Growth and impact of Project ECHO for workforce development in age-friendly care.

BACKGROUND: Use of the Project ECHO® (Extension for Community Healthcare Outcomes) model in geriatrics has increased dramatically largely because of the Health Resources and Services Administration-funded Geriatrics Workforce Enhancement Programs (GWEP) utilizing it as a key tool for age-friendly, interprofessional workforce development. This manuscript describes the scope and impact of geriatrics ECHOs under the GWEP. METHODS: A survey of GWEPs was conducted to measure the reach, foci, evaluation methods, and other characteristics of ECHO networks. RESULTS: All 48 (100%) GWEPs responded to the survey, and 30 (63%) reported using ECHO. GWEP ECHOs have both rural and urban-underserved reach across the United States, and their hub teams include many health professions. Age-friendly care is incorporated through multiple methods and is taught across foci including primary care, dementia, long term care, and novel topics. GWEP ECHOs have many academic and community partners including Area Agencies on Aging, and reach varied health professions, trainees, and caregivers. Geriatrics ECHOs collect outcomes across the evidence continuum including the community-level outcome of Age-Friendly Health System designation. CONCLUSIONS: The ECHO model has been widely adopted by GWEPs as a key approach for workforce training in age-friendly care. Project ECHO is a valuable tool to expand interprofessional training for the geriatrics workforce, particularly for interprofessional teams in rural and underserved areas.

Age Friendly Care: What do Community Aging Services Professionals Need to Know?

There is an increasing need for community-based health education to help older adults understand and manage their complex medical needs. Community Aging Services Professionals (CASPs) are non-medical service providers who facilitate aging in place by providing health education, socialization, and care coordination for older adults in community settings. Through in-depth interviews with 13 CASPs, this study assessed CASPs' knowledge of older adults' medical issues and health education needs. Our goal was to assess CASPs' knowledge of older adults' medical issues and health education needs and determine overlap with the Age Friendly Health System 4 Ms framework. CASPs described promoting older adults' health by providing medical referrals, education, and advice. The interviews revealed that CASPs feel underprepared to provide requested medical support for older adults, and that both CASPs and older adults desire more clinical education to help identify and manage older adults' medical conditions. This study established CASPs as ideal providers to receive and disseminate clinical health education for older adults aging in the community. The results also showed the 4 Ms model of age friendly care is well-received as a framework for health education in community settings.

Management and outcomes of a COVID-19 outbreak in a nursing home with predominantly Black residents.

BACKGROUND/OBJECTIVES: Few studies present clinical management approaches and outcomes of coronavirus disease 2019 (COVID-19) outbreaks in skilled nursing facilities (SNFs). We describe outcomes of a clinical management pathway for a large COVID-19 outbreak in an urban SNF with predominantly racial minority (>90% black), medically complex, older residents. DESIGN: Single-center, retrospective, and observational cohort study (March 1, 2020-May 31, 2020). SETTING AND PARTICIPANTS: All subacute and long-term care residents at an urban SNF between March 1, 2020 and May 31, 2020 (Chicago, IL). INTERVENTION: A multicomponent management pathway was developed to manage a large COVID-19 outbreak in an SNF. MEASUREMENTS: Chart review was used to extract demographics, comorbidities, symptoms, lab results, and clinical outcomes over 12 weeks, which were summarized and compared between residents with and without COVID-19. RESULTS: A multicomponent clinical management pathway was used to care for residents with COVID-19, which included frequent scheduled clinical and laboratory evaluation, use of intravenous fluids, supplemental oxygen, antibiotics when indicated, and goals-of-care discussions. Of the 204 residents, 172 (84.3%) tested positive for SARS-CoV-2 during the 3-month period, with 50.5% symptomatic, 9.3% presymptomatic, and 24.5% asymptomatic, with a 30-day mortality rate of 15.7%. Predominant symptoms were low-grade fever >99 °F, anorexia, delirium, and fatigue. While in the facility, approximately one-quarter of residents experienced hypernatremia [Na > 145 mEq/L] (24.5%), acute kidney injury [Cr > 0.03 mg/dL or 1.5× baseline] (29.7%), or leukopenia [WBC < 4.8 1000/mm3 ] (39.4%). CONCLUSION: We present the first available clinical strategy guiding the medical management of a COVID-19 syndrome in an urban SNF, caring for largely black residents, which may lead to improved mortality.

ECHO-Chicago Geriatrics: using telementoring to "geriatricize" the primary care workforce.

BACKGROUND: The primary care workforce is under-prepared to care for the growing older adult population. Extension for Community Healthcare Outcomes (ECHO) is a continuing education intervention that connects subspecialists and community health care providers (HCPs) via videoconferencing technology for didactic and case-discussion sessions. Methods: We asked participants to complete 8 to 12 educational telementoring sessions. These sessions were conducted between February 2016 and October 2017. Pre/post surveys of self-efficacy and frequency of practice behaviors were collected from eligible participants. Results: 121 HCPs from multiple sites participated. Of these, 89 (non-trainee status) were eligible to complete surveys. Sixty-two participants (69.7%) completed pre/post surveys. Participants were queried regarding 15 geriatrics competencies. Self-efficacy significantly increased across all competencies after series participation (p < 0.05). Frequency of 8 out of 11 queried geriatrics-centered practice behaviors also increased significantly (p < 0.05). Discussion: ECHO-Chicago Geriatrics offers a novel strategy for improving community HCPs' geriatrics self-efficacy and frequency of geriatrics-centered practice behaviors.

Informal Caregiving in a Medically Underserved Community: Challenges, Construction of Meaning, and the Caregiver-Recipient Dyad.

Little is known about informal caregivers' challenges in medically underserved communities. This qualitative study explores their perceptions/experiences of caregiving in a medically underserved community in Midwest United States. Two focus groups (n = 12) were conducted and themes were extracted and analyzed. Theme 1 included perceived barriers/unmet needs; most prevalent of which were lack of informational resources and support groups. A second unsolicited and unanticipated theme highlighted how caregivers constructed meaning through reappraising challenges to create enriching experiences for themselves, reinforcing their evolving dyadic relationship with care-recipient. Challenging and enriching aspects of caregiving coexisted and were rooted in caregiver-care-recipient dyad. Caregivers used meaning-making as a coping strategy for challenges. Prior research corroborates caregivers' challenges and meaning-making; this study contributes by delineating how both become interrelated. Policy makers can (a) alleviate challenges by increasing informational resources and support groups and (b) provide training to optimize caregivers' meaning-making, thus enhancing their positive experiences.