Ellen Flaherty

Geriatric Interdisciplinary Team Training Program : Evaluation Results

Geriatric interdisciplinary team training has long been a goal in health education with little progress. In 1997, the John A. Hartford Foundation funded eight programs nationally to create Geriatric Interdisciplinary Team Training (GITT) programs. Faculty trained 1,341 health professions students. The results of the evaluation, including presentation of new measures developed to assess interdisciplinary knowledge, are presented, and the implications of the program as a model of interdisciplinary education are discussed. Evaluation data from 537 student trainees are presented. At posttest, GITT trainees demonstrated improvement on all measures of attitudinal change, no change on the geriatric care planning measure, and a change in some of the questions on the test of team dynamics that varied by discipline. Changes were greatest for all the attitudinal measures with the self-reported Team Skills Scale indicating the most significant change—a change that is significant across medicine, nursing, and social work trainees.

Agitation and Depression in Frail Nursing Home Elderly Patients With Dementia: Treatment Characteristics and Service Use

OBJECTIVE The authors describe characteristics, treatment, and acute service use associated with agitation and depression in dementia. METHODS Authors used retrospective chart review of symptoms, physician-level prescribing, and acute service use over 3 months for 2,487 physically frail older residents, including 1,836 with dementia, (mean age: 79.8 years) in 109 long-term care facilities, describing differences between uncomplicated dementia and three mutually exclusive subgroups of complicated dementia, including dementia with agitation-only, dementia with depression-only, and dementia with mixed agitation and depression. RESULTS Compared with the other subgroups, frail elderly patients with dementia complicated by mixed agitation and depression have the highest rate of hospitalization, the greatest number of medical diagnoses, and the greatest medical severity, and they receive the greatest number of psychiatric medications. Depression in dementia (either alone or mixed with agitation) was associated with greater prevalence of pain. CONCLUSIONS Dementia complicated by mixed agitation and depression accounts for over one-third of complicated dementia and is associated with multiple psychiatric and medical needs, intensive pharmacological treatment, and use of high-cost services. Research should target this complex, high-risk group to develop appropriate diagnostic criteria and effective treatment interventions.

The geriatric interdisciplinary team training (GITT) program.

ABSTRACT Geriatric interdisciplinary team training (GITT) is an initiative funded by the John A. Hartford Foundation since 1995. Building from the substantial knowledge gained from the Veterans Administration project in interdisciplinary team training and lessons from the Pew Foundation initiative, GITT was reconceived by the Foundation to address the need for teams in the care of older adults in the new era of managed care and health care cost containment. This training program has served to help us understand attitudes toward teams, how teams function, and how teams should be trained in the changing health care environment, where length of stay is dramatically different from the earlier team training projects. This introductory paper provides an overview of GITT, and the companion papers give detail of the GITT curricula, measures and lessons learned.

Frail older patient care by interdisciplinary teams: a primer for generalists.

ABSTRACT Frail older patients-unlike younger persons in the health care system or even well elders-require complex care. Most frail older patients have multiple chronic illnesses. Optimum care cannot be achieved by following the paradigm of ongoing traditional health care, which emphasizes disease and cure. Because no one health care professional can possibly have all of the specialized skills required to implement such a model of health care delivery, interdisciplinary team care has evolved. This paper describes the roles of the participating team members in the context of interdisciplinary care for frail older adults. In addition, the challenges that occur when Geriatric Interdisciplinary (ID) Teams involved in providing care to frail older patients are identified and discussed.

AGS Sets Sights on Better Care, More Responsive Policies for “Unbefriended” Older Adults

The AGS earlier this fall unveiled new guidance on care and decision-making for a unique and growing group of older adults: the “unbefriended.” The unbefriended lack the capacity to provide informed consent to medical treatment, often due to declines in physical and/or mental well-being. But these individuals face added challenges because they have no written outline of their care preferences and also have no identified “surrogate,” such as a family member or friend, to assist in medical decision-making when needed. “Health professionals have a special responsibility for the unbefriended, but we also face particularly challenging situations when it comes to their medical decisions,” notes Timothy W. Farrell, MD, AGSF, a member of the expert panel responsible for the position statement. Added AGS President Ellen Flaherty, PhD, APRN, AGSF: “The AGS has outlined proactive steps we can take to help those at risk of becoming unbefriended. And for older adults who are already facing this reality, our guidance can help create standards and systems of support in more places and for more people.” Across clinical practice, AGS experts have called for: • Avoiding ad hoc approaches to decisionmaking to ensure fairness and respect; • Identifying “non-traditional” surrogates— such as close friends, neighbors, or others who know a person well—wherever and whenever possible; • Putting mechanisms in place to assess decision-making capacity in a systematic fashion; IN THIS ISSUE

Assessing pain in older adults.

WHY: Studies on pain in older adults (persons 65 years of age and older) have demonstrated that 25%45% of community dwelling older people have chronic pain. 45-85% of nursing home residents also report pain that is often left untreated. Although there is minimal research that strictly focuses on pain in older adults, studies with younger participants have elucidated associations between pain and depression. Increased pain has further resulted in decreased socialization, impaired ambulation and increased healthcare utilization and costs. Older adults are reluctant to report pain: therefore, nurses need to be proactive in screening for and assessing pain.

Commemorating key research that shaped geriatrics since the new millennium

Fall is fully and finally here, and in just a few short weeks our clocks will be “falling back” to catch up with the season. There is a certain irony in jumping back to jump ahead in time, but it is a fitting reminder that knowing where we are going also entails knowing where we have been. Just ask the range of experts responsible for a look-back at some of the most influential geriatrics scholarship published by the Journal of the American Geriatrics Society (JAGS) since the new millennium.1 Their retrospective endeavor was recently highlighted in a virtual journal issue and corresponding editorial penned by Thomas T. Yoshikawa, MD, AGSFdwho served as Editor-in-Chief of JAGS from 2000 to 2015dalong with current Executive Editor Joseph G. Ouslander, MD, AGSF, and new JAGS Editor-in-Chief William B. Applegate, MD, MPH, MACP, AGSF.1 For nurses, pharmacists, physicians, physician assistants, social workers, and the range of other health professionals responsible for the care of older adults, this virtual issue offers an important look at how geriatrics expertise has grown in less than two decades’ timedand what emerging trends todaymay be profiled by the professionals of tomorrow. More than 30 members of the JAGS Editorial Board submitted votes for seminal studies from a pool of more than 150 articles cited most frequently on an annual basis from 2000 through 2015.1 Both the committee and their final list of top papers as compiled by Dr. Yoshikawa, Dr. Ouslander, and Dr. Applegate reflect the depth and breadth of geriatrics, not only across research areas of interest but also across professions and specialties. The papers selected focus on everything from cognition and physical disabilities to frailty, medications, and transitional care.1 Indeed, the highlights noted below are but six examples from the 20 articles that have helped shape not only how geriatrics nurses perceive expert care but also when, where, and how we have been able to partner with interprofessional team members to ensure new insights reach older adults and caregivers across the U.S.