Operative risk stratification in the older adult.

As the population ages, the health care system must to adapt to the needs of the older population. Hospitalization risks are particularly significant in the frail geriatric patients, with costly and morbid consequences. Appropriate preoperative assessment can identify sources of increased risk and enable the surgical team to manage this risk, through "prehabilitation," intraoperative modification, and postoperative care.

Intervention thresholds: a conceptual frame for advance care planning choices.

Background: Advance care planning (ACP) provides for decisions in the event of decisional incapacity. Determining ahead of time what a person may want is challenging and limits the utility of ACP. We present empirical evidence for a new approach to ACP: the individual's "intervention threshold.

Patient safety in the nursing home: how nursing staff assess and communicate about change in condition.

Nursing homes must improve quality of care even as it becomes increasingly complex, and patient safety science may provide a helpful paradigm. Training materials are needed to build staff capacity for clinical assessment and communication, thereby improving care processes. Designed to develop curricular materials, this study used focus groups to determine how experienced nurses and aides assess and communicate about resident clinical changes.

Decisions at the end of life: have we come of age?

Decision making is a complex process and it is particularly challenging to make decisions with, or for, patients who are near the end of their life. Some of those challenges will not be resolved - due to our human inability to foresee the future precisely and the human proclivity to change stated preferences when faced with reality. Other challenges of the decision-making process are manageable.

Feasibility and effectiveness of the NEST13+ as a screening tool for advanced illness care needs.

Background: A comprehensive whole-person approach might improve processes and outcomes of care for patients with cancer.

Objective: To assess the ability of NEST13+ (Needs of a social nature; Existential concerns; Symptoms; and Therapeutic interaction), a screening and assessment tool, to identify social, emotional, physical, and care-system needs and to improve clinical outcomes for cancer patients in tertiary care.

Design, Setting, Patients: A controlled trial involving 451 patients hospitalized for cancer care at a comprehensive cancer center.

Religiousness, religious coping, and psychological well-being in nursing home residents.

Objectives: To measure the importance of religion among nursing home residents, describe their use of religious coping strategies, and examine the association between religiousness, religious coping, and psychological well-being.

Design: Cross-sectional study.

Setting: Two nursing facilities in Boston, Massachusetts.

Health-related safety: a framework to address barriers to aging in place.

Maintaining safety in the home and community is a national public health concern, especially for older adults who "age in place." In this article, we introduce a multicausal concept called "health-related safety," which is defined as the minimization of the probability of preventable, unintended harm in community-dwelling individuals. Derived from the modern patient safety movement, health-related safety attributes adverse health events in the home and community to systematic breakdowns in the societal system, not to the commission of errors by particular individuals.

The influence of outpatient comprehensive geriatric assessment on survival: a meta-analysis.

Although outpatient Comprehensive Geriatric Assessment (CGA) has shown certain benefits in functional status and quality of life by many randomized controlled trials, no survival benefit has been reported. We hypothesized that the lack of survival benefit may be due to insufficient power of individual trials. In order to assess the influence of outpatient CGA on survival of older persons, we performed a meta-analysis of all randomized controlled trials of outpatient CGA.