scholarly journals Engaging Older Veterans With Serious Mental Illness in Physical Activity: In-Person, Remote, and Hybrid Models

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 205-206
Author(s):  
Sera Havrilla ◽  
Alicia Lucksted ◽  
Deborah Medoff ◽  
Karen Fortuna ◽  
Amanda Peeples ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Mental Illness ◽  
Lived Experience ◽  
Serious Mental Illness ◽  
Complex Care ◽  
Care Needs ◽  
Coaching Intervention ◽  
Peer Specialists ◽  
Complex Care Needs

Abstract Older adults with serious mental illness (SMI) have complex care needs across medical, psychiatric, cognitive, and social domains. This growing population exhibits high levels of medical comorbidity and sedentariness. Innovative interventions that promote holistic recovery for this group are needed, especially in the context of the COVID-19 pandemic. Peer Education on Exercise for Recovery (PEER) is a peer coaching intervention, delivered by VA Peer Specialists (Veterans with lived experience of mental illness), to promote exercise and physical activity among older adults with SMI. This paper will present on three different models of PEER: fully in-person, fully remote, and a hybrid model with both in-person and remote elements. Preliminary data indicates that PEER is (1) engaging and well-liked, (2) associated with greater sustained increases in physical activity compared to an active control, and (3) can lead to sustained physical activity increases that are resilient to situational constraints such as physical distancing.

scholarly journals Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study (Preprint)

2020 ◽  
Author(s):  
Carolyn Steele Gray ◽  
Terence Tang ◽  
Alana Armas ◽  
Mira Backo-Shannon ◽  
Sarah Harvey ◽  
...  
Keyword(s):  
Older Adults ◽  
Phase 1 ◽  
Care Transitions ◽  
Self Management ◽  
Complex Care ◽  
Phase 2 ◽  
Care Needs ◽  
Centered Care ◽  
Hospital To Home ◽  
Complex Care Needs

BACKGROUND Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home. OBJECTIVE This protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning and self-management in primary care settings. This project poses three overarching research questions that focus on adapting the technology to local contexts, evaluating the impact of the Digital Bridge in relation to the quadruple aim, and exploring the potential to scale and spread the technology. METHODS The study includes two phases: workflow co-design (phase 1), followed by implementation and evaluation (phase 2). Phase 1 will include iterative co-design working groups with patients, caregivers, hospital providers, and primary care providers to develop a transition workflow that will leverage the use of Care Connector and ePRO to support communication through the transition process. Phase 2 will include implementation and evaluation of the Digital Bridge within two hospital systems in Ontario in acute and rehab settings (600 patients: 300 baseline and 300 implementation). The primary outcome measure for this study is the Care Transitions Measure–3 to assess transition quality. An embedded ethnography will be included to capture context and process data to inform the implementation assessment and development of a scale and spread strategy. An Integrated Knowledge Translation approach is taken to inform the study. An advisory group will be established to provide insight and feedback regarding the project design and implementation, leading the development of the project knowledge translation strategy and associated outputs. RESULTS This project is underway and expected to be complete by Spring 2024. CONCLUSIONS Given the real-world implementation of Digital Bridge, practice changes in the research sites and variable adherence to the implementation protocols are likely. Capturing and understanding these considerations through a mixed-methods approach will help identify the range of factors that may influence study results. Should a favorable evaluation suggest wide adoption of the proposed intervention, this project could lead to positive impact at patient, clinician, organizational, and health system levels. CLINICALTRIAL ClinicalTrials.gov NCT04287192; https://clinicaltrials.gov/ct2/show/NCT04287192 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/20220

scholarly journals Geriatric Resource Teams: Equipping Primary Care Practices to Meet the Complex Care Needs of Older Adults

Geriatrics ◽  
2019 ◽  
Vol 4 (4) ◽  
pp. 59 ◽  
Author(s):  
Gwendolen Buhr ◽  
Carrissa Dixon ◽  
Jan Dillard ◽  
Elissa Nickolopoulos ◽  
Lynn Bowlby ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Cognitive Impairment ◽  
Assessment Process ◽  
Complex Care ◽  
Care Needs ◽  
Care Practices ◽  
Primary Care Practices ◽  
Complex Care Needs ◽  
The Impact

Primary care practices lack the time, expertise, and resources to perform traditional comprehensive geriatric assessment. In particular, they need methods to improve their capacity to identify and care for older adults with complex care needs, such as cognitive impairment. As the US population ages, discovering strategies to address these complex care needs within primary care are urgently needed. This article describes the development of an innovative, team-based model to improve the diagnosis and care of older adults with cognitive impairment in primary care practices. This model was developed through a mentoring process from a team with expertise in geriatrics and quality improvement. Refinement of the existing assessment process performed during routine care allowed patients with cognitive impairment to be identified. The practice team then used a collaborative workflow to connect patients with appropriate community resources. Utilization of these processes led to reduced referrals to the geriatrics specialty clinic, fewer patients presenting in a crisis to the social worker, and greater collaboration and self-efficacy for care of those with cognitive impairment within the practice. Although the model was initially developed to address cognitive impairment, the impact has been applied more broadly to improve the care of older adults with multimorbidity.

scholarly journals Self-management in older adults: how to delineate self-management ability, self-management behavior, and self-management support?

2020 ◽  
Author(s):  
Klaske Wynia ◽  
Karin Veldman ◽  
Sophie Spoorenberg ◽  
Maarten Lahr ◽  
Menno Reijneveld
Keyword(s):  
Older Adults ◽  
Integrated Care ◽  
Elderly Care ◽  
Self Management ◽  
Complex Care ◽  
Management Support ◽  
Care Needs ◽  
Risk Profiles ◽  
Management Ability ◽  
Complex Care Needs

Abstract Background: Self-management is a key element in person-centered and integrated care. It involves several related concepts, such as self-management ability, behavior, and support. These concepts are poorly delineated. The aim of this study was to examine hypothesized associations between self-management ability, behavior, and support in older adults (taking their frailty and complexity of care needs into account) and to examine underlying aspects of these concepts, if these hypotheses lacksupport.Methods: Cross-sectional data from the Embrace study, a stratified randomized controlled trial, evaluating person-centered and integrated care in Dutch community-living older adults, were used. Participants (n=537) were aged 75 and older, assigned to health-related risk profiles based on self-reported frailty and complexity of care needs. Ability was assessed with the Self-Management Ability Scale, behavior with the Partner in Health Scale for Older Adults, and support with the Patient Assessment of Integrated Elderly Care.Results: Ability and behavior were positively associated for participants with the risk profiles “Robust” and “Complex care needs” (betas are 0.38 and 0.46). Coping (an aspect of behavior) turned out to be a key element for participants with risk profiles “Robust” and “Complex care needs” (betas ranging from 0.13 to 0.45). Support was associated with aspects of behavior, varying per risk profile.Conclusion: We found no associations for self-management on the conceptual level, but the aspect coping did appear to play a major role. Improving coping strategies of older adults may be a promising way of enhancing self-management ability, and of reducing the need for self-management support.

scholarly journals Group-Based Smoking Cessation Program for Older Adults with Serious Mental Illness

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 864-864
Author(s):  
Heather Leutwyler ◽  
Erin Hubbard
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Mental Illness ◽  
Smoking Cessation ◽  
Serious Mental Illness ◽  
Physical Activity Intervention ◽  
Controlled Trial ◽  
Structured Interview ◽  
Smoking Cessation Counseling ◽  
Excess Morbidity

Abstract Smoking is one of the most important modifiable risk factors for excess morbidity and mortality in older adults with serious mental illness (SMI). Many older smokers with SMI are reportedly motivated to quit, however evidence-based treatment targeting this vulnerable group is limited. To address an urgent need to identify interventions that assist smoking cessation efforts, we are conducting a pilot two-arm randomized controlled trial (RCT) targeting adults with SMI. Our VIdeogame-based Physical activity (“VIP”) smoking cessation intervention includes: a) group videogame-based physical activity intervention (50 minutes, 3X/week for 12 weeks), b) pharmacotherapy (bupropion or nicotine replacement therapy), and c) smoking cessation counseling. Upon completion of the 12 week program, participants in the VIP and control groups completed a semi-structured interview in order to determine how the program impacted their smoking cessation. To date, six participants completed an interview. Participants described how the program helped with smoking cessation because it allowed them to “face their addiction” and learn more about why they smoke and how to quit. The program provided the structure, resources, and encouragement needed to start the process of quitting. Finally, they enjoyed having the game time as a distraction from smoking. Older adults with SMI need support, resources, and group-based exercise as they begin quitting and practice the skills needed to quit.

scholarly journals Assisted Living Care for Special Populations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 676-676
Author(s):  
Philip Sloane ◽  
Sheryl Zimmerman
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Assisted Living ◽  
Sleep Disturbances ◽  
Future Research ◽  
Care Needs ◽  
Term Care ◽  
State Study ◽  
Hospice Use

Abstract Assisted living (AL) is a notable provider of residential long-term care for older adults; there are almost twice as many AL communities as nursing homes, and they provide care to more than 800,000 older adults. As AL has evolved, it has come to serve more individuals with cognitive, mental, and health care needs. For example, 70% of residents have sleep disturbances, 42% have moderate/severe dementia, and mortality rates average 14% annually. Care needs include those for behaviors such as agitation, serious mental illness, and at the end-of-life. However, not all AL communities provide similar care. This symposium will use national data and data from a seven state study of 250 AL communities to focus on four populations receiving care in AL: persons with dementia, serious mental illness, sleep disturbances, and on hospice. The first speaker will discuss how AL staff conceive of and respond to behavioral expressions of persons with dementia; the second will focus on the use of psychosocial/environmental practices for persons with dementia in AL. The third speaker will discuss the growing proportion of persons with serious mental illness in AL and related implications for care. The fourth presenter will address the high use of melatonin in AL, as well as resident- and community-level correlates of melatonin prescribing. The final speaker will examine hospice use in AL and how it varies based on community characteristics. These findings related to care and care needs for four key populations have important implications for practice, policy, and future research.

scholarly journals Addressing Needs of Older Adults in Low-Income Independent Living Facilities in Community Health

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 328-329
Author(s):  
Lisa Rauch ◽  
Toby Adelman ◽  
Daryl Canham ◽  
Nancy Dudley
Keyword(s):  
Older Adults ◽  
Community Health ◽  
Low Income ◽  
Independent Living ◽  
Complex Care ◽  
Care Needs ◽  
Term Care ◽  
Undergraduate Nursing ◽  
Complex Care Needs ◽  
The Impact

Abstract Access to quality care in long-term care settings including independent living facilities is needed for a diverse high-risk aging U.S. population. There is an urgent need to assess and address complex care needs of older adults living longer with chronic conditions and serious illness. However, a system to assess and identify health problems, intervene, and evaluate outcomes is lacking. This session presents learnings from a pilot study developed in collaboration with Nurse Managed Centers at low-income independent living facilities for older adults and undergraduate nursing students in community health practice. We will discuss the adaptation of the Omaha System for provision of care in independent living facilities to address complex care needs. Finally, we will discuss the impact of this project and its potential for healthcare transformation in independent living facilities and transformation of education in undergraduate nursing programs.

scholarly journals ‘Walk this way’: results from a pilot randomised controlled trial of a health coaching intervention to reduce sedentary behaviour and increase physical activity in people with serious mental illness

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Julie Williams ◽  
Brendon Stubbs ◽  
Sol Richardson ◽  
Cathy Flower ◽  
Lucy Barr-Hamilton ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mental Illness ◽  
Randomised Controlled Trial ◽  
Sedentary Behaviour ◽  
Serious Mental Illness ◽  
Controlled Trial ◽  
Health Coaching ◽  
Pilot Randomised Controlled Trial ◽  
Coaching Intervention ◽  
Randomised Controlled

Abstract Background Cardiovascular disease (CVD) is the leading cause of premature death among people with serious mental illness (SMI). Sedentary behaviour (SB) is an independent risk factor for CVD and mortality and people with SMI are highly sedentary. We developed a health coaching intervention called ‘Walk this Way’ to reduce SB and increase physical activity (PA) in people with SMI and conducted a pilot randomised controlled trial (RCT) to test its feasibility and acceptability. Methods We randomised people with SMI from three community mental health teams into either the WTW intervention or treatment as usual. The WTW intervention lasted 17 weeks and included an initial education session, fortnightly coaching, provision of pedometers and access to a weekly walking group. Objective SB and PA were measured with accelerometers. Cardiometabolic risk factors and wellbeing measures were collected. Results We recruited 40 people of whom 33 (82.5%) were followed up. 13/20 (65%) of participants allocated to the coaching intervention completed it. In the intervention group SB decreased by 56 min and total PA increased by 32 min per day on average which was sustained 6 months later. There was no change in PA or SB in the control group. When interviewed, participants in the intervention found the intervention helpful and acceptable. No adverse events were reported from the intervention. Conclusions The intervention was feasible and acceptable to participants. Preliminary results were encouraging with improvement seen in both SB and PA. A larger study is needed to assess the effectiveness of the intervention and address any implementation challenges. Trial registration ISRCTN Registry identifier: ISRCTN37724980, retrospectively registered 25 September 2015.

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