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Nursing facility quality indicators directly involving the individual facility indinavir 400 mg low price, some provide medication adminis- medications generic indinavir 400mg with mastercard. Medication use in assisted living • Symptoms of depression without antidepressant therapy • Residents who take nine or more different medications is still an uncharted area in geriatrics discount indinavir 400mg with visa. Factors to be considered are pharmacologic cheap 400 mg indinavir fast delivery, tions were most effective in ensuring appropriate use of physiologic order indinavir 400 mg on-line, sociologic buy indinavir 400mg fast delivery, practical, and, in the case of psychoactive medications. Once the decision is made Additions to the Interpretive Guidelines in 1999 to prescribe a medication, the right agent and patient- focused on the choice of medications for elderly nursing specific dose must be chosen. Consideration of the patient’s functional and the elderly, were incorporated into the nursing home reg- cognitive status and their living environment may influ- ulations. By balancing all these placed under the definition of "unnecessary medications," factors and being sensitive to the special needs of the and those with a low-severity risk were placed under the elderly, safe and effective medication regimens can be drug regimen review regulations. Department of Health surveyors will scrutinize residents on one of these "potentially inappropriate" medications References to make sure that they are not suffering adverse out- comes. Withdrawal of Indicators for assessing the quality of care in nursing long term diuretic medication in elderly patients: a double facilities; 5 of these 24 indicators specifically refer to blind randomized trial. Adverse events A major change in nursing homes that affected med- related to drugs and drug withdrawal in nursing home res- ication is the change in reimbursement for Medicare idents. Differences in serum newer selective serotonin reuptake inhibitors (SSRIs), concentrations of and responses to generic verapamil in the but the TCAs have more side effects and the outcomes elderly. Postabsorption con- on medication usage and clinical outcomes in LTCFs centration peaks with brand-name and generic verapamil: remains to be seen. Observational cohort study of switching wafarin sodium products in a managed care Assisted Living Facilities organization. Consumer perceptions of risk lines concerning medication use in assisted living facili- and required cost savings for generic prescription drugs. Improper self- Administration, Department of Health and Human administration of ocular medication among patients with Services; 1985. Conditions of participation—pharmaceutical Services, Health Care Financing Administration; 1999. This page intentionally left blank Part II Changing Contexts of Care in Geriatric Medicine This page intentionally left blank 9 Contexts of Care Laurence Z. Rubenstein Geriatric medicine is characterized by multiple levels Use of Services by Older Persons or contexts of care. The geriatrician and their team typi- cally care for elderly patients along a continuum of these contexts, stretching from hospitalization for an acute The population aged 65 and older uses a greatly dispro- problem, such as a stroke, to rehabilitation on a subacute portionate amount of most health services. In developed ward, to convalescence in a nursing home, to continued countries, older persons typically use most services at care at home via a home care program, and finally to a a rate three to four times higher than their proportion return to primary care in the office. Proper geriatric care requires familiarity with all resources have increasing difficulty sustaining these these contexts and an understanding of how best to services. The difficulty in attaining this ob- In several countries with well-organized health care jective without sacrificing the older person’s need for systems (e. Understanding health services utilization, its deter- such as hospital geriatric assessment and management minates, and ways to effectively manage it are major units, rehabilitation wards, day hospitals, nursing homes, priorities for health services research and policy analysis and home care service. In other countries with less-developed geri- product was spent on health care, or $3632 per capita. In a more detailed study using the behavioral model, which subdivided potential predictors of hospital use into the three traditional categories of predisposing, enabling, and need characteristics, signifi- cant predictors of hospital use included lower functional status, poorer perceived health, lack of social supports, and health concerns. The most common diagnoses responsible for hospi- talization among older persons in the United States in 1996 were, in decreasing order, heart disease, cancer, cerebrovascular disease, injuries, pneumonia, and eye diseases.

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Clipp order 400mg indinavir free shipping, RN cheap 400mg indinavir with amex, PhD cheap indinavir 400mg fast delivery, Associate Director for Research buy discount indinavir 400mg line, Geriatric Research buy 400mg indinavir, Education and Clinical Center (GRECC) indinavir 400 mg line, Durham VA Medical Center; Professor, School of Nursing and Professor, Department of Medicine, Division of Geriatrics; Senior Fellow in the Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA Harvey Jay Cohen, MD, Director, Center for the Study of Aging and Human Devel- opment, and Chief, Geriatrics Division, Duke University Medical Center; Director, Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, NC 27710, USA David S. Cooper, MD, Professor of Medicine,The Johns Hopkins University School of Medicine; Director, Division of Endocrinology, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA Jeffrey Crawford, MD, Professor of Medicine, Director, Clinical Research, Duke Com- prehensive Cancer Center, Duke University Medical Center, Durham, NC 27710, USA Jonathan Darer, MD, MPH, General Medicine Fellow, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA Catherine E. DuBeau, MD, Assistant Professor of Medicine, Harvard Medical School, Urban Medical Group; Research Physician, Hebrew Rehabilitation Center for Aged, Jamaica Plain, MA 02130, USA Contributors xix Helen K. Edelberg, MD, Assistant Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY 10029, USA Michael H. Ellman, MD, Professor of Medicine, Rheumatology Section, Division of Medicine, University of Chicago, Chicago, IL 60637, USA Peter C. Enzinger, MD, Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115-5013, USA Emily R. Felzenberg, MPH, JD, Medical Student, New York College of Osteopathic Medicine, Old Westbury, NY 11568 USA Bruce A. Ferrell, MD, Associate Professor, Department of Medicine, Division of Geriatrics, UCLA School of Medicine, Los Angeles, CA 90095-1687, USA John R. Feussner, MD, MPH, Chief Research and Development Officer, Department of Veterans Affairs, Washington, DC 20420, USA Linda P. Fried, MD, MPH, Director, Center on Aging and Health, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA Terry Fulmer, RN, PhD, FANN, Professor and Director for the Center of Nursing Research, and Head, Division of Nursing, New York University, New York, NY 10013, USA George A. Gates, MD, Professor, Otolaryngology-Head and Neck Surgery; Director, Virginia Merrill Bloedel Hearing Research Center, University of Washington School of Medicine, Seattle, WA 98195, USA Marc Gautier, MD, Associate Professor of Medicine, Section of Hematology and Oncology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA Gretchen Gibson, DDS, Director, Special Care Dental Programs, VA North Texas Health Care System, Clinical Associate Professor, Baylor College of Dentistry, Dallas, TX 75216, USA Sarah Goodlin, MD, Assistant Professor of Medicine, Geriatrics Division, University of Utah School of Medicine; Director of Supportive Care and Palliative Medicine, LDS Hospital, Salt Lake City, UT 84143, USA James S. Goodwin, MD, Professor of Medicine, Director, Geriatric Services, Univer- sity of Texas Medical Branch, Galveston, TX 77555-0460, USA Marsha Gordon, MD, Professor and Vice Chairman, Department of Dermatology, Mount Sinai School of Medicine, New York, NY 10029, USA Jerry H. Gurwitz, MD, Professor of Medicine, University of Massachusetts Medical School; Executive Director, Meyers Primary Care Institute, Fallon Healthcare System, Worcester, MA 01605, USA Tamara B. Harris, MD, MS, Chief, Laboratory of Epidemiology, Demography, and Bio- metry, National Institute on Aging, Bethesda, MD 20892, USA Eric B. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA xx Contributors Mitchell T. Heflin, MD, Assistant Professor, Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, NC 27710, USA Maria Hernandez, MD, Chief Medical Officer’s Assistant, Hospital de Clinicas Caracas, San Bernardino, Caracas, Venezuela William R. Hiatt, MD, Novartis Professor of Cardiovascular Research, Section of Vascular Medicine, Unversity of Colorado Health Sciences Center, Denver, CO 80203, USA Patrick R. Hof, MD, Associate Regenstreif Professor of Neuroscience, Kastor Neuro- biology of Aging Laboratories, Mount Sinai School of Medicine, New York, NY 10029, USA Sharon K. Inouye, MD, MPH, Professor of Medicine, Department of Internal Medi- cine, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT 06504, USA Angela Inzerillo, MD, Assistant Professor of Medicine and Geriatrics, Mount Sinai School of Medicine, New York, NY 10029, USA Jameel Iqbal, BS, Research Associate, Mount Sinai School of Medicine, New York, NY 10029, USA Nancy S. Jecker, PhD, Professor, Department of Medical History and Ethics, Univer- sity of Washington School of Medicine, Seattle, WA 98195, USA Fran E. Kane, MD, Professor, Minnesota Chair in Long Term Care and Aging, Uni- versity of Minnesota School of Public Health, Minneapolis, MN 55455, USA Wishwa N. Kapoor, MD, MPH, Falk Professor of Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA Marshall B. Kapp, JD, MPH, Professor, Departments of Community Health and Psychiatry; Director of Geriatric Medicine and Gerontology, Wright State University School of Medicine, Dayton, OH 45435-0001, USA Jason H. Karlawish, MD, University of Pennsylvania, Institute on Aging, Philadel- phia, PA 19104, USA Gary J. Kennedy, MD, Professor of Psychiatry and Behavioral Science, Albert Einste- ing College of Medicine; Director, Division of Geriatric Psychiatry and Fellowship Training Program, Montefiore Medical Center, Bronx Psychiatric Center, Bronx, NY 10024-2490, USA Gerard J.

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