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Objective: This study provides a current analysis of the size and characteristics of the board-certified geriatrician and geriatric psychiatrist workforce in Texas, and thereby its capacity to meet increasing health needs of elders., Method: Secondary data on Texas board-certified geriatricians and geriatric psychiatrists from American Board of Medical Specialties database were analyzed., Results: The study found 1 geriatrician per 5,132 elders, and 1 geriatric psychiatrist per 21,327 elders, in Texas. Over 62% of geriatricians had active certification, 30% were females and the average age was 55.2 years. Rural geriatricians were disproportionately scarce (p < .001)., Discussion: The study indicated a serious shortage of board-certified geriatricians and geriatric psychiatrists in Texas. This shortage is worse than that at the national level, and more marked along the Texas-Mexico border and counties lacking large health facilities. Addressing this workforce deficiency requires improvements in the geriatric training pipeline, reimbursements, and practice environments.

Population ageing is occurring in China at a breathtaking pace and rapidly becoming a major public health issue. Due to the one-child policy, rural/urban migration and other societal changes, the family-dependent long-term care (LTC) of the past will no longer suffice. Barely existent now, both institutional and community-based services will need to expand to meet the growing need. China is still at an earlier stage in economic development and will be challenged to build these services and train staff. Furthermore, many elders are not yet covered by financial and insurance support. This massive demographic transition requires political efforts to develop integrated and sustainable national LTC systems.

Through a national survey, the SFGG's UCC Task Force worked and liaised with the DGOS as to establish a national inventory of the UCCs in France. 43 of the 55 newly opened UCCs in 2011 filled up the survey. These UCCs largely supported patients meeting the admission criteria's from the book of specifications edited by the public department. Those patients were demented, valid and with disruptive behavior disorders. Earnings for the stay were commonly measured by a reduced NPI (32 to 18). Body therapies, cognitive and sensory were mainly performed, even if a quarter of the UCCs also provided acute missions (diagnosis and management of acute diseases). Medical staff and caregivers were very different. Nearly half of the UCCs reported an insufficient staffing and a third of them reported a lack of training. Among the most often claimed difficulty (81% of UCCs), the release of patients is noted, with an average length of stay of 36 days. From an architectural point of view and even if the amount of beds was by the book (in average: 11), 58% of the UCCs proposed only single rooms. The lack of homogeneity shown with this survey tells us to share more our practice.

The graying of the Baby Boomers has created a shortage of professionals in aging-related careers. However, colleges and universities with gerontology and aging programs face a challenge of recruiting students. The purpose of this study was to determine what students are looking for in a career and whether these attributes are congruent with careers in gerontology. Results of this study indicated that factors important to students in a future career include whether career is enjoyable, has adequate benefits, provides personal fulfillment, provides excitements, provides an opportunity to help others, is well respected by others, and provides opportunities for employment.

The study aimed to identify, describe and analyze the practices carried out in the health of the elderly in the city of Campinas-SP, in the perspective of the health government representatives of the elderly, based on the National Policies. This is a qualitative study with thematic content analysis, from the perspective of individuals who assume strategic roles in the conduct of policy directed to the elderly in the county. Five central themes emerged from their comments: time and places; access conditions; population demands; human resources; health promotion and prevention of diseases and disorders; management. Health practices for the elderly health in Campinas-SP are in development, need to be evaluated, extended and systematized in both, the structural issues of human resources, finance and management, and in direct assistance to the elderly.

The projections regarding the ageing of the Italian population are cause for great concern; however, the ageing scenario may actually be interpreted in a more optimistic way. Theories formulated in the 80s envisaging a decline of mortality, morbidity and disability in the elderly are now confirmed and prefigure an unexpected decrease in disability rates in the elderly population. The aim of this review is to attempt to explain the reasons for this by analyzing the role played by the various determinants of health, in particular social isolation, which are likely to play an important role in the future as well.

Background: In the literature there are only few empirical studies that analyse the decision makers' reasoning to contract out health care and social services to private sector. However, the decisions on the delivery patterns of health care and social services are considered to be of great importance as they have a potential to influence citizens' access to services and even affect their health. This study contributes to filling this cap by exploring the frames used by Finnish local authorities as they talk about contracting out of primary health care and elderly care services. Contracting with the private sector has gained increasing popularity, in Finland, during the past decade, as a practise of organising health care and social services., Methods: Interview data drawn from six municipalities through thematic group interviews were used. The data were analysed applying frame analysis in order to reveal the underlying reasoning for the decisions., Results: Five argumentation frames were found: Rational reasoning; Pragmatic realism; Promoting diversity among providers; Good for the municipality; Good for the local people. The interviewees saw contracting with the private sector mostly as a means to improve the performance of public providers, to improve service quality and efficiency and to boost the local economy. The decisions to contract out were mainly argued through the good for the municipal administration, political and ideological commitments, available resources and existing institutions., Conclusions: This study suggests that the policy makers use a number of grounds to justify their decisions on contracting out. Most of the arguments were related to the benefits of the municipality rather than on what is best for the local people. The citizens were offered the role of active consumers who are willing to purchase services also out-of-pocket. This development has a potential to endanger the affordability of the services and lead to undermining some of the traditional principles of the Nordic welfare state.

This article summarizes the Patient Protection and Affordable Care Act (ACA) provisions that have a direct or indirect impact on the workforce caring for the elder population, explores the challenges to developing the workforce, and critiques the adequacy of the ACA provisions in meeting those challenges. The ACA is the first comprehensive federal legislation to acknowledge gaps in the workforce caring for the elder population. However, its provisions are inadequate given insufficient supply in the number and types of workers necessary both to meet the caregiving demand of the growing elder population and to implement the delivery system reforms instituted by the ACA. One of the challenges is that the workforce is not prepared for the new service delivery models specified in the legislation. They are not trained, supported, or held accountable for effective care coordination and service integration, and they lack the requisite skills, knowledge, and competencies. Moreover, it is likely to remain difficult to recruit and retain competent direct care workers, who represent the largest component of the long-term care workforce, because of the negative industry image, noncompetitive wages and benefits, a challenging work environment, and inadequate education and training. Several of the ACA provisions for developing the workforce have not received appropriations. Most are also demonstration projects of limited scope and duration.

Objective: To study the relationship between formal and informal care for the dependent population in a number of European countries., Method: Data from the Survey of Health, Aging and Retirement in Europe for 2004 were used and a bivariate probit model was estimated. Unlike other studies, the present analysis includes the institutional features of the various long-term care systems, in addition to the demographic, health and environmental characteristics of the individual receiving care., Results: A significant correlation was found between the two options, which reveals that, conditional on receiving care, there was a preference for the combination of both types of care. The results show the importance of health status and living arrangements for defining the combination of formal and informal care. There were substantial differences in the likelihood of the two types of care among European countries. A notable finding was the importance of informal care in Spain in comparison with other countries., Conclusions: The probability of receiving formal or informal care is higher in countries where families have a legal obligation to look after dependent relatives and where institutionalization rates are higher. This finding should be considered in the design of long-term care policies. Therefore, to control growth of public expenditure and, at the same time, improve caregiver satisfaction, policies that combine distinct formal services should be promoted over the implementation of care allowances., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Historically, the church has been a central institution in the life of the African American community, and caring for bodies, as well as souls, has been a critical aspect of its ministry. The significance of this role will increase in importance in the foreseeable future given the escalating costs of health care services. There is an increasing realization that churches must be involved in the provision of health services if society is to improve the health status of this population. This paper examines the role of the African American church in providing formal and informal health care services to the underserved aged.

The study aimed to examine the determinants of needing formal care and the factors impacting care arrangements in elderly Taiwanese by analyzing the 1999 and 2003 data of "The Survey of Health and Living Status of the Elderly in Taiwan", a prospective cohort study of older Taiwanese. For the purpose of this study, only participants 70 years or older were analyzed. The association of sociodemographic, lifestyle and health-related variables with care need and care arrangements at baseline and four years later were analyzed. Results showed that the major predictors of needing formal care in elderly Taiwanese were old age, cognitive impairment and functional disability. Self-perceived poor health and prior nursing-home admission were marginally significant. Results also showed that the traditional culture dictated care arrangement. Most elderly Taiwanese preferred to have private home carers (usually from neighboring countries) over institutionalization. The ratio of private care vs. institutionalization increased from 1:3 in 1999 to 1:1 in 2003 as the government allowed introducing more foreign carers. Results suggest that the major determinants of needing formal care in elderly Taiwanese are old age, and cognitive and functional impairments, similar to that observed in Western countries. However, culture and public policy impact care options., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Expenditure on health-care is increasing over the last years and the demographic shift leads to more elderly patients in the health-care system. Debates about the financial situation and solution about this topic are common. Direct, as well as hidden, rationing is verified by experts. This article discusses the concept of age-dependent prioritization and rationing of health-care expenditures in a cross-national setting., Methods: With a standardised questionnaire geriatric physicians in Germany and Austria were asked about their attitude and experience with health-care expenditures in elderly patients. Dimension of medical staff, organising institution and financial resources were also evaluated. The sample was tested with t-test, Mann-Whitney-U-test and explorative factor analysis. All the data were calculated with PASW 17 Statistics(®)., Results: From 419 standardised questionnaires 288 forms (60%, Germany: 123, Austria: 165) were evaluated. Differences were shown in patient-age (Germany: 80.4 y, Austria: 71.8 y), carrying capacity (Germany: 74.8, Austria: 110.8) and in medical staff as physicians (Germany: 6.8, Austria: 12.7) and nursing (Germany: 32.2, Austria: 84.3). In infrastructural basic services and normative focusing there was only marginal discrepancy, the public/ecclesiastical organising institution was 71% in both countries. Related to the different financial systems, there was less cost pressure in taking care of elderly patients in Austria., Conclusion: Age-dependent rationing was approved, but there was also a clear endorsement for making resources available for elderly patients in future. The discussion about rationing of health-care expenditures will still go on and therefore the impact of ageism has to be evaluated in further studies.

This is an integrative literature review of studies on physically disabled elder's access to primary health care, published between 1998 and 2008. The research was performed in: databases, virtual documents from the Health Ministry Library (Brazil), the catalogs of the Nursing Research and Study Center (CEPEN), the Brazilian Nursing Association (ABEn), and through e-mail consultation of experts. Sixty studies were selected and subjected to thematic analysis. The following categories emerged: The history of disability in Brazil, Accessibility and social inclusion, Disability and the elderly. Articles from different scenarios, subjects and methodologies show similar conditions experienced by people with disabilities when accessing health care systems. Scarcity of resources and and the indifference of the public administration were the most evident conditions.

This integrative literature review aims to identify scientific production in nursing about frailty in elderly people using the Scientific Electronic Library Online (SciELO), Latin-American and Caribbean Literature in Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde - LILACS) and Scopus. The study included 16 articles, two published in Brazilian periodicals and 14 of other nations. The review shows that 37.5% (6) of the articles focus on a paradigm shift regarding the care model and 26.7% (4) highlight the family as the primary care unit in the context of a frail elder. It is noted that the nurse plays a key role in the context of frailty, in the development of individual care, and in the support of family members and other caregivers of frail elders.

In this paper, the authors provide a policy prescription for Canada's aging population. They question the appropriateness of predictions about the lack of sustainability of our healthcare system. The authors note that aging per se will only have a modest impact on future healthcare costs, and that other factors such as increased medical interventions, changes in technology and increases in overall service use will be the main cost drivers. They argue that, to increase value for money, government should validate, as a priority, integrated systems of care delivery for older adults and recognize such systems as a major component of Canada's healthcare system, along with hospitals, primary care and public/population health. They also note a range of mechanisms to enhance such systems going forward. The authors present data and policy commentary on the following topics: ageism, healthy communities, prevention, unpaid caregivers and integrated systems of care delivery.

Canada's aging population poses a significant challenge for the existing healthcare system. While individuals 65 and older accounted for 13.7% of the population in 2005, they accounted for 60% of all acute care service spending. This paper further illustrates how the heterogeneity of the older population and its impact on patterns of healthcare use demonstrate the failings of our current care systems. Our outdated acute care models frequently disadvantage the system's highest users, who are often characterized by factors such as poly-morbidity, functional impairment and social frailty. Understanding how implementing innovative models that challenge deeply ingrained ways of providing care has proven to be a significant challenge, this paper highlights one hospital's mission to transform current traditional paradigms of care by developing and implementing an elder-friendly hospital integrated service delivery model. This hospital aims to demonstrate wide-ranging benefits of this model that can contribute toward optimizing the outcomes of hospitalization for older adults and the system as a whole. The establishment of a national agency that could support the development of a national aging strategy to promote best practice dissemination and implementation could also ensure that the significant health, social and economic benefits that better care models can realize could be more easily achieved.

Canada's population is aging, and the authors of this issue's lead article, Neena Chappell and Marcus Hollander, present a policy prescription for how to design a healthcare system that better responds to needs of older Canadians. The timing of this issue of Healthcare Papers is important: the first of the baby boomers turned 65 in January 2011. There is a pressing need to develop policies and implement sustainable reforms that will allow older adults to stay healthier and maintain their independence longer in their place of choice, while also creating efficiencies and quality improvements in our overall healthcare system that will benefit Canadians of all ages.

A necessary component of the prescribed continuing care act should be the creation of a long-term care insurance program in Canada. This social innovation has been implemented in many countries in recent decades to address the aging of the population and associated pandemic of chronic diseases. A specific autonomy insurance fund would have to be created and funded through transfers of current funding for long-term care, tax credits for disabled individuals and substantial new investment to make the shift from institutional to home care. Following a standardized assessment by case managers, an autonomy support benefit would be determined to fund "in kind" public or private services or a "cash-for-care" allowance for older people to purchase services. Case managers would be responsible for coordinating the care, controlling the quality of services and reassessing needs according to changes in individuals' conditions. Funding reform of long-term care would prioritize home care and optimize the functioning of integrated care to improve support for frail older people.

Canada's health and social care system is paralyzed by our decentralized federalist governing structure. Public policy change, such as that suggested by Chappell and Hollander, will require a new political paradigm that recognizes the need for a multi-sectoral, co-operative approach to integrated systems of care delivery. The federal government must provide the necessary leadership, and the provinces and territories must show the political will to co-operate if Canada is to embrace the challenges of an aging population.

The extent to which our aging population impacts the health system is, as Chappell and Hollander suggest, dependent on (1) how that system is defined and organized and (2) our attitudes as a society to aging and the elderly. The Canadian Home Care Association supports the policy prescription described by Chappell and Hollander and believes that a paradigm shift from a reactive and episodic system to one that is proactive and supportive is required. This article expands upon the lead essay by further discussing the role of home care and the need for its integration into the healthcare system. And the article concludes by asserting that we must change our attitude toward aging by improving our understanding of and attention to the needs of older adults.

If the healthcare sky is falling, it is because we have not yet grasped the opportunity to do better. Here we comment on three points in Chappell and Hollander's lead article. First, rather than looking to new federal-provincial mechanisms, which do not currently appear on the political agenda, we propose that federal and provincial governments honour their current commitments, including an extension of the 2004 First Ministers' agreement, set to expire in 2013-2014, that flows federal healthcare dollars to the provinces. Second, we concur that small things (e.g., transportation and medication management) matter in big health systems. Access to a full range of services in integrated systems of care permits cost-effective "downward substitution" instead of more costly, and often inappropriate "upward substitution" to hospital and institutional care. Finally, given the current political climate of fiscal constraint, it is helpful to consider the lessons of successful local initiatives such as supportive housing, which can integrate care "from the ground up" including essential primary and preventive care. Rather than seeing an aging population as the harbinger of healthcare doom, we suggest seeing it as a motivator to rethink, refresh and innovate.

This commentary addresses several issues raised by Chappell and Hollander in their review of policy issues that should be addressed to improve care for the elderly in Canada. First, the author takes some issue with the suggestion that the continuing care system needs to be re-validated. The data seem to indicate that the issue is not re-validation of the system but, rather, operational reform of the current system. Thus, the recommendation to focus on improving integrated care for seniors, which is a process measure, is a very timely one. Then the author raises the question of recommending a value-for-money approach to care of the elderly. Although fraught with problems and a lack of data, increasing numbers of researchers and others are suggesting that there is a need to question how we are spending scarce resources. A value-for-money policy would contribute evidence about the most effective use of services for older people.

In this paper, Chappell and Hollander's argument to recognize continuing care as a major component of the healthcare system is applauded. Further justification for looking at prevention and effective treatment of complex, multiple chronic diseases is offered. Finally, the concept of ageism as an important policy issue is further explored.

Chronic disease management initiatives have thus far focused on single disease entities. The challenge of an aging population is the occurrence of multiple diseases, complicated by geriatric syndromes, in the same person. The term frailty is used to denote such persons, who are more vulnerable to poor health outcomes when challenged by a health stressor. In this paper, it is argued that frailty is a chronic condition and thus requires a chronic disease management approach. Hospital-based and community interventions for managing frail seniors are discussed, with a focus on enhancing primary care, and with appropriate and targeted support from geriatric specialists in the form of capacity building as well as direct clinical service. Finally, a model for integrating individual geriatric interventions into a broader system is proposed.

In response to "Evidence-Based Policy Prescription for an Aging Population," by Chappell and Hollander, this paper proposes that efforts be made to execute strategies to build the political momentum and public support necessary for concrete action toward achieving the recommended policies. It also suggests the implementation of knowledge translation strategies to assist in disseminating and integrating existing successful programs across the wider health system. Finally, this paper proposes a concerted and robust mobilization of forces in order to move from evidence-based agenda setting into active policy implementation. A key element of this transition involves placing greater emphasis on interest group activation and public policy deliberation. Such a focus would enable consensus between policy makers, decision-makers, interest groups and the public, garnering the political traction necessary to allow for the implementation of healthy public policy that best serves the needs of an aging population.

Chappell and Hollander provide support for a set of policy directives formulated for an aging population. An integrated continuum of care model is the fulcrum of the policy prescription, given evidence-based support for its cost-effectiveness; improved quality of care and quality of life; and the success of similar models found in Denmark, Japan and other countries. This commentary addresses the underlying assumptions of these policy recommendations, identifies the major barriers to their implementation and suggests solutions. Improving our understanding of the dynamics of population aging as it relates to health and healthcare use is a necessary requirement to reaching the aims set out by the authors.

Chappell and Hollander "offer an evidence-based policy prescription to meet the challenges …[of] an aging society." The fallacies of apocalyptic demography are briskly dismissed; their message is that decades of solid evidence support the critical importance of an integrated system of continuing care for the chronically ill elderly, both health services and home support. But the paper loses focus with discussions of "ageism", the compression of morbidity, and healthy communities. The authors might have explored why (as they argue) public policy has retreated from their prescription in recent decades. That prescription would require either a re-allocation of resources (incomes) away from politically well-entrenched interests, or simply more money. Neither appears currently promising.

The need for adequate mental health services for older adults is an increasingly urgent issue as the life expectancy of Americans continues to extend; yet there are unresolved questions regarding the public's perception of service needs. The Group for the Advancement of Psychiatry collaborated with advice columnist Jeannie Phillips of "Dear Abby" to invite public feedback on mental health services for the elderly. Feedback was invited on access to services as well as perceived need for improvement in the quality or quantity of those services. The effort resulted in 800 responses that identified three primary issues: problems in accessing care, inadequate detection of mental health conditions by general practitioners, and a need for more psychotherapy services. It is hoped that this Open Forum will stimulate discussion throughout the country for the benefit of older persons with mental health needs as the country grapples with changes to come after the passage of health care reform.

In Italy, as in other European Countries, ageing population drives policymakers to redesign the Long Term Care (LTC) system for the elderly. This study analyses the LTC supply for elderly considering the distribution of different components: formal care (institutional and alternative), and informal one in Italian regions. An observational, cross-sectional, ecological study was carried out using statistical data drawn from the Italian National Institute of Statistics and Ministry of Health referred to 2004. Factorial analysis selected the most important components of LTC phenomenon. These components were used for the application of cluster analysis. Cluster Analysis was performed on main components of Factorial Analysis. Then, the ratio of mean value in each cluster on national mean value was calculated for each indicator. Factorial analysis showed three factors characterized by autovalue > 1 that accounted for 61% of the total variance. Cluster analysis highlighted four groups of regions with different way of supply. High level of home care (141,9) and social network (121,3) emerged in group 1. High level of family who received help and family paying a caregiver (108,3 e 121,1) resulted in group 2. High level of no profit LTC (168) supply was reported in group 3. High level of public residential care (451,4) was found in group 4. These remarkable differences in the way of service supply, highlight the need of improvement of the information system on LTC. Thus LTC policy and practice might be better supported both in planning and organizational targets.

Health foundations have invested in services, research, and advocacy to improve the financing and delivery of long-term services and supports. This article describes some of the broad array of approaches they have taken--in such areas as aging in place, assisted living, "culture change" in nursing homes, quality improvement, augmenting the workforce, and paying for care.

A genetic marker known as apolipoprotein E provides a clear signal of a person's risk of developing Alzheimer's disease and thus that person's future need for long-term care. People who find that they have the variant of the trait that increases Alzheimer's disease risk are more likely to purchase long-term care insurance after receiving this information. If the information is widely introduced into the insurance market, coverage rates could be affected in different ways, depending on who possesses that information. Policymakers will eventually need to confront the issue of the use of this and other markers in the pricing of long-term care insurance.

Social security of elderly people is discussed at different levels of the realization of the geronto-social policy in the Barents Euro-Arctic Region within the context of the Madrid Plan of Actions on Aging. There have been comparatively analyzed demographic indicators that show age structures of the regions which are parts of the Barents Euro-Arctic Region. There have been defined regional differences and trends of improvement of geronto-social policy for providing security of life activity of elderly people in the Russian part of the Barents Euro-Arctic Region.

Introduction: The purpose of this study was to describe the distribution of hospital and aged care services for older people, with a particular focus on transition care places, across Australia and to determine the relationships between the provision of these services., Methods: Aggregation of health and aged care service indicators by Aged Care Assessment Team (ACAT) region including: public and private acute and subacute (rehabilitation and geriatric evaluation and management) hospital beds, flexible and mainstream aged care places as at 30 June 2006., Results: There was marked variation in the distribution of acute and subacute hospital beds among the 79 ACAT regions. Aged care places were more evenly distributed. However, the distribution of transition care places was uneven. Rural areas had poorer provision of all beds. There was no evidence of coordination in the allocation of hospital and aged care services between the Commonwealth and state/territory governments. There was a weak relationship between the allocation of transition care places and the distribution of health and aged care services., Discussion: Overall, the distribution of services available to older persons is uneven across Australia. While the Transition Care Program is flexible and is providing rural communities with access to rehabilitation, it will not be adequate to address the increasing needs associated with the ageing of the Australian population. An integrated national plan for aged care and rehabilitation services should be considered.

Background: The ageing population in Europe is putting an ever increasing demand on the long-term care (LTC) services provided by these countries. This study analyses the relationship between the LTC institutional supply of beds and potential care needs, taking into account the social and health context, the supply of complementary and alternative services, along with informal care., Methods: An observational, cross-sectional, ecological study was carried out. Statistical data were obtained from the Italian National Institute of Statistics and Ministry of Health. Indicators, regarding 5 areas (Supply of beds in long term care institutions, Potential care needs, Social and health context, Complementary and alternative services for the elderly, Informal care), were calculated at Local Health Unit (LHU) level and referred to 2004.Two indicators were specifically used to measure supply of beds in long term care institutions and potential care needs for the elderly. Their values were grouped in tertiles. LHU were classified according to the combination of tertiles in three groups: A. High level of supply of beds in long term care institutions associated with low level of potential care needs; B. Low level of supply of beds in long term care institutions associated with high level of potential care needs; C. Balanced level of supply of beds in long term care institutions with potential care needs. For each group the indicators of 5 areas were analysed.The Index Number (IN) was calculated for each of these indicators., Results: Specific factors that need to be carefully considered were highlighted in each of the three defined groups. The highest level of alternative services such as long-stay hospital discharges in residence region (IN = 125), home care recipients (HCR) (IN = 123.8) were reported for Group A. This group included North regions. The highest level of inappropriate hospital discharges in (IN = 124.1) and out (IN = 155.8) the residence region, the highest value of families who received help (IN = 106.4) and the lowest level of HCR (IN = 68.7) were found in Group B. South regions belong to this group. The highest level of families paying a caregiver (IN = 115.8) was shown in Group C. Central regions are included in third group., Conclusion: Supply of beds in long term care institutions substantially differs across Italian regions, showing in every scenario some imbalances between potential care needs and other studied factors. Our study suggests the need of a comprehensive rethinking of care delivery "system".

The Institute of Medicine's report "Retooling for an Aging America: Building the Health Care Workforce" concluded that the US health care workforce will require significant overhaul to care for the estimated 70 million adults 65 years and older by 2030. No profession trains the numbers of geriatric specialists needed to maintain the current provider to patient ratio. Pharmacy is no exception; currently less than 1% of pharmacists are certified or have specialty training in geriatrics. Schools of pharmacy, accrediting and professional organizations, and boards of pharmacy will need to collaborate to ensure that pharmacists have the core competencies to care for older adults.

Background: Despite the increase in the proportion of older people in the population, little is known about factors that facilitate the development of specialist mental health services for older people., Methods: The relationship between the presence of specialist mental health programs for older people and elderly population size, proportion of older people in the population, gross national domestic product (GDP), and various parameters of health funding, mental health funding and mental health service provision was examined in an ecological study using data from the World Health Organization., Results: The presence of specialist mental health programs for older people was significantly associated with higher GDP, higher expenditure on healthcare and mental healthcare, the presence of a national mental health policy and a national mental health program, the availability of mental health care in primary care and the community, and higher density of psychiatric beds, psychiatrists, psychiatric nurses, psychologists and social workers., Conclusion: The challenge will be to persuade policy-makers in low and medium income countries, where the increase in the elderly population is most rapid, to develop specialist mental health services for older people.

A combination of "environmental factors" in the U.S. has led to an increased demand for health care professionals. However, there has been a significant decrease in the number of U.S. medical graduates selecting careers in family medicine and general internal medicine, thus driving demand for international medical graduates. At the heart of our national workforce policy needs to be good domestic and foreign policies, such as self-sufficiency approaches that include strategies to incentivize rural and underserved practice for U.S. medical graduates.

Background: Elderly suicide rates may be influenced by mental health service provision., Methods: A cross-national study examining the hypothesis that the relationship between elderly suicide rates and markers of mental health service provision would be curvilinear (inverted-U shaped curve) and fit the quadratic equation y = a + bx - cx2 (where y is the elderly suicide rate, x is a marker for mental health service provision, and a, b and c are constants) was undertaken by utilizing data from the World Health Organization., Results: The relationship between the logarithm of suicide rates in both sexes in both the elderly age-bands and the percentage of the total health budget spent on mental health, the total number of psychiatric beds per 10,000 population and the total number of psychiatrists per 10,000 population were curvilinear (inverted U-shaped curve) and fitted the quadratic equation y = a + bx - cx2 with statistical significance., Conclusions: The direction of the causal relationship could be examined in longitudinal studies, after further improvement in levels of mental health service provision, in individual countries segregated by low and high levels of existing mental health service provision.

Background: Tailor-made care in dementia requires an individual needs assessment. The Camberwell Assessment of Need for the Elderly (CANE) was developed to assess needs of older people with mental disorders. In this study the validity and reliability of the Dutch version of the CANE were studied among community-dwelling persons with dementia and their informal carers., Method: Interviews were carried out with 236 people with mild to severe dementia and 322 informal carers; 69 informal carers were interviewed twice. Construct and criterion validity and test-retest reliability of the CANE were studied using data for informal carers. Construct validity was also studied for CANE ratings of people with dementia., Results: The construct validity of the CANE was good among people with dementia and informal carers. Criterion validity could be studied for 76.9% of the CANE items, and all significant correlations were convergent. Test-retest reliability of the CANE varied from poor to very good and was best on domains where needs were explicit and problems well defined., Conclusions: Use of the Dutch version of the CANE among community-dwelling people with dementia and their carers is supported by the study results, with the study showing acceptable construct and criterion validity and test-retest reliability of the CANE.

Purpose of Review: Economic evaluation is becoming more and more important as a means to assist policy makers in choosing the best intervention or treatment against a pervasive scarcity of resources relative to the demands. Health service provision and the practice of geriatric psychiatry are closely associated with costs and outcomes of health economics. Recently published literature raising unanswered questions in these areas is reviewed., Recent Findings: Some studies on the costs, outcomes, and cost-effectiveness of certain interventions or treatments (e.g. respite care, home-visiting community service) compared with usual strategies show that these are not optimal in terms of health economics. The updated guidance by the National Institute for Health and Clinical Excellence that cholinesterase inhibitors should be used only for moderate severity dementia on the grounds of cost-effectiveness has been heavily criticized. Mental health provision for older people varies across 'developed' and 'developing' countries., Summary: Updated findings provide better understanding of recent progress and issues on mental health economics, health service provision, and the practice of geriatric psychiatry. The application of health economics to the field of mental health should make complicated issues simple and explicit. Constructive criticisms and scientific debates will hasten the development of better tools or methodologies to evaluate the cost-effectiveness of current and new interventions or treatments.

Addressing the problems of meeting the needs of ageing populations in rural areas is recognised as a political and service delivery challenge. The National Service Framework (NSF) for Older People (NSFOP) set out a series of service standards to raise quality, to redress variations in service use and to enhance the effectiveness of services across health and social care in England and alluded to the challenges of meeting such standards in rural communities. This paper reports findings from the consultations undertaken with 713 elderly people as part of the midpoint review of the NSFOP in 2006, presenting and analysing the views and experiences of elderly people from rural areas. The consultations to engage with elderly people employed a mixed methodology that included public events, focus groups and individual interviews. The data reveal participants' views of how different patterns of social change in diverse country areas in England influence health and well-being in later life. The costs and benefits of centralization of services, and the pivotal issue of transport are important themes. The findings raise questions about the unclear and contradictory usages of the term 'rural' in England and the portrayal of rural ageing as a homogeneous experience.

Objectives: The purpose of this study was to investigate the factors affecting satisfaction with volunteer work of participants in a meal delivery service for the elderly., Design: A cross-sectional study with a self-administered survey was carried out., Sample: Of 364 volunteers assisting with a meal delivery service for the elderly in rural towns A (80), B (159), and C (125), 247 responded (response rate: 68%)., Method: An anonymous self-administered questionnaire survey was administered seeking information about basic attributes, sense of satisfaction with volunteer work, and working circumstances such as human relationships with fellow volunteers, meal service users or professional staff members, opportunities for meetings or workshop, publicity through public relations magazines, and the like., Results: In multivariate logistic analysis, the sense of satisfaction of volunteers was closely associated with human relations among volunteers (odds ratio [OR] 5.15, 95% Confidence Interval (CI) 1.84-14.40, p<.01), meal service users (OR 3.84, 95% CI 1.37-10.77, p<.05), and professional staff members supervising the meal delivery service (OR 3.53, 95% CI 1.27-9.84, p<.05). Human relations were also affected by the emphasis on communication, consultation with supervisory staff members, having opportunities for meetings, having friends with whom to confer, and publicity through public relations magazines., Conclusion: Satisfaction levels of volunteers in meal delivery services for the elderly were most affected by human relations with fellow volunteers, meal service users, and professional staff members. Increasing opportunities for communication may be important to promote good human relationships among volunteers and volunteer activities.

Objective: To examine if claims for general practice health assessments of older persons in Australia over the period 1 November 1999 to 30 September 2002 were equitably distributed., Design: Closed cohort study with data analysis using logistic regression., Setting: Private general practice in Australia., Participants: All Australians aged 75 or more years at 1 October 1999, who were eligible to claim for a health assessment. MEASURES STUDIED: Medicare and Department of Veterans' Affairs (DVA) medical claims data, and personal characteristics of claimants: age, sex, DVA beneficiary status, rurality and socio-economic status of postcode of residence. Rurality was classified by the Rural Remote and Metropolitan Area Classification (RRMA) and socio-economic status by the Index of Relative Socio-economic Deprivation (IRSD) for the postcode., Results: The cohort initially contained 886 185 subjects. Over the 35 months, 271 939 individuals (31%) claimed at least one health assessment. Those most likely to have claimed for a health assessment were aged 80 to 84 years, female, entitled to treatment under DVA arrangements, lived in postcodes classified as RRMA 1-4 and classified as the most disadvantaged IRSD quartile., Conclusion: Over this period, general practice health assessments appear to have been equitably distributed except for those living in postcodes classified as RRMA 5-7.