Quality of Care in the Elderly

For improved quality of care in the elderly we must first define and measure the problem and the magnitude of the problem. We must also prioritise between problems and select the most important issue. Of course the aim must be improvement for the individual patient. But since quality in healthcare normally is complicated and multifactorial a systematic change in structures and processes is required. 

For quality of care in the elderly this put even higher emphasis on individualisation and on improving the structure and process of care delivery... 

Below we have listed some very important aspects for improving quality of care in the elderly. We also list or explain some models or practical approaches for improvement. 

Improving quality of medication care in the elderly requires systematic processes for the team responsible for the patient care and also for individualisation of each patients care... 

In this book we have provided background for problems and examples of solutions to improve quality of medication care in the elderly. In this chapter we provide visions and objectives for further improvement in care of the elderly. We also summarise some very important practical aspects in the care of the elderly and give references to other chapters in this book. 

Abstract Quality of care is complicated, especially in the elderly. For a start we need drugs with evidence for the benefits and risks in the elderly, this is currently not always the case. Thereafter we need to use the drugs in an evidence based way, which may be difficult in the complex health care system. To achieve maximum benefit for the patient (outcome) and society (health-economy) a well planned process is needed. This includes identification, prevention and resolving of the patients drug-related problems decisions and selection of treatment, communication and decisions together with the patient, risk minimisation, and communication within health care. Several of these aspects are presented in this chapter. 

The death rate for heart disease has actually been declining over the past few decades, while the number of patients with CAD is increasing. This may reflect increasing quality of medical care, but it should be noted that in the elderly, heart disease becomes an ever more important cause of death, much more so than cancer. There are also concerns that while a lot of attention has been directed at smoking and cholesterol as risk factors, hypertension and diabetes are emerging as the next generation of major risk factors and are further accentuated in our increasingly obese and sedentary society. 

Among elderly women as much as 80% suffer from involuntary voiding of the bladder, urinary incontinence (UI). In the United States approximately 12.5 million people are affected by incontinence and a European study showed a prevalence of between 12% and 22% in all ages and an increase to 30-40% in ages over 75 years (Hampel et al. 1997). Women experience UI twice as often as men. Incontinence becomes more common in old age, with existing co-morbidity of all kinds and life styles (Box 5.5). There are different forms of urinary incontinence and they differ in cause and treatment. This problem causes not only personal distress but also a considerable cost for society as a whole (Jackson 1997). Lower quality of life is often reported in people with UI and the risk increases by the withdrawal from social interaction and participation in sports and other activities. An estimated cost for the care of patients with UI in the United States was approximately 26 billion dollars in year 1995 (Wagner and Hu 1998). Other studies have come up with a calculated cost that represents two percent of the total national health budget. 

Gurwitz ]H, Rochon R Improving the quality of medication use in elderly patients a not-so-simple prescription. Arch. Intern. Med. 2002 162 1670-1672. Isetts BJ, McKone BJ. Practice changes facilitated by pharmaceutical care. In Knowlton CH and Perma RP, Eds., Pharmaceutical Care, 2nd ed. Bethesda, MD American Society of Health-System Pharmacy, 2003, chap. 12, pp. 213-231. 

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