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Dementia, Falls Screening in Older Adults Increased in Primary Care with Clinician Education, EHR Enhancement


Screening of older adults for falls and cognitive impairment should be routine in primary care; a recent study highlights an intervention that could help.

Improved screening and quality of care for older adults requires a team-based approach and system-level supports. (©Toa55/Shutterstock.com)
Improved screening and quality of care for older adults requires a team-based approach and system-level supports. (©Toa55/Shutterstock.com)

Screening rates for falls and dementia among persons aged ≥65 years seen in primary care increased significantly after an intervention that combined provider and staff education and health system prompts, according to investigators from the Indiana Geriatrics Education and Training Center (Indiana GETC).

“There is a shortage of geriatrics specialists, so most older adults receive care from a primary care provider. That’s why it is so important to integrate geriatrics into primary care,” said lead study author Debra Litzelman, MD, MA, research scientist at Regenstrief Institute and the principal investigator and director of Indiana GETC, in an Institute press statement.

Moreover, the authors wrote in Gerentology and Geriatrics Education, clinical practice guidelines from the American Geriatrics Society recommend that all older adults be asked about walking and balance difficulties, as well as if they had fallen in the past year and how often. However, many primary care practices do not have routine process in place for falls screening nor do primary care practice guidelines include recommendations for routine dementia screening in older adults, they add.

“We created an intervention that improves attitudes toward older adults and leverages teamwork to integrate these important screenings into care delivery,” said Litzelman.

The specific aim of this study was to improve screening for falls and dementia by: providing professional development to the current interprofessional workforce; improving attitudes toward older adults and toward team work when caring for older patients; and making system improvements by integrating geriatric screening into current process flows.

The interdisciplinary education course developed by researchers at Indiana GETC focused on the range of specific health concerns of older adults and recommended screenings for this population. also something here about attitudes... The program was delivered to primary care providers and their staff including nurse practitioners, nurses, medical assistants, and social workers. The team also created an electronic health record (EHR) flow sheet with screening questions that would be automatically triggered for office visits of patients aged ≥65 years. The screening consisted of 2 questions that were posed by medical assistants as they escorted patients to an exam room:

1) During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse? Yes or no; and
2) Have you noticed any change in your memory or ability to complete routine tasks, such as paying bills or preparing a meal? Yes or no.

Responses were communicated to the primary care clinician.

Litzelman and colleagues introduced the intervention at 8 Federally Qualified Health Centers (FQH) in an Indianapolis, IN, health system. A total of 262 health care providers saw 6670 patients aged ≥65 years who had at least one primary care visit over a 2-year period. The overall patient population was 51% Black and 33% Caucasian, predominantly women (64.74%), with a mean age of 72 years.

Data on the primary outcome of interest -- documentation of screening for falls and dementia, were obtained from the EHR for the year before and year after the interventions began.

The study team found that when all study sites were analyzed together, mean scores on surveys of attitudes toward older adults and perceptions of the importance of a team approach to improve quality of care were significantly higher after the educational intervention vs before (3.71 vs 3.97, p<.001; 4.50 vs 4.74, p<.001 respectively).

Screening rates also increased during training, and continuously increased afterward, across all study sites and for both dementia and falls surveys.

“The greater understanding of the needs of older adults provided by the education sessions likely primed the care teams to implement changes related to screenings for common geriatric syndromes," wrote Litzelman and colleagues. “The fact the screeners did not disrupt the patient flow was also a key to success. This study demonstrates that this intervention can be successfully implemented in primary care settings.”

In fact, added Litzelman, “the intervention is actively being shared with other national Geriatrics Workforce Enhancement Programs.”

Reference: Litzelman DK, Butler DE, Iloabuchi T, et al. Combined interprofessional education and system intervention to improve screening older adults for dementia and falls. Gerentol Geriatr Educ. 2021. doi: 10.1080/02701960.2021.2001336. Published online ahead of print November 10, 2021.

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