ElderWeb

The 236-page conference abstracts book from the 15th National Conference on Chronic Disease Prevention and Control is available online in PDF format from the National Center for Chronic Disease Prevention and Health Promotion.

Yale researchers have designed a cost-saving program that helps prevent older patients from declining physically and mentally while hospitalized. The problem of functional and mental decline is increasingly important since patients aged 65 and older account for more than 48% of all hospital days, said Sharon Inouye, M.D., associate professor of internal medicine and geriatrics at Yale School of Medicine. She is principal investigator of the study published in the December issue of the Journal of the American Geriatric Society about the new Hospital Elder Life Program.

The Hospital Elder Life Program involves entire hospital units, provides skilled staff and trained volunteers to implement interventions for all patients, and targets interventions to specific risk factors. Under the program, patients 70 and older are screened on admission for six delirium risk factors: cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment. Targeted interventions for these risk factors are implemented by an interdisciplinary team, which includes a geriatric nurse specialist, elder life specialists, trained volunteers and a geriatrician. All work closely with the primary nurses. Other experts provide consultation at twice-weekly interdisciplinary rounds.

To date, 1,507 patients have been enrolled during 1,716 hospital admissions. The overall intervention adherence rate was 90% for at least partial adherence with all interventions during 37,131 patient days.

Patients In Program vs Not In Program Who Declined 2%+ While in Hospital:

Decline Measured by: Mini-Mental State Examination (MMSE) 8% vs 26%
Decline Measured by: Activities of Daily Living (ADL) 14% vs 33%

Preliminary, unpublished results show that the program reduces overall hospital costs by $1,500 per patient. Start up costs for the program include the equivalent of 1.7 fulltime paid staff and equipment costs estimated to be about $3,000 for one or two hospital units totaling 35 to 70 beds. The figure includes an optional computer expense of $1,500 for patient enrollment, volunteer assignments, and tracking of adherence and program outcomes. The program is effective for delirium prevention and insomnia. Other benefits include providing cost effective care, gaining recognition as a center of excellence, enhancing patient satisfaction, improving community outreach, and serving as an educational site for acute geriatric care.

Co-authors of the paper include Sidney Bogardus, M.D., assistant professor of internal medicine and geriatrics and medical director of the Adler Geriatrics Assessment Center; Dorothy Baker, research scientist in the Department of Epidemiology and Public Health (EPH); Linda Leo-Summers, programmer-analyst, EPH, and Leo Cooney, M.D., professor and section chief, general internal medicine. The study was funded by the National Institute on Aging, The Commonwealth Fund, the Retirement Research Foundation, the Community Foundation for Greater New Haven and the Yale New Haven Hospital Auxiliary.

Older patients hospitalized with pneumonia for an increasingly shorter length of time are more likely to be re-admitted or discharged to a nursing home, a study by a Yale researcher and collaborators shows. This is important because the length of hospital stays is declining nationwide. Pneumonia among older patients is responsible for more than 600,000 hospitalizations nationally and $9 billion in health care costs every year. About 10% of patients older than 64 who are hospitalized with pneumonia die while hospitalized. Many more die within a month of being discharged. Of those patients who do survive, about 12% require placement in a long-term care or rehabilitation facility.

Meehan and his co-researchers looked at patients over 65 who were discharged from Connecticut hospitals between Oct. 1, 1991 to Sept. 30, 1997, after being treated for pneumonia. In that six-year period, the average length of stay for these patients dropped by about 4 days. They found that the mortality rates during the patients' hospital stays declined, because they were there for a much briefer period of time, but:

* The percentage of patients transferred to long term care facilities increased from 30% to 43%.

* The rate of mortality within 30 days after discharge increased from 7% to 9%.

* Re-admissions to the hospital for pneumonia within 30 days of discharge increased from 3% to 4%.

The mean adjusted costs associated with hospitalization for pneumonia declined steadily over the five year period from $9,228 to $6,897. The next study they plan will look at the total cost to the healthcare system when you factor in rates of re-admission and transfer to long term care facilities.

The principal investigator of the study was Mark Metersky, M.D., of the University of Connecticut School of Medicine. Co-authors included Michael Fine, M.D., of the University of Pittsburgh School of Medicine; and Janet Tate, MPH, and Marcia Petrillo, MA, of Qualidigm, a quality improvement organization based in Middletown. Metersky and Meehan also are affiliated with Qualidigm.

Nurses who graduate from bachelor's-degree programs should have the skill to recognize the complex interactions of acute and chronic conditions common in the elderly, use technology to enhance older adults' independence and safety, and assess older adults' physical, cognitive, psychological, social and spiritual status, say new guidelines issued by the American Association of Colleges of Nursing (AACN) and the John A Hartford Foundation Institute for Geriatric Nursing (Hartford Institute).

They point out that over 48% of hospital patients, 80% of home care patients, and 85% of all residents of nursing homes are elderly. Because of this, the overwhelming majority of nurses practicing in this country today are, by default, geriatric nurses. In spite of that, the number of master's prepared geriatric nurses remains very small. Approximately 1,800 nurses nationally are certified by the American Nurses Credentialing Center (ANCC) as Geriatric Nurse Practitioners, and only 500+ are certified as Gerontological Clinical Nurse Specialists (GCNS).

AACN publication "The Essentials of Baccalaureate Education for Professional Nursing Practice" provides a framework for developing, defining, and revising baccalaureate nursing curricula. This document addresses the professional values, core competencies, core knowledge, and role of the professional nurse. In addition, the document stresses the need for course work and clinical experiences to prepare the graduate to provide care across the lifespan, with particular attention to changes due to aging.

The U.S. Department of Transportation (DOT) and the U.S. Department of Health and Human Services (HHS) are jointly developing a coordination resource, the Transportation Coordination Toolkit, to assist states and communities in their efforts to improve access to transportation services for persons with special mobility needs. Many of these persons need specialized transportation to access the human service programs funded by HHS. To address the overlapping responsibilities, the Coordinating Council on Access and Mobility was created, and is jointly staffed by DOT and HHS.

The initial piece in the Transportation Coordination Toolkit is a guide to coordinating transportation planning for programs in DOT and HHS. This guide addresses the specific information necessary to coordinate the transportation resources of various programs of DOT and HHS. The potential benefits from coordinating transportation services include increased service levels, increased mobility for all consumers, better quality of service for riders, cost savings, upgraded maintenance programs, better reporting and record keeping, more equitable cost sharing between participating agencies and individuals, more professional delivery of transportation services, and safer transportation services.

This guide provides details on 12 HHS programs and 11 DOT programs. Together, these 23 programs provide almost $10 billion annually to assist transportation systems to provide trips for persons with special transportation needs. However, there are over 70 federal programs in which some aspect of transportation services is an allowable use of funds, and the need for information on these programs will be addressed in a future tool, a compilation of these Federal-funding sources called "Building Mobility Partnerships."

The Journal of the American Medical Association (JAMA) reports on a study led by Peter I. Buerhaus, PhD, RN, where researchers studied the implications of the increasing age of the nursing work force. They found that between 1983 and 1998 the average age of working RNs increased by more than 4 years, while the proportion of the RN workforce younger than 30 years old decreased from 30% to 12%, and the number of working nurses younger than 30 years old decreased by 41%. In contrast, the average age of the US workforce as a whole increased by less than 2 years during this period, while the total labor force in the United States younger than 30 years decreased by less than 1%.

The researchers conclude that the primary factor that created the aging of the RN workforce appears to be the decline in the number of younger women choosing nursing as a career during the last 2 decades, and postulate that unless this trend is reversed, the RN workforce will continue to age, and eventually shrink, and will not meet projected long-term workforce requirements.

President Clinton signed an executive order to create the White House Commission on Complementary and Alternative Medicine Policy. The commission is to report on the education and training of health care practitioners in complementary and alternative medicine, coordinated research to increase knowledge about complementary and alternative medicine practices and products, the provision to health care professionals of reliable and useful information about complementary and alternative medicine that can be made readily accessible and understandable to the general public, and guidance for appropriate access to and delivery of complementary and alternative medicine.