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Background Although prior literature suggests that metoprolol may worsen glucose control compared to carvedilol, whether this has clinical relevance among older adults with diabetes and heart failure remains an open question. Methods This was a US retrospective cohort study utilizing data sourced from a 50% national sample of Medicare fee-for-service claims of patients with Part D prescription drug coverage (2007-2017). Among patients with diabetes and heart failure we identified initiators of metoprolol or carvedilol, which were 1:1 propensity score matched on >90 variables. The primary outcome was initiation of a new oral or injectable antidiabetic medication (proxy for uncontrolled diabetes); secondary outcomes included initiation of insulin and severe hyperglycemic event (composite of emergency room visits or hospitalizations related to hyperglycemia). Results Among 24 239 propensity score-matched pairs (mean [SD] age 77.7 [8.0] year; male (39.1%)), there were 8150 [incidence rate per 100 person-years (IR) = 33.5] episodes of antidiabetic medication initiation among metoprolol users (exposure arm) compared to 8576 [IR = 33.4] among carvedilol users (comparator arm) compared to corresponding to an adjusted hazard ratio [aHR] of 0.97 (95% CI: 0.94, 1.01). Similarly, metoprolol was not associated with a significant increase in the risk of secondary outcomes including insulin initiation: aHR of 0.98 (95% CI: 0.93, 1.04)) and severe hyperglycemic events: aHR of 0.98 (95% CI: 0.93, 1.02). Conclusions In this large study of older adults with heart failure and diabetes, initiation of metoprolol compared to carvedilol was not associated with an increase in the risk of clinically relevant hyperglycemia. This article is protected by copyright. All rights reserved.

The purpose of this study was to determine the responses of individuals with advanced dementia to two novel sensory environments in a nursing home facility. The first was a multisensory Snoezelen room; the second was a temporary Japanese garden. Subjects viewed each environment twice a week for 15 minutes during the study. Stress was measured using heart rate and informant-based behavioral changes. By these criteria, the garden-viewing group showed positive behavioral changes while the responses of the subjects in the Snoezelen group were more negative. The response of the subjects' pulse rate was most dramatic. During the 15 minutes in the garden, the average rate (all subjects/all visits) was significantly less than in their residential room. In the Snoezelen room, we detected little or no change. The impact of the garden could also be seen in the negative behavioral signs elicited upon returning the subjects to the garden room after the installation had been replaced with plants and furniture arranged with no formal design. We propose that exposure to a small interior Japanese garden could be an effective intervention for individuals suffering from late stage Alzheimer's disease.

Objectives: To describe the interventions for adult protective service (APS) clients referred for geriatric assessment. Design: Retrospective cohort study. Setting: In-home geriatric assessments conducted in two New Jersey counties. Participants: Two hundred eleven APS clients; 74% female; mean age 77. Measurements: Cognition, affect, nutrition, prevalence of selected medical diagnoses and functional conditions, and categories of interventions. Results: Home health agency services were initiated for 46% of APS clients suffering from all forms of mistreatment. Institutional placements (36%) and guardianship interventions (36%) were correlated with caregiver neglect, especially in female APS clients and those diagnosed with dementia. Urgent medications (25%) were prescribed across all mistreatment classifications, and acute hospitalization (20%) was correlated with circumstances of physical abuse. Conclusion: An in-home geriatric assessment service was able to contribute at least one relevant intervention for 81% of referred APS clients to collaboratively help mitigate elder mistreatment circumstances.

Geriatrics healthcare providers need to be aware of the effect that culture has on establishing treatment priorities, influencing adherence, and addressing end-of-life care issues for older patients and their caregivers. The mnemonic ETHNIC(S) (Explanation, Treatment, Healers, Negotiate, Intervention, Collaborate, Spirituality/Seniors) presented in this article provides a framework that practitioners can use in providing culturally appropriate geriatric care. ETHNIC(S) can serve as a clinically applicable tool for eliciting and negotiating cultural issues during healthcare encounters and as a new instructional strategy to be incorporated into ethnogeriatric curricula for all healthcare disciplines.

The U.S. health care system serves a diverse population, often resulting in significant disparities in delivery and quality of care. Nevertheless, most quality improvement efforts fail to systematically assess diversity and associated disparities. This article describes application of the multimethod assessment process (MAP) for understanding disparities in relation to diversity, cultural competence, and quality improvement in clinical practice. MAP is an innovative quality improvement methodology that integrates quantitative and qualitative techniques and produces a system level understanding of organizations to guide quality improvement interventions. A demonstration project in a primary care practice illustrates the utility of MAP for assessing diversity.

Introduction The need to define and assess optimal strategies for influencing attitudes and facilitating skills development in providing culturally appropriate care is a critical challenge to academic medicine. To address this we created and tested the ETHNICS (Explanation, Treatment, Healers, Negotiate, Intervention, Collaboration, and Spirituality) mnemonic. Methods This is a didactic session and series of handouts on the ETHNICS mnemonic pioneered by the authors. The active learning component includes a facilitated small-group session with two role-plays that allow learners to explore their own health beliefs and practice utilizing the ETHNICS mnemonic. Results The clinical tool and small group facilitator's guide have been used by 158 first-year medical students. The session was highly rated by all first-year medical students for session planning and organization, meeting stated learning objectives, and facilitation. Discussion The ETHNICS mnemonic provides a framework for cross-cultural interviewing that physicians and other healthcare professionals can use in providing culturally appropriate geriatric care. This resource may be used for teaching cross-cultural interviewing with residents, fellows, and interdisciplinary health care professionals.

Healthcare providers can enhance the effectiveness and efficiency of the care they provide by recognizing their patients' health literacy. Health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." It is a measure of the clarity of the communication between the healthcare system and the patient. The consequences that can occur when the patients' health literacy is not addressed include: poorer health status, high rates of health services use, compromised patient safety, and increased health care costs. The mnemonic SPEAK (Speech, Perception, Education, Access, and Knowledge) provides a simple framework that healthcare providers can use to enhance their own awareness of health literacy components during patient care. Case examples show how the mnemonic can be used in everyday practice.

Purpose: We sought to determine the prevalence of remediable health conditions from in-home geriatric assessments of referred adult protective service (APS) clients suffering elder mistreatment. Design and Methods: We used a retrospective cohort study of 21 1 APS clients (74% female; age, M = 77 years) in two central New Jersey counties. Results: Dementia was the most frequent diagnosis (62% prevalence) and was positively correlated with occurrences of financial exploitation (R= .199; p= .01) and caregiver neglect (R = .174; p= .03) among female APS clients. Depression (37% prevalence), hypertension (36%), involuntary weight loss (34%), pain (32%), and falling (26%) all appeared equally distributed, though urinary incontinence (23% prevalence) was strongly correlated with circumstances of caregiver neglect (R = .31; p = .003). Implications: This new effort to link APS workers with geriatric clinicians conducting in-home health assessments proved effective for identifying a high prevalence of remediable health conditions among APS clients suffering various manifestations of elder mistreatment.

To describe the interventions for adult protective service (APS) clients referred for geriatric assessment.Retrospective cohort study.In-home geriatric assessments conducted in two New Jersey counties.Two hundred eleven APS clients; 74% female; mean age 77.Cognition, affect, nutrition, prevalence of selected medical diagnoses and functional conditions, and categories of interventions.Home health agency services were initiated for 46% of APS clients suffering from all forms of mistreatment. Institutional placements (36%) and guardianship interventions (36%) were correlated with caregiver neglect, especially in female APS clients and those diagnosed with dementia. Urgent medications (25%) were prescribed across all mistreatment classifications, and acute hospitalization (20%) was correlated with circumstances of physical abuse.An in-home geriatric assessment service was able to contribute at least one relevant intervention for 81% of referred APS clients to collaboratively help mitigate elder mistreatment circumstances.