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OBJECTIVE To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) outbreaks in skilled nursing facilities (SNFs). DESIGN Cross‐sectional study linking county SARS‐CoV‐2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post‐acute and long‐term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020. SETTING AND PARTICIPANTS The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non‐Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks. MEASUREMENTS For Genesis and non‐Genesis SNFs: any outbreak (one or more residents testing positive for SARS‐CoV‐2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing. RESULTS: One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non‐Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) = 9.6–57.7 percentage point; P =.008) difference in the probability of an outbreak for Genesis and non‐Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4–20.8 cases; P =.003) for Genesis SNFs. A 10‐bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6–1.2 percentage point; P <.001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five‐Star ratings or past infection control deficiency citations and probability or severity of outbreak. CONCLUSIONS: Larger SNFs and SNFs in areas of high SARS‐CoV‐2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. J Am Geriatr Soc 68:2167–2173, 2020. See related Special Article by Ouslander et al. in this issue. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents. Design: Secondary analysis from a randomized controlled trial. Setting: SNFs from across the United States (N=264). Participants: Two hundred of the SNFs from the randomized trial that provided baseline and intervention data on INTERACT use. Interventions: During a 12‐month period, intervention SNFs received remote training and support for INTERACT implementation; control SNFs did not, although most control facilities were using various components of the INTERACT program before and during the trial on their own. Measurements: INTERACT use data were based on monthly self‐reports for SNFs randomized to the intervention group and pre‐ and postintervention surveys for control SNFs. Primary outcomes were rates of all‐cause hospitalizations, potentially avoidable hospitalizations (PAHs), ED visits without admission, and 30‐day hospital readmissions. Results: The 65 SNFs (32 intervention, 33 control) that reported increases in INTERACT use had reductions in all‐cause hospitalizations (0.427 per 1,000 resident‐days; 11.2% relative reduction from baseline, p<.001) and PAHs (0.221 per 1,000 resident‐days; 18.9% relative reduction, p<.001). The 34 SNFs (12 intervention, 22 control) that reported consistently low or moderate INTERACT use had statistically insignificant changes in hospitalizations and ED visit rates. Conclusion: Increased reported use of core INTERACT tools was associated with significantly greater reductions in all‐cause hospitalizations and PAHs in both intervention and control SNFs, suggesting that motivation and incentives to reduce hospitalizations were more important than the training and support provided in the trial in improving outcomes. Further research is needed to better understand the most effective strategies to motivate SNFs to implement and sustain quality improvement programs such as INTERACT. [ABSTRACT FROM AUTHOR]

Objectives To determine the most common clinical conditions associated with older adults visiting Urgent care centers (UCCs) and the potential need for further resource use. Design Cross-sectional retrospective study. Setting Nonprofit academic medical center with campuses and multiple satellite offices in Ohio and Florida. Participants Individuals aged 55 and older who visited UCCs between August 2014 and March 2015 (N = 9,445; average age 63.1 ± 10.1, 64% female). Of those, 2,445 had at least one encounter within the same healthcare system within 30 days after the index visit and were included in our final analysis. Measurements 30-day ED visits and hospitalizations. Results Of the 2,445 patients, 578 (23.6%) visited the emergency department ( ED) or were hospitalized, 974 (39.8%) returned to the UCC, and 895 (63.4%) visited their primary care physician's office. A significantly higher proportion (38.4%, n = 68/177) of individuals aged 85 and older visited the ED or were hospitalized within 30 days ( P < .010) than of those younger than 65 (20.0%, n = 273/1,367). Diabetes mellitus (odds ratio ( OR) = 1.73, 95% confidence interval ( CI) = 1.40-2.15, P < .001), coronary artery disease or cerebrovascular disease ( OR = 2.45 CI 1.95-3.09, P < .001), chronic obstructive pulmonary disorder or asthma ( OR = 1.57, 95% CI = 1.23-2.01, P < .001), polypharmacy ( OR = 1.45, 95% CI = 1.18-1.78, P = .004), and cognitive impairment ( OR = 2.74, 95% CI = 1.74-4.31, P < .010) were associated with higher rates of ED visits or hospitalizations within 30 days of the UCC visit. Conclusion Older adults (especially those aged ≥85) and those with conditions such as polypharmacy and dementia are at higher risk of being hospitalized or visit the ED after seeking care at UCCs than younger adults and those without these conditions. [ABSTRACT FROM AUTHOR]

Objectives To determine effects of Sit 'N' Fit Chair Yoga, compared to a Health Education program ( HEP), on pain and physical function in older adults with lower extremity osteoarthritis ( OA) who could not participate in standing exercise. Design Two-arm randomized controlled trial. Setting One HUD senior housing facility and one day senior center in south Florida. Participants Community-dwelling older adults (N = 131) were randomly assigned to chair yoga (n = 66) or HEP (n = 65). Thirteen dropped after assignment but prior to the intervention; six dropped during the intervention; 106 of 112 completed at least 12 of 16 sessions (95% retention rate). Interventions Participants attended either chair yoga or HEP. Both interventions consisted of twice-weekly 45-minute sessions for 8 weeks. Measurements Primary: pain, pain interference; secondary: balance, gait speed, fatigue, functional ability measured at baseline, after 4 weeks of intervention, at the end of the 8-week intervention, and post-intervention (1 and 3 months). Results The chair yoga group showed greater reduction in pain interference during the intervention ( P = .01), sustained through 3 months ( P = .022). WOMAC pain ( P = .048), gait speed ( P = .024), and fatigue ( P = .037 ) were improved in the yoga group during the intervention ( P = .048) but improvements were not sustained post intervention. Chair yoga had no effect on balance. Conclusion An 8-week chair yoga program was associated with reduction in pain, pain interference, and fatigue, and improvement in gait speed, but only the effects on pain interference were sustained 3 months post intervention. Chair yoga should be further explored as a nonpharmacologic intervention for older people with OA in the lower extremities. Trial Registration: ClinicalTrials.gov: NCT02113410. [ABSTRACT FROM AUTHOR]

The author reflects on the efforts to improve urinary continence care for older adults in the U.S. as of 2016, and it mentions American health policies, medical care for the aged in the country, and various aspects of geriatric care in the nation. The author's experiences as a University of California, Los Angeles faculty member are examined, along with pathophysiology, age-related neurological changes, and the relationship between incontinence and impairments in mobility and cognition.

Background Determining if a transfer of a skilled nursing facility (SNF) patient/resident to an acute hospital is potentially avoidable or preventable is challenging. Most previous research on potentially avoidable or preventable hospitalizations is based on diagnoses without in-depth root cause analysis (RCA), and few studies have examined SNF staff perspective on preventability of transfers. Objectives To examine factors associated with hospital transfers rated as potentially preventable versus nonpreventable by SNF staff. Design Trained staff from SNFs enrolled in a randomized controlled clinical trial of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program performed retrospective RCAs on hospital transfers during a 12-month implementation period. Setting SNFs from across the United States. Participants Sixty-four of 88 SNFs randomized to the intervention group submitted RCAs with a rating of whether the transfer was determined to be potentially preventable or nonpreventable. Interventions SNFs were implementing the INTERACT Quality Improvement (QI) program. Measures Data were abstracted from the INTERACT QI tool, a structured, retrospective RCA on hospital transfers. Results A total of 4527 RCAs with a rating of preventability were submitted during the 12-month implementation period, of which 1044 (23%) were rated as potentially preventable by SNF staff. In unadjusted univariate analyses, factors associated with ratings of potentially preventable included acute changes in condition of fever, decreased food or fluid intake, functional decline, shortness of breath, and new urinary incontinence; other factors included the clinician, resident, and/or family insisting on the transfer, transfers that occurred fewer than 30 days from SNF admission and that occurred on weekends, transfers ordered by a covering physician (as opposed to the primary physician), and transfers that resulted in an emergency department (ED) visit with return to the SNF. Factors associated with ratings of nonpreventable included on-site evaluation by a physician or other clinician, and transfers related to falls. Among factors precipitating the transfers, clinician and resident and/or family insistence on transfer, and transfers related to fever and falls remained significant in a multivariate analysis. There were no significant differences among characteristics of SNFs that rated a relatively high versus low proportion of transfers as potentially preventable. Conclusion SNF staff rated a substantial proportion of transfers as potentially preventable on retrospective RCAs. Factors associated with ratings of preventability, as well as illustrative case examples, provide important insights that can assist SNFs in focusing education and care process improvements in order to reduce unnecessary hospital transfers and their associated morbidity and costs. [ABSTRACT FROM AUTHOR]

Background Performing root cause analyses (RCA) on transfers of skilled nursing facility (SNF) patients to acute hospitals can help identify opportunities for care process improvements and education that may help prevent unnecessary emergency department (ED) visits, hospitalizations, and hospital readmissions. Objectives To describe the results of structured, retrospective RCAs performed by SNF staff on hospital transfers to identify lessons learned for reducing these transfers. Design SNFs enrolled in a randomized, controlled implementation trial of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program submitted RCAs on hospital transfers during a 12-month implementation period. Setting SNFs from across the United States that volunteered and met the enrollment criteria for the implementation trial. Participants Sixty-four of 88 SNFs randomized to the intervention group performed and submitted retrospective RCAs on hospital transfers. Interventions SNFs received education and technical assistance in INTERACT implementation. Measures Data were summarized from the INTERACT Quality Improvement (QI) tool, a structured, retrospective RCA on hospital transfers. Results A total of 4856 QI tools were submitted during the 12-month implementation period. Most transfers were precipitated by multiple symptoms and signs, many of them nonspecific. Patient and/or family preference or insistence was noted to have played a role in 16% of the transfers. Hospital transfers were relatively equally distributed among days of the week, and 29% occurred on the night or evening shift. Approximately 1 in 5 transfers occurred within 6 days of SNF admission from a hospital, and 1 in 10 occurred within 2 days of SNF admission. After completing the RCA, SNF staff identified 1044 (23%) of the transfers as potentially preventable. Common reasons for these ratings included recognition that the condition could have been detected earlier and/or could have been managed safely in the SNF, and that earlier advance care planning and discussions with patients and families about preferences for care may have prevented some transfers. Conclusion Summarizing findings from RCAs of transfers of SNF patients to acute hospitals can provide important insights into areas of focus for care process improvements and related education that may help prevent unnecessary ED visits, hospital admissions, and readmissions. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the proportion of nursing home (NH) residents (NHR) with overactive bladder (OAB) or urinary incontinence (UI) with potential pharma-codynamic contraindications to antimuscarinic treatment because of concomitant anticholinergic medications or acetylcholinesterase inhibitors (AChEIs) and nonpharmaco-logical limitations to antimuscarinic treatment. DESIGN: Cross-sectional retrospective analysis. SETTING: U.S. skilled nursing facilities. PARTICIPANTS: Nursing home residents with a diagnosis of OAB or UI. MEASUREMENTS: Linked and deidentified pharmacy claims and Minimum Data Set (MDS) 3.0 records (October 1, 2010 to September 30, 2012). RESULTS: Of NHRs, 71.3% received at least one anticholinergic medication. Medications that can cause or worsen UI were used commonly. AChEIs and antimuscarinic treatment were prescribed concurrently in 24% of NHRs with OAB or UI. NHRs with OAB or UI were more likely to have concurrent moderate to severe cognitive impairment (MSCI) (70.1%) than those without (29.9%) (P < .001). NHRs with or without OAB or UI and with MSCI were more likely to be treated with an anticholinergic medication than those without MSCI (P = .001). When NHRs with MSCI, severe mobility impairment (SMI), and anticholinergic medication and AChEI use were excluded, only a small proportion of NHRs were potential candidates for antimuscarinic treatment (6.6% with OAB or UI, 6.2% with UI). CONCLUSIONS: This study advances understanding of the challenges in prescribing antimuscarinic treatment safely and appropriately in elderly NHRs with a high prevalence of drug interactions, underlying MSCI, and SMI. [ABSTRACT FROM AUTHOR]

An introduction is presented concerning an article by Blaum et al and Naik et al concerning the implementing of patient-centered care in the U.S. healthcare system. [ABSTRACT FROM AUTHOR]

The authors discuss the article "The Age-Friendly Health System Imperative" by Terry Fulmer et al. that appeared in this issue. They mention the work of the John A. Hartford Foundation (JAHF) and the Institute for Healthcare Improvement (IHI) on reforming health care for the aged, the presentation of an effective model for medical care, and the need to incorporate successful evidence-based programs

Objectives Beneficiaries dually eligible for Medicare and Medicaid are of increasing interest because of their clinical complexity and high costs. The objective of this study was to examine the incidence, costs, and factors associated with potentially avoidable hospitalizations ( PAH) in this population. Design Retrospective study of hospitalizations. Setting Hospitalizations from nursing facilities ( NF) including Medicare and Medicaid-covered stays, and Medicaid Home and Community- Based Services ( HCBS) waiver programs. Participants Dually eligible individuals who received Medicare skilled nursing facility ( SNF) or Medicaid NF services or HCBS waiver services in 2005. Interventions None. Measurements Potentially avoidable hospitalizations were defined by an expert panel that identified conditions and associated Diagnostic Related Groups ( DRGs) which can often be prevented or safely and effectively managed without hospitalization. Results More than one-third of the population was hospitalized at least once, totaling almost 1 million hospitalizations. The admitting DRG for 382,846 (39%) admissions were identified as PAH. PAH rates varied considerably among states, and blacks had a higher rate and costs for PAH than whites. Five conditions (pneumonia, congestive heart failure, urinary tract infections, dehydration, and chronic obstructive pulmonary disease/asthma) were responsible for 78% of the PAH. The total Medicare costs for these hospitalizations were $3 billion, but only $463 million for Medicaid. A sensitivity analysis, assuming that 20%-60% of these hospitalizations could be prevented, revealed that between 77,000 and 260,000 hospitalizations and between $625 million and $1.9 billion in expenditures could be avoided annually in this population. Conclusion Potentially avoidable hospitalizations are common and costly in the dually eligible population. New initiatives are needed to reduce PAH in this population as they are costly and can adversely affect function and quality of life. [ABSTRACT FROM AUTHOR]

Objectives To determine whether anemia is a risk factor for functional decline in nursing home ( NH) residents with chronic kidney disease. Design Prospective 26-week observational study. Setting Eighty-two geographically representative NHs in the United States. Participants Three hundred eleven NH residents with chronic kidney disease ( CKD; estimated glomerular filtration rate <60 mL/min per 1.73 m2) who had anemia (hemoglobin <12 g/dL for women, <13 g/dL for men, n = 177) or not (n = 134). Measurements The primary outcome was the distance walked or wheeled for 10 minutes. Secondary outcomes were single chair stand time, grip strength, leg extension strength, Dartmouth Primary Care Cooperative Information scores, Modified Barthel Index, falls, hospitalization, and mortality. Results Mixed-effects model analysis of distance walked or wheeled showed that changes between weeks 2 and 14 but not between weeks 2 and 26 were significantly different between participants with CKD with anemia and those without anemia. There were no significant differences for the other physical performance or self-report measures. After adjustment for an anemia propensity score, participants with CKD with anemia did not have higher rates of hospitalization or death at 26 weeks than those without anemia. Conclusion Nursing home residents with CKD and anemia experienced greater decline than those with CKD without anemia only for a mobility distance task over a 3-month but not a 6-month period and not for other performance or self-report measures. Anemia may not increase the risk of functional decline in NH residents with CKD, but further research is necessary to confirm these findings and evaluate whether a lower hemoglobin cutpoint confers greater risk for functional decline in this population. [ABSTRACT FROM AUTHOR]

OBJECTIVES To evaluate the number of medical and urological conditions associated with nocturia in a cohort of older men who were primary-care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce nocturia and its bother. SUBJECTS AND METHODS Men aged ≥50 years and with two or more episodes of nocturia were recruited from the primary-care clinics at one Veterans Affairs Medical Center to participate in a 4-week, open-label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for nocturia. Outcome measures included self-reported nocturia and bother on the American Urological Association (AUA)-7 Symptom Index, 3-day bladder diaries and self-reported sleep-related measures recorded using 7-day sleep diaries. RESULTS Fifty-five men completed the protocol (mean age 67 years,sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to nocturia. Highly prevalent conditions included moderate-to-severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary-recorded nocturia decreased from 2.6 to 1.9 ( P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a ‘medium’ to a ‘very small’ problem (on a 5-point scale). Sleep diary-derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep). CONCLUSIONS Given that individual older patients often have multiple coexistent risk factors for nocturia, identifying a principal cause of nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced nocturia frequency, bother from nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To test the accuracy of a brief cognitive assessment of nursing home (NH) residents and to determine whether facility nurses can reliably perform this assessment. DESIGN: Cross-sectional, independent cognitive screening tests with NH residents. SETTING: Six Department of Veteran Affairs nursing facilities. PARTICIPANTS: Three hundred seventy-four residents from six regionally distributed Veteran Affairs NHs. MEASUREMENTS: Three cognitive assessment instruments: the Brief Interview of Mental Status (BIMS), created for this study; the Minimum Data Set (MDS) 2.0 Cognitive Performance Scale (CPS), and the Modified Mini-Mental State Examination (3MS) as the criterion standard. The 15-point BIMS tests memory and orientation and includes free and cued recall items. Research assistants administered the 3MS and BIMS to all subjects. Facility nurses administered the same BIMS to a subsample. RESULTS: Three hundred seventy-four of 417 (89.7%) residents approached completed the 3MS and research assistant–administered BIMS (BIMS-R); 212 residents also received a facility nurse–administered BIMS (BIMS-N). The BIMS-R was more highly correlated with the 3MS than was the CPS (Pearson correlation coefficient ( r)=0.79 vs 0.62; P<.01 for difference). For the subset who received facility assessments, the BIMS-N was also more highly correlated with the 3MS (Pearson r=0.74 vs 0.65; P<.01 for difference). For any impairment (3MS<78), the area under the receiver operator characteristic curve (AUC) was 0.86 for the BIMS, versus 0.77 for the CPS. For severe impairment (3MS<48) the AUC was 0.94, versus 0.85 for the CPS. CONCLUSION: In this population, a brief cognitive test is a more accurate approach to cognitive assessment than the current observational methods employed using the MDS 2.0. [ABSTRACT FROM AUTHOR]

Discusses issues on nursing home medical records related to several critical aspects of geriatrics in the U.S. Importance of accuracy of nursing home medical records; Concerns and comments of several professional associations; Improvement on the accuracy of documentation and its link to delivery of geriatric care.

DESIGN: A descriptive, comparative study of preference for UI treatments of frail older adults, family members of nursing home (NH) residents, and LTC nursing staff. Surveys were mailed to families and self-administered by staff. Older adults were interviewed. MEASUREMENTS: Preference rankings between seven paired combinations of five different UI treatments were measured on an 11-point visual analog scale, with the verbal anchors “definitely prefer” this treatment, “probably prefer” this treatment, and “uncertain.” Respondents gave open-ended comments as well. CONCLUSIONS: Although there was wide variation within and between groups about preferred UI treatment, most respondents preferred noninvasive strategies (diapers and PV) to invasive strategies (indwelling catheters and electrical stimulation). Older adults preferred to a greater degree medications and electrical stimulation, therapies directed at the underlying cause of UI. Despite data documenting that diapering is a less time intensive way to manage UI and that toileting programs are difficult to maintain in LTC, nurses viewed PV as “natural” and strongly preferred it to diapering. Several family members and older adults viewed PV as “embarrassing” and “fostering dependence.” These data highlight the need to elicit preferences for UI treatment among LTC residents and their families. [ABSTRACT FROM AUTHOR]

Studies the effectivity of prompted voiding (PV) for nighttime incontinence in nursing homes in the United States. Characteristics of the subjects being studied; Outcomes of daytime nighttime prompted voiding; Comparison between daytime PC and nighttime PV.

Develops a simple, noninvasive assessment strategy that will enable nursing home staff to identify incontinent residents who respond well to prompted voiding. Methods of the study; Results; Comment.

The article focuses on the prevalence of unnecessary hospitalizations of nursing home residents in the U.S. It reveals that hospitalizations are common among Americans who live in nursing homes. The author discusses the problems associated with preventable hospitalization of nursing home residents, particularly the misalignment of Medicare and Medicaid. He argues that a multifaceted approach is needed to improve care and reduce unnecessary complications and costs related to hospitalization.

Presents a biography of the chairman of the Department of Medicine David H. Solomon at the ULCA Medical Center in Torrance, California. His educational background; Academic endeavors of David in the field of medicine; Contributions made by David to the success and development of the 'Journal of the American Geriatrics Society.'

The article presents preliminary results from an ongoing study involving an ethnically diverse sample of older adults residing in south Florida as part of the Healthy Aging Research Initiative. Topics include the risk of diabetes mellitus in older Afro-Caribbeans in the U.S., health behavior, such as regular physician visits, in Afro-Caribbeans, and statistics on glycosylated hemoglobin (HbA1c) levels.

The article discusses the strict requirements for inpatient hospitalization under U.S. Medicare regulations and how it impacts patients and families. The author describes how Medicare Part A's strict definition of a medically necessary inpatient admission results in many elderly patients falling between the cracks of the system because they are considered not sick enough to be hospitalized while at the same time being considered too medically compromised to be discharged home if they live alone.

Comments on the problem of urinary incontinence among adults in the U.S. Prevalence of the condition; Management of urinary incontinence.

The articles in this supplement are based on a conference held in January 2008 sponsored by a grant from the Robert Wood Johnson Foundation. The purpose of the conference was to summarize major findings and methodological issues in previous and ongoing longitudinal studies on aging and to identify potentially fruitful areas for future research. This article is a review and synthesis of the articles in this supplement. Each of the articles makes important contributions to summarizing existing research, identifying challenging methodological issues, or proposing areas that should be explored in future research. Three themes were identified: general improvement in the health status of the population aged 65 and older in the United States, a shift in longitudinal research on aging from a focus on the endpoints of disease to a focus on the preclinical stage and underlying mechanisms of these diseases, and contemporary developments in longitudinal research methodology. A number of practical suggestions were also drawn from the articles reviewed. [ABSTRACT FROM AUTHOR]

Presents a tribute to the endocrinologist and chairman of the Department of Medicine David H. Solomon at the University of California at Los Angeles Center on Aging in California for his contributions to geriatrics and gerontology on his 80th birthday. Details of his birthday celebration; Tribute paid to him by the editors of the 'Journal of the American Geriatrics Society.'

Abstract: The Minimum Data Set (MDS) is a standardized assessment that is completed on all residents admitted to Medicare certified nursing homes in the US. It is also completed on all residents admitted to Veteran Health Administration Community Living Centers. Its content addresses multiple domains of resident health and function and is intended to facilitate better recognition of each resident''s needs. A new version of the MDS, MDS 3.0, was implemented in October, 2010. This article highlights significant clinical changes found in the MDS 3.0, including new structured resident interviews to assess mood, preferences, pain and cognition; inclusion of the Confusion Assessment Method to screen for delirium; revised psychosis and behavior items; revised balance and falls sections; revised bladder and bowel assessment items; revised pressure ulcer assessment items; revisions to the nutrition items; items reporting on resident expectations for return to the community; and changes to race/ethnicity item and language report. These changes aim to improve the clinical utility of these assessment items. [Copyright &y& Elsevier]

Urinary incontinence in the elderly is a significant health problem fraught with isolation, depression, and an increased risk of institutionalization and medical complications. Stress urinary incontinence (SUI), the complaint of involuntary loss of urine during effort or exertion or during sneezing or coughing, is the most com- mon type of urinary incontinence. SUI can seriously degrade the quality of life for many active seniors, and has become an economic challenge for society. With the rapid increase in the active elderly worldwide, SUI is becoming a significant global problem. However, since only a fraction of women with SUI have consulted a physician, the clinical extent and public health impact of SU1 are probably underestimated. The mounting social, medical, and economic problem of SUI in active elderly women as a rapidly growing segment of the population worldwide is reviewed. We evaluate the age-related changes of the lower urinary tract, examine risk factors, and suggest different treatment options shown to be effective in reducing SUI in this population. [ABSTRACT FROM AUTHOR]

An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier Inc., AMDA – the Society for Post-Acute and Long-Term Care Medicine, American Geriatrics Society. Published by Elsevier Inc. All rights reserved.)

Background: In 2014, the Geriatric Emergency Department (GED) Guidelines were published and endorsed by four major medical organizations. The multidisciplinary GED Guidelines characterized the complex needs of the older emergency department (ED) patient and current best practices, with the goal of promoting more cost-effective and patient-centered care. The recommendations are extensive and most EDs then and now have neither the resources nor the hospital administrative support to provide this additional service., Discussion: At the 2021 American Academy of Emergency Medicine's Scientific Assembly, a panel of emergency physicians and geriatricians discussed the GED Guidelines and the current realities of EDs' capacity to provide best practice and guideline-recommended care of GED patients. This article is a synthesis of the panel's presentation and discussion. With the substantial challenges in providing guideline-recommended care in EDs, this article will explore three high-impact GED clinical conditions to highlight guideline recommendations, challenges, and opportunities, and discuss realistically achievable expectations for non-GED-accredited institutions., Conclusions: In 2014, the GED Guidelines were published, describing the current best practices for GED patients. Unfortunately, most of the EDs worldwide do not provide the level of service recommended by the GED Guidelines. The GED Guidelines can best be termed aspirational for U.S. EDs at the present time., (Copyright © 2022. Published by Elsevier Inc.)

Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest.

The pandemic of coronavirus disease of 2019 (COVID-19) is having a global impact unseen since the 1918 worldwide influenza epidemic. All aspects of life have changed dramatically for now. The group most susceptible to COVID-19 are older adults and those with chronic underlying medical disorders. The population residing in long-term care facilities generally are those who are both old and have multiple comorbidities. In this article we provide information, insights, and recommended approaches to COVID-19 in the long-term facility setting. Because the situation is fluid and changing rapidly, readers are encouraged to access frequently the resources cited in this article. J Am Geriatr Soc 68:912-917, 2020., (© 2020 The American Geriatrics Society.)

Background: Medicare incentivizes the reduction of hospitalizations of nursing facility (NF) residents. The effects of these incentives on resident safety have not been examined., Objective: Examine safety indicators in NFs participating in a randomized, controlled trial of the INTERACT Quality Improvement Program., Design: Secondary analysis of a randomized trial in which intervention NFs exhibited a statistically nonsignificant reduction in hospitalizations., Setting: NFs with adequate on-site medical, radiography, laboratory, and pharmacy services, and capability for online training and data input were eligible., Participants: 264 NFs randomized into intervention and comparison groups stratified by previous INTERACT use and self-reported hospital readmission rates., Intervention: NFs randomized to the intervention group received INTERACT materials, access to online training and a series of training webinars, feedback on hospitalization rates and root-cause analysis data, and monthly telephonic support., Measures: Minimum data set (MDS) data for unintentional weight loss, malnutrition, hip fracture, pneumonia, wound infection, septicemia, urinary tract infection, and falls with injury for the intervention year and the year prior; unintentional weight loss, dehydration, changes in rates of falls, pressure ulcers, severe pain, and unexpected deaths obtained from the NFs participating in the intervention through monthly telephone calls., Results: No adverse effects on resident safety, and no significant differences in safety indicators between intervention and comparison group NFs were identified, with 1 exception. Intervention NFs with high levels of INTERACT tool use reported significantly lower rates of severe pain., Conclusions/implications: Resident safety was not compromised during implementation of a quality improvement program designed to reduce unnecessary hospitalization of NF residents., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Despite improvements in selected nursing facility (NF) quality measures such as reduction in antipsychotic use; local, state, and national initiatives; and regulatory incentives, the quality of clinical care delivered in this setting remains inconsistent. Herein, recommendations for overcoming barriers to achieving consistent, high-quality clinical outcomes in long-term (LTC) and post-acute care are provided to address inadequate workforce, suboptimal culture and interprofessional teamwork, insufficiently evidence-based processes of care, and poor adoption and fidelity of technology and integrated clinical decision support. With high staff attrition rates in NFs, mechanisms to measure and close knowledge gaps as well as opportunities for practice simulations should be available to educate and ensure adoption of clinical quality standards on clinician hiring and on an ongoing basis. Multipronged, integrated approaches are needed to further the quest for sustainment of high clinical quality in NF care. In addition to setting a tone for attainment of clinical quality, leadership should champion adoption of practice standards, quality initiatives, and evidence-based guidelines. Maintaining an optimal ratio of hours per resident per day of nurses and nurse aides can improve quality outcomes and staff satisfaction. Clinicians must consistently and effectively apply care processes that include recognition, problem definition, diagnosis, goal identification, intervention, and monitoring resident progress. In order to do so they must have rapid, easy access to necessary tools, including evidence-based standards, algorithms, care plans, during the care delivery process. Embedding such tools into workflow of electronic health records has the potential to improve quality outcomes. On a national and international level, quality standards should be developed by interprofessional LTC experts committed to applying the highest levels of clinical evidence to improve the care of older persons. The standards should be realistic and practical, and basic principles of implementation science must be used to achieve the desired outcomes., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

The Centers for Medicare and Medicaid Services (CMS) finalized a comprehensive update to nursing home requirements of participation in October 2016. Nearly 10,000 public comments were received regarding the proposed rule, and CMS made multiple modifications based on comments from providers, advocacy organizations, and others before issuing the final rule. The final rule describing nursing home requirements of participation modernizes nursing home regulation. It is being implemented in three phases-beginning in November 2016, November 2017, and November 2019. There are multiple provisions that have implications for clinicians caring for nursing home residents, particularly in terms of management of infections, medication prescribing and monitoring, and delegation of medical orders., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Objectives: To test the feasibility and validity of the Brief Interview for Mental Status (BIMS) as a performance-based cognitive screener that could be easily completed by nursing home staff. The current study examines the performance of the BIMS as part of the national testing of the Minimum Data Set 3.0 (MDS 3.0) for Nursing Homes., Methods: The BIMS was tested as part of the national MDS 3.0 evaluation study among 3822 residents scheduled for MDS 2.0 assessments. Residents were from 71 community nursing homes (NHs) in eight states. Residents were randomly included in a feasibility sample (n = 3258) and a validation sample (n = 418). Cognition was assessed with three instruments: the Brief Interview for Mental Status (BIMS), the MDS 2.0 Cognitive Performance Scale (CPS), and the Modified Mini-Mental State Examination (3MS). Trained research nurses administered the 3MS and BIMS to all subjects in the validation study. The CPS score was determined based on the MDS 2.0 completed by nursing home staff who had undergone additional training on cognitive testing. Standard cutoff scores on the 100-point 3MS were used as the gold standard for any cognitive impairment (<78) and for severe impairment (<48). Staff impressions were obtained from anonymous surveys., Results: The BIMS was attempted and completed in 90% of the 3258 residents in the feasiblity sample. BIMS scores covered the full instrument range (0-15). In the validation sample, correlation with the criterion measure (3MS) was higher for BIMS (0.906, P < .0001) than for CPS (-0.739, P < .0001); P < .01 for difference. For identifying any impairment, a BIMS score of 12 had sensitivity = 0.83 and specificity = 0.91; for severe impairment, a BIMS score of 7 had sensitivity = 0.83 and specificity = 0.92. The area under the receiver operator characteristics curve, a measure of test accuracy, was higher for BIMS than for CPS for identifying any impairment (AUC = 0.930 and 0.824, respectively) and for identifying severe impairment (AUC = 0.960 and 0.857, respectively). Eighty-eight percent of survey respondents reported that the BIMS provided new insight into residents' cognitive abilities. The average time for completing the BIMS was 3.2 minutes., Discussion: The BIMS, a short performance-based cognitive screener expressly designed to facilitate cognitive screening in MDS assessments, was completed in the majority of NH residents scheduled for MDS assessments in a large sample of NHs, demonstrating its feasibility. Compared with MDS 2.0 observational items, the BIMS performance-based assessment approach was more highly correlated with a criterion cognitive screening test and demonstrated greater accuracy. The majority of surveyed staff reported improved assessments with the new approach., (Published by Elsevier Inc.)

Rehospitalization within 30 days consumes a significant portion of health care costs; therefore, interventions aimed at reducing the risk of rehospitalization are needed. A retrospective study was conducted examining rehospitalization rates and diagnoses according to discharge location and comparing characteristics of older adults within 7 and 30 days of discharge from a community hospital. Data on rehospitalization for Medicare fee-for-service patients (75 and older) over a 12-month period were obtained from the information technology department of a not-for-profit community hospital. A total of 6,809 patients were discharged, with 12% rehospitalized within 30 days. Skilled nursing facilities had the highest rehospitalization rates (15%), followed by home with home health care (13%) and then home with self-care (8%). The highest rehospitalization rates were in areas where nursing has a strong presence, suggesting that nurses can play an important role in the development of interventions aimed at reducing rehospitalizations., (Copyright 2012, SLACK Incorporated.)

The purpose of this article is to report the results of a pilot study of the relationship between cognitive impairment and medication self-management errors in older adults discharged home from a community hospital. It is hoped that these preliminary data will provide some new ideas for reducing errors in medication self-management posthospitalization.

A substantial proportion of hospitalizations of nursing home (NH) residents may be avoidable. Medicare payment reforms, such as bundled payments for episodes of care and value-based purchasing, will change incentives that favor hospitalization but could result in care quality problems if NHs lack the resources and training to identify and manage acute conditions proactively. Interventions to Reduce Acute Care Transfers (INTERACT) II is a quality improvement intervention that includes a set of tools and strategies designed to assist NH staff in early identification, assessment, communication, and documentation about changes in resident status. INTERACT II was evaluated in 25 NHs in three states in a 6-month quality improvement initiative that provided tools, on-site education, and teleconferences every 2 weeks facilitated by an experienced nurse practitioner. There was a 17% reduction in self-reported hospital admissions in these 25 NHs from the same 6-month period in the previous year. The group of 17 NHs rated as engaged in the initiative had a 24% reduction, compared with 6% in the group of eight NHs rated as not engaged and 3% in a comparison group of 11 NHs. The average cost of the 6-month implementation was $7,700 per NH. The projected savings to Medicare in a 100-bed NH were approximately $125,000 per year. Despite challenges in implementation and caveats about the accuracy of self-reported hospitalization rates and the characteristics of the participating NHs, the trends in these results suggest that INTERACT II should be further evaluated in randomized controlled trials to determine its effect on avoidable hospitalizations and their related morbidity and cost., (© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.)