Elderly Long-term Care Patients Research Articles

A Study on the Burden on Primary Guardian of Elderly Long-Term Care Patients

A Study on the Burden on Primary Guardian of Elderly Long-Term Care Patients

Interprofessional Spiritual Care Training for Geriatric Care Providers.

Background: Despite the importance patients place on religion and spirituality, many patients with advanced diseases report that their religious and spiritual needs are not met by their health care team, and many nonchaplain clinicians feel unprepared to address religious and spiritual issues in their practice. Objectives: The purpose of this study was to assess the efficacy of a one-day workshop on spiritual care for nonchaplain clinicians who provide care to elderly long-term care patients. Methods: Clinician participants (N = 68) were given a pre-survey at the beginning of the workshop, a post-survey at the conclusion of the workshop, and a three-month follow-up survey to evaluate their comfort in engaging in spiritual issues before and after the workshop. An average ability score of 13 items in the survey was calculated as well as an average comfort score, which was an average of three items in the survey. Ability scores and comfort scores were analyzed using a pairwise t-test, comparing pre- versus post-workshop and post- versus three-month scores. Results: Overall average scores for clinicians' self-reported perceived ability in engaging in issues around spirituality with patients and their families increased from before the workshop to the post-workshop and three months later. Participants' self-perceived comfort increased from before the workshop to immediately following the workshop. Discussion: This study suggests that a spiritual care training program targeted toward geriatric clinicians has the potential to provide clinicians with the tools, skills, and support they need to approach basic spiritual care with their patients and family members.

INTERPROFESSIONAL SPIRITUAL CARE TRAINING FOR GERIATRIC CARE PROVIDERS

Religion and spirituality have been shown to provide older patients and their families with a source of strength, hope, coping, and a sense of meaning in their life (Koenig et al. 1997; Krause et al. 2003). Despite the importance patients place in religion and spirituality, many patients with advanced diseases report that their religious and spiritual needs are not met by their health care team, and many non-chaplain clinicians feel unprepared to address religious and spiritual issues in their clinical practice (Balboni et al. 2013; Puchalski 2012). The purpose of this study was to assess the efficacy of a one-day workshop on spiritual care for non-chaplain clinicians who provide care elderly long-term care patients. Clinician participants (N=68) were given a pre-survey at the beginning of the workshop, a post-survey at the conclusion of the workshop, and a three month follow-up survey to evaluate their comfort in engaging in spiritual issues with patients and families before and after the workshop. Overall scores for clinicians’ self-reported perceived ability and comfort in engaging in issues around spirituality with patients and their families increased significantly right after the training and after three months, although this improvement slightly diminished after three months compared to at the end of the day of the spiritual generalist workshop. This study suggests that a spiritual care training program targeted towards geriatric clinicians has the potential to provide clinicians with the tools, skills, and support they need to approach basic spiritual care with their patients and family members.

Sliding-Scale Insulin Use in Long-Term Care: An Updated Perspective.

Diabetes affects approximately 26% of individuals oldeR THAN 65 years of age in the United States and up to 33% of patients in long-term care facilities. The most commonly prescribed insulin therapy for patients in long-term care is sliding-scale insulin (SSI): the use of finger-stick blood glucose testing to assess the need for insulin administration based on current blood glucose levels. SSI has been on the Beers Criteria of Potentially Inappropriate Medications since 2012. However, its sole use for long-term treatment is specifically not recommended by the American Diabetes Association and other stakeholders in diabetes management. This review discusses recent updates to several published guidelines, including Centers for Medicare & Medicaid Services, the Beers criteria, the American Medical Directors Association, and the American Diabetes Association regarding the use of SSI-only insulin regimens for elderly patients in long-term care.

Abstract 17022: The Gap Between Indicated and Prescribed Stroke Prevention Therapies in A High-risk Geriatric Population in Ontario

Introduction: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with estimated risk of about 25% by 80 years of age. The use of oral anticoagulation (OAC) in the elderly population treated in long term care (LTC) facilities is inconsistent and poorly studied. Hypothesis: We performed a retrospective analysis to assess the magnitude and sources of the gap between indicated and prescribed use of OAC in the elderly with AF along with the prevalence of different therapies. Methods: We retrospectively scanned 25 LTC facilities in Ontario, Canada. The diagnosis of AF was drawn from electronic medical records. This was merged with a pharmacy database, which was the sole provider of all medications for each resident. Attributable risk factors for possible failure to prescribe use of OAC were: Advanced directives for no hospitalization, Do-Not-Resuscitate order, Dementia, Cognitive Performance Scale, Activities of Daily Living Self Performance Hierarchy scale and Changes in Health, End-Stage Disease, Signs, and Symptoms Scale. Results: In total 3378 active residents were examined in 25 LTC facilities. All patients were ≥ 65 years old with mean age 85 ± 8 years and 2449 (72%) were female. We identified 433 (13%) AF patients with mean age 87 ± 7 years and mean CHADS2 score 3 ± 1; all qualify for OAC therapy. Out of all AF patients, 273 (63%) patients were on OAC therapy. Patients were mostly treated with Vitamin K antagonists (N= 114 (42%)), rivaroxaban (N= 71 (26%)) or apixaban (N= 62 (23%)) followed by dabigatran (N= 26 (10%)). Antiplatelet drugs as the only stroke prevention therapy were used in 88 (20%) patients and 28 (6%) patients were on dual therapy (anticoagulation and antiplatelet drugs). Seventy-two (17%) patients were not on any antiplatelet or antithrombotic therapy. None of the attributable risks identified consistently correlated with the failure to prescribe indicated therapy. Conclusions: This real world data set suggests that 37% of eligible elderly LTC patients fail to receive recommended stroke prevention therapies. Vitamin K antagonists are the most common OAC therapy used in elderly patients in LTC facilities. Lack of use of indicated therapy appears to be idiosyncratic.

Nurses’ self-reported time estimation of anticoagulation therapy: a survey of warfarin management in long-term care

BackgroundA nursing shortage in the United States has resulted in increased workloads, potentially affecting the quality of care. This situation is particularly concerning in long-term care (LTC) facilities, where residents are older, frailer, and may be receiving multiple medications for comorbidities, thus requiring a greater commitment of nurse time. We conducted a survey of LTC nurses to determine how much of their time each week is spent managing newly started and stable warfarin-treated residents.MethodsForty LTC nurses validated the questionnaire to determine what protocols/procedures are involved in warfarin management. Twenty LTC nurses completed the survey, quantifying the time they spend on procedures related to warfarin management, and how often they performed each procedure for each resident each week.ResultsThe nurses reported that 26% of their residents were receiving warfarin; the majority (approximately 75%) of these residents began warfarin after admission to the facility. On average, the nurses spent 4.6 hours per week for treatment procedures and monitoring patients initiating warfarin therapy and 2.35 hours per week for each resident who was stable on warfarin therapy on admission. Overall, to care for an average number of newly initiated and stable warfarin patients in a medium-size LTC facility, staff nurses are estimated to spend 68 hours per week.Study limitations include the potential for bias because of the small sample size, representativeness of the sample, and the possibility of inaccuracies in respondents’ self-reported time estimation of warfarin-related procedures.ConclusionsIn the context of a well-documented and expanding nursing shortage in the United States, the substantial use of time and resources necessary to initiate, monitor, and manage warfarin treatment in elderly LTC patients is of concern. Until the problem of understaffing is resolved, implementation of therapies that are simpler and require less nursing time—e.g. the use of new oral anticoagulants in the place of warfarin—may be a way to free up nursing time for other essential care tasks.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-015-0058-x) contains supplementary material, which is available to authorized users.

Preferences for Depression Treatment Among Elderly Home Health Care Patients

Major depressive disorder and milder forms of depression are disproportionately high among home healthcare patients, approaching 14% and 11% respectively (1). While effective pharmacological (2) and psychological treatments (3, 4) exist for depression in older adults, depression remains under-treated in the homecare setting (1, 5, 6) for a variety of reasons including patient reluctance to initiate and adhere to recommended treatments. Examination of patient preferences for depression treatment may shed light on this reluctance, and may identify subgroups of patients more likely to prefer such treatment. The majority of research on treatment preferences has been conducted in primary care settings (7–16), with little known about the preferred mental health treatment approaches of elderly homecare patients. A pilot study found that prayer was the most preferred approach identified by elderly long-term care patients (17). Personal experience with depression, however, increased patient preference for medication or psychotherapy (17). Using cross sectional data from the TRIAD (“Training in the Assessment of Depression”) study of elderly patients newly admitted to homecare (18, 19), we examined the treatment preferences of this understudied population at high risk for experiencing depression. Previous work suggests that depression experience, namely diagnoses of major or minor depression or use of antidepressant medication (7, 12, 14, 17), would be associated with preferences for an active treatment such as antidepressant medication or psychotherapy. We also explored the association of other sociodemographic and clinical variables with preferences for an active treatment.

Evaluation of the Effectiveness of Cholecalciferol in Long-Term Care Elderly Patients with Hypovitaminosis D

To study the efficacy and safety of cholecalciferol (vitamin D3) 2,000 units daily for 12 weeks in elderly patients with hypovitaminosis D. Secondarily, to postulate causes for those patients who did not return to normal 25-hydroxy vitamin D (25-OHD) levels. One-group, pretest post-test. Retrospective chart review. Data collected from Computerized Patient Record System. Long-term care facility at Central Arkansas Veterans Healthcare System. Potential study subjects were elderly patients (≥ 65 years of age) treated with total daily dose of cholecalciferol 2,000 units daily by mouth, for at least 12 weeks' duration period between July 1, 2007, and July 31, 2009, with documented 25-OHD levels before and after treatment. None. Efficacy of cholecalciferol was assessed by categorizing patients as responders (25-OHD levels ≥ 30 ng/mL) and nonresponders (25-OHD levels < 30 ng/mL). Safety of vitamin D3 was determined by measuring prevalence of hypercalcemia. Patient demographics, disease states, and medications that can affect 25-OHD levels between responders and nonresponders of vitamin D treatment were assessed. 24 patients were included in analysis. 58.3% (14) of patients responded to cholecalciferol treatment and 41.7% (10) of patients did not. The mean 25-OHD level after treatment was 38.7 ng/mL in responders and 26.4 ng/mL in non responders. Twelve patients (50%) developed hypercalcemia. The present study has shown that some long-term care elderly patients respond to three months of vitamin D supplementation. The reason why some patients did not respond cannot be determined from this study.

Use of proton-pump inhibitors and their associated risks among frail elderly nursing home residents

Objective. The aim of this study is to investigate the use of proton-pump inhibitors (PPI) and their associated risks among frail elderly nursing home residents. Design. A cross-sectional study. Setting. General practice. Subjects. An assessment of residents (n = 1987, mean age 83.7 years) in all nursing homes in Helsinki was carried out in February 2003. Data included demographic characteristics, symptoms such as diarrhea, vomiting and constipation, use of various drugs, and medical diagnoses. Outcome. Coded data analysis with NCSS statistical program. Multivariate logistic regression analysis served to determine which variables were independently associated with diarrhea; variables which were statistically significant or near p < 0.05 in univariate analyses were included. Results. Altogether 433 residents were on PPIs. The factors associated with regular PPI use in univariate analyses included poor functional status, higher number of comorbidities, higher number of medications and lactose intolerance. The users had suffered from a prior ventricular or duodenal ulcer, cancer and coronary heart disease more often than the non-users. In accordance with our hypothesis, the users of PPIs more often had diarrhea (19.7%) than the non-users (12.9%) (p < 0.001), and they had a prior hip fracture (28.5%) more often than the non-users (19.4%) (p < 0.001). In logistic regression analysis the use of PPIs had an independent association with diarrhea (OR 1.60 (95% CI 1.20 to 2.15). Conclusion. Physicians should avoid unnecessary long-term use of PPIs, particularly among frail elderly long-term care patients.

Prevalence of hypomagnesemia (HM) in a geriatric long-term care (LTC) setting

Electrolyte abnormalities are frequently observed in elderly long-term care (LTC) patients. Magnesium is a trace mineral, but is the second most abundant intracellular cation and the fourth most abundant cation in the body. This was a cross-sectional study to assess the prevalence of hypomagnesemia (HM) in non-selected elderly LTC patients. A total of 159 patients aged 65 years and older were included in the study. The attributes and variables related to the patients’ hospital course were used to compare the two groups. We used univariate and multivariate analyses to correlate magnesium levels with demographic, clinical factors and laboratory data. HM was found in 36% of the patients, of whom 35% presented with moderate HM (0.8–0.9 μequiv./l) and 18% with severe HM (≤0.7 μequiv./l). Patients with HM had a higher number of comorbid diseases per patient ( p = 0.038), low body mass index (BMI) ( p = 0.044) and more of them presented with laboratory markers of malnutrition, such as low total cholesterol (TC) and serum albumin (SA) levels. Coexistence with other electrolyte abnormalities was higher among patients with HM than without ( p = 0.006), predominantly hypocalcemia and hypokalemia ( p = 0.023 and 0.032, respectively). Using regression analysis, independent variables significantly associated with serum magnesium levels were serum albumin, calcium, potassium, urea levels, chronic renal failure (CRF), chronic heart failure (CHF), diabetes mellitus (DM) and diuretic drugs ( R 2 = 0.877). Both early (up to 30 days) and late rate of death were higher in patients with HM. The incidence of HM in LTC elderly patients is high and multifactorial. Understanding the causes of HM, correction of magnesium level, and definitive and effective treatment of the cause leading to HM is important to improve patient prognosis.

高齢慢性期患者における近赤外分光法による体脂肪推定の妥当性について―皮下脂肪厚法との比較―

The aim of this study was to examine the validity of body fat measurement by near infrared spectroscopy (NIRS) in long-term care elderly patients. The subjects were 59 elderly patients (23 men, 36 women, age 82.0+/-6.6 years) and 38 healthy young persons (19 men, 19 women, age 28.1+/-6.1 years). Percentage of body fat (%BF), body fat mass (BFM), and lean body mass (LBM) were estimated by NIRS and skinfold thickness (SF). Body fat was compared by genders and between the elderly patients and the healthy young subjects. The relationship between NIRS and SF of the elderly patients was compared with that of the healthy young subjects. Means of body fat variables of the elderly patients by NIRS were: %BF 18.6%, BFM 8.8 kg, LBM 37.7 kg for men; and %BF 26.0%, BFM 10.7 kg LBM, 29.6 kg; for women. The %BF and BFM values estimated by NIRS were significantly greater than the respective values measured by SF; LBM estimated by NIRS was significantly less than that by SF. These results show that body fat measured by SF may be undervalued. The correlation between NIRS and SF was significant (r > or =0.49, p < or =0.05), and the regression lines for the elderly patients and the healthy young were not significantly different. Body fat of elderly patients by NIRS may be similar to that of healthy young by SF. The results suggest that NIRS yields higher values than SF in measurement of body fat in long-term care elderly patients.

The Change of Blood Pressure in Lower Limb Loading Movement in the Sitting Position in Elderly Patients in Long-Term Care

〔目的〕座位での下肢荷重力測定動作に伴う血圧変化および日常生活活動レベル(以下ADLレベル)の影響について検討することとした。〔対象〕高齢慢性期患者28名（男性8名，女性20名，年齢78.6±8.6歳：mean±SD）とした。〔方法〕対象者の血圧は，測定動作前，測定動作後1分，3分，5分の4水準の血圧測定時期に測定した。測定動作は，座位下肢荷重力測定動作とした。対象者のADLレベルは，FIMの合計得点は80点を境に2群（Low群，High群）に分類した。血圧測定時期とADLレベルを要因とした反復測定の二元配置分散分析で，収縮期血圧（以下SBP）と拡張期血圧（以下DBP）を比較，検討した。また，対応の無いt検定で，ADLレベル各群における下肢荷重力体重比（％）を比較，検討した。〔結果〕SBPとDBPは，血圧測定時期とADLレベルの要因において主効果は認められなかった。下肢荷重力体重比は，群間に有意差が認められた。〔結語〕座位下肢荷重力測定動作は，心血管系に対し低リスクであり，様々なADLレベルの対象者にも適用可能であることが示唆された。

Relationship between Lower Limb Loading Force in the Sitting Position and Independence of Transfer Activity of Elderly Patients in Long-Term Care

Relationship between Lower Limb Loading Force in the Sitting Position and Independence of Transfer Activity of Elderly Patients in Long-Term Care

The Difference of Calf Circumferences between the Mid-Calf and Tibial Tuberosity and the Relationship between the Difference and Mobility in Long-Term Care Elderly Patients

The Difference of Calf Circumferences between the Mid-Calf and Tibial Tuberosity and the Relationship between the Difference and Mobility in Long-Term Care Elderly Patients

Evaluation of the Benefits of Enteral Nutrition in Long-Term Care Elderly Patients

Demented patients may refuse to eat as they come closer to the end of their lives. We evaluated the effectiveness of enteral nutrition in the improvement of survival and nutritional and functional status in very dependent and demented long-term care (LTC) elderly patients and its correlation with the nutritional parameters. Fifty-seven elderly patients, aged 60 years and older, who received nutrition by the enteral route (enteral nutrition group, ENG), were compared with 110 age-, sex-, comorbibity-, cognitive-, and dependent-matched subjects (control group, CG). Indications for enteral nutrition, type of tube; weight status subsequent to enteral nutrition; cognitive, functional, and pressure sore status; and complete clinical, complete blood count, and biochemical profile were recorded for each subject on initiation and conclusion of the study. Enteral nutrition was associated with improvement in blood count (hemoglobin and lymphocyte count), in renal function tests and electrolytes (BUN, creatinine, BUN/creatinine ratio, sodium and potassium), hydration status, serum osmolarity, and in serum proteins (total protein, albumin, and transferrin), but not in serum cholesterol and CRP levels. Decline in functional and in cognitive status was higher in CG than in ENG (Delta changes; respectively P = .24 and P < .001). ENG had a higher Norton scale than CG (Delta changes; P < .001). Mortality rate was higher in ENG (42%) than in CG (27%, P > .05). Complication rate related to nutrition was higher in ENG than in CG (61% and 34%, respectively; P < .001). Enteral nutrition does not have an advantage over oral nutrition in prolonging life or preventing pressure sore development in an LTC setting.

Metabolic alkalosis in skilled nursing patients

Renal failure is common among the long-term care (LTC) elderly. Little is known about the acid/base status of these patients. The aim of this study is to evaluate the relationship between the acid base status and renal function in a representative group of skilled nursing patients and relate it to their feeding status. LTC elderly patients, in stable clinical condition, 50 on naso-gastric tube (NGT) feeding, 40 orally fed (OF), were recruited to this study. As controls, we studied a group of 30 elderly independent, ambulatory patients admitted to the acute geriatric departments of the hospital for different causes which were not related to their acid–base status. Venous blood was taken for the routine tests and blood gases. In the LTC study groups a 24-h urine collection was examined for biochemical parameters and calculations of all clearances. Glomerular filtration rate (GFR) was estimated by the Cockroft and Goult and MDRD formulas. Renal function was similar in the two main study groups. Daily secretion of sodium and chloride were 50% lower in the NGT fed patients ( p < 0.001). The LTC elderly patients had significantly higher venous pH values, with no differences in pCO 2 or HCO 3. An alkalotic state (pH > 7.45) was found in 13.6% of them (18% in the NGT and 6.5% in the OF) while none of the independent elderly had such values ( p < 0.05). Similarly, HCO 3 > 34 was found in 12% of the LTC elderly versus none in the independents ( p = 0.06). Values of pO 2 and O 2 saturation were significantly higher in the nursing elderly and mainly those fed by NGT. Hemoglobin levels had a significantly negative correlation with the pH ( r = −0.3, p < 0.002). In conclusion, unexpected metabolic alkalosis was found in a group of skilled nursing patients, more prominent in those fed by NGT. This finding warrants the inclusion of routine pH determination in patients whenever pharmacokinetic considerations are essential.

Detection of urinary tract infection (UTI) in long-term care setting: Is the multireagent strip an adequate diagnostic tool?

Urinary tract infection (UTI) is one of the most commonly diagnosed and treated infection in elderly residents of long-term care (LTC) setting, and most of them are asymptomatic. Early diagnosis and treatment especially in this group of patients is very important because even a brief delay contributes to mortality as well as to reduce functional and cognitive decline. The purpose of the present study was to determine the validity of multireagent strips (Multistix 10 SG, Bayer, UK) compared with standard urinalysis for the early detection of UTI in LTC elderly patients. Urine specimens were examined for the presence of leukocyte esterase (LE) activity as an indicator of pyuria, nitrite production as an indicator of bacteriuria, erythrocytes (RBC), and protein. The sensitivity, specificity, predictive value, κ agreement, and likelihood ration were determined for each of the four dipstick parameters measurement separately, and in four combinations were calculated against the urine culture for the diagnosis of UTI and asymptomatic bacteriuria. Ninety-six patients aged 65 years and older with symptomatic UTI were compared with similar number, age, sex and comorbidity status matched patients with asymptomatic bacteriuria. In both groups, urinary culture results were compared with the results of multireagent strips. The multireagent strips results were evaluated for the presence of LE activity as an indicator of pyuria, nitrite production as an indicator of bacteriuria, RBC, and protein. All positive sticks results were evaluated as single parameter and in combination of them. Positive urine cultures were found in 71% (68/96) of the patients with symptomatic and in 60% (58/96; p > 0.05) of patients with asymptomatic UTI. In patients with UTI, using multireagent strips κ agreement for LE was 0.53, for nitrite was 0.14, and in combination of them was 0.31. Similar results were reported in patients with asymptomatic bacteriuria, 0.35, 0.23, and 0.35 m. The detection of RBC and protein, as single parameter or in combination with other parameters, decreases accuracy of the tests. Positive dipstick tests for LE and/or nitrite are not specific indicators of UTI, and are not suitable for screening of LTC inpatients for UTI because of high false-negative rates of the LE and nitrite.

Long-term outcome of schizophrenia

Over the past two decades schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Spain. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. This presentation tackle these various elements in the endeavour to reduce the impact of schizophrenia, particularly in long-term care elderly patients.

Dehydration among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia

Introduction: Long-term care (LTC) residents, especially the orally fed with dysphagia, are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly. However, combinations of these indices are more reliable. Objective: Assessment of hydration status among elderly LTC residents with oropharyngeal dysphagia. Methods: A total of 28 orally fed patients with grade-2 feeding difficulties on the functional outcome swallowing scale (FOSS) and 67 naso-gastric tube (NGT)-fed LTC residents entered the study. The common laboratory, serum and urinary tests were used as indices of hydration status. The results were considered as indicative of dehydration and used as ‘markers of dehydration’, if they were above the accepted normal values. Results: The mean number of dehydration markers was significantly higher in the FOSS-2 group (3.8 ± 1.3 vs. 2 ± 1.4, p = 0.000). About 75% of these FOSS-2 patients had ≧4 dehydration markers versus 18% of the NGT-fed group (p = 0.000). A low urine output (<800 ml/day) was significantly more common in the FOSS-2 group (39 vs. 12%, p = 0.002). Above normal values of blood urea nitrogen (BUN), BUN/serum creatinine ratio (BUN/S_Cr), urine/serum osmolality ratio (U/S_Osm), and urine osmolality U_Osm, were significantly more frequent in the dehydration-prone FOSS-2 group. This combination of 4 indices was present in 65% of low urine output patients. In contrast, it was present in only 36% of the higher urine output patients (p = 0.01). Patients with a ‘normal’ daily urine output (>800 ml/day) also had a significant number (2 ± 1.5) of positive indices of dehydration. Conclusions: Dehydration was found to be common among orally fed FOSS-2 LTC patients. Surprisingly, probable dehydration, although of a mild degree, was not a rarity among NGT-fed patients either. The combination of 4 parameters, BUN, BUN/S_Cr, U/S_Osm and U_Osm, offers reasonable reliability to be used as an indication of dehydration status in daily clinical practice.

Using Technology to Reduce Adverse Drug Events in Elderly Long-Term Care Patients: The Case for Computerized Physician Order Entry

Jennifer L Gold1 & Paula A Rochon2† †Author for correspondence 1University of Toronto, Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Faculty of Law, Canada. 2University of Toronto, Institute for Clinical Evaluative Sciences, Sunnybrook & Women’s College Health Sciences Centre, Department of Health Policy, Management and Evaluation, Kunin-Lunenfeld Applied Research Unit Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto M6A 2E1, Canada. Tel.: +1 416 785 2500 ext. 2516; Fax: +1 416 785 4230; E-mail: paula.rochon@ utoronto.ca