Alternative geriatric care and quality metrics

This chapter will discuss alternatives to traditional geriatric care, including home care, transitional care, mobile acute care units for the elderly (MACE), hospital at home, and other alternatives. Methods of measuring quality of care in the hospital and other settings will be discussed in this chapter. Introduction. With the growing number of older adults in society, the need for medical care has expanded tremendously [1]. A recent study found that the use of hospital-based emergency departments (EDs) in older adults outpaced population growth, with the largest growth coming in the oldest old (85+ years) [2]. According to data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) in 2008, patients aged 65–74 years account for 14% of ED visits and approximately 31% were admitted. Patients 75 years and older accounted for 29% of visits and had an admission rate of 41%. These rates are both considerably higher than the admission rate for patients less than 65 years, which was only 13% [3–5]. Older adults use EDs for a variety of reasons. While most visits are for real or potential emergencies, many older adults – similar to younger patients – use EDs as an around-the-clock provider of primary medical care and as a safety net. Compared with the rest of the adult population, older adults have a higher ED utilization rate and have higher rates of adverse health outcomes at er ED visits [6, 7]. h e average three-month mortality rate for an older adult after an ED visit has been estimated at 10% [1]. Older adults also have a 72-hour ED return rate of 24%, and as many as a quarter of these patients who return to the ED are subsequently hospitalized [1]. Despite the large number of older adults visiting EDs, emergency physicians report feeling less confident in caring for their unique needs and report lower job satisfaction taking care of older adults [8]. Many providers think that training, research, and continuing education in the specialty of geriatric medicine is lacking.