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American and British Geriatrics Societies Release New
Guideline on the Prevention of Falls in Older Adults
The
American Geriatrics Society (AGS) and the British Geriatrics Society
(BGS) released new guidelines aimed at preventing falls
among older
adults. "Numerous studies have found that several types of
interventions are effective at reducing the incidence of falls," says
the AGS' Mary E. Tinetti, MD, of Yale University Medical School, one of
the world's leading experts on falls among the elderly. "There is also
evidence
that some fall prevention interventions reduce the incidence of related
injuries, emergency department visits, hospitalizations, nursing home
placement, and functional losses among older adults. "While we know that
prevention can work, we need to do more to ensure that all seniors
actually get screened for falls and, if necessary, receive appropriate
interventions to prevent falls," continues Dr. Tinetti, who, with the
BGS' Rose Anne Kenny, MD, and the AGS' Laurence Rubenstein, MD,
co-chaired the multidisciplinary panel that updated the guidelines.
"That's our goal with these new guidelines. The challenge now is to
embed these practical guidelines into healthcare services for the
growing older population at risk, in a sustainable and effective way. We
also need to continue research that will enable us to further
understand contributors to
falls among the aging." The online
guidelines are now available at http://www.americangeriatrics.org/education/cp_index.shtml.
They recommend a multi-
factorial fall risk assessment for all
older adults who have had a fall, who have been identified as having gait
and balance problems, or who report difficulties with gait or balance.
The guidelines include a clinical algorithm that outlines, step-by-step,
recommended evaluations and interventions, and emphasize the key role
of evidence-based strength and balance training in effective
multi-factorial interventions. The guidelines reaffirm the central role
of evidence-based strength and balance training in effective
multi-factorial interventions. The new guidelines update an earlier set
that the AGS, BGS, and American Academy of Orthopedic Surgeons published
in 2001.
Organizations endorsing the updated guideline include the
American College of Emergency Physicians, the American Medical
Association, the American Occupational Therapy Association, and the
American Physical Therapy Association.
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| Geriatrics at Risk of Vanishing, AGS Member Warns in
Boston Globe Op-Ed (FROM AGS WEEK IN REVIEW)
"It's ironic
that at a time when thousands of Americans are struggling to find
appropriate care for their failing parents, the field of geriatric
medicine appears to be vanishing," AGS' Lewis A. Lipsitz, MD, writes in a
recent Boston Globe op-ed that explains what makes geriatrics care
unique and why addressing growing shortages in the field is essential to
the health and wellbeing of older people.
"For geriatricians, one
distinguishing feature of the specialty - and one that most threatens
its future - is the in-depth conversations about care between doctors,
their older patients, and their families," Dr. Lipsitz writes in "Caring
for the elderly". "Critical issues covered include treatment options,
the efficacy of treatments, and the impact of these treatments on
quality of life. It takes time to manage multiple interacting medical,
social and psychological problems, weigh the risks and benefits of
various interventions, and discuss goals of care with patients and their
families. The problem is that geriatricians are not adequately
compensated for the time they take to address their patients' complex
medical, psychological, and social needs."
As a result, physicians
are steering clear of the specialty even as the need for geriatrics care
is beginning to skyrocket, writes Dr. Lipsitz, professor of medicine at
Harvard Medical School and co-director of the Institute of Aging
Research at Hebrew Senior Life. Geriatrics care is both effective and
cost-effective, he notes. It can help prevent avoidable
hospitalizations, shorten hospital stays, and improve transitions of
care, and identify and rule out unnecessary tests, medications, and
treatments.
"It is critical to the future health of Americans that
the field of geriatric medicine not be allowed to die," Dr. Lipsitz
warns. "A first step might be for Congress to tone down the partisan
rhetoric and present a more thoughtful discussion about reforming care,
not just payment for that care. A second step would be to train medical
students so that every emerging doctor has basic knowledge of geriatrics
- the way every medical doctor has a working knowledge of cardiology. A
third would be to train the academic leaders to teach students about
the special issues confronting older patients."
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| New Site Rates the Performance of California Long Term
Care Services
Report finds increased reliance on home-based services
and continued quality challenges
The California
HealthCare Foundation (CHCF) today unveiled a new Web site rating
thousands of the state's long term care providers on a wide range of
quality of care measures -- information that will help consumers make
better choices and focus providers on improving quality.
A new report
also released today by CHCF shows that more Californians are searching
out home-based long term care services instead of nursing homes, and
that despite some areas of improvement, the states' nursing homes face
continued quality challenges.
The free online service,
CalQualityCare.org, rates the care provided by nursing homes, hospice
programs, and home health agencies, where data is available to evaluate
performance. The site also provides information on many other kinds of
long term care, such as assisted living, retirement communities, and day
care. CalQualityCare features an easy-to-use "Long Term Care Assistant"
tool that helps consumers choose among care options by posing ten
simple questions.
"There are thousands of long term care choices in
California, but the quality of care provided varies from superior to
poor," said Mark D. Smith, M.D., M.B.A., CHCF president and CEO.
"CalQualityCare gives consumers the information to help decide which
providers will best meet their needs."
The new CHCF report, Long Term
Care Facts and Figures, showed that use of long term care services has
increased between 2003 and 2007, with more than one million
Californians, including adults, children with disabilities, and the
elderly, using some type of long term care service. But most of the
growth occurred among people using home and community-based services,
while the number of people in nursing homes has remained steady.
"This
Web site will allow both consumers and nursing home managers to see how
the state's long term care facilities rate based on important quality
measures. It will shine a spotlight on each facility's quality of care
and opportunities for improvement," said Bonnie Darwin, executive
director of the California Culture Change Coalition, a statewide
organization representing nursing home providers, resident advocates,
state and federal regulators, and direct care workers.
Sponsored by
CHCF in partnership with the University of California, San Francisco,
CalQualityCare is an independent service with no commercial
relationships that might bias ratings systems. The data are collected
exclusively from federal and state agencies.
"We believe that if
California consumers have this kind of information when making long term
care decisions, then providers will be motivated to give better quality
care to their patients," adds Maribeth Shannon, director of the CHCF
Market and Policy Monitor Program. "That's our ultimate goal."
Other
key findings from the Long Term Care Facts and Figures report include:
• California's nursing homes have reduced the use of restraints on
patients, but the usage rate is still above the national average.
• California spends $3.8 billion for Medicaid nursing home services,
but nursing homes continue to have a large number of serious federal
deficiencies, serious state citations and complaints, and rank low on
several quality measures compared to the nation.
• California
Medicare beneficiaries use fewer home health and hospice services and
have lower expenditures in this area than the national average.
• California has a higher percentage of Medicaid participants
receiving home- and community-based care (80%) than the national average
(62%).
• In spite of recent increases in Medicaid
reimbursement to nursing homes, California reimbursement rates continue
to lag behind the national average.
Long Term Care Facts and Figures
is published as part of the CHCF California Health Care Almanac, an
online clearinghouse for key data and analysis examining California's
health care marketplace. Find all Almanac reports at
www.chcf.org/almanac.
In addition to CalQualityCare.org, CHCF also
sponsors CalHospitalCompare.org, which provides quality of care
information about the state's hospitals.
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