The Quality of Medical Care Received by Older Persons

Abstract

This paper reviews studies published since 1970 on the quality of medical services received by older persons. Although many of the studies were flawed in design or limited in scope, they suggest that there are problems in the quality of care received by older persons in ambulatory, hospital, and nursing home settings. Changes in health care delivery and financing should attempt to improve, rather than merely maintain, the quality of medical and health services received by this vulnerable population.

Nursing Home Quality: A Framework for Analysis

“…Although they generally exert a weak presence in the daily functioning of the home (Kayser-Jones, 1981;Mitchell, 1982;Mitchell & Hewes, 1986;Retsinas, 1986;Siu, 1987;Tisdale, 1987;Wiener & Kayser-Jones, 1989), at least their perfunctory participation is required, and monthly or bimonthly visits are mandatory for Medicaid residents. Although they generally exert a weak presence in the daily functioning of the home (Kayser-Jones, 1981;Mitchell, 1982;Mitchell & Hewes, 1986;Retsinas, 1986;Siu, 1987;Tisdale, 1987;Wiener & Kayser-Jones, 1989), at least their perfunctory participation is required, and monthly or bimonthly visits are mandatory for Medicaid residents.…”

Pressure Ulcer Prevalence in Long‐Term Nursing Home Residents Since the Implementation of OBRA '87

“…In response to growing concern over the quality of care in the nation's long‐term care facilities, The United States Congress passed new federal requirements under the Omnibus Budget Reconciliation Act of 1987 (OBRA 87) 1–3 . OBRA '87 mandated changes in nursing home operation that were designed to improve the quality of care for residents.…”

“…I n response to growing concern over the quality of care in the nation's long-term care facilities, The United States Congress passed new federal requirements under the Omnibus Budget Reconciliation Act of 1987 (OBRA 87). [1][2][3] OBRA '87 mandated changes in nursing home operation that were designed to improve the quality of care for residents. This legislation included the development of guidelines for the use of physical and pharmacological restraints and the development of a comprehensive assessment tool, the Resident Assessment Instrument (RAI), designed to identify problems in nursing home residents through a standardized data collection instrument, the Minimum Data Set (MDS), and provide care guidelines to improve processes of care (the Resident Assessment Protocols).…”

The Critical Shortage of Geriatrics Faculty

“…Nevertheless, most of the care provided to persons 65 years of age and older will continue to come from physicians without extensive training in geriatric medicine, particularly internists, family physicians, and general practitioners. Several authors have raised concerns about the quality and appropriateness of care currently provided by these physicians 3 , 4 . These concerns may be best addressed by ensuring that physicians‐in‐training receive adequate instruction in the care of older persons.…”