Robert McCann

Program of All-inclusive Care for the Elderly (PACE): An Innovative Model of Integrated Geriatric Care and Financing

OBJECTIVES: The Program of All‐inclusive Care for the Elderly (PACE) is a long‐term care delivery and financing innovation. A major goal of PACE is prevention of unnecessary use of hospital and nursing home care.

Geriatric Co-Management of Proximal Femur Fractures: Total Quality Management and Protocol-Driven Care Result in Better Outcomes for a Frail Patient Population

Hip fractures in older adults are a common event, leading to substantial morbidity and mortality. Hip fractures have been previously described as a “geriatric, rather than orthopedic disease.” Patients with this condition have a high prevalence of comorbidity and a high risk of complications from surgery, and for this reason, geriatricians may be well suited to improve outcomes of care. Co‐management of hip fracture patients by orthopedic surgeons and geriatricians has led to better outcomes in other countries but has rarely been described in the United States. This article describes a co‐managed Geriatric Fracture Center program that has resulted in lower‐than‐predicted length of stay and readmission rates, with short time to surgery, low complication rates, and low mortality. This program is based on the principles of early evaluation of patients, ongoing co‐management, protocol‐driven geriatric‐focused care, and early discharge planning. This is a potentially replicable model of care that uses the expertise of geriatricians to optimize the management of a common and serious condition.

The Relationship Between Ethnicity and Advance Directives in a Frail Older Population

OBJECTIVE: To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly).

Acute Respiratory Tract Infection in Daycare Centers for Older Persons

OBJECTIVE: To evaluate the rate of specific pathogens and clinical syndromes associated with acute respiratory tract infections (ARTI) in frail older persons attending daycare.

Ethnicity and decision-makers in a group of frail older people

OBJECTIVE: To assess the relationship between ethnicity and decision‐makers expressing healthcare wishes in a group of frail older persons enrolled in the Program of All‐inclusive Care for the Elderly (PACE).

The "common cold" in frail older persons: impact of rhinovirus and coronavirus in a senior daycare center.

OBJECTIVE: To evaluate the incidence and impact of rhino‐virus and Coronavirus infections in older persons attending daycare.

Evaluation of a handwashing intervention to reduce respiratory illness rates in senior day-care centers

To decrease respiratory infections in senior day care, staff were educated on viral transmission and the value of hand washing. Fanny packs with alcohol foam supplemented hand washing and were alternated monthly between centers. Infection rates were unchanged with alcohol foam use. The intervention years infection rate was significantly lower than the previous 3 years, suggesting a benefit of education.

Evaluation of Four Methods for the Diagnosis of Respiratory Syncytial Virus Infection in Older Adults

OBJECTIVE: To evaluate four methods of rapid diagnosis of respiratory syncytial virus (RSV) infection in older adults and to compare sensitivities with serologic analysis.

An Emergency Medical Services Program to Promote the Health of Older Adults

OBJECTIVES: To evaluate the feasibility and effect of an emergency medical services (EMS) program that screened, educated, and referred older adults with unmet needs.

Randomized Controlled Trial of CARE: An Intervention to Improve Outcomes of Hospitalized Elders and Family Caregivers

In this randomized controlled trial we tested the efficacy of an intervention program (CARE: Creating Avenues for Relative Empowerment) for improving outcomes of hospitalized older adults and their family caregivers (FCGs). FCG-patient dyads (n = 407) were randomized into two groups. The CARE group received a two-session empowerment-educational program 1-2 days post-admission and 1-3 days pre-discharge. The attention control group received a generic information program during the same timeframe. Follow-up was at 2 weeks and 2 months post-discharge. There were no statistically significant differences in patient or FCG outcomes. However, inconsistent evidence of role outcome differences suggests that CARE may benefit certain FCG subgroups instead of being a one-size-fits-all intervention strategy. Closer examination of CAREs mechanisms and effects is needed.