Skip to main content

Geriatric Models of Care

  • Chapter
  • First Online:
Cardiothoracic Surgery in the Elderly

Abstract

Although patients aged 65 and over represent about 13% of the US population, they account for 40% of those undergoing surgical procedures in American hospitals. Due to the increased likelihood of comorbidities, older patients also represent a higher rate of postoperative complications that influence morbidity and mortality following major surgery. These problems have led to the development of several geriatric models of care across all health care settings. This chapter provides a brief overview of complications that are more frequently found in older patients, care delivery issues that are addressed by geriatric models of care, and a description of the most commonly employed hospital models.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rubenstein LZ. Geriatric assessment programs. In: Capezuti EA, Siegler E, Mezey M, editors. The encyclopedia of elder care. 2nd ed. New York: Springer; 2008. p. 346–9.

    Google Scholar 

  2. Older Patients: A Growing Concern for Surgeons and Related Specialists. American Geriatrics Society – Geriatrics For Specialists. http://www.americangeriatrics.org/specialists/involved.shtml. Accessed 2 Nov 2009.

  3. Gogbashian A, Sepic J, Soltesz EG, Nascimben L, Cohn LH. Operative and long-term survival of elderly is significantly improved by mitral valve repair. Am Heart J. 2006;151(6):1325–33.

    Article  PubMed  Google Scholar 

  4. Sedrakyan A, Vaccarino V, Paltiel AD, Elefteriades JA, Mattera JA, Roumanis SA, et al. Age does not limit quality of life improvement in cardiac valve surgery. J Am Coll Cardiol. 2003;42(7):1208–14.

    Article  PubMed  Google Scholar 

  5. Bonow RO, Carabello BA, Kanu C, de Leon Jr AC, Faxon DP, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114(5):e84–231.

    Article  PubMed  Google Scholar 

  6. Nashef SAM. Is cardiac surgery now a geriatric specialty? Crit Care Resusc. 2007;9(3):248–50.

    PubMed  Google Scholar 

  7. Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326–41.

    PubMed  Google Scholar 

  8. Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci. 1999;54(10):M521–6.

    Article  PubMed  CAS  Google Scholar 

  9. Gill TM, Williams CS, Tinetti ME. The combined effects of baseline vulnerability and acute hospital events on the development of functional dependence among community-living older persons. J Gerontol A Biol Sci Med Sci. 1999;54(7):M377–83.

    Article  PubMed  CAS  Google Scholar 

  10. Naylor MD, Hirschman KB, Bowles KH, Bixby MB, Konick-McMahan J, Stephens C. Care coordination for cognitively impaired older adults and their caregivers. Home Health Care Serv Q. 2007;26(4):57–78.

    Article  PubMed  Google Scholar 

  11. Ahmed N, Mandel R, Fain MJ. Frailty: an emerging geriatric syndrome. Am J Med. 2007;120(9):748–53.

    Article  PubMed  Google Scholar 

  12. Walston J, Fried LP. Frailty and the older man. Med Clin North Am. 1999;83:1173–94.

    Article  PubMed  CAS  Google Scholar 

  13. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol. 2001;56A:M146–56.

    Google Scholar 

  14. Maslow K. How many people with dementia are hospitalized? In: Silverstein N, Maslow K, editors. Improving hospital care for persons with dementia. New York: Springer; 2006. p. 3–22.

    Google Scholar 

  15. Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27–32.

    Article  PubMed  Google Scholar 

  16. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91.

    Article  PubMed  Google Scholar 

  17. Centers for Medicare & Medicaid Services. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist. 2007;72(162):47129–8175.

    Google Scholar 

  18. Pronovost PJ, Goeschel CA, Wachter R. The wisdom and justice of not paying for “preventable complications”. JAMA. 2008;299(18):2197–9.

    Article  PubMed  CAS  Google Scholar 

  19. Wald HL, Kramer AM. Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. JAMA. 2007;298(23):2782–4.

    Article  PubMed  CAS  Google Scholar 

  20. Flood KL, Rohlfing A, Le CV, Carr DB, Rich MW. Geriatric syndromes in elderly patients admitted to an inpatient cardiology ward. J Hosp Med. 2007;2(6):394–400.

    Article  PubMed  Google Scholar 

  21. McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci. 2002;57(9):M569–771.

    Article  PubMed  Google Scholar 

  22. Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med. 1997;12:203–8.

    PubMed  CAS  Google Scholar 

  23. Thomas DR. Focus on functional decline in hospitalized older adults. J Gerontol A Biol Sci Med Sci. 2002;57(9):M567–8.

    Article  PubMed  Google Scholar 

  24. Inouye SK, Wagner DR, Acampora D, Horwitz RI, Cooney LM, Tinetti ME. A controlled trial of a nursing-centered intervention in hospitalized elderly patients: The Yale Geriatric Care Program. J Am Geriatr Soc. 1993;41:1353–60.

    PubMed  CAS  Google Scholar 

  25. Garza JJ, Gantt DS, Van Cleave H, Riggs MW, Dehmer GJ. Hospital disposition and long-term follow-up of patients aged >/=80 years undergoing coronary artery revascularization. Am J Cardiol. 2003;92(5):590–2.

    Article  PubMed  Google Scholar 

  26. Khan JH, McElhinney DB, Hall TS, Merrick SH. Cardiac valve surgery in octogenarians: improving quality of life and functional status. Arch Surg. 1998;133(8):887–93.

    Article  PubMed  CAS  Google Scholar 

  27. Sharony R, Grossi EA, Saunders PC, Schwartz CF, Ribakove GH, Culliford AT, et al. Minimally invasive aortic valve surgery in the elderly: a case-control study. Circulation. 2003;108 (Suppl 1):II43–7.

    PubMed  Google Scholar 

  28. Mihaljevic T, Cohn LH, Unic D, Aranki SF, Couper GS, Byrne JG. One thousand minimally invasive valve operations: early and late results. Ann Surg. 2004;240(3):529–34.

    Article  PubMed  Google Scholar 

  29. Ursomanno P. Functional status in the elderly undergoing minimally invasive valve surgery. Unpublished doctoral dissertation, New York University, New York; 2006.

    Google Scholar 

  30. DiMattio MJ, Tulman L. A longitudinal study of functional status and correlates following coronary artery bypass graft surgery in women. Nurs Res. 2003;52(2):98–107.

    Article  PubMed  Google Scholar 

  31. King KB, Rowe MA, Kimbel LP, Zerwic JJ. Optimism, coping and long term recovery from coronary artery bypass surgery in women. Res Nurs Health. 1998;21:15–26.

    Article  PubMed  CAS  Google Scholar 

  32. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35 Suppl 2:ii37–41.

    Article  PubMed  Google Scholar 

  33. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med. 2002;18(2):141–58.

    Article  PubMed  Google Scholar 

  34. Magaziner J, Hawkes W, Hebel JR, et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55(9):M498–507.

    Article  PubMed  CAS  Google Scholar 

  35. Sullivan DH, Bopp MM, Roberson PK. Protein-energy undernutrition and life-threatening complications among the hospitalized elderly. J Gen Intern Med. 2002;17(12):923–32.

    Article  PubMed  Google Scholar 

  36. Nutrition Screening Initiative. Nutrition State of Principle; 2002. http://www.hospitalmedicine.org/geriresource/toolbox/determine.htm. Accessed 2 Nov 2009.

  37. Lyder CH. Pressure ulcer prevention and management. JAMA. 2003;289(2):223–6.

    Article  PubMed  Google Scholar 

  38. Whittington K, Patrick M, Roberts JL. A national study of pressure ulcer prevalence and incidence in acute care hospitals. J Wound Ostomy Continence Nurs. 2000;27(4):209–15.

    PubMed  CAS  Google Scholar 

  39. Lyder CH, Preston J, Grady JN, et al. Quality of care for hospitalized medicare patients at risk for pressure ulcers. Arch Intern Med. 2001;161(12):1549–54.

    Article  PubMed  CAS  Google Scholar 

  40. Emori TG, Banerjee SN, Culver DH, et al. Nosocomial infections in elderly persons in the United States, 1986–1990: National Nosocomial Infections Surveillance System. Am J Med. 1991;91(3B):289S–93.

    Article  PubMed  CAS  Google Scholar 

  41. Kunin CM. Urinary-catheter-associated infections in the elderly. Int J Antimicrob Agents. 2006;28 Suppl 1:S78–81.

    Article  PubMed  CAS  Google Scholar 

  42. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med. 2000;160:678–82.

    Article  PubMed  CAS  Google Scholar 

  43. Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg. 2008;143(6):551–7.

    Article  PubMed  Google Scholar 

  44. Wald HL, Epstein AM, Radcliff TA, Kramer AM. Extended use of urinary catheters in older surgical patients: a patient safety problem? Infect Control Hosp Epidemiol. 2008;29(2):116–24.

    Article  PubMed  Google Scholar 

  45. Saint S, Lipsky B, Goold S. Urinary catheters: a one-point restraint? Ann Intern Med. 2002;137(2):125–7.

    PubMed  Google Scholar 

  46. Dubois MJ, Bergeron N, Dumont M, Dial S, Skrobik Y. Delirium in an intensive care unit. A study of risk factors. Intensive Care Med. 2001;27:1297–304.

    Article  PubMed  CAS  Google Scholar 

  47. Silverstein JH, Timberger M, Reich DL, Uysal S. Central nervous system dysfunction after noncardiac surgery and anesthesia in the elderly. Anesthesiology. 2007;106(3):622–8.

    Article  PubMed  Google Scholar 

  48. Inouye SK. Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. Ann Med. 2000;32(4):257–63.

    Article  PubMed  CAS  Google Scholar 

  49. Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am J Med. 1999;106(5):565–73.

    Article  PubMed  CAS  Google Scholar 

  50. Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney Jr LM. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med. 2001;161(20):2467–73.

    Article  PubMed  CAS  Google Scholar 

  51. Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998;13(4):234–42.

    Article  PubMed  CAS  Google Scholar 

  52. Arora VM, McGory ML, Fung CH. Quality indicators for hospitalization and surgery in vulnerable elders. J Am Geriatr Soc. 2007;55 Suppl 2:S347–58.

    Article  PubMed  Google Scholar 

  53. Somogyi-Zalud E, Zhong Z, Hamel MB, Lynn J. The use of life-sustaining treatments in hospitalized persons aged 80 and older. J Am Geriatr Soc. 2002;50(5):930–4.

    Article  PubMed  Google Scholar 

  54. Coleman EA, Min SJ, Chomiak A, Kramer AM. Posthospital care transitions: patterns, complications, and risk identification. Health Serv Res. 2004;39(5):1449–65.

    Article  PubMed  Google Scholar 

  55. Foust JB, Naylor MD, Boling PA, Cappuzzo KA. Opportunities for improving post-hospital home medication management among older adults. Home Health Care Serv Q. 2005;24(1–2):101–22.

    Article  PubMed  Google Scholar 

  56. Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7.

    Article  PubMed  Google Scholar 

  57. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–7.

    PubMed  Google Scholar 

  58. Moore C, McGinn T, Halm E. Tying up loose ends: discharging patients with unresolved medical issues. Arch Intern Med. 2007;167(12):1305–11.

    Article  PubMed  Google Scholar 

  59. Flacker J, Park W, Sims A. Hospital discharge information and older patients: do they get what they need? J Hosp Med. 2007;2(5):291–6.

    Article  PubMed  Google Scholar 

  60. Bowles KH, Naylor MD, Foust JB. Patient characteristics at hospital discharge and a comparison of home care referral decisions. J Am Geriatr Soc. 2002;50(2):336–42.

    Article  PubMed  Google Scholar 

  61. Agostini J, Baker D, Inouye S, Bogardus S. Multidisciplinary geriatric consultation services. Making Health Care Safer: A Critical Analysis of Patient Safety Practices; 2001. AHRQ Publication No. 01-E058.

    Google Scholar 

  62. Allen CM, Becker PM, McVey LJ, Saltz C, Feussner JR, Cohen HJ. A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations. JAMA. 1986;255:2617–21.

    Article  PubMed  CAS  Google Scholar 

  63. Phibbs CS, Holty JE, Goldstein MK, et al. The effect of geriatrics evaluation and management on nursing home use and health care costs: results from a randomized trial. Med Care. 2006;44(1):91–5.

    Article  PubMed  Google Scholar 

  64. Palmer RM, Landefeld CS, Kresevic DM, Kowal J. A medical unit for the acute care of the elderly. J Am Geriatr Soc. 1994;42(5):54–5.

    Google Scholar 

  65. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995;332(20):1338–44.

    Article  PubMed  CAS  Google Scholar 

  66. Counsell SR, Holder CM, Liebenauer LL, et al. Effects of a multicomponent intervention on functional outcomes and processes of care in hospitalized older patients: a randomized controlled trial of acute care of elders (ACE) in a community hospital. J Am Geriatr Soc. 2000;48(12):1572–81.

    PubMed  CAS  Google Scholar 

  67. Boltz M, Capezuti E, Bowar-Ferres S, et al. Hospital nurses’ perception of the geriatric nurse practice environment. J Nurs Scholarsh. 2008;40(3):282–9.

    Article  PubMed  Google Scholar 

  68. Fletcher K, Hawkes P, Williams-Rosenthal S, Mariscal CS, Cox BA. Using nurse practitioners to implement best practice care for the elderly during hospitalization: the NICHE journey at the University of Virginia medical center. Crit Care Nurs Clin North Am. 2007;19(3):321–37.

    Article  PubMed  Google Scholar 

  69. Guthrie PF, Schumacher S, Edinger G. A NICHE delirium prevention project for hospitalized elders. In: Silverstein N, Maslow K, editors. Improving hospital care for persons with dementia. New York: Springer; 2006. p. 139–57.

    Google Scholar 

  70. Boltz M, Capezuti E, Bowar-Ferres S, et al. Changes in the geriatric care environment associated with NICHE (Nurses Improving Care for Health System Elders). Geriatr Nurs. 2008;29(3):176–85.

    Article  PubMed  Google Scholar 

  71. LaReau R, Raphelson M. The treatment of the hospitalized elderly patient in a specialized acute care of the elderly unit: a southwest Michigan perspective. Southwest Mich Med J. 2005;2(3):21–7.

    Google Scholar 

  72. Inouye SK, Bogardus ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;1340(9):669–76.

    Article  Google Scholar 

  73. Inouye SK, Baker DI, Fugal P, Bradley EH, for the HELP Dissemination Project. Dissemination of the hospital elder life program: implementation, adaptation, and successes. J Am Geriatr Soc. 2006;54(10):1492–9.

    Article  Google Scholar 

  74. Bradley EH, Webster TR, Schlesinger M, Baker D, Inouye SK. The roles of senior management in improving hospital experiences for frail older adults. J Healthc Manage. 2006;51(5):323–36.

    Google Scholar 

  75. Inouye SK, Bogardus ST, Williams CS, Leo-Summers L, Agostini JV. The role of adherence on the effectiveness of nonpharmacologic interventions: evidence from the delirium prevention trial. Arch Intern Med. 2003;163(8):958–64.

    Article  PubMed  Google Scholar 

  76. Coleman EA, Boult C, American Geriatrics Society Health Care Systems Committee. Improving the quality of transitional care for persons with complex care needs. J Am Geriatr Soc. 2003;51(4):556–7.

    Article  Google Scholar 

  77. Naylor M, Keating SA. Transitional care. Am J Nurs. 2008;108(9 Suppl):58–63.

    Article  PubMed  Google Scholar 

  78. Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive discharge planning for the hospitalized elderly: a randomized clinical trial. Ann Intern Med. 1994;120:999–1006.

    PubMed  CAS  Google Scholar 

  79. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281(7):613–20.

    Article  PubMed  CAS  Google Scholar 

  80. Naylor MD, Brooten DA, Campbell RL, et al. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004;52(5):675–84.

    Article  PubMed  Google Scholar 

  81. Coleman EA, Smith JD, Frank JC, Min S, Parry C, Kramer AM. Preparing patients and caregivers to participate in care delivered across settings: the care transitions intervention. J Am Geriatr Soc. 2004;52(11):1817–25.

    Article  PubMed  Google Scholar 

  82. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822–8.

    Article  PubMed  Google Scholar 

  83. Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. 2008;56(7):1349–56.

    Article  PubMed  Google Scholar 

  84. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49(5):516–22.

    Article  PubMed  CAS  Google Scholar 

  85. Siu AL, Spragens LH, Inouye SK, Morrison RS, Leff B. The ironic business case for chronic care in the acute care setting. Health Aff. 2009;28(1):113–25.

    Article  Google Scholar 

  86. Capezuti E, Brush B. Implementing geriatric care models: what are we waiting for? Geriatr Nurs. 2009;30(3):204–6.

    Article  PubMed  Google Scholar 

  87. Committee on the Future Health Care Workforce for Older Americans, Institute of Medicine. Retooling for an aging America: building the health care workforce. Washington, DC: National Academies Press; 2008.

    Google Scholar 

  88. Wieland D, Eleazer GP, Bachman DL, Corbin D, Oldendick R, Boland R, et al. Does it stick? Effects of an integrated vertical undergraduate aging curriculum on medical and surgical residents. J Am Geriatr Soc. 2008;56(1):132–8.

    Article  PubMed  Google Scholar 

  89. Potter JF, Burton JR, Drach GW, Eisner J, Lundebjerg NE, Solomon DH. Geriatrics for residents in the surgical and medical specialties: implementation of curricula and training experiences. J Am Geriatr Soc. 2005;53(3):511–5.

    Article  PubMed  Google Scholar 

  90. The Council of the Section for Enhancing Geriatric Understanding and Expertise among Surgical and Medical Specialists (SEGUE) program of the American Geriatrics Society. http://www.americangeriatrics.org/specialists/cardiothoracic_surgery.shtml#sts. Accessed 2 Nov 2009.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elizabeth A. Capezuti .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Capezuti, E.A., Ursomanno, P., Boltz, M., Kim, H. (2011). Geriatric Models of Care. In: Katlic, M. (eds) Cardiothoracic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0892-6_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-0892-6_4

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0891-9

  • Online ISBN: 978-1-4419-0892-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics