Caring for the vulnerable elderly: are available quality indicators appropriate?

摘要

In October 2007, an update of the quality measures for "The Assessing Care of Vulnerable Elders-3 (ACOVE-3)" was published.1 Clearly patients receiving long-term care represent a vulnerable group and so it is reasonable to inquire whether these indicators are appropriate for our populations. It should be noted that of the 392 quality indicators, 36% were excluded from patients with advanced dementia (one that interferes with basic activities of daily living) and 34% were excluded from patients with a poor prognosis (expected to live less than 6 months). While many of these recommendations are the bread and butter of basic care for older persons, others appear to be based on care for relatively healthy younger persons and lack evidence for their use in vulnerable elders. As there is a high likelihood that these quality indicators will be used to measure physician performance by government and managed care organizations, it is essential that they are carefully scrutinized.