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.

Survivors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) often experience chronic symptoms that include fatigue, shortness of breath, and brain fog. The collection of ongoing post-COVID-19 symptoms have been classified as Post-Acute Sequela of SARS-CoV-2 (PASC). Older adult patients are especially susceptible to experiencing PASC related complications and have a high risk for long-term cognitive impairment symptoms. Definitions for categorizing PASC- associated cognitive impairment and neuropsychological assessments used to evaluate cognitive impairment are inconsistent between studies examining older adults. This systematic review aims to identify which neuropsychological tests best identify cognitive impairments associated with PASC and suggest a guide to standardize the measurement of PASC-related cognitive impairments. Through a literature search using PubMed, we included within this review 14 studies that fulfilled our inclusion and exclusion criteria evaluating middle-aged and older adult populations affected by PASC-associated cognitive impairments. The majority of the studies used tests designed to screen for general cognitive function to test for the prevalence of cognitive impairment, with the most common one being Montreal Cognitive Assessment (MoCA), followed by MMSE and TICS. MoCA reported the highest prevalence of the general cognitive screeners which suggests higher sensitivity and specificity. Telephone Interview for Cognitive Status (TICS) demonstrated similar scores as MoCA despite administration being remote while MMSE identified the lowest prevalence. Four studies also used domain-specific cognitive evaluations and reported instances of cognitive impairment in individuals who had previously tested healthy. Furthermore, the results gathered in this review were stratified based on disease symptom severity. This review identifies MoCA to be better suited for evaluating general cognitive impairment in older adults. TICS has the added utility in being able to access a wider range of older adults through remote screening. Disease severity must be clearly defined to allow better comparisons between studies and allow for standardization. Early identification of PASC-associated cognitive impairment in middle-aged and older adults can be performed using general cognitive function evaluations and administering a baseline cognitive evaluation one month after infection is suggested.

Low back pain is a worldwide health problem. Preoperative education is essential to provide patients with information across the continuum of care. Gaps exist among healthcare organizations regarding deficiencies in properly educating patients about their surgical experience. The lack of proper preoperative education can negatively impact reimbursement for healthcare systems, providers, and patient outcomes. In a large metropolitan tertiary care center providing spine surgery, an evidence-based project was implemented. A self-developed pre and post intervention surveys was given assessing patients’ knowledge and surgical expectations after surgery. A tri-fold education pamphlet was given to the participants with information that included detailed information regarding expectations before and after surgery.

Descriptive statistics were used to describe the sample and outcome variable. An increase in knowledge in expectations after surgery was noted from pre-intervention (mean 1.83, SD .408) to post-intervention (mean 1.67, SD .816) with a Cohen’s D of 0.248 although this was not statistically significant. However, the change in average length of stay (LOS) was significant. The average LOS for the project participants dropped from 4.54 days to 2.833 days which is within the Centers for Medicare and Medicaid Services (CMS) guidelines of 2.92 days for this surgical population. In conclusion, an increased in patients’ knowledge regarding expectations following surgery and decreased LOS was seen for the project participants.

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.

Elective cosmetic surgery has grown more popular in the last several decades, including procedures specifically targeted at older adults and anti-aging. The aim of this study is to better understand elective cosmetic surgery rationale for older adults. The first part of the study summarizes literature on elective cosmetic surgery for older adults and determines what factors influence the desire for elective cosmetic procedures. From the research databases PubMed, JSTOR, and ScienceDirect, eighteen sources were referenced in the final review. The review found that there are differences in sociocultural views of men and women as they age as well as internal views of aging. The modest number of studies used in the literature review reflect a current gap in current research studying elective cosmetic surgery in older adults. For the second part of the study, data was collected from a 2018 survey designed to better understand aging, body image, and subjective age. The survey was limited to individuals living in the United States aged 40 and above and was deployed through MTurk (Mechanical Turk). A total of 1199 responses were received. Only participants 55 years and above are included for the purpose of this study. Most participants who answered the question for elective cosmetic surgery rationale answered that their primary rationale is to reduce age-related physical markers. For participants identifying as female, nine percent cited self-esteem as their rationale while no male-identifying participants responded similarly. Future research can include questions on internal and external factors older adults feel have the greatest impact on their decision to have elective cosmetic procedures.

Functional GI disorders are categorized as a group of chronic symptoms that are considered to have no abnormalities that can account for patient’s illnesses. Included in this category are those patients with irritable bowel syndrome. Functional GI issues are an important public health concern as they are becoming increasingly more common; they can be disabling and can cause significant socioeconomic burden in regard to health care costs, productivity and disability. There is strong evidence that probiotics have the potential to reduce IBS symptoms. Unfortunately, probiotics are underutilized in the clinical setting.

The purpose of this project is to increase knowledge and self-efficacy in patients with functional GI symptoms regarding the use of probiotics for symptom management. Patients in an outpatient GI practice in Southwestern United States with chronic functional GI symptoms were shown an educational video regarding the origins and benefits of using probiotics to manage chronic symptoms. Knowledge of probiotics, self-efficacy and willingness to utilize probiotics was measured by asking participants to complete a modified Health Belief Model survey before and after viewing the video. Patient demographics were collected. There were 75 participants (n=75) who participated in the project with a mean age of 40.3 years (SD=15.41), 85% female and 15% male. Wilcoxon signed rank test were used to analyze changes in paired data with significant improvements in self-efficacy (Z=3.93, p< .01), benefits of probiotic use (Z=4.33, p<.01) and decreased barriers to probiotics use (Z=-4.31, p<.01). After participants viewed the educational video, 95% of patients indicated they would try probiotics (CI 95%, p<.01) versus 65% of patients who would try probiotics before viewing video. In conclusion, education regarding using probiotics to manage functional GI symptoms improved patient’s self-efficacy and their willingness to use probiotics to manage their symptoms. Keywords: probiotics, GI disorders, diarrhea, IBS, constipation, abdominal pain, self-efficacy.

INCREASED EDUCATION AND SELF-EFFICACY IN PROBIOTIC USE:
Education and Self-efficacy of Probiotic Use in Patients with Chronic Gastrointestinal Symptoms
Functional gastrointestinal (GI) disorders are categorized as a group of chronic symptoms that are considered to have no structural or biochemical abnormalities that can account for patient’s illness. Included in this category are those patients diagnosed with irritable bowel syndrome (IBS). IBS is chronic GI disorder characterized by abdominal pain accompanied by altered bowel function, gas and bloating without the presence of organic disease (Mapel, 2013). Functional gastrointestinal symptoms typically include complaints of long-standing issues (greater than 3 months) of diarrhea, abdominal pain, constipation, gas and bloating.