Faculty Bibliography

Background: Approximately half of patients with HIV in the US are over age 50, but older adults are not commonly screened for HIV despite having known risk factors. Evidence for routine HIV screening in the geriatric population is limited, and the USPSTF only recommends HIV screening in those age 15-65. The aim of this quality improvement project was to measure the rate of HIV screening among older patients as well as assess provider knowledge for HIV testing guidelines in an urban safety net geriatrics clinic.
Method(s): Patient visits between 7/1/2019 - 9/30/2019 in the Bellevue Hospital geriatrics clinic were reviewed for HIV testing and sexual health assessment. In addition, we conducted a brief survey designed to assess how providers (n=14) handle HIV screening in geriatric patients.
Result(s): Of the 1259 patients seen in the geriatrics clinic in a 3 month period, 31 (2.5%) of which were tested for HIV during this time. Of those, 26 (84%) were tested based on a known risk factor. The mean age of the 31 tested was 81.64, and 14 (45%) of the patients were male. Only 7 (22.5%) patients had documentation of their sexual activity. In the provider survey, most providers (10/14) reported knowledge of USPSTF HIV screening guidelines and ordered HIV screening tests if there was a risk factor. Providers responded that they did not order annual HIV screening either because there was "not enough time to discuss" (3/14), or "patient refused to discuss" (3/14). Providers reported discussing patients' sexual practices less than once a year. Of those who did discuss sexual practices, 79% (12/14) assessed condom use.
Conclusion(s): This study showed low rates of HIV screening among geriatric patients, and minimal sexual health documentation. The provider survey demonstrated that clinicians do not assess their patients' sex lives, but order an HIV test if there is a risk factor for HIV. Given this data, we plan to pursue a provider education intervention to increase rates of HIV screening in our older adults

Background: Delirium affects 14-56% of hospitalized older adults, and leads to higher morbidity and increased healthcare costs. At NYULH we implemented the EmpoweRing elder Novel Interventions (ERNI) program in 2017, modeled after Hospital Elder Life Program (HELP), but we utilize trained pre-med and pre-nursing volunteers to prevent delirium. We have shown reduced length of stay and a decreased incidence of delirium with ERNI. Here we report on ERNI as a novel method to grow the geriatrics workforce.
Method(s): Patients 65 years or older admitted to ICU, ED observation, neurology, cardiology, and general medicine units determined to be at high risk for delirium were visited by trained pre-med/ nursing volunteers who engaged them in conversations, listened to music, reoriented them, worked on puzzles, and advocated for patients' needs. We assessed nursing and volunteer satisfaction, and patient/family satisfaction using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data from April 2017- July 2019.
Result(s): 26/31 (84%) nurses rated volunteers 7 or higher on a scale of 1-10, and 84% of nurses felt volunteers helped prevent delirium. The volunteers expressed satisfaction with the program, 17/18 (94%), and felt appreciated by patients and families[BC1]. 16/18 (89%) volunteers plan to pursue a career in healthcare, and 17/18 volunteers (94%) plan to work with older adults. 12/18 (67%) volunteers were the first in their families to work in healthcare. Although not directly related to ERNI, patient HCAHPS scores in the Observation Unit (measured by the hospital), improved after ERNI implementation, with nursing communication increasing from 70.5% to 77% and pain communication from 34.1% to 45.6%.
Conclusion(s): Our ERNI program demonstrated high rates of nursing and volunteer satisfaction, and patients in ED Observation had increased satisfaction. Exposing pre-med/nursing volunteers to older patients in a modified HELP program may be an important step toward increasing recruitment to the geriatrics workforce. For those already considering this career, the ERNI experience might solidify those intentions. Future plans are to expand this program by recruiting more college students as volunteers

OBJECTIVES/OBJECTIVE:Although the population of older adults is rising, the number of physicians seeking geriatrics training is decreasing. This study of fellows in geriatrics training programs across the United States explored motivating factors that led fellows to pursue geriatrics in order to inform recruitment efforts. DESIGN/METHODS:Semi-structured telephone interviews with geriatrics fellows. SETTING/METHODS:Academic medical centers. PARTICIPANTS/METHODS:Fifteen geriatrics fellows from academic medical centers across the United States. MEASUREMENTS/METHODS:This qualitative telephone study involved interviews that were transcribed and descriptively coded by two independent reviewers. A thematic analysis of the codes was summarized. RESULTS:Fellows revealed that mentorship and early exposure to geriatrics were the most influential factors affecting career choice. CONCLUSION/CONCLUSIONS:The results of this study have the potential for a large impact, helping to inform best practices in encouraging trainees to enter the field, and enhancing medical student and resident exposure to geriatrics.

Background: Although the population of older adults is rising rapidly, the number of physicians seeking specialty training in geriat-rics is decreasing. This study of fellows in geriatrics training programs across the United States explored motivating factors that led fellows to pursue geriatrics as a career in order to inform the recruiting of more trainees to the field.
Method(s): 10-15 fellows were sought for interviews, until satu-ration was reached. 30-minute semi-structured telephone interviews were conducted by the primary investigator with fifteen geriatrics fellows from academic medical centers across the United States, 14 of whom were at Claude D. Pepper Older Americans Independence Centers. This qualitative study involved interviews that were tran-scribed and descriptively coded by two independent reviewers. A thematic analysis of the codes was summarized.
Result(s): Fifteen geriatrics fellows in seven different states partic-ipated in the study, and they revealed that mentorship and early clin-ical exposure to geriatrics were some of the most influential factors affecting career choice. Having positive attitudes and close relation-ships with older adults prior to medical school are other critical factors in influencing trainees to pursue careers in geriatrics.
Conclusion(s): The results of this study have the potential for a large impact, helping to inform best practices in encouraging trainees to enter the field, and enhancing medical student and resident exposure to geriatrics and mentorship from geriatricians. As the number of older individuals rises, we need innovative ways to draw medical students and residents to geriatrics. This study demonstrates the need for geri-atricians to serve not only as mentors to trainees but also as proactive ambassadors to the field

Background: Delirium is one of the foremost geriatric emer-gencies. Its incidence increases after age 65 years and leads to higher healthcare expenses, morbidity, and mortality. NYU utilizes BERT (Behavioral Emergency Response Team) to de-escalate behav-ioral emergencies in patients with delirium but it is expensive and traumatizing to patients. We report on a modified version of the Hospital Elder Life Program, entitled the EmpoweRing elder Novel Interventions (ERNI) program, which is a novel partnership among geriatrics, psychiatry, nursing and rehabilitation to proactively iden-tify patients at high risk for delirium and utilize trained volunteers to provide non-pharmacologic interventions to prevent delirium and decrease the number of BERT calls in the hospital.
Method(s): Patients age 65 years or older admitted to the medical ICU, ED observation, or one general medicine floor who were deter-mined by the charge nurse to be at high risk for delirium, but not actively delirious, were chosen to participate in this project. Trained volunteers are utilized by nursing staff to spend time talking to these patients, offering cognitively stimulating activities such as puzzle searches, listening to music, re-orienting patients on a regular basis, and advocating for patients. Outcomes used for this study are length of stay, number of BERT calls, percent of episodes of delirium and nursing satisfaction. Data was collected 3 months before and after intervention was initiated.
Result(s): Preliminary data demonstrated a decrease in the percent of episodes of delirium and average length of stay but a slight increase in the number of BERT calls in the post-intervention period (Table 1). Nursing survey showed a 90% satisfaction rate with interventions performed by volunteers for delirium prevention.
Conclusion(s): Our data suggests that proactive non-pharmacologic interventions lead to higher nursing satisfaction and may decrease the incidence of delirium in geriatric patients in the hospital setting. Further analysis with longer intervention period and more measured outcomes would be helpful in determining the effect of non-pharmacologic interventions in delirium prevention. [Table Presented]

This article describes an innovative post-master's advanced certificate in gerontology program developed by the Hartford Institute for Geriatric Nursing at the New York University Rory Meyers College of Nursing. The program provides advanced practice registered nurses geriatric content to meet eligibility criteria for the Adult-Gerontology Primary Care NP certification exam and develops interprofessional care providers to care for complex older adults.