Among those 45 and older, nearly 9 percent of the population in New Hampshire and nearly 10 percent in Vermont have subjective cognitive decline, one of the earliest signs of Alzheimer’s disease. Healthcare systems can be difficult to navigate for those with dementia or cognitive impairment.
An Age-Friendly Health System
To ensure that our older patients get the care they need, when they need it, and where they need it, Dartmouth Health is committed to being an “Age-Friendly Health System.” This means that we aim to follow an essential set of evidence-based practices, cause no harm, and align with “What Matters” to the older adult and their caregivers, including health outcome goals and care preferences.
- The 4Ms that guide our work
- Our patient-centered programs, including the Aging Resource Center and the Geriatric Emergency Department
- Our policy efforts
- Our team
Our work is guided by the 4Ms of the John A. Hartford Foundation and Institute for Healthcare Improvement (IHI) Age-Friendly Health System:
Align care with each older adult’s specific health outcome goals and care preferences in all care settings.
Prevent, identify, treat, and manage dementia, depression, and delirium for older adults in all care settings.
When medication is needed, use Age-Friendly medications that do not interfere with What Matters, Mobility, and Mentation.
Ensure that older adults move safely every day in order to maintain function and allow them to do What Matters.
Our patient-centered programs
Our programs support what matters most to older adults across New England in their communities. We provide coordinated and exceptional patient care, professional education, evidence-based policy change, and cutting-edge geriatrics research.
The work of the Geriatric Center of Excellence extends through many parts of Dartmouth Health. In particular, we provide patient-centered care and support through the Aging Resource Center and the Geriatric Emergency Department (GED).
Aging Resource Center
Aging Resource Center results
From September to November 2022, we:
- Provided 915 arts and education classes, support groups, and exercise classes and 1062 hours of virtual programming, reaching a total of 7216 participants.
- Made 333 calls to isolated or at-risk older adults each month.
Dartmouth Health’s Aging Resource Center provides older adults, families, and community members with information, education, and support to help them live healthier and more informed lives. Located in Lebanon, New Hampshire, the Aging Resource Center offers a range of programs, events, and support resources, including:
- Arts and aging
- Dementia caregiving and education
- Healthy aging
- Mind and spirit
- Planning ahead
- Support groups
- Technology and aging
86 percent of Aging Resource Center program participants reside in New Hampshire and Vermont. 34 percent live in the Upper Valley region. Through our virtual programs, participants are able to join us from wherever they are, across the U.S. and beyond.
I remember the first time I went to the Aging Resource Center. I was feeling all alone in my new role as a caregiver. I cried with relief and gratefulness that Aging Resource Center people understand and can help.Aging Resource Center program participant
Referrals to the Aging Resource Center
Aging Resource Center referrals numbers
- From September to November 2022, 299 Advance Care Planning referrals were sent to use from across the Dartmouth Health system.
- Dementia support, education, and caregiver support make up 74% of Aging Resource Center incoming referrals.
Other reasons for referrals include:
- Advance care planning
- Bereavement support
- Caregiver support
- Chronic disease self-management
- Falls prevention
- Parkinson’s resources
From June 2021 to July 2022, our Geriatric Workforce Education Program provided 800 hours of educational content for patients, care partners, and healthcare professionals.
Tami is sunshine. I so look forward to Aging Resource Center's weekly check-ins. And if I am not there when Tami calls from Aging Resource Center, I have a light-filled voicemail and I look forward to catching up the following week.Aging Resource Center program participant
The Aging Resource Center’s tech coaching program connects older adults with local high school students, who work one-on-one with older adults to address their technology-related questions and concerns. During scheduled appointments, high schoolers help older adults understand how to manage email, send pictures, set up folders and use a variety of devices, from smartphones to tablets to laptops.
The program not only enables older adults to stay current on the latest technology, but also promotes intergenerational interaction, compassion and lifelong learning. With more than 140 appointments scheduled in 2018, the program has been a huge success. Older adults love the energy of the students, and students have the opportunity to learn from the life experiences of their elders.
Geriatric Emergency Department
Dartmouth Health established its Geriatric Emergency Department (GED) program in 2019, through a $4.5 million research collaboration with the West Health Institute.
In March 2021, the GED at Dartmouth Hitchcock Medical Center (DHMC) earned Level 1 accreditation from the American College of Emergency Physicians in partnership with the West Health Institute. This makes DHMC the only rural academic medical center in the United States to earn Level 1 accreditation, and one of only 24 hospitals nationwide to hold the distinction.
GED survey results
In a Press Ganey survey of GED patients aged 70 and older, 553 patients responded from September 2021 to December 2022. Of these:
- 84% felt that they had made the right decision in going to the DHMC GED.
- 85% said the care team talked in terms that the patient understood.
- 89% felt they were treated with respect.
Standards of a Level 1 GED include:
- Educating staff in geriatric-specific competencies
- Ensuring safe transitions of care when older adults are discharged from the Emergency Department (ED)
- Providing Age-Friendly care environments
- Standardizing the approach to identify and address common geriatric issues
One of the major goals of the GED program at DHMC is to reduce the risk of ED revisits and avoidable re-hospitalizations by focusing on the 4Ms of the Age-Friendly Health System.
Since becoming accredited, we have worked with 4 critical access hospitals and numerous organizations in communities across rural northern New England to extend and expand best-practice emergency care for older adults. Two of these other hospitals—Mount Ascutney Hospital and Health Center and Alice Peck Day Memorial Hospital—have achieved the goal of Level 2 accreditation.
I could have gone to three different Emergency Departments. I definitely felt like I made the right choice in DHMC.DHMC GED patient
Press Ganey survey
Press Ganey analyzed survey results gathered from July 2018 through October 2022 for geriatric DHMC emergency department patients aged 70 and older. For all questions, the data demonstrate significantly higher ratings from the later intervention period (September 2021 through October 2022) when compared with responses from before the GED initiative.
Questions related to doctors
Average ratings for doctor-related questions are high across 3 periods, and especially for the later intervention period.
Likelihood of recommending the GED to others
Ratings from the later intervention period are statistically higher than pre-intervention ratings.
Note: Mean comparisons reveal a statistical difference between the Pre-intervention period and the Later intervention period (p<.05).
DHMC [is] top flight! [The] overall performance by ED staff was excellent!! ...The nurse who came in at the end of my stay was outstanding! He answered all of my questions clearly and in detail. He explained why my heart medication was changed and what all possible side effects would be.DHMC GED patient
Our work includes ensuring that Dartmouth Health policies are consistent with Age-Friendly care. We also work closely with key government officials and agencies to advocate for geriatric programs and research funding, including:
- American Geriatrics Society (AGS)
- National Association for Geriatric Education (NAGE)
- National Council on Aging (NCOA)
- New Hampshire Alliance for Healthy Aging (NHAHA)
- New Hampshire Public Health Association (NHPHA)
- State of New Hampshire Commission on Aging
- Ellen Flaherty, PhD, APRN, AGSF, Vice President, Geriatric Center of Excellence
- Helen Cornman, MSW, Director of Operational Excellence
- Kristina L. Ward, Program Coordinator
Geriatric Center of Excellence team
Aging Resource Center
- Lori Fortini, MEd, Aging Resource Center Lead
- Chizuko Horiuchi, BA, Resource Specialist
- Tami Musty, Administrative Assistant
- Annette Osborn, BA, Program Coordinator
- Megan Reed, Dementia Resource Specialist
- Catherine Amarante, BSN, RN, Geriatric Nurse
- Dan Moran, APRN
- Dawna Pidgeon, PT
- Lora Gerard, MPA, Northern New England Geriatric Education Center Program Leader
- Annaliese Volckaert, BS, Project Coordinator
Policy and communication
- Bethany Bayuk, BA, Project Coordinator
- Michaela Preiss, BS, RN, Nursing Coach
- Martha Bruce, PhD, MPH, Senior Research Advisor
- Sharon Feeney, BEd, Health and Wellness Coaching Coordinator
- Renée Pepin, PhD, Research Lead
Dartmouth Health West Health Foundation Geriatric Emergency Department partnership
- Ellen Flaherty, PhD, APRN, AGSF, Co-Principal Investigator, Geriatric Emergency Department
- Scott Rodi, MD, MPH, FACEP, Co-Principal Investigator, Geriatric Emergency Department
- Moriah Tidwell, MSN, RN, Nursing Lead, Geriatric Emergency Department
- Susan Varga, MD, Medical Director, Geriatric Emergency Department
- Jennifer Raymond, Project Manager, Geriatric Emergency Department
- Kathryn Eastman, Program Coordinator