Extending Life, Enhancing Life A National Research Agenda on Aging (1991) / Chapter Skim
Currently Skimming:
5. Health Services Delivery Research
5. Health Services Delivery Research
Pages 88-106
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 88... ...
In the 1990s health care services will continue to be challenged by the changing demands imposed by the projected growth of the older population and especially by the growth of the "oldest old" those persons 85 years of age and oIcler who are most vulnerable to the problems of ill health and dependency. The growth of the older population will accelerate even more at the beginning of the next century as the baby-boom generation ages.
|
From page 89... ...
This focus on effectiveness, outcome, and functional independence fits well with the new direction being taken by federal research centers. An extended discussion of the issues related to health services research in aging appears in the Health Services Delivery Research Liaison Team report See Appendix B)
|
From page 90... ...
The Health Care Financing Administration, the major federal agency involved in payment for long-term care for older persons, defines it as follows: "Long-term care refers to health, social and residential services provided to chronically disabled persons over an extended period of time. The need for Tong-term care is not necessarily identified with a particular diagnosis, but rather physical or mental disabilities that impair function in activities of daily living" jDoty et al., 19851.
|
From page 91... ...
More than 40 percent of those giving care rate their health as fair or poor, and over a third rate their health as poor or near poor iStone et al., 19871. The past decade of research indicates that family caregiving is a complex phenomenon.
|
From page 92... ...
However, available eviclence in this area suggests the opposite: the addition of formal services to a family caregiving situation does not reduce the amount of informal help provided to the older person Stephens and Christianson, 1986~. Although our un(lerstanding of the phenomenon of family caregiving is increasing, we lack knowledge regarding caregiving among special populations E.g., minority elderly persons, Tow-income elderly persons, elderly persons living alone)
|
From page 93... ...
Numerous professionals are involved in delivering health care to oilier persons; their roles, however, are not clearly defined. Research focusing on role definition and the costs and benefits of alternative Tong-term care providers should be undertaken.
|
From page 94... ...
Second, research focusing on understanding rehabilitation strategies and their relationship to treatment outcomes is needed. Technologies Recent technical advances have the potential to enhance life for many disabled people, but little work has been clone to delineate the positive and negative effects of such technologies.
|
From page 95... ...
the highly concentrated distribution of health care expenses in which very few persons actually consume the majority of health care resources; (3 ~ the individual and societal consequences of a health care policy that floes not cover the costs of Tong-term care; (4J the impact of poverty on health status and access to care; and t5) the lack of suitable health care outcome measures.
|
From page 96... ...
concerns arise in the area of geriatric drug use: inappropriate physician prescribing, widespread elderly patient noncompliance with drug regimens, and increasing drug prices. Inappropriate Prescribing Our body of knowledge regarding the effects of aging on drug therapy and drug metabolism is extensive Bender, 1974; Lamy, 1984; Lipton ant!
|
From page 97... ...
Although most of the studies identify specific drug classes implicated in (lrug admissions, they do not identify the specific reasons the drugs are associated with the problem. For example, if a given drug is responsible for a hospital admission, is the problem related to drug dosage, drug schedule, drug allergy, drug duplication, drug-drug interaction' or drug selection?
|
From page 98... ...
As a result, drug prices have become a source of growing concern for consumers, policymakers, and both individual and institutional purchasers. Although the real income of the aged poor and near poor has remained relatively static in recent years, with Social Security payments increasing at the same rate as inflation, the expenditure for drugs most likely has increased as the result of drug price inflation.
|
From page 99... ...
Investigation is critically needed on mental illness in special populations of older persons. Little is known, for example, about the mental health status or needs of older persons who are members of minority groups.
|
From page 100... ...
These data should be related to the reimbursement system that currently floes not pay for many types of mental health services. DISABILITY/DISEASE PREVENTION AND HEALTH PROMOTION SERVICES Although some work has been undertaken in the area of disease prevention through risk reduction,*
|
From page 101... ...
· The committee recommends research on drug therapy in older persons. This priority area includes research into the factors influencing the development and regulatory approval of drugs and the effectiveness and efficiency of prescribing, (lispensing, and taking pharmaceuticals.
|
From page 102... ...
and that provide linkage of housing arrangements with community Tong-term care facilities; research to examine the effect of employer-initiated cost sharing on the use of preventive and treatment services by older persons; research on the effect of interventions to reduce the incidence of inappropriate drug treatment decisions by physicians; research to study the provision of mental health services to elderly institutionalized persons in the context of need, utility, and outcome; and research to investigate and compare the relative contribution of accepted risk factors in the development of disease among young and aged populations. RESOURCES REQUIRED The committee recommends increased support over current health services research spending during the next 5 years for increased fun(ling of research, for construction, for training, for the expansion of infrastructure Databases, library support, computer capability)
|
From page 103... ...
Third, save in specific areas, health services research in the area of health promotion/disease prevention cannot proceed until clinical research provides clear mechanisms for risk reduction in the older age groups. This need has been identified by Lipton and Lee {1988)
|
From page 104... ...
Journal of the American Geriatrics Society 36:68-72. German, P
|
From page 105... ...
Milbank Memorial Fund Quarterly; Health and Society 63:377-394.
|
From page 106... ...
Milbank Memorial Fund Quarterly; Health and Society 66:309-388. Williamson, J., and J
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.