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The U.S. Department of Veterans Affairs' Operation Stand Down has done much to address homeless needs among veterans. Gaining client trust is central to the effectiveness of the program. Music therapy has been found beneficial in moving individuals from isolation to community. We report our experience with participatory music therapy in Operation Stand Down and offer this as a legitimate intervention to enhance client participation.

Rates of hospitalization for ambulatory care sensitive conditions (ACSC, non-emergent or primary-care-treatable) are indicators of access to and effectiveness of primary care. An assessment of Bridges to Care (BTC), a program that links Nashville's uninsured population to a medical home, was performed by surveying 76 of 756 patients presenting to the Vanderbilt emergency department (ED) between January and March 2007. Rates of ACSCs among BTC patients were not different than those of the uninsured/non-BTC or insured. A 20-item telephone survey showed that reasons for using EDs for ACSCs were not different between BTC and non-BTC patients. More BTC than non-BTC patients cited cost of healthcare as a problem that needed to be improved (p = 0.04). BTC patients have similar ACSC rates when compared to both uninsured/non-BTC and insured patients, and it is likely that cost remains a factor in their accessing healthcare services.

Elderly individuals who have gastric surgery are at increased risk of developing vitamin B12 (cobalamin) deficiency, which often goes unrecognized by the provider. In conjunction with social risk factors and physiologic changes that occur naturally with aging, this population is also at risk for developing protein malnutrition. By intervening early with parenteral vitamin B12 and nutritional assessment prior to onset of weight loss in at risk individuals, clinicians will be able to improve their patients' quality of life. We present a 73-year-old individual with weight loss and anemia. This case presentation serves as a reminder about the prevalence of vitamin B12 deficiency and malnutrition in elderly individuals in our community.

Interdisciplinary teams play a critical role in the delivery of geriatric health care. Health care professionals are commonly left to develop teamwork skills by chance. Medical team function differs from traditional group theory in that all members are caregivers. A non-competitive supportive atmosphere is appropriate for patient care. We propose a participatory (autonomy supportive) model fostering self-realization and positive reinforcement as an organizing philosophy. The primary group task is to maximize patient functional independence and personal goals. Leadership is task-dependent.

Objective: To assess the effectiveness of an acute interdisciplinary inpatient geriatric service in a university hospital., Design: Prospective randomized control study., Setting: Large urban university hospital., Patients: 40 consecutive inpatients, randomized for inclusion on the geriatric service (study patients, n = 20) or to continue usual hospital care (control patients, n = 20) from among the geriatric consult population., Main Outcome Measures: Subjects were followed for changes in length of stay, hospital costs, diagnostic testing, pharmacy use, functional status, discharge disposition, and readmission within 30 days after hospitalization., Results: Mean age of patients study 79.2 years (control 73.9 years). Sixty percent of study patients went home and 30% to nursing homes (control 20% home, 65% nursing homes) P = .03. Total length of stay mean 20.3 days study (control 32.7 days), length of stay after randomization mean 7.7 days study (control 11.2 days), mean overall hospital costs $23,906 study (control $45,189), and mean hospital costs after randomization study $4,671 (control $9,404) were not significantly different by F-tests due to wide variability. Laboratory use was reduced with mean 4.4 tests study (control 16.9) P = .01 and mean laboratory costs $263 study (control $828) P = .02. Functional ability improved (scale 1-7) with mean improvement study 0.8 (control 0.3) P = .09. Mean number of medications were lower in the study group by 30% P = .02; mean cost of medications at discharge was reduced with study $38 (control $112); and mean pharmacy charges after randomization decreased $462 study (control $1,268) P = .06. Readmission 30 days after discharge was not significantly different (study 21%, control 33%)., Conclusions: An interdisciplinary acute geriatric service can be cost effective in providing care to elderly patients in a university hospital. It can improve outcomes measured by decreased laboratory and pharmacy usage, improved functional status, and discharge to a lesser level of care without increasing length of stay or early readmission after discharge.