Thesis (Ed.M.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

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The purpose of this study was to compare the discharge outcomes of two client groups who were admitted to geriatric rehabilitation units (GRUs). The Emergency Department or ED Group were clients seen by WRHA Geriatric Program Assessment Team (GPAT) geriatric clinicians in EDs and admitted directly to geriatric rehabilitation units and the Acute Group were clients admitted from inpatient acute care units to geriatric rehabilitation units. The study design was a retrospective study using administrative data to examine two groups for the following discharge outcomes: discharged home, discharged to personal care home, and poor outcomes of either medical instability or mortality. The study results found that 70% of clients assessed by GPAT clinicians and admitted from the ED directly to a GRU were discharged home. Similarly, 68% of the clients admitted from acute inpatient units to a GRU were discharged home. The discharge home outcomes indicate that geriatric clinicians in consultation with team Geriatricians were able to select geriatric rehabilitation clients in a busy ED despite the need for an abbreviated evaluation period requiring rapid decision-making. Results of the study indicate that clinicians in this unique GPAT program utilizing collaboration between the ED team and clear GRU admission criteria selected ED clients with potential to benefit from the rehabilitation process and return to their homes in the community. Furthermore, 6% of the ED Group cases had poor outcomes of medical instability or mortality and 10% of the Acute Group had poor outcomes following GRU admission (see Table2).

The purpose of this study was to compare the discharge outcomes of two client groups who were admitted to geriatric rehabilitation units (GRUs). The Emergency Department or ED Group were clients seen by WRHA Geriatric Program Assessment Team (GPAT) geriatric clinicians in EDs and admitted directly to geriatric rehabilitation units and the Acute Group were clients admitted from inpatient acute care units to geriatric rehabilitation units. The study design was a retrospective study using administrative data to examine two groups for the following discharge outcomes: discharged home, discharged to personal care home, and poor outcomes of either medical instability or mortality. The study results found that 70% of clients assessed by GPAT clinicians and admitted from the ED directly to a GRU were discharged home. Similarly, 68% of the clients admitted from acute inpatient units to a GRU were discharged home. The discharge home outcomes indicate that geriatric clinicians in consultation with team Geriatricians were able to select geriatric rehabilitation clients in a busy ED despite the need for an abbreviated evaluation period requiring rapid decision-making. Results of the study indicate that clinicians in this unique GPAT program utilizing collaboration between the ED team and clear GRU admission criteria selected ED clients with potential to benefit from the rehabilitation process and return to their homes in the community. Furthermore, 6% of the ED Group cases had poor outcomes of medical instability or mortality and 10% of the Acute Group had poor outcomes following GRU admission (see Table2).

This century will bring an explosion in the geriatric population aged 65 and older, with those over 80 the fastest growing group. Falls, vehicle collisions, burns, and abuse are traumatic events that our geriatric patients may be susceptible to and from which they may not recover. Primary care providers should enhance their understanding of the complex issues of geriatric trauma to facilitate prevention and to assist the patient's recovery to normal function, addressing barriers such as immobility, pain, malnutrition, and acute confusion. Improved outcomes require combined efforts of disciplines and specialties intervening for optimal management for older trauma patients from pre-hospital care through rehabilitation or end-of-life issues.

The recommendation by Skinner (2017) that a standardized geriatric patient simulation should be integrated into community health courses was not fully supported by the data and findings. First, in addition to the lack of statistical significance noted by the authors, the effect size was calculated to determine the difference in aging knowledge test scores before and after the simulation and found it was only r = 9.1%, which is low according to Cohen's criteria ( Cohen, 1988 ); therefore, there was not even a trend toward effectiveness in increasing knowledge of aging. Second, in a qualitative component, many of the student participants made positive statements about how much was learned about older adults, but this conflicted with the unimproved knowledge scores. No negative statements were presented. The discrepancy between the quantitative and qualitative findings can be possibly explained by the absence of any methods for assessing the credibility or dependability of the qualitative findings, such as the classic methods of Lincoln and Guba (1985).

Elderly patients make up a disproportionately high proportion of emergency department visits and represent a high-risk sub group for urosepsis. As a component of the geriatric syndrome, acutely ill patients will often present to triage lacking the cardinal signs and symptoms of infection. Further research is necessary to describe geriatric urosepsis and provide a foundation for education for emergency department providers and triage staff. A retrospective, descriptive approach was utilized to examine geriatric patients age 50 years and over who presented to the emergency department with clinically validated urinary tract infection and sepsis. Geriatric age sub-groups as well as discharge mortality was used to compare the clinical and demographic features present with advancing age and urosepsis. Patients meeting urosepsis diagnosis criteria between June 2005 and June 2010 at a community hospital were queried and 270 of these met inclusion criteria. A significant difference in means between younger geriatric age groups (50-64 years) versus older groups (65-74, 75-84, and 85 and over) was observed with regard to presenting symptoms of acute change in mental status, dysuria, chills/ rigors, and nausea/ vomiting. Clinical variables also varied between age groups to include platelets, neutrophils, blood urea nitrogen, initial triage temperature, triage heart rate, highest obtained emergency department temperature and heart rate. On average there also existed significant difference in age, hospital length of stay, body mass index, blood urea nitrogen, creatinine, albumin, triage temperature, and highest temperature.

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Older adults who maintain their cognitive skills and abilities are able to live more independently than those whose skills have deteriorated. The costs (money, time, personnel) associated with providing cognitive stimulation programs to residents in long-term care homes often prohibit the delivery of these programs. The present study explored the efficacy of using volunteers to administer a stimulation program in two long-term care homes. The program focused on stimulating reasoning, attention, and memory abilities using uncomplicated, pen-and-paper exercises. Thirty-six resident participants and 16 volunteer participants were randomly assigned to one of two parallel groups, either the control or stimulation group. For eight weeks, three times each week, control group participants met for standard “friendly visits” (casual conversation between a resident and volunteer) and stimulation group participants met to work through a variety of exercises meant to stimulate the cognitive abilities of residents. Results were analyzed using a 2-way ANOVA and indicated statistically significant Group x Time interactions for Verbal Memory, Non-Verbal Memory, Learning, and in a screening test for verbal fluency. Volunteers completed a post-study questionnaire which indicated that the volunteers in the stimulation group found their skills-based interactions more stimulating for residents. Therefore this study demonstrates that a volunteer-administered cognitive stimulation program can provide measurable gains in the cognitive abilities of older adults. Further studies concerning the role of volunteers in the maintenance of the cognitive abilities of older adults are recommended. / Thesis (Master, Education) -- Queen's University, 2014-05-29 07:07:01.042