What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture?

Objective: To determine the relationship of surgical repair of acute hip fracture within 2 days of hospital admission, followed by more than 5 sessions per week of physical and occupational therapy (PT/OT), to outcomes after acute hip fracture.

Design: Comparison of hip fracture outcomes via secondary analysis of data obtained by retrospective medical record review according to timing of surgical repair and frequency of PT/OT, adjusted for patient, medical care, and hospital characteristics.

Sample: The study included the medical records of 1880 elderly Medicare recipients admitted from the community to 284 acute care hospitals in 5 states during 1981 and 1982 or 1985 and 1986 with a primary diagnosis of acute hip fracture who underwent surgical repair and received PT/OT.

Association of smoking, body mass, and physical activity with risk of prostate cancer in the Iowa 65+ Rural Health Study (United States).

Smoking, obesity, alcohol, and physical activity can modulate the endocrine system, and therefore have been hypothesized to play a role in the etiology of prostate cancer. At baseline in 1982, 80 percent (n = 3,673) of the noninstitutionalized persons age 65+ in two rural Iowa (United States) counties were enrolled into the Iowa 65+ Rural Health Study. Follow-up for mortality was complete through 1993, and cancer experience was determined by linkage to the State Health Registry of Iowa cancer database for the years 1973-93.

The reliability and validity of an obstacle course as a measure of gait and balance in older adults.

The use of an obstacle course to quantify gait, balance and functional mobility in elderly persons, particularly to assess objectively changes following exercise and rehabilitation interventions, has not been extensively developed or tested. In this study, we describe an 18-item obstacle course developed as an outcome measure for an exercise intervention among fall-prone elderly men. Reliability and validity of the obstacle course was tested in a group of 58 community-living elderly men (mean age = 75 years).

One-leg standing balance and functional status in a population of 512 community-living elderly persons.

The objective of this cross-sectional study (whose baseline data were drawn from a longitudinal population study) was to determine if one-leg standing balance might be a useful marker of functional status in elderly persons independently living in an urban community (N = 512, mean age 73 +/- 7.0, 71.4% women).

Quality assessment in contracting for tertiary care services by HMOs: a case study of three markets.

Background: Few studies have examined the provision of tertiary care services by managed care organizations (MCOs). Moreover, little is known about the role of quality assessment and quality assurance mechanisms in the contracting process. Site visits were conducted in 1995 in three geographic areas to describe and evaluate the contracting processes for tertiary care services, especially neonatal intensive care and coronary artery bypass graft surgery, of health maintenance organizations (HMOs).

The benefits of in-home pharmacy evaluation for older persons.

Objective: To assess the potential benefit of a pharmacist performing in-home medication evaluations on frail older people.

Design: Prospective analysis with pre-post comparison.

Setting: A hospital-based home care program at the Sepulveda Veterans Affairs Medical Center.

Racial differences in the utilization of inpatient rehabilitation services among elderly stroke patients.

Background And Purpose: We undertook this study to ascertain whether elderly black and white patients who are hospitalized for stroke utilize inpatient physical and occupational therapy (PT/OT) services differently, adjusting for characteristics associated with use of these services.

Methods: We retrospectively reviewed medical records regarding the care received by a nationally representative sample of 2497 black and white Medicare patients, aged 65 years of older, who were hospitalized at any of 297 acute-care hospitals located in 30 communities within five states.

Results: Compared with whites, black stroke patients were younger and more likely to have Medicaid coverage, have an ischemic stroke, and have a motor deficit noted at the time of admission.

Falls and fall prevention in the nursing home.

The mean incidence of falls in nursing homes is 1.5 falls per bed per year (range 0.2-3.

What do we know about patient targeting in geriatric evaluation and management (GEM) programs?

Evidence indicates that institution-based programs for interdisciplinary geriatric evaluation and management (GEMs) improve outcomes of care, but results vary considerably between studies. Targeting (i.e.

Information content and clarity of radiologists' reports for chest radiography.

Rationale And Objectives: We systematically characterized the information provided by chest radiography reports on a nationally representative sample of 822 elderly patients hospitalized in 297 acute-care hospitals in five states who had an admission diagnosis of congestive heart failure, acute myocardial infarction, or pneumonia.

Methods: We studied the content of radiography reports, including mention of the type or adequacy of radiography; the presence or absence of a prior radiograph; comments about bones, the aorta, the mediastinum, and pleura and notation of the laterality of findings; and the presence of diagnosis. Two physicians reviewed each patient's report, and a third assigned the final rating when they disagreed.

Evaluation of the VA's Pilot Program in Institutional Reorganization Toward Primary and Ambulatory Care: Part II, A study of organizational stresses and dynamics.

Background: Many academically affiliated hospitals are moving from an inpatient, subspecialty orientation in their patient care and educational programs toward a greater emphasis on ambulatory and primary care. Few studies have focused on the organizational, staffing, and management issues involved in implementing these changes.

Method: The authors carried out a qualitative evaluation of the process of change in an academic Department of Veterans Affairs hospital during implementation of a major ambulatory primary care program.

Evaluation of the VA's Pilot Program in Institutional Reorganization toward Primary and Ambulatory Care: Part I, Changes in process and outcomes of care.

Purpose: To evaluate the impact of the reorganization of an academic Veterans Affairs medical center toward primary and ambulatory care--including the implementation of a medical-center-wide interdisciplinary firm system and ambulatory care training program--on the quality of primary ambulatory care.

Method: Randomly selected male veterans visiting the Veterans Affairs Medical Center in Sepulveda, California, were surveyed in 1992, early in the implementation of the program, and in 1993, after the program had been fully implemented. Two surveys were used: one before the veterans saw their primary care providers (practice-based survey) and the other immediately after patient visits (visit-based survey).

The validity of a nursing assessment and monitoring of signs and symptoms scale in ICU and non-ICU patients.

Purpose: This study examined the validity of medical-record-based nursing assessment and monitoring of signs and symptoms (nursing surveillance) in predicting patients who were admitted to ICUs and those admitted to non-ICUs. The association of this assessment and monitoring with differences in an intermediate patient outcome, instability at discharge, was also explored. Patients admitted to either setting with a diagnosis of acute myocardial infarction, cerebrovascular accident, congestive heart failure, or pneumonia, were included in the study.

The effect of pharmaceutical benefits managers: is it being evaluated?

Over the last decade, the number of pharmaceutical benefits managers has increased, and their influence has expanded rapidly. These managers now provide prescription drug coverage to more than 100 million Americans. The effect of pharmaceutical benefits managers on health care delivery remains unclear.

Exercise in frail elderly men decreases natural killer cell activity.

Six frail male outpatients 70 years and older deemed at risk for fall, but not suffering from serious medical problems nor receiving immune-altering drugs, received an exercise intervention of increasing strenuousness for 60 minutes 3 times a week for 3 months in comparison with 7 controls having no intervention. Psychosocial and immunologic assessments were made at baseline (Time 1), and after 6 (Time 2) and 12 (Time 3) weeks of physical conditioning. Cytotoxic activity of natural killer (NK) cells significantly decreased during the course of the study, in spite of transient exercise-induced increases at times 2 and 3.

Measuring psychosocial aspects of well-being in older community residents: performance of four short scales.

Given that the assessment of multiple dimensions of health/well-being can create respondent burden, assessment scales that are both effective and brief hold great attraction. In this study, we used Cronbach's alpha and correlational methods, including factor analysis, to evaluate the performance of four short scales measuring psychosocial aspects of well-being (depression, quality of life, sense of coherence, social support) in two samples of community-dwelling persons aged 75 and over (n = 414, n = 50). All four scales exhibited good range, high internal consistency, strong temporal reliability, and reasonable levels of construct validity.

Rehabilitation after hip fracture--equal opportunity for all?

Objectives: To determine whether factors unrelated to clinical appropriateness affect use of physical and occupational therapy (PT/OT) in elderly Medicare patients with acute hip fracture.

Design: Bivariate and multivariate analysis of detailed clinical data retrospectively gathered from medical records and of nonclinical variables obtained through linkage with the American Hospital Association data base.

Setting: 297 randomly selected hospitals from 5 states.

Hyponatremia in a nursing home population.

Objective: To determine the prevalence of hyponatremia in a nursing home population and to identify clinical factors that increase the risk for development of hyponatremia.

Design: Retrospective and prospective record review.

Setting: A Veterans Affairs nursing home care unit.

A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community.

Background And Methods: The prevention of disability in elderly people poses a challenge for health care and social services. We conducted a three-year, randomized, controlled trial of the effect of annual in-home comprehensive geriatric assessment and follow-up for people living in the community who were 75 years of age or older. The 215 people in the intervention group were seen at home by gerontologic nurse practitioners who, in collaboration with geriatricians, evaluated problems and risk factors for disability, gave specific recommendations, and provided health education.

Nonsteroidal antiinflammatory drugs and cognitive decline in the elderly.

Objective: To better define the role of nonsteroidal antiinflammatory drugs (NSAID) in cognitive decline of the elderly.

Methods: Population based inception cohort of the rural elderly. NSAID user status was characterized as high dose, low/medium dose, or nonuser at 2 successive in-person interviews 3 years apart (F3 and F6).