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Congestive heart failure (CHF) is the leading reason for hospital admission and readmission, with an average hospital stay (according to the Medicare DR) of 5.4 days, allowing only for stabilization of the acute illness per se. Methods: To bridge the gap between hospital and home, we developed an innovative, multidisciplinary program involving medical management of CHF and inter-related geriatric syndromes, patient/family education, and exercise rehabilitation in a skilled nursing facility (SNF). Results: SNF residents (n=42; x [+ or -] SD age=81 [+ or -] 7 years; 66% female) with a CHF diagnosis were studied from Sept. 2001 to Jan. 2002. Expected SFN length of stay (21.2 days) was reduced by 18% (i.e., to 17.3 days). Functional status and psychosocial well-being (assessed using the Chronic Heart Failure Questionnaire) improved markedly from baseline to discharge: NYHA Class (2.3 vs 1.8); 6-minute walk distance (290 vs. 570 feet); Freedom from Dyspnea Score (22 vs. 30); Freedom from Fatigue Score (13 vs 21.); and Lack of Emotional Distress Score (30 vs. 41). All variables demonstrated statistically significant improvements (p

While urinary urgency with incontinence may be disabling, current pharmaceutical interventions are anticholinergic and may potentially worsen cognition. Patients with baseline cognitive dysfunction may be at greater risk, but control of incontinence may delay institutionalization. Purpose: to determine the effect of Detrol (Det) and Ditropan (Dit) on cognition and urinary incontinence in elderly patients with mild to moderate cognitive impairment. Method: prospective, single blind, crossover study of 13 subjects with predominant urge urinary incontinence; age 86 + 4 (sd) years. Baseline (B) and after 3 weeks 'on-drug' measurements of MMSE, Trails A and B, Royal Clox-I and II, and Urge-Urinary Distress Inventory were performed. Patients were blindly assigned by block randomization to either B/Det/B/Dit or B/Dit/B/Det. A three - week washout occurred between drug and subsequent baseline. There was a trend toward decreased MMSE score (Det= -1.2, sd=3.0, p=0.084; Dit=l.1, sd=3.5, p=0.15; with no significant differences in other cognitive performance measures. Both drugs significantly reduced the urinary symptoms (Det: in home-2.2 + 3.0; p=0.01, out of home -2.3 + 3.7; p=0.02: Dit: in home-3.3 + 2.0; p

Although the Functional Independence Measure (FIM) and Barthel Index are extensively used for outcome measurement in Rehabilitation, neither is widely used in Skilled Nursing Facilities (SNF); each adds paperwork in a climate of limited resources. We propose an MDS-based measure: Functional Impairment Score (FIS). Elderly patients (n=266) discharged from hospital to SNF with recent hip fracture, requiring rehabilitation, were evaluated. Initial (day 1) and discharge FIS were determined based on MDS performance and support scores in 4 categories: Transfer, Bed Mobility, Toilet Use, and Eating. Maximum FIS = 18 (most impaired) and minimum FIS = 4 (least impaired). Patients were classified into Resource Utilization Groups (RUGS) according to their HCFA SNF Prospective Payment System 'Day 5 MDS' which is required by regulation. RUG Category Med High Very Ultra Admission 14.3 13.9 12.5 11.4 Discharge 12.8 11.0 7.8 5.2 FIS Improvement * 1.5 2.9 4.7 6.2 Improvement/Day * 0.11 0.21 0.24 0.28 * p