According to the CDC, one in three older adults fall each year, and every 13 seconds an older adult is treated in the emergency room from a fall. Nearly 50% of cases when falls were a presenting complaint were found to be associated with another diagnosis. A fall may represent geriatric physiological changes such as orthostatic hypotension related to baroreceptor response and a decrease arterial compliance. Functional decline leading to a fall could signify progressive weakness such as that associated with decompensated heart failure or a malignancy.

A significant illness in the older adult can manifest itself with a ground level fall as the initial presenting symptom. Underlying reasons for falls in the older adult may include electrolyte abnormalities (such as hyponatremia or hypercalcemia) or malignancies such as multiple myeloma, infections, or septicemia. A fall may be the consequence of a neurological event a cerebrovascular accident or normal pressure hydrocephalus or seizure disorder may result in. Volume depletion and dehydration can potentiate antihypertensive actions leading to fall or near fall. Older adults are susceptible to cardiovascular events including acute coronary syndrome, rhythm abnormalities (heart block, atrial fibrillation, sick sinus syndrome), or valvular disease (rheumatic heart disease, mitral valve regurgitation, or aortic stenosis) that may be a precursor to a fall.

The purpose of this presentation intends to provide the participant with unfolding case discussions of older adults who have experienced a fall. Exposing the processes of building the differentials related to potential underlying causes will include incorporating domains of a comprehensive geriatric assessment. Interactive imbedded questions will enhance the learning experiences including diagnostic testing, analysis of symptoms, and medication review. In order to identify potentially life-threatening illness in this population, it is necessary to apply advanced assessment skills to determine physiological findings and the age-related changes that underly them. Gerontological advanced practice nurses in acute, primary, and long-term care have an opportunity to showcase their investigative skills while educating patients and carers to report promptly any decline in function or fall to their care team.

Projected estimates for lesbian, gay, bisexual, transgender, queering (LGBTQ) populations the United States reach 4-8 million older adults by 2030 (Fredriksen-
Goldsen, Kim, Shiu, Goldsen, J. &; Emlet, 2015). Healthy People 2020 created goals “to improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender individuals,” (US Health and Human Services. Healthy People 2020). Not all political agendas point to resolutions favorable for this population. Provisions under the Affordable Care Act once considered status quo protections for the LGBTQ society are now threatened as law makers are rolling back healthcare mandates, giving members of the LGBTQ community exposure to potential exacerbations of prejudice, discrimination, and stigmatizations previously seen as historical violations of human rights. The purpose of the presentation is to identify how current healthcare policies have created legal windows of opportunity for persons to discriminate and create juxtaposition with goals and objectives of Healthy People 2020, promoting barriers in the health care continuum for LGBTQ aging adults.

The project’s purpose was to evaluate the impact of an educational series on nurses’ knowledge and competence in caring for older adults with behavioral health needs. The NIH (2022) found that between 65% and 90% of nursing home residents have a mental health disorder such as anxiety, depression, and schizophrenia. Quality of care in nursing homes became a public issue during the COVID pandemic, and Cortes (2022) identified that one of the biggest issues in nursing homes is lack of knowledge or competence to recognize or treat mental illness, likely due to lack of specialized training in behavioral health. Participants were recruited via an email sent to 1,396 nurses caring for Medicare Advantage members in nursing homes which described the initiative, including completion of three surveys and at least five educational activities. 132 nurses volunteered to participate. The surveys measured self-reported knowledge, competence, and other elements on a one-to-five scale. Following the first survey, participants were offered a choice of eleven on-demand behavioral health NCPD educational activities, with the expectation of completing at least five within a two-month period. The same survey was distributed upon completion of the education and again three months later. Most participants had a master’s/post-master’s degree (79%), doctoral degree (14%), associate degree (5%), and diploma (1%). While 100% of participants completed the first survey, 27% completed all three. The results demonstrated a 24% increase in knowledge, 11% increase in competence, 17% increase in identification of behavioral health needs, 27% increase in non-pharmacological management, and 16% increase in patient/family education between the first and third survey. There was no meaningful change between the second and third. This project demonstrates self-reported improvement in knowledge and competence for caring for older adults with mental illness. Opportunities include repeating this project with a larger sample size and measuring clinical outcomes (e.g., number of psychotropic medications, falls, and hospitalizations). Targeted education can improve the quality of care that APNs provide to older adults with mental illness.

Outcome: Learners will state at least one way education can impact knowledge and competence in nurses caring for older adults with behavioral health needs.

Homebound seniors in Galveston County are at an increased risk for morbidity and mortality associated with severe natural disasters such as hurricanes. The State of Texas Emergency Assistance Registry (STEAR) provides local emergency planners information on citizens who may require emergency assistance during a disaster, such as help with evacuation before and after a hurricane. In April 2022, Galveston County Office of Emergency Management (OEM) reported only 33 residents registered for STEAR of an estimated 6,509 homebound persons over 65 years of age in Galveston County. The goal of this quality improvement project was to increase the number of Galveston County residents registered on the STEAR program by 20% during June 2022 to November 2022. Nurse practitioners and students provided education on hurricane preparedness to 118 older adults at 4 senior community centers in May through June 2022. Geriatric house call NPs conducted routine house call visits including hurricane preparation education to 115 homebound seniors. Education included registration process, evacuation planning, medication, and emergency contact list and provided a sample hurricane supply emergency kit. NPs raised funds to supply sample hurricane emergency kits through bake sales and donations. House call patients received pre- and post-education surveys reviewing STEAR registry and hurricane preparation knowledge. At the conclusion of hurricane season in November 2022, Galveston County OEM reported 108 STEAR registrants for an increase of 227%. The project to improve hurricane preparedness among Galveston County homebound seniors surpassed initial goals for the 2022 hurricane season. Post-survey results 1 month after education reported 35% of housecall patients registered for STEAR with 8.6% more planning to apply. Through additional funding, the project has extended into the 2023 hurricane season.