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Elderly Healthcare

Advance Care Planning: Preferences for Care at the End of Life
Health Services Research on Aging: Building on Biomedical
   and Clinical Research
Improving the Health Care of Older Americans
Managing Osteoarthritis: Helping the Elderly Maintain Function
   and Mobility
Medicare Uses of AHRQ Research
Physical Activity and Older Americans: Benefits and Strategies
Pocket Guide to Staying Healthy at 50+
Preventing Disability in the Elderly With Chronic Disease

Agency Press Releases

4/28/04 Elderly Pay More out of Pocket for Dental Services Than Any Other Age Group
4/15/04 AHRQ Announces Booklet To Help Older Adults Stay Healthy
8/5/03 Spending for Prescribed Medicines Rose Sharply From 1997 Through 2000

User Liaison Program Workshop Summaries
Expanding Long-term Care Choices for the Elderly
Improving Long-term Care for American Indians in Region VIII

Research Findings

Research Activities, May 2004:
Less than half of older women who have suffered fractures due to osteoporosis are treated properly to prevent further fractures
Better monitoring of the cardiac drug amiodarone among outpatients could improve its safety
Early surgery reduces hip fracture pain
Practices that allot more time for acute care visits and promote immunization have higher adult vaccination rates
Doctors should target chronic disease and functioning among frail older patients to lower the risk of hospitalization
More than half of assisted living facilities will not admit individuals who have moderate cognitive impairment or behavioral problems or need assistance with transfer
Increased State Medicaid reimbursement for nursing home care reduces residents' risk of being hospitalized
State governments assumed an increasing role in funding home care after passage of the 1997 Balanced Budget Act
Use of medical care in the Nation is greatest among the wealthy, and income-related inequality in use is highest among seniors
Young and healthy individuals fare better than moderately sick individuals with consumer-directed health benefits

Research Activities, April 2004:
Diagnosis and treatment of depression in the elderly increased in the 1990s, but racial and other disparities persist
Problems in self-management of congestive heart failure may contribute to ER visits and poor prognosis
Hip fracture patients function better after hip repair surgery if they receive transfusions for anemia while in the hospital
Many medications are effective in managing atrial fibrillation
Studies focus on care for respiratory tract infections in the elderly
Medicare drug benefit bill will increase physicians' exposure to drug formularies
Medicare enrollees in for-profit plans are no less likely to receive high-cost procedures than those in non-profit plans

Research Activities, March 2004:
Renal disease progression is not slower among women than men, and it may even be faster
EXCEED projects focus on prevention and treatment of cardiovascular disease
Certain oral blood-sugar-lowering drugs may increase the risk of heart failure in patients with type 2 diabetes
Screening relatively healthy elderly women for breast cancer every 2 years is cost effective
Inconsistent use of medications by elderly Mexican Americans with diabetes may explain their greater risk of some complications
Only about half of stroke survivors living in nursing homes receive medicine to prevent another stroke
Hospital costs are higher for elderly Medicare patients with low functional status
Medicare's role in financing nursing home care has greatly expanded
State shifting of Medicaid home care costs to Medicare greatly increases Medicare expenditures for home care
Higher RN staffing is associated with fewer deaths among elderly Medicare patients hospitalized for heart attack

Research Activities, February 2004:
New study estimates potential savings gained by expanding use of beta-blockers in heart failure patients
Complications from prostate cancer treatment vary according to pretreatment function and choice of treatment

Research Activities, January 2004:
Few postmenopausal women who have suffered a fracture receive drug treatment to prevent further fractures
Transfusion after hip fracture surgery reduces the risk of rehospitalization for older patients with significant anemia
Age alone should not be a deterrent for recommending coronary bypass surgery
Elderly, low-income black women need more education about the importance of breast cancer screening
Residents of assisted living facilities with a full-time RN are less likely to leave the facility for a nursing home
Providing rehabilitation to newly admitted nursing home residents increases the likelihood of community discharge and lengthens survival
Researchers examine factors affecting diagnosis of acute illness and mental health conditions among nursing home residents
Recent HCSUS studies focus on HIV infection in older individuals and women, use of complementary and alternative therapies, and insurance status

Research Activities, December 2003:
New study suggests that death rates for some cardiac and cancer surgeries may be linked to surgeons' experience
Use of coagulometers by home health nurses could reduce costs of monitoring the homebound elderly taking warfarin

Research Activities, November 2003:
Use of antidepressants for elderly primary care patients has increased markedly
Fewer Medicare patients hospitalized for heart failure died in the 1990s, but shorter hospital stays may be a problem
Nearly half of elderly Mexican Americans who suffer a heart attack die of another heart attack within 7 years

Research Activities, October 2003:
High-risk patients with certain cancers are the best candidates for referral to high-volume cancer surgery hospitals
Benefits of adding radiation therapy to tamoxifen after breast conserving surgery diminish with increasing age
Better diagnosis, management, and monitoring of hypertension is needed for older American Indians and Alaskan Natives
Costs of care for pneumonia in nursing home residents vary widely and could be reduced

Research Activities, September 2003:
Study finds that overall use of DNR orders changed little after passage of the Patient Self-Determination Act
Factors that predict rehospitalization of home health care patients should be targeted by home health providers
Nearly one-third of hip fracture patients are readmitted to the hospital within 6 months, usually for nonsurgical problems Depression and anxiety affect a substantial number of elderly people living in the community
Recommended medications are underused among elderly people with diabetes
Researchers examine functional decline among the frail elderly
Unsteadiness and falls often lead to hip fracture and subsequent decline in the elderly
Some States with high Medicaid use of home care may be able to shift some of these visits to Medicare

Research Activities, August 2003:
Researchers examine medication effectiveness and depression among cardiac patients
Pneumonia triples the risk of death following hospitalization for acute stroke
PSA testing may deserve part of the credit for the recent decline in prostate cancer deaths, but more data are needed
Guidelines for improving the care of older people with diabetes emphasize reducing cardiovascular risk factors
Researchers examine accuracy of patient reports of vaccination as well as vaccination barriers and facilitators among seniors
Nursing home patients' quality of life is the most important consideration in medical decisionmaking

Research Activities, July 2003:
Among elderly stroke victims, blacks are less likely than whites to be alive 3 years after stroke
Expanding Medicare to include a drug benefit would reduce the financial burden on elders but might not greatly increase drug access
Physician recommendations and patient concerns about vaccine safety are associated with elderly influenza vaccination rates
Infections are a serious problem in nursing homes
Symposium highlights the important role of nurses in managing urinary incontinence

Research Activities, June 2003:
Educating older men and women about the dangers of hypertension could increase their blood pressure control
Patients should be assessed for risk of cardiac arrhythmia if they are prescribed certain QT-prolonging drugs
Variations in hospitalization rates for nursing home residents may be due to facility and market characteristics
Defending against lawsuits may divert considerable resources from nursing home quality improvement efforts

Research Activities, May 2003:
Studies focus on use of cardiac procedures and post-hospital rehab services among elderly heart attack patients
People who have more disability prior to hip replacement surgery have worse functioning and more pain after surgery
Researchers find little evidence to explain the enthusiasm for aggressive screening and treatment for prostate cancer
Performing a geriatric assessment of elderly patients in the ER can reduce later nursing home admissions
Medicare plan quality information doesn't prompt people to switch from traditional to HMO plans or to choose low-cost HMOs

Research Activities, April 2003:
Certain medications that can increase the risk of cardiac arrest and arrhythmias are often prescribed together
Collaborative program can reduce potential medication problem among elderly home health care patients
Use of intensive care for patients with severe pneumonia is common and expensive, but hospital ICU admission rates vary
Local preferences and factors other than market structure influence county differences in hospice use
Despite new critical care technologies, the proportion of Medicare spending on end-of-life care is not increasing

Research Activities, March 2003:
Outpatient prescription drug-related injuries are common in older patients, but many can be prevented
Removal of axillary lymph nodes substantially reduces quality of life for many elderly women with localized breast cancer
Regular help with personal care from adult children substantially reduces the likelihood of nursing home use by the elderly

Research Activities, February 2003:
One-fifth of older women hospitalized for hip fracture become incontinent while in the hospital

Research Activities, January 2003:
Patients with hip fracture who leave the hospital too soon are at risk for worse outcomes
Older women who have breast cancer recover faster and have a more positive outlook when they are offered treatment choices
Florida physicians are more aggressive in screening and treating men for prostate cancer than colleagues in other States
Being uninsured for just 2 years adversely affects the health of adults in late middle age

Research Activities, December 2002:
Most hip fracture patients do not have medical complications following surgery
Many elderly people believe they are unlikely to get the flu and don't realize they need the pneumonia vaccine

Research Activities, October 2002:
Use of the less expensive streptokinase over tPA is difficult to justify for some heart attack patients
Researchers examine the effects of androgen deprivation therapy on survival and quality of life of men with prostate cancer
Over half of elderly patients with unstable angina have atypical symptoms
Better doctor-patient communication could enhance the quality of care for older women with breast cancer
Cognitive impairment and depression are associated with functional decline in elderly people
Nurses may need to update their skills in assessing the medical status of nursing home residents

Research Activities, September 2002:
Health plan report cards may have limited relevance for certain vulnerable patient groups
Elderly patients often discontinue use of cholesterol-lowering drugs that help to prevent heart problems and stroke
Pneumonia and influenza vaccination rates continue to be suboptimal among elderly inner city residents
Many prostate biopsies are done on very elderly men who are less likely than younger men to benefit from treatment
More elderly patients are receiving eye care, but Medicare costs have remained constant
Elderly people in rural areas receive fewer home health care services and have worse outcomes than those in urban areas

Research Activities, August 2002:
ER doctors often overestimate the need for critical care for patients with acute congestive heart failure
Most patients with coronary artery disease take aspirin to prevent strokes and heart attacks, but some do not
Implantable defibrillators reduce cardiac deaths and are as cost effective as many generally accepted therapies
Use of cholesterol-lowering drugs by elderly heart attack survivors has increased substantially since the mid-1990s
Areas with higher cardiac procedure rates for patients with coronary artery disease do not overuse the procedures
Internal thoracic artery grafting can improve survival in elderly patients undergoing coronary bypass surgery
Educating neurologists about coagulation tests could improve their use of such tests in stroke patients

Research Activities, July 2002:
Researchers compare options for prostheses for patients who need hip replacement surgery
Fee-for-service Medicare plans offer better quality care than Medicare HMO plans, but costs are higher
Even with insurance, elderly Hispanics undergo far fewer hip replacement operations than older non-Hispanic whites

Research Activities, June 2002:
Hysterectomy does not appear to diminish long-term life satisfaction among older women
Impaired nursing home residents may not get the end-of-life care they want, even if they have an advance directive

Research Activities, May 2002:
Researchers examine the impact of drug pricing and copayments on medication use among elderly Canadians
Elderly people's decisions about end-of-life medical treatment may change over time
Prediction models may help surrogates make end-of-life treatment decisions for incompetent elderly patients
Making pneumonia and influenza vaccinations more convenient may increase immunizations among elderly and at-risk people
Mammography increases early detection of breast cancer and the likelihood of breast conserving surgery among older women
Findings from hysterectomy study discount the link between estrogen deficiency and cognitive decline in older women
Elderly blacks and whites enrolled in Medicare managed care plans do not receive the same quality of care

Research Activities, April 2002:
Nationwide study confirms that older patients who need certain high-risk surgeries fare better in more experienced hospitals
Elderly heart attack patients treated in VA and non-VA hospitals are equally likely to receive appropriate medications
Medicare payment is related to use of breast-conserving surgery and mastectomy among elderly women with breast cancer
Elderly people find new Medicare information materials useful in navigating the maze of health plan choices

Research Activities, February 2002:
Frail elderly people are more likely than home care professionals to rate home health care as sufficient

Research Activities, January 2002:
Risk of bleeding is low in elderly nursing home stroke survivors taking aspirin and warfarin

Research Activities, December 2001:
Potentially inappropriate medications are prescribed for up to one in five elderly people
Elderly women with the fewest resources to negotiate the health care system have the highest burden of illness
New studies focus on lower respiratory infection in nursing home residents

Research Activities, November 2001:
Drug benefit caps reduce use of essential drugs among older people who have multiple chronic illnesses
Low education and income are related to poor health, chronic illness, and depression among Medicare-insured older women

Research Activities, October 2001:
Weight goals for younger people may not be appropriate for the elderly, for whom weight may be protective
Elderly people who are hearing impaired use fewer health services than would be expected
Large remote rural towns may provide the best conditions for high-quality care of older people with diabetes

Research Activities, September 2001:
Two-thirds of elderly stroke survivors in nursing homes are not receiving medication to prevent further strokes
One-third of elderly home health care patients are having problems with their medications
Men aged 50 to 75 should be advised about PSA testing so they can make an informed decision
New risk index can identify elderly people at increased risk for death within a year after hospital discharge
Reducing Medicaid benefits or restricting eligibility would disproportionately affect nursing home stays of elderly blacks

Research Activities, August 2001:
Rising medication costs prompt many rural elders to take fewer medicines and smaller doses than prescribed
Cancer screening decisions for the elderly should not be based on age alone

Research Activities, July 2001:
Study finds no differences in heart attack followup care provided to Medicare fee-for-service and HMO patients, but effective drugs are underprescribed for both
Variation in use of coronary angiography after heart attack may reflect use in patients who don't need it
Elderly patients have more complications and are more likely to die after noncardiac surgery than younger patients
Hospitalization of the elderly for pneumonia and heart rhythm problems rose dramatically in the 1990s
Outpatient geriatric evaluation and management programs slow functional decline of the elderly
Older adults often view incontinence as a normal part of aging and don't bother to discuss it with their doctors

Research Activities, June 2001:
New assessment scale confirms that pain is prevalent and often untreated in nursing home residents

Research Activities, May 2001:
Designating ob-gyns as primary care physicians could affect how medical services are provided to elderly women
Researchers compare strategies for treating elderly patients who have an infected hip prosthesis
Advance directives improve patient satisfaction but do not ensure compliance with end-of-life treatment wishes

Research Activities, April 2001:
Use of warfarin to reduce risk of stroke in very elderly people with atrial fibrillation is challenging

Research Activities, March 2001:
Elderly veterans who suffer heart attacks have similar clinical outcomes at VHA and non-VHA hospitals
Elderly men and women are fairly accurate in predicting their need for nursing home care in the next few years

Research Activities, February 2001:
Certain clinical criteria can identify elderly trauma victims who don't need an x-ray to rule out cervical spine injury
Hospitalizations of the elderly for bloodstream infections rose sharply in the early to mid-1990s

Research Activities, January 2001:
Breast cancer treatment in older women often depends on the woman's age and treatment preferences

Research Activities, November 2000:
Current research and quality improvement efforts show potential for improving quality and outcomes for older women
Medicare Catastrophic Coverage Act has not reduced financial strain or increased independence among the elderly
Nurse staffing hours is one of several factors that affect quality of care for nursing home residents
Outpatient geriatric evaluation and management programs reduce the burden on caregivers

Research Activities, September 2000:
Teaching hospitals provide better care for older heart attack patients
Studies suggest better ways to manage elderly hip fracture patients with delirium and end-stage dementia
Policies that provide postretirement health benefits to the near-elderly may encourage some workers to retire early

Research Activities, August 2000:
Older age, high blood pressure, and other factors increase the risk of complications from cardiac catheterization
After age 80, women are less likely to receive full range of treatments for breast cancer

Research Activities, July 2000:
Urinary incontinence is associated with the risk of depression among the elderly
Higher risk of out-of-pocket health care expenses is associated with an increased risk of premature death among the elderly

Research Activities, June 2000:
Improvements are needed in the management of warfarin therapy for patients with atrial fibrillation

Research Activities, May 2000:
Medicare reforms that will raise out-of-pocket costs for some elderly people need careful consideration

Research Activities, February 2000:
Middle-aged children often provide money, caregiving time, and shared living space to help their disabled elderly parents

Research Activities, January 2000:
Elderly heart attack patients who have multiple health problems may not receive prompt clot-busting treatment
Home-based monitoring program reduces hospitalizations and costs for elderly patients with heart failure

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