Article Type
Article
Changed
Fri, 03/17/2023 - 13:59
Author(s)
Andrea Wershof Schwartz, MD, MPH, AGSF

One morning I stepped into the elevator in the lobby of the US Department of Veterans Affairs (VA) medical center where I work, holding a cup of coffee, joining another staffer, a middle-aged man, wearing a veteran’s pin on his employee badge. An older veteran slowly approached the elevator doors, shuffling with each step, and since he was at the front of the elevator, he cheerfully bellowed “Which floor?” as he offered to push the button for us.

“What’s on 12?” he asked in a jovial voice. I smiled. “Aging research,” referring to the Geriatrics Research Education and Clinical Center where I work.1

“I definitely need that—I forgot where I’m going!” he joked, his fingers hovering over the elevator buttons.

As we reached his floor, the doors opened, he waved with a smile and unsteadily made his way out of the elevator and down the hall to his appointment. As the elevator doors closed behind him, the other staffer turned to me and said with a shrug, “That’ll be me one day,” as he got off at the next floor.

When I got off the elevator and walked toward my office, I reflected on the care that I as a geriatrician and we at the VA hope to provide to aging veterans, now and in the future: Age-Friendly care. Age-Friendly means the compassionate care that we want for those who have served our country, for our loved ones, and for ourselves as we age. Age-Friendly means person-centered, evidence-based care that as we grow older will help us to address challenges that may come with older age, such as falls, cognitive impairment, and polypharmacy. Too often the health care system remains focused on the chief concern or on a clinician’s specialty and may not focus on those important areas where we can potentially intervene to support aging veterans.

The VA has set a goal to become the largest Age-Friendly Health System (AFHS) in the country.2 Led by the Institute for Healthcare Improvement and funded by the John A. Hartford Foundation, the Age-Friendly Health Systems Initiative aims to help clinicians and care settings “follow an essential set of evidence-based practices; cause no harm; and align with what matters to the older adult and their family caregivers.”3 An AFHS cares for older adults with attention to the 4Ms—What Matters, Mobility, Mentation, and Medications.4 Specifically, in an AFHS, older adults are asked what matters to them so we can align their health care with their goals; clinicians evaluate veterans for safe mobility and fall risk reduction, cognitive impairment and mood disorders, and identify and avoid high-risk medications.5 In an AFHS, the 4Ms are practiced as a set, reliably, across settings, so that there should be no wrong door or wrong floor for an older veteran to receive Age-Friendly care within the VA health care system.6

 

 

I thought of the veteran with the sense of humor getting off the elevator and wondered whether the clinician seeing him would have training in some of the many VA resources available for delivering Age-Friendly care (Table).
Would they notice the slow gait speed, a poor prognostic marker that may indicate frailty, but often modifiable when addressed?7 Perhaps they would see the difficulty he had getting up from a chair in the waiting room, or climbing on to the examination room table. To address Mobility, the clinician might reach out to the primary care practitioner, or refer the patient to one of the many excellent VA mobility or rehabilitation medicine programs such as Live Long Walk Strong or Gerofit.8,9 In the Mentation domain, the veteran joked about forgetfulness, but given the high prevalence of cognitive impairment among older veterans, perhaps the clinician would notice missed refills or repetitive questions and perform a cognitive assessment, or consult with the geriatrics or neurology memory clinic if abnormal.10 For Medications, a clinician trained in Age-Friendly principles would recognize and avoid or deprescribe high-risk medications, such as those on the American Geriatrics Society Beers Criteria, or use a VA tool for optimizing medications such as VIONE.11-13 And for What Matters, the clinician could ask veterans what their goals are, using programs such as Whole Health, Patient Priorities Care, the VA Life Sustaining Treatment Initiative, or My Life My Story to learn about the patient as a person and align care with goals.14–17 Working with an interprofessional team, the clinician could connect veterans with the tools needed to support them as they age.

Too often our health care system and health professions education have left clinicians unprepared to care for older adults using an Age-Friendly framework; rather, we have been trained in problem-based or disease-based care that can miss the forest for the trees in an older adult living with multiple chronic conditions and/or frailty. We may focus on providing evidence-based care for individual medical conditions while neglecting the often practical interventions that can help an older person age in place by focusing on what matters, supporting safe mobility, addressing cognition and mood, and optimizing medications.18

The vision of the VA as the largest AFHS in America is urgently needed; nearly half of the veteran population is aged 65 ≥ years, compared with 16% of the general population.19 Building on the VA’s legacy of creativity and innovation in geriatrics, and the VA’s goal of being a high reliability organization, becoming an AFHS will ensure that for that older veteran stepping off that elevator there is no wrong floor, and no wrong door to receive the Age-Friendly care he deserves and that we all hope for as we age.1,5,19,20

Acknowledgments

This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Boston Healthcare System and the New England Geriatric Research Education and Clinical Center. 

References

1. Supiano MA, Alessi C, Chernoff R, Goldberg A, Morley JE, Schmader KE, Shay K; GRECC Directors Association. Department of Veterans Affairs Geriatric Research, Education and Clinical Centers: translating aging research into clinical geriatrics. J Am Geriatr Soc. 2012;60(7):1347-1356. doi:10.1111/j.1532-5415.2012.04004.x

2. US Department of Veterans Affairs. VA geriatrics and extended care: the Age-Friendly Health Systems Initiative. Updated July 29, 2022. Accessed February 8, 2023. https://www.va.gov/geriatrics/pages/VA_Age_Friendly_Health_Systems_Initiative.asp

3. What is an age-friendly health system? Accessed November 15, 2022. https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx

4. Mate KS, Berman A, Laderman M, Kabcenell A, Fulmer T. Creating age-friendly health systems - a vision for better care of older adults. Healthc (Amst). 2018;6(1):4-6. doi:10.1016/j.hjdsi.2017.05.005

5. Church K, Munro S, Shaughnessy M, Clancy C. Age-friendly health systems: improving care for older adults in the Veterans Health Administration. Health Serv Res. Published online December 7, 2022. doi:10.1111/1475-6773.14110

6. Emery-Tiburcio EE, Berg-Weger M, Husser EK, et al. The geriatrics education and care revolution: diverse implementation of age-friendly health systems. J Am Geriatr Soc. Published online October 8, 2021. doi:10.1111/jgs.17497

7. James K, Schwartz AW, Orkaby AR. Mobility assessment in older adults. N Engl J Med. 2021;385(8):e22. doi:10.1056/NEJMvcm2009406

8. Harris R, Bean J. The Llive Long Walk Strong clinical rehabilitation program. Arch Phys Med Rehabil. 2019;100(12):e205. doi:10.1016/j.arrct.2022.100205

9. Morey MC, Lee CC, Castle S, et al. Should structured exercise be promoted as a model of care? Dissemination of the Department of Veterans Affairs Gerofit program. J Am Geriatr Soc. 2018;66(5):1009-1016. doi:10.1111/jgs.15276

10. McCarten JR, Anderson P, Kuskowski MA, McPherson SE, Borson S. Screening for cognitive impairment in an elderly veteran population: acceptability and results using different versions of the Mini-Cog. J Am Geriatr Soc. 2011;59(2):309-313. doi:10.1111/j.1532-5415.2010.03249.x

11. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi:10.1111/jgs.15767

12. Linsky A, Gellad WF, Linder JA, Friedberg MW. Advancing the science of deprescribing: a novel comprehensive conceptual framework. J Am Geriatr Soc. 2019;67(10):2018-2022. doi:10.1111/jgs.16136

13. Battar S, Watson Dickerson KR, Sedgwick C, Cmelik T. Understanding principles of high reliability organizations through the eyes of VIONE: a clinical program to improve patient safety by deprescribing potentially inappropriate medications and reducing polypharmacy. Fed Pract. 2019;36(12):564-568.

14. Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019;179(12):1688. doi:10.1001/jamainternmed.2019.4235

15. Levy C, Ersek M, Scott W, et al. Life-sustaining treatment decisions initiative: early implementation results of a national Veterans Affairs program to honor veterans’ care preferences. J Gen Intern Med. 2020;35(6):1803-1812. doi:10.1007/s11606-020-05697-2

16. Nathan S, Fiore LL, Saunders S, et al. My life, my story: teaching patient centered care competencies for older adults through life story work. Gerontol Geriatr Educ. 2022;43(2):225-238. doi:10.1080/02701960.2019.1665038

17. Reddy KP, Schult TM, Whitehead AM, Bokhour BG. Veterans Health Administration’s whole health system of care: supporting the health, well-being, and resiliency of employees. Glob Adv Health Med. 2021;10:21649561211022696. doi:10.1177/21649561211022698

18. Aronson L. Necessary steps: how health care fails older patients, and how it can be done better. Health Aff (Millwood). 2015;34(3):528-532. doi:10.1377/hlthaff.2014.1238

19. Farrell TW, Volden TA, Butler JM, et al. Age-friendly care in the Veterans Health Administration: past, present, and future. J Am Geriatr Soc. 2023;71(1):18-25. doi:10.1111/jgs.18070

20. Burke RE, Brown RT, Kinosian B. Selecting implementation strategies to drive age-friendly health system adoption. J Am Geriatr Soc. 2022;70(1):313-318. doi:10.1111/jgs.17489

21. Centers for Disease Control and Prevention. STEADI- older adult fall prevention. July 26,2021. Updated July 26, 2021. Accessed February 6, 2023. https://www.cdc.gov/steadi/index.html

22. Exercise and physical activity. National Institute on Aging. Accessed February 6, 2023. https://www.nia.nih.gov/health/topics/exercise-and-physical-activity

23. Hastings SN, Sloane R, Morey MC, Pavon JM, Hoenig H. Assisted early mobility for hospitalized older veterans: preliminary data from the STRIDE program. J Am Geriatr Soc. 2014;62(11):2180-2184.

24. Ashcroft T, Middleton A, Driver JA, Ruopp M, Harris R, Bean JF. An innovative rehabilitation program for the Veterans Affairs post-acute skilled nursing setting: preliminary results. J Am Geriatr Soc. 2023;10.1111/jgs.18214. doi:10.1111/jgs.18214

25. AGS CoCare. Accessed February 6, 2023. https://www.americangeriatrics.org/programs/ags-cocarer

26. Jedele JM, Curyto K, Ludwin BM, Karel MJ. Addressing behavioral symptoms of dementia through STAR-VA implementation: do outcomes vary by behavior type? Am J Alzheimers Dis Other Demen. 2020;35:1533317520911577.

27. Phung E, Triantafylidis L, Zhang H, Yeh IM. New Media, Part 5: Online Deprescribing Tools. J Palliat Med. 2018;21(2):269-270.

28. Freytag J, Dindo L, Catic A, et al. Feasibility of clinicians aligning health care with patient priorities in geriatrics ambulatory care. J Am Geriatr Soc. 2020;68(9):2112-2116.

29. The Conversation Project. Accessed February 22, 2023. https://theconversationproject.org

30. Daubman BR, Bernacki R, Stoltenberg M, Wilson E, Jacobsen J. Best practices for teaching clinicians to use a serious illness conversation guide. Palliat Med Rep. 2020;1(1):135-142. Published 2020 Jul 28. doi:10.1089/pmr.2020.0066

31. Freytag J, Street RL Jr, Barnes DE, et al. Empowering older adults to discuss advance care planning during clinical visits: The PREPARE Randomized Trial. J Am Geriatr Soc. 2020;68(6):1210-1217. doi:10.1111/jgs.16405

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Author and Disclosure Information
Andrea Wershof Schwartz, MD, MPH, AGSFa
Correspondence: Andrea Schwartz ([email protected])
 

aNew England Geriatrics Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Massachusetts bHarvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts

cBrigham and Women's Hospital, Boston, Massachusetts

Author disclosures

The author reports serving as faculty for the Institute for Healthcare Improvement and on the US Department of Veterans Affairs Geriatrics and Extended Care Age-Friendly Steering Committee and acknowledges the support of the Harvard Medical School Dean’s Innovation Grant.

Disclaimer

The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.

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Andrea Wershof Schwartz, MD, MPH, AGSF
Author(s)
Andrea Wershof Schwartz, MD, MPH, AGSF
Author and Disclosure Information
Andrea Wershof Schwartz, MD, MPH, AGSFa
Correspondence: Andrea Schwartz ([email protected])
 

aNew England Geriatrics Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Massachusetts bHarvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts

cBrigham and Women's Hospital, Boston, Massachusetts

Author disclosures

The author reports serving as faculty for the Institute for Healthcare Improvement and on the US Department of Veterans Affairs Geriatrics and Extended Care Age-Friendly Steering Committee and acknowledges the support of the Harvard Medical School Dean’s Innovation Grant.

Disclaimer

The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.

Author and Disclosure Information
Andrea Wershof Schwartz, MD, MPH, AGSFa
Correspondence: Andrea Schwartz ([email protected])
 

aNew England Geriatrics Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Massachusetts bHarvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts

cBrigham and Women's Hospital, Boston, Massachusetts

Author disclosures

The author reports serving as faculty for the Institute for Healthcare Improvement and on the US Department of Veterans Affairs Geriatrics and Extended Care Age-Friendly Steering Committee and acknowledges the support of the Harvard Medical School Dean’s Innovation Grant.

Disclaimer

The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.

Article PDF
fdp0403098.pdf
Article PDF
fdp0403098.pdf

One morning I stepped into the elevator in the lobby of the US Department of Veterans Affairs (VA) medical center where I work, holding a cup of coffee, joining another staffer, a middle-aged man, wearing a veteran’s pin on his employee badge. An older veteran slowly approached the elevator doors, shuffling with each step, and since he was at the front of the elevator, he cheerfully bellowed “Which floor?” as he offered to push the button for us.

“What’s on 12?” he asked in a jovial voice. I smiled. “Aging research,” referring to the Geriatrics Research Education and Clinical Center where I work.1

“I definitely need that—I forgot where I’m going!” he joked, his fingers hovering over the elevator buttons.

As we reached his floor, the doors opened, he waved with a smile and unsteadily made his way out of the elevator and down the hall to his appointment. As the elevator doors closed behind him, the other staffer turned to me and said with a shrug, “That’ll be me one day,” as he got off at the next floor.

When I got off the elevator and walked toward my office, I reflected on the care that I as a geriatrician and we at the VA hope to provide to aging veterans, now and in the future: Age-Friendly care. Age-Friendly means the compassionate care that we want for those who have served our country, for our loved ones, and for ourselves as we age. Age-Friendly means person-centered, evidence-based care that as we grow older will help us to address challenges that may come with older age, such as falls, cognitive impairment, and polypharmacy. Too often the health care system remains focused on the chief concern or on a clinician’s specialty and may not focus on those important areas where we can potentially intervene to support aging veterans.

The VA has set a goal to become the largest Age-Friendly Health System (AFHS) in the country.2 Led by the Institute for Healthcare Improvement and funded by the John A. Hartford Foundation, the Age-Friendly Health Systems Initiative aims to help clinicians and care settings “follow an essential set of evidence-based practices; cause no harm; and align with what matters to the older adult and their family caregivers.”3 An AFHS cares for older adults with attention to the 4Ms—What Matters, Mobility, Mentation, and Medications.4 Specifically, in an AFHS, older adults are asked what matters to them so we can align their health care with their goals; clinicians evaluate veterans for safe mobility and fall risk reduction, cognitive impairment and mood disorders, and identify and avoid high-risk medications.5 In an AFHS, the 4Ms are practiced as a set, reliably, across settings, so that there should be no wrong door or wrong floor for an older veteran to receive Age-Friendly care within the VA health care system.6

 

 

I thought of the veteran with the sense of humor getting off the elevator and wondered whether the clinician seeing him would have training in some of the many VA resources available for delivering Age-Friendly care (Table).
Would they notice the slow gait speed, a poor prognostic marker that may indicate frailty, but often modifiable when addressed?7 Perhaps they would see the difficulty he had getting up from a chair in the waiting room, or climbing on to the examination room table. To address Mobility, the clinician might reach out to the primary care practitioner, or refer the patient to one of the many excellent VA mobility or rehabilitation medicine programs such as Live Long Walk Strong or Gerofit.8,9 In the Mentation domain, the veteran joked about forgetfulness, but given the high prevalence of cognitive impairment among older veterans, perhaps the clinician would notice missed refills or repetitive questions and perform a cognitive assessment, or consult with the geriatrics or neurology memory clinic if abnormal.10 For Medications, a clinician trained in Age-Friendly principles would recognize and avoid or deprescribe high-risk medications, such as those on the American Geriatrics Society Beers Criteria, or use a VA tool for optimizing medications such as VIONE.11-13 And for What Matters, the clinician could ask veterans what their goals are, using programs such as Whole Health, Patient Priorities Care, the VA Life Sustaining Treatment Initiative, or My Life My Story to learn about the patient as a person and align care with goals.14–17 Working with an interprofessional team, the clinician could connect veterans with the tools needed to support them as they age.

Too often our health care system and health professions education have left clinicians unprepared to care for older adults using an Age-Friendly framework; rather, we have been trained in problem-based or disease-based care that can miss the forest for the trees in an older adult living with multiple chronic conditions and/or frailty. We may focus on providing evidence-based care for individual medical conditions while neglecting the often practical interventions that can help an older person age in place by focusing on what matters, supporting safe mobility, addressing cognition and mood, and optimizing medications.18

The vision of the VA as the largest AFHS in America is urgently needed; nearly half of the veteran population is aged 65 ≥ years, compared with 16% of the general population.19 Building on the VA’s legacy of creativity and innovation in geriatrics, and the VA’s goal of being a high reliability organization, becoming an AFHS will ensure that for that older veteran stepping off that elevator there is no wrong floor, and no wrong door to receive the Age-Friendly care he deserves and that we all hope for as we age.1,5,19,20

Acknowledgments

This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Boston Healthcare System and the New England Geriatric Research Education and Clinical Center. 

One morning I stepped into the elevator in the lobby of the US Department of Veterans Affairs (VA) medical center where I work, holding a cup of coffee, joining another staffer, a middle-aged man, wearing a veteran’s pin on his employee badge. An older veteran slowly approached the elevator doors, shuffling with each step, and since he was at the front of the elevator, he cheerfully bellowed “Which floor?” as he offered to push the button for us.

“What’s on 12?” he asked in a jovial voice. I smiled. “Aging research,” referring to the Geriatrics Research Education and Clinical Center where I work.1

“I definitely need that—I forgot where I’m going!” he joked, his fingers hovering over the elevator buttons.

As we reached his floor, the doors opened, he waved with a smile and unsteadily made his way out of the elevator and down the hall to his appointment. As the elevator doors closed behind him, the other staffer turned to me and said with a shrug, “That’ll be me one day,” as he got off at the next floor.

When I got off the elevator and walked toward my office, I reflected on the care that I as a geriatrician and we at the VA hope to provide to aging veterans, now and in the future: Age-Friendly care. Age-Friendly means the compassionate care that we want for those who have served our country, for our loved ones, and for ourselves as we age. Age-Friendly means person-centered, evidence-based care that as we grow older will help us to address challenges that may come with older age, such as falls, cognitive impairment, and polypharmacy. Too often the health care system remains focused on the chief concern or on a clinician’s specialty and may not focus on those important areas where we can potentially intervene to support aging veterans.

The VA has set a goal to become the largest Age-Friendly Health System (AFHS) in the country.2 Led by the Institute for Healthcare Improvement and funded by the John A. Hartford Foundation, the Age-Friendly Health Systems Initiative aims to help clinicians and care settings “follow an essential set of evidence-based practices; cause no harm; and align with what matters to the older adult and their family caregivers.”3 An AFHS cares for older adults with attention to the 4Ms—What Matters, Mobility, Mentation, and Medications.4 Specifically, in an AFHS, older adults are asked what matters to them so we can align their health care with their goals; clinicians evaluate veterans for safe mobility and fall risk reduction, cognitive impairment and mood disorders, and identify and avoid high-risk medications.5 In an AFHS, the 4Ms are practiced as a set, reliably, across settings, so that there should be no wrong door or wrong floor for an older veteran to receive Age-Friendly care within the VA health care system.6

 

 

I thought of the veteran with the sense of humor getting off the elevator and wondered whether the clinician seeing him would have training in some of the many VA resources available for delivering Age-Friendly care (Table).
Would they notice the slow gait speed, a poor prognostic marker that may indicate frailty, but often modifiable when addressed?7 Perhaps they would see the difficulty he had getting up from a chair in the waiting room, or climbing on to the examination room table. To address Mobility, the clinician might reach out to the primary care practitioner, or refer the patient to one of the many excellent VA mobility or rehabilitation medicine programs such as Live Long Walk Strong or Gerofit.8,9 In the Mentation domain, the veteran joked about forgetfulness, but given the high prevalence of cognitive impairment among older veterans, perhaps the clinician would notice missed refills or repetitive questions and perform a cognitive assessment, or consult with the geriatrics or neurology memory clinic if abnormal.10 For Medications, a clinician trained in Age-Friendly principles would recognize and avoid or deprescribe high-risk medications, such as those on the American Geriatrics Society Beers Criteria, or use a VA tool for optimizing medications such as VIONE.11-13 And for What Matters, the clinician could ask veterans what their goals are, using programs such as Whole Health, Patient Priorities Care, the VA Life Sustaining Treatment Initiative, or My Life My Story to learn about the patient as a person and align care with goals.14–17 Working with an interprofessional team, the clinician could connect veterans with the tools needed to support them as they age.

Too often our health care system and health professions education have left clinicians unprepared to care for older adults using an Age-Friendly framework; rather, we have been trained in problem-based or disease-based care that can miss the forest for the trees in an older adult living with multiple chronic conditions and/or frailty. We may focus on providing evidence-based care for individual medical conditions while neglecting the often practical interventions that can help an older person age in place by focusing on what matters, supporting safe mobility, addressing cognition and mood, and optimizing medications.18

The vision of the VA as the largest AFHS in America is urgently needed; nearly half of the veteran population is aged 65 ≥ years, compared with 16% of the general population.19 Building on the VA’s legacy of creativity and innovation in geriatrics, and the VA’s goal of being a high reliability organization, becoming an AFHS will ensure that for that older veteran stepping off that elevator there is no wrong floor, and no wrong door to receive the Age-Friendly care he deserves and that we all hope for as we age.1,5,19,20

Acknowledgments

This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Boston Healthcare System and the New England Geriatric Research Education and Clinical Center. 

References

1. Supiano MA, Alessi C, Chernoff R, Goldberg A, Morley JE, Schmader KE, Shay K; GRECC Directors Association. Department of Veterans Affairs Geriatric Research, Education and Clinical Centers: translating aging research into clinical geriatrics. J Am Geriatr Soc. 2012;60(7):1347-1356. doi:10.1111/j.1532-5415.2012.04004.x

2. US Department of Veterans Affairs. VA geriatrics and extended care: the Age-Friendly Health Systems Initiative. Updated July 29, 2022. Accessed February 8, 2023. https://www.va.gov/geriatrics/pages/VA_Age_Friendly_Health_Systems_Initiative.asp

3. What is an age-friendly health system? Accessed November 15, 2022. https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx

4. Mate KS, Berman A, Laderman M, Kabcenell A, Fulmer T. Creating age-friendly health systems - a vision for better care of older adults. Healthc (Amst). 2018;6(1):4-6. doi:10.1016/j.hjdsi.2017.05.005

5. Church K, Munro S, Shaughnessy M, Clancy C. Age-friendly health systems: improving care for older adults in the Veterans Health Administration. Health Serv Res. Published online December 7, 2022. doi:10.1111/1475-6773.14110

6. Emery-Tiburcio EE, Berg-Weger M, Husser EK, et al. The geriatrics education and care revolution: diverse implementation of age-friendly health systems. J Am Geriatr Soc. Published online October 8, 2021. doi:10.1111/jgs.17497

7. James K, Schwartz AW, Orkaby AR. Mobility assessment in older adults. N Engl J Med. 2021;385(8):e22. doi:10.1056/NEJMvcm2009406

8. Harris R, Bean J. The Llive Long Walk Strong clinical rehabilitation program. Arch Phys Med Rehabil. 2019;100(12):e205. doi:10.1016/j.arrct.2022.100205

9. Morey MC, Lee CC, Castle S, et al. Should structured exercise be promoted as a model of care? Dissemination of the Department of Veterans Affairs Gerofit program. J Am Geriatr Soc. 2018;66(5):1009-1016. doi:10.1111/jgs.15276

10. McCarten JR, Anderson P, Kuskowski MA, McPherson SE, Borson S. Screening for cognitive impairment in an elderly veteran population: acceptability and results using different versions of the Mini-Cog. J Am Geriatr Soc. 2011;59(2):309-313. doi:10.1111/j.1532-5415.2010.03249.x

11. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi:10.1111/jgs.15767

12. Linsky A, Gellad WF, Linder JA, Friedberg MW. Advancing the science of deprescribing: a novel comprehensive conceptual framework. J Am Geriatr Soc. 2019;67(10):2018-2022. doi:10.1111/jgs.16136

13. Battar S, Watson Dickerson KR, Sedgwick C, Cmelik T. Understanding principles of high reliability organizations through the eyes of VIONE: a clinical program to improve patient safety by deprescribing potentially inappropriate medications and reducing polypharmacy. Fed Pract. 2019;36(12):564-568.

14. Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019;179(12):1688. doi:10.1001/jamainternmed.2019.4235

15. Levy C, Ersek M, Scott W, et al. Life-sustaining treatment decisions initiative: early implementation results of a national Veterans Affairs program to honor veterans’ care preferences. J Gen Intern Med. 2020;35(6):1803-1812. doi:10.1007/s11606-020-05697-2

16. Nathan S, Fiore LL, Saunders S, et al. My life, my story: teaching patient centered care competencies for older adults through life story work. Gerontol Geriatr Educ. 2022;43(2):225-238. doi:10.1080/02701960.2019.1665038

17. Reddy KP, Schult TM, Whitehead AM, Bokhour BG. Veterans Health Administration’s whole health system of care: supporting the health, well-being, and resiliency of employees. Glob Adv Health Med. 2021;10:21649561211022696. doi:10.1177/21649561211022698

18. Aronson L. Necessary steps: how health care fails older patients, and how it can be done better. Health Aff (Millwood). 2015;34(3):528-532. doi:10.1377/hlthaff.2014.1238

19. Farrell TW, Volden TA, Butler JM, et al. Age-friendly care in the Veterans Health Administration: past, present, and future. J Am Geriatr Soc. 2023;71(1):18-25. doi:10.1111/jgs.18070

20. Burke RE, Brown RT, Kinosian B. Selecting implementation strategies to drive age-friendly health system adoption. J Am Geriatr Soc. 2022;70(1):313-318. doi:10.1111/jgs.17489

21. Centers for Disease Control and Prevention. STEADI- older adult fall prevention. July 26,2021. Updated July 26, 2021. Accessed February 6, 2023. https://www.cdc.gov/steadi/index.html

22. Exercise and physical activity. National Institute on Aging. Accessed February 6, 2023. https://www.nia.nih.gov/health/topics/exercise-and-physical-activity

23. Hastings SN, Sloane R, Morey MC, Pavon JM, Hoenig H. Assisted early mobility for hospitalized older veterans: preliminary data from the STRIDE program. J Am Geriatr Soc. 2014;62(11):2180-2184.

24. Ashcroft T, Middleton A, Driver JA, Ruopp M, Harris R, Bean JF. An innovative rehabilitation program for the Veterans Affairs post-acute skilled nursing setting: preliminary results. J Am Geriatr Soc. 2023;10.1111/jgs.18214. doi:10.1111/jgs.18214

25. AGS CoCare. Accessed February 6, 2023. https://www.americangeriatrics.org/programs/ags-cocarer

26. Jedele JM, Curyto K, Ludwin BM, Karel MJ. Addressing behavioral symptoms of dementia through STAR-VA implementation: do outcomes vary by behavior type? Am J Alzheimers Dis Other Demen. 2020;35:1533317520911577.

27. Phung E, Triantafylidis L, Zhang H, Yeh IM. New Media, Part 5: Online Deprescribing Tools. J Palliat Med. 2018;21(2):269-270.

28. Freytag J, Dindo L, Catic A, et al. Feasibility of clinicians aligning health care with patient priorities in geriatrics ambulatory care. J Am Geriatr Soc. 2020;68(9):2112-2116.

29. The Conversation Project. Accessed February 22, 2023. https://theconversationproject.org

30. Daubman BR, Bernacki R, Stoltenberg M, Wilson E, Jacobsen J. Best practices for teaching clinicians to use a serious illness conversation guide. Palliat Med Rep. 2020;1(1):135-142. Published 2020 Jul 28. doi:10.1089/pmr.2020.0066

31. Freytag J, Street RL Jr, Barnes DE, et al. Empowering older adults to discuss advance care planning during clinical visits: The PREPARE Randomized Trial. J Am Geriatr Soc. 2020;68(6):1210-1217. doi:10.1111/jgs.16405

References

1. Supiano MA, Alessi C, Chernoff R, Goldberg A, Morley JE, Schmader KE, Shay K; GRECC Directors Association. Department of Veterans Affairs Geriatric Research, Education and Clinical Centers: translating aging research into clinical geriatrics. J Am Geriatr Soc. 2012;60(7):1347-1356. doi:10.1111/j.1532-5415.2012.04004.x

2. US Department of Veterans Affairs. VA geriatrics and extended care: the Age-Friendly Health Systems Initiative. Updated July 29, 2022. Accessed February 8, 2023. https://www.va.gov/geriatrics/pages/VA_Age_Friendly_Health_Systems_Initiative.asp

3. What is an age-friendly health system? Accessed November 15, 2022. https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx

4. Mate KS, Berman A, Laderman M, Kabcenell A, Fulmer T. Creating age-friendly health systems - a vision for better care of older adults. Healthc (Amst). 2018;6(1):4-6. doi:10.1016/j.hjdsi.2017.05.005

5. Church K, Munro S, Shaughnessy M, Clancy C. Age-friendly health systems: improving care for older adults in the Veterans Health Administration. Health Serv Res. Published online December 7, 2022. doi:10.1111/1475-6773.14110

6. Emery-Tiburcio EE, Berg-Weger M, Husser EK, et al. The geriatrics education and care revolution: diverse implementation of age-friendly health systems. J Am Geriatr Soc. Published online October 8, 2021. doi:10.1111/jgs.17497

7. James K, Schwartz AW, Orkaby AR. Mobility assessment in older adults. N Engl J Med. 2021;385(8):e22. doi:10.1056/NEJMvcm2009406

8. Harris R, Bean J. The Llive Long Walk Strong clinical rehabilitation program. Arch Phys Med Rehabil. 2019;100(12):e205. doi:10.1016/j.arrct.2022.100205

9. Morey MC, Lee CC, Castle S, et al. Should structured exercise be promoted as a model of care? Dissemination of the Department of Veterans Affairs Gerofit program. J Am Geriatr Soc. 2018;66(5):1009-1016. doi:10.1111/jgs.15276

10. McCarten JR, Anderson P, Kuskowski MA, McPherson SE, Borson S. Screening for cognitive impairment in an elderly veteran population: acceptability and results using different versions of the Mini-Cog. J Am Geriatr Soc. 2011;59(2):309-313. doi:10.1111/j.1532-5415.2010.03249.x

11. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi:10.1111/jgs.15767

12. Linsky A, Gellad WF, Linder JA, Friedberg MW. Advancing the science of deprescribing: a novel comprehensive conceptual framework. J Am Geriatr Soc. 2019;67(10):2018-2022. doi:10.1111/jgs.16136

13. Battar S, Watson Dickerson KR, Sedgwick C, Cmelik T. Understanding principles of high reliability organizations through the eyes of VIONE: a clinical program to improve patient safety by deprescribing potentially inappropriate medications and reducing polypharmacy. Fed Pract. 2019;36(12):564-568.

14. Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019;179(12):1688. doi:10.1001/jamainternmed.2019.4235

15. Levy C, Ersek M, Scott W, et al. Life-sustaining treatment decisions initiative: early implementation results of a national Veterans Affairs program to honor veterans’ care preferences. J Gen Intern Med. 2020;35(6):1803-1812. doi:10.1007/s11606-020-05697-2

16. Nathan S, Fiore LL, Saunders S, et al. My life, my story: teaching patient centered care competencies for older adults through life story work. Gerontol Geriatr Educ. 2022;43(2):225-238. doi:10.1080/02701960.2019.1665038

17. Reddy KP, Schult TM, Whitehead AM, Bokhour BG. Veterans Health Administration’s whole health system of care: supporting the health, well-being, and resiliency of employees. Glob Adv Health Med. 2021;10:21649561211022696. doi:10.1177/21649561211022698

18. Aronson L. Necessary steps: how health care fails older patients, and how it can be done better. Health Aff (Millwood). 2015;34(3):528-532. doi:10.1377/hlthaff.2014.1238

19. Farrell TW, Volden TA, Butler JM, et al. Age-friendly care in the Veterans Health Administration: past, present, and future. J Am Geriatr Soc. 2023;71(1):18-25. doi:10.1111/jgs.18070

20. Burke RE, Brown RT, Kinosian B. Selecting implementation strategies to drive age-friendly health system adoption. J Am Geriatr Soc. 2022;70(1):313-318. doi:10.1111/jgs.17489

21. Centers for Disease Control and Prevention. STEADI- older adult fall prevention. July 26,2021. Updated July 26, 2021. Accessed February 6, 2023. https://www.cdc.gov/steadi/index.html

22. Exercise and physical activity. National Institute on Aging. Accessed February 6, 2023. https://www.nia.nih.gov/health/topics/exercise-and-physical-activity

23. Hastings SN, Sloane R, Morey MC, Pavon JM, Hoenig H. Assisted early mobility for hospitalized older veterans: preliminary data from the STRIDE program. J Am Geriatr Soc. 2014;62(11):2180-2184.

24. Ashcroft T, Middleton A, Driver JA, Ruopp M, Harris R, Bean JF. An innovative rehabilitation program for the Veterans Affairs post-acute skilled nursing setting: preliminary results. J Am Geriatr Soc. 2023;10.1111/jgs.18214. doi:10.1111/jgs.18214

25. AGS CoCare. Accessed February 6, 2023. https://www.americangeriatrics.org/programs/ags-cocarer

26. Jedele JM, Curyto K, Ludwin BM, Karel MJ. Addressing behavioral symptoms of dementia through STAR-VA implementation: do outcomes vary by behavior type? Am J Alzheimers Dis Other Demen. 2020;35:1533317520911577.

27. Phung E, Triantafylidis L, Zhang H, Yeh IM. New Media, Part 5: Online Deprescribing Tools. J Palliat Med. 2018;21(2):269-270.

28. Freytag J, Dindo L, Catic A, et al. Feasibility of clinicians aligning health care with patient priorities in geriatrics ambulatory care. J Am Geriatr Soc. 2020;68(9):2112-2116.

29. The Conversation Project. Accessed February 22, 2023. https://theconversationproject.org

30. Daubman BR, Bernacki R, Stoltenberg M, Wilson E, Jacobsen J. Best practices for teaching clinicians to use a serious illness conversation guide. Palliat Med Rep. 2020;1(1):135-142. Published 2020 Jul 28. doi:10.1089/pmr.2020.0066

31. Freytag J, Street RL Jr, Barnes DE, et al. Empowering older adults to discuss advance care planning during clinical visits: The PREPARE Randomized Trial. J Am Geriatr Soc. 2020;68(6):1210-1217. doi:10.1111/jgs.16405

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