Health Care For Elderly Patients Research Articles

A clinician-to-clinician universal electronic consultation programme at the cardiology department of a Galician healthcare area improves healthcare accessibility and outcomes in elderly patients.

We aimed to assess longer-term results (accessibility, hospital admissions, and mortality) in elderly patients referred to a cardiology department (CD) from primary care using e-consultation in outpatient care. We included 9963 patients >80 years from 1 January 2010 to 31 December 2019. Until 2012, all patients attended an in-person consultation (2010-2012). In 2013, we instituted an e-consult programme (2013-2019) for all primary care referrals to cardiologists that preceded a patient's in-person consultation when considered. We used an interrupted time series (ITS) regression approach to investigate the impact of e-consultation on (i) cardiovascular hospital admissions and mortality. We also analysed (ii) the total number and referral rate (population-adjusted referred rate) in both periods, and (iii) the accessibility was measured as the number of consultations and variation according to the distance from the municipality and reference hospital. During e-consultation, the demand for care increased (12.8 ± 4.3% vs. 25.5 ± 11.1% per 1000 inhabitants, P < 0.001) and referrals from different areas were equalized. After the implementation of e-consultation, we observed that the increase in hospital admissions and mortality were stabilized [incidence rate ratio (iRR): 1.351 (95% CI, 0.787, 2.317), P = 0.874] and [iRR: 1.925 (95% CI: 0.889, 4.168), P = 0.096], respectively. The geographic variabilities in hospital admissions and mortality seen during the in-person consultation were stabilized after e-consultation implementation. Implementation of a clinician-to-clinician e-consultation programme in outpatient care was associated with improved accessibility to cardiology healthcare in elderly patients. After e-consultations were implemented, hospital admissions and mortality were stabilized.

A universal electronic consultation programme at the cardiology department after general practitioner referrals to improve healthcare accessibility and outcomes in elderly patients

Abstract Background The on-line healthcare models are an opportunity to improve the accessibility and efficiency in clinical assistance, however, analyses of the effects of outpatient care on healthcare quality, including safety, are limited, particularly in vulnerable populations such as elderly patients 1. The care of elderly patients (generally &amp;gt;80 years) is usually characterized as having more chronic pathologies, particularly more cardiovascular diseases, resulting in having a worse risk profile 2. However, this group is also usually characterized by problems with functionality and dependency that can increase difficulties in moving from their homes to health care centres, particularly in areas of great geographical dispersion such as in our study 3. The healthcare systems that have integrated electronic clinical records between different assistance levels provide an electronic consultation (e-consultation) as a first step of ambulatory care for all general practitioner (GP) referrals. Healthcare systems that include an e-consultation have already shown favorable health outcomes and reduced displacement of the population served 4,5 and could also improve accessibility to outpatient care, although there are not results to demonstrate its safety in this particular group of high-risk patients. Purpose We aimed to assess the accessibility and health outcomes (hospital admissions and mortality) in elderly patients referred to a cardiology department (CD) from primary care after inclusion of an e-consultation in outpatient care. Methods We included 9,963 patients &amp;gt;80 years old referred to the CD from January 1st, 2010, to December 31st, 2019. In 2013, we instituted an e-consultation programme (2013–2019) for all primary care referrals to cardiologists that preceded patient in-person consultations when considered. We compared both models (in-person consultation and e-consultation) using I: an interrupted time series regression on delay time, hospital admission, and mortality, II: the accessibility measured as population-adjusted referred rate in both periods, and III: analysing the changes in each municipality in delay time, hospital admission and mortality. Results During the e-consult period, the demand of care increased (12.8±4.3% vs 25.5±11.1% per 1,000 inhabitants, p&amp;lt;0.001), delay for care was reduced (−0.094 days; 95% CI [−0.063, −0.140], p&amp;lt;0.001), and age-dependent delay disappeared. After the implementation of e-consults, hospital admission (incidence rate ratio [iRR]: 1.351 [95% CI, 0.787, 2.317], p=0.874), Figure 1, and mortality (iRR: 1.925 [95% CI: 0.889, 4.168], p=0.096) stabilised with a slight downward trend, Figure 2. Conclusion Implementation of e-consultations in the outpatient care programme in CD was associated with improved access to cardiology healthcare in elderly patients. After the implementation of the e-consultation, hospital admissions and mortality were stabilised and showed a slight non-significant downward trend. Funding Acknowledgement Type of funding sources: None.

Analysis of Risk Factors for Inappropriate Prescribing of Psychotropic Drugs in Primary Health Care in Elderly Patients

Abstract Backround: Older people are at risk of inappropriate drug prescribing because pharmacodynamics and pharmacokinetics, and consequently the efficacy and safety of drugs, change after patient’s age. Objective: The aim of study is to identify major significant risk factors for Potentially Inappropriate Medicines (PIM) of psychotropic drugs and Potential Prescription Omissions (PPO) of psychotropic drugs in population of patients over 65 years of age with associated pathological conditions according to Screening Tool of Older Person’s potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria. Material and method: The study was designed as a cross-sectional study involving 492 patients and 9 selected general practitioners. It was conducted in period from May 2020 to December 2021, after receiving decision from Ethics Committee of HC Kragujevac. Results: 492 patients, mean age 71.77 ± 5.95, with 62.2% women, participated in the study. 164 PIMs were identified in 139 patients (28.2%). The most common were: use of benzodiazepines over 4 weeks (43.9%) with simultaneous use of different groups of antidepressants (20.3%). Patients with more than two psychotropic drugs have a higher risk for PIM [adjusted OR 2.83, 95% CI (1.98 - 4.140], p &lt;0.001. 439 PPOs were also identified in 270 patients (54.8%). Risk factors for PPO are: age, number of illnesses, total number of medications, number patients, depression presence, patient’s place of residence, cigarettes usage and monthly income level. Conclusion: STOPP/START criteria can have a major impact in recognizing inadequate prescribing of psychotropic drugs at patients over 65 years of age. Patients who use benzodiazepines more than four weeks and / or antidepressants may be at increased risk of PIM psychotropic drugs. The total number of drugs and presence of symptoms of depression bring higher risk of PPO psychotropic drugs.

Knowledge and Behaviors Toward Health Care for Elderly Patients with Hypertension, and Quality of Life Among Informal Caregivers in Northern Thailand.

BackgroundInformal caregivers play an important role in caring for patients with chronic conditions. Little is known about the quality of life among caregivers of patients with chronic illnesses in Thailand. The purpose of this study was to investigate the relationships among knowledge and behaviors toward health care for elderly patients with hypertension, and the quality of life among informal caregivers.MethodsA total of 402 informal caregivers for their elderly co-habitants suffering from hypertension were randomly selected to participate in this cross-sectional study. Data collection was performed in rural areas of Phayao province, located in the northern part of Thailand. Self-administered questionnaires were employed, which covered knowledge and behaviors toward health care for elderly patients with hypertension, and the Thai version of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire.ResultsThe scores of knowledge and behaviors toward health care for elderly patients with hypertension, and the quality of life were at low and fair levels. In the multivariable linear regression model, the results showed that four variables – age, caregiver’s relationship to the patient, knowledge, and behaviors toward health care for elderly patients with hypertension – were significantly related to quality of life among caregivers (p < 0.05).ConclusionKnowledge and behaviors toward health care for hypertensive patients influence the quality of life among informal caregivers. The caregivers in rural communities should be encouraged to become educated on the stages of hypertension, preparation for taking care of the elderly with high blood pressure, and effective behavioral care for patients, in order to improve the quality of life of both caregiver and patient. In addition, health care providers should have clear guidelines for development of the health care system to enhance the potential care and quality of life among informal caregivers.

It is time for everyone to own the bone

The current status of the population's bone health has caused considerable concern in the USA and around the world. In keeping with that situation, the US Surgeon General issued a special report on Bone Health and Osteoporosis in 2004 calling attention to a rapidly increasing healthcare problem especially linked to a growing and aging population base. The report specifically cited the medical profession's failure to treat the underlying osteoporosis in elderly individuals with fragility fractures with a 20% treatment rate as the norm. It was noted that an individual fracture was a sentinel event that provided a "teachable moment" for the patient in order to prevent future fractures. Additional statistics revealed the annual total number of fragility fractures, more than two million, exceeded the combined annual total incidence of stroke, myocardial infarction, and breast cancer. Realizing that the American Heart Association and the cardiology community had a successful US national program encouraging the use of beta blockers in patients after myocardial infarction in order to prevent recurrences, the American Orthopaedic Association (AOA) embarked on a course leading to the development of a program to improve bone healthcare in elderly patients with fragility fractures. The cardiology project, "Get With The Guidelines" (GWTG), included a registry in order to document improvement in cardiac patient care. Therefore, the AOA, a leadership group of orthopaedic surgeons, decided it was time to engage the orthopaedic community in a quality improvement initiative patterned after GWTG. Thus, Own the Bone was created as a multidisciplinary program in order to engage patients and physicians from different specialties who might be involved with the bone health concerns of patients with fragility fractures. After the success of a pilot study from 2005 to 2006, Own the Bone was launched as a US national quality improvement program in 2009. It involves a turnkey protocol, utilizing a web-based registry, in order to complete ten basic measures of patient care in patients 50 years and older with fragility fractures. Those measures center on information and counseling on nutrition, physical activity, lifestyle changes, diagnosis and treatment of osteoporosis, and communication to the patient and primary care physician, mentioning the need for osteoporosis care. While this project was initially meant to be implemented in a hospital setting, it can also be applied in an outpatient clinic or emergency care facility. The program continues to expand to numerous hospitals in many states with the support of a growing number of orthopedists and allied medical specialists interested in bone health and osteoporosis. Thus, Own the Bone is a systems-based, quality improvement initiative which provides many benefits for patients with fragility fractures and their treating physicians.

Psychische Komorbidität bei Menschen mit chronischen Erkrankungen im höheren Lebensalter unter besonderer Berücksichtigung von Krebserkrankungen

Human life expectancy has increased, nationally and internationally, during recent years and will continue to increase in the future. Old age is commonly associated with health-related impairments, chronic diseases, increasing multimorbidity, as well as with psychosocial burdens, such as social deprivation, reduced social participation, and impairment in activities of daily living. Against this background, studies on mental health addressing psychological distress and mental disorders of older people have gained increasing attention. The aim of the present overview is to provide insight into psychological comorbidity in elderly with chronic illnesses. The following questions are addressed: (1) what are the prevalence rates of mental disorders in the elderly in general and, specifically, in patients with cancer? (2) How are mental disorders and cancer, respectively, diagnosed in elderly patients? (3) What are common risk factors associated with the development of mental disorders? (4) Which treatment options are available, and which aspects of health care for elderly patients with chronic diseases need to be considered?

Measuring Patients’ Perceptions and Social Influence on Home Telecare Management System Acceptance

Successful implementation of a Home Telecare Management System (HTMS) requires acceptance by the users, especially when technical innovation is applied to manage chronic healthcare in elderly patients, who are unaccustomed to using modern technology. Based on the Technology Acceptance Model (TAM) and Social Influence Theory (SIT), a Home Telecare Management System (HTMS) Acceptance Model is proposed and tested to improve the understanding of patients’ acceptance of HTMS and the impact of social influence on patients’ attitude and behavioral intentions in using HTMS. Via empirical research and analysis of 221 patients’ questionnaires, the partial least squares (PLS) technique indicates that most of the model’s hypotheses are significant. Implications for both theory and practice are also provided.

Improving Access to Health Care for Uninsured Elderly Patients

The purpose of this article is to explore the barriers that the uninsured elderly population encounter when accessing health care in the United States. These barriers include, but are not limited to lack of transportation, insurance, or family support; the daunting complexity of the health care system; poverty; culture; poor patient-health care provider communications; race/ethnicity; and lack of health care professionals such as nurses and doctors with adequate geriatric preparation, or generalists who are undereducated in geriatrics. The number of health care professionals currently available to treat elderly persons in the United States is inadequate. The Federal government should take steps to develop solutions to improve access to health care and decrease health disparities for older adults. As a nation, we should be proactive in addressing these concerns instead of waiting for new barriers to arise that further limit access to health care for elderly patients and their families. In this article, we provide an assessment of the barriers that limit access to health care in the uninsured elderly population and suggest recommendations and possible solutions to eliminate or reduce these barriers.

Two-Minute Mental Health Care for Elderly Patients: Inside Primary Care Visits

Two-Minute Mental Health Care for Elderly Patients: Inside Primary Care Visits

Two‐Minute Mental Health Care for Elderly Patients: Inside Primary Care Visits

To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients. Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health. Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners. Thirty-five primary care physicians and 366 of their elderly patients. Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk. Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients. Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits "during which a mental health problem is discussed" may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed.

Home health care for elderly patients after cervical myelopathy surgery

Home health care for elderly patients after cervical myelopathy surgery

Evidence for age-based rationing in a Swiss university hospital.

To test the hypothesis that rationing of medical management mainly based on age exists in our health care system today. We studied 303 consecutive patients hospitalised for acute coronary syndrome (ACS) and 163 consecutive patients hospitalised with congestive heart failure (CHF). They were divided into two age groups; patients aged less than 75 years and those equal to or older than 75 years. Our main findings were a significant underuse of stress tests (p < 0.001) and coronary angiography (p < 0.0001) in elderly patients with ACS and a significant underuse of echocardiography (p < 0.0001) in patients with CHF of the same age group. In patients with ACS, there was also a trend towards underuse of statins in elderly patients with hypercholesterolaemia. In addition, we noted that the use of beta-blockers in ACS and of ACE inhibitors in CHF was better than in previous published studies but that many patients were still not treated according to evidence based medicine. The lower rates of diagnostic tests performed and the lower statin use observed in elderly patients suggest "hidden" rationing of health care in elderly patients.

Evidence for age-based rationing in a Swiss university hospital.

To test the hypothesis that rationing of medical management mainly based on age exists in our health care system today. We studied 303 consecutive patients hospitalised for acute coronary syndrome (ACS) and 163 consecutive patients hospitalised with congestive heart failure (CHF). They were divided into two age groups; patients aged less than 75 years and those equal to or older than 75 years. Our main findings were a significant underuse of stress tests (p < 0.001) and coronary angiography (p < 0.0001) in elderly patients with ACS and a significant underuse of echocardiography (p < 0.0001) in patients with CHF of the same age group. In patients with ACS, there was also a trend towards underuse of statins in elderly patients with hypercholesterolaemia. In addition, we noted that the use of beta-blockers in ACS and of ACE inhibitors in CHF was better than in previous published studies but that many patients were still not treated according to evidence based medicine. The lower rates of diagnostic tests performed and the lower statin use observed in elderly patients suggest "hidden" rationing of health care in elderly patients.

Utilizing nurse practitioners to provide health care for elderly patients in Massachusetts nursing homes.

This study evaluates the nursing contribution to the process of care utilizing nurse practitioners (NPs) to provide health care for nursing home patients in Massachusetts. Using magnetic tapes of data collected through retrospective chart reviews of 2,651 patient records in 110 Massachusetts nursing homes, comparisons were made of the process of care variables of NP/physician team and physician-only models of care. Results from discriminant function analysis revealed process of care variables did discriminate between the two models. The conclusion that NPs provide not only a substitutive role to that of medical care but also a complementary one should be instrumental in enabling policy decisions that encourage the full utilization of NPs.