Eastern Colorado Geriatric - Clinical
Eastern Colorado GRECC is a hub of clinical innovation committed to creating systems of support for Veterans as they age and across the continuum of care, regardless of geography. Our Eastern Colorado GRECC participates in national clinical dissemination projects, including GRECC Connect and Gerofit.
Clinical demonstration projects provide opportunities to integrate research, education and clinical services. Current clinical demonstration projects include:
The goal of GRECC Connect is to improve access to geriatric care for Veterans in rural areas. Older Veterans living in rural areas often have limited access to geriatric care and rural providers and staff often lack opportunities to learn about best practices for management of Veterans with geriatrics syndromes.
The Eastern Colorado GRECC links geriatrics specialists (geriatricians, palliative care physicians, geropsychologist, social workers, pharmacists, audiologists and trainees), located at Rocky Mountain Regional VAMC with six outlying community-based outreach clinics (CBOCs) and Veterans in their homes.
Current modalities include clinical video telehealth, electronic consultation, and educational teleconferences. Consultation is provided in tele-geriatrics, tele-palliative care, and tele-geropsychology. All visits are transdisciplinary with at least physician, social worker, and pharmacist input. Many veterans and caregivers are also seen by the geropsychologist, especially related to dementia and caregiver support needs.
Through this project, we aim to equip rural providers and staff with the knowledge and skills to care for older adults, and to support staff at rural clinics by providing geriatrics consultation.
Eastern Colorado became a GRECC Connect site at the conclusion of 2017. As part of GRECC Connect, we are partnering with Dr. Cari Levy and the VA Seattle-Denver COIN in the VHA Office of Rural Health funded clinical demonstration project – Vet Connect.
The goals of this program are to conduct tele-health geriatric, palliative care, and psychotherapy visits to Veterans in community nursing homes, beginning with Denver Metro facilities and expanding to rural state Veterans homes and community living centers.
Vet Connect addresses the challenges facing Veterans transitioning from VA hospitals to community nursing homes for sub-acute rehab after an acute illness. The program provides an easy, convenient way for Veterans, community nursing home staff, and VA staff to coordinate care to improve Veteran care, safety, and care coordination.
Virtual tours for community nursing homes: improve care coordination via video technology
The goal of virtual visits is to aid in Veterans’ transition from in-patient hospital stay to nursing facilities. Through virtual tours to nursing homes prior to discharge, Veterans and their families may ask questions, see potential future living quarters, and make educated choices regarding their future health care.
Our VA in-patient social workers identify appropriate patients and offer them the option of participating in a tour. If you or your family is interested, the project team coordinates with your potential nursing homes staff (often admissions or social services) and, at the time of the visit, utilize secure Facetime or Veteran Video Connect applications to conduct the tour of the nursing home from the patient’s bedside. This is a multi-site collaboration. It is funded as a VA Shark Tank proposal internally.
GeroFit, first developed in 1986 at the VA Medical Center in Durham, North Carolina, is a group-based, supervised exercise program for Veterans over 65. The Denver-based Gerofit program began July 1, 2018.
Veterans meet 3 times a week for 2 hours of exercise, which incorporates balance, core coordination and strength training. Local experts lead discussions on topics of interest during monthly Gerofit Learning Opportunities for Wellness (GLOW) classes. Themes include arthritis, adult vaccines and the effect of exercise on sleep. The Eastern Colorado GRECC Gerofit Program beat its enrollment goal as the program grew to 33 enrolled participants within the first few months and routinely receives 2 to 3 consults a week.
Targeted audiologic training and support
Tinnitus and hearing loss are the 2 most prevalent disabilities reported among Veterans receiving VA benefits. Hearing loss causes, contributes to, or exacerbates: communication challenges, social isolation, anger, frustration, fatigue, and cognitive decline.
The director and staff of the audiology department at the Rocky Mountain Regional VA Medical Center have carried out a clinical demonstration project that focuses on providing training in audiology best practices to other associated health trainees, geriatric medicine fellows and GRECC clinical faculty.
Our needs assessment identified that health care providers receive little to no education in audiology best practices, despite the high percentage of older Veterans with significant hearing loss. The audiology supervisor and trainees address this gap through a variety of approaches.
Geriatric Scholars Physical Function workshop and practicum experience
The purpose of the Geriatric Scholars Physical Function workshop is to provide intensive face-to-face training in functional assessment and intervention to rehabilitation professionals, namely occupational therapists and physical therapists, who wish to gain more expertise in geriatrics. The course is also appropriate for primary care clinicians who wish to extend their knowledge of functional disability and recovery in older populations.
The overall goal is to improve assessment, intervention, and prevention related to functional abilities to support older Veterans’ ability to live independently and remain in their homes. The course emphasizes more progressive intervention strategies to address the widespread tendency to provide low dose rehabilitation interventions. This course provides an overview of the research behind techniques to improve function more efficiently to ensure clinicians can carry this information over into individual treatment programs for Veterans. Course instructors help identify barriers to treatment and how to work around those obstacles. This workshop includes a 1 day quality improvement course to provide intensive training in conducting quality improvement projects at local facilities.
Dr. Jennifer Stevens-Lapsley is doing important work looking at optimizing mobility for the elderly. Visit the optimizing mobility page.
VA tele-health (CVT) (geriatrics, dementia, palliative care)
Geriatric evaluation and management (inpatient and outpatient clinic)
Patient-aligned care teams (PACT) in geriatrics and palliative care
Contract Nursing Home Program: this program pays for housing of Veterans in local nursing homes
Advance Care Planning Group Medical Visits Program using The Conversation Project tool