Dissemination and implementation of age-friendly care and geriatric emergency department accreditation at Veterans Affairs hospitals.

OBJECTIVES: In 2018, the U.S. Department of Veterans Affairs (VA) National Office of Geriatrics and Extended Care (GEC) and the National Emergency Medicine (EM) Program partnered to improve emergency care for older Veterans. A core team disseminated age-friendly models of care via education and standardization of practice with the goal of multisite geriatric emergency department (GED) accreditation. We compare rates of GED screening at VAs with GED implementation to those without. METHODS: Observational evaluation of GED screening of older Veterans (≥65 years) at VA Emergency Departments (ED) from January 2018 to March 2022, during peak pandemic years. Data were extracted from the VA Corporate Data Warehouse of Veteran ED visit encounters to track documented GED screens and Veteran demographic data. Generalized estimating equation models were used to compare screening completion across different levels of GED accreditation, adjusting for potential confounding. RESULTS: During this period, over 1.07 million Veterans ≥ 65 years of age made 4.07 million VA ED visits. Mean (±SD) age was 73.4 (±7.2) years, 96.5% were male, 68% were White, and 89.9% made their index ED visit at a non-GED VA ED. As of early 2022, a total of 50 of 111 VA EDs have achieved or applied for GED accreditation. During early 2022, 8.3% of all visits by older Veterans had at least one GED screen documented; 15% were screened at Levels 1-3 GED versus 2.2% at non-GED facilities. Screens identifying older adults at risk for poor outcomes, for delirium, and for falls had the highest usage rates within VA GEDs. Veterans seen at Level 1 GEDs had a 76-fold greater odds of having a GED screen than at Level 3 GEDs (odds ratio 75.8, 95% confidence interval 72.8-79.0). CONCLUSIONS: Through VA National Office of GEC and EM Program partnership, the VA has created, standardized, and disseminated a GED Model of Care, despite the pandemic. GED accreditation was associated with GED screen implementation, with Level 1 having the highest screening prevalence.

Telehealth for geriatric post-emergency department visits to promote age-friendly care.

OBJECTIVE: To describe a feasibility pilot study for older adults that addresses the digital divide, unmet health care needs, and the 4Ms of Age-Friendly Health Systems via the emergency department (ED) follow-up home visits supported by telehealth. DATA SOURCES AND STUDY SETTING: Data sources were a pre-implementation site survey and pilot phase individual-level patient data from six US Department of Veterans Affairs (VA) EDs. STUDY DESIGN: A pre-implementation survey assessed existing geriatric ED processes. In the pilot called SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services), sites identified high-risk patients during an ED visit. After ED discharge, Intermediate Care Technicians (ICTs, former military medics), performed follow-up telephone, or home visits. During the follow-up visit, ICTs identified "what matters," performed geriatric screens aligned with Age-Friendly Health Systems, observed home safety risks, assisted with video telehealth check-ins with ED providers, and provided care coordination. SCOUTS visit data were recorded in the patient's electronic medical record using a standardized template. DATA COLLECTION/EXTRACTION METHODS: Sites were surveyed via electronic form. Administrative pilot data extracted from VA Corporate Data Warehouse, May-October 2021. PRINCIPLE FINDINGS: Site surveys showed none of the EDs had a formalized way of identifying the 4 M "what matters." During the pilot, ICT performed 56 telephone and 247 home visits. All home visits included a telehealth visit with an ED provider (n = 244) or geriatrician (n = 3). ICTs identified 44 modifiable home fall risks and 99 unmet care needs, recommended 80 pieces of medical equipment, placed 36 specialty care consults, and connected 180 patients to a Patient Aligned Care Team member for follow-up. CONCLUSIONS: A post-ED follow-up program in which former military medics perform geriatric screens and care coordination is feasible. Combining telehealth and home visits allows providers to address what matters and unmet care needs.

Effects of Diaphorina citri Population Density on Daily Timing of Vibrational Communication Calls: Potential Benefits in Finding Forage.

Adult Diaphorina citri (ACP) use visual and chemical cues to locate young citrus flush shoots on which they forage and oviposit, and they use vibrational communication duetting calls as cues to help locate mates. For individual pairs, calling and mating usually peaks between 10:00 and 15:00. To explore whether call rates (calls/h) are affected by interactions with nearby conspecifics, rates were compared in small citrus trees on which either 5 or 25 ACP female and male pairs had been released at 17:00 for later recording from sunrise (06:00) to 22:00. Final ACP locations were noted 40 h after release. Call rates were similar in both treatments during normal mating hours. However, rates were significantly higher for low- than high-density treatments between 06:00 and 10:00, which suggests calling during this period may be affected by conspecific density. Both sexes aggregated on flush at both densities. We discuss the potential that ACP producing calls near sunrise, outside of normal mating hours, might benefit from gains in reproductive fitness in low-density contexts if they call not only to locate mates but also to locate preferred flush-in which case, co-opting of vibrations to disrupt both mating and foraging may be feasible.