Models of Evidence-Based Care Delivery for the Older Adult

How does an Acute Care for Elders (ACE) Unit contribute to improved care for the older adult? Removes the burden of care from the family of the older adult. Provides comprehensive geriatric assessments by a team specializing in geriatrics. Works directly with third party payers to relieve the stress of financial responsibilities. Provides discounted care based on the multiple disciplines involved in the patient's care.

Provides comprehensive geriatric assessments by a team specializing in geriatrics. It provides comprehensive geriatric assessments by a team consisting of a geriatrician, geriatric advanced practice nurse, social worker as well as specialists from other disciplines, and the geriatric resource nurse.

Interventions provided by the HELP model have been shown to reduce the incidence of delirium by what percentage? 10-20% 30-40% 50-60% 70-80%

30-40% Interventions monitored by an interprofessional team have been found to reduce the incidence of delirium by 30-40% in a number of high-quality studies.

Which statement describes transitional care? Safety aspects used to transfer an elderly patient from the bed to the chair A set of criteria used by licensed independent practitioners while determining where to place the seriously ill older adult Physician orders used to transition the critically ill geriatric patient from the emergency department to the critical care unit Actions designed to ensure coordination and continuity of care as patients transfer between different locations or levels of care

Actions designed to ensure coordination and continuity of care as patients transfer between different locations or levels of care The American Geriatrics Society defines transitional care as a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care.

Which content does the GRN Model provide to direct care/staff nurses? Delirium prevention techniques Information regarding financial assistance Care management for geriatric syndromes Geriatric expertise related to nursing assessments

Care management for geriatric syndromes The GRN model provides direct care/staff nurses with content focusing on care management for geriatric syndromes.

Which types of care are offered by PACE centers? Curative Diagnostic Supportive Preventative Rehabilitative

Curative PACE centers have the capability to provide curative care. Supportive PACE centers can provide supportive care in the home and community. Preventative PACE programs can offer preventative care. Rehabilitative PACE programs have the ability to provide rehabilitative care to patients.

Which outcomes can be attributed to the implementation of the HELP model? Decrease in fall rate Decrease in sitter use Prevention of delirium Decrease in functional decline Prevention of hospital-acquired infections

Decrease in fall rate The implementation of the HELP model may result in a decrease in fall rates. Decrease in sitter use Utilization of the HELP model can decrease the need for sitters. Prevention of delirium The HELP model has been shown to prevent the development of delirium in hospitalized patients. Decrease in functional decline The implementation of the HELP model decreases the functional decline experienced by hospitalized older adults.

Which outcomes were seen as a result of implementing PACE? Decrease in inpatient hospital days Decrease in nurse's visits to the home Increased attendance at social activities Positive impact on ambulatory care visits Decrease in days spent in the community

Decrease in inpatient hospital days A decrease in inpatient hospital days resulted from the implementation of PACE programs. Decrease in nurse's visits to the home PACE programs led to a decrease in nurse's visits to the home. Increased attendance at social activities PACE programs had a positive effect on attendance at social activities. Positive impact on ambulatory care visits PACE programs also had a positive impact on ambulatory care visits.

Which risk factors for delirium are focuses of the HELP program? Dehydration Sleep deprivation Cardiac dysrhythmias Cognitive impairment Electrolyte imbalances

Dehydration Dehydration is one of six risk factors that are addressed by the HELP program. Sleep deprivation Sleep deprivation is one of six risk factors addressed by the HELP program. Cognitive impairment Cognitive impairment is one of six risk factors addressed by the HELP program.

Which interventions might you expect to see implemented on a HELP unit? Independent meals Encouraging mobility Managing patient pain A daily visitor program Decreasing noise levels at night

Encouraging mobility Encouraging and assisting with mobility is an intervention frequently initiated on a HELP Unit. Managing patient pain Managing the older adult's pain is an important intervention seen on a HELP Unit. A daily visitor program A daily visitor program provides cognitive orientation, communication, and social support, and the program is incorporated into a HELP Unit. Decreasing noise levels at night Keeping the unit quiet at night promotes sleep and is frequently implemented on a HELP Unit.

Which statements describe core features for planning and implementing a transitional care program? Evidence-based plan Coordinated services Initiation and extension of care Gathering and sharing information Assessment of family goals and preferences

Evidence-based plan The implementation of an evidence-based plan of transitional care is a core feature of a transitional care program. Coordinated services A core feature of implementing a transitional care program involves a health care professional with special knowledge of chronic illness to coordinate services needed by the patient. Initiation and extension of care A key consideration when planning a transitional care program involves not only initiating care upon hospital admission but also extending it beyond discharge by means of home visits and telephone follow-up. Gathering and sharing information A core feature for implementing a transitional care program involves developing mechanisms to gather and share information across sites of care. An electronic medical record system is a good example of this.

Which outcomes can be attributed to the Advanced Practice Nurse Transitional Care Model (APN TCM)? Fewer readmissions Improved quality of life Increased physical function Decreased satisfaction with care Increased time between ED visits

Fewer readmissions The APN TCM has documented fewer rehospitalizations during the year after discharge. Improved quality of life The APN TCM has shown an improvement in quality of life among patients. Increased physical function The APN TCM improves physical functioning in older patients. Increased time between ED visits The APN TCM has documented increased time between visits to the emergency department.

Which services are included in the PACE package? Medications Primary care Housekeeping Transportation Physical therapy

Medications Medications are included in the PACE package. Primary care Primary care services are included in the PACE package. Transportation Transportation services are included in the PACE package. Physical therapy Physical therapy is included in the PACE package.

Which model of care reports an increase in patient, family, and nurse satisfaction? ACE Model GRN Model NICHE Model GRN and ACE Combination Model

GRN and ACE Combination Model The GRN and ACE Combination Model reports greater independence in activities of daily living, shorter length of stay, and higher satisfaction among patients, family, clinicians, and nurses.

Which location is preferred for the older adult to live according to PACE? Home Assisted living Nursing home Hospice residence

Home PACE strives to allow older adults to continue to live at home.

Which is an example of the electronic medical record system making health care more seamless? It decreases double lab testing. It increases the ease of documentation. It increases the time the nurse is in the room. It restricts the sharing of information to a single health care facility.

It decreases double lab testing. The electronic medical record can decrease laboratory and diagnostic double tests because all providers can see the results.

Which are reflective of the goals of PACE? Decrease the length of stay in the hospital environment Manage the health of older adults in homes or community Increase the viability of home care programs across the country Avoid institutionalization of older adults with complex medical needs Maintain a number of open beds in nursing home facilities for frail adults

Manage the health of older adults in homes or community A goal of PACE is to manage the health of older adults in their homes, community, or PACE center. Increase the viability of home care programs across the country Increasing the viability of home care programs is a goal of PACE. Avoid institutionalization of older adults with complex medical needs A goal of PACE is to avoid institutionalization of older adults with complex medical and functional needs.

How does the system-level approach of NICHE support the health care organization? NICHE provides specially trained nurses to care for the hospitalized older adult. NICHE publishes medical protocols for health care organizations to use in caring for older adults. NICHE provides additional funding to assist health care organizations in the provision of care necessary for the older adult. NICHE provides a structure for nurses to collaborate with other disciplines and to actively participate in geriatric acute care models.

NICHE provides a structure for nurses to collaborate with other disciplines and to actively participate in geriatric acute care models. The system-level approach of NICHE provides a structure for nurses to collaborate with other disciplines and to actively participate in geriatric care models.

Which statements describe NICHE? NICHE stands for Nurses Improving Care for Healthsystem Elders. NICHE stands for National Institute for the Care of Hospitalized Elders. NICHE is a state-run program designed to improve care for older adults. A goal of NICHE is to improve the competence of nurses providing care to older adults. NICHE is a national program aimed at system improvement in the care of the older adult.

NICHE stands for Nurses Improving Care for Healthsystem Elders. NICHE is the acronym for Nurses Improving Care for Healthsystem Elders. A goal of NICHE is to improve the competence of nurses providing care to older adults. One of the goals of NICHE is to improve nurse competence in the care of the older adult. NICHE is a national program aimed at system improvement in the care of the older adult. NICHE strives to improve the quality of care provided to older adults.

Which factors contribute to gaps in care during critical transitions? Poor communication Lack of a primary control person Incomplete transfer of information Limited access to essential services Education of patients and family members

Poor communication Poor communication contributes to gaps in care during critical transitions. Lack of a primary control person Lack of a primary control person decreases coordination and contributes to gaps in care during critical transitions. Incomplete transfer of information Incomplete transfer of information can also contribute to gaps in care during transitions. Limited access to essential servicesLimited access to essential services can lead to gaps in care.

Which statements describe a goal of the HELP model? Prevent unplanned readmissions Eliminate the incidence of delirium Maximizing independence at discharge Facilitate the transition from hospital to home Maintain cognitive functioning during hospitalization

Prevent unplanned readmissions One of the goals of the HELP model is to prevent unplanned readmissions. Maximizing independence at discharge Maximizing independence at discharge is a goal of the HELP model. Facilitate the transition from hospital to home One of the goals of the HELP model is to facilitate the transition from hospital to home. Maintain cognitive functioning during hospitalization Maintaining cognitive and physical functioning during hospitalization is a goal of the HELP model.

Which statements describe the Programs for All-Inclusive Care for the Elderly (PACE)? Provides an alternative to institutional care for patients aged 55 and older Includes a comprehensive team-oriented approach in care for frail older adults Provides all the care and services covered by Medicare and Medicaid if authorized Provides a structure to "pace" patients in their recovery, adding activities as appropriate Helps to meet the health care needs in the community instead of going to a care facility

Provides an alternative to institutional care for patients aged 55 and older PACE provides an alternative to institutional care for persons aged 55 and older who require a nursing-facility level of care. Includes a comprehensive team-oriented approach in care for frail older adults PACE uses a comprehensive, individualized, and team-oriented approach in the care of frail older adults. Provides all the care and services covered by Medicare and Medicaid if authorized PACE provides all the care and services covered by Medicare and Medicaid if authorized by the health care team. Helps to meet the health care needs in the community instead of going to a care facility PACE helps people meet their health care needs in the community instead of going to a nursing home or other care facility.

Which organizational strategies are facilitated by evidence-based practices at the bedside promoted by the NICHE Model? Provision of administrative support System-wide geriatric clinical protocols Focusing on care management for geriatric syndromes Specific guidelines for the provision of clinical care for the older adult Inclusion of environmental adaptations to assist in independent activities

Provision of administrative support The NICHE Model addresses the need of administrative support; it provides a structure for interdisciplinary collaboration. System-wide geriatric clinical protocols System-wide geriatric clinical protocols may result from the application of evidence-based practice at the bedside. Specific guidelines for the provision of clinical care for the older adult Specific guidelines for the provision of clinical care for the older adult may stem from the application of evidence-based practice at the bedside.

Which outcomes can be attributed to the ACE Model? Reduction in functional decline Increase in returns to homes post discharge Decreased rates of nursing home placement Increase in professional development of nursing staff Development of a structure that supports interdisciplinary collaboration

Reduction in functional decline The ACE Model has led to a reduction in functional decline of older adults. Increase in returns to homes post discharge The ACE Model has documented an increase in the number of older adults who return home post discharge. Decreased rates of nursing home placement The ACE Model has shown a decreased rate of nursing home placements.

Which statements describe the pillars of care transition as seen in the Care Transitions Intervention Model? Self-management of medications Management of nutritional status Follow-up care with primary physician Patient-centered health record keeping Recognition of signs indicating worsening condition

Self-management of medications Medication self-management is one of the four pillars of care transition. Follow-up care with primary physician Follow-up care is an important pillar in the Care Transitions Intervention Model. Patient-centered health record keeping Dynamic patient-centered health record keeping is one of the four pillars in the Care Transitions Intervention Model. Recognition of signs indicating worsening condition Learning how to recognize and respond to red flags that indicate a worsening condition is considered one of the four pillars of the Care Transitions Intervention Model.

Which statement describes the purpose of the Geriatric Resource Nurse (GRN) model? To shorten the duration of stay and decrease hospital costs To provide physicians with a resource in planning treatment modalities To provide community resources to facilitate keeping older adults out of the hospital To address the adverse events and functional decline that accompanies hospitalization

To address the adverse events and functional decline that accompanies hospitalization The GRN model is foundational to NICHE and was designed to address the adverse events and functional decline that accompanies hospitalization.

What is the driving focus of the Hospital Elder Life Program (HELP) Model? To prevent the development of delirium To prevent the development of pressure injury To decrease the likelihood of medication errors To decrease the prevalence of hospital-acquired infections

To prevent the development of delirium The HELP model focuses on managing six risk factors for delirium: cognitive impairment, sleep deprivation, immobility, visual impairments, hearing impairments, and dehydration.