A Health-Care System for the Elderly

Primary care physicians are often confronted with demands that elderly patients be institutionalized. Patients who appear to have no new medical problems present a therapeutic dilemma. Should they be admitted to a general hospital or should they be placed directly in a nursing home? This longitudinal prospective study involved 29 consecutive elderly patients judged to be in need of nursing home placement but who were without medical indications for admission. They were assessed and treated in a 30-bed ward of a general hospital. The mean length of stay was 19 days. Of the 29 patients, 8 (24 percent) benefited from the hospitalization; the outcome was placement and retention at a level of care less intensive than that in a nursing home. On admission to this special ward, the presence of 2 of the following 3 characteristics identified the patients who would benefit from this preplacement hospitalization (with 75 percent sensitivity and 86 percent specificity): 1) a score of A or B (Katz Scale) for activities of daily living; 2) a score of 3 or fewer errors on the mental status scale (Pfeiffer); and 3) the presence of family members willing to care for the patient, although unable to do so at the time of admission. These 3 factors constitute a screening tool to differentiate elderly patients who will benefit most under a regimen of intensive rehabilitation from those who will be inevitable recipients of long-term care.

Section: Discussionmentioning

confidence: 99%

Nursing Home Candidates: Hospital Inpatient Trial to Identify Those Appropriately Assignable to Less Intensive Care

Sloane

1980

“…We did not attempt to evaluate the relationship between the patient's disease state and either the prevalence of hypokalemia or the mean serum potassium level. Since serious diagnostic errors have been reported for geriatric nursing‐home patients, 20 we did not believe that such an evaluation would contribute significant data. The absence of serum potassium values in the records of 16 patients receiving diuretics, including one who had received a diuretic for 2.5 years, was remarkable, and raises some concern about the quality of medical care received by some geriatric nursing‐home patients.…”

Section: Discussionmentioning

confidence: 99%

Female Preponderance in Diuretic‐associated Hypokalemia

Clark¹,

Wheatley²,

Rawlings³

et al. 1982

A retrospective review of the medical records of 161 geriatric nursing-home patients receiving diuretics alone or in combination with potassium supplements or potassium sparing-diuretics revealed a 13.7 per cent overall prevalence of hypokalemia. The prevalence of hypokalemia in patients receiving diuretics alone, diuretics with potassium supplements, and potassium-sparing diuretics with kaliuretic diuretics were similar. However, there was a significantly higher prevalence of hypokalemia in women (16.4 per cent) compared with men (3.0 per cent), P less than 0.05. In patients taking non-chloride salts of potassium, there was a significantly higher prevalence of hypokalemia than in those taking the chloride salt (3.6 per cent vs. 8 per cent, P less than 0.025). Seven per cent of patients taking diuretics with potassium supplements and 11.5 per cent of patients taking potassium-sparing diuretics had hyperkalemia. Thus, although many elderly women taking diuretics may have hypokalemia routine potassium supplementation for all non-digitalized geriatric patients receiving diuretics does not seem to be indicated.

“…The purpose of the present study was to determine whether patients cared for on this geriatric unit were more likely to be discharged to a home setting and to achieve greater independence. Home settings are generally recognized as a better environment for elderly patients 2 …”

mentioning

confidence: 99%

Success With an Inpatient Geriatric Unit: A Controlled Study of Outcome and Follow‐up

Lefton

Bonstelle

Frengley

1983

To assess the worth of a newly established geriatric unit, outcomes for 50 subject patients cared for on this unit were compared with outcomes for 50 control patients. Both groups of patients were hospitalized in Highland View Hospital, the chronic illness and rehabilitation section of a major teaching hospital in Cleveland, Ohio. Analysis of admission data showed the two groups to be closely comparable. All patients were managed by multidisciplinary teams, and the length of stay of both groups was comparable. The discharge data showed that the subject patients were more independent, with significantly greater numbers improving in ambulation and significantly more subject patients being discharged to a home setting. Although the patients in the control group were discharged at lower levels of function, they showed improvement at follow-up. Follow-up data also showed that both groups largely remained in their discharge environments. Explanations for these findings are discussed. The results of this study support the establishment of geriatric inpatient units.