Leveraging Home‐Delivered Meal Programs to Address Unmet Needs for At‐Risk Older Adults: Preliminary Data - American Geriatric Society

BACKGROUND

Home‐delivered meal programs serve a predominantly homebound older adult population, characterized by multiple chronic conditions, functional limitations, and a variety of complex care needs, both medical and social.

DESIGN

A pilot study was designed to test the feasibility of leveraging routine meal‐delivery service in two home‐delivered meal programs to proactively identify changes in older adult meal recipients’ (clients’) health, safety, and well‐being and address unmet needs.

INTERVENTION

Meal delivery personnel (drivers) were trained to use a mobile application to submit electronic alerts when they had a concern or observed a change in a client's condition. Alerts were received by care coordinators, who followed up with clients to offer support and help connect them to health and community services.

RESULTS

Over a 12‐month period, drivers submitted a total of 429 alerts for 189 clients across two pilot sites. The most frequent alerts were submitted for changes in health (56%), followed by self‐care or personal safety (12%) and mobility (11%). On follow‐up, a total of 132 referrals were issued, with most referrals for self‐care (33%), health (17%), and care management services (17%). Focus groups conducted with drivers indicated that most found the mobile application easy to use and valued change of condition monitoring as an important contribution.

CONCLUSION

Findings suggest that this is a feasible approach to address unmet needs for vulnerable older adults and may serve as an early‐warning system to prevent further decline and improve quality of life. Efforts are underway to test the protocol across additional home‐delivered meal programs.

from Wiley: Journal of the American Geriatrics Society: Table of Contents http://bit.ly/2XanV5q
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Post–Hip Fracture Mortality in Nursing Home Residents by Obesity Status - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

from Wiley: Journal of the American Geriatrics Society: Table of Contents http://bit.ly/2RbRJZV
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Prostate Laser Photovaporization in Older People With and Without Bladder Catheter - American Geriatric Society

OBJECTIVES

To compare results of prostate laser photovaporization (PVP) by age groups to evaluate morbidity and functional results. Then, to specifically analyze surgical data for patients with an indwelling bladder catheter.

DESIGN

Monocentric retrospective study of a prospective maintained database of all laser PVPs performed at our university hospital between December 2012 and June 2017.

SETTINGS AND PARTICIPANTS

A total of 305 patients (three groups: younger than 70, 70‐80, and older than 80 years) were operated on in our hospital center for the treatment of urinary tract disorders related to benign prostatic hyperplasia.

RESULTS

A difference was found between the three age groups, with a higher rate of complications for patients older than 80 years (45%) (P = .013). Rate of patients with postoperative bladder catheters at 1 year was higher for patients older than 80 years (15%) (P = .004). Postoperative quality‐of‐life (QoL) score was worse for patients older than 80 years (P = .04).

For patients with an indwelling bladder catheter undergoing surgery, morbidity was greater in patients older than 80 years, but the difference was not significant. International Prostate Symptom Score and QoL score were not significantly different between the three groups.

Rate of patients with a remaining bladder catheter at 1 year was higher for patients older than 80 years (17.1% vs 7.1% for patients between 70 and 80, and 4.8% for patients under 70.) but with no statistical difference.

CONCLUSION

PVP had a greater morbidity in octogenarians compared to younger subjects. Functional results were less satisfactory for patients older than 80 years compared to younger ones. For subjects operated on with an indwelling bladder catheter, no significant difference in outcome and morbidity was found between the three groups.

from Wiley: Journal of the American Geriatrics Society: Table of Contents http://bit.ly/2XfYTlG
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Analyzing Hospital Transfers Using INTERACT Acute Care Transfer Tools: Lessons from MOQI - American Geriatric Society

OBJECTIVES

We explored the differences in potentially avoidable/unavoidable hospital transfers in a retrospective analysis of Interventions to Reduce Acute Care Transfers (INTERACT) Acute Transfer Tools (ACTs) completed by advanced practice registered nurses (APRNs) working in the Missouri Quality Improvement (QI) Initiative (MOQI).

DESIGN

Cross‐sectional descriptive study of 3996 ACTs for 32.5 calendar months from 2014 to 2016. Univariate analyses examined differences between potentially avoidable vs unavoidable transfers. Multivariate logistic regression analysis of candidate factors identified those contributing to avoidable transfers.

Setting

Sixteen nursing homes (NHs), ranging from 120 to 321 beds, in urban, metro, and rural communities within 80 miles of a large midwestern city.

PARTICIPANTS

A total of 5168 residents with a median age of 82 years.

MEASUREMENTS

Data from 3946 MOQI‐adapted ACTs.

RESULTS

A total of 54% of hospital transfers were identified as avoidable. QI opportunities related to avoidable transfers were earlier detection of new signs/symptoms (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.61‐3.42; P < .001); discussions of resident/family preference (OR = 2.12; 95% CI = 1.38‐3.25; P < .001); advance directive/hospice care (OR = 2.25; 95% CI = 1.33‐3.82; P = .003); better communication about condition (OR = 4.93; 95% CI = 3.17‐7.68; P < .001); and condition could have been managed in the NH (OR = 16.63; 95% CI = 10.9‐25.37; P < .001). Three factors related to unavoidable transfers were bleeding (OR = .59; 95% CI = .46‐.77; P < .001), nausea/vomiting (OR = .7; 95% CI = .54‐.91; P = .007), and resident/family preference for hospitalization (OR = .79; 95% CI = .68‐.93; P = .003).

CONCLUSION

Reducing avoidable hospital transfers in NHs requires challenging assumptions about what is avoidable so QI efforts can be directed to improving NH capacity to manage ill residents. The APRNs served as the onsite coaches in the use and adoption of INTERACT. Changes in health policy would provide a revenue stream to support APRN presence in NH, a role that is critical to improving resident outcomes by increasing staff capacity to identify illness and guide system change.

from Wiley: Journal of the American Geriatrics Society: Table of Contents http://bit.ly/2IeDmS5
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Statement on FDA’s scientific work to understand per- and polyfluoroalkyl substances (PFAS) in food, and findings from recent FDA surveys - FDA Press Releases

FDA’s scientific work to understand per- and polyfluoroalkyl substances (PFAS) in food, and findings from recent FDA surveys

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FDA finalizes guidance for premarket tobacco product applications for electronic nicotine delivery systems as part of commitment to continuing a strong oversight of e-cigarettes - FDA Press Releases

FDA finalizes guidance for manufacturers submitting premarket tobacco product applications for electronic nicotine delivery systems, such as e-cigarettes or “vapes.”

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Chromones with lipoprotein oxidation inhibitory activity from an endophytic fungus Alternaria brassicae JS959 derived from Vitex rotundifolia - Journal of Antibiotics

The Journal of Antibiotics, Published online: 11 June 2019; doi:10.1038/s41429-019-0198-4

Chromones with lipoprotein oxidation inhibitory activity from an endophytic fungus Alternaria brassicae JS959 derived from Vitex rotundifolia

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