Annals of Long Term Care

Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention

Eric A. Coleman, MD, MPH, Jodi D. Smith, ND, GNP, Janet C. Frank, DrPH, Sung-Joon Min, AM, Carla Parry, PhD, MSW, and Andrew M. Kramer, MD

Objectives: To test whether an intervention designed to encourage older patients and their caregivers to assert a more active role during care transitions can reduce rehospitalization rates.

Design: Quasi-experimental design whereby subjects receiving the intervention (n=158) were compared with control subjects derived from administrative data (n=1,235).

Setting: A large integrated delivery system in Colorado.

Participants: Community-dwelling adults aged 65 and older admitted to the study hospital with one of nine selected conditions.

Intervention: Intervention subjects received tools to promote cross-site communication, encouragement to take a more active role in their care and assert their preferences, and continuity across settings and guidance from a transition coach.

Measurements: Rates of postdischarge hospital use at 30, 60, and 90 days. Intervention subjects’ care experience was assessed using the care transitions measure.

Results: The adjusted odds ratio comparing rehospitalization of intervention subjects with that of controls was 0.52 (95% confidence interval (CI)=0.28-0.96) at 30 days, 0.43 (95% CI= 0.25-0.72) at 90 days, and 0.57 (95% CI=0.36-0.92) at 180 days. Intervention patients reported high levels of confidence in obtaining essential information for managing their condition, communicating with members of the healthcare team, and understanding their medication regimen.

Conclusion: Supporting patients and caregivers to take a more active role during care transitions appears promising for reducing rates of subsequent hospitalization. Further testing may include more diverse populations and patients at risk for transitions who are not acutely ill. J Am Geriatr Soc 2004;52(11): 1817-1825.

The Coming Epidemic of Obesity in Elderly Americans

David E. Arterburn, MD, MPH, Paul K. Crane, MD, MPH, and Sean D. Sullivan, PhD

Objectives: To estimate the prevalence of obesity in elderly Americans in 2010 and to discuss the health and economic implications of these estimates.

Design: Three methods of generating future point-prevalence estimates using data from consecutive cross-sectional studies.

Setting: All regions of the United States.

Participants: Estimates were based on five nationally representative surveys of the adult population of the United States, conducted from 1960 to 2000, and population estimates from the U.S. Census Bureau.

Measurements: Changes in obesity (body mass index [BMI] ≥ 30 kg/m2) and normal weight (BMI <25 kg/m2) prevalence for men and women by 10-year U.S. birth cohorts were examined. The prevalence of obesity and normal weight in the elderly in 2010 was estimated under three different scenarios of obesity prevalence change.

Results: It was estimated that the prevalence of obesity in adults aged 60 and older will increase from 32.0% in 2000 to 37.4% in 2010 (range 33.6-39.6%). The number of obese adults aged 60 and older will increase from 14.6 to 20.9 million (range 18.8-22.2 million). Similarly, it was estimated that the prevalence of normal weight among adults aged 60 and older will decrease from 30.6% in 2000 to 26.7% in 2010 (range 31.0-24.7%).

Conclusion: The prevalence of obesity in elderly Americans will likely continue to increase, challenging healthcare delivery and financing systems in the United States. J Am Geriatr Soc 2004;52(11):1907-1912.

Resistance Training in the Early Postoperative Phase Reduces Hospitalization and Leads to Muscle Hypertrophy in Elderly Hip Surgery Patients—A Controlled, Randomized Study

Charlotte Suetta, MD, S. Peter Magnusson, DMSc, Anna Rosted, MD, Per Aagaard, PhD, Prof, Ane K. Jakobsen, Lone H.