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Press Release

UCLA CHIEF OF GERIATRICS RECEIVES RECOGNITION FOR LEADERSHIP IN GERIATRICS EDUCATION

MAY 1, 2000

Dr. David B. Reuben (Westside resident), chief, division of geriatrics at the UCLA Center for the Health Sciences and Medical Center, is being honored for his leadership and contributions in the field of geriatrics education and improving the health of older people.

Dr. Reuben will receive the Dennis H. Jahnigan Memorial Award from the American Geriatrics Society (AGS) during the AGS 2000 Annual Meeting May 17-21 in Nashville, Tennessee. This award is given to an individual with a nationally recognized, distinguished career in geriatrics education.

Reuben, who is also director of the UCLA Multicampus Program in Geriatric Medicine and Gerontology (MPGMG) and professor of medicine at the UCLA School of Medicine, is being recognized in part for his work as lead author of "Geriatrics at Your Fingertips," a professional reference guide used in providing care to older persons in health care settings, now in its second edition.

In addition to his academic and research activities, Dr. Reuben maintains a clinical primary care practice of frail older persons and attends on inpatient, geriatric psychiatry, and nursing home units at UCLA. He has won seven awards for excellence in teaching at undergraduate and graduate levels. He is director (with co-director, John Schnelle, Ph.D.) of the NIA-UCLA Claude D. Pepper Older Americans Independence Center.

Founded in 1942, the American Geriatrics Society is a nationwide association of geriatrics healthcare professionals.

UCLA's division of geriatrics provides continuing medical education opportunities for health professionals; conducts medical and non-medical interventional research activities with the goal of promoting the health and independence of older persons; and provides inpatient, nursing home, hospice and community-based clinical care for older patients in the Los Angeles area. For the last eight years, UCLA's geriatrics program has ranked the best in the nation, according to U.S. News and World Report.

INNOVATIVE USE FOR PHOTOGRAPHY: IDENTIFYING AND TREATING MALNUTRITION IN NURSING HOME RESIDENTS

March 13, 2000

Poor nutrition and dehydration among the elderly, particularly those living in nursing homes, are common yet treatable conditions that often adversely impact health and quality of life. According to a recent report by the United States Government Account Office (GAO), malnutrition and dehydration among nursing home residents are significant problems in many nursing homes throughout California. More importantly, hampering any efforts to accurately document and treat these conditions is the GAO finding that they were not correctly identified in nursing home records. A UCLA study, published in the March 2000 issue of the Journal of the American Geriatrics Society, has found that disposable camera photographs offer a unique "low-tech" method of identifying the at-risk and undernourished nursing home resident. Currently, the most common method used to assess nutritional intake is staff estimates, usually taken by certified nursing assistants (CNAs). However, recent studies have found that nursing staff overestimate nutritional intake by an average of 15% and higher for the majority of residents, and in some cases, record no documentation whatsoever. Moreover, traditionally high nursing staff turnover rates, as well as the failure of training and management interventions to improve the accuracy of estimates, call for the development of an alternative documentation method. For this study, UCLA investigators compared nursing home staff chart documentation, direct observations by research staff, and before-and-after meal photographs taken by researchers over several days. Results show that nursing staff documentation significantly overestimated (22%) the nutritional intake of residents, as compared to research staff estimates. More importantly, nursing staff also failed to identify over half (53%) of those residents whose intake levels would require a follow-up nutritional evaluation as mandated by government regulations (75% or less of most meals). While both of the remaining methods, research staff direct observations and photographs, were reliably accurate, photographs provide several advantages. They are not dependant on an observer's memory; they provide detailed, permanent information that can be reviewed by multiple professionals, including nutritionists, physicians, and nurses; and they give limited nursing home staff more time to focus their efforts on assisting residents with their meals. In sum, UCLA researchers suggest nursing homes supplement current methods with this time-efficient, reliable alternative, which could provide accurate and specific information to those trying to target and effectively treat at-risk and malnourished nursing home residents. "Nutritional intake monitoring for nursing home residents: A comparison of staff documentation, direct observation, and photographs" was authored by principal investigator Sandra F. Simmons, Ph.D., and David B. Reuben, M.D, chief of UCLA's division of geriatrics. Dr. Simmons is a recipient of a National Institute on Aging-UCLA Claude D. Pepper Older Americans Independence Center Career Development Award, which provided support for this study.

PHYSICIAN PANEL RATES OVER ONE-THIRD OF NURSING HOME TO HOSPITAL TRANSFERS AS INAPPROPRIATE

February 7, 2000

Study Cites Need for Improved Patient Evaluation and Quality of Care As skilled nursing facilities care for growing numbers of patients with numerous and complex medical conditions, appropriate management of acute illnesses has become an important component of overall quality of care for residents. Transferring residents from a nursing facility to an emergency department or hospital is an often-used intervention in managing acute illnesses. A UCLA geriatrics study, published in the February 2000 Journal of the American Geriatrics Society, examined the records of one hundred such resident transfers over a one year period from eight skilled nursing facilities and ten admitting hospitals in the Los Angeles area. While hospitalization can often increase functioning and pain control, and reduce mortality, equally effective care can often be provided within the nursing facility, with less stress, trauma and disorientation for the resident while avoiding the higher costs associated with transfers and hospital care. To examine the medical records, UCLA researchers assembled an advisory panel of trained and board-certified internal and family medicine physicians experienced in providing care to nursing facility residents. The physician panel used a unique "structured implicit review" process developed by UCLA researchers for this study. The panel assessed such factors as baseline health status and characteristics of the acute illness, clinical care resources necessary and available for managing the illness, and the quality of acute care within the nursing facility. An important distinction was made between assessing the need for transfer to a hospital once the acute change or problem was identified, and not assessing whether prevention or earlier recognition should have occurred. Transfers were rated appropriate when no lower level of care would suffice to safely deliver the care patients required. Results indicate inappropriate transfers and admissions from nursing facilities to emergency departments and hospitals are a potentially large problem. Physician reviewers deemed 36% of emergency department transfers and 40% of hospital admissions inappropriate. Moreover, when resident preferences were considered, including advance directives, inappropriate emergency department transfers increased to 44% and hospitalizations to 45%. The physician reviewers also found that a significant number of residents received poor care in the nursing facility and this poor care may be an important factor in the decision to move residents to the more expensive hospital setting. UCLA researchers note that increasing the quality of care provided to nursing home residents could result in few future hospital transfers and lead to long-term cost savings. According to Stanley L. Slater, MD, Deputy Associate Director for Geriatrics, National Institute on Aging, "These findings will be useful to policy makers as they consider how best to structure our system of medical care for nursing home residents." The principal investigator for the study and lead author of "Appropriateness of the Decision to Transfer Nursing Facility Residents to the Hospital" was Debra Saliba, MD, MPH. Dr. Saliba is a recipient of a UCLA Claude D. Pepper Older Americans Independence Center Career Development Award. This study was supported by the National Institute on Aging-UCLA Claude D. Pepper Older Americans Independence Center. The study was also supported by the UCLA Center on Aging Irving & Helga Cooper Award for Geriatric Research and the Veterans Administration HSR&D Center for the Study of Health Care Provider Behavior.

UCLA-RAND STUDY FINDS INNOVATIVE OUTPATIENT PROGRAM CAN BE COST-EFFECTIVE METHOD OF IMPROVING HEALTH OF ELDERLY

December 6, 1999

As the cost of providing health care for an ever-growing aging population increases, developing improved and more cost-effective systems of care becomes a paramount concern for health care professionals and policy makers. In the December issue of Medical Care, UCLA and RAND researchers report that an outpatient comprehensive geriatric assessment intervention (CGA), when compared to a similar, more expensive inpatient program, proved to be a beneficial, cost-effective method of preventing functional decline and improving physical functioning in community-dwelling older adults.

UCLA researchers conducted a single consultative CGA in an outpatient setting with 363 community-dwelling older adults who had at least 1 of 4 geriatric conditions (depressive symptoms, urinary incontinence, falls or functional impairment). The UCLA assessment team included a geriatrician, nurse practitioner, physical therapist, and social worker. Unique intervention steps utilized in this study designed to increase both patient and physician adherence to recommended care plans included telephone calls, written recommendations, and patient education and empowerment counseling sessions.

In addition to functional measures, researchers from RAND Health, which specializes in research and policy analysis, collected cost data related to the intervention, as well as the use of the medical services in the following 64 weeks. RAND Health researchers found the CGA intervention prevented functional decline or contributed to modest improvements in physical functioning, at a cost that compared favorably with common medical interventions. Moreover, the authors conclude that outpatient CGA has the potential to improve health at a lower cost for a wider group of geriatric patients, compared to inpatient programs.

"Cost-Effectiveness of Outpatient Geriatric Assessment with an Intervention to Increase Adherence" was authored by Emmett B. Keeler, PhD, of RAND Health and David Robalino of RAND Graduate School; and UCLA authors Janet C. Frank, DrPH, Susan H. Hirsch, MPH, Rose C. Maly, MD, and geriatrics chief David B. Reuben, MD. The National Institute on Aging-UCLA Claude Pepper Older Americans Independence Center supported the study.

UCLA's division of geriatrics provides continuing medical education opportunities for health professionals, conducts medical and non-medical interventional research activities with the goal of promoting the health and independence of older persons; and provides inpatient, nursing home, hospice and community-based clinical care for older patients in the Los Angeles area. For the last eight years, UCLA's geriatrics program has ranked the best in the nation, according to U.S. News and World Report.

Researchers FIND IN-HOME nurse intervention CAN HELP effectively treat malnutrition in older persons

November 8, 1999

Although malnutrition in older adults is common and potentially treatable, previous research has not supported the notion that those who are malnourished or at-risk can be accurately identified or current interventions can change the course of the disorder. Lead by David B. Reuben, MD, chief of UCLA geriatrics, an interdisciplinary team of nurses, geriatricians, social workers, dieticians, speech therapists and dentists developed an in-home assessment tool to be administered by a nurse.

Each abnormal assessment finding was linked to a specific recommendation and given to subjects and their physicians. Examples included a dental referral for dental/oral diseases, social work evaluation for lack of economic resources, or speech therapy evaluation for swallowing disorders or aspiration problems. The patient or nurse could also implement certain recommendations (e.g., a "meals-on-wheels" program). Subjects were measured pre- and post- intervention for protein-energy levels and other health-related quality of life markers. Results did show an increase in protein-energy levels, known as serum albumin, and one of the indicators of malnutrition. Several markers of immune function also demonstrated changes indicating improvement.

While the UCLA researchers note the limitations of generalizing the results from this small sample size (ten persons aged 65 and older), the findings do support the feasibility and possible benefit of nurse assessments and protocols addressing contributing factors to malnutrition in the elderly.

Reported in the October Journal of the American Society of Geriatrics, "An In-Home Nurse-Administered Geriatric Assessment for Hypoalbuminemic Older Persons: Development and Preliminary Experience," was supported by the National Institute on Aging, Claude D. Pepper-UCLA Older Americans Independence Center. For the last eight years, UCLA's geriatrics program has ranked the best in the nation, according to U.S. News and World Report.

OLDER ADULTS WITH VISION AND HEARING IMPAIRMENTS AT HIGHER RISK FOR DEVELOPING FUNCTIONAL DISABILITIES

Researchers Note Lack of Coverage for Eyeglasses and Hearing Aids by Medicare

August 4, 1999

In a study released this week, UCLA geriatric researchers have found that older adults with vision and hearing impairments are more likely to develop physical functional disabilities. These impairments are among the most common conditions affecting this population. Moreover, the study suggests these sensory impairments should be identified and treated early to help prevent the effects of future functional decline, including the potential loss of physical independence.

Using data collected by the National Center for Health Statistics for the first National Health and Nutrition Examination Survey (NHANES I) and Epidemiologic Follow-up Study (NHEFS) ten years later, UCLA researchers analyzed the relationships between vision and hearing loss and 10-year mortality and functional dependence. The national sample for this population-based longitudinal study included over 5,000 community-dwelling adults aged 55 to 74 years at the beginning of the study.

The authors analyzed self-reported and measured (on physical examination) visual and hearing impairments, 10-year mortality rates, and dependency in various physical activities, including bathing, shopping, housecleaning and walking. Functional dependency was indicated when participants reported needing personal assistance with performing any of these tasks.

Researchers found that while only measured visual impairment was predictive of mortality, both measured and self-reported vision, hearing, and both sensory impairments were predictive of some functional dependency 10 years from baseline measurements. And persons who had measured hearing and visual impairments had the highest risk of subsequent functional impairment, suggesting that those who have only one sensory loss may compensate better than those who have lost both of their major sensory functions.

"These findings demonstrate that sensory impairment can have serious long-term consequences," said Dr. David Reuben, M.D., lead author of the study and chief, division of geriatrics, UCLA.

Although it has yet to be determined whether early correction of these sensory impairments can prevent long-term functional decline, the authors note several studies have demonstrated sensory aids can improve the functional status, social relations, and overall quality of life of those with vision and hearing impairments. The authors go on to say that while assistive devices such as hearing aids and eyeglasses may not have much impact on mortality, they may have profound impact on the future functional status and quality of life of older persons.

"Devices aimed at correcting sensory impairments have been excluded from traditional Medicare coverage. Perhaps it's time to reconsider the wisdom of such reimbursement policies," said Reuben.

Reported in the August 1999 Journal of the American Society of Geriatrics, "The Prognostic Value of Sensory Impairment in Older Persons" was supported by the National Institute on Aging, Claude D. Pepper Older Americans Independence Center, the John A. Hartford Foundation, and the American Federation for Aging Research.

UCLA's division of geriatrics, a national leader in academic medicine, provides clinical care, education and research aimed at improving the health and independence of older adults. For the last eight years, UCLA's geriatrics program has ranked the best in the nation, according to U.S. News and World Report. Address reprint requests to Cheril Miller, MPGMG, UCLA School of Medicine, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095-1687.

VISION STUDY shows that even MILDest FORMS OF MACULAR DEGENERATION CAN make VISUAL FUNCTIONING difficult FOR OLDER ADULTS

July 15, 1999

Reporting their results in the July issue of the American Journal of Ophthalmology, UCLA and Harvard researchers found that even the earliest forms of age-related macular degeneration can have a negative impact on an older adult's ability to pursue everyday visual activities.

Age-related maculopathy (ARM), an eye disease involving deterioration of the retina, is the leading cause of irreversible blindness among the elderly in developed countries, with more than 25 percent of those over 75 having evidence of early ARM. More commonly known as macular degeneration, it is one of a number of conditions that contribute to the cumulative effects of numerous chronic medical conditions associated with aging, such as congestive heart failure and diabetes.

According to the authors, while clinical researchers need to understand the origins of eye diseases, as well as treatments for prevention and halting progression, it is also essential to understand how visual disability influences the range of activities older persons can pursue. Moreover, researchers also need to understand the influence of chronic eye diseases on an older adult's overall physical functioning and emotional well being. By including outcomes such as physical and social function and overall health in future clinical studies, it may be possible to understand the influence of eye diseases such as ARM on everyday activities. Furthermore, a better understanding of the positive impact of vision-preserving therapies on a patient's health-related quality-of-life and capacity for independent living may lead to a greater commitment of future resources dedicated to the development of therapies for treating ARM and improving the ability of older adults to live independently.

Researchers surveyed 201 people with various stages of ARM with the primary goal of determining the impact of ARM on an older adult's ability to perform common visual activities used in their overall quality of life. Results did indicate a significant association between severe ARM and the poorer levels of visual function reported by patients in their surveys. However, results also showed no significant correlation between general quality-of-life health surveys and the clinical indicators of the severity of ARM. The authors suggest this finding may mean that general quality-of-life measures may not be as useful a tool for capturing vision-specific disabilities related to early forms of macular degeneration.

"The Influence of Age-related Maculopathy on Visual Functioning and Health-related Quality of Life" was authored by principal investigator Carol M. Mangione, M.D., M.S.P.H., Peter R. Gutierrez, M.A., Gary Lowe, M.S., E. John Orav, Ph.D., and Johanna M. Seddon, M.D. The study was supported in part by the UCLA Older Americans Independence Center, a program of the National Institute on Aging. Article reprints are available by contacting Cheril Miller, UCLA Geriatrics, 10945 LeConte Avenue, #2339, Los Angeles, CA 90095.

June 25, 1999

Reporting their results in the June issue of The Gerontologist, UCLA researchers found that nursing home residents may express satisfaction with some aspects of their daily care even when receiving levels below clinical quality standards and their own stated preferences.

Comparing different interview strategies, researchers sought to identify the most useful strategy for assessing resident satisfaction with incontinence and mobility care (walking assistance), leading to the design and evaluation of interventions to improve these care processes. Almost one hundred residents in three Los Angeles-area nursing homes participated in the interviews. Previous studies have found that both residents and their family members consider these two daily care areas very important aspects of nursing home care. However, many nursing home residents, because they are dependent on others for their care and may fear repercussions, often report high rates of satisfaction with substandard or inconsistent levels of daily care.

UCLA researchers questioned residents about their satisfaction and preferences for care and compared results with direct observations of actual care processes. Results showed that despite high reported rates of satisfaction, direct observation revealed low frequencies of daily incontinence and mobility care provision. In fact, according to clinical quality criteria, the frequency of daily incontinent and mobility care was significantly below that which would be necessary to produce positive clinical outcomes. Objective care frequencies were also significantly below residents' reported preferences. The high reported rates of satisfaction could thus mean that residents are "satisfied" with significantly lower objective care frequencies than would be necessary to produce positive clinical outcomes; or residents' responses could reflect a combination of acquiescence, reduced expectations and/or distorted perceptions of received care levels.

According to the authors, results are more likely to be due to residents' acquiescence and reduced expectations. Residents remained consistent in reporting that their care needs were being met (i.e., satisfied) despite the fact that observed levels of care were below residents' quantitative care preferences. Logically, residents should be reporting high rates of dissatisfaction between received and preferred care levels.

The authors offer several recommendations for the design and evaluation of interventions to improve nursing home resident care processes. First, the satisfaction measurement strategy should avoid ceiling effects or high reported rates of satisfaction that result primarily from acquiescence and reduced expectations. Second, it is critical for improvement purposes that a satisfaction measurement strategy provides details about what and how care processes should be implemented to improve residents' satisfaction. Quantitative estimates of how often a resident prefers different care activities on a daily basis is an example of a measurement approach that provides specific information necessary for the design of interventions. Third, it is essential that a satisfaction measurement strategy identify the specific aspects of the care process that are associated with improved resident satisfaction levels. Establishing a causal relationship is important because there is currently no evidence documenting what or how care processes should be implemented to improve residents' subjective estimates of their levels of satisfaction.

Authors of "Strategies to Measure Nursing Home Residents' Satisfaction and Preferences Related to Incontinence and Mobility Care: Implications for Evaluating Intervention Effects" are principal investigator Sandra F. Simmons, Ph.D., and John F. Schnelle, Ph.D., Director of the UCLA Borun Center for Gerontological Research at the Jewish Homes for the Aging. The study was supported in part by UCLA's Older Americans Independence Center, a program of the National Institute on Aging. UCLA's division of geriatrics, a worldwide leader in academic medicine, provides clinical care, education and research aimed at improving the health and independence of older adults. Article reprints are available by contacting Cheril Miller, UCLA Geriatrics, 10945 LeConte Avenue, #2339, Los Angeles, CA 90095.

UCLA STUDY FINDS ELDERLY PATIENTS BENEFIT FROM INNOVATIVE HEALTH CARE DELIVERY IN OUTPATIENT SETTING

March 2, 1999

In one of the first studies of its kind, UCLA researchers found that a single health evaluation with a specially designed geriatrics team significantly slowed the decline of physical function in elderly patients. This novel approach may prove effective in lowering health care costs and preserving health.

Reported in the March 1999 issue of The Journal of the American Society of Geriatrics, the study utilized a thorough health evaluation geared to older adults called a comprehensive geriatric assessment (CGA). Patients receive this special health evaluation from a geriatrics team including physicians, a social worker, a nurse practitioner and a physical therapist. The CGA consists of a series of standardized assessments of medical, cognitive, mood, sensory, economic, social and functional health.

"Proven successful in hospital and rehabilitation settings, this is one of the first studies demonstrating that the CGA is also effective with older adults receiving their care in outpatient or doctor's office settings," said Dr. David Reuben, principal investigator and chief, division of geriatrics, UCLA.

UCLA researchers conducted a randomized trial, using 356 older adults, average age 76, with age-related risk factors for falls, urinary incontinence, depression and function decline. Researchers split participants into two groups. One group received the CGA, while the other received their usual health care and served as a control group.

At the end of the 15-month study, researchers found physical decline had slowed 8-10 percent in patients receiving the CGA, compared with the control group. The CGA group also demonstrated improved energy, social functioning and physical health. Patients receiving the CGA also experienced three fewer restricted activity days per month compared with the control group. Restricted activity occurs when individuals cannot perform their day-to-day-routines. "We found that the CGA helped patients preserve their physical function and quality of life," said Reuben.

In a unique feature of the study, special intervention steps addressed to both patients and their primary care physicians were taken to improve compliance with CGA recommendations. Geriatricians leading the health evaluation personally followed up with the patients' primary care physicians, including a telephone call followed by a letter outlining recommendations and patient medical information. Health educators reviewed recommendations with patients and helped prepare participants to discuss health issues with their primary care physicians. "Empowering patients contributed to the success of the study," said Reuben. "Patients learned to take responsibility for their health and play a stronger role in their care."

According to Reuben, the CGS coupled with the intervention steps may prove very cost-effective and easy to replicate in an HMO outpatient setting. "The next step is to study the costs associated with implementing the CGA," said Reuben. "We may find that this health assessment method is a wise financial investment in maintaining the health of seniors," he continued.

The National Institute on Aging, a division of the National Institute of Health, funded the study. The UCLA division of geriatrics, a worldwide leader in academic medicine, provides clinical care, education and research aimed at improving the health and independence of older adults. For the last seven years, UCLA's geriatrics program ranked the best in the nation, according to U.S. News and World Report.

UCLA-OAIC Researchers Develop Safety Assessment for Use in Nursing Home Restraint Reduction Programs

June, 1994

Researchers at the UCLA Claude D. Pepper Older Americans Independence Center have developed a safety assessment for the frail elderly that measures behavioral factors associated with falls. The assessment was designed to help nursing home staff identify restrained residents who are likely to benefit from restraint reduction programs. Such programs have proliferated in recent years in response to federal legislation that limits the use of physical restraints in nursing homes. "Restraint reduction programs have popped up with little consideration given to post-restraint follow-up interventions designed to improve a resident's freedom of movement or mobility," said John F. Schnelle, PhD, director of UCLA's Borun Center for Gerontological Research and the assessment study's principal investigator. "The safety assessment makes available for the first time ever a reliable, valid protocol for targeting such intervention services." Additionally, the assessment identifies potentially remedial problems, such as problems with balance, foot control or posture, that increase a resident's risk for falling or injury. By law, nursing home staff are required to provide rehabilitation for problems associated with higher risk for injury. Described in the June, 1994, issue of the Journal of the American Geriatrics Society, the safety assessment for the frail elderly, or SAFE, is a performance assessment of two major skills, walking and transitioning (moving from a sitting position to standing, or vice versa). The assessment examines both safety awareness--for example, does a resident lock the wheelchair before standing-- and physical functioning skills, such as gait and balance. The assessment was tested using a sample of 108 restrained and 111 unrestrained residents in eight different nursing homes. Overall, restrained residents scored lower on the SAFE, indicating that they are at higher risk for falling and injury. These findings suggest that nursing home staff are appropriately targeting residents for restraint management. The investigators cautioned, however, that the study did not address whether the use of restraints in fact helped cause the functional and cognitive impairments that put residents at risk for injury. A surprising conclusion of the study is that restraint removal would not necessarily result in enhanced freedom of movement for residents who are unable to walk--at least 50 percent of restrained nursing home residents. "Restraint reduction may be politically correct, but it is not a panacea," Schnelle said. "Without restraints, residents who are unable to walk may fall out of their chairs if they have poor sitting balance or if they attempt to walk despite their physical incapacity." As an alternative, some nursing homes place nonambulatory residents in reclining chairs that effectively prevent standing, yet appear to be restraint- free. "The problem with this strategy is that the resident is still immobile," Schnelle said. "He or she might be better off belted in a wheelchair and offered assistance in getting around through exercises designed to improve wheelchair mobility." The study also identified a largely ignored segment of unrestrained nursing home residents who Schnelle describes as "cognitively restrained." Despite being free to move, these residents limit their physical activities due to a fear of falling. Guided by SAFE, mobility exercises targeted toward this group could result in major increases in activity levels. In addition to Schnelle, the study's other authors were Priscilla G. MacRae, PhD, Sandra F. Simmons, MA, Gwen Uman, PhD, Joseph G. Ouslander, MD, Lori L. Rosenquist, PhD, and Betty Chang, RN

"The Prevention for Elderly Persons (PEP) Program: A Model of Municipal and Academic Partnership to Meet the Needs of Older Persons for Preventive Services"

A unique partnership between a municipal agency (the City of Los Angeles Area Agency on Aging) and an academic medical center (the UCLA Multicampus Program in Geriatric Medicine and Gerontology).

The objective of the PEP program was to identify preventive needs for community-dwelling older persons and incorporate intervention strategies to improve implementation of these services.

The PEP program screened 927 persons aged 60 years or older during its first two years. The most common physician-initiated preventive recommendations were: (tetanus booster (72%), aspirin prophylaxis (68%), pneumonia vaccination (61%), and colorectal cancer screening (51%). The most common self-care recommendations were calcium supplementation (54% of women) and breast self-examination (51% of women). As part of the adherence intervention, researchers were able to complete health educator calls for 65 of the subjects. In addition, the physicians of 65% of the subjects were contacted either by telephone or letter.

Researchers concluded the a community-based preventive services program can identify large numbers of unmet preventive services needs, and a dual intervention strategy aimed at meeting these needs can be delivered successfully to the majority of participants. Implementation rates of specific recommendations and impacts on health outcomes remain to be determined.

David B. Reuben, MD, Susan H. Hirsch, MPH, Janet C. Frank, DRPH, Rose C. Maly, MD, Michael S. Schlesinger, BS, Nancy Weintraub, MD, and Sharon Yancey, RD. Journal of the American Geriatrics Society, 44:1394-1398.

Click here to download study instruments

Related article: Maly RC, Frank JC, Marshall GN, DiMatteo MR, Reuben DB. Perceived efficacy in patient-physician interactions (PEPPI): Validation of an instrument in older persons. Journal of American Geriatrics Society, 46(7):889-894.

Address reprint requests to Mr. Lucio Arruda, MPGMG, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095-1687.

Last Updated: March 3, 2006 © 2000 UCLA GeroNet