Implementation of a 4Ms approach in age-friendly oral health care at an Academic Specialty Care Dental Clinic.

BACKGROUND: Implementing the Age-Friendly Health System (AFHS) framework into dental care provides a significant opportunity to link oral health to healthy aging. This project aimed to implement the AFHS 4Ms (what matters, medications, mentation, and mobility) in the provision of oral health care. This article describes the planning, integration, training development, and outcome measurements supporting a 4Ms approach at an academic dental clinic. METHODS: The Eastman Institute for Oral Health (EIOH) implemented screening instruments based on the 4Ms framework recommended for ambulatory care clinics by the Institute for Health Care Improvement (IHI). These ambulatory instruments were integrated into the workflows of a Specialty Care Clinic through the development of a plan-do-study-act cycle, utilization of available clinic resources, and creation of interdisciplinary collaborations. RESULTS: This project demonstrated the feasibility of implementing an AFHS checklist and tracking forms in dental practice by integrating available resources and prioritizing the 4Ms elements. This effort necessitated interdisciplinary collaborations between dental, medical, and social service professionals. It also created a new age-friendly focused education and training curriculum for dental residents and faculty. CONCLUSIONS: This pilot project is the first to establish dental standards for AFHS implementation, adapting the 4Ms assessment and metrics to oral health. This AFHS underscores key oral health processes, including assessment, planning, and personalized oral health care, adapted to the unique needs of the older adult population, especially those with cognitive impairment.

Postgraduate dental resident education: A pilot in age-friendly "mentation" training.

OBJECTIVE: Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age-Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health. BACKGROUND: Age-friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias. MATERIALS AND METHODS: We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e-Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice. RESULTS: The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45  ± $ \pm \ $ 0.97) and knowledge acquisition (4.36  ± $ \pm \ $ 0.84). Residents strongly believed that learning about the AFHS-mentation topic would improve patient care. CONCLUSION: Our pilot study is a pioneer project in support of a new AFHS-themed dental curriculum for clinical education. Further expansion of the age-friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers.

Future forward: AGS initiative addressing intersection of structural racism and ageism in health care.

The American Geriatrics Society is committed to taking purposeful steps to address racism in health care, given its impact on older adults, their families, and our communities. In fall 2020, AGS added a statement to our vision for the future, which reflects that our commitment is central to mission: "We all are supported by and able to contribute to communities where ageism, ableism, classism, homophobia, racism, sexism, xenophobia, and other forms of bias and discrimination no longer impact healthcare access, quality, and outcomes for older adults and their caregivers." In 2021, we will be working to flesh out a multi-year, multi-pronged initiative that addresses the intersection of structural racism and ageism in health care. This will include engaging members in identifying strategies and with the goal of increasing member engagement around the idea that it will take all of us working together to achieve our vision for a collective future that is free of discrimination and bias. The Society has set as the first objective that by 2031, 100% of research presented at the AGS Annual Scientific Meeting and published in the Journal of the American Geriatrics Society (JAGS) will reflect the diversity of the population being studied. Other immediate efforts include undertaking a complete update of the Geriatrics Cultural Navigator, development of corresponding public education materials, and a webinar series focused on helping us all understand our own implicit bias, recognize implicit and explicit bias, and consider actions that we each might take to address bias when we observe it.

Plotting the steady march of progress: The American Geriatrics Society lays out its plans for a new initiative addressing the intersection of structural racism and ageism in healthcare.

The American Geriatrics Society (AGS) announced this summer its commitment to working towards a just society, one in which all people are treated equally. Following its announcement, the AGS immediately began planning a multi-year, multi-pronged initiative that is focused on the intersection of structural racism and ageism in health care. The new initiative will take three main action steps to achieve the AGS' goals. Progress is already underway, and the AGS anticipates a long, but ultimately successful journey toward the equitable future it envisions.

Chief to Chief: Reflections on Cultivating the Next Generation of Geriatrics Program Leaders.

What does it take to successfully lead a Division of Geriatrics? Is it the same skill set today as it was two or three decades ago? Is it the same for each chief, given the wide spectrum of geriatrics programs across our nation? Early leaders in our field showcased and role-modeled the career and job satisfaction that accompanies leadership of traditional geriatrics academic programs. This has been well articulated in past issues of the Journal of the American Geriatrics Society in articles by Dr William Hazzard and Dr Greg Sachs. How can we develop the next generation of geriatrics program leaders and ensure their success? Developed as a conversation between three generations of geriatrics division chiefs, this reflective article offers a shared perspective on what is required for success in advancing as a leader in our field and wholeheartedly enjoying the best job in the world.

Reducing Fluoroquinolone Use and Clostridioides difficile Infections in Community Nursing Homes Through Hospital-Nursing Home Collaboration.

OBJECTIVE: Nursing homes (NHs) are an important target for antibiotic stewardship (AS). We describe a collaborative model to reduce Clostridioides difficile infections (CDIs) in NHs through optimization of antibiotic use including a reduction in high-risk antibiotics such as fluoroquinolones. DESIGN: Quasi-experimental, pre- and post-intervention study. SETTING AND PARTICIPANTS: Six NHs in Monroe County, NY. METHODS: A hospital-based AS expert team assisted NHs in identifying targets for improving antibiotic use. Interventions included (1) collaboration with a medical director advisory group to develop NH consensus guidelines for testing and treatment of 2 syndromes (urinary tract infections and pneumonia) for which fluoroquinolone use is common, (2) provision of multifaceted NH staff education on these guidelines and education of residents and family members on the judicious use of antibiotics, and (3) sharing facility-specific and comparative antibiotic and CDI data. We used Poisson regression to estimate antibiotic use per 1000 resident days (RD) and CDIs per 10,000 RD, pre- and post-intervention. Segmented regression analysis was used to estimate changes in fluoroquinolone and total antibiotic rates over time. RESULTS: Postintervention, the monthly rate of fluoroquinolone days of therapy (DOT) per 1000 RD significantly decreased by 39% [rate ratio (RR) 0.61, 95% confidence interval (CI) 0.59-0.62, P < .001] across all NHs and the total antibiotic DOT decreased by 9% (RR 0.91, 95% CI 0.90-0.92, P < .001). Interrupted time series analysis of fluoroquinolone and total DOT rates confirmed these changes. The quarterly CDI rate decreased by 18% (RR 0.82, 95% CI 0.68-0.99, P = .042). CONCLUSIONS AND IMPLICATIONS: A hospital-NH partnership with a medical director advisory group achieved a significant reduction in total antibiotic and fluoroquinolone use and contributed to a reduction in CDI incidence. This approach offers one way for NHs to gain access to AS expertise and resources and to standardize practices within the local community.

A culinary laboratory for nutrition education.

BACKGROUND: Proficiency in medical nutrition requires an understanding of food-related biochemistry and the application of this knowledge in the context of culinary, cultural, psychosocial and interprofessional components. CONTEXT: Our aim was to develop a teaching format where medical students could learn the biochemistry of nutrition in the context of patient narratives, interactive cooking and dialogues with nutrition professionals. INNOVATION: We designed and implemented a day-long culinary laboratory intervention (lab), which is taught to first-year medical students at the University of Rochester with the help of dietetic interns from Cornell University. Here, we present the details of the intervention, the resources used and the preliminary outcomes on student attitudes. We designed and implemented a day-long culinary lab, which is taught to first-year medical students METHODS AND RESULTS: A questionnaire with quantitative rating scales and open-ended questions was used to probe student attitudes regarding the educational approach used in the lab. Our preliminary findings suggest that the lab was well received and that the dietetic interns were viewed as effective teachers in this context. IMPLICATIONS: A culinary lab is a feasible educational environment for integrating the breadth of topics within the discipline of nutrition. The experiential, food-based format appears to stimulate questions central to current nutritional controversies, particularly challenges related to translating biochemical mechanism into practical nutrition interventions. Close involvement with basic science faculty members, clinical faculty members and allied health professions are essential for this type of endeavour.

Staying in the game: the 10-step approach to sustaining geriatrics education in hospitalists and subspecialty providers.

Geriatrics as a field has been fortunate to have the support of several philanthropic organizations to advance geriatrics education and training in the past two decades. Awardees of such grants were presented with unparalleled opportunities to develop new and innovative educational initiatives affecting learners at multiple levels and in multiple disciplines and specialties. The lessons learned from the Donald W. Reynolds Foundation initiatives about effect and sustainability are invaluable to the ongoing strategic development of geriatrics nationally. This article highlights successful educational initiatives developed at four institutions with past and current Donald W. Reynolds Foundation funding. Following an ice hockey playbook, this article identifies 10 strategies and initiatives to "stay in the geriatrics game" by training hospitalists and subspecialty providers. The authors' collective experience suggests that geriatrics educational initiatives can not only influence provider education, but also improve the care of older adults in multiple settings.

"Geriatricizing" hospitalists: identifying educational opportunities.

The objective of this study was to identify differences between geriatricians and hospitalists in caring for hospitalized older adults, so as to inform faculty development programs that have the goal of improving older patient care. Eleven hospitalists and 13 geriatricians were surveyed regarding knowledge, confidence, and practice patterns in caring for hospitalized older adults, targeting areas previously defined as central to taking care of older hospitalized patients. Overall, geriatricians had more confidence and more knowledge in caring for older hospitalized adults. The areas in which hospitalists expressed the least confidence were in caring for patients with dementia, self-care issues, and care planning. Geriatricians reported more routine medication reviews, functional and cognitive assessments, and fall evaluations. Geriatricians and hospitalists differ in their approach to older adults. Where these differences reflect lack of knowledge or experience, they set the stage for developing curricula to help narrow these gaps.