Frail Elderly Persons Research Articles

New issues in geriatric care.

The rapid growth of the elderly population has increased the need for improved geriatric care and prevention of disability. For example, the prevalence and severity of osteoporosis can be reduced significantly by the use of estrogen, with or without added progestin, in postmenopausal women. A common and devastating problem of frail elderly persons is urinary incontinence, most cases of which can be classified without referral for urologic services. Appropriate treatment can improve nearly half of all cases of persistent incontinence. Comprehensive geriatric assessment is effective in guiding the treatment of frail elderly patients and leads to significantly improved outcomes under appropriate conditions. The advent of the teaching nursing home has shed light on the medical problems of elderly residents of nursing homes, including malnutrition, dysregulation of water and electrolyte balance, falling, cognitive and affective illnesses, behavior disturbances, infections, and pathogenic drug use. The future application of advanced technology may revolutionize nursing home care.

Geriatric Assessment: An Overview of Its Impacts

Geriatric assessment programs of various types have become an increasingly important component of the geriatric health care delivery system in the United States. Such programs provide interdisciplinary assessment, treatment planning, case management, and, often, rehabilitation for frail elderly persons and are especially important for those suspected of needing long-term institutional care. A growing body of literature, summarized in this chapter, documents many proven benefits to health care outcomes. Among these benefits are better diagnostic accuracy and treatment planning, more appropriate placement decisions with less referral to nursing homes, improved patient functional and mental status, prolonged patient survival, and lower overall use of costly institutional care services.

Geriatric Assessment Programs in the United States: Their Growing Role and Impact

Geriatric assessment programs have become a growing component of the health care delivery system for the elderly in the United States. They generally provide interdisciplinary assessment, treatment planning, case management, and often rehabilitation for frail elderly persons and are especially important for persons suspected of needing long-term institutional care. Their development here stems from long experience with geriatric assessment in the United Kingdom and increasing evidence of their effectiveness in North American settings. Among their demonstrated benefits are better diagnostic accuracy and treatment planning, more appropriate placement decisions with less referral to nursing homes, and improved patient functional status, general well-being, and survival. This article provides, in addition to an overview of geriatric assessment programs and their effectiveness, practical guidelines for their establishment in the hospital setting.

Development of Innovative Health Services for the Frail Elderly:

This paper delineates a model of health services for the elderly in industrialized societies and examines innovative developments in these services in recent years in Edinburgh. Scotland and Rochester, NY. Emphasis of innovations in the former has been upon early intervention in health problems of the frail elderly in the home and avoidance of hospitalization ("preventive geriatrics"). The focus in the latter has been largely upon improving efficiency and appropriateness of placement of elderly persons who require long term care. These experiences reflect the distinctive organization and financing of health services in the UK and the US as well as the exemplary efforts of professional leaders in identifying and addressing unmet needs of frail elderly persons in the respective communities studied. Opportunities for each society to benefit from the other's experience are discussed.

Attributes of Religious Maturity in Aging People

Religious maturity, a classic problem in the psychology of religion, is reinterpreted in order to reflect the lived experience of aging people. Using an approach modeled on Erik Erikson's description of ego integrity, this paper examines attributes of religious maturity revealed in the ways aging people remember the past, experience the prescnt, and anticipate the future. While most descriptions of religious maturity appear to apply primarily to healthy, active, middle-aged adults, this paper argues that frail elderly persons need not lose their claim to religious maturity.

The Medicare Prospective Payment System and the care of the frail elderly.

The development of the Medicare Prospective Payment System based on diagnosis-relating groupings is reviewed. Special emphasis is placed on analysis of the provisions that have a potential impact on geriatric medicine and on the care of the frail elderly. The authors conclude that in its present form, the DRG system may systematically undercompensate hospitals for treating the frail elderly and, therefore, result in attempts by some hospitals to reduce or avoid altogether programs in geriatric medicine and admissions of frail elderly persons. These effects, together with federal and state efforts to limit nursing home and home care costs, may result in a major under-provision of care for the frail elderly and exclusion of clinical geriatric medicine from the medical care system.

Community mental health and the elderly: service and training approaches.

There is a growing gap between needed and available mental health services for older adults. This article discusses the training needs, personnel shortages, and lack of effective service programs and proposes some strategies for dealing with the problems. There is a lack of adequate methods for identifying and referring frail elderly persons in need of mental health services. Services that are currently available to the elderly are identified along with factors that may influence their use by older adults and other service personnel. There are shortages of mental health professionals with special training and experience in gerontology and geriatrics, and clinical geropsychologists. An innovative and practical service model that was developed to coordinate and integrate the identification and treatment of frail, community-dwelling elderly is presented. Various aspects of the program that include outreach and case management approaches, the integration of student volunteer activities with those of special volunteer corps within public housing and specially trained paraprofessionals, telephone reassurance programs, and a system of layered supervision are described. Comparisons are made between this Coordinated Agency Resources for Elderly Services (CARES) model and existing service delivery programs. A three-tiered approach to training and coordinating the activities of trained mental health personnel: (a) paraprofessionals and volunteers, (b) middle-level professionals and (c) supervisory professionals within an integrated system is proposed. Specific roles and functions of personnel at each level are described. The summary discusses the potential of the proposed strategies for dealing with the problems created by the shortage of personnel and services. It suggests some time frames within which the strategies could be operationalized.

A geriatric rehabilitation and assessment unit in a community hospital.

This report describes functional status at admission, discharge, and six months later for 100 elderly persons treated at a community hospital assessment and rehabilitation unit. The goal of the unit is to prevent institutionalization of frail elderly persons considered at risk for nursing home placement. Characteristics of the first 100 admissions include the following: average age, 79 years; female, 77 per cent; length of stay, 23 days; average number of admitting diagnoses, 3.4. Ninety-one new diagnoses of treatable conditions were made. On admission, 81 per cent of patients were confined to bed or chair or needed assistance with ambulation, compared with 27 per cent at discharge and 22 per cent at six months. Activities showing significant improvement include dressing, housekeeping, use of toilet, and ambulation. At six months, 15 per cent had died, 67 per cent were living in the community, and 19 per cent were institutionalized. It is concluded that care at the geriatric unit probably resulted in improved function and decreased nursing home placement.

Intergenerational Care Providers of Non-Institutionalized Frail Elderly

This study reports on the care provided to (41) non-institutionalized frail older persons by their children and/or grandchildren. The study is based on a population of frail elderly persons referred for in-home assessment services to the Iowa Model Gerontology Project in Scott County, Iowa. These referrals were based on the referral sources belief that the older person was at risk for institutional care. The study explores three aspects of intergenerational family caregiving: the characteristics of the off-spring caregivers, their perceptions of both the positive and negative impacts of providing care, and their perceptions of supplementary assistance needed and desired from outside agencies in carrying out the caregiving tasks.

Role conflict for aides in a homemaker aide program for frail elderly persons.

To determine whether aides in a homemaker program for the frail rural elderly experienced role conflict, the views of clients, aides, and staff were examined by means of an 18-item Likert-type test which assessed the difficulty of an aide in various possible problematic situations. While consensus existed among the three groups on a few items, a significant interaction of clients, aides, staff × item indicated that, for the most part, whether or not a situation was perceived as a difficult problem depended upon who did the rating. What aides saw as a difficult problem situation for themselves often differed markedly from what the staff and clients saw. Clients and staff often differed significantly from one another. This lack of consensus suggests that a direct service worker in a program such as this one might often not only find himself in an uncomfortable situation, but even worse, such a situation will not necessarily be recognized by either the program's clients or staff.

The Impact of Visitation on Patient Well-Being in Nursing Homes

A substantial body of research documents the importance and pervasiveness of supportive contact by family members with frail elderly persons. For elderly living in the community, the primary sources of supportive care, often instrumental in avoiding institutionalization, are friends and family (Brody et al., 1978; Cantor, 1977; Community Council, 1978; Shanas, 1979). It has likewise been documented that elderly persons are not abandoned by family upon institutional entry but typically maintain extensive family contacts, mainly via visitation by family members (York & Calsyn, 1977). This latter finding has been of particular interest since it has helped to dispel the myth that elderly persons are dumped into nursing homes and abandoned by their families (Shanas, 1979). Indeed, some evidence suggests that the quality of interpersonal relationships between the institutionalized elderly person and family members has sometimes been improved, rather than attenuated or destroyed, as a result of institutionalization (Smith & Bengtson, 1979). Although it is generally assumed that the maintenance of family contacts by impaired elderly residents of nursing homes, particularly through visitation, is important to patient well-being, to our knowledge no systematic empirical research bearing directly on this question has been reported in the literature. In related studies, however, Harel (1981) has found that patients who attribute greater importance to continuity of social relationships tend to have better morale and Gottesman (1974) has found that patients who are visited more frequently appear to receive more attention from staff. Furthermore, no systematic research on factors that influence the propensity of a patient to

Cerebral atherosclerosis--a comparative autopsy study between Nigerian Negroes and American Negroes and Caucasians.

Respiratory syncytial virus (RSV) is the most common single cause of respiratory hospitalisation of infants and is the second largest cause of lower respiratory infection mortality worldwide. In adults, RSV is an under-recognised cause of deterioration in health, particularly in frail elderly persons. Infection rates typically rise in late autumn and early winter causing bronchiolitis in infants, common colds in adults and insidious respiratory illness in the elderly. Virus detection methods optimised for use in children have low detection rate in adults, highlighting the need for better diagnostic tests. There are many vaccines under development, mostly based on the surface glycoprotein F which exists in two conformations (prefusion and postfusion). Much of the neutralising antibody appears to be to the prefusion form. Vaccines being developed include live attenuated, subunit, particle based and live vectored agents. Different vaccine strategies may be appropriate for different target populations: at-risk infants, school-age children, adult caregivers and the elderly. Antiviral drugs are in clinical trial and may find a place in disease management. RSV disease is one of the major remaining common tractable challenges in infectious diseases and the era of vaccines and antivirals for RSV is on the near horizon.