Subacute care for seniors:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2000
|
| Schriftenreihe: | Clinics in geriatric medicine
16,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII S., S. 683 -910 graph. Darst. |
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Datensatz im Suchindex
| _version_ | 1804128247184621568 |
|---|---|
| adam_text | SUBACUTE CARE FOR SENIORS
CONTENTS
Preface xi
Nina Tumosa and John E. Morley
The Future of Subacute Care 683
Steven Levenson
Subacute care is a program of care for individuals with recent or
current illness or injury. Currently, the services received by pa¬
tients in subacute care vary considerably among sites, partly be¬
cause these sites may specialize in certain treatments and partly
because providers often define subacute care according to their
own areas of expertise. Certain approaches to patient care, how¬
ever, are universal regardless of diagnosis, and care that is given
should be based on essential geriatric principles. In setting a stan¬
dard for care in the subacute care setting, certain parameters must
be clarified, including (1) defining subacute care, including what it
is and what it is not; (2) selecting the right patient to receive sub¬
acute care; (3) making sure that care is centered on patients rather
than sites or providers; and (4) ensuring that care is reimbursed
adequately and appropriately. These issues are addressed, and
guidelines on how to accomplish the goal of standardizing sub¬
acute care are provided.
The Life Care Center of St. Louis Experience
with Subacute Care 701
Timothy R. Makowski, William Maggard, and John E. Morley
The Life Care Center of St. Louis is a 100 bed, freestanding, sub¬
acute care facility. The major differences between subacute care
facilities and nursing homes are described. The problems associ¬
ated with dealing with medically complex conditions in a subacute
care facility are stressed. The center s approach to rehabilitation is
reviewed in detail. The utility of the Functional Independence Mea¬
sure in subacute care settings is discussed. Common conditions
seen in subacute care facilities are briefly reviewed.
CLINICS IN GERIATRIC MEDICINE
VOLUME 16 • NUMBER 4 • NOVEMBER 2000 V
The Minnesota Model of Subacute Care 725
James W. Haefemeyer, Lynn Convery, Rita Petty Manninen,
and Thomas von Sternberg
HealthPartners, a nonprofit managed care organization in Minne¬
apolis, Minn., has developed an integrated system of care for sen¬
iors in clinics, hospitals, and subacute care centers. The organiza¬
tion contracts for subacute care with a few skilled nursing facilities
distributed throughout the area. Concentration of patients in these
facilities allows for the presence of a nurse practitioner on site. The
nurse practitioner collaborates with a geriatrician to provide care
for 15 to 20 seniors. This team uses principles of geriatric assess¬
ment to optimize utilization and outcomes for frail seniors.
Chronic Ventilator Dependence in Elderly Patients 735
Mary Ellen Kleinhenz and Cecilia Younger Lewis
Long term ventilator dependence is the need for mechanical ven¬
tilation for more than 6 h/d for more than 21 days. Long term
ventilator dependence complicates 9% to 20% of the episodes of
mechanical ventilation treated in the intensive care units of acute
care hospitals; it is associated with an average mortality rate of
40%. Unlike acute respiratory failure, the risk for which does not
increase with age, long term ventilator dependence falls dispro¬
portionately to patients aged 70 years or older. During the past 2
decades, a profusion of care sites for patients with long term ven¬
tilator dependence has evolved, largely as the product of the pro¬
spective payment system for health services introduced by the
Health Care Financing Administration in 1983. The outcome of
long term ventilator dependence in elderly patients across this
health care continuum is addressed.
Implications of the Balanced Budget Act of 1997 757
Dulcelina Albano Stahl
The sweeping and challenging changes in the health care industry
emanating from the Balanced Budget Act of 1997 have exceeded
those experienced by health care providers and consumers under
the Tax Equity and Fiscal Responsibility Act of 1982, the Diagnosis
Related Groupings in 1984, and the Resource Based Relative Value
Scale in 1992. To understand and cope with these changes, the fi¬
nancial impact of the Balanced Budget Act is examined in depth,
particularly in terms of reimbursement or funding for all health
care settings, providers, and medical education. The dramatic
changes in the health care delivery process that have caused havoc
and turmoil also are examined. For survival and growth under the
Balanced Budget Act, reengineering strategies are presented. The
ethical and social responsibilities that underlie the current and fu¬
ture impact of the Balanced Budget Act are analyzed to foster the
principles of justice, fairness, and best interests of the public.
vi CONTENTS
Effectiveness of Acute Rehabilitation Services in Geriatric
Evaluation and Management Units 775
Douglas K. Miller
As pressure for cost containment has mounted and the US popu¬
lation ages, causing increased levels of disability among the popu¬
lation and a greater focus on quality of life and rehabilitation after
acute illness, the emphasis on acute rehabilitation services has in¬
creased. Acute rehabilitation services include many programs, and
the field is changing rapidly along several dimensions, some of
which are explored. In such a complex and fluid situation, a defin¬
itive overview is impossible, but some useful remarks are at¬
tempted.
Wound Management in Postacute Care 783
David R. Thomas and Hosam K. Kamel
Decreasing hospital length of stay has dictated that postacute and
long term care facilities bear the brunt of treating acute and chronic
wounds. Two types of chronic wounds are discussed: (1) pressure
ulcers and (2) diabetic ulcers. The differential diagnosis of these
ulcers is imperative because the management of both types of
wound differs substantially. Wound therapy includes relieving
pain, correcting nutritional deficiencies, maintaining an optimal
wound environment, shielding the wound from further damage,
removing necrotic debris, promoting granulation tissue formation,
protecting against bacterial contamination, choosing an appropri¬
ate dressing, and surgical treatment. The application of these prin¬
ciples is discussed, and the differences among wound types are
highlighted.
Infection Control in Subacute Care 805
Joseph M. Mylotte and David W. Bentley
Little or no published data are available regarding infections or
infection control measures in subacute care units in the United
States. Infection control measures designed for long term care fa¬
cilities should, in general, suffice for subacute care units. When
developing an infection control program for a subacute unit, one
must be continuously cognizant of the objectives of care rendered
by such a unit to ensure that policies and procedures are consistent
with those objectives.
Management of Nutritional Problems in Subacute Care 817
John E. Morley
Poor nutritional status is one of the major factors associated with
functional decline and mortality in older persons. Older persons
are at increased risk for malnutrition because of the physiologic
anorexia of aging. During a stay in a subacute care facility, atten¬
tion to nutrition is a major component of the rehabilitative process.
CONTENTS vii
The pathophysiology of malnutrition, diagnostic techniques avail¬
able to diagnose malnutrition, causes and management of protein
energy malnutrition, specific nutritional problems caused by vita¬
min and trace element deficiency, and nutritional management of
specific diseases (e.g., hip fracture and diabetes mellitus) are re¬
viewed.
Management of Elderly Diabetic Patients in the Subacute
Care Setting 833
Amy Lee
Type 2 diabetes is a commonly encountered condition in the sub
acute care setting. The results of the landmark UK prospective
studies have confirmed that aggressive glycemic and blood pres¬
sure control delayed diabetes related microvascular and macro
vascular complications and significantly improved diabetic out¬
comes. Within the past few years, new drugs have been developed
to address both aspects of the type 2 diabetes syndrome: insulin
resistance and insulin secretory defect. C peptide analysis may be
useful to predict a successful response to therapy with insulin sen
sitizers or the need to initiate therapy with insulin or insulin stim¬
ulators. The issues regarding the general approach to elderly dia¬
betics and the strategies of dealing with diabetic complications
encountered in the subacute care program are discussed and up¬
dated. It is hoped that diabetic management can be improved and
that suggested alternate therapies can be used in the subacute care
facilities.
Pain Management 853
Bruce A. Ferrell
Pain is a common problem encountered among elderly people in
subacute and long term care facilities. Pain often is underestimated
and undertreated in these settings. Most pain problems can be im¬
proved by careful assessment and careful use of analgesic drugs
and nondrug strategies. Subacute care and other long term care
facilities often present unique challenges to pain management. Cli¬
nicians who care for patients in these settings must help to establish
a plan of care that is reasonable for the given resources and skills
often available in these settings. Clinicians have an obligation to
improve comfort and dignity for these patients, especially those
near the end of life.
Death and Dying: Management of Patients
with End Stage Disease 875
June Y. Leland
The culture of nursing homes historically has been rehabilitative.
This approach has been enforced by the Omnibus Budget Recon¬
ciliation Act (1987) regulations, which focus on decline as largely
viii contents
avoidable. With the passage of the Prospective Payment System,
nursing homes have become increasingly a site of death. In the
same way that no sharp transition exists between living and dying,
no sharp transition exists between life prolonging, disease specific
therapy and palliative therapy. Life prolonging therapy can lead
to symptoms that require palliation, and, in some instances, (e.g.,
end stage heart failure) life prolonging therapy and palliative ther¬
apy may be indistinguishable. Palliative care, with the control of
symptoms, relief of suffering, and promotion of quality of life, is
appropriate to all stages of disease, with an increasing proportion
of palliative care relative to curative therapy as the disease pro¬
gresses. The goals of symptom management and attention to po¬
tential sources of suffering in palliative care are components of
quality end of life care and are discussed.
Cumulative Index 2000 895
Subscription Information Inside back cover
CONTENTS ix
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| spelling | Subacute care for seniors Nina Tumosa .., guest ed. Philadelphia [u.a.] Saunders 2000 XII S., S. 683 -910 graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in geriatric medicine 16,4 Gériatrie Personnes âgées - Réadaptation Personnes âgées - Soins médicaux - États-Unis Personnes âgées - Soins à long terme Personnes âgées, Services aux - États-Unis Services de gériatrie Soins aux mourants Soins infirmiers en gériatrie Soins subaigus Health Services for the Aged Older people Services for Subacute Care Subacute care Terminal Care Terminal care Alter (DE-588)4001446-0 gnd rswk-swf Subakute Krankheit (DE-588)4618888-5 gnd rswk-swf Medizinische Versorgung (DE-588)4038270-9 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Alter (DE-588)4001446-0 s Subakute Krankheit (DE-588)4618888-5 s Medizinische Versorgung (DE-588)4038270-9 s DE-604 Tumosa, Nina Sonstige oth Clinics in geriatric medicine 16,4 (DE-604)BV000019839 16,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009184575&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Subacute care for seniors Clinics in geriatric medicine Gériatrie Personnes âgées - Réadaptation Personnes âgées - Soins médicaux - États-Unis Personnes âgées - Soins à long terme Personnes âgées, Services aux - États-Unis Services de gériatrie Soins aux mourants Soins infirmiers en gériatrie Soins subaigus Health Services for the Aged Older people Services for Subacute Care Subacute care Terminal Care Terminal care Alter (DE-588)4001446-0 gnd Subakute Krankheit (DE-588)4618888-5 gnd Medizinische Versorgung (DE-588)4038270-9 gnd |
| subject_GND | (DE-588)4001446-0 (DE-588)4618888-5 (DE-588)4038270-9 (DE-588)4143413-4 |
| title | Subacute care for seniors |
| title_auth | Subacute care for seniors |
| title_exact_search | Subacute care for seniors |
| title_full | Subacute care for seniors Nina Tumosa .., guest ed. |
| title_fullStr | Subacute care for seniors Nina Tumosa .., guest ed. |
| title_full_unstemmed | Subacute care for seniors Nina Tumosa .., guest ed. |
| title_short | Subacute care for seniors |
| title_sort | subacute care for seniors |
| topic | Gériatrie Personnes âgées - Réadaptation Personnes âgées - Soins médicaux - États-Unis Personnes âgées - Soins à long terme Personnes âgées, Services aux - États-Unis Services de gériatrie Soins aux mourants Soins infirmiers en gériatrie Soins subaigus Health Services for the Aged Older people Services for Subacute Care Subacute care Terminal Care Terminal care Alter (DE-588)4001446-0 gnd Subakute Krankheit (DE-588)4618888-5 gnd Medizinische Versorgung (DE-588)4038270-9 gnd |
| topic_facet | Gériatrie Personnes âgées - Réadaptation Personnes âgées - Soins médicaux - États-Unis Personnes âgées - Soins à long terme Personnes âgées, Services aux - États-Unis Services de gériatrie Soins aux mourants Soins infirmiers en gériatrie Soins subaigus Health Services for the Aged Older people Services for Subacute Care Subacute care Terminal Care Terminal care Alter Subakute Krankheit Medizinische Versorgung Aufsatzsammlung |
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