Many studies have documented the importance of family and friends in providing long-term care to the elderly. A study conducted in 1982 examined a nationally representative probability sample of informal caregivers assisting frail and/or disabled elderly persons in an effort to develop a descriptive profile of the informal caregiver. Data were drawn from the Informal Caregivers Survey, a component of the National Long-Term Care Survey (LTCS). From October 1982 through January 1983, interviews were conducted with 1,924 persons aged 14 years and older who were identified by the elderly participants of the LTCS as providing unpaid assistance with at least one activity of daily living. The results revealed that informal caregivers to the disabled elderly were predominantly female and that three-quarters of them lived with the care recipient. The findings suggest that caregivers as well as care recipients are a vulnerable group since one-third of the cargivers were over age 65, reported incomes in the poor to near-poor category, mid described their health status as fair or poor. Less than 10 percent of the caregivers reported purchasing services. Evidence was also found of competing familial ahd employment demands among a subgroup of caregivers. References and five data tables are appended. (Author/NB)

Overall inappropriate medication use in elderly patients remains a serious problem. Despite challenges in using explicit criteria for assessing inappropriate medications for elderly patients, such criteria can be applied to population-based surveys to identify opportunities to improve quality of care and patient safety. Enhancements of existing data sources to include dosage, duration, and indication may augment national improvement and monitoring efforts.

Total hip replacement, partial hip replacement, and revision hip replacement are associated with different rates of postoperative complications and readmissions. Advanced age, comorbidities, and nonelective admissions are associated with inferior outcomes.

The study suggests that at least a preliminary distinction among NHs can be made on the basis of staffing patterns and that the benefits of the additional staffing may vary with the problem under consideration. More work is needed to establish just what sorts of patients are most likely to benefit from the higher level of NH care.

We report on a federal initiative to develop a CAHPS (The Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality-of-care and quality-of-life in nursing homes (known as NHCAHPS). We focus on how we created and tested questions for inclusion in the instrument and tested a possible cognitive screener to determine which residents could participate in a NHCAHPS interview. The major lessons learned were: (1) In contrast to other CAHPS surveys, ratings were more useful than reports because of the difficulty that residents had with summarizing over time and people; (2) consistent with other CAHPS surveys, the 0 to 10 response scale appeared to work well with nursing home residents for many of the quality-of-care questions; however, a different response scale was needed for many of the quality-of-life items; and (3) in contrast with typical survey methodology and other CAHPS surveys where explicit time reference periods are used, a non-specific present reference period in questions seemed to work best.