Impact of Cancer on Nutrition in the Geriatric Cancer Population.

Malnutrition in geriatric cancer patients is a leading cause of morbidity and mortality. A nutrition risk assessment should be done early to identify and treat those at risk for cancer-related malnutrition. The goal of this study was to assess nutritional status in geriatric patients diagnosed with all cause cancer. We conducted a single institutional prospective cohort study of geriatric patients with cancer from 2013-2018. Patients 65 years old and above had undergone a comprehensive geriatric assessment before starting treatment (day 0), post-treatment (day 30), and post-post treatment (day 90). Body Mass Index (BMI) and the Mini Nutritional Assessment (MNA) were used to assess nutrition status. Results showed an increase in nutrition status from pretreatment (day = 0) to treatment (day =30), followed by a decrease in MNA scores at day 90. Results showed a decrease in BMI across all time points. This study supports that cancer and anti-cancer therapy in geriatric patients cause malnutrition, indicating the importance of early nutritional evaluation and intervention.

Integra at Home: A flexible continuum of in-home medical care for older adults with complex needs.

BACKGROUND: As individuals age, they may need new strategies to manage exacerbations of chronic disease to maintain their dignity and independence. Many end up in a revolving cycle of emergency department visits, hospitalizations, and post-acute care. Support to stay at home, which is often their preference, becomes a challenge and varies with insurance coverage, location, and financial status. There are few home-based options sufficiently agile enough to respond when acute conditions arise particularly with exacerbations of chronic disease. METHODS: In 2018, Integra designed a home-based option to treat acute exacerbations of chronic illness. A partnership with community paramedicine enabled faster response times and provided additional treatment tools. Using process improvement methodology, we developed "Integra at Home" workflows and team-based care. We counted averted emergency visits and hospitalizations, patient and staff satisfaction, and evidence of financial sustainability as a result of our program. RESULTS: Integra successfully developed a suite of home-based services, including responses to acute problems, to address beneficiaries' fluctuating medical needs. Following responses to 415 acute events, 74% (N = 307) resulted in averted emergency department visits. Based on InterQual® criteria, 34% (N = 103) of averted visits would have qualified as an averted hospitalization. All 64 respondents to patient surveys (N = 170) stated they would recommend our program. The staff indicated the model is a better way of caring for patients with higher rewards than traditional settings. The average length of stay in hospice for patients referred from the program (N = 22) was 4 weeks. CONCLUSIONS: Home-based care continuums are feasible, yet resources to manage acute exacerbations remain inadequate. To fill this gap, we created higher acuity services to respond to urgent needs and monitor symptoms between episodes. Amid successes and challenges, we are serving higher acuity older adults in Integra's home-based continuum model. We encourage further spread of longitudinal home-based acute care models.

The Impact of Elder Abuse on a Growing Senior Veteran Population.

The VHA addresses the growing national health emergency by increasing awareness, education, prevention, and research on elder abuse.

Care of the victim.

The number of elder abuse cases is expected to rise as the number of persons older than age 65 doubles over the next 20 years. Patients affected by elder abuse present in all care settings, including inpatient and outpatient clinical care, emergency rooms, long-term care facilities, and home care. Victims have significant medical consequences, physical and psychological, and often need additional resources, including legal guidance. Health care professionals need additional training to be effective advocates for survivors of elder abuse. Care of the victim must also be recognized as an equally important topic for research and education.

Healthcare transitions of older adults: an overview for the general practitioner.

Healthcare transition refers to the care "hand-off" of a patient among providers and treatment settings. Older adults experience more frequent care transitions than younger patients due to the presence of co-morbidities, cognitive impairment, increased dependence and medication use. Hospitalization and subsequent readmission after discharge to a nursing home represents a unique care transition situation. It is estimated that as many as 60% of readmissions from nursing homes can be avoided. Poor communication between hospital and nursing home staff; delayed, inaccurate, or missing discharge summaries; lack of accurate medication reconciliation; pending test results; inappropriate follow-up; and poor education of patient and families all contribute to poor care transition quality, and increase the probability of rehospitalization. Interventions for improved care transitions are suggested. They focus on patient and family-centered care effectiveness, minimizing adverse events, and increasing timely, accurate and complete communication.