U.S. Department of Health and Human Services Active Aging: A Shift in the Paradigm May 1997 This discussion paper was prepared as a background document for the Denver Summit by aging experts from the eight industrial countries who attended the Summit. The Department of Health and Human Services' Office of Disability, Aging and Long-Term Care Policy and the National Institute on Aging organized this Experts Meeting. Many of the themes addressed in the paper were reflected in the Denver Summit communique. For additional information, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.htm or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Robert Clark.
Alzheimer's Disease: A Family Affair and a Growing Social Problem (Released April 2001)
by Sandra S. Stanton I see her, dressed in rose knit pants and flowered shirt, sitting in a chair. Her soft gray wavy hair has been neatly brushed, though not (I know) by the hands that lie still in her lap. There is no expression to be read in her face, and her pale blue eyes look straight ahead not at, but seemingly right through, a group of women stringing bead necklaces at a nearby table. Though I am in her line of vision, she doesn't notice my approach. I reach out and touch her shoulder and she looks up, startled at first and then puzzled. I say "Hi Mom, it's Sandy! I'm here to see you." A tentative smile crosses her face and then spreads to her eyes, their pale blue color seeming
How society functions based on high returnsBy SCOTT BURNSUniversal Press Syndicate
Live long and prosper! If we do the first, we may not be able to do the second. That's the problem we face as individuals and as a society. The longer we live in retirement, the longer we will consume resources we don't produce.
Our apparent choice is very simple. We can save more. Or we can earn a higher return on what we save.
The trade-off seems simple. In fact, the strength, growth and structure of our entire consumer society depends on high investment returns. Without high returns, we'll have to save more while we're working. Otherwise, we'll suffer a major reduction in our standard of living when we retire. Either way, we'll consume less. It's not a question of whether but rather a question of when.
Andrews LB, Stocking C, Krizek T, et al. An alternative strategy for studying adverse events in medical care. Lancet. 1997;349(9048):309-13.
BACKGROUND: Data about the frequency of adverse events related to inappropriate care in hospitals come from studies of medical records as if they represented a true record of adverse events. In a prospective, observational design we analysed discussion of adverse events during the care of all patients admitted to three units of a large, urban teaching hospital affiliated to a university medical school. Discussion took place during routine clinical meetings. We undertook the study to enhance understanding of the incidence and scope of adverse events as a basis for preventing them. METH
Recent articles in the clinical literature suggest several mechanisms whereby more intensive diagnostic testing and treatment, many of which are likely consequences of the more intensive clinical practices made possible in the inpatient setting, could lead to harm. (Black 1993, Creditor 1993, Fisher 1999). Mechanisms of potential harm have been delineated related to both diagnosis and treatment.
Diagnosis. The benefits of early diagnosis (and screening) depend upon the accuracy of the test and whether earlier intervention has a positive impact on long term health outcomes. In the case of hypertension, for example, early detection and intervention have been demonstrated to be effective in reducing all-cause mortality and deaths from stroke and coronary artery disease, and these benefits have been confirmed in the elderly. For many other conditions, however, the long-term benefits of screening and early diagnosis have yet to be proven (e.g. screening for ovarian cancer or prostate cancer). The pri
The table below presents the estimated effect on population mortality of an increased rate of hospitalization due to greater local bed supply, based on published studies of rates of adverse events in hospitalized patients. The table assumes that the excess hospitalizations due to greater capacity are discretionary -- in the sense that these patients would have been cared in the outpatient setting in low hospital capacity regions and that the outcomes of the specific treatment (e.g. care of diabetes or heart failure) would have been similar. The table estimates the impact of the potential adverse events a
The quality of medical intervention is often more a matter of the quality of caring than the quality of curing, and never more so than when life nears its end. Yet medicine's focus is disproportionately on curing, or at least on the ability to keep patients alive with life-support systems and other medical interventions. This ability to intervene at the end of life has raised a host of medical and ethical issues for patients, physicians, and policy makers.
The Dartmouth Atlas demonstrates that, to the extent that end of life issues are addressed in practice, they are resolved in ways that depend on where the patient happens to live, not on the patient's preferences or the power of care to extend life. The American experience of death varied remarkably from one community to another in 1995-96: