Search results

This study examines elderly and advanced elderly inpatients' perceptions of acute care service quality, prioritises opportunities for quality improvement, and assesses variation in patients' satisfaction with care. Psychometrically‐validated postal questionnaires were sent to random samplings of patients discharged from the US acute care facilities in 2002 (n=2,057,164). Quality improvement priorities among non‐elderly (< 65 years), elderly (65‐74 years), and advanced elderly (>74 years) were similar but substantial variation was found comparing single items between age groups. Elderly and advanced elderly patients rated the quality of meals and rooms significantly lower than the non‐elderly, and the advanced elderly rated treatment decision making involvement significantly lower than the other two age groups. The data reveals specific, actionable areas for quality improvement and a non‐linear relationship between age and satisfaction. Findings question assumptions regarding older patients' evaluations of care and indicate directions for quality improvement that account for their unique needs.

The purpose of this paper is to show that the categorization of elderly patients as vulnerable is affected by health-care service interactions with caregivers, which may increase, reduce or even negate entirely elderly patients’ vulnerable status.

The paper reports the results of a qualitative study based on in-depth interviews conducted with a large and varied sample of health-care personnel in charge of elderly patients in two hospital geriatric departments in France.

Findings show that the limits of the service-dominant logic approach when the service (care) relationship concerns vulnerable individuals who are, completely or partially, unable to take part in the co-creation of the service and the roles played by caregivers as resource integrators (intermediaries, facilitatorapomediaries and transformativeapomediaries) and that this affects the categorization of elderly patients as vulnerable.

The results enrich knowledge about the service relationship with vulnerable people by showing that the categorization of elderly patients as vulnerable is not immutable but stems from the dynamics among actors that may variously “reify it” (contribute to its internalization), “reduce it” (enable access to aspects of normal life), or “neutralize it” (help free this cohort from their categorization as vulnerable).

The findings provide insights for care providers by stressing the need to raise awareness among hospital staff regarding their active role in affecting the categorization of elderly patients as vulnerable through their care practices. In the context of public health policies, the findings show that the regulatory injunction to empower patients to preserve their well-being tends to produce the opposite effect on the frailest patients, who are unable to participate in their care pathway.

The research shows that categorization as vulnerable, in the health-care services context, is affected by the care interactions between caregivers and elderly patients. The support provided to hospital staff in this context helps to maintain patients’ well-being and dignity.

This paper identifies and explores issues of medication, the elderly, and the problems in securing and using evidence from randomised control trials. Demographic and health care data are presented. While the elderly are a significant set of consumers of medicines, there is a lack of published evidence, in control trial format, on which medications are better for elderly patients. Even if all the trial evidence on a new drug was published before the drug was put on the market, as recently recommended, there are serious issues to consider in securing and using evidence from clinical trials. This paper indicates ten problems in securing and using evidence from randomised control trials. Three examples of randomised control trials involving the elderly are given. While it is easier to call for improvements in the evidence base than to achieve improvements, this paper argues that improvements are fundamentally necessary. This is because if no significant improvement comes through on the evidence base, we will never know if we are providing the elderly with the cost‐effective care and attention that they deserve.

Multiple pathologies and age-related physiological changes lead to acute respiratory failure. This necessitates mechanical ventilation among elderly patients. Mechanically ventilated critically ill elderly patients may confront various problems, including physical and psychological issues. Therefore, the purpose of this paper is to present the frequent problems encountered by critically ill elderly patients and management of such problems.

This paper reviews relevant literatures.

Physical problems include pain and respiratory infections. Additionally, psychological problems include anxiety and stress. Such problems should be managed by physicians, nurses and family members. Pharmacological and non-pharmacological approaches can be used to manage these problems. Pharmacological management involves use of medications, while non-pharmacological interventions include use of music therapy, acupuncture and sensory stimulation.

The paper indicates physical and psychological problems of mechanically ventilated critically ill elderly patients. To ensure effective management of complications encountered by mechanically ventilated elderly patients, health-care professionals ought to be aware of physical and psychological age-related changes.

Discrimination against the elderly people is becoming an increasingly common phenomenon. Despite the obvious fact of the aging of societies, everlasting youth, fitness, and thus usefulness of a person are promoted. Discrimination also extends to the field of healthcare. It can be concluded that a sick and weak person is more exposed to it. Manifestations of such behaviors are regulations that do not give equal rights to all age groups and limit access to selected services for the elderly people. Such actions also include the attitudes of the medical staff, which, often imbued with stereotypes about old age, approaches the elderly patient with disregard.

The aim of this chapter is to show the problem of discrimination against elderly patients in the Polish healthcare system, and to indicate possible measures to improve the situation of such people. An attempt will also be made to answer the question about the causes of discriminatory behavior. On the one hand, it is connected with the attitude of the medical personnel, who often treat such patients with superiority. On the other hand, the cause of limited access to some treatments and medical procedures are systemic solutions. Systemic solutions cause that such patients have limited access to some treatments and medical procedures. It is important to consider how these two issues are related. Do social attitudes, stereotypes, influence regulations, or regulations limiting the rights of the elderly cause a change in the reactions of medical staff? To answer this question, an appropriate solution can be proposed. Should the actions fighting discrimination be actions aimed at changing legal regulations or should the burden be shifted to education and social campaigns?

Migration appears to be a determinant in health-care utilisation, particularly among the elderly in India. Ageing and migration are essential socio-demographic phenomena in the 21st century for developing and developed countries to establish better public health-care policies. This study aims to focus on the status and determinants of health-care utilisation among elderly migrants who have migrated after attaining the age of 45 and above.

This study used the data from the first wave of the longitudinal ageing study in India (LASI) in 2017–2018. Two outcome variables were used to examine the health-care utilisation, including in-patient and out-patient care. Binary logistic regression was used to explore the predictors of healthcare utilisation in terms of in-patient and out-patient care among the elderly migrant population.

A total of 82.9% of elderly migrants had visited out-patient care when they were sick, whereas 15.3% have used in-patient care. Enabling factors, such as wealth quintile and health insurance, and need factor, such as chronic disease and self-rated health, were more significant factors influencing the health-care utilisation.

This study contributes to our understanding of older migrants’ health-care utilisation. Focussing on this study’s outcome, policymakers and decision makers may consider improving older migrants’ access to health-care by raising their income level, offering local health insurance and health awareness programs.

Heart Failure (HF) is one of the leading mortality causes in elderly people. The purpose of this study is to assess readmission rates and reasons in elderly patients with HF.

The authors explored medical records of elderly patients with HF (75 years and more) at Chapidze Emergency Cardiology Center (Georgia) from 2015 to 2019. The authors analyzed the structure of the cardiovascular diseases and readmission rates of hospitalized patients with HF (I50, I50.0 I50.1). A multivariate logistic regression model was used to identify factors, associated with readmission for any reason during 6–9 months after the initial hospitalization for HF.

The major complication of cardiovascular diseases in elderly patients is HF (68.6%). Hospitalization rates due to HF in elderly patients have increased in recent years, which is associated with the population aging process. This trend will be most likely continue. Despite significant improvements in HF treatment, readmission rates are still high. HF is the most commonly revealed cause of readmission (48% of all readmissions). About 6–9 months after the primary hospitalization due to HF, readmission for any reason was 60%. Patients had concomitant diseases, including hypertension (43%), myocardial infarction (14%), diabetes (36%) and stroke (8%), affecting the readmission rate.

HF remains an important problem in public health. During HF-associated hospitalizations, both cardiac and non-cardiac conditions should be addressed, which has the potential for health problems and disease progression. Some readmissions may be prevented by the proper selection of medicines and monitoring.

This paper theoretically and empirically analyzes the effects of the elderly’s physical health status on their need for care and the choice of care models in China.

Empirically, the estimation results of a large-sample randomized intervention trial with chronic obstructive pulmonary disease (COPD) patients through the difference-in-difference method indicated the following: (1) After the COPD intervention trial, the physical health status of the elderly in the treatment group improved significantly, the need for care was substantially reduced and the health improvement led to a 35.5% reduction in the probability of using elderly care. (2) The reduction in the need for care regarding the treatment group occurred mainly in social care. The probability of using social care decreased by 67.8% due to the elderly’s health improvement, while that of home care remained unchanged generally. (3) Further heterogeneity tests suggested that families with fewer potential internal resources for caregiving had a more pronounced decline in the need for social care.

Theoretically, these empirical results support the existence of the “pecking order” theory in the family’s choice of elderly care model, that is, families tend to employ all internal resources for caregiving before resorting to social care, resulting in a higher sensitivity of social care to health.

The main policy implication of this paper is that ex ante preventive health intervention policies can significantly alleviate the burden of care, especially social care, on families. And preventive health intervention policies are particularly effective in reducing the burden of the families with relatively few resources for informal internal care.

Elder mistreatment is a widespread medical and social problem that is often under‐recognised by primary care physicians. The primary aim of this study was to estimate the prevalence of elder mistreatment among elderly patients with mental disorders in Bosnia and Herzegovina. One‐hundred‐and‐eighty‐four patients with different mental disorders were asked to complete the EAST questionnaire as part of a comprehensive geriatric assessment. Screening results were evaluated, and patients who had responses associated with ‘mistreatment’ were invited back to the clinics for additional clinical evaluation. Different types of mistreatment were identified in 71% of all patients. This led to a conclusion that screening for elder mistreatment should be a part of the routine health assessment for all older persons and a part of comprehensive geriatric assessment.

Health-care systems currently face great challenges, including an increasing elderly population. To respond to this problem, a hospital emergency department, three municipalities, and self-employed general practitioners in Denmark decided to collaborate with the aim of reorganizing treatment of elderly acute ill patients. By establishing a small-scale collaborative community and through an action research process, we show, how to jointly explore and develop a new organization design for in-home hospital treatment that enables the health professionals to collaborate in new ways, and at the same time to investigate and improve this cocreation process and codesign of knowledge among multiple different stakeholders.