Improving Health Care for Older Patients
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SOURCE: Shekelle PG, Rubenstein L, Solomon D, Roth CP, Chang J. Quality of Health Care Received by Older Adults," RB9051, RAND, 2004.
Older adults are especially vulnerable to the effects of poor care. But until recently, we have lacked reliable information about the quality of care that elders receive.
A RAND Health team developed and applied the first quality-of-care system for vulnerable older adults — those most likely to die or become frail in the next two years. The Assessing Care of Vulnerable Elders (ACOVE) study is the most comprehensive examination to date of the quality of medical care provided to vulnerable older Americans.
Consistent with findings from other RAND assessments of health care quality, the ACOVE team found that the vulnerable elderly received recommended care only half the time. Care for geriatric conditions — such as dementia and urinary incontinence--was even poorer. In addition, physicians often failed to prescribe recommended medications for older adults and did not adequately screen for chronic pain.
Quality of care matters. Patients who receive better care are more likely to be alive three years later than those who received poorer care.
To help improve care for elders, the RAND team designed and tested a program to train office staff to screen patients for three conditions associated with aging (impaired mobility, urinary incontinence, and cognitive impairment) and to provide recommended treatment as appropriate. RAND's evaluation found that the program improved care for mobility impairments and incontinence, but it didn't improve care for conditions that weren't the focus of the program.
The findings from ACOVE suggest that medical schools and residency programs should increase their emphasis on diagnosis and treatment of geriatric conditions, particularly as the baby-boomer population ages. In addition, patients and their family members need to be better informed about appropriate care for age-related ailments.
In 2008, the ACOVE project was awarded the John M. Eisenberg Patient Safety and Quality Award in recognition of the project's contributions to improving geriatric care.