Here - American Geriatrics Society

P OSTER
A BSTRACTS
be more reluctant to do so. However, they do value incorporation of
their concerns and wishes into clinical decisions. Therefore, we developed
a method for discussing goals with frail older people. Here, we
describe primary care professionals’ first experiences with this
method.
Methods: We developed a two-step method for discussing goals
with community-dwelling frail older people. It consists of an openended
question: If there is one thing we can do for you to improve
your situation, what would you like?; followed by an agenda-setting
chart. Primary care nurses and gerontological social workers then
used this method to discuss goals with community-dwelling frail older
people of ≥ 70 years. The research team reviewed the goals elaborated
and studied professionals’ experiences with the method using a
survey. This included questions concerning time spent on discussing
goals; reasons for not formulating goals; and perceived value of the
method.
Results: 140 frail older people described a total of 175 goals.
These most frequently concerned mobility (n=43; 24.6%), well-being
(n=52; 29.7%), and social context (n=58; 33.1%). Professionals (n=18)
were positive about the method, which took about 16 minutes for
each step. 17 (94.4%) agreed with the statement that it had helped
them determine what the frail older person valued and 15 (83.3%)
agreed that it had helped them to put the wishes of frail older persons
first. Goals were not always formulated, frequently mentioned reasons
for this were the frail older person being comfortable with the
current situation; not being accustomed to discussing goals; or not
being able to formulate goals due to cognitive problems.
Conclusions: The first experiences with this brief two-step goalsetting
method have shown that discussing goals with frail older people
helps professionals to gain insight into what a frail older person
values. This can assist professionals, and possibly frail older people, in
choosing the most appropriate treatment or care option, thus increasing
frail older people’s involvement in decision making.
A107
The Relationships between the Type of Long-Term Care Benefits
and Cognitive Function among Long-Term Care Insurance
Beneficiaries with Dementia in Korea, 2008-2010.
T. Lee, 1 J. Chung, 2 E. Cho. 1 1. Dept. of Nursing Environments &
Systems, Yonsei University College of Nursing, Seoul, Republic of
Korea; 2. Dept. of Biobehavioral Nursing & Health Systems,
University of Washington School of Nursing, Seattle, WA.
Supported By: Korean National Health Insurance Corporation
Background: In Korea, the population over age 65 is expected to
double by 2020, and the prevalence of dementia among those will rise
up to about 10%. The Act on Long-term Care Insurance for Senior
Citizens (LTCI) was enacted in 2008 in an effort to fulfill the care
needs of the elderly with chronic diseases, and the number of beneficiaries
with dementia has reached approximately 80,000. In this
paper, we aimed to examine the relationships between the type of
LTC benefits and the level of cognitive function among LTCI beneficiaries
with dementia.
Methods: We assembled a national sample of all LTCI beneficiaries
with dementia aged ≥ 65 years (N=80,293), examined for LTC
rating in 2008 and followed through 2010. A standardized 10-item
scale was used to assess cognitive function, with higher scores indicating
lower cognitive function. Linear mixed models were used to investigate
whether the LTC benefit type (fixed effects) was a significant
predictor for cognitive function improvement over time
(random effects).
Results: There are three benefit types: in-home services (HS, a
physician/nurse visits the homes of beneficiaries and provides services),
aged care facility services (FS, the LTC facility provides services),
and a combined type of in-home services and aged-care facility
services (CS). From 2008 to 2010, there was a decrease in the mean
cognitive function scores (CFS) for HS beneficiaries from 6.25 to 6.20
(p < .001) and for FS beneficiaries from 7.19 to 6.86 (p < .001). However,
the mean CFS of CS beneficiaries increased from 6.25 to 6.58
during the same period (p < .001) (Table).
Conclusion: Older adults with dementia showed an improvement
in their cognitive function after receiving LTC services delivered
at their home or aged care facilities.
Mean Cognitive Function Scores of Long-Term Care Beneficiaries
with Dementia by Benefit Type and Year
A108
Lower Cost of Care for Serious Chronic Disease by Increasing
Services Not Restrictions.
T. Edes, 1 S. Shreve, 2 L. Klepac, 1 B. Kinosian. 3 1. Dept Veterans Affairs,
Washington, DC; 2. Dept of Veterans Affairs, Lebanon, PA; 3. Dept of
Veterans Affairs and Univ of PA, Philadelphia, PA.
Supported By: No research funding support.
Purpose: To demonstrate that systems can increase access, improve
quality and lower total cost of care by adding services rather
than restricting services.
Background: Congressional Budget Office report (2007) noted
the cost per patient per year in the 7 years from 1998 to 2005 rose
29% in Medicare, while costs rose only 1.7% in Department of Veterans
Affairs (VA). The highest cost patients were those with multiple
serious chronic diseases, many of whom were homebound. One factor
attributed for VA’s cost containment was that VA has programs in
place specifically for persons with serious chronic disease. VA has
continued to expand programs specifically for Veterans with serious
advanced chronic disease to receive patient-centered care in the least
restrictive setting. We report an economic impact analysis of two such
VA programs: Hospice & Palliative Care (HPC), and Home Based
Primary Care (HBPC).
Methods: VA databases were used to determine Veterans’ use of
HBPC, use of HPC in all settings, and location of death. Utilization
and costs of care were determined for 2003 and 2010.
Results: Between 2003 and 2010, while the number of VA enrollee
deaths decreased 11% and the number ofVA inpatient deaths decreased
15%,the number of deaths inVA acute medical hospital decreased 36%,
the number in VA inpatient hospice beds increased 179% and the number
of Veterans in VA-paid home hospice increased 592%. 4582 fewer
deaths occurred in acute medical plus ICU, and 5731 more Veterans received
VA-paid home hospice per day. With the cost difference, the net
cost reduction was over $8 million for each day 4500 Veterans received
care in home hospice rather than VA acute medical inpatient care. The
number of Veterans receiving HBPC increased 190%. Total net cost
avoidance for 24,957 HBPC patients was over $70 million, at $2900 per
patient per year largely by reducing avoidable inpatient days.
Conclusion: Increasing access to inpatient hospice care, to VA-paid
home hospice care and toVA-provided HBPC resulted in net reductions
in total VA costs of care, without imposing any restrictions of services.
A109 Encore Presentation
Geriatric Surgery: The Association between Adherence to Processbased
Quality Indicators and Postoperative Complications.
V. Martelli, 3 S. A. Fraser, 1 V. Isabelle, 3 M. Deban, 3 C. Holcroft, 3
M. Monette, 3 J. Monette, 2 S. Bergman. 1 1. Surgery, Jewish General
Hospital, Montreal, QC, Canada; 2. Geriatric Medicine, Jewish
General Hospital, Montreal, QC, Canada; 3. Lady Davis Institute for
Medical Research, Jewish General Hospital, Montreal, QC, Canada.
Supported By: Canadian Institutes of Health Research
Background:
AGS 2012 ANNUAL MEETING
S53