Health care for Canadian native people.

Current recommendations for the management of the choking victim have arisen from a long history of anecdotal experience and controversial experimental and clinical data. The author reviews the available literature on the various maneuvers and discusses the existing controversies. He also gives brief recommendations for the management of the choking victim.     

Health care trends for older people.

Research is showing us a radically different view of aging from the one seen by earlier generations. Attitudes, which were based on the myth that physical and mental decline are inevitable with age, are beginning to change as a result of new scientific information. What we are learning is that aging involves both intrinsic and extrinsic factors. The universal phenomena that occur in all of us as we advance in age are intrinsic characteristics of aging, while extrinsic factors are those characteristics that can be prevented or modified, such as lifestyle choices, environmental exposure, and disease.     

Health care trends for older people

Research is showing us a radically different view of aging from the one seen by earlier generations. Attitudes, which were based on the myth that physical and mental decline are inevitable with age, are beginning to change as a result of new scientific information. What we are learning is that aging involves both intrinsic and extrinsic factors. The universal phenomena that occur in all of us as we advance in age are intrinsic characteristics of aging, while extrinsic factors are those characteristics that can be prevented or modified, such as lifestyle choices, environmental exposure, and disease.     

Randomised trial of impact of model of integrated care and case management for older people living in the community

Objective: To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community. Design: Randomised study with 1 year follow up. Setting: Town in northern Italy (Rovereto). Subjects: 200 older people already receiving conventional community care services. Intervention: Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care. Main outcome measures: Admission to an institution, use and costs of health services, variations in functional status. Results: Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of £1125 ($1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v 13.0% loss in controls; P<0.001). Decline of cognitive status (measured by the short portable mental status questionnaire) was also reduced (3.8% v 9.4%; P<0.05). Conclusion: Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community.

Key messages

• Responsibility for management of care of elderly people living in the community is poorly defined
• Integration of medical and social services together with care management programmes would improve such care in the community
• In a comparison of this option with a traditional and fragmented model of community care the integrated care approach reduced admission to institutions and functional decline in frail elderly people living in the community and also reduced costs