Abstract：
:By most clinical and economic measures, our health care system is not providing effective or affordable care to Medicare beneficiaries with severe chronic illness. Two million elders, constituting most of the 5% who account for nearly half of Medicare costs, have multiple chronic conditions, functional disability, and average per capita costs of over $50,000 per year. Prior reforms aimed at this population did not change the flawed delivery system, which remains centered in the doctor's office, hospitals, and nursing homes. This article describes a model of coordinated home-based medical care, called Independence at Home (IAH), which operates on a limited basis in many US communities and in the Veterans Affairs system. IAH-type teams deliver a full range of medical and social services at home to seriously ill elders and thereby reduce overall health care costs. We review the evidence that this approach can lower total costs by 25 percent or more while improving patient satisfaction and outcomes. We discuss funding for the new model, which also produces net savings for Medicare. A Medicare reform bill, called the Independence at Home Act, was introduced in the US House and Senate in 2008 to promote replication of this mobile elder care model.
journal_name
Clin Geriatr Medjournal_title
Clinics in geriatric medicineauthors
DeJonge KE,Taler G,Boling PAdoi
10.1016/j.cger.2008.11.004subject
Has Abstractpub_date
2009-02-01 00:00:00pages
155-69, ixissue
1eissn
0749-0690issn
1879-8853pii
S0749-0690(08)00070-0journal_volume
25pub_type
杂志文章abstract：:Urinary infection is the most common infection in elderly populations. There is a high prevalence of asymptomatic bacteriuria, but this is benign and does not require treatment. A urine specimen for culture should be obtained before initiating antimicrobial therapy for symptomatic infection. Antimicrobial treatment re...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2009.04.005
更新日期：2009-08-01 00:00:00
abstract：:Early Parkinson disease is the approximate time period between initial diagnosis and the onset of motor fluctuations. Treatment requires an integrative approach, including identification of motor and nonmotor symptoms, choice of pharmacologic treatment, and emphasis on exercise. Patients should be treated for motor sy...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2019.09.001
更新日期：2020-02-01 00:00:00
abstract：:Musculoskeletal disease is not an inevitable consequence of aging. Complaints of musculoskeletal disease indicate disease. Differential diagnosis relies on clinical skills. Management is directed toward maintaining function. ...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：
更新日期：1988-05-01 00:00:00
abstract：:It should be recognized that sexuality in the aging male is of such import that a complete sexual history must be performed. By taking a complete sexual history, facts can be obtained that will allow for appropriate focus relating to a holistic evaluation and will enable us to dispel antiquated sexual myths pertaining...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章
doi：10.1016/j.cger.2010.02.007
更新日期：2010-05-01 00:00:00
abstract：:To a considerable extent, the advent of the term sarcopenia has contributed to the focus on this important condition and its effects on the quality of life and care of older persons. It is hoped that the advances in our understanding of the etiology and treatment of sarcopenia will further contribute to placing this d...
journal_title：Clinics in geriatric medicine
pub_type： 历史文章,杂志文章
doi：10.1016/j.cger.2011.03.003
更新日期：2011-08-01 00:00:00
abstract：:There are three major obstacles to a recommendation for screening the elderly for NIDDM. The first is the conflicting evidence as to whether early detection and treatment reduce complications. The second is that treatment of hyperglycemia with attainment of euglycemia is difficult to achieve in the elderly. Nondrug th...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：
更新日期：1990-11-01 00:00:00
abstract：:Over one-third of Medicare stroke patients are admitted to nursing homes for rehabilitation. Patients with stroke who are admitted to nursing homes are extremely heterogeneous, including both those with minimal physical and cognitive impairment and those who are totally physically dependent. Quality measures that are ...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：
更新日期：1999-11-01 00:00:00
abstract：:Although many individuals who have had strokes or other physical problems assume that they can no longer drive, they are often unaware of retraining programs. In addition to formal courses supported by sponsoring agencies, such as the AAA, there are also programs run by occupational therapists. This article addresses ...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：
更新日期：1993-05-01 00:00:00
abstract：:The elderly have few bleeding disorders related exclusively to the aging process. However, abnormalities of coagulation are seen frequently in this group as complications of other illnesses. Thus a good understanding of basic coagulation physiology and testing will provide the necessary tools for therapeutic guidance....
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章
doi：
更新日期：1985-11-01 00:00:00
abstract：:Older women may experience sexual dysfunction due to many different causes. Some problems related to menopausal hormonal change may be easily treated with estrogen supplements. Other problems involve intricate interpersonal relations between the woman and her sexual partner and may require a combination of medical the...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：
更新日期：1991-02-01 00:00:00
abstract：:Depression is common in geriatric patients, especially in those with multiple comorbidities and polypharmacy. Depression in older adults is often underdiagnosed and undertreated. Initial screening for depression can easily be accomplished in the waiting room. Yet the clinical interview still remains the gold standard ...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2017.03.007
更新日期：2017-08-01 00:00:00
abstract：:There is no single definition of polypharmacy. Use of 5 or more medications commonly is used. An alternative, quantitative definition, such as use of more medications than clinically indicated or use of unnecessary or harmful prescribing, has been proposed. Protocols or algorithms to improve polypharmacy and prescribi...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2017.01.007
更新日期：2017-05-01 00:00:00
abstract：:The definition of sarcopenia continues to evolve, from an observational phenomenon to a differential diagnostic approach. Clinical relevance for sarcopenia is defined by a loss in lean muscle mass and impairment of functional status. A therapeutic approach to the loss of skeletal muscle mass and strength in older pers...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章
doi：10.1016/j.cger.2010.02.012
更新日期：2010-05-01 00:00:00
abstract：:The concept of cognitive reserve (CR) was proposed to account for the discrepancy between levels of brain pathologic process or damage and clinical and cognitive function. We provide a detailed review of prospective longitudinal studies that have investigated the interaction between CR and Alzheimer disease (AD) bioma...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2019.11.006
更新日期：2020-05-01 00:00:00
abstract：:Pulmonary embolism (PE) is a difficult diagnosis in patients of all ages, but more so in the elderly. Nonspecific symptoms and laboratory results are often misattributed to common diseases or to age itself, and can delay or even deter the diagnosis and treatment of PE. Advanced age is sometimes mistakenly seen as a co...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/s0749-0690(02)00055-1
更新日期：2003-02-01 00:00:00
abstract：:Pulmonary hypertension is a pathologic hemodynamic condition defined by a mean pulmonary arterial pressure of 25 mm Hg or greater at rest. Because of age-associated stiffening of the heart and the pulmonary vasculature and the higher prevalence in the elderly of comorbidities associated with the development of pulmona...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2017.06.007
更新日期：2017-11-01 00:00:00
abstract：:The pathophysiology of stone disorder in older adults, as compared to their younger counterparts, has not been thoroughly investigated. This article examines the differences in serum and urine chemistries between groups that are younger and older than 60 years of age. The principal finding is that stone formation occu...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：
更新日期：1998-05-01 00:00:00
abstract：:Geriatric hip fracture is a common event associated with high costs of care and often with suboptimal outcomes for the patients. Ideally, a new care model to manage geriatric hip fractures would address both quality and safety of patient care as well as the need for reduced costs of care. The geriatric fracture center...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2014.01.002
更新日期：2014-05-01 00:00:00
abstract：:Physical abuse of the elderly is a significant public health concern. The true prevalence of all types is unknown, and under-reporting is known to be significant. The geriatric population is projected to increase dramatically over the next 10 years, and the number of abused individuals is projected to increase also. I...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2014.08.005
更新日期：2014-11-01 00:00:00
abstract：:Environmental change offers an attractive approach to falls prevention, particularly as part of multidimensional intervention strategies. This article reviews and summarizes prior research that has examined environmental factors in falls experienced by older people in community and long-term care settings. Limitations...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：
更新日期：1996-11-01 00:00:00
abstract：:Clinical assessment of fitness to drive can be a challenging part of primary care of older adults. There are no guidelines on screening for driver safety, so it falls to provider judgment on when to assess older drivers. This review offers recommendations on when to assess for driver safety based on red flag condition...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2017.09.006
更新日期：2018-02-01 00:00:00
abstract：:Falls, syncope, and the associated complications are among the most serious problems that face the elderly population. The most common underlying causes and risk factors for falls include muscle weakness, gait and balance problems, visual impairment, cognitive impairment, depression, functional decline, and particular...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/s0749-0690(02)00002-2
更新日期：2002-05-01 00:00:00
abstract：:Osteoarthritis (OA) is the most common cause of chronic disability in older adults. Although classically considered a "wear and tear" degenerative condition of articular joints, recent studies have demonstrated an inflammatory component to OA that includes increased activity of several cytokines and chemokines in join...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2010.03.002
更新日期：2010-08-01 00:00:00
abstract：:Current arrangements for health care in the United States do not adequately address the needs of a growing population that has serious, eventually fatal chronic illness. New programs and policies are necessary to encourage coordination of care; better match services to the needs of patients; better provide education a...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章
doi：10.1016/j.cger.2004.08.008
更新日期：2005-02-01 00:00:00
abstract：:In conclusion, the majority, or at least a large proportion, of accidental injuries in the elderly are preventable with careful medical and environmental evaluation and intervention. A vigorous diagnostic, therapeutic, and preventive approach is appropriate in all older patients who fall in addition to those at a high...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：
更新日期：1991-11-01 00:00:00
abstract：:Urinary incontinence is a prevalent condition in elderly women with significant associated morbidity. Incontinence can by grouped into several types: stress incontinence, urgency incontinence, overflow incontinence, functional incontinence, and mixed urinary incontinence. Careful evaluation, including history and phys...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2015.07.003
更新日期：2015-11-01 00:00:00
abstract：:Epidemiological data suggests that the prevalence of musculoskeletal and neuropathic pain increases with age until at least late mid-life, though the pattern is somewhat unclear beyond this point. And though the prevalence of some types of pain may peak in late midlife, pain is still a substantial and common complaint...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2016.06.005
更新日期：2016-11-01 00:00:00
abstract：:Dry eye and dry mouth symptoms are each reported by up to 30% of persons more than 65 years of age, particularly in women. Medication side effects are the most common contributing factors. The evaluation of these symptoms requires measures of ocular and oral dryness. Sjögren syndrome is the prototypic disease associat...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2016.08.007
更新日期：2017-02-01 00:00:00
abstract：:Gastroesophageal reflux disease (GERD) is a common disorder among elderly patients seeking medical care. Diagnosis and management of GERD in the older patient is a unique challenge for both the primary care provider and the gastroenterologist. Such patients may have atypical symptoms, more severe disease, and a higher...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,评审
doi：10.1016/j.cger.2013.10.006
更新日期：2014-02-01 00:00:00
abstract：:Falls are a major health concern for elderly people and cause substantial health care costs. The authors used meta-analytic findings on the effectiveness of fall prevention interventions to determine cost-effectiveness of a proposed Medicare fall prevention program for people who experience a recent fall. Using publis...
journal_title：Clinics in geriatric medicine
pub_type： 杂志文章,meta分析
doi：10.1016/j.cger.2010.07.005
更新日期：2010-11-01 00:00:00
