Finding ways to improve geriatric care worldwide

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Tuesday, June 05, 2007
EARLIER THIS MONTH, a group of about 50 clinicians and researchers from all over the world met in Ottawa, Canada. This organization, interRAI, helps design systems to improve the care of elders everywhere.

It has created forms that allow for health-related data to be col lected in a uniform manner. Then, its scientists have looked at the data from millions of these forms at many sites of care from many coun tries. Some of the people at this meeting had interesting things to say about geriatric care in their nations.

Two researchers from the Czech Republic, Eva Topinkova, M.D., PhD, and Daniela Fialoda, PharmD, PhD, have been instrumental in trying to decrease the use of potentially inappropriate drugs in elders. Because of their re cently published study demonstrating that large numbers of such drugs were being prescribed in their country, all physicians there received prescribing guidelines. In addition, more than 40 drugs were withdrawn from the market.

Professor A. B. Dey, chief of geriatric services at the All India Institute of Medical Sciences in Delhi, reminds us that, in his coun try, there are few long-term care institutions. Because families provide much of the care to elders, home- care services need to be developed. Geriatric medicine is only about 10 years old in India, which already has some 85 million people over the age of 60, the retirement age there.

Professor Gray has been a leader in Australia in the design of a standardized way of assessing persons in the acute-care setting. His work encourages hospital staff to be more aware of some of the negative consequences of acute illness and hospitalization. For example, he has worked to have physicians prescribe “bed rest” only when it is absolutely necessary. Extended periods of bed rest are associated with many negative consequences, including longer hospital stays and longer periods of rehabilitation. His work also permits post- hospitalization care plans to be more appropriately targeted to each person’s unique needs.

One of the most interesting studies was reported by the medical director of the Telemedicine and Psychiatric Consultation Service at an institution closer to home. Working at the University of Ver mont, Terry Rabinowitz, M.D., provides psychiatric consultation to large numbers of elders in nursing homes through “telemedicine.” These elders would have great diffi culty getting a psychiatric consultation without such a system. On the initial “visit,” the resident goes to a special room at the nursing home, where a two-way video system is available. A family member, as well as a nurse and a social worker, likely are present as well. To date, the residents, their families and the nursing home staff all report finding it very helpful.

The interRAI organization has published some 500 scientific papers and works with many governments. Check out www.inter At this time, it is working with Medicare and Medicaid in our country and with the State of New Jersey to improve the health care of all of us as we age.

Write to Dr. R. Knight Steel at Hackensack University Medical Center, 30 Prospect Ave., Hackensack, N.J. 07601.

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