Efforts are being made to ensure that COVID-19 vaccination among older adults is as complete as possible. Dialogue-based interventions tailored to patients’ specific concerns have shown potential for effectiveness in promoting vaccination. We implemented a quality improvement project intended to help patients in an outpatient geriatrics clinic overcome barriers to COVID-19 vaccination. We offered tailored conversations by telephone in which we discussed the barriers to vaccination that the patients were facing and offered to provide relevant information and/or logistical assistance. Of the 184 patients reached by phone, 125 (68%) endorsed having already been vaccinated and 59 (32%) did not. About one third of the unvaccinated patients were willing to participate in tailored conversations (20 patients = 34% of the unvaccinated). In follow-up calls 30 days after the intervention we found that four of these 20 patients had received COVID-19 vaccination, one patient was scheduled for vaccination, 10 continued to be deciding about vaccination, four had decided against it and one could not be reached. Dialogue-based interventions that are conducted by telephone and are tailored to the specific barriers to vaccination being faced by older adults may have some effectiveness in encouraging vaccination against COVID-19. The effectiveness of such interventions may be decreased in populations that already have high vaccination rates and in which many patients have already formed strong opinions regarding vaccination against COVID-19. Completion of Plan-Do-Study-Act cycles is a feasible way to design, implement and work to optimize quality improvement efforts related to COVID-19 vaccination.
Introduction: Understanding the needs of higher-risk older adult patients can support the delivery of high quality and patientcentered healthcare. We sought to characterize the physical, functional, social and psychological needs of High-Need High-Risk (HNHR) Veterans. We hypothesized that the concept of frailty could be useful in identifying the highest-risk HNHR patients and characterizing their needs. Methods: We conducted a cross-sectional study of Veterans in the Miami Veterans Affairs Healthcare System who were identified as High-Need High-Risk by the Department of Veterans Affairs (VA) using data analytic techniques. We analyzed data of 634 Veterans who completed questionnaires by mail, telephone or in person. We assessed the Veterans' frailty status and needs in the physical, functional, psychological and social domains. Beyond descriptive statistics, we used Chi-square (χ 2 ) test, one-way ANOVA and Kruskal-Wallis to analyze whether there were differences in Veterans' needs in relation to frailty status. Results: The HNHR Veterans who participated in the questionnaire had complex needs that spanned the physical, functional, psychological, and social domains. We observed a potential mismatch between functional needs and social support; over two-thirds of respondents endorsed having dependence in at least one ADL but only about a third of respondents reported having a caregiver. Patients with frailty had higher levels of functional dependence and were more likely than the other HNHR respondents to report recent falls, recent hospitalizations, depression, and transportation issues. Conclusion: High-Need High-Risk Veterans have complex needs related to the physical, functional, psychological and social domains. Within the HNHR population, HNHR Veterans with frailty appear to have particularly high levels of risk and multidomain needs. Increased attention to identifying members of these groups and aligning them with biopsychosocial interventions that are targeted to their specific needs may support development of appropriate strategies and care-models to support HNHR Veterans.
Objectives: To facilitate the success of surgical patients with prefrailty and frailty in meeting diet and exercise goals in the context of the COVID-19 pandemic, and to encourage patient satisfaction with remote care. Methods: In the setting of the COVID-19 pandemic, surgical patients with prefrailty and frailty were offered remote visits with a geriatrician and a remote diet and exercise coaching program. Results: The coaching participants set a mean of 37 (±15) individualized dietary goals and 17 (±11) individualized exercise goals. 75% of the coaching participants met at least 65% of their dietary goals and 75% met at least 50% of their exercise goals. All patients met at least one diet goal and at least one exercise goal. Patients endorsed high levels of satisfaction with the program. Discussion: Diet and exercise interventions for surgical patients with prefrailty and frailty have potential for adaptation to remote formats. Such interventions may facilitate patients’ meeting of individualized diet and exercise goals and may also encourage patient satisfaction.
Success in delaying long term institutionalization (LTI) depends on creating means to adequately support each Veteran’s needs. To better understand the unmet needs of Veterans, we identified a random sample of 20,000 Veterans from five VA sites. Veterans were stratified into low-, moderate- or high-risk tiers using a measure of predicted 2-year probability of LTI. Veterans and their caregivers were asked to complete separate surveys to assess demographic, physical, psychological, and social domains, unmet needs, and experience with HCBS and caregiver support programs. Responses were received between July-Dec 2021 from 8056 Veterans (80.3+/-9.8y; 94.0% men; 82.6% White; 8.9% Hispanic) and 3579 caregivers (71.1+/-13.1y; 75.1% women; 80.5% White; 15.1% Hispanic; 57.1% spousal) responded by mail (96%) or online (4%). Both Veterans and caregivers endorse complex Veteran unmet needs spanning medical, psychological, and social domains. Survey results will be used to inform HCBS policy to support aging Veterans and their caregivers.
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