T. Franklin Williams

Fall risk index for elderly patients based on number of chronic disabilities

The present study was designed to identify prospectively the individual chronic characteristics associated with falling among elderly persons and to test the hypothesis that risk of falling increases as the number of chronic disabilities increases. Seventy-nine consecutive admissions to three intermediate care facilities were evaluated. Twenty-five of the subjects became recurrent fallers. The nine risk factors included in the fall risk index were mobility score, morale score, mental status score, distant vision, hearing, postural blood pressure, results of back examination, postadmission medications, and admission activities of daily living score. A subjects fall risk score was the number of index factors present. The proportions of recurrent fallers increased from 0 percent (0 of 30) in those with 0 to three risk factors, to 31 percent (11 of 35) in those with four to six factors, to 100 percent (14 of 14) in those with seven or more factors. Falling, at least among some elderly persons, appears to result from the accumulated effect of multiple specific disabilities. Some of these disabilities may be remediable. The mobility test, the best single predictor of recurrent falling, may be useful clinically because it is simple, recreates fall situations, and provides a dynamic, integrated assessment of mobility.

The ecology of medical care

CURRENT discussions about medical care appear largely concerned with two questions: Is the burgeoning harvest of new knowledge fostered by immense public investment in medical research being delive...

Instruments for the Functional Assessment of Older Patients

Structured assessment instruments are particularly useful in screening for problems that often go undetected in older patients. In addition, such instruments can provide information about conditions and abilities or limitations that are not regularly assessed in standard clinical practice. Often, their administration is delegated to other health professionals, but these tools still provide useful information to the physician. Clinicians should view assessment instruments as they would any other clinical test. They should be familiar with the strengths, weaknesses, and precision of any test used and understand how best to use the test as an adjunct to clinical practice. In addition, clinicians must learn to focus on functional status, in terms of both assessment and outcome, in their care of older patients.

How Does the Team Approach to Outpatient Geriatric Evaluation Compare with Traditional Care: A Report of a Randomized Controlled Trial

Although team‐oriented geriatric assessment clinics are growing throughout the country, little documentation exists regarding their clinical efficacy, cost‐effectiveness, or impact on patient functioning and well‐being. This report describes a randomized controlled clinical trial to evaluate the effectiveness of a team‐oriented geriatric assessment approach compared to traditional care. One hundred‐seventeen subjects 65 years of age and over, meeting eligibility criteria to target frail older persons with changing medical and social needs, were randomly assigned to receive a comprehensive geriatric assessment by a multidisciplinary team (treatment) or by one of a panel of community internists who were reimbursed according to their usual and customary fee (controls). Extensive analysis of baseline information failed to identify any significant differences between groups. Over the 1‐year follow‐up period, treatment participants experienced 26 hospital admissions and used 670 hospital days compared with 23 admissions and 1113 days for controls (a 39.8% difference). Annual hospital costs averaged

New model of health promotion and disease prevention for the 21st century

4297 for treatment subjects and

Families, informal supports, and Alzheimer's disease. Current research and future agendas.

7018 for controls. Overall institutional costs including hospital and nursing home care revealed an average saving of

Geriatric Consultation Teams in Acute Hospitals: Impact on Back‐up of Elderly Patients

2189 per person for treatment subjects compared with controls, a 25% reduction. A small proportion of subjects accounted for this difference. No significant differences were noted in patient or caregiver satisfaction with the evaluation process, functional ability, or health status. These findings suggest that team‐oriented outpatient geriatric assessment provides a promising way to deliver high‐quality, satisfying care to older persons without increasing (and possibly decreasing) health care costs.

Social support and risk-adjusted mortality in a frail older population

Our susceptibility to disease increases as we grow older. Robert Butler and colleagues argue that interventions to slow down ageing could therefore have much greater benefit than those targeted at individual disease

Observation of Medication Errors Made by Diabetic Patients in the Home

With the aging of most Western populations, there is growing research attention to the social and behavioral aspects of age-related chronic diseases and disabilities. Research is just beginning to focus on how families and other social supports affect and are affected by Alzheimers Disease and related disorders. This article reviews the current state of knowledge in this area and suggests a future research agenda.

Diabetes and dementia in long-term care

Back‐up of elderly patients in hospital awaiting long‐term placement has become a major problem in some areas of the United States and elsewhere. In 1982, geriatric consultation teams (physician, nurse, and social worker) were introduced into six acute hospitals in Monroe County, New York, to help alleviate the problem through more attention to restoration of patient function and comprehensive discharge planning. Over a six‐month period, 4,328 newly hospitalized patients aged 70 or older were screened, and geriatric consultations were provided for 366 (8.5 per cent) who were judged to be at risk of requiring prolonged hospital stays. During this period, the mean monthly census of elderly patients backed up in hospital declined 21 per cent, a reversal of previous rises that could not be explained by any other identifiable factors. The impact was on length of stay on back‐up status rather than rate of entry to that status. A variety of medical, rehabilitative, and social interventions accounted for this outcome. A number of health care system barriers to expeditious rehabilitation and discharge of hospitalized elderly patients were identified. Geriatric consultation was deemed useful for implementation in acute hospitals in other settings.