Mobile medical care to the elderly: an evaluation

Impact of an oncogeriatric consulting team on therapeutic decision-making

Increased life expectancy and cancer incidence imply the need to develop a specialized care policy for elderly patients with cancer. We created an oncogeriatric consulting team (OGCT) in Toulouse University Hospital to carry out comprehensive gerontological assessment at the bedside of hospitalized patients. We analyze the impact on the final cancer treatment decision of this mobile geriatric assessment. We carried out a descriptive, retrospective real-life analysis of a patient cohort over a two-year period. The OGCT assessed 124 patients, of whom the majority were women (54.8%), median age 81 years, living at home (95.2%) and with family caregivers (86.5%). Nearly all were frail (96.7% according to the classification of Balducci and colleagues) and 3.2% were vulnerable. The team's decisions were analyzed for patients who had not yet been treated (n=107). After analysis, the team's proposal was in line with the initial cancer treatment plan in 68.2% of cases (n=73). In cases where there was a disagreement, the final decision was in line with the mobile team's proposal in 17.75% of 107 patients (n=19). The decision of the team was followed more often when their assessment proposed strictly palliative treatment. The decision to give elderly patients specific cancer treatment seems in our experience rather to be a matter for the oncologists, and is not very susceptible to modification by geriatric opinion. On the other hand, the geriatrician appears to be more credible and his/her opinion more likely to be followed when the patient is considered too frail and less aggressive, or even exclusively palliative, treatment is proposed.

Effectiveness of a mobile medical van in providing screening services for STDs and HIV

This retrospective study assesses the efficacy of a mobile medical van in screening high risk individuals and identifying new cases of HIV and other sexually transmitted diseases (STDs) in an urban setting from July 1996 through March 1997. High risk sex and drug use were common, while consistent condom use was rare. Relatively few patients were screened for STDs; positive cases represented only a small proportion of the STD cases identified in the study community. The mobile program, however, accounted for 11.5% of all HIV tests conducted at public test sites in the city. Mobile medical programs have the potential to improve STD and HIV control efforts by providing services to high risk individuals who may lack access to care elsewhere. Doing so, however, will require more active case finding techniques, including new, less invasive techniques to test asymptomatic individuals.

Social network assessment: a critical component in case management for functionally impaired older persons

Case managers who develop long-term care service plans for functionally impaired elderly persons must integrate the supportive efforts of the client's social network into the overall service approach. The ultimate goal is to develop a plan whereby the formal service providers supplement rather than supplant the care and assistance available from the older person's network. This article presents a framework that identifies those variables associated with the relationship dynamics that exist between older persons and their social network members. The framework can be used by case managers to help them assess the characteristics and functioning of their clients' social network relations and develop service strategies that maximize the helping efforts of those networks.

Health status and social conditions of the elderly in remote districts. Results of a screening programme

In 1978 a cohort of 1040 individuals aged 65 years or over was screened by public health nurses in Kuusamo. The screening produced basic data about health status and social conditions for an intervention of active medical care of the elderly by means of a mobile unit in rural districts. The response rate of the screening was 90%. 72% of the men and 35% of the women lived with their spouse; 6% of the men and 20% of the women lived alone. Poor health was assessed least commonly (36%) by those living alone, and most commonly by women living with their spouse (51%), even though 87% of them were under 75 years old. A visit to a physician during the past 12 months was more common among younger subjects. 15% of the men and 18% of the women had slightly restricted mobility. Men living alone had better mobility than women living alone.

Knowledge and use of services by the elderly: a critical review of the literature

This article critically reviews the existing literature on the perceptions, knowledge, and use of services by the elderly. Definitive statements concerning these topics are difficult to make because of the contradictory research findings and inadequacies of existing studies. However, the following observations are supported by this review: many elderly do not hold positive attitudes towards services, a bare majority appear aware of services, utilization rates are extremely low, and the correlates of service use are not well understood. In addition, this article identifies a number of weaknesses with the existing research and discusses the following specific recommendations for improvement: conceptualization and operationalization of knowledge and use as continuums, not as discrete phenomena, examination of the processes by which individuals come to know of and use services, and consideration of the roles played by informal networks as facilitators or deterrents to knowledge and use of services.

Alternative forms of transport and their use in the health services of developing countries

During the past few years greater interest has been shown in ways in which the coverage of health services in developing countries might be increased. Frequently, it has been advocated that greater use be made of mobile health services, often using relatively sophisticated transport systems, including aircraft. The present article examines the uses to which mobility in health services has been put and the merits of different forms of transport, within the resource constraints and health "needs" of Third World countries. Our main conclusions are that for the majority of health service movement appropriate intermediate technology transport should be used (i.e. bicycle, animals, or motorcycles). The use of mechanical transport within health services with the highest benefit per unit cost is likely to be that employed in the regular supportive (not policing) visits to permanently staffed fixed basic care facilities by more highly skilled and scarce health personnel. Those clinics located closer to the regional base can usually be reached more cheaply by land transport, while those at a distance might justify the use of a light aircraft. Where aircraft are used in this supportive role, it is important they are integrated into the ongoing health services and tightly scheduled to lessen the risk of their diversion to less cost-effective activities.

Recent rural health research

Recent rural health research may be examined in two ways: needs and solutions. A definition of needs requires an evaluation of the social factors that affect the expectations and the behavior of both the provider and the consumer. Three types of solutions should be considered: the appropriate utilization of manpower, including the efforts to influence physician location and specialty distribution, new health practitioners, and team approaches; the new technology for transportation and communication; and the organization of new delivery systems. Two areas of rural health research that need more attention are program evaluation and financial planning.