Objective To explore the association between baseline life-space mobility and nursing home (NH) admission among community-dwelling older adults over six years. Methods Using data from a prospective, observational cohort study consisting of a random sample of 1000 Medicare beneficiaries ≥ 65 years of age stratified by race (African American and non-Hispanic White), sex, and rural/urban residence. Baseline life-space mobility was assessed during in-home interviews. Participants were contacted by telephone every six months to ascertain NH admissions, Life-Space Assessment (LSA) scores and vital status (living or deceased). Using multivariate logistic regression, the significance and independence of the relationship of life-space mobility with NH admission was examined. Results Over six years, the odds of NH admission increased 2% for every one point lower baseline life-space score independent of previously recognized risk factors. Discussion The LSA may be a useful tool to identify older adults at risk for NH admission.

The interprofessional clinical experience (ICE) was designed to introduce trainees to the roles of different healthcare professionals, provide an opportunity to participate in an interprofessional team, and familiarize trainees with caring for older adults in the nursing home setting. Healthcare trainees from seven professions (dentistry, medicine, nursing, nutrition, occupational therapy, optometry and social work) participated in ICE. This program consisted of individual patient interviews followed by a team meeting to develop a comprehensive care plan. To evaluate the impact of ICE on attitudinal change, the UCLA Geriatric Attitudes Scale and a post-experience assessment were used. The post-experience assessment evaluated the trainees' perception of potential team members' roles and attitudes about interprofessional team care of the older adult. Attitudes toward interprofessional teamwork and the older adult were generally positive. ICE is a novel program that allows trainees across healthcare professions to experience interprofessional teamwork in the nursing home setting.

Successful interprofessional teams are essential when caring for older adults with multiple complex medical conditions that require ongoing management from a variety of disciplines across healthcare settings. To successfully integrate interprofessional education into the healthcare professions curriculum, the most effective learning experiences should utilize adult learning principles, reflect real-life practice, and allow for interaction among trainees representing a variety of health professions. Interprofessional clinical experiences are essential to prepare future healthcare professionals to provide quality patient care and understand the best methods for utilizing members of the healthcare team to provide that care. To meet this need, the University of Alabama at Birmingham Geriatric Education Center has developed an Interprofessional Clinical Experience (ICE) to expose future healthcare providers to an applied training experience with older adults in the nursing home setting. This paper outlines how this program was developed, methods used for program evaluation, and how the outcome data influenced program revisions.

Context Symptom burden has been associated with functional decline in community-dwelling older adults and may be responsive to interventions. Known predictors of nursing home (NH) admission are often nonmodifiable. Objectives To determine if symptom burden independently predicted NH admission among community-dwelling older adults over an 8½ year follow-up period. Methods A random sample of community-dwelling Medicare beneficiaries in Alabama, stratified by race, gender, and rural/urban residence, had baseline in-home assessments of sociodemographic measurements, Charlson comorbidity count, and symptoms. Symptom burden was derived from a count of 10 patient-reported symptoms. Nursing home admissions were determined from telephone interviews conducted every six months over the 8½ years of the study. Cox proportional hazard modeling was used to examine the significance of symptom burden as a predictor for NH admission after adjusting for other variables. Results The mean±SD age of the sample (N=999) was 75.3±6.7 years, and the sample was 51% rural, 50% African American, and 50% male. Thirty-eight percent (n=380) had symptom burden scores ≥ 2. Seventy-five participants (7.5%) had confirmed dates for NH admission during the 8½ years of follow-up. Using Cox proportional hazard modeling, symptom burden remained an independent predictor of time to NH placement (HR=1.11, P=0.02), even after adjustment for comorbidity count, race, sex and age. Conclusion Symptom burden is an independent risk factor for NH admission. Aggressive management of symptoms in older adults may reduce or delay NH admission.

Background With aging, the probability of experiencing multiple chronic conditions is increased, along with symptoms associated with these conditions. Symptoms form a central component of illness burden and distress. To date, most symptom measures have focused on a particular disease population. Objective We sought to develop and evaluate a simple symptom screen using data obtained from a representative sample of community-dwelling older adults. Methods Psychometric analyses were conducted on 10 self-reported dichotomous symptom indicators collected during in-person interviews from a sample of 1000 community-dwelling older adults. Symptoms included shortness of breath, feeling tired or fatigued, problems with balance or dizziness, perceived weakness in legs, constipation, daily pain, stiffness, poor appetite, anxiety, and anhedonia. Results Over one-third of the sample (37.4%) had 5 or more concurrent symptoms. Stiffness and feeling tired were the most common symptoms. Confirmatory factor analyses were performed on the 10 symptoms for single factor and bifactor (physical and affective) models of symptom reporting. Goodness of fit indices indicated better fit for the bifactor model (χ2df=10=89.6, p<0.001) but the practical significance of the improvement in fit was negligible. Differential item functioning (DIF) analyses showed some differences of relatively high magnitude in location parameters by race; however, because the DIF was in different directions, the impact on the overall measure was most likely lessened. Conclusion Among community-dwelling older adults, a large proportion experienced multiple co-occurring symptoms. This Brief Symptom Screen can be used to quickly measure overall symptom load in older adult populations, including those with multiple chronic conditions.