Hospitalization for an acute event can lead to long-term institutionalization Published on October 4, 2011 at 1:31 AM Confirming many elderly

patients' worst fears, a national study has shown that being hospitalized for an acute event, such as a stroke or hip fracture, can lead to long-term institutionalization in a nursing home. Equally alarming, researchers found that direct discharge to a skilled nursing facility -- a common practice designed to reduce hospital stays -- put patients at "extremely high risk" of needing long-term nursing home care. According to researchers at the University of Texas Medical Branch in Galveston, these findings suggest that programs aimed at helping older patients recuperate successfully at home instead of in an institutional setting could greatly improve their health outcomes and reduce healthcare costs. The study is published online today in theJournal of Gerontology. "Hospitalization is a tipping point for older patients, often reducing their ability to live as independently as before," said lead author James S. Goodwin, MD, Director, Sealy Center on Aging at UTMB and the George & Cynthia Mitchell Distinguished Chair in Geriatric Medicine. Goodwin also noted that certain factors common among the elderly -- cognition problems, frailty, lack of social support -- increase the risk of nursing home institutionalization. "Add the enormous systemic pressure to reduce hospital stays and a dearth of viable programs to help patients fully recover their health and independence after hospitalization, and there simply isn't a clear path to get the patient back home," he said. Medicare pays 100 percent for 20 days at a skilled nursing facility for patients who have just been released from the hospital but still need extra care. "There is a very narrowly defined view of what Medicare will provide post-hospital," said Goodwin. "If Medicare payment guidelines were broadened to cover in-home care -- bathing and food preparation for example -- there is a tremendous potential for savings and patients could adjust gradually back to their familiar home environment. Medicare will not pay for the in-home care." Goodwin and his colleagues measured a five percent sample of Medicare enrollees (approximately 762,000) aged 66 or older between 1996 and 2008 who were admitted to nursing homes. Of that population, 75 percent were admitted to a nursing home for long-term care within six months of a hospital stay. According to Goodwin, the period studied paralleled a time of growth in the use of skilled nursing facilities, which may have been due to Medicare's adoption of a prospective payment system that encouraged hospitals to reduce the length of stays. Institutionalization after hospitalization increased with older age, in women and in patients without a primary care physician. The odds of institutionalization were also more than six-fold higher in patients

with a dementia diagnosis and increased in patients with other co-morbidities, including delirium and incontinence. Being transferred to a skilled nursing facility on discharge was the primary risk factor leading to substantial long-term care. The percent of hospitalized Medicare patients transferred on discharge increased from 10.8 percent in 1996 to 16.5 percent in 2008. Additionally, the study found that nearly 65 percent of patients in a nursing home six month after hospitalization had first been transferred to a skilled nursing facility. This was up from 50 percent in 1996. Risk-reducing factors Researchers also found several factors that reduced the risk of long-term institutionalization. Patients cared for in larger hospitals and major teaching hospitals were less likely to be in a nursing home six months after discharge, as were patients treated by their primary care physicians. In general, rates of nursing home institutionalization were lower in Midwest and Western states, where regulations, cultural and social factors may reduce nursing home use. Goodwin recommends that hospitals consider alternatives to skilled nursing facilities posthospitalization, such as community-based facilities, assisted living facilities and at-home care. Developing preventive programs that target the population at-risk for long-term nursing home care -hospitalized Medicare patients -- may serve as another avenue to avert long-term institutionalization. He also suggests exploring ways to reduce the economic incentives of keeping patients in long-term care and divert savings to such alternatives and prevention programs. "There is no perfect solution for caring for patients who may not be able to function completely independently and who lack a social network of able caregivers," said Goodwin. "We do know that most people fervently wish to remain at home and it is our responsibility to help avoid preventable nursing home admissions." Source: The Gerontological Society of America http://www.news-medical.net/news/20111004/Hospitalization-for-an-acute-event-can-lead-to-longterm-institutionalization.aspx

Link between age-related changes, health and cognition Published on September 2, 2011 at 8:29 AM Critical life course events and experiences - in both youth and middle adulthood - may contribute to health and cognition in later life, according to a new supplemental issue of the Journals of Gerontology Series B: Psychological Sciences and Social Sciences. Furthermore, the authors find that the processes of aging linked to cognition and those linked to health should be studied simultaneously, as part of the same set of processes.

There also is an emerging consensus that a multidisciplinary theoretical approach is necessary to understand the nature of the processes of cognitive aging. Thus, the studies presented in the issue represent the work of scholars in the areas of biology, epidemiology, demography, developmental psychology, gerontology, neuropsychology, and sociology. "Knowledge of the relationship of aging to health and cognitive function is crucial to the understanding of the linkages between age-related socioeconomic, racial/ethnic, gender, and health disparities," state Guest Editors Duane F. Alwin, PhD, and Scott M. Hofer, PhD. Among the issue's findings: For many cognitive abilities, the declines associated with aging do not manifest themselves until after age 75. High school class rank has a much larger effect than on survival than IQ across the lifespan. The progressive substitution of mechanical power for human physical activity is undermining the physical fitness needed to preserve cognitive function. Greater social contact and support are associated with better cognitive functioning, whereas greater conflict is associated with lower cognitive functioning. Diseases either caused by or associated with aging - particularly vascular changes - play a larger role in age-related cognitive changes than is often acknowledged.

Source: The Gerontological Society of America http://www.news-medical.net/news/20110902/Link-between-age-related-changes-health-andcognition.aspx

Virginia Tech to create portable fall prediction monitoring system for the elderly Published on August 19, 2011 at 6:47 AM According to the U.S. Center for Disease Control and Prevention, falls among Americans over age 65 are the leading cause of injury-related death. Falls also are the most common cause of nonfatal injuries and hospital admissions for trauma. In 2007, more than 18,000 older adults died from unintentional fall injuries. In 2009, 2.2 million nonfatal fall injuries among elderly adults were treated in emergency rooms and more than 581,000 of these patients were hospitalized.

Researchers at Virginia Tech and the University of Virginia are hoping to stem this tide. With a $1.2 million grant from the National Science Foundation's Smart Health and Wellbeing Program, they are creating a portable fall prediction monitoring system for early detection of fall risks that can provide early diagnosis and treatment before a fall occurs to reduce long-term health effects and injuries, and ultimately, help stave off death.

Users likely would wear the device as a faux piece of jewelry on a piece of clothing or around an ankle. It will measure potentially small declining increments in gait, posture and mobility of a patient, major indictors that can help point to a future fall, said Thurmon Lockhart (http://www.ise.vt.edu/people/bio.php?content_id=330&type=teaching), an associate professor with the Virginia Tech Grado Department of Industrial and Systems Engineering (http://www.ise.vt.edu/main/index.php).

"I believe we could really help some people, that is the reason for this program, helping save lives" said Lockhart, who also is director of the Virginia Tech Locomotion Research Lab, and has worked with dozens of U.S. companies - including delivery giant UPS - in training workers in fall training safety (http://www.vt.edu/spotlight/impact/2010-01-04-falls/fall-prevention.html).

Joining Lockhart on the research project from Virginia Tech are Dong Ha (http://www.ece.vt.edu/faculty/ha.php), professor of computer and electrical engineering (http://www.ece.vt.edu/), and Karen Roberto (http://www.humandevelopment.vt.edu/roberto.html), professor of human development and director of the Center for Gerontology (http://www.gerontology.vt.edu/) and the Institute for Society Culture and Environment (http://www.isce.vt.edu/). Also joining the study is John Lach, a professor of electrical and computer engineering at the University of Virginia in Charlottesville. The two universities will share the grant, with $750,000 going to Virginia Tech, and $450,000 to University of Virginia.

"Our focus is on preventative measures," Roberto said. "The idea is to identify with some confidence those older adults most at risk for falling before they actually fall. With this type of information, facilities could implement safety measures and work with those individuals to prevent and reduce fall accidents."

The federal grant money is a pittance compared to the health care costs associated with falls among the elderly, said Lockhart. In 2005, the latest numbers available from the U.S. Center for Disease Control and Prevention, direct medical costs of falls totaled more than $19 billion and fatal fall costs $349 million. With inflation, skyrocketing health care costs and the aging of the baby-boomer generation, these numbers likely are to dramatically increase. An early prototype of the sensor already has been built and tested under a previous National Science Foundation funded project by Lockhart and Lach. The newer project will develop a monitoring system called "ROOP-Alert" for Remote Observation Operating Platform, named in humorous tribute for Roop Mahajan, director of Virginia Tech's Institute for Critical Technologies and Applied Science. It will bridge

gait and posture analysis, body sensor networks, low-power radio frequency wireless communication, and gerontology. The sensor is about the size of an iPod Mini, and designed to be worn on minimally invasive locations. Data from the monitors would be continually sent wirelessly to the ROOP-Alert system in a monitoring station, such as a nurses' office at a nursing home or retirement center to help recognize a resident's mobility decrements and related falls risk, before they fall. A group of residents at a Radford, Va., nursing home operated by Commonwealth Care of Roanoke Inc. will be the first to test the monitoring devices, said Roberto. Debbie Petrine, chief executive and chief operating officer at Commonwealth Care is a Virginia Tech alumna of the Pamplin College of Business, and is a member of the Center for Gerontology advisory board. Lockhart and Ha will concentrate on algorithms and low-power radio development that will capture data for mobility analysis and fall risk assessment, as well as software for the device, while Lach will focus on the hardware aspects of the device, including its battery life and usage. Roberto will focus on the user end, making the device user friendly as the prototype progresses during the four-year grant process. The monitor must be nonintrusive and easy to manage for its elderly users, including those with dementia who can become easily confused and distressed. Lockhart likens his hopeful end-model as being about the size of a dime, and just as light. As well, the device must have a durable battery life, Lockhart said. Source: Virginia Tech http://www.news-medical.net/news/20110819/Virginia-Tech-to-create-portable-fall-predictionmonitoring-system-for-the-elderly.aspx