Older adults residing in assisted living facilities (ALFs) often face fragmented medical care, especially when managing complex chronic conditions, cognitive impairment, or end-of-life needs. This article describes an interprofessional provider-led, integrated care model embedded within an ALF in a major metropolitan area that includes memory care and home hospice. The model integrates geriatrics and palliative medicine-trained providers into routine care, supported by structured communication, tele-emergency services, and collaboration with hospice and hospital teams. While formal outcomes are not yet available, this model offers a potentially replicable framework for integrating care delivery into ALFs and describes a possible payment and policy model that supports integrated medical care in noninstitutional long-term care settings.

Background: People living with HIV (PLWH) are increasingly reaching older ages due to the success of antiretroviral therapy. However, aging with HIV is associated with increased risk of multimorbidity, neurocognitive impairment, frailty, psychosocial stress, and functional decline. Multidomain geriatric screening framed within an Age-Friendly 4Ms Framework (Mentation, Medication, Mobility, What Matters Most) and consideration of multi-complexity may help identify aging-related vulnerabilities and guide multidisciplinary care with greater impact on patient outcomes. However, real-world implementation of such programs within HIV clinical settings remains limited. Methods: We conducted a retrospective analysis of adults aged ≥50 years enrolled in a multidisciplinary Healthy Aging Program within a large, integrated HIV care system. Multidomain screening assessments included cognitive evaluation (Montreal Cognitive Assessment), mental health screening (PHQ-2, GAD-2), functional assessment (Katz ADL, Lawton IADL), frailty screening (Edmonton Frail Scale), and intrinsic capacity domains using the WHO Integrated Care for Older People (ICOPE) framework. Screening results, referrals, clinical interventions, and cardiometabolic risk management measures were extracted from clinical program databases and electronic medical records. Results: A total of 317 adults aged ≥50 years completed multidomain screening. Participants had well-controlled HIV infection, with viral suppression in 96.2% and a median CD4 count of 660 cells/mm3. Despite this, aging-related vulnerabilities were common. Overall, 78.4% of participants had at least one abnormal screening domain. Cognitive impairment was identified in nearly half of individuals screened, including mild impairment in 39.8% and moderate impairment in 8.7%. Functional limitations were identified in 10.1% of participants, while anxiety symptoms were present in 9.5%. Sensory impairments were common, including vision impairment in 36.5% of participants. Polypharmacy was prevalent, with 33.2% of participants prescribed five or more chronic medications. Screening frequently generated multidisciplinary referrals, including behavioral health services (42.3%), social work support (42.9%), and pharmacist-led cardiometabolic risk review (56.8%). Age-stratified analyses demonstrated similar prevalence of screening abnormalities across age groups, including individuals aged 50–59 years. Modest improvements in cardiometabolic preventive care were observed during follow-up. Statin utilization increased from 65.6% at baseline to 70.0% at 12 months, and LDL cholesterol declined modestly during the observation period. Conclusions: Multidomain screening integrated into routine HIV care identified a high prevalence of aging-related vulnerabilities among PLWH aged ≥50 years despite excellent virologic control. These findings suggest that aging-related risk in HIV is not adequately captured by chronological age alone and support early, universal implementation of multidomain screening within HIV care models.

Background/Objectives: People aging with HIV (PAWHs) face distinct health challenges, including early onset of aging and heightened risk for chronic comorbidities despite effective antiretroviral therapy (ART). However, significant gaps persist in understanding the lived experience and how PAWHs perceive the interplay between their controlled HIV and the aging process. This study examined PAWHs’ illness perceptions of aging, health, and relationship of HIV to other health conditions. Methods: Semi-structured interviews were conducted with a convenience sample of 25 PAWHs (mean age 63.5; mean time living with HIV 22.3 years; 24 virally suppressed) recruited through an academic HIV specialty clinic. Demographic and clinical data were collected from Electronic Health Records (EHRs), and interviews were analyzed using inductive thematic analysis. Results: A central finding was the disconnect between participants’ illness perceptions of controlled HIV and other aging-related health concerns. Absence of acute somatic symptoms and sustained viral suppression fostered a view of HIV as chronologically remote, leading to an apparent unawareness of HIV’s systemic links to accelerated aging and comorbidities. Two primary themes around aging emerged: acceptance/disengagement and fear of future debility (prevalent among older, socially isolated individuals concerned about dementia and finances). Conclusions: This pervasive disconnect, understandable through the lens of the Common Sense Model of Self-Regulation, highlights a critical need to adjust health counseling strategies for PAWHs. Clinicians can leverage existing trusted provider relationships to explicitly address and refine PAWHs’ illness models, clarifying that viral suppression is not a cure and educating on HIV’s systemic links to chronic conditions (e.g., ‘inflammaging’). Tailored educational interventions are crucial for fostering shared decision-making, encouraging early screening, and improving health outcomes for this vulnerable and growing population. Generalizability may be limited by sample characteristics.

Home health aides (HHAs) are the frontline providers for vulnerable community-dwelling older adults. Despite their critical role, HHAs are often a understudied workforce. This study aimed to evaluate HHAs' workplace experiences and perceptions regarding caring for older adults, including data on dementia care needs. Following preliminary focus groups, an anonymous survey was distributed to HHAs from a large home health care agency in the greater New York metropolitan area. The survey collected demographic data, professional experience, training, perceived job-related challenges, barriers to care, and self-reported burnout and stress levels. Logistic and ordinal logistic regression models, along with Spearman's correlations, identified factors associated with burnout and stress. Most HHAs (N = 224/600, response rate 37.3

Many older adults with advanced cancer never communicate goals of care or treatment preferences to their clinicians, raising the risk that care received will not match their values. Scalable models of care may help surmount this barrier. To test whether a combined patient and clinician intervention increased the rate of advance care planning (ACP) documentation in large health care systems. This stepped-wedge cluster randomized clinical trial using an open cohort design included patients aged 65 years or older with advanced cancer seen at oncology clinics in 3 health care systems located in the US South, Midwest, and Mid-Atlantic regions from April 1, 2020, to November 30, 2022. Data collection ended in 2024. The intervention involved delivering brief evidence-based patient-facing video decision aids available in 25 languages as well as goals-of-care communication training to oncology clinicians. Patients in the control period received usual care. The primary outcome was ACP documentation, which included any electronic health record documentation of a goals-of-care conversation, palliative care, hospice, or limitation of life-sustaining treatments, identified via a validated natural language processing program. Analysis was performed on an intention-to-treat basis. Twenty-nine practices, comprising 13 800 unique eligible patients with a total of 29 357 repeated measurements, were included (mean [SD] age, 74.5 [6.6] years; 52.3% men [15 344 of 29 357 measurements]). The proportion of patients with ACP documentation was greater in the intervention phase compared with the usual care phase (adjusted rate difference, 6.8% [95% CI, 2.8%-10.8%]; P < .001). ACP documentation in the intervention phase occurred among 3980 of 15 754 patients (25.3%) (goals-of-care conversation, 21.4% [3377 of 15 754]; palliative care, 9.6% [1517 of 15 754]; hospice, 5.4% [847 of 15 754]; and limitation of life-sustaining treatments, 7.2% [1128 of 15 754]). In comparison, ACP documentation in the usual care phase occurred among 2834 of 13 603 patients (20.8%) (goals-of-care conversation, 16.8% [2281 of 13 603]; palliative care, 9.5% [1287 of 13 603]; hospice, 5.3% [724 of 13 603]; and limitation of life-sustaining treatments, 8.4% [1149 of 13 603]). In this stepped-wedge cluster randomized clinical trial for older adults with advanced cancer, a bundled evidence-based decision aid and communication training intervention increased the proportion of older patients with ACP documentation. This approach offers an innovative paradigm with a clinically meaningful increase in ACP documentation, a widely used quality metric that reflects high-quality patient-centered care delivery. ClinicalTrials.gov Identifier: NCT03609177

COVID-19 infection is associated with an increased risk of developing dementia, particularly among older adults. We examined the impact of immune status on this risk using the COVID-19 Real World Data Infrastructure (DOI: 10.1093/0fid/ofaf021), a publicly available resource of 5.2 million unique deidentified patient records, linked with the NCI SEER registry. Two cohorts of patients were defined for the study period (12/1/2018-12/31/2024): COVID-19 Positive Persons (CPP) with positive SARS-CoV-2 NAAT and/or COVID-19 ICD-10 code. COVID-19 Negative Persons (CNP) had COVID-related information (including SARS-CoV-2 diagnostic or serologic testing and/or documented vaccination), but no positive NAAT or COVID-19 ICD-10 code. Patients < 65 years, with history of dementia or psychotropic medication use on or before index date (1/1/2020) were excluded. There were 225,852 CPP and 499,295 CNP eligible patients. Incidence of newly-diagnosed dementia among the CPP cohort was 25.6%, vs. 17.3% in CNP (Relative Risk [RR] 1.48; 95% CI: 1.46-1.49). Stratification by immunocompromised status (473,559 immunocompromised; 251,588 non-immunocompromised) showed no significant difference between RR for dementia associated with COVID-19 (RR = 1.48, 95% CI:1.46-1.50 and RR = 1.47, 95% CI: 1.45-1.50 respectively). These unadjusted analyses align with prior findings that COVID-19 infection in patients aged ≥65 years is associated with a greater risk of subsequent dementia diagnosis but suggest immunocompromised individuals have the same increased risk as the general population. Further analysis will examine timing of diagnoses, and relevance of covariates such as vaccination status and anti-viral medication use on dementia risk in CPP patients.

‘Guiding an Improved Dementia Care Experience’ (GUIDE) is a CMS Innovation Center pilot program implemented January 2024, as an alternate payment model for interprofessional teams to provide comprehensive dementia care for people living with dementia and their caregivers. Program criteria encompass screening and recruitment, comprehensive and home safety assessment, ongoing beneficiary monitoring, data collection/management/reporting, respite, caregiver supports, etc. We report first-year implementation and evolution as an ‘Established Track’ program in a large integrated health system in a major metropolitan area. To date, the program has enrolled 158 beneficiaries and their caregivers; 19% low, 73% moderate, 8% high complexity. Average age of beneficiaries 79 years, caregiver relationship 53% child, 35% spouse, 10% other. Over 35% of eligible beneficiaries have utilized respite services. Approximately 9% have disenrolled, the majority (64%) expired/hospice. An adaptable team-based approach has been a critical strategy for success. Helpful processes that have evolved include structured recurring meetings, weekly review of data and submissions, care coordination and scheduled monitoring of required care-delivery services. Education and outreach with all stakeholders (e.g. interprofessional healthcare providers, lay community) is essential. Internal challenges have included need for ongoing adjustment of workflows and processes, and system constraints on structuring database/submission/reporting. Additional challenges include changing program requirements, recognizing and addressing the need to supplement internal resources (e.g. home visits, respite care), and identifying and establishing partnerships with external entities. These successes and challenges may significantly impact effectiveness of this pilot model program. Providing additional resources for this vulnerable population requires a true interprofessional, multidisciplinary approach.

The 4Ms framework -What Matters Most (WMM)/Medication/Mentation/Mobility- facilitates addressing issues critical to care of older adults. We identified different interventions, “Act-ons”, for positive screens in hospitalized patients assessed for all 4Ms. Unique patients identified by Age-Friendly Health System (AFHS) dashboard aggregating data on adults ≥65y/o admitted to one of 8 hospitals and assessed for all 4Ms. Individual EMR manually reviewed for demographic and clinical data, and for each positive M to determine Act-ons. Admissions reviewed from July-September 2024. A total of 297 patients received all 4Ms (9.6% of 3104 admissions). Median age: 84y/o (IQR:76-90); 57% female, (85%); race: 63% White, 13% Black/AA, 12% Asian, 13% other; 85% English speaking Median LOS: 9 days (IQR:6-15). All 297 had GOC documented but 58.3% did not include WMM. Act-ons: managing team discussed with patient (60%); palliative care consult (40%). For 121 positive Medication assessments, 57.8% had Act-ons: documented reason for no change (73.6%); decrease/deprescribed (26.4%). For 297 Mobility screens, 83.1% had Act-ons: 99% PT consult; 1% RN plan. For 13 positive Mentation screens, 2 (15.4%) had Act-on: electrolytes reviewed/reported; medication side effect treated. This is one of the first reports of Act-ons for 4Ms. Mobility had most Act-ons, then Medication, WMM, lastly Mentation. Act-ons were similar for 3 of the 4Ms across different hospitals within the health system. Delirium was essentially not detected across locations, suggesting need for a root-cause analysis and further education/training. In the future, structured processes for Act-ons may help ensure patient needs are optimally met.

Outcomes 1. Assessing charitable resource allocation, participants will self-report the ability to describe how charitable funding is distributed for unfunded and underfunded hospice patients in New York State.2. Analyzing charitable funding utilization, participants will self-report the ability to evaluate if New York State hospices have benefitted from undocumented immigrants older than 65 having increased access to hospice through Medicaid eligibility expansion to this population. Key Message Little is known about how charitable spending for unfunded and underfunded hospice patients is allocated. This abstract addresses how New York State (NYS) hospices use charitable resources and if hospices have benefited from NYS Medicaid funding increases for undocumented immigrants age 65 and above through expansion of eligibility for end-of-life care. Abstract Approximately three percent of hospice patients receive care through charitable funding (1). Medicare-certified hospices are required to provide care to all eligible patients regardless of a patient's ability to pay (2,3). Additionally, in January of 2024, New York State (NYS) Medicaid criteria expanded to include coverage for undocumented immigrants 65 and older increasing access to end-of-life care given that this population generally has poor access to insurance (4,5). However, little is known about how hospice resources are utilized for unfunded patients, especially those that are undocumented immigrants. Methods This study describes to what services charitable funding is allocated within hospice organizations in NYS. With NYS Medicaid's recent eligibility expansion, this study also evaluated whether hospices benefitted from increased funding for end-of-life care provided to undocumented immigrants through this policy change. Forty hospice organizations in NYS were identified and surveyed to better understand charitable funding and utilization of expanded resources. Conclusion Unfunded and underfunded hospice patients are more likely to be members of vulnerable populations such as those of low socioeconomic status, undocumented immigrants, and minority groups (1). Knowledge of charitable resources can help highlight what can be done in the future to better serve these individuals. References 1. Lorenz, K. A., Rosenfeld, K. E., Asch, S. M., & Ettner, S. L. (2003). Charity for the dying: Who receives unreimbursed hospice care? Journal of Palliative Medicine, 6(4), 585–591. https://doi.org/10.1089/109662103768253696 2. U.S. Government Publishing Office. (n.d.). CFR Title 42 - Public health. https://www.ecfr.gov/current/title-42 3. National Coalition for Hospice and Palliative Care. (2018). Clinical practice guidelines for quality palliative care (4th ed.). https://www.nationalcoalitionhpc.org/wp-content/uploads/2024/03/NCHPC67840.html#[79,%22XYZ%22,76.5,657.75,null 4. New York City Mayor's Office of Special Projects and Community Affairs. (n.d.). Expanded Medicaid. https://www.nyc.gov/site/mayorspeu/resources/expanded-medicaid.page 5. Aborode, A. T., Lawal, L., Agwuna, F. O., et al. (2023). Health disparities among illegal immigrants and homeless people in the USA: a struggle within. IJS Global Health, 6(6), e0362. https://doi.org/10.1097/GH9.0000000000000362

There is a need for evidence-based interventions to reduce loneliness in family caregivers of patients with dementia. Given the inverse relationship between finding meaning in life and loneliness, interventions to reduce loneliness may be strengthened by incorporating concepts from Meaning-Centered Psychotherapy (MCP), a psychotherapy effective in increasing meaning in life in patients with advanced cancer and their caregivers. The purpose of this presentation is to describe the development and preliminary testing of RELOAD-C (REducing LOneliness in Alzeheimer’s Disease-Caregivers), a web-based platform that delivers concepts from MCP, adapted for caregivers of patients with dementia, via 6 brief videos, 7 virtual peer group meetings, and written content. During development, N = 15 dementia caregivers completed one-on-one interviews with the study PI. Input from stakeholders indicated: 1) preference for specific terminology; 2) removing MCP content that urges caregivers to engage in complex conversations with the person they care for; 3) providing an explanation of ambiguous concepts, such as “unfinished business”; and 4) refraining from using the term “intervention” given its negative connotations. Following integration of stakeholder feedback and creation of the RELOAD-C web-based intervention, usability/acceptability testing occurred with a separate 16 caregivers. Of the 16 caregivers, n = 13 (81.3%) correctly completed all 10 discreet tasks. Averages on 9/10 items of the System Usability Scale were below 2.0 (possible range 1-5), indicating favorable usability of RELOAD-C. In sum, RELOAD-C is a user-friendly intervention, informed by multiple rounds of review by a multidisciplinary research team and stakeholders from the very population it is designed to help.

Introduction: Inpatient palliative units increase the utilization of palliative and hospice services, and are associated with greater patient and caregiver satisfaction, and lower cost at end of life. Not all hospital settings can accommodate a dedicated palliative unit due to limitations in space, staffing, and cost. An alternative model, such as the Scatter Bed Hospice Unit (SBHU), which disperses hospice patients amongst those requiring standard acute care has been proposed. Despite its potential, limited data exists on the effectiveness of this model. This initiative aimed to increase palliative and hospice utilization through implementation of a SBHU within an academic acute care facility. Methods: In December 2022, a Scatter Bed Hospice Unit (SBHU) was implemented at an urban tertiary care hospital. Retrospective chart review was conducted of patients who received palliative care consultation during the six months prior to SBHU implementation (July"December 2022) and the six months following implementation (January"June 2023). The primary aims were to perform a pre-post assessment of the number of Geriatric and Palliative (GAP) consultations and patients discharged with hospice services. Secondary outcomes included documented goals of care discussions, patients with comfort measures orders, patients who expired without hospice enrollment, reasons for GAP consultation, and time from hospice referral to admission. Results: There was a significant increase in GAP consults (p=0.0021) post-implementation of our SBHU. The number of patients discharged with hospice services, documented goals of care discussions, and patients with comfort measures orders all showed increasing trends (non-significant). Amongst patients with a comfort measures order, there was a significant increase in patients discharged with hospice services from 32.7% vs 44.7% post SBHU implementation (p = 0.02). Post-SBHU, the time from inpatient hospice referral to hospice admission decreased from nearly three days to less than one (p < 0.001). Conclusions: The SHBU improved utilization of palliative and hospice services through increased consultation and overall hospice enrollment amongst terminally ill patients. Transition to hospice care is more efficient with this model as evidenced by decreased time from inpatient hospice referral to hospice admission post-implementation of the SBHU model.

Eliciting patient-centered goals of care (GOC) leads to tailored treatment plans, better outcomes, greater patient/family/provider satisfaction. Most educational approaches elicit immediate feedback on self-perceived change in knowledge and skills (Kirkpatrick level 1 and 2). Our health system implemented Goals of Care Conversation Education Program (GoCCEP) and wished to assess if GoCCEP impacted provider behavior (Kirkpatrick level 3). GoCCEP-trained resident physicians from 7 different residency programs (2 family med {FM}, 3 internal {IM}, 1 PMR, 1 surgery) compared to matched controls from same program/year of training who didn’t take the course. Total number of unique patients seen by each resident with at least 1 GOC note identified (numerator) over total number unique patients seen by that resident (denominator) 6 months pre-GoCCEP and 6 months post-GoCCEP. Inpatients included were aged ≥65 or LACE ≥12. Z scores for differences calculated with 2 proportions test. Total of 2,067 patients with GOC notes located for 76 GoCCEP and 301 Control residents (total 312,895 unique patients). GoCCEP-trained residents increased documentation pre-post 0.6% to 1.1% (p < 0.001). GoCCEP vs. control PGY-1: 1.3% vs. 0.6% (z=-10.17, p < 0.001); PGY-2: 1.1 vs. 0.7% (z=-2.96, p < 0.004); PGY 3: 0.9% vs. 0.6% (z=-3.78, p < 0.001); PGY-3 Chief/higher: 1.1 vs.0.23% (z=-8.1, p < 0.001). Trained FM residents had significantly higher documentation than IM residents, 3.23% vs. 0.45% (z = 13.00, p < 0.001). GoCCEP associated with increased GOC documentation though overall level of documentation low regardless of year of experience. Multiple factors likely underlie these observations suggesting need for multipronged education/interventions to increase patient-centered GOCC.

The Institute for Healthcare Improvement developed the 4Ms framework (What Matters Most/Medication/Mentation/Mobility) to facilitate Age-Friendly Health Systems (AFHS). Each M has evidence-based screening tools leading to improved outcomes among older adults. We report screening 4Ms vs. 1-3Ms outcomes for hospitalized adults aged ≥65 across hospitals in a large healthcare system. Demographics and clinical data abstracted manually from EMR and from 4Ms AFHS dashboard. Patients ≥65y/o admitted July-September 2024 to eight hospitals committed to care excellence. Outcomes: Length of stay (LOS), 30-day readmission, 30-day ED visits, mortality. Of 3,103 older adult admissions, 298 (9.6%) received all 4Ms and 2,805 received 1-3Ms. Median age: for 4Ms, 84 (IQR:76-90) and for 1-3Ms, 77 (IQR:71-84). Primary language was English for both. Median LOS: for 4Ms, 9 days (IQR:6-15) and for 1-3Ms, 9 days (IQR:5-16). Those receiving 4Ms had a lower AMPAC mobility score (13 vs 18, p < 0.001) fewer 30-day ED visits (16% vs. 22%, p = 0.02), higher mortality (11% vs. 5.3% p < 0.001), and trend towards lower 30-day readmissions (13% vs. 16%, p = 0.2). In conclusion, a small proportion of hospitalized older adults were screened for all 4Ms. Those with 4Ms were older with lower mobility. They had fewer post-discharge ED visits and a trend towards lower readmissions which may become significant with accrual of more events. Higher mortality may reflect age, greater illness burden. This preliminary assessment provides evidence for 4Ms care as a quality framework associated with key patient outcomes.

BACKGROUND:More than 60% of caregivers of persons with Alzheimer's disease and related dementias (AD/ADRD) are lonely. Meaning and purpose in life is associated with reduced feelings of loneliness, but has not yet been systematically fostered among caregivers of patients with AD/ADRD. Adapting meaning-centered psychotherapy (MCP), an evidence-based treatment for increasing meaning and purpose in life in cancer caregivers, might decrease loneliness in the dementia caregiver population. PURPOSE:The purpose of this manuscript is to report on the development, usability, and acceptability testing of REducing LOneliness in Alzeheimer's Disease-Care Partners (RELOAD-C), a web-based platform that features six brief videos and aims to reduce loneliness in caregivers of patients with dementia through introducing major concepts and principles adapted from meaning centered psychotherapy. METHOD:Within 12 months, RELOAD-C was developed through two rounds of one-on-one interviews with 15 dementia caregivers to obtain feedback on video scripts, recording of videos, and placement of videos and written content (e.g. thought exercises) on the website. Following this, RELOAD-C underwent rigorous usability and acceptability testing by another 16 dementia caregivers. RESULTS:Quantitative assessments show that RELOAD-C is deemed usable by caregivers (mean = 1.69 on system usability scale, where possible range is 1-5 and lower scores indicate more favorable views of the website; and more than 90% of the usability sample correctly engaged in ≥8 of 10 discreet tasks). Qualitative data indicate acceptability of the intervention with feedback such as "love that the videos are clear and load fast." CONCLUSIONS:RELOAD-C is a web-based intervention focused on reducing loneliness in dementia caregivers. It contains six therapist-narrated videos and written content, reinforcing MCP principles. It is currently undergoing pilot testing in preparation for a large-scale randomized controlled clinical trial evaluating its efficacy in reducing loneliness in dementia caregivers.

The field of Geriatrics is inherently based on interprofessional collaboration, requiring a variety of health professionals to address the principles and complexity of caring for older adults. A novel workshop curriculum was developed and implemented across a large health system weaving three threads: the 5M’s framework, the Interprofessional Education Collaborative (IPEC) core competencies, and health system navigation for patients and caregivers. Stakeholders in numerous health professions were included in content creation and learner recruitment. The interactive, half-day, in-person sessions reframed each “M” in the context of health system navigation: 1) Medications: How do older adults pay for/access them? 2) Mobility: What is the proper venue to care for older adults with debility? 3) Mind: How do we provide support and coverage for custodial care for older adults with dementia? 4) What Matters Most: How can a health system align care and support patients’ goals? 5) Multicomplexity: How can we work collaboratively to care for older adults and help them navigate complex health systems? This paper reports results of > 200 learners from nine health professions who have taken the course. Curriculum evaluation was guided by the Kirkpatrick model, assessing learners’ attitudes, knowledge, and behavior. Over 93% felt knowledge would help both clinical practice and professional development. There were statistically significant increases in knowledge of IPEC competencies, ability to define roles of other health professions, intent to apply 5M’s in clinical practice, and interest in pursuing formal Geriatrics training. Next steps include further internal/external dissemination and adaptation (e.g., asynchronous learning modules).

BACKGROUND:Current financial penalties for rehospitalization of skilled nursing facilities (SNFs) patients are based in part on the studies by Ouslander et al., 2011, and Mor et al., 2010, demonstrating that many SNF hospitalizations were avoidable. With increasing age, complex illness severity, and use of SNFs for subacute rehabilitation, readmission metrics and financial penalties based on previous data may be due for reevaluation.METHODS:Retrospective electronic medical record (EMR) review of 21,591 admissions and discharges between 2010 and 2019 inclusive. Data extracted included demographics, LACE, Charlson comorbidity index (CCI), and simplified HOSPITAL score parameters. The scores were calculated for the study years from the extracted data. Patients readmitted to the hospital within 30 days were identified.RESULTS:Mean yearly score of all three indices rose steadily: LACE score 10.76-12.04 (0.43 estimated annual increase, 95% CI [0.39, 0.46]), CCI 4.26-5.05 (0.31 estimated annual increase, 95% CI [0.27, 0.34]), and simplified HOSPITAL score 3.46-4.03 (0.21 estimated annual increase, 95% CI [0.18, 0.24]). The estimated probability of readmission across observed CCI scores ranged from 15.4% to 15.9%, 95% CI bounds (10.8%, 22.7%). The estimated probability of readmission across observed LACE scores ranged from 4.7% to 36.3%, 95% CI bounds (3.4%, 54.7%). The estimated probability of readmission across observed HOSPITAL scores ranged from 5.8% to 54.1%, 95% CI bounds (6.2%, 66.0%).CONCLUSIONS AND IMPLICATIONS:The study confirms anecdotal experience that the illness acuity of patients admitted to SNFs increased progressively over time and was associated with an increased risk of 30-day readmissions to the hospital. Our study suggests that the use of clinically validated readmission risk assessment tools instead of the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) current risk adjustors may be a more accurate reflection of the current illness severity of a facility's patient population at the time of payment adjustment.

BACKGROUND: Despite significant morbidity and mortality related to atherosclerotic cardiovascular disease, to date, most major clinical trials studying the effects of statin therapy have excluded older adults. The objective of this analysis was to evaluate the effect of initiating statin therapy on incident dementia and mortality among individuals 75 years of age or older across the complete spectrum of kidney function. METHODS: We conducted a retrospective cohort study of 640,191 VA health system patients who turned 75 years of age between 2000 and 2018. Patients on statin therapy received the medication for an average of 6.3 years (standard deviation 4.6 years). The primary outcome of interest included incident dementia diagnosis during the study period. The secondary outcome was all-cause mortality. Cox proportional hazard analysis was used to evaluate the adjusted association of statin initiation with these outcomes. RESULTS: There was a higher rate of incident dementia in the No Statin group (4.7%) vs the Statin group (3.2%). Additionally, we observed a 22% all-cause mortality benefit associated with statin therapy. We did not observe a treatment effect with respect to primary or secondary outcomes across varying levels of kidney function. CONCLUSION: This large cohort study did not reveal an association between the initiation of statin therapy and incident dementia. A survival benefit was seen in statin users compared with nonusers. Prospective studies in more diverse populations including older adults will be needed to verify these findings. (c) 2024 Published by Elsevier Inc. center dot The American Journal of Medicine (2024) 137:839-846 - 846