Journal of the American Geriatrics Society
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Randomized Controlled Trial Clinical Trial
The effect of geriatric evaluation and management on Medicare reimbursement in a large public hospital: a randomized clinical trial.
To study the effect of a geriatric evaluation and management program on health care charges and Medicare reimbursement. ⋯ A geriatric evaluation and management program appeared to shift utilization and Medicare expenditures from inpatient services to home health care services. There was no evidence that the experimental program resulted in increased expenditures for Medicare. In selected populations, geriatric evaluation and management programs may contribute to cost containment.
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To determine the effect of depression on preferences for life-sustaining therapy in older persons. ⋯ These results suggest that depression is associated with treatment refusal in situations with a good medical prognosis. Depression, however, is only a weak predictor of treatment refusal. Further research is needed to define which patients would accept medical treatment if effectively treated for depression.
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Because patients with Alzheimer's disease are on a path of declining capacity to give consent, advancement of research with Alzheimer's disease subjects presents challenging and perplexing ethical and legal dilemmas. Although generic regulations for the protection of human subjects apply, special considerations for cognitively impaired dementia subjects have depended on local Institutional Review Boards and relevant state laws and regulations, producing a lack of uniformity regarding encouragement of research and protection of subjects. ⋯ Proposed is an agenda of ethical research needs for advancing biomedical research on Alzheimer's disease. Needed are empirical studies concerning recruitment of Alzheimer's disease subjects, the actual processes of informed consent, and the difficulties encountered by researchers, collaborative development of tests for both diagnosing Alzheimer's disease and assessing subjects' capacities to provide informed consent, and exploration of innovative uses of advance and proxy consents for participation in Alzheimer's disease research.
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To determine if dietary intake, nutritional status, and other physical markers are risk factors for the development of pressure sores in the elderly. ⋯ Risk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.