A statement of principles: Toward improved care of older patients in surgical and medical specialties

Article Abstract:

Surgical and medical specialists must take much responsibility for future geriatric care, and such specialists need opportunities to learn principles, strategies and tactics for excellence in rendering such care. An estimated 30,000 geriatricians are needed, while only 9,000 are available. A statement and recommendations have come from deliberations of geriatricians and specialists from ten disciplines in 1998-1999, with support from the John A. Hartford Fdtn. and under the auspices of the American Geriatrics Society. Nongeriatrics specialists involved were from anesthesiology, emergency medicine, general surgery, obstetrics and gynecology, ophthalmology, orthopaedic surgery, otolaryngology, physical medicine and rehabilitation, thoracic surgery, and urology. Hazards of hospitalization and surgery for older patients are listed. As part of the rationale, demographic data are given.

Medical economics, Forecasts and trends, Statistics, Demographic aspects, Surgery, Medical personnel, Medical personnel training, Aged patients, Elderly patients, Interdisciplinary research

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The new frontier: increasing geriatrics expertise in surgical and medical specialties

Article Abstract:

Increasing expertise in surgical and medical specialties relative to geriatrics is discussed. Basic training of residents in general surgery, the surgical specialties, gynecology (both surgery and primary care), and other relevant specialties, among them emergency medicine, anesthesiology, and physical medicine and rehabilitation should involve principles of good geriatric care. The next frontier of geriatrics involves this change, which is supported by a new policy of recently formulated by the American Geriatrics Society and representatives of the leadership of 10 specialities. The major challenge is funding for extra training, some of which will come from the John A. Hartford Fdtn. Clinical research will be important.

Social policy, John A. Hartford Foundation

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Improving care management and health outcomes for frail older people: implications of the PACE model

Article Abstract:

Implications of the Program for All-Inclusive Care of the Elderly (PACE) model relative to improving care management and health outcomes for frail elderly people are discussed. The success of PACE depends to some degree on the management link, the assumption of longitudinal primary care in the community for high-risk frail elderly by clinicians with expertise in the area. This link was lacking in comprehensive geriatric assessment (CGA) programs, which were similar to PACE. The link cannot exist in the inflexible acute-care-and-treatment-driven economy of traditional medical practice. Where recommendations for care are followed, efficacy assessed, and a new direction taken when needed, there is an impact on hospitalization. PACE is cost effective.

Editorial, Research, Management, Hospitals, Community health services, Medical care, Medical care utilization, Managed care plans (Medical care), Nursing homes, Evidence-based medicine, Medicare, Gerontology, Capitated payment systems (Medical care), Medical care needs assessment, Frail elderly, Home care services, Chronically ill, Home care

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