The Program of All-Inclusive Care for the Elderly (PACE) is a well-established health care model that serves older adults who are eligible for nursing home–level of care but are living in the community. Significantly, PACE has been recognized as a "permanent provider" by the Centers for Medicare & Medicaid Services (CMS) for >25 years. 1 McNabney M.K. Fitzgerald P. Pedulla J. et al. The Program of All-inclusive Care for the Elderly: an update after 25 years of permanent provider status. J Am Med Dir Assoc. 2022; 23: 1893-1899 Abstract Full Text Full Text PDF Scopus (5) Google Scholar ,2 Program of all-inclusive care for the Elderly (PACE) manual. https://www.cms.gov/regulations-and-guidance/guidance/manuals/internet-only-manuals-ioms-items/cms019036Date accessed: January 16, 2024 Google Scholar The primary objective of PACE is to provide coordinated care that focuses on person-centered goals and to minimize use of hospitals and nursing homes. On a national level, PACE has been highly effective at achieving those goals. 1 McNabney M.K. Fitzgerald P. Pedulla J. et al. The Program of All-inclusive Care for the Elderly: an update after 25 years of permanent provider status. J Am Med Dir Assoc. 2022; 23: 1893-1899 Abstract Full Text Full Text PDF Scopus (5) Google Scholar Providing Behavioral Health Care in PACE – A Review of Federal and State Manual RegulationsJournal of the American Medical Directors AssociationVol. 25Issue 5PreviewPresent analysis of the federal and state regulations that guide The Program of All-Inclusive Care for the Elderly (PACE) operations and core clinical features for direction on behavioral health (BH). Full-Text PDF

Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA Geriatric Medicine, Greater Baltimore Medical Center, Towson, Maryland, USA Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri, USA

Aim: To examine the relationship between falls among high-risk older adults at one Program of All-Inclusive Care for the Elderly (PACE) and the COVID-19 closure of its Day Health Center (DHC), which provides participants with social and rehabilitative services and contributes to their weekly physical activity. Methods: Self-reported falls during the 3 months before the DHC’s closure (“pre–COVID-19”) were compared in number and in character to falls during its closure (“COVID-19”). Results: One thirty five participants were enrolled during the entire 6-month period; 37% ( n = 50) fell during this time. These participants experienced fewer falls during COVID-19 (mean = 0.64) than they did pre–COVID-19 (mean=1.24, p = .0003). Conclusions: In this population of high-risk, community-dwelling older adults, an abrupt reduction in activity levels may have reduced falls. Physical activity has been shown to both increase and protect against falls in older adults. The long-term consequences of a comparably prolonged period of inactivity merit further study.

As people age, they are more likely to have an increasing number of medical diagnoses and medications, as well as healthcare providers who care for those conditions. Health professionals caring for older adults understand that medical issues are not the sole factors in the phenomenon of this "care complexity." Socioeconomic, cognitive, functional, and organizational factors play a significant role. Care complexity also affects family caregivers, providers, and healthcare systems and therefore society at large. The American Geriatrics Society (AGS) created a work group to review care to identify the most common components of existing healthcare models that address care complexity in older adults. This article, a product of that work group, defines care complexity in older adults, reviews healthcare models and those most common components within them and identifies potential gaps that require attention to reduce the burden of care complexity in older adults.

PACE is the gold standard for community-based integrated care. Over the 25 years as permanent provider status by Centers for Medicare and Medicaid Services, it has evolved in design and grown in numbers served. We review the evidence base, history, and future direction of PACE.

In the United States (US), residential long-term care is provided in nursing homes and assisted living (AL) communities. Regardless of the type of care setting, long-term care residents are at increased risk of transfer to the emergency department (ED) and for subsequent hospitalization. 1 Wilber S.T. Gerson L.W. Terrell K.M. et al. Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system. Acad Emerg Med. 2006; 13: 1345-1351 Crossref PubMed Google Scholar Given the iatrogenic risks that hospitalization poses to older adults, as well as the costs associated with these transfers, there is considerable interest in ways to understand this process and improve outcomes by reducing such transfers. 2 Hastings S.N. Schmader K.E. Sloane R.J. et al. Adverse health outcomes after discharge from the emergency department incidence and risk factors in a veteran population. J Gen Intern Med. 2007; 22: 1527-1531 Crossref PubMed Scopus (80) Google Scholar

Background Frailty syndrome disproportionately affects older people, including 15% of non-nursing home population, and is known to be a strong predictor of poor health outcomes. There is a growing interest in incorporating frailty assessment into research and clinical practice, which may provide an opportunity to improve in home frailty assessment and improve doctor patient communication. Methods We conducted focus groups discussions to solicit input from older adult care recipients (non-frail, pre-frail, and frail), their informal caregivers, and medical providers about their preferences to tailor a mobile app to measure frailty in the home using sensor based technologies. Focus groups were recorded, transcribed, and analyzed thematically. Results We identified three major themes: 1) perspectives of frailty; 2) perceptions of home based sensors; and 3) data management concerns. These relate to the participants’ insight, attitudes and concerns about having sensor-based technology to measure frailty in the home. Our qualitative findings indicate that knowing frailty status is important and useful and would allow older adults to remain independent longer. Participants also noted concerns with data management and the hope that this technology would not replace in-person visits with their healthcare provider. Conclusions This study found that study participants of each frailty status expressed high interest and acceptance of sensor-based technologies. Based on the qualitative findings of this study, sensor-based technologies show promise for frailty assessment of older adults with care needs. The main concerns identified related to the volume of data collected and strategies for responsible and secure transfer, reporting, and distillation of data into useful and timely care information. Sensor-based technologies should be piloted for feasibility and utility. This will inform the larger goal of helping older adults to maintain independence while tracking potential health declines, especially among the most vulnerable, for early detection and intervention. Keywords: Frailty, wearable, health services

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Pain in older adults is associated with increased health care utilization in hospitals, emergency departments (EDs), and outpatient settings. 1 Nahin R.L. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2015; 16: 769-780 Abstract Full Text Full Text PDF PubMed Scopus (519) Google Scholar ,2 Weiss A.J. Wier L.M. Stocks C. Blanchard J. Overview of Emergency Department Visits in the United States, 2011: Statistical Brief #174. Agency for Healthcare Research and Quality (US), 2006http://www.ncbi.nlm.nih.gov/books/NBK235856/Date accessed: July 15, 2019 Google Scholar This is especially true as older adults approach death. 3 Smith A.K. McCarthy E. Weber E. et al. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff. 2012; 3: 1277-1285 Crossref Scopus (117) Google Scholar ,4 Riley G.F. Lubitz J.D. Long-term trends in Medicare payments in the last year of life. Health Serv Res. 2010; 45: 565-576 Crossref PubMed Scopus (297) Google Scholar Opioid prescriptions are frequently initiated for individuals receiving end-of-life care through hospice 5 Lowey S.E. Smith J.A. Xue Y. Powers B.A. Opioid use in the last year of life among medicare beneficiaries with advanced illnesses: A retrospective cohort study. J Hosp Palliat Nurs. 2015; 17: 242 Crossref Scopus (4) Google Scholar ; however, similar trends have not been established in different practice models.

Ensuring that older adults in long-term care settings can effectively communicate is important. The goal of this study was to characterize key modifiable factors that could affect verbal communication in an adult day care setting, namely prevalence of audiometric hearing loss and the acoustic characteristics in the activity hall. The prevalence of age-related hearing loss among participants (n=51) was 71%, although only 15% of enrollees at the group care setting (n=21 of 140) used amplification. The noise and reverberation characteristics of the activity hall revealed signal-to-noise ratios of -3.1 decibels (dB) and -2.4 dB during morning activity and lunch, respectively, which are poorer than the recommended levels for understanding speech in background noise. Older adults attending adult day services are likely to spend the day in a room with acoustics that are too challenging to understand speech clearly. Opportunities to improve listening environments in group care settings for older adults are discussed.

There is paucity of research on the effects of obesity and its related comorbidities on the care of long-term Care (LTC) residents living in nursing facilities. There is a strong association between higher body mass index (BMI) and greater utilization of health care resources for hospitalized and community dwelling patients. Research has shown that even a modest 5-10% weight loss can decrease obesity related- comorbidity. A research study in LTC setting can address such disparities in care associated with obesity. Our study aims to determine the relationship between BMI and dependence in activities of daily living (ADLs) in LTC residents.