In March 2020, at the beginning of the COVID-19 pandemic, state-funded community mental health service programs (CMHSP) in Michigan, organized into 10 regions known as a "Prepaid Inpatient Health Plan" (PIHP), grappled with the task of developing a modified plan of operations, while complying with mitigation and social distancing guidelines. With the premise that psychiatric care is essential healthcare, a panel of physician and non-physician leaders representing Region 5, met and developed recommendations, and feedback iteratively, using an adaptive modified Delphi methodology. This facilitated the development of a service and patient prioritization document to triage and to deliver behavioral health services in 21 counties which comprised Region 5 PIHP. Our procedures were organized around the principles of mitigation and contingency management, like physical health service delivery paradigms. The purpose of this manuscript is to share region 5 PIHP's response; a process which has allowed continuity of care during these unprecedented times.
(1) Background: There is increasing scholarly support for the notion that properly implemented and used, technology can be of substantial benefit for older adults. Use of technology has been associated with improved self-rating of health and fewer chronic conditions. Use of technology such as handheld devices by older adults has the potential to improve engagement and promote cognitive and physical health. However, although, literature suggests some willingness by older adults to use technology, simultaneously there are reports of a more cautious attitude to its adoption. Our objective was to determine the opinions towards information technologies, with special reference to brain health, in healthy older adults either fully retired or still working in some capacity including older adult workers and retired adults living in an independent elderly living community. We were especially interested in further our understanding of factors that may play a role in technology adoption and its relevance to addressing health related issues in this population; (2) Methods: Two focus groups were conducted in an inner-city community. Participants were older adults with an interest in their general health and prevention of cognitive decline. They were asked to discuss their perceptions of and preferences for the use of technology. Transcripts were coded for thematic analysis; (3) Results: Seven common themes emerged from the focus group interviews: physical health, cognitive health, social engagement, organizing information, desire to learn new technology, advancing technology, and privacy/security; and (4) Conclusions: This study suggests that in order to promote the use of technology in older adults, one needs to consider wider contextual issues, not only device design per se, but the older adult’s rationale for using technology and their socio-ecological context.
Polypharmacy in older nursing home patients is a well-documented concern. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia, and the economic impact of polypharmacy is also substantial, with annual medicationrelated issues costing $7.6 billion in nursing facilities alone. We chose to use the Assess, Review, Minimize, Optimize, Reassess (ARMOR) protocol for our team-based intervention to address inappropriate prescribing in older residents. A reduction in the use of psychotropic medications was associated with an improvement in activities of daily living and fewer reports of depression but was also linked to an increase in the rate of falls and reports of pain. The lower use of antipsychotics also appears to unmask untreated anxiety, expressed in the results as the increased rate of antianxiety medications.
SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.
Physical distancing and visiting restrictions during the COVID-19 pandemic posed significant challenges in providing timely medical care in nursing homes. The rising number of new COVID-19 cases created hardship in providing scheduled and non-urgent care visits. Virtual visits were pivotal in providing patient care. However, the additional responsibility of facilitating virtual visits for both social and clinical purposes further constrained the ability of nursing home staff to provide care. The critical deficiency of the workforce, rising numbers of new cases, and required triage of patients have been significant barriers to regularly scheduled care. We hypothesize that regular non-COVID-19 services in the evaluated nursing home facilities were lower than COVID-19 visits during this period. Our goal is to show the types of services affected during the pandemic. In this study, we analyzed 563 virtual visits during the COVID-19 pandemic in three nursing home facilities in Michigan from December 2020 through February 2022. Upon analyzing the types of services and trends, our results revealed that the number of COVID-19 related visits (68) was significantly lower than non-COVID-19 related visits (485), refuting our hypothesis. This illustrates that routine care could still be delivered during the pandemic. Additionally, the overall number of virtual visits declined steadily over the study period. This trend could suggest an increase of in-person services or a decrease in COVID-19 cases. The decline could also be related to the barriers faced by the nursing home workforce considering the time and additional responsibility of monitoring a virtual visit.
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