Journal of gerontological nursing最新文献

Purpose: A dynamic tension exists between preventing falls and optimally mobilizing hospitalized patients. The SAFER program aimed for patients, families, and staff to collaboratively design and simultaneously operationalize patient-specific fall reduction and mobilization strategies.

Method: This pilot project was implemented on six units of a large level one trauma center. Patients were engaged in goal setting to maximize their mobilization potential while avoiding a fall during hospitalization. A poster displaying each patient's fall risk factors, corresponding mitigation strategies, and patient responsibilities served as a visual aid to assist staff, patients, and families in following the individualized safe mobilization plan. Falls and mobilization trends were measured.

Results: This project achieved a 43% reduction in falls with a trend toward increased patient mobilization over a 6-month period.

Conclusion: This project demonstrated a patient-centered approach to promoting safe mobilization within the context of the Age-Friendly Health Systems 4Ms Framework during hospitalization.

Purpose: The current systematic review examined how community-based physical activity (PA) interventions for Latino older adults assessed intervention costs, health care utilization costs, and overall cost-effectiveness.

Method: Five databases were searched for U.S.-based studies published from 2021 to 2025 that (a) assessed community-based PA interventions; (b) evaluated cost-effectiveness, reported intervention cost, and utilization data; (c) included populations aged ≥55 years; and (d) focused on Latino/Hispanic participants. Data were extracted on cost measurement methods, health care utilization metrics, and economic evaluation outcomes.

Results: Few eligible studies met full criteria, and most interventions reported general program costs, whereas only a few incorporated health care utilization or conducted formal cost-effectiveness analyses. Programs that measured PA improvements generally demonstrated favorable cost patterns but lacked standardized reporting. Among the few interventions that included Latino participants, results were typically reported in combination with other racial or ethnic groups, limiting the ability to interpret cost and cost-effectiveness outcomes specific to Latino older adults.

Conclusion: The limited and inconsistent economic evaluation of community-based PA programs for Latino older adults highlights the need for more studies to evaluate intervention, utilization costs, and cost effectiveness reporting. Strengthening economic evaluations can guide resource allocation, support culturally tailored program development, and promote translating trial-based evidence into practical public policy for healthy aging.

Purpose: To describe how a nursing geriatrics workgroup in an academic age-friendly health system (AFHS) designed, developed, and piloted an age-friendly dashboard (AFD) that featured select patient experience scores and nursing-sensitive indicators (NSIs) that disproportionally impact hospitalized older adults.

Method: A nurse-led interdisciplinary team developed an interactive dashboard that aggregated existing age-friendly data and allowed for stratifying by age, campus, unit, and NSIs. Pilot users included frontline unit leaders, Nurses Improving Care for Healthsystems Elders program coordinators, gerontological nurse practitioners, and nurse educators.

Results: Optimization feedback was shared by pilot users. One campus used the AFD to inform and guide a quality improvement project that yielded a 51% reduction in the falls rate of adults aged ≥65 years.

Conclusion: The AFD is a practical example of leveraging NSIs and patient experience data to support age-friendly care by making data accessible to frontline leaders, nurses, and clinicians in an AFHS.

Purpose: The Institute for Healthcare Improvement developed the 4Ms Framework-What Matters, Medication, Mentation, and Mobility-to enhance age-friendly, person-centered care. At one medical center, nurses ask inpatients daily, "What is most important to you?" to align care with patient priorities and the "What Matters" component of the 4Ms. Thus, the current study aimed to identify patterns and recurring themes across age groups and departments.

Method: The current study analyzed >11,000 responses from geriatric inpatients using unsupervised clustering and topological data analysis.

Results: Four key themes emerged: Inpatient Quality of Life, Discharge Planning, Pain Management, and Clarification of Medical Terminology.

Conclusion: Understanding these priorities can help provide more responsive and tailored care. Integrating these themes into system-level pathways and consult triggers may strengthen alignment with the 4Ms.

Purpose: To describe how a Mobility Dashboard was created to aggregate patient mobility metrics monthly by unit to empower bedside teams to implement and measure mobility-related quality improvement (QI) activities as part of an Age-Friendly Health System (AFHS).

Method: A multidisciplinary team improved existing electronic health record documentation to facilitate count of mobility events and created a framework for mobility measurement. Through partnering with IT Analytics, the dashboard was built and made accessible to interdisciplinary teams to facilitate future QI efforts.

Results: Implementation of the dashboard yielded quantifiable mobility data for all system hospitals to achieve AFHS recognition. The dashboard facilitates nursing QI initiatives. Two projects are described yielding increased mobility, reduction in length of stay, falls, and discharges to inpatient rehabilitation facilities with hospital-wide dissemination.

Conclusion: Focus on mobility in an AFHS and enhanced access to accurate mobility data encourages nursing QI efforts and leads to measurable and improved patient outcomes.

Purpose: To describe implementation strategies, successes, and challenges of spreading Age-Friendly Health Systems (AFHS) practices across diverse clinical settings within a large academic medical center focusing on the 4Ms (What Matters, Medication, Mentation, and Mobility).

Method: We engaged five clinical sites across three health systems in an 18-month national AFHS System-Wide Spread Collaborative. Interprofessional teams conducted Plan-Do-Study-Act cycles, held weekly meetings, and tracked documentation and actions on the 4Ms via chart reviews.

Results: Charts were reviewed beginning in April 2024. On average, 49% of patients were assessed on all 4Ms, and 33% had all 4Ms acted upon. Key facilitators to implementation included leadership support, leveraging the electronic health record (EHR), and staff education. Challenges included workflow variability by site and limited EHR capabilities.

Conclusion: Multisite AFHS implementation is feasible, but requires local adaptation and leadership engagement. Standardized documentation and tools are essential for sustainability, and more work is needed to align with the upcoming Centers for Medicare & Medicaid Services quality measures.

Older adults hospitalized in an intensive care unit (ICU) frequently experience adverse outcomes, including delirium, functional decline, medication-related harm, and goal-discordant care. Despite the availability of evidence-based interventions to address these risks, adoption and sustained implementation remain limited. The Age-Friendly Health Systems 4Ms Framework offers a policy-aligned structure for advancing adoption and sustainability of gerontological nursing interventions in the ICU. The Centers for Medicare & Medicaid Services announcement of the 2025 Age-Friendly Hospital Measure marks a turning point: hospitals will be incentivized to deliver care integrated with the 4Ms (What Matters, Medication, Mentation, and Mobility) to older adults. The introduction of this new measure presents a timely opportunity to align innovative gerontological nursing interventions with institutional quality goals. Grounding interventions in the 4Ms will facilitate engagement with key stakeholders, including frontline health care providers and hospital leadership, who are essential to the adoption and sustainability of age-friendly critical care for older adult patients in the ICU.