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The article presents abstracts on geriatric healthcare topics including outcomes for pneumonia treatment in nursing home patients with dementia, self-efficacy in health insurance decision-making and cohort differences in the health status of older veterans.

The article presents abstracts of medical research including "Chief Resident Immersion Training in Geriatrics (Crit)," "Development of a Standardized Patient Instructor to Teach Functional Assessment and Communication Skills to Medical Students and House Officers," " Achieving Class-Wide Medical Student Competency in Mobility Assessment: Results From a Curriculum Using Online and Tradition Instruction," and more.

Background: Robust quality indicators (QIs) are essential for monitoring and improving the quality of care and learning from good practice. We aimed to identify and assess QIs for the care of older people and people with dementia who are nearing the end of life and recommend QIs for use with routinely collected electronic data across care settings. Methods: A systematic review was conducted, including five databases and reference chaining. Studies describing the development of QIs for care of older people and those with dementia nearing the end of life were included. QIs were categorized as relating to processes or outcomes, and mapped against six care domains. The psychometric properties (acceptability, evidence base, definition, feasibility, reliability, and validity) of each QI were assessed; QIs were categorized as robust, moderate, or poor. Results: From 12,980 titles and abstracts screened, 37 papers and 976 QIs were included. Process and outcome QIs accounted for 780 (79.7%) and 196 (20.3%) of all QIs, respectively. Many of the QIs concerned physical aspects of care (n = 492, 50.4%), and very few concerned spiritual and cultural aspects of care (n = 19, 1.9%). Three hundred and fifteen (32.3%) QIs were robust and of those 220 were measurable using routinely collected electronic data. The final shortlist of 71 QIs came from seven studies. Conclusions: Of the numerous QIs developed for care of older adults and those with dementia nearing the end of life, most had poor or moderate psychometric properties or were not designed for use with routinely collected electronic datasets. Infrastructure for data availability, combined with use of robust QIs, is important for enhancing understanding of care provided to this population, identifying unmet needs, and improving service provision. [ABSTRACT FROM AUTHOR]

This paper is a statement of the American Geriatrics Society's (AGS) core policy priorities and the Society's positions on federal programs and policies that support older Americans as articulated to the new administration. Among the AGS priorities discussed in this paper are health reform, Medicare, and Medicaid. The AGS is committed to leveraging its expertise to inform regulatory and legislative policy proposals. [ABSTRACT FROM AUTHOR]

Objectives To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions ( MCCs). Design Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. Setting Survey conducted through the Health Care Systems Research Network ( HCSRN) and Claude D. Pepper Older Americans Independence Centers ( OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. Participants Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. Measurements A 'top box' methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. Results The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. Conclusion Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this 'high-need, high-cost' population and the healthcare delivery systems responsible for serving it. [ABSTRACT FROM AUTHOR]

Presents abstracts of several research papers on geriatrics medical care published in April 2003 issue of the 'Journal of the American Geriatrics Society.' Research paper describing end-of-life of nursing home residents with advanced dementia; Study focusing on visual impairment and psychosis; Abstract discussing diabetes, hyperglycemia and inflammation in elderly people.

OBJECTIVES: To evaluate the extent to which electronic prescribing (e-prescribing) alters communication about medication use between geriatric patients and their clinicians, as well as geriatric patients' perceptions regarding e-prescribing. DESIGN: Cross-sectional. SETTING: Thirty-five physician practices in six states using e-prescribing. PARTICIPANTS: Convenience sample of patients (n=244) aged 65 and older. MEASUREMENTS: Patient perceptions regarding discussions with their doctors regarding medication costs, adherence, and potential side effects, as well as expectations about and satisfaction with e-prescribing collected on a voluntary survey. RESULTS: Of patients at e-prescribing practices, 53% reported ever receiving e-prescriptions. Patients who reported having e-prescriptions were more likely to feel favorably toward the electronic method, whereas most of those who reported never receiving e-prescriptions preferred paper prescriptions. Patients reporting use of e-prescriptions were somewhat more likely to have adherence discussions often or most of the time than patients who had not used e-prescriptions. Regardless of e-prescribing experience, few patients reported that they would tell their physicians if they did not want a drug or did not plan to pick up the drug from the pharmacy. CONCLUSION: E-prescribing technology solutions may provide opportunities for earlier and enhanced communication between geriatric patients and their clinicians; geriatric patients may require more education to appreciate the value of e-prescribing. [ABSTRACT FROM AUTHOR]

This paper describes the activities of the Consortium of E-Learning in Geriatrics Instruction (CELGI), a group dedicated to creating, using, and evaluating e-learning to enhance geriatrics education. E-learning provides a relatively new approach to addressing geriatrics educators' concerns, such as the shortage of professionals trained to care for older people, overcrowded medical curricula, the move to transfer teaching venues to community settings, and the switch to competency-based education models. However, this innovative education technology is facing a number of challenges as its use and influence grow, including proof of effectiveness and efficiency. CELGI was created in response to these challenges, with the goal of facilitating the development and portability of e-learning materials for geriatrics educators. Members represent medical and nursing schools, the Department of Veterans Affairs healthcare system, long-term care facilities, and other institutions that rely on continuing streams of quality health education. CELGI concentrates on providing a coordinated approach to formulating and adapting specifications, standards, and guidelines; developing education and training in e-learning competencies; developing e-learning products; evaluating the effect of e-learning materials; and disseminating these materials. The vision of consortium members is that e-learning for geriatric education will become the benchmark for valid and successful e-learning throughout medical education. [ABSTRACT FROM AUTHOR]

The Korean healthcare system is faced with a crisis caused by rapidly changing social values tending toward westernization, increasing insurance benefit requests for elder health care, financial instability of the National Health Insurance (NHI) program, and a lack of social infrastructure for the elderly. The demand for health care for the elderly has increased markedly, because of a rapidly aging population, growing female participation in the labor market, elevated expectations for health care, and a change in the pattern of medical conditions in the elderly from acute illness to chronic disability. NHI lacks the finances to meet the benefit request for long-term care (LTC). Only 0.39% of the elderly can be accommodated in LTC beds. Consequently, the chronically disabled elderly overflow to acute care beds in general hospitals, which places an undue burden on the already strained NHI system in terms of longer stays and higher cost of treatment in hospitals compared with care specific to the elderly in LTC facilities. It is clear that the Korean healthcare system does not have the facilities to meet such challenges and is in a state of disorder. Korea has failed to predict and prepare for population needs before they arise, including financing and the development of appropriate care models, particularly concerning the adequate provision of LTC. This paper advocates the necessity of international discussion of the prospects for developing health care for aging populations and encourages the sharing of differing national experiences concerning care for the elderly. [ABSTRACT FROM AUTHOR]

Models of care for frail older adults have increasingly used advanced practice nurses (APNs) to achieve outcomes. Knowledge of the common APN functions and skills that contribute to the success of these models could better inform education and evidence-based practice and guide further research, but published investigations associated with models of gerontologic care neither describe fully these functions and skills nor link the activities of the APN with specific outcomes. Using examples primarily from the University of Pennsylvania School of Nursing, this paper identifies, describes, and analyzes common functions and skills of APNs in published gerontologic care models; examines the strength of the evidence for the effect of APNs on outcomes of care; and identifies areas for further study. [ABSTRACT FROM AUTHOR]

1970 was a turbulent and transitional period. It marked the end of the 1960s and the Vietnam war, the birth and death of disco, and some bold fashion statements. The decade has seen a nostalgic resurgence. Author's motivation for volunteering to review and identify articles published in the periodical 'Journal of the American Geriatrics Society' (JAGS) was in part nostalgic. Author started reviewing the table of contents for all issues published in JAGS from January 1970 through December 1979. Changes in JAGS throughout the 1970s were primarily due to its editorial leadership and the formation of the National Institute on Aging (NIA). Training in aging research also emerged in the 1970s, including fellowship training. The NIA supported and continues to support intramural and extramural funding, pre- and postdoctoral training opportunities, and midcareer training for researchers wishing to change their career path.

Background: Older adults comprise an increasing proportion of emergency general surgery (EGS) admissions and face high morbidity and mortality. We created a geriatric surgical service with geriatric and palliative expertise to mitigate risks of hospitalization most hazardous to older patients. We sought to identify geriatric surgical service interventions most relevant to EGS patients. Methods: We prospectively identified patients ≥75 years admitted to the EGS service at an urban tertiary care hospital from January 2020–March 2021 who screened positive for frailty (FRAIL score ≥3 [scale 0–5, higher being worse]) or with cognitive impairment. A pilot geriatric surgical service, led by a dually‐board certified geriatric and palliative care specialist, conducted a comprehensive geriatric assessment and modified Rockwood Frailty Index calculation for each eligible patient. Patient, hospital admission, and geriatric consultation characteristics were collected via chart review. Results: Fifty consecutive patients (median age 82 years [IQR 78–90], 56% female) received geriatric consultation (median time 3 days [IQR 1–6] from admission). The most common admission diagnosis was bowel obstruction (32%). Sixty‐four percent of patients underwent ≥1 surgical procedure. Using the Frailty Index, 64% were moderately or severely frail. Interventions most frequently performed by the geriatric team included delirium prevention and management (66%), consideration of swallowing function (52%), individualized pain management (50%), and facilitation of serious illness conversations (58%). Conclusions: Geriatric service involvement addresses a high burden of both geriatric and palliative care needs in older EGS patients. Geriatric recommendations may direct interventions for surgical education in fundamental geriatric and palliative care knowledge to maximize geriatric resources for the most high‐risk patients. [ABSTRACT FROM AUTHOR]

Background: The REStORing health of acutely unwell adulTs (RESORT) is an observational longitudinal cohort, including geriatric rehabilitation inpatients aged ≥65 years admitted to a geriatrician‐led rehabilitation service at a tertiary hospital. The aim of this study is to describe a home‐based bed‐substitution rehabilitation model for geriatric inpatients, including patient phenotype, and health outcomes at preadmission, admission, discharge, and three‐month follow‐up. Methods: A standardized Comprehensive Geriatric Assessment was performed on admission and discharge, including demographics (home situation, cognitive impairment, medical diagnoses, etc.), frailty (Clinical Frailty Scale (CFS)), mobility (patient‐reported and Functional Ambulation Classification), physical performance (Short Physical Performance Battery (SPPB), handgrip strength), and functional independence (Activities of Daily Living (ADL), Instrumental ADL (IADL)). Service provision data (health care staff visits, length of stay (LOS), and negative events (e.g., falls)) were extracted from medical records. Three‐month outcomes included mobility, ADL and IADL scores, institutionalization, and mortality. Results: Ninety‐two patients were included with a mean age of 81.1 ± 7.8 years, 56.5% female. Twenty‐nine (31.5%) patients lived alone, 39 (42.4%) had cognitive impairment and the commonest geriatric rehabilitation admission reason was falls (n = 30, 32.6%). Patients received care from nurses, physicians, and a median of four (interquartile range (IQR) 3–6) allied health disciplines for a median LOS of 13.0 days (IQR 10.0–15.0). On a population level, patient mobility and functional independence worsened from preadmission to admission. CFS, SPPB, ADL, and IADL scores improved from admission to discharge, and seven (7.6%) patients fell. At three‐month follow‐up, patient‐reported mobility was comparable to preadmission baseline, but functional independence (ADL, IADL) scores worsened for 27/69 (39.1%) and 28/63 (44.4%), respectively. Conclusions: Hospitalization‐associated decline in mobility and functional independence improved at discharge and three‐months, but was not fully reversed in the multidisciplinary home‐based geriatric rehabilitation bed‐substitution service. Future research should compare outcomes to equivalent hospital‐based geriatric rehabilitation and evaluate patient perspectives. See related Editorial by William J. Hall in this issue. [ABSTRACT FROM AUTHOR]

Much of the geriatric imperative that is facing providers in the United States is an ethnogeriatric imperative, because one-third of older Americans are projected to be from one of the minority populations by mid-century, and that vastly underrepresents the actual diversity providers will see. Because of the vast heterogeneity of culture, language, health beliefs, risk for disease, and other factors, it is important for policy makers and health providers to be familiar with the diverse characteristics and needs of the various groups that will need geriatric care if they are to receive effective services. Challenges to high-quality ethnogeriatric care include disparities in health status and health care, differences of acculturation level and other characteristics within the populations, language and limited English proficiency, health literacy, culturally defined health beliefs and syndromes, and specific beliefs and preferences about long-term and end-of-life care. Some models of successful ethnogeriatric care have been identified and have in common the involvement of members of the target population in the development and design of the services and the use of cultural liaisons from the ethnic community being served, such as community health workers, or promatores. Thirteen recommendations are suggested for policy and practice changes in multiethnic and ethnic-specific health programs to provide competent ethnogeriatric care in the U.S. healthcare system. [ABSTRACT FROM AUTHOR]

China faces an aging tsunami. By the end of 2016, the number of older adults aged 60 and older reached 230 million. This number is projected to reach 418 million by 2035 and peak at 487 million by 2053. The number of individuals aged 80 and older, the oldest adults, reached 26 million and continues to grow by 1 million a year. The socioeconomic context, characterized by an inverted pyramid family structure and the number of “empty nesters,” has greatly compromised traditional Chinese family support for older adults. This article aims to provide an overview of geriatrics development in China. It begins with a brief account of the dramatic demographic shift, major socioeconomic factors, China's healthcare system, and reform related to senior health with a historical perspective. It then describes recent advances in government policy and support and development of a geriatrics physician workforce, care models, primary care networks, and privately owned senior care facilities and support services. Although it is impossible to cover all aspects of the topic, it is hoped that this article provides readers an overall picture of Chinese geriatrics and senior healthcare development in a complex and evolving healthcare system. Geriatrics communities in the United States and around the world will undoubtedly learn and benefit from the unparalleled and continued efforts to address this unprecedented opportunity and challenge in China. [ABSTRACT FROM AUTHOR]

This article outlines the current and future-projected demographic data, organization, networks for the care of older people, and perspectives in Costa Rica in relation to the challenges resulting from exponential growth of the older adult population, most notably those aged 80 and older. It includes consideration of the Norms of Integrated Care of the Older Adult of Costa Rica's national social security system and contributions from other public and private institutions. It also makes note of commentaries on the need for ever-increasing efforts to manage the care of Costa Rica's burgeoning older adult population. [ABSTRACT FROM AUTHOR]

Commencing in 2017, the Medicare Access and CHIP Reauthorization Act ( MACRA) of 2015 will change how Medicare pays health professionals. By enacting MACRA, Congress brought an end to the (un)sustainable growth rate formula while also setting forth a vision for how to transform the U.S. healthcare system so that clinicians deliver higher-quality care with smarter spending by the Centers for Medicare and Medicaid Services ( CMS). In October 2016, CMS released the first of what stakeholders anticipate will be a number of (annual) rules related to implementation of MACRA. CMS received extensive input from stakeholders including the American Geriatrics Society. Under the Quality Payment Program, CMS streamlined multiple Medicare value-based payment programs into a new Merit-based Incentive Payment System ( MIPS). CMS also outlined how it will provide incentives for participation in Advanced Alternative Payment Models (called APMs). Although Medicare payments to geriatrics health professionals will not be based on the new MIPS formula until 2019, those payments will be based upon performance during a 90-day period in 2017. This article defines geriatrics health professionals as clinicians who care for a predominantly older adult population and who are eligible to bill under the Medicare Physician Fee Schedule. Given the current paucity of eligible APMs, this article will focus on MIPS while providing a brief overview of APMs. [ABSTRACT FROM AUTHOR]

Objectives To examine whether a novel videoconference that connects an interdisciplinary hospital-based team with clinicians at postacute care sites improves interprofessional communication and reduces medication errors. Design Prospective cohort. Setting One tertiary care medical center and eight postacute care sites. Participants Hospital-based providers (hospitalists, geriatricians, pharmacists, social workers, medical trainees, and subspecialists) and postacute care clinicians. Intervention All patients discharged to eight postacute care sites were discussed in a weekly videoconference. Measurement Preliminary data including demographic characteristics of the patients discussed, postacute care provider satisfaction survey results, and data on medication errors are reported. Results Over 2 years, 907 patients were discussed; 84.6% were discussed with staff at subacute skilled nursing facilities and the remainder with clinicians at one long-term acute care facility. They had an average hospital length of stay of 6.8 days. Postacute care providers felt that the videoconference enhanced communication and provided much-needed access to information and hospital staff. Of the 106 pharmacy discrepancies identified, 16% involved an omission of a medication. Conclusion As increasing numbers of older adults are discharged to postacute care facilities, they face high-risk care transitions. Extension for Community Healthcare Outcomes-Care Transitions ( ECHO- CT) facilitates interdisciplinary communication between hospital and postacute care providers, who normally have minimal interaction. Preliminary data suggests that ECHO- CT may improve the transitions of care processes between these sites. [ABSTRACT FROM AUTHOR]

Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals ( GDHs) have been implemented mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short-term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting. During the 6-hour visits made weekly for up to 2 months, participants receive integrated evaluations of their various health domains, education, and rapid access to examinations and procedures based on a multidisciplinary approach. In the first 6 years, 2,322 individuals attended the GDH. The analysis of a representative sample (n = 645) revealed that 81% were treated in the GDH without the need for another type of hospital care. This percentage was high for the different reasons for referral (infection, 71%; delirium, 73%; decompensated chronic disease, 81%). Between baseline and discharge, participants maintained their functional status, and their self-reported health improved. This study represents the first step in describing the role of the GDH as a possible alternative to emergency department use or hospitalization for older adults. Future studies are needed to determine the optimal individual for this model of care and to ensure its cost-effectiveness. [ABSTRACT FROM AUTHOR]

This editorial comments on the article by Gadbois et al. and Burke et al. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the Standards for Reporting Implementation Studies (StaRI) guidelines which provide a uniform structure for describing the methods, results, and interpretation of implementation science research, and it mentions a knowledge translation concept and the problems that are associated with U.S. health services research and healthcare delivery. Geriatrics research and Enhancing the Quality and Transparency of Health Research reporting guidelines are assessed.

Objectives To assess the relationship between the number of primary care providers ( PCPs) in an area and emergency department ( ED) visits by older adults. Design Population-based cross-sectional observational study. Setting Nonfederal EDs in North Carolina in 2010. Participants All older adults (n = 640,086) presenting to a nonfederal ED in North Carolina in 2010. Measurements The primary outcome was the number of ED visits by older adults in each ZIP code per 100 adults aged 65 and older living in that ZIP code. A secondary outcome was the number of ED visits not resulting in hospital admission per 100 older adults. The primary predictor variable was the number of PCPs per 100 older residents for each ZIP code. Covariates included those representing healthcare need (Medicare hospitalizations, nursing home beds), predisposing factors for healthcare use (race, education, population density of older adults), and enabling factors (distance to the nearest ED). Results In a multivariable regression model corrected for spatial clustering, ZIP code characteristics associated with ED visits included more hospitalizations by Medicare beneficiaries, more nursing home beds, and closer proximity to an ED. Number of PCPs per 100 older adult residents in each ZIP code was not associated with ED use, and the 95% confidence limit indicates at most a small effect of PCP availability on ED use. Conclusion These findings suggest that primary care availability has at most a limited effect on ED use by older adults in North Carolina. [ABSTRACT FROM AUTHOR]

Accessing timely acute medical care is a challenge for older adults. This article describes an innovative healthcare model that uses high-intensity telemedicine services to provide rapid acute care for older adults without requiring them to leave their senior living community ( SLC) residences. This program, based in a primary care geriatrics practice that cares for SLC residents, is designed to offer acute care through telemedicine for complaints that are felt to need attention before the next available outpatient visit but not to require emergency department ( ED) resources. This option gives residents access to care in their residence. Measures used to evaluate the program include successful completion of telemedicine visits, satisfaction of residents and caregivers with telemedicine care, and site of care that would have been recommended had telemedicine been unavailable. During the first 2 years of the program's operation, 281 of 301 requested telemedicine visits were completed successfully. Twelve residents were sent to an ED for care after the telemedicine visit. Ninety-four percent of residents reported being satisfied or very satisfied with telemedicine care. Had telemedicine not been available, residents would have been sent to an ED (48.1%) or urgent care center (27.0%) or been scheduled for an outpatient visit (24.4%). The project demonstrated that high-intensity telemedicine services for acute illnesses are feasible and acceptable and can provide definitive care without requiring ED or urgent care use. Continuation of the program will require evaluation demonstrating equal or better resident-level outcomes and the development of sustainable business models. [ABSTRACT FROM AUTHOR]

This community-partnered study was developed and fielded in partnership with key community stakeholders and describes age- and race-related variation in delays in care and preventive service utilization between middle-aged and older adults living in South Los Angeles. The survey sample included adults aged 50 and older who self-identified as African American or Latino and lived in ZIP codes of South Los Angeles (N=708). Dependent variables were self-reported delays in care and use of preventive services. Insured participants aged 50 to 64 were more likely to report any delay in care (adjusted predicted percentage (APP)=18%, 95% confidence interval (CI)=14-23) and problems obtaining needed medical care (APP=15%, 95% CI=12-20) than those aged 65 and older. Uninsured participants aged 50 to 64 reported even greater delays in care (APP=45%, 95% CI=33-56) and problems obtaining needed medical (APP=33%, 95% CI=22-45) and specialty care (APP=26%, 95% CI=16-39) than those aged 65 and older. Participants aged 50 to 64 were generally less likely to receive preventive services, including influenza and pneumococcal vaccines and colonoscopy than older participants, but women were more likely to receive mammograms. Participants aged 50 to 64 had more problems obtaining recommended preventive care and faced more delays in care than those aged 65 and older, particularly if they were uninsured. Providing insurance coverage for this group may improve access to preventive care and promote wellness. [ABSTRACT FROM AUTHOR]

This article documents the development of geriatric medicine fellowship training in the United States through 2009. Results from a national cross-sectional survey of all geriatric medicine fellowship training programs conducted in 2007 is compared with results from a similar survey in 2002. Secondary data sources were used to supplement the survey results. The 2007 survey response rate was 71%. Sixty-seven percent of responding programs directors have completed formal geriatric medicine fellowship training and are board certified in geriatrics, and 29% are board certified through the practice pathway. The number of Accreditation Council for Graduate Medical Education-accredited fellowship programs has slowly increased, from 120 (23 family medicine (FM) and 97 internal medicine (IM)) in 2001/02 to 145 in 2008/09 (40 FM and 105 IM), resulting in a 21% increase in fellowship programs and a 13% increase in the number of first-year fellows (259 to 293). In 2008/09, the growth in programs and first-year slots, combined with the weak demand for geriatrics training, resulted in more than one-third of first-year fellow positions being unfilled. The number of advanced fellows decreased slightly from 72 in 2001/00 to 65 in 2006/07. In 2006/07, 55% of the advanced fellows were enrolled at four training programs. In 2008/09, 66% of fellows were international medical school graduates. The small numbers of graduating geriatric medicine fellows are insufficient to care for the expanding population of older frail patients, train other disciples in the care of complex older adults, conduct research in aging, and be leaders in the field. [ABSTRACT FROM AUTHOR]

Homebound seniors suffer from high levels of functional impairment and are high-cost users of acute medical services. This article describes a 7-year experience in building and sustaining a physician home visit program. The House Calls for Seniors program was established in 1999. The team includes a geriatrician, geriatrics nurse practitioner, and social worker. The program hosts trainees from multiple disciplines. The team provides care to 245 patients annually. In 2006, the healthcare system (62%), provider billing (36%), and philanthropy (2%) financed the annual program budget of $355,390. Over 7 years, the team has enrolled 468 older adults; the mean age was 80, 78% were women, and 64% were African American. One-third lived alone, and 39% were receiving Medicaid. Reflecting the disability of this cohort, 98% had impairment in at least one instrumental activity of daily living (mean 5.2), 71% had impairment in at least one activity of daily living (mean 2.6), 53% had a Mini-Mental State Examination score of 23 or less, 43% were receiving services from a home care agency, and 69% had at least one new geriatric syndrome diagnosed by the program. In the year after intake into the program, patients had an average of nine home visits; 21% were hospitalized, and 59% were seen in the emergency department. Consistent with the program goals, primary care, specialty care, and emergency department visits declined in the year after enrollment, whereas access and quality-of-care targets improved. An academic physician house calls program in partnership with a healthcare system can improve access to care for homebound frail older adults, improve quality of care and patient satisfaction, and provide a positive learning experience for trainees. J Am Geriatr Soc 57:1103–1109, 2009 [ABSTRACT FROM AUTHOR]

OBJECTIVES: To explore barriers to multiple advance care planning (ACP) steps and identify common barrier themes that impede older adults from engaging in the process as a whole. DESIGN: Descriptive study. SETTING: General medicine clinic. San Francisco County. PARTICIPANTS: One hundred forty-three English and Spanish speakers aged 50 and older (mean 61) enrolled in an advance directive preference study. MEASUREMENT: Six months after reviewing two advance directives, self-reported ACP engagement and barriers to each ACP step were measured with open- and closed-ended questions using quantitative and qualitative (thematic content) analyses. RESULTS: Forty percent of participants did not contemplate ACP, 46% did not discuss with family or friends, 80% did not discuss with their doctor, and 90% did not document ACP wishes. Six barrier themes emerged: perceiving ACP as irrelevant (84%), personal barriers (53%), relationship concerns (46%), information needs (36%), health encounter time constraints (29%), and problems with advance directives (29%). Some barriers were endorsed at all steps (e.g., perceiving ACP as irrelevant). Others were endorsed at individual steps (e.g., relationship concerns for family or friend discussions, time constraints for doctor discussion, and problems with advance directives for documentation). DISCUSSION: Perceiving ACP to be irrelevant was the barrier theme most often endorsed at every ACP step. Other barriers were endorsed at specific steps. Understanding ACP barriers may help clinicians prioritize and address them and may also provide a framework for tailoring interventions to improve ACP engagement. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). DESIGN: Prospective cohort study. SETTING: Single academic medical center. PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status. MEASUREMENTS: Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse). RESULTS: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3–83.7% vs 75.8%, 95% CI=70.5–81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3–83.7 vs 31.4% 95% CI=27.5–35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission. CONCLUSION: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care. [ABSTRACT FROM AUTHOR]

This article examines the changing demographics of China, with particular attention paid to the effect of the one-child policy in relation to long-term care of older people. It also examines the current state of health care for older people. Long-term stays characterize hospital care. Most geriatric syndromes are less common in hospitalized older people (e.g., delirium, falls), but some (e.g., polypharmacy) are more common. A high volume of patients and brief targeted visits characterize outpatient care. Nursing homes exist in China, but relatively fewer than in the most developed countries. Geriatric departments in university-based hospitals primarily have developed out of a need to care for retired government officials and workers. There are no formal geriatric fellowships or national board certifications in geriatrics Health care is primarily based on fee for service. Not all elderly have healthcare insurance. Although costs of health care and medications are less expensive than in the United States, they are relatively high for lower-and middle-class Chinese and have increased more quickly than has the standard of living in the past 20 years. Family and community support for older people is strong in China. Some older people have one-to-one care from a baomu (literally “protection” ( bao) “mother” ( mu)), a type of live-in maid who also provides care for the older person. Some of the challenges facing China in the care of its aging population are how to increase geriatric research and training, how to care for the uninsured or underinsured, and how to handle the inevitable growth of disabled and frail older people. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether a computerized tool that alerted pharmacists when patients aged 65 and older were newly prescribed potentially inappropriate medications was effective in decreasing the proportion of patients dispensed these medications. DESIGN: Prospective, randomized trial. SETTING: U.S. health maintenance organization. PARTICIPANTS: All 59,680 health plan members aged 65 and older were randomized to intervention (n=29,840) or usual care (n=29,840). Pharmacists received alerts on all patients randomized to intervention who were newly prescribed a targeted medication. INTERVENTION: Prescription and age information were linked to alert pharmacists when a patient aged 65 and older was newly prescribed one of 11 medications that are potentially inappropriate in older people. MEASUREMENTS: Physicians and pharmacists collaborated to develop the targeted medication list, indications for medication use for which an intervention should occur, intervention guidelines and scripts, and to implement the intervention. RESULTS: Over the 1-year study, 543 (1.8%) intervention group patients aged 65 and older were newly dispensed prescriptions for targeted medications, compared with 644 (2.2%) usual care group patients ( P=.002). For medication use indications in which an intervention should occur, dispensings of amitriptyline ( P<.001) and diazepam ( P=.02) were reduced. CONCLUSIONS: This study demonstrated the effectiveness of a computerized pharmacy alert system plus collaboration between healthcare professionals in decreasing potentially inappropriate medication dispensings in elderly patients. Coupling data available from information systems with the knowledge and skills of physicians and pharmacists can improve prescribing safety in patients aged 65 and older. [ABSTRACT FROM AUTHOR]

In this review of a recent set of faculty development initiatives to promote geriatrics teaching by general internists, nontraditional strategies to promote sustained change were identified, included enrolling a limited number of “star” faculty, creating ongoing working relationships between faculty, and developing projects for clinical or education program improvement. External funding, although limited, garnered administration support and was associated with changes in individual career trajectories. Activities to enfranchise top leadership were felt essential to sustain change. Traditional faculty development programs for clinician educators are periodic, seminar-based interventions to enhance teaching and clinical skills. In 2003/04 the Collaborative Centers for Research and Education in the Care of Older Adults were funded by the John A. Hartford Foundation and administered by the Society of General Internal Medicine. Ten academic medical centers received individual grants of $91,000, with required cost sharing, to develop collaborations between general internists and geriatricians to create sustained change in geriatrics clinical teaching and learning. Through written and structured telephone surveys, activities designed to foster sustainability at funded sites were identified, and the activities and perceived effects of funding at the 10 funded sites were compared with those of the 11 highest-ranking unfunded sites. The experience of the Collaborative Centers supports the conclusion that modest, targeted funding can provide the credibility and legitimacy crucial for clinician educators to allocate time and energy in new directions. Key success factors likely include high intensity and duration, integration into career trajectories, integration into clinical programs, and activities to enfranchise institutional leadership. [ABSTRACT FROM AUTHOR]

Generalist physicians provide most primary care for older people. Increasingly, undergraduate clinical education occurs in community sites. Hence, community-based generalist faculty members need continuing education in geriatrics to support clinical practice and teaching. The Geriatrics Scholars Program provided continuing medical education (CME) in geriatrics over a 3-year period to 88 participants. Sixty physicians completed 30 or more hours of education and were designated Geriatrics Scholars. On an anonymous exit survey, Scholars reported being better equipped to care for elderly patients and to teach geriatrics and improved patient care in specific aspects of geriatrics, including medication use, cognition, and functional assessment. In summary, community-based generalist faculty who participated in a substantial, 3-year program of geriatrics CME reported that their care of older people and their teaching of geriatrics were enhanced. [ABSTRACT FROM AUTHOR]

Objectives: To establish the effectiveness of the Green Prescription physical activity counseling program in increasing activity and quality of life in older community-dwelling people. Design: Post hoc subgroup analysis of a large cluster randomized, controlled trial. Setting: One hundred seventeen doctors in 42 primary care practices (74% participation rate) in the Waikato region of New Zealand. Participants: Two hundred seventy sedentary primary healthcare patients aged 65 and older (67% participation rate). Intervention: Patients in intervention practices prompted their primary care doctors or practice nurse to deliver brief activity counseling. A “Green Prescription” was written involving the negotiation of activity goals. Trained exercise specialists from a regional sports foundation gave follow-up telephone support over 3 months. Measurements: Leisure moderate and vigorous physical activity, total energy expenditure, systolic and diastolic blood pressure, health-related quality of life, musculoskeletal injuries, falls, and hospitalizations. Results: After 12 months of follow-up, leisure time moderate activity increased by 0.67 h/wk more in the intervention group than the control group (95% confidence interval (CI)=0.17–1.17) and energy expenditure increased by 2.67 kcal/kg per week (95% CI=0.87–4.47) more. For intervention group participants, vitality and general health scales of the 36-item Short Form showed statistically and clinically relevant improvements, and there was a decrease in hospitalizations ( P<.03). There were no observable changes in blood pressure, injuries, or falls as a result of the Green Prescription program. Conclusion: This physical activity intervention improved activity, energy expenditure, health-related quality of life, and hospitalizations for older primary care patients. Systematic inclusion of the Green Prescription in routine primary health care will probably lead to health gain for older people. [ABSTRACT FROM AUTHOR]

Cognitive impairment in old age is one of the most important topics in modern geriatrics. This article discusses the historical dimensions of this phenomenon. To this end, a number of primary sources ranging from antiquity to the modern era are evaluated. Although a physiology and pathology of old age were conceptualized in Greco-Roman times, cognitive impairment in old age remained a marginal issue until the 17th century. Alternatively, after 1500, medicine boasted detailed theories on the physiology and pathology of old age. There are several possible explanations for this unusual situation. Underlying conflict between idealistic and materialistic views of man played a decisive role, for these concepts differed considerably regarding the intellectual and mental functioning of the soul as well as the effects of the passage of time. After Cartesianism and Iatromechanism had pushed these traditional boundaries back, the problem of cognitive impairment in old age was increasingly regarded as a physical illness and began to receive more attention. Just as its philosophical and theological context shaped early modern medicine, contemporary nonmedical disciplines such as genetics, (neuro-)biology, and the information sciences influence modern research. [ABSTRACT FROM AUTHOR]

Little is known about differences between current patterns of antiresorptive therapy (ART) use in nursing facility (NF) residents and by community-dwelling older adults (CDs). ART use was compared in older NF residents and CDs. Cross-sectional analysis. Kansas Medicaid files from May 2000 through April 2001. Women aged 65 and older having at least 9 months of data as a CD or NF resident. Pharmacy claims were used to identify any ART prescription, including hormone replacement therapy (HRT), a bisphosphonate, raloxifene, or calcitonin. Demographic and clinical variables were identified from the claims files. Factors associated with ART use in bivariate analyses were entered into logistic regression models. Similar analyses were performed for bisphosphonate use among non-estrogen replacement therapy (non-ERT) ARTs (excluding HRT). The final study sample (N=2,289) included 898 NF (mean age 85.2) residents and 1,391 CDs (mean age 76.6). CDs were more likely to receive any ART (24.5%) than NF residents (19.6%). After adjustment for potential confounders, NF residents aged 65 to 84 were less likely (odds ratio (OR)=0.61, 95% confidence interval (CI)=0.44–0.85) to receive ART than CDs of the same age. Conversely, of those aged 85 and older, NF residents were more likely than CDs to receive ART (OR=1.96, 95% CI=1.18–3.25). Calcitonin was the most common non-ERT ART prescribed for NF residents, whereas bisphosphonates were more often prescribed for CDs. Underusage of ART is common in NF and CD cohorts. NF residents are less likely to receive bisphosphonates and more likely to receive calcitonin, for which efficacy is less clear. Further research is needed to identify factors influencing ART prescribing and selection of specific ARTs in different settings. [ABSTRACT FROM AUTHOR]

To determine whether use of atypical antipsychotics (olanzapine and risperidone) is associated with lower risk of falls than use of typical antipsychotics. Prospective cohort study with 1-month follow-up. Residential aged care facilities in Sydney, Australia. Two thousand five people aged 65 to 104 (mean age 86). Medication use at baseline was collected from medical records. Data on potential confounders were collected at interview and physical examination and from medical records. The outcome was accidental falls (one or more). One thousand one hundred seven subjects (55%) used at least one type of psychotropic medication, with 289 (14%) using an antipsychotic. There were 82 olanzapine users, 38 risperidone users, and 181 users of typical antipsychotics. Eleven percent of subjects (n=226) had at least one fall during follow-up. After adjusting for a comprehensive range of falls risk factors, hazard ratios (HRs) for falls were 1.35 (95% confidence interval (CI)=0.87–2.09) for typical antipsychotics, 1.32 (95% CI=0.57–3.06) for risperidone, and 1.74 (95% CI=1.04–2.90) for olanzapine. Antidepressants were also associated with falls (adjusted HR=1.45, 95% CI=1.09–1.93). Despite fewer extrapyramidal side effects, atypical antipsychotic medications are not associated with fewer falls than the older, more-established antipsychotics. [ABSTRACT FROM AUTHOR]

To identify the extent of inappropriate prescribing using criteria for proper use developed by the Agency for Healthcare Research and Quality (AHRQ) and dose-limitation criteria defined by Beers, as well as to describe duration of use and patient characteristics associated with inappropriate prescribing for older people. Retrospective national Veterans Health Administration (VA) administrative database analysis. VA outpatient facilities during fiscal year 2000 (FY00). Veterans aged 65 and older having at least one VA outpatient visit in FY00 (N=1,265,434). Operational definitions of appropriate use were developed based on recommendations of an expert panel convened by the AHRQ (Zhan criteria). Inappropriate use was identified based on these criteria and inappropriate use of drugs per Beers criteria for dose-limitations in older people. Furthermore, duration of use and patient characteristics associated with inappropriate use were described. After adjusting for diagnoses, dose, and duration, inappropriate prescribing decreased from 33% to 23%. Exposure to inappropriate drugs was prolonged. Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents constituted 61% of inappropriate prescribing. Whites, patients with psychiatric comorbidities, and patients receiving more medications were most likely to receive inappropriate drugs. Women were more likely to receive Zhan criteria drugs; men were more likely to receive dose-limited drugs For the most part, the Zhan criteria did not explain inappropriate prescribing, which includes problems related to dose and duration of prescriptions. Interventions targeted at prescriptions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents may dramatically decrease inappropriate prescribing and improve patient outcomes. [ABSTRACT FROM AUTHOR]

To evaluate which indices of blood pressure (BP) homeostasis are the strongest predictors of mortality in older low-level-care residents in long-term health facilities. Prospective cohort study. Eight long-term healthcare facilities in Canberra, Australia. A total of 179 randomly selected semi-independent residents aged 65 and older (mean age±standard deviation 83.2±7.0; 80% women). Baseline BP levels taken while lying, after standing for 1 and 3 minutes, and sitting before and 1 hour after meal intake were recorded, as well as demographic information, chronic medical conditions, medications, and all-cause mortality during follow-up. Postprandial hypotension (PPH) was defined as a fall in systolic BP (SBP) of 20 mmHg or more 1 hour postmeal while sitting. Orthostatic hypotension (OH) was defined as a fall in SBP of 20 mmHg or more or in diastolic BP (DBP) of 10 mmHg or more within 3 minutes of standing from a supine position. Hypertension was defined as BP greater than 160/90 mmHg at commencement of the study. Mean arterial pressure (MAP) and pulse pressure (PP) were calculated. At baseline, 47% of participants had hypertension, 38% PPH, and 23% OH; PP was 70 mmHg or greater in 54%, and DBP was 65 mmHg or lower in 6%. Over 4.7 years, 97 (54%) participants died. Those who died were significantly older and more likely to have PPH (47% vs 28%) and atrial fibrillation (35% vs 17%) and a significantly greater decrease in BP after meal intake. Mortality rates in those with and without PPH were 145.0 and 98.5 per 1,000 person-years, respectively. Using multivariate Cox proportional hazards models after adjustment for age, sex, presence of atrial fibrillation, Parkinson's disease, and use of diuretics, PPH was the only BP parameter that significantly and independently predicted 4.7-year all-cause mortality (relative risk (RR)=1.79; 95% confidence interval (CI)=1.19−2.68; P=.005). Further adjustment for the presence of OH, hypertension, low resting BP, coronary artery disease, cerebrovascular disease, congestive heart failure, history of syncope, cognitive impairment, cancer, diabetes mellitus, chronic obstructive pulmonary disease, and history of smoking did not reveal any new statistically significant associations. There was a dose–response relationship between postprandial fall in SBP and mortality rates. Absolute postprandial SBP of 120 mmHg or less was also significantly associated with total mortality (RR=1.69, 95% CI=1.04−2.78; P=.04). Low DBP was also associated with increased mortality (RR=1.10, 95% CI=1.01−1.13; P=.03), although this association became nonsignificant in multivariate analysis. In older low-level-care residents, PPH is an independent predictor of all-cause mortality with no added predictive value explained by other BP indices: OH, hypertension, PP, MAP. [ABSTRACT FROM AUTHOR]

To determine the relative effects of cobblestone mat walking, in comparison with regular walking, on physical function and blood pressure in older adults. Randomized trial with allocation to cobblestone mat walking or conventional walking. General community in Eugene, Oregon. One hundred eight physically inactive community-dwelling adults aged 60 to 92 (mean age±standard deviation=77.5±5.0) free of neurological and mobility-limiting orthopedic conditions. Participants were randomized to a cobblestone mat walking condition (n=54) or regular walking comparison condition (n=54) and participated in 60-minute group exercise sessions three times per week for 16 consecutive weeks. Primary endpoint measures were balance (functional reach, static standing), physical performance (chair stands, 50-foot walk, Up and Go), and blood pressure (systolic, diastolic). Secondary endpoint measures were Short Form-12 physical and mental health scores and perceptions of health-related benefits from exercise. At the 16-week posttest, differences between the two exercise groups were found for balance measures ( P=.01), chair stands ( P<.001), 50-foot walk ( P=.01), and blood pressure ( P=.01) but not for the Up and Go test ( P=.14). Although significant within-group changes were observed in both groups for the secondary outcome measures, there were no differences between intervention groups. Cobblestone mat walking improved physical function and reduced blood pressure to a greater extent than conventional walking in older adults. Additional benefits of this walking program included improved health-related quality of life. This new physical activity may provide a therapeutic and health-enhancing exercise alternative for older adults. [ABSTRACT FROM AUTHOR]

To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Prospective observational study to compare PCT levels in infected and uninfected patients. Geriatric teaching hospital in Switzerland. Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit. Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C-reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient. Long-term corticotherapy, chronic immune diseases, fever of 38°C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False-negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true-positive PCT. This finding may also be related to aging per se. PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. [ABSTRACT FROM AUTHOR]

To describe the features of community-acquired pneumonia (CAP) requiring hospitalization in subjects receiving home care.Prospective study from November 15, 2000, to November 14, 2002.Six hospitals in the Edmonton, Canada, area.Two thousand four hundred sixty-four subjects aged 17 years and older with CAP, 21.9% of whom were receiving home care.Pneumonia attack rates, demographic features, severity of illness, medication, length of stay, mortality, in hospital complications, and time to achieve physiological stability.The overall rate of CAP requiring a visit to an emergency department in home care recipients was 25 per 1,000 person years, 90.8% of whom were admitted to the hospital for treatment. Patients who were receiving home care at the time of admission were older and less likely to be current tobacco smokers, had higher in-hospital mortality (11%) and a longer length of stay, were receiving more medications, and had more comorbidity and fewer symptoms except for shortness of breath and altered mental state than those who were not receiving home care. Home care patients had four times as many myocardial infarctions and recurrent aspiration as the non-home care patients. Falls occurred five times more often, and urinary catheters were inserted twice as often. Except for oxygen saturation, time to achieve physiological stability was the same for the two groups of patients. Half (51.2%) of the home care patients passed the get-up-and-go test, compared with 75% (P<.001) of the non-home care patients.Home care patients with CAP had an 11% mortality rate and a higher rate of complications than those who did not receive home care. [ABSTRACT FROM AUTHOR]

To assess the status of geriatric medicine (GM) fellows' training experiences in end-of-life care via self-report.Anonymous surveys completed by mail, Web access, and telephone.U.S. accredited GM fellowship training programs.Two hundred ninety-six surveys were sent to graduating GM fellows in 1- and 2-year programs across the Unites States.Measurements assessed self-reported attitudes, quantity and quality of end-of-life care education, preparation to provide care, and perceived value of caring for dying patients.Response rate was 74%. Ninety-five percent or more of respondents held positive views about physicians' responsibility and ability to help dying patients. Seventy percent of fellows had completed a rotation focused on end-of-life care. Fellows who had done such rotations rated their end-of-life care education as highly as their overall geriatrics training. Fellows frequently received teaching in many end-of-life care topics, with lower rates of teaching how to say goodbye and responding to requests for assisted suicide. Overall, fellows felt well prepared to care for dying patients. Four factors independently predicted such preparedness: having had a palliative or end-of-life care rotation, being female, having been taught how to say goodbye to patients, and perceiving that it is important to attending physicians that fellows learn to care for dying patients.GM fellows feel their end-of-life care education is excellent and feel prepared to take care of dying patients. It is critical that geriatricians in training have access to and take advantage of palliative and end-of-life care rotations. [ABSTRACT FROM AUTHOR]

The healthcare workforce is currently unprepared for the increasing number of older persons and the complexities of their healthcare needs. Too few healthcare workers are adequately trained in geriatrics, and developers of educational curricula across healthcare disciplines have been slow to incorporate or require geriatric training. In April 2003, leaders in geriatrics met in Washington, D.C., to discuss and recommend solutions to the growing shortage of an appropriately trained workforce for geriatric research, education, and patient care. After considering data, presenting statistics, and offering insights into the future, the conference concluded by formulating recommendations to meet specific challenges. This report is a summary of the conference proceedings and recommendations, and it serves as a reminder that demographic trends and an everexpanding geriatric knowledge base demand not only attention, but also action. [ABSTRACT FROM AUTHOR]

To estimate the prevalence of different levels of mobility in a hospitalized older cohort, to measure the degree and rate of adverse outcomes associated with different mobility levels, and to examine the physician activity orders and documented reasons for bedrest in the lowest mobility group. A prospective cohort study. An 800-bed university teaching hospital. Four hundred ninety-eight hospitalized medical patients, aged 70 and older. Using average mobility level, scored from 0 to 12, the low-mobility group was defined as having a score of 4 or less, intermediate as a score of higher than 4 to 8, and high as higher than 8. Outcomes were functional decline, new institutionalization, death, and death or new institutionalization. Low and intermediate levels of mobility were common, accounting for 80 (16%) and 157 (32%) study patients, respectively. Overall, any activity of daily living (ADL) decline occurred in 29%, new institutionalization in 13%, death in 7%, and death or new institutionalization in 22% of patients in this cohort. When compared with the high mobility group, the low and intermediate groups were associated with the adverse outcomes in a graded fashion, even after controlling for multiple confounders. The low-mobility group had an adjusted odds ratio (OR) of 5.6 (95% confidence interval (CI)=2.9–11.0) for ADL decline, 6.0 (95% CI=2.5–14.8) for new institutionalization, 34.3 (95% CI=6.3–185.9) for death, and 7.2 (95% CI=3.6–14.4) for death or new institutionalization. The intermediate group had adjusted ORs of 2.5 (95% CI=1.5–4.1), 2.9 (95% CI=1.4–6.0), 10.1 (95% CI=1.9–52.9), and 3.3 (95% CI=1.8–5.9) for ADL decline, new institutionalization, death, and death or new institutionalization, respectively. Bedrest was ordered at some point during hospitalization in 165 (33%) patients. For most patients, mobility was limited involuntarily (bedrest orders), and almost 60% of bedrest episodes in the lowest mobility group had no documented medical indication. Low mobility and bedrest are common in hospitalized older patients and are important predictors of adverse outcomes. This study demonstrated that the adverse outcomes associated with low mobility and bedrest may be viewed as iatrogenic events leading to complications, such as functional decline. [ABSTRACT FROM AUTHOR]

Discusses issues on nursing home medical records related to several critical aspects of geriatrics in the U.S. Importance of accuracy of nursing home medical records; Concerns and comments of several professional associations; Improvement on the accuracy of documentation and its link to delivery of geriatric care.

As the percentage of time devoted to the care of older adults by internists continues to rise, the need for these physicians to be skilled at their care becomes even more critical. In fact, the Education Committee of the American Geriatrics Society has recommended the development of structured educational curricula to teach the principles of geriatric care. This article describes a comprehensive, evidence-based curriculum for internal medicine house staff in inpatient geriatric medicine. The intervention encompasses a novel instructional method, defined skill and behavioral goals, and a competency-based effectiveness evaluation. Moreover, the principles in this curricular model are those that may affect any hospitalized older adult and so will be important for all house staff taking care of inpatient geriatric patients, regardless of their future subspecialty choice. [ABSTRACT FROM AUTHOR]

Reports on the systems of grading the evidence for patient care considering several studies chosen for their potential to change current clinical geriatrics practice in the U.S. Benefits of six weeks medication of Ginkgo biloba in cognitive function to cognitively intact elderly adults; Ability of topical ocular hypotensive medications to delay or prevent glaucoma in high-risk people; Improvement of muscular strength endurance using low-intensity and high-intensity resistance exercise.

Presents guidelines for improving the care of older persons suffering from diabetes mellitus. Symptoms of the disease; Problems related to the medical care of elderly people suffering from the disease; Guideline development process and methods.

Focuses on the introduction of geriatrics for first-year medical students of the University of Texas Heath Science Center, San Antonio, United States. Impact of the new educational program on the attitudes of students; Factors formed in the analysis of results; Awareness of students of the physical decline in old age.

The author reflects on efforts which rock musicians Bono and Bob Geldof made to promote age attuned health systems and debt reduction for low and middle income countries at the 2011 World Economic Forum. He suggests that the idea of having powerful economic forums focus on the areas of health and aging should be celebrated. He argues that the medical profession should engage with the developing interest of influential economic forums.