Five-year experience of a community outreach program for the elderly.

The authors report on more than 2,000 impaired elderly people who were referred to a geriatric outreach program during its first 5 years of operation. These patients were referred by a wide variety of professionals and private citizens, who were usually concerned about the person's ability to care for himself or herself or about psychiatric symptoms. The most common diagnosis was dementing illness (21% of the patients), followed by depression (13%). Intervention usually involved making appropriate plans based on an accurate diagnosis, often including coordinating the services of other agencies. A follow-up of 100 patients showed that most of the patients who were still living had maintained their independence.

Psychiatric diagnoses among geriatric patients seen in an outreach program.

Over 2300 patients referred to a geriatric outreach program were evaluated for the relationships between diagnosis and (1) referral reason, (2) referral source, and (3) age. Referral reason was only a clue to the eventual diagnosis. Patients referred for depression received a diagnosis of depression in only 46 per cent of such referrals, and patients referred for forgetfulness or confusion received a diagnosis of dementia in only 37 per cent of these referrals. Families were most likely to refer demented patients, and health agencies to refer depressed patients. Apartment managers and housing authority representatives were least likely to refer depressed patients and most likely to refer paranoid patients. The rate for diagnosis of dementia increased with age, whereas the rates for diagnoses of depression and alcohol/drug abuse decreased with age.

Anticipated and actual barriers to developing community mental health programs for the elderly.

Teams of state and local agency professionals responsible for mental health and aging services participated in a model project utilizing education and consultation to facilitate community mental health programming for the elderly. Participants identified both anticipated and actual barriers to programming. Competing program priorities and lack of staff knowledge about mental health and aging were anticipated and confirmed as major barriers. Agency-organizational barriers were unanticipated, yet there were severe problems in cooperative interagency programming.

Nurses and social workers in home health care: identifying and resolving turf conflict.

A survey of role perceptions of nurses and social workers employed in home health care in Washington State indicated potential turf conflict in a number of roles involved in home care of elderly patients. Nurses tended to perceive themselves capable of all patient-directed tasks and perceived few professional tasks in home health care as the unique domain of social work. This attitude was in sharp contrast to social workers' perceptions, particularly regarding tasks in the psychosocial area. Strategies for identifying and overcoming professional turf conflict in home health care agencies are discussed.

The effects of drug counseling and other educational strategies on drug utilization of the elderly.

The medication behavior of 183 elderly apartment residents was assessed for problems in medication regimen compliance, regimen comprehension, drug interactions, and drug storage. Following an initial assessment, the residents were given instructions in drug utilization and access to drug counseling was provided intermittently for almost 2 years. Approximately 1 year after the educational intervention a final assessment of a sample of 39 residents, who initially were found to have the greatest numbers of problems, revealed a significant 11% decrease in the number of prescriptions taken and a significant 39% decrease in the number of medication behavior problems. The initial average was 3.7 prescriptions currently used and 2.7 problems per person that subsequently decreased to 3.3 prescriptions and 1.6 problems for the same residents at the end of the study. Results suggest that pharmacist consultation provides an effective health prevention strategy in elderly resident settings. Educational strategies used in this study appear to be well adapted for use with elderly home-based populations.

Medication usage in an elderly population.

One hundred eighty-three independently living elderly residents of two federally subsidized, urban high-rise apartment buildings were interviewed in their homes to determine the numbers and types of medications they used and stored and their utilization of pharmacy services. From these interviews and observations, the frequencies of use of medications and pharmacy services and the prevalence of potential problems were determined. Results showed that 75% of interviewees used a prescription drug regularly, and 82% used a nonprescription drug regularly. Fifty-one percent had stored noncurrent prescription drugs, while 67% had noncurrent nonprescription drugs in their homes. The most common problems encountered were discrepancies between labeled dosage and dosage actually used, potential drug interactions, and underuse of medication. Findings that may contribute to the risk of future medication problems were the prevalence of noncurrent medications stored in homes, the respondents' lack of knowledge about recognition and management of adverse drug reactions, and the underutilization of pharmacists as drug therapy consultants.