Home-Care Analysis

Functional Assessment. Medical information plays a role in tracking and treating chronic diseases, but the ability to stay at home largely depends on the elder's functional ability -- both mental and physical.

• Track functional status -- changes in eating, drinking, and vital signs -- to identify potentially treatable illnesses. Typically, the caregiver sees a decline two weeks before hospitalization becomes necessary.
• Clinic visits are inadequate for functional assessment because they are too brief and out of context. The caregiver doesn't see the individual move about to assess mobility status and has little time to carry on conversation for mental/emotional status.
• About 75% of elders maintain a structured life. An elder who has changing or deteriorating structure will probably leave the home soon. Sensing changes in daily routine would be an accurate predictor of change in status.

• Patients have multiple doctors, each of whom prescribes medications.
• It is difficult for nurses to keep track of all patient information and to keep it accurate and up-to-date.
• Pharmacist do not know why a physician has prescribed a medication (e.g., an anti-depressant prescribed in small dose as a sleeping aid does not mean elder is depressed).
• Physicians need to tell elders why particular medications have been prescribed: what the medicine does, what happens if the elder deviates from the prescribed instructions, and what disease the drug is intended to manage.

• Time limitations in the clinic means doctors don't usually get or keep much useful information on geriatrics -- stories, functional status. Doctors tend to focus on medical tests, diseases, etc.
• Professional caregivers must get physician approval for any test or treatment administered in the home, requiring access to the physician throughout the day.
• Caregivers provide more information about elder complaints than the elders do, but may not be present at clinic visits.
• Few doctors understand enough about dementia to properly handle elders brought to hospitals by their caregivers for episodes of agitation.

• Educating caregivers and elders about elder health related issues will lead to a better decision making and better quality of overall care.
• Geriatricians need better training about dementia; for example, how to recognize the effects of a hospital or clinic environment and respond to environmental influences appropriately. Unusual behavior outside the familiar home environment may be dementia-related confusion rather than the result of a medical condition.
• Professional caregivers are often the point of reference for family caregivers to provide education about disease progression, treatment options, future plans/decisions that will need to be madeThese caregivers need education to provide accurate and useful information.
• Family caregivers need training about dementia -- what to expect, how to handle situations, where to find resources, decision making at each stage of dementia, how to handle stress, and how to communicate with the medical community and elders. They need to know where to find local resources and organizations that can provide services (banking, transport, meal, etc.) for elders, especially when caregivers live outside their elders' communities.