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A Breakthrough in Preventing Falls, Providing Cognitive Therapy for Seniors, and Reducing Rehospitalizations through Automated Alerts Are Focus of Research Presented at AGS Annual Scientific Meeting

April 11th, 2013

NEW YORK — A groundbreaking intervention that prevents falls in nursing homes by improving communications; a new approach to countering cognitive loss among older patients in intensive care units; and a pilot project that sheds new light on the complexities of using health information technology (HIT) to prevent hospital readmissions will be presented at the AGS’ upcoming 2013 Annual Scientific Meeting. 

The meeting, which will run from May 3 through 5 in Grapevine, Texas, is the premier educational event in geriatrics, covering the latest in clinical care, research in aging, and inn ovative models of care. The three papers, judged the best among several hundred submissions by their peers, will be presented on May 4. 

A New Program for Falls Prevention in Nursing Homes 

Falls are a leading cause of injury and death among older adults, and are particularly common in nursing homes. Falls-prevention programs have proved successful in research trials. But often, the programs’ efficacy isn’t sustained once the research has been completed and nursing home staff have taken  responsibility for executing it. Why? Because communication, problem solving, and connections among nursing home staff are often inadequate, explains Cathleen S. Colon-Emeric, MD, lead author of the first of the three studies. 

“The entire nursing home team—physical therapists, nursing assistants, nurses, physicians, activities directors, social workers -- needs to coordinate these fairly complex falls prevention programs,” explains Dr. Colon-Emeric, of Duke University Medical Center. “If the staff don’t regularly meet and work together, or if there are hierarchical management practices that inhibit people from talking to other people, these programs can be difficult to implement and sustain.” 

To address this, Dr. Colon-Emeric and colleagues developed CONNECT, a program that helps staff: identify and bridge communication gaps; appreciate the importance of sharing information across disciplines; and use strategies that foster stronger connections with their co-workers to improve falls programs. The researchers, who also provided a comprehensive falls prevention program dubbed FALLS, then randomly assigned 8 nursing homes to implement either the combined CONNECT and FALLS interventions, or the FALLS program alone, for 6 months. Nursing homes in the combination group showed significant improvement in areas such as perceived communication quality, participation in decision making, safety, and caregiving quality. They also saw a 12% decrease in falls. In contrast, homes using the FALLS program alone saw no decline in falls.  The researchers are now conducting a larger study to confirm the impact on resident falls. Providing Cognitive Therapy for Elderly Patients in Intensive Care Units is Feasible. 

Providing Cognitive Therapy for Elderly Patients in Intensive Care Units is Feasible 

Hospitalizations, particularly stays in intensive care units (ICUs), increase older adults’ risks of cognitive impairment. Cognitive therapy (CT) can improve cognitive function in some patients but has not been previously studied among the critically ill. Early physical and occupational therapy interventions are associated with better functional outcomes in the critically ill, but it is unknown if older adults to participate in CT while still in intensive care. 

To determine whether this might be feasible, researchers at Vanderbilt Medical School randomly assigned 87 critically ill patients to one of three groups within 72 hours of admission to the ICU. Because critically ill patients often need both physical therapy (PT) and cognitive therapy, the researchers assigned one group to roughly 20 minutes of CT twice daily and 25 minutes of PT once daily followed by 12 weeks of in-home CT; the second group, to 25 minutes of PT daily; and the third (control) group, to PT as clinically necessary. 

“The majority of patients in the study — 95 percent — were able to undergo some kind of CT, and those patients were able to do it nearly all of their days in the ICU,” notes lead researcher Nathan E. Brummel, MD. “This type of intervention appears feasible.” 

Next on the researchers’ list is developing protocols for identifying those patients most likely to develop cognitive impairment following the ICU, and determining whether providing CT in intensive care can alter patients’ long-term outcomes.  

Lessons Learned from Using Health Information Technology (HIT) to Cut Seniors’ Hospital Readmission Rates   

Roughly 20 percent of older adults are readmitted to the hospital within 30 days of discharge.  The lack of continuity of care during transitions to ambulatory settings is a common contributor to readmissions. 

“A great deal occurs during transitions,” explains Jerry H. Gurwitz, MD, of the University of Massachusetts Medical School, the lead author of the study. “An estimated 40 percent of the medications that older patients were taking before they were hospitalized are discontinued during hospitalization, and about 45 percent of those they’re taking at discharge are started in the hospital. So it’s very important to ensure that there’s adequate flow of information from the hospital to the patient’s primary care physician—at or soon after discharge.”  

With this in mind, Dr. Gurwitz and colleagues designed a randomized, year-long, health information technology (HIT)–based transitional care intervention, and randomly enrolled more than 3,600 older patients newly discharged from the hospital to ambulatory settings. The researchers automatically alerted the intervention patients’ healthcare providers of their hospitalizations and discharges. They also identified any new drugs that these patients were taking; alerted the providers to potential drug-drug interactions; recommended follow-up laboratory testing, and reminded the providers’ staff to schedule post-discharge office visits. Comparing the intervention and control groups, the researchers found no significant differences in the incidence of re-hospitalizations within 30 days of discharge. 

Nevertheless, the study provides valuable insights about the limits of provider-focused, HIT-based interventions to reduce the risk of rehospitalizations. One major lesson learned was the need to directly engage patients and caregivers in transitional care interventions. “Family caregivers’ involvement is a crucial element and we didn’t include them in the intervention at all,” says Dr. Gurwitz, who hopes to conduct follow-up studies that will incorporate this missing component. 

To schedule an interview with these researchers please contact Jillian Akavan at 347-491-9309 or jakavan@americangeriatrics.org.

About the American Geriatrics Society
The American Geriatrics Society (AGS) is a not-for-profit organization of nearly 6,000 health professionals devoted to improving the health, independence and quality of life of all older people. The Society provides leadership to healthcare professionals, policy makers and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy.

Modified On: November 18th, 2013