Delirium-like symptomatology in community-dwelling older adults with dementia.

Background: Delirium, a sudden and acute state of confusion, is known to be more prevalent in hospitalised older adults with dementia and is associated with lower levels of functioning after the delirium episode; yet, the literature on estimates of delirium prevalence in community-dwelling older adults with dementia is scarce. The aim of this study was to define and determine the frequency of delirium-like symptoms in two different samples of community-dwelling persons living with dementia, as reported by their family caregivers. 'Delirium-like symptoms' is a concept that specifies an occurrence of cognitive and behavioural symptoms, provoking suspicion of delirium, that represent a sudden and unusual deleterious change in a community-dwelling person living with dementia that can be identified by family caregivers and prompt healthcare seeking behaviours.

Delirium Due to Potentially Avoidable Hospitalizations Among Older Adults.

Background: Delirium is a common complication during acute care hospitalizations in older adults. A substantial percentage of admissions are for ambulatory care-sensitive conditions (ACSCs) or potentially avoidable hospitalizations-conditions that might be treated early in the outpatient setting to prevent hospitalization and hospital complications.

Methods: This retrospective cross-sectional study examined rates of delirium among older adults hospitalized for ACSCs.

Multisite Implementation of an American College of Surgeons Geriatric Surgery Quality Improvement Initiative.

Background: The American College of Surgeons (ACS) Coalition for Quality in Geriatric Surgery (CQGS) identified standards of surgical care for the growing, vulnerable population of aging adults in the US. The aims of this study were to determine implementation feasibility for 30 selected standards, identify barriers and best practices in their implementation, and further refine these geriatric standards and verification process.

Study Design: The CQGS requested participation from hospitals involved in the ACS NSQIP Geriatric Surgery Pilot Project, previous CQGS feasibility analyses, and hospitals affiliated with a core development team member.

Delirium Mediates Incidence of Hospital-Associated Disability Among Older Adults.

Objective: To examine whether delirium predicts occurrence of hospital-associated disability (HAD), or functional decline after admission, among hospitalized older adults.

Design: Retrospective cross-sectional study.

Setting And Participants: General inpatient (non-ICU) units of a large regional Southeastern US academic medical center, involving 33,111 older adults ≥65 years of age admitted from January 1, 2015, to December 31, 2019.

The current landscape of Acute Care for Elders units in the United States.

Background: The clinical benefits of Acute Care for Elders (ACE) units have been established for over 25 years. However, how widely disseminated ACE units are in the United States and the degree of fidelity to the key elements of this model of care are unknown. Our objective was to identify all existing ACE units in the United States and to obtain detailed information about variations in implementation.

An Implementation Assessment of the Virtual Acute Care for Elders Program From the Perspective of Key Stakeholders.

Objective: The aim of this study was to obtain feedback from key stakeholders and end users to identify program strengths and weaknesses to plan for wider dissemination and implementation of the Virtual Acute Care for Elders (Virtual ACE) program, a novel intervention that improves outcomes for older surgical patients.

Background: Virtual ACE was developed to deliver evidence-based geriatric care without requiring daily presence of a geriatrician. Previous work demonstrated that Virtual ACE increased mobility and decreased delirium rates for surgical patients.

Acute Care for Elders (ACE) Team Model of Care: A Clinical Overview.

The Institute of Medicine (IOM) Reports of and have called for more interprofessional and coordinated hospital care. For over 20 years, Acute Care for Elders (ACE) Units and models of care that disseminate ACE principles have demonstrated outcomes in-line with the IOM goals. The objective of this overview is to provide a concise summary of studies that describe outcomes of ACE models of care published in 1995 or later.

A Performing Arts Intervention Improves Cognitive Dysfunction in 50 Hospitalized Older Adults.

Background And Objectives: Arts in medicine programs have emerged as a patient-centered approach that aims to improve health-related quality of life for patients in U.S. hospitals.

Improving Geriatric Care Processes on Two Medical-Surgical Acute Care Units: A Pilot Study.

The Acute Care for Elders (ACE) Unit model improves cognitive and functional outcomes for hospitalized elders but reaches a small proportion of patients. To disseminate ACE Unit principles, we piloted the "Virtual ACE Intervention" that standardizes care processes for cognition and function without daily geriatrician oversight on two non-ACE units. The Virtual ACE Intervention includes staff training on geriatric assessments for cognition and function and on nurse-driven care algorithms.

Meals Enhancing Nutrition After Discharge: Findings from a Pilot Randomized Controlled Trial.

Background: After older adults experience episodes of poor health or are hospitalized, they may not return to premorbid or prehospitalization eating behaviors. Furthermore, poor nutrition increases hospital readmission risk, but evidence-based interventions addressing these risks are limited.

Objective: This pilot study's objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meal program's impact on older adults' nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program.

Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer.

Purpose: Survival in older adults with cancer varies given differences in functional status, comorbidities, and nutrition. Prediction of factors associated with mortality, especially in hospitalized patients, allows physicians to better inform their patients about prognosis during treatment decisions. Our objective was to analyze factors associated with survival in older adults with cancer following hospitalization.

Factors Associated With Hospital Admission for Older Adults Receiving Care in U.S. Emergency Departments.

Background: Emergency departments (EDs) play a growing role in hospital admissions for older adults, yet nationally representative data on predictors of admission from the EDs are limited.

Methods: We examined sociodemographic, clinical, and hospital characteristics associated with non-ICU admissions, using National Hospital Ambulatory Medical Care Survey data and multivariate Poisson regression models.

Results: There were an estimated 175 million ED visits by adults older than 65 years from 2001 to 2010.

The Association Between Life-Space and Health Care Utilization in Older Adults with Heart Failure.

Background: Life-space is associated with adverse health outcomes in older adults, but its role in health care utilization among individuals with heart failure is not well understood. We examined the relationship between life-space and both emergency department (ED) utilization and hospitalization.

Methods: Participants were community-dwelling older adults with a verified diagnosis of heart failure who completed a baseline in-home assessment and at least one follow-up telephone interview.

Geriatric assessment as predictors of hospital readmission in older adults with cancer.

Background: Hospital readmission is a common, costly problem. Little is known regarding risk factors for readmission in older adults with cancer. This study aims to identify factors associated with 30-day readmission in a cohort of older medical oncology patients.

Mobility limitation in the older patient: a clinical review.

Importance: Mobility limitations are common in older adults, affecting the physical, psychological, and social aspects of an older adult's life.

Objective: To identify mobility risk factors, screening tools, medical management, need for physical therapy, and efficacy of exercise interventions for older primary care patients with limited mobility.

Evidence Acquisition: Search of PubMed and PEDro from January 1985 to March 31, 2013, using the search terms mobility limitation, walking difficulty, and ambulatory difficulty to identify English-language, peer-reviewed systematic reviews, meta-analyses, and Cochrane reviews assessing mobility limitation and interventions in community-dwelling older adults.

Mealtime assistance for hospitalized older adults: a report on the SPOONS volunteer program.

Mealtime assistance may be necessary to prevent declines in hospitalized older adults' nutritional well-being. This article reports the implementation of the Support for and Promotion Of Optimal Nutritional Status (SPOONS) volunteer assistance program. Patients were 65 and older, admitted to the Acute Care for Elders Unit at the University of Alabama at Birmingham Hospital, and in need of mealtime assistance.

Effects of an acute care for elders unit on costs and 30-day readmissions.

Importance: Providing high-quality care while containing cost is essential for the economic stability of our health care system. The United States is experiencing a rapidly growing elderly population. The Acute Care for Elders (ACE) unit interdisciplinary team model of care has been shown to improve outcomes in hospitalized older adults.

Nutritional processes of care for older adults admitted to an oncology-acute care for elders unit.

Background: Acute care for elders (ACE) units have been established in the United States to prevent functional decline in older hospitalized patients.

Purpose: We sought to examine whether an ace unit that focused specifically on care of older oncology patients (OACE) compared with a usual care cancer ward (UCCW) demonstrated improved nutritional processes of care in patients who had documentation of nutritional deficits.

Methods: We conducted a retrospective chart review to examine whether orders had been placed for a nutritional consult or use of nutritional supplements.

The underrecognized epidemic of low mobility during hospitalization of older adults.

Objectives: To examine the proportion of time spent in three levels of mobility (lying, sitting, and standing or walking) by a cohort of hospitalized older veterans as measured by validated wireless accelerometers.

Design: A prospective, observational cohort study.

Setting: One hundred fifty-bed Department of Veterans Affairs hospital.

Polypharmacy in hospitalized older adult cancer patients: experience from a prospective, observational study of an oncology-acute care for elders unit.

Background: A novel Oncology-Acute Care for Elders (OACE) unit that uses an interdisciplinary team to enhance recognition and management of geriatric syndromes in hospitalized older adult cancer patients has been established at Barnes-Jewish Hospital (St. Louis, Missouri). The OACE team includes a clinical pharmacist whose primary role is to improve the appropriateness of prescribing.

Management of osteoporosis among home health and long-term care patients with a prior fracture.

Osteoporosis is a growing health concern as the number of senior adults continues to increase worldwide. Falls and fractures are very common among frail older adults requiring home health and long-term care. Preventative strategies for reducing falls have been identified and many therapies (both prescription and nonprescription) with proven efficacy for reducing fracture risk are available.

The changing prevalence of comorbidity across the age spectrum.

The purpose of the research was to demonstrate that comorbid health conditions disproportionately affect elderly cancer patients. Descriptive analyses and stacked area charts were used to examine the prevalence and severity of comorbid ailments by age of 27,506 newly diagnosed patients treated at one of eight cancer centers between 1998 and 2003. Hypertension was the most common ailment in all patients, diabetes was the second most prevalent ailment in middle-aged patients, and previous solid tumor(s) were the second most prevalent ailment in patients aged 74 and older.

Geriatric syndromes in elderly patients admitted to an inpatient cardiology ward.

Background: Older adults make up an increasing proportion of patients hospitalized with cardiovascular disease. Such patients often have multiple coexisting geriatric syndromes that may affect management and outcomes and are frequently underdiagnosed and untreated.

Objectives: To determine the prevalence of geriatric syndromes and incidence of selected adverse events in hospitalized elderly patients with cardiovascular disease.

Geriatric syndromes in elderly patients admitted to an oncology-acute care for elders unit.

Purpose: The goal of this study was to characterize an elderly population admitted to a novel Oncology-Acute Care for Elders (OACE) unit, determine the prevalence of functional dependencies and geriatric syndromes, and examine their suitability for an interdisciplinary model of care.

Patients And Methods: We conducted a retrospective review of 119 patients age 65 years or older who had a primary oncologic or hematologic diagnosis and were admitted to the OACE Unit. Standard geriatric screens were administered to assess mood, functional, and cognitive status.