Planning for a statewide network of dementia assessment services: A survey of geriatric assessment services in Michigan

All 38 geriatric assessment service units identified in Michigan were surveyed and responded as a component of planning a statewide network of diagnostic and assessment services for patients with dementia. Most units were outpatient (71 percent), urban (71 percent), and hospital-based (82 percent). Some provided primarily geropsychiatric services (21 percent), while the rest provided general geriatric services. The staff included physicians (95 percent), nurses (100 percent), social workers (95 percent) and other professionals (SO percent) such as nutritionists, neuro psychologists or clinical pharmacists. Assessments performed by most units included physical (92 percent), psychosocial (95 percent), functional (95 percent), neurological (71 percent) mental (95 percent), and financial (89 percent). Patient referral sources were most frequently self/family, followed by physician, community agencies, and community mental health. Reasons for referral were most often confusion! memory loss, followed by behavior change, caregiver stress, depression, and evaluation for placement. Most patients seen were between 65 and 84 years of age (72 percent), lived within 25 miles of the unit (87 percent), and had dementia (62 percent). Urban sites assessed significantly more persons per month (19 percent) than non-urban sites (4 percent). Community-based services spent significantly more time per month on geriatric assessments (68 hours) than did hospital-based services (26 hours). These survey results will aid the development of a statewide network of dementia diagnostic and assessment services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67004/2/10.1177_153331759200700606.pd

Racial differences in influenza vaccination among older americans 1996–2000: longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey

BACKGROUND: Influenza is a common and serious public health problem among the elderly. The influenza vaccine is safe and effective. METHODS: The purpose of the study was to determine whether frequencies of receipt vary by race, age group, gender, and time (progress from 1995/1996 to 2000), and whether any racial differences remain in age groups covered by Medicare. Subjects were selected from the Health and Retirement Study (HRS) (12,652 Americans 50–61 years of age (1992–2000)) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (8,124 community-dwelling seniors aged 70+ years (1993–2000)). Using multivariate logistic regression, adjusting for potential confounders, we estimated the relationship between race, age group, gender, time and the main outcome measure, receipt of influenza vaccination in the last 2 years. RESULTS: There has been a clear increase in the unadjusted rates of receipt of influenza vaccination for all groups from 1995/1996 to 2000. However, the proportions immunized are 10–20% higher among White than among Black elderly, with no obvious narrowing of the racial gap from 1995/1996 to 2000. There is an increase in rates from age 50 to age 65. After age 70, the rate appears to plateau. In multivariate analyses, the racial difference remains after adjusting for a series of socioeconomic, health, and health care related variables. (HRS: OR = 0.63 (0.55–0.72), AHEAD: OR = 0.55 (0.44–0.66)) CONCLUSIONS: There is much work left if the Healthy People 2010 goal of 90% of the elderly immunized against influenza annually is to be achieved. Close coordination between public health programs and clinical prevention efforts in primary care is necessary, but to be truly effective, these services must be culturally appropriate

Alternative Transportation Energy

Transportation energy issues are moving to the forefront of the public consciousness in the U.S. and particularly California, and gaining increasing attention from legislators and regulators. The three principal concerns motivating interest in transportation energy are urban air quality, oil dependence, and the threat of global warming. Transportation fuels are a principal contributor to each of these. The transportation sector, mostly motor vehicles, contributes roughly half the urban air pollutants, almost one-third of the carbon dioxide, and consumes over 60% of all petroleum