Clare Luz

Televisits: Sustaining long distance family relationships among institutionalized elders through technology

The role of social support in the health of older persons is well documented. This support is particularly important for isolated nursing home residents. The purpose of this study was to test the feasibility of using low-cost videophones to enhance communication between nursing home residents and their families. Ten pairs of residents and family members received videophones and engaged in regular televisits for six months. All participants completed brief survey instruments prior to and after the study period to determine the effects of the televisits on the frequency and quality of contacts. A post-study survey assessed ease and satisfaction with using videophones. Findings include identification of technical and design problems, possible solutions, factors affecting actual use of equipment, and conditions under which benefits of use may be optimal. Categories for estimating potential actual users are suggested. Importantly, the study demonstrates that videophones can be used successfully by a wide range of frail nursing home residents and can enhance social interactions, regardless of distance. Affordable videophone technology offers the potential for reduced isolation among institutionalized elders and others with distance and mobility barriers.

How are the experiences and needs of families of individuals with mental illness reflected in medical education guidelines

ObjectiveThis descriptive study explored the extent that medical education curriculum guidelines contained content about the experiences and needs of family members of people with serious mental illness.MethodsKey family-focused-literature themes about the experiences and needs of families of individuals with mental illness were drawn from a review of over 6,000 sources in the mental health practice literature that were identified within a systematic search and thematic development process. The study identified the extent and nature of family-focused key literature themes as reflected in medical education curriculum guidelines for psychiatry and primary care practice specialties of family practice, internal medicine and pediatrics. An iterative process was used to retrieve and analyze text data drawn from the curriculum guidelines of national accrediting organizations for undergraduate, graduate, and continuing medical education.ResultsThe key family-focused themes, as drawn from the mental health practice research literature, were: mental illness stigma; family caregiver burden; information exchange and referral; family stress, coping, and adaptation; family support; crisis response; and family psychoeducation. Two of these seven themes appeared in medical education curriculum guidelines: information exchange and caregiver burden. The most frequently appearing family-focused key literature theme was information exchange. Psychiatry and undergraduate medical education reflected the most family content.ConclusionIt appears that medical education curriculum guidelines have insufficient content about families of people with mental illness. The educational experiences of psychiatrists and primary care physicians may not adequately prepare them for working with family members of their patients. It is recommended that medical education curriculum guidelines incorporate information about family stigma; family/caregiver burden; information exchange; family stress, coping, and adaptation; family support; crisis response; and multiple family group psychoeducation.

Do Canes or Walkers Make Any Difference? NonUse and Fall Injuries

Purpose of the Study Examine patterns of cane and walker use as related to falls and fall injuries. Hypotheses Among people who fall at home, most do not have an assistive device with them when they fall. Nonusers who fall sustain more severe injuries. Design and Methods This was a cross-sectional study using a self-administered written survey completed by 262 people aged 60 and older who were community dwelling, cognitively intact, and current cane/walker users with a history of falls. They were recruited through clinical practice sites, churches, and senior housing in central Michigan. Outcomes of interest included patterns of device use, reasons for nonuse, device use at time of fall, and fall-related injuries. Results Seventy-five percent of respondents who fell were not using their device at the time of fall despite stating that canes help prevent falls. Reasons for nonuse included believing it was not needed, forgetfulness, the device made them feel old, and inaccessibility. Perceived risk was not high enough to engage in self-protective behavior. However, nonuse led to a significantly higher proportion of falls resulting in surgery than among device users. Among respondents requiring surgery, 100% were nonusers. Most respondents never received a home safety evaluation (68%) and only 50% received training on proper device use. Implications Providers must place increased emphasis on the importance of cane/walker use for injury prevention through patient education to promote personal relevance, proper fitting, and training. New strategies are needed to improve device acceptability and accessibility.

Medication Reconciliation in an Outpatient Geriatrics Clinic: Does Accuracy Improve If Patients "Brown Bag" Their Medications for Appointments?

pharmacy and GPs with their own pharmacy incorporated changes to the medication regimen best (95.0% control, 70.7% intervention; HR = 0.74, 95% CI = 0.50–1.11). The reasons for changes were not documented in the CP or GP files. A transitional pharmaceutical care intervention alone does not improve incorporation of changes to medication regimens in CP and GP files. Continuity in pharmacotherapeutic care can only be ensured when CPs and GPs both receive complete and structured information on the discharge medication regimen and implement this information in their files so that it is readily available in case of a new change to the medication regimen or a transfer to another healthcare setting.

Filling the Care Gap Personal Home Care Worker Training Improves Job Skills, Status, and Satisfaction

With an aging population and provider shortages, personal care aides (PCAs) hold potential for providing low-cost, high-quality in-home supports and services. They comprise an unprecedented workforce in terms of size and rapid growth. However, this workforce is also characterized by costly high-turnover rates that threaten quality of care and outcomes. It is imperative that measures be taken to improve PCA skills and stabilize their employment. In 2010, a PCA training program was developed titled “Building Training . . . Building Quality” as part of a national demonstration. Key findings were that learners’ skills, employability, and job satisfaction significantly improved, and “intent to stay” was associated with increased confidence in ability to do the job. This report details findings of value to those interested in retaining high-quality PCAs.

Training the Personal and Home Care Aide Workforce Challenges and Solutions

Personal care aides (PCAs) are critical to meeting the need for low-cost, high-quality care for frail older adults at home. Developing this workforce entails not only increasing its size but also ensuring that PCAs possess the skills necessary to deliver competent, safe, and respectful care. Yet, no federal PCA competencies or training requirements exist, and state requirements vary widely. In 2010, a 77-hour PCA model training program was developed as part of a national demonstration. However, a key finding of this study was that many enrollees faced serious socio-economic challenges that prevented them from graduating. This report details findings from a survey sent to all non-completers to ascertain reasons for attrition and improve program success. It offers recommendations for future program planners.

A National Survey on the Effect of the Geriatric Academic Career Award in Advancing Academic Geriatric Medicine

A workforce that understands principles of geriatric medicine is critical to addressing the care needs of the growing elderly population. This will be impossible without a substantial increase in academicians engaged in education and aging research. Limited support of early‐career clinician–educators is a major barrier to attaining this goal. The Geriatric Academic Career Award (GACA) was a vital resource that benefitted 222 junior faculty members. GACA availability was interrupted in 2006, followed by permanent discontinuation after the Geriatrics Workforce Education Program (GWEP) subsumed it in 2015, leaving aspiring clinician–educators with no similar alternatives. GACA recipients were surveyed in this cross‐sectional, multimethod study to assess the effect of the award on career development, creation and dissemination of educational products, funding discontinuation consequences, and implications of program closure for the future of geriatric health care. Uninterrupted funding resulted in fulfillment of GACA goals (94%) and overall career success (96%). Collectively, awardees reached more than 40,700 learners. Funding interruption led to 55% working additional hours over and above an increased clinical workload to continue their GACA‐related research and scholarship. Others terminated GACA projects (36%) or abandoned academic medicine altogether. Of respondents currently at GWEP sites (43%), only 13% report a GWEP budget including GACA‐like support. Those with GWEP roles attributed their current standing to experience gained through GACA funding. These consequences are alarming and represent a major setback to academic geriatrics. GACAs singular contribution to the mission of geriatric medicine must prompt vigorous efforts to restore it as a distinct funding opportunity.

Direct Care Workforce Training: Internet Accessibility and Acceptance

Evidence exists that web-based learning for health care professionals can improve topic-specific knowledge, increase access to training, and lower training costs. However, limited information exists on the value of online education for improving hands-on skills as part of personal care aide (PCA) training. New PCA training programs are emerging that are fully online or hybrid models that blend online with in-person instruction. Such programs require access to a computer and high-speed internet, which could prove difficult for low-income PCAs who are less likely to own a computer. The current study evaluated a PCA training demonstration that examined issues of internet access, use, and acceptability for PCA training. Results show most trainees prefer a hybrid online/in-person model, but there are gaps in access and acceptability, particularly related to reading ability. These findings have implications for health care providers who deliver training programs aimed at developing a qualified PCA workforce capable of providing competent care to older adults. [Journal of Gerontological Nursing, 43(6), 46-52.].

Improving Patient Experiences and Outcomes Through Personal Care Aide Training

Introduction: The rapidly aging US population is resulting in major challenges including delivering quality care at lower costs in the face of a critical health-care workforce shortage. The movement toward home care has dramatically increased the need for qualified, paid personal care aides (PCAs). Adequate PCA training that focuses on skills for person-centered, at home support is an imperative. This study provides evidence that clients of PCAs who have completed a comprehensive, evidence-based PCA training program, titled Building Training…Building Quality (BTBQ), report higher satisfaction and better health outcomes, compared to clients of PCAs with lesser or other training. Methods: A mixed-methods, quasi-experimental design was used to compare self-reported survey responses from clients of BTBQ-trained PCAs (treatment group) with responses from clients of non-BTBQ-trained PCAs (control group). Results: Clients of BTBQ-trained PCAs had significantly fewer falls and emergency department visits compared to clients whose PCAs had no BTBQ training (P < .05). Conclusion: BTBQ-like PCA training reduces costly adverse events.

Family Medicine: Bridge to Life

Reflecting on the suicide of a close friend, this essay explores what comprises, and inspires a will to live, and how those in Family Medicine can address suicide risk even in the face of debilitating or terminal illness. Research indicates that the will to live is a measurable indicator of general well-being, distinct from depression, and an important predictor of a persons motivation to “hold on to life”. As such, understanding what is at the heart of a desire to live should alter clinical practice. This essay offers ideas for ways in which to create bridges for patients that could help sustain life.