that can inform clinical treatments and interventions for older adults. Although implementation of frailty across medical subspecialties has the potential to improve care for the aging population, its uptake has been heterogenous. While frailty assessment is highly integrated into certain medical subspecialties, other subspecialties have only recently begun to consider frailty in the context of patient care.

Chiropractic Spinal Manipulation and Fall Risk in Older Adults With Spinal Pain: Observational Findings From a Matched Retrospective Cohort Study.

Introduction: Limited research suggests that spinal manipulative therapy (SMT) might positively influence balance, yet its association with falls remains underexplored. We hypothesized that older adults receiving chiropractic SMT for spinal pain would have a reduced fall risk during 13 months of follow-up compared to matched controls.

Methods: We searched >116 million patient records from TriNetX (2013-2023; Cambridge, MA, US) to identify adults aged ≥65 years with spinal pain.

Integrating Geriatrics and Lifestyle Medicine: Paving the Path to Healthy Aging.

Aging is a lifelong process, and many chronic diseases and geriatric syndromes are influenced by lifestyle factors. Here, we discuss the benefits of integrating education in geriatrics and lifestyle medicine to not only improve competency of health professions learners in each area, but also so that learners can promote healthy aging in the clinical care of their future patients. We review the current state of geriatrics education, the role of lifestyle medicine in aging, and strategies to bridge the gaps between geriatrics and lifestyle medicine.

An age-friendly chart review tool: integrating geriatrics education and quality improvement in a resident primary care clinic.

Resident primary care clinics have no standardized approach for assessing geriatric-specific quality of care measures. This results in wide variability in the quality of care offered to older adults in these clinics and the quality of geriatrics education residents receive in the primary care setting. To address this need, we developed a structured resident self-assessment chart review tool designed to be integrated into a required Geriatrics rotation within an Internal Medicine residency program.

"What's Going to Happen?": Internal Medicine Resident Experiences of Uncertainty in the Care of Older Adults.

Purpose: Internal medicine residents care for clinically complex older adults and may experience increased moral distress due to knowledge gaps, time constraints, and institutional barriers. We conducted a phenomenological study to explore residents' experiences and challenges through the lens of uncertainty.

Methods: Between January and March 2022, six focus groups were conducted comprising a total of 13 internal medicine residents in postgraduate years 2 and 3, who had completed a required 2-week geriatrics rotation.

Holistic frailty prevention: The promise of movement-based mind-body therapies.

Aging is characterized by fundamental cellular and molecular hallmarks that result in physiologic decline of most body systems. This may culminate in frailty, a state of decreased reserve. Because frailty is a state of multisystem dysregulation, multimodal interventions may be necessary to mitigate and prevent progression rather than interventions targeting a single system.

Managing Geriatric Patients with Falls and Fractures.

Orthopedic fractures in adults 65 and older are common and can lead to functional decline and increased morbidity and mortality. Falls are often the precipitating event for fractures in this population, linked to common aging physiology with increasing comorbid conditions and advancing frailty. Managing falls and orthopedic fractures in the geriatric population is complex, requiring a systematic and collaborative approach spearheaded by a multidisciplinary team focused on improving patient outcomes.

An age-friendly residency: Geriatrician and internist perspectives on geriatric education in an internal medicine residency.

Background: General internists and subspecialists need skills to deliver age-friendly care to older adults, yet a minority of Internal Medicine (IM) residency programs provide robust geriatric-specific clinical instruction. We sought to explore internist and geriatrician perspectives regarding current strengths and weakness of geriatric education, and perceived supports, barriers, and strategies to enhance geriatric education in an IM residency program.

Methods: Using social learning theory as a conceptual framework, we conducted a needs assessment using focus groups and semi-structured interviews with IM residency leadership and geriatricians at an academic medical center.

Effect of Yoga on Frailty in Older Adults : A Systematic Review.

Background: Yoga, a multicomponent mind-body practice, improves several domains of physical and psychological health and may affect frailty in older adults.

Purpose: To evaluate the available trial evidence on the effect of yoga-based interventions on frailty in older adults.

Data Sources: MEDLINE, EMBASE, and Cochrane Central from their inception to 12 December 2022.

Strategic response to bleeding in laparoscopic hepato-pancreato-biliary surgery: an intraoperative checklist.

Background: The aim is to develop and test the utility of an event-initiated, team-based check list to optimize the response to bleeding during laparoscopic HPB surgery.

Methods: To build a checklist for managing bleeding events, we conducted a systematic review. Using nominal group technique (NGT), a checklist consisting of four domains was developed.

From research to bedside: Incorporation of a CGA-based frailty index among multiple comanagement services.

The comprehensive geriatric assessment (CGA) is the core tool used by geriatricians across diverse clinical settings to identify vulnerabilities and estimate physiologic reserve in older adults. In this paper, we demonstrate the iterative process at our institution to identify and develop a feasible, acceptable, and sustainable bedside CGA-based frailty index tool (FI-CGA) that not only quantifies and grades frailty but also provides a uniform way to efficiently communicate complex geriatric concepts such as reserve and vulnerability with other teams. We describe our incorporation of the FI-CGA into the electronic health record (EHR) and dissemination among clinical services.

Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial.

Background And Objective: Mind-body interventions (MBIs) have been shown to be effective individual-level interventions for mitigating physician burnout, but there are no controlled studies of yoga-based MBIs in resident physicians. We assessed the feasibility of a yoga-based MBI called RISE (resilience, integration, self-awareness, engagement) for residents among multiple specialties and academic medical centers.

Methods: We conducted a waitlist controlled randomized clinical trial of the RISE program with residents from multiple specialty departments at three academic medical centers.

Promoting Healthy Aging During COVID-19.

Older adults have been markedly impacted by the coronavirus disease 19 (COVID-19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID-19 on health promotion are recognized.

Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center.

Background: Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race.