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For this process SAP has developed an invoice named WIA It is relevant for cross-EU border invoicing only with plants abroad It is called via the billing indicator J on the item category calling up this WIA invoice This will only be necessary for goods movements across borders where there is no invoice to show values It would be relevant for KAN and KBN item categories

Therapy in elders should be guided by the estimated life expectancy and the patients values and goals (Figure 4 1) Interventions that are likely to help elders who are well may differ from those that will benefit elders who are frail Estimating life expectancy can help a health care provider focus on those issues most likely to be beneficial in a given patient A mammogram would be appropriate for a healthy older woman with a life expectancy of 12 years, but not for a woman with congestive heart failure and chronic obstructive pulmonary disease with a life expectancy of less than 5 years Detecting and treating some conditions produce almost immediate benefit, and those may be useful at any age These include visual impairment, hearing loss, falls, depression, incontinence, immobility, and pain Smoking cessation and initiating an exercise program can also produce very rapid benefits, even in the oldest old An awareness of a patient s goals, values, and preferences can help the health care provider focus the patient s visits appropriately For example, many evaluations and interventions can be avoided in an elderly patient who is interested in receiving symptomatic, but not life prolonging, care Certain strategies can make the care of older people in a busy outpatient practice a little more manageable Such strategies include using brief assessment instruments for common geriatric conditions when appropriate, training non-provider personnel in administering some of these assessments (hearing screen, vision screen), having portable amplifiers ( pocket talkers ) available, and designing protocols for following up abnormal screening assessments For example, a medical assistant might perform the simple geriatric screen (Figure 4 2) on all patients older than 75 years, and prompt the provider by having follow up instruments such as the Mini-Mental State Examination (MMSE) and the geriatric depression scale available when the screen was positive.

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About one-fourth of patients over 65 have impairments in their IADLs (instrumental activities of daily living: transportation, shopping, cooking, using the telephone, managing money, taking medications, housecleaning, laundry) or ADLs (basic activities of daily living: bathing, dressing, eating, transferring from bed to chair, continence, toileting) Half of those persons older than 85 years have these latter impairments Persons who are unable to perform IADLs independently are far more likely to have dementia than their independent counterparts A functional assessment is essential in older adults and will assist providers in detecting declines (or improvements) from baseline, determining what support services and equipment might be appropriate for patients and their caregivers, making appropriate placement decisions, and estimating prognosis In general, persons who need help only with IADLs can usually live independently with minimal supports, such as financial services (eg, a representative payee) or a chore worker If institutional care is needed, residential care, board-and-care, or assisted living is usually sufficient While many persons who need help with ADLs may require a nursing home level of care, most live at home with caregivers and other community services (eg, day care)

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