Search

Background: Internal medicine residency programs have increased the time devoted to ambulatory medicine and the range of nonmedical areas in which expertise is expected. Whether existing teaching locations can provide [...]

This article investigates the prevalence of abuse, neglect, and mistreatment of the elderly in Texas. A review of case reports from adult protective services indicate that neglect accounts for the majority of allegations and that the risk of elder abuse increases dramatically after the age of sixty-five.

Results demonstrate a high prevalence of depression and dementia among older people who are either abused or mistreated. Data also indicate that age, race, income, functional impairment, and stress are causative factors for the mistreatment of older people.

Background: Primary care physician treatment practices affect the rate of hypertension control to the goal of 140/90 mm Hg. Awareness of and agreement with national hypertension management guidelines, and grounding in evidence-based medicine principles, may be important determinants of practice. Methods: A 26-item mail questionnaire was sent to a national sample of 1200 primary care physicians. The questionnaire elicited (1) the blood pressure (BP) criteria physicians use to initiate and intensify hypertension treatment, (2) first-line drug treatment choices, (3) familiarity with the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC) hypertension treatment guidelines, and (4) familiarity with research methods used to develop evidence-based medicine guidelines. The analysis focused on (1) determining the percentage of physicians who reported treatment practices consistent with JNC recommendations and (2) the relation between familiarity with JNC guidelines, evidence-based medicine methods, and reported treatment practices. Results: The overall response rate was 34%, with no important differences in demographic or professional training variables between respondents and nonrespondents. For middle-aged patients with uncomplicated hypertension, 33% of physicians would not start drug therapy unless the diastolic BP was greater than 95 mm Hg, and 43% would not start unless the systolic BP was greater than 160 mm Hg. In patients without complications who were receiving drug treatment, 25% of physicians would not intensify therapy for a persistent diastolic BP of 94 mm Hg, and 33% would not intensify therapy for a systolic BP of 158 mm Hg. Physicians were generally less aggressive in older patients. Angiotensin-converting enzyme inhibitors were the most common first-line drug choice. Forty-one percent of physicians had not heard of or were not familiar with the JNC guidelines. In multiple logistic regression models, familiarity with the JNC guidelines was associated with lower treatment thresholds, and increased familiarity with research methods was associated with greater use of diuretics or [Beta]-blockers as first-line agents. Conclusions: Many physicians have higher BP thresholds for the diagnosis and treatment of hypertension than the 140/90 mm Hg criterion recommended by the JNC. Therefore, further improvements in population hypertension control will require physician behavior change. Physician practice is associated with awareness of practice guidelines and familiarity with evidence-based medicine methods, but the precise nature and extent of this relation requires further study. Arch Intern Med. 2000;160:2281-2286

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.01979.x Byline: Aanand D. Naik (*[dagger][double dagger]), Cayla R. Teal (*[dagger]), Valory N. Pavlik (s.), Carmel B. Dyer ([double dagger]), Laurence B. McCullough (*[dagger][parallel]) Keywords: self-neglect syndrome; elder abuse and neglect; capacity; decision-making Abstract: Identifying impairments in the capacity to make and execute decisions is critical to the assessment and remediation of elder self-neglect. Few capacity assessment tools are available for use outside of healthcare settings, and none have been validated in the context of elder self-neglect. Health and social services professionals are in need of validated tools to assess capacity for self-care and self-protection (SC&P) during initial evaluations of older adults with suspected self-neglect syndrome. Currently, legal and medical declarations of incapacity and guardianship rely on clinical evaluations and instruments developed to assess only decision-making capacity. This article first describes the conceptual and methodological challenges to assessing the capacity to make and execute decisions regarding safe and independent living. Second, the article describes the pragmatic obstacles to developing a screening tool for the capacity for SC&P. Finally, the article outlines the process for validation and field testing of the screening tool. Social services professionals can then use a valid and feasible screening tool during field assessments to screen for potential impairments in the capacity for SC&P in vulnerable older adults. Author Affiliation: (*)Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Departments of [dagger]Medicine and (s.)Family and Community Medicine and ([parallel])Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas ([double dagger])Geriatrics Program, Harris County Hospital District, Houston, Texas, and Department of Internal Medicine, University of Texas Health Science, Houston, Texas. Article note: Address correspondence to Aanand D. Naik, MD, Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030. E-mail: Anaik@bcm.tmc.edu