Geriatric Care

This newly revised bibliography contains the defining literature on geriatric syndromes including home care, ambulatory clinics, community partnerships, transitional care and reducing frailty. Articles include clinical trials, behavioral and self-management support literature, as well as publications describing the Chronic Care Model. Links to the articles on the National Library of Medicine (NLM) Web site are provided when possible. The NLM site gives access to the article abstract when available, as well as other information. For information regarding the research methodology used to produce this bibliography, see the Bibliography Overview.
Articles referencing clinicial guidelines may not reflect current standards.† For up-to-date clinical guidelines, please consult the National Guideline Clearinghouse (NGC), a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality.

Home Care
Gill TM. Baker DI. Gottschalk M. Peduzzi PN. Allore H. Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. NEJM 2002 347(14):1068-74. [Link]

A targeted home-based program consisting of 6 months of physical therapy reduced progression of functional decline.
Stuck AE, Egger M, Hammer A et al. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA 2002;287:1022-1028. [Link]
This article synthesizes a rigorous body of work on the effectiveness of home visits on reducing nursing home placement among older adults.
Tinetti ME, Baker D, Gallo T et al. Evaluation of restorative care versus usual care for older adults receiving an acute episode of home care. JAMA 2002;287:2098-2105. [Link]
This study demonstrated the benefits of a targeted restorative therapy on reducing emergency department visits, improving pain, and maintaining community residence.
Clark F, Azen S, Zemke R, Jackson J, Carlson M, Mandel D et al. Occupational therapy for independent-living older adults, a randomized controlled trial. JAMA 1997; 278(16):1321-1326. [Link]

This study evaluated the effectiveness of preventive occupational therapy services specifically tailored for multiethnic, independent-living older adults residing in government subsidized apartment complexes.
Community Partnerships
Bass DM, Clark PA, Looman WJ, McCarthy CA, Eckert S. The Cleveland Alzheimer's managed care demonstration: outcomes after 12 months of implementation. Gerontologist 2003; 43(1):73-85. [Link]

Describes how a community agency and a managed care organization coordinate dementia services.
Anetzberger GJ. Community resources to promote successful aging. Clin Geriatr Med 2002;18:611-625. [Link]

Summarizes resources available in most communities that provide support for older adults in maintaining independence.
HMO Workgroup on Care Management. Establishing relations with community resource organizations: an imperative for managed care organizations serving Medicare beneficiaries. 1-26. 1999. Washington DC, AAHP Foundation. [Details]

Insightful white paper on how managed care organizations can forge partnerships with community-based organizations to better meet the needs of common clientele.
Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V et al. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ 1998; 316(7141):1348-1351. [Link]

An Italian study that demonstrates the value of integrating health care delivery with community resources in order to improve care of older adults.
Fortinsky R. How linked are physicians to community support services for their patients with dementia. J Appl Gerontol 1998; 17(4):480-498. [Link N/A]

Although a small study, illustrates the challenges of establishing partnerships between primary care clinics and a community support service for persons with dementia.
Leveille SG, Wagner EH, Davis C, et al. Preventing disability and managing chronic illness in frail older adults: A randomized trial of a community-based partnership with primary care. JAGS. 1998 Oct;46(10):1191-8. [Link]

Reports the findings of the Health Enhancement Project, which addressed health promotion and chronic illness self-management with a program based in a senior center.
Reuben DB, Hirsch SH, Frank JC, et al. The Prevention for Elderly Persons (PEP) Program: a model of municipal and academic partnership to meet the needs of older persons for preventive services. J Am Geriatr Soc. 1996 Nov; 44(11): 1394-1398. [Link]

This article describes a successful community-based program for preventive services for older adults.
Ambulatory Clinics
Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, Lowe CJ. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ 2001; 323(7325):1340-3. [Link]
Reuben DB, Frank JC, Hirsch SH, McGuigan KA, Maly RC. A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations [see comments]. J Am Geriatr Soc 1999; 47(3):269-76. [Link]

Relatively modest intervention strategies are feasible and lead to high levels of physician implementation of and patient adherence to physician-initiated CGA recommendations.
Boult C, Boult L, Morishita L, Smith SL, Kane RL. Outpatient geriatric evaluation and management. JAGS. 1998;46: 296-302. [Link]

Describes a freestanding geriatric evaluation and management unit that provided targeted care to community-dwelling older adults.
Beck A, Scott J, Williams P, et al. A randomized trial of group outpatient visits for chronically ill older HMO members: The cooperative health care clinic. JAGS. 1997;45:543-549. [Link]

Evidence that group visits can provide clinical care and result in beneficial outcomes for patients and providers.
Hanlon JT, Weinberger M, Samsa GP et al. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med 1996; 100(4):428-37. [Link]

These two papers demonstrate that clinical pharmacists are capable of conducting effective drug review consultations.
Maly RC, Abrahamse AF, Hirsch SH, Frank JC, Reuben DB. What influences physician practice behavior? An interview study of physicians who received consultative geriatric assessment recommendations. Arch Family Medicine. 1996;5:448-454. [Link]

Study demonstrating the amount of influence patients have over physician recommendations.
Nursing Home Care
Kane R, Huck S. The implementation of the EverCare demonstration project. J Am Geriatr Soc 2000; 48(2):218-223. [Link]

Describes an innovative, nurse-practitioner led care delivery system for long-term care residents.
Reuben D. Primary care of long-stay nursing home residents: approaches of three health maintenance organizations. J Am Geriatr Soc 1999; 47(1):131-138. [Link]

This study described innovative programs of three health maintenance organizations for providing primary care for long-stay nursing home residents and compared this care with that of fee-for-service residents at the same nursing homes.
Hospital Care
Marcantonio ER. Flacker JM. Wright RJ. Resnick NM. Reducing delirium after hip fracture: a randomized trial. Journal of the American Geriatrics Society 2001; 49(5):516-22. [Link]

Geriatrics consultation reduced delirium by one-third in patients undergoing hip fracture repair, a particularly high-risk group.
Inouye S, Bogardus S, Charpentier P, Leo-Summers L, Acampora D, Holford T et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340(9):669-676. [Link]

This multi-component intervention included six standardized protocols for the management of risk factors demonstrated a reduction in the prevalence of delirium.
Landefeld C, Palmer R, Kresevic D, Fortinsky R, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med 1995; 332(20):1338-1344. [Link]

Randomized trial of a special unit designed to help older persons maintain or achieve independence in self-care during hospitalization.
Transitional Care
Coleman EA, Boult C. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc 2003; 51(4):556-557. [Link]

Position statement released by the American Geriatrics Society.
Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc 2003; 51(4):549-555. [Link]

Companion article to the American Geriatrics Society position statement.
Naylor M, Brooten D, Campbell R, Jacobsen B, Mezey M, Pauly M et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA 1999; 281(7):613-620. [Link]

Advanced practice nurses engaged high-risk patients in the hospital and provided comprehensive and continuous care into patientsí homes, reducing hospital re-admission rates.
Townsend J, Piper M, Frank AO, Dyer S, North WRS, Meade TW. Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial. BMJ 1988; 297:544-548. [Link]

Patients who received support from care attendants for up to 12 hours a week for two weeks were found to have reduced rates of hospital re-admission.
Self-Management/Caregiver Support
Ball K. Berch DB. Helmers KF. Jobe JB. Leveck MD. Marsiske M. Morris JN. Rebok GW. Smith DM. Tennstedt SL. Unverzagt FW. Willis SL. Advanced Cognitive Training for Independent and Vital Elderly Study Group. Effects of cognitive training interventions with older adults: a randomized controlled trial. JAMA 2002;288(18):2271-81. [Link]

Intervention patients experienced improved cognitive ability that was sustained at 2 years.
Burgio KL. Goode PS. Locher JL. Umlauf MG. Roth DL. Richter HE. Varner RE. Lloyd LK. Behavioral training with and without biofeedback in the treatment of urge incontinence in older women: a randomized controlled trial. JAMA 2002; 288(18):2293-9. [Link]

This study reports on the benefits of a non-pharmacologic management program for urge incontinence.
Dubbert PM. Cooper KM. Kirchner KA. Meydrech EF. Bilbrew D. Effects of nurse counseling on walking for exercise in elderly primary care patients. Journals of Gerontology Series A-Biological Sciences & Medical Sciences 2002; 57(11):M733-40. [Link]

Simple and relatively inexpensive nurse contacts can motivate elderly primary care patients to walk for exercise, and this activity is associated with measurable health benefits.
Hepburn K, Tornatore J, Center B, Ostwald S. Dementia family caregiver training: affecting beliefs about caregiving and caregiving outcomes. J Am Geriatr Soc 2001; 49(4):450-457. [Link]

This study tested a role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving.
Stearns S, Bernard S, Fasick S, Schwartz R, Konrad T, Ory M et al. The economic implications of self-care: the effect of lifestyle, functional adaptations, and medical self-care among a national sample of Medicare beneficiaries. Am J Public Health 2001; 90(10):1608-1612. [Link]

This study demonstrates an association between self-reported activities and costs of care among older adults.
Frank JC, Hirsch SH, Chernoff J, et al. Determinants of patient adherence to consultative comprehensive geriatric assessment recommendations. J Gerontol A Biol Sci Med Sci. 1997 Jan;52(1): M44-M51. [Link]

This trial demonstrated that recommendations which are seen as worthwhile, not too much trouble, and able to be accomplished are the most likely to be initiated by older adults. Older adults with relatively higher functional levels are also more likely to follow through with CGA recommendations even though their needs may be less.
Mittelman M, Ferris S, Shulman E, Steinbery G, Levin B. A family intervention to delay nursing home placement of patients with Alzheimer disease: a randomized controlled trial. JAMA 1996; 276(21):1725-1731. [Link]

This study demonstrated that providing family caregivers with a comprehensive support and counseling program is effective in delaying time to nursing home placement for persons with dementia by more than thirty percent.
Reuben DB, Maly RC, Hirsch SH, et al. Physician implementation of and patient adherence to recommendations from comprehensive geriatric assessment. Am J Med. 1996 Apr; 100(4):444-451. [Link]

Relatively modest intervention strategies are feasible and lead to high levels of physician implementation of and patient adherence to physician-initiated CGA recommendations.
Health Care Organization
Reuben DB. Organizational interventions to improve health outcomes of older persons. Medical Care 2002;40(5):416-28. [Link]

This article provides a comprehensive overview of system- or organizational-level interventions designed to improve care to older adults.
Boult C, Boult L, Pacala J. Systems of care for older populations of the future. J Am Geriatr Soc 1998; 46(4):499-505. [Link]

This article examines various systems of care and their potential for improving health care delivery to older adults.
Monane M, Matthias D, Nagle B, Kelly M. Improving prescribing patterns for the elderly through an online drug utilization review intervention: a system linking the physician, pharmacist and computer. JAMA 1998; 280(14):1249-1252. [Link]

Pharmacists with training in geriatrics telephoned prescribing physicians about modifying potentially adverse drug regimens detected using a computerized surveillance data system resulted in a change to a lower risk alternative in 40 percent of older adults on long-acting benzodiazepines.
Eng C, Pedulla J, Eleazer G, McCann R, Fox N. Program of All-inclusive Care for the Elderly (PACE): an innovative model of integrative geriatric care and financing. J Am Geriatr Soc 1997; 45(2):223-232. [Link]

This article describes a comprehensive program that integrates acute and long-term care to maintain older adultsí ability to remain in the community.
Mukamel D, Chou C, Zimmer J, Rothenberg B. The effect of accurate patient screening on the cost-effectiveness of case management programs. Gerontologist 1997; 37(6):777-784. [Link]

This insightful study examines the relationship between the characteristics of the screening instrument and the cost-effectiveness of the ensuing case-management program.
Pacala J, Boult C, Reed R, Aliberti E. Predictive validity of the PRA instrument among older recipients of managed care. J Am Geriatr Soc 1997; 45(5):614-617. [Link]

This article provides background into the development of the PRA, one of the most widely used screening tools for older adults at risk for high utilization.
Wagner EH. The promise and performance of HMOs in improving outcomes in older adults. JAGS. 1996; 44:1251-1257. [Link]

Reprint of the Solomon Lecture for the Geriatric Medicine Review outlining the challenges in caring for older adults.
Reducing Frailty/Disability
HMO Care Management Workgroup. Improving the care of older adults with common geriatric conditions. 1-71. 2002. Washington D.C., AAHP Foundation.† [Details]

This report focuses on population-based approaches managed care organizations can take to improve health and function of older adults with common conditions.
Unutzer J. Katon W. Callahan CM. et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002; 288(22):2836-45. [Link]

In older adults with moderate to severe depression, collaborative care resulted in decreased depression, less functional impairment, and improved quality of life.
Gillespie LD, Gillespie WJ, Robertson MC et al. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2001;3:CD000340-CD000340. [Link]

Cochrane systematic synthesis of the literature on fall prevention.
Wagner E. Preventing decline in function: evidence from randomized trials around the world. West J Med 1997; 167(4):295-298. [Link]

This article summarizes rigorous evidence that supports multi-component interventions aimed at reducing functional decline.
Tinetti M, Inouye S, Gill T, Doucette J. Shared risk factors for falls, incontinence, and functional dependence: unifying the approach to geriatric syndromes. JAMA 1995; 273(17):1348-1353. [Link]

Provides empiric support for how commonly occurring risk factors contribute to multiple geriatric syndromes.

Bibliography Editors
Eric A. Coleman, M.D., M.P.H.
Dr. Coleman is Associate Professor of Medicine within the Divisions of Health Care Policy and Research and Geriatric Medicine at the University of Colorado Health Sciences Center. He also serves as Clinician Researcher with Kaiser Permanente, Colorado. Dr. Coleman concurrently pursued his medical degree from the University of California, San Francisco and a Master's in Public Health and Aging from the University of California, Berkeley. Dr. Coleman's research focuses on improving care transitions across acute and post-acute settings, measuring quality and improving care across sites of geriatric care, and implementing system-level practice improvement interventions.
Martin Levine, M.D.
Dr. Levine is a family physician and geriatrician at Group Health in Seattle, WA.† In addition to clinical duties, he is the Medical Director of Senior Care, responsible for the designing, implementing, and testing of innovations in the care of older adults.