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Measuring Health Outcomes for Older People Using the Sage Database

Cet article cherche à établir le potentiel d'évaluation des programmes d'une base de données sur les soins de longue durée dans la communauté. Les données proviennent d'un projet-pilote sur la qualité et la clientèle du Health Care Financing Administration, incluant tous les établissements couverts par Medicare/ Medicaid de cinq états américains entre 1992 et 1994. À l'aide du Minimum Data Set, 70 000 résidents de plus de 65 ans souffrant d'insuffisance cardiaque globale ont été identifiés. L'analyse préliminaire de la pharmacothérapie de l'insuffisance cardiaque globale et de ses effets sur le déclin des fonctions physiques est présentée. L'état des fonctions physiques, mesuré par le taux de déclin des activités instrumentales de la vie quotidienne des patients qui suivent une thérapie combinée s'améliore par rapport à ceux qui prennent seulement de la digoxine ou des inhibiteurs de l'enzyme convertissant l'angiotensine. La disponibilité d'un ensemble de donnees sur la population fournit done une méthode d'évaluation des politiques et des pratiques courantes.

Aortic valve replacement in the elderly: frequently indicated yet frequently denied

BACKGROUND

The prevalence of aortic stenosis is nearly 20% in octogenarians. Aortic valve replacement (AVR) is the optimal therapy choice, yet many symptomatic patients are denied this beneficent technology. Whether mechanical or bioprosthetic, aortic valves are not a scarce resource and their safety, effectiveness and longevity are proven.

OBJECTIVE

Because the geriatric population is soaring, clinicians will be encountering more cases of aortic stenosis and the decision-making that leads to surgical referral or non-referral warrants exploration.

METHODS

A literature review was conducted to explore the notion that physicians deny AVR to their patients based solely on their chronological age value.

RESULTS

Using age as the sole exclusion criterion, medical literature documents the fact that AVR is frequently denied to the elderly.

CONCLUSION

It appears that AVR is another beneficent cardiac technology that has been added to the age discrimination list, even though the devices are not scarce, they are cost-effective, and they can improve the life of a symptomatic elderly patient. There is no ethical justification for denying AVR to clinically suitable elderly candidates who request such therapy.

Perindopril improves six minute walking distance in older patients with left ventricular systolic dysfunction: a randomised double blind placebo controlled trial

OBJECTIVE

To evaluate the effects of the angiotensin converting enzyme inhibitor perindopril on six minute walking distance and quality of life in very old patients with left ventricular systolic dysfunction.

DESIGN

Prospective, double blind placebo controlled trial.

SETTING

Medicine for the elderly day hospital.

PATIENTS

66 patients (average age 81) with left ventricular systolic dysfunction identified by echocardiography.

INTERVENTIONS

10 weeks of treatment with titrated doses of perindopril or placebo.

MAIN OUTCOME MEASURES

Six minute walking distance 10 weeks following treatment, quality of life measurements including the Minnesota living with heart failure questionnaire and the 36 item short form health survey.

RESULTS

In patients with left ventricular systolic dysfunction, six minute walking distance was significantly increased in the treatment group (37.1 m) compared with the placebo group (-0.3 m, p < 0.001). The medication was well tolerated and there were no significant adverse events.

CONCLUSIONS

Six minute walking distance is improved considerably by treatment with perindopril in older patients with heart failure caused by left ventricular systolic dysfunction.