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Quality of care for geriatric-prevalent conditions is worse than general care among the hospitalized frail elderly

Among hospitalized frail elderly patients, the quality of care for geriatric-prevalent conditions, such as pressure ulcers, delirium, and dementia, is worse than the quality of general medical care, such as screening for pain and nutritional status, concludes a new study. University of Chicago researchers interviewed and reviewed the charts of 328 hospitalized vulnerable elders to assess their quality of care using 16 Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs).

One example of a general care QI is prevention of the formation of blood clots (usually with anticoagulant medication) in a major vein, which can break off and travel to the lungs (venous thromboembolism). This problem can arise after recent surgery or due to other factors. Examples of QIs for geriatric-prevalent conditions include evaluation of cognitive status of elders within 24 hours of admission and screening for depression in any elder with dementia to offering an exercise program to elders who have problems with gait, strength, or endurance.

The QIs for general medical care at the hospital studied were met at a significantly higher rate than for pressure ulcer care (81.5 vs. 75.8 percent) and delirium and dementia care (81.5 vs. 31.4 percent). Nurses were more likely than physicians to screen elderly patients for pain, nutrition, functional status, and pressure ulcer risk. However, among the elderly with functional limitations, nurse hospital admission assessments of functional limitations often did not agree with those reported by patients.

The researchers conclude that hospital care QIs that focus on protocol-driven care may overestimate care quality for vulnerable elders, because they ignore care of geriatric-related conditions. The study was supported in part by the Agency for Healthcare Research and Quality (HS10597).

More details are in "Using assessing care of vulnerable elders quality indicators to measure quality of hospital care for vulnerable elders," by Vineet M. Arora, M.D., M.A., Martha Johnson, B.S., Jared Olson, B.S., and others, in the November 2007 Journal of the American Geriatric Society 55(11), pp. 1705-1711.

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