Programs and Communities

Falls are prevalent among those aged 65 years and older and may result in minor to debilitating injuries in this vulnerable population. Frailty, unsteady gait, and medication side effects all contribute to fall risk as well as dementia, a type of cognitive impairment that disrupts memory and judgment leading to an underestimation of fall risk. Fall prevention evidence suggests that interventions aimed at decreasing fall rates begin with a fall risk assessment and tailored fall prevention measures that promote safety.

To examine the effectiveness of a fall prevention program in dementia care, an evidence-based pilot was conducted in a long-term care facility focused on dementia care. A convenience sample of 16 nurses received a fall prevention education intervention. A fall prevention knowledge instrument measured pre and post-fall prevention knowledge. There was a significant increase in fall risk knowledge from the pre-test (p < .001). The participants then conducted a fall risk assessment of 50 dementia patients using the Morse Fall Scale.

Of the 50 dementia patients, 28 were identified as high risk for falls. The nurses then instituted tailored fall risk prevention measures for those high risk for falls. As a result of the pilot, 40 fall events were noted within a three-month time period, reflecting a significant reduction in falls (p < .001) from the previous year. The institution of a fall prevention program in dementia care incorporating nursing education, a fall risk scale, and measures to promote safety can reduce fall risk in dementia patients.

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

Ineffective transitional care programs for ensuring the continuation of care from acute settings to the home settings post discharge can result in rehospitalization of elderly patients with chronic diseases. Usually, transitional care should be time-sensitive, patient-centered services intended to ensure continuity of care and an efficient transition between health care settings or home. A patient centered transitional care program was implemented at an outpatient primary care facility to reduce readmission rates. Institutional Review Board approval was obtained.

Twenty adult patients with chronic diseases discharged from an acute setting were identified. A follow up phone call and/or a home visit within 24-72 hours post discharge was employed. The Care Transitions Measure (CTM®) and Medication Discrepancy Tool (MDT®) were utilized to identify quality of care of transition and medication discrepancies. A chart audit collected data on the age of participant, diagnosis for initial hospitalization, CTM score, home visit, and ED visits or re-hospitalizations after 30 days of discharge. The outcome indicated that transitional care within primary care utilizing evidence-based practices is beneficial in reducing readmission rates. A logistic regression showed model significance, p = .002, suggesting that the CTM score was effective for both telephone support (TS) and home visit (HV).

A correlation analysis showed that as age of participants increased, the CTM score decreased, indicating that older adults required more support. A significance p <.001, of a proportional test indicated that readmission rates after the intervention was lower. It is evident that providing a timely and effective transitional care intervention in a primary care setting can reduce hospital readmissions, improve symptom management and quality of life of adult patients with chronic diseases.

To investigate the impacts of an energy efficiency retrofit, indoor air quality and resident health were evaluated at a low‐income senior housing apartment complex in Phoenix, Arizona, before and after a green energy building renovation. Indoor and outdoor air quality sampling was carried out simultaneously with a questionnaire to characterize personal habits and general health of residents. Measured indoor formaldehyde levels before the building retrofit routinely exceeded reference exposure limits, but in the long‐term follow‐up sampling, indoor formaldehyde decreased for the entire study population by a statistically significant margin. Indoor PM levels were dominated by fine particles and showed a statistically significant decrease in the long‐term follow‐up sampling within certain resident subpopulations (i.e. residents who report smoking and residents who had lived longer at the apartment complex).

Purpose: To examine the implementation of a web-based depression care management training program to increase home health nurses’ knowledge and attitudes regarding depression.

Background and Significance: The Centers for Disease Control and Prevention reported in 2015 that the incidence of major depression in elderly receiving home health service rose to 13.5% compared to less than 5% with those not receiving care in the community.

Materials and Methods: An intervention program was offered to a convenience sample of home health nurses caring for elderly in the community. The Depression CARE for Patients AT Home (depression CAREPATH), which is an evidenced-based online training program consisting of didactic resources about depression screening and depression care management and e-learning modules. Participants were given a pre and post survey to assess their knowledge of the material. Additionally demographic information was obtained via self-report.

Results: A total of 8 out of 18 home health nurses participated in the study. All were females; 13% Caucasian and 88% were Asian. There’s an average of 37 years old (SD 14.7, range 23-58) and had 3 years of experience (SD 2.07, range <1-6). The mean depression CAREPATH knowledge total pre-test score was 15 (SD 1.85, range 13-18), while the mean total post-test score was 18.13 (SD 0.99, range 17-19). There was a difference in the depression knowledge test scores at baseline. All the participants obtained a passing score for the post-test (80%). The mean R-DAQ total pre-test score was 71 (SD 13.37, range 53-71) and mean total post-test score was 68, (SD 3.48, range 62-70). The professional confidence in depression attitude indicated agreement post intervention, except with the feeling comfortable in working with physical illness than mental illness (pre intervention 62.5%, post intervention 100%). Participants agreed that home health nurses are well placed and more confident in assisting patients with depression (pre Depression Care Management 3 3 intervention 75%, post intervention 100%). In addition, participants felt more confident in assessing suicide risk post intervention in patient s presenting with depression. Based from Wilcoxon Signed-ranks test, there was a statistical difference, z = -2.536, p= .01, between the depression knowledge pre and post-test scores, which indicates that there is an increase in depression knowledge after the intervention. However, there was no significant difference, z = -.846, p = .397 between the depression attitude, which indicate that there is no change in depression attitude after the intervention.

Conclusion: For this sample, depression knowledge was increased post intervention, however, increase in knowledge did not significantly alter the depression attitude. Further study in a larger more diverse sample is needed for this intervention.

Aim: To reduce the fear of falling in an elderly population by teaching ‘Tai Chi for Falls Prevention’ classes twice a week for 12 weeks.

Background & Significance: Falls continue to be the leading cause of injury-related deaths of Arizonans who are 65 years or older - well above the national average. It is predicted that by 2030, national medical spending for this population will total over $31 billion, yearly. Tai Chi is revered for being a beneficial form of simple, low-impact exercise, which the CDC endorses for its falls risk reduction benefits.

Methods: The intervention consisted of 60-minute classes occurring twice a week for 12 weeks. Participants were English-speaking, between 65-85 years old, and able to ambulate independently. Appropriate pre-screening tools were used before applicants consented. Their Fear of Falling (FoF) was measured using a fall risk perception tool at the beginning, middle, and the end of the project. This ordinal data was analyzed with Friedman ANOVA using SPSS 25

Outcomes/Results: After enrolling five total participants, only three completed the project. This severely limited data analysis of their FoF, resulting in a statistical significance (p = 0.68), deeming the intervention ineffective - Despite observable downwards trending FoF scores.

Conclusion: The acceptance of the null hypothesis is attributed to the low enrollment and high attrition rate. Also, the only data measured was quantifiable, subjective data. Future projects could add objective data to reinforce the benefits of Tai Chi. This might reinforce the validity of Tai Chi as a practical recommendation due to its cost-effective simple interventional design and effectiveness for prevention of accidental falls. Increased focus on improved recruitment & retainment strategies should be prioritized for similar projects in the future.

As Baby Boomers age, the number of older homeless patients facing end of life is increasing. Homeless individuals die of the same diseases as their domiciled counterparts, but they have distinct barriers to equitable end-of-life care, such as lack of regular medical care, a higher likelihood of comorbid serious mental illness and substance abuse, alienation from potential healthcare proxies, and specific fears related to dying. Completion of an advance directive (AD) would address many of these barriers, as well as national goals of reducing medical costs associated with end of life care. A review of the literature indicates that homeless individuals, once educated on the purpose and significance of ADs, complete them at a higher rate than non-homeless people. Further, racial and ethnic disparities in document completion are minimized with educational interventions about an AD’s purpose.

King’s Theory of Goal Attainment provides the theoretical basis for the application of such an intervention in the setting of a medical respite center and a day resource center that both serve the homeless. Thirty-seven clients of the two sites and 14 staff members were administered a pre-and post-test measuring attitudes and knowledge relating to ADs on a Likert scale, resulting in an increase in knowledge about one of the two documents that traditionally comprise an AD, while not significantly affecting attitudes. Implications for practice include an inexpensive intervention that does not require a medically trained individual to deliver, enabling a broad application to a variety of settings with the goal of empowering a traditionally disenfranchised population to make health decisions related to the most vulnerable of life passages.