Rhoda Meador

Environmental Sustainability in an Aging Society: A Research Agenda

Objectives. This article presents the results of a multidisciplinary consensus conference held to recommend a research agenda on the relationship between aging and environmental sustainability and conservation. The intersection of these two topics has important implications for the health and well-being of older persons but it has thus far received little scientific attention. Methods. The consensus conference was conducted with gerontological experts from various disciplines and environmental scientists. Using a structured methodology, participants achieved consensus on recommendations for a research agenda on aging and environmental sustainability. Results. Eight major recommendations for research are detailed in this article as well as cross-cutting research themes affecting all areas, including racial and economic diversity, geographical region, cohort, and intergenerational linkages. Discussion. Given the vulnerability of older persons to environmental threats detailed by the consensus conference, conferees recommended that research on these topics be urgently promoted, both by researchers and by funding agencies.

Effects of Electronic Health Information Technology Implementation on Nursing Home Resident Outcomes

Objective: To examine the effects of electronic health information technology (HIT) on nursing home residents. Methods: The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. Results: No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents’ subjective assessment of the HIT intervention were generally positive. Discussion: The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on resident behavior.

A Community-Based Participatory Critique of Social Isolation Intervention Research for Community-Dwelling Older Adults.

This article examines the dialogue that occurred within the structure of a Research-to-Practice Consensus Workshop that critiqued academic research priorities regarding social isolation among community-dwelling older adults and identified practice-based suggestions for a social isolation research agenda. The investigators adapted the scientific consensus workshop model to include expert practitioners and researchers in a discussion of the current state and future directions of social isolation intervention research. The groups critique resulted in several key recommendations for future research including the need for a social isolation measure with specific capacity to identify isolated older adults during a community crisis. This study demonstrates that the Research-to-Practice Consensus Workshop model can be used successfully to identify priority areas for research that have implications for community practice, construct an evidence base more relevant for community application, strengthen existing community—researcher partnerships, and build agency and practitioner capacity to take part in community-based participatory research.

Going home: identifying and overcoming barriers to nursing home discharge.

This article describes barriers to nursing home discharge encountered in an intervention designed to transition nursing home residents to the community. Staff in the intervention (“Project Home”) provided intensive case management and discharge planning services to nursing home residents who expressed a desire to return to community-based living arrangements. Sixty program participants took part in the program evaluation that informs this article. With the exception of Medicaid status, no differences were found between the social, demographic, and health characteristics of individuals who remained in the nursing home and those who were discharged. A qualitative analysis was conducted to describe barriers to discharge and strategies intervention staff used to leverage each client’s strengths and work around obstacles. Three main barriers to discharge were found: having an unstable or complex medical condition, lacking family or social support, and being unable to obtain suitable housing. Intervention staff advocated on the behalf of clients, encouraged clients to build skills toward independent living, and contributed extensive knowledge of local resources to advance client goals. Cases of successful transition suggest that a person-centered approach from intervention staff combined with a flexible organizational structure is a promising model for future interventions.

Resident-to-Resident Mistreatment: Evaluation of a Staff Training Program in the Reduction of Falls and Injuries

Resident-to-resident elder mistreatment (R-REM) occurs frequently in long-term services and support settings. The purpose of the current study was to evaluate the effect of a R-REM training program for nursing and other frontline staff on resident falls and injuries in a cluster randomized trial of units within four nursing homes. Interview and observational data from a sample of 1,201 residents (n = 600 and n = 601 in the usual care and intervention groups, respectively) and staff were collected at baseline and 6 and 12 months. A generalized linear model was used to model the falls/injuries outcome. The net reduction in falls and injuries was 5%, translating to 10 saved events per year in an averagesized facility. Although the result did not reach statistical significance due to low power, the findings of fall prevention associated with implementing the intervention in long-term care facilities is clinically important. [Journal of Gerontological Nursing, 44(6), 15-23.].