Journal ArticlePM R · July 5, 2024
INTRODUCTION: The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed t ...
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Journal ArticleJ Am Geriatr Soc · February 2024
BACKGROUND: Falls are the most common medication-related safety event in older adults. Deprescribing fall risk-increasing drugs (FRIDs) may mitigate fall risk. This study assesses the effects of an innovative deprescribing program in reducing FRID burden a ...
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Journal ArticleBr J Anaesth · January 2024
BACKGROUND: In the eyes-closed, awake condition, EEG oscillatory power in the alpha band (7-13 Hz) dominates human spectral activity. With eyes open, however, EEG alpha power substantially decreases. Less alpha attenuation with eyes opening has been associ ...
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Journal ArticleStress Health · September 2023
The objectives of this article are to introduce a conceptual framework for physical resilience in the context of ageing and to discuss key elements and challenges in the design of studies of physical resilience after health stressors. Advancing age is asso ...
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Journal ArticleBMC Nurs · January 31, 2023
BACKGROUND: Deprescribing initiatives in the long-term care (LTC) setting are often unsuccessful or not sustained. Prior research has considered how physicians and pharmacists feel about deprescribing, yet little is known about the perspectives of frontlin ...
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Journal ArticleGerontologist · September 7, 2022
BACKGROUND AND OBJECTIVES: Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stak ...
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Journal ArticleBMC Health Serv Res · July 29, 2022
BACKGROUND: Clinical interventions often need to be adapted from their original design when they are applied to new settings. There is a growing literature describing frameworks and approaches to deploying and documenting adaptations of evidence-based prac ...
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Journal ArticleAdv Skin Wound Care · June 1, 2022
OBJECTIVE: To investigate the clinical effectiveness of three nursing-home-wide repositioning intervals (2-, 3-, or 4-hour) without compromising pressure injury (PrI) incidence in 4 weeks. METHODS: An embedded pragmatic cluster randomized controlled trial ...
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Journal ArticleJournal of the American Geriatrics Society · March 2022
As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and as ...
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Journal ArticleJ Am Geriatr Soc · March 2022
As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and as ...
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Journal ArticleArch Osteoporos · January 3, 2022
UNLABELLED: Decisions on whether to use pharmacologic osteoporosis therapy in skilled nursing facility residents are complex and require shared decision-making. Residents, proxies, and staff desire individualized fracture risk estimates that consider advan ...
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Journal ArticleContemp Clin Trials · January 2022
Current guidelines recommend primary osteoporosis screening for at-risk men to reduce the morbidity, mortality, and cost associated with osteoporotic fractures. However, analyses in a national Veterans Health Administration cohort of over 4,000,000 men dem ...
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Journal ArticleGeriatr Nurs · 2022
As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and as ...
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Chapter · January 1, 2022
Osteosarcopenia is an important shared risk factor for the overlapping geriatric syndromes of falls and fractures. Importantly, the occurrence of falls and fractures frequently sets off a negative cycle of decreased physical activity which further worsens ...
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Journal ArticleJ Am Geriatr Soc · November 2021
BACKGROUND: Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, ...
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Journal ArticleBMC Health Serv Res · August 12, 2021
BACKGROUND: Quality improvement (QI) is used in nursing homes (NH) to implement and sustain improvements in patient outcomes. Little is known about how QI strategies are used in NHs. This lack of information is a barrier to replicating successful strategie ...
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ConferenceJBMR Plus · August 2021
Risk factors for nonadherence to osteoporosis medication have been well described for cohorts of women with osteoporosis, but little is known about predictors or mediators of nonadherence in men. We conducted a secondary analysis of a national cohort of ma ...
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Journal ArticleJ Am Geriatr Soc · July 2021
BACKGROUND: Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE: This qualitative study uses a socioecological framework to explore factors th ...
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Journal ArticleBMC Nephrol · June 19, 2021
BACKGROUND AND OBJECTIVES: After dialysis initiation, older adults may experience orthostatic or post-dialysis hypotension. Some orthostasis-causing antihypertensives (i.e., central alpha agonists and alpha blockers), are considered potentially inappropria ...
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Journal ArticleOsteoporos Int · June 2021
UNLABELLED: In patients with surgical repair of a low-trauma hip fracture, zoledronic acid (ZA) reduced the risk of subsequent fractures regardless of pretreatment femoral neck and total hip bone mineral density (BMD). INTRODUCTION: Zoledronic acid reduces ...
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Journal ArticleNeurology · March 23, 2021
OBJECTIVE: To assess long-term (2 years) effects of bimagrumab in participants with sporadic inclusion body myositis (sIBM). METHODS: Participants (aged 36-85 years) who completed the core study (RESILIENT [Efficacy and Safety of Bimagrumab/BYM338 at 52 We ...
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Journal ArticleOsteoporos Int · March 2021
UNLABELLED: We evaluated the fracture risk assessment tool (FRAX) without bone mineral density (BMD) in predicting treatment recommendations for patients with a recent low trauma fracture other than hip or vertebral. The concordance, sensitivity, and speci ...
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Journal ArticleTrials · February 5, 2021
BACKGROUND: Skilled nursing facility (SNF) patients are medically complex with multiple, advanced chronic conditions. They are dependent on caregivers and have experienced recent acute illnesses. Among SNF patients, the rate of mortality or acute care use ...
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ConferenceArch Osteoporos · February 2, 2021
UNLABELLED: We determined the extent of and reasons for non-adherence to oral bisphosphonates among veterans and conducted a pilot text message reminder application aimed at the most commonly cited reason for non-adherence. The intervention was found to be ...
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Journal ArticleJ Am Med Dir Assoc · February 2021
OBJECTIVES: To evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65Â years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs). DESIGN: Retrospective design/cohort analysis of Centers for Med ...
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ConferenceWorld J Surg · January 2021
BACKGROUND: Geriatric collaborative care models improve postoperative outcomes for older adults. However, there are limited data exploring how preoperative geriatric assessment may affect surgical cancellations. METHODS: This is a single-center retrospecti ...
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Journal ArticleJ Am Med Dir Assoc · January 2021
Clinicians struggle with whether to prescribe osteoporosis medications for fracture prevention for older nursing home (NH) residents with dementia, given the lack of evidence in this population. To better understand real-world clinical practice, we conduct ...
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Journal ArticleFront Syst Neurosci · 2021
Physiologic signals such as the electroencephalogram (EEG) demonstrate irregular behaviors due to the interaction of multiple control processes operating over different time scales. The complexity of this behavior can be quantified using multi-scale entrop ...
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Journal ArticleAging Clin Exp Res · December 2020
BACKGROUND: Administrative data sets lack functional measures. AIM: We examined whether trajectories of cost can be used as a marker of functional recovery after hospitalization. METHODS: Secondary analysis of the National Health and Aging Trends Study mer ...
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Journal ArticleJ Gerontol A Biol Sci Med Sci · September 25, 2020
BACKGROUND: Clinically similar older adults demonstrate variable responses to health stressors, heterogeneity attributable to differences in physical resilience. However, molecular mechanisms underlying physical resilience are unknown. We previously derive ...
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Journal ArticleJ Appl Gerontol · August 2020
Prior studies have not described strategies for implementing transitional care in skilled nursing facilities (SNFs). As part of the Connect-Home study, we pilot tested the Transition Plan of Care (TPOC) template, an implementation tool that SNF staff used ...
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Journal ArticleJ Am Med Dir Assoc · August 2020
OBJECTIVES: Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, ...
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Journal ArticleJ Aging Phys Act · April 24, 2020
This study describes the availability of physical activity information in the electronic health record, explores how electronic health record documentation correlates with accelerometer-derived physical activity data, and examines whether measured physical ...
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Journal ArticleJ Gerontol A Biol Sci Med Sci · March 9, 2020
BACKGROUND: Approaches for quantifying physical resilience in older adults have not been described. METHODS: We apply two conceptual approaches to defining physical resilience to existing longitudinal data sets in which outcomes are measured after an acute ...
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Journal ArticleQual Life Res · March 2020
PURPOSE: Patient priorities for quality of life change with age. We conducted a qualitative study to identify quality of life themes of importance to older adults receiving dialysis and the extent to which these are represented in existing quality of life ...
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Journal ArticleJ Bone Miner Res · March 2020
Acetylcholinesterase inhibitors (AChEIs) have been noted to increase bone density and quality in mice. Human studies are limited but suggest an association with improved bone healing after hip fracture. We examined the relationship between AChEI use and fr ...
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Journal ArticleJ Am Geriatr Soc · February 2020
BACKGROUND: Hospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital. OBJECTIVE: To examine whether wearable hospital activity trackers can be used to predict HAD. DESIGN: A prospective observational stu ...
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Journal ArticleAnesth Analg · January 2020
Deciding whether to pursue elective surgery is a complex process for older adults. Comprehensive geriatric assessment (CGA) can help refine estimates of benefits and risks, at times leading to a delay of surgery to optimize surgical readiness. We describe ...
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Journal ArticleJ Am Geriatr Soc · January 2020
This report summarizes the presentations and recommendations of the eleventh annual American Geriatrics Society and National Institute on Aging research conference, "Osteoporosis and Soft Tissue (Muscle/Fat) Disorders," on March 11-12, 2019, in Bethesda, M ...
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Journal ArticleKidney Med · 2020
RATIONALE & OBJECTIVE: Physical function is not routinely measured in older adults receiving dialysis. We evaluated the appropriateness of repeated measurements of physical function, including Short Physical Performance Battery (SPPB), handgrip strength, a ...
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Journal ArticleKidney Med · 2020
RATIONALE & OBJECTIVE: Attention to geriatric impairments is not routinely provided to older adults receiving dialysis. Our objective was to identify patient and personnel perspectives on experiences with geriatric problems, unmet needs that may affect a p ...
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Journal ArticleJ Am Geriatr Soc · December 2019
OBJECTIVES: Defining common patterns of recovery after an acute health stressor (resiliency groups) has both clinical and research implications. We sought to identify groups of patients with similar recovery patterns across 10 outcomes following hip fractu ...
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Journal ArticleJ Bone Miner Res · November 2019
Diabetes mellitus among older men has been associated with increased bone mineral density but paradoxically increased fracture risk. Given the interactions among medication treatment, glycemic control, and diabetes-associated comorbidities, the relative ef ...
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Journal ArticleFed Pract · October 2019
A telehealth program supports meaningful partnerships between urban geriatric specialists and rural health care providers to facilitate increased access to specialty care. ...
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Journal ArticleBMC Nephrol · July 15, 2019
BACKGROUND: There is limited evidence on the relationship between social support and renal outcomes in African Americans. We sought to determine the association of social support with prevalent chronic kidney disease (CKD) and kidney function decline in an ...
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Journal ArticleHealth Aff (Millwood) · June 2019
Although most care for people with serious illness is delivered by multiple providers and agencies, there is no gold standard for how to assemble, train, unify, and sustain strong teams. Using lessons from complexity science, a way of studying complex syst ...
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Journal ArticleJ Am Geriatr Soc · February 2019
After passage of the 21st Century Cures Act, the National Institutes of Health held a workshop in 2017 to consider expanding its inclusion policy to encompass individuals of all ages. American Geriatrics Society (AGS) leaders and members participated in th ...
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Journal ArticleHealth Care Manag (Frederick) · 2019
The purpose of this article is to describe changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement (TKR) in 2009 and 2014. Data came from the Healthcare Cost and Utilization Project net-Nationwide Readmissio ...
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Journal ArticleKidney Med · 2019
RATIONALE & OBJECTIVE: Timely recognition of functional decline in older adults receiving dialysis will allow clinicians to pursue interventions to prevent further disability and/or lead patient-centered goals of care discussions. Annual change in the 12-I ...
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Journal ArticleMayo Clin Proc · December 2018
OBJECTIVE: To determine the association between dual-energy x-ray absorptiometry (DXA) testing for osteoporosis and subsequent fractures in US male veterans without a previous fracture. PATIENTS AND METHODS: This is a propensity score-matched observational ...
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Journal ArticleAppl Clin Inform · July 2018
OBJECTIVE: Venous thromboembolism (VTE) prophylaxis is an important consideration for hospitalized older adults, and the Padua Prediction Score (PPS) is a risk prediction tool used to prioritize patient selection. We developed an automated PPS (APPS) algor ...
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Journal ArticleArch Phys Med Rehabil · June 2018
OBJECTIVE: To document changes in 30-day hospital readmission rates and causes for returning to the hospital for care in THR patients. DESIGN: Retrospective cross-sectional descriptive design. SETTING: Community-based acute care hospitals. PARTICIPANTS: To ...
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Journal ArticleJ Am Med Dir Assoc · May 2018
OBJECTIVES: Validated process measures that correlate with patient outcomes are needed for research and quality improvement. DESIGN: Cross-sectional analysis within a cluster-randomized fall prevention study. SETTING: Nursing homes in North Carolina (n = 1 ...
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Journal ArticleImplement Sci · April 20, 2018
BACKGROUND: Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, ...
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ConferenceJournal of Hospital Medicine · April 10, 2018
Background: Clinical practice guidelines state that mobility is supposed to play an important role in determining use and duration of pharmacologic VTE prophylaxis. This study examines whether measured mobility levels relate to pharmacologic VTE prophylaxi ...
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Journal ArticleJ Am Geriatr Soc · March 2018
OBJECTIVES: To examine whether chronic kidney disease (CKD) at any stage is associated with fracture risk after adjusting for competing mortality and to determine whether age or race modify the relationship between CKD and fracture risk. DESIGN: Prospectiv ...
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Journal ArticleBMC Geriatr · February 20, 2018
BACKGROUND: Pressure ulcers/injuries (PrUs), a critical concern for nursing homes (NH), are responsible for chronic wounds, amputations, septic infections, and premature deaths. PrUs occur most commonly in older adults and NH residence is a risk factor for ...
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Journal ArticleBMC Nephrol · January 15, 2018
BACKGROUND: For older adults receiving dialysis, health-related quality of life is not often considered in prognostication of death or future hospitalizations. To determine if routine health-related quality of life measures may be useful for prognosticatio ...
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Journal ArticleJ Clin Endocrinol Metab · January 1, 2018
INTRODUCTION: Type 2 diabetes mellitus among older women has been associated with increased bone mineral density, but paradoxically with increased fracture risk. Findings among older men have varied, and potential mechanisms have not been fully elucidated. ...
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Journal ArticleHealth Care Manag (Frederick) · 2018
We sought to understand strategies reported by members of the nursing home management team used to prevent falls in short-stay nursing home patients. Using Donabedian's model of structure, process, and outcomes, we interviewed 16 managers from 4 nursing ho ...
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Journal ArticleJAMA Intern Med · November 1, 2017
IMPORTANCE: New approaches are needed to enhance implementation of complex interventions for geriatric syndromes such as falls. OBJECTIVE: To test whether a complexity science-based staff training intervention (CONNECT) promoting high-quality staff interac ...
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Journal ArticleJ Am Geriatr Soc · October 2017
BACKGROUND: Older adults that transfer from skilled nursing facilities (SNF) to home have significant risk for poor outcomes. Transitional care of SNF patients (i.e., time-limited services to ensure coordination and continuity of care) is poorly understood ...
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Journal ArticleClin J Am Soc Nephrol · June 7, 2017
BACKGROUND AND OBJECTIVES: Although arteriovenous fistulas have been found to be the most cost-effective form of hemodialysis access, the relative benefits of placing an arteriovenous fistula versus an arteriovenous graft seem to be least certain for older ...
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Journal ArticleJ Am Geriatr Soc · April 2017
BACKGROUND: Nursing home (NH) residents who require assistance during mealtimes are at risk for malnutrition. Supportive handfeeding is recommended, yet there is limited evidence supporting use of a specific handfeeding technique to increase meal intake. O ...
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Journal ArticleJ Am Geriatr Soc · April 2017
OBJECTIVES: Little is known about how nursing home staff use resident characteristics to individualize care delivery or whether care is affected by implicit bias. DESIGN: Randomized factorial clinical vignette survey. SETTING: Sixteen nursing homes in Nort ...
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Journal ArticleJ Am Geriatr Soc · October 2016
Older adults with advanced chronic kidney disease (CKD) experience functional impairment that can complicate CKD management. Failure to recognize functional impairment may put these individuals at risk of further functional decline, nursing home placement, ...
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Journal ArticleJ Am Geriatr Soc · October 2016
Observational studies are an important source of evidence for evaluating treatment benefits and harms in older adults, but lack of comparability in the outcome risk factors between the treatment groups leads to confounding. Propensity score (PS) analysis i ...
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Journal ArticleImplement Sci · July 16, 2016
BACKGROUND: Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staf ...
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Journal ArticleBMC Health Serv Res · May 17, 2016
BACKGROUND: Among hospitalized older adults who transfer to skilled nursing facilities (SNF) for short stays and subsequently transfer to home, twenty two percent require additional emergency department or hospital care within 30Â days. Transitional care se ...
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ConferenceJournal of the American Geriatrics Society, Special Issue 2016: Annual Scientific Meeting Abstract Book · April 22, 2016Full textLink to itemCite
Journal ArticleJ Gerontol A Biol Sci Med Sci · April 2016
BACKGROUND: Resilience has been described in the psychosocial literature as the capacity to maintain or regain well-being during or after adversity. Physical resilience is a newer concept that is highly relevant to successful aging. Our objective was to ch ...
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Journal ArticleGerontologist · February 2016
PURPOSE OF THE STUDY: Postmenopausal osteoporosis can impact quality-of-life even prefracture. To determine whether osteoporosis should be a greater concern in women Veterans versus non-Veterans, we compared fracture rates and bone mineral density (BMD) fo ...
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Journal ArticleRural Remote Health · 2016
INTRODUCTON: Low-trauma, osteoporotic fractures among older men are associated with a significant increase in morbidity and mortality. Despite effective therapies for osteoporosis, several studies have demonstrated that management and treatment after a low ...
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Journal ArticleGeriatr Nurs · 2016
Transitional care may be an effective strategy for preparing older adults for transitions from skilled nursing facilities (SNF) to home. In this systematic review, studies of patients discharged from SNFs to home were reviewed. Study findings were assessed ...
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Journal ArticleBone · December 2015
PURPOSE: With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to ...
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Journal ArticleJ Am Geriatr Soc · August 2015
OBJECTIVES: To examine the effect of functional impairments in older women with diabetes mellitus (DM) on incident clinical fractures. DESIGN: Secondary analysis of two large prospective cohort studies. SETTING: North Carolina Established Populations for E ...
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Journal ArticleGerontologist · August 2015
PURPOSE OF THE STUDY: To describe key adaptive challenges and leadership behaviors to implement culture change for person-directed care. DESIGN AND METHODS: The study design was a qualitative, observational study of nursing home staff perceptions of the im ...
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Journal ArticleClin J Am Soc Nephrol · March 6, 2015
BACKGROUND AND OBJECTIVES: Older adults with ESRD often receive care in skilled nursing facilities (SNFs) after an acute hospitalization; however, little is known about acute care use after SNF discharge to home. DESIGN, SETTING, PARTICIPANTS, & MEASUREMEN ...
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Journal ArticleGeriatr Nurs · 2015
This study examined whether chronic kidney disease (CKD) is associated with recurrent falls in older adults in nursing homes (NHs). We used data abstracted over a six month period from 510 NH residents with a history of falls. Thirty-five percent of the NH ...
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Journal ArticleClinical and Experimental Rheumatology · January 1, 2015
Objective: Few studies have assessed the effectiveness of different drugs for osteoporosis (OP). We aimed to determine if fracture and mortality rates vary among patients initiating different OP medications. Methods: We used the Medicare 5% sample to ident ...
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Journal ArticleJ Bone Miner Res · December 2014
Minimizing post-fracture bone loss is an important aspect of recovery from hip fracture, and determination of factors that affect bone mineral density (BMD) response to treatment after hip fracture may assist in the development of targeted therapeutic inte ...
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Journal ArticleBMC Health Serv Res · June 5, 2014
BACKGROUND: To describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents and staff. METHODS: We conducted comparative, multiple-case studies in selected NHs (N = 4). Dat ...
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Journal ArticleCalcif Tissue Int · June 2014
Fewer than 24% of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identif ...
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Journal ArticleGerontologist · June 2014
PURPOSE OF THE STUDY: The CONNECT intervention is designed to improve staff connections, communication, and use of multiple perspectives for problem solving. This analysis compared staff descriptions of the learning climate, use of social constructivist le ...
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Journal ArticleJ Am Geriatr Soc · January 2014
OBJECTIVES: To describe the time to first acute care use (e.g., emergency department (ED) use without hospitalization or rehospitalization) for older adults discharged to home after receiving postacute care in skilled nursing facilities (SNFs); to identify ...
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Journal ArticleJ Am Geriatr Soc · December 2013
OBJECTIVES: To determine whether an intervention that improves nursing home (NH) staff connections, communication, and problem solving (CONNECT) would improve implementation of a falls reduction education program (FALLS). DESIGN: Cluster randomized trial. ...
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Journal ArticleCurr Osteoporos Rep · December 2013
Osteoporosis and related fractures disproportionately impact patients with advanced age, those with the frailty phenotype, and those with multiple comorbidities. Recent studies report a changing incidence in fracture type among the oldest old throughout th ...
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Journal ArticleAm Fam Physician · September 15, 2013
Functional disability is common in older adults. It is often episodic and is associated with a high risk of subsequent health decline. The severity of disability is determined by physical impairments caused by underlying medical conditions, and by external ...
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Journal ArticleJ Am Med Dir Assoc · August 2013
BACKGROUND: The Safety Organizing Scale is a valid and reliable measure on safety behaviors and practices in hospitals. PURPOSE OF THE STUDY: This study aimed to explore the psychometric properties of the Safety Organizing Scale-Nursing Home version (SOS-N ...
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Journal ArticleJ Am Assoc Nurse Pract · August 2013
PURPOSE: To describe the development, implementation, and preliminary results of the Transitional Care (TLC) Partners, a clinical demonstration program that supports the transition from hospital to home of older veterans. DATA SOURCES: Hospital records of ...
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Journal ArticleJ Am Med Dir Assoc · July 2013
Long term care deserves focused attention within a geriatric medicine fellowship curriculum to ensure that graduates are prepared not only for clinical care but also for the leadership, administrative, educational, quality improvement, and health policy as ...
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Journal ArticleJ Bone Miner Res · May 2013
Bisphosphonates have been shown to reduce mortality in patients with osteoporotic fractures, but the mechanism is unclear. Bisphosphonates have immunomodulatory effects that may influence the development of vascular disease. We sought to determine if bisph ...
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Journal ArticleJ Am Geriatr Soc · May 2013
OBJECTIVES: To compare the cost-effectiveness of population screening for vitamin D insufficiency with that of universal vitamin D supplementation in community-dwelling older adults. DESIGN: A Markov decision model simulating follow-up over a 36-month peri ...
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Journal ArticleJ Am Med Dir Assoc · April 2013
OBJECTIVES/INTRODUCTION: Demand for nursing home (NH) care by patients with end-stage renal disease (ESRD) is likely to increase with growing numbers of older adults initiating chronic dialysis. We completed a systematic review to summarize the literature ...
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Journal ArticleImplement Sci · January 2, 2013
BACKGROUND: Many challenges arise in complex organizational interventions that threaten research integrity. This article describes a Tool for Evaluating Research Implementation Challenges (TECH), developed using a complexity science framework to assist res ...
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Journal ArticleBonekey Rep · December 12, 2012
The annual number of hip fractures worldwide is expected to exceed 6 million by 2050. Currently, nearly 50% of hip fracture patients will develop at least one short-term complication including infection, delirium, venous thromboembolism (VTE), pressure ulc ...
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Journal ArticleAging Health · October 1, 2012
Despite the increasing number of treatment options for osteoporosis, healthcare providers continue to face clinical conundrums when deciding if and how to treat frail, older adults. The under-representation of this population in randomized controlled trial ...
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Journal ArticleJ Clin Invest · May 2012
Clinical vignette: A 68-year-old woman consults you after a recent bone mineral density screening revealed osteopenia, total hip T score of –1.8. Further evaluation shows her only other abnormal lab value is a serum 25-hydroxyvitamin D [25(OH)D] level of 1 ...
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Journal ArticleJ Am Geriatr Soc · March 2012
OBJECTIVES: To explore the perspectives and priorities of nursing home residents, family members, and frontline nursing staff concerning a broad range of items representing common targets of culture change initiatives. DESIGN: Qualitative study. SETTING: A ...
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Journal ArticleImplement Sci · February 29, 2012
BACKGROUND: Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occu ...
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Journal ArticleJ Am Med Dir Assoc · February 2012
INTRODUCTION: Nursing Home Compare quality ratings are designed to allow patients, families, and clinicians to compare facilities based on quality, but associations of the current measures with important clinical outcomes are not known. Our study examined ...
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Journal ArticleFam Community Health · 2012
After hospitalization, more than 1.5 million older adults each year receive postacute care in skilled nursing facilities (SNFs). Transitional care services, designed to prepare older SNF patients (and their family caregivers) for their transitions from an ...
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Journal ArticleMed Teach · 2012
Peer-mentoring groups are purported to enhance faculty productivity and retention, but the literature about implementation is sparse. Nominal Group Sessions (n=5) with 66 faculty members in different tracks developed prioritized lists of unmet professional ...
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Journal ArticleCalcif Tissue Int · December 2011
Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were ...
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Journal ArticleJ Am Geriatr Soc · November 2011
OBJECTIVES: To assess the efficacy of once-yearly zoledronic acid (ZOL) 5 mg in increasing bone mineral density (BMD) in men with a recent hip fracture participating in the Health Outcomes and Reduced Incidence with Zoledronic Acid Once- Yearly Recurrent F ...
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Journal ArticleOsteoporos Int · September 2011
UNLABELLED: This study evaluated the benefits of ZOL versus placebo on health-related quality of life (HRQoL) among patients from HORIZON-RFT. At month 24 and end of the study visit, ZOL significantly improved patients' overall health state compared to pla ...
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Journal ArticleJ Am Geriatr Soc · September 2011
OBJECTIVES: To evaluate the cost-effectiveness of oral bisphosphonate therapy for osteoporosis in women at different ages and life expectancies. DESIGN: A Markov model was used to analyze oral bisphosphonate treatment for 5 years compared to no interventio ...
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Journal ArticleOsteoporos Int · August 2011
UNLABELLED: Patients in the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly (HORIZON) Recurrent Fracture Trial were assessed for evidence of delayed hip fracture healing. No association was observed between zoledronic acid (ZOL) and ...
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Journal ArticleCalcif Tissue Int · May 2011
Additional fractures after hip fracture are common, but little is known about the risk factors associated with these events. We determined the clinical risk factors associated with fracture following a low-trauma hip fracture and whether clinical risk fact ...
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Journal ArticleMt Sinai J Med · 2011
Osteoporosis frequently coexists with other chronic diseases and syndromes of aging, and therefore multimorbidity interactions can potentially complicate its evaluation and treatment. This article reviews osteoporosis comorbidity interactions with select c ...
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Journal ArticleJ Am Med Dir Assoc · October 2010
INTRODUCTION: Undertreatment of osteoporosis is common, even for high-risk patients. Among the reasons for undertreatment may be a clinician's perception of a lack of treatment benefit, particularly in light of patients' expected future mortality. Among US ...
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Journal ArticleQual Health Res · September 2010
Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindf ...
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Journal ArticleAm J Geriatr Pharmacother · April 2010
BACKGROUND: Medication discrepancies are unintended differences between medication regimens (ie, between a patient's home regimen and medications prescribed on admission to the hospital). OBJECTIVE: The goal of this study was to describe the incidence, dru ...
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Journal ArticleAnn Intern Med · March 16, 2010
BACKGROUND: Although an increased risk for death after hip fracture is well established, whether this excess mortality persists over time is unclear. PURPOSE: To determine the magnitude and duration of excess mortality after hip fracture in older men and w ...
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Journal ArticleAm J Geriatr Pharmacother · February 2010
BACKGROUND: Vitamin D insufficiency is prevalent among older adults and may be associated with higher risk for cardiovascular (CV) disease, mortality, depression, and cognitive deficits. OBJECTIVE: The aim of this article was to review published observatio ...
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Journal ArticleAm J Geriatr Pharmacother · February 2010
BACKGROUND: Osteoporosis and seizure disorders are common diagnoses in older adults and often occur concomitantly. OBJECTIVE: The goal of this review was to discuss the current hypothesis for the pathogenesis of anticonvulsant-induced bone density loss and ...
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Journal ArticleJ Am Geriatr Soc · February 2010
OBJECTIVES: To determine the efficacy of once-yearly intravenous zoledronic acid (ZOL) 5 mg in reducing risk of clinical vertebral, nonvertebral, and any clinical fractures in elderly osteoporotic postmenopausal women. DESIGN: A post hoc subgroup analysis ...
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Journal ArticleJ Bone Miner Res · January 2010
Zoledronic acid reduces the risk of death by 28% after hip fracture, but the mechanisms are not known. This exploratory analysis sought to identify potential pathways for the reduction in mortality with zoledronic acid after hip fracture. This was a retros ...
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Journal ArticleOsteoporos Int · November 2009
UNLABELLED: Using data from long-term glucocorticoid users and long-term care residents, we evaluated osteoporosis prescribing patterns related to physician behavior and common practice settings. We found no significant clustering effect for common practic ...
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Journal ArticleJ Am Geriatr Soc · September 2009
OBJECTIVES: To develop order entry algorithms for five common nursing home problems and to test their acceptance, use, and preliminary effect on nine quality indicators and resource utilization. DESIGN: Pre-post, quasi-experimental study. SETTING: Two Depa ...
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Journal ArticleJ Aging Stud · August 2009
Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home st ...
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Journal ArticleJ Bone Miner Res · July 2009
Annual infusions of zoledronic acid (5 mg) significantly reduced the risk of vertebral, hip, and nonvertebral fractures in a study of postmenopausal women with osteoporosis and significantly reduced clinical fractures and all-cause mortality in another stu ...
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Journal ArticleSouth Med J · April 2009
Osteoporosis is a growing health concern as the number of senior adults continues to increase worldwide. Falls and fractures are very common among frail older adults requiring home health and long-term care. Preventative strategies for reducing falls have ...
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Journal ArticleDrugs Aging · 2009
Older adults are not only at higher risk of experiencing stroke, but also have multiple co-morbidities that make treatment for secondary stroke prevention challenging. Very few clinical trials specifically related to secondary stroke prevention treatment e ...
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Journal ArticleWest J Nurs Res · October 2008
In this study, the authors describe certified nursing assistants' (CNA) Explanatory Models (EMs) of depression and aspects of their EMs that may contribute to the underdetection of depression in nursing homes. Interviews with 18 CNAs working in two nursing ...
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Journal ArticleOsteoporos Int · August 2008
UNLABELLED: Nursing home residents with a history of hip fractures or prior osteoporotic fractures were found to have an increased risk of another osteoporotic fracture over the ensuing two years when compared to nursing home residents with no fracture his ...
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Journal ArticleAm J Geriatr Pharmacother · December 2007
BACKGROUND: Vitamin D deficiency is common in older populations, particularly during the winter months due to low levels of ultraviolet light exposure, and in nursing home residents. OBJECTIVE: The main objective of the current study was to assess the dist ...
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Journal ArticleAm J Med · October 2007
BACKGROUND: Interventions to improve the fracture prevention in nursing homes are needed. METHODS: Cluster-randomized, single-blind, controlled trial of a multi-modal quality improvement intervention. Nursing homes (n=67) with > or =10 residents with a dia ...
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Journal ArticleJ Am Geriatr Soc · September 2007
OBJECTIVES: To identify barriers to and facilitators of the diffusion of clinical practice guidelines (CPGs) and clinical protocols in nursing homes (NHs). DESIGN: Qualitative analysis. SETTING: Four randomly selected community nursing homes. PARTICIPANTS: ...
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Journal ArticleOsteoporos Int · April 2007
SUMMARY: We studied nursing home residents with osteoporosis or recent fracture to determine the frequency and predictors of osteoporosis treatment. There was wide variation in performance, and both clinical and systems variables predicted use. This study ...
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Journal ArticleN Engl J Med · 2007
BACKGROUND: Mortality is increased after a hip fracture, and strategies that improve outcomes are needed. METHODS: In this randomized, double-blind, placebo-controlled trial, 1065 patients were assigned to receive yearly intravenous zoledronic acid (at a d ...
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Journal ArticleWest J Nurs Res · December 2006
Dissemination of research findings to practice and maintenance of rigor and validity in qualitative research are continuing challenges for nurse researchers. Using three nursing home case studies as examples, this article describes how exit interview-consu ...
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Journal ArticleJ Am Geriatr Soc · September 2006
OBJECTIVES: To describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities. DESIGN: Natural experiment with nonparticipating facilities serving as controls. SETTING: Comm ...
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Journal ArticleJ Am Med Dir Assoc · September 2006
BACKGROUND: Barriers prevent osteoporosis care in nursing homes. Successful interventions designed to circumvent these barriers benefit from target recipient input during development. OBJECTIVE: To elicit suggestions for an osteoporosis quality improvement ...
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Journal ArticleBest Pract Res Clin Rheumatol · August 2006
Osteoporotic fractures are emerging as a major public health problem in the aging population. Fractures result in increased morbidity, mortality and health expenditures. This article reviews current evidence for the management of common issues following os ...
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Journal ArticleWest J Nurs Res · April 2006
This study describes how Minimum Data Set (MDS) coordinators' relationship patterns influence nursing home care processes. MDS coordinators interact with nursing home staff to coordinate resident assessment and care planning, but little is known about how ...
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Journal ArticleQual Health Res · February 2006
Complexity science teaches that relationships among health care providers are key to our understanding of how quality care emerges. The authors sought to compare the effects of differing patterns of medicine-nursing communication on the quality of informat ...
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Journal ArticleHealth Care Manage Rev · 2006
We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth ...
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Journal ArticleQual Health Res · October 2005
In a nursing home case study using observation and interview data, the authors described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule guided CNAs to respond to residents as they would want someone to do ...
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Journal ArticleDirector · 2005
The Golden Rule guides people to choose for others what they would choose for themselves. The Golden Rule is often described as 'putting yourself in someone else's shoes', or 'Do unto others as you would have them do unto you'(Baumrin 2004). The viewpoint ...
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Journal ArticleJournal of the American Medical Directors Association · January 1, 2005
Objectives: The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the ...
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Journal ArticleJ Am Med Dir Assoc · 2005
OBJECTIVES: The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the ...
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Journal ArticleJAMA · December 15, 2004
CONTEXT: Although recent US Preventive Services Task Force guidelines recommend bone densitometry for all women older than 65 years, identifying younger women at increased risk for osteoporosis and women with occult vertebral fractures remains a clinical c ...
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Journal ArticleCurr Med Res Opin · June 2004
OBJECTIVE: To present the novel design of a trial testing the safety and efficacy of a yearly bisphosponate, zoledronic acid, in preventing new clinical fractures in patients with recent low trauma hip fracture repair. RESEARCH DESIGN AND METHODS: Randomiz ...
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Journal ArticleJ Am Med Dir Assoc · 2004
OBJECTIVES: The objectives of this study were to identify the barriers to osteoporosis clinical practice guideline use perceived by Medical Directors (MED DIR) and Directors of Nursing (DON) in skilled nursing facilities; and to describe differences in the ...
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Journal ArticleOsteoporos Int · November 2003
BACKGROUND: The contribution of hip fracture to the risk of subsequent fractures is unclear. METHODS: Data from the Baltimore Hip Studies and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used. Baltimore subjects enrolle ...
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Journal ArticleOsteoporos Int · July 2003
This paper aims to identify risk factors for hip fracture in Medicare skilled nursing facility (SNF) residents and to develop a predictive model based on routinely collected administrative data (the Minimum Data Set, MDS) to identify high-risk residents. P ...
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Journal ArticleAge Ageing · January 2003
OBJECTIVE: to evaluate the economic impact of external hip protector use in nursing facilities. DESIGN: cost-effectiveness and cost-utility analyses. MEASUREMENTS: event probabilities, intervention effectiveness, treatment costs, and utility of hip fractur ...
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Journal ArticleOsteoporos Int · December 2002
The objectives of the study were: (1) to evaluate the contribution of impaired functional status, cognition and medication to fracture risk; (2) to determine whether risk factor profiles differ between regionally and socially diverse populations; and (3) t ...
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Journal ArticleJ Am Geriatr Soc · October 2000
OBJECTIVES: To develop recommendations for the evaluation and the treatment of men with osteoporotic hip fracture from expert publications in the field of male osteoporosis, and to define the current practice patterns in a tertiary care VA Medical Center i ...
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Journal ArticleAnnals of Long Term Care · February 4, 1999
Because many illnesses present with fever and confusion in the long- term care setting, neuroleptic malignant syndrome (NMS) in the elderly is a challenging, yet uncommon, diagnosis. Catatonia is implicated as a predisposing factor for the development of N ...
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