Elizabeth M. Goldberg

Background: Falls are a leading cause of emergency department (ED) visits among older adults and represent a critical opportunity to identify cognitive and functional impairments that influence treatment and recovery. While smartphone‐ and wearable‐based assessments are increasingly used to assess cognitive and physical function in older adults, their feasibility in the ED setting, particularly after a fall, remains unclear. Methods: From August 2021 to January 2024, community‐dwelling older ED patients (≥ 65 years) were screened for cognitive impairment (six‐item screener) and functional limitations (modified Barthel Index, mobility equipment). Apple ResearchKit digital assessments measured cognition (Stroop, Trail Making, reaction time) and physical function (gait/balance, timed walk). Wearable devices monitored movement. Feasibility was examined via attempt and completion rates. Reasons for non‐attempt/non‐completion and associations with patient characteristics were explored. Results: Among 196 patients (mean age 78.2 ± 7.6 years, 68% women), 77% attempted at least one digital assessment. Cognitive tests had moderate‐to‐high completion rates (68%–87%) among those who attempted, and completion was associated with lack of cognitive impairment ( p = 0.002, 0.002, 0.01, for Stroop, Trail Making, and reaction time tests, respectively). Non‐completion was due most often to lack of glasses, not feeling well, or technology issues. Physical function tests had much lower completion rates (18%–20%), and completion was associated with functional status (Barthel Index; p = 0.02, 0.01 for gait and balance and timed walk tests) and mobility equipment use ( p = 0.02, 0.03). Low completion rates were mainly due to safety concerns, pain, and injury. Conclusions: Digital assessment of cognitive function is feasible in most older adults presenting to the ED for falls, but physical function tests had low feasibility in this population. Future research will explore whether such data predict clinically relevant outcomes (e.g., time to injury recovery, ED revisits) and can inform personalized intervention (e.g., physical therapy referrals, skilled nursing facility placement). Trial Registration: Clinical Trial Number: NCT04304495

BACKGROUND Cardiac rehabilitation (CR) remains underutilized due to low referral rates, limited availability, and logistical constraints despite improving outcomes in patients following transcatheter aortic valve replacement (TAVR). “Rehabbing with Peloton”, a novel CR support model, aims to address this through use of digital exercise platforms to offer convenient, safe activity for patients post-TAVR. With unique limitations post-TAVR and the extensive content offered on Peloton, a systematic review and curation of exercise modules is needed to set the foundation for CR support models that can improve activity promotion and outcomes. OBJECTIVE To review and curate a list of exercise modules available through the Peloton application to support an activity promotion intervention appropriate for use with patients in the weeks following a TAVR procedure. METHODS Peloton modules were filtered by inclusion criteria including category (outdoor walking, strength, yoga, and low impact cardio), duration, and difficulty (beginner for all, intermediate for low-impact cardio). Additional filters included “low impact" and “warm-up” for low impact cardio, and “chair yoga" and “shavasana” for yoga. Videos were reviewed by trained personnel and excluded if they exceeded 20 minutes, required additional equipment, or included movements deemed risky by experts for patients post-TAVR (e.g., balancing, Valsalva-inducing, or producing significant afterload). 20% of videos were randomly selected for double review. RESULTS Of over 8,000 Peloton videos screened—outdoor walking (n=639), strength (n=3,000+), yoga (n=4,000+), and low-impact cardio (n=457)— review yielded 231 videos meeting the inclusion and exclusion criteria: outdoor walking (n=116), strength (n=52), yoga (n=23), and low impact cardio (n=40). CONCLUSIONS This project establishes a novel systematic, patient-centered review process to identify safe and appropriate digital exercise content for post-TAVR patients within extensive commercial fitness content. The framework models a key step for future CR support models, including “Rehabbing with Peloton”, that integrate virtual platforms to address challenges in access to CR and enhance accessibility for patients, potentially leading to improvements in clinical outcomes, patient engagement, and scalability. Through consideration of the limitations and needs in post-transcatheter aortic valve replacement patients, this project provides a novel outline of expert review and selection of widely available digital exercise content that programs like “Rehabbing with Peloton” and others can use in building modules to safely and effectively support cardiac rehabilitation. This crucial step allows this project and others to integrate virtual exercise platforms like Peloton to address significant challenges in access to cardiac rehabilitation, such as low availability and logistical constraints, and enhance accessibility for patients, which can potentially improve clinical outcomes, patient activity and engagement, and scalability. CLINICALTRIAL ClinicalTrials ID # NCT07008911

BACKGROUND Nearly 77% of older adults have multiple chronic conditions (MCC), leading to functional impairments and greater healthcare needs, which are exacerbated by depressive symptoms. Limited screening and treatment accessibility necessitates innovative interventions. OBJECTIVE This study aimed to assess the feasibility and usability of MY-Skills Mobile, an mHealth intervention combining yoga and self-management strategies, among older adults with MCC experiencing depressive symptoms and their care partners. METHODS A single-site, single-arm pilot trial was conducted. Participants included individuals over 60 with MCC and depressive symptoms, and their care partners. MY-Skills Mobile was an 8-week program involving synchronous virtual yoga sessions and asynchronous self-management tools. Feasibility was assessed using benchmarks for recruitment, retention, attendance, tool usage, and data collection. Usability was measured using the User Mobile Application Rating Scale (uMARS). RESULTS N=33 participants who were 70±5 years old enrolled in the trial, including n=24 older adults with 5±3 chronic conditions and 9 of their care partners. Benchmarks were achieved for recruitment, enrollment, retention, yoga attendance, and usability. Self-management tool usage was slightly below expectations. No adverse events were reported, though five participants were flagged for moderate suicide risk. Participants rated MY-Skills Mobile positively (mean uMARS score 3.7/5) and qualitative feedback highlighted the program's relaxation, calming, and anxiety-reducing benefits. Trends indicated potential improvements in older adult depressive symptoms and self-efficacy, and care partner social support. CONCLUSIONS MY-Skills Mobile is a feasible and user-friendly intervention for older adults with MCC and their care partners. The program's positive reception and preliminary health benefits suggest potential for enhancing well-being in this population. Future research should focus on enhancing self-management tool engagement and conducting larger trials to confirm these findings and assess long-term impacts. CLINICALTRIAL NCT04758312

Background: Falls are a leading cause of morbidity among older adults. Although emergency departments (EDs) routinely screen for fall risk, few patients are connected to prevention programs after discharge. Digital tools could automate notification and referral, yet few have been developed or tested in acute care settings with ED end‐users in mind. Objective: To assess the feasibility, acceptability, and usability of ALERT‐ED, a novel digital intervention designed to automate fall risk notification and referral. Methods: We conducted semi‐structured interviews with English‐ and Spanish‐speaking ED patients aged ≥ 65, caregivers, and nurses across multiple hospitals within a large integrated healthcare system. ALERT‐ED automatically embeds a QR code in the After Visit Summary of high fall risk ED patients, linking to a chatbot (Livi) that supports self‐screening, fall education, and referral to community programs. Thematic analysis of interview transcripts informed optimization of the intervention ahead of a planned clinical trial. Results: Interviews of 6 nurses, 12 patients, and 4 caregivers revealed seven themes: (1) feasibility depends on dissemination strategies and workflow alignment; (2) barriers include limited awareness and nursing time constraints; (3) acceptability improves trust, readability, and personalization; (4) expanding scope to enhance engagement; (5) privacy and artificial intelligence skepticism persist; (6) usability is high due to the QR interface; and (7) accessibility gaps remain for users with impairments. Conclusion: ALERT ‐ ED demonstrates strong feasibility, acceptability, and usability among older adults, caregivers, and ED nurses. By automating fall risk notification and referral, ALERT‐ED offers a pathway for integrating public health interventions into emergency care.

Background: Alcohol misuse among midlife and older adults is increasing, and age‐related physiological vulnerability heightens the risk for adverse outcomes. Emergency departments (EDs) are key health system touchpoints for identifying alcohol misuse, yet the delivery of evidence‐based interventions following screening in this population remains poorly described. Methods: We conducted a retrospective cohort study of ED encounters from January 1, 2019–December 31, 2023, across 11 hospital‐based EDs in a large integrated health system. We included patients aged ≥ 55 years old who screened positive for alcohol misuse using the Alcohol Use Disorders Identification Test–Consumption (AUDIT‐C; ≥ 4 for men, ≥ 3 for women). Primary outcomes were delivery of evidence‐based interventions, including brief intervention and referral to treatment and provision of medication for alcohol use disorder (MAUD). Secondary measures included demographics, co‐occurring substance use, clinical presentation, and health care utilization. Age‐adjusted logistic regression evaluated associations between AUDIT‐C score and outcomes. Results: Of 698,308 ED encounters among adults aged ≥ 55 years old, 39,912 (5.7%) screened positive for alcohol misuse. Men accounted for 58% of encounters, with gender differences narrowing with age. Co‐use of substances was common: 21% reported illicit drug use, 27% cannabis use, and 23% tobacco use, with higher prevalence in younger age groups. Recent opioid and benzodiazepine prescriptions were documented in 12% and 6% of encounters, respectively. Brief intervention and referral to treatment occurred in 30% of encounters overall and in 46% among those with severe misuse. Despite guideline support for pharmacotherapy, MAUD was prescribed in only 3% of encounters. Conclusions: Among midlife and older ED patients who screen positive for alcohol misuse, delivery of evidence‐based interventions, particularly pharmacotherapy, is uncommon despite substantial healthcare utilization and co‐occurring risk factors. These findings highlight a gap between identification and treatment and underscore the ED's potential role in initiating evidence‐based interventions for alcohol misuse.

Background: One in five emergency department (ED) visits is by older adults aged 65+ years. Clinical practice guidelines are needed to optimize patient care by translating the best available evidence into actionable recommendations to guide person‐centered management for this medically complex and growing patient population. Our objective was to understand contributors' experiences and share best practices to inform other guideline working groups. Methods: We conducted a qualitative study based on thematic analysis with an interpretivist paradigm in June–July 2025, using semi‐structured interviews of Geriatric Emergency Department (GED) Guidelines 2.0 contributors to understand their experiences. Interviews were transcribed, independently reviewed by team members, and reflexively coded to identify themes. Results: We interviewed 18 participants. Four main themes emerged: (1) motivations for participation, (2) varying opportunities to be involved, (3) personal benefits, and (4) challenges for improvement. Participants contrasted the strengths of shared learning and development with the burdens of organization and coordination. Conclusion: Contributors to the GED Guidelines 2.0 reported a positive experience. They joined because they wanted to contribute to better care of older patients and to achieve personal and professional goals. Many cited that their roles aligned with their strengths and expertise. They also gained skills and knowledge on systematic reviews and benefited from networking. Future groups planning a similar process should consider having multiple levels of leadership, experts in systematic reviews, regular reminders, and creative incentives to improve the process and foster improved networking opportunities within their disciplines.