American Medical Association white paper on elderly health: report of the Council on Scientific Affairs

Article Abstract:

This article reviews current and future problems in health care of the elderly, The elderly population in America currently comprises 28 million people, about 12 percent of the population, who consume about one third of all health care expenditures in the US. By 2020, the elderly population is expected to reach 64 million. The American Medical Association currently supports initiatives in elderly health care starting in medical school and continuing through geriatric emphasis in all specialties, encouragement of assessment of geriatric care during specialty certification procedures, and affiliations between nursing homes and resident training programs. The elderly face health problems such as higher disease prevalence, more frequent chronic illnesses, and more functional disability or activity limitation. It is sometimes forgotten that while some elderly become ill or impaired by the time they are 65, others remain vigorous through their 70s or later. In dealing with the elderly who do become ill, physicians frequent face complex geriatric medical problems, which are discussed. Medical care may be provided to the elderly in hospitals, nursing homes, or at home. Decreasing functional capacity may be as significant a problem as disease, and this includes visual and hearing impairment, falling, and incontinence. Issues in preventive gerontology are discussed. Mental health issues among the elderly include depression, related alcoholism, and suicide, as well as dementia. Substance abuse and elder abuse are two other issues with which physicians need to be familiar, and these are also discussed. Excessive medications and the potential for drug interactions are also a significant problem. Issues which should be addressed during the education of physicians about geriatrics are described, and the significance of ageism (stereotyping and discrimination against the aged) and ethical issues are discussed. There is much that physicians can do in meeting health needs of elderly America. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Medical care, Demographic aspects, American Medical Association

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Home care for the elderly: the new institution

Article Abstract:

Caring for a patient at home can be a humane alternative to hospital care, or reduce a patient's hospital stay. Most services provided by a hospital can be provided at home, if the physical setting is appropriate, an adequate support system exists, and a physician is available to oversee the patient's care. Reimbursement for home care has existed since 1965, when this service was seen as an adjunct to hospitalization. Subsequent legislation allowed home care to be provided as a substitute for hospital care. Studies have shown that the use of home care is low in communities that have an extensive social and medical support structure, but the use of home care may be much greater in communities that lack these resources. As hospitals try to shorten hospital stays, the demand for home care will increase, and physicians will be called upon to participate in home care programs. It is not clear whether home care will reduce hospital admissions, but one study found that it may reduce nursing home admissions. One of the biggest problems in the provision of home care is the assortment of service agencies available, the diverse payment mechanisms, and the enormous amount of paperwork required to co-ordinate patient care. It is therefore recommended that physicians assign administrators, preferably nurses, to oversee all aspects of home care for their patients. As an aid to those who seek to provide home care services, many companies offer products and services specifically for the home care market. Physicians must learn to be comfortable with this nontraditional method of health care, and medical schools should include training in home care services in their curricula. Schools that do so report that the majority of their medical students find the experience rewarding. Both the American College of Physicians and the American Medical Association have gone on record emphasizing the need to include home care services in the education and training of medical students and residents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Study and teaching, Medical care utilization, Home care services

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