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Table 3 Summary of age-friendly evidence-based practice interventions

From: Study protocol: Type III hybrid effectiveness-implementation study implementing Age-Friendly evidence-based practices in the VA to improve outcomes in older adults

 

Surgical pause

Empower

TAP

CAPABLE

Description

“Surgical Pause” involves systematic screening for frailty using the Risk Analysis Index (RAI) prior to surgery, triggering care pathways that clarify goals pre-operatively

“Eliminating Medications through Patient Ownership of End Results” (EMPOWER) is a direct-to-consumer booklet sent to older adults receiving a high-risk medication on a chronic basis paired with academic detailing for prescribers

“Tailored Activities Program” (TAP) is a 4-month structured, manualized intervention led by an occupational therapist (OT) that trains caregivers of patients with dementia to deliver activities tailored to the care recipients’ interests and capabilities

“Community Aging in Place – Advancing Better Living for Elders” (CAPABLE) utilizes a nurse, occupational therapist, and handyperson to identify and facilitate the functional goals related to aging in place of low-income older adults with 1 ADL or 2 IADL impairments

Core components

• Prior to surgical decision making, patient completes the RAI

• Patients with RAI ≥ 37 referred for goal clarification conversation

• Clinician(s) and patient review treatment plan, with or without surgery, to align with patient’s overarching goals and values

• Identifying patient panel

• Mail EMPOWER brochure which includes a self-assessment of risks for medication, presentation of evidence of harms, medication education, and suggestions for conversation with provider

• Provider prescriber education

• OT formal training

• OT conducts home assessment to identify Veterans’ preserved capabilities and interests

• OT develops 3 tailored activity prescriptions

• Caregiver and Veteran participate in at least 3 TAP sessions

• OT and nurse formal training

• Staffing components:

• OT assess functional abilities, home accessibility, and safety then collaborates with Veteran to create up to 3 ADL/IDAL goals

• Nurse—assesses medical status and develops 3 nursing goals

• Handy Person—completes home modifications/repairs

Example adaptations

• Which staff screen

• Strategy for communicating results to surgeon

• In-person versus virtual training

• Which clinician completes goal clarification conversation

• Format of brochure

• Timing of brochure mailing and communication with prescriber

• Which staff mail the brochure

• Number of mailings

• Other health professionals (social worker, psychologist, RN) may also implement TAP with OT supervision

• Location of session

• Number of visits

• Referral source

• Addressing more critical and expensive home repairs

• Number of sessions conducted virtually vs in home after the initial assessment

Patient eligibility

• Age 65 + 

• RAI ≥ 37

• Considering “major surgery” as defined by a VASQIP-eligible CPT code

• Age 65 + 

• Community-dwelling (i.e., not residing in a nursing home)

• Receiving a prescription for a targeted drug class for at least 90 of the last 120 days from a VA prescriber

• Age 65 + 

• Has a dementia diagnosis

• Has an adult caregiver willing/able to participate

• Can participate in at least two basic ADLs

• Age 65 + 

• Low income

• At least 1 ADL or 2 IADL deficiencies

• Able to ambulate around house independently with or without an assistive device

Potential setting

Preoperative clinics (e.g., surgery, anesthesia, primary care, medical subspecialties)

Primary care, mental health

Home care, home-based primary care, caregiver support program

Home care

  1. VASQIP Veterans Affairs Surgical Quality Improvement Program, CPT code Current Procedural Terminology, VA Veterans Administration, RN registered nurse, IADL Instrumental Activities of Daily Living