Hebrew SeniorLife created the word ReAge to reflect the breadth and depth of services we offer: providing world-class health care; building innovative senior communities; funding groundbreaking research; and teaching future generations of geriatricians.

ReAge, a combination of “redefine” and “aging,” means to question everything about the aging process. Through ReAging, we are challenging conventions in order to create and implement new standard-of-care approaches that will positively impact the lives of older adults.

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Boston Researchers Develop New Method to Measure Delirium

Delirium, characterized by confusion or a change in mental status, is a common occurrence among older adults, particularly among hospitalized seniors recovering from illness or surgical procedure.

Delirium can lead to poorer prognosis among older patients.  Studies have connected delirium in adults 65 and older with hospital mortality rates of up to 33 percent and estimated health care costs of more than $182 billion yearly.

A new system for assessing delirium in older adults—the culmination of research from Harvard Medical School, Brown, and UMASS—may lead to improved clinical care, prognosis and treatment response for future patients. 

Based on the current Confusion Assessment Method (CAM), the new CAM-S scoring emerged from a study funded by the National Institute on Aging and published in Annals of Internal Medicine. The CAM-S measurements of delirium pointed to a strong connection with clinical outcomes including:

  • Length of hospital stay
  • Nursing home placement
  • Functional/cognitive decline
  • Death
  • Hospital and post-hospital costs

“Our findings demonstrate that the CAM-S provides a new standardized severity measure with high inter-rater reliability, and a strong association with clinical outcomes related to delirium,” says Sharon K. Inouye, M.D., M.P.H., Director of the Aging Brain Center at the Institute for Aging Research (IFAR) at Hebrew SeniorLife and professor of Medicine at Harvard Medical School (HMS).

The new CAM-S system was developed and validated in two groups of patients, all aged 70 or older.  The first group of 300 patients were scheduled for major surgery as part of the Successful Aging after Elective Surgery (SAGES) study.  The second group of 919 adults were admitted to the hospital as part of the Project Recovery study. 

Researchers based the new scoring method on the original 4-item short form and 10-item long form versions of the CAM.  They then examined the impact of the CAM-S scores on hospital and post-hospital clinical outcomes.

They found that length of hospital stay for patients increased with the degree of delirium severity—from seven days for no delirium symptoms to 13 days for severe delirium based on CAM-S short-form scores. The CAM-S long form scores showed similar increases in length of stay from six days to 12 days between no and severe symptom groups.

The researchers also found that the mean hospital costs increased along with delirium severity. Measured by the CAM-S short form, costs rose from $5,100 for patients without delirium symptoms to $13,200 for those with severe symptoms. The CAM-S long form scores showed mean costs rising from $4,200 to $11,400 across delirium symptom groups ranging from no delirium to severe.

“We believe that this measure holds great promise to improve understanding of the effects of delirium on clinical care, prognosis, pathophysiology, and response to treatment.  Ultimately, we hope that this measure will help to prevent the effects of this devastating condition and improve quality of life for older adults,” says Sharon K. Inouye.

Learn more about delirium and HSL’s Aging Brain Center at the Institute for Aging Research.

Learn more about our patient services and contact Hebrew SeniorLife.

View our recent press on delirium measurements. 

New Study Clarifies Diagnosis Criteria for Sarcopenia

Older patients commonly display loss of muscle mass and strength.  While these symptoms can potentially indicate sarcopenia, diagnosing the condition is often challenging.  Now, findings from a recent study may ease the process of diagnosing sarcopenia in a clinical setting.

Scientists from Harvard Medical School–affiliated Institute for Aging Research (IFAR) at Hebrew SeniorLife collaborated in a U.S.-based study that has identified evidence-based criteria to assist in detecting sarcopenia. Results from the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium Sarcopenia Project, a study investigating the impact of sarcopenia on mobility and mortality, have been published in the April issue of The Journals of Gerontology.

The new recommendations can potentially assist with determining the degree of this condition in patients to prescribe treatments, identify patients at risk for poor outcomes and clarify sarcopenia categories for insurers Medicare and Medicaid.

“The FNIH Sarcopenia Project bridges a major gap in aging research by providing empirically-derived criteria for diagnosing sarcopenia among older adults,” said Robert McLean, D.Sc., M.P.H, an IFAR researcher and lead author of the FNIH.study. “Our goal is to advance the development of criteria that can be used in clinical practice as indicators for treating seniors with disability due to weakness.” 

The project resulted in five studies examining muscle loss and weakness in older adults, which suggested that weakness be defined as grip strength less than 26 kilograms (kg) or (57 lb) for men and 16 kg (35 lb) or less in women, and low muscle mass defined as an ALM-to-BMI ratio of less than 0.789 for men and 0.512 for women.  These criteria were linked to a higher risk of reduced mobility during three years of follow-up, regardless of low muscle mass.

Researchers for the project used a pooled sample of participants that included 26,625 community-dwelling seniors; 43 percent were male with a mean age of 75 years, and 57 percent were women with a mean age of 79.  The study used data that measured appendicular lean mass, which includes arm and leg muscles, grip strength, gait speed and body mass index.

The pooled studies used included the Age, Gene and Environment Susceptibility-Reykjavik Study; Boston Puerto Rican Health Study; Framingham Heart Study; Health, Aging, and Body Composition Study; Invecchiare in Chianti; Osteoporotic Fractures in Men Study; Rancho Bernardo Study; Study of Osteoporotic Fractures; and a series of six clinical trials from the University of Connecticut.

Click here to learn more about our patient services and contact Hebrew SeniorLife.

Bringing a Continuum of Care to the Senior Community

By Gregory P. Toot

Vice President Post-Acute Care & Professional Services

Navigating today’s health care system can be particularly challenging for older adults. Many seniors managing chronic conditions or recovering from acute illnesses struggle with finding the best options to help them remain independent in the community or transition from one health care environment to another.

At Hebrew SeniorLife, we provide a comprehensive continuum of senior care. As leaders in senior health care, we’re a trusted partner working closely with a number of Boston hospitals to provide care for their senior patients.  And our renowned Institute for Aging Research continually advances the science behind our care with studies on common age-related conditions that impact quality of life for older adults.

Our broad spectrum of care extends from community-based clinics and home health care to skilled rehabilitative and long-term care. Patients can access our range of resources at any point and move seamlessly between them as their needs and goals for health care change.

Our programs and services focus on a geriatric population, providing evidence-based care that improves the lives of seniors. HSL’s teams of geriatric specialists—physicians, geriatric nurse practitioners, rehabilitation specialists, social workers, registered nurses and certified nursing assistants—work together to meet the unique needs of individual patients, helping each access the right care at the right time, quickly and easily.

Hebrew SeniorLife is proud to offer the following programs and services, many of which are Medicare certified:

  • Long-Term Care at Hebrew Rehabilitation Center in Boston and at NewBridge on the Charles in Dedham.  At both locations, our life enhancing programs and expressive therapies help seniors live their best lives.
  • Post -Acute Care – A Medical Acute Care Unit, a Long-Term Acute Care Hospital, at Hebrew Rehabilitation Center in Boston and Rehabilitative Services Units, Skilled Nursing Facilities, at Hebrew Rehabilitation Center in Boston and in Dedham.
  • Outpatient Clinics for audiology, exercise, memory disorders, osteoporosis screening, physiatry, and physical, occupational and speech therapy.
  • Adult Day Health Programs at two Boston locations; Roslindale and Brighton. Both offer structured daytime programming for older adults who might otherwise be isolated at home.
  • Home Health Care provides nursing and rehab care in a patients’ home. 
  • HSL Medical Group offers primary and specialty medical care for seniors in the Greater Brookline community and for residents living in HSL housing communities.
  • Hospice Care.  Our expert team of compassionate clinicians and volunteers provide expertise in symptom management and support in the final phase of life.

At Hebrew SeniorLife, our goal is always the same – to help seniors gain as much independence as possible.  That independence can mean going home after recovering from an illness or surgery, or setting meaningful goals as a long-term care resident. For individuals receiving care in our outpatient department, it means regaining strength and learning new strategies for renewed vitality.

We’re always working closely with referring professionals and family members to provide the highest quality of care, regardless of the setting.  Here, the patient and his or her family members are an important part of the care team.  The peace of mind that comes from knowing a senior is receiving the very best care is a phrase that’s echoed by family members and professionals alike.

Click here to help patients access our continuum.