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This paper aims to discuss and urge further deliberation on possible strategies to help geriatric and special needs patients to receive dental care during the pandemic.

This paper contains literature review of published research articles related to past epidemics, COVID-19 and older persons.

Accurate prediction of adverse outcomes, detection of unidentified problems, improved estimation of residual life expectancy and appropriate use of geriatric interventions is required to understand the necessity of the treatment and effect of possible COVID-19 contraction during the treatment.

The authors reviewed the only published literature and collated the lessons learnt from past epidemics, as the natural history of the COVID-19 is not known.

Future dentists must be trained in crisis management to deal with pandemics more effectively. The dental fraternity should be equipped to provide some sort of “psychological counseling and reassurance” prior to dental care to vulnerable individuals with comorbidities and special needs.

There are very few published articles focused on unique dental care plans for geriatric and special needs patients.

Older patients are at high risk of hospital readmission, which has led to an increasing number of screening and intervention programs. Knowledge on implementing screening tools for preventing readmissions in emergency department (ED), where the primary focus is often the present-day flow of patients, is scant. The purpose of this paper is to explore whether a new screening tool for predicting readmissions and functional decline in medical patients>65 years of age could be implemented and its influence on cross-continuum collaborations between the primary and secondary sectors.

The study took place in an ED in Denmark, in collaboration with the surrounding municipalities. An evaluation workshop with nurses and leaders from the ED and the surrounding municipalities took place with the aim of investigating the organizational changes that occurred in daily practice after the implementation of the screening tool. The workshop was designed and analyzed using cultural historical activity theory (CHAT).

The results showed that it was possible to develop collaboration between the two sectors during the test period. However, the screening tool created different transformations for the municipality employees and in the ED. The contradictions indicated that the screening tool did not mediate a general and sustained transformation in the cross-continuum collaboration.

Screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context and sectors. CHAT offers a perspective to understand the collective object when working with organizational transformations and implementation.

The study have shown that screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context. This is called adaption process. This adaption requires time and resources that should be taken into consideration from the beginning of introduction of new screens.

This paper contributes with knowledge about CHAT which offers a way to understand the leading collective object when working with organizational transformations and implementation. CHAT focuses not only on the structural changes but also on the cultural aspects of organizational changes, which is important if we want to reach a sustained change and implement the new screening tool in different sectors.

Comprehensive geriatric assessment (CGA) is a widely used approach in geriatric care and involves multidisciplinary assessments focused on determining a frail elderly person’s medical, psychological and functional capability to develop an integrated plan for treatment. The purpose of this paper is to describe and scrutinize the CGA implementation process at six acute geriatric departments in three county councils and to study the outcome by the documentation in the patient medical records, and the staff perceptions using CGA.

The paper describes the implementation process stages. Outcome measures were based on patient medical records reviews at baseline and follow-ups at year 1 and year 2. Staff perceptions of using CGA were gathered by a questionnaire at the second follow-up.

The implementation had not yet reached sustainability so the implementation process must continue. Results show that documentation on the different areas increased in year 1, as well as the use of standardized assessment tools. However, results from the reviews for year 2 showed some decrease. Staff considered CGA to have high value for the geriatric patient but pointed out the need for continuing education.

Successful strategies for this implementation were strong support from the managers, small seminars, CGA rounds, good introduction routines for new staff and the use of reminders such as pocket-sized focus cards. A high staff turnover occurred during the study, which probably had a significant negative impact on the results.

Geriatric medicine is the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in older people. Rather than being defined by some arbitrary cut‐off in chronological age, it recognises that most older people, especially the ‘young‐old’, are in good health for most of the time. They are likely to benefit from standard medical management by generalists. Geriatricians focus on the more challenging patients ‐ those older people who are physically and cognitively frail, many of whom will be among the growing numbers of the ‘old‐old’. This population is characterised by non‐specific presentation of illness, functional dependency and a need for a multidisciplinary approach to care and judicious use of drug therapy. Drawing on publications from the department of geriatric medicine in Cardiff, this article illustrates important aspects of clinical care of older people and highlight the need for better recognition and prevention, better assessment and diagnosis and better therapeutic tools to manage acute and chronic illness in old age.

The acute geriatric community hospital (AGCH) in an intermediate care facility is an alternative to conventional hospitalization. A comprehensive geriatric assessment and rehabilitation are integrated into acute medical care for older patients. This study aims to evaluate patient experience and satisfaction with the AGCH.

This is a mixed method observational study including a satisfaction questionnaire and qualitative interviews with AGCH patients or informal caregivers.

A total of 152 participants filled in the questionnaire, and thirteen semi-structured interviews were conducted. Twelve categories and four overarching themes emerged in the analysis. In general, study participants experience the admission to the AGCH as positive and are satisfied with the care they received; there were also suggestions for improvement.

Limitations of this study include possible participation bias. The results show that patients value this type of care indicating that it should be implemented elsewhere. Further research will focus on health outcomes, readmission rates and cost effectiveness of the AGCH.

This is the first study to evaluate care satisfaction with the AGCH. It shows that hospitalized older adults positively value the AGCH as an alternative to hospitalization.

The purpose of this paper is to provide an overview of post-Soviet and demographic challenges faced by the government in Moldova that have posed as challenges to reform of the healthcare system. Since independence from the Soviet Union in 1991, Moldova has undergone significant challenges and reforms throughout the society. Healthcare has been no exception. Changes in family structures due to migration, a decreased birthrate, and an aging population have placed strain on the healthcare system which is working to both modernize and provide specialized care. Legislation has helped to streamline and reform the healthcare system but systemic challenges are still faced by at-risk populations including the elderly, women, and rural populations.

Information presented in this paper is based on a review of independent research, United Nations and government reports.

Findings show that progress has been made through legislative reform, new government programming, and most recently volunteer/nonprofit involvement in healthcare reform. Currently, the government is working to establish holistic patient centered care and to bridge the healthcare divide between rural and urban populations. Healthcare reforms include basic universal health care services and family support programming. Additionally, there has been a renewed emphasis on how environmental factors, like housing and nutrition, interact with health quality.

Moldova faces an increasing challenge of caring for elderly populations at the family and societal level due to the increased number of elderly, shifts in family structures, and international migration for employment. A discussion of the developing role of nonprofit and nongovernment organizations is included.

The implications of new public management (NPM) have been studied from several theoretical perspectives. The present paper sets out to argue that there is a missing dimension to the theoretical debate regarding NPM reform – that of time and space. On the basis of two different notions of time‐space logics, the present paper seeks to develop a framework that contributes to a fuller understanding of NPM reform and organizational change/inertia in general.

The theoretical framework of the paper draws on studies of time and space in organizations, research on public‐sector reform, and neo‐institutional theory. The empirical case study presented here focuses on an attempt to change geriatric care using NPM initiatives.

The paper describes two paradigms of time‐space logics – the paradigm of “speed” (as used in finance and manufacturing) and the paradigm of “closeness” (as used in health care and associated care‐giving practices). The study argues that speed is a feature of almost all NPM programs, but that NPM programs are often directed at practices institutionalized by a time‐space paradigm of closeness. The study utilizes the two time‐space paradigms to understand the effects of NPM in the case reported. The use of time‐space paradigms in studies of public‐sector reform adds to the arsenal of theoretical tools for the analysis of NPM‐reform.

Although the methodology of a case study is an appropriate vehicle for introducing the time‐space paradigm to this area of research, the methodology is not well suited to generalizing the findings to other contexts. Future research could elaborate on the present study by applying quantitative approaches to the subject‐matter.

The study presents an analysis of an NPM‐reform program in geriatric care – a context in which ideas of “speed” clash with the traditional practice of “closeness”. This potential clash has important practical implications for managers.

The paper introduces notions of time and space into research on NPM‐reform. This novel approach to the study of NPM reform might be of value in future research.

The current policy context demands that health service providers demonstrate that services are effective, efficient, value for money and of good quality. Recent Government interest in intermediate care has increased pressure on day hospitals in particular to supply such evidence, because they face competition for their core services (such as rehabilitation care) from other community‐based providers. This review was conducted as part of a small study to evaluate a day hospital service in North London. Findings suggest that the outcomes of day hospital care are especially difficult to appraise because of the highly variable nature of both individual facilities and the needs and capabilities of patients attending. Traditional quantitative methods, such as randomised controlled trials or the use of standardised tools to assess treatment outcomes, face severe methodological problems owing to this variability. Three problems in particular would appear to hamper such research: comparability difficulties, owing to great variations in facilities and patient profiles; defining outcomes, because varying need may result in very different intended treatment outcomes, and determining complete costs, because patients rarely receive day hospital treatment in isolation from other health and social care services. The review suggests therefore that future researchers take a more user‐focused and qualitative research approach to the evaluation of day hospital care, such as by evaluating joint care plans with patients and staff, by assessing costs, by following small numbers of users through treatment and by studying users' and carers' views of (and preferences for) care.

This chapter aims to provide an overview of the ethical framework and decision-making in clinical dementia research, and to analyze and discuss the ethical challenges and issues that can arise when conducting clinical dementia research.

Informed consent is the most scrutinized and controversial aspect of clinical research ethics. In clinical dementia research, assessing decision-making capacity may be challenging as the nature and progress of each disease influences decision-making capacity in diverse ways. Persons with dementia represent a vulnerable population deserving special attention when developing, implementing, and evaluating the informed consent process. In this chapter, particular attention will be given to vulnerability categories and how these influence decision-making capacity. Ethical frameworks with a pragmatic contour and implication are needed to protect vulnerable patients from potential harms and ensure their optimal participation in clinical dementia research.

In addition, this chapter analyses important ethical challenges and issues in clinical dementia research. If handled thoughtfully, they would not pose insuperable barriers to research. But if they are ignored, they could slow the research process, alienate potential study subjects and cause harm to research participants. Ethical considerations in research involving persons with dementia primarily concern the representation of the interests of the participants with dementia and protection of their vulnerabilities and rights.

A core set of ethical questions and recommendations are drawn to aid researchers, institutional review boards and potential research participants in the process of participating in clinical dementia research.

The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.

This is a descriptive paper summarizing population and program data about rural veterans.

VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.

This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.