Quality of Medical Care for Patients Older Than Age 65 Years

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The summary below is from the full report titled "The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients." It is in the 4 November 2003 issue of Annals of Internal Medicine (volume 139, pages 740-747). The authors are N.S. Wenger, D.H. Solomon, C.P. Roth, C.H. MacLean, D. Saliba, C.J. Kamberg, L.Z. Rubenstein, R.T. Young, E.M. Sloss, R. Louie, J. Adams, J.T. Chang, P.J. Venus, J.F. Schnelle, and P.G. Shekelle.

What is the problem and what is known about it so far?

A growing proportion of Americans are older than 65 years of age and are at risk for functional decline because of health concerns that lead to increasing dependence in carrying out their daily activities. High-quality medical care might help to prevent or postpone the functional decline that often accompanies aging. However, many efforts to evaluate quality of care have focused on hospital care or general medical conditions rather than on conditions that specifically affect people older than age 65 years.

Why did the researchers do this particular study?

To evaluate the quality of care provided to older patients who were at risk for functional decline.

Who was studied?

420 patients enrolled in 2 managed care organizations who reported health information indicating a risk for functional decline. Patients were 65 years of age or older, spoke English, and lived in the community as opposed to a nursing home.

How was the study done?

The researchers used quality indicators developed for the Assessing Care of Vulnerable Elders (ACOVE) project. There were 207 quality indicators that addressed 22 conditions. The quality indicators focused on medical conditions that are common in this age group (such as congestive heart failure and diabetes) and on geriatric syndromes that can have a substantial influence on people's ability to care for themselves (such as falls or incontinence). Quality indicators are statements about what should happen in the course of care for specific patients, such as, "ALL vulnerable elders should have documentation of the presence or absence of urinary incontinence during an initial doctor visit." The researchers reviewed patients' medical records and interviewed patients or their caregivers to obtain information about each of the quality indicators relevant to each patient. They then examined how often and in what types of situations care met the quality standards.

What did the researchers find?

Quality of care varied substantially by condition, being worst for end-of-life care and best for stroke. Care aimed at treating an illness was more likely to meet quality indicator standards than care aimed at follow-up, diagnosis, or prevention. Quality of care was better for general medical conditions (such as heart disease or diabetes) than for common geriatric conditions (such as memory problems or falls).

What were the limitations of the study?

The results might not apply to other care settings. The study relied heavily on medical records, which were not available for some patients and possibly incomplete for others.

What are the implications of the study?

Patients older than age 65 years are likely not to receive care that meets quality standards for several geriatric concerns. We need to develop ways to ensure high-quality care for common conditions that may have a large negative impact on the functional status of older patients.