Profiling care and benchmarking best practice in care of hospitalized elderly: the Geriatric Institutional Assessment Profile.

This article reports on a new instrument, the Geriatric Institutional Assessment Profile (GIAP), developed to assess (1) hospital workers' knowledge, attitudes, and perceptions regarding care of geriatric patients, and (2) the perceived adequacy of an institutional environment to serve geriatric patients' needs. Findings are reported from 303 questionnaires completed by health care employees from a 658-bed academic medical center. Internal consistency estimates were consistently high for the various components of the GIAP. Factor analysis was performed to examine underlying dimensions of knowledge and institutional environment. The GIAP has the potential to narrow the gap between actual and best practice in geriatric care by identifying staff information needs and concerns, as well as institutional barriers and facilitators to providing quality geriatric hospital care.

An intervention study to enhance medication compliance in community-dwelling elderly individuals.

OBJECTIVE: To determine whether daily videotelephone or regular telephone reminders would increase the proportion of prescribed cardiac medications taken in a sample of elderly individuals who have congestive heart failure (CHF). METHODS: The authors recruited community-dwelling individuals age 65 and older who had the primary or secondary diagnosis of CHF into a randomized controlled trial of reminder calls designed to enhance medication compliance. There were three arms: a control group that received usual care; a group that received regular daily telephone call reminders; and a group that received daily videotelephone call reminders. Compliance was defined as the percent of therapeutic coverage as recorded by Medication Event Monitoring System (MEMS) caps. Subjects were recruited from 2 sources: a large urban home health care agency and a large urban ambulatory clinic of a major teaching hospital. Baseline and post-intervention MOS 36-Item Short-Form Health Survey (SF-36) scores and Minnesota Living with Heart Failure (MLHF) scores were obtained. RESULTS: There was a significant time effect during the course of the study from baseline to post-intervention (F[2,34] = 4.08, p < .05). Over time the elderly individuals who were called, either by telephone or videotelephone, showed enhanced medication compliance relative to the control group. There was a trend, but no significant difference between the two intervention groups. Both SF-36 and MLHF scores improved from baseline to post-intervention for all groups. There was no significant change in the SF-36 scores for the sample, but there was a significant change for the MLHF scores (p < .001). The control group had a significant fall off in the medication compliance rate during the course of the study, dropping from 81% to 57%. CONCLUSIONS: Telephone interventions are effective in enhancing medication compliance and may prove more cost effective than clinic visits or preparation of pre-poured pill boxes in the home. Technologic advances which enable clinicians to monitor and enhance patient medication compliance may reduce costly and distressing hospitalization for elderly individuals with CHF.

Pain management protocol. NICHE Faculty.

Pain management for the elderly person is complex, challenging, but ultimately rewarding for the nurse who learns the core knowledge for assisting the older individual who is in pain.

Diagnostic and treatment guidelines on elder abuse and neglect.

It is estimated that between 1.5 and 2 million older adults experience abuse or neglect each year in the United States. Elder mistreatment may be physical, psychological, or financial, and it may be perpetrated by family members or by other informal or formal caregivers. Physicians are encouraged to play an active role in assessment, intervention, and prevention.

Needs of the family during critical illness of elderly patients.

Persons 65 years of age or older occupy 46% of all intensive-care beds. This number will rise in the next decade as the percentage of persons age 65 or older rises to a projected 13% by the turn of the century. Elderly patients require care that may be different from their younger counterparts. The needs of the families of the elderly may also be different. Nurses should carefully consider the needs and differences of each family, especially the need to participate in care and to be with the elder and the needs for information, reassurance, and comprehensive discharge planning.

Mistreatment of elders. Assessment, diagnosis, and intervention.

Elder mistreatment is a significant elder care issue that demands a concerted, multidisciplinary effort and systematic follow-up in order to provide positive results. As our nation continues to age and the profile of the care provider changes with more women in the work force and fewer offspring to provide care, there is a potential for an epidemic of elder mistreatment. Thoughtful planning now can provide the system and personnel to make the difference as more and more people become potential victims.