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Neurological Care for the Elderly

Joe Cantlupe, for HealthLeaders Media, March 13, 2013
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Florida Hospital officials say they want to identify NPH patients who may benefit from the placement of a stent to reduce inpatient admissions and avoid potential ED visits. The hospital also wants to increase knowledge and treatment of NPH through evaluations.

A University of Florida analysis shows that patients with Parkinson's disease are 50% more likely to visit an ED than those who do not have the disease. Often, they are treated because of ancillary issues such as urinary tract infection, pneumonia, and heart failure, according to the National Parkinson Foundation.

Florida Hospital officials say that patients with Alzheimer's are readmitted to hospitals more often than other patients. "We have looked at our data, and patients with a primary or secondary diagnosis of Alzheimer's have almost a 10% higher chance of being readmitted to the hospital multiple times," Spielman says. "The change in mental status, many times caused by other medical conditions such as UTI or pneumonia, continues to bring them in over and over.

"So much crossover occurs in this particular population, and so many things can be going on: What's causing the illness?" Spielman asks. "They may have multiple readmissions. They are not coming back necessarily because of dementia, but because of congestive heart failure. It's not the ideal situation if they have dementia or Alzheimer's. They end up staying twice as long, in some cases, as somebody else. Their condition requires a special communication style, a special approach. It's case management on steroids for this subset of Medicare patients, and we are trying to keep them out of the hospital for avoidable medical conditions."

For dementia patients, it's a case of issues on top of issues—from medication complexities to pulmonary complications and urinary tract issues—which compounds the readmission quandary.

In the latest Hospital Compare reports from 2012, Florida Hospital had a 27.3% readmission rate for 3,666 heart failure patients, compared to the national average of 24.7%. The hospital also had a 20.7% readmission rate for 2,223 pneumonia patients, compared to 18.5% for the national average. Readmission for elderly patients is more complicated because of their array of conditions.

Success key No. 4: Outpatient programs

Parkinson's disease, a progressive disorder of the nervous system, affects a patient's movement, balance, speech, fine motor skills, thinking, and behavior. In the United States, up to 60,000 cases of Parkinson's are diagnosed each year, and 1 million people currently have it. While the disease can't be cured, a combination of medications, therapy, and other programs reduce the symptoms—as does surgery.

The 60-bed Spaulding Rehabilitation Hospital Cape Cod in East Sandwich, Mass., utilizes a holistic approach that includes medication management. Spaulding's solution consists of timely rehabilitation and coordinated care using neuro-rehab specialists, says David Lowell, MD, CMO at Spaulding's Centers for Geriatric Neurology. Through a combination of outpatient and inpatient treatment approaches, elderly Parkinson's patients have been able to extend the time they are able to live at home on average 1.5 more years, instead of needing to live in an assisted living or skilled nursing facility, Lowell says.

The Centers for Geriatric Neurology are part of the Spaulding Rehabilitation Network, which is part of Partners HealthCare System based in Boston. When they opened in 2010, the centers served 62 patients. In 2012, they admitted 124 new patients, Lowell says.

What began as the Parkinson's Center for Comprehensive Care expanded to also include care for stroke, gait disorders, and cognitive disorders. Lowell says the centers' rehab model offers functional and holistic therapies along with medical management.

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