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The aim of the study was to compare two coaching channels-a combination of telephone and face-to-face coaching (combined phone and face-to-face) versus telephone coaching only (phone)-on exercise performances in a home-based low-intensity program. Multiple regression models were used to examine if the two coaching channels were associated with different 3-month posttest exercise performances. Individuals with the combined phone and face-to-face coaches had better exercise performances at 3-month posttest, compared to those who received phone coaching only. The evaluation suggests that, in a home-based, low-intensity training program that has been demonstrated to benefit high-risk, ethnically diverse older adults, face-to-face coaching appears to be a more powerful motivator than a phone-based approach only. [ABSTRACT FROM AUTHOR]

Evaluates the Visiting Nurse Association Foundation Transprofessional Model of terminal home care for HIV/AIDS in Los Angeles, California. Role of social workers in pre-hospice terminal care services; Improvement in patients' quality of life; Use of evaluation date to develop a cost profile of patient care.

The Healthy Moves for Aging Well program piloted a home-based, low-intensity strength exercise program that targeted a nursing home certifiable, ethnically diverse sample of community-residing adults aged 65 and older. This study examined the effectiveness of the Healthy Moves program in reducing participants' number of falls, fear of falling, depression, and pain. Results indicated that participants (n = 338) had statistically significant declines in the number of falls and level of pain. These declines were found among participants who improved their exercise performance. This pilot suggests that a modest intervention that couples behavior change with seated exercise can have a positive outcome on a sample of older adults who have high levels of functional impairment and lack a regular exercise regime.

Objective: To identify characteristics associated with four potential medication problems among older adults at risk for nursing home placement., Design: Cross-sectional survey., Setting: Three sites of California's Multipurpose Senior Services Program (MSSP), a Medi-Cal waiver care management program., Participants: Six hundred fifteen dual-eligible, functionally impaired, community-dwelling adults aged 65 years and older enrolled in MSSP between June 2004 and January 2006., Intervention: Medication screening using the Home Health Criteria that include medication use and clinical risk factors., Main Outcome Measures: Demographic and health characteristics associated with four problem types: 1) unnecessary therapeutic duplication, 2) psychotropic medication use with concurrent falls or confusion, 3) cardiovascular medication problems, and 4) use of nonsteroidal anti-inflammatory drugs (NSAIDs) with risk of peptic ulcer complications. Independent measures included age, gender, race/ethnicity, living arrangement, number of medications, health status, and utilization., Results: Each problem type was associated with different characteristics, as identified by logistic regression modeling. Increased number of medications was associated with therapeutic duplication (odds ratio [OR] = 1.27; confidence interval [CI] 1.20-1.35; P < 0.001) and problematic psychotropic medication use (OR = 1.15; CI 1.08-1.22; P < 0.001). Psychotropic use was also associated with emergency department, hospital, or skilled nursing admission in the previous year (OR = 1.86; CI 1.15-3.00; P = 0.012), living with someone (OR = 0.57; CI 0.34-0.95; P = 0.032), and new care management enrollment (OR = 1.99; CI 1.22-3.24; P = 0.006). New enrollment was also associated with cardiovascular medication problems (OR = 2.15; CI 1.32-3.51; P = 0.002). There were no significant characteristics associated with NSAID problems (not shown)., Conclusion: Unique predictors of potential medication problems highlight the need for systematic medication screening and treatment planning. These should include medication therapy management for vulnerable community-dwelling elders (upon enrollment for care management) and for those taking multiple medications. Funding mechanisms via Medicare Part D (prescription drug program) should be explored in this population to increase identification of medication problems and their resolution.

This article describes a geriatric care management project that is testing whether geriatric care management plus a brief purchase of service (POS) intervention will lower medical costs, improve satisfaction with care, increase care plan adherence, and improve perceived quality of life. Kaiser Permanente members aged 65 and older who were eligible for geriatric care management and consented to participate in the study were randomized to one of four study groups: information and referral via mail, telephone care management, geriatric care management, or geriatric care management with POS capability. The POS intervention provides up to $2,000 of designated, paid services including in-home supportive services, transportation, respite, or medical equipment within the first 6 months of care management enrollment. Approximately 1,400 senior members were referred to the geriatric care management program, and 451 were randomly assigned to one of the four study groups. Those enrolled in the geriatric care management program were significantly more likely to be ethnic minorities and have lower income than the general Kaiser Permanente senior enrollment. Barriers encountered in implementing the POS intervention included establishing contractual agreements between Kaiser Permanente and private and community agencies, locating adequate and sufficient community agencies to provided needed services, monitoring service contracts, and delaying use of the POS benefit.