Clinics in geriatric medicine
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This review provided an overview of the current evidence in relation to the use of e-prescribing and other forms of technology, such as CDSS, to reduce inappropriate prescribing in older people. The evidence indicates that various types of e-prescribing and CDSS interventions have the potential to reduce inappropriate prescribing and polypharmacy in older people, but the magnitude of their effect varies according to study design and setting. ⋯ Overall, health care providers report being satisfied with e-prescribing systems and see the systems as having a positive impact on the safety of their prescribing practices, yet the problem of overriding or ignoring alerts persists. The problem of large numbers of inaccurate and insignificant alerts and this issue, along with the other barriers that have been identified, warrant further investigation.
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Frailty and its management represent an emerging area of clinical care in older adults. Geriatricians have long recognized a syndrome of multiple comorbid conditions, immobility, weakness, and poor tolerance of physiologic stressors in older adults. Patients with these characteristics are described as frail and suffer increased adverse clinical outcomes. ⋯ Several operational definitions of frailty and the associated clinical signs, symptoms, and outcomes are outlined. The biologic mechanisms hypothesized to underlie frailty are explored, particularly in the musculoskeletal, endocrine, and immune systems. Treatment options for frail, older adults are discussed, including physiologic system-targeted interventions and geriatric models of care.
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In response to the anticipated growth of the veteran population with chronic disabling diseases, the Department of Veterans Affairs (VA) established Home Based Primary Care (HBPC). This article focuses on that program, a home care program that specifically targets individuals with complex chronic disabling disease, with the goal of maximizing the independence of the patient and reducing preventable emergency room visits and hospitalizations. HBPC programs provide comprehensive longitudinal primary care by an interdisciplinary team in the homes of veterans with complex chronic disease, who are not effectively managed by routine clinic-based care. ⋯ HBPC is delivered by an interdisciplinary team, rather than one or two independent providers. Currently operating in three-fourths of VA facilities, HBPC expansion continues to be driven by clinical success and the highest satisfaction of all VA services. VA HBPC is a model to emulate for the care of persons with complex, chronic disabling conditions, improving quality without added cost, and maximizing their independence through comprehensive longitudinal interdisciplinary care delivered in their homes.