Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-02T21:28:29.208Z Has data issue: false hasContentIssue false
  • English
  • Français

Integration of Research Methods and Outcome Measures: Comprehensive Care for the Frail Elderly

Published online by Cambridge University Press:  29 November 2010

Kenneth Rockwood
Kenneth Rockwood
Affiliation:
Dalhousie University
Get access Rights & Permissions [Opens in a new window]

Abstract

Research measures can be integrated into routine care if they are useful to care providers. Measures will be useful if they facilitate the processes of care, and if the outcomes which they measure reflect outcomes of importance to the patient. Many current measures suffer from being unwieldy for routine use, or not adequately measuring relevant outcomes. In the care of the frail elderly, who have complex needs, these challenges are particularly difficult. The techniques of Comprehensive Geriatric Assessment and Goal Attainment Scaling (GAS) are proposed as means of embracing the complexity of the needs of the frail elderly, and measuring the effectiveness of specialized interventions. GAS appears to meet the current definition of a Health-Related Quality of Life measure, suggesting that its routine use provides advantages both as a management process and as an outcome measure.

Résumé

Les instruments de recherche peuvent être intégrées dans les soins de routine si ceux-ci sont utiles aux pourvoyeurs de soins. Ainsi, ils sont utiles s'ils facilitent la prestation de soins et si ce qu'ils mesurent reflètent des résultats qui importent aux patients. Bon nombre de mesures actuelles sont moins utiles parce qu'elles ne peuvent servir dans le quotidien ou mesurent de façon inadéquate les résultats pertinents. Au plan des soins auprès des personnes âgées frêles, qui ont des besoins complexes, ces défis sont particulièrement difficiles à relever. Les techniques d'évalutation gériatrique complète et l'établissement d'une échelle de l'atteinte des objectifs (Goal Attainment Scaling — GAS) sont proposées comme des moyens d'englober la complexité des besoins des personnes âgées frêles et de mesurer l'efficacité des interventions spécialisées. L'échelle GAS est conforme à la définition de la qualité de la vie de l'instrument Health-Related Quality of Life. Ce qui suggère que son utilisation dans le quotidien offre des avantages tant au niveau de la gestion que de la mesure des résultats.

Keywords

Frail ElderlyQuality of LifeOutcome Measures.Âge vulnérablequalité de la viemesures des résultats.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 14 , Issue S1 , Été/Summer 1995 , pp. 151 - 164
Copyright
Copyright © Canadian Association on Gerontology 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Phelps, LE. The methodologie foundation of studies of the appropriateness of medical care. N Engl J Med 1993; 329: 1241–5.CrossRefGoogle Scholar
2.Kosecoff, J, Kahan, KL, Rogers, W et al. Prospective payment system and impairment at discharge: the “quicker-and-sicker” story revisited. JAMA 1990; 264: 1980–3.CrossRefGoogle ScholarPubMed
3.Shaughnessy, PW, Kramer, AM. The increased needs of patients in nursing homes and patients receiving home health care. N Engl J Med 1990; 322: 21–27.CrossRefGoogle ScholarPubMed
4.Orchard, C.Comparing health care outcomes. Brit Med J 1994; 308: 1493–6.CrossRefGoogle Scholar
5.Hicks, NR.Some observations on attempts to measure appropriateness of care. Br Med J 1994; 309: 730–3.CrossRefGoogle ScholarPubMed
6.Stuck, AE, Siu, L, Wieland, GD et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 1993; 342: 1032–6.CrossRefGoogle ScholarPubMed
7.Hogan, D.Impact of Geriatric Consultation Services for Elderly Patients Admitted to Acute Care Hospitals Can J Aging 1990; 9: 35–44.Google Scholar
8.Deyo, R, Applegate, WB, Kramer, A, Meehan, S.The Future of Geriatric Assessment. J Amer Geriatr Soc 1991; 39: S1–S40.Google Scholar
9.Philp, I, Rockwood, K.Geriatricians and Quality Assurance. Age Ageing 1993; 22: 401–3.CrossRefGoogle ScholarPubMed
10.Rockwood, K.Fox, RA, Stolee P et al. Frailty in elderly people. Can Med Assoc J 1994; 150: 819–25.Google Scholar
11.Engel, GL. The need for a new medical model: a challenge for biomedicine. Science 1977; 196: 129–35.CrossRefGoogle Scholar
12.Schwartz, GE. Testing the biopsychosocial model: the ultimate challenge facing behavioural medicine? J Consult Clin Psychol 1982; 50: 1040–53.CrossRefGoogle Scholar
13.Estes, CL, Binney, EA. The biomedicalization of aging: dangers and dilemmas. Gerontologist 1989; 29: 587–96.CrossRefGoogle ScholarPubMed
14.Deeg, DJH, van Zonneveld, RJ, van der Maas, PJ, Habbema, JDF. Medical and social predictors of longevity in the elderly: Total predictive value and interdependence. Soc Sci Med 1989; 29: 1271–80.CrossRefGoogle ScholarPubMed
15.Fox, RA, Puxty, J.Medicine in the Frail Elderly. London: Edward Arnold, 1993.Google Scholar
16.Winograd, CH, Gerety, MB, Lai, NA. A negative trial of inpatient geriatric consultation. Arch Int Med 1993; 153: 2017–23.CrossRefGoogle ScholarPubMed
17.Inouye, SK, Wagner, DR, Acampora, et al. A controlled trial of a nursing-centered intervention in hospitalized elderly medical patients: The Yale Geriatric Care program. J Amer Geriatric Soc 1993; 41: 1351–60.Google Scholar
18.McVey, LJ, Becker, P, Saltz, C et al. Effect of a geriatric consultation team on functional status of elderly hospitalized patients. Ann Int Med 1987; 110: 79–84.CrossRefGoogle Scholar
19.Gayton, D, Wood-Dauphinee, S, de Lorimer, M, et al. Trial of a geriatric consultation team in an acute care hospital. J Amer Geriatric Soc 1987; 35: 726–36.CrossRefGoogle Scholar
20.Tugwell, P, Bombardier, C.Current Quality of Life Research Challenges in Arthritis. Control Clin Trials, 1991; 12: 217S–25S.CrossRefGoogle ScholarPubMed
21.Joyce, B, Rockwood, K, Mate-Kole, C.Use of Goal Attainment Scaling in brain injury in a rehabilitation hospital. Am J Phys Med Rehabil 1994; 37: 10–14.CrossRefGoogle Scholar
22.Malec, JF, Smigielski, JS, DePompolo, RW. Goal Attainment Scaling and outcome measurement in post-acute brain injury rehabilitation. Arch Phys Med Rehabil 1991; 72: 138–43.Google Scholar
23.Stolee, P, Rockwood, K., Fox, RA, Streiner, D.The Use of Goal Attainment Scaling in a Geriatric Care Setting. J Amer Geriatric Soc 1992; 40: 574–8.CrossRefGoogle Scholar
24.Rockwood, K., Stolee, P, Fox, RA. Use of Goal Attainment Scaling in measuring clinically important change in the frail elderly. J Clin Epidemiol 1993; 46: 1113–8.CrossRefGoogle ScholarPubMed
25.Kiresuk, TJ, Sherman, RE. Goal Attainment Scaling: A general method for evaluating comprehensive community mental health programs. Comm Men Health J 1968; 4: 443–5.CrossRefGoogle Scholar
26.Rockwood, K, Stolee, P. Problem lists, goals and their resolution. Philp I (ed) Assessing the elderly. London: Farrand Press, 1994.Google Scholar
27.Rockwood, K.Use of Goal Attainment Scaling in Geriatric Rehabilitation. Reviews in Clinical Gerontology, 1994; 4: 141–9.CrossRefGoogle Scholar
28.Rockwood, K.The occurrence and duration of symptoms in elderly patients with delirium. J Geront 1993; 48: M162–6.CrossRefGoogle ScholarPubMed
29.Joyce, BM, Rockwood, K, Mate-Kole, C, Stolee, P.Responsiveness of outcome measures in cognitive rehabilitation. Clin Exper Med 1993; 16: B112/697.Google Scholar
30.Knapp, MJ, Knopman, DS, Dolomon, PR, et al. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer's disease. JAMA 1994; 271: 985–91.CrossRefGoogle ScholarPubMed
31.Lawton, MP. A multidimensional view of quality of life in frail elders. In: Birren, JE, Lubben, JE, Rowe, JC, Deutchman, DE eds. The concept and measurement of quality of life in the frail elderly. New York: Academic Press, 1991, Ch.l.Google Scholar
32.Guyatt, GH, Eagle, DJ, Sackett, et al. Measuring quality of life in the frail elderly. J Clin Epidemiol 1993; 46: 1433–44.CrossRefGoogle ScholarPubMed
33.Spitzer, WO, Dobson, AJ, Hall, J et al. Measuring the quality of life of cancer patients. J Chron Dis 1984; 34: 585–97.CrossRefGoogle Scholar
34.Stewart, AL, Ware, JE Jr (eds). Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Durham: Duke University Press, 1992.Google Scholar
35.Ware, JE. Measuring patients' views: the optimum outcome measure. BMJ 1993; 306: 1429–30.CrossRefGoogle ScholarPubMed
36.Brazier, JE, Harper, R, Jones, NMB et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992; 305: 160–4.CrossRefGoogle ScholarPubMed
37.Garratt, AM, Ruta, DA, Abdalla, MI et al. The SF 36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ 1993; 1440–4.CrossRefGoogle ScholarPubMed
38.Lyons, RA, Perry, HM, Littlepage, BNC. Evidence for the Validity of the Shortform 36 Questionnaire (SF-36) in an Elderly Population. Age Ageing 1994; 23: 182–4.CrossRefGoogle Scholar
39.Wagner, EH, LaCroix, AZ, Grothaus, LC, Hecht, JA. Responsiveness of health status measures to change among older adults. J Amer Geriatric Soc 1993; 41: 241–8.CrossRefGoogle ScholarPubMed
40.Rockwood, K, Noseworthy, TW, Gibney, RTN, et al. One-year outcome of elderly and young patients admitted to Intensive Care Units Critical Care Medicine 1993; 21: 687–91.Google Scholar
41.Horrath, KA, Disesa, VJ, Peigh, PS et al. Favorable results of coronary artery bypass grafting in patients older than 75 years. J Thorac Cardiovasc Surg 1990; 99: 92–96.CrossRefGoogle Scholar
42.Guadagnol, E, Ajarian, JZ, Cleay, PD. Comparison of patient-reported outcomes after elective coronary artery bypass grafting in patients aged > and < 65 years. Am J Cardiol 1992; 70: 60–64.CrossRefGoogle Scholar