Health Services Research on Aging: Building on Biomedical and Clinical Research
Translating Research Into Practice
It is estimated that by the year 2020, 16 percent of the U.S. population will be age 65 or older. With the aging of America comes a greater need for information on how people can live healthier lives. Biomedical and clinical research has made great progress in identifying ways to prevent and treat common conditions associated with aging, thereby improving the health of those who suffer with age-associated chronic illness. Health services research complements and builds on the findings of clinical and biomedical research.
Health services research, as conducted by the Agency for Healthcare Research and Quality (AHRQ) and others, addresses issues of cost, quality, and access to care within the Nation's health care delivery system. By closely examining "what works in health care, health services research is helping to close the gap between what is learned in the laboratory and what is done in the real world to improve the quality of health care.
AHRQ's research on aging has:
- Clarified risks and benefits of many treatment options for patients with prostate disease, underscoring the need for patients to be involved in the decisionmaking process.
- Led to increases in the use of beta-blockers by elderly heart attack patients, a therapy which can prevent future attacks and help reduce mortality.
- Demonstrated that serious complications of hip replacement surgery among older patients are lower than originally thought.
- Shown that increasing the nurse-to-patient ratio could translate to 3,000 fewer deaths per year in Medicaid-certified nursing homes.
Biomedical researchers have developed vaccines and other tools to prevent many diseases such as influenza, which is a significant health risk for the elderly. Health services researchers have been instrumental in demonstrating the benefits of these vaccines and, thus, in helping to make prevention of influenza a reality. For example, AHRQ-funded research has shown that being immunized against influenza reduces winter hospitalizations, emergency room visits, and blood tests by 10 to 30 percent. These reductions in turn reduce the cost of care.
AHRQ research has also shown that elderly patients of family physicians and general internists were more likely than others to receive influenza vaccines and other preventive services, which suggests the importance of these physicians to the aging population. Other research supported by AHRQ has shown that physicians who receive computer-generated reminders were twice as likely as doctors who received no reminders to administer vaccines to those at risk for influenza.
Two AHRQ studies suggest that primary care physicians should screen elderly patients more closely for signs of potential health problems often seen in the primary care setting. The first study showed that 5 percent of older primary care patients with depression have suicidal thoughts. However, the only reliable method of identifying these patients is to ask them directly and specifically if they have had such thoughts. The second study demonstrated that 1 in 10 primary care patients 60 years of age and older were found to show signs of alcoholism, although less than half were documented. Doctors may be reluctant to document cases for privacy reasons; but, because of the known adverse health consequences of excessive drinking for elders, identification of these patients is essential.
Managing Health Problems
Health services researchers have examined the effectiveness of many technologies and strategies developed by biomedical and clinical researchers to treat health conditions common in older people. AHRQ studies have found that providing information about the actual outcomes of different therapies can help patients and their providers make better treatment choices.
Hip replacement surgery. Weighing the risks and benefits of having surgery is of concern to many older people. For total hip replacement surgery, AHRQ research has shown that serious complications are quite low, although mortality within a year of having this common surgical procedure is somewhat higher for males and people age 75 and older.
Prostate disease. AHRQ research on prostate disease, including benign prostatic hyperplasia (BPH), has helped to clarify the risks and benefits of various treatment options by underscoring the need for the patient's involvement in the treatment decision. Although transurethral prostatectomy is effective in alleviating symptoms of moderate BPH, nonsurgical therapies as well as watchful waiting have been shown to be safe alternatives.
Heart disease. AHRQ health services research is helping to close the gap between what we know and what we do. AHRQ-supported outcomes research has found that:
- For elderly heart attack patients, emergency treatment within the first 24 hours, not subsequent bypass surgery or other invasive cardiovascular procedures, has the greatest impact on long-term survival.
- A third of elderly patients who survived a heart attack failed to receive aspirin within 2 days of hospitalization, even though the use of aspirin after heart attack has been shown to reduce mortality.
- Only 21 percent of eligible elderly heart attack patients receive beta blockers after a heart attack, even though other AHRQ-supported researchers had previously shown that the use of this therapy prevented further heart attacks and reduced mortality in elderly patients by 43 percent. After peer-physician education and feedback, usage of beta-blockers was increased by 63 percent.
High blood pressure. Biomedical research has shown that controlling high blood pressure can prevent heart attack and stroke; yet many patients are not receiving adequate treatment. AHRQ researchers are looking at factors that affect how doctors decide to medicate patients for high blood pressure and at possible variations in drug costs.
Vision problems. Because some vision problems are more treatable than other age-related health problems, studies of the use of vision specialists by elderly patients are now underway. AHRQ researchers are comparing vision care in fee-for-service and managed care settings by examining differences in referral patterns that suggest unmet care needs.
Other AHRQ researchers found that use of a laser to cut the lens capsule after cataract surgery increases the risk of retinal detachment by nearly four times, suggesting the need for a strong clinical justification for the procedure. Based on this knowledge, patients should be given clear instructions for identifying the symptoms of post-surgical retinal detachment.
Care settings. Health services research, unlike biomedical research, can provide insight into which care settings, including home or community-based care, are best and which risk factors are associated with entering these settings.
In addition, AHRQ has sponsored research on long-term care in nursing home settings for several years; this research has been particularly useful to policymakers at both the Federal and the State level. Among the findings:
- Strong family support networks can reduce the risk of entering a nursing home from 20 to 40 percent.
- An increase of only one-half of a full-time registered nurse position per 100 residents could translate to 3,000 fewer deaths per year in Medicaid-certified nursing homes.
- Women are three times more likely than men to enter a nursing home without assets and already eligible for Medicaid.
Quality measures. AHRQ researchers are at the forefront of developing quality measures, especially outcome-based measures, for use in long-term care research. For example:
- A recent AHRQ study proposed using a combined scale that includes measures of both self-care and of ability to function in a community; the scale would provide an enhanced and more sensitive measure of functional disability.
- Another current AHRQ study is assessing quality indicators, including severity of pressure ulcers, use of pain relievers, and management of incontinence, and how these characteristics are related to residents' race/ethnicity and facility staffing levels.
AHRQ Workshops for Policymakers
AHRQ brings research-based information to State and local policymakers through its user liaison workshops. Issues related to the aging population are addressed in two 1999 workshops: "New Directions in Long-term Care" and "Aging in Rural Areas: Preparing for the Future."
For More Information
Select AHRQ research programs to access more online information.