Biomedical subjects

D R Mehr

Publications and source records attributed to D R Mehr.

7 recordsLinked to original sources

PubMed1995

Resource use on Alzheimer's special care units.

A multistate nursing home data base was used to compare resource use by residents on Alzheimer's Special Care Units (SCUs) and on other nursing home units. Overall, staff time expended per resident was less on SCUs. However, facilities with an SCU used considerably more staff time than facilities without. Unexpectedly, after accounting for case mix, SCU residents actually used the same amount of resources as other residents in facilities with an SCU. SCUs appear to be an attractive alternative for caring for demented nursing home residents. In assessing their cost effectiveness, appropriate comparison groups will be crucial.

Alzheimer Disease↗

PubMed1995

The importance of geriatrics to family medicine: a position paper by the Group on Geriatric Education of the Society of Teachers of Family Medicine.

The role of geriatrics and geriatricians in family medicine remains unsettled. Despite a rapidly aging population, a tremendous shortage now exists of faculty with interest and expertise in geriatrics. Relatively few family practice residents choose to enter geriatric fellowship programs, and federal funding for such programs has been reduced. Despite accreditation requirements, residency programs are not always able to provide the range of geriatric experiences needed to properly prepare graduates to provide care for the broad range of older patients. Medical students' exposure to geriatrics remains limited. The Group on Geriatric Education of the Society of Teachers of Family Medicine believes that family medicine faculty must recognize and be committed to the notion that geriatrics is integral to family medicine. Both undergraduate and residency training programs should emphasize experience with geriatric patients in multiple settings. In particular, the nursing home should not be the main focus of geriatric training. The small number of certified geriatric faculty will be able to provide leadership, but a broad range of faculty must become involved in teaching geriatrics. Faculty development activities and continuing education programs to foster the necessary expertise will be essential to the accomplishment of this task.

Aged↗

PubMed1994

MDS Cognitive Performance Scale.

BACKGROUND: Chronic cognitive impairment is a major problem in U.S. nursing homes, yet traditional assessment systems in most facilities included only limited information on cognitive status. Following the Congressional mandate in the Omnibus Reconciliation Act of 1987 (OBRA '87), U.S. nursing homes now complete the Minimum Data Set (MDS), a standardized, comprehensive assessment of each resident's functional, medical, psychosocial, and cognitive status. We designed a Cognitive Performance Scale (CPS) that uses MDS data to assign residents into easily understood cognitive performance categories. METHODS: Information was drawn from three data sets, including two multistate data sets constructed for the Health Care Financing Administration. The prevalence and reliability of the MDS cognitive performance variables were established when assessed by trained nursing personnel. Five selected MDS items were combined to create the single, functionally meaningful seven-category hierarchical Cognitive Performance Scale. RESULTS: The CPS scale corresponded closely with scores generated by the Mini-Mental State Examination and the Test for Severe Impairment, nursing judgments of disorientation, and neurological diagnoses of Alzheimer's disease and other dementias. CONCLUSIONS: The new CPS provides a functional view of cognitive performance, using readily available MDS data. It should prove useful to clinicians and investigators using the MDS to determine a resident's cognitive assets.

Activities of Daily Living↗

PubMed1992

A criterion-based review of preventive health care in the elderly. Part 2. A geriatric health maintenance program.

Although the geriatric population is growing rapidly and using an increasing portion of health care dollars, no consensus exists about the best approach to preventive medicine in this age group. The most comprehensive review to date is the 1989 United States Preventive Services Task Force (USPSTF) recommendations. However, the USPSTF did not specifically address the unique situation of the elderly. Consequently, we have evaluated numerous screening tests and preventive interventions for the elderly by systematically applying the geriatric-specific criteria for preventive services proposed in Part 1 of this article (J Fam Pract 1992; 34: 205-224). Tests and interventions were measured against specific screening criteria and put into one of three categories: those that have been proven effective, those that may be effective but about which more research is needed, and those that are not effective. Recommendations were compared with those of the USPSTF. Proof of the efficacy of most screening tests and interventions in the current literature was found to be lacking, pointing to the need for substantial future research in this area.

Aged↗

PubMed1992

Risk factors for mortality from lower respiratory infections in nursing home patients.

BACKGROUND: Little is known about the factors that predict whether nursing home residents with lower respiratory infection (LRI) will do well or poorly, although this information is critically important when making treatment decisions. METHODS: Using nursing home and hospital medical records, we performed a case-control study to identify risk factors for death from LRI among residents of a 110-bed, midwestern community nursing home. Three experienced geriatricians aided in the development of an operational definition of an LRI. In a 3 1/2-year period, we identified 26 cases in which the patients died from LRI and 66 control episodes in which the patients recovered from LRI. RESULTS: Compared with those who survived, those who died were 14 times more likely to be totally dependent with respect to activities of daily living (ADL) than the group of patients least ALD-dependent (odds ratio [OR] = 14; 95% confidence interval [95% CI] = 2.85 to 68.87). After adjusting for ADL, mortality was significantly decreased when a broad-spectrum oral antibiotic (trimethoprim-sulfamethoxazole, cefaclor, amoxicillin-clavulanate, or ciprofloxacin) was used as the initial therapy (OR = .14; 95% CI = .02 to .81). CONCLUSIONS: Better functional status and initial therapy with broad-spectrum oral antibiotics were strong predictors of surviving an LRI in this population of nursing home patients. The antibiotic effect may be a treatment effect or the consequence of underlying factors leading physicians to select particular antibiotics; however, it appears possible to identify low-risk persons who do not require the aggressive treatment and hospitalization that is often recommended for these patients. An approach to the treatment of nursing home LRI is suggested.

Activities of Daily Living↗

PubMed1992

A criterion-based review of preventive health care in the elderly. Part 1. Theoretical framework and development of criteria.

The magnitude of health care resources devoted to care for the elderly is increasing; however, little is known about the efficacy of the services purchased with those resources. This is especially true in the area of preventive health care. In the absence of a consistent and comprehensive definition of health for the elderly population, it has been difficult either to establish criteria for evaluating preventive services or to assess the impact of those services. This article extends criterion-based review to the assessment of preventive services for the elderly. Health in the elderly can be defined by three related factors: the absence of disease, the maintenance of optimal function, and the presence of an adequate support system. Based on this definition of health, goals for preventive care should include compression of morbidity in addition to prevention of disease, and will require that quality of life be measured to completely assess the value of services. Unfortunately, existing measures of quality of life are difficult to apply to the elderly population, and there are no consistent societal values on which to base a new definition for quality of life. Because existing sets of criteria for the evaluation of preventive services do not address the distinctive health issues affecting the elderly, we have constructed a set of six criteria designed specifically for the well elderly population. In a companion article, we will apply these criteria to candidate preventive services for the elderly population to develop a geriatric health maintenance protocol for use in clinical practice.

Aged↗

PubMedDate not supplied

Use of administrative records to describe longitudinal patterns of health services use among veterans.

Administrative records of the Department of Veterans Affairs (DVA) and the National Death Index were linked to create a four-year longitudinal database that describes the clinical status, hospital and nursing home use, and mortality for a nationwide cohort of persons admitted to DVA nursing homes (n = 23,039). Using Social Security Numbers as identifiers, the records of only 6% of these persons had logically inconsistent or implausible patterns. Nineteen percent of the remaining records had correctable logical errors. Information on the creation, consistency, and potential uses of this database may prove useful to health services researchers interested in describing longitudinal patterns of health care use across multiple settings within and outside the DVA.

Bias↗