Do we need to create geriatric hospitals?

Gender differences in medical errors among older patients and inequalities in medical compensation compared with younger adults

Background

Despite growing evidence focusing on health inequalities in older adults, inequalities in medical compensation compared with younger adults and gender disparities of medical errors among older patients have received little attention. This study aimed to disclose the aforementioned inequalities and examine the disparities in medical errors among older patients.

Methods

First, available litigation documents were searched on "China Judgment Online" using keywords including medical errors. Second, we compiled a database with 5,072 disputes. After using systematic random sampling to retain half of the data, we removed 549 unrelated cases. According to the age, we identified 424 and 1,563 cases related to older and younger patients, respectively. Then, we hired two frontline physicians to review the documents and independently judge the medical errors and specialties involved. A third physician further considered the divergent results. Finally, we compared the medical compensation between older and younger groups and medical errors and specialties among older patients.

Results

Older patients experienced different medical errors in divergent specialties. The medical error rate of male older patients was over 4% higher than that of females in the departments of general surgery and emergency. Female older patients were prone to adverse events in respiratory medicine departments and primary care institutes. The incidence of insufficient implementation of consent obligation among male older patients was 5.18% higher than that of females. However, females were more likely to suffer adverse events at the stages of diagnosis, therapy, and surgical operation. The total amount of medical compensation obtained by younger patients was 41.47% higher than that of older patients.

Conclusions

Except for the common medical errors and departments involved, additional attention should be paid to older patients of different genders according to the incidence of medical errors. Setting up the department of geriatrics or specialist hospitals is also an important alternative to improve patient safety for older people. Furthermore, there may be inequality in medical compensation in older patients due to the tort liability law of China.

Development of integrated care pathways: toward a care management system to meet the needs of frail and disabled community-dwelling older people

INTRODUCTION

The home care and services provided to older adults with the same needs are often inadequate and highly varied. Integrated care pathways (ICPs) can resolve these issues. The aim of this study was to develop the content of ICPs to follow-up frail and disabled community-dwelling older people.

THEORY AND METHOD

A RIGOROUS PROCESS WAS APPLIED ACCORDING TO A SERIES OF STEPS: identification of desirable characteristics and a theoretical framework; review of evidence-based practices and current practices; and determination of ICPs by an interdisciplinary task team.

RESULTS

ICPs are intended to prevent specific problems, maximize independence, and promote successful aging. They are organized according to a dynamic process: (1) needs assessment and assessment of risk/protection factors; (2) data-collection summary and goals identification; (3) planning of interventions from a client-centered view; (4) coordination, delivery, and follow-up; and (5) identification of variances, as well as review and adjustment of plans.

CONCLUSION

Once computerized, these ICPs will facilitate the exchange of information as well as the clinical decision-making process with a perspective to adequately matching the needs of an individual person with resources that delay or slow the progression of frailty and disability. Once aggregated, the data will also support managers in organizing teamwork and follow-up for clients.

[Required competence in geriatrics in the view of the Competence Center for Geriatrics]

The geriatric patient is defined by a high specific risk that is taken into account by the special geriatric treatment concept. This risk relates to suffering from the permanent and significant loss of earlier functional independence caused by relatively trivial accessory conditions or other changes to the personal situation or falling in need of or increasing the need for care. It results from the geriatric patient's limited reserve capacities that are caused by physiological age-related limitations of organ and organ system reserves and/or manifested or at least latent functional impairments. A rather narrow definition of the geriatric patient based on this specific risk is a key criterion for the future systematic integration of geriatric care into the health service. In such a definition, use of the age component alone is adequate only from a very old age on. The high-risk group of geriatric patients narrowly defined in such a way also calls for primary medical geriatric case management: from commencement of a treatment throughout its entire course, from therapy to rehabilitation to longterm and outpatient care. This comprises first and foremost an comprehensive geriatric assessment and a treatment oriented primarily towards achieving quality of life and independence, medical treatment control including a systematic risk management system, continuous patient support, even in case of other temporary, specific treatments, the individual use of early rehabilitative treatments and the coordination of secondary treatment initiatives. Positioning geriatrics in the health care system in such a way means that the required skills extend beyond a general knowledge of geriatric medicine. Above all, high generic treatment expertise and experience in geriatric rehabilitation are also needed. Additionally, the guide and support function of the geriatrician demands a willingness to take special medical and ethical responsibility and an abundant ability to integrate and communicate. The education, training and development initiatives for attaining geriatric qualifications must satisfy these requirements. Lasting efficient geriatric care concepts also call for the appropriate skills in primary medical outpatient care.

Review Article: Patient Safety in Geriatrics: A Call for Action

Patient safety has become a major public health concern following the publication of the landmark report, To Err Is Human, by the Institute of Medicine in 1999. This report, along with a subsequent report, Crossing the Quality Chasm, recommended the design of a safer health care system by integrating well-established safety methods to avert medical errors. However, neither patient safety report specifically addressed the implications of safety for elderly patients. This article examines those implications by describing the association between aging and medical errors, identifying geriatric syndromes as medical errors, and focusing on six recommendations that will improve the safety of geriatric care. These six recommendations include the detection and reporting of geriatric syndromes, identifying system failures when geriatric syndromes occur, establishing dedicated geriatric units, improving the continuity of care, reducing adverse drug events, and improving geriatric training programs.