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Biomedical subjects

R L Kane

Publications and source records attributed to R L Kane.

At least 19 recordsLinked to original sources
PubMed1992

Lessons in long-term care: the benefits of a northern exposure.

Canada stands as an important lesson for the United States. At the very minimum it represents the art of the possible. For those interested in long-term care, it suggests that it is possible to include long-term care in a programme of universally accessible care without national bankruptcy. Although Canada has brought medical and social services closer together and has brought acute and chronic care under the same aegis, not all the problems of coordinating such efforts have been solved. For others, the Canadian example shows that care can be provided to all persons who need it without creating uncontrollable expenses or removing families' motivations to care for their own. In so doing, universal coverage creates the opportunity for better coordination of services and ultimately for more efficient care.

Canada↗
PubMed1992

Computerized assessment in neuropsychology: a review of tests and test batteries.

This article contains detailed reviews of 13 computerized neuropsychological and performance test batteries and six stand-alone computer tests. Tasks found on these instruments are described and tables illustrate which batteries employ which measures. In addition to issues of reliability and validity, special considerations apply to computerized assessment. These issues are discussed and readers are provided information to help them assess computerized tests in relation to their particular clinical and research needs. Since many computerized tests were developed as performance assessment tools, the relationship between performance and neuropsychological assessment is examined.

Brain Damage, Chronic↗
PubMed1992

Longitudinal study of psychotropic drug use by elderly nursing home residents.

In this longitudinal study of patterns of use of psychotropic drugs by a cohort of elderly nursing home residents (N = 5,752), drug use was examined upon admission, 3 months later, and at discharge/end of study. At each time point, 17% of the cohort used neuroleptics. Half of the subjects discontinued neuroleptics at each time point; however, a similar number were initiated on the drug. Benzodiazepines were used by 21%, 15%, and 15% at each of the three time points, respectively. Twice as many people were taken off benzodiazepines as initiated on them following admission. The 5% rate of antidepressant use was constant across the three time periods, although only half of those who took antidepressants upon admission were also taking them upon discharge/end of study. The amount of change due to discontinuation of these drugs and adjustment in dosage levels challenges the stereotype of the "neglected psychotropic drug user" in nursing homes.

Aged↗
PubMed1992

Qualitative analysis of the Program of All-inclusive Care for the Elderly (PACE).

The innovative model of capitated acute and chronic care for nursing-home-eligible elderly persons, which was developed at On Lok in San Francisco's Chinatown and stresses using community care in lieu of institutional care, has been replicated at eight sites around the country. The early experience in developing these sites tests the extent to which the principles of this approach, based on day health care, can be reproduced in a variety of other settings. Four of the eight sites have begun formal capitated care; enrollment has been less active than anticipated, apparently due to reluctance to change physicians and resistance to day care.

Acute Disease↗
PubMed1992

Self-report versus medical record functional status.

The importance of assessing functional status in the hospitalized patient is gaining recognition. However, the availability and accuracy of medical record functional status data are uncertain. We collected data on 2,504 patients greater than 65 years of age discharged alive. A personal interview conducted 2 days before discharge recorded the patient's self-reported ability to perform 5 activities of daily living scales. Medical record abstraction was used independently to determine ability to perform the same activities of daily living scales. Patients who required any human assistance to perform a function were considered dependent. Patients were also contacted after discharge to determine the site of posthospital care (28% discharged to a nursing home). The amount of missing medical record functional status data varied by function from 20% for bathing to 50% for dressing. Ten percent of patients had no medical record functional status documentation concerning any of the five functions. The prevalence of self-reported dependence at discharge varied by function from 24% for feeding to 93% for bathing. The total number of dependencies differed between the two methods (medical records, 2.3 +/- 1.9; self-report data, 3.2 +/- 1.5). There was exact agreement between the two methods on the total number of dependencies in 28% of cases and differences of greater than or equal to 3 in 20%. In a stepwise logistic model predicting discharge to a nursing home and adjusting for other relevant variables, the number of dependencies as determined by self-report and medical record data each remained significant (Odds Ratios = 1.6). Self-report and medical record functional status data differ substantially, and the medical record data remain independently associated with nursing home placement. Several possible explanations for this finding are explored.

Activities of Daily Living↗
PubMed1992

Inadequate treatment of depressed nursing home elderly.

OBJECTIVE: To determine the prevalence of antidepressant drug treatment among nursing home elderly with major depression. DESIGN: Survey early and late in nursing home stay. SETTING: Sixty Medicaid/Medicare-certified skilled nursing homes. PARTICIPANTS: Admission cohort of 5,752 residents age 65 or older in 1976 through 1983. MEASURES: Chart review by nurse-abstractors of physicians' diagnoses, drug used, and alertness rating. Diagnosis of depression equivalent to DSM-III-R major depression. RESULTS: Of 868 persons with a diagnosis of depression in the medical record, only 10% were treated with antidepressant drugs. More received neuroleptics and benzodiazepines than received antidepressants, but most (52%) received no psychoactive drug at all. A subset of 258 depressed persons had positive notations in their records supporting a mental status rating of "alert and oriented." Of that subset, only 15% received antidepressants. When followed from admission to discharge or end of study the prevalence rate of antidepressant drug treatment increased by 4%. CONCLUSIONS: In the late 1970's and early 1980's, even when the primary care physician made and recorded a diagnosis of depression, most such nursing home residents remained untreated, incorrectly treated, or inadequately treated.

Aged↗
PubMed1991

Standardized and flexible batteries in neuropsychology: an assessment update.

This article summarizes current literature relevant to commonly used tests and test batteries in clinical neuropsychology. The first section contains a discussion of the philosophy and relative advantages of standardized and flexible battery approaches in neuropsychology. The second contains historical background and a literature review of the two major standardized test batteries: the Halstead-Reitan and Luria-Nebraska. The third section includes reviews of tests that are frequently used in the flexible battery approach. Various tests of intellectual functioning, attention, memory, language, and spatial analyses are critiqued in this section. Contributions of the process approach are noted. The article ends by underscoring the need for continued research into the nature of neuropsychological measures and the abilities they assess.

Attention↗
PubMed1991

Forecasting the number of future disabled elderly using Markovian and mathematical models.

The accuracy of forecasting the number of future disabled elderly people depends on the accuracy of projecting mortality rates and the rates of transition to and from functional disability. We describe a new two-step method for constructing mathematical models that project these future rates dynamically. (1) A Markovian model of elders' transitions between functional states is specified. (2) A mathematical model of the probability of each transition is created. We conducted pilot studies of the fundamental mathematical processes of this method using data from the Longitudinal Study of Aging. First we constructed prototypic mathematical models of the probabilities of remaining functionally able and of making transitions to disability and to death within 2 years. Then we used these models to project hypothetical rates of transition for white women of selected ages, morbidity ratings and health statuses.

Activities of Daily Living↗
PubMed1991

Using ADLs to establish eligibility for long-term care among the cognitively impaired.

Using a database from the Oregon Medicaid program, we examined the differences in the potential insurance coverage of demented persons by using different formulations of ADL (activities of daily living) dependencies in which the definition of dependency did or did not include the need for supervision. For those with clear dementia, 81-88% of the persons with significant behavioral problems were correctly identified when a cut score of three or more ADLs was used; this percentage was even higher for two or more ADLs. This approach was not as effective in correctly discriminating those who had no behavioral problems.

Activities of Daily Living↗
PubMed1991

Improving primary care in nursing homes.

We conducted a quasi-experiment to evaluate the impact of a Medicare waiver which allowed the use of nurse practitioners (NPs) and physicians assistants (PAs) to deliver primary care to Massachusetts nursing home patients and removed the limits on the reimbursable numbers of visits per month. A carefully matched set of 1,327 Medicaid patients from 95 non-participating homes in the same areas of Massachusetts was compared to 1,324 Medicaid demonstration patients from 75 homes. Information came from specially designed record reviews and the Medicaid and Medicare information systems. Separate analyses were done for newly admitted cases and rollovers. Comparisons of quality of care suggested that the medical groups using NPs and PAs provided as good or better care than did the physicians in the control group. There were no differences in functional status changes or in the use of medications. The demonstration patients received more attention, as reflected in more orders written and an average of one additional visit a month. Demonstration patients showed higher scores on three of seven specially designed quality tracers, congestive heart failure and hypertension for both new administrations and rollovers, and new urinary incontinence for new admissions. Rollovers had significantly fewer emergency and total hospital days. A cost analysis suggests that the use of NPs and PAs saves at least as much as it costs and may save additional money with more sustained use.

Aged↗
PubMed1991

Adult foster care for the elderly in Oregon: a mainstream alternative to nursing homes?

BACKGROUND: In Oregon, adult foster care (AFC) homes, which are private residences where a live-in manager cares for one to five disabled residents, have been covered by Medicaid since 1981 and seem to offer a mainstream alternative to nursing homes. They house almost 6000 older people, two thirds of which pay privately. METHODS: In a cross-sectional study, we interviewed 400 AFC and 400 nursing home residents. Data analyses included descriptive cross-tabulations; hierarchial loglinear models for judging the effects of care setting and payment status on resident characteristics; and logit analyses for predicting care setting and payment status within care settings. RESULTS: On average, nursing home residents were more physically and cognitively impaired than AFC residents, but there was considerable overlap in patterns of frailty in the two settings. Medicaid AFC residents were less disabled than privately paying AFC residents. AFC residents reported more social activity, even when we controlled for disability status. AFC residents and their families were more likely to value privacy and homelike settings when choosing a care setting, whereas nursing home residents were more likely to value rehabilitation and organized activity programs. CONCLUSIONS: Both AFC and nursing homes are viable components of a long-term care repertoire. The greater disability levels of private-pay AFC residents refutes the criticisms that disabled Medicaid residents were being inappropriately channeled to AFC.

Aged↗
PubMed1990

Impact of geriatric nurse practitioners on nursing-home residents' functional status, satisfaction, and discharge outcomes.

This study evaluated the impact of geriatric nurse practitioners (GNP) employed by nursing homes on quality of patient care and residents' outcomes during a 12-month study period. Quality of care was assessed in standardized interviews of 525 residents in five nursing homes with GNPs and 323 residents in five other nursing homes without GNPs. Each resident was interviewed up to four times during the study period (at baseline, and 3, 6, and 12 months later) to determine functional status, satisfaction with care, and physical condition at each of these points. The only significant difference between groups was that fewer newly admitted residents were hospitalized from GNP homes than from those without a GNP. The results of this interview study showed that the GNP as a nursing home employee had little impact on residents' functional status, physical condition, or satisfaction.

Activities of Daily Living↗
PubMed1990

Rethinking long-term care.

In the context of several proposals for financing long-term care (LTC), this article suggests three areas in which reform of the structure of LTC is needed to create more appropriate incentives for better care. The interfaces between short- and long-term care can be addressed by either a number of specific changes or more global approaches, such as one or another form of capitated care. Using the ratio of achieved/expected outcomes as a prominent part of a regulatory strategy offers a means to increase the flexibility of regulation to encourage innovation while retaining meaningful accountability. New combinations of housing and nursing care offer a way for both a better and more flexible way of living in the context of an approach that guarantees universal coverage of care together with an incentive to save to afford better accommodations.

Attitude to Health↗