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The Roger C. Lipitz Center for Integrated Health Care

Keyword: older adults

SHARING Choices: A Pilot Study to Engage Family in Advance Care Planning of Older Adults With and Without Cognitive Impairment in the Primary Care Context

A study led by center director Jennifer Wolff and co-authors Danny Scerpella, Kimberly Cockey, Naaz Hussain, Tara Funkhouser, Diane Echavarria, Jennifer Aufill, Amy Guo, Danetta Sloan, Sydney Dy, Kelly Smith, and SHARING Choices Investigators in the American Journal of Hospice and Palliative Care found that SHARING Choices, an advance care planning intervention, was acceptable among older adults with and without cognitive impairment and may increase advance directive completion. The study engaged family in advance care planning of older adults with and without cognitive impairment in the primary care context. Patients remarked that SHARING Choices clarified communication and preferences while family reported a better understanding of their role in advance care planning and communication. SHARING Choices is now being tested in a pragmatic trial at 55 primary care clinics in the Baltimore-Washington area. Read more.

Evaluation of Hospice Enrollment and Family and Unpaid Caregivers’ Experiences With Health Care Workers in the Care of Older Adults During the Last Month of Life

A study by Jennifer Wolff, Vicki Freedman, Katherine Ornstein, John Mulcahy, and Judith Kasper in JAMA Network Open uses NHATS and NSOC data to evaluate family and unpaid caregivers’ experiences with health care workers while caring for an older adult near the end of life. Findings suggest end-of-life caregivers commonly assisted with symptom management, participated in medical decision-making, and generally reported favorable experiences communicating with health care workers. However, 1 in 3 were never asked by health care workers if they needed help managing care and just half of caregivers assisting with symptom management received training. 

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Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults

A study by Sarah Szanton, Lindy Clemson, Minhui Liu, Laura Gitlin, Melissa Hladek, Sarah LaFave, David Roth, Katherine Marx, Cynthia Felix, Safiyyah Okoye, Xuan Zhang, Svetlana Bautista, and Marianne Granbom in the Journal of Applied Gerontology discusses the impacts of the LIVE-LiFE intervention, a multifaceted approach including medication review, vision checkups, and occupational therapist-led-exercises for older adults at risk for falls. Study results indicated a reduction in all fall-related predictor categories and higher reported feelings of safety at home. ...Read More

Family Caregivers’ Experiences With Health Care Workers in the Care of Older Adults With Activity Limitations

A study by Jennifer Wolff, Vicki Freedman, John Mulcahy, and Judith Kasper in JAMA Open Network finds nearly one-half of caregivers were never asked by older adults' clinicians about whether they needed help in managing care. Caregivers of adults with dementia were more likely to report being asked about needing help, but no more likely to be asked about whether they understood treatments or felt listened to by healthcare professionals. Further investigation into how to create and sustain supportive relationships between caregivers and older adults' health care workers may facilitate higher-quality care. ...Read More

Change Over Time in Caregiving Networks for Older Adults With and Without Dementia

Article by Brenda Spillman, Vicki Freedman, Judith Kasper and Jennifer Wolff provides national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time....Read More

Why State Medicaid Programs Should Cover Hearing Aids for Adults

Hearing loss affects approximately 1 in 5 Americans aged 12 years or older. Prevalence is highest among older adults; two-thirds of Americans aged 70 years and older have hearing loss. Hearing loss is associated with numerous negative health and quality-of-life outcomes, including cognitive decline, dementia, falls, depression, social isolation, hospitalizations, readmissions, and higher health care costs. Studies have shown the impact of hearing loss on patient-clinician communication, indicating it likely impedes effective care provision. Although there are many reasons for Medicaid programs to cover hearing aids and related services, the up-front cost of including this benefit can create barriers....Read More

Older Adult Factors Associated With Identified Need for Family Caregiver Assistance During Home Health Care

A study led by doctoral student Julia Burgdorf with Alicia Arbaje and Jennifer Wolff in Home Health Care Management & Practice analyzes the role of family caregivers during Medicare home health visits. The Centers for Medicare and Medicaid Services (CMS) recently enacted a policy that requires home health providers to assess family caregivers’ abilities and offer training and education. The study finds nearly 9 in 10 Medicare beneficiaries receiving home health care require family caregiver assistance in addition to care from home health care: the majority require assistance with 5 or more health care activities. Study findings support calls to develop training interventions and strengthen the partnership between home health providers and family caregivers. ...Read More

The Common Attributes of Successful Care Manager Programs for High-Need, High-Cost Persons: A Cross-Case Analysis.

Thurber EGBoyd CLeff BWolff JAnderson G


Many programs use care managers to improve care coordination for high-need, high-cost patient populations. However, little is known about how programs integrate care managers into care delivery or the attributes shared by successful programs. We used a case study approach to examine the common attributes of 10 programs for high-need, high-cost individuals utilizing a longitudinal care manager that had achieved success in reducing cost, improving quality, or increasing patient satisfaction. Through interviews with program leaders and document review, we identified 10 common attributes of successful care manager programs, offering insights for providers aiming to better serve the high-need, high-cost population.

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Reduced Lower Extremity Functioning Is Associated With an Increased Rate of Being a Nondriver: The National Health and Aging Trends Study

In the United States and other industrialized countries, driving is an important component of independent mobility for adults. Driving connects adults with many fundamental aspects of daily life such as employment, social engagements, and personal care. As the number of older adult drivers increases, health professionals play an important role in keeping older drivers safely on the road, for example, by providing rehabilitative and prevention services for correctable problems such as musculoskeletal strength. If the physical therapy profession is going to “transform society by optimizing movement to improve the human experience,”, it is arguable that maintaining independent and safe driving mobility is a goal for physical therapy. ...Read More