A guiding principle of the Council on Health Care Technology is a special focus on medical technology assessment measures that coincide with patient well-being, quality of health care, and quality of life. Of particular concern is care of the elderly, which constitutes a special and vulnerable patient population. This comprehensive book discusses the appropriate use of technology to minimize risks posed to the elderly patient in the delivery of health care services. It covers home and community care as well as acute hospital care, and system resources and constraints.

Contents

• Acknowledgments
• Council on Health Care Technology
• Preface
• Introduction to the Council on Health Care Technology
• Quality of Care and the Health Needs of the Elderly Patient
  • The Meaning of Quality
  • The Objectives of Health Care
  • The Means for Attaining the Objectives of Care
  • Some Aspects of System Design
  • Conclusions
• Home and Community Care of the Elderly: Introduction
• Home and Community Care of the Elderly: Framing the Issues
  • Changes in Severity of Care
  • Sites and Types of Care
  • Linkages Between Acute and Chronic Care
  • Geriatric Assessment
  • Alternative Modes of Care
  • Quality of Care
  • Research Opportunities in Technologies
  • References
• Framing the Issues of Home and Community Care: Response
  • Case Management
  • Changes in Medical Care
  • Opportunities for Progress
• Special Perspectives on Home and Community Care
  • Health Services
  • Education
  • Research
  • Conclusion
• Special Perspectives on Home and Community Care
  • Informal Caregivers
  • Other Caregivers
  • Research Issues
  • References
• Special Perspectives on Home and Community Care
  • Programs for Home Care
  • Home Care Professionals
  • Case Studies
• Special Perspectives on Home and Community Care
  • Survey of Abuse and Neglect of the Elderly
  • Problems in Care of the Elderly
  • Reference
• Special Perspectives on Home and Community Care
  • Insurers' Perspectives
• Home and Community Care of the Elderly: System Resources and Constraints
  • Availability of Financing
  • Availability of Services
  • Reimbursement for Community Care
  • Availability of Low-Tech Community Care Services
  • Availability of Manpower for Community Care
  • Informal Care Providers
  • Coordinating Available Services
  • References
• Home and Community Care of the Elderly: System Resources and Constraints
  • Rehabilitation
  • Supplemental Versus Substitute Care
  • Economic Consequences of Spinal Cord Injury
• Home and Community Care of the Elderly: Research and Policy Issues
  • High and Low Technology
  • Service Development
  • Financing
  • References
• Home and Community Care of the Elderly: Research and Policy Issues
  • Methodologic Research
  • Policy-Type Research
  • Problems in Research
  • Implication of Recent Policy Studies
  • Research Questions
  • Values
  • Reference
• The Acute Care Hospital and the Elderly: Introduction
• The Acute Care Hospital and the Elderly: Framing the Issues
  • Acute Hospital Care of the Elderly
  • Problems of the Elderly in the Hospital
  • Primary Nursing
  • Reference
• Special Perspectives on Acute Hospital Care
  • Developing a Geriatric Health Program
  • Community Care Alternatives in Baltimore
  • Acute Care Background
  • Geriatric Assessment
  • Benefits of a Geriatric Assessment Program
  • Concluding Remarks
• Special Perspectives on Acute Hospital Care
  • The Interview Sample and Process
  • Definition of Terms
  • The Distribution of Elderly in Acute Care Hospitals
  • The Elderly's Access to Technology
  • Improving Support Services for the Elderly
  • Policy Issues
  • Research Needs and Opportunities
  • Summary
  • References
  • Appendix Interview Guide
• Special Perspectives on Acute Hospital Care
  • Families' Interest in Quality of Care Issues
  • Activities Advancing the Understanding of Quality in Medicine
  • Impediments to Quality of Care
  • Advancing the Cause of Quality of Care
• Special Perspectives on Acute Hospital Care
  • Needs of Sick Elderly in Hospitals
  • Post-Hospital Problems of the Sick Elderly
  • NEA Recommendations
• Acute Hospital Care of the Elderly: System Resources and Constraints
  • Resources for Acute Care
  • Possible Solutions
  • Constraints
  • Policy Issues and Research Opportunities
• Acute Hospital Care of the Elderly: System Resources and Constraints
  • Separation of Acute and Chronic Illness
  • Age Versus Life Expectancy
  • Focus on Life Extension and Fear of Death
  • Data for Making Decisions About Technology Use by Older Persons
  • Need for Regulation of Technology
  • Reimbursement and Financing
  • References
• Acute Hospital Care of the Elderly: Research and Policy Issues
  • Can We Develop Non-Age-Based Outcome Criteria for Selection of Patients Who Can Benefit from High-Tech Therapeutic Intervention?
  • The Efficacy of Intensive Care Units
  • Specialized Units for Care of the Elderly
  • Confusional States in the Elderly
  • Diagnostic-Related Groups
  • Consultation Teams
  • Geriatric Evaluation Units
  • References
• Acute Hospital Care of the Elderly: Research and Policy Issues
  • Issues Driving Congressional Decisions
  • Major Health Policy Issues Affecting the Elderly
• Care of the Elderly Patient: Summation of the Forum
• List of Authors

THE INSTITUTE OF MEDICINE was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government, and its own initiative in identifying issues of medical care, research, and education.

THE COUNCIL ON HEALTH CARE TECHNOLOGY was established in 1986 by the Institute of Medicine of the National Academy of Sciences as a public-private entity to address issues of health care technology and technology assessment. The council is committed to the well-being of patients as the fundamental purpose of technology assessment. In pursuing that goal, the council draws on the services of the nation's experts in medicine, health policy, science, engineering, and industry.