Elderly Healthcare Often Poor
Family Involvement Key to Good Nursing-Home Care
March 13, 2003 -- Healthcare for the elderly is often inadequate. That's particularly true for nursing-home residents, a British study shows.
Tom Fahey, MD, a doctor and professor at the University of Dundee, led a research team that looked at the care given to 172 nursing-home residents and 526 age-matched patients receiving care at home. All patients lived in Bristol, England.
"The quality of medical care that elderly patients receive in one U.K. city -- particularly those in nursing homes -- is inadequate," Fahey and colleagues write in the March 15 issue of the British Medical Journal. "We suggest that better coordinated care for these patients would avoid the problems of overuse of unnecessary or harmful drugs, underuse of beneficial drugs, and poor monitoring of chronic disease."
Is the same thing true in the U.S.? There's been no comparable study. Elderly healthcare in the U.S. is organized far differently than that in the U.K. Tom Burke, spokesman for the American Health Care Association (AHCA), says that there's no good way to compare the care an elderly person gets at home with the care that person would get in a nursing home.
"There are excellent home care situations and there are terrible ones," Burke tells WebMD. "The same goes for nursing homes. But it is almost like apples and oranges to compare the two kinds of care."
That's true, says Joseph Ouslander, MD, chief medical officer at Wesley Woods Geriatrics Center and head of the division of geriatrics at Emory University School of Medicine. But he notes that the U.S. has its own problems in caring for elderly people.
"In the U.S., both inside and outside nursing homes, there is still a lack of doctors who have the expertise to manage some of the complex medical problems of very frail elderly patients," Ouslander tells WebMD. "It is a major problem. There are some 2 million older people in nursing homes. There are two to three times that many who are just as disabled -- just as medically complicated -- living at home. One big push is to try to educate as many doctors as possible in the identification and management of key geriatric conditions."
Another big U.S. problem is the cost of the growing number of drugs elderly patients need. Often these patients have multiple conditions. It's not uncommon for an elderly patient to need more drugs than he or she can pay for.
"These medications are expensive. Medicaid does not pay for drugs outside of the hospital," Ouslander says. "A handful of states will pay for only five medicines and that is it. So what is a patient to do, who by best-practice standards should be on seven or eight drugs, but the state only pays for five?"