In 2017, the Institute for Healthcare Improvement (IHI), the John A Hartford Foundation (JAHF), the American Hospital Association (AHA) and the Catholic Health Association (CHA) of the United States attempted to address the development of age-friendly health systems using a clinical framework to improve the complex care of older adults.
These organizations defined and operationalized age-friendly care following the guidelines of beneficence, evidence-based medicine, and patient/family aligned goals and concerns. The 4M Framework was the result: What Matters Most, Mentation, Mobility, and Medication.
Good communication with older adults and their caregivers is important to delivering high quality care. Effective, empathetic communication improves patient and family coping skills and creates a care plan that is consistent with the patient’s goals. It also improves important metrics of health outcomes, patient safety, patient satisfaction, and cost of care.
Health literacy refers to an individual’s ability to understand his or her health and effectively navigate the health care system. An older patient with low health literacy might present with repeated provider visits or phone calls, misunderstanding of, or non-adherence to, their medication plan, or exacerbations of chronic illness.
Guardianship is the court appointment of legal authority over the person and property of another individual, called the ward. Consultation with an attorney or bioethicist is advised for individual patient cases.
Sexually Transmitted Infections (STIs) are increasing in older adults. These infections may include chlamydia, gonococcal infections, and syphilis5. Patients may experience no symptoms or symptoms may be mistaken for a urinary tract infection.
Sexually Transmitted Infections (STIs) are increasing among older adults. These infections may include chlamydia, gonococcal infections, and syphilis5. Patients may experience no symptoms or symptoms may be mistaken for a urinary tract infection.
While sexually transmitted infections (STIs) are on the rise among older adults, medical providers may associate this problem with younger populations, missing prevention and treatment opportunities.
Possible Reasons for the increase of STIs in older adults1:
- Lack of STI screening and treatment
- Physiologic changes (e.g., weakened immune system, thinning mucosal tissue)
- Changing relationships (e.g., widow/widowerhood, divorce)
- Increased availability of medication for intercourse (e.g. sildenafil)
- Misinformation/misunderstanding (e.g., risks of unprotected sex, need for condom use even for postmenopausal women, STI transmission routes)
- Inaccessibility to STI protection in community living environments
Conversations about “safer sex” may be difficult and uncomfortable for providers and patients but are vital to maintain patients’ health. Having open, nonjudgmental discussions about individual risk factors may lead to safer sexual practices.
Assessing delirium in dementia patients in the emergency room
Outlining the different options for senior living and which option is appropriate based on the older adult.
Create awareness amongst providers about the role and value in conducting Performance Improvement (PI) programs in the nursing home.
Identifying inapproproate medications in elderly patients
Determine appropriate surgical management for elderly breast cancer patients.
Dealing with obesity in the older population in an out-patient setting.
Managing diabetes in older adults in an outpatient setting.
Establish capacity for consent and the patient’s understanding of the need of surgery.
Identify the specific difficult behavior and apply best practice management strategies.
Define, compare, and contrast power of attorney for health care, surrogate decision maker, and guardian.
Define advance directives and the components that are commonly incorporated.
Determine an older adult’s ability to make medical decisions in a hospital or clinic setting.
Outline standard approaches for planning, leading, and concluding difficult family meetings with strategies for navigating conflict.
Master geriatric-specific diagnostic considerations in the assessment of an older adult in the emergency department.
Develop a comprehensive approach to the timely evaluation of older adults with abdominal pain in the ED.
Primary and secondary options for therapy of osteoporosis.
Screening for osteoporosis aims to identify patients at increased risk of fragility fractures who may benefit from an intervention to mitigate that risk.
Non-contrast CT is the initial diagnostic test to evaluate for acute ischemia and rule out hemorrhage.
Identify and define inappropriate sexual behavior (ISB) in the context of a patient with dementia.
Identify causes of anesthesia related nerve injury.
Radiation Therapy in the Management of High Risk Nonmetastatic Prostate Cancer in the Geriatric Population - #51
Describes the role of radiation therapy in the management of high risk non-metastatic prostate cancer.
Understand key concepts in healthcare quality improvement in any setting.
Radiation Therapy in the Management of Low and Intermediate Risk Prostate Cancer in the Geriatric Population - #49
Understand the course of treatment for patients with low and intermediate risk prostate cancer.
Assess magnitude of benefit for radiation after breast conserving surgery.
Understand key concepts in patient safety in any care setting.
Adult ICU patients should be routinely monitored for delirium.
Frailty assessment of patients at time of ICU admission may be useful in identification of vulnerable elderly patients.
This Fast Fact reviews the pathophysiology of severe asymptomatic aortic stenosis and helps determine when to order a Transthoracic Echocardiogram (TTE) for diagnostic evaluation.
Resources available for facilitating driving cessation.
Learn the basic medical requirements for safe driving and the components of clinical evaluation.
Identify and define the options for geriatric living and associated levels of care.
Identify and define treatment strategies for geriatric insomnia patients.
Identify and define various etiologies of anemia in older adults.
Learn underlying basic science and practical clinical management of insomnia evaluation.
Review toxic affects of chemo therapy on geriatric patients.
Diagnostic testing and treatment are determined based on ability to improve disease process or quality of life/goals of care.
Approximately 11.4% of adults over the age of 60 years will experience some form of mistreatment.
An approach to diagnoses of geriatric patients who have suspected NPH.
A summary of the risk factors, incidence, and survival associated with intraoperative cardiac arrest.
How to manage patients once it is determined they have low vision.
Initial diagnosis of tinnitus by history and physical exam.
Learn necessary positioning and mobility requirements for geriatric patients undergoing a fluoroscopic study.
Review systemic effects of ocular medications for glaucoma and pupillary dilation.
Review systemic effects of ocular medications for age related macular degeneration.
Identify and manage ophthalmic complications of systemic medications.
Use geriatric assessment tools to determine appropriateness of invasive cardiac interventions.
Review available home care services and Medicare requirements.
Learn practical interpretations of echocardiographic changes.
Review antiplatelet therapy in coronary artery disease.
How will a home safety evaluation benefit your geriatric patient?
Learn a systems-based approach to evaluation non-vertigo dizziness.
Review cardiac causes of syncope.
Differentiate peripheral and central causes of dizziness.
Practical dosing information for ceruminolytic agents.
Review use and side affects of common medications for otolaryngologic diseases.
Identify fall risk factors and common interventions that decrease fall risk.
Learn to assess multiple factors causing falls.
Identify and assess delirium.
Determine blood pressure goals in older adults and possible medications.
Perioperative medication that may increase delirium risk.
Factors that may be clues to underlying dementia in acutely delirius patients.
Review perioperative anticoagulation management of geriatric patients.
Review an algorithm for pain management of rib fractures.
Review key renal function lab values in a geriatric patient.
Review pharmacologic aspects of renal drug clearance.
Consider quality of life assessment in initiating renal replacement therapy.
Review etiolgies of acute kidney injury in hospitalized patients.
Learn practical gait assessment for geriatric patients.
Review frequent impairment and complications of acute stroke.
Learn to assess post-stroke depression (PSD).
Review assessments to consider in evaluating "falls".