How does MDS work to improve the health and care of the most vulnerable elderly? MDS is a comprehensive, state-of-the art documentation system that helps nursing home staff to gather definitive information on a resident's health, needs and strengths. Arranged by sections, the system targets 18 areas for caregivers to evaluate, including residents' medical and dental conditions, mental status, capabilities for activities and the potential for rehabilitation. Used during nursing home admissions, annual reviews and whenever a significant change develops in residents' conditions, MDS helps to "flag" potential problems before they get out of hand.

In evaluating the documentation system, a national team of researchers recently compared health conditions of elderly nursing home residents before and after implementation of MDS. They analyzed data that was gathered from more than 2,000 residents in 268 nursing homes throughout 10 states and reported their findings in the August 1997 issue of the Journal of the American Geriatrics Society. They discovered that MDS has resulted in significant improvements.

"We found a 28% drop in the rate of hospitalization of the frailest nursing home residents, with no increase in their death rate," says Dr. Morris, who's now a codirector of Hebrew SeniorLife's Institute for Aging Research, where he also occupies the Alfred A. and Gilda Slifka Chair in Gerontological Research. "There was also significantly less decline in residents' ability to perform activities of daily living, such as dressing or feeding themselves, and less decline in their cognitive performance and social involvement," says Dr. Morris.

Moreover, there were reductions in other medical conditions. Fewer residents suffered from malnutrition or vision problems. And there was a 50 % decline in the prevalence of dehydration, one of the 10 most common reasons the elderly, especially those between the ages of 85 and 99, are hospitalized. This translates into 18,000 nursing home residents in the United States who have been spared this potentially fatal condition, and a health care system without the related costs of treatment.

Although still in need of some refinement, this resident assessment instrument has already become "our national gold standard for nursing home assessment," writes Joseph Ouslander, MD, director of the Division of Gerontology and Geriatric Medicine at the Wesley Woods Geriatric Center at Emory University in Atlanta, in a special article accompanying the research findings in the Journal of the American Geriatrics Society. A modified form of the MDS assessment tool has also proven successful in assisting and planning care for older adults in community settings as far away as Japan and Italy. In fact, both versions of MDS (for use in nursing homes and for home care) have been translated and adopted for use in 15 foreign countries.