Myrna Silverman

Evaluation of outpatient geriatric assessment: a randomized multi-site trial.

OBJECTIVE: To evaluate the process and outcome of outpatient consultative geriatric assessment compared with traditional community care.

Recruiting older adults for clinical trials.

More than 400 community-dwelling older adults were recruited into a clinical trial which compared the effectiveness of diagnosis and treatment through geriatric assessment with that provided through usual community physician care. Six recruitment methods were utilized: referrals, solicitations, presentations, media, mailings, and fliers. Each method is described and its results reported in terms of numbers recruited, yield, and cost per participant. The most efficient method was referrals; the method producing the largest number was presentations; the least effective method was fliers. Problems and solutions are discussed, and guidelines for recruiting older adults are suggested. These guidelines include: monitoring with accompanying adaptation, targeting the groups most likely to benefit, providing incentives, and reducing uncertainty among potential participants.

Women's Retirement:

Womens work related issues such as retirement have not traditionally interested researchers. Social research has recently produced new information on womens work and retirement. However, such work has been quantitative, focusing on measurements of attitudes, satisfaction with retirement, and economic stability. This a proach has resulted in gaps in the record which we feel may be crosed through a case study approach. Pilot data from our research on womens retirement using such an approach suggests that womens decisions regarding retirement and its process may be more complex than previously reported in areas of family health problems, retirement planning and spouses retirement.

Strategies for Increasing the Rigor of Qualitative Methods in Evaluation of Health Care Programs

The traditional quantitative emphasis of health services research obscures the fact that qualitative techniques are the best means of investigating the evaluation of certain health services research problems. Two evaluation studies employing qualitative methods are described to illustrate the appropriateness of such methods for addressing certain research questions. A brief discussion of current opinion concerning reliability and validity issues associated with these methods is provided A detailed description of the techniques that can be used to improve the rigor and credibility of qualitative methods in evaluation research concludes this article.

Maintenance of Mobility in Residents of an Alzheimer Special Care Facility

The cognitive and functional decline of demented residents in a specialized Alzheimers facility was compared to that of demented residents living in a traditional nursing home. All residents met DSM-III-R criteria for dementia. The evaluation consisted of a clinical interview with patients and collateral assessments of cognition, general health, problem behaviors, depression, and a broad range of activities of daily living (ADLs) including mobility. Residents were evaluated at baseline and 6-month intervals over 18 months. Similar rates of decline were found in cognition and overall ADLs in both groups. However, the most striking finding was preserved mobility in residents of the Alzheimers facility. This finding suggests that specialized facilities do not halt or slow the overall progression of cognitive and functional decline seen in Alzheimers disease; however, residents of such facilities may show slower decline in mobility.

Self-Care and Professionally Guided Care in Osteoarthritis Racial Differences in a Population-Based Sample

Objective: The aim of this study was to examine the prevalence of self-management practices among older White and African American persons with osteoarthritis. Self-management was defined broadly to include all behaviors adopted to reduce morbidity, whether recommended by physicians or not. Methods: A population-based sample of Medicare beneficiaries (N = 551) was recruited. An expanded set of self-management behaviors using structured and open-ended inquiry, along with use of arthritis-specific medications was elicited. Results: Few differences in self-care behaviors between race groups were found. However, older African American persons were significantly less likely to have prescriptions for nonsteroidal anti-inflammatory agents (NSAIDs) and more likely to use over-the-counter nonprescription analgesics. Discussion: Older White and African American persons made similar use of self-care strategies to reduce disease morbidity. African Americans without access to prescription pain relievers substituted nonprescription analgesics. A broader view of self-management is valuable for assessing the ways people may move between professionally guided care and self-care.

Self care for chronic illness: Older African Americans and whites

In-person interviews with two hundred and twenty-one older African Americans and whites in Allegheny County, Pennsylvania on their use of self care activities in the care of one of four chronic illnesses (chronic obstructive pulmonary disease (COPD), heart disease, diabetes mellitus, and arthritis, addressed which types of self care they used for each of these illnesses) the similarities and differences between African Americans and whites in their use of self care and how self care is initiated, modified and integrated into a context that includes help from others. The most common response in each of the illnesses was the use of medications or medical treatments by both African Americans and whites. However, there were some differences in the self care practices used by these two groups by illness type. Whites reported monitoring their illness significantly more than African Americans for diabetes and using assistive devices in the management of COPD significantly more than African Americans. While both African Americans and whites practice self care similarly in the management of heart disease, African Americans reported greater use of exercise in their management of arthritis. The amount of assistance provided by others in support of self care varied by illness and by African American and white. The differences in self care usage may be attributed to many factors, among them, differences in cultural experiences with the illness, health beliefs regarding its efficacy and the amount of assistance received from informal supports.

Identification and Intervention for Urinary Incontinence by Community Physicians and Geriatric Assessment Teams

Objective: To determine the difference in the recognition and intervention/referral rates for urinary incontinence (UI) by out‐patient Geriatric Assessment Units (GAUs) and private physicians in community‐based practices (CMDs).

Geriatric assessment: Inside the black box

Abstract Geriatric assessment, a new, multidisciplinary team approach to health care for older adults, is examined in terms of what happens during the assessment, how it is interpreted by the providers, the patients and their families, and how these interpretations may affect the assessment outcomes. Four outpatient geriatric assessment units were studied and nineteen of their patients/families observed as they went through the assessment. Interviews and observations revealed that although there was some variation between the units, the core of the geriatric assessment remained the same for all. Through case studies of patients and families, four elements which can affect the operation and efficacy of geriatric assessment were identified. This study has implications for the role that process studies can play in the evaluation of geriatric assessment.

Overcoming Barriers to Serving the Aging/Mental Health Client

This paper presents a model, based upon a series of state-level initiatives in the Commonwealth of Pennsylvania, for improving coordination between the aging and mental health systems to better serve elderly persons with mental health problems. The mental health needs of the elderly are discussed and service delivery obstacles - systemic, individual, and agency/staff - are reviewed and synthesized. Policy initiatives by the Commonwealth of Pennsylvania that relate to these issues are presented as a case study, with a focus upon a series of regional conferences held around the state for providers in the aging and mental health networks to encourage better coordination of services. The process and outcomes of these conferences are discussed, together with an analysis of the implications for practice, policy, and teaching.