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• Telemedicine Aids in Alzheimer’s Follow-up
• Medicaid May Be a Link to Home Health Care for Older Individuals in Rural Areas
• Nearly One Third of Prescriptions for the Elderly May Be Inappropriate Medications
• New Research Results Available
• New Web Site for Patient Safety
• Insomnia in Elderly Nursing Home Residents Predicts Risk of Future Falls

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Telemedicine Aids in Alzheimer’s Follow-up 

Doctors at the Alzheimer’s Disease Center of the University of Texas Southwestern Medical School are using telemedicine in a new way—to provide periodic checkups on Alzheimer’s patients. The University is one of the first of 32 National Institutes of Health-funded Alzheimer’s Disease Centers across the United States to use telemedicine. The National Institute of Aging has funded studies at the University that examine patterns of Alzheimer’s disease and other forms of memory loss in American Indian populations, and many of the study patients live as far as 200 miles from their doctors. Dr. Myron Weiner, professor of psychiatry and neurology at UT Southwestern, and his colleagues are using telemedicine to track their patients’ progress. Once a patient has received their initial diagnosis, it is not always necessary to have follow-up, face-to-face meetings; telemedicine follow-up allows the doctors to track a patient’s progress without the patient having to travel long distances. Doctors can “see” their patients and the patients can “see” their doctors. Assessments for side effects of psychotropic medications and estimates of disease progression can be made. Similar telemedicine setups could be adapted in any remote location, enabling doctors to better serve patients who live in rural areas where access to healthcare is limited.

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Medicaid May Be a Link to Home Health Care for Older Individuals in Rural Areas 

According to the Agency for Healthcare Research and Quality (AHRQ), Medicaid may be an important method of linking older rural residents with formal home care. Combined data from the 1998 Medical Expenditure Panel Survey—Household Component were examined to ascertain the impact of rural-urban residence on use of formal home care (reimbursed by Medicare of any source) among older people and to determine whether and how Medicaid coverage influenced this association. After adjusting for other factors, the likelihood of any formal home care use was significantly higher for Medicaid enrollees residing in nonmetropolitan counties having no town of 10,000 or more people. Use of Medicare home health care was significantly greater for residents of the most rural counties, irrespective of their Medicaid coverage. Within very rural counties, Medicare home care may substitute for other forms of health and long-term care that would normally be reimbursed through Medicare but that are less available, such as hospitals or advanced medical services. Medicaid coverage may facilitate access to acute and chronic care services. For further information, see the full study (Gerontologist 2004;44:655-64).

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Nearly One Third of Prescriptions for the Elderly May Be Inappropriate Medications 

According to a recent study published in the February 2005 issue of the Journal of the American Geriatrics Society, Dr. Steven Simon, assistant professor of ambulatory care at Harvard Medical School, indicates that medication safety is of paramount concern in the elderly. Potentially adverse drug events in the elderly are a public health concern because older persons generally use more medications and seek more medical help than younger persons. The study showed that nearly 29% of people aged over 65 had received at least 1 prescription that was potentially inappropriate. Women were more likely than men to receive an inappropriate medication. In another study that addresses the problem of inappropriate medications, published in the January 2005 Archives of Internal Medicine, the study director, Dr. Khaled Imam, indicated that 3 factors contribute to the continuing problem: lack of knowledge on the physician’s part; lack of awareness that older, cheaper, and commonly prescribed medications can cause adverse reactions in the elderly; and patient request for certain medications. Elders and their caregivers can help by bringing their doctor a list of all of the medications, including prescriptions, over-the-counter medications, dietary supplements and herbal remedies, that are in the home.

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New Research Results Available 

The Agency for Healthcare Research and Quality (AHRQ) has recently released the federal government’s first compendium of studies on the successes and challenges of efforts to improve patient safety and reduce medical errors. The 4-volume set of 140 peer-reviewed articles represents an overview of patient safety studies by AHRQ-funded researchers and other government-sponsored research. Each of the volumes has a commentary from a safety expert who addresses questions and topics: Volume 1 covers research; Volume 2 addresses concepts and methodology and examines complex systems of care; Volume 3 covers implementation issues; and Volume 4 showcases programs and products, screening tools, and process simulations. The articles reflect the array of health care settings in which safety efforts are underway, from hospitals to nursing homes to other community settings. A limited number of 4-volume printed sets are available, and the set is also available as a searchable CD-ROM. To order, contact the AHRQ Publications Clearinghouse at (800) 358-9295 or online at www:ahrqpubs@ahrq.gov.

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New Web Site for Patient Safety 

The Joint Commission International Center for Patient Safety recently announced the launch of its Web site, www.jcipatientsafety.org. The site, designed and implemented to serve as a central location for resources and information related to all aspects of patient safety, will provide an array of practical safety solutions that can be used to improve safety and quality of patient care in hospitals, outpatient clinics, nursing homes, home care settings, and assisted living facilities. According to Peter B. Angood, MD, chief patient safety officer for the Joint Commission International Center, the Web site should be a valuable source to health care professionals who are seeking to implement recognized safely principles in their practices. It should also be a valuable tool for patients, their families, and the general public. The goal is to provide a wide spectrum of important safety information that is highly relevant and readily accessible.

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Insomnia in Elderly Nursing Home Residents Predicts Risk of Future Falls 

According to a recent study by the University of Michigan Health System, published online in the March 2005 issue by the Journal of the American Geriatrics Society, elderly people with insomnia often go untreated because of the perception that sleeping pills increase the risk of falls and injuries. The real culprit may be underlying insomnia, rather than the medications used to treat it. Elderly residents with untreated or partially treated sleeplessness have a higher risk of falls than those who take sleep medications and get relief from their insomnia. In the study, individuals with untreated insomnia at the start of the study period were 90% more likely to fall in the next 6 months compared with those who did not have insomnia. In contrast, those who were taking hypnotic drugs (sleep-aiding medications including many older, long-lasting drugs such as benzodiazepines and barbiturates, as well as newer, shorter lasting, and commonly advertised drugs with fewer side effects) to treat their insomnia at the start of the study were only 29% more likely to fall. Another striking finding was that nursing home residents who were on sleep medications and reported no problems sleeping at the start of the study had about the same risk of falling in the next 6 months as those who slept well without drugs. Insomnia, which includes trouble falling asleep, trouble staying asleep, frequent night-time waking and early waking, affects more than 40% of adults over age 50 and half of adults over age 70, compared with 30% of adults in their 40s. About 1 and 5 adults over age 65 has persistent insomnia. The results should encourage older people and their caregivers to pay attention to insomnia and to seek help for it.