Advance Care Planning, End-of-Life Preferences, and Burdensome Care: A Pragmatic Cluster Randomized Clinical Trial.

Importance: Primary care is a key setting for advance care planning (ACP).

Objective: To test the effects of a multicomponent primary care-based ACP intervention (SHARING Choices) on documented end-of-life preferences and potentially burdensome care at end of life.

Design, Setting, And Participants: This pragmatic cluster randomized clinical trial in primary care practices from 2 health systems was conducted between March 2021 and April 2022.

Feasibility of Using Simulation to Evaluate Implementation Fidelity in an Advance Care Planning Pragmatic Trial.

Traditional methods of fidelity monitoring are not possible in pragmatic trials in real-world clinical settings. We describe our approach to monitoring and reinforcing the fidelity to ACP conversations for a hard-to-reach subpopulation by using standardized patients in a pragmatic trial. We developed standardized patient scenarios grounded in the Respecting Choices First Steps™ Advance Care Planning curriculum to provide an opportunity to reinforce and assess ACP facilitator competency.

Effects of Activities on the Psychological Well-Being of Caregivers of Older Adults: A Systematic Review.

Given that approximately 41.8 million Americans provide unpaid care to older adults and caregiving roles are often associated with decreased well-being, it is critical to identify strategies to maximize their well-being. The purpose of this review was to explore which activities significantly improve well-being among caregivers of older adults.

Qualitative evaluation of the SHARING Choices trial of primary care advance care planning for adults with and without dementia.

Background: Primary care can be an important setting for communication and advance care planning (ACP), including for those with dementia and their families. The study objective was to explore experiences with a pragmatic trial of a communication and ACP intervention, SHARING Choices, in primary care for older adults with and without dementia.

Methods: We conducted qualitative interviews using tailored semi-structured guides with three groups: ACP facilitators who conducted the intervention; clinicians, managers, and administrators from sites randomized to the intervention; and patients and families who met with ACP facilitators.

Mixed reality technology for older adults: Evaluating the impact of a novel virtual humanoid coach in a community-based physical exercise program in the Philippines.

Physical inactivity among older adults remains a global burden, leading to a variety of health challenges and even mortality. This study evaluated the impact of a novel virtual humanoid coach-driven physical exercise program among older adults. A non-randomized (quasi) experimental research was conducted in two community senior centers.

Considerations of Intersectionality for Older Adults with Palliative Care Needs in the Emergency Department: An Integrative Review.

Purpose Of Review: We sought to identify current interventions, research, or non-research evidence that has direct or indirect consideration of intersectionality in the care of older adults in the emergency department (ED). An integrative review informed by Crenshaw's Theory of Intersectionality was conducted in accordance with Whittemore and Knafl's five-stage methodology. A rigorous review process determined appropriateness for inclusion, and articles were analyzed for areas related to direct or indirect relationship to intersectionality.

Use of mobile applications and health technologies among dementia caregivers with chronic conditions: A cross-sectional study.

Objective: Almost 80% of people, who are caring for someone with dementia, have one or more chronic conditions and require self-management support. New technologies offer promising solutions; however, little is known about what technologies caregivers use for their health or in general. This study aimed to describe the prevalence of mobile application (app) and health-related technology use among caregivers who have chronic conditions and care for someone with dementia.

SHARING Choices: Lessons Learned from a Primary-Care Focused Advance Care Planning Intervention.

Background: Few advance care planning (ACP) interventions have been scaled in primary care.

Problem: Best practices for delivering ACP at scale in primary care do not exist and prior efforts have excluded older adults with Alzheimer's Disease and Related Dementias (ADRD).

Intervention: SHARING Choices (NCT#04819191) is a multicomponent cluster-randomized pragmatic trial conducted at 55 primary care practices from two care delivery systems in the Mid-Atlantic region of the U.

Perceived Barriers and Facilitators of Implementing a Multicomponent Intervention to Improve Communication With Older Adults With and Without Dementia (SHARING Choices) in Primary Care: A Qualitative Study.

Introduction: Implementing patient- and family-centered communication strategies has proven challenging in primary care, particularly for persons with dementia. To address this, we designed SHARING Choices, a multicomponent intervention combining patient and family partnered agenda setting, electronic portal access, and supports for advance care planning (ACP). This qualitative descriptive study describes factors affecting SHARING Choices implementation within primary care.

Improving diabetes care of community-dwelling underserved older adults.

Background: Diabetes care among rural underserved older adults is negatively affected by social determinants of health (SDOH). Although there is an increased awareness of this problem, evidence-based clinical and community interventions are not widely integrated. This project implemented telemedicine and community health worker (CHW) interventions to improve diabetes management and outcomes.

Advance Care Planning in Serious Illness: A Narrative Review.

Context: Advance care planning (ACP) intends to support person-centered medical decision-making by eliciting patient preferences. Research has not identified significant associations between ACP and goal-concordant end-of-life care, leading to justified scientific debate regarding ACP utility.

Objective: To delineate ACP's potential benefits and missed opportunities and identify an evidence-informed, clinically relevant path ahead for ACP in serious illness.

SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care.

Background: Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and family engagement in primary care.

Methods: We cluster-randomized 55 diverse primary care practices across two health systems to the intervention or usual care.

Dementia care in the age of COVID-19: Community resources for nurses.

The COVID-19 pandemic and related measures, such as social distancing, have adversely impacted persons with dementia (PWD) and their caregivers. Nurses must be able to identify the care needs of PWD and their caregivers and intervene with relevant resources.

Implementation and Effectiveness of Integrating Palliative Care Into Ambulatory Care of Noncancer Serious Chronic Illness: Mixed Methods Review and Meta-Analysis.

Purpose: To perform a mixed methods review to evaluate the effectiveness and implementation of models for integrating palliative care into ambulatory care for US adults with noncancer serious chronic illness.

Methods: We searched 3 electronic databases from January 2000 to May 2020 and included qualitative, mixed methods studies and randomized and nonrandomized controlled trials. For each study, 2 reviewers abstracted data and independently assessed for quality.

High-fidelity simulation and nurse clinical competence-An integrative review.

Aim: The aim of this review was to synthesise current knowledge of high-fidelity simulation practices and its impact on nurse clinical competence in the acute care setting.

Background: There is no consensus or standardisation surrounding best practices for the delivery of high-fidelity simulation in the acute care setting. This is an understudied area.

Home/community-based interventions to improve function in persons with mild cognitive impairment/early dementia.

Persons with mild cognitive impairment/early dementia have a possible 20-year trajectory of disability and dependence with little information on the effectiveness of interventions to improve function. This review investigates the literature of home/community-based interventions for physical and executive function in persons with mild cognitive impairment/early dementia. A 2007-2020 systematic literature search was conducted through PubMed, CINAHL Plus with Full Text and PsycINFO.

Diabetes management among underserved older adults through telemedicine and community health workers.

Background: Diabetes mellitus (DM) disproportionately affects older adults from marginalized communities. In the United States, the prevalence of DM in ages ≥65 years is twofold higher than the national average for adult populations. Telemedicine and community health workers (CHWs) are emerging diabetes care models but their impact on older adults with limited resources are relatively neglected within the medical literature.

Advance Care Planning Shared Decision-Making Tools for Non-Cancer Chronic Serious Illness: A Mixed Method Systematic Review.

Context: Shared decision-making tools can facilitate advance care planning and goals of care conversations in non-cancer serious illness. More information on integrating these tools in ambulatory care could better support clinicians and patients/caregivers in these conversations.

Objectives: We evaluated effectiveness and implementation of integrating palliative care shared decision-making tools into ambulatory care for U.

Place of Death for Persons With and Without Cognitive Impairment in the United States.

Background/objectives: There is increasing recognition that place of death is an important component of quality of end-of-life care (EOLC) and quality of death. This study examined where older persons with and without cognitive impairment die in the United States, what factors contribute to place of death, and whether place of death influences satisfaction with EOLC.

Design: Cross-sectional secondary data analysis.

Association of Hearing Loss With Neuropsychiatric Symptoms in Older Adults With Cognitive Impairment.

Unlabelled: Neuropsychiatric symptoms (NPS) in persons with dementia (PWD) are common and can lead to poor outcomes, such as institutionalization and mortality, and may be exacerbated by sensory loss. Hearing loss is also highly prevalent among older adults, including PWD.

Objective: This study investigated the association between hearing loss and NPS among community- dwelling patients from a tertiary memory care center.

Strategies to Increase Pneumococcal Vaccination in Veterans: An Integrative Review.

The current integrative review aimed to explore the extent to which pneumococcal pneumonia impacts the Veteran population and strategies to increase pneumococcal vaccination in this population. The search strategy began with three electronic databases (CINAHL, PubMed, and Embase). After analysis of 50 studies, considering inclusion and exclusion criteria, nine studies were selected for final analysis.

Integrating Culturally Competent Advance Care Planning for Korean Immigrants: An Integrative Review.

Aims: This review aims to explore the extant literature on the current utilization of ACP in Kisin order to obtain a comprehensive understanding of their health disparities and to determineevidence-based best practices to integrate culturally-competent ACP for EOL care of KIs.

Design: A systematic integrative review of the literature Data Sources:  Four electronic databases including PubMed, the Cumulative Index of Nursing and Allied Health Literature, the Cochrane Library, and Embase.

Method: The detailed search strategy for databases implicated a combination of MeSHkeywords and associated terms, which can be found in Table A.