This century will bring an explosion in the geriatric population aged 65 and older, with those over 80 the fastest growing group. Falls, vehicle collisions, burns, and abuse are traumatic events that our geriatric patients may be susceptible to and from which they may not recover. Primary care providers should enhance their understanding of the complex issues of geriatric trauma to facilitate prevention and to assist the patient's recovery to normal function, addressing barriers such as immobility, pain, malnutrition, and acute confusion. Improved outcomes require combined efforts of disciplines and specialties intervening for optimal management for older trauma patients from pre-hospital care through rehabilitation or end-of-life issues.

Purpose: To describe family perceptions about pediatric primary care management following diagnosis of type 1 diabetes mellitus (T1DM) in preschool-aged children living in the Pacific Northwest region of the United States. Study Design and Method: Mothers of children diagnosed with T1DM before the fifth birthday and within the past two years were recruited anonymously through two regional support groups. Perceptions about pediatric primary care management following T1DM diagnosis were elicited through an anonymous 30-item online survey. Demographic characteristics of mother and child were obtained as well as information about five important domains of health care management for a young child with T1DM: (1) multidisciplinary, (2) holistic and compassionate, (3) accessible and communicative, (4) uses current standards and technology, and (5) actively promotes safe self-management. Results: Twenty-one biological mothers participated in this study, each on behalf of a child diagnosed with T1DM who fit inclusion criteria. Overall mothers held positive perceptions about care management by PCPs and endocrinologists within context of each of the five domains. Most mothers felt included in care planning, valued periodic well-child exams, and believed the child's providers were accessible, communicated effectively, and usually demonstrated consideration/compassion for the family. Although a majority of mothers at least somewhat agreed that the PCP used current standards and technology to care for the child, and functioned as the center of his/her health care coordination, these domains elicited a slightly greater number of responses indicating uncertainty or disagreement. Clinical Implications: Nurses and pediatric practitioners can use findings from this study to plan continued exploration into the perceptions and care management needs of families following diagnosis of a very young child with T1DM. The domains of care used to assess mothers' perceptions about care management-based on tenets of the Chronic Care Model (CCM) and Patient Centered Medical Home (PCMH)-can be used by pediatric PCPs and endocrinologists to dialogue with patients and staff about how care management may be improved for these families. Providing opportunities for feedback to the families of young children with T1DM should be encouraged so future research can examine relationships between care management variables and clinical outcomes.