BACKGROUND: Healthcare providers may not offer patient portal (PP) access to electronic health records (EHRs) to their patients older than 85 years, due to the false impression that they do not utilize technology. It is imperative that older adults be given equal opportunity to use technology in regard to their healthcare. OBJECTIVE: To characterize the content and frequency of use of PP messaging tethered to EHRs by older adults, aged 85 years and older, and their caregivers. DESIGN, SETTING, AND PARTICIPANTS: User-initiated communications from electronic PPs (MyChart) tethered to an EHR (Epic) for patients who were 85 years and older, receiving care at outpatient internal medicine and geriatric clinics at an academic health center from July 1, 2016, to December 31, 2016, were reviewed retrospectively and analyzed with mixed methods. RESULTS: A total of 1254 user-initiated messages, sent by 62 patients aged 85 years and older (mean age = 87.9 years; n = 576 messages; mean = 9.9 messages per person) and 82 caregivers (n = 678 messages; mean = 7.8 messages per person), were analyzed. Qualitative analysis revealed 12 main themes: clinical issues, medication/vaccine questions, medication refills, laboratory orders/results, therapy/ durable medical equipment, care coordination, care transitions, scheduling, appreciation/thank you, administrative/ billing, telephone requests, and death notification. Caregivers significantly initiated messages more for care transitions (P < .001). Patients significantly initiated messages more for scheduling (P = .04) and medication refills (P = .04). Patients who had heart failure, coronary artery disease, or Alzheimerʼs disease were significantly more likely to have caregivers using the PP as their proxy (30.7% vs 21.6%; P = .01).

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Many older adults wish to age-in-place but do not have long-term care plans for when they may require more assistance. PlanYourLifespan.org (PYL) is an evidence-based tool that helps older adults understand and plan for their long-term care needs. We examined the long-term effects of PYL use on user perceptions and planning of long-term care services. Individuals who previously accessed PYL were invited to complete an online, nation-wide mixed methodology survey about end-user outcomes related to PYL. Among 115 completed surveys, users found PYL helpful with long-term planning for their future needs. Over half of website users reported having conversations with others because of PYL use. However, 40% of respondents reported not having a conversation with others about their plans; common themes for barriers to planning included procrastination and a lack of immediate support needs. Although PYL helps with planning, many people are still not communicating their long-term care plans.

BACKGROUND Hospitalized seniors are frequently too sick to make informed decisions about their postdischarge care. Subsequently, loved ones often make support choices (eg, skilled nursing facility placement, caregivers) at discharge. We sought to advance the timeline for postacute care decisions to before a hospitalization occurs. OBJECTIVE Investigate the effect of PlanYourLifespan.org (PYL) on knowledge of posthospital discharge options. DESIGN Multisite randomized controlled trial. SETTING/PATIENTS Nonhospitalized adults, aged ≥65 years, living in urban, suburban, and rural areas of Texas, Illinois, and Indiana. INTERVENTION PYL is a national, publicly available tool that provides education on posthospital therapy choices and local home-based resources. MEASUREMENTS Participants completed an in-person baseline survey, followed by exposure to intervention or attention control (AC) websites, then 1-month and 3-month telephone surveys. The primary knowledge outcome was measured with 6 items (possible 0–6 points) pertaining to hospital discharge needs. RESULTS Among 385 participants randomized, mean age was 71.9 years (standard deviation 5.6) and 79.5% of participants were female. At 1 month, the intervention group had a 0.6 point change (standard deviation = 1.6) versus the AC group who had a −0.1 point change in knowledge score. Linear mixed modeling results suggest sex, health literacy level, level of education, income, and history of high blood pressure/kidney disease were significant predictors of knowledge over time. Controlling for these variables, treatment effect remained significant (P < 0.0001). CONCLUSION Seniors who used PYL demonstrated an increased understanding of posthospitalization and home services compared to the control group. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT0 2256072.

Purpose of Study: Older adults frequently choose not to accept recommended social support services (e.g., caregiver and home therapy). Social workers/case managers (SWs/CMs) are often caught in the conflict encouraging patients to accept services, but facing resistance. As a result, older adults may experience unsafe home scenarios and hospital discharges. This research sought to examine whether business school negotiation and dispute resolution (NDR) training could ease these conflicts and potentially improve outcomes for both older adults and SWs/CMs. Practice Settings: Urban health care system (pilot), national case management conference (implementation). Methodology and Sample: Researchers tailored the NDR training, offered at graduate business schools, for SWs/CMs. Researchers then pilot tested the NDR training at an urban hospital and implemented it with a national cohort of SWs/CMs at a national case management conference. Participants completed a survey that ascertained conflicts, utility of the NDR program, real-world applicability, and future directions. Results: Eighty-five SW/CM participants, from 22 states, completed the NDR training and survey. Participants reported experiencing conflicts frequently in their workday. Post-NDR training, respondents were very positive about the knowledge gained from the course, specifically noting themes of learning the negotiation basics, tactics (e.g., framing), and integrative strategies (e.g., win-win/expanding to multi-issue discussions). All participants planned to use the NDR skills in the future. Implications for Case Management Practice: The NDR training program can provide SWs/CMs with formal strategies to facilitate older adults' acceptance of social services while balancing patient autonomy. Learning negotiating techniques can be “win-win” for both older adults' home safety and case manager well-being.