Sara M. Bradley

Falls in Older Adults

Falls are prevalent among older adults and can lead to injury, hospitalization, and increased healthcare costs. Environmental hazards, medications, vision problems, and impairments in strength, gait, or balance can increase fall risk. A multifactorial fall-risk assessment including a fall history, physical exam, gait and balance evaluation, and environmental assessment is recommended for all older adults who present with a fall or problem with gait or balance. Multiple-component exercise programs, tai chi, vitamin D supplementation, withdrawal of psychotropic medications, and early cataract surgery have all been shown to reduce fall rates. Multifactorial interventions that include medication review, vision correction, management of orthostasis, environmental modification, and balance, strength, and gait training can also be beneficial in preventing falls.

A Patient Safety and Transitions of Care Curriculum for Third-Year Medical Students

The elderly are the most vulnerable to adverse events during and after hospitalization. This study sought to evaluate the effectiveness of a curriculum on patient safety and transitions of care for medical students during an Internal Medicine-Geriatrics Clerkship on students’ knowledge, skills, and attitudes. The curriculum included didactics on patient safety, health literacy, discharge planning and transitions of care, and postdischarge visits to patients. Analysis of pre- and postassessments showed afterwards students were significantly more comfortable assessing a patient’s health literacy and confident performing a medication reconciliation, providing education regarding medications, and identifying barriers during transitions. More students were able to identify the most common source of adverse events after discharge (86% vs. 62% before), risk factors for low health literacy (28% vs. 14%), and ways to assess a patient’s health literacy (14% vs. 2%). It was feasible to implement a postdischarge visit assignment in an urban tertiary care setting and only required on average of approximately an one and one half hours for students to complete.

Some Smart Approaches to a Tough Problem

The importance of having a large cadre of physicians trained in the care of older adults is, as they say, a “no-brainer.” Not only is the entire U.S. population aging, but the frailest, the oldest-old, are rapidly increasing in number. Currently one in every eight Americans is over the age of 65; by 2040 this number is predicted to be one in every five. One in 53 Americans is age 85 or older; by 2040 it’s predicted to be one in 29 (Administration on Aging, 2010). Yet, as the readers of this journal know, the numbers of geriatricians is not growing. While there have been strides made in both undergraduate and graduate geriatric medical education, we still struggle with recruiting students into the field and getting non-geriatricians to learn the differences between caring for 50 year olds and 80 year olds (Golden, Silverman, & Mintzer, 2012). There currently are only about 7,000 geriatricians in the United States; that translates into 5.3 geriatricians for every 10,000 adults currently over the age of 75; and as the numbers of older adults swell, it will fall to only 1.9 geriatricians per 10,000 adults over the age of 75 by 2040. Only 50% of geriatric medicine fellowship slots are filled yearly, and only 56 fellows trained in geriatric psychiatry in 2009–2010 (American Geriatrics Society, 2013). According to the 2013 Association of American Medical Colleges (AAMC) graduation questionnaire, 15% of all medical students believed their training in the care of geriatric patients was inadequate and only 30% of students had any field experience in a nursing home (AAMC, 2013a). So it is heartening that this issue of Gerontology & Geriatrics Education provides several new and innovative ways to address these concerns, including (a) methods for teaching clinical geriatrics despite limitations in curricular

Evaluation of a Community-Based Program That Integrates Joyful Movement Into Fall Prevention for Older Adults:

Background: Despite the development of evidence-based fall-prevention programs, there remains a need for programming that will engage older adults in real-world settings. Objective: This study aimed to evaluate a community-based group program that integrates joyful movement into fall prevention. The curriculum emphasizes a positive experience of movement, cultivating a healthy body image, and retraining of biomechanics. Design: Program evaluation was conducted using a one-group pre–post test study design. Key outcomes were functional balance and confidence. Qualitative feedback was gathered at the final class sessions. Results: Two hundred fifteen older adults enrolled at four sites over the period from 2010 to 2014. Among 86 participants who provided feedback, most credited the program for an increased sense of optimism and/or confidence (70%), and better walking ability (50%). Among 102 participants who completed both initial and final assessments, there was evidence of significant improvements on the Functional Reach Test (d = .60, p < .001) and Modified Falls Efficacy Scale (d = .17, p < .001). Conclusion: A joyful movement curriculum is acceptable to older participants, and they show improvements in functional balance and confidence. Future research should examine whether the positive changes encouraged by joyful movement lead to lasting reductions in fall risk and additional health benefits.

Medical students' reflections of a posthospital discharge patient visit

ABSTRACT Transitions of care is an important part of patient safety that is not often taught in medical schools. As part of a curriculum for patient safety and transitions of care, third-year medical students followed patients they cared for during their inpatient rotations on a posthospital discharge visit. Students answered reflection questions on these visits, which were reviewed at a group debriefing session. The written reflections and oral debriefings were analyzed qualitatively to identify what medical students were able to learn from a posthospital discharge visit. Of the students who visited patients, 265 participated in the debriefing sessions, and their responses were grouped into 7 domains and 33 themes. Students commented most often on the importance of family and caregivers who provided support for the patient after hospitalization. They identified problems specific to the discharge process and factors that helped or hindered transitions, noted new experiences visiting postacute care facilities, and also developed solutions to improve transitions. Postdischarge visits combined with brief reflection writing and debriefing allowed students to better understand difficulties that can be faced in care transitions.