Every month, the leadership team at the Gerontological Advanced Practice Nurses Association (GAPNA) highlights the most important published literature that impacts geriatric practice. This month, Deborah Dunn, EdD, GNP-BC, ACNS-BC, GS-C, GAPNA’s Immediate Past President, discusses how patient portals, new emergency medicine protocols, and the COVID-19 pandemic will influence how clinicians care for older adults.

Older Adults’ Use of Patient Portals: Experiences, Challenges, and Suggestions Shared Through Discussion Board Forms

Geriatr Nurs. 2020;41(4):387-393

In an analysis of 205 discussion posts from patients aged 50 and older, researchers evaluated how participants use patient portals (PPs) to manage information about their health and communicate with providers. The study authors divided their findings into thematic categories and formulated suggestions for PP vendors and providers in an effort to make the platform more user-friendly for older patients.

Commentary by Dr Dunn:


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Communication and information exchange is an essential component to effectively managing one’s own health. PPs have become essential web-based technologies for the exchange of healthcare information and are a powerful tool that older adults can use to manage their healthcare.

This research explored the experiences and satisfaction of older adults with the use of a portal for health information, communication, and care management.  Older adults reported the extent to which they found their PP helpful and easy to use as well as their concerns with PP use.

Several lessons we can learn from this research indicate that older adult’s experiences with PPs can be enhanced if:

  • Technology developers and healthcare systems place seniors at the center of patient portal design
  • Patient portal learning tutorials are included
  • Healthcare providers enter health information into the portal promptly following visits
  • Older adults have the ability to easily grant health care proxy access to their PP when desired.

Supporting and increasing older adults’ use of PPs for managing their health care is a win-win for patients, their families, and the providers who serve them.

The Emergency Care Model: A New Paradigm for Skilled Nursing Facilities

Geriatr Nurs. 2020;41(3):242-247.

To better serve nursing home residents and reduce the number of annual patient visits to emergency departments, researchers designed an intervention in which caregivers at skilled nursing facilities (SNFs) collaborate with physicians and advanced care providers to develop protocols for common emergency situations.

SNF staff performed an initial triage of patients with acute emergencies, then followed protocols in collaboration with other clinicians to provide basic management of the patient’s condition. The new model resulted in a 55% reduction in unplanned hospital visits for residents, as well as lower costs and less patient disruption.

Commentary by Dr Dunn:

Before the COVID-19 pandemic, a major concern already existed regarding best approaches to caring for residents of SNFs who experience an acute change in condition. The impact of COVID-19 on the vulnerable older adults residing in SNFs has highlighted the strained and limited capacity of many SNFs to provide rapid evaluation and treatment of residents when an acute change in condition occurs.

In this pilot study conducted pre-pandemic, researchers propose a solution called the Emergency Care Model. Through this team-based model, SNF staff are provided 24-hour access to advanced practice providers and an emergency department physician trained in geriatric emergency care who evaluate and manage residents with acute changes in condition.

The study demonstrated positive resident outcomes, including decreases in unplanned hospital admissions, decreased diagnostic test costs, and potential avoidance of nosocomial complications.

Challenged by the experiences of the COVID-19 pandemic, we must find new solutions in providing effective acute change in condition care as early as possible to SNF residents. The Emergency Care Model deserves serious consideration as a potential solution to provide early intervention through expert geriatric emergency care to SNF residents experiencing acute changes in condition.  

Combatting Social Isolation Among Older Adults in a Time of Physical Distancing: The COVID 19 Social Connectivity Paradox

Front Public Health. 2020;8:403

Researchers unpack the push and pull between social distancing measures designed to protect older adults from a potentially lethal case of COVID-19, and the repercussions of disconnecting seniors from their routines and social circles. The authors introduce a concept called “The COVID-19 Social Connectivity Paradox,” which defines the benefits and harms of social distancing for older adults.

The authors propose that the aging social services network be used as a framework for increasing older adults’ community engagement to prevent loneliness in a safe, physically distant format.

Commentary by Dr Dunn:

Social isolation has been recognized as an independent risk factor for negative health outcomes. A number of factors have been correlated with social isolation, including restricted physical mobility, being homebound, experiencing poverty, and having a restricted social network. 

COVID-19 has forced an increasing number of older adults to experience social isolation and has placed them at increased risk for loneliness, depression, and negative health effects. Throughout the pandemic, healthcare professionals have been challenged to balance protecting older adults from the spread of infection while creating new strategies to mitigate the negative effects of social isolation.

The model put forth in this article provides a depiction of the impact that social distancing, shelter-in-place, and stay-at-home orders can have on the experience of social isolation and reminds us of the protective effects of social connectivity. The authors provide several resources available to healthcare professionals for social isolation screening as well as evidenced-based programs that can be delivered virtually to enhance social connectivity among older adults, their families, and social networks.

As advanced practice providers, it is imperative that we address not only the need to protect older adults from the risk of COVID-19 infection but that we do not lose sight of maintaining well-being by addressing social isolation, a serious threat to senior health.

References

  1. Nahm ES, Son H, Yoon JM. Older adults’ use of patient portals: experiences, challenges, and suggestions shared through discussion board forums. Geriatr Nurs. 2020;41(4):387-393.
  2. Brickman KR, Silvestri JA. The emergency care model: a new paradigm for skilled nursing facilities. Geriatr Nurs. 2020;41(3):242-247.
  3. Smith ML, Steinman LE, Casey EA. Combatting social isolation among older adults in a time of physical distancing: the COVID-19 social connectivity paradoxFront Public Health. 2020;8:403.