Highlights What is the primary question addressed by this study? Do older adults who participate in evidence-based community health programming experience improvement in loneliness and social isolation? What is the main finding of this study? Older adults who met with a health coach and participated in a single session of community exercise programming reported decreased loneliness and social isolation at 6 months post-participation, compared to their baseline scores. What is the meaning of the finding?Facilitating enrollment of older adults into community exercise programs may assist with alleviating loneliness and social isolation in addition to other health benefits previously proven by these evidence-based programs.
In addition to medical diseases, psychological, social, cognitive, and functional issues influence the health of older persons. Therefore, the traditional medical assessment alone is often not enough to evaluate the older population with multiple comorbidities. Out of this recognized need, the geriatric assessment has been developed, which emphasizes a broader approach to evaluating contributors to health in older persons. Geriatric assessment uses specific tools to help determine patient's status across several different dimensions, including assessment of medical, cognitive, affective, social, economic, environmental, spiritual, and functional status. This article reviews specific tools that practitioners can use in their screening for the following geriatric syndromes: hearing impairment, vision impairment, functional
Objective To evaluate outcomes associated with an integrated inpatient and outpatient program aimed at optimizing the care of geriatric fracture patients in a mixed community and academic health system setting. Data Sources and Study Setting This study took place at a tertiary‐care, 886‐bed hospital system. The Geriatric Fracture Program (GFP) was designed in 2018 using the 4Ms Framework (What Matters, Medication, Mentation, and Mobility). Patients ≥65 years old with non‐spine fractures managed by orthopedic faculty surgeons and participating hospitalist groups were included. A fracture liaison team educated patients regarding bone health and ensured ambulatory geriatrics follow‐up. Outpatient geriatric visits focused on mobility, fall risk, bone health imaging, and medications. Study Design We compared GFP‐enrolled patients (n = 746) to patients seen by non‐GFP‐participating physicians (n = 852) and used a generalized estimating equations approach and Poisson models to analyze associations between participation in the GFP program and four inpatient outcomes (time to surgery, length of stay, Vizient length of stay index, and total direct costs). We examined outcomes across all fractures and also stratified them by fracture type (hip vs. non‐hip). We descriptively examined post‐discharge care outcomes: fall, gait, and balance assessments; bone health imaging; and medications. Data Collection/Extraction Methods We collected data through chart reviews/electronic health record extracts from July 2018 to June 2021. Principal Findings GFP‐enrolled patients with all fracture types had a significantly lower length of stay (marginal effect [ME]: −2.12, 95%CI: −2.61, −1.63), length of stay index (ME: −0.33, 95%CI: −0.42, −0.25), and total direct costs (ME: −$5316, 95%CI: −$6806, −$3826); the magnitude of the effects was greater for non‐hip fractures. There was no significant difference in time to surgery. Of 746 GFP patients, 170 (23%) had a post‐discharge visit with a participating geriatrician ≥6 months. Conclusions A systematic approach to improving care for older adults with fractures improved length of stay and total direct costs.
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