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Cummings J, Sano M, Auer S, Bergh S, Fischer CE, Gerritsen D, Grossberg G, Ismail Z, Lanctôt K, Lapid MI, Mintzer J, Palm R, Rosenberg PB, Splaine M, Zhong K, Zhu CW. Reduction and prevention of agitation in persons with neurocognitive disorders: an international psychogeriatric association consensus algorithm. Int Psychogeriatr 2024; 36:251-262. [PMID: 36876335 PMCID: PMC10480345 DOI: 10.1017/s104161022200103x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA). DESIGN Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion. SETTING IPA Agitation Workgroup. PARTICIPANTS IPA panel of international experts on agitation. INTERVENTION Integration of available information into a comprehensive algorithm. MEASUREMENTS None. RESULTS The IPA Agitation Work Group recommends the Investigate, Plan, and Act (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and acting with an emphasis on shared decision-making; the success of the plan is evaluated and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Psychosocial interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal/circadian agitation; mild-moderate agitation or agitation with prominent mood features; moderate-severe agitation; and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a variety of venues-home, nursing home, emergency department, hospice-and adjustments to the therapeutic approach are presented. CONCLUSIONS The IPA definition of agitation is operationalized into an agitation management algorithm that emphasizes the integration of psychosocial and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision-making.
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Affiliation(s)
- Jeffrey Cummings
- Joy Chambers-Grundy Professor of Brain Science, Director, Chambers-Grundy Center for Transformative Neuroscience, Co-Director, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences. University of Nevada Las Vegas (UNLV)
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NYC NY and James J. Peters VAMC, Bronx NY
| | - Stefanie Auer
- Centre for Dementia Studies, University for Continuing Education Krems, Austria
| | - Sverre Bergh
- The research centre for age-related functional decline and disease, Innlandet hospital trust, Ottestad, Norway
| | - Corinne E. Fischer
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Radboud Alzheimer Center, Nijmegen, the Netherlands
| | - George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry St Louis University School of Medicine
| | - Zahinoor Ismail
- Departments Psychiatry, Neurology, Epidemiology, and Pathology, Hotchkiss Brain Institute & O’Brien Institute for Public Health University of Calgary
| | - Krista Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; and Departments of Psychiatry and Pharmacology/Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria I Lapid
- Mayo Clinic Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Jacobo Mintzer
- Psychiatrist, Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Rebecca Palm
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Michael Splaine
- Owner Splaine Consulting, Managing Partner, Recruitment Partners LLC
| | - Kate Zhong
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Carolyn W. Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, NYC, NY and James J. Peters VAMC, Bronx NY
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Sano M, Cummings J, Auer S, Bergh S, Fischer CE, Gerritsen D, Grossberg G, Ismail Z, Lanctôt K, Lapid MI, Mintzer J, Palm R, Rosenberg PB, Splaine M, Zhong K, Zhu CW. Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition. Int Psychogeriatr 2024; 36:238-250. [PMID: 36880250 PMCID: PMC10684256 DOI: 10.1017/s1041610222001041] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND The International Psychogeriatric Association (IPA) published a provisional consensus definition of agitation in cognitive disorders in 2015. As proposed by the original work group, we summarize the use and validation of criteria in order to remove "provisional" from the definition. METHODS This report summarizes information from the academic literature, research resources, clinical guidelines, expert surveys, and patient and family advocates on the experience of use of the IPA definition. The information was reviewed by a working group of topic experts to create a finalized definition. RESULTS We present a final definition which closely resembles the provisional definition with modifications to address special circumstances. We also summarize the development of tools for diagnosis and assessment of agitation and propose strategies for dissemination and integration into precision diagnosis and agitation interventions. CONCLUSION The IPA definition of agitation captures a common and important entity that is recognized by many stakeholders. Dissemination of the definition will permit broader detection and can advance research and best practices for care of patients with agitation.
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Affiliation(s)
- Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NYC NY and James J. Peters VAMC, Bronx NY
| | - Jeffrey Cummings
- Joy Chambers-Grundy Professor of Brain Science, Director, Chambers-Grundy Center for Transformative Neuroscience, Co-Director, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences. University of Nevada Las Vegas (UNLV)
| | - Stefanie Auer
- Centre for Dementia Studies, University for Continuing Education Krems, Austria
| | - Sverre Bergh
- The research centre for age-related functional decline and disease, Innlandet hospital trust, Ottestad, Norway
| | - Corinne E. Fischer
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Radboud Alzheimer Center, Nijmegen, the Netherlands
| | - George Grossberg
- Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry St Louis University School of Medicine
| | - Zahinoor Ismail
- Departments Psychiatry, Neurology, Epidemiology, and Pathology, Hotchkiss Brain Institute & O’Brien Institute for Public Health University of Calgary
| | - Krista Lanctôt
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; and Departments of Psychiatry and Pharmacology/Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maria I Lapid
- Mayo Clinic Department of Psychiatry and Psychology, Rochester, MN, USA
| | - Jacobo Mintzer
- Psychiatrist, Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Rebecca Palm
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Michael Splaine
- Owner Splaine Consulting, Managing Partner, Recruitment Partners LLC
| | - Kate Zhong
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas
| | - Carolyn W. Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, NYC, NY and James J. Peters VAMC, Bronx NY
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Splaine M. Findings from Dialogue with Patients and Families of Persons with Dementia. Alzheimers Dement 2022. [DOI: 10.1002/alz.064706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Splaine M. Adult Protective Services and Law Enforcement: Does It Add or Subtract to the Precarity of Living Alone With Dementia? Innov Aging 2020. [PMCID: PMC7742224 DOI: 10.1093/geroni/igaa057.2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In 2014, more than 12.5 million people age 65+ lived alone in the U.S. Of these, approximately one third had a cognitive impairment. Although protective services may identify risks to such individuals, they may not have a full understanding of the notion of precarity, or the looming uncertainty regarding space and place, that solo dwellers experience. This presentation explores the tension between the intentions of protective services and the experience of precarity for persons living alone. More specifically, persons living alone with dementia participating in online groups and community events report feelings of risk of loss of autonomy and rights if their status becomes known. The presenter will review these impressions against current police and adult protective services policies and standard practices.
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Dawson WD, Bangerter LR, Splaine M. The Politics of Caregiving: Taking Stock of State-Level Policies to Support Family Caregivers. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/ppar/praa005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Walter D Dawson
- Department of Neurology, Oregon Health & Science University, Portland, OR
- Institute on Aging, Portland State University, Portland, OR
- Global Brain Health Institute, University of California, San Francisco, CA
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French M, Splaine M, Shean J, Holt H. LISTENING AND LEARNING TO FORM THE HBI ROAD MAP FOR INDIAN COUNTRY. Innov Aging 2019. [PMCID: PMC6840355 DOI: 10.1093/geroni/igz038.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
American Indian and Alaska Native (AI/AN) communities are establishing new paths as more older adults develop Alzheimer’s and other dementias along with other co-morbidities. To offer a flexible framework of public health strategies that proactively address the growing issue of dementia among AI/ANs, Alzheimer’s Association and Centers for Disease Control and Prevention (CDC) developed the first-ever Healthy Brain Initiative Road Map for Indian Country. Partnering with International Association for Indigenous Aging supported Road Map development through virtual listening sessions and written comments from regional Native health experts, tribal aging service leaders, and tribal government officials. Many additional discussions, engagement of a cultural guide, and an additional partnership with National Indian Health Board further informed Road Map contents, graphic design, and marketing. Presenter will describe rationale for the process, themes from the consultations, and lessons learned by the Association and CDC that can apply to similar initiatives.
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Affiliation(s)
- Molly French
- Alzheimer’s Association, Washington, District of Columbia, United States
| | | | - John Shean
- Alzheimer’s Association, Washington DC, District of Columbia, United States
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Bangerter LR, Fadel M, Riffin C, Splaine M. The Older Americans Act and Family Caregiving: Perspectives from Federal and State Levels. Public Policy Aging Rep 2019; 29:62-66. [PMID: 31205404 DOI: 10.1093/ppar/prz006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Lauren R Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, MN
| | - Meghan Fadel
- Bureau of Community Integration and Alzheimer's Disease, Division of Long Term Care, New York State Department of Health Office of Health Insurance Programs, Albany
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY
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8
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Splaine M. Thinking About Thinking: Why Cognition Should Be the Sixth Vital Sign. MD Advis 2019; 12:19-20. [PMID: 31430077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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9
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Splaine M. THE DEMENTIA JOURNEY IN INDIAN COUNTRY: OPTIONS FOR A PUBLIC HEALTH RESPONSE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Splaine
- Splaine Consulting, Columbia, Maryland, United States
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10
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Janicki MP, McCallion P, Splaine M, Santos FH, Keller SM, Watchman K. Consensus Statement of the International Summit on Intellectual Disability and Dementia Related to Nomenclature. Intellect Dev Disabil 2017; 55:338-346. [PMID: 28972868 DOI: 10.1352/1934-9556-55.5.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A working group of the 2016 International Summit on Intellectual Disability and Dementia was charged to examine the terminology used to define and report on dementia in publications related to intellectual disability (ID). A review of related publications showed mixed uses of terms associated with dementia or causative diseases. As with dementia research in the non-ID population, language related to dementia in the ID field often lacks precision and could lead to a misunderstanding of the condition(s) under discussion, an increasingly crucial issue given the increased global attention dementia is receiving in that field. Most articles related to ID and dementia reporting clinical or medical research generally provide a structured definition of dementia or related terms; social care articles tend toward term use without definition. Toward terminology standardization within studies/reports on dementia and ID, the Summit recommended that a consistent approach is taken that ensures (a) growing familiarity with dementia-related diagnostic, condition-specific, and social care terms (as identified in the working group's report); (b) creating a guidance document on accurately defining and presenting information about individuals or groups referenced; and
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Affiliation(s)
| | | | | | | | - Seth M Keller
- Seth M. Keller, American Academy of Developmental Medicine and Dentistry, Lumberton, NJ; and
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Watchman K, Janicki MP, Splaine M, Larsen FK, Gomiero T, Lucchino R. International Summit Consensus Statement: Intellectual Disability Inclusion in National Dementia Plans. Am J Alzheimers Dis Other Demen 2017; 32:230-237. [PMID: 28417674 PMCID: PMC10852755 DOI: 10.1177/1533317517704082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The World Health Organization (WHO) has called for the development and adoption of national plans or strategies to guide public policy and set goals for services, supports, and research related to dementia. It called for distinct populations to be included within national plans, including adults with intellectual disability (ID). Inclusion of this group is important as having Down's syndrome is a significant risk factor for early-onset dementia. Adults with other ID may have specific needs for dementia-related care that, if unmet, can lead to diminished quality of old age. An International Summit on Intellectual Disability and Dementia, held in Scotland, reviewed the inclusion of ID in national plans and recommended that inclusion goes beyond just description and relevance of ID. Reviews of national plans and reports on dementia show minimal consideration of ID and the challenges that carers face. The Summit recommended that persons with ID, as well as family carers, should be included in consultation processes, and greater advocacy is required from national organizations on behalf of families, with need for an infrastructure in health and social care that supports quality care for dementia.
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Affiliation(s)
- Karen Watchman
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom
| | - Matthew P. Janicki
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Frode K. Larsen
- Norwegian National Advisory Unit on Ageing and Health, Oslo, Norway
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Splaine M. P3–246: Acute care and dementia: Emerging lessons from national policies. Alzheimers Dement 2013. [DOI: 10.1016/j.jalz.2013.05.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Ogrinc G, Mooney SE, Estrada C, Foster T, Goldmann D, Hall LW, Huizinga MM, Liu SK, Mills P, Neily J, Nelson W, Pronovost PJ, Provost L, Rubenstein LV, Speroff T, Splaine M, Thomson R, Tomolo AM, Watts B. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care 2008; 17 Suppl 1:i13-32. [PMID: 18836062 PMCID: PMC2602740 DOI: 10.1136/qshc.2008.029058] [Citation(s) in RCA: 282] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
As the science of quality improvement in health care advances, the importance of sharing its accomplishments through the published literature increases. Current reporting of improvement work in health care varies widely in both content and quality. It is against this backdrop that a group of stakeholders from a variety of disciplines has created the Standards for QUality Improvement Reporting Excellence, which we refer to as the SQUIRE publication guidelines or SQUIRE statement. The SQUIRE statement consists of a checklist of 19 items that authors need to consider when writing articles that describe formal studies of quality improvement. Most of the items in the checklist are common to all scientific reporting, but virtually all of them have been modified to reflect the unique nature of medical improvement work. This "Explanation and Elaboration" document (E & E) is a companion to the SQUIRE statement. For each item in the SQUIRE guidelines the E & E document provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item. As with the E & E documents created to accompany other biomedical publication guidelines, the purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication. The SQUIRE statement itself, this E & E document, and additional information about reporting improvement work can be found at http://www.squire-statement.org.
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Affiliation(s)
- G Ogrinc
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, VT 05009, USA.
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Patterson JA, Bierman AS, Splaine M, Goodlin SJ, Schreiber RJ, Wasson JH. The population of people age 80 and older: a sentinel group for understanding the future of health care in the United States. J Ambul Care Manage 1998; 21:10-6. [PMID: 10181842 DOI: 10.1097/00004479-199807000-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Those age 80 years or older (80+) constitute a relatively small percentage of a health care system's population. However, because of the associated risks, costs, and variation of their medical care, 80+ patients are sentinel for elder care quality. This article describes the survey components of the 80+ Project. This project was designed to help clinicians gain a complete picture of the special needs of the 80+ population. The information about these patients' health and functional status, how they utilize health care resources, how they obtain access to care, and their satisfaction with the care is useful for clinicians who wish to improve health care delivery.
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Affiliation(s)
- J A Patterson
- Department of Medicine, Dartmouth Medical School, Hanover, NH, USA
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Abstract
This article describes some potential solutions to the many practical barriers that arise when trying to improve clinical care in everyday practice. A useful mnemonic for incorporating measurement into daily work is called GAPS--setting Goals, Assessing the current processes, Planning a new approach, and Starting it. The 80+ Project represents a foundation of information and offers promise to create durable, productive interactions for elderly individuals and their health care providers.
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Abstract
Understanding the barriers to obtaining care that the population of people age 80 and older (80+) experiences is one of the first steps toward developing organizational and clinical strategies aimed at improving care. This article reviews the data from the 80+ Project's survey to assess the prevalence of barriers to care and identify the characteristics that place the 80+ population at risk. Barriers to access for older adults occur on many levels. Ultimately, the ability to improve health outcomes through reducing barriers to care is dependent on the effectiveness and quality of care received. By recognizing the barriers to care that limit access, health care professionals can begin to develop strategies to eliminate these barriers and improve the health care of older adult patients.
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Affiliation(s)
- A S Bierman
- Center for Outcomes and Effectiveness Research, Agency for Health Care Policy and Research, Department of Health and Human Services, Rockville, MD, USA
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Abstract
Today, managing care from the "outside in" is the predominant model for changing health care. The risk of this outside-in approach is that the health care system may lose sight of the people and communities for which it serves and cares. In this article, an "inside-out" model for viewing health care in a geriatric population is presented from the perspective of patients and providers, placing the provider in a proactive rather than reactive role. By focusing attention on the outcomes or value a patient is experiencing, providers are challenged to consider new ways of managing care.
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Splaine M, Brooks WB, Patterson JA, von Reyn L, Wasson JH. Geriatric education: a system approach. J Ambul Care Manage 1998; 21:40-8. [PMID: 10181846 DOI: 10.1097/00004479-199807000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes an institutionwide geriatric educational initiative (called Geriatrics Awareness Month) that provided didactic and formal experiential learning designed for health professionals. From an educational perspective, to learn geriatrics requires systems thinking, and, to learn systems thinking, geriatrics provides an excellent clinical context. The authors evaluated the didactic and experiential aspects of Geriatric Awareness Month. For attendees of didactic sessions, the availability of pocket-sized educational materials was deemed most valuable. Despite busy schedules, house staff were able to make a change in their practice and study the effect of this change.
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Abstract
The co-ordinates of the dwellings where cases of variola minor (alastrim) occurred during a small epidemic were used in a worked example of contour mapping of disease spread. The contoured variable was the date of onset, relative to an arbitrary base date, of the case introducing the disease into each of twenty-two households. Three contour maps prepared with slightly different computer programmes or dates exhibited similar concentric loops whose centres were close to the first infected household. The average rate of spread of the disease was estimated by regression of the number of days to onset of the first case in the household on the average distance from an arbitrary origin to the relevant contour line. The calculated average rate of spread was 1.22 metres per day. An additional map was contoured using the cumulative number of cases as the contoured variable, relative to the onset of the example epidemic.
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Barclay GP, Splaine M. The distribution of the sickle cell trait in Zambia: a comparison of results from rural and urban areas. Trop Geogr Med 1972; 24:393-400. [PMID: 4648652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Splaine M, Hayes EB, Barclay GP. Calculations for changes in sickle-cell trait rates. Am J Hum Genet 1971; 23:368-74. [PMID: 5097903 PMCID: PMC1706706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Splaine M, Lintott AP, Barclay GP. Pictorial representation of the distribution of the sickle-cell trait by contours drawn by a computer-controlled X-Y plotter. Ann Hum Genet 1970; 34:51-9. [PMID: 5476664 DOI: 10.1111/j.1469-1809.1970.tb00219.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Barclay GP, Jones HI, Splaine M. A survey of the incidence of sickle cell trait and glucose-6-phosphate dehydrogenase deficiency in Zambia. Trans R Soc Trop Med Hyg 1970; 64:78-93. [PMID: 5442090 DOI: 10.1016/0035-9203(70)90197-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Bainbridge L, Beishon J, Hemming JH, Splaine M. A Study of Real-Time Human Decision-Making Using a Plant Simulator. ACTA ACUST UNITED AC 1968. [DOI: 10.2307/3007477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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