The cross-sectional association of frailty with past and current exposure to strong anticholinergic drugs.

Background: Anticholinergic drugs may contribute to frailty by impairing cognitive and physical functions. Strong anticholinergic drugs in particular may have adverse effects among older adults.

Objectives: Determine the association between frailty and the use of strong anticholinergic drugs among older US Veterans.

The Association of Ageist Attitudes With All-Cause Hospitalizations and Mortality.

Ageism is the systematic stereotyping and discrimination against older adults. Explicit ageism involves conscious control and implicit ageism involves unconscious processes. Studies have shown that ageist attitudes may be associated with poor clinical outcomes like hospitalizations and mortality.

Is there an association between ageist attitudes and frailty?

Background: Frailty is defined as a state of vulnerability to stressors that is associated with higher morbidity, mortality and healthcare utilization in older adults. Ageism is "a process of systematic stereotyping and discrimination against people because they are old." Explicit biases involve deliberate or conscious controls, while implicit bias involve unconscious processes.

Depression but not frailty contributed to a higher risk for all-cause hospitalizations in male older veterans.

Introduction: Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Depression and frailty often coexist, suggesting a bidirectional relationship that may increase the effects of each individual condition on clinical outcomes and health-care utilization in older adults.

Objective: To determine the effects of concurrent frailty and depression on all-cause hospitalizations.

Validation of an automatically generated screening score for frailty: the care assessment need (CAN) score.

Background: Frailty is a state of vulnerability to stressors that is prevalent in older adults and is associated with higher morbidity, mortality and healthcare utilization. Multiple instruments are used to measure frailty; most are time-consuming. The Care Assessment Need (CAN) score is automatically generated from electronic health record data using a statistical model.

Association of the CAN score with the FRAIL scale in community dwelling older adults.

Background: Frailty is a state of vulnerability to stressors which results in higher morbidity, mortality and healthcare utilization. The FRAIL scale is used as a validated screening for frailty. The Care Assessment Need (CAN) score is automatically generated from electronic health record data using a statistical model that includes data elements similar to the deficit accumulation model for frailty and predicts risk for hospitalization and/or mortality.

Dramatic Reduction in 30-Day Readmissions Through High-Risk Screening and Two-Phase Interdisciplinary Care.

Objectives: Thirty-day readmissions are common, serious, and costly. Most important, often they are preventable. The purpose of this quality improvement study was to evaluate an interdisciplinary, two-phase intervention to reduce 30-day readmissions among high-risk medical patients.

Group-based differences in anti-aging bias among medical students.

Medical students (MS) may develop ageist attitudes early in their training that may predict their future avoidance of caring for the elderly. This study sought to determine MS' patterns of explicit and implicit anti-aging bias, intent to practice with older people and using the quad model, the role of gender, race, and motivation-based differences. One hundred and three MS completed an online survey that included explicit and implicit measures.

Effects on performance of individual versus dyadic practice during an avatar-based three-dimensional virtual home safety simulation.

This pilot study tests the effects on individual performance of dyadic versus individual practice in a 3D virtual world (VW) home safety assessment. Sixty medical students in three conditions (dyadic spatially separated with paired avatars DPA; individual with avatar IND; and dyadic spatially together with single avatar DSA) participated in a geriatric home safety simulation. The participants, via avatars, conducted an assessment of physical hazards.

Fatal falls in an ethnically diverse urban community: the link between demographic factors and the circumstances surrounding fatal falls.

Objectives: Fatal falls cause more than 15,000 deaths per year in the United States. Despite this, the circumstances surrounding fatal falls in elderly adults are poorly understood. It is unknown whether these circumstances differ across ethnicities, although Hispanic American individuals are at reduced risk for fatal falls.

Simulating geriatric home safety assessments in a three-dimensional virtual world.

Virtual worlds could offer inexpensive and safe three-dimensional environments in which medical trainees can learn to identify home safety hazards. Our aim was to evaluate the feasibility, usability, and acceptability of virtual worlds for geriatric home safety assessments and to correlate performance efficiency in hazard identification with spatial ability, self-efficacy, cognitive load, and presence. In this study, 30 medical trainees found the home safety simulation easy to use, and their self-efficacy was improved.

A competency-based medical student curriculum: taking the medication history in older adults.

Older adults are the largest consumers of prescription medications. Taking multiple medications, which interact with medical, psychological, and socioeconomic factors, increases a person's risk of nonadherence and adverse events. A curriculum was developed to train medical students to identify these risks and make recommendations for improving medication safety.

Hispanic ethnicity and fatal fall risk: do age, gender, and community modify the relationship?

Background: Hispanic ethnicity is associated with a reduced risk of fatal falls in the elderly despite lower socioeconomic standing. The factors responsible for this "Hispanic paradox" are unknown. We hypothesized that age and gender would modify this relationship and that the association would be accentuated in a community with prominent Hispanic culture.

Hispanic ethnicity and unintentional injury mortality in the elderly.

Background: Unintentional injury is a leading cause of preventable mortality in elderly populations and is most often related to accidental falls and motor vehicle accidents. Hispanic ethnicity has been previously associated with decreased risk of accidental fall death as well as improved outcomes in other health states, the "Hispanic paradox." A timely analysis of national data with consideration for multiple injury types and age could provide insight into this epidemiologic phenomenon and help guide the use of prevention efforts.

A fourth-year medical school clerkship that addressed negative attitudes toward geriatric medicine.

Despite extensive educational efforts, many medical students still have negative attitudes toward the field of geriatric medicine and the care of older adult patients. This article describes a fourth-year geriatric clerkship that addressed this issue by providing opportunities for students to actively discuss many of the negative stereotypes that exist regarding geriatric medicine. Emphasis was also placed on personalizing the course content to show the relevance of geriatric medicine to all medical students.

Trial of a survey instrument to establish the hurricane preparedness of and medical impact on a vulnerable, older population.

Introduction: Millions of vulnerable, elderly individuals live in coastal areas susceptible to hurricanes and are at risk for adverse health outcomes. The purpose of this study was to determine the status of preparedness for and possible health consequences of a hurricane on a vulnerable, but experienced, elderly population.

Problem: Preparedness guidelines have been published, but it is unclear how well-prepared elderly individuals are for hurricanes, and what impact hurricanes may have on their health.

An interactive e-learning tutorial for medical students on how to conduct the performance-oriented mobility assessment.

We evaluated the effectiveness of an e-learning tutorial (iPOMA) as a supplement to traditional teaching of the Performance-Oriented Mobility Assessment. Second-year medical students (137) completed the iPOMA, in preparation for a session on fall risk assessment consisting of a lecture, practice with elder volunteers and small group debriefing. Before and after the tutorial, students completed online questionnaires, a quiz on POMA scoring immediately after the tutorial and competency assessments on POMA performance 1 month later.

Learning objects in medical education.

A learning object (LO) is a grouping of instructional materials structured to meet a specified educational objective. Digital LOs, which can be stored electronically, allow a new approach to instructional activity, making medical education more efficient, and potentially more cost-effective. They are reusable and can incorporate text, graphics, animations, audio, and video to support and enhance learning.

The use of the internet in geriatrics education: results of a national survey of medical geriatrics academic programs.

In order to characterize use of the Internet in medical geriatrics education programs, 130 medical education programs in the U.S. that train medical students, interns, residents, fellows and practicing physicians were asked to complete a survey developed by the Consortium of E-Learning in Geriatrics Instruction (CELGI).

The Consortium of E-Learning in Geriatrics Instruction.

This paper describes the activities of the Consortium of E-Learning in Geriatrics Instruction (CELGI), a group dedicated to creating, using, and evaluating e-learning to enhance geriatrics education. E-learning provides a relatively new approach to addressing geriatrics educators' concerns, such as the shortage of professionals trained to care for older people, overcrowded medical curricula, the move to transfer teaching venues to community settings, and the switch to competency-based education models. However, this innovative education technology is facing a number of challenges as its use and influence grow, including proof of effectiveness and efficiency.