PURPOSE: To describe second-year nursing students' perception and clinical learning experiences related to the Age-Friendly Care 4Ms Framework. METHOD: A qualitative exploratory study using inductive thematic analysis of...PURPOSE: To describe second-year nursing students' perception and clinical learning experiences related to the Age-Friendly Care 4Ms Framework. METHOD: A qualitative exploratory study using inductive thematic analysis of student-generated clinical reflections and course artifacts was performed. Data were coded independently by researchers and synthesized into themes to ensure analytic rigor and accuracy. RESULTS: Five themes emerged and included , , , , and . CONCLUSION: Integration of the 4Ms Framework into early clinical education fostered empathy, critical thinking, and professional growth. Students' perceptions evolved toward person-centered care and highlighted the richness of nursing home experiences in shaping professional identity. Embedding structured, age-friendly clinical experiences in nursing education can shift attitudes, enhance communication skills, and better prepare students to work effectively with older adults living in nursing homes.
PURPOSE: To describe a model of nurse-led age-friendly care in the acute care setting and associated processes and outcomes aligned with the 4Ms Framework. METHOD: We implemented the Supporting Older Adults at Risk Model...PURPOSE: To describe a model of nurse-led age-friendly care in the acute care setting and associated processes and outcomes aligned with the 4Ms Framework. METHOD: We implemented the Supporting Older Adults at Risk Model-a novel model of care that includes primary care geriatric nurse practitioner co-management and AGS CoCare:HELP-and used descriptive statistics to evaluate outcomes aligned with each of the 4Ms: What Matters, Medication, Mentation, and Mobility. RESULTS: Advance care planning conversations were documented for 81% of the selected sample, resulting in subsequent family meetings and goal-concordant care. Beers Criteria and anticholinergic medications were identified and reduced. Mobility goals were identified for 100% of the selected sample and mobility was maintained or improved for 46%. Addressing mentation was done in alignment with What Matters. CONCLUSION: Nurses are well-positioned to lead age-friendly care and drive optimal outcomes in the acute care setting, especially considering the geriatrician work-force shortage.
PURPOSE: With the increasing aging population, the demand for long-term care (LTC) services, particularly in nursing homes, is expected to rise substantially. Interest in working in LTC has been low but the Teaching Nurs...PURPOSE: With the increasing aging population, the demand for long-term care (LTC) services, particularly in nursing homes, is expected to rise substantially. Interest in working in LTC has been low but the Teaching Nursing Home Collaborative is trying to combat this lack of interest. In the state of Pennsylvania, three universities participated in the collaborative adding clinical experiences in nursing homes for nursing students. METHOD: The experience of three universities establishing clinical in nursing homes was evaluated and suggestions for improving the clinical experience were included. RESULTS: Students attend clinical rotations at nursing homes/LTC from 6 to 12 hours and from one to multiple days over one semester. Clinical rotations are placed in one to three courses offering a variety of experiences and assignments. CONCLUSION: Well prepared faculty and an established agenda for the clinical experience are essential.
PURPOSE: Falls are a leading cause of morbidity and mortality among older adults. The Age-Friendly Health Systems 4Ms Framework identifies objective mobility screening and follow up as essential health care for older adu...PURPOSE: Falls are a leading cause of morbidity and mortality among older adults. The Age-Friendly Health Systems 4Ms Framework identifies objective mobility screening and follow up as essential health care for older adults, yet objective mobility screening is challenging to complete and often missed in primary care appointments. METHOD: In the current project, objective mobility screening was changed from Timed Up and Go to visual gait speed in a geriatrics primary care clinic in a Plan, Do, Study, Act rapid process improvement project with four 2-week cycles. Data were collected through electronic health record audits and surveys. RESULTS: Objective mobility screening using the visual gait speed test increased from 32% to 61% during the improvement period. Follow-up mobility actions also improved during this time. CONCLUSION: Adoption of the visual gait speed test for mobility screening can successfully occur and improve in a geriatric primary care clinic setting during an 8-week improvement period.
Increasing efforts to improve mobility and promote exercise that facilitates healthy aging have generated new opportunities for policymakers and nurses. With the popularity of wearable devices, such as smartwatches, on t...Increasing efforts to improve mobility and promote exercise that facilitates healthy aging have generated new opportunities for policymakers and nurses. With the popularity of wearable devices, such as smartwatches, on the rise, governments, health systems, national organizations, and insurance payers are actively engaged in identifying use cases for these devices that help patients manage their conditions in real-world settings; however, less attention has been paid to using wearable devices to prevent the development of risk factors for chronic disease. This is particularly true regarding musculoskeletal (MSK) care, for which a growing number of digital platforms have recently been validated. Numerous pathways for policy reform to support the adoption of wearable devices in everyday living during the preventive phase of MSK disorders have been identified, each of which requires the expertise and engagement of gerontological nurses to shift the focus of aging care from disease management to prevention.
PURPOSE: Persons with dementia (PWD) often encounter challenges in effectively managing their medications, which can result in medication deviation. The objective of the current study is to provide references for enhanci...PURPOSE: Persons with dementia (PWD) often encounter challenges in effectively managing their medications, which can result in medication deviation. The objective of the current study is to provide references for enhancing the management of medication deviations among PWD. METHOD: A comprehensive literature search was conducted across six databases (PubMed, ProQuest, Web of Science, CNKI, Wanfang, VIP) to identify cross-sectional and cohort studies investigating medication deviations in PWD, published between January 1, 2015, and March 1, 2025. A scoping review methodology was used to summarize and analyze the basic characteristics, assessment tools, types of medication deviations, and influencing factors of included studies. RESULTS: Twenty-one studies were included. Most used the Beers Criteria or STOPP criteria to assess medication deviations. Risk factors for deviations were categorized into three domains: individual factors (e.g., advanced age, cognitive impairment), caregiver-related factors (e.g., insufficient supervision), and medication-related factors (e.g., polypharmacy). Potentially inappropriate medications were the most prevalent type of deviation, with reported rates ranging from 12.2% to 85%. CONCLUSION: Medication deviations are pervasive in dementia populations. Strengthening medication management protocols-including systematic medication reviews, caregiver education, and multidisciplinary interventions-is critical to reducing adverse drug events and preventable hospital readmissions. Future research should prioritize standardized assessment tools and context-specific strategies tailored to the neurobehavioral complexities of dementia.
PURPOSE: To describe changes in the 4Ms-What Matters, Medication, Mentation, and Mobility-from before and the first 6 months of the coronavirus disease 2019 pandemic among nursing home residents. METHOD: Measures include...PURPOSE: To describe changes in the 4Ms-What Matters, Medication, Mentation, and Mobility-from before and the first 6 months of the coronavirus disease 2019 pandemic among nursing home residents. METHOD: Measures included able to express self, understand verbal content, medication use, depression and cognitive status, locomotion support, and use of assisted mobility devices. Measures were compared between the pre-pandemic period to the first and second 3 months of the pandemic among 85 residents. RESULTS: Between the baseline and follow-up pandemic quarters, residents experienced declines in ability to express themselves, had increases in the use of depression medication, and needed more locomotion support over time. There were improved and worsening symptoms for depression and cognitive status between the baseline and follow-up pandemic quarters. CONCLUSION: Strengthening nursing homes' ability to sustain the 4Ms during a public health crisis is essential for providing quality care.
PURPOSE: Despite national and international calls to improve the preparation of our long-term care workforce, educators themselves often lack the necessary competencies for professional practice in nursing home settings....PURPOSE: Despite national and international calls to improve the preparation of our long-term care workforce, educators themselves often lack the necessary competencies for professional practice in nursing home settings. A pilot study of the Revisiting the Teaching Nursing Home initiative was designed to evaluate the initial outcomes of the academic/practice partnership and to offer direction for improving the educational experience faculty provide to students in the nursing home. METHODS: Qualitative findings were used to respond to faculty and student-identified educational needs. RESULTS: Faculty and students identified lack of educational resources that provide the necessary competencies to deliver quality care in nursing homes. CONCLUSION: Resources that help nursing faculty achieve a quality educational experience were compiled by experts and practitioners in the field. These resources are described and help ensure that our future workforce can meet the complex challenges that are the responsibility of the profession.
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...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.
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 operationa...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: To provide an overview of the Revisiting the Teaching Nursing Home (RTNH) pilot initiative, lessons learned, and recommendations for future projects. METHOD: The RTNH pilot initiative (2021-2023) implemented a c...PURPOSE: To provide an overview of the Revisiting the Teaching Nursing Home (RTNH) pilot initiative, lessons learned, and recommendations for future projects. METHOD: The RTNH pilot initiative (2021-2023) implemented a contemporary version of the Teaching Nursing Home (TNH) model in Pennsylvania. This initiative demonstrated how enhanced partnerships between academic nursing schools and nursing homes improve nursing home resident care, nursing student education, and nursing faculty support. RESULTS: Drawing upon existing resources from the Age-Friendly Health Systems and the original TNH model implementation from the 1980s, the RTNH pilot illustrated the varied benefits of a formalized academic-practice partnership combined with a practice framework on nursing home residents and nursing home staff, and nursing students and faculty. CONCLUSION: The momentum and promising outcomes of the pilot have resulted in the expansion of the initiative's Phase II (2023-2026), which aims to deepen relationships between schools of nursing and nursing homes across Pennsylvania and the country.
PURPOSE: Routinely listening to personalized music selections has been shown to reduce agitation, the most common symptom of Alzheimer's disease and related dementias. The purpose of the current study was to assess chang...PURPOSE: Routinely listening to personalized music selections has been shown to reduce agitation, the most common symptom of Alzheimer's disease and related dementias. The purpose of the current study was to assess changes in participant agitation by providing a 6-week personalized music listening (PML) intervention of 30 minutes to 10 nursing home residents with dementia. METHOD: The Cohen-Mansfield Agitation Inventory (CMAI) was administered every 2 weeks throughout the study period. The objective was to see if PML would reduce symptoms of agitation, as measured by participants' CMAI scores. RESULTS: Results from a one-way repeated measures analysis of variance showed improvement in CMAI scores pre- versus post-intervention. Using a Greenhouse-Geisser correction, CMAI score reduction was statistically significant at different time points of the study (F [1.487, 13.886] = 4.63, = 0.044). CONCLUSION: Results suggest that PML can be an effective and low-cost means for improving dementia-related agitation in the short term.
PURPOSE: To identify latent profiles of ego depletion among older adults with type 2 diabetes mellitus (T2DM), and analyze how these profiles relate to health promotion behaviors. METHOD: A cross-sectional study surveyed...PURPOSE: To identify latent profiles of ego depletion among older adults with type 2 diabetes mellitus (T2DM), and analyze how these profiles relate to health promotion behaviors. METHOD: A cross-sectional study surveyed 220 older adults with T2DM on ego depletion and health promotion behaviors. Latent profile analysis identified distinct profiles of ego depletion, and multinomial logistic regression explored their links to health promotion behaviors. RESULTS: Latent profile analysis revealed three distinct profiles: high cognitive depletion, high behavioral depletion, and high emotional depletion. The high behavioral depletion profile was associated with fewer complications, more hypoglycemia, better stress management, greater enjoyment of life, and increased health responsibility. The high emotional depletion profile had lower levels of physical activity, reduced risk reduction behaviors, poorer stress management, and less adherence to a healthy diet. CONCLUSION: Tailored interventions addressing ego depletion are crucial for improving health promotion behaviors in this population.
PURPOSE: To examine the food consumed by older adults and their physical activity to determine which dietary components (carbohydrates, proteins, and fats) are associated with physical activity and establish a respective...PURPOSE: To examine the food consumed by older adults and their physical activity to determine which dietary components (carbohydrates, proteins, and fats) are associated with physical activity and establish a respective baseline. METHOD: A total of 1,353 older adults (755 males, 598 females) were recruited from the 9th Korea National Health and Nutrition Examination Survey. Participants' physical activity and food intake were assessed. RESULTS: According to the amount of protein consumed by males and females, significant differences in moderate physical activity ( = 0.047 and = 0.007, respectively) and moderate-to-vigorous physical activity ( = 0.026 and = 0.027, respectively) were identified. In the unadjusted model, participants who met the recommended protein intake (odds ratio [OR] = 6.9, 95% confidence interval [CI] [1.52, 31.35]) were more likely to have higher levels of physical activity than those who did not meet the recommended protein intake. Associations with meeting the recommended protein intake (OR = 9.73, 95% CI [1.21, 78.05]) were attenuated after adjusting (sex, age, skeletal muscle index) for covariates. Protein intake and amount of physical activity were positively correlated across all participants ( = 0.184, < 0.05). CONCLUSION: Older adults should consume the recommended amount of protein to increase physical activity, which improves their health. Protein intake has a positive effect on physical performance by influencing muscle mass and function of older adults.
PURPOSE: To examine the relationship between cognition and pain among community-dwelling older adults using the Omaha System. METHOD: A quantitative longitudinal retrospective correlational study was performed. Patterns...PURPOSE: To examine the relationship between cognition and pain among community-dwelling older adults using the Omaha System. METHOD: A quantitative longitudinal retrospective correlational study was performed. Patterns of pain and cognition in adults aged ≥65 years from the Omaha System data were obtained. Four groups of individuals with pain, cognition, both, and neither were compared on admission and discharge, including changes between and within groups. RESULTS: Findings from 6,546 patients demonstrated the cognition group gained the most from nursing interventions. The cognition and both groups' knowledge, behavior, and status ratings differed on admission, but the difference was minimized on discharge. CONCLUSION: Lower cognitive functioning may impede patient expression of pain and/or accurate assessment of pain by nurses. When assessing pain status in older adults, nurses should account for possible effects of cognition problems, and the use of objective assessment is preferred for this population.
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...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.