One of the most important tools in improving geriatric care developed in the last 20 years is the ACOVE framework (Assessing Care Of Vulnerable Elders)–something we’ve written about many times. In this approach, experts and evidence are used to define a floor of quality care below which would constitute bad care for vulnerable elders. ACOVE uses a series of IF . . . THEN . . . BECAUSE . . . statements to specify triggering conditions for a process of care and a rationale for performing the process. For example, IF an older adult has had two or more falls in a year, THEN s/he should have gait and balance assessed BECAUSE therapy or environmental modification can reduce the risk of a fall with injury.
The current ACOVE framework has sixty-five IF. .. THEN statements that can be broken into two major categories: general medical issues that are more common among older adults but not restricted to them, such as hypertension, diabetes, and depression; and geriatric syndromes that are almost entirely limited to older adults, such as dementia, incontinence, and falls. The basic finding has been that even among the vulnerable older adult population (i.e., the 15 to 20 percent of most at risk elders), providers offer about 55 percent of indicated care for general medical conditions, but only 30 percent of indicated care for geriatric conditions. (As an aside, we all recognize that the health care system and particularly primary care providers are pretty overwhelmed even achieving this level of care. Only better constituted and organized health care teams are going to be able to dedicate the time on task needed to improve quality significantly.)
Given the fact that older adults’ well being is MORE dependent upon quality care than younger adults, both numbers are troubling. But two major talks at the recent American Geriatrics Society meeting shed further light on these issues. First, in his Henderson lecture, David Reuben, MD, one of the members of the original ACOVE RAND/UCLA team and a current John A. Hartford Foundation Center of Excellence Director, discussed how quality of care had improved over time for general medical conditions as assessed in 1998, 2002, 2006, and 2007. However, there has been little or no improvement in care of geriatric conditions over that time. To my mind this pattern of differences shows that the changes are not an artifact of reporting or shifting data collection techniques, but rather represent a real distinction. Health care systems have worked hard on issues like diabetes and even depression care and improved their processes.
However, one small part of the project, really an afterthought, has survived and grown over the years since 1998 and has just celebrated its 14th birthday. Out of a $1.9 million grant to the American Geriatrics Society (
If we want to improve primary care for older adults, we need to know something about their primary care experiences. To find out, we commissioned our first poll, with help from 
Sometime in the last few weeks Health AGEnda had its third birthday, making this a good time to review and reflect. Writing about the blog will also help me to get my thoughts in order for my upcoming presentation on the Foundation’s use of social media in an American Geriatrics Society symposium in Seattle. Called “Facebook, Blogs, and Twitter: Using Social Media to Advance Geriatrics,” it’s taking place Thursday, May 3 at 2:45 in room 4C 1/2 with the redoubtable Paula Span of the New York Times’ 
