Care coordination assisted by technology for multiethnic caregivers of persons with dementia: a pilot clinical demonstration project on caregiver burden and depression.

We evaluated a care-coordination project assisted by a screen-phone to support and educate caregivers. A total of 113 caregivers of home-dwelling veterans with dementia were recruited to the study: 72 were white, 32 were African American and nine were Hispanic. Caregivers were assessed for burden, depression, coping, quality of life, knowledge and satisfaction. None of the outcome measures changed significantly after 12 months. Forty care-recipient and caregiver dyads responded to the 12-month telephone satisfaction survey. The respondents were more satisfied with the care-coordination (90%) aspect of the programme than the education (77%) or the monitoring (50%). The pilot project suggests that care coordination aided by screen-phones may be a useful model for caregiver support in a managed-care setting. A systematic study is now required.

Trial of a survey instrument to establish the hurricane preparedness of and medical impact on a vulnerable, older population.

INTRODUCTION: Millions of vulnerable, elderly individuals live in coastal areas susceptible to hurricanes and are at risk for adverse health outcomes. The purpose of this study was to determine the status of preparedness for and possible health consequences of a hurricane on a vulnerable, but experienced, elderly population. PROBLEM: Preparedness guidelines have been published, but it is unclear how well-prepared elderly individuals are for hurricanes, and what impact hurricanes may have on their health. METHODS: Five hundred forty-seven ambulatory patients who attended an urban teaching hospital's geriatrics clinic in Florida were surveyed. A 25-question survey that asked whether subjects followed the American Red Cross guidelines for hurricane preparation was developed. The participants were asked what hurricane supplies they had, and whether they would need to evacuate or utilize storm-proof window shutters. They also were queried about definitions and their understanding of hurricane warnings. Three possible health impacts during the two weeks following Hurricane Wilma in 2005 were asked: (1) falls; (2) missed medication; and (3) missed doctor's appointments. An additional 105 patients in the same clinic were asked about the same three health outcomes one and one-half years after the hurricane struck. RESULTS: Two-thirds of respondents were missing at least one supply item. A multivariate analysis indicated that there was no relationship between the subjects' demographic characteristics and the possession of the suggested disaster supplies. Although 36% would need to evacuate, only 56% of these 36% had a plan. Only 63% had storm-proof windows or shutters, and of these, only 46% could install them. Gasoline-powered electrical generators can be useful, but also a source of morbidity or mortality following a hurricane. For example, this study found that 28% of respondents had generators, but only 46% knew how to use them. Subjects immediately after the hurricane missed fewer doses of medication than at other times (3.4% vs. 6.7%; p < 0.0001) and fell slightly less often (8.8% vs. 12.9%; p < 0.0001). However, there were significantly more missed doctors appointments after the hurricane (11.6% vs. 0.1%, p < 0.0001). CONCLUSIONS: The survey indicated that even a well-experienced population lacks adequate hurricane preparation. Most still are vulnerable in at least one aspect of preparation. The elderly may be more likely to miss medical appointments immediately following a hurricane. Interventions to improve hurricane preparedness should be piloted.

Influence of race and ethnicity on alternative medicine as a self-treatment preference for common medical conditions in a population of multi-ethnic urban elderly.

The use of complementary and alternative medicine (CAM) is prevalent among elderly individuals. While race and ethnicity may influence the choice of CAM, it is uncertain how this influence affects an individual's choice of CAM or conventional medicine. Furthermore, it is unclear whether this choice of CAM or conventional medicine might vary for different medical conditions. A survey of CAM use was performed on a convenience sample of 338 multi-ethnic urban elderly subjects who attended clinic at two large university-affiliated hospitals over 2 years. The survey asked about individual CAM therapies used, and whether subjects would prefer conventional (prescription or over-the-counter) or CAM (herbal or other) treatment for three different medical conditions: colds, insomnia, and back pain. Hispanic ethnicity and female gender were the best predictors of CAM use. Blacks were more likely than whites to utilize CAM. Hispanics were more likely to choose herbal medications to self-treat colds and insomnia than whites or blacks, or low-back pain than whites. More Hispanics chose herbal medications to treat insomnia than over-the-counter or prescription medications.

The gallon-jug shelf-transfer test: an instrument to evaluate deteriorating function in older adults.

This study examined the validity, reliability, and discriminatory capacity of the gallon-jug shelf-transfer (GJST) test. Six hundred fifty-three independent-living older adults (463 women age 72.9 +/- 7.0 years, 190 men age 74.3 +/- 6.7 years) participated. Participants moved five 1-gallon jugs (approximately 3.9 kg) from a knee-high to a shoulder-high shelf as quickly as possible. The GJST showed an exponential performance decline with age, and there were significant correlations between the GJST and common functional tests (p<.001). High within-day and between-days reliability was detected. The test also detected differences resulting from training status (p<.01) and training protocols (p<.05). The GJST is a valid, reliable, inexpensive, safe, and easily administered clinical test for identifying physically vulnerable elders who could benefit from interventions such as exercise to improve their physical capacities and maintain independence.

The use of open-access scheduling for the elderly.

Open-access scheduling is a method of reducing both waits in access to care and the number of appointments missed by outpatients. The Department of Veterans Affairs has pioneered a system that includes a feature known as advanced clinic access as a quality improvement project to improve access to care. Patients are not scheduled for an appointment more than 30 days in advance but instead are reminded 30 days before anticipated appointments to call to be scheduled. Same-day appointments are also available. Although this system may pose theoretical disadvantages for the elderly, in Miami no significant reduction occurred in numbers of patients seen, and the number of missed appointments decreased significantly.