Interdisciplinary videoconference model for identifying potential adverse transition of care events following hospital discharge to postacute care

Discharge from hospitals to postacute care settings is a vulnerable time for many older adults, when they may be at increased risk for errors occurring in their care. We developed the Extension for Community Healthcare Outcomes-Care Transitions (ECHO-CT) programme in an effort to mitigate these risks through a mulitdisciplinary, educational, case-based teleconference between hospital and skilled nursing facility providers. The programme was implemented in both academic and community hospitals. Through weekly sessions, patients discharged from the hospital were discussed, clinical concerns addressed, errors in care identified and plans were made for remediation. A total of 1432 discussions occurred for 1326 patients. The aim of this study was to identify errors occurring in the postdischarge period and factors that predict an increased risk of experiencing an error. In 435 discussions, an issue was identified that required further discussion (known as a transition of care event), and the majority of these were related to medications. In 14.7% of all discussions, a medical error, defined as 'any preventable event that may cause or lead to inappropriate medical care or patient harm', was identified. We found that errors were more likely to occur for patients discharged from surgical services or the emergency department (as compared with medical services) and were less likely to occur for patients who were discharged in the morning. This study shows that a number of errors may be detected in the postdischarge period, and the ECHO-CT programme provides a mechanism for identifying and mitigating these events. Furthermore, it suggests that discharging service and time of day may be associated with risk of error in the discharge period, thereby suggesting potential areas of focus for future interventions.

An Interdisciplinary Videoconference to Improve Transitions of Care and Reduce Readmission, Cost, and Post-Acute Length of Stay in a Teaching and Community Hospital

OBJECTIVES

Coordination of care across health care settings is needed to ensure safe patient transfers. We examined the effects of the ECHO-Care Transitions program (ECHO-CT) on readmissions, skilled nursing facility (SNF) length of stay (LOS), and costs.

DESIGN

This is a prospective cohort study evaluating the ECHO-CT program. The intervention consisted of weekly 90-minute teleconferences between hospital and SNF-based teams to discuss the care of recently discharged patients.

SETTING AND PARTICIPANTS

The intervention occurred at one small community hospital and 7 affiliated SNFs and 1 large teaching hospital and 11 associated SNFs between March 23, 2019, and February 25, 2021. A total of 882 patients received the intervention.

METHODS

We selected 13 hospitals and 172 SNFs as controls. Specific hospital-SNF pairings within the intervention and control groups are referred to as hospital-SNF dyads. Using Medicare claims data for more than 10,000 patients with transfers between these hospital-SNF dyads, we performed multivariable regression to evaluate differences in 30-day rehospitalization rates, SNF lengths of stay, and SNF costs between patients discharged to intervention and control hospital-SNF dyads. We split the post period into pre-COVID and COVID periods and ran models separately for the small community and large teaching hospitals.

RESULTS

There was no significant difference-in-differences among intervention compared to control facilities during either post-acute care period for any of the outcomes.

CONCLUSIONS AND IMPLICATIONS

Although video-communication of care plans between hospitalists and post-acute care clinicians makes good clinical sense, our analysis was unable to detect significant reductions in rehospitalizations, SNF lengths of stay, or SNF Medicare costs. Disruption of the usual processes of care by the COVID pandemic may have played a role in the null findings.

Feasibility and Safety of Sequential Transcranial Direct Current Stimulation and Physical Therapy in Older Adults at Risk of Falling: A Randomized Pilot Study

Objective

To establish the feasibility and safety of administering transcranial direct current stimulation (tDCS) immediately prior to physical therapy (PT) sessions in older adults at risk of falls.

Design

A pilot randomized controlled study.

Setting

Outpatient geriatric physical therapy clinic.

Participants

Ten older adults living within supportive housing facilities (86.8±7.9 y/o, 8F) were enrolled in the study.

Interventions

Participants received tDCS or sham stimulation targeting the left dorsal lateral prefrontal cortex for 20 minutes, immediately prior to up to 10 of their PT visits.

Main Outcome Measures

Feasibility, safety, and functional outcomes were reported to inform the design of a larger and more definitive trial.

Results

Six fallers (88.8±5.0 y/o, 5F) completed the study and received 82.3% of the possible stimulation sessions, suggesting adding a 20-minute session of stimulation immediately prior to PT training sessions, along with pre- and post-assessments is feasible. The blinding strategy was successful and all reported side effects were expected and transient. While feasible and safe, the trial was met with numerous challenges, including selection bias, time and energy commitment, and large variation in functional performance, that must be considered when designing and implementing larger more definitive trials.

Conclusion

This study provides preliminary evidence about the feasibility, safety, and challenges to combine PT and tDCS in very frail older adults.

Nighttime ambient temperature and sleep in community-dwelling older adults

This longitudinal study examines the association between bedroom nighttime temperature and sleep quality in a sample of community dwelling older adults. Using wearable sleep monitors and environmental sensors, we assessed sleep duration, efficiency, and restlessness over an extended period within participants' homes while controlling for potential confounders and covariates. Our findings demonstrated that sleep was most efficient and restful when nighttime ambient temperature ranged between 20 and 25 °C, with a clinically relevant 5-10 % drop in sleep efficiency when the temperature increased from 25 °C to 30 °C. The associations were primarily nonlinear, and substantial between-subject variations were observed. These results highlight the potential to enhance sleep quality in older adults by optimizing home thermal environments and emphasize the importance of personalized temperature adjustments based on individual needs and circumstances. Additionally, our study underscores the potential impact of climate change on sleep quality in older adults, particularly those with lower socioeconomic status, and supports increasing their adaptive capacity in the face of a changing climate.

COGNITIVE FUNCTION CONTRIBUTES TO THE NONLINEAR RELATIONSHIP BETWEEN AGE AND DUAL-TASK GAIT IN MID-AGED POPULATION

The capacity to maintain safe walking is critical to functional independence in older adults. However, the timing/stage when such capacity starts to diminish, and its potential contributors have not been well characterized. To explore that, we here conducted analysis based upon the data of 651 participants of age between 40 and 65 years from Barcelona Brain Health Initiative Study. Each participants completed: 1) one 45-second trial of walking normally (single-task) and while performing a serial-subtraction-by-three task (dual-task), of which gait was measured using a smartphone-based gait-assessment application; and 2) a battery of cognitive tests. The dual-task cost (DTC) (i.e., percent changes from single- to dual-task condition) to mean stride time (ST) and stride time variability (STV) and the score of global cognitive function were obtained. The LOESS analyses demonstrated nonlinear relationships between age and DTCs with a turning point at age of 54 years (R2>3%). Regression models showed significantly greater associations (p=0.01~0.03) between age and DTCs (i.e., older age, worse gait) (β=0.22~0.28, p< 0.006), as well as between global cognitive function and DTCs (β=-0.28~-0.18, p< 0.002), in older group (i.e., age≥54 years) compared to younger group. The structural-equation-modeling suggested that in older group, cognitive function mediated the relationship between age and dual-task gait (p< 0.02) with a contribution of 43~47% to such relationship. The observations here revealed that as early at age of 54 years, dual-task gait starts to significantly diminish, and its dependence on cognitive function dramatically increases, providing critical knowledge for the management of mobility and cognitive aging in mid-age population.

BRAIN ACTIVITY DURING DUAL-TASK STANDING IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT

Performance of a cognitive task while standing disrupts balance in older adults. This disruption is exaggerated in those with mild cognitive impairment (MCI). Moreover, older adults with MCI who exhibit greater dual-task ‘cost’ are more likely to develop falls and dementia. EEG studies suggest that cognitive-motor dual-tasking is associated with brain activity fluctuations originating from central brain regions at specific frequencies, particularly in the alpha-band (8–13 Hz). We hypothesized that older adults with MCI would demonstrate decreased EEG alpha power during dual-task standing compared to healthy controls, and that decreased alpha power would be associated with elevated dual-task cost. We recorded postural sway and EEG in 14 participants with MCI [Montreal Cognitive Assessment (MoCA) < 25] and 16 healthy older adults [MoCA>25] as they completed trials of standing with and without serial subtractions. Postural sway metrics were derived, and from EEG we calculated absolute alpha-, theta-, and beta-band powers within a-priori defined regions-of-interest: the left and right anterior, central, and posterior regions. Repeated Measures ANOVA demonstrated that participants with MCI exhibited decreased alpha power in the central regions during dual-task standing compared to healthy controls (p= 0.01). No significant difference was observed for theta and beta-band powers between participants with MCI and healthy controls. In those with MCI, lower alpha power during dual-task standing correlated with increased dual-task cost to postural sway path (worse balance) (r=-0.4, p=0.03). These results provide preliminary evidence that specific patterns of brain activity during dual-tasking are disrupted in MCI and this is associated with elevated dual-task costs.

NOVEL INTERVENTIONS AND TARGETS FOR THE PREVENTION OF DEMENTIA AND FRAILTY: 2021 EDITOR’S CHOICE ARTICLES FROM JGMS

This symposium will present four 2021 “Editor’s Choice” articles from the Journal of Gerontology Medical Sciences that focus on novel interventions and targets for the prevention of dementia and frailty. Jeffrey Scherrer and colleagues, in their article “Lower Risk for Dementia Following Adult Tetanus, Diphtheria, and Pertussis (Tdap) Vaccination,” examine the links between adult vaccinations and decreased dementia risk. Katharine Brewster, Justin Golub (presenter), and colleagues, in “Age-Related Hearing Loss, Late-Life Depression, and Risk for Incident Dementia in Older Adults,” investigate hearing loss and depression as independent risk factors for eventual conversion to dementia. By understanding these potentially reversible mechanisms for dementia, targets for early interventions could be identified. “Association Between Long-Term Aspirin Use and Frailty in Men: The Physicians’ Health Study,” written by Ariela Orkaby and colleagues, examines the association between long-term aspirin use and frailty, furthering our understanding of the benefits of anti-inflammatory medications even in older adults. Kristen George and coauthors, in their article, “Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-Life Cognition: Study of Healthy Aging in African Americans,” examine how cardiovascular risk factors early in life may affect late life cognition in Black Americans. Beverly Gwen Windham, the discussant, will highlight commonalities and lessons learned from these studies.

IMPACT OF HOME AMBIENT TEMPERATURE ON SELF-REPORTED MOOD AND ATTENTION IN COMMUNITY-DWELLING OLDER ADULTS

Background

Many older adults experience variations in daily mood and/or attention. Lab-based studies show that, among other variables, ambient temperature can influence both. The objective of this study was to determine if and how habitual home temperature influences self-reported mood and attention in this population.

Methods

Ambient temperature and humidity data were collected from the homes of 41 community-dwelling older adults (age=78±7, 35 females) living in Boston from June 1st to Aug 15th. Participants received two time-stamped smartphone-based questionnaires each day to report their mood and attention.

Results

On average, participants completed 86(±29) questionnaires. Those with most variations in subjective outcomes (top quartile of % of time reporting “feeling down/depressed” or “difficult keeping attention”), compared to the rest of the sample, tended to reside in homes with both higher mean ambient temperature (p=0.01) and greater deviation in temperature over time (p=0.10). Logistic regression analysis combining data from all participants revealed that ambient temperature at the time of response did not predict either self-reported outcome. However, within-subject analyses indicated that of the 17 participants who reported at least some variation in attention or mood, the likelihood of experiencing poor mood and/or attention was correlated with time-synced ambient temperature in six individuals. Gender, age, or housing type (affordable vs. private) did not predict the presence of such associations.

Conclusion

Variations in self-reported mood and attention are at least partially explained by the home thermal environment in a non-trivial fraction of older adults.

Six month lower-leg mechanical tactile sensory stimulation alters functional network connectivity associated with improved gait in older adults with peripheral neuropathy – A pilot study

Foot sole somatosensory impairment associated with peripheral neuropathy (PN) is prevalent and a strong independent risk factor for gait disturbance and falls in older adults. Walkasins, a lower-limb sensory prosthesis, has been shown to improve gait and mobility in people with PN by providing afferent input related to foot sole pressure distributions via lower-leg mechanical tactile stimulation. Given that gait and mobility are regulated by sensorimotor and cognitive brain networks, it is plausible improvements in gait and mobility from wearing the Walkasins may be associated with elicited neuroplastic changes in the brain. As such, this study aimed to examine changes in brain network connectivity after 26 weeks of daily use of the prosthesis among individuals with diagnosed PN and balance problems. In this exploratory investigation, assessments of participant characteristics, Functional Gait Assessment (FGA), and resting-state functional magnetic resonance imaging were completed at study baseline and 26 weeks follow-up. We found that among those who have completed the study (N = 8; mean age 73.7 years) we observed a five-point improvement in FGA performance as well as significant changes in network connectivity over the 26 weeks that were correlated with improved FGA performance. Specifically, greater improvement in FGA score over 26 weeks was associated with increased connectivity within the Default Mode Network (DMN; p < 0.01), the Somatosensory Network (SMN; p < 0.01), and the Frontoparietal Network (FPN; p < 0.01). FGA improvement was also correlated with increased connectivity between the DMN and the FPN (p < 0.01), and decreased connectivity between the SMN and both the FPN (p < 0.01) and cerebellum (p < 0.01). These findings suggest that 26 weeks of daily use of the Walkasins device may provide beneficial neural modulatory changes in brain network connectivity via the sensory replacement stimulation that are relevant to gait improvements among older adults with PN.

Feasibility of High-Frequency Monitoring of the Home Environment and Health in Older Adults: Proof of Concept

Technology provides new opportunities to understand and optimize the relationship between the home indoor environmental quality and health outcomes in older adults. We aimed to establish proof-of-concept and feasibility of remote, real-time, high-frequency, and simultaneous monitoring of select environmental variables and outcomes related to health and wellbeing in older adults. Thirty-four participants (27 were female) with an average age (SD) of 81 years (±7.1) were recruited from community and supportive housing environments. Environmental sensors were installed in each home and participants were asked to use a wearable device on their finger and answer smartphone-based questionnaires on a daily basis. Further, a subgroup of participants were asked to complete tablet-based cognitive tests on a daily basis. Average compliance with the wearable (time worn properly / total time with device) was 81%. Participants responded to 69% of daily smartphone surveys and completed 80% of the prescribed cognitive tests. These results suggest that it is feasible to study the impact of the home thermal environment and air quality on biological rhythms, cognition, and other outcomes in older adults. However, the success of non-passive data collection elements may be contingent upon baseline cognition.

Effect of Race and Dementia Prevalence on a COVID-19 Infection Control Intervention in Massachusetts Nursing Homes

Nursing home (NH) residents, especially those who were Black or had dementia, had the highest infection rates during the COVID-19 pandemic. A 9-week COVID-19 infection control intervention in 360 Massachusetts NHs showed that adherence to an infection control checklist with proper PPE use and cohorting, was associated with declines in weekly infection rates. NHs were offered weekly webinars, answers to infection control questions, resources to acquire personal protective equipment, backup staff, and SARS-CoV-2 testing. We asked whether the effect of this intervention differed by racial and dementia composition of the NHs. Data were obtained from 4 state audits using infection control checklists, weekly infection rates, and Minimum Data Set variables on race and dementia to determine whether adherence to the checklist competencies was associated with decline in average weekly rates of new COVID-19 infections. Using a mixed effects hurdle model, adjusted for county COVID-19 prevalence, we found that the overall effect of the intervention did not differ by race, but proper cohorting of residents was associated with a greater reduction in infection rates among facilities with ≥20% non-whites (n=83). Facilities in the middle (50-61%; n=116) and upper (>61%; n=118) tertiles of dementia prevalence had the largest reduction in infection rates as checklist scores improved. Cohorting was associated with greater reductions in infection rates among facilities in the middle and upper tertiles of dementia prevalence. Thus, adherence to proper infection control procedures, particularly cohorting, can reduce COVID-19 infections, even in facilities with high percentages of high-risk residents (non-white and dementia).

Effects of Age on Dual Task Walking Performance as Measured Using a Smartphone Application in Middle-Aged Adults

After the age of 65, one’s ability to walk while performing an additional cognitive task (i.e., dual-tasking) is predictive of both future falls and cognitive decline. However, while it is well-known that older adults exhibit diminished dual-task performance, the time course of age-related dual-task decline has not been established. We thus conducted an analysis of data collected within the ongoing Barcelona Brain Health Initiative, a prospective population-based study characterizing the determinants of brain health maintenance in middle-aged adults. Cognitively-unimpaired participants (n=655) aged 40-65 years without neuro-psychiatric disease completed laboratory-based trials of walking normally (single-task) and walking while performing a verbalized serial subtraction task (dual-task). A smartphone-based gait assessment application was used to capture data and derive both the mean stride time (ST) and stride time variability (STV, defined as the coefficient of variation about the mean stride time) of each trial. The dual-task costs (DTC) to each gait metric were obtained by calculating the percent change from single- to dual-task conditions. We categorized participants into five groups according to age (e.g. Group 1: 40-45 years; Group 5: 60-65 years). Age group did not have an effect on single-task gait outcomes (p&gt;0.51). However, the oldest age group, as compared to each of the other groups, exhibited greater DTC to both ST and STV (p&lt;0.03). These results indicate that dual-task walking performance in particular may begin to diminish in late middle age even in the absence of detectable cognitive issues, DTC may offer a sensitive metric to age-related change in cognitive function.

Six-Month Lower-Leg Sensory Stimulation Augments Neural Network Connectivity Associated With Improved Gait

Foot sole somatosensory impairment associated with peripheral neuropathy (PN) is prevalent and a strong independent risk factor for gait disturbance and falls in older adults. A lower-limb sensory prosthesis providing afferent input related to foot sole pressure distributions via lower-leg vibrotactile stimulation has been demonstrated to improve gait in people with PN. The effects of this device on brain function related to motor control, however, remains equivocal. This study aimed to explore changes in brain network connectivity after six months of daily use of the prosthesis among individuals with diagnosed PN and balance problems. Functional Gait Assessment (FGA) and resting-state functional magnetic resonance imaging were completed before and after the intervention. Preliminary analysis on participants who have completed the study to date (N=5; mean age 76 years) indicated altered connectivity of the sensorimotor network (SMN), frontoparietal network (FPN), and the default mode network (DMN) post-intervention (Z&gt;3.11, unadjusted p&lt;0.05). Participants displayed an average improvement of 5.5 point in the FGA (Minimal Clinically Important Differences&gt;4 for community-dwelling older adults) that was correlated with connectivity changes (unadjusted p&lt;0.05). Specifically, improved FGA was associated with: 1) increased connectivity between the SMN, cerebellum, and occipital cortex; 2) increased connectivity between the FPN, cerebellum, calcarine and intracalcarine; and 3) decreased connectivity between DMN and intracalcarine. These early findings suggest that long-term use of a lower-limb sensory prosthesis may induce neuroplastic changes in brain network connectivity reflecting enhanced bottom-up sensory-attentional processing and suppression of the DMN that are relevant to gait improvements among older adults with PN.

Gait Speed Maintenance Is Associated With Sensorimotor and Frontoparietal Network Connectivity Among Older Adults

Mobility impairment is a geriatric giant. Particularly, slow gait is associated with elevated risk for cognitive decline, disabilities and dementia. Gait is the product of complex neural network interactions and changes in their connectivity pattern may negatively impact gait speed. However, mechanistic neural correlates for gait speed maintenance and decline remained unclear. As such, the aim of this study is to investigate differences in neural network connectivity in older adults with and without gait speed decline over 24 months. This sub-analysis included 35 community-dwelling older adults age >70 years from the MOBILIZE Boston Study. Baseline assessments included four-meter gait speed test and resting-state fMRI. Gait speed was reassessed at a 24-month follow-up. Participants were stratified to “Maintainer” and “Decliner” groups based upon a cut-off of >0.05 m/s decline in gait speed from baseline to follow-up. A priori selected functional network included sensori-motor network (SMN) and frontoparietal network (FPN). Multivariate analysis of variance was performed to determine between group differences in network connectivity. Discriminant analysis was conducted to identify relative contribution of network connectivity to group classification. Between the 14 Maintainers and 21 Decliners (mean age 83.9 years), Maintainers were younger (p=0.088). After adjusting for age, Maintainers exhibited lower SMN premotor-precentral gyrus connectivity (p=0.023), greater FPN ventral visual-supramarginal gyrus connectivity (p=0.025), and trend level greater SMN-FPN cerebellum-occipital connectivity (p=0.053). Premotor-precentral gyrus connectivity showed greatest contribution to discriminant function. These preliminary findings suggest aberrant connectivity patterns of the SMN and FPN may be predictive of older adults’ ability to maintain gait speed.

The Cortical Dynamics of Dual-Task Standing in Older Adults

In older adults, the extent to which performing a cognitive task when standing diminishes postural control is predictive of future falls and cognitive decline. The cortical control of such “dual-tasking,” however, remains poorly understood. Electroencephalogram (EEG) studies have demonstrated that the level of attention and cognitive inhibitory activity during cognitive task performance can be quantified by changes in brain activity in specific frequency bands; namely, an increase in theta/beta ratio and a decrease in alpha-band power, respectively. We hypothesized that in older adults, dual-tasking would increase theta/beta ratio and decrease alpha-band power, and, that greater alpha-band power during quiet standing would predict worse dual-task performance. To test this hypothesis, we recorded postural sway and EEG (32-channels) in 30 older adults without overt disease as they completed trials of standing, with and without verbalized serial subtractions, on four separate visits. Postural sway speed, as well as absolute theta/beta power ratio and alpha-band power, were calculated. The theta/beta power ratio and alpha-band power demonstrated high test-retest reliability during quiet and dual-task standing across visits (intra-class correlation coefficients >0.70). Compared with quiet standing, dual-tasking increased theta/beta power ratio (p<0.0001) and decreased alpha-band power (p=0.002). Participants who exhibited greater alpha-band power during quiet standing demonstrated a greater dual-task cost (i.e., percent increase, indicative of worse performance) to postural sway speed (r=0.3, p=0.01). These results suggest that in older adults, dual-tasking while standing increases EEG-derived metrics related to attention, and, that greater cognitive inhibitory activity during quiet standing is associated with worse dual-task standing performance.

Feasibility of combining noninvasive brain stimulation and personalized counseling to increase physical activity

Few older adults meet recommended physical activity guidelines. Behavioral interventions may be more effective when combined with other modalities to promote activity. Transcranial direct current stimulation (tDCS) designed to increase the excitability of the left dorsolateral prefrontal cortex (dlPFC) — a brain region subserving motivation and executive function — has the potential to augment behavioral interventions. We designed a randomized, double-blinded trial to examine the feasibility of combining personalized behavioral counseling and tDCS targeting the left dlPFC to improve physical activity and related outcomes in sedentary older adults living within the supportive housing. Participants wore a Fit-Bit throughout the study period. Baseline step counts were determined for two weeks, then participants completed four bi-weekly personalized counseling sessions over eight weeks. They were also randomized to receive 10 sessions of tDCS or sham stimulation over the two weeks after the baseline. Physical, cognitive, and patient-reported outcomes were assessed at baseline, after ten brain stimulation sessions, and after four behavioral sessions. 33 individuals were screened and 16 enrolled (age=80±7, 13 females). 13 participants completed the study, including 100% of study assessments, 99±5% of brain stimulation sessions, and 98±7% of behavioral sessions. Fit-Bit adherence rate was 93±13%. Daily step counts were 3197±1480 at baseline and 4722±2553 over the last two weeks of the intervention. While the study is ongoing and blinded, these preliminary results indicate that it is feasible to conduct a controlled study of tDCS combined with personalized behavioral counseling to increase physical activity in sedentary older adults living within supportive housing.

A Platform to Study the Effects of Home Environment on Health and Wellbeing of Older Adults

While older adults’ living environment is rarely well-tuned to their specific needs, technological advances provide new opportunities to understand, and ultimately optimize, the relationship between the home environment and health outcomes. We aimed to establish proof-of-concept and feasibility of a platform enabling real-time, high-frequency, and simultaneous monitoring of environment, biological variables, and outcomes related to health and wellbeing in older adults. We recruited 7 participants (6 females, 1 male, aged 78-90, MoCA scores 14–28), installed environmental sensors measuring temperature, humidity, and CO2 inside their homes, provided them with wearables that measure sleep, activity, body temperature, and heart rhythms, and asked them to use a tablet to complete four sets of questionnaires and cognitive tests per day for three consecutive weeks. Environmental sensors collected data with no disruption or complaint from participants. Average compliance with the wearables was 81% (ring) and 60% (watch). All participants preferred the ring due to ease-of-use. Compliance was better in those with higher MoCA scores. Three participants were able to use the tablet successfully and completed 90% of prescribed questionnaires and cognitive tests. Cognitive and/or motor issues prevented the other participants from using the tablet. Exit interviews revealed that participants would prefer to complete a maximum of two sets of daily questionnaires and cognitive tests (five minutes each) in longer-term studies. These results suggest that it is feasible to study the impact of the environment on biological rhythms, cognition, and other outcomes in older adults and provide recommendations for ensuring long-term compliance with the protocol.

Abstract MP59: Effects Of Sodium Reduction And Weight Loss On Lightheadedness And Falls In Older Adults: Results From TONE

Background: The Trial of Nonpharmacologic Interventions in the Elderly (TONE) demonstrated the efficacy of sodium reduction and weight loss to reduce hypertension medication use in older adults. However, adverse events related to lightheadedness and falls have not been reported.

Objective: To determine whether sodium reduction and weight loss are associated with greater risk of lightheadedness and falls among older adults.

Methods: TONE was a randomized trial of 60-80 year-old adults with systolic BP (SBP) and diastolic BP (DBP) below 145 and 85 mm Hg, respectively, while receiving treatment with a single antihypertensive medication. Participants were randomized to behavioral interventions focused on sodium reduction, weight loss, both, or neither (usual care); 3 months after randomization, the antihypertensive medication was withdrawn and only restored later during the study if needed for uncontrolled hypertension. Total follow-up was 36 months post-randomization. Two physicians independently adjudicated adverse event logs, masked to intervention assignment. The primary outcome was a composite of the first occurrence of adverse event related to falls (total N=95): 72 involved orthostatic symptoms (lightheadedness, dizziness, vertigo), while 23 involved hard events (fall or syncope). Hazard ratios were determined via Cox proportional hazards models.

Results: Among the 975 participants (mean age 66 yrs, 48% women, 24% black), mean SBP and DBP were 128 and 71 mm Hg. The cumulative incidence of adverse events at 30 months was 0.08, 0.13, 0.11, and 0.14 for usual care, reduced sodium, weight loss, or both, respectively ( Figure ). In adjusted multi-variable analyses, sodium reduction was associated with higher risk of an adverse event (HR 1.52; 95% CI: 1.02, 2.27), while weight loss was not associated with adverse events (HR 1.18; 0.77, 1.79).

Conclusions: In the context of antihypertensive medication withdrawal, sodium reduction was associated with a higher risk of fall-related adverse events, predominantly symptoms.

The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing

BACKGROUND/OBJECTIVES

This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services.

DESIGN

Cluster randomized controlled trial with randomization at the housing site level.

SETTING

Greater Boston, Massachusetts.

PARTICIPANTS

The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition.

INTERVENTION

Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65.

RESULTS

The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group.

CONCLUSION

ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.

ECHO-CT: An Interdisciplinary Video-Conference Model for Identifying Post-Discharge Transition-of-Care Events

Introduction: Discharge from the hospital to a post-acute care setting can be complex and potentially dangerous, with opportunities for errors and lapses in communication between providers. Data collected through the Extension for Community Health Outcomes-Care Transitions (ECHO-CT) model were used to identify and classify transitional care events (TCEs.) Methods: The ECHO-CT model employs multidisciplinary teleconferences between a hospital-based team and providers in post-acute settings; during this conference, concerns arising in the patient’s care transition were identified and recorded. Results: 675 patients were discussed during interdisciplinary videoconferences. A total of 139 TCEs were identified; 52 (37.4%) were classified as medication issues, and 58 (41.7%) involved discharge communication or coordination errors. Conclusions: These identified TCEs highlight areas in which providers can work to reduce issues arising in the course of discharge to post-acute facilities. Standardized processes to identify, record, and report transition of care events are necessary to provide high-quality, safe care for patients as they move across care settings.

The Decreased Complexity of Blood Pressure Dynamics Is Associated With Higher White Matter Lesions in Older Adults

White matter lesions (WML) are highly prevalent in older adults and thought to represent cerebral microvascular disease, contributing to slow gait and dementia. Hypertension is associated with WML. However, the underlying mechanism of this association is unclear. The complex beat-to-beat BP fluctuations represent the influence of BP regulatory mechanisms over multiple time scales. The association between WML and abnormalities in BP regulation may be manifest as a loss of complexity in BP dynamics. The aim of this study is thus to explore the relationships between hypertension, BP complexity, and WML in older adults. Twenty-two older adults with hypertension (SBP>140 mmHg) and 19 age-matched older adults without hypertension (i.e., control) completed this study. Their whole-brain WML were assessed by two neurologists using the Fazekas Scale. Greater score reflects higher WML grade. Each participant completed a 10-minute BP assessment when sitting quietly following the MRI. The continuous SBP and DBP series were recorded, and the complexity of them was quantified using multiscale entropy (MSE). Lower MSE reflects lower complexity. Compared to the controls, hypertensives had significantly greater Fazekas scores (i.e., higher WML grade) (F=4.8, p=0.02) and lower complexity of SBP and DBP (F>3.7, p<0.01), after adjusting for age. Across two cohorts, those with lower SBP and DBP complexity had higher Fazekas score (r<-0.51, p<0.01), and this association was independent of age and group. These results suggest that WML are associated with a loss of complexity in BP dynamics. Future longitudinal studies are needed to examine the causal relationship between WML and BP.

Abstract MP36: Effects Of Intensive Blood Pressure Treatment On Orthostatic Hypotension: An Individual-level Meta-analysis

Background: Intensive blood pressure (BP) treatment reduces the risk of cardiovascular disease, but there are ongoing concerns that it also might be harmful by increasing the risk of orthostatic hypotension (OH). However, individual trials have been inconclusive.

Methods: In this individual participant data meta-analysis, we systematically reviewed MEDLINE, EMBASE, and CENTRAL databases through October 7, 2019 for randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) on measured OH. OH was defined as a drop in SBP ≥20 mmHg or DBP ≥10 mmHg after changing positions from seated to standing. Ultimately, five trials of BP treatment goal were identified. Effects were examined overall and in subgroups of baseline characteristics, including diabetes, standing BP pre-randomization (<110 vs ≥110 mm Hg), and pre-randomization OH.

Results: There were 18,466 participants with 127,998 follow-up visits. Most trials demonstrated low risk of bias with minimal heterogeneity of effects across trials ( I 2 = 0.0%). Intensive BP treatment significantly lowered risk of OH (OR 0.93; 95% CI: 0.86, 0.99). Effects were strongest among adults without diabetes (OR 0.90 vs 1.10; P -interaction = 0.015) and adults with lower standing SBP (OR 0.66 for <110 mmHg vs 0.96 for ≥110 mmHg; P -interaction = 0.02). Effects did not differ by pre-randomization OH ( P -interaction = 0.80). In sensitivity analyses that included 4 additional placebo-controlled trials, overall and subgroup findings were unchanged ( Figure ).

Conclusion: OH prior to or in the setting of more intensive BP treatment should not be viewed as a reason to avoid or to de-escalate treatment for hypertension.

Key strategies for improving transitions of care collaboration: lessons from the ECHO-care transitions program

Transitioning the care of a patient from a hospital to a skilled nursing facility (SNF) is critical and often risky. Poor care transitions can result in delays, medication mistakes, incomplete follow-up care, and adverse health outcomes. Ensuring a smooth and effective care transition is the goal for providers at both the hospital and SNF. At its foundation, successful care transitions rely on teamwork, relationship building, and communication among diverse groups of providers. Beth Israel Deaconess Medical Center (BIDMC) developed the ECHO-CT (Extension for Community Healthcare Outcomes-Care Transitions) program to improve transitions of care through structured, bi-directional communication between hospital-based and SNF-based providers. This paper describes key strategies for success in this model including: facilitating teamwork, eliminating hierarchy, and encouraging a bi-directional learning environment. We propose these as strategies that could be implemented in other organizations seeking to improve value during transitions of care.

THE VIRTUE OF A LIFE OF COMPLEXITY: THE KEY TO HEALTHY AGING

People often wish to simplify their lives as they age, hoping to lead a less complex, stress-free, and happy existence. However, the loss of complexity may actually endanger one’s health. Aging is often associated with the pruning of work, family, and social networks in our external environment, and on a smaller scale, with the degradation of various anatomic structures and physiologic processes internally. This loss of complexity can impair our ability to perform activities of daily life or adapt to surgery or other stressors. We can quantify complexity using measures derived from the concept of fractals that describe patterns of behavior across different scales in space or time. Using these metrics we have shown that complexity loss is potentially reversible. This presentation will describe the measures, mechanisms, and consequences of complexity loss in different human systems, and interventions that can restore complexity and thereby improve functional health in older age.

NOVEL REMOTE ASSESSMENT OF THE STANDING POSTURAL CONTROL IN YOUNGER AND OLDER ADULTS USING SMARTPHONE APPLICATION

In older adults, assessment of standing postural control under various task and/or environmental conditions provides valuable insight into cognitive-motor function. To date, however, such assessments have been limited primarily to laboratory or clinical settings. We therefore created a smartphone App to enable remote assessments of postural control. This App provides users with standardized multi-media instructions and harnesses the phone’s internal motion sensors to capture postural sway, with the phone placed in the user’s pants pocket, during trials of standing with eyes open, eyes-closed, and while performing serial-subtractions (i.e., dual tasking). We then established the test-retest reliability of several metrics of postural sway derived from this assessment tool, as well as their sensitivity to the effect of age and standing condition. Fifteen healthy younger and 15 older adults completed multiple standing trials in two separate laboratory visits and on three separate days in their own homes. Postural sway metrics included the mean distance from the center of the trajectory and root mean square were derived from both transverse-plane acceleration and angular velocity time series. Each sway metric demonstrated excellent test-retest reliability, even when analyzed separately by group and standing condition (ICCs: 0.78-0.89). Moreover, each metric was sensitive to age group and standing condition, such that greater sway was observed in older adults as compared to younger adults (p<0.03), and in more challenging standing conditions (p<0.0001). These results suggest that sensitive metrics of standing postural control may be reliably obtained from remote smartphone-based assessments in both younger and older adults.

VALIDITY AND RELIABILITY OF REMOTE, SMARTPHONE-BASED ASSESSMENT OF DUAL-TASK STANDING AND WALKING IN OLDER ADULTS

Dual task walking assessments provide valuable insights into cognitive-motor function in aging. To date, such assessments have been limited primarily to laboratory-based settings. We thus created a smartphone App utilizing multi-media instructions and the phone’s motion sensors to record movements during normal and dual task walking, with the phone placed in the user’s pants pocket. Thirty younger and older adults completed two lab visits, during which walking data were simultaneously acquired by the App and the GAITRite mat. Participants also completed App-based assessments in their homes on three separate days. Across all detected strides in laboratory trials, gait metrics derived from the App correlated closely with those derived from the GAITRite mat (r2>0.96). Across trials, gait metrics demonstrated excellent test-retest reliability, both within and between laboratory visits and home-based assessments (ICC: 0.79–0.90). Remote, smartphone-based dual task walking assessments may therefore be feasible for relatively healthy younger and older adults.

A Usability Evaluation of the InfoSAGE App for Family-Based Medication Management

The design of a mobile medication manager within a broader family and elder-centric collaboration platform faces challenges of usability and wide applicability. To inform the development and use cases of eldercare apps, we present the preliminary results of a usability study of an iOS and Android app intended for both family members and aging adults for the mobile management of medication lists. Seven participants were recorded during the performance of eight typical use-case scenarios of the medication portion of the InfoSAGE app. Audio and video recordings were analyzed for themes and events. The aim of this paper is to help inform future design choices for eldercare mobile apps.

STOP-FALLING: A Simple Checklist Tool for Fall Prevention in a Nursing Facility

Falls are highly prevalent and lead to major health morbidity and mortality in older adults. We developed a "STOP-FALLING" checklist as a multifactorial intervention tool kit for a single long-term care facility. The objective of this study was to determine feasibility and adherence of the checklist, and to determine whether STOP-FALLING reduces total number of falls, frequent fallers, and fall-related injuries. This is a quality improvement demonstration project comparing the effect on falls 3 months before and 3 months after introducing a STOP-FALLING checklist. All older adult patients who lived in the long-term care unit of a single facility were included. PTs, geriatricians, and registered nurses participated in the STOP-FALLING initiative. Staff were surveyed on satisfaction by 8-item questionnaires, which were obtained 3 months after checklist implementation. Data on the rate of falls, the number of recurrent fallers, the number of minor injuries, and the number of major injuries 3 months prior and 3 months after the intervention were collected by facility fall log. A total of 32 patients were screened using the STOP-FALLING checklist. Staff survey revealed a high satisfaction rate with ≤15 minutes to complete the checklist. Data at 3 months after initiation of the checklist revealed a reduction in the fall rates (2.80-1.65 falls per person-year), number of frequent fallers (5.00-2.30/mo after), number of falls without injuries (3.00-1.67/mo), number of minor injuries (4.00-2.67/mo), and number of major injuries (0.33-0/mo). We observed excellent staff satisfaction using the STOP-FALLING checklist. Our pilot project suggests that the intervention may decrease fall rates and other fall-related injuries.

InfoSAGE: Supporting Elders and Families through Online Family Networks

With an increasingly elderly population, families are finding it increasingly challenging to coordinate care for their older family members. This paper reports on the findings of InfoSAGE, an online private social network that has tools for communication and care coordination for elders and their families. The InfoSAGE system has 257 registered users; 52 of these opted into an in-depth longitudinal study. A descriptive analysis of these early participants, the online family networks, and barriers to participation that were encountered are presented.

Information sharing across generations and environments (InfoSAGE): study design and methodology protocol

Background

Longevity creates increasing care needs for healthcare providers and family caregivers. Increasingly, the burden of care falls to one primary caregiver, increasing stress and reducing health outcomes. Additionally, little has been published on adults’, over the age of 75, preferences in the development of health information sharing with family members using online platforms. This study aims to assess a novel, Internet based, family-centric communication and collaboration platform created to address the information needs of elders and their informal caregivers in a community setting.

Methods

This study is an internet-based, open prospective cohort study, enrolling dyad pairs of one adult over the age of 75 with one informal caregiver. Dyads will be offered to use the InfoSAGE online platform without prospective assignment. Participants will consent using an online process that enables participation from any location and shares important study and privacy details. The platform will enable the capture of search queries and tracking of functions such as tasks and discussions. Surveys every six months assess health status, health and social needs, and caregiver burden using validated instruments over a two-year period. We will use a mixed methods approach, utilizing qualitative survey data along with website usage analytic data.

Discussion

Analysis of the longitudinal usage and survey data will help to examine the patterns of family communication and health information seeking as the central older adult ages. We will use the study data to inform design recommendations relevant to a complex mixture of users, with special consideration to the needs of older adult users and potential physical limitations.

Transcranial Direct Current Stimulation May Improve Cognitive-Motor Function in Functionally Limited Older Adults

OBJECTIVE

To determine the effects of a transcranial direct current stimulation (tDCS) intervention with the anode placed over the left dorsolateral prefrontal cortex (dlPFC) and cathode over the right supraorbital region, on cognition, mobility, and "dual-task" standing and walking in older adults with mild-to-moderate motor and cognitive impairments.

METHODS

A double-blinded, block-randomized, sham-controlled trial was conducted in 18 nondemented, ambulatory adults aged ⩾65 years with slow walking speed (⩽1.0 m/s) and "executive" dysfunction (Trail Making Test B score ⩽25th percentile of age- and education-matched norms). Interventions included ten 20-minute sessions of tDCS or sham stimulation. Cognition, mobility, and dual-task standing and walking were assessed at baseline, postintervention, and 2 weeks thereafter. Dual tasking was also assessed immediately before and after the first tDCS session.

RESULTS

Intervention compliance was high (mean ± SD = 9.5 ± 1.1 sessions) and no unexpected or serious side effects were reported. tDCS, compared with sham, induced improvements in the Montreal Cognitive Assessment total score ( P = .03) and specifically within the executive function subscore of this test ( P = .002), and in several metrics of dual-task standing and walking ( P < .05). Each of these effects persisted for 2 weeks. tDCS had no effect on the Timed Up-and-Go test of mobility or the Geriatric Depression Scale. Those participants who exhibited larger improvements in dual-task standing posture following the first tDCS session exhibited larger cognitive-motor improvements following 2 weeks of tDCS ( P < .04).

INTERPRETATION

tDCS intervention designed to stimulate the left dorsolateral prefrontal cortex may improve executive function and dual tasking in older adults with functional limitations.

What Should Be the Target Blood Pressure for This Older Patient With Hypertension?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Hypertension is prevalent and the most important risk factor for cardiovascular disease. Controversy exists regarding the optimum threshold above which to begin antihypertensive therapy and the optimum target blood pressure once medication is begun. This controversy is particularly true for older patients, who may be more likely to benefit from treatment because of their higher risk for cardiovascular events, but may also be more at risk for adverse effects of treatment. Two guidelines published in 2017 address this issue. The American College of Physicians/American Academy of Family Physicians guideline recommends initiating antihypertensive therapy for older patients (aged 60 years or older) if systolic blood pressure is 150 mm Hg or higher and to treat to the same target. They recommend a lower threshold for starting treatment and a lower target systolic blood pressure (140 mm Hg) for patients with cerebrovascular disease and potentially those at high risk for cardiovascular events. The American College of Cardiology/American Heart Association guideline, which is based primarily on SPRINT (Systolic Blood Pressure Intervention Trial), advises a target systolic blood pressure of 130 mm Hg for community-dwelling ambulatory patients aged 65 years or older. This article presents the case of a 79-year-old man who is contemplating antihypertensive therapy. Two experts discuss the optimal approach for the patient and suggest how to apply the 2 guidelines to his care.

Addressing the Challenges of Aging: How Elders and Their Care Partners Seek Information

Purpose

Elders in retirement communities face many challenges concerning information and communication. We know little about whether or how online technologies help meet their medical and social needs. The objective of this study was to gain insights into how these elders and their families manage health information and communication.

Design and Methods

Qualitative analysis of 10 focus groups with elders and family members. Participants were 30 elders at least 75 years of age residing in 5 senior living communities in and near Boston, MA, and 23 family members.

Results

Elders and families turned first to their personal networks when they needed information or help. They stayed informed about elders' health primarily by talking directly with providers. They used online resources infrequently, including portal access to medical records. They wanted online access to medication lists and visit notes, up-to-date information about local services and social activities, and a way to avoid the overwhelming nature of Internet searches.

Implications

Elders in senior living communities and their families piece together information primarily from word of mouth communication. In the future, electronic social and collaborative technologies may make information gathering easier.

Smartphone App-Based Assessment of Gait During Normal and Dual-Task Walking: Demonstration of Validity and Reliability

BACKGROUND

Walking is a complex cognitive motor task that is commonly completed while performing another task such as talking or making decisions. Gait assessments performed under normal and "dual-task" walking conditions thus provide important insights into health. Such assessments, however, are limited primarily to laboratory-based settings.

OBJECTIVE

The objective of our study was to create and test a smartphone-based assessment of normal and dual-task walking for use in nonlaboratory settings.

METHODS

We created an iPhone app that used the phone's motion sensors to record movements during walking under normal conditions and while performing a serial-subtraction dual task, with the phone placed in the user's pants pocket. The app provided the user with multimedia instructions before and during the assessment. Acquired data were automatically uploaded to a cloud-based server for offline analyses. A total of 14 healthy adults completed 2 laboratory visits separated by 1 week. On each visit, they used the app to complete three 45-second trials each of normal and dual-task walking. Kinematic data were collected with the app and a gold-standard-instrumented GAITRite mat. Participants also used the app to complete normal and dual-task walking trials within their homes on 3 separate days. Within laboratory-based trials, GAITRite-derived heel strikes and toe-offs of the phone-side leg aligned with smartphone acceleration extrema, following filtering and rotation to the earth coordinate system. We derived stride times-a clinically meaningful metric of locomotor control-from GAITRite and app data, for all strides occurring over the GAITRite mat. We calculated stride times and the dual-task cost to the average stride time (ie, percentage change from normal to dual-task conditions) from both measurement devices. We calculated similar metrics from home-based app data. For these trials, periods of potential turning were identified via custom-developed algorithms and omitted from stride-time analyses.

RESULTS

Across all detected strides in the laboratory, stride times derived from the app and GAITRite mat were highly correlated (P<.001, r²=.98). These correlations were independent of walking condition and pocket tightness. App- and GAITRite-derived stride-time dual-task costs were also highly correlated (P<.001, r²=.95). The error of app-derived stride times (mean 16.9, SD 9.0 ms) was unaffected by the magnitude of stride time, walking condition, or pocket tightness. For both normal and dual-task trials, average stride times derived from app walking trials demonstrated excellent test-retest reliability within and between both laboratory and home-based assessments (intraclass correlation coefficient range .82-.94).

CONCLUSIONS

The iPhone app we created enabled valid and reliable assessment of stride timing-with the smartphone in the pocket-during both normal and dual-task walking and within both laboratory and nonlaboratory environments. Additional work is warranted to expand the functionality of this tool to older adults and other patient populations.

When Adults Don't Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults

Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effective methods of health-promotion, yet statistics show that only a small percentage of middle-aged and older adults engage in the recommended amount of regular exercise. This state of affairs is less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms. Many types of intervention programs target exercise in later life, but they typically do not achieve sustained behavior change, and there has been very little increase in the exercise rate in the population over the last decade. The goal of this paper is to consider the use of effective low-cost motivational and behavioral strategies for increasing physical activity, which could have far-reaching benefits at the individual and population levels. We present a multicomponent framework to guide development of behavior change interventions to increase and maintain physical activity among sedentary adults and others at risk for health problems. This involves a personalized approach to motivation and behavior change, which includes social support, goal setting, and positive affect coupled with cognitive restructuring of negative and self-defeating attitudes and misconceptions. These strategies can lead to increases in exercise self-efficacy and control beliefs as well as self- management skills such as self-regulation and action planning, which in turn are expected to lead to long-term increases in activity. These changes in activity frequency and intensity can ultimately lead to improvements in physical and psychological well-being among middle-aged and older adults, including those from underserved, vulnerable populations. Even a modest increase in physical activity can have a significant impact on health and quality of life. Recommendations for future interventions include a focus on ways to achieve personalized approaches, broad outreach, and maintenance of behavior changes.

InfoSAGE: Use of Online Technologies for Communication and Elder Care

Aging creates new information and communication needs for families who are helping to coordinate care for frail parents. To identify how information and communication needs evolve with the aging process, we created a living laboratory of families, supported by an online private social network with tools for care coordination. Site registrants are invite to participate in a more in-depth survey-based longitudinal study. In year one, we assessed the feasibility of an online living laboratory. During this first year, 155 individuals registered on InfoSAGE, and 26% opted into the more in-depth longitudinal study. The survey response rate for those in the study was 61%. We present here a descriptive analysis of our early participants and networks, as well as barriers to participation that the study team encountered.

Extension for Community Healthcare Outcomes-Care Transitions: Enhancing Geriatric Care Transitions Through a Multidisciplinary Videoconference

OBJECTIVES

To examine whether a novel videoconference that connects an interdisciplinary hospital-based team with clinicians at postacute care sites improves interprofessional communication and reduces medication errors.

DESIGN

Prospective cohort.

SETTING

One tertiary care medical center and eight postacute care sites.

PARTICIPANTS

Hospital-based providers (hospitalists, geriatricians, pharmacists, social workers, medical trainees, and subspecialists) and postacute care clinicians.

INTERVENTION

All patients discharged to eight postacute care sites were discussed in a weekly videoconference.

MEASUREMENT

Preliminary data including demographic characteristics of the patients discussed, postacute care provider satisfaction survey results, and data on medication errors are reported.

RESULTS

Over 2 years, 907 patients were discussed; 84.6% were discussed with staff at subacute skilled nursing facilities and the remainder with clinicians at one long-term acute care facility. They had an average hospital length of stay of 6.8 days. Postacute care providers felt that the videoconference enhanced communication and provided much-needed access to information and hospital staff. Of the 106 pharmacy discrepancies identified, 16% involved an omission of a medication.

CONCLUSION

As increasing numbers of older adults are discharged to postacute care facilities, they face high-risk care transitions. Extension for Community Healthcare Outcomes-Care Transitions (ECHO-CT) facilitates interdisciplinary communication between hospital and postacute care providers, who normally have minimal interaction. Preliminary data suggests that ECHO-CT may improve the transitions of care processes between these sites.

Sub-sensory vibratory noise augments the physiologic complexity of postural control in older adults

Background

Postural control requires numerous inputs interacting across multiple temporospatial scales. This organization, evidenced by the “complexity” contained within standing postural sway fluctuations, enables diverse system functionality. Age-related reduction of foot-sole somatosensation reduces standing postural sway complexity and diminishes the functionality of the postural control system. Sub-sensory vibrations applied to the foot soles reduce the speed and magnitude of sway and improve mobility in older adults. We thus hypothesized that these vibration-induced improvements to the functionality of the postural control system are associated with an increase in the standing postural sway complexity.

Method

Twelve healthy older adults aged 74 ± 8 years completed three visits to test the effects of foot sole vibrations at 0 % (i.e., no vibration), 70 and 85 % of the sensory threshold. Postural sway was assessed during eyes-open and eyes-closed standing. The complexity of sway time-series was quantified using multiscale entropy. The timed up-and-go (TUG) was completed to assess mobility.

Results

When standing without vibration, participants with lower foot sole vibratory thresholds (better sensation) had greater mediolateral (ML) sway complexity (r² = 0.49, p < 0.001), and those with greater ML sway complexity had faster TUG times (better mobility) (r² = 0.38, p < 0.001). Foot sole vibrations at 70 and 85 % of sensory threshold increased ML sway complexity during eyes-open and eyes-closed standing (p < 0.0001). Importantly, these vibration-induced increases in complexity correlated with improvements in the TUG test of mobility (r² = 0.15 ~ 0.42, p < 0.001 ~ 0.03).

Conclusions

Sub-sensory foot sole vibrations augment the postural control system functionality and such beneficial effects are reflected in an increase in the physiologic complexity of standing postural sway dynamics.