IOM report on medical care for the elderly

The Institute of Medicine recently released a report from the workgroup charged with assessing geriatric care in the US, including how our clinicians are trained, trends in the expected demand for geriatric care and the clinical workforce that cares for them -- it also proposes recommendations for changes that need to happen to effectively meet the needs of this growing group. The report is titled "Retooling for an Aging America: Building the Health Care Workforce" and you can read it for free on the IOM website.

The IOM's overview notes:

The resulting report, Retooling for an Aging America: Building the Health Care Workforce, says that as the population of seniors grows to comprise approximately 20 percent of the U.S. population, they will face a health care workforce that is too small and critically unprepared to meet their health needs. The committee concluded that if our aging family members and friends are to continue to live robustly and in the best possible health, we need bold initiatives designed to

- explore ways to broaden the duties and responsibilities of workers at various levels of training;
- better prepare informal caregivers to tend to the needs of aging family members and friends; and
- develop new models of health care delivery and payment as old ways sponsored by federal programs such as Medicare prove to be ineffective and inefficient.

The AMNews also has a nice synopsis of the report and links to the AMA's initiative focusing on caring for the elderly and several advocacy initiatives related to geriatric health.

Search challenge 7: strategies

Last week's search challenge explored whether there is evidence in the literature to support the use of nutritional therapy in patients with pressure ulcers.

A PubMed search strategy that seems to work well:
(pressure ulcer[mh] OR pressure ulcer*[tiab] OR decubitus ulcer*[tiab]) AND (nutrition[tiab] OR nutritional[tiab] OR nutrition therapy[mh] OR diet therapy[sh] OR vitamins[mh] OR vitamin[tiab] OR vitamins[tiab]) AND eng[la] AND humans[mh]

I also tried the MeSH term "nutritional support," since I was seeing some articles that looked at feeding regimens which are often indexed in this broad MeSH category, but didn't find that it added anything to the retrieval, probably because of the text words I'd included.

In reviewing the results, there's a meta-analysis that includes the literature through 2004: Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R, Elia M. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev. 2005 Aug;4(3):422-50 (PubMed abstract) -- this meta-analysis included studies that focused on either enteral nutrition formulas or other oral supplements (e.g. vitamin C). The meta-analysis seemed well-executed and had clear inclusion/exclusion criteria; it also provided a good overview of the previous literature on this topic.

For this kind of question, I think I'd be comfortable providing a good meta-analysis accompanied by any high-quality references (e.g. trials or cohorts) published since the time it was executed; I'd also want to look at the kinds of things that they excluded and consider whether any of those need to be mentioned. For example, there might be therapies represented in small experimental studies that wouldn't make it into a meta-analysis but still would be useful to mention to the requester as a potential option, so that I'd feel like I was thoroughly representing all of the possible "options" that are in the literature.

April JMLA posted in PubMed Central

And with it, the next installment in our case study series:

Cahall M, Jerome RN, Powers J. The impact of a literature consult service on geriatric clinical care and training in falls prevention. J Med Libr Assoc. 2008 April; 96(2): 88–100.

The case:
You frequently collaborate with a geriatrician in the adult primary care clinic of your large academic medical center. On a routine visit to his office to discuss his current needs for clinical evidence, he requests that you analyze the literature on effective interventions to reduce accidental falls in older persons. As he also provides geriatric care at the local Veterans Administration hospital and is the medical director at several local nursing homes and home health agencies, he notes that he is interested in literature describing interventions for use in private homes as well as those implemented in institutional settings.

More in the full article here.

Health and older Americans

Report released yesterday by the National Institute on Aging and the National Center for Health Statistics, among others from the Federal Interagency Forum on Aging-Related Statistics -- Older Americans 2008: Key Indicators of Well-Being, including a special section on literacy and health literacy

More:
- the press release
- PowerPoint slides of charts
- US News & World Report article on the report