Elder Care Issues

Advice on tackling common health care issues affecting the senior population and resources to turn to for help.

Home-Based Dementia Care Offers Support to Caregiver

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Caregivers of patients with dementia claimed greater caregiver satisfaction when using geriatric care programs that included care management strategies.

Caregivers of patients with dementia claimed greater caregiver satisfaction when using geriatric care programs that included care management strategies.

If you care for a loved one who has dementia, you may have some new caregiver support tools to help better care for your loved one and delay their move to a nursing home.

In a randomized controlled trial, trained non-physician managers used evidence-based protocols to educate and offer support to caregivers through a telephone-based assessment and care management program.

Medscape Medical News reports:

In their study, lead investigator Joshua Chodosh, MD, from the UCLA Health System in Los Angeles and his team randomized 242 patient–caregiver dyads to the dementia-care management program and 256 dyads to usual care.

Care managers were trained social workers, nurses, and nurse practitioners.

Greater Caregiver Satisfaction

All caregivers were surveyed at baseline and at 9 and 18 months.

At 18 months, satisfaction with healthcare was rated higher, on a 100-point scale, by caregivers in the intervention group than in the usual care group (89.6 vs 86.3; P = .06). When caregivers rated confidence in their abilities, scores in the intervention group were 5.6 points higher than scores in the usual care group (P < .05).

The unadjusted rate of nursing home use during the intervention period, documented in patients’ medical records, was lower in the intervention group than in the usual care group (7.6% vs 17.5%; P = .042).

Improvements from baseline were seen for nearly all process measures in both group, but most between-group differences were not significant.

During the first 2 months of the study, the health plan referred 75% of members in the usual care group to geriatric care programs that included care management strategies, which were likely influenced by the intervention, Dr Chodosh reported.

In addition, most patients had moderate-severity dementia. At that stage, patients tend to need more care and are more likely to benefit from care management than those at an early stage

American Geriatrics Society (AGS) 2015 Annual Scientific Meeting: Abstract P1. Presented May 15, 2015.


Program Reduces Falls; Keeps Seniors Home Longer

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Are you at risk for falling? Risk factors include fear of falling, gait and balance issues, certain medications, clutter in the home, and some health conditions.

Are you at risk for falling? Risk factors include fear of falling, gait and balance issues, certain medications, clutter in the home, and some health conditions.

A new falls prevention program developed by the U.S. Department of Health and Human Services is expected to help seniors stay in their homes longer and postpone the move into other long-term care settings such as nursing homes.

The prevention program includes clinical in-home assessments of health, physical functioning, falls history, home environment, and medications to create customized recommendations.

The study found that the program led to significantly lower rates of falls over a one-year study period. Those who received the intervention had a 13 percent lower rate of falls, and an 11 percent reduction in risk of falling compared to the control group. Participants also had a significantly lower rate of injurious falls. Long-term care insurance claims were 33 percent lower over a three-year period. The intervention, which cost $500 per person to administer, saved $838 per person.

Falls, which occur to 1 in 3 people age 65 and over every year, can cause pain, suffering, and death, and cost an estimated $35 billion in health care spending in 2014. They are a leading risk factor for needing long-term care at home or in a nursing facility.

“While falls are preventable, we need to intervene at the right time in a way that is comprehensive and yet individually tailored,” said Richard Frank, Ph.D., the assistant secretary for planning and evaluation at HHS, whose office funded the study. “Preventing falls helps everyone: the older person, their family, and the health and long-term care systems. And this study shows that by investing in falls prevention, we can reduce long-term care use and spending.”

The risk factors for a fall include fear of falling, gait and balance problems, certain medications, clutter in the home, and some health conditions. Few interventions have taken a comprehensive approach to address all of the risk factors through one program.

Although this study focused on the rate of falls and long-term care utilization and costs, future research will examine the impact of the intervention on health care utilization and costs.

“We expect to see a similar or greater return on investment in terms of health care costs,” added Richard Frank.

The 2015 White House Conference on Aging, in partnership with the National Council on Aging, recently convened a Falls Prevention Summit to call attention to the critical role of falls prevention in healthy aging and to provide opportunities for older Americans and stakeholders to share their views and ideas on this important issue.

More information here.


Only Small Percent of Homebound Seniors Receive Medical Care

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Only 11 percent of homebound individuals receive the care they need.

Only 11 percent of homebound individuals receive the care they need.

A large number of Medicare beneficiaries are too ill to leave their homes and not receiving appropriate medical care, according to findings published recently in JAMA Internal Medicine.

“The homebound population of older adults is 50 percent larger than the nursing home population in this country but almost completely invisible,” says senior author Sarah Szanton, PhD, ANP, FAAN, associate professor and PhD program director at the Johns Hopkins School of Nursing. “Only 11 percent receive homebound medical care, and the others may receive no care or intermittent care.”

Out of all community-dwelling Medicare beneficiaries, about 5.6% were homebound as of 2011, the study reports. These figures equate to more than 395,000 totally homebound seniors and more than 1.5 million who were partially homebound, meaning they could leave the home only with assistance or had difficulty leaving the home.

These homebound individuals were more likely to be older, female and non-white, with less education and income than the average Medicare beneficiary.

“As Medicare considers home health payment reform and changes in the methods of paying for medical care, the development and dissemination of home-based primary care and associated quality frameworks are essential,” they wrote. “Much of what we know about homebound individuals is based on studies of those who receive home health care services or home-based primary care. Combining survey data with administrative data on service use may inform the development of improved clinical services for homebound individuals.”

The findings are based on an analysis of cross-sectional data from the National Health and Aging Trends Study collected in 2011. In addition to Johns Hopkins School of Nursing, authors were affiliated with a variety of institutions, including Icahn School of Medicine at Mount Sinai in New York City and the Geriatrics Division at the Department of Medicine at the University of California, San Francisco.