Background: The COVID-19 pandemic resulted in rapid increases in telehealth utilization across all age groups. Although older adults had previously been overlooked as the primary focus for disparity-reducing telehealth interventions, their high rates of morbidity and mortality dictate that they now be placed center stage. These changes in healthcare delivery highlight the need to further increase access to telehealthcare for older adults to avoid exacerbation of health disparities. Digital health innovations need to be mobilized to help find better ways to protect older adults.Objective: To effectively implement a geriatric-inclusive telehealth program at an academic medical center, barriers to care must be adequately explored. PICOT: This study posed the following research question: What are ways to mitigate barriers (I) for healthcare providers (P) to provide effective care for geriatric patients via telehealth (O) as compared to usual in-office care (C) during the COVID-19 pandemic (T)? Research Design/Methods: Telehealth barriers and facilitators were identified through semi-structured interviews with two Healthcare Providers (HCPs) and two Information Technologists (IT) employed at a large urban academic medical center’s geriatric specialty clinic. Thematic analysis using the qualitative interview data was conducted. Results: The following telehealthcare themes emerged: (1) improved patient care as the major benefit; (2) the necessity of educational and technical support for telehealth program success, and (3) improving provider utilization. Conclusion: With a well-designed support and educational infrastructure, providers can rapidly deploy telehealth and remote patient monitoring solutions to improve older adult patients’ access to care and improve healthcare outcomes.

Background: The SARS-CoV-19 (COVID-19) pandemic has been detrimental for older adults, aged 65 years and older, due to exacerbations of acute illnesses and extensive chronic disease conditions. Current emergency department (ED) triaging practices and structures are incompatible with the needs of this population who require highly individualized plan of care due to complex health needs, particularly in the setting of a global pandemic. This study aimed to analyze the demographics of older adult patients who seek emergency care during the COVID-19 pandemic, including those who were eligible for enrollment to the Healing at Home (H@H) program and those who did not meet the eligibility criteria. This data represented the dynamics of population-specific interventions that seek to address specific challenges of complex patient conditions, demanding ED workflows, increased risk of exposure to disease, and limited resources during the height of a global pandemic.

Methods: The parent study was titled “Healing at Home,” which was a Quality Improvement Feasibility project that transformed ED triaging by expediting care to the older adult patients’ homes in order to minimize disease exposure and transmission in an academic medical center in California. This present study utilized data from the parent study to conduct a retrospective chart review from mid-October 2020 to mid-June 2021. The study analyzed patient demographic data for those enrolled in the H@H program and explored barriers to enrollment for those who did not meet eligibility criteria. The data were collected through electronic health records (EHR). Provider interviews and participant satisfaction with the H@H program were also conducted and evaluated through telephonic interviews and surveys respectively at the end of the intervention.

Results: A total of 461 patients aged 65 years or older were screened in the ED for potential enrollment into the H@H program, of which only 20 were enrolled. Out of the 441 patients who did not meet eligibility for enrollment, 45.4 % did not have a primary care physician (PCP) within the academic medical center and 35.8% required inpatient hospitalization due to severe acuity of presenting illness. Of the participants who were surveyed regarding patient satisfaction of the care they received through the program, 76.9% gave the highest possible score of 6, which affirmed that they had benefitted from the H@H program during the pandemic.

Conclusion: Future nurse leaders and practitioners are needed to address the gaps in care for older adults who are at high risk for morbidity and mortality during the pandemic. Transitions care coordination, follow-up within 48 hours of discharge, remote patient monitoring, multilingual accommodations, and clear patient education regarding ED precautions are crucial in optimizing patient outcomes and preventing rehospitalizations during crises for this vulnerable patient population.

Despite the geriatric patient’s high utilization of the Emergency Department (ED), the care delivery models guiding traditional emergency care fail to address the complexity of the older adult, thus resulting in poor patient outcomes. In response, geriatric emergency experts have developed the Geriatric ED Accreditation and the 2014 consensus guideline to standardize best practice; despite these efforts, geriatric emergency care remains heterogenous as most EDs struggle to implement the guideline. An analysis of innovations to establish Geriatric EDs across a large, academic medical healthcare system will highlight the barriers to implementation of the 2014 guidelines and identify paths to advance geriatric care. This qualitative study aimed to characterize and evaluate team member composition (Geriatric Emergency Nurse Initiative Expert to Geriatric Expert Practitioner), as well as the structures and processes in Geriatric EDs across the healthcare system. Data from open-ended, semi-structured interviews with geriatric emergency leaders and observations in two leading Geriatric ED of academic healthcare system, were analyzed for content and themes. Geriatric emergency leaders reported widespread recognition that geriatric expertise, as currently implemented across the healthcare system, lacks a foundational care delivery model for implementation. Specifically, this analysis generated the following recommendations: advanced practice nursing to guide capacity development; a foundational care delivery model for patient assessment and care coordination; and a multidisciplinary team-based approach to care delivery. Importantly, institutional leaders also reported a high level of organizational readiness for change. The slow development of geriatric expertise in the ED stems from the absence of well-evidenced, model-based care delivery and assessment. Implementation of geriatric assessment grounded in the Comprehensive Geriatric Assessment Model, and geriatric emergency care delivery founded upon the Geriatric Practitioner Model, will serve to inform role development, develop successful care processes, and improve team coordination. Adoption of a model-based approach to geriatric expertise in the ED may become the pathway toward increasing the current number of accredited Geriatric EDs (4%), and toward improving the delivery of competent and compassionate geriatric emergency care.

The Covid-19 pandemic has propelled the use of telehealth rather than in-person visits driven forward by the California state-mandated Stay-home-orders and social distancing guidelines. During this public health crisis, high-risk older adult populations faced many barriers preventing them from utilizing telehealth to the full extent and maximizing their potential to obtain better health outcomes. This DNP scholarly project is a quality improvement project and feasibility study that aims to reduce these barriers to the adoption of telehealth in older adults, with the goal of improving digital literacy through an intervention of telehealth education. Building upon the parent study “Assisting and Supporting Socially Isolated Seniors Through Telehealth in the Covid-19 Pandemic,” a group of 21 older adult participants from a geriatrics specialty clinic was recruited and provided with the latest technology to self-monitor their vital signs (blood pressure and weight) in the comfort and safety of their own home. As an intervention, these participants were provided with 1) senior-friendly education materials; 2) in-person hands-on teaching session by Registered Nurse (RN) or DNP educators; 3) weekly check-in phone calls by RN educators and medical student volunteers to help improve digital literacy and boost telehealth utilization. A survey was collected immediate post-intervention to determine the efficacy of the intervention, and an interview was conducted with the RN educators who were involved in the education process. In the end, it was found that the RN educators were successful in educating the older adult participants. Post-intervention, participants were able to overcome their physical challenges that hindered their use of telehealth through personalized teaching. They were also able to navigate through technology with greater confidence and competence, leading to better management of their own health. Moreover, these socially isolated older adults reported significant benefits from the social connection and ongoing support that they received from the research team. In the end, the intervention was deemed successful in engaging and facilitating the participants’ utilization of technology as well as improving their digital literacy.

Purpose

Design and methods

Results

Conclusions

Background

Purpose

Methods

Results

Clinical implications

Hispanic children have greater mental health challenges but fewer received mental health services than other ethnic groups. A classroom-based Emotional Health Curriculum (EHC) was developed to address mental health disparities in an underserved Hispanic community.

A quasi-experimental design with one group pre- and post-intervention was used to test the feasibility of an 8-week EHC for one hundred 3rd and 4th grade children in a dual-immersion Spanish-English elementary school. Limited efficacy was measured by changes in depression and anxiety scores reported by children and teachers. Acceptance was evaluated by a child-reported satisfaction survey and a focus group in which the four teachers shared their experiences. Implementation was measured by participation, retention, and fidelity rates.

The child-reported depression and anxiety and teacher-reported depression were significantly decreased in at-risk children with the effect size ranging from 0.60 to 1.16 (ps < 0.05). The majority of children (89.7%) enjoyed the EHC and teachers observed that children had acquired skills to manage their emotional distress. The participation, retention, and fidelity rates were 98%, 94%, and 99.13%, respectively.

The results provide promising evidence that the EHC has the potential to improve depression and anxiety symptoms in at-risk children.