Geriatric Care: A Comprehensive Guide for Interprofessional Healthcare Professionals, Study notes of Nursing

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HIGN eLearning Catalog

Table of Contents

• Courses & Case Studies ………………………………………………………………………………………..…..3-
  • Across the Healthcare Continuum ……………………..………………………………………………….3-
    • APRN Case Studies ……………………………………………………………………………………...
    • Foundations of Nursing Care for Older Adults……………………………………………….
    • Leadership Series………………………………………………………………………………………..
  • Primary Care …………………………………………………………………………………………………....8-
    • Care Coordination of Complex Older Adults ……………………………..…….……………..
    • Geriatric and Gerontological Care in Primary Care ………………..……………………..
    • IPEP Case Studies ………………………………………………………………………………..……...
    • Primary Care of Older Adults for Interprofessionals (PCOA-IP) ..........................
    • Primary Care of Older Adults, Primary Care Providers (PCOA-PCP) ................
    • Primary Care of Older Adults for Registered Nurses (PCOA-RN ).......................
  • Long-Term Care ……………………………………………………………………………………………...19-
    • Care of Older Adults in the Long-Term Care Setting (COA-LTC) Series …….…...
    • Integrating Care for Older Residents Into Student Clinical Rotations ………..….
    • Nursing Homes Series ………………………..……………………………………………………...
  • Home Health …………………………………………………………………………………………………..27-
    • Building a Community Based Chronic Disease Self-Management Program ..….
    • Care of Older Adults in Home Care Series for Interprofessionals (COA-HC-IP)..
    • Care of Older Adults in Home Care Series for Registered Nurses (COA-HC-RN).
  • Behavioral Health …………………………………………………………………………………………...31-
    • Behavioral Health in Primary Care Series (BHPC) .............................................
    • Geropsychiatric Nursing Initiative (GPNI) Series ………………………………………..
  • Speciality Care ………………………………………………………………………………………..…….…35-
    • Integrating the Geriatric Surgery Verification (GSV) Program with the 4Ms…….
• Webinars …………………………………………………………………………………………………………………37-
• Resources ………………………………………………………………………………………………………………..41-
• Gerontological Certification Review Course …….……………………………………………………..

considers the neuropathology, dementia complexity with comorbidities, and psychosocial planning needs. APRN Case Study 5: Evaluating Acute Confusion: A CNS Perspective In completion of this case study, learners will be able to use a systematic approach to assess the multifactorial etiologies that can contribute to acute mental status changes (i.e., delirium) in older adults, and understand how the under-recognition of delirium superimposed on dementia leads to potential deleterious outcomes for hospitalized adults. This case study covers the evidence-based strategies for assessing, preventing, and managing delirium in persons with dementia in the hospital setting. It also describes the system challenges that impact the quality of care for hospitalized older adults and its potential solutions. APRN Case Study 6: Medications and Adverse Outcomes in Older Adults In completion of this case study, learners will be able to use a systematic approach to identify medication-related problems, high-risk medications, drug-disease, drug-drug interactions, and risk of adverse outcomes prior to their prescription in older adults. APRN Case Study 7: Pain Management This case study covers the most appropriate assessment tool, diagnosis and treatment plans for geriatric pain conditions. APRN Case Study 8: COPD and Weight Loss In completion of this case study, learners will be able to recognize the inability to maintain weight as a multi-faceted problem in older adults, assess and diagnose age-specific changes in nutrition and hydration status in an older adult, and devise an individualized management plan for an older person with weight loss issues. This case study will also show learners how to make the appropriate referrals and follow-ups to inter-professional providers in both the health and social service fields. APRN Case Study 9: Dizziness and Falls This case study will list the major causes of falls among the elderly. In completion of this case study, learners will be able to take a focused history from an elderly person or witness when a fall has taken place, perform a focused physical examination to help determine the cause of the fall, evaluate the complaint of “dizziness”, and perform basic strategies to prevent falls among the elderly.

APRN Case Study 10: Management of Urinary Incontinence

In completion of this case study, learners will know how to obtain a complete focused history for a patient presenting with UI, describe the appropriate components of an evaluation for a UI, differentiate between common types of UI, describe the appropriate

behavioral and pharmacological treatment or management strategies for UI, and recognize the appropriate referral criteria. APRN Case Study 11: Transitional Care for the NP In completion of this case study, learners will be able to identify patients at high risk for poor outcomes at the time of a transition, define challenges and complex issues of transitional care, and assume accountability for controllable and anticipated issues surrounding transitions. APRN Case Study 12: Transitional Care for the Adult-Gerontology CNS This case study will discuss the core components of the Transitional Care Model (TCM) and demonstrate the translation of them into clinical practice. It will also identify gaps in current clinical knowledge related to management of high risk chronically ill adults. In completion of this case study, learners will be able to integrate knowledge of the TCM Model into state of the science management of common chronic health problems to develop plans of care that manages the transition of these high risk elderly from hospital to home, including temporary stay in rehabilitation or skilled nursing facility.

Foundations of Nursing Care for Older Adults

About this Series The Foundations of Nursing Care for Older Adults series consists of 13 individual and interactive online modules featuring the latest content developed by faculty at NYU Rory Meyers College of Nursing, engaging graphics, and knowledge checks for learners as they proceed through the learning content. CEs Awarded: 0.5 - 1.5 nursing contact hour(s)/course This series can be taken by RNs who are working in a variety of settings including hospital care, home health care, assisted-living, PACE programs, and nursing homes. Content topics include:

1. Foundations of Practice for Gerontological Nursing
2. Integrating the 4Ms into the Care of Older Adults
3. Health Promotion and Assessment and Age-Related Changes
4. Geriatric Syndromes
5. Psychological Issues: The Three D's: Depression, Dementia and Delirium
6. Palliative Care
7. Pain
8. Common Cardiovascular Health Conditions

occur, what ill effects are created when the workplace is not safe and healthy, and the effects of deviant behavior on patient care, staff morale and organizational resources. We discuss why a zero tolerance policy is the desired strategy for managing incivil behavior, how leaders can learn to address incivility and what supports are helpful to them in doing so. Managing in Times of Crisis Using the coronavirus pandemic as a framework, the critical role of the leader in managing chaos, complexity and uncertainty is explored. Important behaviors such as staying calm and focused, delivering honest, fact-based communication, being visible and available to staff, and setting short term goals are discussed. We address the necessity of capturing what frontline workers have learned from caring for patients with a novel virus so that organizational learning can be enhanced and best practices can be created and shared. The importance of finding meaning in the grief and loss created by the pandemic is addressed. Managing Up and Across This seminar addresses the importance of appreciating and adapting to people with different perspectives, priorities, and personalities regardless of whether you are the boss, a middle manager, or a member of the direct workforce. The participant will learn strategies to navigate and influence people who approach work differently. The importance of looking beyond your own needs and perspectives to consider the needs and perspectives of others is discussed. Shared Decision Making This seminar differentiates between collaboration and shared decision making. It highlights the importance of communication amongst staff and the importance of the resident or patient in self-determination, or "what matters," as well as the importance of staff members being empowered to make decisions within their scope of practice.

Primary Care

Care Coordination of Complex Older Adults

This course discusses care coordination for the older adult with complex healthcare needs. In completion of this course, learners will be able to differentiate between care coordination and disease management, describe characteristics of care coordination, recognize the role of care coordination in establishing working partnerships, describe risk stratified care coordination, and distinguish between the levels of care coordination.

Geriatric and Gerontological Care in Primary Care

This module is an overview of the unique aspects of assessing older adults in the primary care setting. After completing this module, practitioners will be able to promote comprehensive care for older adults in primary care, differentiate caring for older adults from younger adults, and assess geriatric conditions prevalent in primary care.

IPEP Case Study Series

About the Series The Interprofessional Education and Practice (IPEP) online case studies will prepare healthcare practitioners to effectively and efficiently collaborate in providing quality primary care to adults with chronic conditions. The IPEP Case Studies are a companion to the IPEP eBooks, which can be found in the Resources section. The interprofessional primary care provider level virtual patient case development was supported by funds from the Division of Nursing (DN), Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS) under grant number D09HP25934 and title Advanced Nursing Education. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the DN, BHW, HRSA, HHS, or the U.S. Government. This work was also partly funded by a Human Resources Services Administration Bureau of Health Workforce Academic Administrative Units in Primary Care grant (HRSA#D54HP05446 PI Zabar). IPEP Case Study: Alcohol This case study follows Sue Smith, a 70-year-old female, who is returning to the clinic for a follow-up appointment after visiting the clinic two weeks ago for intermittent abdominal and chest pain. IPEP Case Study: COPD

PCOA-IP 1: Medicare Annual Wellness Visits and Health Promotion and Disease Prevention in Older Adults After completing this course, healthcare professionals will be able to identify the purpose and components of the Welcome to Medicare Preventive Visit, the Medicare Annual Wellness Visit, and an annual healthcare physical. The course also describes health promotion and disease prevention strategies, and includes recommended immunizations for older adults. PCOA-IP 2: Collaborative Care Approach to Memory Disorders in Primary Care This course defines the roles and contributions of team members in a collaborative care model for patients with Alzheimer’s disease and other dementias. It also describes common challenges and offers solutions to implementing collaborative care models. After completing this course, practitioners will be familiar with evidence-based research that supports the efficacy of collaborative care. PCOA-IP 3: Advance Directives The course defines and describes the purpose of advance directives. It also outlines the primary care practitioner’s responsibility related to advance directives. After completing this course, practitioners will be able to differentiate living wills and healthcare proxy documents, convey appropriate and timely information on advance directives to patients and their families, and identify patient characteristics consistent with a lack of decision-making capacity. PCOA-IP 4: Palliative and Hospice Care This course defines and differentiates between palliative care and hospice care. It also describes the appropriate use of opioid medications for pain control in older adults. After completing this course, practitioners will be able to assess pain in patients with dementia, manage agitation in older adults at the end of life, and describe the rationale and steps for admitting older adults with dementia into hospice. PCOA-IP 5: A Practical Guide to Healthcare Financing The course reviews Medicare and Medicaid, including benefit requirements and payment schedules. It will describe the impact these benefits and personal finances has on healthcare options for older adults. After taking this course, practitioners will increase their familiarity with other healthcare and community benefits and services that are available to older adults. PCOA-IP 6: Distinguishing Dementia, Alzheimer’s Type, from Major Depression This course reviews and compares the Diagnostic and Statistical Manual of Mental Disorders’ (DSM-IV and DSM-V) criteria for dementia, delirium and depression. After taking this course, practitioners will be able to recognize, identify, assess, and screen for dementia, delirium, and depression. Learners will also be able to understand the hallmarks of each of these conditions in older adults and detect red flags.

PCOA-IP 7: Person and Family Centered Care This course explains how person and family-centered care (PFCC) differs from other models of care. After completing this course, practitioners will be able to recognize why PFCC is especially important in providing care for older adults (including those with cognitive impairments), and will understand how to engage individuals, family members, and caretakers in this model of care. PCOA-IP 8A: Health Promotion: Health Literacy This course focuses on the importance of health literacy on health promotion in primary care. After taking this course, practitioners will be able to understand the importance of health literacy on health promotion in primary care, understand how to best communicate information to older adults, and describe how to integrate components of health literacy and health promotion into practice. PCOA-IP 8B: Health Promotion: Population Health This course focuses on the importance of population health on health promotion in primary care. After taking this course, practitioners will be able to recognize the importance of health promotion, describe how to best work with adult learners, describe the impact that a population-health focus has on the care of patients, families, and caregivers, and describe how interprofessional members of the healthcare team can integrate components of health promotion in practice. PCOA-IP 9: Mistreatment Detection in Older Adults This course defines different types of elder mistreatment and identifies strategies for detection. After completing this course, practitioners will understand the important role RNs and other interprofessional team members have in recognizing and reporting elder mistreatment, and the significance of interdisciplinary interventions to address this issue in healthcare settings. PCOA-IP 10: Substance Misuse in Older Adults This course describes the characteristics of substance use disorders and substance misuse patterns in older adults. This includes illicit drug use, prescription drug misuse, alcohol-related disorders, and tobacco use. The opioid misuse problem in adults age 55+ is discussed. The course outlines assessing older adults for substance misuse and compares these usage patterns in older adults with those of other populations. After viewing this course, practitioners will be able to describe and implement a brief motivational intervention as a component of care and assess and utilize other treatment modalities. PCOA-IP 11: Falls and Fall Prevention This course defines the causes and risk factors for falls in older adults, describes the need for comprehensive assessment for falls in this population, and identifies validated screening tools to utilize when evaluating for fall risk. After viewing this course, practitioners will understand their

PCOA-PCP 2: Common Screening for Older Adults This course describes the prevalence of common chronic illnesses among older adults and common screening recommendations for these illnesses. After completing this course, practitioners will be able to use these evidence-based screening tools and describe principles to consider in assessing for illness in the primary care of older adults. PCOA-PCP 3: Cancer Screening in Older Adults After completing this course, practitioners will be able to understand lung, breast, cervical, colorectal, and prostate cancer screening recommendations for older adults. Practitioners will also be able to identify the differences between U.S. Preventive Services Task Force and American Cancer Society cancer screening recommendations for older adults. PCOA-PCP 4: Presentation of Illness in Older Adults This course describes physiological changes associated with aging and identifies common ways illness presents in older adults. It also differentiates the manifestations of common diseases in older adults versus those in younger adults. PCOA-PCP 5: Dementia in Primary Care This course discusses the importance of screening for cognitive impairments at wellness visits with appropriate screening tools as well as the guidelines on referrals outside of primary care. This module also defines cognitive impairment in older adults using the DSM-5 criteria. Guidance on how to implement non-pharmacological and pharmacological approaches in the management of older adults with mild cognitive impairment, Alzheimer’s disease and other dementias are also listed. PCOA-PCP 6: Advance Directives The course defines and describes the purpose of advance directives and the role of primary care practitioners in the discussion and implementation of advance directives. After completing this module, practitioners will understand the differences of living wills, healthcare proxy documents, durable power of attorney and physician orders for life-sustaining treatment (POLST). Guidance on conveying appropriate and timely information on advance directives to patients and their families is also provided. PCOA-PCP 7: Palliative and Hospice Care The course defines and differentiates between palliative care and hospice care. It also describes the appropriate use of opioid medications for pain control in older adults. After completing this module, practitioners will be able to assess pain in patients with dementia, manage agitation in older adults at the end of life, and describe the rationale and steps for admitting older adults with dementia into hospice.

PCOA-PCP 8: Multiple Chronic Conditions This course discusses the impact of multiple chronic conditions on older adult health. By completing this module, practitioners will learn to incorporate the patient and family as an essential part of the healthcare team, understand how prognosis influences treatment decisions, and how to minimize harm and optimize benefits to effectively plan care for patients with multiple chronic conditions. PCOA-PCP 9: Persistent Pain in Older Adults This course describes how persistent pain presents and how to assess pain in older adults, including those living with dementia and/or multiple chronic conditions with standardized pain scales. After completing this course, practitioners will be able to describe and evaluate the efficacy of traditional and non-traditional pain treatment options, understand how to manage pain at the end of life and referrals to pain clinics, and understand the cultural influence on pain perception and reporting. PCOA-PCP 10: Medication Management in Older Adults This course describes how age-related physiological changes influence drug pharmacodynamics and the epidemiology of medication use in older adults. After viewing this module, practitioners will be able to utilize the Good-Palliative Geriatric Practice Algorithm to ensure appropriateness of medication regimen for older adults and to evaluate risk factors for adverse drug events. PCOA-PCP 11: A Practical Guide to healthcare Financing This course reviews the benefit requirements, payment schedules and coverage limits of Medicare and defines Medicaid. The impact of healthcare services on personal finances for older adults are discussed. After taking this module, practitioners will increase their familiarity with different insurance entitlement and community programs available to older adults. PCOA-PCP 12: Pain, Opioids, and Older Adults Practitioners will be able to define and distinguish opioid use disorder (OUD) from physical dependence and recognize the importance of assessment and reassessment to identify strategies to manage risks for opioid misuse in older adults.

Primary Care of Older Adults for Registered Nurses (PCOA-RN)

About this Series This series was developed to increase the age-sensitive healthcare knowledge and skills of primary care nurses. These courses promote team-based, coordinated, patient-centered, evidence-based care that is responsive to the particular needs of older adults.

options for older adults. After taking this course, practitioners will increase their familiarity with other healthcare and community benefits and services that are available to older adults. PCOA-RN 6: Distinguishing Dementia, Alzheimer’s Type, from Major Depression This course reviews and compares the Diagnostic and Statistical Manual of Mental Disorders’ (DSM-IV and DSM-V) criteria for dementia, delirium and depression. After taking this course, practitioners will be able to recognize, identify, assess, and screen for dementia, delirium, and depression. Learners will also be able to understand the hallmarks of each of these conditions in older adults and detect red flags. PCOA-RN 7: Person and Family Centered Care This course explains how person and family-centered care (PFCC) differs from other models of care. After completing this course, practitioners will be able to recognize why PFCC is especially important in providing care for older adults (including those with cognitive impairments), and will understand how to engage individuals, family members, and caretakers in this model of care. PCOA-RN 8A: Health Promotion: Health Literacy This course focuses on the importance of health literacy on health promotion in primary care. After taking this course, practitioners will be able to understand the importance of health literacy on health promotion in primary care, understand how to best communicate information to older adults, and describe how to integrate components of health literacy and health promotion into practice. PCOA-RN 8B: Health Promotion: Population Health This course focuses on the importance of population health on health promotion in primary care. After taking this course, practitioners will be able to recognize the importance of health promotion, describe how to best work with adult learners, describe the impact that a population-health focus has on the care of patients, families, and caregivers, and describe how interprofessional members of the healthcare team can integrate components of health promotion in practice. PCOA-RN 9: Mistreatment Detection in Older Adults This course defines different types of elder mistreatment and identifies strategies for detection. After completing this module, practitioners will understand the important role RNs and other interprofessional team members have in recognizing and reporting elder mistreatment, and the significance of interdisciplinary interventions to address this issue in healthcare settings. PCOA-RN 10: Substance Misuse in Older Adults This course describes the characteristics of substance use disorders and substance misuse patterns in older adults. This includes illicit drug use, prescription drug misuse, alcohol-related

disorders, and tobacco use. The opioid misuse problem in adults age 55+ is discussed. The course outlines assessing older adults for substance misuse and compares these usage patterns in older adults with those of other populations. After viewing this course, practitioners will be able to describe and implement a brief motivational intervention as a component of care and assess and utilize other treatment modalities. PCOA-RN 11: Falls and Fall Prevention This course defines the causes and risk factors for falls in older adults, describes the need for comprehensive assessment for falls in this population, and identifies validated screening tools to utilize when evaluating for fall risk. After viewing this course, practitioners will understand their role in preventing falls and in intervening when a patient has a fall, and will understand strategies to prevent falls and serious injury in ambulatory and home care settings. PCOA-RN 12: Medication Management This course describes pharmacokinetic principles related to age changes in absorption, metabolism, and excretion, outlines risk factors for adverse drug interactions in older adults, and explains key factors that impact medication adherence. After viewing this course, practitioners will be able to use strategies that promote medication management and reconciliation, list common medication interactions and explain the importance of the 2019 AGS Beers Criteria for identifying inappropriate use of certain medications in older adults. PCOA-RN 13: Persistent Pain in Older Adults This course describes how persistent pain presents and how to assess pain in older adults, including those living with dementia and/or multiple chronic conditions. After completing this course, practitioners will be able to describe and evaluate the effectiveness of traditional and non-traditional pain treatment options, understand how to manage pain at the end of life, and discuss how prognosis influences treatment decisions. PCOA-RN 14: Skin Disorders in Older Adults This course identifies the signs, symptoms, and treatment of skin conditions common to older adults, and differentiates skin cancers common to older adults. The course also describes the stages of pressure injuries and outlines key pressure injury prevention strategies. PCOA-RN 15: Sensory Changes in Older Adults This course outlines age-related sensory changes commonly seen in the older adults and how to manage and compensate for the safety risks these changes cause. After viewing this course, learners will understand the interprofessional team’s responsibilities in managing older adults with sensory changes, including interventions that can enhance communication for those suffering from sensory loss.

Long-Term Care

Care of Older Adults in the Long-Term Care Setting (COA-LTC)

Series

About this Series

Care of Older Adults in the Long-Term Care Setting (COA-LTC) is a series created by the

Hartford Institute of Geriatric Nursing (HIGN) at NYU Rory Meyers College of Nursing,

in partnership with ArchCare, the Continuing Care Community of the Archdiocese of

New York. The program was created to assure that all healthcare team members have

the knowledge to care for older adults in long-term care settings. The program promotes

team-based, coordinated, person-centered, evidence-based care for older adults.

CEs Awarded: 1.0 - 1.5 nursing contact hour(s)/couse

Courses (All Professionals)

COA-LTC: Person and Family Centered Care : This module will guide providers on how to provide care that is respectful of and responsive to individuals, as well as how to put patients/residents and their families at the center of decision-making. COA-LTC: Serving a Diverse Population in Long-Term Care: This module will outline best practices to use when caring for LGBTQ older adults. This is done by explaining terminology, describing conceptual frameworks, and outlining health disparities faced by this community. Additionally, best-practices in caring for LGBTQ older adults are outlined.

Courses (Discharge Planner)

COA-LTC: Transitional Care for Older Adults: This module will define transitional care, identify gaps in transitional care and risk factors for readmission, and outline the roles of the Interprofessional Team in transitional care. Learners will be able to describe the 4Ms of an age-friendly health system, identify the eight care services associated with improved patient outcomes, and apply techniques that improve patient education.

Courses (HHA/CNA)

COA-LTC: Care Coordination for Older Adults: This module will guide HHAs, PCAs and CNAs on how to describe the importance of knowing and reporting a patient’s baseline condition, recognize the signs and symptoms including subtle changes that indicate a change in patient condition, demonstrate the application of the early warning tool “Stop and Watch” to identify patient status changes, describe when to report and when to ask for help when

observing an acute change in condition, and define who should be notified when observing an acute change in condition. COA-LTC: Falls and Fall Prevention: This module discusses the significance of falls among long-term care residents, describes risk factors that make a person more likely to experience falls, and describes the interventions that HHA/CNA can do to reduce the risk of falls. Additionally, this module helps the learner understand the interventions that the HHA/CNA should do in the event of a fall and describes the role of the HHA/CNA as a member of the care team in fall prevention. COA-LTC: Health Literacy: Understanding the importance of patient health literacy is an important piece of health promotion. This module will guide HHAs, PCAs and CNAs on how to integrate components of health literacy and health promotion in their care of older adults. COA-LTC: Preventing, Recognizing and Treating Sepsis in Long-Term Care: This module will focus on the differences between bacteremia, sepsis and septic shock, the signs and symptoms of sepsis in the older adult, and the presentation of sepsis in older adults. Learners will discuss ways to prevent sepsis both in long-term care (LTC) and home care, define post-sepsis syndrome, and identify and report signs, symptoms and presentation of sepsis to the charge nurse in LTC and/or the home health nurse. COA-LTC: Transitional Care for Older Adults: This module will help professionals understand the importance of transitional care, understand the role of the HHA-CNA on the IP team in caring for patients/residents, use communication tools that will help report a change of status, and recognize and communicate when an action may affect the safety of a patient/resident. COA-LTC: Urinary Tract Infections : This module discusses the risk factors for UTIs in older adults in long-term care (LTC) and in home care, such as indwelling urinary catheters. It also defines a UTI, how to prevent UTI's in older adults in long-term care and home care, and signs and symptoms of UTI's in people with and without dementia.

Courses (PCP)

COA-LTC: Medication Management for Older Adults: This module will focus on physiologic changes in aging which influence drug pharmacodynamics and the epidemiology of medication use in the elderly. Additionally, learners will be able to identify risk factors for adverse drug events and explain the framework for appropriate prescribing in older adults. COA-LTC: Preventing, Recognizing and Treating Sepsis in Long-Term Care: This module outlines how primary care providers (PCPs) can recognize, diagnose and treat sepsis in older adults. Key definitions, symptoms, and indications for diagnosis and treatment are reviewed. Risk factors for this vulnerable population and prevention methods are highlighted.