Improving Healthcare Delivery in Nursing Homes: Focus on Broken Bones
The objective of this study is to focus on health care management issues, problems, and policies in a current organization and specifically that of a nursing home with a focus on broken bones.
Identification of Problem
Osteoporosis and fracture related to osteoporosis "are primary health concerns and sources of significant death and disability around the world." (Clinton, 2011) In 2006, it is stated that hip fractures along "cost Americans in excess of $20 billion." (Clinton, 2011) This is a huge problem since one in four patients with a hip fracture die "within one year of having the fracture." (Clinton, 2011) Osteoporosis is a bone disease that is stated to "decrease bone density" and to increase the "risk of fractures." (Clinton, 2011) These types of fractures are termed 'fragility fracture' and this occur with "minimal trauma and typically would not happen if the patient did not have weakened bone." (Clinton, 2011)
The body is stated to absorb more bone than it actually produces and this causes the bones to become dense and to become weaker. Affected is the spongy trabecular bones at the ends of the bones more so that the hard cortical bone that comprises the shaft of bones. (Clinton, 2011, paraphrased) Age is a primary risk factor for developing osteoporosis in both men and women. It is stated that breaking bone is serious, especially in older adults. It is reported that broken bones "can cause severe pain that may not be completely treatable. Almost all fragility fractures are associated with a decreased life expectancy when compared to patients who have not had a fracture. Twenty-five percent of seniors who break a hip die within one year from problems related to the broken bone itself or surgery to repair it. Many of those who survive need long-term nursing home care. A woman's lifetime risk of breaking a hip from osteoporosis is equal to her risk of breast, ovarian, and uterine cancer combined." (Clinton, 2011)
It is reported in one study that there have been few in the way of "major health promotion efforts…directed toward old people." (Kutner, et al., 1992) The reason stated for this is that there are "widely held myths" that serve to provide discouragement for inclusion of older adults in such efforts." (Kutner, et al., 1992) Myths include that "health promotion means the prevention of disease rather than improving health status" and that "older people are unable to tolerate health promotion interventions, as for example, exercise regimens as well as for the reasons that older adults are not able or willing to change their health attitudes, behaviors, or lifestyles and that older people are difficult to recruit into studies and hard to evaluate and finally that behavioral or lifestyle changes in late life will have only minimal impact on the health and functioning of old people and that intervention is not cost effective for the elderly." (Kutner, et al., 1992) Of primary importance is that since most older adults have at least one chronic disease or disability, health promotion efforts for them are important for maintain function." (Kutner, et al., 1992)
II. Analysis of Problem
The Multicenter Trials of Frailty and Injuries reports the Cooperative Studies of Intervention Techniques (FICSIT) that is a project supported under a cooperative agreement for 1990 through 1993 by the National Institute on Aging and the National Center for Nursing Research of the National Institutes of Health. FICSIT is reported as a "series of clinical trials of biomedical, behavioral, and environmental interventions designed to increase physical function capacity and reduce falls and fall-related injuries among the frail elderly." (Kutner, et al., 1992)
The difference between FICSIT and other interventions in the elderly is that it is a multi-institutional cooperative investigation." (Kutner, et al., 1992) Its interventions are reported as "randomized clinical trials with sample sizes ranging from 100 to 1,250." (Kutner, et al., 1992) It is reported that clinical center that participate conducted "their own proposed interventions and collect associated site-specific data, while simultaneously contributing to a large body of data collected from all sites." (Kutner, et al., 1992) The eight clinical sites are collaborative with a statistical coordinating center and a monitoring board. It is reported that participating sites as well as their populations and their proposed interventions and major outcomes are as follows:
(1) Kaiser Permanente, Northwest Region, Center for Health Research, Portland, OR -- This study compares a control group to a moderate exercise group. The objective of the study is to modify environmental risks for reduction of falls in...
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