Comprehensive Geriatric Assessment
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A national qualitative study of Hospital‐at‐Home implementation under the CMS Acute Hospital Care at Home waiver - Gorbenko - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

The Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home (AHCaH) waiver resulted in the largest expansion of the Hospital-at-Home (HaH) to date. HaH programs allowed older adults at high risk for adverse out- comes from COVID-19 to receive high-quality acute hospital-level care at home. HaH is a com- plex care delivery model. Using a qualitative approach, we examined issues related to estab- lishing HaH programs under the CMS waiver. We found that HaH leaders were enthusiastic about advantages of HaH for patients and fami- lies. Program leaders reported concerns about the future of the CMS waiver given that its existence is tied to the COVID-19 public health emergency. Key implementation issues included building

electronic health records components for HaH and having the sufficient staff to support HaH pro- grams. The stage between planning and imple- mentation represented the largest hurdle and technical assistance should be most focused in this stage

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Improving health system performance in Mexico

Assessment of health system performance is a complex task, especially amid major political
change, structural reforms, and a global pandemic. The Health Policy paper by Felicia
Marie Knaul and colleagues1 in The Lancet identifies many challenges to improving
the performance of the Mexican health system in the 21st century. Their analysis seeks
to illustrate how successful implementation of health reform requires continuous efforts
at improvement and careful political management of key stakeholder groups.
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Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation - Wang - 2023 - Journal of the American Geriatrics Society - Wiley Onli...

Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation - Wang - 2023 - Journal of the American Geriatrics Society - Wiley Onli... | Comprehensive Geriatric Assessment | Scoop.it
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Desde el MGH...

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Anticoagulation for atrial fibrillation: Time to revise the paradigm? - Rich - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

Anticoagulation for atrial fibrillation: Time to revise the paradigm? - Rich - 2023 - Journal of the American Geriatrics Society - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it

Wang W, Lessard D, Kiefe CI, et al. Differential effect of anticoagulation according to cognitive function and frailty in older patients with atrial fibrillation. J Am Geriatr Soc. 2023;71(2): 394-403

 

The findings suggest that in older patients with significant cognitive impairment, the exceed potential harm of anticoagulation may by a margin substantial the potential benefit. Similarly, the findings raise concern that anticoagulation may not be associated with a net clinical benefit for frail older patients with AF.

Nonetheless, while the findings are provocative and may be incorporated into shared decision-making in selected cases, they are largely hypothesis-generating and limited by a lack of randomization, a modest sample size, and the relative homogeneity of the study population. In summary, while additional studies are clearly needed to replicate or refute these findings, it would be premature to revise the paradigm, update the guidelines, or translate the results of this study into the routine care of older adults with AF. 

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Quizás no sea todavía el momento de revisar el paradigma de la ACO en la FA pero si estar atentos a futuros estudios sobre el tema en el paciente anciano frágil. Los resultados del estudio de Wang et al. son cuanto menos sorprendentes. Para los pacientes con deterioro cognitivo NNT to prevent stroke 38 y NNHarm (major bleeding or death) 8, mientras que para los frágiles el NNT para prevenir stroke era de 35 y el NNH (major bleeding or death) 10.

 

 

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What's next for Hospital at Home Programs in the United States: A clarion call for permanent, person‐centered solutions - Brody - 2023 - Journal of the American Geriatrics Society - Wiley Online Li...

The 4 M model

 

Potential patient reported measures include a return to prior function, receiving enough support to perform self-care during the HaH stay, and effective transitional care education, over sight, and handoffs. Adding to this pragmatically collected patient-centered measures such as deprescribing and sim plifying medication regimens, documentation of an advance care planning or serious illness communication discussion, and emergent transfers could provide a multi layered PCC quality and safety approach all the while minimizing regulatory burdens and expense.

 

Providing flexibility in how programs provide skilled care while creating limits around the number, timing, amount, and in-person versus virtual care required by skilled clini cians needs balance and careful crafting in order to ensure efficiency, safety, and thus the viability of HaH programs.

 

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Home Page: Clinics in Geriatric Medicine

Home Page: Clinics in Geriatric Medicine | Comprehensive Geriatric Assessment | Scoop.it
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Comprehensive geriatric assessment: Valuation and patient preferences in older Japanese adults with cancer - Nishijima - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

Abstract Background Current guidelines recommend a comprehensive geriatric assessment (CGA) for the management of older adults with cancer. We evaluated the effect of CGA conducted by a geriatri
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frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis | Age and Ageing | Oxford Academic

frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it
Abstract. The frailty index (FI) quantifies frailty as deficit accumulation. It has been adapted to employ laboratory test data (FI-Lab). Our objective was to s
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Effects of Nurse Staffing on Resident Outcomes in Nursing Homes: A Systematic Review

Effects of Nurse Staffing on Resident Outcomes in Nursing Homes: A Systematic Review | Comprehensive Geriatric Assessment | Scoop.it
To evaluate the evidence on effects of nurse staffing in nursing homes on resident
outcomes.
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Efectividad del suero salino hipertónico nebulizado en pacientes con hipersecreción bronquial | Medicina Clínica

IntroducciónEl suero salino hipertónico (SSH) nebulizado mejora la calidad de vida
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Effect of Geriatric Comanagement in Older Patients Undergoing Surgery for Gastrointestinal Cancer: A Retrospective, Before-and-After Study

Effect of Geriatric Comanagement in Older Patients Undergoing Surgery for Gastrointestinal Cancer: A Retrospective, Before-and-After Study | Comprehensive Geriatric Assessment | Scoop.it
Patients from both groups received a preoperative comprehensive geriatric assessment in the preoperative phase and were followed according to the Enhanced Recovery After Surgery model in the perioperative period. In the geriatric comanagement group, targeted interventions during daily geriatrician-led ward rounds were performed. Inverse probability weighting was used to adjust estimates for potential baseline confounders.
Our study supports the implementation of geriatric comanagement in the care of older patients undergoing surgery for gastrointestinal cancer.
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Systematic review and meta-analysis of reablement interventions for people in permanent residential aged care homes | Age and Ageing | Oxford Academic

Systematic review and meta-analysis of reablement interventions for people in permanent residential aged care homes | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it

To determine the effect of reablement interventions provided in permanent residential aged care (PRAC) homes on residents’ level of function in activities of daily living (ADL) and quality of life (QoL)

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Profundizando en los conceptos de las "4 R": Rehabilitation , Reablement, Restorative, Reactivation

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Management of Heart Failure | Cardiology | JAMA | JAMA Network

Management of Heart Failure | Cardiology | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This JAMA Clinical Guidelines Synopsis summarizes the 2022 ACC/AHA/HFSA guidelines for management of heart failure in adults with a diagnosis of or at risk for heart failure.
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Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management

Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management | Comprehensive Geriatric Assessment | Scoop.it

Acute respiratory distress syndrome (ARDS) is characterised by acute hypoxaemic respiratory failure with bilateral infiltrates on chest imaging, which is not fully explained by cardiac failure or fluid overload. ARDS is defined by the Berlin criteria. In this
Series paper the diagnosis, management, outcomes, and long-term sequelae of ARDS are reviewed. Potential limitations of the ARDS definition and evidence that could inform future revisions are considered. Guideline recommendations, evidence, and uncertainties in relation to ARDS management are discussed.

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Persistent olfactory dysfunction in mild COVID-19 patients: A descriptive study of the characteristics and association with other symptoms | Medicina Clínica

IntroductionPost-COVID olfactory dysfunction continues to be studied due to the controversy of the
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Development of telehealth principles and guidelines for older adults: A modified Delphi approach - Wardlow - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

.- Clinicians are increasingly providing telehealth care to older adults despite a lack of comprehensive guidance on age-friendly implementation and practice.

.- The reach of telehealth for older adults remains limited due to several factors, including existing or perceived challenges around physical and cognitive limitations, and a lack of comprehensive guidance on older-adult- focused implementation.

.- This is the first comprehensive set of provider- focused telehealth principles and guidelines, developed by aging and telehealth experts, to address the specific needs of an aging population.

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A national qualitative study of Hospital‐at‐Home implementation under the CMS Acute Hospital Care at Home waiver - Gorbenko - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

The Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home (AHCaH) waiver resulted in the largest expansion of the Hospital-at-Home (HaH) to date. HaH programs allowed older adults at high risk for adverse out- comes from COVID-19 to receive high-quality acute hospital-level care at home. HaH is a com- plex care delivery model. Using a qualitative approach, we examined issues related to estab- lishing HaH programs under the CMS waiver. We found that HaH leaders were enthusiastic about advantages of HaH for patients and fami- lies. Program leaders reported concerns about the future of the CMS waiver given that its existence is tied to the COVID-19 public health emergency. Key implementation issues included building

electronic health records components for HaH and having the sufficient staff to support HaH pro- grams. The stage between planning and imple- mentation represented the largest hurdle and technical assistance should be most focused in this stage

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Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications - Candon - 2023 - Journal of the American Geriatrics Society - Wiley Online Library

Abstract Background Antiepileptics are commonly prescribed to nursing home residents with Alzheimer's disease and related dementias (ADRD) but there is little scientific support for their use i
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The clinical profile of cerebral small vessel disease: Toward an evidence‐based identification of cognitive markers - Salvadori - 2023 - Alzheimer's & Dementia - Wiley Online Library

There is no consensus on which test is more suited to outline the cognitive deficits of cerebral small vessel disease (cSVD) patients. We explored the ability of eight cognitive tests, selected in a previous systematic review as the most commonly used in this population, to differentiate among cSVD patients, controls, and other dementing conditions performing a meta-analysis of 86 studies. We found that cSVD patients performed worse than healthy controls in all tests while data on the comparison to neurodegenerative diseases were limited. We outlined a lack of data on these tests’ accuracy on the diagnosis. Cognitive tests measuring processing speed were those mostly associated with neuroimaging cSVD markers. There is currently incomplete evidence that a single test could differentiate cSVD patients with cognitive decline from other dementing diseases. We make preliminary proposals on possible strategies to gain information about the clinical definition of cSVD that currently remains a neuroimaging-based one.

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What's next for Hospital at Home Programs in the United States: A clarion call for permanent, person‐centered solutions - Brody - 2023 - Journal of the American Geriatrics Society - Wiley Online Li...

This editorial comments on the article by Gorbenko et al. in this issue.

 

The 4M Framework could be a cornerstone of quality metrics for the HaH population. Potential patient- reported measures include a return to prior function, receiving enough support to perform self-care during the HaH stay, and effective transitional care education, over- sight, and handoffs. Adding to this pragmatically collected patient-centered measures such as deprescribing and sim- plifying medication regimens, documentation of an advance care planning or serious illness communication discussion, and emergent transfers could provide a multi- layered PCC quality and safety approach all the while minimizing regulatory burdens and expense.

 

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Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis | Age and Ageing | Oxford Academic

Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalisation: a systematic review and meta-analysis | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it
AbstractBackground. Due to the increasing number of older people with multi-morbidity, the demand for outpatient geriatric rehabilitation (OGR) will also increa
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Comprehensive Geriatric Hospital at Home: Adaptation to Referral and Case-Mix Changes During the COVID-19 Pandemic

Comprehensive Geriatric Hospital at Home: Adaptation to Referral and Case-Mix Changes During the COVID-19 Pandemic | Comprehensive Geriatric Assessment | Scoop.it
To describe the evolution of a Hospital at Home (HAH) based on comprehensive geriatric
assessment (CGA), including its adaptability to changing case-mixes and pathways during
the COVID-19 pandemic.
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Self-Reported Frailty Screening Tools: Comparing Construct Validity of the Frailty Phenotype Questionnaire and FRAIL        J Am Med Dir Assoc. 2022;23(11):1870 e1- e7.

Self-Reported Frailty Screening Tools: Comparing Construct Validity of the Frailty Phenotype Questionnaire and FRAIL        J Am Med Dir Assoc. 2022;23(11):1870 e1- e7. | Comprehensive Geriatric Assessment | Scoop.it

Chia JQ et al. examined the construct validity of 2 self-reported frailty questionnaires, the Frailty Phenotype Questionnaire (FPQ) and FRAIL, against the Cardiovascular Health Study frailty phenotype (CHS-FP).

Sergio Ariño Blasco's insight:

Los cuestionarios autoadministrados (selfreported) están cobrando protagonismo en estos últimos años, probablemente favorecidos por los condicionantes de la pandemia y de la telemedicina.

En población residente en la comunidad el instrumento FPQ muestra un poder discriminante y valor predictivo superiores al instrumento FRAIL para identificación de fragilidad. 

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Predictors for the Transitions of Poor Clinical Outcomes Among Geriatric Rehabilitation Inpatients

Predictors for the Transitions of Poor Clinical Outcomes Among Geriatric Rehabilitation Inpatients | Comprehensive Geriatric Assessment | Scoop.it

To investigate the associations of morbidity burden and frailty with the transitions between functional decline, institutionalization, and mortality

Conclusions and Implications: This study demonstrates that greater frailty severity, assessed using the CFS, is a significant risk factor for poor clinical outcomes and demonstrates the importance of implementing it in the geriatric rehabilitation setting.

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Development and Validation of the Summary Elixhauser Comorbidity Score for Use With ICD-10-CM–Coded Data Among Older Adults

Older adults have many comorbidities contributing to mortality. Objective: To develop a summary Elixhauser (S-Elixhauser) comorbidity score to predict 30-day, in-hospital, and 1-year mortality in older adults using the 38 comorbidities operationalized by the Agency for Healthcare Research and Quality (AHRQ)

 

Conclusion: The S-Elixhauser comorbidity score is well calibrated and internally validated but its advantage over the AHRQ Elixhauser and Charlson summary scores is unclear. Primary Funding Source: National Institute on Aging.

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Acute Pulmonary Embolism: A Review | Emergency Medicine | JAMA | JAMA Network

Acute Pulmonary Embolism: A Review | Emergency Medicine | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
This Review discusses the incidence, diagnosis, symptomatic characteristics, treatment, and prognosis for patients with pulmonary embolism.
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