Health Resource Package: Older Adults

Congress Asks . . .

How Can We Improve the Quality of Health Care Provided to At-Risk Older Adults?

RAND Health Research

The quality of health care provided to the elderly is an increasing concern.

  • More people are surviving to old age.
  • Existing tools for measuring quality of health care and health status are often inappropriate for the elderly.
  • Older adults substantially prefer certain types of care and do not consistently prefer care that prolongs life over comfort.

RAND has developed evidence-based guidelines to evaluate the quality of health care delivered to community-dwelling older adults.

  • A survey taken to assess age, self-rated health, limitations in physical capability, and functional limitations can identify elderly at risk for functional decline or death.
  • Thirty-two percent of the sample in the pilot study was identified as vulnerable (proportion varies by population).
  • Twenty-two illnesses and conditions were identified as most critical.
  • Indicators of minimum standards for care were developed for each condition covering prevention, diagnosis, treatment, and follow-up.

The indicators can be used to assess and improve care.

  • Fact sheets based on the indicators have been disseminated to primary care providers nationwide.
  • Indicators are not practice guidelines (which aim to define optimal or ideal care in the context of complex decisionmaking); rather, indicators are tools to set a minimal standard for acceptable care.
  • These indicators assess care at the system level, not at the level of the individual patient.

This work has entered a second phase, which aims to improve medical care provided to older adults and to develop methods for changing clinical practice that will be tailored to private settings.

References

This fact sheet is based on the following publications:

"Developing Quality of Care Indicators for the Vulnerable Elderly: The ACOVE Project." 2002; RAND RB-4545.

Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ, Roth C, MacLean CH, Shekelle PG, Sloss EM, Wenger NS. "The Vulnerable Elders Survey: A Tool for Identifying Vulnerable Older People in the Community." Journal of the American Geriatric Society. 2001;49(12):1691-1699.

Wenger NS, Shekelle PG. "Assessing Care of Vulnerable Elders: ACOVE Project Overview."Annals of Internal Medicine. 2001;135(8, Pt.2):642-646.

For more information, contact Shirley Ruhe at (703) 413-1100, extension 5632, or by email at ruhe@rand.org.