Preparing the Next Generation of Leaders in Gerontological Nursing: Over the past decade, GAPNA’s influence has increased on endorsing standard of care practices and health care policy that improves healthcare for older adults. The work of GAPNA has been sustained, in large part, through members who have assumed leadership roles and opportunities within the organization. GAPNA’s growth and influence will continue to grow, as more clinicians are caring for the nation’s rapidly-expanding older adult population. It is critically important to identify and support members who are interested in developing, reinforcing, and broadening leadership skills to better prepare them for leadership roles within the organization. The GAPNA Leadership Institute is a 1-year-long leadership program that includes both online synchronous and face-to-face components. An experienced and nationally recognized nurse leader facilitates the curriculum. All fellows work one-on-one with mentors, all of whom have held leadership positions within GAPNA.

Preparing the Next Generation of Leaders in Gerontological Nursing: Over the past decade, GAPNA’s influence has increased on endorsing standard of care practices and health care policy that improves healthcare for older adults. The work of GAPNA has been sustained, in large part, through members who have assumed leadership roles and opportunities within the organization. GAPNA’s growth and influence will continue to grow, as more clinicians are caring for the nation’s rapidly-expanding older adult population. It is critically important to identify and support members who are interested in developing, reinforcing, and broadening leadership skills to better prepare them for leadership roles within the organization. The GAPNA Leadership Institute is a 1-year-long leadership program that includes both online synchronous and face-to-face components. An experienced and nationally recognized nurse leader facilitates the curriculum. All fellows work one-on-one with mentors, all of whom have held leadership positions within GAPNA.

Preparing the Next Generation of Leaders in Gerontological Nursing: Over the past decade, GAPNA’s influence has increased on endorsing standard of care practices and health care policy that improves healthcare for older adults. The work of GAPNA has been sustained, in large part, through members who have assumed leadership roles and opportunities within the organization. GAPNA’s growth and influence will continue to grow, as more clinicians are caring for the nation’s rapidly-expanding older adult population. It is critically important to identify and support members who are interested in developing, reinforcing, and broadening leadership skills to better prepare them for leadership roles within the organization. The GAPNA Leadership Institute is a 1-year-long leadership program that includes both online synchronous and face-to-face components. An experienced and nationally recognized nurse leader facilitates the curriculum. All fellows work one-on-one with mentors, all of whom have held leadership positions within GAPNA.

Preparing the Next Generation of Leaders in Gerontological Nursing: Over the past decade, GAPNA’s influence has increased on endorsing standard of care practices and health care policy that improves healthcare for older adults. The work of GAPNA has been sustained, in large part, through members who have assumed leadership roles and opportunities within the organization. GAPNA’s growth and influence will continue to grow, as more clinicians are caring for the nation’s rapidly-expanding older adult population. It is critically important to identify and support members who are interested in developing, reinforcing, and broadening leadership skills to better prepare them for leadership roles within the organization. The GAPNA Leadership Institute is a 1-year-long leadership program that includes both online synchronous and face-to-face components. An experienced and nationally recognized nurse leader facilitates the curriculum. All fellows work one-on-one with mentors, all of whom have held leadership positions within GAPNA.

Purpose: To evaluate the long-term effects of once-daily valbenazine in elderly patients with tardive dyskinesia (TD), a persistent and potentially disabling movement disorder associated with exposure to antipsychotics and other dopamine-receptor blocking agents (DRBAs).

Rationale: Older patients have increased risk for TD, even with lower DRBA doses and shorter treatment durations. Identifying appropriate TD treatment options for this population is essential.

Conceptual/theoretical framework: Valbenazine is the only approved TD medication with enough clinical trial data to specifically indicate no required dose adjustment in elderly patients (≥65 years). These data can therefore be used to describe treatment effects in an elderly study population.

Methods: Data were pooled from two studies (KINECT 3-extension, KINECT 4) in which participants received valbenazine (40mg or 80mg) once-daily for up to 48 weeks. Analyses by age (≥65yrs, <65yrs) at Wk48 included: mean change from baseline in abnormal involuntary movement scale total score (AIMS-CFB); ≥50% improvement from baseline AIMS (AIMS-50%); and score ≤2 (“much improved” or better) for clinical global impression of change-tardive dyskinesia (CGI-TD≤2) and patient global impression of change (PGIC≤2). Treatment-emergent adverse events (TEAEs) were also monitored.

Results: Treatment outcomes were generally comparable between age subgroups. At Wk48, outcomes for once-daily valbenazine 40mg (≥65yrs [n=8]; <65yrs [n=46]) and 80mg (≥65yrs [n=20]; <65yrs [n=105]) were as follows: mean AIMS-CFB (≥65yrs, -6.4 and -9.8 [40mg and 80mg, respectively]; <65yrs, -5.5 and -8.3); AIMS-50% (≥65yrs, 75% and 85%; <65yrs, 50% and 70%); CGI-TD≤2 (≥65yrs, 88% and 95%; <65yrs, 62% and 83%); and PGIC≤2 (≥65yrs, 75% and 90%; <65yrs, 77% and 80%). Both age subgroups had similar incidences of any TEAEs (≥65yrs, 73%; <65yrs, 72%) and any serious TEAEs (≥65yrs, 18%; <65yrs, 17%), but discontinuations due to TEAEs were more common in elderly participants (≥65yrs, 26%; <65yrs, 13%; P<0.05).
Applicability to APN practice: The analyses in this presentation indicate that long-term treatment with once-daily valbenazine is appropriate and beneficial for elderly patients (≥65 years), who had robust TD improvements that were comparable to those in the younger cohort (<65 years).

Learning outcome: Apply the treatment outcomes found in these analyses to the real-world management of TD in elderly patients.

Purpose: To evaluate the efficacy and safety of opicapone in older participants (≥65 years).

Rationale: Opicapone is an oral once-daily catechol-O-methyltransferase (COMT) inhibitor approved as an adjunctive treatment to levodopa/carbidopa in patients with Parkinson’s disease (PD) experiencing “OFF”-episodes. This post hoc analysis utilized pooled data from two pivotal phase 3 studies, BIPARK-1 (NCT01568073) and BIPARK-2 (NCT01227655).

Conceptual/theoretical framework: Opicapone has sufficient clinical data to specifically indicate no required dose adjustment in older patients (≥65 years). These data can therefore be used to describe treatment effects of opicapone in an older study population.

Methods: In BIPARK-1 and BIPARK-2, participants received 14/15 weeks of double-blind treatment with opicapone 50 mg (OPC-50) or placebo (PBO). The pooled study data were analyzed by treatment in older participants and the pooled full analysis set (FAS [included for context]). Least-squares mean changes from baseline to week 14/15 in absolute “OFF”-time and absolute “ON”-time without troublesome dyskinesia were analyzed using a mixed model for repeated measures. Treatment-emergent adverse events (TEAEs) were analyzed descriptively.

Results: The pooled FAS included 517 participants, 251 (48.5%) of whom were ≥65 years old. Significant reductions in “OFF”-time (hours) with OPC-50 versus PBO were similar between older participants (OPC-50, -2.29 [P

Purpose: To evaluate the utilization of home administration of the subcutaneous study drug (gantenerumab or placebo) in the phase III trials GRADUATE I and II (NCT03444870; NCT03443973), ongoing in early Alzheimer’s disease (AD).

Rationale: Home administration may help avoid anticipated study drug noncompliance due to COVID-19 and thus preserve study integrity.

Conceptual framework: COVID-19 has impacted clinical study conduct significantly, particularly in Alzheimer’s disease, which includes an aged population with increased comorbidities. Perceived risk of infection by traveling to a clinic, together with widespread clinical site closures and movement restrictions, reduced study drug compliance.

Methods: The GRADUATE studies are ongoing and will evaluate gantenerumab versus placebo administered subcutaneously. The protocol allows home administration for consenting participants. After the COVID-19 outbreak, home nursing scope was expanded. Uptake of home nursing administration prior to and during different phases of the pandemic was analyzed.

Results: From March 2019–February 2020, 94 participants from 11 of 31 countries utilized home nursing, contributing to an average of approximately 35 home nursing visits per month. Between March–August 2020, this increased to 234 participants actively utilizing home nursing in 15 countries and an average of approximately 300 monthly visits. The highest peak in uptake was observed between March–April 2020.

Applicability to advanced practice nursing practice: Expanding the availability of home nursing in GRADUATE in response to the COVID-19 pandemic resulted in a large and rapid increase in uptake, likely facilitated by gantenerumab’s subcutaneous route of administration. Expanding home administration helped to preserve study integrity by reducing the risk of study drug noncompliance compared to the usual reliance upon administration at sites, many of which closed or were inaccessible to study participants. Such benefits of home administration could extend beyond clinical trials to the real world, once drugs are approved, by giving patients more choice and flexibility in how to access gantenerumab.

Falls have traditionally been problematic in long-term care facilities; therefore, it is important to ensure that appropriate methods are implemented to minimize the frequency and severity of falls within these facility types. This quality improvement study aimed to determine if the addition of an educational fall prevention toolkit to new employee orientation (NEO) would support staff’s efforts in decreasing patient falls. The key objectives will be directed toward increasing staff awareness of general and individualized fall risk factors, fall prevention, and management strategies and benefits of understanding how to use assessment tools and documenting appropriately. This project study was a 4-month initiative. Seven participants were recruited from the practice site (one registered nurse and six nursing assistants) to receive the fall prevention training. The participants served as fall advisors on their units for the length of the study and were required to conduct safety huddles with peers and disseminate information that was learned from the fall prevention training. Additionally, a small cohort of four patient’s meeting fall-risk criteria were followed through analyzing the electronic health record and facility falls data to determine trends in fall occurrences. This project study falls in line with Imogene King’s theory of goal attainment and the clinical nurse specialist (CNS) national competencies that focus on empowering patients to participate in their own well-being to improve their quality of care and the nursing professional and patient collaboration in goal setting and problem solving. Data findings showed that the cohort contributed to 45% of the total falls that occurred during the project period and most falls were noted to occur among residents with a dementia or related diagnoses, such as Parkinson’s disease. The survey results revealed that all participants agreed that the toolkit should be added to the NEO process. Although no falls occurred within thirty days of the conclusion of the project, to understand the full effects of the project outcomes, a larger sample of nursing staff would need to participate in the fall prevention training.