Scaling and spreading age-friendly care: Early lessons from the VA National Age-Friendly Action Community.

Background: The Age-Friendly Health System (AFHS) initiative seeks to improve care for older adults through assessing and acting on the 4Ms (What Matters, Medication, Mentation, Mobility). The Department of Veterans Affairs (VA) joined the initiative in 2020, and from 2022 to 2023, VA led its first Age-Friendly Action Community, a 7-month online educational series to teach clinicians about implementing the 4Ms across VA care settings.

Methods: The VA Action Community was designed to spread awareness about Age-Friendly care for older Veterans, improve interprofessional team knowledge for providing care guided by the 4Ms, and support AFHS implementation across multiple care settings.

A mobile telehealth program for behavioral treatment of urinary incontinence in women Veterans: Qualitative evaluation of MyHealthBladder.

Women Veterans constitute a distinctive cohort whose exposure to military service can contribute to development of bladder conditions, such as urinary incontinence (UI), as they age. Behavioral therapies are recommended as first-line treatment for incontinence, yet many VA Medical Centers do not have staff trained to administer them. The purpose of this research study was to conduct a qualitative program evaluation of MyHealthBladder, a mobile telehealth version of an evidence-based eight-week behavioral treatment program designed for women Veterans with incontinence.

Impacts of COVID-19 on Health and Healthcare for Rural Veterans in Home-Based Primary Care.

This qualitative study explored the impact of COVID-19 on older rural-dwelling veterans and their caregivers enrolled in home-based primary care (HBPC) through the Birmingham VA Health Care System (BVAHCS). Phone interviews were conducted with 16 veterans and/or their caregivers and rapid qualitative analysis of interview notes was performed. Average age of veterans was 77 (range = 69-97) and 93.

Age-friendly care in the Veterans Health Administration: Past, present, and future.

The Veterans Health Administration (VHA) has long recognized the need for age-friendly care. VHA leadership anticipated the impact of aging World War II veterans on VA healthcare systems and in 1975 developed Geriatric Research, Education, and Clinical Centers (GRECCs) to meet this need. GRECCs catalyzed a series of innovations in geriatric models of care that span the continuum of care, most of which endure.

Social Determinants of Health: Considerations for Care of Older Veterans.

Social determinants of health (SDOH), the environments and circumstances in which people are born, grow, live, work and age, are potent drivers of health, health disparities, and health outcomes over the lifespan. Military service affords unique experiences, exposures, and social and health vulnerabilities which impact the life course and may alter health equity and health outcomes for older veterans. Identifying and addressing SDOH, inclusive of the military experience, allows person-centered, more equitable care to this vulnerable population.

Role Reversal: In-Situ Simulation to Enhance the Value of Interprofessional Team-Based Care.

Background: Effective interprofessional team-based care relies critically on understanding and valuing the role of each team member. Using role reversal with multiple levels of interprofessional education trainees, we developed an in-situ simulation learning experience to enhance team-based care coordination.

Method: A mixed-methods approach was used to examine participants' readiness, perceived value, and attitude toward interprofessional learning using in-situ simulation in the context of role reversal.

Perioperative Mobile Telehealth Program for Post-Prostatectomy Incontinence: A Randomized Clinical Trial.

Purpose: Perioperative pelvic floor muscle training can hasten recovery of bladder control and reduce severity of urinary incontinence following radical prostatectomy. Nevertheless, most men undergoing prostatectomy do not receive this training. The purpose of this trial was to test the effectiveness of interactive mobile telehealth (mHealth) to deliver an evidence-based perioperative behavioral training program for post-prostatectomy incontinence.

The use of patient-led goal setting in the intervention of chronic low back pain in adults: a narrative review.

Chronic low back pain (cLBP) impacts millions of adults annually. Several nonsurgical interventions are recommended for treating this condition, however, limited literature exists regarding the impact patient-led goals may have on outcomes in the treatment of cLBP. The purpose of this narrative review is to identify gaps and synthesize literature examining the associations of patient-led goals combined with care for cLBP.

Heterogeneity in Vision, Hand Function, Cognition, and Health Literacy Among Older Veterans: Impacts, Outcomes, and Clinical Recommendations for First-Time Hearing Aid Users.

Background: Age-related changes (both normal and pathological), and health literacy are relevant to audiological practice. Changes associated with the musculoskeletal, vascular, and nervous systems drive manual, visual, and cognitive function. These in turn affect the capabilities required for effective hearing aid (HA) skill acquisition, use, and management.

A mobile telehealth program for behavioral treatment of urinary incontinence in women veterans: Development and pilot evaluation of MyHealtheBladder.

Aim: To develop and pilot test an interactive mobile telehealth program (mHealth) for behavioral treatment of women veterans with urinary incontinence (UI).

Methods: We developed an evidence-based 8-week behavioral mHealth program, MyHealtheBladder, with input from women veterans, behavioral medicine and health education experts, and clinical providers treating UI in the VA system. The program was story-based and included pelvic floor muscle exercises, bladder control strategies, fluid management, risk factor reduction, and self-monitoring.

The Body Position Spatial Task, a Test of Whole-Body Spatial Cognition: Comparison Between Adults With and Without Parkinson Disease.

Background: The Body Position Spatial Task (BPST) is a novel measure of whole-body spatial cognition involving multidirectional steps and turns. Individuals with Parkinson disease (PD) are affected by motor and cognitive impairments, particularly in spatial function, which is important for mental imagery and navigation. Performance on the BPST may inform understanding of motor-cognitive and spatial cognitive function of individuals with PD.

Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic.

Background: Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management.

Academic Detailing with Provider Audit and Feedback Improve Prescribing Quality for Older Veterans.

Suboptimal prescribing persists as a driver of poor quality care of older veterans and is associated with risk of hospitalization and emergency department visits. We adapted a successful medication management model, Integrated Management and Polypharmacy Review of Vulnerable Elders (IMPROVE), from an urban geriatric specialty clinic to rural community-based clinics that deliver primary care. The goals were to promote prescribing quality and safety for older adults, including reduced prescribing of potentially inappropriate medications (PIMs).

Older Patients' Perspectives on Managing Complexity in CKD Self-Management.

Background And Objectives: Patients with CKD are asked to perform self-management tasks including dietary changes, adhering to medications, avoiding nephrotoxic drugs, and self-monitoring hypertension and diabetes. Given the effect of aging on functional capacity, self-management may be especially challenging for older patients. However, little is known about the specific challenges older adults face maintaining CKD self-management regimens.

Association of Multimorbidity with Mortality and Healthcare Utilization in Chronic Kidney Disease.

Objectives: Chronic kidney disease (CKD) almost universally occurs in individuals with other medical problems. However, few studies have described CKD-related multimorbidity using a framework that identifies chronic conditions as concordant (having overlap in treatment goals) versus discordant (having opposing treatment recommendations) and unrelated (having no overlap, but contributing to complexity via different resource requirements).

Design: Retrospective cohort.

Improving geriatric prescribing in the ED: a qualitative study of facilitators and barriers to clinical decision support tool use.

Quality Problem Or Issue: Clinical decision support (CDS) may improve prescribing for older adults in the Emergency Department (ED) if adopted by providers.

Initial Assessment: Existing prescribing order entry processes were mapped at an initial Veterans Administration Medical Center site, demonstrating cognitive burden, effort and safety concerns.

Choice Of Solution: Geriatric order sets incorporating 2012 Beers guidelines and including geriatric prescribing advice and prepopulated order options were developed.

Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments.

The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUiPPED) program aimed to reduce potentially inappropriate medication prescribing to older adults at 5 VAMCs.

Polypharmacy Review of Vulnerable Elders: Can We IMPROVE Outcomes?

Medication management involving pharmacists and PCPs and empowering patients and caregivers resulted in higher satisfaction and cost savings.

Enhancing the Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUiPPED): Preliminary Results from Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department, a Novel Multicomponent Interdisciplinary Quality Improvement Initiative.

Suboptimal medication prescribing for older adults has been described in a number of emergency department (ED) studies. Despite this, few studies have examined ED-targeted interventions aimed at reducing the use of potentially inappropriate medications (PIMs). Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the ED (EQUiPPED) is an ongoing multicomponent, interdisciplinary quality improvement initiative in eight Department of Veterans Affairs EDs.

Multimodal Exercise Benefits Mobility in Older Adults With Visual Impairment: A Preliminary Study.

Evidence-based recommendations for interventions to reduce fall risk in older adults with visual impairment are lacking. Adapted tango dance (Tango) and a balance and mobility program (FallProof) have improved mobility, balance, and quality of life (QOL) in individuals with movement impairment. This study compared the efficacy of Tango and FallProof for 32 individuals with visual impairment (age: M = 79.

Video-based educational tool improves patient comprehension of common prostate health terminology.

Background: Health care providers often counsel prostate cancer patients about treatment options with medical terminology. However, studies have demonstrated a severe lack of comprehension of these terms, particularly in underserved populations. It was hypothesized that a video-based educational tool would significantly improve the understanding of key terms related to prostate health in a predominantly lower literacy population.

Impact of a hospice emergency kit for veterans and their caregivers: a prospective cohort study.

Background: Although hospice emergency kits (HEKs) are provided by many home hospice agencies, little is known about their use, side effects, and perceived impact.

Objective: To evaluate HEK medication utilization, side effects, and impact as perceived by home hospice patients and their caregivers.

Methods: We conducted a prospective longitudinal cohort study.

Severe lack of comprehension of common prostate health terms among low-income inner-city men.

Background: Patients diagnosed with prostate cancer are often counseled about treatment options with the use of terms that are part of the "core vocabulary" of prostate cancer. It is hypothesized that predominantly lower literacy patients would demonstrate a severe lack of comprehension of prostate cancer terms, thus validating the findings of a previous single-institution study.

Methods: A previously developed survey was used to evaluate understanding of terms related to urinary, bowel, and sexual function.

Dancing for balance: feasibility and efficacy in oldest-old adults with visual impairment.

Background: Fall risk increases with age and visual impairment, yet the oldest-old adults (>85 years) are rarely studied. Partnered dance improves mobility, balance, and quality of life in older individuals with movement impairment.

Objective: The aim of the study was to determine the feasibility and participant satisfaction of an adapted tango program amongst these oldest-old adults with visual impairment.

Blast exposure and dual sensory impairment: an evidence review and integrated rehabilitation approach.

Combat exposures to blast can result in both peripheral damage to the ears and eyes and central damage to the auditory and visual processing areas in the brain. The functional effects of the latter include visual, auditory, and cognitive processing difficulties that manifest as deficits in attention, memory, and problem solving--symptoms similar to those seen in individuals with visual and auditory processing disorders. Coexisting damage to the auditory and visual system is referred to as dual sensory impairment (DSI).