Category Archives: Geriatric Medicine

Making Electronic Health Records Responsive to Needs of Older Adults (Really Meaningful Use)

EHR_shutterstock_150374810_300pI was recently in New Orleans and coincidently listened to an interview with Robert Wachter of the University of California, San Francsico talking about health IT and his new book on where the nation stands regarding electronic health records (EHRs).

Somehow, the temptations of the French Quarter and the problem of EHRs combined in my mind to produce the image of the nation’s health system out on the town, binging on HITECH Act ARRA money, blackout drunk, and waking up married to some very inappropriate electronic health record system.

This isn’t exactly how it happened, but most of the bloom does seem to be off the rose of the electronic medical record and we are in a phase of regret and disillusionment. Physicians have been complaining for years about the hours added to their days by the workflow disruption of digital data entry and the breach in the relationship with patients created by interacting with the computer, rather than the person. At the same time most of the anticipated fabulous features of EHRs are still in the anticipated stage.

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Geriatric Emergency Medicine: The Time to Act is Now
Part Two

Teresita Hogan, MD

One of this blog post’s authors, Teresita Hogan, MD, speaks on care transitions during the Geriatric EM Boot Camp in Milwaukee.

Editor’s Note: In our Feb. 19 Health AGEnda post, the team we’re informally calling the Hartford Geri EM Champions shared information about the first two Geriatric Emergency Medicine Boot Camps and a meeting hosted by the John A. Hartford Foundation in late January to discuss new opportunities to improve acute care of older adults. Today, in the second of two parts, our EM experts discuss why our current system is failing older Americans, and share their vision for better emergency department care that can both serve the needs of older adults and contribute to a more efficient and value-based health care system.

The acute care provided to older adults in emergency departments (ED) across the country, and world, is often inadequate and sometimes dangerous.

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Geriatric Emergency Medicine: The Time to Act is Now

Drs. Kevin Biese and Jan Busby-Whitehead

One of this blog’s authors, Dr. Kevin Biese, right, and Dr. Jan Busby-Whitehead lead a collaborative project at UNC-Chapel Hill to develop a unique model of a geriatric emergency department (ED) focused on improving care transitions.

Editor’s Note: This is the first of two parts.

“Geriatric Emergency Medicine”—As health professionals in Emergency Medicine (EM) who have chosen to focus on the geriatric population, we wish we could claim the topic brings a sense of excitement and opportunity to EM physicians worldwide.

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When It Comes to Geriatrics Expertise, If You Can’t Change the Numbers, Change the Game

“Whoever said nothing is impossible obviously hasn’t tried nailing Jell-O to a tree.”—John Candy

As the year comes to a close, there are many lists of the best and worst in almost every imaginable category for 2014. Here at Health AGEnda, we have made an annual practice of reviewing the workforce in training data—specifically, the number of graduating resident physicians choosing additional training in geriatric fellowship programs—published in the Journal of the American Medical Association (JAMA). (Read Boxing Day Brings Glad Tidings for Geriatrics Field from 2013, Decline in Geriatric Fellows Defies Pay Boost: +10% = -10% from 2012 and Falling Leaves, Falling Numbers from 2011.)

I recently saw one of my charts presented (without attribution :-( ) in a Washington briefing session on the workforce available to care for older adults, so I guess I have to keep updating them.

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MSTAR Program Shines at Reception for Supporters

Hartford Trustees Kathryn D. Wriston, left, and Lile R. Gibbons, at a recent reception honoring them as personal supporters of the MSTAR program.

Hartford Trustees Kathryn D. Wriston, left, and Lile R. Gibbons, at a recent reception honoring them as personal supporters of the MSTAR program.

Over the past 20 years, the Medical Student Training in Aging Research (MSTAR) program—a summer internship that draws physicians-in-training into the field of geriatrics and aging research—has supported more than 2,000 medical students.

We celebrated the program’s 20th anniversary and its remarkable record last week with a reception honoring John A. Hartford Foundation Trustees and other individuals who have personally donated to the sustainability of this initiative, administered by the American Federation for Aging Research (AFAR).

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Tools You Can Use: Webinar Series Covers Geriatrics-Competent Care for Medicare-Medicaid Population

Resources_Integrated_Care_400pMany of the John A. Hartford Foundation’s grant projects are working hard to improve the quality of health care for the older adults who are dually enrolled in both Medicare and Medicaid.

As a group, these low-income, older adults have more complex health conditions and a greater need for coordinated, geriatrics-expert care that meets their own individualized health goals.

To improve quality and reduce costs in this population, states are working with the federal government and local managed care health plans to integrate the financing and care delivered through Medicare and Medicaid. Changes are happening fast as states experiment with delivering care to this population of “duals” through these health plans, many of which have never had experience caring for an older adult population with complex conditions.

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MSTAR Students Already Making Important Contributions to Geriatrics Research

Daniella Schocken, a student at the Icahn School, presents on her research on a Mount Sinai emergency department program that deploys EMTs to help older adults transition home after hospitalization.

Daniella Schocken, a student at the Icahn School, presents on her research on a Mount Sinai emergency department program that deploys EMTs to help older adults transition home after hospitalization.

What did you do for summer vacation? While many of us head to the beach or elsewhere to relax and get away from it all for a while, 149 enterprising students across the country instead devoted the break between their first and second year of medical school to learning about geriatrics and aging research.

Through the Medical Student Training in Aging Research (MSTAR) program, these future physicians engaged in geriatrics training and a mentored research experience at medical schools with outstanding geriatrics programs.

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Tools You Can Use:
The Essentials of Cardiovascular Care in Older Adults

ACC_seal_blue_dark300The most potent risk factor for heart disease is aging, according to the American College of Cardiology (ACC). Given how rapidly our population is aging, that’s sobering news indeed, especially when you consider that clinical practice guidelines rarely apply to older adults with multiple chronic conditions.

That means regardless of how experienced and skilled a cardiologist or other clinician may be in treating cardiovascular disease, they may not have received adequate training in how best to treat cardiovascular disease in older adults.

Fortunately, the American College of Cardiology has released the Essentials of Cardiovascular Care in Older Adults (ECCOA), a free, online self-assessment curriculum designed for cardiovascular specialists and other clinicians who care for older patients with cardiovascular disease. (Continuing education credits are available for physicians and nurses). The curriculum was developed with funding from a John A. Hartford Foundation grant.

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Tools You Can Use: Residency Training Toolkits and Best Practices Guidelines for Surgeons and Related Specialists

GeriToolkit_468622323Let’s say you are 80 years old and about to undergo surgery. Perhaps it was an unexpected fall that placed you in the emergency department and you’ll need an orthopedic surgeon to repair your hip. You’ll undergo anesthesia during the procedure and afterwards will likely require rehab.

All of the physicians who might care for you—from the ER doc to the anesthesiologist to the physical medicine/rehab physician—have spent years and years of training to specialize in their discipline.

But do they know about the drugs that should be avoided in older patients? Do they appropriately assess for frailty or cognitive impairment? Do they understand the risk factors for post-operative delirium (an acute state of confusion) and how to mitigate them?

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