American Association for Geriatric Psychiatry

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Positioning Medical Students for the Geriatric Imperative: Using Geriatrics to Effectively Teach Medicine

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Nguyen, Annie L.; Duthie, Elizabeth A.; Denson, Kathryn M.; Franco, Jose; Duthie, Edmund H.

2013-01-01

Medical schools must consider innovative ways to ensure that graduates are prepared to care for the aging population. One way is to offer a geriatrics clerkship as an option for the fulfillment of a medical school's internal medicine rotation requirement. The authors' purpose was to evaluate the geriatrics clerkship's impact on internal medicine…

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students’ perceptions of geriatrics and geriatric education in the United States

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Jennifer C. Reneker

2016-10-01

Full Text Available This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT students, 21–33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen’s d-values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15–0.30. Two perceptions of geriatric physical therapy demonstrated a significant positive increase (P<0.05 with moderate effect sizes (d=0.47 and d=0.50. The students’ perceptions of geriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68 and enjoyment (d=1.96. Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.

[Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (ÖGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013].

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Singler, K; Stuck, A E; Masud, T; Goeldlin, A; Roller, R E

2014-11-01

Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies.In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue.

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students' perceptions of geriatrics and geriatric education in the United States.

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Reneker, Jennifer C; Weems, Kyra; Scaia, Vincent

2016-01-01

This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21-33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen's d values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15-0.30). Two perceptions of geriatric physical therapy demonstrated a significant positive increase (Pgeriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68) and enjoyment (d=1.96). Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.

The portal of geriatrics online education: a 21st-century resource for teaching geriatrics.

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Ramaswamy, Ravishankar; Leipzig, Rosanne M; Howe, Carol L; Sauvigne, Karen; Usiak, Craig; Soriano, Rainier P

2015-02-01

The way students are taught and evaluated is changing, with greater emphasis on flexible, individualized, learner-centered education, including the use of technology. The goal of assessment is also shifting from what students know to how they perform in practice settings. Developing educational materials for teaching in these ways is time-consuming and can be expensive. The Portal of Geriatrics Online Education (POGOe) was developed to aid educators in meeting these needs and become quicker, better-prepared teachers of geriatrics. POGOe contains more than 950 geriatrics educational materials that faculty at 45% of allopathic and 7% of osteopathic U.S. medical schools and the Centers for Geriatric Nursing Excellence have created. These materials include various instructional and assessment methodologies, including virtual and standardized patients, games, tutorials, case-based teaching, self-directed learning, and traditional lectures. Materials with common goals and resource types are available as selected educational series. Learner assessments comprise approximately 10% of the educational materials. POGOe also includes libraries of videos, images, and questions extracted from its educational materials to encourage educators to repurpose content components to create new resources and to align their teaching better with their learners' needs. Web-Geriatric Education Modules, a peer-reviewed online modular curriculum for medical students, is a prime example of this repurposing. The existence of a robust compendium of instructional and assessment materials allows educators to concentrate more on improving learner performance in practice and not simply on knowledge acquisition. It also makes it easier for nongeriatricians to teach the care of older adults in their respective disciplines. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Geriatric fall-related injuries.

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Hefny, Ashraf F; Abbas, Alaa K; Abu-Zidan, Fikri M

2016-06-01

Falls are the leading cause of geriatric injury. We aimed to study the anatomical distribution, severity, and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. All injured patients with an age ≥ 60 years who were admitted to Al-Ain Hospital or died in the Emergency Department due to falls were prospectively studied over a four year period. We studied 92 patients. Fifty six of them (60.9%) were females. The mean (standard deviation) of age was 72.2 (9.6) years. Seventy three (89%) of all incidents occurred at home. Eighty three patients (90.2%) fell on the same level. The median (range) ISS was 4 (1-16) and the median GCS (range) was 15 (12-15). The lower limb was the most common injured body region (63%). There were no statistical significant differences between males and females regarding age, ISS, and hospital stay (p = 0.85, p = 0.57, and p = 0.35 respectively). The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk factors for falls including home hazards is essential for prevention of geriatric fall-related injuries.

International Society of Geriatric Oncology Consensus on Geriatric Assessment in Older Patients With Cancer

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Wildiers, Hans; Heeren, Pieter; Puts, Martine; Topinkova, Eva; Janssen-Heijnen, Maryska L.G.; Extermann, Martine; Falandry, Claire; Artz, Andrew; Brain, Etienne; Colloca, Giuseppe; Flamaing, Johan; Karnakis, Theodora; Kenis, Cindy; Audisio, Riccardo A.; Mohile, Supriya; Repetto, Lazzaro; Van Leeuwen, Barbara; Milisen, Koen; Hurria, Arti

2014-01-01

Purpose To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. Methods SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. Results GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. Conclusion There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base. PMID:25071125

Psychosocial Issues in Geriatric Rehabilitation.

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Rodriguez, Ricardo M

2017-11-01

Geriatric patients present multiple age-related challenges and needs that must be taken into account during the rehabilitation process to achieve expected goals. This article examines the importance of identifying and managing psychosocial issues commonly observed in older adults and presents strategies to optimize their rehabilitation process. Depression, anxiety, fear of falling, adjustment issues, neurocognitive disorders, and caregiver support are discussed as a selection of factors that are relevant for geriatric patients undergoing rehabilitation. An argument is made for the importance of comprehensive geriatric assessment in older adults to identify salient issues that may impact rehabilitation and quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

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Adelman, Ronald D.; Ansell, Pamela; Breckman, Risa; Snow, Caitlin E.; Ehrlich, Amy R.; Greene, Michele G.; Greenberg, Debra F.; Raik, Barrie L.; Raymond, Joshua J.; Clabby, John F.; Fields, Suzanne D.; Breznay, Jennifer B.

2011-01-01

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area…

PALLIATIVE CARE IN GERIATRICS: CURRENT ISSUES AND PROSPECTS

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I. P. Рonomareva

2016-01-01

Full Text Available The purpose of the study is to identify the main problems and prospects of development of palliative care in geriatrics at the present stage. Method of research was to analyze the printed and electronic databases that meet the stated issues. The results of the study highlight the problems of the development of palliative care in geriatric practice: the lack of a developed procedure of rendering palliative care and adequate elderly patient selection criteria, the lack of trained professional staff. The main prospects-association of palliative practices and concepts of modern geriatrics required specialized geriatric assessment and the provision of clinical, medical, social and socio-psychological geriatric syndromes. While promising option for the development of palliative care geriatrics is the integration into the existing health care system, acceptance of the fact that it is a part of the specialized geriatric care. This requires the involvement and training of not only specialists with medical education, but also persons without medical training from among social workers and volunteers working in palliative care. Therefore, the obtained data allowed to conclude that topical is the development of palliative care in geriatrics, taking into account not only clinical but medico-social, socio-psychological features.

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students’ perceptions of geriatrics and geriatric education in the United States

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Jennifer C. Reneker; Kyra Weems; Vincent Scaia

2016-01-01

This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21–33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at th...

Prevalence and determinants for malnutrition in geriatric outpatients

NARCIS (Netherlands)

van Bokhorst-de van der Schueren, M.A.E.; Lonterman-Monasch, S.; de Vries, O.J.; Danner, S.A.; Kramer, M.H.H.; Muller, M.

2013-01-01

Background & aims: Few data is available on the nutritional status of geriatric outpatients. The aim of this study is to describe the nutritional status and its clinical correlates of independently living geriatric older individuals visiting a geriatric outpatient department. Methods: From 2005 to

Health policy 2016: implications for geriatric urology.

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Suskind, Anne M; Clemens, J Quentin

2016-03-01

The US healthcare system is undergoing fundamental changes in an effort to improve access to care, curtail healthcare spending, and improve quality of care. These efforts largely focused on Medicare, and therefore, will have a fundamental impact on the care of geriatric patients. This article reviews contemporary health policy issues, with a focus on how these issues may impact the care of geriatric urology patients. The Affordable Care Act has broadened the scope of Medicare coverage. Future Medicare reimbursement will be increasingly tied to care coordination, quality reporting, and demonstration of appropriate outcomes. Additional research is needed to better define the comparative effectiveness of urologic therapies in geriatric patients. Workforce projections indicate that there is a shortage of urologists in many areas of the country, and that this shortage will worsen over time unless a new funding model is instituted for graduate medical education. Medicare spending drives many health policy decisions. Therefore, few health policy topics are unique to geriatrics or geriatric urology. However, certain health policy topics (e.g., care coordination and risk-stratification) are particularly germaine to the elderly patients. Urologists with a particular interest in geriatric urology should be familiar with these issues.

Evaluation of geriatric changes in dogs

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Soumyaranjan Pati

2015-03-01

Full Text Available Aim: The present study has been envisaged to ascertain the old age for critical management of geriatric dogs considering the parameters of externally visible changes, haemato-biochemical alterations and urine analysis in geriatric dogs approaching senility. Materials and Methods: The study was undertaken in the Department of Veterinary Pathology in collaboration with Teaching Veterinary Clinic complex spanning a period of 1 year. For screening of geriatric dogs, standard geriatric age chart of different breeds was followed. The external characteristics such as hair coat texture, dental wear and tear, skin texture and glaucoma were taken as a marker of old age. Haematology, serum biochemistry and urine analysis were also included in the study. Results: External visible changes like greying of hair, dull appearance of hair coat, glaucoma, osteoarthritis, dental wear and tear were commonly encountered in the aged dogs. The haemoglobin, total erythrocyte count and packed cell volume showed a decreasing trend in the geriatric groups. Biochemical values like total protein, albumin, calcium level showed a decreasing trend while urea level with an increasing trend in geriatric dogs without any much alteration in serum glutamicoxaloacetic transaminse, serum glutamic-pyruvate transaminase, cholesterol and creatinine. Physical examination of urine revealed yellow, amber, red, deep red color with turbidity and higher specific gravity. Chemical examination revealed presence of protein, glucose, ketone bodies, blood and bilirubin on some cases. The culture and sensitivity test of the urine samples revealed presence of bacteria with sensitive and resistance to some antibiotics. Conclusion: External visible changes are still the golden standard of determining the old age in dogs. Haemato-biochemical evaluation can be useful for correlating with the pathophysiological status of the animal. Biochemical analysis of urine can be employed rightly as kidney

MANAJEMENT OF INSOMNIA IN GERIATRIC PATIENTS

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Cokorda Istri Devi Larayanthi

2013-04-01

Full Text Available Sleep is an unconscious condition that is relatively more responsive to internal stimuli. Insomnia is a sleep disorder with characteristic difficulty of initiating sleep or difficulty in maintaining sleep. Insomnia is divided into 2 primary insomnia and secondary insomnia. Conection with age, the function of organs in the body decreases. So that geriatric patients are susceptible to illnesses, especially insomnia. Many of the causes of insomnia in geriatric mental disorders, psychiatric, general medical conditions, medications, certain substances, and others. Management of insomnia in geriatric patients were divided into 3 method: 1 manage underlying cause, 2 nonpharmacological therapies such as cognitive behavior therapy (CBT, and 3 pharmacological therapies such as benzodiazepine and non-benzodiazepine that eszopiclone and Ramelteon. Pharmacological treatment in geriatrics should follow the rule "start low, go slow", starting dose of ½ of the adult dose, and its use in the short term.

Analysis and Management of Geriatric Anxiety.

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Sallis, James F.; Lichstein, Kenneth L.

1982-01-01

Reviews the prevalence, negative health implications, and clinical management of geriatric anxiety. Proposes an interactive model of geriatric anxiety whereby physical disease and anxiety processes enter into reciprocal stimulation as a function of diminished capacity to withstand stress and hypervigilance of stress symptomatology. Outlines…

Teaching geriatric fellows how to teach: a needs assessment targeting geriatrics fellowship program directors.

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Rivera, Veronica; Yukawa, Michi; Aronson, Louise; Widera, Eric

2014-12-01

The entire healthcare workforce needs to be educated to better care for older adults. The purpose of this study was to determine whether fellows are being trained to teach, to assess the attitudes of fellowship directors toward training fellows to be teachers, and to understand how to facilitate this type of training for fellows. A nine-question survey adapted from a 2001 survey issued to residency program directors inquiring about residents-as-teachers curricula was developed and administered. The survey was issued electronically and sent out three times over a 6-week period. Of 144 ACGME-accredited geriatric fellowship directors from geriatric, internal medicine, and family medicine departments who were e-mailed the survey, 101 (70%) responded; 75% had an academic affiliation, 15% had a community affiliation, and 10% did not report. Academic and community programs required their fellows to teach, but just 55% of academic and 29% of community programs offered teaching skills instruction as part of their fellowship curriculum; 67% of academic programs and 79% of community programs felt that their fellows would benefit from more teaching skill instruction. Program directors listed fellow (39%) and faculty (46%) time constraints as obstacles to creation and implementation of a teaching curriculum. The majority of fellowship directors believe that it is important for geriatric fellows to become competent educators, but only approximately half of programs currently provide formal instruction in teaching skills. A reproducible, accessible curriculum on teaching to teach that includes a rigorous evaluation component should be created for geriatrics fellowship programs. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

WATER AND SALT METABOLISM IN THE GERIATRIC SYNDROMES

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Carlos G. Musso

2010-01-01

Full Text Available Geriatrics has already described four syndromes of its own: confusional syndrome, incontinence (fecal and/or urinary, and gait disorders and immobility syndrome, naming them geriatric giants. This name reflects their prevalence and great importance in the elderly. Ageing process induces many changes in renal physiology such as a reduction in glomerular filtration rate (senile hyponatremia, and water and sodium reabsorbtion capability. Besides, there are particular water and salt metabolism alteration characteristics of the geriatric syndromes, such as dehydration and hypernatremia in psychiatric disturbances as well as hyponatremia in patients suffering from immobility syndrome. The geriatric giants and nephrogeriatric physiology changes, are a good example of feed-back between geriatric syndromes, clinical entities characteristics in the elderly that predispose and potentiate each other, leading to catastrophic clinical events.

Effects of inpatient geriatric interventions in a German geriatric hospital: Impact on ADL, mobility and cognitive status.

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Bordne, S; Schulz, R-J; Zank, S

2015-06-01

Given the demographic changes, the need for effective geriatric intervention is obvious. Geriatric care aims to maintain the highest possible level of independence and quality of life and to reduce the risk of need for care. This study investigated the benefits of geriatric care on functional performance, mobility and cognition. This study involved a retrospective analysis of clinical data from 646 patients. At hospital admission and discharge functional status was assessed using the Barthel index. Mobility was evaluated by means of the Tinetti test and cognition by the mini-mental state examination (MMSE). A follow-up was conducted on 112 patients 2-5 months after hospital discharge. Statistical analysis included t-tests including Cohen's d for effect size and multivariate regression analysis. The mean age of the study population was 81.1 ± 7.1 years including 439 women (68%) and 207 men (32%). There were significant average improvements for activities of daily living (ADL), mobility and cognition comparing discharge and admission scores. For functional and mobility status, effect sizes were medium to high. Regression analyses showed that ADL improvement was predicted by functional, mobile and cognitive status at admission. Follow-up analyses revealed a high percentage of former patients still living at home and an overall maintenance of ADL levels. Geriatric patients seem to experience long-term improvements during geriatric treatment, which appears to fulfill its aim of recovering independence. For a better understanding of relevant factors for the recreation of geriatric patients, further research is needed, e.g. with respect to the impact of the nutritional status.

The Magnitude of Atherogenic Dyslipidaemia among Geriatric ...

African Journals Online (AJOL)

The Magnitude of Atherogenic Dyslipidaemia among Geriatric Nigerians with ... June 2011 on 122 consecutive geriatric patients with systemic hypertension ... of dyslipidaemia and a marker of dyslipidaemic cardiometabolic risk among them.

[Endoprostheses in geriatric traumatology].

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Buecking, B; Eschbach, D; Bliemel, C; Knobe, M; Aigner, R; Ruchholtz, S

2017-01-01

Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.

Geriatric and Student Perceptions following Student-led Educational Sessions

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Kristin Janzen

2018-01-01

Full Text Available Objective: The objective of this study was to measure the effect of student-led educational events on geriatric patient and student participant perceptions in a community setting. Methods: Students led three events at a senior community center, focusing on learning and memory, sleep hygiene, and arthritis pain. The participants were geriatric patients who themselves were providers of support to homebound peers (“clients” through an independently organized program. Geriatric participants completed pre- and post-event surveys to measure changes in familiarity with the topics. Student participants also completed pre- and post-event surveys that tracked changes in their comfort in working with the geriatric population. Results: Each event demonstrated at least one positive finding for geriatric patients and/or their clients. Students reported increased comfort in working with and teaching the geriatric population following the first and third events, but not the second. Conclusion: Student-led educational sessions can improve perceived health-related knowledge of geriatric participants while simultaneously exposing students to the geriatric patient population. Overall, both students and geriatric participants benefited from these events. Practice Implications: Incorporation of single, student-led educational events could be mutually beneficial to students and the elderly population in the community and easily incorporated into any healthcare curriculum. Funding:This work was supported by a Butler University Innovation Fund Grant. Treatment of Human Subjects: IRB review/approval required and obtained   Type: Original Research

Enhancing Geriatric Curriculum in Nursing School

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Collins, Kevin

2013-01-01

People are living longer. The average age of the population is increasing, and is expected to keep growing. Any person age 65 and older is now considered "geriatric." However, although growing, this population is not receiving adequate nursing care, and results in increased pain, falls, and even death. Geriatric curriculum is becoming…

The geriatric polytrauma: Risk profile and prognostic factors.

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Rupprecht, Holger; Heppner, Hans Jürgen; Wohlfart, Kristina; Türkoglu, Alp

2017-03-01

In the German population, the percentage of elderly patients is increasing, and consequently there are more elderly patients among trauma cases, and particularly cases of polytrauma. The aim of this study was to present clinical results and a risk profile for geriatric polytrauma patients. Review of 140 geriatric (over 65 years of age) polytrauma patients who received prehospital treatment was performed. Severity of trauma was retrospectively assessed with Hannover Polytrauma Score (HPTS). Age, hemoglobin (Hb) level, systolic blood pressure (BP), Glasgow Coma Scale (GCS) score, timing of and necessity for intubation were analyzed in relation to mortality and in comparison with younger patients. Geriatric polytrauma patients (n=140) had overall mortality rate of 65%, whereas younger patients (n=1468) had mortality rate of 15.9%. Despite equivalent severity of injury (HPTS less age points) in geriatric and non-geriatric groups, mortality rate was 4 times higher in geriatric group. Major blood loss with Hb polytrauma patients. Additional risk factors include very low GCS score and systolic BP <80 mm Hg, for instance, as potential clinical indicators of massive bleeding and traumatic brain injury. Such parameters demand early and rapid treatment at prehospital stage and on admission.

Do we need community geriatrics?

LENUS (Irish Health Repository)

O'Hanlon, S

2012-01-30

Community geriatrics has evolved as a specific aspect of geriatric medicine in the UK. In Ireland there is uncertainty as to how it should be planned. This is the first national survey of consultants, specialist registrars and general practitioners to seek their opinions. Most consultants and GPs reported already having a community aspect to their current practice, e.g. nursing home visits or community hospital visits, whereas most SpRs did not. Forty three of 62 respondents (69%) agreed that there is a need for community geriatricians and that there should be integration with hospital medicine. Fifty seven of 62 respondents (92%) felt that there would be a beneficial effect on GP services, though some expressed concern about work overlap. Thirteen of the 25 SpRs (52%) in training hoped to begin practice in community geriatrics in the future.

Biological therapy in geriatric patients

International Nuclear Information System (INIS)

Mego, M.

2012-01-01

Targeted biological therapy, alone or in combination with conventional chemotherapy, make significant progress in the treatment of patients with malignancy. Its use as opposed to high-dose chemotherapy is not limited by age, nevertheless, we have relatively little knowledge of the toxicity and effectiveness in geriatric patients. Aim of this article is to give an overview of the biological effectiveness and toxicity of anticancer therapy in geriatric patients, based on published data. (author)

Hierachy of needs of geriatric patients.

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Majercsik, E

2005-01-01

The aim of the study is to contribute to the improvement of the quality of care of geriatric patients. In order to be able to improve the geriatric care we have to know clearly the needs of the elderly patients. The hierarchy of needs of geriatric patients in clinical circumstances had to be assessed by a psychometric technique based on a motivational approach. The process was based on the method of paired comparisons, and a duly composed questionnaire was administered to the geriatric patients who were proven to have consistent thinking and surpassed a pre-established threshold in the Mini Mental State Examination. The evaluation of the responds leads to a numerical derivation (on an interval scale) of the hierarchy of needs. The received hierarchy of needs proved to oppose the general hypothesis of Maslow's motivation theory. This may induce a necessary shift in the approach to the care of the elderly, and accentuate the self-actualization and esteem needs beside the overtly emphasized physiological care. Copyright (c) 2005 S. Karger AG, Basel

Malignancies of gastrointestinal tract in geriatric patients

International Nuclear Information System (INIS)

Bystricky, B.

2017-01-01

Incidence of gastrointestinal cancer rises with age. In spite of this fact, older patients are underrepresented in clinical trials. We need to take into account several variables prior to selection of therapy in these patients. These are physiologic aging processes, comorbidities, functional and cognitive status. There are several assessment tools in geriatric population – the most used is comprehensive geriatric assessment (CGA). A close cooperation with geriatrician is useful before starting cancer treatment. This article reviews treatment algorithms in selected malignancies of GI tract in geriatric patients. (author)

Health Policy 2016 – Implications for Geriatric Urology

Science.gov (United States)

Suskind, Anne M.; Clemens, J. Quentin

2016-01-01

Purpose of Review The U.S. healthcare system is undergoing fundamental changes in an effort to improve access to care, curtail healthcare spending, and improve quality of care. These efforts largely focused on Medicare, and therefore will have a fundamental impact on the care of geriatric patients. This article reviews contemporary health policy issues, with a focus on how these issues may impact the care of geriatric urology patients. Recent Findings The Affordable Care Act (ACA) has broadened the scope of Medicare coverage. Future Medicare reimbursement will be increasingly tied to care coordination, quality reporting, and demonstration of appropriate outcomes. Additional research is needed to better define the comparative effectiveness of urologic therapies in geriatric patients. Workforce projections indicate that there is a shortage of urologists in many areas of the country, and that this shortage will worsen over time unless a new funding model is instituted for graduate medical education. Summary Medicare spending drives many health policy decisions. Therefore, few health policy topics are unique to geriatrics or geriatric urology. However, certain health policy topics (e.g., care coordination, risk-stratification) are particularly germaine to the elderly patients. Urologists with a particular interest in geriatric urology should be familiar with these issues. PMID:26765043

American Geriatrics Society

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... Learn More Social Media Facebook Twitter LinkedIn Instagram Social Media Bar Right Menu Annual Meeting Donate to our Foundation Contact Us American Geriatrics Society 40 Fulton St., 18th Floor New York, NY ...

Comprehensive geriatric assessment

African Journals Online (AJOL)

2007-09-14

Sep 14, 2007 ... i.e. difficulty performing simple physical and mental tasks necessary for daily life. ... Definition. Comprehensive geriatric assessment (CGA) is a multidimensional .... The formation of a programme of therapy is decided on.

Academic detailing to teach aging and geriatrics.

Science.gov (United States)

Duckett, Ashley; Cuoco, Theresa; Pride, Pamela; Wiley, Kathy; Iverson, Patty J; Marsden, Justin; Moran, William; Caton, Cathryn

2015-01-01

Geriatric education is a required component of internal medicine training. Work hour rules and hectic schedules have challenged residency training programs to develop and utilize innovative teaching methods. In this study, the authors examined the use of academic detailing as a teaching intervention in their residents' clinic and on the general medicine inpatient wards to improve clinical knowledge and skills in geriatric care. The authors found that this teaching method enables efficient, directed education without disrupting patient care. We were able to show improvements in medical knowledge as well as self-efficacy across multiple geriatric topics.

Nutritional status assessment in geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology Nutrition Work Group.

Science.gov (United States)

Camina-Martín, M Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, J Antonio; Redondo-del-Río, M Paz

2015-07-01

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, because elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología, SEGG) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories seeks to aid in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment associated to laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is to further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. Copyright © 2015 Elsevier Ireland Ltd. All rights

[Nutritional status assessment in Geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology NutritionWork Group].

Science.gov (United States)

Camina-Martín, María Alicia; de Mateo-Silleras, Beatriz; Malafarina, Vincenzo; Lopez-Mongil, Rosa; Niño-Martín, Virtudes; López-Trigo, José Antonio; Redondo-Del-Río, María Paz

2016-01-01

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics. Copyright © 2015 SEGG. Published by Elsevier

An Overview of Otorhinolaryngeal Problems in Geriatrics

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Girija Shankar Mohanta

2018-06-01

Full Text Available Summary: Background: The increase of geriatric population, as well as their age-related problems, is of great concern for the society and for the governments all over the world and also in India. The main objectives were to overview and find the prevalence of Oto-rhino-laryngological problems in the geriatric population. Method: A prospective study of geriatric patients was undertaken in ENT & HNS Department, S.C.B Medical College & Hospital, Cuttack, India, from November 2014 to August 2016.Inclusion criteria –The patients of age 60 yrs & above who attended ENT outpatient department were studied. Among 3563 patients studied, 363 patients were admitted. The patients were segregated according to sex (male/female, ages (60–64 yr group, 65–69 yr group, 70 yr & above, disease ratio, and prevalence of diseases, associated co-morbidities, and socio-economic aspects. Results: Total patients studied were 3563. The otological problems were being prevalent in geriatrics among study population (51.77% in which presbycusis was the highest with 17.71% of total and 34.21% of otological problems. The problems related to nose were 13.03%, among which epistaxis was 4.98% of total and 37.60% of nasal problems. The neck and throat problems were 35.20%. The problems were more in males (63.65% than in females (36.35%. Conclusion: The hearing loss is the most prevalent diagnosis amongst all otologic problems and epistaxis amongst nasal symptoms. The emergence of head & neck cancers among the geriatric population is a great concern in a developing country like India. Keywords: Oto-rhino-laryngological problems, geriatric populations

The oncologic and the geriatric patient

International Nuclear Information System (INIS)

Philotheou, Geraldine M

2002-01-01

The oncologic and the geriatric patient have special needs in the nuclear medicine department. The nuclear medicine technologists must be knowledgeable and compassionate when dealing with these patients. The diagnosis of cancer will have a sociological and psychological impact on the patient, to which the technologist must relate in an empathetic way. Furthermore, the technologist should take cognisance of the patient's physical condition and be able to modify the examination accordingly. Dealing with the geriatric patient should be correctly placed on the continuum between a gerontological and geriatric approach taking into consideration normal changes due to aging. The patient experience when undergoing the high technology nuclear medicine diagnostic procedure is unique and all effort must be made to ensure the success of the examination and the satisfaction of the patient (Au)

Predoctoral Teaching of Geriatric Dentistry in U.S. Dental Schools.

Science.gov (United States)

Ettinger, Ronald L; Goettsche, Zachary S; Qian, Fang

2017-08-01

The aim of this study was to assess the current teaching of geriatric dentistry in U.S. dental schools and compare the findings to previous reports. Academic deans at all 67 U.S. dental schools were contacted in November 2015 via email, asking them to complete a questionnaire about the teaching of geriatric dentistry or gerodontology at their institution. Questionnaires were received from 56 of the 67 schools (84% response rate). The results showed that geriatric dentistry was taught in all responding schools; for 92.8% of the respondents, the instruction was compulsory. Among the responding schools, 62.5% were teaching it as an independent course, 25% as an organized series of lectures, and 8.9% as occasional lectures in parts of other courses. In addition, 57.1% had some form of compulsory clinical education in geriatric dentistry. Public schools, as opposed to private schools, were marginally associated with an increased interest in expanding geriatric dentistry teaching (p=0.078). No differences were found between any teaching variables and school location. This study found that the form of education in geriatric dentistry in U.S. dental schools differed in many ways, but the teaching of geriatric dentistry had increased among all respondents and had been increasing for over 30 years. Future research is needed to determine the impact of this teaching on services to the geriatric community.

Approach to the pressure sores in geriatric patients

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Emre İnözü

2012-09-01

Full Text Available Objectives: The aim of this study was to evaluate the follow-up results of nutritionally supported geriatric patientswho were admitted for their pressure sores then plannedtheir treatment.Materials and methods: In this study, we analyzed thehospitalized geriatric pressure sore patients in our clinicwho were admitted between 2006 and 2011. We calculatedBody Mass Index and the blood albumin levels of allhospitalized geriatric patients. In this patient group proteinenergy malnutrition and deficiency were analyzed andproper nutrition support was provided accordingly. Afterrecovering from malnutrition further treatment surpassed.Results: The mean albumin levels of the hospitalized patientswas 2,53 ± 0,25 g/dL after nutritional support thoselevels increased to mean 3,95 ± 0,42 g/dL . Of all thosepatients 75% were operated when their general conditionallowed us for a surgery. Due to their high risk wedid not perform any surgical operation to the remaining25%.. Post operative mean hospitalization period was 12(8-21 days. Majority of the patients (78.6% were treatedsuccessfully either with surgical or conservative treatmentmodalities.Conclusions: The success of the geriatric pressure soretreatment is highly related with the proper nutritional supportfor the ongoing malnutrition-like pathologies. Beforeoperation nutritional support not only makes a healthygranulation tissue but also yields fast and reliable woundhealing. Despite their chronic health problems many ofour geriatric patients were treated surgically for their pressuresores.Key words: Pressure sore, geriatric medicine, malnutrition,nutritional support

Graduate and Undergraduate Geriatric Dentistry Education in a Selected Dental School in Japan

Science.gov (United States)

Kitagawa, Noboru; Sato, Yuji; Komabayashi, Takashi

2010-01-01

Geriatric dentistry and its instruction are critical in a rapidly aging population. Japan is the world’s fastest-aging society, and thus geriatric dentistry education in Japan can serve as a global model for other countries that will soon encounter the issues that Japan has already confronted. This study aimed to evaluate geriatric dental education with respect to the overall dental education system, undergraduate geriatric dentistry curricula, mandatory internships, and graduate geriatric education of a selected dental school in Japan. Bibliographic data and local information were collected. Descriptive and statistical analyses (Fisher and Chi-square test) were conducted. Japanese dental schools teach geriatric dentistry in 10 geriatric dentistry departments as well as in prosthodontic departments. There was no significant differences found between the number of public and private dental schools with geriatric dentistry departments (p = 0.615). At Showa University School of Dentistry, there are more didactic hours than practical training hours; however, there is no significant didactic/practical hour distribution difference between the overall dental curriculum and fourth-year dental students’ geriatric dental education curriculum (p=0.077). Graduate geriatric education is unique because it is a four-year Ph.D. course of study; there is neither a Master’s degree program nor a certificate program in Geriatric Dentistry. Overall, both undergraduate and graduate geriatric dentistry curricula are multidisciplinary. This study contributes to a better understanding of geriatric dental education in Japan; the implications of this study include developing a clinical/didactic curriculum, designing new national/international dental public health policies, and calibrating the competency of dentists in geriatric dentistry. PMID:21985207

Fried frailty phenotype assessment components as applied to geriatric inpatients

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Bieniek J

2016-04-01

Full Text Available Joanna Bieniek, Krzysztof Wilczynski, Jan Szewieczek Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Background: Management of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in elderly patients presenting with relatively good health status. Objective: The aim of this article was to assess the usefulness and limitations of Fried frailty phenotype criteria in geriatric inpatients, characterized by comorbidity and functional impairments, and to estimate the frailty phenotype prevalence in this group. Patients and methods: Five hundred consecutive patients of the university hospital subacute geriatric ward, aged 79.0±8.4 years (67% women and 33% men, participated in this cross-sectional study. Comprehensive geriatric assessment and Fried frailty phenotype component evaluation were performed in all patients. Results: Multimorbidity (6.0±2.8 diseases characterized our study group, with a wide range of clinical conditions and functional states (Barthel Index of Activities of Daily Living 72.2±28.2 and Mini-Mental State Examination 23.6±7.1 scores. All five Fried frailty components were assessed in 65% of patients (95% confidence interval [CI] =60.8–69.2 (diagnostic group. One or more components were not feasible to be assessed in 35% of the remaining patients (nondiagnostic group because of lack of past patient’s body mass control and/or cognitive or physical impairment. Patients from the nondiagnostic group, as compared to patients from the diagnostic group, presented with more advanced age, higher prevalence of dementia, lower prevalence of hypertension, lower systolic and diastolic blood pressure, body mass index, Mini

[Challenges of implementing a geriatric trauma network : A regional structure].

Science.gov (United States)

Schoeneberg, Carsten; Hussmann, Bjoern; Wesemann, Thomas; Pientka, Ludger; Vollmar, Marie-Christin; Bienek, Christine; Steinmann, Markus; Buecking, Benjamin; Lendemans, Sven

2018-04-01

At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers. As a conglomerate hospital at two locations, we are cooperating with two external geriatric clinics. In 2015, a geriatric trauma center certification in the form of a conglomerate network structure was agreed upon for the first time in Germany. For this purpose, the requirements for certification were observed. Both structure and organization were defined in a manual according to DIN EN ISO 9001:2015. Between 2008 and 2016, an increase of 70% was seen in geriatric trauma cases in our hospital, with a rise of up to 360% in specific diagnoses. The necessary standards and regulations were compiled and evaluated from our hospitals. After successful certification, improvements were necessary, followed by a planned re-audit. These were prepared by multiprofessional interdisciplinary teams and implemented at all locations. A network structure can be an alternative to classical cooperation between trauma and geriatric units in one clinic and help reduce possible staffing shortage. Due to the lack of scientific evidence, future evaluations of the geriatric trauma register should reveal whether network structures in geriatric trauma surgery lead to a valid improvement in medical care.

Geriatric fall-related injuries | Hefny | African Health Sciences

African Journals Online (AJOL)

Background: Falls are the leading cause of geriatric injury. ... and outcome of geriatric fall-related injuries in order to give recommendations regarding their prevention. Methods: All injured patients with an age ≥ 60 years who were admitted to ...

MANAJEMENT OF INSOMNIA IN GERIATRIC PATIENTS

OpenAIRE

Cokorda Istri Devi Larayanthi

2013-01-01

Sleep is an unconscious condition that is relatively more responsive to internal stimuli. Insomnia is a sleep disorder with characteristic difficulty of initiating sleep or difficulty in maintaining sleep. Insomnia is divided into 2 primary insomnia and secondary insomnia. Conection with age, the function of organs in the body decreases. So that geriatric patients are susceptible to illnesses, especially insomnia. Many of the causes of insomnia in geriatric mental disorders, psychiatric, gene...

Geriatric consultation services-are wards more effective than teams?

Science.gov (United States)

Cameron, Ian D; Kurrle, Susan

2013-02-22

Geriatric consultation teams are one of the models for bringing comprehensive geriatric assessment to vulnerable and frail older people in the acute care hospital setting. While ward-based comprehensive geriatric assessment has been established as effective with reference to improving functional status and other outcomes, the team-based variant remains unproven for outcomes other than mortality in the medium term, as shown in a recent study published in BMC Medicine by Deschodt and colleagues. Further research might establish the effectiveness of the team-based model but, for current clinical practice, the emphasis should be on streaming older people with complex problems needing multidisciplinary assessment and treatment to ward-based models of comprehensive geriatric assessment.

Medical students' recognition and application of geriatrics principles in a new curriculum.

Science.gov (United States)

Nanda, Aman; Farrell, Timothy W; Shield, Renée R; Tomas, Maria; Campbell, Susan E; Wetle, Terrie

2013-03-01

Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Lean business model and implementation of a geriatric fracture center.

Science.gov (United States)

Kates, Stephen L

2014-05-01

Geriatric hip fracture is a common event associated with high costs of care and often with suboptimal outcomes for the patients. Ideally, a new care model to manage geriatric hip fractures would address both quality and safety of patient care as well as the need for reduced costs of care. The geriatric fracture center model of care is one such model reported to improve both outcomes and quality of care. It is a lean business model applied to medicine. This article describes basic lean business concepts applied to geriatric fracture care and information needed to successfully implement a geriatric fracture center. It is written to assist physicians and surgeons in their efforts to implement an improved care model for their patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Factors Influencing Depression among Elderly Patients in Geriatric Hospitals

OpenAIRE

Jee, Young Ju; Lee, Yun Bok

2013-01-01

[Purpose] The purpose of this study was to investigate the prevalence of depression among elderly patients and identify the factors influencing depression in a geriatric hospital in Korea. [Subjects] A self-report questionnaire was administered to the patients in community geriatric hospitals. Participants were 195 elderly patients. [Methods] The instruments utilized in this study were the Geriatric Depression Scale Short Form Korea (GDSSF-K), an activity of daily living scale, a self-esteem ...

Geriatric syndromes in patients with chronic kidney disease

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Tomasz Gołębiowski

2016-06-01

Full Text Available The recent epidemiologic data pointed out, that the general number of patients on hemodialysis is steadily increasing, especially in group of elderly patients over 75 years old. The geriatric syndromes are a multietiological disorder related to physiological aging and partly associated with comorbid conditions. Frailty, falls, functional decline and disability, cognitive impairment and depression are main geriatric syndromes and occurs in patients with impaired renal function more often than among general population. The causes of higher prevalence of those syndromes are not well known, but uremic environment and overall renal replacement therapy may have an important impact on its progress. The patient with geriatric syndrome require comprehensive treatment as well as physical rehabilitation, psychiatric cure and support in everyday activities.Herein below we would like to review recent literature regarding to particular features of main geriatric syndromes in a group of nephrological patients.

Altered Synchronizations among Neural Networks in Geriatric Depression.

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Wang, Lihong; Chou, Ying-Hui; Potter, Guy G; Steffens, David C

2015-01-01

Although major depression has been considered as a manifestation of discoordinated activity between affective and cognitive neural networks, only a few studies have examined the relationships among neural networks directly. Because of the known disconnection theory, geriatric depression could be a useful model in studying the interactions among different networks. In the present study, using independent component analysis to identify intrinsically connected neural networks, we investigated the alterations in synchronizations among neural networks in geriatric depression to better understand the underlying neural mechanisms. Resting-state fMRI data was collected from thirty-two patients with geriatric depression and thirty-two age-matched never-depressed controls. We compared the resting-state activities between the two groups in the default-mode, central executive, attention, salience, and affective networks as well as correlations among these networks. The depression group showed stronger activity than the controls in an affective network, specifically within the orbitofrontal region. However, unlike the never-depressed controls, geriatric depression group lacked synchronized/antisynchronized activity between the affective network and the other networks. Those depressed patients with lower executive function has greater synchronization between the salience network with the executive and affective networks. Our results demonstrate the effectiveness of the between-network analyses in examining neural models for geriatric depression.

76 FR 54536 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-09-01

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

78 FR 55778 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2013-09-11

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting.... App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

77 FR 49865 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2012-08-17

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

A prospective study assessing agreement and reliability of a geriatric evaluation

OpenAIRE

Locatelli, Isabella; Monod, St?fanie; Cornuz, Jacques; B?la, Christophe J.; Senn, Nicolas

2017-01-01

Background The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. Method...

76 FR 17999 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2011-03-31

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 14... pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care facilities...

75 FR 54232 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2010-09-03

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on September... pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care facilities...

77 FR 14860 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2012-03-13

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 11... matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care...

75 FR 11638 - Geriatrics and Gerontology Advisory Committee; Notice of Meeting

Science.gov (United States)

2010-03-11

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee; Notice of Meeting... Committee Act) that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 22... all matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA...

78 FR 6406 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting

Science.gov (United States)

2013-01-30

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting.... App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee will be held on April 10... matters pertaining to geriatrics and gerontology. The Committee assesses the capability of VA health care...

Development of statewide geriatric patients trauma triage criteria.

Science.gov (United States)

Werman, Howard A; Erskine, Timothy; Caterino, Jeffrey; Riebe, Jane F; Valasek, Tricia

2011-06-01

The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims. A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria. The following criteria were identified as geriatric-specific criteria: (1) GCS score trauma; (2) SBP trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center. The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the

[Geriatric rehabilitation care: Doing the right things right].

Science.gov (United States)

de Vos, A J B M; van Balen, R; Gobbens, R J J; Bakker, T J E M

2018-02-01

Geriatric rehabilitation concerns short-term integrated multidisciplinary care aimed at functional recovery and social participation for relatively frail elderly. Given the geriatric clients' complex care issues, nurses should possess sufficient and appropriate competencies in order to identify and assess the relevant symptoms and intervene effectively. Yet, nurses experience a certain apprehensiveness to perform their tasks and express difficulties in multidisciplinary communication and collaboration in a constructive manner. In addition to the client's and informal care giver's perception of their input in the geriatric rehabilitation process, this study provides an in-depth understanding of the way nurses perceive their role in geriatric rehabilitation. This descriptive study entails a quantitative and a qualitative component. The quantitative component concerns questionnaires for clients, informal care givers, nurses, and team leaders. The qualitative component aims to obtain in-depth information (i. e. opinions, meanings, and reflections) with regard to the decision making process and the performance of the rehabilitation care by means of open-ended questions (in the questionnaire) and semi-structured interviews. Clients and informal care givers rate specific themes in geriatric rehabilitation in a more negative light than nurses and team leaders do. These themes concern the provision of information in the hospital (prior to admission in the rehabilitation facility), involvement in the draw-up of the treatment plan and rehabilitation goals, geriatric rehabilitation as a 24/7 activity, and taking into account the client's other life events. The latter three findings in particular, are caused by nurses' apprehensiveness to perform their tasks adequately. Nurses working in geriatric rehabilitation, experience apprehensiveness to perform their tasks adequately. Uncertainty about the client's reaction or fear of damaging the relationship of trust, results

The cost of dysphagia in geriatric patients

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Westmark S

2018-06-01

Full Text Available Signe Westmark,1 Dorte Melgaard,1,2 Line O Rethmeier,3 Lars Holger Ehlers3 1Center for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; 2Department of Physiotherapy and Occupational Therapy, North Denmark Regional Hospital, Hjørring, Denmark; 3Danish Center for Healthcare Improvements, Aalborg University, Aalborg, Denmark Objectives: To estimate the annual cost at the hospital and in the municipality (social care due to dysphagia in geriatric patients.Design: Retrospective cost analysis of geriatric patients with dysphagia versus geriatric patients without dysphagia 1 year before hospitalization.Setting: North Denmark Regional Hospital, Hjørring Municipality, Frederikshavn Municipality, and Brønderslev Municipality.Subjects: A total of 258 hospitalized patients, 60 years or older, acute hospitalized in the geriatric department.Materials and methods: Volume-viscosity swallow test and the Minimal Eating Observation Form-II were conducted for data collection. A Charlson Comorbidity Index score measured comorbidity, and functional status was measured by Barthel-100. To investigate the cost of dysphagia, patient-specific data on health care consumption at the hospital and in the municipality (nursing, home care, and training were collected from medical registers and records 1 year before hospitalization including the hospitalization for screening for dysphagia. Multiple linear regression analyses were conducted to determine the relationship between dysphagia and hospital and municipality costs, respectively, adjusting for age, gender, and comorbidity.Results: Patients with dysphagia were significantly costlier than patients without dysphagia in both hospital (p=0.013 and municipality costs (p=0.028 compared to patients without dysphagia. Adjusted annual hospital costs in patients with dysphagia were 27,347 DKK (3,677 EUR, 4,282 USD higher than patients without dysphagia at the hospital, and annual health care costs in the

Fried frailty phenotype assessment components as applied to geriatric inpatients

OpenAIRE

Bieniek, Joanna; Wilczy?ski, Krzysztof; Szewieczek, Jan

2016-01-01

Joanna Bieniek, Krzysztof Wilczynski, Jan Szewieczek Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Background: Management of geriatric patients would be simplified if a universally accepted definition of frailty for clinical use was defined. Among definitions of frailty, Fried frailty phenotype criteria constitute a common reference frame for many geriatric studies. However, this reference frame has been tested primarily in ...

Geriatric Oncology Program Development and Gero-Oncology Nursing.

Science.gov (United States)

Lynch, Mary Pat; DeDonato, Dana Marcone; Kutney-Lee, Ann

2016-02-01

To provide a critical analysis of current approaches to the care of older adults with cancer, outline priority areas for geriatric oncology program development, and recommend strategies for improvement. Published articles and reports between 1999 and 2015. Providing an interdisciplinary model that incorporates a holistic geriatric assessment will ensure the delivery of patient-centered care that is responsive to the comprehensive needs of older patients. Nursing administrators and leaders have both an opportunity and responsibility to shape the future of geriatric oncology. Preparations include workforce development and the creation of programs that are designed to meet the complex needs of this population. Copyright © 2015 Elsevier Inc. All rights reserved.

Dental Students' Self-Assessed Competence in Geriatric Dentistry.

Science.gov (United States)

Kiyak, H. Asuman; Brudvik, James

1992-01-01

A study of four classes of dental students (n=172) exposed to both didactic and clinical geriatric dental training found that the students perceived significant improvements in their abilities to manage geriatric patients in all areas assessed, notably treatment planning, preventive dentistry, referrals, and providing care in alternative settings.…

Psychological background of prevention and treatment in geriatrics

Directory of Open Access Journals (Sweden)

Nazarov M.l.

2015-03-01

Full Text Available Confidentiality as the component of an interpersonal "patient — medical practitioner" contact formation can be considered as a corner stone of geriatric practice. Major psychological pitfalls of geriatric practice have been reviewed. The main issue of the paper is psychological substantiation of treatment and prevention of elderly.

Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts.

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Mohile, Supriya Gupta; Velarde, Carla; Hurria, Arti; Magnuson, Allison; Lowenstein, Lisa; Pandya, Chintan; O'Donovan, Anita; Gorawara-Bhat, Rita; Dale, William

2015-09-01

Structured care processes that provide a framework for how oncologists can incorporate geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were geriatric oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in geriatric oncology research. The panel met consensus that "all patients aged 75 years or older and those who are younger with age-related health concerns" should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. This Delphi investigation of geriatric oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes. Copyright © 2015 by the National Comprehensive Cancer Network.

Catalogue of learning goals for pregraduate education in geriatric medicine. A recommendation of the German Geriatric Society (DGG), the German Society of Gerontology and Geriatrics (DGGG), the Austrian Society of Geriatrics and Gerontology (OGGG) and the Swiss Society of Geriatric Medicine (SFGG) on the basis of recommendations of the European Union of Medical Specialists Geriatric Medicine Section (UEMS-GMS) 2013

DEFF Research Database (Denmark)

Singler, K.; Stuck, A. E.; Masud, T.

2014-01-01

using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end...... at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties...

Curriculum content in geriatric dentistry in USA dental schools.

Science.gov (United States)

Ettinger, Ronald L; Goettsche, Zachary S; Qian, Fang

2018-03-01

The aim of this study was to re-examine the teaching of geriatric dentistry in the USA dental schools, to identify curriculum content and compare the findings to previous reports. All dental schools in the United States were contacted via email with a questionnaire to assess the teaching of geriatric dentistry. Non-responding schools were sent a minimum of three reminder emails to complete the survey. A statistical analysis was performed. Descriptive statistics were conducted to profile the variables of interest. Bivariate analysis was performed to explore if any of the variables were related using Fisher's exact test, non-parametric Wilcoxon rank-sum test and the Kruskal-Wallis test. Fifty-six of the 67 dental schools completed the questionnaire. Geriatric dentistry was taught in all dental schools; for 92.8%, the course was compulsory. We found that 62.5% were teaching it as an independent course, 25% as an organised series of lectures and 8.9% as occasional lectures in parts of other courses. Clinically, 84.2% have some form of compulsory education in geriatric dentistry. Public schools were marginally associated with an increased interest in expanding the geriatric dentistry curriculum (P = .078). No differences were found between these variables and school location. Geriatric dentistry is now required in 92.8% of dental schools. The teaching of traditional topics has not changed much; however, the number of gerontological topics has increased. Clinical teaching needs to be expanded, as in only 57.1% of schools was it a requirement. The ageing imperative will require research to determine the impact of teaching on services to the geriatric community. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Multiresistant pathogens in geriatric nursing – infection control in residential facilities for geriatric nursing in Germany

Directory of Open Access Journals (Sweden)

Peters, Claudia

2014-09-01

Full Text Available [english] Background: The increase of multidrug-resistant organisms (MDROs causes problems in geriatric nursing homes. Older people are at increased a growing risk of infection due to multimorbidity and frequent stays in hospital. A high proportion of the elderly require residential care in geriatric nursing facilities, where hygiene requirements in nursing homes are similar to those in hospitals. For this reason we examined how well nursing homes are prepared for MDROs and how effectively protect their infection control residents and staff.Methods: A cross-sectional study was performed on infection control in residential geriatric nursing facilities in Germany 2012. The questionnaire recorded important parameters of hygiene, resident and staff protection and actions in case of existing MDROs.Results: The response was 54% in Hamburg and 27% in the rest of Germany. Nursing homes were generally well equipped for dealing with infection control: There were standards for MDROs and regular hygiene training for staff. The facilities provided adequate protective clothing, affected residents are usually isolated and hygienic laundry processing conducted. There are deficits in the communication of information on infected residents with hospitals and general practitioners. 54% of nursing homes performed risk assessments for staff infection precaution.Conclusion: There is a growing interest in MDROs and infection control will be a challenge in for residential geriatric nursing facilities in the future. This issue has also drawn increasing attention. Improvements could be achieved by improving communication between different participants in the health service, together with specific measures for staff protection at work.

[Geriatric intensive care patients : Perspectives and limits of geriatric intensive care medicine].

Science.gov (United States)

Müller-Werdan, U; Heppner, H-J; Michels, G

2018-04-18

Critically ill geriatric patients are vitally endangered due to the aging processes of organs, the frequently existing multimorbidity with subsequent polypharmacy and the typical geriatric syndrome of functional impairments. Aging processes in organs lower the clinical threshold for organ dysfunction and organ failure. Physiological organ aging processes with practical consequences for intensive care medicine are atypical manifestion of sepsis in immunosenescence, altered pharmacokinetics, reduced tolerance to hypovolemia due to proportionally reduced water compartment of the body in old age, the frequently only apparently normal function of the kidneys and the continuous reduction in pulmonary function in old age. The main reasons for changes in therapeutic targets are the will of the patient and risk-benefit considerations. The guidelines of the ethics section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) provide assistance and suggestions for a structured decision-making process.

Exercise Promotion in Geriatric Oncology.

Science.gov (United States)

Burhenn, Peggy S; Bryant, Ashley Leak; Mustian, Karen M

2016-09-01

Evidence of the benefits of exercise for people with cancer from diagnosis through survivorship is growing. However, most cancers occur in older adults and little exercise advice is available for making specific recommendations for older adults with cancer. Individualized exercise prescriptions are safe, feasible, and beneficial for the geriatric oncology population. Oncology providers must be equipped to discuss the short- and long-term benefits of exercise and assist older patients in obtaining appropriate exercise prescriptions. This review provides detailed information about professionals and their roles as it relates to functional assessment, intervention, and evaluation of the geriatric oncology population. This review addresses the importance of functional status assessment and appropriate referrals to other oncology professionals.

Positive and negative volume-outcome relationships in the geriatric trauma population.

Science.gov (United States)

Matsushima, Kazuhide; Schaefer, Eric W; Won, Eugene J; Armen, Scott B; Indeck, Matthew C; Soybel, David I

2014-04-01

In trauma populations, improvements in outcome are documented in institutions with higher case volumes. However, it is not known whether improved outcomes are attributable to the case volume within specific higher-risk groups, such as the elderly, or to the case volume among all trauma patients treated by an institution. To test the hypothesis that outcomes of trauma care for geriatric patients are affected differently by the volume of geriatric cases and nongeriatric cases of an institution. This retrospective cohort study using a statewide trauma registry was set in state-designated levels 1 and 2 trauma centers in Pennsylvania. It included 39 431 eligible geriatric trauma patients (aged >65 years) in the Pennsylvania Trauma Outcomes Study. In-hospital mortality, major complications, and mortality after major complications (failure to rescue). Between 2001 and 2010, 39 431 geriatric trauma patients and 105 046 nongeriatric patients were captured in a review of outcomes in 20 state-designated levels 1 and 2 trauma centers. Larger volumes of geriatric trauma patients were significantly associated with lower odds of in-hospital mortality, major complications, and failure to rescue. In contrast, larger nongeriatric trauma volumes were significantly associated with higher odds of major complications in geriatric patients. Higher rates of in-hospital mortality, major complications, and failure to rescue were associated with lower volumes of geriatric trauma care and paradoxically with higher volumes of trauma care for younger patients. These findings offer the possibility that outcomes might be improved with differentiated pathways of care for geriatric trauma patients.

[The mobile geriatrics team, global patient management].

Science.gov (United States)

Bach, Fréderiue; Bloch, Frédéric

2013-01-01

The mobile geriatric team of Cochin hospital in Paris is responsible for the management and orientation of fragile elderly patients over the age of 75 admitted to emergency departments. It carries out a multi-disciplinary assessment, contributes to the creation of the care project and life project of geriatric patients and is involved in organising the patient's return home. This article focuses on the role of the social assistant through two clinical cases.

78 FR 12831 - Geriatrics and Gerontology Advisory Committee, Notice of Meeting Amendment

Science.gov (United States)

2013-02-25

... DEPARTMENT OF VETERANS AFFAIRS Geriatrics and Gerontology Advisory Committee, Notice of Meeting....S.C. App. 2, that a meeting of the Geriatrics and Gerontology Advisory Committee has been... and the Under Secretary for Health on all matters pertaining to geriatrics and gerontology. The...

Older adults in jail: high rates and early onset of geriatric conditions.

Science.gov (United States)

Greene, Meredith; Ahalt, Cyrus; Stijacic-Cenzer, Irena; Metzger, Lia; Williams, Brie

2018-02-17

The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ("accelerated aging"), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults. This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth. All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older. Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.

[Ten years of early complex geriatric rehabilitation therapy in the DRG system].

Science.gov (United States)

Kolb, G; Breuninger, K; Gronemeyer, S; van den Heuvel, D; Lübke, N; Lüttje, D; Wittrich, A; Wolff, J

2014-01-01

Geriatric medicine, as a specialized form of treatment for the elderly, is gaining in importance due to demographic changes. Especially important for geriatric medicine is combining acute care with the need to maintain functionality and participation. This includes prevention of dependency on structured care or chronic disability and handicap by means of rehabilitation. Ten years ago, the German DRG system tried to incorporate procedures (e.g., "early rehabilitation in geriatric medicine") in the hospital reimbursement system. OPS 8-550.x, defined by structural quality, days of treatment, and number of therapeutic interventions, triggers 17 different geriatric DRGs, covering most of the fields of medicine. OPS 8-550.x had been revised continuously to give a clear structure to quality aspects of geriatric procedures. However, OPS 8-550.x is based on proven need of in-hospital treatment. In the last 10 years, no such definition has been produced taking aspects of the German hospital system into account as well as aspects of transparency and benefit in everyday work. The German DRG system covers just basic reimbursement aspects of geriatric medicine quite well; however, a practicable and patient-oriented definition of "hospital necessity" is still lacking, but is absolutely essential for proper compensation. A further problem concerning geriatric medicine reimbursement in the DRG system is due to the different structures of providing geriatric in-hospital care throughout Germany.

[Management of malnutrition in geriatric hospital units in Germany].

Science.gov (United States)

Smoliner, C; Volkert, D; Wirth, R

2013-01-01

Elderly hospitalized patients have a high risk for developing malnutrition. The causes for an impaired nutritional status in old age are various and the impact is far-reaching. Malnutrition is a comorbidity that is well treatable and various studies show the favorable effect of nutrition therapy on nutritional status and prognosis. In the past few years, several guidelines have been developed to improve nutritional management and to ensure standardized procedures to identify patients at nutritional risk who will benefit from nutrition therapy. However, it is still not clear to what extent nutrition management has been implemented in geriatric wards in Germany. This survey is intended to give an overview on the situation of the current diagnosis and therapy of malnutrition and nutritional management in geriatric hospital units for acute and rehabilitative care. In 2011, the task force of the German Geriatric Society ("Deutsche Gesellschaft für Geriatrie", DGG) developed a questionnaire which was sent out to 272 directors of geriatric hospital and rehabilitational units. Included were questions regarding the size and staffing of the hospital and wards, food provision, diagnosis and therapy of malnutrition, as well as communication of malnutrition and nutrition therapy in the doctor's letter. A total of 38% of the questioned units answered. The following information was compiled: 31% of the geriatric facilities employed a doctor with training in clinical nutrition, 42% employ dieticians or nutritional scientists, and 90% speech and language pathologists. In 36% of the wards, a so-called geriatric menu is offered (small portions, rich in energy and/or protein, easy to chew). In 89% of the wards, snacks are available between meals. Diagnosis of malnutrition is mainly done by evaluation of weight and BMI. Validated and established screening tools are only used in 40% of the geriatric wards. Food records are carried out in 64% of the units when needed. Diagnosed

Undergraduate Teaching in Geriatrics and Pediatrics in Portuguese Medical Schools: An Observational Study.

Science.gov (United States)

Amaral, Mariana; Matias, Filipa; Massena, Lígia; Cardoso, Nuno

2016-12-30

Motivated by the contracting nature of the Portuguese age pyramid, and thereby the ever increasing geriatric population, the aim of this study was to compare the number of European Credit Transfer and Accumulation System Credits dedicated to Geriatrics with Pediatrics in Portuguese Medical Schools. An observational, descriptive and cross-sectional study was conducted and included six Portuguese Medical Schools that have six years of training and a total of 360 credits. The study plans were obtained from the medical schools' websites or requested. Schools were grouped in modular/classic teaching methodology and the courses were categorized in mandatory/optional and specific/related. The credits of Geriatrics and Pediatrics were compared. Four schools had classical methodology and two had a modular one. Overall, they had more credits dedicated to Pediatrics than Geriatrics. Three schools offered mandatory courses specifically oriented to Geriatrics (1.5 - 8 credits) compared to all schools mandatory courses courses on Pediatrics (5.7 - 26.5 credits). The ratio of averages of mandatory specific courses (Pediatrics/Geriatrics) was 12.4 in the classical and 1.5 in the modular group. Pediatrics teaching has revealed to be superior to Geriatrics in all categories. Based on our results, we consider the Portuguese Geriatrics' undergraduate teaching sub-optimal. Nowadays, geriatric population is quantitatively similar to pediatric population. Efforts should be made to adequate Geriatrics teaching to our reality in order to provide a more adequate health care to this age group.

[Geriatrics, a form of holistic health care. A bright spot in difficult financial economic times?].

Science.gov (United States)

Dillmann, E B

1984-02-01

Geriatrics has a functional aim, also in a clinical setting; it determines meaningful priorities in the process of diagnosis and treatment of the vulnerable elderly patient and is of a horizontal nature within the other specializations. Additional tasks of geriatrics are the development of adjusted methods for examination and treatment, the pursuing of early onset diagnostics, to supply specific information and the training of geriatric specialists. Clinical geriatric examination should only take place after evaluating the patient in his or her living conditions at home. The patient should thereby fulfil the geriatric trias, that no admission in a nursery home or psychiatric hospital is indicated, that examination at home or at the outpatient department is impossible and that an emergency situation necessitates admission. Ambulantory geriatric care is indispensable for the well functioning of a clinical geriatric department and the two should form an unbreakable tie, which could eventually be transformed into a personal union. A geriatric department in a general hospital is limited in its indications for the admission of geriatric patients, has high operating costs and should be restricted in size per regio, having a minimal capacity of 25 to 30 beds. The geriatric team is broad in composition and strong in coherence. The period of admission of the patient should not exceed six weeks. A regional social-geriatric circuit combines a geriatric department of a general hospital with the ambulantory social-geriatric service, the admission and indication committee of nursing homes into a well tuned system of provisions for the aged.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiopulmonary disease in the geriatric dog and cat

Energy Technology Data Exchange (ETDEWEB)

Miller, M. S.; Tilley, L. P.; Smith, F.W.K. Jr.

1989-01-15

The incidence of cardiopulmonary disease increases with age. Degenerative valvular disease, chronic obstructive pulmonary disease, and arrhythmias are common in the geriatric dog. Chronic bronchial disease, pulmonary neoplasia, and arrhythmias occur in the geriatric cat. Systemic diseases in both species often show cardiopulmonary manifestations. Medical management to treat the underlying disease and to control clinical signs is complicated by altered absorption, metabolism, and elimination of drugs.

Cardiopulmonary disease in the geriatric dog and cat

International Nuclear Information System (INIS)

Miller, M.S.; Tilley, L.P.; Smith, F.W.K. Jr.

1989-01-01

The incidence of cardiopulmonary disease increases with age. Degenerative valvular disease, chronic obstructive pulmonary disease, and arrhythmias are common in the geriatric dog. Chronic bronchial disease, pulmonary neoplasia, and arrhythmias occur in the geriatric cat. Systemic diseases in both species often show cardiopulmonary manifestations. Medical management to treat the underlying disease and to control clinical signs is complicated by altered absorption, metabolism, and elimination of drugs

gerIatrIc ImperatIve

African Journals Online (AJOL)

developments of geriatric medicine in the medical schools and hospitals of Europe .... including physical, mental, social, economic, functional and environmental .... occupational therapy and speech therapy has grown over the years, further ...

Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

OpenAIRE

John Ebnezar; Yogita Bali; Rakesh John

2017-01-01

Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management.

Common geriatric emergencies in a rural hospital in South‑Eastern ...

African Journals Online (AJOL)

Common geriatric emergencies in a rural hospital in South‑Eastern Nigeria. ... by emergency health conditions that predispose them to higher risk of disability and ... The geriatric patients seen within the study period who met the selection ...

Review of fall risk assessment in geriatric populations using inertial sensors

OpenAIRE

Howcroft, Jennifer; Kofman, Jonathan; Lemaire, Edward D

2013-01-01

Background Falls are a prevalent issue in the geriatric population and can result in damaging physical and psychological consequences. Fall risk assessment can provide information to enable appropriate interventions for those at risk of falling. Wearable inertial-sensor-based systems can provide quantitative measures indicative of fall risk in the geriatric population. Methods Forty studies that used inertial sensors to evaluate geriatric fall risk were reviewed and pertinent methodological f...

Basic Geriatrics Knowledge Among Internal Medicine Trainees in a Teaching Hospital in Saudi Arabia.

Science.gov (United States)

Al-Aama, Tareef

2016-06-01

To assess the basic knowledge of medical trainees, in the absence of a structured geriatrics curriculum, around a variety of geriatric medicine components that are considered essential for the care of the rapidly increasing elderly population. Eighty-three trainees at different levels of training in internal medicine were asked about a variety of common geriatric conditions. Those included: delirium, falls, geriatric syndromes, pain, cognitive impairment, and medications. The trainees' knowledge about common geriatric condition was overall poor. The most pronounced deficits included: the lack of familiarity in diagnosing geriatric syndromes (63 %) or managing them (67 %), the underestimation of the prevalence of delirium (49 %), and the tendency to undertreat pain (64 %). Poor familiarity with polypharmacy and its impact, as well as inappropriate prescription practices in the elderly were also observed. In the absence of a structured geriatric medicine curriculum, internal medicine trainees' knowledge about important geriatric conditions is poor, even if their internal medicine knowledge is overall adequate. This would translate into suboptimal care for this vulnerable and rapidly expanding segment of the population.

Postdoctoral Teaching of Geriatric Dentistry in U.S. Dental Schools.

Science.gov (United States)

Ettinger, Ronald L; Goettsche, Zachary S; Qian, Fang

2017-10-01

The aim of this study was to determine the number and size of postdoctoral teaching programs in geriatric dentistry in U.S. dental schools and other health professions educational institutions and those programs with Health Resources and Services Administration (HRSA) funding. In 2015, all 67 U.S. dental schools were contacted via email with a questionnaire to ask if they had a postdoctoral program in geriatric dentistry; if they did, they were asked to report the length and size of the program. Directors of all 16 HRSA-funded geriatric fellowships were also invited to participate in the survey. Fifty-six of the 67 (83.6%) dental schools and 15 of the 16 (93.8%) HRSA-funded programs completed the questionnaire. Postdoctoral geriatric dentistry programs were reported in 12 dental schools and six medical institutions, although only six programs were currently accepting fellows. The length of the programs was 12-36 months. The maximum number of residents in any program was ten. The oldest program was in Minnesota; it began in 1981. The newest program was beginning in 2017 at Boston University as a revised version of its previous HRSA-funded program. The loss of HRSA funding has had a major negative impact on the number of training programs. Future research is needed to determine how the loss of HRSA-funded programs has affected the availability of educators in geriatric dentistry for dental schools and the services provided to the geriatric community.

Electroconvulsive Therapy in the Elderly: New Findings in Geriatric Depression.

Science.gov (United States)

Geduldig, Emma T; Kellner, Charles H

2016-04-01

This paper reviews recent research on the use of electroconvulsive therapy (ECT) in elderly depressed patients. The PubMed database was searched for literature published within the past 4 years, using the search terms: "electroconvulsive elderly," "electroconvulsive geriatric," "ECT and elderly," and "ECT elderly cognition." The studies in this review indicate excellent efficacy for ECT in geriatric patients. Adverse cognitive effects of ECT in this population are usually transient and not typically severe. In addition, continuation/maintenance ECT (C/M-ECT) may be a favorable strategy for relapse prevention in the elderly after a successful acute course of ECT. ECT is an important treatment option for depressed geriatric patients with severe and/or treatment-resistant illness. New data add to the evidence demonstrating that ECT is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients.

Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

Directory of Open Access Journals (Sweden)

John Ebnezar

2017-01-01

Full Text Available Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management.

Measuring pharmacogenetics in special groups: geriatrics.

Science.gov (United States)

Seripa, Davide; Panza, Francesco; Daragjati, Julia; Paroni, Giulia; Pilotto, Alberto

2015-07-01

The cytochrome P450 (CYP) enzymes oxidize about 80% of the most commonly used drugs. Older patients form a very interesting clinical group in which an increased prevalence of adverse drug reactions (ADRs) and therapeutic failures (TFs) is observed. Might CYP drug metabolism change with age, and justify the differences in drug response observed in a geriatric setting? A complete overview of the CYP pharmacogenetics with a focus on the epigenetic CYP gene regulation by DNA methylation in the context of advancing age, in which DNA methylation might change. Responder phenotypes consist of a continuum spanning from ADRs to TFs, with the best responders at the midpoint. CYP genetics is the basis of this continuum on which environmental and physiological factors act, modeling the phenotype observed in clinical practice. Physiological age-related changes in DNA methylation, the main epigenetic mechanisms regulating gene expression in humans, results in a physiological decrease in CYP gene expression with advancing age. This may be one of the physiological changes that, together with increased drug use, contributed to the higher prevalence of ADRs and TFs observed in the geriatric setting, thus, making geriatrics a special group for pharmacogenetics.

Geriatric dentistry content in the curriculum of the dental schools in Chile.

Science.gov (United States)

León, Soraya; Araya-Bustos, Francisca; Ettinger, Ronald L; Giacaman, Rodrigo A

2016-09-01

The purpose of this study was to identify the status of pre-doctoral geriatric dentistry education among all Chilean dental schools. Chile is one of the most rapidly ageing countries in Latin America. Consequently, specific knowledge and training on the needs of elderly populations need to be emphasised in dental schools. The current extent and methods of teaching geriatric dentistry among the dental schools in Chile are unknown. A web-based questionnaire was developed and sent to all 19 Chilean dental schools to identify which schools had a formal programme on geriatric dentistry and ask about their format, content and type of training of the faculty who taught in the programmes. Data were analysed, and a comparison was made among the schools. Sixteen (84%) of the participant schools reported teaching at least some aspects of geriatric dentistry, using various methodologies, but only 7 (37%) had specific courses. Of those schools reporting a didactic content on geriatric dentistry, 71% included clinical training, either in the school's dental clinics or in an extramural service. Contents mostly included demographics of ageing, theories of ageing and medical conditions. More than half of the faculty (57%) stated that they had formal training in geriatric dentistry, 43% were trained in prosthodontics, public health or other areas. Although most dental schools taught geriatric dentistry, only some had a specific course. Most schools with formal courses followed the international curriculum guidelines for geriatric dentistry. © 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Humanities and Geriatric Education: a Strategy for Recruitment?

Science.gov (United States)

Frank, Christopher; Martin, Ruth Elwood

2015-01-01

Ageing is a common subject in arts and literature as it is a universal experience. The use of the humanities in medical education may have a positive effect on trainees’ attitude to caring for seniors and on geriatrics as a career choice. This paper summarizes the role of humanities in medical education and provides some examples and thoughts on how humanities curriculum can be used in geriatric teaching. PMID:25825611

[Antibiotic prescription usage and assessment in geriatric patients].

Science.gov (United States)

Dinh, Aurélien; Davido, Benjamin; Salomon, Jérôme; Le Quintrec, Jean-Laurent; Teillet, Laurent

2016-01-01

Due to the high risk of infection, the geriatric population is regularly subjected to antibiotics. Faced with bacterial resistance, particularly among elderly dependent patients, it is essential to promote proper use and correct prescription of antibiotics. A study evaluated antibiotic prescription in a geriatric hospital with 598 beds and highlighted the importance of collaboration between geriatricians and infectious disease specialists. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Geriatric syndromes in patients with chronic kidney disease

OpenAIRE

Tomasz Gołębiowski; Hanna Augustyniak-Bartosik; Wacław Weyde; Marian Klinger

2016-01-01

The recent epidemiologic data pointed out, that the general number of patients on hemodialysis is steadily increasing, especially in group of elderly patients over 75 years old. The geriatric syndromes are a multietiological disorder related to physiological aging and partly associated with comorbid conditions. Frailty, falls, functional decline and disability, cognitive impairment and depression are main geriatric syndromes and occurs in patients with impaired renal function more often than ...

Geriatric Rehabilitation Patients’ Perceptions of Unit Dining Locations

OpenAIRE

Baptiste, Françoise; Egan, Mary; Dubouloz-Wilner, Claire-Jehanne

2014-01-01

Background Eating together is promoted among hospitalized seniors to improve their nutrition. This study aimed to understand geriatric patients’ perceptions regarding meals in a common dining area versus at the bedside. Methods An exploratory qualitative study was conducted. Open-ended questions were asked of eight patients recruited from a geriatric rehabilitation unit where patients had a choice of meal location. Results Eating location was influenced by compliance with the perceived rules ...

Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

Science.gov (United States)

Trust, Marc D; Teixeira, Pedro G; Brown, Lawrence H; Ali, Sadia; Coopwood, Ben; Aydelotte, Jayson D; Brown, Carlos V R

2018-01-01

Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age < 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p < 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p < 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15%; p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.

[Rehabilitation for musculoskeltal disorders in geriatric patients].

Science.gov (United States)

Shirado, O

1997-07-01

Aging is typically accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness in any organs. Musculoskeltal system is one of the most involved organs in geriatric patients. Appropriate roles in geriatric rehabilitation for musculoskeltal disorders should be emphasized not only to treat the disorders, but also to prevent many complications cause by specific disease or injury. Representative management methods in geriatric rehabilitation are introduced in this section. Rest is often effective, especially in the acute phase of illness or injury. However, cautions should be paid in disuse syndrome which may be produced by prolonged bed rest. Major manifestations in this syndrome includes muscle weakness and atrophy, joint contracture, decubitus, osteoporosis, ectopic ossification, cardiovascular impairment, pneumonia, urological and mental problems. Physical agents such as heat, cold, light and pressure have been used as therapeutic agents. Electrical stimulation is often effective in the treatment of low-back pain syndrome. Traction is the act of drawing, or a pulling force. Its mechanism to relieve pain seems to immobilize the injured parts, to increase peripheral circulation by massage effect and to improve muscle spasm. Brace is very effective to control acute pain in musculoskeltal system. However, long-term wear of brace should be avoided to prevent the disuse syndrome. Exercise is one of the most important rehabilitation modalities. This includes stretching and muscle strengthening programs. Education of body mechanism in activity of daily living is essential in rehabilitation of geriatric patients.

Teaching geriatric medicine at the Queen's University of Belfast.

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Stout, R W

1983-01-01

Undergraduate teaching at the Queen's University, Belfast, takes place in the fourth year of a five year curriculum. It lasts three weeks and this is divided into two parts. First, held within the university department, is topic-based teaching including seminars, discussions, case histories and visits. The second phase of two weeks consists of attachment of two to four students to geriatric medical units both in and outside Belfast. The whole of this module is situated within a combined course involving community medicine, general practice, geriatric medicine and mental health lasting 12 weeks and involving one-third of the year of 150 students each time. In addition to the three weeks teaching in geriatrics, joint discussion groups are held.

Common geriatric emergencies in a rural hospital in South-Eastern ...

African Journals Online (AJOL)

2011-11-02

Nov 2, 2011 ... epidemiologically recognized as constitutional risk factor ... Materials and Methods: This was a descriptive hospital-based study of 216 geriatric patients who .... (hypertension and hypertension-related heart failure) the ... [7,8] This finding has ... measured with sphygmomanometer, majority of geriatric.

[Specialties in dentistry. 4. Post-academic specialization in geriatric dentistry

NARCIS (Netherlands)

Schaub, R.M.; Baat, C. de

2006-01-01

In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational

Specialties in dentistry. 4. Post-academic specialization in geriatric dentistry

NARCIS (Netherlands)

Schaub, R.M.; de Baat, C.

2006-01-01

In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational

Teaching Programs in Geriatric Optometry.

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Rosenbloom, Albert A.

1985-01-01

Results of a survey of U.S. and Canadian optometry programs concerning curriculum design, clinical and residency training programs, continuing education, and research projects planned or under way in geriatric optometry are presented and discussed. (MSE)

Perceptions, attitudes, and experiences of hematology/oncology fellows toward incorporating geriatrics in their training.

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Maggiore, Ronald J; Gorawara-Bhat, Rita; Levine, Stacie K; Dale, William

2014-01-01

The aging of the U.S. population continues to highlight emerging issues in providing care generally for older adults and specifically for older adults with cancer. The majority of patients with cancer in the U.S. are currently 65 years of age or older; therefore, training and research in geriatrics and geriatric oncology are viewed to be integral in meeting the needs of this vulnerable population. Yet, the ways to develop and integrate best geriatrics training within the context of hematology/oncology fellowship remain unclear. Toward this end, the current study seeks to evaluate the prior and current geriatric experiences and perspectives of hematology/oncology fellows. To gain insight into these experiences, focus groups of hematology/oncology fellows were conducted. Emergent themes included: 1) perceived lack of formal geriatric oncology didactics among fellows; 2) a considerable amount of variability exists in pre-fellowship geriatric experiences; 3) shared desire to participate in a geriatric oncology-based clinic; 4) differences across training levels in confidence in managing older adults with cancer; and 5) identification of specific criteria on how best to approach older adults with cancer in a particular clinical scenario. The present findings will help guide future studies in evaluating geriatrics among hematology/oncology fellows across institutions. They will also have implications in the development of geriatrics curricula and competencies specific to hematology/oncology training. © 2013.

Geriatric pharmacology and pharmacotherapy education for health professionals and students: a systematic review

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Keijsers, Carolina J P W; van Hensbergen, Larissa; Jacobs, Lotte; Brouwers, Jacobus R B J; de Wildt, Dick J; ten Cate, Olle Th J; Jansen, Paul A F

2012-01-01

AIMS Given the reported high rates of medication errors, especially in elderly patients, we hypothesized that current curricula do not devote enough time to the teaching of geriatric pharmacology. This review explores the quantity and nature of geriatric pharmacology education in undergraduate and postgraduate curricula for health professionals. METHODS Pubmed, Embase and PsycINFO databases were searched (from 1 January 2000 to 11 January 2011), using the terms ‘pharmacology’ and ‘education’ in combination. Articles describing content or evaluation of pharmacology education for health professionals were included. Education in general and geriatric pharmacology was compared. RESULTS Articles on general pharmacology education (252) and geriatric pharmacology education (39) were included. The number of publications on education in general pharmacology, but not geriatric pharmacology, has increased over the last 10 years. Articles on undergraduate and postgraduate education for 12 different health disciplines were identified. A median of 24 h (from 15 min to 4956 h) devoted to pharmacology education and 2 h (1–935 h) devoted to geriatric pharmacology were reported. Of the articles on education in geriatric pharmacology, 61.5% evaluated the teaching provided, mostly student satisfaction with the course. The strength of findings was low. Similar educational interventions were not identified, and evaluation studies were not replicated. CONCLUSIONS Recently, interest in pharmacology education has increased, possibly because of the high rate of medication errors and the recognized importance of evidence-based medical education. Nevertheless, courses on geriatric pharmacology have not been evaluated thoroughly and none can be recommended for use in training programmes. Suggestions for improvements in education in general and geriatric pharmacology are given. PMID:22416832

Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

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Otremba I

2016-04-01

Full Text Available Iwona Otremba, Krzysztof Wilczyński, Jan SzewieczekDepartment of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, PolandBackground: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies.Objective: Evaluate specific factors for development of delirium in a geriatric ward setting.Methods: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men, admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed.Results: Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001, preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001, previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001, previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006, and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014.Conclusion: Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.Keywords: delirium

Geriatric dentistry education and context in a selection of countries in 5 continents.

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Marchini, Leonardo; Ettinger, Ronald; Chen, Xi; Kossioni, Anastassia; Tan, Haiping; Tada, Sayaka; Ikebe, Kazunori; Dosumu, Elizabeth Bosede; Oginni, Fadekemi O; Akeredolu, Patricia Adetokunbo; Butali, Azeez; Donnelly, Leeann; Brondani, Mario; Fritzsch, Bernd; Adeola, Henry A

2018-05-01

To summarize and discuss how geriatric dentistry has been addressed in dental schools of different countries regarding to (1) teaching students at the predoctoral level; (2) advanced training, and (3) research. A convenience sample of faculty members from a selection of high, upper-middle and lower-middle income countries were recruited to complete the survey. The survey had 5 open-ended main topics, and asked about (1) the size of their elderly population, (2) general information about dental education; (3) the number of dental schools teaching geriatric dentistry, and their teaching methods; (4) advanced training in geriatric dentistry; (5) scholarship/research in geriatric dentistry. (1) There is great variation in the size of elderly population; (2) duration of training and content of dental education curriculum varies; (3) geriatric dentistry has not been established as a standalone course in dental schools in the majority of the countries, (4) most countries, with the exception of Japan, lack adequate number of dentists trained in geriatric dentistry as well as training programs, and (5) geriatric dentistry-related research has increased in recent years in scope and content, although the majority of these papers are not in English. © 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.

Elder Specialists: Psychosocial Aspects of Medical Education in Geriatric Care

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McCann-Stone, Nancy; Robinson, Sherry B.; Rull, Gary; Rosher, Richard B.

2009-01-01

This paper describes an Elder Specialist Program developed by one school of medicine to sensitize medical students to geriatric psychosocial issues. Elder Specialists participate in panel discussions as part of each geriatric session. As an alternative to traditional senior mentoring programs, the Elder Specialist Program provides all students a…

Geriatric Optometry Programs of Promise.

Science.gov (United States)

Verma, Satya B.

1985-01-01

The curriculum design, philosophy, and innovation of four programs in geriatric optometry are described: the Pennsylvania College of Optometry and the colleges of Optometry at the State University of New York, University of Alabama at Birmingham, and University of Houston. (MSE)

Practice of geriatric oncology in the setting of a comprehensive cancer center

International Nuclear Information System (INIS)

Droz, J.

2004-01-01

Geriatric oncology is defined by the multidimensional and multidisciplinary approach of the elderly cancer patients. Autonomy, beneficence, non maleficence and justice are the four fundamental principles on which are based the treatment objectives and practical management of these patients. The Comprehensive Geriatric Assessment is the most used tool to detect the functional problems in these elderly patients. The standard oncologic managements of cancer is applies to these patients. However treatment plan and geriatric interventions must be adapted to each individual characteristics of the patients.Thus a strong interdependence between oncologic and geriatric teams is warranted. This implies specific teaching programs during initial medical studies and in the setting of continuous medical education. Furthermore, such wold wide teaching programs may help to the implementation of Geriatric Oncology. In the Geriatric Oncology Program in Lyon we have developed a specific miniassessement to be practiced in an oncologic setting. Geriatric data were obtained by the version of the geriatric multidimensional assessment tool, which we have called minimal comprehensive geriatric assessment” or mini-CGA. This procedure has been designed to collect information on several major domains including medical (co-morbidity), functional, cognitive, affective, social, and environmental aspects. It is essentially based on a very careful medical examination. We also used other evaluation tools previously validated in elderly people. Dependence was measured using three tools: Katz’s Activities of Daily Living (ADLs) scale that focuses on six basic activities of daily living (bathing, dressing, toile ting, transferring, continence, and feeding); Lawton’s Instrumental Activities of Daily Living (IADLs) scale that appraises more complex activities essential for independence in community residence; and the Karnofsky Performance scale (KPS) that is widely used in the oncology setting to

Novel ethical dilemmas arising in geriatric clinical practice.

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Calleja-Sordo, Elisa Constanza; de Hoyos, Adalberto; Méndez-Jiménez, Jorge; Altamirano-Bustamante, Nelly F; Islas-Andrade, Sergio; Valderrama, Alejandro; García-Peña, Carmen; Altamirano-Bustamante, Myriam M

2015-05-01

The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population.

[A new stage of development of gerontology and geriatrics in Russia: problems of creation of a geriatric care system. Part 1. Relevance, regulatory infrastructure].

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Anisimov, V N; Serpov, V Yu; Finagentov, A V; Khavinson, V Kh

2017-01-01

This article is a 1st part of the analytical review, focused on a new step in development of geriatrics in Russia. Creation of state system geriatric care as important part of state politics in the area of enhancement of quality of life was proved. General aspects of improvement of social support of disable elderly persons in condition of restricted budget and interagency separation was presented. Establishment of unified system of medical social support and gerotechnologies for the elderly was substantiated, as a mechanism facilitated life activity and decreasing of demographic loading on economic status of regions of Russian Federation. Legislative and normative regulations of gerontology and geriatric development were observed as well. Accepted legislative and normative acts were analyzed for period since 1977 to 2014. The necessity of approaches to regulation modernization for elderly was demonstrated. Analytical review on number of legislative state documents issued after meeting of Presidium of State Council of the Russian Federation being in August 2014 was also presented. Applicability of these documents for realization new strategy of gerontology and geriatrics development in Russia was proved.

Clinical application value of impulse oscillometry in geriatric patients with COPD

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Liu Z

2017-03-01

Full Text Available Zhonghui Liu,* Lianjun Lin,* Xinmin Liu Geriatrics Department, Peking University First Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Background: The diagnosis and assessment of COPD rely mainly on the use of spirometry, which is an effort-dependent test and requires good patient cooperation. Impulse oscillometry (IOS is a non-volitional method that requires less effort and cooperation and presents advantages for geriatric patients. However, the clinical application value of IOS in geriatric patients with COPD remains unclear. Aim: The aim of this study was to investigate the clinical application value of IOS in geriatric patients with COPD. Subjects and methods: A total of 234 subjects were retrospectively enrolled in this study, including 133 patients with COPD and 101 healthy volunteers. All the participants underwent IOS and spirometry examination. The data were collected and analyzed in the overall group, the geriatric group (aged ≥65 years, and the advanced elderly group (aged ≥80 years. Results: 1 In COPD patients, a significant increase in respiratory impedance (Z5, resonant frequency (Fres, and respiratory resistance (R5, R20, R5–R20 and a decrease in respiratory reactance (X5 were observed in the overall group, the geriatric group, and the advanced elderly group compared with the healthy control subjects. 2 The IOS parameters correlated well with spirometry in COPD. In particular, R5–R20 showed the best correlation with forced expiratory volume in 1 second (FEV1 in the different age groups. 3 Fres and R5–R20 had the best diagnostic efficiency for COPD. The area under the curve (AUC values for Fres, expressed by the receiver operating characteristic (ROC curve, were 0.905, 0.909, and 0.914, for the different age groups, respectively. 4 The optimal cutoff values for Fres to diagnose airflow obstruction from ROC curves was 17.715 in the COPD patients. Its sensitivity and

Geriatric Syndromes in Hospitalized Older Adults Discharged to Skilled Nursing Facilities

Science.gov (United States)

Bell, Susan P.; Vasilevskis, Eduard E.; Saraf, Avantika A.; Jacobsen, J. Mary Lou; Kripalani, Sunil; Mixon, Amanda S.; Schnelle, John F.; Simmons, Sandra F.

2016-01-01

Background Geriatric syndromes are common in older adults and associated with adverse outcomes. The prevalence, recognition, co-occurrence and recent onset of geriatric syndromes in patients transferred from hospital to skilled nursing facilities (SNFs) are largely unknown. Design Quality improvement project. Setting Acute care academic medical center and 23 regional partner SNFs. Participants 686 Medicare beneficiaries hospitalized between January 2013 and April 2014 and referred to SNFs. Measurements Nine geriatric syndromes were measured by project staff -- weight loss, decreased appetite, incontinence and pain (standardized interview), depression (Geriatric Depression Scale), delirium (Brief-Confusion Assessment Method), cognitive impairment (Brief Interview for Mental Status), falls and pressure ulcers (hospital medical record utilizing hospital-implemented screening tools). Estimated prevalence, new-onset prevalence and common coexisting clusters were determined. The extent that syndromes were commonly recognized by treating physicians and communicated to SNFs in hospital discharge documentation was evaluated. Results Geriatric syndromes were prevalent in more than 90% of hospitalized adults referred to SNFs; 55% met criteria for 3 or more co-existing syndromes. Overall the most prevalent syndromes were falls (39%), incontinence (39%), decreased appetite (37%) and weight loss (33%). Of individuals that met criteria for 3 or more syndromes, the most common triad clusters included nutritional syndromes (weight loss, loss of appetite), incontinence and depression. Treating hospital physicians commonly did not recognize and document geriatric syndromes in discharge summaries, missing 33–95% of syndromes present as assessed by research personnel. Conclusion Geriatric syndromes in hospitalized older adults transferred to SNF are prevalent and commonly co-exist with the most frequent clusters including nutritional syndromes, depression and incontinence. Despite

Valproic Acid Suppositories for Management of Seizures for Geriatric Patients.

Science.gov (United States)

DiScala, Sandra L; Tran, Nhi N; Silverman, Michael A

This case describes the use of valproic acid suppositories for secondary seizure prophylaxis in a geriatric veteran with a feeding and swallowing disorder. The effectiveness of valproic acid suppositories is outlined to reinforce the need for compounding pharmacies to have this formulation available to meet the needs of geriatric patients.

[Contribution of psychoanalysis to geriatric care for institutionalized patients].

Science.gov (United States)

Charazac, Pierre-Marie

2014-06-01

The contribution of psychoanalysis to geriatric care in nursing home is discussed in three directions: its conception of care, specially on its negative sides; its implication in geriatric units, in their conception and in the analysis of their management of care; the holding of care-givers and nurses by making clear what we call transference and conter-transference and their reflection on their function.

Geritalk: communication skills training for geriatric and palliative medicine fellows.

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Kelley, Amy S; Back, Anthony L; Arnold, Robert M; Goldberg, Gabrielle R; Lim, Betty B; Litrivis, Evgenia; Smith, Cardinale B; O'Neill, Lynn B

2012-02-01

Expert communication is essential to high-quality care for older patients with serious illness. Although the importance of communication skills is widely recognized, formal curricula for teaching communication skills to geriatric and palliative medicine fellows is often inadequate or unavailable. The current study drew upon the educational principles and format of an evidence-based, interactive teaching method to develop an intensive communication skills training course designed specifically to address the common communication challenges that geriatric and palliative medicine fellows face. The 2-day retreat, held away from the hospital environment, included large-group overview presentations, small-group communication skills practice, and development of future skills practice commitment. Faculty received in-depth training in small-group facilitation techniques before the course. Geriatric and palliative medicine fellows were recruited to participate in the course and 100% (n = 18) enrolled. Overall satisfaction with the course was very high (mean 4.8 on a 5-point scale). After the course, fellows reported an increase in self-assessed preparedness for specific communication challenges (mean increase 1.4 on 5-point scale, P communication skills program, customized for the specific needs of geriatric and palliative medicine fellows, improved fellows' self-assessed preparedness for challenging communication tasks and provided a model for ongoing deliberate practice of communication skills. © 2012, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

Geriatric hip fracture management: keys to providing a successful program.

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Basu, N; Natour, M; Mounasamy, V; Kates, S L

2016-10-01

Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program. The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital's data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process. To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential-those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.

A community-based approach for integrating geriatrics and gerontology into undergraduate medical education.

Science.gov (United States)

Martinez, Iveris L; Mora, Jorge Camilo

2012-01-01

Medical school accreditation requirements require educational opportunities in geriatrics. Twenty-six minimum graduating competencies in geriatrics have recently been identified for medical students. The authors describe how these competencies are being integrated into a new medical curriculum through coursework and community-based experiences. This approach is intended to expose students to older adults from diverse communities and adequately prepare students to address the complex and individual needs of these patients. Initial results indicate proficiency in the minimum geriatric competencies covered. The growth and diversity of the older adult population makes it important to integrate and evaluate geriatrics education in undergraduate medical education.

[A new stage of development of gerontology and geriatrics in Russia: Problems o creation of a geriatric care system. Part 2. The structure of the system, scientific approach].

Science.gov (United States)

Anisimov, V N; Serpov, V Yu; Finagentov, A V; Khavinson, V Kh

2017-01-01

The publication is the second part of the analytical review on the new stage of development of gerontology and geriatrics in Russia. Components of social support system for senior citizens and the structure of social-medical care as its crucial components are presented. The problem of positioning of geriatric care within the system of social support for senior citizens, as well as its peculiarities and the algorithm providing geriatric care are discussed. The analysis of this algorithm allowed us to justify the indissoluble link and continuity of individual components of geriatric care and its cost-effectiveness. The position of the Russian Federation Ministry of Health concerning of introduction of geriatric care as an element in the system of medical care for older citizens was looking through. The pilot project «Territory of Care» proposed by the Russian Federation Ministry of Labor and Ministry of Health for establishment of long-term system of medical and social care to citizens of the older generation on the principles of multidisciplinary and interdepartmental interaction was elucidated as well. Some failures of the project have been highlighted and recommendations for its development were stressed. The role of gerontology as a systemic basis for creation of geriatric service in Russia and for the development of an integrated social and medical care to citizens of the older generation was underlined. The main priorities in the field of aging in the forthcoming decade are formulated. The most promising areas of research in the field of gerontology were discussed, the implementation of which will allow to realize the State social policy goals focused on the quality of life of senior citizens. Finally, the position of Gerontological Society of the Russian Academy of Sciences on the creation of mechanisms of scientific support for the renovation of geriatric services, including collaboration with experts in the field of practical medicine, social workers, and

A prospective study assessing agreement and reliability of a geriatric evaluation.

Science.gov (United States)

Locatelli, Isabella; Monod, Stéfanie; Cornuz, Jacques; Büla, Christophe J; Senn, Nicolas

2017-07-19

The present study takes place within a geriatric program, aiming at improving the diagnosis and management of geriatric syndromes in primary care. Within this program it was of prime importance to be able to rely on a robust and reproducible geriatric consultation to use as a gold standard for evaluating a primary care brief assessment tool. The specific objective of the present study was thus assessing the agreement and reliability of a comprehensive geriatric consultation. The study was conducted at the outpatient clinic of the Service of Geriatric Medicine, University of Lausanne, Switzerland. All community-dwelling older persons aged 70 years and above were eligible. Patients were excluded if they hadn't a primary care physician, they were unable to speak French, or they were already assessed by a geriatrician within the last 12 months. A set of 9 geriatricians evaluated 20 patients. Each patient was assessed twice within a 2-month delay. Geriatric consultations were based on a structured evaluation process, leading to rating the following geriatric conditions: functional, cognitive, visual, and hearing impairment, mood disorders, risk of fall, osteoporosis, malnutrition, and urinary incontinence. Reliability and agreement estimates on each of these items were obtained using a three-way Intraclass Correlation and a three-way Observed Disagreement index. The latter allowed a decomposition of overall disagreement into disagreements due to each source of error variability (visit, rater and random). Agreement ranged between 0.62 and 0.85. For most domains, geriatrician-related error variability explained an important proportion of disagreement. Reliability ranged between 0 and 0.8. It was poor/moderate for visual impairment, malnutrition and risk of fall, and good/excellent for functional/cognitive/hearing impairment, osteoporosis, incontinence and mood disorders. Six out of nine items of the geriatric consultation described in this study (functional

Decision making in geriatric oncology

NARCIS (Netherlands)

Hamaker, M.E.

2012-01-01

The studies in this thesis show that for older cancer patients, tailor-made care should be the standard of care, striking the golden mean between undertreatment and overtreatment and fully taking into account the heterogeneity of this patient population. The comprehensive geriatric assessment will

Professional development and exposure to geriatrics: medical student perspectives from narrative journals.

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Shield, Renée R; Farrell, Timothy W; Campbell, Susan E; Nanda, Aman; Wetle, Terrie

2015-01-01

Teaching professionalism is an important goal in American medical education. With the aging of the U.S. population, it is critical to understand how medical students develop professional behaviors when caring for older adults. Exposure to geriatrics and older patients can enhance students' professional development with patients of all ages and across different specialties. Medical students learn explicit and implicit messages during their education. In addition to helping to evaluate curricula, reflective journaling encourages individual development and helps in revealing how medical students become professionals. In this study, medical student volunteers described their responses to new geriatrics content in their curriculum, encounters with older patients in clinical settings, and their evolving physician identities. Multidisciplinary team analysis elicited 10 themes regarding: evaluation of geriatrics within the curriculum, recognition of geriatrics principles, and attitudes regarding aging and professional development over time. This article focuses on the impact of geriatrics exposure on students' professional development, revealing ways that students think about professionalism and older patients. Medical educators should consider journaling to help foster and gauge students' professional development.

An Innovative Approach for Decreasing Fall Trauma Admissions from Geriatric Living Facilities: Preliminary Investigation.

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Evans, Tracy; Gross, Brian; Rittenhouse, Katelyn; Harnish, Carissa; Vellucci, Ashley; Bupp, Katherine; Horst, Michael; Miller, Jo Ann; Baier, Ron; Chandler, Roxanne; Rogers, Frederick B

2015-12-01

Geriatric living facilities have been associated with a high rate of falls. We sought to develop an innovative intervention approach targeting geriatric living facilities that would reduce geriatric fall admissions to our Level II trauma center. In 2011, a Trauma Prevention Taskforce visited 5 of 28 local geriatric living facilities to present a fall prevention protocol composed of three sections: fall education, risk factor identification, and fall prevention strategies. To determine the impact of the intervention, the trauma registry was queried for all geriatric fall admissions attributed to patients living at local geriatric living facilities. The fall admission rate (total fall admissions/total beds) of the pre-intervention period (2010-2011) was compared with that of the postintervention period (2012-2013) at the 5 intervention and 23 control facilities. A P value fall admissions attributed to local geriatric living facilities (intervention: 179 fall admissions; control: 308 fall admissions). The unadjusted fall rate decreased at intervention facilities from 8.9 fall admissions/bed pre-intervention to 8.1 fall admissions/bed postintervention, whereas fall admission rates increased at control sites from 5.9 to 7.7 fall admissions/bed during the same period [control/intervention odds ratio (OR), 95% confidence interval (CI) = 1.32, 1.05-1.67; period OR, 95%CI = 1.55, 1.18-2.04, P = 0.002; interaction of control/intervention group and period OR 95% CI = 0.68, 0.46-1.00, P = 0.047]. An aggressive intervention program targeting high-risk geriatric living facilities resulted in a statistically significant decrease in geriatric fall admissions to our Level II trauma center.

Validation of Geriatric Care Environment Scale in Portuguese Nurses

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João Paulo de Almeida Tavares

2013-01-01

Full Text Available The number of hospitalized older adults in Portugal necessitates a better understanding of the acute care environment for older adults. This study translated and examined the psychometric qualities of the Geriatric Care Environment Scale (GCES among 1,068 Portuguese registered nurses (RNs. Four factors emerged from the exploratory factor analyses: resource availability, aging-sensitive care delivery, institutional values regarding older adults and staff, and continuity of care. The internal consistency of the GCES was α=.919. The GCES was significantly associated with the variables of region, hospital type, unit type, and RNs perception of hospital educational, staff knowledge, difficulty, rewarding, and burdensome in caring for older adults. Nurses who worked in hospitals centers in the northern region and medical and surgery units had more positive perceptions of the geriatric care environment. More positive perception was also found among RNs that reported more educational support, had more knowledge, and felt more rewarding and less difficulty and burden in caring older adults. This process resulted in a valid and reliable measurement of the geriatric care environment Portuguese version which provides hospital leadership with an instrument to evaluate organizational support for geriatric nursing practice and target specific areas that support or hinder care delivery.

Do-not-resuscitate policy on acute geriatric wards in Flanders, Belgium

NARCIS (Netherlands)

Gendt, de C.; Bilsen, J.J.; Stichele, van der R.; Lambert, M.; Noortgate, N. Den; Deliens, L.H.J.

2005-01-01

OBJECTIVES: To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation. DESIGN: Structured mail questionnaires. SETTING: All 94 acute geriatric wards in hospitals in Flanders

Physician and Nurse Acceptance of Technicians to Screen for Geriatric Syndromes in the Emergency Department

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Brian F Gage

2011-05-01

Full Text Available Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of this anonymous survey was to evaluate ED nurse and physician perceptions about the geriatric screener feasibility and barriers to implementation. In addition, as a secondary objective, respondents reported ongoing geriatric screening efforts independent of the research screeners. Results: The survey was completed by 72% of physicians and 33% of nurses. Most nurses and physicians identified geriatric technicians as beneficial to patients without impeding ED throughput. Fewer than 25% of physicians routinely screen for any geriatric syndromes. Nurses evaluated for fall risk significantly more often than physicians, but no other significant differences were noted in ongoing screening efforts. Conclusion: Dedicated geriatric technicians are perceived by nurses and physicians as beneficial to patients with the potential to improve patient safety and clinical outcomes. Most nurses and physicians are not currently screening for any geriatric syndromes. [West J Emerg Med. 2011;12(4:489–495.

Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin.

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Spandau, Dan F; Lewis, Davina A; Somani, Ally-Khan; Travers, Jeffrey B

2012-06-01

Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was shown to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of IGF-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer.

The influence of ageism, experience, and relationships with older adults on physical therapy students' perception of geriatrics.

Science.gov (United States)

Blackwood, Jennifer; Sweet, Christina

2017-01-01

Increased exposure to geriatrics throughout a student's professional education has been reported to improve the desire to work in this area; however, factors that influence the perception of geriatric physical therapy may prohibit students from actively seeking those experiences. The purpose of this study was to examine the perceptions of geriatric physical therapy by first-year graduate physical therapy students. A qualitative case study research approach was performed. Three focus groups were completed using students enrolled in their second semester of a graduate-level physical therapy program. Dialogue was reviewed and coded by three raters. Twenty-five subcategories of open-coding terms were triangulated and grouped into 4 themes via axial coding. Four themes emerged: (1) ageism exists in health care, (2) personal and professional experiences serve as a framework for students' perception of geriatrics, (3) interpersonal relationships formed within geriatric practice are highly valued, and (4) additional contextual barriers exist in geriatrics. To meet the needs of a highly skilled geriatric workforce, students should participate in enhanced geriatric experiences in didactic coursework as well as within interprofessional geriatric clinics throughout their education.

Ethical considerations in geriatric neuropsychology.

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Martin, Thomas A; Bush, Shane S

2008-01-01

The practice of geriatric neuropsychology demands specialized training and experience that enables the practitioner to appreciate the unique challenges and opportunities that are encountered when working with older adults. In addition to maintaining advanced knowledge regarding medical and psychological conditions, assessment issues, and treatment needs specific to older persons, clinicians working with older adults must be prepared to recognize and confront ethical dilemmas that arise. For example, ethical challenges related to professional competence, informed consent, assessment, and privacy and confidentiality may be prominent when working with older persons. Maintaining an emphasis on "positive ethics" and utilizing an ethical decision-making model will promote the practitioner's ability to avoid, identify, and resolve ethical challenges. The present article reviews (1) the concept of positive ethics, (2) a comprehensive ethical decision-making model, and (3) ethical issues that are commonly encountered by geriatric neuropsychologists. A case vignette is presented to illustrate the application of the aforementioned tools to promote ethical practice.

Geriatric health care in India - Unmet needs and the way forward

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Prabha Adhikari

2017-01-01

Full Text Available India has nearly 120 million elderly people with various physical, psychosocial, economic, and spiritual problems. While the functionally and cognitively fit can access usual health-care facilities provided by the government, these people need active aging program to keep them independent. Health ministry has created geriatric centers and geriatric clinics in most of the states; however, these centers may not serve the functionally and cognitively impaired elderly. There is great need for mobile units, day-care centers and hospices, and need for training of personnel in home nursing. Routine care clinics cannot handle the burden of geriatric population to address their multimorbidity and several other age-related problems. There is a need for a rapid training of health-care professionals of various disciplines in geriatric care. Government must support nongovernmental organizations and other agencies which provide day care, home care, and palliative care so that these services become affordable to all the elderly.

Mental Status and Functional Behavior In Male Geriatric Patients

OpenAIRE

Mayer, Gregory Lee

1989-01-01

It was the goal of this study to examine the ecological validity of a number of measures of mental status for geriatric individuals. Subjects were 40 alert, ambulatory male VA patients. Mental status instruments included the Mini-Mental State Examination (MMSE), the Wechsler Memory Scale (WMS) and the Vocabulary subtest of the WAIS-R. Measures of functional behavior included the Woodcock-Johnson Scales of Independent Behavior (SIB) and the Parachek Geriatric Behavior Rating Scale (PGBRS). Sig...

Abstracts from the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society Quebec City, April 2012

OpenAIRE

Auais, M.; Morin, S.; Finch, L.; Sara, A.; Mayo, N.; Charise, A.; Islam, A.; Muir, Susan; Montero-Odasso, Manuel; Kennedy, C.C.; Papaioannou, A.; Ioannidis, G.; Giangregorio, L.M.; Adachi, J.D.; Thabane, L.

2012-01-01

The opinions expressed in the abstracts are those of the authors and are not to be construed as the opinion of the publisher (Canadian Geriatrics Society) or the organizers of the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society. Although the publisher (Canadian Geriatrics Society) has made every effort to accurately reproduce the abstracts, the Canadian Geriatrics Society and the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society assumes no responsibility and/...

Delirium in the geriatric unit: proton-pump inhibitors and other risk factors.

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Otremba, Iwona; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. Evaluate specific factors for development of delirium in a geriatric ward setting. Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed. Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54-5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44-3.65; Pfall incidents (OR =1.76; CI =1.17-2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11-2.53; P=0.014). Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.

An under-diagnosed geriatric syndrome: sleep disorders among older adults.

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Tufan, Asli; Ilhan, Birkan; Bahat, Gulistan; Karan, Mehmet Akif

2017-06-01

Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered 'yes' to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment.

Continuing interprofessional education in geriatrics and gerontology in medically underserved areas.

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Toner, John A; Ferguson, K Della; Sokal, Regina Davis

2009-01-01

There is a widening gap between the health care needs of older persons and the treatment skills of the health care professionals who serve them. This gap is especially severe in rural areas, where there is a shortage of and inadequate collaboration between health care professionals and poor access to services for older persons. There is also a special opportunity in rural areas, particularly those designated as "medically underserved," for continuing interprofessional education as a vehicle for retaining health care professionals who tend to leave medically underserved areas for more lucrative professional opportunities elsewhere. In collaboration with the Consortium of New York Geriatric Education Centers, the Columbia-New York Geriatric Education Center at the Stroud Center of Columbia University has developed the Program for Outreach to Interprofessional Services and Education (POISE). The purpose of POISE is to develop, implement, evaluate, and sustain interprofessional education and training for health care learners, while emphasizing improved access to health services for the geriatric population in medically underserved areas. The POISE model was designed as an effective approach to teaching the core geriatrics and gerontology curriculum endorsed by the national (U.S. Department of Health and Human Services) network of Geriatric Education Centers to health care learners in medically underserved areas of upstate New York. This article describes the adaptation and implementation of the POISE model.

The clinical features of foreign body aspiration into the lower airway in geriatric patients

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Lin LJ

2014-09-01

Full Text Available Lianjun Lin,1 Liping Lv,2,* Yuchuan Wang,1 Xiankui Zha,2 Fei Tang,2 Xinmin Liu1,* 1Geriatric Department, Peking University First Hospital, Beijing, People’s Republic of China; 2Pulmonary Intervention Department, Anhui Chest Hospital, Hefei, People’s Republic of China *These authors contributed equally to this work Purpose: To analyze the clinical features of foreign-body aspiration into the lower airway in geriatric patients. Patients and methods: The clinical data of 17 geriatric patients with foreign-body aspiration were retrospectively analyzed and compared with 26 nongeriatric adult patients. The data were collected from Peking University First Hospital and Anhui Chest Hospital between January 2000 and June 2014.Results: (1 In the geriatric group, the most common symptoms were cough and sputum (15 cases, 88%, dyspnea (six cases, 35%, and hemoptysis (four cases, 24%. Five patients (29% in the geriatric group could supply the history of aspiration on their first visit to doctor, a smaller percentage than in the nongeriatric group (13 cases, 50%. Only three cases in the geriatric group were diagnosed definitely without delay. Another 14 cases were misdiagnosed as pneumonia or lung cancer, and the time of delayed diagnosis ranged from 1 month to 3 years. Complications due to delay in diagnosis included obstructive pneumonitis, atelectasis, lung abscess, and pleural effusion. (2 Chest computed tomography demonstrated the foreign body in three cases (21% in the geriatric group, which was lower than the positive proportion of detection in the nongeriatric group (nine cases, 35%. The most common type of foreign body in the geriatric group was food, such as bone fragments (seven cases, 41% and plants (seven cases, 41%, and the foreign body was most often lodged in the right bronchus tree (eleven cases, 65%, especially the right lower bronchus (seven cases, 41%. Flexible bronchoscopy removed the foreign body successfully in all patients

Gait characteristics and their discriminative power in geriatric patients with and without cognitive impairment.

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Kikkert, Lisette H J; Vuillerme, Nicolas; van Campen, Jos P; Appels, Bregje A; Hortobágyi, Tibor; Lamoth, Claudine J C

2017-08-15

A detailed gait analysis (e.g., measures related to speed, self-affinity, stability, and variability) can help to unravel the underlying causes of gait dysfunction, and identify cognitive impairment. However, because geriatric patients present with multiple conditions that also affect gait, results from healthy old adults cannot easily be extrapolated to geriatric patients. Hence, we (1) quantified gait outcomes based on dynamical systems theory, and (2) determined their discriminative power in three groups: healthy old adults, geriatric patients with- and geriatric patients without cognitive impairment. For the present cross-sectional study, 25 healthy old adults recruited from community (65 ± 5.5 years), and 70 geriatric patients with (n = 39) and without (n = 31) cognitive impairment from the geriatric dayclinic of the MC Slotervaart hospital in Amsterdam (80 ± 6.6 years) were included. Participants walked for 3 min during single- and dual-tasking at self-selected speed while 3D trunk accelerations were registered with an IPod touch G4. We quantified 23 gait outcomes that reflect multiple gait aspects. A multivariate model was built using Partial Least Square- Discriminant Analysis (PLS-DA) that best modelled participant group from gait outcomes. For single-task walking, the PLS-DA model consisted of 4 Latent Variables that explained 63 and 41% of the variance in gait outcomes and group, respectively. Outcomes related to speed, regularity, predictability, and stability of trunk accelerations revealed with the highest discriminative power (VIP > 1). A high proportion of healthy old adults (96 and 93% for single- and dual-task, respectively) was correctly classified based on the gait outcomes. The discrimination of geriatric patients with and without cognitive impairment was poor, with 57% (single-task) and 64% (dual-task) of the patients misclassified. While geriatric patients vs. healthy old adults walked slower, and less regular, predictable, and

Evaluation of a geriatric assessment unit

NARCIS (Netherlands)

Gerritsen, J.C.; van der Ende, P.C.; Wolffensperger, Edwin; Boom, René

Psychogeriatric patients are a very vulnerable group among the elderly. A relative large proportion is institutionalized. In addition, many studies point to the heavy burden on the informal carers of psychogeriatric patients, frequently leading to depression. Geriatric expertise in primary care,

EVALUATION OF A GERIATRIC ASSESSMENT UNIT

NARCIS (Netherlands)

GERRITSEN, JC; VAN DER ENDE, PC; WOLFFENSPERGER, EW; BOOM, RC

Psychogeriatric patients are a very vulnerable group among the elderly. A relative large proportion is institutionalized. In addition, many studies point to the heavy burden on the informal carers of psychogeriatric patients, frequently leading to depression. Geriatric expertise in primary care,

Why medical students do not choose a career in geriatrics: a systematic review.

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Meiboom, Ariadne A; de Vries, Henk; Hertogh, Cees M P M; Scheele, Fedde

2015-06-05

While the demand for doctors specialised in the medical care of elderly patients is increasing, the interest among medical students for a career in geriatrics is lagging behind. To get an overview of the different factors reported in the literature that affect the (low) interest among medical students for a career in geriatrics, a systematic literature search was conducted using PubMed, Embase, PsycINFO, and ERIC. Quality assessment criteria were applied. Twenty studies met the criteria and were included in the review. In relation to the nature of the work, the preference of medical students is young patients, and acute somatic diseases that can be cured. The complexity of the geriatric patient deters students from choosing this specialty. Exposure by means of pre-clinical and particularly clinical education increases interest. The lack of status and the financial aspects have a negative influence on interest. Exposure to geriatrics by means of education is necessary. The challenge in geriatric education is to show the rewarding aspects of the specialty.

Improved Functional Performance in Geriatric Patients During Hospital Stay

DEFF Research Database (Denmark)

Karlsen, Anders; Loeb, Mads Rohde; Andersen, Kristine Bramsen

2017-01-01

OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.Measurement......OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.......Measurements were obtained on days 2 to 4, day 5 to 8, and days 9 to 13. Functional performance was measured with De Morton Mobility Index (DEMMI) test and a 30-second chair stand test (30-s CST). Muscular strength was measured with handgrip strength. Activity level was determined with accelerometry (Activ...... in 30-s CST (P performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay...

Dietary Intake of Minerals, Vitamins, and Trace Elements Among Geriatric Population in India.

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Gupta, Aakriti; Khenduja, Preetika; Pandey, Ravindra Mohan; Sati, Hem Chandra; Sofi, Nighat Yaseen; Kapil, Umesh

2017-11-01

The geriatric population is at a high risk of developing deficiencies of essential micronutrients such as minerals, vitamins, and trace elements and their related deficiency signs and symptoms. Scarce data is available on the dietary intake of essential micronutrients among geriatric subjects in India. Hence, to fill the gap in the existing knowledge, a community-based cross-sectional study was conducted during 2015-2016 in District Nainital, Uttarakhand State, India. A total of 255 geriatric subjects were enrolled from 30 clusters (villages) identified by using population proportionate to size sampling methodology. Data were collected on sociodemographic profile and dietary intake of essential micronutrients (24-h dietary recall, food frequency questionnaire) from all the geriatric subjects. A high percentage of geriatric subjects did not consume the recommended daily intake for essential micronutrients such as energy (78%), protein (78%), calcium (51%), thiamine (33%), riboflavin (64%), niacin (88%), vitamin C (42%), iron (72%), folic acid (72%), magnesium (48%), zinc (98%), copper (81%) and chromium (89%) adequately. Food groups rich in essential micronutrients such as pulses, green leafy vegetables, roots and tubers, other vegetables, fruits, nonvegetarian food items, and milk and milk products were consumed irregularly by the subjects. The overall intake of energy and essential micronutrients was inadequate among the geriatric population in India, possibly due to poor quality and quantity of the diet consumed.

[Regional geriatric team--a model for cooperation between nursing homes and hospitals].

Science.gov (United States)

Sellaeg, Wenche Frogn

2005-04-21

Few studies describe and evaluate the use of ambulatory geriatric teams in nursing homes. This article gives an account of a model in which a multidisciplinary group from the local hospital has been visiting 17 communities in Norway twice a year for 11 years. The ambulatory geriatric team includes a geriatrician, a geriatric nurse, a physiotherapist and an occupational therapist. Their aim is to raise the quality of geriatric assessment and care and to enhance the cooperation between the hospital and the nursing homes in the communities. The team members are doing a comprehensive geriatric assessment of some of the patients; they assess cases for further referral, and examine patients with declining functioning with a view to rehabilitation. The team provides instruction in various aspects of geriatrics to community care professionals. Much time is devoted to discussions on problems raised by the staff, such as management of patients with dementia-related behavioural problems, and to provide feedback to staff-members. The team liaise between hospitals, nursing homes and community care services in the communities in order to enhance communication between the professionals involved. An evaluation of the team was done on behalf of the National Institute of Health through a postal questionnaire which was returned by 223 doctors, nurses and allied health care professionals. The results indicate that visits by the ambulatory team improve the knowledge of doctors and allied professionals about diseases in the elderly; 92% reported that they now felt they were doing a better job.

Geriatric gambling disorder: challenges in clinical assessment.

Science.gov (United States)

Smith, Mara; Hategan, Ana; Bourgeois, James A

2017-12-01

To the Editor: The gaming industry is growing rapidly, as is the proportion of older adults aged 65 years or older who participate in gambling (Tse et al., 2012). With casinos tailoring their venues and providing incentives to attract older adults, and with the increasing popularity of "pleasure trips" to casinos organized by retirement homes, plus active promotion of government-operated lotteries in many countries, this trend is likely to continue. Gambling disorder (GD) or "pathological" or "problem" gambling presents a public health concern in the geriatric population. However, ascertainment of its prevalence and diagnostic accuracy have proven challenging. This is largely due to the absence of diagnostic criteria specific to the geriatric age and rating scales validated for use in this population.

Analysis of cytopenia in geriatric inpatients.

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Röhrig, G; Becker, I; Pappas, K; Polidori, M C; Schulz, R J

2018-02-01

Peripheral blood dyscrasias in older patients are repeatedly seen in geriatric clinical practice; however, there is substantial lack of data about the epidemiology, possible causes and treatment options in this patient group. Proton pump inhibitors (PPI) are extensively used in older patients and associated with leukopenia. The primary objective of this study was the assessment of encoded cytopenia prevalence in a geriatric patient cohort and the secondary objective was the assessment of putative causes and the analysis of PPI administration in patients with cytopenia. Retrospective evaluation of patients admitted to the geriatric department of a German urban hospital between 2010 and 2012. Electronic patient data were screened for encoded diagnosis of cytopenia according to the International Classification of Diseases (ICD) 10. Inclusion criteria were ICD code D69.0-9 and/or D70.0-7, age ≥60 years and exclusion criteria were no ICD code D69.0-9 and/or D70.0-7 and age <60 years. Out of 9328 screened inpatients 54 patients remained for analysis. Study parameters included hemoglobin (Hb), red blood cell count (RBC), leucocytes, platelets, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), presence of leukopenia (<4000/µl), presence of thrombocytopenia (<140,000/µl) and presence of anemia according to the World Health Organization (WHO). Substitution of blood products, medication with PPI and potential causes for dyscrasias were evaluated based on electronic patient records. The mean age was 78.3 ± 6.5 years (27 females, 27 males), anemia was seen in 78%, leukopenia was encoded in13% and thrombocytopenia in 44.4%. In most of the patients no substitution of blood products was documented. In most of the patients (20.4%) cytopenia was attributed to either heparin-induced thrombocytopenia (HIT) or hemato-oncologic (20.4%) diseases, followed by drug association in 18

Geriatric assessment in daily oncology practice for nurses and allied health care professionals: Opinion paper of the Nursing and Allied Health Interest Group of the International Society of Geriatric Oncology (SIOG).

Science.gov (United States)

Burhenn, Peggy S; McCarthy, Alexandra L; Begue, Aaron; Nightingale, Ginah; Cheng, Karis; Kenis, Cindy

2016-09-01

The management of older persons with cancer has become a major public health concern in developed countries because of the aging of the population and the steady increase in cancer incidence with advancing age. Nurses and allied health care professionals are challenged to address the needs of this growing population. The International Society of Geriatric Oncology (SIOG) Nursing and Allied Health (NAH) Interest Group described key issues that nurses and allied health care professionals face when caring for older persons with cancer. The domains of the Geriatric Assessment (GA) are used as a guiding framework. The following geriatric domains are described: demographic data and social support, functional status, cognition, mental health, nutritional status, fatigue, comorbidities, polypharmacy, and other geriatric syndromes (e.g. falls, delirium). In addition to these geriatric domains, quality of life (QoL) is described based on the overall importance in this particular population. Advice for integration of assessment of these geriatric domains into daily oncology practice is made. Research has mainly focused on the role of treating physicians but the involvement of nurses and allied health care professionals is crucial in the care of older persons with cancer through the GA process. The ability of nurses and allied health care professionals to perform this assessment requires specialized training and education beyond standard oncology knowledge. Copyright © 2016 Elsevier Inc. All rights reserved.

Developing osteopathic competencies in geriatrics for medical students.

Science.gov (United States)

Noll, Donald R; Channell, Millicent King; Basehore, Pamela M; Pomerantz, Sherry C; Ciesielski, Janice; Eigbe, Patrick Arekhandia; Chopra, Anita

2013-04-01

Minimum core competencies for allopathic medical students in the specialty area of geriatrics have been developed, comprising 26 competencies divided into 8 topical domains. These competencies are appropriate for osteopathic medical students, but they do not include competencies relating to osteopathic principles and practice (OPP) in geriatrics. There remains a need within the osteopathic profession to develop specialty-specific competencies specific to OPP. To develop more specific and comprehensive minimum competencies in OPP for osteopathic medical students in the field of geriatric medicine. The Delphi technique (a structured communication technique that uses a panel of experts to reach consensus) was adapted to generate new core competencies relating to OPP. Osteopathic geriatricians and members of the Educational Council on Osteopathic Principles (ECOP) of the American Association of Colleges of Osteopathic Medicine participated in a breakout session and 2 rounds of surveys. Proposed competencies with 80% of the participants ranking it as "very important and should be added as a competency" were retained. Participants were also asked if they agreed that competencies in OPP should include specific types of osteopathic manipulative treatment techniques for the elderly. Responses were received from 26 osteopathic physician experts: 17 ECOP members and 9 geriatricians. Fourteen proposed competencies were developed: 7 related to the existing topic domains, and 7 were placed into a new domain of osteopathic manipulative medicine (OMM). Six proposed competencies were retained, all of which were in the new OMM domain. These competencies related to using OMM for gait and balance assessment, knowing adverse events and contraindications of OMM, using OMM for pain relief and end-of-life care, using OMM in the hospital and nursing home setting, adapting OMM to fit an elderly individual, and using OMM to address limited range of motion and ability to perform activities of

Geritalk: Communication Skills Training for Geriatrics and Palliative Medicine Fellows

Science.gov (United States)

Kelley, Amy S.; Back, Anthony L.; Arnold, Robert M.; Goldberg, Gabrielle R.; Lim, Betty B.; Litrivis, Evgenia; Smith, Cardinale B.; O’Neill, Lynn B.

2011-01-01

Expert communication is essential to high quality care for older patients with serious illness. While the importance of communication skills is widely recognized, formal curricula for teaching communication skills to geriatrics and palliative medicine fellows is often inadequate or unavailable. We drew upon the educational principles and format of an evidence-based, interactive teaching method, to develop an intensive communication skills training course designed specifically to address the common communication challenges faced by geriatrics and palliative medicine fellows. The 2-day retreat, held away from the hospital environment, included large-group overview presentations, small-group communication skills practice, and development of future skills practice commitment. Faculty received in-depth training in small-group facilitation techniques prior to the course. Geriatrics and palliative medicine fellows were recruited to participate in the course and 100% (n=18) enrolled. Overall satisfaction with the course was very high (mean 4.8 on 5-point scale). Compared to before the course, fellows reported an increase in self-assessed preparedness for specific communication challenges (mean increase 1.4 on 5-point scale, pcommunication skills program, tailored to the specific needs of geriatrics and palliative medicine fellows, improved fellows’ self-assessed preparedness for challenging communication tasks and provided a model for ongoing deliberate practice of communication skills. PMID:22211768

A Model of Interdisciplinary Ambulatory Geriatric Care in a Veterans Administration Medical Center.

Science.gov (United States)

Millman, Andrea; And Others

1986-01-01

Presents a model of outpatient interdisciplinary geriatric care provided at a veteran's hospital. Compares characteristics of patients served in this program with those in community-based geriatrics outpatient clinics described in the literature. (Author/ABB)

[Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits].

Science.gov (United States)

Pareja, Teresa; Hornillos, Mercedes; Rodríguez, Miriam; Martínez, Javier; Madrigal, María; Mauleón, Coro; Alvarez, Bárbara

2009-01-01

To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.

Assesment of Disabled Geriatric Health Council Reports

Directory of Open Access Journals (Sweden)

Cem Sahin

2014-12-01

Full Text Available Aim: In this study it is aimed to evaluate geriatric patients who apply to health council. Material and Method:The study retrospectively assessed 3112 patients admitted to the disability ward, of which 601 geriatric patients were included in the study. Results: Of the 601 patients, 53.1% were men and 46.9% were women. The mean age of these patients was 60 (std ± 18.35 years. Some of the reasons for admission in the hospital were need for social services (45.6% and determination of disability rate (21.6%. Most common diseases in patients aged %u226565 years were hypertension (21.6%, diabetes (12.6%, and chronic obstructive lung disease and dilated cardiomyopathy (3.7%; p 0.05. Internal disability rate was not statistically significant (p > 0.05, but total disability was statistically significant (p < 0.05. Moreover, prevalence of additional conditions was statistically significant (p < 0.05 in patients aged %u226565 years.Discussion: Rapid increases in life expectancy and number of older people has increased the prevalence of disabilities among older people. Being diagnosed with chronic diseases should not be the end of life for geriatric populations. Their mood, social life, general health, and mental profile should progress. Sufficient attention should be paid to the special needs of older patients thereby leading to a wider use of facilities.

Medications Associated with Geriatric Syndromes (MAGS) and their Prevalence in Older Hospitalized Adults Discharged to Skilled Nursing Facilities

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Saraf, Avantika A.; Peterson, Alec W.; Simmons, Sandra F.; Schnelle, John F.; Bell, Susan P.; Kripalani, Sunil; Myers, Amy P.; Mixon, Amanda S.; Long, Emily A.; Jacobsen, J. Mary Lou; Vasilevskis, Eduard E.

2016-01-01

Background More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than three geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. Objectives Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to skilled nursing facilities (SNFs) Design Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. Setting Academic Medical Center in the United States Participants 154 hospitalized Medicare beneficiaries discharged to SNFs Measurements Development of a list of medications that are associated with six geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. Results A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes while antipsychotics, antidepressants, antiparkinsonism and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge, 5.5 (±2.2). Conclusions Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. PMID:27255830

Predicting the mortality in geriatric patients with dengue fever

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Huang, Hung-Sheng; Hsu, Chien-Chin; Ye, Je-Chiuan; Su, Shih-Bin; Huang, Chien-Cheng; Lin, Hung-Jung

2017-01-01

Abstract Geriatric patients have high mortality for dengue fever (DF); however, there is no adequate method to predict mortality in geriatric patients. Therefore, we conducted this study to develop a tool in an attempt to address this issue. We conducted a retrospective case–control study in a tertiary medical center during the DF outbreak in Taiwan in 2015. All the geriatric patients (aged ≥65 years) who visited the study hospital between September 1, 2015, and December 31, 2015, were recruited into this study. Variables included demographic data, vital signs, symptoms and signs, comorbidities, living status, laboratory data, and 30-day mortality. We investigated independent mortality predictors by univariate analysis and multivariate logistic regression analysis and then combined these predictors to predict the mortality. A total of 627 geriatric DF patients were recruited, with a mortality rate of 4.3% (27 deaths and 600 survivals). The following 4 independent mortality predictors were identified: severe coma [Glasgow Coma Scale: ≤8; adjusted odds ratio (AOR): 11.36; 95% confidence interval (CI): 1.89–68.19], bedridden (AOR: 10.46; 95% CI: 1.58–69.16), severe hepatitis (aspartate aminotransferase >1000 U/L; AOR: 96.08; 95% CI: 14.11–654.40), and renal failure (serum creatinine >2 mg/dL; AOR: 6.03; 95% CI: 1.50–24.24). When we combined the predictors, we found that the sensitivity, specificity, positive predictive value, and negative predictive value for patients with 1 or more predictors were 70.37%, 88.17%, 21.11%, and 98.51%, respectively. For patients with 2 or more predictors, the respective values were 33.33%, 99.44%, 57.14%, and 98.51%. We developed a new method to help decision making. Among geriatric patients with none of the predictors, the survival rate was 98.51%, and among those with 2 or more predictors, the mortality rate was 57.14%. This method is simple and useful, especially in an outbreak. PMID:28906367

A Proposed Curriculum Model for Geriatric Optometry.

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Rosenbloom, Albert A.

1985-01-01

A model for a geriatric optometry curriculum that defines key content areas and addresses the values essential for effective practice and basic therapeutic modalities used in treatment regimens with older adults is outlined. (MSE)

A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

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Chong Mei

2011-08-01

Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

Rationale and methods of the multicenter randomised trial of a heart failure management programme among geriatric patients (HF-Geriatrics

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Casado Jose

2011-08-01

Full Text Available Abstract Background Disease management programmes (DMPs have been shown to reduce hospital readmissions and mortality in adults with heart failure (HF, but their effectiveness in elderly patients or in those with major comorbidity is unknown. The Multicenter Randomised Trial of a Heart Failure Management Programme among Geriatric Patients (HF-Geriatrics assesses the effectiveness of a DMP in elderly patients with HF and major comorbidity. Methods/Design Clinical trial in 700 patients aged ≥ 75 years admitted with a primary diagnosis of HF in the acute care unit of eight geriatric services in Spain. Each patient should meet at least one of the following comorbidty criteria: Charlson index ≥ 3, dependence in ≥ 2 activities of daily living, treatment with ≥ 5 drugs, active treatment for ≥ 3 diseases, recent emergency hospitalization, severe visual or hearing loss, cognitive impairment, Parkinson's disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD, anaemia, or constitutional syndrome. Half of the patients will be randomly assigned to a 1-year DMP led by a case manager and the other half to usual care. The DMP consists of an educational programme for patients and caregivers on the management of HF, COPD (knowledge of the disease, smoking cessation, immunizations, use of inhaled medication, recognition of exacerbations, diabetes (knowledge of the disease, symptoms of hyperglycaemia and hypoglycaemia, self-adjustment of insulin, foot care and depression (knowledge of the disease, diagnosis and treatment. It also includes close monitoring of the symptoms of decompensation and optimisation of treatment compliance. The main outcome variables are quality of life, hospital readmissions, and overall mortality during a 12-month follow-up. Discussion The physiological changes, lower life expectancy, comorbidity and low health literacy associated with aging may influence the effectiveness of DMPs in HF. The HF-Geriatrics study

A comparison of pharmacy students' and active older adults' perceptions regarding geriatric quality of life.

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Gilligan, Adrienne M; Loui, James Aaron; Mezdo, Ashorena; Patel, Nikita; Lee, Jeannie K

2014-02-12

To measure perceptions of quality of life (QOL) in an active geriatric population and compare their responses with pharmacy students' perceptions of older adult QOL. Pharmacy students and active older adults completed the modified and standard version of a validated health survey instrument, respectively, and their responses were compared. Eighty-six students and 20 active older adults participated. Student perceptions of geriatric QOL were significantly lower in all domains except health change compared to older adult perceptions (p<0.001 for all domains). Interest in a geriatric pharmacy career (p=0.04) and previously having taken the Perspectives in Geriatrics course and laboratory (p=0.05 and 0.02, respectively) were significantly associated with higher student scores on the physical component portion of the survey. Stronger emphasis on geriatric QOL within pharmacy curricula may improve pharmacy students' perceptions regarding outcomes related to healthy older adults.

9 CFR 381.157 - Canned boned poultry and baby or geriatric food.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Canned boned poultry and baby or geriatric food. 381.157 Section 381.157 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Standards of Identity or Composition § 381.157 Canned boned poultry and baby or geriatric food. (a) Canned...

Burden of Geriatric Events Among Older Adults Undergoing Major Cancer Surgery.

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Tan, Hung-Jui; Saliba, Debra; Kwan, Lorna; Moore, Alison A; Litwin, Mark S

2016-04-10

Most malignancies are diagnosed in older adults who are potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought to assess the prevalence and ramifications of geriatric events during major surgery for cancer. Using Nationwide Inpatient Sample data from 2009 to 2011, we examined hospital admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes. Within a weighted sample of 939,150 patients, we identified at least one event in 9.2% of patients. Geriatric events were most common among patients age ≥ 75 years, with a Charlson comorbidity score ≥ 2, and who were undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach (P geriatric event had a greater likelihood of concurrent complications (odds ratio [OR], 3.73; 95% CI, 3.55 to 3.92), prolonged hospitalization (OR, 5.47; 95% CI, 5.16 to 5.80), incurring high cost (OR, 4.97; 95% CI, 4.58 to 5.39), inpatient mortality (OR, 3.22; 95% CI, 2.94 to 3.53), and a discharge disposition other than home (OR, 3.64; 95% CI, 3.46 to 3.84). Many older patients who receive cancer-directed surgery experience a geriatric event, particularly those who undergo major abdominal surgery. These events are linked to operative morbidity, prolonged hospitalization, and more expensive health care. As our population ages, efforts focused on addressing conditions and complications that are more common in older adults will be essential to delivering high-quality cancer care. © 2016 by

[Activating therapeutic care in geriatrics : Evaluation of a practice concept].

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Acklau, Stefanie; Gödecker, Lisa; Kaden, Andrea; Jahn, Patrick

2016-10-01

The special feature of the concept of activating therapeutic care in geriatrics (ATP-G) is based on the focus of nursing and therapeutic elements specifically related to the elderly. Further significance lies in the bottom-up development of this concept, which shows a close proximity to the nursing practice. The research project targeted the characteristics of ATP-G from a nursing point of view. Furthermore, the resulting elements of professional nursing care understanding for inpatient geriatric rehabilitation were used to build a scientific and theoretical foundation of the ATP-G concept. In this study 12 semi-structured interviews with professional caregivers were realized. The data collection was undertaken in three different facilities of inpatient geriatric (early) rehabilitation, chosen by lot. The data analysis was based on the methodology of qualitative content analysis according to Mayring. The research project showed that the basic elements described in the ATP-G concept are consistent with the view of nursing practitioners and therefore reflect the characteristic features of routine daily practice; nonetheless, some new aspects were found, primarily the importance of interdisciplinary teamwork in geriatric settings. There were also difficulties related to the ATP-G concept which were experienced as restraints by the questioned professionals. Further research should therefore investigate the structures for optimal implementation of the ATP-G concept into standard practice.

Nursing Assessment and Intervention to Geriatric Patients Discharged From Emergency Department

DEFF Research Database (Denmark)

Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten

% of geriatric patients have complex and often unresolved caring needs. Objective: To examine the effect of a two-stage nursing assessment and intervention to address the patients uncompensated problems given just after discharge from ED and one and six months after. Method: We conducted a prospective...... nursing assessment comprising a checklist of 10 physical, mental, medical and social items. The focus was on unresolved problems which require medical intervention, new or different home care services, or comprehensive geriatric assessment. Following this the nurses made relevant referrals...... to the geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Findings: Primary endpoints will be presented as unplanned readmission to ED; admission to nursing home; and death. Secondary endpoints will be presented as physical function; depressive symptoms...

Multimorbidity Patterns in Hospitalized Older Patients: Associations among Chronic Diseases and Geriatric Syndromes.

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Mercedes Clerencia-Sierra

Full Text Available The clinical status of older individuals with multimorbidity can be further complicated by concomitant geriatric syndromes. This study explores multimorbidity patterns, encompassing both chronic diseases and geriatric syndromes, in geriatric patients attended in an acute hospital setting.Retrospective observational study.Unit of Social and Clinical Assessment (UVSS, Miguel Servet University Hospital (HUMS, Zaragoza (Spain. Year, 2011.A total of 924 hospitalized patients aged 65 years or older.Data on patients' clinical, functional, cognitive and social statuses were gathered through comprehensive geriatric assessments. To identify diseases and/or geriatric syndromes that cluster into patterns, an exploratory factor analysis was applied, stratifying by sex. The factors can be interpreted as multimorbidity patterns, i.e., diseases non-randomly associated with each other within the study population. The resulting patterns were clinically assessed by several physicians.The mean age of the study population was 82.1 years (SD 7.2. Multimorbidity burden was lower in men under 80 years, but increased in those over 80. Immobility, urinary incontinence, hypertension, falls, dementia, cognitive decline, diabetes and arrhythmia were among the 10 most frequent health problems in both sexes, with prevalence rates above 20%. Four multimorbidity patterns were identified that were present in both sexes: Cardiovascular, Induced Dependency, Falls and Osteoarticular. The number of conditions comprising these patterns was similar in men and women.The existence of specific multimorbidity patterns in geriatric patients, such as the Induced Dependency and Falls patterns, may facilitate the early detection of vulnerability to stressors, thus helping to avoid negative health outcomes such as functional disability.

The growth of gerontology and geriatrics in Mexico: Past, present, and future.

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Rivera-Hernandez, Maricruz; Flores Cerqueda, Sergio; García Ramírez, José Carlos

2017-01-01

Life expectancy is increasing in Mexico, creating new opportunities and challenges in different areas, including gerontology and geriatric education and research. Although in the European Union there are more than 3,000 institutions that focus on aging research, in Latin America there are only 250 programs where theoretical and practical knowledge is taught. In Mexico, the number of institutions that offer gerontology and geriatric education is relatively small. One of the major concerns is that Mexico is not adequately prepared to optimally deal with the aging of its population. Thus, the main challenge that Mexico faces is to train practitioners, researchers, and policy makers to be able to respond to the aging priorities of this country. The goal of this review is to investigate the literature regarding 60 years in the fields of gerontology and geriatrics in Mexico. Even when programs have evolved within the past decades, there are some challenges to gerontological and geriatric education and aging research in Mexico. The implications for Mexico are discussed, as well as opportunities for moving these fields forward.

Venlafaxine-Induced Orthostatic Hypotension in a Geriatric Patient

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Vidyashree Chikkaramanjegowda

2013-01-01

Full Text Available Venlafaxine is not usually associated with risk of orthostatic hypotension. A 65-year-old US Caucasian female taking 225 mg/day of venlafaxine extended-release developed symptomatic orthostatic hypotension. The systolic and diastolic blood pressure dropped by 25 and 18 mm Hg, respectively, from supine position to standing position within 3 minutes. The patient was otherwise healthy and the orthostatic hypotension resolved with venlafaxine discontinuation. This was a probable venlafaxine adverse drug reaction according to the Naranjo scale. This case contributes to the scarce literature that indicates that clinicians need to be aware that occasionally venlafaxine can induce clinically significant orthostatic hypotension, particularly in geriatric patients. Our patient did not have orthostatic hypotension when she was taking venlafaxine at 60 years of age in higher venlafaxine doses (300 mg/day but developed this adverse drug reaction when venlafaxine was restarted at the geriatric age. This case indicates that a history of prior tolerance to venlafaxine does not guarantee tolerance after 65 years of age. If a clinician decides to use venlafaxine in geriatric patients, the clinician should warn the patient about the risk of orthostatic hypotension and consider very slow titration and low doses.

Outcomes and provider perspectives on geriatric care by a nurse practitioner-led community paramedicine program.

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Kant, Rebecca E; Vejar, Maria; Parnes, Bennett; Mulder, Joy; Daddato, Andrea; Matlock, Daniel D; Lum, Hillary D

2018-05-03

This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016-May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care. Published by Elsevier Inc.

Gerontology and geriatrics in Dutch medical education.

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Tersmette, W; van Bodegom, D; van Heemst, D; Stott, D; Westendorp, R

2013-01-01

The world population is ageing and healthcare services require trained staff who can address the needs of older patients. In this study we determined how current medical education prepares Dutch students of medicine in the field of Gerontology and Geriatrics (G&G). Using a checklist of the essentials of G&G, we assessed Dutch medical education on three levels. On the national level we analysed the latest National Blueprint for higher medical education (Raamplan artsopleiding 2009). On the faculty level we reviewed medical curricula on the basis of interviews with program directors and inspection of course materials. On the student level we assessed the topics addressed in the questions of the cross-institutional progress test (CIPT). The National Bluepr int contains few specific G&G objectives. Obligatory G&G courses in medical schools on average amount to 2.2% of the total curriculum measured as European Credit Transfer System units (ECTS). Only two out of eight medical schools have practical training during the Master phase in the form of a clerkship in G&G. In the CIPT, on average 1.5% of questions cover G&G. Geriatric education in the Netherlands does not seem to be in line with current demographic trends. The National Blueprint falls short of providing sufficiently detailed objectives for education on the care of older people. The geriatric content offered by medical schools is varied and incomplete, and students are only marginally tested on their knowledge of G&G in the CIPT.

What to Expect from the Evolving Field of Geriatric Cardiology

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Bell, Susan P.; Orr, Nicole M.; Dodson, John A.; Rich, Michael W.; Wenger, Nanette K.; Blum, Kay; Harold, John Gordon; Tinetti, Mary; Maurer, Mathew S.; Forman, Daniel E.

2016-01-01

The population of older adults is expanding rapidly and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. While some assume a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, and thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients. PMID:26361161

[Geriatrics and gerontology in Senegal].

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Coumé, Mamadou; Touré, Kamadore; Faye, Atoumane; Moreira, Therese Diop

2013-01-01

Senegal is dealing positively with its demographic transition. On September 1st 2006, the Senegalese government introduced the "Plan Sesame", a national free health care program for elderly people aged 60 years and over. The University of Dakar academic authorities support the Sesame plan through an innovative training program in geriatrics and gerontology. Such programs aim to address the challenge of ageing in a developing country.

Spatial Variability of Geriatric Depression Risk in a High-Density City: A Data-Driven Socio-Environmental Vulnerability Mapping Approach.

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Ho, Hung Chak; Lau, Kevin Ka-Lun; Yu, Ruby; Wang, Dan; Woo, Jean; Kwok, Timothy Chi Yui; Ng, Edward

2017-08-31

Previous studies found a relationship between geriatric depression and social deprivation. However, most studies did not include environmental factors in the statistical models, introducing a bias to estimate geriatric depression risk because the urban environment was found to have significant associations with mental health. We developed a cross-sectional study with a binomial logistic regression to examine the geriatric depression risk of a high-density city based on five social vulnerability factors and four environmental measures. We constructed a socio-environmental vulnerability index by including the significant variables to map the geriatric depression risk in Hong Kong, a high-density city characterized by compact urban environment and high-rise buildings. Crude and adjusted odds ratios (ORs) of the variables were significantly different, indicating that both social and environmental variables should be included as confounding factors. For the comprehensive model controlled by all confounding factors, older adults who were of lower education had the highest geriatric depression risks (OR: 1.60 (1.21, 2.12)). Higher percentage of residential area and greater variation in building height within the neighborhood also contributed to geriatric depression risk in Hong Kong, while average building height had negative association with geriatric depression risk. In addition, the socio-environmental vulnerability index showed that higher scores were associated with higher geriatric depression risk at neighborhood scale. The results of mapping and cross-section model suggested that geriatric depression risk was associated with a compact living environment with low socio-economic conditions in historical urban areas in Hong Kong. In conclusion, our study found a significant difference in geriatric depression risk between unadjusted and adjusted models, suggesting the importance of including environmental factors in estimating geriatric depression risk. We also

Orthostatic hypotension and overall mortality in 1050 older patients of the outpatient comprehensive geriatric assessment unit.

Science.gov (United States)

Freud, Tamar; Punchik, Boris; Kagan, Ella; Barzak, Alex; Press, Yan

2018-03-02

Orthostatic hypotension is a common problem in individuals aged ≥65 years. Its association with mortality is not clear. The aim of the present study was to evaluate associations between orthostatic hypotension and overall mortality in a sample of individuals aged ≥65 years who were seen at the Outpatient Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel. Individuals who were evaluated in the Outpatient Comprehensive Geriatric Assessment Unit between January 2005 and December 2015, and who had data on orthostatic hypotension were included in the study. The database included sociodemographic characteristics, body mass index, functional and cognitive state, geriatric syndromes reached over the course of the assessment, and comorbidity. Data on mortality were also collected. The study sample included 1050 people, of whom 626 underwent comprehensive geriatric assessment and 424 underwent geriatric consultation. The mean age was 77.3 ± 5.4 years and 35.7% were men. Orthostatic hypotension was diagnosed in 294 patients (28.0%). In univariate analysis, orthostatic hypotension was associated with overall mortality only in patients aged 65-75 years (HR 1.5, 95% CI 1.07-2.2), but in the multivariate model this association disappeared. In older frail patients, orthostatic hypotension was not an independent risk factor for overall mortality. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

A novel multidimensional geriatric screening tool in the ED: evaluation of feasibility and clinical relevance.

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Schoenenberger, Andreas W; Bieri, Christoph; Özgüler, Onur; Moser, André; Haberkern, Monika; Zimmermann, Heinz; Stuck, Andreas E; Exadaktylos, Aristomenis

2014-06-01

Geriatric problems frequently go undetected in older patients in emergency departments (EDs), thus increasing their risk of adverse outcomes. We evaluated a novel emergency geriatric screening (EGS) tool designed to detect geriatric problems. The EGS tool consisted of short validated instruments used to screen 4 domains (cognition, falls, mobility, and activities of daily living). Emergency geriatric screening was introduced for ED patients 75 years or older throughout a 4-month period. We analyzed the prevalence of abnormal EGS and whether EGS increased the number of EGS-related diagnoses in the ED during the screening, as compared with a preceding control period. Emergency geriatric screening was performed on 338 (42.5%) of 795 patients presenting during screening. Emergency geriatric screening was unfeasible in 175 patients (22.0%) because of life-threatening conditions and was not performed in 282 (35.5%) for logistical reasons. Emergency geriatric screening took less than 5 minutes to perform in most (85.8%) cases. Among screened patients, 285 (84.3%) had at least 1 abnormal EGS finding. In 270 of these patients, at least 1 abnormal EGS finding did not result in a diagnosis in the ED and was reported for further workup to subsequent care. During screening, 142 patients (42.0%) had at least 1 diagnosis listed within the 4 EGS domains, significantly more than the 29.3% in the control period (odds ratio 1.75; 95% confidence interval, 1.34-2.29; Pdeterminants of subsequent care. Copyright © 2014 Elsevier Inc. All rights reserved.

Integrating geriatrics into medical school: student journaling as an innovative strategy for evaluating curriculum.

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Shield, Renée R; Farrell, Timothy W; Nanda, Aman; Campbell, Susan E; Wetle, Terrie

2012-02-01

The Alpert Medical School of Brown University began to integrate geriatrics content into all preclerkship courses and key clerkship cases as part of a major medical school curriculum redesign in 2006. This study evaluates students' responses to geriatrics integration within the curriculum using journals kept by volunteer preclerkship and clerkship students between 2007 and 2010. The journals were used to assess the quality of curricular integration of geriatrics didactic and clinical content, to gather information for shaping the evolving curriculum, and to elicit students' responses about their professional development and caring for older adults. Student "journalers" wrote narrative reactions to and evaluations of aging-related content and exposure to older patients in response to written semistructured questions. An interdisciplinary team (including a health services researcher, gerontologist, medical anthropologist, and 2 geriatricians) used qualitative analysis to code the 405 journal entries. The team identified 10 themes within the following domains: (a) evaluation of efforts to integrate geriatrics within the medical school curriculum, (b) recognition and application of geriatrics principles, (c) student attitudes and cultural experiences regarding aging and the care of older patients, and (d) personal and professional development over time. Themes emerging within these domains reflect the effectiveness of geriatrics integration within the new curriculum as well as students' professional development. Journaling provides a novel and effective method for capturing medical students' responses to curricular content in real time, allowing for midcourse corrections and identifying key components of their professional development.

Distortion product otoacoustic emissions in young adult and geriatric cats.

Science.gov (United States)

Strain, George M; McGee, Kain A

2017-03-01

Recordings of distortion product otoacoustic emissions (DPOAEs) were taken from 15 geriatric cats (mean age ± standard deviation, SD, 13.6 ± 2.7 years; range 10.2-19.4 years) and 12 young adult control cats (mean ± SD 4.6 ± 0.5 years; range 3.4-5 years) to identify frequency-specific age-related changes in cochlear responses. Recordings were performed for primary frequencies from 2 to 12 kHz in 2 kHz increments. Cats were considered to be geriatric > 11.9 ± 1.9 years of age. Brainstem auditory evoked response (BAER) recordings were also made for subjective comparison with DPOAE responses. No differences in DPOAE response amplitudes were observed at any tested frequency in geriatric cats compared to control cats, reflecting an apparent absence of loss of cochlear outer hair cells along the length of the cochlea. No linear regression relationships were found for DPOAE response amplitude versus age in geriatric cats, despite the progressive nature of age-related hearing loss in other species. The absence of reductions in response at any of the tested frequencies in cats within the age span where cats are considered to be geriatric indicates that age-related hearing loss, if it does develop in cats, begins later in the life span of cats than in dogs or human beings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association of polypharmacy with fall risk among geriatric outpatients.

Science.gov (United States)

Kojima, Taro; Akishita, Masahiro; Nakamura, Tetsuro; Nomura, Kazushi; Ogawa, Sumito; Iijima, Katsuya; Eto, Masato; Ouchi, Yasuyoshi

2011-10-01

To investigate the association of fall risk with comorbidities and medications in geriatric outpatients in a cross-sectional design.   A total of 262 outpatients (84 men and 178 women, mean age 76.2±6.8years) were evaluated. Physical examination, clinical histories and medication profile were obtained from each patient. History of falls in the past year, 22-item fall risk index, 13-point simple screening test for fall, and time interval of one-leg standing test were examined as markers of fall risk. On univariate analysis, older age, female sex, hypertension, osteoporosis, history of stroke, number of comorbidities, use of antihypertensives, aspirin, bisphosphonates, hypnotics and number of prescribed drugs were significantly associated with either of four indices. On multiple regression analysis, the number of drugs was associated with all of the four indices, independent of other factors associated in the univariate analysis. The association of number of drugs with fall risk indices was stepwise. In geriatric outpatients, polypharmacy rather than number of comorbidities was associated with fall risk. Prospective and intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidities and fall risk. © 2011 Japan Geriatrics Society.

A profile of acute care in an aging America: snowball sample identification and characterization of United States geriatric emergency departments in 2013.

Science.gov (United States)

Hogan, Teresita M; Olade, Tolulope Oyeyemi; Carpenter, Christopher R

2014-03-01

The aging of America poses a challenge to emergency departments (EDs). Studies show that elderly patients have poor outcomes despite increased testing, prolonged periods of observation, and higher admission rates. In response, emergency medicine (EM) leaders have implemented strategies for improved ED elder care, enhancing expertise, equipment, policies, and protocols. One example is the development of geriatric EDs gaining in popularity nationwide. To the authors' knowledge, this is the first research to systematically identify and qualitatively characterize the existence, locations, and features of geriatric EDs across the United States. The primary objective was to determine the number, distribution, and characteristics of geriatric EDs in the United States in 2013. This was a survey with potential respondents identified via a snowball sampling of known geriatric EDs, EM professional organizations' geriatric interest groups, and a structured search of the Internet using multiple search engines. Sites were contacted by telephone, and those confirming geriatric EDs presence received the survey via e-mail. Category questions included date of opening, location, volumes, staffing, physical plant changes, screening tools, policies, and protocols. Categories were reported based on general interest to those seeking to understand components of a geriatric ED. Thirty-six hospitals confirmed geriatric ED existence and received surveys. Thirty (83%) responded to the survey and confirmed presence or plans for geriatric EDs: 24 (80%) had existing geriatric EDs, and six (20%) were planning to open geriatric EDs by 2014. The majority of geriatric EDs are located in the Midwest (46%) and Northeast (30%) regions of the United States. Eighty percent serve from 5,000 to 20,000 elder patients annually. Seventy percent of geriatric EDs are attached to the main ED, and 66% have from one to 10 geriatric beds. Physical plant changes include modifications to beds (96%), lighting (90

Differential characteristics in polypathological inpatients in internal medicine departments and acute geriatric units: the PLUPAR study.

Science.gov (United States)

Díez-Manglano, Jesús; de Escalante Yangüela, Begoña; García-Arilla Calvo, Ernesto; Ubis Díez, Elena; Munilla López, Eulalia; Clerencia Sierra, Mercedes; Revillo Pinilla, Paz; Omiste Sanvicente, Teresa

2013-12-01

To determine whether there are any differences between polypathological patients attended in Internal Medicine departments and acute Geriatric units. A cross-sectional multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data of age, sex, living in a nursing residence or at home, diagnostic category, use of chronic medication, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, delirium during last admission, need of a caregiver, and having a caregiver were gathered. The need of a caregiver was defined when the Barthel index wasinternal medicine and 144 from geriatrics units were included. Geriatrics inpatients were older and more frequently female. Cardiac (62.1% vs 49.6%; p=.01), digestive (8.3% vs 3.0%; p=.04) and oncohematological diseases (30.2% vs 18.8%; p=.01) were more frequent in patients of internal medicine units and neurological (66.2% vs 40.2%; pinternal medicine inpatients [4.0(2.1) vs 3.5(2.1); p=.04). Patients attended in geriatrics scored higher in Pfeiffer questionnaire [5.5(3.7) vs 3.8(3.3); pinternal medicine and geriatrics departments. © 2013.

Study Protocol: Nutritional Support in a Cross-sector Model for the Rehabilitation of Geriatric Patients

DEFF Research Database (Denmark)

Beck, Anne Marie; Rask, Kø; Leedo, Eva

2014-01-01

Background: Hospital stays are generally getting shorter which leaves limited time to improve a poor nutritional status for geriatric patients. Therefore, it seems necessary to integrate nutritional support also in the period after discharge. Furthermore, improving cross-sector cooperation...... support to geriatric patients. This may ultimately lead to reduced health care costs, and improvement in mobility, independence and quality of life for geriatric patients at nutritional risk. Trial registration: Clinical Trials.gov NCT01776762....... in the transition of geriatric patients between hospital and home-care institutions is essential to ensure follow-up and completion of hospital (nutritional) treatment and rehabilitation of patients. In spite of many issues, i.e. the multi-morbidity, the reduced level of functioning and the excessive use...

Brief assessments and screening for geriatric conditions in older primary care patients: a pragmatic approach.

Science.gov (United States)

Seematter-Bagnoud, Laurence; Büla, Christophe

2018-01-01

This paper discusses the rationale behind performing a brief geriatric assessment as a first step in the management of older patients in primary care practice. While geriatric conditions are considered by older patients and health professionals as particularly relevant for health and well-being, they remain too often overlooked due to many patient- and physician-related factors. These include time constraints and lack of specific training to undertake comprehensive geriatric assessment. This article discusses the epidemiologic rationale for screening functional, cognitive, affective, hearing and visual impairments, and nutritional status as well as fall risk and social status. It proposes using brief screening tests in primary care practice to identify patients who may need further comprehensive geriatric assessment or specific interventions.

Decision making in geriatric oncology

OpenAIRE

Hamaker, M.E.

2012-01-01

The studies in this thesis show that for older cancer patients, tailor-made care should be the standard of care, striking the golden mean between undertreatment and overtreatment and fully taking into account the heterogeneity of this patient population. The comprehensive geriatric assessment will provide valuable information about a patient’s overall health status, but its exact place within the decision-making process still remains to be defined.

[Refeeding syndrome in geriatric patients : A frequently overlooked complication].

Science.gov (United States)

Wirth, Rainer; Diekmann, Rebecca; Fleiter, Olga; Fricke, Leonhardt; Kreilkamp, Annika; Modreker, Mirja Katrin; Marburger, Christian; Nels, Stefan; Schaefer, Rolf; Willschrei, Heinz-Peter; Volkert, Dorothee

2018-01-01

The refeeding syndrome is a life-threatening complication that can occur after initiation of a nutrition therapy in malnourished patients. If the risk factors and pathophysiology are known, the refeeding syndrome can effectively be prevented and treated, if recognized early. A slow increase of food intake and the close monitoring of serum electrolyte levels play an important role. Because the refeeding syndrome is not well known and the symptoms may vary extremely, this complication is poorly recognized, especially against the background of geriatric multimorbidity. This overview is intended to increase the awareness of the refeeding syndrome in the risk group of geriatric patients.

Faculty Preparedness in Geriatric Optometry Education.

Science.gov (United States)

Mancil, Gary L.; And Others

1995-01-01

A survey of chief academic officers and faculty (n=27) in 16 schools of optometry found that, since 1986, there has been a 75% increase in institutions requiring coursework in geriatric optometry and an 83% increase in those offering continuing professional education in this field. However, 67% of faculty report no formal training. Three faculty…

Geriatric management in medieval Persian medicine

Science.gov (United States)

Emami, Morteza; Sadeghpour, Omid; Zarshenas, Mohammad M.

2013-01-01

In Iran, a large group of patients are elderly people and they intend to have natural remedies as treatment. These remedies are rooted in historical of Persian and humoral medicine with a backbone of more than 1000 years. The current study was conducted to draw together medieval pharmacological information related to geriatric medicine from some of the most often manuscripts of traditional Persian medicine. Moreover, we investigated the efficacy of medicinal plants through a search of the PubMed, Scopus and Google Scholar databases. In the medieval Persian documents, digestible and a small amount of food such as chicken broth, honey, fig and plum at frequent intervals as well as body massage and morning unctioning are highly recommended. In the field of pharmacotherapy, 35 herbs related to 25 families were identified. Plants were classified as tonic, anti-aging, appetizer, memory and mood enhancer, topical analgesic and laxative as well as health improvement agents. Other than historical elucidation, this paper presents medical and pharmacological approaches that medieval Persian practitioners applied to deal with geriatric complications. PMID:24381461

Using Facebook Within a Geriatric Pharmacotherapy Course

Science.gov (United States)

2010-01-01

Objective To evaluate using an Internet-based social networking site within an elective geriatric pharmacotherapy course. Design Thirty pharmacy students enrolled in a geriatric pharmacotherapy elective course were invited to join a closed Facebook (Facebook Inc, Palo Alto, CA) group to enhance communication among students and faculty members within the course. Creating a discussion board was the primary activity in the course. Each week, 3 students were assigned to post a healthy aging topic, and other students in the class were expected to post their comments and reactions. The healthy aging topics also were discussed during class. Assessment Students wrote reflections about their experiences using Facebook for the activities within this course. A survey instrument also measured students' opinions about using Facebook for educational purposes. Conclusion Using Facebook allowed students to discuss topics more openly and encouraged classroom discussions of healthy aging topics. PMID:21179256

Nurses' Perspectives on the Geriatric Nursing Practice Environment and the Quality of Older People's Care in Ontario Acute Care Hospitals.

Science.gov (United States)

Fox, Mary T; Sidani, Souraya; Butler, Jeffrey I; Tregunno, Deborah

2017-06-01

Background Cultivating hospital environments that support older people's care is a national priority. Evidence on geriatric nursing practice environments, obtained from studies of registered nurses (RNs) in American teaching hospitals, may have limited applicability to Canada, where RNs and registered practical nurses (RPNs) care for older people in predominantly nonteaching hospitals. Purpose This study describes nurses' perceptions of the overall quality of care for older people and the geriatric nursing practice environment (geriatric resources, interprofessional collaboration, and organizational value of older people's care) and examines if these perceptions differ by professional designation and hospital teaching status. Methods A cross-sectional survey, using Dillman's tailored design, that included Geriatric Institutional Assessment Profile subscales, was completed by 2005 Ontario RNs and registered practical nurses to assess their perceptions of the quality of care and geriatric nursing practice environment. Results Scores on the Geriatric Institutional Assessment Profile subscales averaged slightly above the midpoint except for geriatric resources which was slightly below. Registered practical nurses rated the quality of care and geriatric nursing practice environment higher than RNs; no significant differences were found by hospital teaching status. Conclusions Nurses' perceptions of older people's care and the geriatric nursing practice environment differ by professional designation but not hospital teaching status. Teaching and nonteaching hospitals should both be targeted for geriatric nursing practice environment improvement initiatives.

Geriatric oncology in Spain: survey results and analysis of the current situation.

Science.gov (United States)

Gironés, R; Morilla, I; Guillen-Ponce, C; Torregrosa, M D; Paredero, I; Bustamante, E; Del Barco, S; Soler, G; Losada, B; Visa, L; Llabrés, E; Fox, B; Firvida, J L; Blanco, R; Antonio, M; Aparisi, F; Pi-Figueras, M; Gonzalez-Flores, E; Molina-Garrido, M J; Saldaña, J

2017-12-11

Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived.

Spatial Variability of Geriatric Depression Risk in a High-Density City: A Data-Driven Socio-Environmental Vulnerability Mapping Approach

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Hung Chak Ho

2017-08-01

Full Text Available Previous studies found a relationship between geriatric depression and social deprivation. However, most studies did not include environmental factors in the statistical models, introducing a bias to estimate geriatric depression risk because the urban environment was found to have significant associations with mental health. We developed a cross-sectional study with a binomial logistic regression to examine the geriatric depression risk of a high-density city based on five social vulnerability factors and four environmental measures. We constructed a socio-environmental vulnerability index by including the significant variables to map the geriatric depression risk in Hong Kong, a high-density city characterized by compact urban environment and high-rise buildings. Crude and adjusted odds ratios (ORs of the variables were significantly different, indicating that both social and environmental variables should be included as confounding factors. For the comprehensive model controlled by all confounding factors, older adults who were of lower education had the highest geriatric depression risks (OR: 1.60 (1.21, 2.12. Higher percentage of residential area and greater variation in building height within the neighborhood also contributed to geriatric depression risk in Hong Kong, while average building height had negative association with geriatric depression risk. In addition, the socio-environmental vulnerability index showed that higher scores were associated with higher geriatric depression risk at neighborhood scale. The results of mapping and cross-section model suggested that geriatric depression risk was associated with a compact living environment with low socio-economic conditions in historical urban areas in Hong Kong. In conclusion, our study found a significant difference in geriatric depression risk between unadjusted and adjusted models, suggesting the importance of including environmental factors in estimating geriatric depression risk

Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials.

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Ellis, Graham; Whitehead, Martin A; Robinson, David; O'Neill, Desmond; Langhorne, Peter

2011-10-27

To evaluate the effectiveness of comprehensive geriatric assessment in hospital for older adults admitted as an emergency. We searched the EPOC Register, Cochrane's Controlled Trials Register, the Database of Abstracts of Reviews of Effects (DARE), Medline, Embase, CINAHL, AARP Ageline, and handsearched high yield journals. Randomised controlled trials of comprehensive geriatric assessment (whether by mobile teams or in designated wards) compared with usual care. Comprehensive geriatric assessment is a multidimensional interdisciplinary diagnostic process used to determine the medical, psychological, and functional capabilities of a frail elderly person to develop a coordinated and integrated plan for treatment and long term follow-up. Three independent reviewers assessed eligibility and trial quality and extracted published data. Two additional reviewers moderated. Twenty two trials evaluating 10,315 participants in six countries were identified. For the primary outcome "living at home," patients who underwent comprehensive geriatric assessment were more likely to be alive and in their own homes at the end of scheduled follow-up (odds ratio 1.16 (95% confidence interval 1.05 to 1.28; P = 0.003; number needed to treat 33) at a median follow-up of 12 months versus 1.25 (1.11 to 1.42; P P P = 0.001) and were more likely to experience improved cognition (standardised mean difference 0.08, 0.01 to 0.15; P = 0.02) in the comprehensive geriatric assessment group. Comprehensive geriatric assessment increases patients' likelihood of being alive and in their own homes after an emergency admission to hospital. This seems to be especially true for trials of wards designated for comprehensive geriatric assessment and is associated with a potential cost reduction compared with general medical care.

Evaluation of geriatrics education at a Chinese University: a survey of attitudes and knowledge among undergraduate medical students.

Science.gov (United States)

Shi, Sandra; Lio, Jonathan; Dong, Hongmei; Jiang, Ivy; Cooper, Brian; Sherer, Renslow

2018-05-08

Despite widespread reforms in medical education across China, nationally there has been no mandate or movement toward systemically incorporating geriatrics into curricula. To what degree medical students are trained and have exposure to geriatric topics remains unclear. We surveyed 190 medical students during their final year of medical school at a Chinese medical university, graduating from reformed and also traditional curricula. The survey was comprised of a subjective assessment of attitudes and reported knowledge, as well as an objective assessment of knowledge via a multiple choice test. Student attitudes were favorable toward geriatrics, with 91% supporting the addition of specialized clinical experiences to the curriculum. Students generally reported low exposure to geriatrics, with no statistically significant differences between reform and traditional curricula. There was a statistically significant difference in performance on the multiple choice test between curricula but at a degree unlikely to be practically significant. Students had very favorable attitudes toward geriatrics as a field and specialty; however scored poorly on competency exams, with the lowest performance around diagnosis and treatment of specific geriatric conditions. Our results suggest that there is a need and desire for increased geriatric-oriented learning at Chinese medical schools.

What to Expect From the Evolving Field of Geriatric Cardiology.

Science.gov (United States)

Bell, Susan P; Orr, Nicole M; Dodson, John A; Rich, Michael W; Wenger, Nanette K; Blum, Kay; Harold, John Gordon; Tinetti, Mary E; Maurer, Mathew S; Forman, Daniel E

2015-09-15

The population of older adults is expanding rapidly, and aging predisposes to cardiovascular disease. The principle of patient-centered care must respond to the preponderance of cardiac disease that now occurs in combination with the complexities of old age. Geriatric cardiology melds cardiovascular perspectives with multimorbidity, polypharmacy, frailty, cognitive decline, and other clinical, social, financial, and psychological dimensions of aging. Although some assume that a cardiologist may instinctively cultivate some of these skills over the course of a career, we assert that the volume and complexity of older cardiovascular patients in contemporary practice warrants a more direct approach to achieve suitable training and a more reliable process of care. We present a rationale and vision for geriatric cardiology as a melding of primary cardiovascular and geriatrics skills, thereby infusing cardiology practice with expanded proficiencies in diagnosis, risks, care coordination, communications, end-of-life, and other competences required to best manage older cardiovascular patients. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Geriatric depression in advanced cancer patients: the effect of cognitive and physical functioning.

Science.gov (United States)

Mystakidou, Kyriaki; Parpa, Efi; Tsilika, Eleni; Panagiotou, Irene; Zygogianni, Anna; Giannikaki, Eugenia; Gouliamos, Athanasios

2013-04-01

The aims of the current study were to evaluate geriatric depression and its risk factors in advanced cancer patients. A cross-sectional study was carried out in a palliative care unit in Greece. Patients completed the Geriatric Depression Scale, the M. D. Anderson Symptoms Instrument (MDASI), the Activities of Daily Living and the Mini-Mental State Examination. Patients were included if they were aged >65 years, if they had cancer, were able to communicate and had agreed to sign informed consent. The final sample consisted of 92 elderly advanced cancer patients. The prevalence of depression was found to be 67.4%. The univariate comparison between the depressed elderly and non-depressed group showed that patients with metastases were found to be 2.2-fold more likely to suffer from geriatric depression compared with those without metastases (P = 0.074). Patients with moderate or severe cognitive impairment were found to be 3.61-fold more likely to suffer from geriatric depression in comparison with those with normal cognitive function (P = 0.019). In the multiple logistic regression analysis, elderly with cognitive impairment were 3.3-fold more likely to have geriatric depression than those without (adjusted odds ratio = 3.3 [95% CI 0.99-10.74], P = 0.052) and MDASI factor 1 was consistently a significant risk factor for depression in the elderly; when MDASI factor 1 increased by 1 unit, the odds of being classified as depressed increased by 7.6%. The present study found that cognitive impairment and symptoms such as enjoyment of life, walking, relationship with people, general activity, sadness and pain (MDASI F1) are strong independent predictors of depression in the elderly. © 2012 Japan Geriatrics Society.

Geriatric dietary meat-based products

OpenAIRE

Kuzelov, Aco; Agunova, Larisa

2016-01-01

The contemporary nutrition pattern referring to different age groups of the population does not meet quantitative and qualitative requirements. In Ukraine the manufacture of geriatric meat-based dietary products is underdeveloped. Therefore, the development of healthy and functional foods is the priority objective for the food industry. The research is devoted to considering the possibility of using quail meat, wheat germ flakes and walnut oil in the production process of the sausages for ...

Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin

OpenAIRE

Spandau, Dan F; Lewis, Davina A.; Somani, Ally-Khan; Travers, Jeffrey B.

2012-01-01

Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylacti...

Development of Geriatric Mental Health Learning Objectives for Medical Students: A Response to the Institute of Medicine 2012 Report.

Science.gov (United States)

Lehmann, Susan W; Brooks, William B; Popeo, Dennis; Wilkins, Kirsten M; Blazek, Mary C

2017-10-01

America is aging as the population of older adults increases. The shortage of geriatric mental health specialists means that most geriatric mental healthcare will be provided by physicians who do not have specialty training in geriatrics. The Institute of Medicine Report of 2012 highlighted the urgent need for development of national competencies and curricula in geriatric mental health for all clinicians. Virtually all physicians can expect to treat older patients with mental health symptoms, yet currently there are no widely accepted learning objectives in geriatric mental health specific for medical students. The authors describe the development of a set of such learning objectives that all medical students should achieve by graduation. The iterative process included initial drafting by content experts from five medical schools with input and feedback from a wider group of geriatric psychiatrists, geriatricians, internists, and medical educators. The final document builds upon previously published work and includes specific knowledge, attitudes and skills in six key domains: Normal Aging, Mental Health Assessment of the Geriatric Patient, Psychopharmacology, Delirium, Depression, and Dementia. These objectives address a pressing need, providing a framework for national standards and curriculum development. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Identifying Risk Factors for Elder Falls in Geriatric Rehabilitation in Israel.

Science.gov (United States)

Ben Natan, Merav; Heyman, Neomi; Ben Israel, Joshua

2016-01-01

To identify risk factors for elder falls in a geriatric rehabilitation center in Israel. Retrospective chart review study. Four hundred and twelve medical records of inpatients in geriatric rehabilitation were retrospectively analyzed to compare between elders who sustained falls and those who did not. Of elders hospitalized during this year, 14% sustained falls. Fallers included a high proportion of males, with little comorbidity, not obese, and cardiovascular patients. Falls occurred frequently during patients' first week at the facility, mostly during the daytime. The falls occurred frequently in patients' rooms, and a common scenario was a fall during transition. The research findings single out patients who are allegedly at a lower risk of falls than more complex patients. Caregivers in geriatric rehabilitation settings should pay attention to patients who are allegedly at a lower risk of falls than more complex patients, and to cardiovascular patients in particular. © 2014 Association of Rehabilitation Nurses.

The association between nutritional status and frailty characteristics among geriatric outpatients.

Science.gov (United States)

Kurkcu, M; Meijer, R I; Lonterman, S; Muller, M; de van der Schueren, M A E

2018-02-01

Frailty is a common clinical syndrome in older adults and is associated with an increased risk of poor health outcomes, e.g. falls, disability, hospitalization, and mortality. Nutritional status might be an important factor contributing to frailty. This study aims to describe the association between nutritional status and characteristics of frailty in patients attending a geriatric outpatient clinic. Clinical data was collected of 475 patients who visited the geriatric outpatient department of a Dutch hospital between 2005 and 2010. Frailty was determined by: incontinence, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Geriatric Depression Scale (GDS) and Mini Mental State Exam (MMSE). Nutritional status was represented by the Mini Nutritional Assessment (MNA) and plasma concentrations of several micronutrients, whereby MNAnutritional status could prove usefulness in early clinical detection and prevention of frailty. Copyright © 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It?

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Paolo Orlandoni

2017-10-01

Full Text Available ObjectiveTo assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS and hospital mortality.DesignA retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST. Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models.SettingThe study was performed in an Italian geriatric research hospital (INRCA, Ancona.SubjectsTwo hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years, who gave their written consent to participate in the study, were enrolled.ResultsAccording to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses—linear and logistic regression—were performed considering different potential

On-spot rheumatology consultations in a multilevel geriatric hospital.

Science.gov (United States)

Lubart, Emily; Leibovitz, Arthur; Shapir, Vadim; Segal, Refael

2014-01-01

Musculoskeletal and joint disorders are extremely common in the elderly. They directly affect mobility, gait stability, quality of life, and independence. To assess the nature of joint problems encountered in a geriatric inpatient population and evaluate the contribution of a rheumatologist. We reviewed the rheumatology consultation records that were conducted in a geriatric medical center over a 10 year period. A total of 474 consultations were held; most of these patients (86%) were hospitalized in the acute geriatric departments, 10% in the rehabilitation ward and 4% in the long-term care wards. Some patients were seen more than once. A rheumatologic joint problem was the main reason for hospitalization in 53% of these patients. Monoarthritis was the most frequent complaint (50%), followed by pauciarticular arthritis (two to five joints) in 30% of patients. Arthrocentesis, diagnostic and therapeutic, was performed in 225 patients, most of them in knee joints (81%). The most frequent diagnosis was osteoarthritis with acute exacerbation (28%), followed by gout (18%), pseudo-gout (9%) and rheumatoid arthritis (9%). In 86 cases (18%) the diagnosis was a non-specific rheumatologic problem: arthralgia, nonspecific generalized pain, or fibromyalgia. Prompt and appropriate evaluation, as well as arthrocentesis and treatment initiation, including local injections, were made possible by the presence of an in-house rheumatologist.

An Etiologic Profile of Anemia in 405 Geriatric Patients

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Tabea Geisel

2014-01-01

Full Text Available Background. Anemia is a common condition in the elderly and a significant risk factor for increased morbidity and mortality, reducing not only functional capacity and mobility but also quality of life. Currently, few data are available regarding anemia in hospitalized geriatric patients. Our retrospective study investigated epidemiology and causes of anemia in 405 hospitalized geriatric patients. Methods. Data analysis was performed using laboratory parameters determined during routine hospital admission procedures (hemoglobin, ferritin, transferrin saturation, C-reactive protein, vitamin B12, folic acid, and creatinine in addition to medical history and demographics. Results. Anemia affected approximately two-thirds of subjects. Of 386 patients with recorded hemoglobin values, 66.3% were anemic according to WHO criteria, mostly (85.1% in a mild form. Anemia was primarily due to iron deficiency (65%, frequently due to underlying chronic infection (62.1%, or of mixed etiology involving a combination of chronic disease and iron deficiency, with absolute iron deficiency playing a comparatively minor role. Conclusion. Greater awareness of anemia in the elderly is warranted due to its high prevalence and negative effect on outcomes, hospitalization duration, and mortality. Geriatric patients should be routinely screened for anemia and etiological causes of anemia individually assessed to allow timely initiation of appropriate therapy.

Hypotension, bedridden, leukocytosis, thrombocytopenia and elevated serum creatinine predict mortality in geriatric patients with fever.

Science.gov (United States)

Chung, Min-Hsien; Chu, Feng-Yuan; Yang, Tzu-Meng; Lin, Hung-Jung; Chen, Jiann-Hwa; Guo, How-Ran; Vong, Si-Chon; Su, Shih-Bin; Huang, Chien-Cheng; Hsu, Chien-Chin

2015-07-01

The geriatric population (aged ≥65 years) accounts for 12-24% of all emergency department (ED) visits. Of them, 10% have a fever, 70-90% will be admitted and 7-10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality. We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point. A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine >2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were. The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever. © 2014 Japan Geriatrics Society.

Loss of Olfactory Function and Nutritional Status in Vital Older Adults and Geriatric Patients

NARCIS (Netherlands)

Toussaint, N.; Roon, de M.; Campen, van J.P.C.M.; Kremer, S.; Boesveldt, S.

2015-01-01

The aim of this cross-sectional study was to assess the association of olfactory function and nutritional status in vital older adults and geriatric patients. Three hundred forty-five vital (mean age 67.1 years) and 138 geriatric older adults (mean age 80.9 years) were included. Nutritional status

Food intakes and preferences of hospitalised geriatric patients

Science.gov (United States)

Shahar, Suzana; Chee, Kan Yin; Wan Chik, Wan Chak Pa'

2002-01-01

Background A cross sectional survey was carried out on 120 hospitalised geriatric patients aged 60 and above in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur to investigate their nutrient intakes and food preferences. Methods Food intakes were recorded using a one day weighed method and diet recall. Food preferences were determined using a five point hedonic score. Food wastages and factors affecting dietary adequacy were also investigated. Results The findings indicated that the mean intakes of energy and all nutrients investigated except for vitamin C and fluid were below the individual requirement for energy, protein and fluid, and the Malaysian Recommendation of Dietary Allowances (RDA) for calcium, iron, vitamin A, thiamin, riboflavin, niacin and acid ascorbic. In general, subjects preferred vegetables, fruits and beans to red meat, milk and dairy products. There was a trend of women to have a higher percentage for food wastage. Females, diabetic patients, subjects who did not take snacks and subjects who were taking hospital food only, were more likely to consume an inadequate diet (p Food service system in hospital should consider the food preferences among geriatric patients in order to improve the nutrient intake. In addition, the preparation of food most likely to be rejected such as meat, milk and dairy products need some improvements to increase the acceptance of these foods among geriatric patients. This is important because these foods are good sources of energy, protein and micronutrients that can promote recovery from disease or illness. PMID:12165100

Comprehensive Geriatric Assessment (CGA in general practice: Results from a pilot study in Vorarlberg, Austria

Directory of Open Access Journals (Sweden)

Mann Eva

2004-05-01

Full Text Available Abstract Background Most comprehensive geriatric assessment (CGA programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community. Methods We developed and pilot tested a German language geriatric assessment instrument adapted for general practice. Nine general practices in a rural region of Austria participated in this cross-sectional study and consecutively enrolled 115 persons aged over 75 years. The prevalence of specific geriatric problems was assessed, as well as the frequency of initiated procedures following positive and negative tests. Whether findings were new to the physician was studied exemplarily for the items visual and hearing impairment and depression. The acceptability was recorded by means of self-administered questionnaires. Results On average, each patient reported 6.4 of 14 possible geriatric problems and further consequences resulted in 43.7% (27.5% to 59.8% of each problem. The items with either the highest prevalence and/or the highest number of initiated actions by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and fall risk. Visual impairment was newly detected in only 18% whereas hearing impairment and depression was new to the physician in 74.1% and 76.5%, respectively. A substantial number of interventions were initiated not only following positive tests (43.7% per item; 95% CI 27.5% to 59.8%, but also as a consequence of negative test results (11.3% per item; 95% CI 1.7% to 20.9%. The mean time expenditure to accomplish the assessment was 31 minutes (SD 10 min. Patients (89% and all physicians confirmed the CGA to provide new information in general on the patient's health status. All physicians judged the CGA to be feasible in everyday

Grip strength as a frailty diagnostic component in geriatric inpatients

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Dudzińska-Griszek J

2017-07-01

Full Text Available Joanna Dudzińska-Griszek, Karolina Szuster, Jan Szewieczek Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Background: Frailty has emerged as a key medical syndrome predictive of comorbidity, disability, institutionalization and death. As a component of the five frailty phenotype diagnostic criteria, patient grip strength deserves attention as a simple and objective measure of the frailty syndrome. The aim of this study was to assess conditions that influence grip strength in geriatric inpatients.Patients and methods: The study group consisted of 80 patients aged 78.6±7.0 years ( X ± SD, with 68.8% women, admitted to the Department of Geriatrics. A comprehensive geriatric assessment was complemented with assessment for the frailty phenotype as described by Fried et al for all patients in the study group. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index, Instrumental Activities of Daily Living Scale and Mini-Mental State Examination.Results: Three or more frailty criteria were positive in 32 patients (40%, while 56 subjects (70% fulfilled the frailty criterion of weakness (grip strength test. Multivariate linear regression analysis revealed that two independent measures showed positive association with grip strength – Mini-Mental State Examination score (β=0.239; P=0.001 and statin use (β=0.213; P=0.002 – and four independent measures were negatively associated with grip strength – female sex (β=–0.671; P<0.001, C-reactive protein (β=–0.253; P<0.001, prior myocardial infarction (β=–0.190; P=0.006 and use of an antidepressant (β=–0.163; P=0.018. Low physical activity was identified as the only independent qualitative frailty component associated with 2-year mortality in multivariate logistic regression analysis after adjustment for age and sex (odds ratio =6.000; 95% CI =1.357–26.536; P=0.018.Conclusion: Cognitive

How Many Sides Does a Coin Have? A Phenomenology of Filipino Nurses' Motivation and Attitudes toward Geriatric Care

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de Guzman, Allan B.; Dangoy, Reena-Jane D.; David, Kathleen Christian V.; Dayo, Ken Jarrett H.; de Claro, Keisha A.; de Guzman, Giorgio von Gerri G.; de Jesus, Gerald Ian D.

2009-01-01

Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the…

Association between multiple geriatric syndromes and life satisfaction in community-dwelling older adults: A nationwide study in Taiwan.

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Yang, Deng-Chi; Lee, Jenq-Daw; Huang, Chi-Chang; Shih, Hsin-I; Chang, Chia-Ming

2015-01-01

Although previous studies have investigated the association between a single geriatric syndrome and life satisfaction in the older adults, the accumulated effects of multiple geriatric syndromes on life satisfaction remain unclear. We conducted a nationwide study by using data from the Taiwan Longitudinal Study on Aging database. A total of 2415 older adults were enrolled. Life satisfaction was evaluated according to the Life Satisfaction Index, and the geriatric syndromes included a depressive disorder, cognitive impairment, functional impairment, urine incontinence, pain, a fall, and polypharmacy. Other characteristics were age, sex, marital status, education level, self-rated health, and chronic diseases. Univariate analysis revealed that the older adults, who were illiterate, did not live with a partner, yet other issues such as stroke, malignancy, osteoarthritis, poor self-rated health, a depressive disorder, functional impairment, urine incontinence, or pain were associated with lower life satisfaction. In the multivariate regression model, the older adults who were male, illiterate, lived without a partner, had poor self-rated health, or had a depressive disorder were more likely to have lower life satisfaction. In addition, life satisfaction was unaffected in the older adults with only 1 geriatric syndrome, but among those with ≥2 geriatric syndromes, an increased number of geriatric syndromes were associated with lower life satisfaction. In addition to socio-demographic factors, cumulative effects of multiple geriatric syndromes might affect life satisfaction in the older adults. Further study of interventions for reducing geriatric syndromes to maintain life satisfaction is required. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Polypharmacy as a risk for fall occurrence in geriatric outpatients.

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Kojima, Taro; Akishita, Masahiro; Nakamura, Tetsuro; Nomura, Kazushi; Ogawa, Sumito; Iijima, Katsuya; Eto, Masato; Ouchi, Yasuyoshi

2012-07-01

To investigate the predictors of falls, such as comorbidity and medication, in geriatric outpatients in a longitudinal observational study. A total of 172 outpatients (45 men and 126 women, mean age 76.9 ± 7.0 years) were evaluated. Physical examination, clinical history and medication profile were obtained from each patient at baseline. These patients were followed for up to 2 years and falls were self-reported to their physicians. The factors associated with falls were analyzed statistically. A total of 32 patients experienced falls within 2 years. On univariate analysis, older age, osteoporosis, number of comorbid conditions and number of drugs were significantly associated with falls within 2 years. On multiple logistic regression analysis, the number of drugs was associated with falls, independent of age, sex, number of comorbid conditions and other factors that were significantly associated in univariate analysis. A receiver-operator curve evaluating the optimal cut-off value for the number of drugs showed that taking five or more drugs was a significant risk. In geriatric outpatients, polypharmacy is associated with falls. Intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidity and falls. © 2011 Japan Geriatrics Society.

Cardiovascular aspects of geriatric medicines in traditional Persian medicine; a review of phytochemistry and pharmacology.

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Zarshenas, Mohammad M; Jamshidi, Sahar; Zargaran, Arman

2016-10-15

Geriatrics are a group of patients over 65 years and with multiple comorbidities and different functional impairments. Apart from decline in body mass, presence of exhaustion and general fatigue, an aged person may also suffer from various disorders. Approximately, around 30% of geriatric subjects have significant cardiovascular ailments. Apart from the intensive management of cardiovascular aspects in elderly, monitoring of the complementary cardiac medicine in those people should be received more attention. There are many management lines for a cardio-geriatric condition in Traditional Persian Medicine (TPM). Accordingly, this paper aimed to deal with those medicaments as well as evidence-based clinical aspects and phytochemistry. By searching through main pharmaceutical manuscripts of Persian medicine during 10th-18th centuries (A.D.), concurrently, natural medicines for geriatrics and remedies for cardiovascular ailments were derived. On the other side, related phytochemical and pharmacological aspects of those remedies were highlighted. In all, 38 cardiovascular and 34 geriatric medicaments were found in those manuscripts. Antihyperlipidemic and cholesterol lowering activities of those medicines were the most reported activities in current medicine. However, other pharmacological reports were related to hypotensive, coagulant, cardio-protective and cardiotonic activities. In regard of the chemical composition, medicaments were mainly of polyphenols and flavonoids and also most of the employed extracts and fractions were yielded from polar or semi-polar solvents. With reference to these findings, flavonoid-rich medicaments from Persian medicine may be selected as considerable herbs for geriatrics with cardiovascular ailments. Copyright © 2016 Elsevier GmbH. All rights reserved.

Geriatric medicine leadership of health care transformation: to be or not to be?

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Heckman, George A; Molnar, Frank J; Lee, Linda

2013-01-01

Geriatric Medicine is well-suited to inform and lead health-care system redesign to address the needs of seniors with complex conditions. We posit that geriatricians must urgently consider how to "brand" Geriatric Medicine in a manner that garners active support from those outside the specialty, including how to adapt practice patterns to better meet the needs of patients and of the health-care system.

European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

LENUS (Irish Health Repository)

Masud, Tahir

2014-09-01

the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school.

Effect of Comprehensive Geriatric Training for The Long-term Care Insurance user.

OpenAIRE

磯崎, 弘司; 石井, 佐和子; 高橋, 美千子

2007-01-01

Comprehensive geriatric training (CGT) is training devised for the elderly persons which uses exercise therapy together with instrumental training. The comprehensive geriatric training was provided to a Long-term Care Insurance user group in order to evaluate the effect of the training. The subjects of the training include 12 Long-term Care Insurance users (mean 80.9 age, SD 7.6 years). Physical strength examinations were made before and after the training and their results were used to evalu...

Geriatria, uma especialidade centenária =Geriatrics, a centenarian medical specialty

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Schwanke, Carla Helena Augustin

2009-01-01

Full Text Available Objetivos: para comemorar o centenário da Geriatria, os autores apresentam uma revisão sobre o fenômeno do envelhecimento, o indivíduo idoso, as características da medicina geriátrica e um resumo da sua história. Fonte de dados: foi realizada uma revisão da literatura através de artigos localizados nas bases MedLine e LILACS, além de livros, dissertações, teses e diretrizes governamentais. Síntese dos dados: a Geriatria é a área da medicina que cuida da saúde e das doenças da velhice; que lida com os aspectos físicos, mentais, funcionais e sociais nos cuidados agudos, crônicos, de reabilitação, preventivos e paliativos dos idosos; e que ultrapassa a “medicina centrada em órgãos e sistemas” oferecendo tratamento holístico, em equipes interdisciplinares e com o objetivo principal de otimizar a capacidade funcional e melhorar a qualidade de vida e a autonomia dos idosos. A capacidade funcional, a autonomia e a qualidade de vida são o cerne desta especialidade médica. O geriatra, na prática assistencial diária, lida com questões peculiares como a heterogeneidade dos pacientes e dos cenários de atendimento; a concomitância de múltiplas patologias (plurimorbidade; as síndromes geriátricas (“gigantes da geriatria”; a dificuldade de identificação de todos os problemas do idoso (fenômeno do iceberg; a polifarmácia; a fragilidade; a vulnerabilidade; as várias perdas que o idoso apresenta; e a terminalidade. Conclusões: a Geriatria é a especialidade médica responsável pelos aspectos clínicos do envelhecimento e pelos amplos cuidados de saúde necessários às pessoas idosas. Pela sua complexidade somada ao envelhecimento populacional, torna-se uma especialidade instigante, desafiadora e contemporânea. Aims: To commemorate the centennial of the geriatrics, the authors present a review of the population aging, the elderly individual, the characteristics of the geriatric medicine, and its history. Source of

Geriatric resources in acute care hospitals and trauma centers: a scarce commodity.

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Maxwell, Cathy A; Mion, Lorraine C; Minnick, Ann

2013-12-01

The number of older adults admitted to acute care hospitals with traumatic injury is rising. The purpose of this study was to examine the location of five prominent geriatric resource programs in U.S. acute care hospitals and trauma centers (N = 4,865). As of 2010, 5.8% of all U.S. hospitals had at least one of these programs. Only 8.8% of trauma centers were served by at least one program; the majorities were in level I trauma centers. Slow adoption of geriatric resource programs in hospitals may be due to lack of champions who will advocate for these programs, lack of evidence of their impact on outcomes, or lack of a business plan to support adoption. Future studies should focus on the benefits of geriatric resource programs from patients' perspectives, as well as from business case and outcomes perspectives. Copyright 2013, SLACK Incorporated.

Geriatric education across 94 million acres: adapting conference programming in a rural state.

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Murphy-Southwick, Colleen; McBride, Melen

2006-01-01

Montana, a predominantly rural state, with a unique blend of geography and history, low population density, and cultural diversity represents the challenges for program development and implementation across remote areas. The paper discusses two statewide multidisciplinary geriatric education programs for health professionals offered by the recently established Montana Geriatric Education Center (MTGEC); use of telecommunications technology; collaborations with Geriatric Education Centers (GECs) and the Montana Healthcare Telemedicine Alliance (MHTA); and training outcomes, insights, and implications for continuing education of health professionals who practice in hard-to-reach regions. In addition, data from a statewide needs assessment are presented specific to preferred format. The MTGEC training model that combined traditional classroom and videoconference increased attendance by twofold and may be adapted in other regions to train providers in remote areas of the U.S.

[Prevalence of sarcopenia in geriatric outpatients and nursing homes. The ELLI study].

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Osuna-Pozo, Carmen María; Serra-Rexach, José Antonio; Viña, José; Gómez-Cabrera, María del Carmen; Salvá, Antoni; Ruiz, Domingo; Masanes, Ferrán; Lopez-Soto, Alfonso; Formiga, Francesc; Cuesta, Federico; Cruz-Jentoft, Alfonso

2014-01-01

There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings. To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics. A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed. Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated. The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: a multicenter study.

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Tufan, Fatih; Yuruyen, Mehmet; Kizilarslanoglu, Muhammet Cemal; Akpinar, Timur; Emiksiye, Sirhan; Yesil, Yusuf; Ozturk, Zeynel Abidin; Bozbulut, Utku Burak; Bolayir, Basak; Tasar, Pinar Tosun; Yavuzer, Hakan; Sahin, Sevnaz; Ulger, Zekeriya; Ozturk, Gulistan Bahat; Halil, Meltem; Akcicek, Fehmi; Doventas, Alper; Kepekci, Yalcin; Ince, Nurhan; Karan, Mehmet Akif

2015-01-01

The number of older people is growing fast in Turkey. In this context, internal medicine residents and specialists contact older people more frequently. Thus, healthcare providers' knowledge and attitudes toward older people is becoming more important. Studies that specifically investigate internal medicine residents' attitudes toward the elderly are scarce. We aimed to investigate the attitudes of internal medicine residents toward older people. This cross-sectional multicenter study was undertaken in the internal medicine clinics of six university state hospitals that provide education in geriatric care. All internal medicine residents working in these hospitals were invited to participate in this questionnaire study between March 2013 and December 2013. We recorded the participants' age, sex, duration of internal medicine residency, existence of relatives older than 65 years, history of geriatrics course in medical school, geriatrics rotation in internal medicine residency, and nursing home visits. A total of 274 (82.3%) of the residents participated in this study, and 83.6% of them had positive attitudes toward older people. A geriatrics rotation during internal medicine residency was the only independent factor associated with positive attitudes toward the elderly in this multivariate analysis. A geriatrics course during medical school was associated with positive attitudes in the univariate analysis, but only tended to be so in the multivariate analysis. Geriatrics rotation during internal medicine residency was independently associated with positive attitudes toward older people. Generalization of geriatrics education in developing countries may translate into a better understanding and improved care for older patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Why gerontology and geriatrics can teach us a lot about mentoring.

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Clark, Phillip G

2018-05-15

Gerontology, geriatrics, and mentoring have a lot in common. The prototype of this role was Mentor, an older adult in Homer's The Odyssey, who was enlisted to look after Odysseus' son, Telemachus, while his father was away fighting the Trojan War. Portrayed as an older man, the name "mentor" literally means "a man who thinks," which is not a bad characterization generally for faculty members in gerontology! In particular, gerontological and geriatrics education can teach us a lot about the importance of mentoring and provide some critical insights into this role: (1) the importance of interprofessional leadership and modeling, (2) the application of the concept of "grand-generativity" to mentoring, (3) "it takes a community" to be effective in mentoring others, and (4) the need to tailor mentorship styles to the person and the situation. This discussion explores these topics and argues that gerontological and geriatrics educators have a particularly important role and responsibility in mentoring students, colleagues, and administrators related to the very future of our field.

[Screening of the risk of functional decline performed by an inpatient geriatric consultation team in a general hospital].

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Benoît, F; Bertiaux, M; Schouterden, R; Huard, E; Segers, K; Decorte, L; Robberecht, J; Simonetti, C; Surquin, M

2013-01-01

The Mobile Geriatric Team (MGT) is part of the Geriatric Care Program and aims to provide interdisciplinary geriatric expertise to other professionals for old patients hospitalized outside geriatric department. Our hospital has a MGT since 2008. Our objective is to retrospectively describe the population of patients of 75 years and older hospitalized outside the geriatric ward and screened for the risk of functional decline by the MGT between 1 October 2009 and 30 September 2011. We recorded the risk of functional decline, as indicated by the Identification of Senior At Risk score (ISAR) performed within 48 h after admission, place of living, discharge destination, Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS) scores. In two years, 1.568 patients > or = 75 Y were screened with the ISAR score (mean age 82.5 Y, 60.7% of women). We identified 833 patients with a high-risk of functional decline (ISAR > or = 3). The majority of high-risk subjects (78%) were living at home before hospitalization and 58.7% returned home after discharge. Depression and cognitive impairment were identified among respectively 41% and 59% of high-risk subjects. Only 128 patients were admitted for fall. Most of the faller patients were living at home prior hospitalization and had an ISAR score > or = 3. The MGT allowed identifying many patients > or = 75 Y living at home and presenting with high-risk of functional decline and geriatric syndromes, confirming that good screening procedures are necessary to optimize management of hospitalized olders. Most of faller patients have an ISAR score > or = 3 and should benefit a comprehensive geriatric assessment.

Risk Evaluation of Postoperative Delirium Using Comprehensive Geriatric Assessment in Elderly Patients with Esophageal Cancer.

Science.gov (United States)

Yamamoto, Masaaki; Yamasaki, Makoto; Sugimoto, Ken; Maekawa, Yoshihiro; Miyazaki, Yasuhiro; Makino, Tomoki; Takahashi, Tsuyoshi; Kurokawa, Yukinori; Nakajima, Kiyokazu; Takiguchi, Shuji; Rakugi, Hiromi; Mori, Masaki; Doki, Yuichiro

2016-11-01

The number of geriatric patients with esophageal cancer is increasing in step with the aging of the population. Geriatric patients have a higher risk of postoperative complications, including delirium that can cause a fall or impact survival. Therefore, it is very important that we evaluate risks of postoperative complications before surgery. The aim of this study was to predict postoperative delirium in elderly patients. We retrospectively reviewed the medical records of 91 patients aged 75 years and over who underwent esophagectomy between January 2006 and December 2014. We investigated the association between postoperative delirium and clinicopathological factors, including comprehensive geriatric assessment (CGA). Postoperative delirium developed in 24 (26 %) patients. Postoperative delirium was significantly associated with low mini-mental state examination (MMSE) and high Geriatric Depression Scale 15 (GDS15), which are components of CGA, and psychiatric disorder (P patients undergoing esophagectomy for esophageal cancer. Intervention by a multidisciplinary team using CGA might help prevent postoperative delirium.

A Typology of Interprofessional Teamwork in Acute Geriatric Care: A Study in 55 units in Belgium.

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Piers, Ruth D; Versluys, Karen J J; Devoghel, Johan; Lambrecht, Sophie; Vyt, André; Van Den Noortgate, Nele J

2017-09-01

To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types. Cross-sectional multicenter study. Acute geriatric units in Belgium. Team members of different professional backgrounds. Perceptions of interprofessional teamwork among team members of 55 acute geriatric units in Belgium were measured using a survey covering collaborative practice and experience, managerial coaching and open team culture, shared reflection and decision-making, patient files facilitating teamwork, members' belief in the power of teamwork, and members' comfort in reporting incidents. Cluster analysis was used to determine types of interprofessional teamwork. Professions and clusters were compared using analysis of variance. The overall response rate was 60%. Of the 890 respondents, 71% were nursing professionals, 20% other allied health professionals, 5% physicians, and 4% logistic and administrative staff. More than 70% of respondents scored highly on interprofessional teamwork competencies, consultation, experiences, meetings, management, and results. Fewer than 55% scored highly on items about shared reflection and decision-making, reporting incidents from a colleague, and patient files facilitating interprofessional teamwork. Nurses in this study rated shared reflection and decision-making lower than physicians on the same acute geriatric units (P teamwork in acute geriatric units is satisfactory, but shared reflection and decision-making needs improvement. Four types of interprofessional teamwork are identified and can be used to benchmark the teamwork of individual teams. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Occupational health for an ageing workforce: do we need a geriatric perspective?

Directory of Open Access Journals (Sweden)

Koh David

2006-05-01

Full Text Available Abstract Extending retirement ages and anti-age discrimination policies will increase the numbers of older workers in the future. Occupational health physicians may have to draw upon the principles and experience of geriatric medicine to manage these older workers. Examples of common geriatric syndromes that will have an impact on occupational health are mild cognitive impairment and falls at the workplace. Shifts in paradigms and further research into the occupational health problems of an ageing workforce will be needed.

Food intakes and preferences of hospitalised geriatric patients

Directory of Open Access Journals (Sweden)

Wan Chik Wan Chak

2002-08-01

Full Text Available Abstract Background A cross sectional survey was carried out on 120 hospitalised geriatric patients aged 60 and above in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur to investigate their nutrient intakes and food preferences. Methods Food intakes were recorded using a one day weighed method and diet recall. Food preferences were determined using a five point hedonic score. Food wastages and factors affecting dietary adequacy were also investigated. Results The findings indicated that the mean intakes of energy and all nutrients investigated except for vitamin C and fluid were below the individual requirement for energy, protein and fluid, and the Malaysian Recommendation of Dietary Allowances (RDA for calcium, iron, vitamin A, thiamin, riboflavin, niacin and acid ascorbic. In general, subjects preferred vegetables, fruits and beans to red meat, milk and dairy products. There was a trend of women to have a higher percentage for food wastage. Females, diabetic patients, subjects who did not take snacks and subjects who were taking hospital food only, were more likely to consume an inadequate diet (p Conclusions Food service system in hospital should consider the food preferences among geriatric patients in order to improve the nutrient intake. In addition, the preparation of food most likely to be rejected such as meat, milk and dairy products need some improvements to increase the acceptance of these foods among geriatric patients. This is important because these foods are good sources of energy, protein and micronutrients that can promote recovery from disease or illness.

European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

Directory of Open Access Journals (Sweden)

Baijens LW

2016-10-01

Full Text Available Laura WJ Baijens,1 Pere Clavé,2,3 Patrick Cras,4 Olle Ekberg,5 Alexandre Forster,6 Gerald F Kolb,7 Jean-Claude Leners,8 Stefano Masiero,9 Jesús Mateos-Nozal,10 Omar Ortega,2,3 David G Smithard,11 Renée Speyer,12 Margaret Walshe13 1Department of Otorhinolaryngology – Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; 2Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital of Mataró, Autonomous University of Barcelona, Mataró, 3CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain; 4Department of Neurology, Antwerp University Hospital, University of Antwerp, Born Bunge Institute, Edegem, Belgium; 5Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Malmö, Sweden; 6Clinique Bois-Bougy, Nyon, Switzerland; 7Department of Geriatrics and Physical Medicine, Bonifatius Hospital, Lingen, Germany; 8Long Term Care and Hospice, Ettelbruck, Luxembourg; 9Rehabilitation Unit, Department of Neuroscience, University of Padua, Padova, Italy; 10Department of Geriatric Medicine, Hospital Ramón y Cajal, Madrid, Spain; 11Clinical Gerontology, Princess Royal University Hospital, King’s College Hospital Foundation Trust, London, UK; 12College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia; 13Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland Abstract: This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids

Poor oral health, a potential new geriatric syndrome

NARCIS (Netherlands)

Putten, G.J. van der; Baat, C. de; Visschere, L. De; Schols, J.

2014-01-01

This article presents a brief introduction to the medical aspects of ageing and age-related diseases, and to some geriatric syndromes, followed by a discussion on their impact on general and oral healthcare provision to community-dwelling older people. Recent investigations suggest that inflammation

European Society for Swallowing Disorders – European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

Science.gov (United States)

Baijens, Laura WJ; Clavé, Pere; Cras, Patrick; Ekberg, Olle; Forster, Alexandre; Kolb, Gerald F; Leners, Jean-Claude; Masiero, Stefano; Mateos-Nozal, Jesús; Ortega, Omar; Smithard, David G; Speyer, Renée; Walshe, Margaret

2016-01-01

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies

Results of Screening of Apparently Healthy Senior and Geriatric Dogs.

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Willems, A; Paepe, D; Marynissen, S; Smets, P; Van de Maele, I; Picavet, P; Duchateau, L; Daminet, S

2017-01-01

There is a growing interest in health care of elderly dogs; however, scientific information about physical and laboratory examination findings in this age group is limited. To describe systolic blood pressure (SBP), and results of physical examination and laboratory tests in senior and geriatric dogs that were judged by the owner to be healthy. Hundred client-owned dogs. Dogs were prospectively recruited. Owners completed a questionnaire. SBP measurement, physical, orthopedic and neurologic examination, direct fundoscopy and Schirmer tear test were performed. Complete blood count, serum biochemistry, and urinalysis were evaluated. Forty-one senior and 59 geriatric dogs were included. Mean SBP was 170 ± 38 mmHg, and 53 dogs had SBP > 160 mmHg. Thirty-nine animals were overweight. A heart murmur was detected in 22, severe calculus in 21 and 1 or more (sub)cutaneous masses in 56 dogs. Thirty-two dogs had increased serum creatinine, 29 hypophosphatemia, 27 increased ALP, 25 increased ALT, and 23 leukopenia. Crystalluria, mostly amorphous crystals, was commonly detected (62/96). Overt proteinuria and borderline proteinuria were detected in 13 and 18 of 97 dogs, respectively. Four dogs had a positive urine bacterial culture. Frequency of orthopedic problems, frequency of (sub)cutaneous masses, and platelet count were significantly higher in geriatric compared with senior dogs. Body temperature, hematocrit, serum albumin, and serum total thyroxine concentration were significantly lower in geriatric compared with senior dogs. Physical and laboratory abnormalities are common in apparently healthy elderly dogs. Veterinarians play a key role in implementing health screening and improving health care for elderly pets. Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

A theoretical framework for improving education in geriatric medicine.

Science.gov (United States)

Boreham, N C

1983-01-01

Alternative concepts of learning include a formal system in which part of the medical curriculum is designated as that for geriatric medicine; a non-formal system including conferences, lectures, broadcasts, available to both medical students and physicians; and thirdly, an informal system in which doctors learn medicine through their experience practising the profession. While the most emphasis in medical schools would seem to be on the formal system it is essential that medical educators (if they wish their students in later life to maintain high levels of self-initiated learning) must use all three strategies. The structure of a system of formal teaching for geriatric medicine is examined. An important objective is attitude change and it is in achieving this that geriatricians must be particularly involved in non-formal and informal systems.

Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90.

Science.gov (United States)

Brown, Joshua B; Gestring, Mark L; Forsythe, Raquel M; Stassen, Nicole A; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

2015-02-01

Undertriage is a concern in geriatric patients. The National Trauma Triage Protocol (NTTP) recognized that systolic blood pressure (SBP) less than 110 mm Hg may represent shock in those older than 65 years. The objective was to evaluate the impact of substituting an SBP of less than 110 mm Hg for the current SBP of less than 90 mm Hg criterion within the NTTP on triage performance and mortality. Subjects undergoing scene transport in the National Trauma Data Bank (2010-2012) were included. The outcome of trauma center need was defined as Injury Severity Score (ISS) greater than 15, intensive care unit admission, urgent operation, or emergency department death. Geriatric (age > 65 years) and adult (age, 16-65 years) cohorts were compared. Triage characteristics and area under the curve (AUC) were compared between SBP of less than 110 mm Hg and SBP of less than 90 mm Hg. Hierarchical logistic regression was used to determine whether geriatric patients newly triaged positive under this change (SBP, 90-109 mm Hg) have a risk of mortality similar to those triaged positive with SBP of less than 90 mm Hg. There were 1,555,944 subjects included. SBP of less than 110 mm Hg had higher sensitivity but lower specificity in geriatric (13% vs. 5%, 93% vs. 99%) and adult (23% vs. 10%, 90% vs. 98%) cohorts. AUC was higher for SBP of less than 110 mm Hg individually in both geriatric and adult (p AUC was similar for SBP of less than 110 mm Hg and SBP of less than 90 mm Hg in geriatric subjects but was higher for SBP of less than 90 mm Hg in adult subjects (p < 0.01). Substituting SBP of less than 110 mm Hg resulted in an undertriage reduction of 4.4% with overtriage increase of 4.3% in the geriatric cohort. Geriatric subjects with SBP of 90 mm Hg to 109 mm Hg had an odds of mortality similar to those of geriatric patients with SBP of less than 90 mm Hg (adjusted odds ratio, 1.03; 95% confidence interval, 0.88-1.20; p = 0.71). SBP of less than 110 mm Hg increases sensitivity. SBP of

Decline of influenza-specific CD8+ T cell repertoire in healthy geriatric donors

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Ramachandra Lakshmi

2011-08-01

Full Text Available Abstract Background While influenza vaccination results in protective antibodies against primary infections, clearance of infection is primarily mediated through CD8+ T cells. Studying the CD8+ T cell response to influenza epitopes is crucial in understanding the disease associated morbidity and mortality especially in at risk populations such as the elderly. We compared the CD8+ T cell response to immunodominant and subdominant influenza epitopes in HLA-A2+ control, adult donors, aged 21-42, and in geriatric donors, aged 65 and older. Results We used a novel artificial Antigen Presenting Cell (aAPC based stimulation assay to reveal responses that could not be detected by enzyme-linked immunosorbent spot (ELISpot. 14 younger control donors and 12 geriatric donors were enrolled in this study. The mean number of influenza-specific subdominant epitopes per control donor detected by ELISpot was only 1.4 while the mean detected by aAPC assay was 3.3 (p = 0.0096. Using the aAPC assay, 92% of the control donors responded to at least one subdominant epitopes, while 71% of control donors responded to more than one subdominant influenza-specific response. 66% of geriatric donors lacked a subdominant influenza-specific response and 33% of geriatric donors responded to only 1 subdominant epitope. The difference in subdominant response between age groups is statistically significant (p = 0.0003. Conclusion Geriatric donors lacked the broad, multi-specific response to subdominant epitopes seen in the control donors. Thus, we conclude that aging leads to a decrease in the subdominant influenza-specific CTL responses which may contribute to the increased morbidity and mortality in older individuals.

The relationship between geriatric depression and health-promoting behaviors among community-dwelling seniors.

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Chang, Chyong-Fang; Lin, Mei-Hsiang; Wang, Jeng; Fan, Jun-Yu; Chou, Li-Na; Chen, Mei-Yen

2013-06-01

People older than 65 years old account for about 10.9% of Taiwan's total population; it is also known that the older adults experience a higher incidence of depression. Public health nurses play an important role in promoting community health. Policymaking for community healthcare should reflect the relationship between health-promoting behavior and depression in community-dwelling seniors. Therefore, the encouragement of healthy aging requires strategic planning by those who provide health promotion services. This study was designed to elicit the health-promoting behaviors of community seniors and investigate the relationship between geriatric depression and health-promoting behaviors among seniors who live in rural communities. We used a cross-sectional, descriptive design and collected data using a demographic information datasheet, the Health Promotion for Seniors and Geriatric Depression Scale short forms. The study included 427 participants. Most were women; mean age was 75.8 years. Most were illiterate; roughly half engaged in a limited number of health-promoting activities. The Geriatric Depression Scale score was negatively associated with health-promoting behavior. Social participation, health responsibility, self-protection, active lifestyle, and total Health Promotion for Seniors score all reached statistical significance. Multivariate analysis indicated that geriatric depression and physical discomfort were independent predictors of health-promoting behavior after controlling the confounding factors. Participants practiced less than the recommended level of health-promoting behaviors. We found a negative correlation between the geriatric depression score and health-promoting behavior. Results can be referenced to develop strategies to promote healthy aging in the community, especially with regard to promoting greater social participation and increased activity for community-dwelling older adults experiencing depression.

Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic

NARCIS (Netherlands)

Kikkert, Lisette H. J.; de Groot, Maartje H; van Campen, Jos P.; Beijnen, Jos H.; Hortobagyi, Tibor; Vuillerme, Nicolas; Lamoth, Claudine C. J.

2017-01-01

Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric

Assessment of recovery in older patients hospitalized with different diagnoses and functional levels, evaluated with and without geriatric assessment.

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Abrahamsen, Jenny Foss; Haugland, Cathrine; Ranhoff, Anette Hylen

2016-01-01

The objective of the present study was to investigate 1) the role of different admission diagnoses and 2) the degree of functional loss, on the rate of recovery of older patients after acute hospitalization. Furthermore, to compare the predictive value of simple assessments that can be carried out in a hospital lacking geriatric service, with assessments including geriatric screening tests. Prospective, observational cohort study, including 961community dwelling patients aged ≥ 70 years, transferred from medical, cardiac, pulmonary and orthopedic acute hospital departments to intermediate care in nursing home. Functional assessment with Barthel index (BI) was performed at admission to the nursing home and further geriatric assessment tests was performed during the first week. Logistic regression models with and without geriatric assessment were compared concerning the patients having 1) slow recovery (nursing home stay up to 2 months before return home) or, 2) poor recovery (dead or still in nursing home at 2 months). Slow recovery was independently associated with a diagnosis of non-vertebral fracture, BI subgroups 50-79 and model including geriatric assessment, also with cognitive impairment. Poor recovery was more complex, and independently associated both with BI model, cognitive impairment. Geriatric assessment is optimal for determining the recovery potential of older patients after acute hospitalization. As some hospitals lack geriatric services and ability to perform geriatric screening tests, a simpler assessment based on admission diagnoses and ADL function (BI), gives good information regarding the possible rehabilitation time and possibility to return home.

Geriatric Core Competencies for Family Medicine Curriculum and Enhanced Skills: Care of Elderly

OpenAIRE

Charles, Lesley; Triscott, Jean A.C.; Dobbs, Bonnie M.; McKay, Rhianne

2014-01-01

Background There is a growing mandate for Family Medicine residency programs to directly assess residents’ clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Methods Iterative expert panel...

Usefulness of ceruloplasmin testing as a screening methodology for geriatric patients with osteoporosis

OpenAIRE

Karakas, Emel Yigit; Yetisgin, Alpaslan; Cadirci, Dursun; Sezen, Hatice; Altunbas, R?za; Kas, Fehmi; Demir, Mehmet; Ulas, Turgay

2016-01-01

[Purpose] To evaluate serum ceruloplasmin levels in geriatric patients with osteoporosis. [Subjects and Methods] Seventy geriatric patients over 65?years of age were recruited. Patients were divided into two groups: group 1 (?OP?, n=35) consisted of patients with osteoporosis, and group 2 (n=35) consisted of patients without osteoporosis. Dual-energy X-ray absorptiometry scanning was used in the measurement of bone mineral density in all cases. Inflammatory parameters, including C-reactive pr...

Objective Structured Video Examinations (OSVEs) for Geriatrics Education

Science.gov (United States)

Simpson, Deborah; Gehl, Suzanne; Helm, Robin; Kerwin, Diana; Drewniak, Theresa; Bragg, Dawn St. A.; Ziebert, Monica M.; Denson, Steven; Brown, Diane; Heffron, Mary Gleason; Mitchell, Julie; Harsch, Harold H.; Havas, Nancy; Duthie, Edmund, Jr.; Denson, Kathryn

2006-01-01

The Medical College of Wisconsin (MCW) and the Wisconsin Geriatric Education Center (WGEC) are committed to developing educational materials for primary care physicians in training. In response to the opportunity created by the Accreditation Council for Graduate Medical Education (ACGME) competency mandate, an MCW-led interdisciplinary working…

Education in geriatric medicine for community hospital staff.

LENUS (Irish Health Repository)

O'Hanlon, Shane

2010-12-01

Community hospitals provide many services for older people. They are mainly managed by nursing staff, with some specialist input. Little is known about education provided in these facilities. Most education in geriatric medicine is provided in hospitals, despite most elderly care being provided in the community. The authors surveyed senior nursing staff in Irish community hospitals to examine this area in more detail. Staff in all 18hospitals in the Health Service Executive (South) area were invited to participate. The response rate was 100%. Sixteen of the 18 respondents (89%) felt staff did not have enough education in geriatric medicine. Just over half of hospitals had regular staff education sessions in the area, with a minority of sessions led by a geriatrician, and none by GPs. Geriatrician visits were valued, but were requested only every 1-3 months. Staff identified challenging behaviour and dementia care as the areas that posed most difficulty.

Geriatric rehabilitation patients' perceptions of unit dining locations.

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Baptiste, Françoise; Egan, Mary; Dubouloz-Wilner, Claire-Jehanne

2014-06-01

Eating together is promoted among hospitalized seniors to improve their nutrition. This study aimed to understand geriatric patients' perceptions regarding meals in a common dining area versus at the bedside. An exploratory qualitative study was conducted. Open-ended questions were asked of eight patients recruited from a geriatric rehabilitation unit where patients had a choice of meal location. Eating location was influenced by compliance with the perceived rules of the unit, physical and emotional well-being, and quarantine orders. Certain participants preferred eating in the common dining room where they had more assistance from hospital staff, a more attractive physical environment, and the opportunity to socialize. However, other participants preferred eating at their bedsides, feeling the quality of social interaction was poor in the dining room. Participants' experiences of, and preferences for, communal dining differed. If the benefits of communal dining are to be maximized, different experiences of this practice must be considered.

Geriatric Rehabilitation Patients’ Perceptions of Unit Dining Locations

Science.gov (United States)

Baptiste, Françoise; Egan, Mary; Dubouloz-Wilner, Claire-Jehanne

2014-01-01

Background Eating together is promoted among hospitalized seniors to improve their nutrition. This study aimed to understand geriatric patients’ perceptions regarding meals in a common dining area versus at the bedside. Methods An exploratory qualitative study was conducted. Open-ended questions were asked of eight patients recruited from a geriatric rehabilitation unit where patients had a choice of meal location. Results Eating location was influenced by compliance with the perceived rules of the unit, physical and emotional well-being, and quarantine orders. Certain participants preferred eating in the common dining room where they had more assistance from hospital staff, a more attractive physical environment, and the opportunity to socialize. However, other participants preferred eating at their bedsides, feeling the quality of social interaction was poor in the dining room. Conclusions Participants’ experiences of, and preferences for, communal dining differed. If the benefits of communal dining are to be maximized, different experiences of this practice must be considered. PMID:24883161

Basic geriatric assessment does not predict in-hospital mortality after PEG placement

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Smoliner Christine

2012-09-01

Full Text Available Abstract Background Percutaneous endoscopic gastrostomy (PEG is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement. Methods All patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality. Results A total of 1232 patients (60.4% women with a median age of 82 years (range 60 to 99 years were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients (n = 664, with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis (55.2%. In-hospital mortality was 12.8%. In a logistic regression analysis, old age (odds ratio (OR 1.030, 95% confidence interval (CI 1.003-1.056, male sex (OR 1.741, 95% CI 1.216-2.493, and pneumonia (OR 2.641, 95% CI 1.457-4.792 or the diagnosis group ‘miscellaneous disease’ (OR 1.864, 95% CI 1

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

Science.gov (United States)

Prestmo, Anders; Hagen, Gunhild; Sletvold, Olav; Helbostad, Jorunn L; Thingstad, Pernille; Taraldsen, Kristin; Lydersen, Stian; Halsteinli, Vidar; Saltnes, Turi; Lamb, Sarah E; Johnsen, Lars G; Saltvedt, Ingvild

2015-04-25

Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010). Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated

Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes.

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Cheng, Huai Yong; Davis, Molly

2017-02-01

Prior reviews of geriatrics curricula for internal medicine (IM) and family medicine (FM) residents have not evaluated study quality or assessed learning objectives or specific IM or FM competencies. This review of geriatrics curricula for IM and FM residents seeks to answer 3 questions: (1) What types of learning outcomes were measured? (2) How were learning outcomes measured? and (3) What was the quality of the studies? We evaluated geriatrics curricula that reported learning objectives or competencies, teaching methods, and learning outcomes, and those that used a comparative design. We searched PubMed and 4 other data sets from 2003-2015, and assessed learning outcomes, outcome measures, and the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and Best Evidence Medical Education (BEME) methods. Fourteen studies met inclusion criteria. Most curricula were intended for IM residents in the inpatient setting; only 1 was solely dedicated to FM residents. Median duration was 1 month, and minimum geriatrics competencies covered were 4. Learning outcomes ranged from Kirkpatrick levels 1 to 3. Studies that reported effect size showed a considerable impact on attitudes and knowledge, mainly via pretests and posttests. The mean MERSQI score was 10.5 (range, 8.5-13) on a scale of 5 (lowest quality) to 18 (highest quality). Few geriatrics curricula for IM and FM residents that included learning outcome assessments were published recently. Overall, changes in attitudes and knowledge were sizeable, but reporting was limited to low to moderate Kirkpatrick levels. Study quality was moderate.

The brave new world of GEC evaluation: the experience of the Rhode Island Geriatric Education Center.

Science.gov (United States)

Filinson, Rachel; Clark, Phillip G; Evans, Joann; Padula, Cynthia; Willey, Cynthia

2012-01-01

In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics.

Educational games in geriatric medicine education: a systematic review

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Schünemann Holger J

2010-04-01

Full Text Available Abstract Objective To systematically review the medical literature to assess the effect of geriatric educational games on the satisfaction, knowledge, beliefs, attitudes and behaviors of health care professionals. Methods We conducted a systematic review following the Cochrane Collaboration methodology including an electronic search of 10 electronic databases. We included randomized controlled trials (RCT and controlled clinical trials (CCT and excluded single arm studies. Population of interests included members (practitioners or students of the health care professions. Outcomes of interests were participants' satisfaction, knowledge, beliefs, attitude, and behaviors. Results We included 8 studies evaluating 5 geriatric role playing games, all conducted in United States. All studies suffered from one or more methodological limitations but the overall quality of evidence was acceptable. None of the studies assessed the effects of the games on beliefs or behaviors. None of the 8 studies reported a statistically significant difference between the 2 groups in terms of change in attitude. One study assessed the impact on knowledge and found non-statistically significant difference between the 2 groups. Two studies found levels of satisfaction among participants to be high. We did not conduct a planned meta-analysis because the included studies either reported no statistical data or reported different summary statistics. Conclusion The available evidence does not support the use of role playing interventions in geriatric medical education with the aim of improving the attitudes towards the elderly.

Geriatrics and radiation oncology. Pt. 1. How to identify high-risk patients and basic treatment principles

International Nuclear Information System (INIS)

Fels, Franziska; Kraft, Johannes W.; Grabenbauer, Gerhard G.

2010-01-01

Background: Until the mid of this century, 33% of the Western population will be ≥ 65 years old. The percentage of patients being ≥ 80 years old with today 5% will triple until 2050. Therefore, radiation oncologists must be familiar with special geriatric issues to meet the increasing demand for multidisciplinary cooperation and to offer useful and individual treatment concepts. Patients and Methods: This review article will provide basic data on the definition, identification and treatment of geriatric cancer patients. Results: The geriatric patient is defined by typical multimorbidity (15 items) and by age-related increased vulnerability. Best initial identification of geriatric patients will be provided by assessment including the Barthel Index evaluating self-care and activity in daily life, by the Mini-Mental Status Test that will address cognitive pattern, and by the Timed 'Up and Go' Test for evaluation of mobility. As for chemotherapy, standard treatment was associated with increased toxicity, consequently, dose modifications and supportive treatment are of special importance. Conclusion: Geriatric cancer patients need to be identified by special assessment instruments. Due to increased toxicity following chemotherapy, supportive measures seem important. Radiation treatment as a noninvasive and outpatient-based treatment remains an important and preferable option. (orig.)

Falls and other geriatric syndromes in Blantyre, Malawi: a ...

African Journals Online (AJOL)

Geriatric syndromes (falls, immobility, intellectual or memory impairment, and ... age of their children. Only one .... many people walk long distances and even those who are not in paid ... 46% with AMT scores < 725 and in Botswana, short term.

History of geriatric medicine: from Hippocrates to Marjory Warren.

Science.gov (United States)

Ritch, A

2012-01-01

It is widely assumed that geriatric medicine was an invention of the twentieth century. However, from the time of Hippocrates, there has been interest in the prolongation of the lifespan, the maintenance of health in old age and agerelated disease patterns. The debate about whether old age was a natural phenomenon or a disease state was not resolved until the nineteenth century. Calls for medicine relating to old age to be recognised as a discrete entity at the time when medical specialisation was developing were disregarded until the second half of the twentieth century. This review discusses the history of the theories of ageing and of disease and the practice of medicine for older people from the classical period up to Marjory Warren's initiative in London in 1935 and the development of geriatrics as a medical specialty.

The Role of the Advanced Practice Nurse in Geriatric Oncology Care.

Science.gov (United States)

Morgan, Brianna; Tarbi, Elise

2016-02-01

To describe how the Advanced Practice Nurse (APN) is uniquely suited to meet the needs of older adults throughout the continuum of cancer, to explore the progress that APNs have made in gero-oncology care, and make suggestions for future directions. Google Scholar, PubMed, and CINAHL. Search terms included: "gero-oncology," "geriatric oncology," "Advanced Practice Nurse," "Nurse Practitioner," "older adult," "elderly," and "cancer." Over the last decade, APNs have made advances in caring for older adults with cancer by playing a role in prevention, screening, and diagnosis; through evidence-based gero-oncology care during cancer treatment; and in designing tailored survivorship care models. APNs must combat ageism in treatment choice for older adults, standardize comprehensive geriatric assessments, and focus on providing person-centered care, specifically during care transitions. APNs are well-positioned to help understand the complex relationship between risk factors, geriatric syndromes, and frailty and translate research into practice. Palliative care must expand beyond specialty providers and shift toward APNs with a focus on early advanced care planning. Finally, APNs should continue to establish multidisciplinary survivorship models across care settings, with a focus on primary care. Copyright © 2015 Elsevier Inc. All rights reserved.

Diagnosis and management of geriatric insomnia: a guide for nurse practitioners.

Science.gov (United States)

Krishnan, Preetha; Hawranik, Pamela

2008-12-01

To discuss the assessment, diagnosis, and management of geriatric insomnia, a challenging clinical condition of older adults frequently seen by primary care providers. Extensive literature review of the published research articles and textbooks. Complaints of insomnia among older adults are frequently ignored, considered a part of the normal aging process or viewed as a difficult to treat condition. Geriatric insomnia remains a challenge for primary care providers because of the lack of evidence-based clinical guidelines and limited treatment options available. Effective management of this condition is necessary for improved quality of life, which is a primary issue for the elderly and their families. Therefore, geriatric insomnia warrants thorough attention from the nurse practitioners (NPs) who provide care for older adults. Undiagnosed or under treated insomnia can cause increased risk for falls, motor vehicle accidents, depression, and shorter survival. Insomniacs double their risk for cardiovascular disease, stroke, cancer, and suicide compared to their counterparts. Insomnia is also associated with increased healthcare utilization and institutionalization. NPs could play a central role in reducing the negative consequences of insomnia through a systematic approach for diagnosis, evaluation, and management.

Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients.

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Liesbeth Hempenius

Full Text Available The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined.A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life.Data of 260 patients (intervention n = 127, Control n = 133 were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02-6.88, an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02-5.87 and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07-0.49.A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed.Nederlands Trial Register, Trial ID NTR 823.

PROBLEMS AND CHANCES AT THE INTERFACE BETWEEN HOSPITAL CARE AND GERIATRIC REHABILITATION

Directory of Open Access Journals (Sweden)

Fastenmeier Heribert

2011-07-01

Full Text Available Available statistical data offer valuable information on recent demographic changes and developments within European healthcare and welfare systems. The demographic evolution is expected to have considerable impact upon various, major aspects of the economic and social life in all European countries. The healthcare system plays an important role especially in the context of ageing societies, such as Germany. This paper focuses on the evolution of the prevention or rehabilitation service sector during the last years in Germany, analyzes the specific characteristics of the elderly patients being cared for in these facilities and underlines important aspects at the interface between (acute hospital and geriatric rehabilitative care. Networking, integrated care services and models will be of even greater importance in the future demographic setting generating (most probably increasing numbers and percentages of elderly, multimorbid hospitalized patients. More than this, the cooperation at regional level between acute geriatric hospital departments and geriatric rehabilitation facilities has become a mandatory quality criterion in the Free State of Bavaria. This paper presents and analyzes issues referring to a precise cooperation model (between acute and rehabilitative care recommended for implementation even by the Free State of Bavaria while emphasizing several examples of good practice that have guaranteed the success of this cooperation model. The analysis of the main causes leading to longer length of stay (and thus delayed discharges for the elderly patients transferred to geriatric rehabilitation facilities within the reference model for acute-rehabilitative care provides important information and points at the existing potential for optimization in the acute hospital setting. Vicinity, tight communication and cooperation, early screening, implementation of standard procedures and case management are some of the activities that have

Medical Readers' Theater: Relevance to Geriatrics Medical Education

Science.gov (United States)

Shapiro, Johanna; Cho, Beverly

2011-01-01

Medical Readers' Theater (MRT) is an innovative and simple way of helping medical students to reflect on difficult-to-discuss topics in geriatrics medical education, such as aging stereotypes, disability and loss of independence, sexuality, assisted living, relationships with adult children, and end-of-life issues. The authors describe a required…

A clinical study of geriatric dermatoses

OpenAIRE

Leena Raveendra

2014-01-01

Introduction: The geriatric population is composed of persons over 65 years of age and very few studies are available on the dermatologic diseases in this group. This study was done to study the spectrum of cutaneous manifestations and prevalence of physiological and pathological changes in the skin of elderly people. Material and Methods: Two hundred consecutive patients aged more than 65 years of age attending the outpatient clinic or admitted as inpatients in the Department of Dermato...

Home geriatric physiological measurements.

Science.gov (United States)

Tamura, Toshiyo

2012-10-01

In an ageing society, the elderly can be monitored with numerous physiological, physical and passive devices. Sensors can be installed in the home for continuous mobility assistance and unobtrusive disease prevention. This review presents several modern sensors, which improve the quality of life and assist the elderly, disabled people and their caregivers. The main concept of geriatric sensors is that they are capable of providing assistance without limiting or disturbing the subject's daily routine, giving him or her greater comfort, pleasure and well-being. Furthermore, this review includes associated technologies of wearable/implantable monitoring systems and the 'smart-house' project. This review concludes by discussing future challenges of the future aged society.

Home geriatric physiological measurements

International Nuclear Information System (INIS)

Tamura, Toshiyo

2012-01-01

In an ageing society, the elderly can be monitored with numerous physiological, physical and passive devices. Sensors can be installed in the home for continuous mobility assistance and unobtrusive disease prevention. This review presents several modern sensors, which improve the quality of life and assist the elderly, disabled people and their caregivers. The main concept of geriatric sensors is that they are capable of providing assistance without limiting or disturbing the subject's daily routine, giving him or her greater comfort, pleasure and well-being. Furthermore, this review includes associated technologies of wearable/implantable monitoring systems and the ‘smart-house’ project. This review concludes by discussing future challenges of the future aged society. (topical review)

An Innovative Continuing Nursing Education Program Targeting Key Geriatric Conditions for Hospitalized Older People in China

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Xiao, Lily Dongxia; Shen, Jun; Wu, Haifeng; Ding, Fu; He, Xizhen; Zhu, Yueping

2013-01-01

A lack of knowledge in registered nurses about geriatric conditions is one of the major factors that contribute to these conditions being overlooked in hospitalized older people. In China, an innovative geriatric continuing nursing education program aimed at developing registered nurses' understanding of the complex care needs of hospitalized…

The Brave New World of GEC Evaluation: The Experience of the Rhode Island Geriatric Education Center

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Filinson, Rachel; Clark, Phillip G.; Evans, Joann; Padula, Cynthia; Willey, Cynthia

2012-01-01

In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these…

Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center.

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Wang, Hao; Coppola, Marco; Robinson, Richard D; Scribner, James T; Vithalani, Veer; de Moor, Carrie E; Gandhi, Raj R; Burton, Mandy; Delaney, Kathleen A

2013-04-01

It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered "minor trauma" with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients. Data were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique. From 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co

A randomized controlled trial on teaching geriatric medical decision making and cost consciousness with the serious game GeriatriX.

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Lagro, Joep; van de Pol, Marjolein H J; Laan, Annalies; Huijbregts-Verheyden, Fanny J; Fluit, Lia C R; Olde Rikkert, Marcel G M

2014-12-01

Medical students often lack training in complex geriatric medical decision making. We therefore developed the serious game, GeriatriX, for training medical decision making with weighing patient preferences, and appropriateness and costs of medical care. We hypothesized that education with GeriatriX would improve the ability to deal with geriatric decision making and also increase cost consciousness. A randomized, controlled pre-post measurement design. Fifth-year medical students. Playing the serious game GeriatriX as an additive to usual geriatric education. We evaluated the effects of playing GeriatriX on self-perceived knowledge of geriatric themes and the self-perceived competence of weighing patient preferences, appropriateness, and costs of medical care in geriatric decision making. Cost consciousness was evaluated with a postmeasurement to estimate costs of different diagnostic tests. There was a large positive increase in the self-perceived competence of weighing patient preferences, appropriateness, and costs of medical care in the intervention group (n = 71) (effect sizes of 0.7, 1.0, and 1.2, respectively), which was significantly better for the last 2 aspects than in the control group (n = 63). The intervention group performed better on cost consciousness. Although the self-perceived knowledge increased substantially on some geriatric topics, this improvement was not different between the intervention and control groups. After playing the serious game, GeriatriX, medical students have a higher self-perceived competence in weighing patient preferences, appropriateness, and costs of medical care in complex geriatric medical decision making. Playing GeriatriX also resulted in better cost consciousness. We therefore encourage wider use of GeriatriX to teach geriatrics in medical curricula and its further research on educational and health care outcomes. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier

Clinical preference for factors in treatment of geriatric depression

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Riepe MW

2014-12-01

Full Text Available Matthias W Riepe Mental Health and Geriatric Psychiatry, Psychiatry II, Ulm University, Ulm, Germany Abstract: Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69% returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials. Keywords: depressive disorder, symptoms, analytic hierarchy process, toxicity, adverse events, symptoms

Oral Health and Salivary Profiles of Geriatric Outpatients in Cipto Mangunkusumo General Hosp ital

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Aji Kurniawan

2012-12-01

Full Text Available Introduction: Population of geriatric patients would increase in line with that of elderly population. Health problems related to this group of people would have impact on general and oral health maintenance aiming for good quality of life. Objectives: This study aimed to determine the profile of oral health, saliva, and oral mucosa on geriatric patients at Geriatric Policlinic in Cipto Mangunkusumo Hospital. Materials and Methods: This research was a descriptive crosssectional study, which data was taken using questionnaire containing basic demographical information and oral clinical examination using standard form used by Faculty of Dentistry Universitas Indonesia. Results: The study included 75 geriatric patients, ranging from 60 to 86 of age. The mean of DMF-T score of 69 geriatric patients was 4.68 ±2.893, OHI-S 2.790 ±1.102, PBI 0.779±0.585. The mean of unstimulated salivary pH score was 6.618 ± 0.54 and stimulated buffer capacity of saliva was 7.46±2.827. Mean of salivary flow rate is 0.24mL/min and 39 people had hiposalivation. 93 normal variations and 117 pathological oral lesion was found. Conclusion: This study showed that poor oral health status and pathological oral lesion found in this study elderly population could be caused from poor salivary flow, pH saliva, and buffer capacity of saliva. Systematic oral examination of the elderly is of considerable importance and ought be carried out regularly by a dentist in collaboration with the physician; making holistic management of the elderly properly performed.DOI: 10.14693/jdi.v17i2.46

Associations Between Geriatric Syndromes and Mortality in Community-Dwelling Elderly: Results of a National Longitudinal Study in Taiwan.

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Huang, Chi-Chang; Lee, Jenq-Daw; Yang, Deng-Chi; Shih, Hsin-I; Sun, Chien-Yao; Chang, Chia-Ming

2017-03-01

Although geriatric syndromes have been studied extensively, their interactions with one another and their accumulated effects on life expectancy are less frequently discussed. This study examined whether geriatric syndromes and their cumulative effects are associated with risks of mortality in community-dwelling older adults. Data were collected from the Taiwan Longitudinal Study in Aging in 2003, and the participant survival status was followed until December 31, 2007. A total of 2744 participants aged ≥65 years were included in this retrospective cohort study; 634 died during follow-up. Demographic factors, comorbidities, health behaviors, and geriatric syndromes, including underweight, falls, functional impairment, depressive condition, and cognitive impairment, were assessed. Cox proportional hazard regression analysis was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the probability of survival according to the cumulative number of geriatric syndromes. The prevalence of geriatric syndromes increased with age. Mortality was significantly associated with age ≥75 years; male sex; ≤6 years of education; history of stroke, malignancy; smoking; not drinking alcohol; and not exercising regularly. Geriatric syndromes, such as underweight, functional disability, and depressive condition, contributed to the risk of mortality. The accumulative model of geriatric syndromes also predicted higher risks of mortality (N = 1, HR 1.50, 95% CI 1.19-1.89; N = 2, HR 1.69, 95% CI 1.25-2.29; N ≥ 3, HR 2.43, 95% CI 1.62-3.66). Community-dwelling older adults who were male, illiterate, receiving institutional care, underweight, experiencing a depressive condition, functionally impaired, and engaging in poor health behavior were more likely to have a higher risk of mortality. The identification of geriatric syndromes might help to improve comprehensive care for community-dwelling older adults. Copyright © 2016 AMDA – The Society for

A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations.

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Allen, C M; Becker, P M; McVey, L J; Saltz, C; Feussner, J R; Cohen, H J

1986-05-16

As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n = 93) groups. In the control group, only 27.1% of the actions that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore, relatively high compliance can be achieved with recommendations made by a geriatric consultation team, thereby overcoming the first barrier to the establishment of such a service.

Maximizing the Potential of Internships in Gerontology and Geriatrics

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Karasik, Rona J.

2009-01-01

Internships and similar applied opportunities have long been valued for providing students with opportunities for practical experience, career preparation, and personal growth. The need for applied experiences in gerontology and geriatrics is particularly salient. Creating and sustaining effective internship experiences, however, requires careful…

A clinical study of geriatric dermatoses

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Leena Raveendra

2014-07-01

Full Text Available Introduction: The geriatric population is composed of persons over 65 years of age and very few studies are available on the dermatologic diseases in this group. This study was done to study the spectrum of cutaneous manifestations and prevalence of physiological and pathological changes in the skin of elderly people. Material and Methods: Two hundred consecutive patients aged more than 65 years of age attending the outpatient clinic or admitted as inpatients in the Department of Dermatology at Vydehi Institute of Medical Sciences and Research Centre were subjects for the study. A detailed history of cutaneous complaints, present and past medical ailments was taken. A complete general physical, systemic examination and dermatological examination was done and all findings were noted in a pre designed proforma. Skin changes observed due to ageing were classified as physiological and pathological. Findings were collated in a master chart and results analyzed. Results: Out of 200 patients studied, 71% were males and 29% were females. Pruritus was the single most common complaint elicited (44%. Among the physiological changes, xerosis was the commonest (93%. Among the pathological changes skin tumours, eczemas, infections were the common findings. Conclusions: The geriatric dermatoses are different in different populations as some of the skin changes seen in western skin and Indian skin are not identical.

Assessment of a Chief Complaint–Based Curriculum for Resident Education in Geriatric Emergency Medicine

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Robert L Muelleman

2011-05-01

Full Text Available Introduction: We hypothesized that a geriatric chief complaint–based didactic curriculum would improve resident documentation of elderly patient care in the emergency department (ED. Methods: A geriatric chief complaint curriculum addressing the 3 most common chief complaints—abdominal pain, weakness, and falls—was developed and presented. A pre- and postcurriculum implementation chart review assessed resident documentation of the 5 components of geriatric ED care: 1 differential diagnosis/patient evaluation considering atypical presentations, 2 determination of baseline function, 3 chronic care facility/caregiver communication, 4 cognitive assessment, and 5 assessment of polypharmacy. A single reviewer assessed 5 pre- and 5 postimplementation charts for each of 18 residents included in the study. We calculated 95% confidence and determined that statistical significance was determined by a 2-tailed z test for 2 proportions, with statistical significance at 0.003 by Bonferroni correction. Results: For falls, resident documentation improved significantly for 1 of 5 measures. For abdominal pain, 2 of 5 components improved. For weakness, 3 of 5 components improved. Conclusion: A geriatric chief complaint–based curriculum improved emergency medicine resident documentation for the care of elderly patients in the ED compared with a non–age-specific chief complaint–based curriculum. [West J Emerg Med. 2011;12(4:484–488.

Frailty profile for geriatric patients in outpatient clinic of RSUP H. Adam Malik Medan

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Permatasari, T. D.; Sihombing, B.; Arianto, P.

2018-03-01

Frailty is a circumstance of increased vulnerability to bad resolution of homeostasis after a stressor occasion, which increases the risk of adverse outcomes. Early detection of frailty in elderly patients is a must but is rarely in the Geriatric Outpatient settings. We conducted a study to see the frailty profile for geriatric patients in the outpatient clinic of RSUP H. Adam Malik Medan. A cross-sectional research with a descriptive method was in the Geriatric Outpatient Clinic of Adam Malik Hospital from July-September 2016. The population of this study was patients from the Geriatric Outpatient Clinic, and sampling was by using consecutive methods. Samples were by questionnaires assessing (FRAIL Scale).This study was140 patients. Based on age, the age group of 81-90 years was dominantly frail (53.8%). Most of the subjects worked as government employees (109 subjects), and most of them were robust (42.2%). Based on income, both groups were dominated by robust (38.3% and 41.3%, respectively). Based on BMI, most were robust with underweight 33.5%, normoweight 37.8%, and obese 44.7%. Among the 140 patients, frailty was in the 27.1% of the subjects and the contributing factors were Age, Gender, and Obesity.

Redesigned geriatric emergency care may have helped reduce admissions of older adults to intensive care units.

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Grudzen, Corita; Richardson, Lynne D; Baumlin, Kevin M; Winkel, Gary; Davila, Carine; Ng, Kristen; Hwang, Ula

2015-05-01

Charged with transforming geriatric emergency care by applying palliative care principles, a process improvement team at New York City's Mount Sinai Medical Center developed the GEDI WISE (Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements) model. The model introduced workforce enhancements for emergency department (ED) and adjunct staff, including role redefinition, retraining, and education in palliative care principles. Existing ED triage nurses screened patients ages sixty-five and older to identify those at high risk of ED revisit and hospital readmission. Once fully trained, these nurses screened all but 6 percent of ED visitors meeting the screening criteria. Newly hired ED nurse practitioners identified high-risk patients suitable for and desiring palliative and hospice care, then expedited referrals. Between January 2011 and May 2013 the percentage of geriatric ED admissions to the intensive care unit fell significantly, from 2.3 percent to 0.9 percent, generating an estimated savings of more than $3 million to Medicare. The decline in these admissions cannot be confidently attributed to the GEDI WISE program because other geriatric care innovations were implemented during the study period. GEDI WISE programs are now running at Mount Sinai and two partner sites, and their potential to affect the quality and value of geriatric emergency care continues to be examined. Project HOPE—The People-to-People Health Foundation, Inc.

Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups

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Marschollek, Michael; Gövercin, Mehmet; Rust, Stefan; Gietzelt, Matthias; Schulze, Mareike; Wolf, Klaus-Hendrik; Steinhagen-Thiessen, Elisabeth

2012-01-01

Abstract Background Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1), and to identify high-risk subgroups from the data (aim#2). Methods A ...

[Rational physiotherapy in geriatrics (author's transl)].

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Dörfler, R; Seifert, M

1977-01-01

According to the economical principle to obtain the highest advantage with the minimalst engagement for the society we passed over in geriatrics from the individual physiotherapy to the therapy in the group, which was very successful in our institution. Four important groups of diseases of the second part of the life have been taken into consideration: Patients with chronic bronchitis, with movement-diseases of the shoulder, the sameone of the hips and the knees and with arterial obturative disease of the extremities.

Advances in research, education and practice in geriatric medicine, 1982-2012.

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Flicker, Leon

2013-10-01

Over the last 30 years, major advances in the provision of services for frail older people in Australasia have taken place. This has been spurred on by the accumulation of the evidence for benefits of the multidisciplinary team model of comprehensive geriatric assessment and management. Current research is now uncovering mechanisms of frailty associated with the ageing process and will lead to further interventions in the management of the health problems of older people. These interventions will almost certainly include both medical and lifestyle strategies. Although there have been major improvements in the education of health professionals in aspects of geriatrics, more concerted efforts are required for the ageing population. © 2013 ACOTA.

Polypharmacy in geriatric patients: too little or too much?

NARCIS (Netherlands)

Tulner, C.R.

2009-01-01

This thesis deals with accidents happening in usual care regarding medication use. The evaluation of polypharmacy during geriatric assessment is described. Finally, the di-lemmas in the treatment of frequently present cardiovas-cular diseases are discussed. In chapter 1.1 a case report is presented

Implementing the objective structured clinical examination in a geriatrics fellowship program-a 3-year experience.

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Avelino-Silva, Thiago J; Gil, Luiz A; Suemoto, Claudia K; Kikuchi, Elina L; Lin, Sumika M; Farias, Luciana L; Jacob-Filho, Wilson

2012-07-01

The Objective Structured Clinical Examination (OSCE) appears to be an effective alternative for assessing not only medical knowledge, but also clinical skills, including effective communication and physical examination skills. The purpose of the current study was to implement an OSCE model in a geriatrics fellowship program and to compare the instrument with traditional essay examination. Seventy first- and second-year geriatric fellows were initially submitted to a traditional essay examination and scored from 0 to 10 by a faculty member. The same fellows subsequently underwent an OSCE with eight 10-minute stations covering a wide range of essential aspects of geriatric knowledge. Each OSCE station had an examiner responsible for its evaluation according to a predefined checklist. Checklist items were classified for analysis purposes as clinical knowledge items (CKI) and communication skills items (CSI); fellow responses were scored from 0 to 10.Although essay examinations took from 30 to 45 minutes to complete, 180-200 minutes were required to evaluate fellows using the proposed OSCE method. Fellows scored an average of 6.2 ± 1.2 on the traditional essay examination and 6.6 ± 1.0 on the OSCE (P examination was similar to their performance on CKI (P = .13). Second-year fellows performed better than first-year fellows on the essay examination (P geriatrics fellowship program. Combining different testing modalities may provide the best assessment of competence for various domains of knowledge, skills, and behavior. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial.

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McVey, L J; Becker, P M; Saltz, C C; Feussner, J R; Cohen, H J

1989-01-01

To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients. Randomized controlled clinical trial. University-affiliated referral Veterans Administration Medical Center. One hundred and seventy-eight hospitalized elderly men 75 years or older admitted to medical, surgical, and psychiatry services, but excluding patients admitted to intensive care units. Eighty-eight intervention group patients received multidimensional evaluation by an interdisciplinary geriatric consultation team composed of a faculty geriatrician, geriatrics fellow, geriatric clinical nurse specialist, and a social worker trained in geriatrics. Results of the evaluation, including problem identification and recommendations, were given to the patients' physicians. Ninety control group patients received only usual care. Intervention and control groups were comparable initially. The major outcome variable was the Index of Independence in the Activities of Daily Living (ADL) (Katz). Thirty-nine percent of the total study population was functionally independent on admission, 27% required assistance with one to three ADL, 22% required assistance with four to six ADL, and 12% were completely dependent. Many patients remained unchanged from admission to discharge: intervention group, 38%; control group, 39%. In the intervention group, 34% improved and 28% declined; in the control group, 26% improved and 36% declined. Although these changes reflected a trend toward greater improvement in the intervention group, the results were not statistically significant. Among elderly patients entering an acute-care hospital, approximately 60% had some degree of, and one third had serious functional disability. Such patients are at risk for further decline during hospitalization. A geriatric consultation team was unable to alter the degree of functional decline. Geriatric units or consultation teams may have to offer direct preventive or restorative services in

The Interdisciplinary Geriatric/Gerontological Team in the Academic Setting.

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Mellor, M Joanna; Solomon, Renee

1992-01-01

Geriatric health care requires the services of an interdisciplinary health care team to assess, treat and order the social service needs of the older person, and this concept needs to be included in geriatric social work education. But while the necessity of interdisciplinary team care is recognized, little focus has been placed on the actual process of developing a functional team. The issues that arise-disparate terminologies, organizational and administrative differentials, turf-and the steps needed for a team to become viable are described, using an interdisciplinary team based in academia as a case model. The academic interdisciplinary team may easily become a forum for 'hot air' rather than a catalyst for good practice. This danger is reviewed with reference to stages in the interdisciplinary team development-- goal development group affiliation; team awareness; and goal evaluation. The chapter concludes with a discussion on the impact of the interdisciplinary team on faculty, students and the academic setting.

Feasibility and validity of frailty measurement in geriatric rehabilitation.

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Arjunan, Aparna; Peel, Nancye M; Hubbard, Ruth E

2018-02-10

The measurement of frailty using a Frailty Index (FI) has been criticised as too time-consuming for use in hospital settings. We aimed to assess the feasibility and characteristics of an FI derived from routinely collected data. A total of 258 participants aged 65 and older were included in a single-centre prospective cohort study conducted in inpatient geriatric rehabilitation wards. The functional independence measure (FIM™), medication count and comorbidities were coded as deficits. An FI could be derived in all participants. It was normally distributed with a mean (SD) of 0.42 (0.13) and reached a submaximal limit of 0.69. Adjusting for age and sex, the odds ratio of a poor outcome (death/discharge to higher care) was 1.38 (confidence interval 1.11-1.70) per unit (0.1) increase in FI. Derivation of an FI from routinely collected data is feasible in geriatric rehabilitation settings and is predictive of poor outcomes. © 2018 AJA Inc.

Rapid Geriatric Assessment of Hip Fracture.

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Zanker, Jesse; Duque, Gustavo

2017-08-01

A comprehensive geriatric assessment, combined with a battery of imaging and blood tests, should be able to identify those hip fracture patients who are at higher risk of short- and long-term complications. This comprehensive assessment should be followed by the implementation of a comprehensive multidimensional care plan aimed to prevent negative outcomes in the postoperative period (short and long term), thus assuring a safe and prompt functional recovery while also preventing future falls and fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

[Interdisciplinary treatment in geriatric traumatology from the trauma surgeons' perspective : Results of a survey in Germany].

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Bücking, B; Walz, M; Hartwig, E; Friess, T; Liener, U; Knobe, M; Ruchholtz, S; Bliemel, C

2017-01-01

Many patients treated on trauma surgery wards are geriatric trauma patients. To improve treatment of these often multimorbid patients, various interdisciplinary treatment concepts have been established in Germany between trauma surgeons and geriatricians. The aim of this study was to evaluate the dissemination and the impact of the different orthogeriatric treatment concepts for geriatric trauma in Germany. Material and methods In March and April 2014 an electronic questionnaire for assessing the interdisciplinary treatment of geriatric trauma patients was sent to 691 medical directors of trauma surgery departments in Germany. A total of 259 (37 %) fully answered questionnaires could be analyzed. The analysis revealed that 70 % of all responding trauma surgery departments had an orthogeriatric treatment cooperation. Most of them reported having patient discharge agreements to geriatric rehabilitation facilities (59 %). Geriatric counseling services were reported by 39 % while 24 % reported having regular interdisciplinary visits and orthogeriatric wards were available in 13 %. The need for orthogeriatric services was considered to be high by 79 % of the participants and benefits especially for the patients were expected. These expectations were largely fulfilled. More than 70 % of respondents planned to intensify the orthogeriatric cooperation. In this context difficulties were seen in the lack of personnel resources, especially in a lack of geriatricians. The results of this survey underline the impact and the positive experiences in orthogeriatric services. Solutions have to be found to address the emerging problem of capacity constraints.

Do Geriatric Conditions Increase Risk of Adverse Drug Reactions in Ambulatory Elders? Results From the VA GEM Drug Study

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Hanlon, Joseph T.; Sloane, Richard J.; Boscardin, W. John; Schmader, Kenneth E.

2011-01-01

Background. Many clinicians prescribe cautiously to older adults with common geriatric conditions for fear of causing adverse drug reactions (ADRs). However, little is known about the association between these conditions and risk of ADRs. Methods. Using data from the VA Geriatric Evaluation and Management Drug Study, we determined any, preventable, and serious ADRs in 808 elders for 12 months after hospital discharge using a validated process involving patient self-report and chart review adjudicated by two health care professionals. Eight common geriatric conditions (activities of daily living, dementia, incontinence, falls, difficulty ambulating, malnourishment, depression, and prolonged bed rest) were evaluated at study baseline through self-report and structured assessments. We used Poisson regression to model the relationship between these geriatric conditions and ADRs. Results. Participants had a mean of 2.9 ± 1.2 geriatric conditions. Over the 12-month follow-up period, 497 ADRs occurred in 269 participants, including 187 ADRs considered preventable and 127 considered severe. On multivariable analyses, participants with dependency in one or more activities of daily living were less likely to suffer ADRs than those who were fully independent (incidence rate ratio: 0.78, 95% confidence interval = 0.62–1.00). None of the other seven geriatric conditions assessed were associated with ADR risk. Results were similar for preventable and serious ADRs, although participants with a history of falls were more likely to develop serious ADRs (incidence rate ratio: 1.49, 95% confidence interval = 1.00–2.21). Conclusions. Many geriatric conditions were not associated with risk of ADRs. Although it is prudent to prescribe judiciously in patients with these conditions, excessive caution may not be warranted. PMID:21321003

The Association between Parameters of Malnutrition and Diagnostic Measures of Sarcopenia in Geriatric Outpatients

Science.gov (United States)

Reijnierse, Esmee M.; Trappenburg, Marijke C.; Leter, Morena J.; Blauw, Gerard Jan; de van der Schueren, Marian A. E.; Meskers, Carel G. M.; Maier, Andrea B.

2015-01-01

Objectives Diagnostic criteria for sarcopenia include measures of muscle mass, muscle strength and physical performance. Consensus on the definition of sarcopenia has not been reached yet. To improve insight into the most clinically valid definition of sarcopenia, this study aimed to compare the association between parameters of malnutrition, as a risk factor in sarcopenia, and diagnostic measures of sarcopenia in geriatric outpatients. Material and Methods This study is based on data from a cross-sectional study conducted in a geriatric outpatient clinic including 185 geriatric outpatients (mean age 82 years). Parameters of malnutrition included risk of malnutrition (assessed by the Short Nutritional Assessment Questionnaire), loss of appetite, unintentional weight loss and underweight (body mass index malnutrition (independent variables) and diagnostic measures of sarcopenia (dependent variables) were analysed using multivariate linear regression models adjusted for age, body mass, fat mass and height in separate models. Results None of the parameters of malnutrition was consistently associated with diagnostic measures of sarcopenia. The strongest associations were found for both relative and absolute muscle mass; less stronger associations were found for muscle strength and physical performance. Underweight (p = malnutrition relate differently to diagnostic measures of sarcopenia in geriatric outpatients. The association between parameters of malnutrition and diagnostic measures of sarcopenia was strongest for both relative and absolute muscle mass, while less strong associations were found with muscle strength and physical performance. PMID:26284368

Physician and Nurse Acceptance of Technicians to Screen for Geriatric Syndromes in the Emergency Department

OpenAIRE

Carpenter, Christopher R; Griffey, Richard T; Stark, Susan; Coopersmith, Craig M; Gage, Brian F

2011-01-01

Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED) survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of t...

Effect of a steam foot spa on geriatric inpatients with cognitive impairment: a pilot study

OpenAIRE

Koike Y; Kondo H; Kondo S; Takagi M; Kano Y

2013-01-01

Yoshihisa Koike,1 Hideki Kondo,2 Satoshi Kondo,1 Masayuki Takagi,1 Yoshio Kano31Department of Occupational Therapy, Prefectural University of Hiroshima, Mihara, Japan; 2Yoshiigawa Hospital, Okayama, Japan; 3Department of Occupational Therapy, Kibi International University, Takahashi, JapanPurpose: To investigate whether a steam foot spa improves cognitive impairment in geriatric inpatients.Methods: Geriatric inpatients with cognitive impairment were given a steam foot spa treatment at 42&...

Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials

OpenAIRE

Ellis, G.; Whitehead, M.A.; Robinson, D.; O'Neill, D.; Langhorne, P.

2011-01-01

Objective - To evaluate the effectiveness of comprehensive geriatric assessment in hospital for older adults admitted as an emergency.\\ud \\ud Search strategy - We searched the EPOC Register, Cochrane’s Controlled Trials Register, the Database of Abstracts of Reviews of Effects (DARE), Medline, Embase, CINAHL, AARP Ageline, and handsearched high yield journals.\\ud \\ud Selection criteria - Randomised controlled trials of comprehensive geriatric assessment (whether by mobile teams or in designat...

Aging in Rural Appalachia: Perspectives from Geriatric Social Service Professionals

Directory of Open Access Journals (Sweden)

Natalie D. Pope

2014-09-01

Full Text Available This paper uses qualitative methodology to explore the experience of growing old in rural Appalachia. Given the growing population of older adults seeking and utilizing services, it is important to understand the challenges and specific needs related to aging. Within the context of rural Appalachia, these challenges and needs may be different than those in urban areas or areas outside of the region itself. From interviews with 14 geriatric service providers in rural southeast Ohio, the authors were able to identity three prevalent themes associated with aging in rural North Central Appalachia: scarcity of resources, valuing neighbors and family, and the prevalence of drug use. These findings suggest that preparation and ongoing training of rural geriatric social workers should include attention to topics such as substance abuse and strengthening social support networks that often exist in these regions.

Falls and other geriatric syndromes in Blantyre, Malawi: A ...

African Journals Online (AJOL)

Background: The prevalence of geriatric syndromes (falls, immobility, intellectual or memory impairment, and incontinence) is unknown in many resource-poor countries. With an aging population such knowledge is essential to develop national policies on the health and social needs of older people. The aim of this study ...

Culture Competence in the Training of Geriatric Medicine Fellows

Science.gov (United States)

Tanabe, Marianne K. G.

2007-01-01

With the aging and diversifying of the elder population in the United States, there is a pressing need for an organized and effective curriculum in cultural competence. The Accreditation Council for Graduate Medical Education (ACGME) requires that the curriculum for Geriatric Medicine Fellowship training include cultural competency training.…

Profile of the geriatric patients hospitilised at Universitas hospital ...

African Journals Online (AJOL)

For successful geriatric care at Universitas Hospital there will be a need for at least 11 days hospitalisation, and a unit with good training in internal medicine, psychiatry, urology, orthopaedy and oncology. The main supporting services will be physiotherapy, occupational therapy and social welfare. Laboratory analyses will ...

Update for 2014 on clinical cardiology, geriatric cardiology, and heart failure and transplantation.

Science.gov (United States)

Barón-Esquivias, Gonzalo; Manito, Nicolás; López Díaz, Javier; Martín Santana, Antonio; García Pinilla, José Manuel; Gómez Doblas, Juan José; Gómez Bueno, Manuel; Barrios Alonso, Vivencio; Lambert, José Luis

2015-04-01

In the present article, we review publications from the previous year in the following 3 areas: clinical cardiology, geriatric cardiology, and heart failure and transplantation. Among the new developments in clinical cardiology are several contributions from Spanish groups on tricuspid and aortic regurgitation, developments in atrial fibrillation, syncope, and the clinical characteristics of heart disease, as well as various studies on familial heart disease and chronic ischemic heart disease. In geriatric cardiology, the most relevant studies published in 2014 involve heart failure, degenerative aortic stenosis, and data on atrial fibrillation in the geriatric population. In heart failure and transplantation, the most noteworthy developments concern the importance of multidisciplinary units and patients with preserved systolic function. Other notable publications were those related to iron deficiency, new drugs, and new devices and biomarkers. Finally, we review studies on acute heart failure and transplantation, such as inotropic drugs and ventricular assist devices. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

[Nutritional management in geriatric traumatology].

Science.gov (United States)

Singler, K; Goisser, S; Volkert, D

2016-08-01

The prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation. This article gives an overview of the recently updated recommendations on nutritional management in orthogeriatric patients as published by the orthogeriatric working group of the German Geriatric Society.

Risk stratification and rapid geriatric screening in an emergency department - a quasi-randomised controlled trial.

Science.gov (United States)

Foo, Chik Loon; Siu, Vivan Wing Yin; Ang, Hou; Phuah, Madeline Wei Ling; Ooi, Chee Kheong

2014-08-30

To determine if risk stratification followed by rapid geriatric screening in an emergency department (ED) reduced functional decline, ED reattendance and hospitalisation. This was a quasi-randomised controlled trial. Patients were randomised by the last digit of their national registration identity card (NRIC). Odd number controls received standard ED care; even number patients received geriatric screening, followed by intervention and/or onward referrals. Patients were followed up for 12 months. There were 500 and 280 patients in the control and intervention groups. The intervention group had higher Triage Risk Screening Tool (TRST) scores (34.3% vs 25.4% TRST ≥3, p = 0.01) and lower baseline Instrumental Activity of Daily Living (IADL) scores (22.84 vs 24.18, p fall risk (65.0%), vision (61.4%), and footwear (58.2%). 28.2% were referred to a geriatric clinic and 11.8% were admitted. 425 (85.0%) controls and 234 (83.6%) in the intervention group completed their follow-up. After adjusting for TRST and baseline IADL, the intervention group had significant preservation in function (Basic ADL -0.99 vs -0.24, p geriatric screening at the request of the ED doctor. A major limitation was that a large proportion of patients who were randomized to the intervention group either refused (18.8%) or left the ED before being approached (32.0%). These two groups were not followed up, and hence were excluded in our analysis. Risk stratification and focused geriatric screening in ED resulted in significant preservation of patients' function at 12 months. National Healthcare Group (NHG) Domain Specific Review Board (DSRB) C/09/023. Registered 5th March 2009.

Effectiveness of acute geriatric units in the real world: the case of short-term mortality among seniors hospitalized for pneumonia.

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Ding, Yew Yoong; Abisheganaden, John; Chong, Wai Fung; Heng, Bee Hoon; Lim, Tow Keang

2013-01-01

We sought to compare the effectiveness of acute geriatric units with usual medical care in reducing short-term mortality among seniors hospitalized for pneumonia in the real world. In a retrospective cohort study, we merged chart and administrative data of seniors aged 65 years and older admitted to acute geriatric units and other medical units for pneumonia at three hospitals over 1 year. The outcome was 30-day mortality. Hierarchical logistic regression modeling was carried out to estimate the treatment effect of acute geriatric units for all seniors, those aged 80 years and older, and those with premorbid ambulation impairment, after adjusting for demographic and clinical characteristics, and accounting for clustering around hospitals. Among 2721 seniors, 30-day mortality was 25.5%. For those admitted to acute geriatric and other medical units, this was 24.2% and 25.8%, respectively. Using hierarchical logistic regression modeling, treatment in acute geriatric units was not associated with significant mortality reduction among all seniors (OR 0.72, 95% CI 0.52-1.00). However, significant mortality reduction was observed in the subgroups of those aged 80 years and older (OR 0.73, 95% CI 0.54-0.99), and with premorbid ambulation impairment (OR 0.65, 95% CI 0.46-0.93). Acute geriatric units reduced short-term mortality among seniors hospitalized for pneumonia who were aged 80 years and older or had premorbid ambulation impairment. Further research is required to determine if this beneficial effect extends to seniors hospitalized for other acute medical disorders. © 2012 Japan Geriatrics Society.

Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults.

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Ichwan, Brian; Darbha, Subrahmanyam; Shah, Manish N; Thompson, Laura; Evans, David C; Boulger, Creagh T; Caterino, Jeffrey M

2015-01-01

We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. We studied a retrospective cohort of injured patients aged 16 years or older in the 2006 to 2011 Ohio Trauma Registry. Patients aged 70 years or older were considered geriatric. We identified whether each patient met the geriatric and the adult triage criteria. The outcome measure was need for trauma center care, defined by surrogate markers: Injury Severity Score greater than 15, operating room in fewer than 48 hours, any ICU stay, and inhospital mortality. We calculated sensitivity and specificity of both triage criteria for both age groups. We included 101,577 patients; 33,379 (33%) were geriatric. Overall, 57% of patients met adult criteria and 68% met geriatric criteria. Using Injury Severity Score, for older adults geriatric criteria were more sensitive for need for trauma center care (93%; 95% confidence interval [CI] 92% to 93%) than adult criteria (61%; 95% CI 60% to 62%). Geriatric criteria decreased specificity in older adults from 61% (95% CI 61% to 62%) to 49% (95% CI 48% to 49%). Geriatric criteria in older adults (93% sensitivity, 49% specificity) performed similarly to the adult criteria in younger adults (sensitivity 87% and specificity 44%). Similar patterns were observed for other outcomes. Standard adult EMS triage guidelines provide poor sensitivity in older adults. Ohio's geriatric trauma triage guidelines significantly improve sensitivity in identifying Injury Severity Score and other surrogate markers of the need for trauma center care, with modest decreases in specificity for older adults. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The Case for Dual Training in Geriatric Medicine and Palliative Care: The Time is Now.

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Gabbard, Jennifer; McNabney, Matthew

2018-02-01

The majority of older adults die from chronic illnesses which are preceded by years of progressive decline and increasing symptom burden. Delivery of high-quality care cannot take place without sufficient numbers of health professionals with appropriate training and skills in both geriatric and palliative care medicine. Despite the surge in aging population and the majority of deaths being attributed to patients with multiple comorbidities, very few health-care providers undergo dual training in these areas. Thus, the nation is facing a health-care crisis as the number of geriatric patients with chronic disease increasingly outpaces the number of physicians with adequate skills to manage them. Joint training in palliative care and geriatric medicine could prepare physicians to better manage our aging population by addressing all their health-care needs irrespective of their stage of disease emphasizing patient-directed care.

Associations of Various Health-Ratings with Geriatric Giants, Mortality and Life Satisfaction in Older People

DEFF Research Database (Denmark)

Puvill, Thomas; Lindenberg, Jolanda; Gussekloo, Jacobijn

2016-01-01

Self-rated health is routinely used in research and practise among general populations. Older people, however, seem to change their health perceptions. To accurately understand these changed perceptions we therefore need to study the correlates of older people's self-ratings. We examined self......-rated, nurse-rated and physician-rated health's association with common disabilities in older people (the geriatric giants), mortality hazard and life satisfaction. For this, we used an age-representative population of 501 participant aged 85 from a middle-sized city in the Netherlands: the Leiden 85-plus......) were included as geriatric giants. Participants provided a score for life satisfaction and were followed up for vital status. Concordance of self-rated health with physician-rated (k = .3 [.0]) and nurse-rated health (k = .2 [.0]) was low. All three ratings were associated with the geriatric giants...

Psychosocial work load and stress in the geriatric care.

Science.gov (United States)

Nübling, Matthias; Vomstein, Martin; Schmidt, Sascha G; Gregersen, Sabine; Dulon, Madeleine; Nienhaus, Albert

2010-07-21

Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain.Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database).Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration).Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity.A supplementary subgroup analysis showed that the degree of negative evaluation of psychosocial factors concerning demands was related to the amount of working hours per week and the

The Value of Geriatric Assessments in Predicting Treatment Tolerance and All-Cause Mortality in Older Patients With Cancer

NARCIS (Netherlands)

Hamaker, Marije E.; Vos, Alinda G.; Smorenburg, Carolien H.; de Rooij, Sophia E.; van Munster, Barbara C.

2012-01-01

Background. Awareness of the use of geriatric assessments for older patients with cancer is increasing. The aim of this review is to summarize all available evidence on the association between geriatric assessments and relevant oncologic outcomes. Method. A systematic search was conducted in Medline

Geriatric injuries among patients attending a regional hospital in ...

African Journals Online (AJOL)

Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS computer system. A total of 94 geriatric trauma patients constituting 22.7% of all trauma admissions ... Pre-hospital care was recorded in 5.3% of cases. The musculoskeletal (72.3%) and head (66.0%) regions were commonly affected.

Predicting in-patient falls in a geriatric clinic: a clinical study combining assessment data and simple sensory gait measurements.

Science.gov (United States)

Marschollek, M; Nemitz, G; Gietzelt, M; Wolf, K H; Meyer Zu Schwabedissen, H; Haux, R

2009-08-01

Falls are among the predominant causes for morbidity and mortality in elderly persons and occur most often in geriatric clinics. Despite several studies that have identified parameters associated with elderly patients' fall risk, prediction models -- e.g., based on geriatric assessment data -- are currently not used on a regular basis. Furthermore, technical aids to objectively assess mobility-associated parameters are currently not used. To assess group differences in clinical as well as common geriatric assessment data and sensory gait measurements between fallers and non-fallers in a geriatric sample, and to derive and compare two prediction models based on assessment data alone (model #1) and added sensory measurement data (model #2). For a sample of n=110 geriatric in-patients (81 women, 29 men) the following fall risk-associated assessments were performed: Timed 'Up & Go' (TUG) test, STRATIFY score and Barthel index. During the TUG test the subjects wore a triaxial accelerometer, and sensory gait parameters were extracted from the data recorded. Group differences between fallers (n=26) and non-fallers (n=84) were compared using Student's t-test. Two classification tree prediction models were computed and compared. Significant differences between the two groups were found for the following parameters: time to complete the TUG test, transfer item (Barthel), recent falls (STRATIFY), pelvic sway while walking and step length. Prediction model #1 (using common assessment data only) showed a sensitivity of 38.5% and a specificity of 97.6%, prediction model #2 (assessment data plus sensory gait parameters) performed with 57.7% and 100%, respectively. Significant differences between fallers and non-fallers among geriatric in-patients can be detected for several assessment subscores as well as parameters recorded by simple accelerometric measurements during a common mobility test. Existing geriatric assessment data may be used for falls prediction on a regular basis

Quality indicators for in-hospital geriatric co-management programmes: a systematic literature review and international Delphi study.

Science.gov (United States)

Van Grootven, Bastiaan; McNicoll, Lynn; Mendelson, Daniel A; Friedman, Susan M; Fagard, Katleen; Milisen, Koen; Flamaing, Johan; Deschodt, Mieke

2018-03-16

To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes. An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers). Western Europe and the USA. Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited. Twenty-eight experts (16 from the USA and 12 from Europe) participated in both Delphi rounds (85% response rate). Participants rated the indicators on a nine-point scale for their (1) appropriateness and (2) feasibility to use the indicator for the evaluation of geriatric co-management programmes. Indicators were considered appropriate and feasible based on a median score of seven or higher. Consensus was based on the level of agreement using the RAND/UCLA Appropriateness Method. In the first round containing 37 indicators, there was consensus on 14 indicators. In the second round containing 44 indicators, there was consensus on 31 indicators (structure=8, process=7, outcome=16). Experts indicated that co-management should start within 24 hours of hospital admission using defined criteria for selecting appropriate patients. Programmes should focus on the prevention and management of geriatric syndromes and complications. Key areas for comprehensive geriatric assessment included cognition/delirium, functionality/mobility, falls, pain, medication and pressure ulcers. Key outcomes for evaluating the programme included length of stay, time to surgery and the incidence of complications. The indicators can be used to assess the performance of geriatric co-management programmes and identify areas for improvement. Furthermore, the indicators can be used to monitor the implementation and effect of these programmes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All

Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.

Science.gov (United States)

Williams, Brent C; Warshaw, Gregg; Fabiny, Anne Rebecca; Lundebjerg Mpa, Nancy; Medina-Walpole, Annette; Sauvigne, Karen; Schwartzberg, Joanne G; Leipzig, Rosanne M

2010-09-01

Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory

Microbial diversity and evidence of novel homoacetogens in the gut of both geriatric and adult giant pandas (Ailuropoda melanoleuca.

Directory of Open Access Journals (Sweden)

Hein Min Tun

Full Text Available Recent studies have described the bacterial community residing in the guts of giant pandas, together with the presence of lignocellulolytic enzymes. However, a more comprehensive understanding of the intestinal microbial composition and its functional capacity in giant pandas remains a major goal. Here, we conducted a comparison of bacterial, fungal and homoacetogenic microbial communities from fecal samples taken from two geriatric and two adult captive giant pandas. 16S rDNA amplicon pyrosequencing revealed that Firmicutes and Proteobacteria are the most abundant microbiota in both geriatric and adult giant pandas. However, members of phylum Actinobacteria found in adult giant pandas were absent in their geriatric counterparts. Similarly, ITS1 amplicon pyrosequencing identified developmental changes in the most abundant fungal classes from Sordariomycetes in adult pandas to Saccharomycetes in geriatric pandas. Geriatric pandas exhibited significantly higher abundance of a potential probiotic fungus (Candida tropicalis as compared to adult pandas, indicating their importance in the normal digestive physiology of aged pandas. Our study also reported the presence of a lignocellulolytic white-rot fungus, Perenniporia medulla-panis, and the evidence of novel homoacetogens residing in the guts of giant pandas.

Measuring medical students' attitudes and knowledge about geriatrics and gerontology in Brazilian medical students: A comparison of instruments.

Science.gov (United States)

Lucchetti, Alessandra Lg; da S Ezequiel, Oscarina; Moreira-Almeida, Alexander; Lucchetti, Giancarlo

2018-04-14

To compare instruments available for evaluating attitudes and knowledge about geriatrics and gerontology. This cross-sectional study investigated 83 third-year Brazilian medical students (with exposure to geriatrics and gerontology) and 75 incoming students (with no exposure to this content). We used the University of California at Los Angeles Geriatrics Attitudes Scale, Palmore's Facts on Aging Quiz, modified Maxwell-Sullivan Attitude Survey, Aging Semantic Differential Scale and an instrument assessing their cognitive knowledge in geriatrics. The instruments investigated had moderate-to-high correlations when evaluating similar constructs, had satisfactory or borderline internal consistency for the most part (Cronbach's α: 0.62-0.94) and were capable of discriminating between students exposed or not to practical and theoretical content. Our findings reinforce previous studies that these scales are capable of differentiating students who have or have not had exposure/intervention and, in general, seem to be assessing different constructs. © 2018 AJA Inc.

Recommendations for standardized diagnostics, treatment and following care in tumor diseases. Geriatric patient with tumor disease

International Nuclear Information System (INIS)

Hagmueller, E.; Neises, M.; Queisser, W.; Richter, H.; Schneider, G.

2001-01-01

The recommendations for the treatment of geriatric patients with tumor disease, presented in the paper, cover: surgery; chemotherapy; radiotherapy and immunotherapy. Radiotherapy is recommended for skin tumors, pain treatment in the bone metastases (40 - 50 Gy), system diseases (with reduction of the usual size of the irradiated area), small size tumors etc. It is considered as an appropriate method (excluding wide fields) for geriatric outpatients

Prevalence of factors associated with malnutrition among acute geriatric patients in Norway: a cross-sectional study.

Science.gov (United States)

Jacobsen, Ellisiv Lærum; Brovold, Therese; Bergland, Astrid; Bye, Asta

2016-09-06

Data on acute geriatric patients' nutritional status are lacking, and the associations among physical function, sarcopenia, health status and nutritional status are not sufficiently investigated in this population. The aims of this study are to investigate (1) nutritional status and sarcopenia in a group of acute geriatric patients, (2) the association between nutritional status, physical function and sarcopenia in acute geriatric patients, controlling for health status. A cross-sectional study. Two acute geriatric hospital wards in Norway. This study included 120 patients with a mean age of 82.6±8 years. The following inclusion criteria were used: age ≥65 years and admitted to an acute geriatric ward. The exclusion criteria included terminal illness, Mini-Mental State Examination Physical function was measured using the Barthel activities of daily life index and the Short Physical Performance Battery (SPPB). Sarcopenia was diagnosed using the mid-arm muscle circumference, gait speed and grip strength, in accordance with the EWGSOP algorithm. Diseases are organised by organ system classification. On the basis of the MNA classification, nearly one in two patients were at risk of malnutrition, while one in four were malnourished. Sarcopenia was present in 30% of the patients. A multivariate linear regression model was estimated and showed significant independent associations between SPPB score (β 0.64, 95% CI 0.38 to 0.90), sarcopenia (β -3.3, 95% CI -4.9 to -1.7), pulmonary disease (β -2.1, 95% CI -3.7 to -0.46), cancer (β -1.7, 95% CI -3.4 to -0.033) and nutritional status. Our study shows a high prevalence of risk of malnutrition, malnutrition and sarcopenia. Further, the results indicate that a low total SPPB score, sarcopenia, cancer and pulmonary disease are significantly associated with declines in nutritional status, as measured by the MNA, in acute geriatric patients. Published by the BMJ Publishing Group Limited. For permission to use (where not

A Novel Geriatric Screening Tool in Older Patients with Cancer: The Korean Cancer Study Group Geriatric Score (KG-7.

Directory of Open Access Journals (Sweden)

Jin Won Kim

Full Text Available Geriatric assessment (GA is resource-consuming, necessitating screening tools to select appropriate patients who need full GA. The objective of this study is to design a novel geriatric screening tool with easy-to-answer questions and high performance objectively selected from a large dataset to represent each domain of GA. A development cohort was constructed from 1284 patients who received GA from May 2004 to April 2007. Items representing each domain of functional status, cognitive function, nutritional status, and psychological status in GA were selected according to sensitivity (SE and specificity (SP. Of the selected items, the final questions were chosen by a panel of oncologists and geriatricians to encompass most domains evenly and also by feasibility and use with cancer patients. The selected screening questions were validated in a separate cohort of 98 cancer patients. The novel screening tool, the Korean Cancer Study Group Geriatric Score (KG-7, consisted of 7 items representing each domain of GA. KG-7 had a maximal area under the curve (AUC of 0.93 (95% confidence interval (CI 0.92-0.95 in the prediction of abnormal GA, which was higher than that of G-8 (0.87, 95% CI 0.85-0.89 within the development cohort. The cut-off value was decided at ≤ 5 points, with a SE of 95.0%, SP of 59.2%, positive predictive value (PPV of 85.3%, and negative predictive value (NPV of 82.6%. In the validation cohort, the AUC was 0.82 (95% CI 0.73-0.90, and the SE, SP, PPV, and NPV were 89.5%, 48.6%, 77.3%, and 75.0%, respectively. Furthermore, patients with higher KG-7 scores showed significantly longer overall survival (OS in the development and validation cohorts. In conclusions, the KG-7 showed high SE and NPV to predict abnormal GA. The KG-7 also predicted OS. Given the results of our studies, the KG-7 could be used effectively in countries with high patient burden and low resources to select patients in need of full GA and intervention.

Effect of a steam foot spa on geriatric inpatients with cognitive impairment: a pilot study

Science.gov (United States)

Koike, Yoshihisa; Kondo, Hideki; Kondo, Satoshi; Takagi, Masayuki; Kano, Yoshio

2013-01-01

Purpose To investigate whether a steam foot spa improves cognitive impairment in geriatric inpatients. Methods Geriatric inpatients with cognitive impairment were given a steam foot spa treatment at 42°C for 20 minutes for 2 weeks (5 days/week). Physiological indicators such as blood pressure, percutaneous oxygen saturation, pulse, tympanic temperature, and sleep time and efficiency were assessed. Cognitive function and behavioral and psychological symptoms of dementia were assessed using the Mini-Mental State Examination, Dementia Mood Assessment Scale, and Dementia Behavior Disturbance scale. Results Significant decreases in systolic (P steam foot spas. A significant improvement was seen in the Mini-Mental State Examination score (P steam foot baths. In this study, a control group was not used. Raters and enforcers were not blinded. Conclusion The results of this pilot study suggest that steam foot spas mitigate cognitive impairment in geriatric inpatients. PMID:23717038

Acceptance of NCPAP in a sample of patients admitted for geriatric rehabilitation

Directory of Open Access Journals (Sweden)

Frohnhofen H

2009-12-01

Full Text Available Abstract Objective Sleep apnea syndrome (SAS is common in older people. Nasal continuous airway pressure (NCPAP therapy is the treatment of choice for sleep apnea, but is not always accepted by patients. The rate of successful initiation of NCPAP is unknown in geriatric patients. Methods All patients admitted for geriatric rehabilitation were considered for sleep studies. Sleep apnea was assessed using an Edentrace (Nellcor, Hayward, CA multi-channel recording system. SAS was defined as an apnea-hypopnea-index (AHI of more than five events per hour plus excessive daytime sleepiness, or an AHI of more than fifteen events per hour regardless of reported sleepiness. Disability was assessed using the Barthel Index of Activities of Daily Living. Results Two hundred sixty nine of 322 consecutive patients (84% had adequate sleep studies and gave informed consent. SAS was found in 169 subjects (68%. There was no gender difference in the prevalence of SAS. Six subjects (4% accepted NCPAP therapy. Individuals who accepted NCPAP were younger and less disabled (p Conclusion NCPAP should not be withheld in the elderly. However, initiation of treatment for SAS remains to be a great challenge in those patients. Geriatric assessment procedures may help better manage older subjects with sleep apnea syndrome.

A novel internet-based geriatric education program for emergency medical services providers.

Science.gov (United States)

Shah, Manish N; Swanson, Peter A; Nobay, Flavia; Peterson, Lars-Kristofer N; Caprio, Thomas V; Karuza, Jurgis

2012-09-01

Despite caring for large numbers of older adults, prehospital emergency medical services (EMS) providers receive minimal geriatrics-specific training while obtaining their certification. Studies have shown that they desire further training to improve their comfort level and knowledge in caring for older adults, but continuing education programs to address these needs must account for each EMS provider's specific needs, consider each provider's learning styles, and provide an engaging, interactive experience. A novel, Internet-based, video podcast-based geriatric continuing education program was developed and implemented for EMS providers, and their perceived value of the program was evaluated. They found this resource to be highly valuable and were strongly supportive of the modality and the specific training provided. Some reported technical challenges and the inability to engage in a discussion to clarify topics as barriers. It was felt that both of these barriers could be addressed through programmatic and technological revisions. This study demonstrates the proof of concept of video podcast training to address deficiencies in EMS education regarding the care of older adults, although further work is needed to demonstrate the educational effect of video podcasts on the knowledge and skills of trainees. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

A formative evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic.

Science.gov (United States)

Hansen, Kevin T; McDonald, Cheryl; O'Hara, Sue; Post, Leslie; Silcox, Susan; Gutmanis, Iris A

2017-07-01

The number of older adults with multiple complex comorbidities and frailty is expected to increase dramatically in the coming decades, which will necessitate a concomitant increase in the need for skilled clinicians who are able to manage complex geriatric needs. Many physicians, however, lack the required formal training, often leading to long wait-lists for specialist clinics. Yet, clinics led by non-physician professionals specialising in geriatric care could decrease these delays. This article describes the development and evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic (Inter-D Clinic). A combination of semi-structured clinician interviews, post-clinic follow-up phone calls, satisfaction surveys, and information from the hospital workload management system served as data sources for this formative programme evaluation. Between January 2013 and December 2014, 293 patients were seen in the clinic with the majority being referred for either memory issues (49%) or functional decline (35%). The clinic assessment frequently uncovered other issues, which led to guidance around falls prevention, improved nutrition, medication management, and referrals to available community supports. Both patients and referring physicians were very satisfied with this model of care, which is likely transferable to other locations provided the needed clinical expertise and community support services are available.

Xerostomia and medication: a cross-sectional study in long-term geriatric wards.

Science.gov (United States)

Desoutter, A; Soudain-Pineau, M; Munsch, F; Mauprivez, C; Dufour, T; Coeuriot, J-L

2012-01-01

The purpose of this study was to determine the prevalence of xerostomia in old people living in long-term geriatric wards, and to measure the relationship between xerostomia and etiologic factors such as age and medication (total number of medications, xerogenic medications, anticholinergic medications and medications that induce hypersialorrhea). An observational retrospective, comparative, multicentre epidemiological study. Long-term geriatric wards, in Reims, France. 769 old people living in long-term geriatric wards. Prevalence of xerostomia assessed from age, total number of medications, xerogenic medications, anticholinergic medications and those that induce hypersialorrhea. Multivariable logistic regression was used to calculate Odds Ratios (OR) and their 95% Confidence Intervals (95% CI). Among 769 old people (average age 84.6±8.4 years old), 287 residents suffered from xerostomia (37.3%). Significant predictors of xerostomia were: resident's age OR=1.56, 95% CI (1.30-1.88), pxerostomia identified was medications that induce hypersialorrhea OR=0.81, 95% CI (0.67-0.98), p=0.03. The total number of medications and xerogenic medications did not play a significant role in xerostomia. Increasing Age and anticholinergic medications induce a dry mouth. Conversely, the total number of medications and xerogenic medications do not influence xerostomia. Medications that induce hypersialorrhea protect against the occurrence of dry mouth.

Geriatric teaching in Brazilian medical schools in 2013 and considerations regarding adjustment to demographic and epidemiological transition

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Ana Conceição Norbim Prado Cunha

2016-04-01

Full Text Available Summary Objective: This study aims to describe the profile of medical schools that introduced courses on Geriatrics and Elderly Health or Aging in their curriculum, and compare such information with the age distribution and health epidemiological data of the Brazilian population, using data until the year of 2013. Methods: 180 universities offering medical undergraduate courses and registered with the Ministry of Education and Culture of Brazil (MEC were found, as seen on the MEC website (www.emec.mec.gov.br in February 2013. Based on the list of institutions, the authors created a database. Results: Brazil's Southeast region is the one presenting most of the courses, both offered as core or elective subjects, in the area of Geriatrics. The Midwest region had the least offer of Geriatrics and Elderly Health and Care courses. The Southeast region presents the greater absolute number of institutions with elective subjects, followed by the South and Northeast regions, each with a single institution. The Southeast region was at the same time the one that presented the biggest absolute number of institutions offering core subjects in the area of Geriatrics, being followed by the Northeast, South, North, and Midwest regions. Conclusion: By analyzing the availability of courses that emphasize aging and Geriatrics in brazilian medical schools, the present study reveals that specialized training should be encouraged with respect to the specificities of health care given to the elderly population, which has a higher frequency of chronic and degenerative diseases.

Association between acute geriatric syndromes and medication-related hospital admissions

NARCIS (Netherlands)

Wierenga, Peter C.; Buurman, Bianca M.; Parlevliet, Juliette L.; van Munster, Barbara C.; Smorenburg, Susanne M.; Inouye, Sharon K.; de Rooij, Sophia E. J. A.

2012-01-01

Background: Elderly patients are at a 4-fold higher risk of adverse drug events (ADEs) and drug-related hospitalization. Hospitalization of an elderly patient is often preceded by geriatric syndromes, like falls or delirium. Objectives: The primary aim of this study was to investigate whether

Association between Acute Geriatric Syndromes and Medication-Related Hospital Admissions

NARCIS (Netherlands)

Wierenga, Peter C.; Buurman, Bianca M.; Parlevliet, Juliette L.; van Munster, Barbara C.; Smorenburg, Susanne M.; Inouye, Sharon K.; de Rooij, Sophia E. J. A.

2012-01-01

Background: Elderly patients are at a 4-fold higher risk of adverse drug events (ADEs) and drug-related hospitalization. Hospitalization of an elderly patient is often preceded by geriatric syndromes, like falls or delirium. Objectives: The primary aim of this study was to investigate whether

Geriatric information analysis of the molecular properties of mexidole

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O. A. Gromova

2017-01-01

Full Text Available Objective: by using the pharmacoinformation profiling, to comprehensively assess all possible effects of the molecules of mexidol, choline alfoscerate, piracetam, glycine, and semax in accordance with the anatomical therapeutic and chemical (ATC classification system.Material and methods. Chemoreactomic, pharmacoinformation, and geriatric information analyses of the properties of the molecules are based on chemoreactomic methodology. The chemoreactomic analysis uses the information from the PubChem, HMDB, and String databases; the pharmacoinformation analysis applies the information from the international ATC classification and a combined sample of data from the Therapeutic Target Database (TTD, SuperTarget, Manually Annotated Targets and Drugs Online Resource (MATADOR, and Potential Drug Target Database (PDTD; geriatric information analysis employs the data on the geroprotective effect of individual substances from the PubChem database and the data available in the literature data on geroprotection from the PubMed database, which have been collected through the artificial intelligence system.Results and discussion. Mexidol is characterized by the maximum set of positive effects (the drug is used to treat CNS and cardiovascular diseases and metabolic disorders and has anti-inflammatory and anti-infective properties, etc.. Mexidol and glycine are predicted to cause the lowest frequency of adverse reactions, such as itching, constipation, paresthesia, vomiting, etc. Geriatric information assessments of changes in the life span of model organisms have shown that mexidol contributes to the higher life expectancy of C. elegans (by 22.7±10%, Drosophila (by 14.4±15%, and mice (by 14.6±3%; the control drugs do by no more than 6.1%.Conclusion. The results of the study indicate that mexidol has a high potential to be used as a geroprotector.

Advocating vaccination of adults aged 60 years and older in Western Europe: statement by the Joint Vaccine Working Group of the European Union Geriatric Medicine Society and the International Association of Gerontology and Geriatrics-European Region.

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Michel, Jean-Pierre; Chidiac, Christian; Grubeck-Loebenstein, Beatrix; Johnson, Robert W; Lambert, Paul Henri; Maggi, Stefania; Moulias, Robert; Nicholson, Karl; Werner, Hans

2009-04-01

Vaccines are an underused public health strategy for healthy aging. Considering the risks of vaccine-preventable diseases and the current low vaccine coverage rates in older European citizens, the two European geriatric and gerontological societies (European Union Geriatric Medicine Society [EUGMS] and International Association of Gerontology and Geriatrics-European Region [IAGG-ER]) convened a Joint Vaccine Working Group to develop a consensus document advocating routine vaccination of aging populations. The mandate of this Working Group was to improve the uptake of routine vaccinations in adults aged 60 years and over. The consensus statement underlines the need to establish, strengthen, and harmonize European policies that continue routine vaccinations to adulthood and that will include older populations. Improved vaccination rates will promote healthy aging by reducing the burden of vaccine-preventable infectious diseases in older populations, a population that is rapidly increasing in Europe.

[Co-management in geriatric traumatology].

Science.gov (United States)

Kammerlander, C; Blauth, M; Gosch, M; Böcker, W

2015-09-01

Fragility fractures are becoming more common and are leading to significantly increased morbidity and mortality rates. In order to improve the outcome of these patients, they are increasingly being treated from the beginning interdisciplinarily and interprofessionally as part of co-management models. The main contents of these systems are rapid surgical stabilization for rapid remobilization, treatment with standardized paths and regular communication within the team and a well-functioning discharge management. Furthermore, the organization is a key ingredient in secondary prevention of geriatric traumatology. If this system can be implemented as a whole, this will lead to an improvement of the functional outcomes for the patient as well as to cost savings.

Pattern of geriatric dermatoses at a Tertiary Care Teaching Hospital of South Rajasthan, India

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Anshu Goyal

2017-07-01

Full Text Available Background: Geriatric health care has assumed worldwide importance due to increase in the life expectancy during the last few decades. Aging skin has a marked susceptibility to dermatologic disorders due to the structural and physiologic changes that occur as a consequence of intrinsic and extrinsic aging. Aim: This study was aimed to evaluate the magnitude, pattern, contributory factors and systemic association of various dermatoses among geriatric population. Materials and Methods: Patients aged 60 years and above attending the dermatology outpatient department during a period of one year were enrolled in the study. Detailed history taking followed by general, systemic and cutaneous examination, and relevant investigations were carried out. The findings were recorded in a proforma for analysis and interpretation of data. Results: Out of total 610 patients enrolled, 68.2% were males and 31.8% females. The male to female ratio was 2.14:1. Maximum (339; 55.6% number of patients were in the age group of 60-69 years. Wrinkling (273; 44.8% was the commonest physiological cutaneous finding. Among the pathological changes, benign tumors (620; 39.9%, nevus (253; 16.3%, infection and infestation (244; 15.7%, dermatitis (158; 10.1%, pruritus (78; 5.0%, pigmentary disorders (67; 4.3% and papulosquamous disorders (62; 4.0% were common conditions. Associated systemic illness was recorded in 180 (29.5% patients, of which hypertension (96; 15.7% was the commonest. Conclusion: With the expected increase in the geriatric population in the coming years, the dermatological problems in geriatric population assume great importance. Our study shows that physiological changes seen with ageing such as wrinkling, senile purpura, xerosis, senile comedone, atrophy and senile lentigens are major cutaneous findings. Eczemas of various types and fungal and bacterial infections are the common dermatological morbidities. These dermatological morbidities in geriatric

Evaluation of the Impact of a senior mentor program on medical students' geriatric knowledge and attitudes toward older adults.

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Mendoza De La Garza, Maria; Tieu, Christina; Schroeder, Darrell; Lowe, Kathleen; Tung, Ericka

2018-06-18

Medical schools throughout the country struggle with how best to train students to provide quality, patient-centered care to the burgeoning population of older adults. The Senior Sages Program (SSP) is a longitudinal Senior Mentor Program (SMP) that offers students the opportunity to learn about the aging process and core geriatric medicine concepts through the eyes of an aging expert: their Senior Sage. The SSP marries a robust electronic curriculum with an SMP and online discussion board. The aim of this program evaluation was to measure the impact on students' geriatric knowledge and attitudes toward older adults. This asynchronously facilitated course improved students' geriatric knowledge and facilitated stability of positive attitudes toward older adults. The majority of students felt that their SSP interactions were meaningful and valuable to their clinical development. The combination of SMP and electronic curricula offer a feasible, practical way to bridge the geriatric training chasm.

Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic

OpenAIRE

Kikkert, Lisette H. J.; de Groot, Maartje H; van Campen, Jos P.; Beijnen, Jos H.; Hortobagyi, Tibor; Vuillerme, Nicolas; Lamoth, Claudine C. J.

2017-01-01

Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric patients to identify fallers with highest sensitivity and specificity with a focus on gait performance. Patients (n = 61, age = 79; 41% fallers) underwent extensive screening in three categories: (1)...

Multidisciplinary education in geriatrics: an experimental course at the Middlesex Hospital.

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Beynon, G P; Wedgwood, J; Newman, J; Hutt, A

1978-11-01

For two years mixed groups of medical, nursing and physiotherapy students have taken part in an experimental course in geriatric medicine. The course organization and content are described and the students' evaluation of the course is discussed.

[The geriatric perioperative unit, a high performance care department for elderly surgical patients].

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Papas, Anne; Caillard, Laurence; Nion, Nathalie

2011-01-01

For over a year Professor Marc Verny's geriatric department at Pitié-Salpêtrière hospital in Paris has had ten beds set aside for the perioperative care of elderly people. This geriatric perioperative unit (UPOG) offers patients the skills of a multidisciplinary team trained in the specificities of caring for elderly patients often suffering from polypathology. The team works closely together around a common goal: the rapid return of the patient's autonomy during the postoperative period, crucial for the future of elderly people. So far UPOG's results have been very positive, as more than 90% of patients regain their autonomy after a short and uncomplicated period of postoperative care.

Geriatric Respondents and Non-Respondents To Probiotic Intervention Can Be Differentiated By Inherent Gut Microbiome Composition

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Suja eSenan

2015-09-01

Full Text Available Scope: Probiotic interventions are known to have been shown to influence the composition of the intestinal microbiota in geriatrics. The growing concern is the apparent variation in response to identical strain dosage among human volunteers. One factor that governs this variation is the host gut microbiome. In this study, we attempted to define a core gut metagenome which could act as a predisposition signature marker of inherent bacterial community that can help predict the success of a probiotic intervention. Methods and Results: To characterize the geriatric gut microbiome we designed primers targeting the 16S rRNA hypervariable region V2-V3 followed by semiconductor sequencing using Ion Torrent PGM. Among respondents and non- respondents the chief genera of phylum Firmicutes that showed significant differences are Lactobacillus, Clostridium, Eubacterium, and Blautia (q< 0.002 while in the genera of phylum Proteobacteria included Shigella, Escherichia, Burkholderia and Camphylobacter (q <0.002. Conclusion: We have identified potential microbial biomarkers and taxonomic patterns that correlate with a positive response to probiotic intervention in geriatric volunteers. Future work with larger cohorts of geriatrics with diverse dietary influences could reveal the potential of the signature patterns of microbiota for personalized nutrition.

Geriatric workforce capacity: a pending crisis for nursing home residents.

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Lee, Wei-Chen; Sumaya, Ciro V

2013-07-29

The nursing home (NH) population in the US has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification) indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.

Geriatric epidemiology of trauma in a hospital in Southern Colombia

Institute of Scientific and Technical Information of China (English)

Yolercy Vsquez; Jos Daniel Charry; Juan Daniel Ochoa; Ana Mara Gmez; Karen Herrera; Jorman Harvey Tejada; Jose Domingo Alarcn

2017-01-01

Objective: To describe the clinical and sociodemographic characteristics of geriatric patients who were treated at a university hospital in southern Colombia. Methods: A database of trauma patients over 65 admitted between June 2014 and December 2015 was constructed. Univariate analysis was performed. Measures of central tendency and dispersion for continuous variables were calculated. Results: A total of 760 patients were analyzed, the median age was 74 years (65–98). The median injury severity score was 9 (4–25) the 71.97% were men, and overall mortality was 25.39%. The 92.10% was blunt trauma, and the main mechanism of injury was falls. Conclusions: Trauma in the elderly is a common condition with high risk of mortality. It is important to know the frequency of these injuries to provide the best possible handling. In our hospital we found that geriatric trauma is a common disease, the main cause is falls without embargos traffic accidents are common in this population.

Improving geriatric trauma outcomes: A small step toward a big problem.

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Hammer, Peter M; Storey, Annika C; Bell, Teresa; Bayt, Demetria; Hockaday, Melissa S; Zarzaur, Ben L; Feliciano, David V; Rozycki, Grace S

2016-07-01

Because of the unique physiology and comorbidities of injured geriatric patients, specific interventions are needed to improve outcomes. The purpose of this study was to assess the effect of a change in triage criteria for injured geriatric patients evaluated at an American College of Surgeons Level I trauma center. As of October 1, 2013, all injured patients 70 years or older were mandated to have the highest-level trauma activation upon emergency department (ED) arrival regardless of physiology or mechanism of injury. Patients admitted before that date were designated as PRE; those admitted after were designated as POST. The study period was from October 1, 2011, through April 30, 2015. Data collected included demographics, mechanism of injury, hypotension on admission, comorbidities, Injury Severity Score (ISS), ED length of stay (LOS), complications, and mortality. Bivariate and multivariable analyses were used to compare outcomes between the study groups (p analysis, increasing age, higher ISS, and hypotension were associated with higher mortality. POST patients were more likely to have an ED LOS of 2 hours or shorter (odds ratio, 1.614; 95% confidence interval, 1.088-2.394) after controlling for hypotension, ISS, and comorbidities. POST mortality significantly decreased (odds ratio, 0.689; 95% confidence interval, 0.484-0.979). Based on age alone, the focused intervention of a higher level of trauma activation decreased ED LOS and mortality in injured geriatric patients. Therapeutic/care management study, level IV.

Decrease in Antioxidant Status of Plasma and Erythrocytes from Geriatric Population

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Manjulata Kumawat

2012-01-01

Full Text Available Background: Ageing is associated with an accumulation of free radical damage, which leads to physiological and clinical modifications. The study aims to find out the status of lipid profile, antioxidant enzymes, malondialdehyde in geriatric population.

Enhanced Recovery After Surgery (ERAS) - The Evidence in Geriatric Emergency Surgery

DEFF Research Database (Denmark)

Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez

2017-01-01

Background: Geriatric surgery is rising and projected to continue at a greater rate. There is already concern about the poor outcomes for the emergency surgery in elderly. How to manage the available resources to improve outcomes in this group of patients is an important object of debate...... to conventional care. Emergency surgical patients also had fewer postoperative complications with ERAS compared to conventional care. Hospital stay was reduced in 2 out of 3 studies for emergency surgery.Conclusions:ERAS can be safely applied to elderly and emergency patients with a reduction in postoperative....... OBJECTIVES: We aimed to determine the feasibility and safety of applying ERAS pathways to emergency elderly surgical patients. METHOD: Two searches were undertaken for ERAS protocols in elderly patients and emergency surgery, in order to gather evidence in relation to ERAS in geriatric emergency patients...

Psychosocial work load and stress in the geriatric care

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Dulon Madeleine

2010-07-01

Full Text Available Abstract Background Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. Methods The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain. Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database. Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p Results In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC, 313 in Geriatric Nursing Homes (GNH, 164 in other professions (e.g. administration. Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195 and the total mean across all professions, COPSOQ-total (N = 11.168, the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity. A supplementary subgroup analysis showed that the degree of

[Geriatric nursing staff retention. Opportunities, potentials, and strategies].

Science.gov (United States)

Joost, A

2013-08-01

Retaining geriatric nurses in their line of work could be an important strategy to prevent the shortage of skilled staff in the future. A prerequisite for this is detailed knowledge of the length and structure of professional careers. The IWAK ( Institut für Wirtschaft, Arbeit und Kultur) evaluated data from the German Social Insurance and carried out a structural analysis of the professional careers of geriatric nurses. Results showed that the average duration of professional careers is 20 years, of which 11.7 years constitute the period of employment and 7.8 years account for periods of inactivity. According to these findings, there is a considerable potential in extending professional careers and reducing the periods of inactivity to make better use of the existing skilled staff and to reduce staff shortage in this area. Concrete measures could involve improvement of working conditions (with the aim of avoiding long periods of inactivity and illness-related premature career endings as well as of increasing job satisfaction), creating better conditions for a good balance between work and family life, as well as setting up individual strategies to expand weekly working hours. Key players are businesses but also local authorities and politicians.

Antimicrobial Stewardship for a Geriatric Behavioral Health Population

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Kristen Ellis

2016-01-01

Full Text Available Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU. Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02, and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01. There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04. Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit.

Co-Prescription of QT-Interval Prolonging Drugs: An Analysis in a Large Cohort of Geriatric Patients.

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Simone Schächtele

Full Text Available Drug-induced QT-interval prolongation is associated with occurrence of potentially fatal Torsades de Pointes arrhythmias (TdP. So far, data regarding the overall burden of QT-interval prolonging drugs (QT-drugs in geriatric patients are limited.This study was performed to assess the individual burden of QT-interval prolonging drugs (QT-drugs in geriatric polymedicated patients and to identify the most frequent and risky combinations of QT-drugs.In the discharge medication of geriatric patients between July 2009 and June 2013 from the Geriatrics in Bavaria-Database (GiB-DAT (co-prescriptions of QT-drugs were investigated. QT-drugs were classified according to a publicly available reference site (CredibleMeds® as ALL-QT-drugs (associated with any QT-risk or High-risk-QT-drugs (corresponding to QT-drugs with known risk of Torsades de Pointes according to CredibleMeds® and in addition as SmPC-high-risk-QT-drugs (according to the German prescribing information (SmPC contraindicated co-prescription with other QT-drugs.Of a cohort of 130,434 geriatric patients (mean age 81 years, 67% women, prescribed a median of 8 drugs, 76,594 patients (58.7% received at least one ALL-QT-drug. Co-prescriptions of two or more ALL-QT-drugs were observed in 28,768 (22.1% patients. Particularly risky co-prescriptions of High-risk-QT-drugs or SmPC-high-risk-QT-drugs with at least on further QT-drug occurred in 55.9% (N = 12,633 and 54.2% (N = 12,429 of these patients, respectively. Consideration of SmPCs (SmPC-high-risk-QT-drugs allowed the identification of an additional 15% (N = 3,999 patients taking a risky combination that was not covered by the commonly used CredibleMeds® classification. Only 20 drug-drug combinations accounted for more than 90% of these potentially most dangerous co-prescriptions.In a geriatric study population co-prescriptions of two and more QT-drugs were common. A considerable proportion of QT-drugs with higher risk only could be detected by

[Impact of low-molecular-weight heparin practice guidelines in a geriatric hospital].

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d'Arailh, Lydie; Gaubert-Dahan, Marie-Line; Muller, Florence; Lechowski, Laurent; Teillet, Laurent

2011-06-01

The purpose of this study was to assess the impact of good use of anticoagulants guidelines implementation on low molecular weight heparin (LMWH) prescription in a french geriatric hospital. This interventional "before and after" study was conduced by the same geriatrician on a d-day in 2006 and 2009. Guidelines for anticoagulant's prescription based on selected references in the literature was established by an expert's consensus and implemented in 2008. Data were collected in all departments at the Sainte-Perine geriatric hospital for each patient with an LMWH prescription. Assessment was based on quality judgment criteria (indication, dosage, treatment duration, biological monitoring of LMWH). Data were collected for 72 prescriptions prior to the guidelines implementation and for 54 after. Sex-ratio, mean age and percentage of LMWH prescription did not differ significantly between the two periods. There was a better conformity for LMWH dosage prescription (p = 0.002) and biological monitoring prescription (p = 0.036) after the guidelines implementation. Conformity of LMWH indication and treatment duration were improved but the difference remained not significant (respectively p = 0.49 and p = 0.80). Implementing guidelines for LMWH use in geriatrics can improve quality of prescription. The impact was effective but limited. These guidelines are now in general use in the Sainte-Perine hospital.

An exploration of risk for recurrent falls in two geriatric care settings

Science.gov (United States)

2013-01-01

Background Fall events were examined in two distinct geriatric populations to identify factors associated with repeat fallers, and to examine whether patients who use gait aids, specifically a walker, were more likely to experience repeat falls. Each unit already had a generic program for falls prevention in place. Methods Secondary data analysis was conducted on information collected during the pilot testing of a new quality assurance Incident Reporting Tool between October 2006 and September 2008. The study settings included an in-patient geriatric rehabilitation unit (GRU) and a long stay veterans’ unit (LSVU) in a rehabilitation and long-stay hospital in Ontario. Participants were two hundred and twenty three individuals, aged 65 years or older on these two units, who experienced one or more fall incidents during the study period. Results Logistic regression analyses showed that on the GRU age was significantly associated with repeat falls. On the LSVU first falls in the morning or late evening were associated with repeat falling. Walker as a gait aid listed at time of first fall was not associated with repeat falls. Conclusions This study suggests that different intervention may be necessary in different geriatric settings to identify, for secondary prevention, certain individuals for which the generic programs prove inadequate. Information collection with a specific focus on the issue of repeat falls may be necessary for greater insight. PMID:24106879

[Care of elderly subject with iron deficiency anaemia: evaluation of geriatric practice].

Science.gov (United States)

Berrut, Gilles; Dibon, Christelle; Hanon, Olivier; Gavazzi, Gaëtan; Chassagne, Philippe; de Decker, Laure

2014-06-01

The anemia with iron deficiency is frequent in the elder subjects. Few studies have reported the practice of the geriatric medicine about anemia. A national survey asked geriatric medical practitioners of hospital geriatric ward from June till September, 2013. Questionnaires were sent, filled over the phone. On 568 sent questionnaires, 312 (55%) were filled. The frequency of the anemia is considered of 46 ± 21%. The definition of the anemia in an elderly person is on average 10.7 ± 0.8 g/dL, taking into account the situation of the patient. The wanted biological examinations are the haemoglobin and the ferritinaemia, but many people suggest measuring also folates and vitamin B12 given strong prevalence of comorbidity. Prevalence of iron deficiency anemia estimated between 20 and 80% because of high prevalence of mixed cause which modified the answer. The major causes were reported as of digestive, gynecological and post-operative origins. The treatment is proposed from 9 g/dL. The oral iron and the transfusions are the most quoted. The possibility of injectable iron is reported only by 17%, of the geriatricians. The answers of the geriatricians show strong coherences in the management of the iron deficiency anemia. Guidelines should be adapted for elderly people for exercice capacity, mainly on high frequency of mixed cases.

Designing Home-Based Telemedicine Systems for the Geriatric Population: An Empirical Study.

Science.gov (United States)

Narasimha, Shraddhaa; Agnisarman, Sruthy; Chalil Madathil, Kapil; Gramopadhye, Anand; McElligott, James T

2018-02-01

Background and Introduction: Telemedicine, the process of providing healthcare remotely using communication devices, has the potential to be useful for the geriatric population when specifically designed for this age group. This study explored the design of four video telemedicine systems currently available and outlined issues with these systems that impact usability among the geriatric population. Based on the results, design suggestions were developed to improve telemedicine systems for this population. Using a between-subjects experimental design, the study considered four telemedicine systems used in Medical University of South Carolina. The study was conducted at a local retirement home. The participant pool consisted of 40 adults, 60 years or older. The dependent measures used were the mean times for telemedicine session initiation and video session, mean number of errors, post-test satisfaction ratings, the NASA-Task Load Index (NASA-TLX) workload measures, and the IBM-Computer Systems Usability Questionnaire measures. Statistical significance was found among the telemedicine systems' initiation times. The analysis of the qualitative data revealed several issues, including lengthy e-mail content, icon placement, and chat box design, which affect the usability of these systems for the geriatric population. Human factor-based design modifications, including short, precise e-mail content, appropriately placed icons, and the inclusion of instructions, are recommended to address the issues found in the qualitative study.

Toward the realization of a better aged society: messages from gerontology and geriatrics.

Science.gov (United States)

Arai, Hidenori; Ouchi, Yasuyoshi; Yokode, Masayuki; Ito, Hideki; Uematsu, Hiroshi; Eto, Fumio; Oshima, Shinichi; Ota, Kikuko; Saito, Yasushi; Sasaki, Hidetada; Tsubota, Kazuo; Fukuyama, Hidenao; Honda, Yoshihito; Iguchi, Akihisa; Toba, Kenji; Hosoi, Takayuki; Kita, Toru

2012-01-01

1. Recent medical advancements, and improvements in hygiene and food supply have led to Japan having the longest life expectancy in the world. Over the past 50 years, the percentage of the elderly population has increased fourfold from 5.7% in 1960 to 23.1% in 2010. This change has occurred at the fastest rate in the world. Compared with France, where the percentage of the elderly population has increased just twofold in the past 100 years, Japanese society is aging at an unprecedented rate. In addition, the percentage of the very elderly (aged 75 years and over), comprising more frail people, exceeded 10% of the nation's population in 2008. In such a situation, many elderly Japanese wish to spend their later years healthy, and wish to achieve great accomplishments in their lives. To achieve that, rather than considering an aging population as a negative social phenomenon, we should create a society where elderly people can enjoy a healthy, prosperous life through social participation and contribution. Factors that hamper the elderly from leading a healthy life include various psychological and social problems occurring in older age, as well as a high incidence of diseases. Therefore, gerontology, which focuses on health promotion of the elderly by encompassing the study of social welfare, psychology, environment and social systems; and geriatrics, which focuses on health care of elderly people and carried out research, education and practices to promote health in the elderly, are becoming more important. Furthermore, along with a need for multidisciplinary care to support geriatric medicine, the development of a comprehensive education system for aged-care professionals is awaited. Thus, we should now recognize the importance of gerontology and geriatrics, and a reform of medical-care services should be made in order to cope with the coming aged society. Population aging is a global phenomenon. The actions being taken by Japan, the world's most aged society, have

Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors.

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Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( [Formula: see text] ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years ( P fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76-19.49; P falls (OR =2.55; 95% CI =1.05-6.19; P =0.039), age (OR =1.14; 95% CI =1.05-1.23; P =0.001), and BMI (OR =0.91; 95% CI =0.83-0.99; P =0.034). Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.

Costs of medication in older patients: before and after comprehensive geriatric assessment

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Unutmaz GD

2018-04-01

Full Text Available Gulcin Done Unutmaz,1 Pinar Soysal,2 Busra Tuven,1 Ahmet Turan Isik3 1Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Geriatric Center Kayseri Education and Research Hospital, Kayseri, Turkey; 3Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey Background: Polypharmacy and inappropriate drug use cause numerous complications, such as cognitive impairment, frailty, falls, and functional dependence. The present study aimed to determine the effect of the comprehensive geriatric assessment (CGA on polypharmacy, potentially inappropriate medications (PIMs and potential prescribing omissions (PPOs, and to evaluate the economic reflections of medication changes.Methods: One thousand five hundred and seventy-nine older patients, who had undergone CGA, were retrospectively evaluated. The drugs, drug groups, and number of drugs that the patients used were recorded. Appropriate drug therapy was identified by both CGA and STOPP/START criteria. Based on these criteria, PIMs were discontinued and PPOs were started. The monthly cost of these drugs was calculated separately for PIMs and PPOs by using the drugstore records.Results: After CGA, while the prevalence of non-polypharmacy was increased from 43.3% to 65.6%, the prevalence of polypharmacy and hyperpolypharmacy was decreased from 56.7% to 34.4% and 12.0% to 3.6%, respectively. The three most common PIMs discontinued were proton pump inhibitors, anti-dementia drugs, and antipsychotics, respectively. However, the most common PPOs started were vitamin D and B12 supplements, and anti-depressants. After CGA, monthly saved total per capita cost of PIMs was US$12.8 and monthly increased total per capita cost of PPOs was $5.6.Conclusion: It was demonstrated that prevalence of polypharmacy, PIM, and PPO could be decreased by CGA including START/STOPP criteria in older adults. Furthermore, this will have beneficial effects on

Designing Telemedicine Systems for Geriatric Patients: A Review of the Usability Studies.

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Narasimha, Shraddhaa; Madathil, Kapil Chalil; Agnisarman, Sruthy; Rogers, Hunter; Welch, Brandon; Ashok, Aparna; Nair, Aswathi; McElligott, James

2017-06-01

One area where telemedicine may prove to be highly effective is in providing medical care to the geriatric population, an age group predicted to account for 20% of the population in the near future. However, even though telemedicine has certain advantages, the usability of these systems with this population merits investigation. This article reviews the literature published from 2000 to 2016 with the goal of analyzing the characteristics of usability-related studies conducted using geriatric participants and the subsequent usability challenges identified. Articles were found using Web of Knowledge and PubMed citation indexing portals using the keywords (1) Telemedicine* AND Geriatrics* (2) Telemedicine* AND Usability* (3) Telemedicine* AND Usability* AND Older Adults*. A total of 297 articles were obtained from the initial search. After further detailed screening, 16 articles were selected for review based on the inclusion criteria. Of these, 60% of the studies focused on the overall usability of telemedicine systems; 6.25% focused on the usability of a telepresence robot; 12.5% compared a face-to-face medical consultation with the use of telemedicine systems, and 25% focused on the study of other aspects of telemedicine in addition to its usability. Findings reported in the studies included high patient satisfaction with telemedicine in 31.25%, whereas another 31.25% indicated a high acceptance of this method of medical consultation. Care coordination in 6.25% of the studies; confidence in telemedicine in 6.25%; trust, privacy, and reliability in 6.25%; and increased convenience when compared to personal visits in 18.75% were also reported. This review suggests limited research providing scientifically valid and reproducible usability evaluation at various stages of telemedicine system development. Telemedicine system designers need to consider the age-related issues in cognition, perception, and behavior of geriatric patients while designing telemedicine

Matching technologies of home automation, robotics, assistance, geriatric telecare and telemedicine

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Franchimon, F.; Brink, M.

2009-01-01

The aging society could have a greater societal impact than the current financial crisis. The percentage of older adults has increased while the size of the health care workforce has remained constant. Home automation, robotics, assistive technology, geriatric telecare and telemedicine can support

Development and Validation of the Geriatric In-Hospital Nursing Care Questionnaire

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Persoon, Anke; Bakker, Franka C.; van der Wal-Huisman, Hanneke; Rikkert, Marcel G. M. Olde

ObjectivesTo develop a questionnaire, the Geriatric In-hospital Nursing Care Questionnaire (GerINCQ), to measure, in an integrated way, the care that older adults receive in the hospital and nurses' attitudes toward and perceptions about caring for older adults. DesignQuestionnaire development.

Gerontology found me: gaining understanding of advanced practice nurses in geriatrics.

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Campbell-Detrixhe, Dia D; Grassley, Jane S; Zeigler, Vicki L

2013-10-01

Examining the meanings of the experiences of advanced practice nurses (APNs) who chose to work with older adults and why they continue to work with this population was the focus of this hermeneutic qualitative research study. Twelve geriatric APNs currently practicing in two South Central states were interviewed using an open-ended interview guide. Using Gadamerian hermeneutics, the researchers identified Gerontology Found Me as the significant expression that reflected the fundamental meaning of the experience as a whole. Four themes emerged that further described the meanings of the participants' personal, educational, and professional experiences: Becoming a Gerontology Nurse, Being a Gerontology Nurse, Belonging to Gerontology, and Bringing Others to Gerontology. This study concluded that APNs' personal and professional experiences were more influential than educational experiences to become geriatric nurses, and having these personal and professional experiences of being in relationship with older individuals further contributed to their choice of gerontology.

Geriatric core competencies for family medicine curriculum and enhanced skills: care of elderly.

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Charles, Lesley; Triscott, Jean A C; Dobbs, Bonnie M; McKay, Rhianne

2014-06-01

There is a growing mandate for Family Medicine residency programs to directly assess residents' clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit.

A Psychometric Properties Evaluation of the Italian Version of the Geriatric Depression Scale

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Giovanni Galeoto

2018-01-01

Full Text Available Objective. The Geriatric Depression Scale (GDS is an evaluation tool to diagnose older adult’s depression. This questionnaire was defined by Yesavage and Brink in 1982; it was designed expressly for the older person and defines his/her degree of satisfaction, quality of life, and feelings. The objective of this study is to evaluate the psychometric properties of the Italian translation of the Geriatric Depression Scale (GDS-IT. Methods. The Italian version of the Geriatric Depression Scale was administered to 119 people (79 people with a depression diagnosis and 40 healthy ones. We examined the following psychometric characteristics: internal consistency reliability, test-retest reliability, concurrent validity, and construct validity (factor structure. Results. Cronbach’s Alpha for the GDS-IT administered to the depressed sample was 0.84. Test-retest reliability was 0.91 and the concurrent validity was 0.83. The factorial analysis showed a structure of 5 factors, and the scale cut-off is between 10 and 11. Conclusion. The GDS-IT proved to be a reliable and valid questionnaire for the evaluation of depression in an Italian population. In the present study, the GDS-IT showed good psychometric properties. Health professionals now have an assessment tool for the evaluation of depression symptoms in the Italian population.

Clustering excellence to exert transformative change: the Hartford Geriatric Nursing Initiative (HGNI).

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McBride, Angela Barron; Watman, Rachael; Escobedo, Marcus; Beilenson, John

2011-01-01

This paper describes how the John A. Hartford Foundation sought to maximize the influence of its various geriatric nursing projects by organizing and managing them collectively as the Hartford Geriatric Nursing Initiative (HGNI). This initiative aimed to develop a shared identity, encouraged cross-pollination of efforts, convened project leaders to address opportunities and problems, launched across-project collaborations, and created tools and resources to support overall efforts. This paper ends with some reflections on the processes implemented to maximize HGNI effectiveness, particularly the importance of forging a common identity in order to encourage expanded solutions. The HGNI can serve as an example of how intersecting interests can fuel new ideas, thus helping others think more strategically about change efforts in the future. Copyright © 2011 Elsevier Inc. All rights reserved.

Prevalence of Psychiatric Disorders among the Rural Geriatric Population: A Pilot Study in Karnataka, India

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Sreejith S. Nair

2015-03-01

Full Text Available Background: Increasing life expectancy around the world, an outstanding achievement of our century, has brought with it new public health challenges. India is the second most populous country in the world, with over 72 million inhabitants above 60 years of age as of 2001. The life expectancy in India increased from 32 years in 1947 to over 66 years in 2010, with 8.0% of the population now reaching over 60 years of age. Few studies in India target the health, especially mental health, of this geriatric population. This study aims to estimate the current prevalence of psychiatric disorders in the geriatric population of the rural area of Singanodi,Karnataka, India.Methods: This cross sectional, epidemiological, community-based study was conducted in a rural health training area of Singanodi, Raichur District, Karnataka, India.The General Health Questionnaire-12, Mini Mental State Examination, and Geriatric Depression Scale were administered to 366 participants. Chi square tests with Yates correction were utilized for statistical analysis using SPSS 19.0 software.Results:We found that 33.9% of the geriatric population in the selected province were above the threshold for mental illness based on the GHQ-12 questionnaire. Females had a higher prevalence of mental disorder at 77.6% (152 out of 196 as compared to males who had a prevalence of 42.4% (72 out of 170. The most common psychiatric disorder was depression (21.9%, and generalized anxiety was present in 10.7% of the study population. Prevalence of cognitive impairment was 16.3%, with a significantly higher percentage of  affected individuals in 80+ age group.Conclusion: Mental disorders are common among elderly people, but they are not well documented in rural India. The assessment of psychiatric disorder prevalence will help strengthen psycho-geriatric services and thus improve the quality of life of the elderly.  A system that ensures comprehensive health care will have to be developed for

Prevalence of Psychiatric Disorders among the Rural Geriatric Population: A Pilot Study in Karnataka, India.

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Nair, Sreejith S; Raghunath, Pooja; Nair, Sreekanth S

2015-01-01

Increasing life expectancy around the world, an outstanding achievement of our century, has brought with it new public health challenges. India is the second most populous country in the world, with over 72 million inhabitants above 60 years of age as of 2001. The life expectancy in India increased from 32 years in 1947 to over 66 years in 2010, with 8.0% of the population now reaching over 60 years of age. Few studies in India target the health, especially mental health, of this geriatric population. This study aims to estimate the current prevalence of psychiatric disorders in the geriatric population of the rural area of Singanodi,Karnataka, India. This cross sectional, epidemiological, community-based study was conducted in a rural health training area of Singanodi, Raichur District, Karnataka, India.The General Health Questionnaire-12, Mini Mental State Examination, and Geriatric Depression Scale were administered to 366 participants. Chi square tests with Yates correction were utilized for statistical analysis using SPSS 19.0 software. We found that 33.9% of the geriatric population in the selected province were above the threshold for mental illness based on the GHQ-12 questionnaire. Females had a higher prevalence of mental disorder at 77.6% (152 out of 196) as compared to males who had a prevalence of 42.4% (72 out of 170). The most common psychiatric disorder was depression (21.9%), and generalized anxiety was present in 10.7% of the study population. Prevalence of cognitive impairment was 16.3%, with a significantly higher percentage of affected individuals in 80+ age group. Mental disorders are common among elderly people, but they are not well documented in rural India. The assessment of psychiatric disorder prevalence will help strengthen psycho-geriatric services and thus improve the quality of life of the elderly. A system that ensures comprehensive health care will have to be developed for this purpose as part of our future efforts.

[Mini-Mental State Examination in geriatrics : An evaluation of diagnostic quality].

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Beyermann, S; Trippe, R H; Bähr, A A; Püllen, R

2013-12-01

Several studies have identified moderate reliability and validity for the Mini-Mental State Examination (MMSE). Some researchers showed the superiority of other dementia screening tests over the MMSE considering the test quality criteria. The aim of this study was the evaluation of MMSE, especially in the area of geriatrics. MMSE and DemTect were carried out with 154 geriatric patients: 71 persons without cognitive impairment and 83 persons without delirium showed cognitive impairments as revealed by the DemTect. In addition, we also applied the Clock-Drawing-Test (CDT), Reisberg-Scale, Geriatric Depression-Scale (GDS, 15-item version) and the Confusion-Assessment-Method (CAM). According to the multitrait-multimethod approach, MMSE's convergent and divergent validity is similar to that of the DemTect. Both tests correlate only moderately with Spearman (r = 0.609) and revealed similar results for dementia in 57.1 % of the patients. MMSE showed low reliability and moderate reliability (Cronbach's α = 0.82) when ten items with low discriminatory power were excluded from the total test score. Difficulty of all items is only moderate (p = 0.86) and only eight items of the MMSE showed good test difficulty. All in all, DemTect and MMSE are not interchangeable. The MMSE estimates the average cognitive impairment of patients as considerably less pronounced than the DemTect. MMSE is, thus, not an instrument that would be recommended for the identification of mild cognitive impairment. In this case, tests with higher reliability and validity should be used.

[Risk scores for community acquired pneumonia in elderly and geriatric patients].

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Pflug, M A; Wesemann, T; Heppner, H J; Thiem, U

2015-10-01

Community-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients. For epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users. Since the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients. At present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults. For treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.

Impact of a collaborative interprofessional learning experience upon medical and social work students in geriatric health care.

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Gould, Paul Robert; Lee, Youjung; Berkowitz, Shawn; Bronstein, Laura

2015-01-01

Interprofessional collaborative practice is increasingly recognized as an essential model in health care. This study lends preliminary support to the notion that medical students (including residents) and social work students develop a broader understanding of one another's roles and contributions to enhancing community-dwelling geriatric patients' health, and develop a more thorough understanding of the inherent complexities and unique aspects of geriatric health care. Wilcoxon Signed Rank Tests of participants' scores on the Index of Interdisciplinary Collaboration (IIC) indicated the training made significant changes to the students' perception of interprofessional collaboration. Qualitative analysis of participants' statements illustrated (1) benefits of the IPE experience, including complementary roles in holistic interventions; and (2) challenges to collaboration. The findings suggest that interprofessional educational experiences have a positive impact upon students' learning and strategies for enhanced care of geriatric patients.

How to Measure Physical Motion and the Impact of Individualized Feedback in the Field of Rehabilitation of Geriatric Trauma Patients.

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Altenbuchner, Amelie; Haug, Sonja; Kretschmer, Rainer; Weber, Karsten

2018-01-01

This preparatory study accelerates an implementation of individualized monitoring and feedback of physical motion using conventional motion trackers in the rehabilitation process of geriatric trauma patients. Regaining mobility is accompanied with improved quality of life in persons of very advanced age recovering from fragility fractures. Quantitative survey of regaining physical mobility provides recommendations for action on how to use motion trackers effectively in a clinical geriatric setting. Method mix of quantitative and qualitative interdisciplinary and mutual complementary research approaches (sociology, health research, philosophy/ethics, medical informatics, nursing science, gerontology and physical therapy). While validating motion tracker use in geriatric traumatology preliminary data are used to develop a target group oriented motion feedback. In addition measurement accuracy of a questionnaire about quality of life of multimorbid geriatric patients (FLQM) is tested. Implementing a new technology in a complex clinical setting needs to be based on a strong theoretical background but will not succeed without careful field testing.

Quality Assurance in Gerontological and Geriatric Training Programs: The European Case

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Politynska, Barbara; van Rijsselt, Rene J. T.; Lewko, Jolanta; Philp, Ian; Figueiredo, Daniella; De Sousa, Lilliana

2012-01-01

Quality assurance (QA) in gerontological and geriatric education programs is regarded as essential to maintain standards, strengthen accountability, improve readability of qualifications, and facilitate professional mobility. In this article the authors present a summary of international developments in QA and elaborate four international trends,…

Geriatric Workforce Capacity: A Pending Crisis for Nursing Home Residents

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Wei Chen eLee

2013-07-01

Full Text Available Introduction: The nursing home (NH population in the U.S. has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. Methods: This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. Results: English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Conclusion: Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.

The range of diagnoses for oral soft-tissue biopsies of geriatric patients in a Saudi Arabian teaching hospital

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Ahmed Qannam

2016-04-01

Conclusions: The range of lesions seen in Saudi geriatric patients were similar to those reported for other parts of the world, although the lesions were more similar to those reported from developing countries. The very high rate of oral cancer, however, is expected to take the majority of the resources allocated to geriatric oral health care, except if a strong, population-based prevention program is initiated immediately.

Geriatric Conditions in Acutely Hospitalized Older Patients: Prevalence and One-Year Survival and Functional Decline

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Buurman, Bianca M.; Hoogerduijn, Jita G.; de Haan, Rob J.; Abu-Hanna, Ameen; Lagaay, A. Margot; Verhaar, Harald J.; Schuurmans, Marieke J.; Levi, Marcel; de Rooij, Sophia E.

2011-01-01

Background To study the prevalence of eighteen geriatric conditions in older patients at admission, their reporting rate in discharge summaries and the impact of these conditions on mortality and functional decline one year after admission. Method A prospective multicenter cohort study conducted between 2006 and 2008 in two tertiary university teaching hospitals and one regional teaching hospital in the Netherlands. Patients of 65 years and older, acutely admitted and hospitalized for at least 48 hours, were invited to participate. Eighteen geriatric conditions were assessed at hospital admission, and outcomes (mortality, functional decline) were assessed one year after admission. Results 639 patients were included, with a mean age of 78 years. IADL impairment (83%), polypharmacy (61%), mobility difficulty (59%), high levels of primary caregiver burden (53%), and malnutrition (52%) were most prevalent. Except for polypharmacy and cognitive impairment, the reporting rate of the geriatric conditions in discharge summaries was less than 50%. One year after admission, 35% had died and 33% suffered from functional decline. A high Charlson comorbidity index score, presence of malnutrition, high fall risk, presence of delirium and premorbid IADL impairment were associated with mortality and overall poor outcome (mortality or functional decline). Obesity lowered the risk for mortality. Conclusion Geriatric conditions were highly prevalent and associated with poor health outcomes after admission. Early recognition of these conditions in acutely hospitalized older patients and improving the handover to the general practitioner could lead to better health outcomes and reduce the burden of hospital admission for older patients. PMID:22110598

Effect of a steam foot spa on geriatric inpatients with cognitive impairment: a pilot study

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Koike Y

2013-05-01

Full Text Available Yoshihisa Koike,1 Hideki Kondo,2 Satoshi Kondo,1 Masayuki Takagi,1 Yoshio Kano31Department of Occupational Therapy, Prefectural University of Hiroshima, Mihara, Japan; 2Yoshiigawa Hospital, Okayama, Japan; 3Department of Occupational Therapy, Kibi International University, Takahashi, JapanPurpose: To investigate whether a steam foot spa improves cognitive impairment in geriatric inpatients.Methods: Geriatric inpatients with cognitive impairment were given a steam foot spa treatment at 42°C for 20 minutes for 2 weeks (5 days/week. Physiological indicators such as blood pressure, percutaneous oxygen saturation, pulse, tympanic temperature, and sleep time and efficiency were assessed. Cognitive function and behavioral and psychological symptoms of dementia were assessed using the Mini-Mental State Examination, Dementia Mood Assessment Scale, and Dementia Behavior Disturbance scale.Results: Significant decreases in systolic (P < 0.01 and diastolic blood pressure (P < 0.05 along with a significant increase in tympanic temperature (P < 0.01 were observed after the steam foot spas. A significant improvement was seen in the Mini-Mental State Examination score (P < 0.01 and the overall dementia severity items in Dementia Mood Assessment Scale (P < 0.05.Limitations: Japanese people are very fond of foot baths. However, it is difficult to understand why inpatients cannot receive steam foot baths. In this study, a control group was not used. Raters and enforcers were not blinded.Conclusion: The results of this pilot study suggest that steam foot spas mitigate cognitive impairment in geriatric inpatients.Keywords: steam foot spa, geriatric inpatients, cognitive impairment, tympanic temperature

Geriatric epidemiology of trauma in a hospital in Southern Colombia

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Yolercy Vasquez

2017-01-01

>Conclusions: Trauma in the elderly is a common condition with high risk of mortality. It is important to know the frequency of these injuries to provide the best possible handling. In our hospital we found that geriatric trauma is a common disease, the main cause is falls without embargos traffic accidents are common in this population.

[Regional geriatric care concept in the District of Lippe : Structural effects and network formation in the case management-based model project].

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Şahin, Charlotte; Iseringhausen, Olaf; Hower, Kira; Liebe, Constanze; Rethmeier-Hanke, Anja; Wedmann, Bernd

2018-04-01

Regional planning of healthcare requires special consideration for the complex needs of elderly, multimorbid people living in a domestic environment. In the District of Lippe, a hospital (Klinikum Lippe) and network of ambulatory care physicians (Ärztenetz Lippe) developed and tested a geriatric care network based on case management for geriatric patients living in a domestic environment. The establishment of the geriatric care network (e.g. promoting networking acceptance and implementation) was formatively evaluated, e. g. with qualitative methods. Data were acquired by guideline-based interviews with experts and analyzed by qualitative content analysis according to Mayring. Structural effects included forming a cross-sectoral and interdisciplinary network for a functioning care network and a geriatric care pathway. The practical work of case managers (CM) is essential for communication with patients, family members and care providers as well as integrating providers into the network. A critical factor was working together with general practitioners and the close cooperation with the hospital's department of geriatric. The quality of care is improved because of exchange of information between sectors and continuity in the course of care. In the District of Lippe the quality of care was improved and structures of care were integrated by the network according to the needs of the target group. The integrative perspective was achieved in particular by the geriatric care pathway and integration of providers into the communication and care process; however, the scope of this care model could not be extended into routine care due to the rigid and subdivided health care system.

Health status, geriatric syndromes and prescription of oral anticoagulant therapy in elderly medical inpatients with atrial fibrillation.

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Bo, Mario; Sciarrillo, Irene; Maggiani, Guido; Falcone, Yolanda; Iacovino, Marina; Grisoglio, Enrica; Fonte, Gianfranco; Grosjean, Simon; Gaita, Fiorenzo

2017-03-01

The aim of the present study was to investigate the prevalence of geriatric syndromes among older medical inpatients with atrial fibrillation, and their association with use of vitamin K antagonists. A retrospective study of patients aged ≥65 years discharged with a diagnosis of atrial fibrillation from the Acute Geriatric Ward was carried out. Stroke and bleeding risk were evaluated according to the CHA 2 DS 2 -VASC and HAS-BLED scores. Comorbidity, cognitive status, functional autonomy and contraindications to vitamin K antagonists were also considered. Atrial fibrillation was documented in 1078 of 3650 patients (29.5%, mean age 83.4 ± 6.6 years, 60.3% women). Contraindications to vitamin K antagonists were documented in 24.9% of patients. Prescription of vitamin K antagonists at discharge was 37.8% and 47.9%, in the overall sample and in those without contraindications, respectively. In the overall sample, prescription of vitamin K antagonists was associated with younger age, permanent/persistent atrial fibrillation, home discharge, less comorbidity, higher hemoglobin levels, better functional independence, known atrial fibrillation at admission and lower HAS-BLED score. Among patients without contraindications to vitamin K antagonists, their use at discharge was independently associated with younger age, permanent/persistent atrial fibrillation, home discharge, higher hemoglobin levels and CHA2DS2-VASC score, better functional autonomy, and greater number of drugs. We showed a high prevalence of atrial fibrillation among older medical inpatients, who have a poor health status and a high prevalence of geriatric syndromes. Vitamin K antagonists were prescribed in less than half of the patients; underuse was mainly accounted for by a high prevalence of comorbidities/contraindications, poor health status and limited functional autonomy. Geriatr Gerontol Int 2017; 17: 416-423. © 2016 Japan Geriatrics Society.

[Aspects for data mining implementation in gerontology and geriatrics].

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Mikhal'skiĭ, A I

2014-01-01

Current challenges facing theory and practice in ageing sciences need new methods of experimental data investigation. This is a result as of experimental basis developments in biological research, so of information technology progress. These achievements make it possible to use well proven in different fields of science and engineering data mining methods for tasks in gerontology and geriatrics. Some examples of data mining methods implementation in gerontology are presented.

Interdisciplinary Educational Approaches to Promote Team-Based Geriatrics and Palliative Care

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Howe, Judith L.; Sherman, Deborah Witt

2006-01-01

Despite the increasing public demand for enhanced care of older patients and those with life-threatening illness, health professionals have had limited formal education in geriatrics and palliative care. Furthermore, formal education in interdisciplinary team training is limited. In order to remedy this situation, proactive interventions are being…

Review of fall risk assessment in geriatric populations using inertial sensors

Science.gov (United States)

2013-01-01

Background Falls are a prevalent issue in the geriatric population and can result in damaging physical and psychological consequences. Fall risk assessment can provide information to enable appropriate interventions for those at risk of falling. Wearable inertial-sensor-based systems can provide quantitative measures indicative of fall risk in the geriatric population. Methods Forty studies that used inertial sensors to evaluate geriatric fall risk were reviewed and pertinent methodological features were extracted; including, sensor placement, derived parameters used to assess fall risk, fall risk classification method, and fall risk classification model outcomes. Results Inertial sensors were placed only on the lower back in the majority of papers (65%). One hundred and thirty distinct variables were assessed, which were categorized as position and angle (7.7%), angular velocity (11.5%), linear acceleration (20%), spatial (3.8%), temporal (23.1%), energy (3.8%), frequency (15.4%), and other (14.6%). Fallers were classified using retrospective fall history (30%), prospective fall occurrence (15%), and clinical assessment (32.5%), with 22.5% using a combination of retrospective fall occurrence and clinical assessments. Half of the studies derived models for fall risk prediction, which reached high levels of accuracy (62-100%), specificity (35-100%), and sensitivity (55-99%). Conclusions Inertial sensors are promising sensors for fall risk assessment. Future studies should identify fallers using prospective techniques and focus on determining the most promising sensor sites, in conjunction with determination of optimally predictive variables. Further research should also attempt to link predictive variables to specific fall risk factors and investigate disease populations that are at high risk of falls. PMID:23927446

Late- versus early-onset geriatric depression in a memory research center

Directory of Open Access Journals (Sweden)

Carol Dillon

2009-10-01

Full Text Available Carol Dillon1, Ricardo F Allegri2, Cecilia M Serrano1, Mónica Iturry1, Pablo Salgado1, Frank B Glaser1, Fernando E Taragano21Memory Research Center, Department of Neurology, Hospital General Abel Zubizarreta, GCBA Buenos Aires, Argentina; 2Department of Neuropsychology (SIREN, CEMIC University, Buenos Aires, ArgentinaObjective: To contrast early-onset (<60 years and late-onset (>60 years depression in geriatric patients by evaluating differences in cognition, vascular comorbidity and sociological risk factors. Both patient groups were compared with normal subjects.Materials and methods: We recruited 76 patients with depressive symptoms (37 late onset and 39 early onset and 17 normal controls matched by age and educational level. All subjects were assessed using a semistructured neuropsychiatric interview and an extensive neuropsychological battery. Vascular and sociological risk factors were also evaluated.Results: We found a significant variation in performance between depressive patients and normal controls in most cognitive functions, especially memory (P < 0.0001, semantic fluency (P < 0.0001, verbal fluency, and digit-symbol (P < 0.0001. Late-onset depression patients scored lower and exhibited more severe impairment in memory domains than early-onset depression patients (P < 0.05. Cholesterol levels and marital status were significantly (P < 0.05 different between the depressive groups. Both depressed groups (early- and lateonset were more inactive than controls (P < 0.05; odds ratio: 6.02.Conclusion: Geriatric depression may be a manifestation of brain degeneration, and the initial symptom of a dementia. It is important to consider this in the treatment of patients that exhibit late-onset depressive symptoms.Keywords: early- and late-onset depression, geriatrics, cognition

Research on the influence factors of the fall efficiency of the hospitalized geriatric patients with cerebrovascular diseases.

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Li, Weili; Cheng, Ruilian

2016-11-01

To investigate the fall efficiency and its influence factors of the hospitalized geriatric patients with cerebrovascular diseases. The Modified Fall Efficacy Scale (MFES), Morse Fall Risk Assessment Scales (MFS), Berg Balance Scale (BBS) and Tinetti Gait Analysis (TGA) were adopted and the combined ways of questionnaires and observation were utilized to investigate the 113 hospitalized geriatric patients with cerebrovascular diseases. The fall efficiency of the geriatric patients with cerebrovascular diseases were 7.85±2.57 scores. The two projects "walking up and down stairs" and "taking public transport means" have got the lowest scores; The two projects "stretching out the hand to the box or the drawer for taking something" and "sitting up and down to the chair" have got the highest scores. It was found that there were three factors which had significant influences on the fall efficiency, they were myodynamia of the right upper extremity, Berg balance functions and gait. For the sake of helping the geriatric patients with cerebrovascular diseases to establish the self-confidence of preventing the falls, the medical workers need to take further psychological counseling for the patients and befittingly and specifically to improve the fall efficiency of patients so as to effectively prevent the occurring of the fall on the basis of improving the balance ability and gait of patients.

Redesigning geriatric healthcare: how cross-functional teams and process improvement provide a competitive advantage.

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Andrews, B C; Kaye, J; Bowcutt, M; Campbell, J

2001-01-01

This study examines the consequences of adding a geriatric subacute unit to the traditional health care mix offered by a nonprofit hospital. Historically, geriatric health care offerings have been limited to either acute care units or long-term care facilities. The study's findings demonstrate that the addition of a subacute unit that is operated by an interdisciplinary team is a competitively rational move for two reasons. First, it provides a continuum of care that integrates services and departments, thereby reducing costs. Second, it provides a supportive environment for patients and their families. As a consequence patients have a higher probability of returning home than patients who are assigned to more traditional modes of care.

Phase angle assessment by bioelectrical impedance analysis and its predictive value for malnutrition risk in hospitalized geriatric patients.

Science.gov (United States)

Varan, Hacer Dogan; Bolayir, Basak; Kara, Ozgur; Arik, Gunes; Kizilarslanoglu, Muhammet Cemal; Kilic, Mustafa Kemal; Sumer, Fatih; Kuyumcu, Mehmet Emin; Yesil, Yusuf; Yavuz, Burcu Balam; Halil, Meltem; Cankurtaran, Mustafa

2016-12-01

Phase angle (PhA) value determined by bioelectrical impedance analysis (BIA) is an indicator of cell membrane damage and body cell mass. Recent studies have shown that low PhA value is associated with increased nutritional risk in various group of patients. However, there have been only a few studies performed globally assessing the relationship between nutritional risk and PhA in hospitalized geriatric patients. The aim of the study is to evaluate the predictive value of the PhA for malnutrition risk in hospitalized geriatric patients. One hundred and twenty-two hospitalized geriatric patients were included in this cross-sectional study. Comprehensive geriatric assessment tests and BIA measurements were performed within the first 48 h after admission. Nutritional risk state of the patients was determined with NRS-2002. Phase angle values of the patients with malnutrition risk were compared with the patients that did not have the same risk. The independent variables for predicting malnutrition risk were determined. SPSS version 15 was utilized for the statistical analyzes. The patients with malnutrition risk had significantly lower phase angle values than the patients without malnutrition risk (p = 0.003). ROC curve analysis suggested that the optimum PhA cut-off point for malnutrition risk was 4.7° with 79.6 % sensitivity, 64.6 % specificity, 73.9 % positive predictive value, and 73.9 % negative predictive value. BMI, prealbumin, PhA, and Mini Mental State Examination Test scores were the independent variables for predicting malnutrition risk. PhA can be a useful, independent indicator for predicting malnutrition risk in hospitalized geriatric patients.

[Report: an analysis of publications by members of the Spanish Geriatrics and Gerontology Society from 2006 to 2011].

Science.gov (United States)

Salvà, Antoni; Domingo, Àlex; Roqué i Figuls, Marta; Serra-Rexach, José Antonio

2013-01-01

Data is presented from the survey conducted by the Sociedad Española de Geriatría y Gerontología (SEGG) (Spanish Society of Geriatrics and Gerontology) among its members in order to assess their scientific production between 2006 and 2011, specifically articles in journals that are indexed in the Science Citation Index. The scientific quality of the publications was quantified using the number of times every article was cited and the journal's impact factor. A total of 162 out of the 2450 members responded (6.6%), reporting a total of 903 individual articles, 335 (37%) of them in geriatrics-specific journals, and 568 (63%) in other journals of other specialties. The number of publications increased yearly from 128 in 2006 to 201 in 2010. The scientific quality could be calculated for 530 articles. On average, publications have been cited 8.2 times (median: 2), with the range of citations being from 0 to 242. The average impact factor was 3.1 (median 2.4), ranging from 0 to 53.5. A number of articles have been published in some of the largest impact factor journals, in those of general-interest, as well as geriatrics-specific and basic science journals. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture.

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Bohl, Daniel D; Shen, Mary R; Hannon, Charles P; Fillingham, Yale A; Darrith, Brian; Della Valle, Craig J

2017-12-20

Serum albumin level is the most well-established serum marker of malnutrition, with a serum albumin concentration malnutrition. The purpose of this study was to test if serum albumin level is associated with death, specific postoperative complications (e.g., pneumonia), length of hospital stay, and readmission following a surgical procedure for geriatric hip fracture. A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without hypoalbuminemia. All comparisons were adjusted for baseline and procedural differences between populations, and patients with missing serum albumin concentration were included in analyses using a missing data indicator. There were 29,377 geriatric patients undergoing a hip fracture surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had serum albumin available for analysis. The prevalence of hypoalbuminemia was 45.9%. Following adjustment for baseline and procedural characteristics, the risk of death was inversely associated with serum albumin concentration as a continuous variable (adjusted relative risk, 0.59 [95% confidence interval (CI), 0.53 to 0.65]; p patients with normal albumin concentration, patients with hypoalbuminemia had higher rates of death (9.94% compared with 5.53% [adjusted relative risk, 1.52 (95% CI, 1.37 to 1.70); p patients with hypoalbuminemia at 5.67 ± 4.68 days compared with those without hypoalbuminemia at 4.99 ± 3.95 days; the adjusted difference was 0.50 day (95% CI, 0.38 to 0.63 day; p patients with hypoalbuminemia (10.91%) and those without hypoalbuminemia (9.03%); the adjusted relative risk was 1.10 (95% CI, 1.00 to 1.21). Hypoalbuminemia is a powerful independent risk factor for mortality following a surgical procedure for geriatric hip fracture. These data suggest

[Physical and pharmacological restraints in geriatric and gerontology services and centers].

Science.gov (United States)

Ramos Cordero, Primitivo; López Trigo, José Antonio; Maíllo Pedraz, Herminio; Paz Rubio, José María

2015-01-01

Physical and pharmacological restraints are a controversial issue in the context of geriatric care due to their moral, ethical, social and legal repercussions and, despite this fact, no specific legislation exists at a national level. The use of restraints is being questioned with growing frequency, as there are studies that demonstrate that restraints do not reduce the number of falls or their consequences, but rather can increase them, cause complications, injuries and potentially fatal accidents. Restraints are not always used rationally, despite compromising a fundamental human right, that is, freedom, protected in the Constitution, as well as values and principles, such as dignity and personal self-esteem. There are centers where restraints are applied to more than 50% of patients, and in some cases without the consent of their legal representatives. On some occasions, restraints are used for attaining organizational or environmental objectives, such as complying with tight schedules, and for reducing or avoiding the supervision of patients who walk erratically and, at times, are used indefinitely. Even greater confusion exists with respect to the emerging concept of chemical or pharmacological restraints, since no conceptual framework exists based on scientific evidence, and with sufficient consensus for guiding healthcare workers. In this context, the Sociedad Española de Geriatría y Gerontología (SEGG--Spanish Geriatrics and Gerontology Society), aware of the significance and transcendence of the issue, and in an attempt to preserve and guarantee maximum freedom, dignity and self-esteem, on the one hand, and to ensure the maximum integrity and legal certainty of the persons cared for in geriatric and gerontology services and centers, on the other, decided to create an "Interdisciplinary Committee on Restraints" made up by members from different disciplines and members of SEGG Working Groups or Committees, external health care workers, groups

[Pressure sores in geriatric medicine: the role of nutrition].

Science.gov (United States)

Fontaine, Juliette; Raynaud-Simon, Agathe

2008-01-01

Malnutrition is frequent in geriatric patients: it affects 30 to 60% of elderly residents of institutions and 30 to 70% of patients admitted for short-term hospitalization. Malnutrition is a risk factor for developing pressure sores, and patients with them are more often and more severely malnourished than patients without them. In elderly subjects, multiple and interlinked factors may trigger or aggravate malnutrition; they may be physical, psychological or social and may be worsened by drugs and some diets. Malnutrition has been recognized as a risk factor for the onset and perpetuation of pressure sores. Of the dietary factors, protein intake seems most important. A low body mass index (BMI), low serum albumin, and weight loss are associated with an increased risk of pressure sores. A physician observing pressure sores must conduct a nutritional assessment, using clinical and laboratory screening tools. The criteria for malnutrition in elderly subjects are weight loss > or =5% in 3 months or > or =10% in 6 months, BMIpressure sores in geriatric medicine. It must be adapted for each patient. The recommended calorie intake in malnourished patients at risk of or with pressure sores is 30-40 kcal/kg/d, with 1.2-1.5 g of proteins/kg/d.

Monitoring Brain Activity of Geriatric Learners with Low-Cost Neurophysiological Technology

Science.gov (United States)

Romero-Hall, Enilda; Scott, JoAnne

2017-01-01

Cultural stereotypes rooted in both antiquated data and misinterpretation of data have long perpetuated the belief that older adults are unable to learn new concepts because they are doomed to lose brain cells at an alarming rate during their geriatric years. However, advances in neurophysiological technologies that allow researchers to observe…

The effect of chemotherapy on nutritional status and weakness in geriatric gastrointestinal system cancer patients.

Science.gov (United States)

Bicakli, Derya Hopanci; Ozveren, Ahmet; Uslu, Ruchan; Dalak, Reci Meseri; Cehreli, Ruksan; Uyar, Mehmet; Karabulut, Bulent; Akcicek, Fehmi

2018-03-01

Malnutrition is common in patients with geriatric gastrointestinal system (GIS) cancer. This study aimed to evaluate patients with geriatric GIS cancer in terms of nutritional status and weakness and determine the changes caused by chemotherapy (CT). Patients with geriatric GIS cancer who received CT were included in the study. Their nutritional status was assessed with the Mini Nutritional Assessment, and weakness was assessed with the handgrip strength/body mass index ratio. After CT (minimum 4 wk and maximum 6 wk later), patients were assessed for the same parameters. A total of 153 patients aged ≥65 y (mean age, 70.5 ± 5.6 y; 44 female and 109 male) were evaluated. The population consisted of patients who were diagnosed with colorectal (51.6%), gastric (26.8%), pancreatic (11.8%), hepatic (7.2%), biliary tract (2%), and esophageal (0.7%) cancer. Of these patients, 37.9% were malnourished, 34.6% were at risk of malnutrition, and 27.5% were well nourished. After one course of CT, the frequency of malnutrition increased to 46.4% (P = 0.001). The patient groups with the highest rates of weakness were those who were diagnosed with biliary tract, hepatic, and colorectal cancer (33.3%, 27.3%, and 20%, respectively). Weakness was significantly increased after one course of CT in patients who received CT before (P = 0.039). Malnutrition and weakness were common in patients with geriatric GIS cancer, and even one course of CT worsened the nutritional status of the patients. Patients who have received CT previously should be carefully monitored for weakness. Copyright © 2017 Elsevier Inc. All rights reserved.

Osteosarcopenia: A new geriatric syndrome.

Science.gov (United States)

Hassan, Ebrahim Bani; Duque, Gustavo

2017-11-01

Longevity, the increase in the ageing population and a lifestyle of minimal physical activity come with a hefty price. Consequently, two diseases are increasingly becoming a concern for the welfare of patients and the health industry: osteoporosis and sarcopenia. These conditions are usually interrelated through several mechanisms and metabolic pathways, and comprise a syndrome called osteosarcopenia. As patients with osteosarcopenia represent an important subset of frail individuals at higher risk of institutionalisation, falls and fractures, the aim of this review is to further familiarise general practitioners with osteosarcopenia as a new geriatric syndrome that requires early diagnosis and effective therapeutic interventions. The most important aspects of osteosarcopenia are discussed here. These include pathogenesis, prevalence, diagnostic criteria, management and follow-up. Finally, the role of multidisciplinary clinics for the care of patients with osteosarcopenia is discussed in brief.

Post Operative Cognitive Dysfunction (POCD in Geriatric Population

Directory of Open Access Journals (Sweden)

Rajesh MC

2015-10-01

Full Text Available Post-operative mental dysfunction and confusion in aged patients is a well recognized entity. Commonly known as post-operative delirium and cognitive dysfunction (POCD, these are important for any peri-operative physician dealing with geriatric population. The incidence is more in older patients with pre-existing impairment. Impact of POCD is grave. This can result in poor rehabilitation outcome and increased hospital stay. Incidence ranges from 15-50% with ˂5% for cataract surgery and as high as 60% after hip replacement procedures.

Complexity in graduate medical education: a collaborative education agenda for internal medicine and geriatric medicine.

Science.gov (United States)

Chang, Anna; Fernandez, Helen; Cayea, Danelle; Chheda, Shobhina; Paniagua, Miguel; Eckstrom, Elizabeth; Day, Hollis

2014-06-01

Internal medicine residents today face significant challenges in caring for an increasingly complex patient population within ever-changing education and health care environments. As a result, medical educators, health care system leaders, payers, and patients are demanding change and accountability in graduate medical education (GME). A 2012 Society of General Internal Medicine (SGIM) retreat identified medical education as an area for collaboration between internal medicine and geriatric medicine. The authors first determined a short-term research agenda for resident education by mapping selected internal medicine reporting milestones to geriatrics competencies, and listing available sample learner assessment tools. Next, the authors proposed a strategy for long-term collaboration in three priority areas in clinical medicine that are challenging for residents today: (1) team-based care, (2) transitions and readmissions, and (3) multi-morbidity. The short-term agenda focuses on learner assessment, while the long-term agenda allows for program evaluation and improvement. This model of collaboration in medical education combines the resources and expertise of internal medicine and geriatric medicine educators with the goal of increasing innovation and improving outcomes in GME targeting the needs of our residents and their patients.

[Advanced organ failure in the elderly. Some issues from a geriatrics, palliative medicine and bioethics perspectives].

Science.gov (United States)

Alonso-Renedo, Francisco Javier; González-Ercilla, Leire; Iráizoz-Apezteguía, Itziar

2014-01-01

To analyze the literature as regards the knowledge, skills and attitudes that these disciplines can provide in improving technical, ethical and human quality health care in the elderly with advanced organ failure, multimorbidity, frailty and progressive dementia. A comprehensive review focused on available references on the interrelationship between geriatric medicine and palliative medicine, education in bioethics, prognostic tools, functional status, and the humanization of health care. Advance care planning, comprehensive geriatric assessment, the study of the values of the patient and their introduction in decision-making process, as well as the need to promote moral, care, and healthcare organizational ethics, are essential elements to achieve this objective. Practitioners and healthcare organizations should seek excellence as a moral requirement. To achieve this, there is a priority to acquire virtues of care and fundamental concepts of geriatric and palliative medicine, assessing functional status, advance care planning and patient/family needs as essential issues to protect, care for and promote them in all care settings. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

Geriatric Foot Care: A Model Educational Program for Mid-Level Practitioners.

Science.gov (United States)

Suggs, Patricia K.; Krissak, Ruth; Caruso, Frank; Teasdall, Robert

2002-01-01

An educational program on geriatric foot care was completed by 59 nurse practitioners, 12 physicians' assistants, and 1 physician. The 3 1/2 day program included interactive sessions, observation, and hands-on patient care. Posttest results and 6-month follow-up showed significant knowledge increases and incorporation of learning into practice.…

Senile anorexia in different geriatric settings in Italy.

Science.gov (United States)

Donini, L M; Dominguez, L J; Barbagallo, M; Savina, C; Castellaneta, E; Cucinotta, D; Fiorito, A; Inelmen, E M; Sergi, G; Enzi, G; Cannella, C

2011-11-01

Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status. Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto). 526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 "Cause e Prevalenza dell'Anoressia senile"). Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day "Club Francophone de Gériatrie et Nutrition" form), in absence of oral disorders preventing mastication. The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet

Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions.

Science.gov (United States)

Lichtenstein, Brian J; Reuben, David B; Karlamangla, Arun S; Han, Weijuan; Roth, Carol P; Wenger, Neil S

2015-10-01

The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician-performed tasks, 0.55 for nurse practitioner (NP)-, physician assistant (PA)-, and registered nurse (RN)-performed tasks; and 0.61 for medical assistant- and licensed vocational nurse-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Emergency general surgery in the geriatric patient.

Science.gov (United States)

Desserud, K F; Veen, T; Søreide, K

2016-01-01

Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

The effect of geriatric intervention in frail elderly patients receiving chemotherapy for colorectal cancer

DEFF Research Database (Denmark)

Lund, C M; Vistisen, K K; Dehlendorff, C

2017-01-01

patients are offered inclusion and are then randomized to two groups (the intervention group and the control group). Patients in the intervention group receive a full geriatric assessment of comorbidity, medication, psycho-cognitive function, physical, functional and nutrition status, and interventions......BACKGROUND: Better surgical techniques, chemotherapy and biological therapy have improved survival in patients with colorectal cancer (CRC), most markedly in younger patients. About half of patients over 70 years receive dose reductions or early treatment discontinuation of the planned adjuvant...... or first-line treatment due to side effects. The Comprehensive Geriatric Assessment (CGA) is a multidisciplinary evaluation of an elderly individual's health status. This assessment in older patients with cancer can predict survival, chemotherapy toxicity and morbidity. METHODS: This randomized phase II...

Blood pressure and 10-year mortality risk in the Milan Geriatrics 75+ Cohort Study

DEFF Research Database (Denmark)

Ogliari, Giulia; Westendorp, Rudi G J; Muller, Majon

2015-01-01

BACKGROUND: optimal blood pressure targets in older adults are controversial. OBJECTIVE: to investigate whether the relation of blood pressure with mortality in older adults varies by age, functional and cognitive status. DESIGN: longitudinal geriatric outpatient cohort. SETTING: Milan Geriatrics...... 75+ Cohort Study. SUBJECTS: one thousand five hundred and eighty-seven outpatients aged 75 years and over. METHODS: the relations of systolic (SBP) and diastolic blood pressure (DBP) with mortality risk were analysed using Cox proportional hazards models. Blood pressure, Mini-Mental State Examination......: the correlations of SBP and DBP with mortality were U-shaped. Higher SBP is related to lower mortality in subjects with impaired ADL and MMSE. ADL and MMSE may identify older subjects who benefit from higher blood pressure....

Artificial Neural Network (ANN) Model to Predict Depression among Geriatric Population at a Slum in Kolkata, India.

Science.gov (United States)

Sau, Arkaprabha; Bhakta, Ishita

2017-05-01

Depression is one of the most important causes of mortality and morbidity among the geriatric population. Although, the aging brain is more vulnerable to depression, it cannot be considered as physiological and an inevitable part of ageing. Various sociodemographic and morbidity factors are responsible for the depression among them. Using Artificial Neural Network (ANN) model depression can be predicted from various sociodemographic variables and co morbid conditions even at community level by the grass root level health care workers. To predict depression among geriatric population from sociodemographic and morbidity attributes using ANN. An observational descriptive study with cross-sectional design was carried out at a slum under the service area of Bagbazar Urban Health and Training Centre (UHTC) in Kolkata. Among 126 elderlies under Bagbazar UHTC, 105 were interviewed using predesigned and pretested schedule. Depression status was assessed using 30 item Geriatric Depression Scale. WEKA 3.8.0 was used to develop the ANN model and test its performance. Prevalence of depression among the study population was 45.7%. Various sociodemographic variables like age, gender, literacy, living spouse, working status, personal income, family type, substance abuse and co morbid conditions like visual problem, mobility problem, hearing problem and sleeping problem were taken into consideration to develop the model. Prediction accuracy of this ANN model was 97.2%. Depression among geriatric population can be predicted accurately using ANN model from sociodemographic and morbidity attributes.

Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review.

Science.gov (United States)

Vieira, Edgar Ramos; Freund-Heritage, Rosalie; da Costa, Bruno R

2011-09-01

To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings. Eligible studies were systematically searched on 16 databases from inception to December 2010. The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ≥65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded. A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified. Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings.

Applying a Lifespan Developmental Perspective to Chronic Pain: Pediatrics to Geriatrics.

Science.gov (United States)

Walco, Gary A; Krane, Elliot J; Schmader, Kenneth E; Weiner, Debra K

2016-09-01

An ideal taxonomy of chronic pain would be applicable to people of all ages. Developmental sciences focus on lifespan developmental approaches, and view the trajectory of processes in the life course from birth to death. In this article we provide a review of lifespan developmental models, describe normal developmental processes that affect pain processing, and identify deviations from those processes that lead to stable individual differences of clinical interest, specifically the development of chronic pain syndromes. The goals of this review were 1) to unify what are currently separate purviews of "pediatric pain," "adult pain," and "geriatric pain," and 2) to generate models so that specific elements of the chronic pain taxonomy might include important developmental considerations. A lifespan developmental model is applied to the forthcoming Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society Pain Taxonomy to ascertain the degree to which general "adult" descriptions apply to pediatric and geriatric populations, or if age- or development-related considerations need to be invoked. Copyright © 2016. Published by Elsevier Inc.

Cost effectiveness of withdrawal of fall-risk-increasing drugs in geriatric outpatients

NARCIS (Netherlands)

van der Velde, Nathalie; Meerding, Willen Jan; Looman, Caspar W.; Pols, Huibert A. P.; van der Cammen, Tischa J. M.

2008-01-01

BACKGROUND: Withdrawal of fall-risk-increasing drugs has been proven to be effective in older persons. However, given the enormous rise in healthcare costs in recent decades, the effect of such withdrawals on healthcare costs also needs to be considered. METHOD: Within a common geriatric outpatient

European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique

DEFF Research Database (Denmark)

Masud, T.; Blundell, A.; Gordon, A. L.

2014-01-01

Introduction: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among...... geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. Methods: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi...... rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. Results: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement...

Automated Assessment of Medical Students' Clinical Exposures according to AAMC Geriatric Competencies.

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Chen, Yukun; Wrenn, Jesse; Xu, Hua; Spickard, Anderson; Habermann, Ralf; Powers, James; Denny, Joshua C

2014-01-01

Competence is essential for health care professionals. Current methods to assess competency, however, do not efficiently capture medical students' experience. In this preliminary study, we used machine learning and natural language processing (NLP) to identify geriatric competency exposures from students' clinical notes. The system applied NLP to generate the concepts and related features from notes. We extracted a refined list of concepts associated with corresponding competencies. This system was evaluated through 10-fold cross validation for six geriatric competency domains: "medication management (MedMgmt)", "cognitive and behavioral disorders (CBD)", "falls, balance, gait disorders (Falls)", "self-care capacity (SCC)", "palliative care (PC)", "hospital care for elders (HCE)" - each an American Association of Medical Colleges competency for medical students. The systems could accurately assess MedMgmt, SCC, HCE, and Falls competencies with F-measures of 0.94, 0.86, 0.85, and 0.84, respectively, but did not attain good performance for PC and CBD (0.69 and 0.62 in F-measure, respectively).

Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward

DEFF Research Database (Denmark)

Buck, Thomas Croft; Gronkjaer, Louise Smed; Duckert, Marie-Louise

2013-01-01

OBJECTIVE: Incomplete medication histories obtained on hospital admission are responsible for more than 25% of prescribing errors. This study aimed to evaluate whether pharmacy technicians can assist hospital physicians' in obtaining medication histories by performing medication reconciliation an...... reconciliation and focused medication reviews. Further randomized, controlled studies including a larger number of patients are required to elucidate whether these observations are of significance and of importance for securing patient safety....... and prescribing reviews. A secondary aim was to evaluate whether the interventions made by pharmacy technicians could reduce the time spent by the nurses on administration of medications to the patients. METHODS: This observational study was conducted over a 7 week period in the geriatric ward at Odense...... University Hospital, Denmark. Two pharmacy technicians conducted medication reconciliation and prescribing reviews at the time of patients' admission to the ward. The reviews were conducted according to standard operating procedures developed by a clinical pharmacist and approved by the Head of the Geriatric...

Nonpharmacological therapeutic techniques to decrease agitation in geriatric psychiatric patients with dementia.

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Mitchell, Ann M; Chiappetta, Laurel; Boucek, Lynn; Cain, Michelle; Patterson, Georgia; Owens, Kim; Herisko, Camellia; Stark, Kirsti Hetager

2015-02-01

Agitation is not only a frequent and disturbing behavior for many patients with dementia, but it also troubles their caregivers and families. Many serious problems and side effects are associated with the use of medications to treat agitation; therefore, alternative approaches to treating agitation must be assessed. The current article presents results from a quality improvement pilot project that examined the usefulness of a specially designed, multisensory room intervention for geriatric psychiatric inpatients with mild to moderate agitation. Thirty-two visits to the sensory room were made by 13 inpatients with dementia. A significant decrease occurred in the Pittsburgh Agitation Scale (PAS) total scores over time from pre-room to post-room intervention, as well as 1-hour post-room intervention (F = 95.3, p agitation, and resistance to care), with the exception of the aggression subscale. The multisensory room intervention was effective in decreasing some symptoms of agitation in the geriatric psychiatric patient, thus contributing to positive patient, family, and nursing outcomes. Copyright 2015, SLACK Incorporated.

Relevance of G8 scale in referring elderly patients with aortic stenosis requiring a TAVI for a geriatric consultation.

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de Thézy, Albane; Lafargue, Aurélie; d'Arailh, Lydie; Dijos, Marina; Leroux, Lionel; Salles, Nathalie; Rainfray, Muriel

2017-12-01

Aortic stenosis (AS) may soon become a significant public health issue. Referring elderly suffering from aortic stenosis for a transcatheter aortic valve implantation (TAVI) versus surgical valve replacement might be difficult and requires a multidisciplinary staff. G8 is a geriatric screening scale for frailty, validated in oncogeriatry. We study sensibility and specificity of G8 used by cardiologists in comparison to a comprehensive geriatric assessment (CGA) performed by geriatrician. Prospective study, from February to July 2015, in Bordeaux university Hospital, France. Every elderly admitted for a TAVI had a G8 scale performed by cardiologist and CGA by a geriatrician in blind. Comorbidities were assessed using Cumulative Illness Rating Scale in his geriatric version (CIRS-G). CGA was abnormal if: MMSE value in comparison to gold-standard CGA. 49 patients were included (55.1% women, mean age 84.8 years old). Nearly half of the patients (48.96%) had multiple comorbidities (CIRS G score >3 for at least three items excluding the cardiology item). 38 CGA were abnormal (77.55%) and 41 G8 (83.67%). G8 had a sensibility of 100% (IC 95% [0.9-1]), a specificity of 72.7% (IC 95% [0.43-0.9]), a positive predictive value of 92.6% and a negative prospective value of 100% (IC: 95%). G8 scale seems to be an efficient geriatric screening tool for frailty in elderly undergoing TAVI in comparison to CGA. Simple and useful, G8 scale could be performed by cardiologists in older patients with AS for identifying patients with a geriatric risk profile in consultation before surgery. Further studies with bigger samples are needed to confirm these results.

[Effectiveness of teaching gerontology and geriatrics in students of the 1st Faculty of Medicine, Charles University in Prague].

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Mádlová, P; Neuwirth, J; Topinková, E

2006-01-01

Increasing number of seniors in the society requires more university-degree educated professionals--health care professionals, social care workers and managers with basic exposure to and knowledge of gerontology and geriatrics. The aim of our paper was to evaluate the effectiveness of undergraduate training of gerontology and geriatrics among students of the 1st Faculty of Medicine, Charles University in Prague. To get information about knowledge of medical students and students of ergotherapy and physiotherapy and about their attitudes towards senior citizens we conducted a survey using two anonymous questionnaires prepared in our department and piloted earlier. The survey ran during the academic year 2004/2005. Students completed identical questionnaires twice, first time before the start of the clinical rotation and second time after the training end (n=134). Evaluation of knowledge and attitudes confirmed that one to two weeks clinical rotation at Department of Geriatrics was effective and increased knowledge of students in the topic trained. The percentage of correct answers in all three evaluated training programmes increased after the completion of the clinical rotation and reached 83% and more. From 134 participating students, 54.5 % appreciated life experience and wisdom of seniors they met, 98.4 % of students were satisfied with the training programme and 67.2 % of students reported that after training they changed their attitude towards senior population. Our survey confirmed that clinical training in geriatric medicine at 1st Faculty of Medicine, Charles University in Prague, prepared in agreement with current European recommendations is sufficiently effective and well accepted by the students. Therefore we recommend introduction of formal geriatric training for students in all medical faculties in the Czech Republic.

Using traditional or flipped classrooms to teach "Geriatrics and Gerontology"? Investigating the impact of active learning on medical students' competences.

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Granero Lucchetti, Alessandra Lamas; Ezequiel, Oscarina da Silva; Oliveira, Isabella Noceli de; Moreira-Almeida, Alexander; Lucchetti, Giancarlo

2018-01-21

The present study aims to investigate the effect of two educational strategies to teach geriatrics (flipped classroom-FL and traditional lectures-TR) in relation to a control group (no intervention) on students' competences. An intervention study was conducted during the third year of medicine. Two different educational strategies (flipped classroom and traditional lectures) were incorporated into a theoretical-practical discipline of geriatrics. Students were evaluated about their attitudes towards older persons (Maxwell-Sullivan, UCLA geriatric attitudes), empathy (Maxwell-Sullivan), knowledge (Palmore and cognitive knowledge), skills (standardized patient assessment), and satisfaction with the activities. A total of 243 students were assessed. The FL group demonstrated greater gains in knowledge among students and improved attitude compared to the TR. We found no differences in the skills using a standardized patient. In addition, students exposed to FL felt more prepared to treat older people, believed they had more knowledge, were more satisfied, and evaluated the discipline's format better in relation to the traditional group. Strategies in teaching geriatrics can impact students' knowledge, attitudes, and satisfaction with the course. We found that the way this teaching is delivered can influence students' learning, since there were differences between active and traditional strategies.

The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents

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Yardimci, Bulent; Aran, Sinan N.; Ozkaya, Ismail; Aksoy, Sevki M.; Demir, Tarik; Tezcan, Gulsen; Kaptanoglu, Aysegul Y.

2016-01-01

Objectives: To determine the relation among the risk of falls, geriatric assessment, and anthropometric measurements, including the mini mental state examination, geriatric depression scale, handgrip test, and key pinch test. Methods: This prospective study included 89 residents hospitalized between May 2014 and September 2015 in the geriatric care unit of the Istanbul Balikli Rum Hospital, Istanbul, Turkey. Patients were followed-up for one year, and their falls were recorded. Medical records of the included patients were retrieved and analyzed. Results: A total of 89 patients, comprising 37 men and 52 women with an average age of 75.8 ± 8.2 years were included in the study. The residents’ annual falling averages were 1.0 ± 1.5. The most significant factors were identified to be predicted muscle mass, skeletal muscle index, whole body bioimpedance, dominant arm muscle strength, dominant arm bioimpedance, and free fat mass. Conclusions: The mini mental test, geriatric depression scale and lawton-brody scale combined with the handgrip, 6-meters walking, and bioimpedance tests are favorable for detecting the risk of falls and recurrent falls in vulnerable elderly nursing home residents. PMID:27652361

[Six-months outcomes after admission in acute geriatric care unit secondary to a fall].

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Dickes-Sotty, Hélène; Chevalet, Pascal; Fix, Marie-Hélène; Riaudel, Typhaine; Serre-Sahel, Caroline; Ould-Aoudia, Vincent; Berrut, Gilles; De Decker, Laure

2012-12-01

Fall in elderly subject is a main event by its medical and social consequences, but few studies were dedicated to the prognosis from hospitalization in geriatric acute care unit. Describe the outcome of elderly subjects hospitalized after a fall in geriatric acute care unit. Longitudinal study of 6 months follow-up, 100 patients of 75 and more years old hospitalized after a fall in acute care geriatric unit. On a total of 128 patients hospitalized for fall, 100 agreed to participate in the study, 3 died during the hospitalization, so 97 subjects were able to be followed. During 6 months after the hospitalization, 14 patients died (14.9%), 51 (58%) have fallen again (58%) and 11 (22%) of them suffer from severe injuries. Thirty seven (39.7%) were rehospitalized and 10 of them related to fall. Among the patients coming from their home, 25 had been institutionalized. The main risk factor which have been identified to be associated with a new fall during the follow-up was a known dementia at the entry. The medical and social prognosis of an elderly subject hospitalized in an acute care unit is severe. The main comorbidity which influences the medical and social outcome is a known dementia, in addition to a history of previous fall.

Narrative of a Teaching Practice. An Autoethnography about Being a Geriatrics Professor

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Bulgarelli, Alexandre F.; Toassi, Ramona F. C.

2018-01-01

This study was developed to show a professor's perspective to comprehend his difficulties and challenges, within a different scenario and culture of teaching geriatric dentistry in a nursing home. It was a self-analysis theoretically supported by the Social Constructionism and the Interpretative Autoethnography perspective. Data were constructed…

Geriatric Rehabilitation ('Alters-Rehabilitation'): The New Challenge for Social Medicine and Science.

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Barolin, G. S.

1996-01-01

This discussion of geriatric rehabilitation stresses the importance of holistic and permanent rehabilitation with a fluent transition from the acute phase to the rehabilitation phase under one specialist's care and in one institution. Recommendations include mixed age groups in one ward; systematic education of relatives; follow-up rehabilitation…

The RBANS Effort Index: base rates in geriatric samples.

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Duff, Kevin; Spering, Cynthia C; O'Bryant, Sid E; Beglinger, Leigh J; Moser, David J; Bayless, John D; Culp, Kennith R; Mold, James W; Adams, Russell L; Scott, James G

2011-01-01

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.

Controlling urinary tract infections associated with intermittent bladder catheterization in geriatric hospitals.

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Girard, R; Gaujard, S; Pergay, V; Pornon, P; Martin Gaujard, G; Vieux, C; Bourguignon, L

2015-07-01

Controlling urinary tract infections (UTIs) associated with intermittent catheterization in geriatric patients. After a local epidemiological study identified high rates of UTI, a multi-disciplinary working group implemented and evaluated corrective measures. In 2009, a one-month prospective study measured the incidence of UTI, controlled for risk factors and exposure, in six geriatric hospitals. In 2010, a self-administered questionnaire on practices was administered to physicians and nurses working in these geriatric units. In 2011, the working group developed a multi-modal programme to: improve understanding of micturition, measurement of bladder volume and indications for catheter drainage; limit available medical devices; and improve prescription and traceability procedures. Detailed training was provided to all personnel on all sites. The epidemiological study was repeated in 2012 to assess the impact of the programme. Over 1500 patients were included in the 2009 study. The incidence of acquired infection was 4.8%. The infection rate was higher in patients with intermittent catheters than in patients with indwelling catheters (29.7 vs 9.9 UTI per 100 patients, P = 0.1013) which contradicts the literature. In 2010, the 269 responses to the questionnaire showed that staff did not consider catheterization to place patients at risk of infection, staff had poor knowledge of the recommended indications and techniques, and the equipment varied widely between units. Following implementation of the programme, the study was repeated in 2012 with over 1500 patients. The frequency of UTI in patients with intermittent catheters fell to rates in the published literature. Multi-modal programmes are an effective means to control UTI. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program

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Scott D. Casey

2017-04-01

Full Text Available Introduction: Over 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED pain management of geriatric fragility hip fractures. Methods: We performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP. Outcomes were time to (any first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB in the ED, and amount of opioid medication administered in the first 24 hours. We used permutation tests to evaluate differences in ED pain management following GFP implementation. Results: We studied 131 patients in the pre-GFP period and 177 patients in the post-GFP period. In the post-GFP period, more patients received FICB (6% vs. 60%; difference 54%, 95% confidence interval [CI] 45–63%; p<0.001 and acetaminophen (10% vs. 51%; difference 41%, 95% CI 32–51%; p<0.001 in the ED. Patients in the post-GFP period also had a shorter time to first analgesic (103 vs. 93 minutes; p=0.04 and received fewer morphine equivalents in the first 24 hours (15mg vs. 10mg, p<0.001 than patients in the pre-GFP period. Conclusion: Implementation of a GFP was associated with improved ED pain management for geriatric patients with fragility hip fractures. Future studies should evaluate the effects of these changes in pain management on longer-term outcomes.

Meeting American Geriatrics Society Competencies: Are Residents Meeting Expectations for Quality Care of Older Adults?

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Bynum, Debra L; Wilson, Lindsay A; Ong, Thuan; Callahan, Kathryn E; Dalton, Thomas; Ohuabunwa, Ugochi

2015-09-01

In order to determine how often internal medicine and family medicine residents performed specific actions related to the geriatric competencies established by the American Geriatrics Society (AGS) when caring for older hospitalized adults, a cross-sectional anonymous survey of residents at the University of North Carolina, University of Washington, Wake Forest University, Duke University, and Emory University was undertaken. Data on frequency of self-reported behaviors were analyzed, with comparisons made for different levels of training, institution, and program. A total of 375 residents responded for an overall response rate of 48%. Residents reported that they often do not demonstrate all of the AGS recommended core competencies when caring for older adults in the hospital setting. Residents report more frequently performing activities that are routinely integrated into hospital systems such as reviewing medication lists, working with an interdisciplinary team, evaluating for inappropriate bladder catheters, and evaluating for pressure ulcers. There were no consistent differences between institutions and only minor differences noted between Family Medicine and Internal Medicine residents. Operationalizing core competencies by integrating them into hospital systems' quality process indicators may prompt more consistent high-quality care and ensure systems support residents' competence. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Number of X-ray examinations performed on paediatric and geriatric patients compared with adult patients

International Nuclear Information System (INIS)

Aroua, A.; Bochud, F. O.; Valley, J. F.; Vader, J. P.; Verdun, F. R.

2007-01-01

The age of the patient is of prime importance when assessing the radiological risk to patients due to medical X-ray exposures and the total detriment to the population due to radiodiagnostics. In order to take into account the age-specific radiosensitivity, three age groups are considered: children, adults and the elderly. In this work, the relative number of examinations carried out on paediatric and geriatric patients is established, compared with adult patients, for radiodiagnostics as a whole, for dental and medical radiology, for 8 radiological modalities as well as for 40 types of X-ray examinations. The relative numbers of X-ray examinations are determined based on the corresponding age distributions of patients and that of the general population. Two broad groups of X-ray examinations may be defined. Group A comprises conventional radiography, fluoroscopy and computed tomography; for this group a paediatric patient undergoes half the number of examinations as that of an adult, and a geriatric patient undergoes 2.5 times more. Group B comprises angiography and interventional procedures; for this group a paediatric patient undergoes a one-fourth of the number of examinations carried out on an adult, and a geriatric patient undergoes five times more. (authors)

Predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge

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Johari N

2016-10-01

Full Text Available Nuruljannah Johari,1 Zahara Abdul Manaf,1 Norhayati Ibrahim,2 Suzana Shahar,1 Norlaila Mustafa3 1Dietetics Programme, 2Health Psychology Programme, Faculty of Health Sciences, 3Medical Department, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Purpose: Diabetes mellitus is prevalent among older adults, and affects their quality of life. Furthermore, the number is growing as the elderly population increases. Thus, this study aims to explore the predictors of quality of life among hospitalized geriatric patients with diabetes mellitus upon discharge in Malaysia. Methods: A total of 110 hospitalized geriatric patients aged 60 years and older were selected using convenience sampling method in a cross-sectional study. Sociodemographic data and medical history were obtained from the medical records. Questionnaires were used during the in-person semistructured interviews, which were conducted in the wards. Linear regression analyses were used to determine the predictors of each domain of quality of life. Results: Multiple regression analysis showed that activities of daily living, depression, and appetite were the determinants of physical health domain of quality of life (R2=0.633, F(3, 67=38.462; P<0.001, whereas depression and instrumental activities of daily living contributed to 55.8% of the variability in psychological domain (R2=0.558, F(2, 68=42.953; P<0.001. Social support and cognitive status were the determinants of social relationship (R2=0.539, F(2, 68=39.763; P<0.001 and also for the environmental domain of the quality of life (R2=0.496, F(2, 68=33.403; P<0.001. Conclusion: The findings indicated different predictors for each domain in the quality of life among hospitalized geriatric patients with diabetes mellitus. Nutritional, functional, and psychological aspects should be incorporated into rehabilitation support programs prior to discharge in order to improve patients�

Nutritional intervention in cognitively impaired geriatric trauma patients: a feasibility study

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Eschbach D

2016-09-01

Full Text Available D Eschbach,1 T Kirchbichler,1 T Wiesmann,2 L Oberkircher,1 C Bliemel,1 S Ruchholtz,1 B Buecking1 1Center for Orthopedics and Trauma Surgery, 2Department of Anaesthesiology and Critical Care, University of Marburg, Marburg, Germany Background: Most studies focusing on improving the nutritional status of geriatric trauma patients exclude patients with cognitive impairment. These patients are especially at risk of malnutrition at admission and of worsening during the perioperative fasting period. This study was planned as a feasibility study to identify the difficulties involved in including this high-risk collective of cognitively impaired geriatric trauma patients. Patients and methods: This prospective intervention study included cognitively impaired geriatric patients (Mini–Mental State Examination <25, age >65 years with hip-related fractures. We assessed Mini Nutritional Assessment (MNA, Nutritional Risk Screening (NRS 2002, body mass index, calf circumference, American Society of Anesthesiologists’ classification, and Braden Scale. All patients received parenteral nutritional supplementation of 800 kcal/d for the 96-hour perioperative period. Serum albumin and pseudocholinesterase were monitored. Information related to the study design and any complications in the clinical course were documented. Results: A total of 96 patients were screened, among whom eleven women (median age: 87 years; age range: 74–91 years and nine men (median age: 82 years; age range: 73–89 years were included. The Mini–Mental State Examination score was 9.5 (0–24. All patients were manifestly undernourished or at risk according to MNA and NRS 2002. The body mass index was 23 kg/m2 (13–30 kg/m2, the calf circumference was 29.5 cm (18–34 cm, and the mean American Society of Anesthesiologists’ classification status was 3 (2–4. Braden Scale showed 18 patients at high risk of developing pressure ulcers. In all, 12 patients had nonsurgical

[Adaptations of psychotropic drugs in patients aged 75 years and older in a departement of geriatric internal medecine: report of 100 cases].

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Couderc, Anne-Laure; Bailly-Agaledes, Cindy; Camalet, Joëlle; Capriz-Ribière, Françoise; Gary, André; Robert, Philippe; Brocker, Patrice; Guérin, Olivier

2011-06-01

The elderly often with multiple diseases are particularly at risk from adverse drug reactions. Nearly half of iatrogenic drug in the elderly are preventable. Some medications such as psychotropic drugs are particularly involved in iatrogenic accidents. We wanted to know if the tools of the comprehensive geriatric assessment or other factors could influence the changes of psychotropic drugs in a geriatric departement. Our prospective study of four months in 100 patients aged 75 years and older hospitalized in the Geriatric Internal Medecine Departement of University Hospital of Nice investigated what were the clinical or biological reasons and tools used during changes of psychotropic drugs. We compared these changes according to the comprehensive geriatric assessment tools and we analyzed the changes based on lists of potentially inappropriate medications by Laroche et al. and from the instrument STOPP/START. The Mini Mental State Examination (MMSE) was the tool that has most influenced the changes in psychotropic including a tendency to increase and the introduction of anxiolytics when MMSE < 20 (p = 0.007) while neuroleptics instead arrested and decreased (p = 0.012). The comprehensive geriatric assessment has its place in decision support during the potentially iatrogenic prescriptions of drugs such as psychotropic and new tools such as STOPP/START can also be a help to the prescriber informed.

Geriatric Depression Scale (GDS: A Tool for Assessment of Depression in Elderly

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Vandana A. Kakrani

2015-01-01

Full Text Available Background: India is in the process of rapid demographic progression of increased life expectancy and aging with geriatric population of 7.2 percent which is estimated to rise to 20 percent in 2050. With increasing geriatric population elderly with dementia and associated depressive illness are expected to rise in number to almost an epidemic. Among the morbidity encountered in elderly, depressive disorders are common. Aim & Objectives: The present study was conducted with the objective to assess the extent and degree of depression in elderly, and study some correlates associated with depression in them. Material & Methods: The study was carried out at geriatric clinic of Dr. D. Y. Patil Medical College, Pune under the guidance of department of community medicine. Methodology:The randomly selected elderly above the age of 60 years attending the clinic and willing to participate in study were administered the questionnaire of Geriatric Depression Scale (GDS, scores were given, based on which the subjects were categorized as mild, moderate and severe. Those with score >5 were considered as suggestive of depression and some factors studied were analysed to find out their association with depression. Results: It was revealed that the proportion of elderly having depression was 52.4% with 84.6% of depressed in age group of 76-80 years. Moderate to severe type was more commonly seen in illiterate; however some degree of depression was present in all elderly irrespective of literacy status. Moderate to severe type was seen more commonly in elderly living in nuclear families (23.8%, and living alone (33.3%. Thus more than half of elderly studied were having depression, and it was observed that as the age advanced the degree of depression significantly increased. Some of the factors studied like low education status, poor economic status, nuclear family status, single status, loneliness, were associated with depression. The GDS Scale can be considered as

Home Care Services as Teaching Sites for Geriatrics in Family Medicine Residencies.

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Laguillo, Edgardo

1988-01-01

A national survey of family medicine programs and residency training in geriatrics found almost half using home care services as teaching sites. In the program design preferred by residents, the resident followed the patient long-term and discussed management with a multidisciplinary team. An alternative combined rotation is discussed. (Author/MSE)

The incidence of falls among geriatric outpatients in relation to the number and types of drugs taken

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Magdalena Sylwia Kamińska

2016-06-01

Full Text Available Background . Causes of falls among people over 65 are complex because of age-related involutional changes, comorbidity and polypragmasy that exert negative influence on physical mobility. Objectives . The purpose of this study is to assess the incidence of falls in geriatric outpatients in relation to the number and type of drugs taken. Material and methods . The study involved 304 subjects aged 65–100 years, using ambulatory care services. The mean age of the respondents was 78.6 ± 7.4. Women constituted 77.3% of those analyzed, men – 22.7%. This survey-based study was performed using the Geriatric Environmental Inquiry. Results . A higher number of drugs corresponded with more frequent falls (χ2 test; p 0.05. Gender was proved to influence the number of drugs (χ 2 test; p < 0.05. There was a statistically significant relationship between the number of falls and taking hypotensive, anxiolytic and oral antidiabetic drugs (χ2; p < 0.05. Conclusions . 1. The use of a higher number of drugs, irrespective of their pharmacological group, contributes to a higher number of falls, which may be associated with an interaction between particular drugs or be a consequence of a multitude of diseases predisposing to falls. 2. Polypharmacotherapy is a fall risk factor, however it is difficult to say which pharmacology group, discussed in the study, contributes most to the incidence of falls. 3. It is suggested that geriatric pharmacotherapy should be individualized to minimize the incidence of the iatrogenic geriatric syndrome, which predisposes to falls.

Intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer for geriatric and stroke patients

OpenAIRE

Hirano, Masahiro; Katoh, Munenori; Kawaguchi, Saori; Uemura, Tomomi

2016-01-01

[Purpose] This study aimed to verify the appropriate number of measurements and the intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD) for geriatric and stroke patients. [Subjects and Methods] The subjects were 40 inpatients, who were divided into two groups: 20 stroke patients in the stroke group (SG), and 20 geriatric patients in the no-stroke group (N-SG). Measurements were performed three times using an HHD with a...

Geriatric depression and its relation with cognitive impairment and dementia.

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Dillon, Carol; Tartaglini, María Florencia; Stefani, Dorina; Salgado, Pablo; Taragano, Fernando E; Allegri, Ricardo F

2014-01-01

Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with cognitive impairment, searched for differential variables and tried to propose a study model. A hundred and eighteen depressive patients and forty normal subjects matched by age and educational level were evaluated with an extensive neuropsychological battery, scales to evaluate neuropsychiatric symptoms and daily life activities (DLA). Depressive patients were classified in groups by SCAN 2.1: Major Depression Disorder (MDD) (n: 31), Dysthymia Disorder (DD) (n: 31), Subsyndromal Depression Disorder (SSD) (n: 29), Depression due to Dementia (n: 27) (DdD). Neuropsychological significant differences (pdepressive groups, demonstrating distinctive cognitive profiles. Moreover, significant differences (pdepression. Beck Depression Inventory (BDI) and Mini Mental State Examination (MMSE) were significant variables that helped to differentiate depressive groups. Significant correlations between BDI and Neuropsychological tests were found in MDD and DD groups. Depressive symptoms and its relation with neuropsychological variables, MMSE, cognitive profiles, DLA and age of onset of depression should be taken into consideration for the study of subtypes of geriatric depression. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The role of autosuggestion in geriatric patients' quality of life: a study on psycho-neuro-endocrine-immunology pathway.

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Sari, Nina Kemala; Setiati, Siti; Taher, Akmal; Wiwie, Martina; Djauzi, Samsuridjal; Pandelaki, Jacub; Purba, Jan Sudir; Sadikin, Mohamad

2017-10-01

There has been no study conducted about the effect of autosuggestion on quality of life for geriatric patients. Our aim was to evaluate the efficacy of autosuggestion for geriatric patients' quality of life and its impact on psycho-neuro-endocrine-immune pathway. Sixty geriatric patients aged ≥60 years in a ward were randomly assigned to either receive autosuggestion or not. Autosuggestion was recorded in a tape to be heard daily for 30 days. Both groups received the standard medical therapy. Primary outcome was quality of life by COOP chart. Secondary outcomes were serum cortisol level, interleukin-2, interleukin-6, interferon-γ, and N-acetylaspartate/creatine ratio in limbic/paralimbic system by magnetic resonance spectroscopy. The study was single blinded due to the nature of the intervention studied. Out of 60 subjects, 51 finished the study. The autosuggestion group reported better scores than the control one for quality of life, COOP chart 1.95 vs. 2.22 (95% CI, p = 0.02). There were increments of serum cortisol (p = 0.03) and interleukin-6 in the autosuggestion group (p = 0.04). Interleukin-2, interferon-γ, and N-acetylaspartate/creatine ratio in prefrontal cortex showed a tendency to increase in the autosuggestion groups. Autosuggestion is associated with improvement of geriatrics' quality of life, serum cortisol level, and adaptive immunity. There is a better trend for neuroplasticity in prefrontal cortex in the autosuggestion group.

Contextual Exploration of a New Family Caregiver Support Concept for Geriatric Settings Using a Participatory Health Research Strategy.

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Dorant, Elisabeth; Krieger, Theresia

2017-11-28

Family caregivers are the backbone of the long-term care support system within the home environment. Comprehensive caregiver support programs require collaboration and coordination within the system. A new public health concept, Vade Mecum, aims to harmonize and professionalize family caregiver support initiatives in geriatric care settings in the Euregion Maas-Rhine. Exploration of the new concept recently started in Germany to gain in-depth insight into current support and the needs of the geriatric care team and family caregivers. Within the context of an exploratory qualitative study, a participatory health research (PHR) strategy was applied to make optimal use of experience and knowledge from the system. Care professionals, engaged as co-researchers, were responsible for decisions about the research question, data collection methods and procedures of engaging family caregivers. A research team representing all professions within the geriatric department was formed. Research objectives were formulated and an appropriate mix of qualitative data collection methods consisting of interviews, focus groups and story-telling was chosen. Needs and expectations of the new concept, and practical solutions for involving family caregivers were discussed. A PHR strategy resulted in initiating a qualitative study in a geriatric care setting carried out by care professionals from the department. Knowledge was generated in a co-creative manner, and co-researchers were empowered. A comprehensive understanding of the system serves as a starting point for advancement of the new family caregiver concept.

Long-Term Results of Fixed High-Dose I-131 Treatment for Toxic Nodular Goiter: Higher Euthyroidism Rates in Geriatric Patients

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Gül Ege Aktaş

2015-10-01

Full Text Available Objective: Geriatric patient population has special importance due to particular challenges. In addition to the increase in incidence of toxic nodular goiter (TNG with age, it has a high incidence in the regions of low-medium iodine intake such as in our country. The aim of this study was to evaluate the overall outcome of high fixed dose radioiodine (RAI therapy, and investigate the particular differences in the geriatric patient population. Methods: One hundred and three TNG patients treated with high dose I-131 (370-740 MBq were retrospectively reviewed. The baseline characteristics; age, gender, scintigraphic patterns and thyroid function tests before and after treatment, as well as follow-up, duration of antithyroid drug (ATD medication and achievement of euthyroid or hypothyroid state were evaluated. The patient population was divided into two groups as those=>65 years and those who were younger, in order to assess the effect of age. Results: Treatment success was 90% with single dose RAI therapy. Hyperthyroidism was treated in 7±7, 2 months after RAI administration. At the end of the first year, overall hypothyroidism rate was 30% and euthyroid state was achieved in 70% of patients. Age was found to be the only statistically significant variable effecting outcome. A higher ratio of euthyroidism was achieved in the geriatric patient population. Conclusion: High fixed dose I-131 treatment should be preferred in geriatric TNG patients in order to treat persistent hyperthyroidism rapidly. The result of this study suggests that high fixed dose RAI therapy is a successful modality in treating TNG, and high rates of euthyroidism can be achieved in geriatric patients.

Results of Screening of Apparently Healthy Senior and Geriatric Dogs

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Willems, A.; Paepe, D.; Marynissen, S.; Smets, P.; Van de Maele, I.; Picavet, P.; Duchateau, L.; Daminet, S.

2016-01-01

BACKGROUND: There is a growing interest in health care of elderly dogs; however, scientific information about physical and laboratory examination findings in this age group is limited.OBJECTIVES: To describe systolic blood pressure (SBP), and results of physical examination and laboratory tests in senior and geriatric dogs that were judged by the owner to be healthy.ANIMALS: Hundred client-owned dogs.METHODS: Dogs were prospectively recruited. Owners completed a questionnaire. SBP measurement...

[Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

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Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

2015-02-01

Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Evaluation of chronic stress indicators in geriatric and oncologic caregivers: a cross-sectional study.

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Aguiló, Sira; García, Esther; Arza, Adriana; Garzón-Rey, Jorge M; Aguiló, Jordi

2018-01-01

Caregiving induces chronic stress with physical and psychological impact on informal caregivers health. Therefore, subjective and objective indicators are needed for the early diagnosis of pathologic stress to prevent the risk of developing stress-related diseases in caregivers. Our aim was to assess the self-perceived stress, that is, how and how much the stressor affects the individual, through endocrine, metabolic, and immunologic biomarkers levels in geriatric and oncologic informal caregivers. Informal caregivers and non-caregivers were invited to participate in a cross-sectional study at the Clinic Hospital of Barcelona. Demographic and lifestyle characteristics, self-perceived stress (Perceived Stress Scale, State-Trait Anxiety Inventory and Stress Visual Analogue Scale), and biomarkers (copeptin, glucose, glycated hemoglobin, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), cholesterol, triglycerides, α-amylase, cortisol, tumor necrosis factor (TNF-α), and Interleukins (IL-6 and IL-10)) were evaluated. Descriptive and non-parametric statistical data analysis were performed. Fifty-six subjects (19 non-caregivers, 17 geriatric caregivers, and 20 oncologic caregivers) participated. Median age (IQR) was 57 years (47-66) and 71.46% were women. Self-perceived stress was higher in oncologic caregivers than geriatric caregivers in all psychometric test analyzed (Wilcoxon Rank Sum test, p value  .05). These findings suggest that perceived stress is not homogeneous in the caregivers community and thus these two groups could be differentiated. These results provide the baseline information to initiate social actions addressed to each group of caregivers to increase their wellbeing.

A STUDY ESTABLISHING THE IMPORTANCE OF BODY COMPOSITION ANALYSIS, REGULAR PHYSIOTHERAPY AND DIETARY MODIFICATIONS FOR INDEPENDENT AND HEALTHY LIVING AMONG GERIATRIC POPULATION: A DETAILED SYSTEMATIC REVIEW ARTICLE

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Rohit Subhedar

2015-10-01

Full Text Available Background: This systematic review article aims towards comprehensive and elaborative collection of research articles related to the importance of body composition analysis, Physiotherapy and nutrition for independent geriatric lifestyle. The review article includes articles which suggest the importance of Body composition analysis, Physiotherapy interventions, specific exercises and a combination of fat free, fiber, fruit and fluid diet. Methods: A comprehensive electronic search was conducted using electronic databases Pub Med, MEDLINE, Google Scholar, Science Direct, Research gate, ICMJE, DOAJ, DRJI, IOSR, WAME and many others. In Total 3714, Research papers were reviewed which reported, Age ≥50 years, changes in Body composition in elderly , effects of Diet &Exercises on Body composition and effects of regular Physiotherapy in Geriatric health and obesity. Literature search was restricted to the studies conducted during 1980-2015. Results: Finally 55 papers along with references in research proposal were included. Review shows that ageing, body composition, Physiotherapeutic intervention and nutrition play an interdependent role in providing independent and healthy living among geriatric population. Conclusion: Combined and comprehensive interventions in form of periodic Body Composition Analysis, Physiotherapy interventions with Exercise therapy sessions and Nutritional Supplementation, will be more effective in combating ageing and independent healthy living among Geriatric population. Finally with this review we shall conclude that achieving perfect geriatric health depends upon awareness among the geriatric community to periodically analyze their body composition and regularly comply with exercise therapy sessions, subjective Physiotherapy modality sessions and nutritional supplementation. These principles help in achieving physically fit, healthy, happy and independent geriatric Community.

Why medical students do not choose a career in geriatrics: a systematic review

NARCIS (Netherlands)

Meiboom, A.A.; de Vries, H.; Hertogh, C.M.P.M.; Scheele, F.

2015-01-01

Background: While the demand for doctors specialised in the medical care of elderly patients is increasing, the interest among medical students for a career in geriatrics is lagging behind. Methods: To get an overview of the different factors reported in the literature that affect the (low) interest

Serum antibody responses to vaccinal antigens in lean and obese geriatric dogs.

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Ellis, John; Gow, Sheryl; Rhodes, Carrie; Lacoste, Stacey; Kong, Lyndsay; Musil, Kristyna; Snead, Elisabeth

2016-05-01

The immune responses in control dogs [1 to 4 years of age, body condition score (BCS): 4 to 5 out of 9] were compared to those of aging dogs (based on breed and body size) either categorized as lean (BCS: 4 to 5 out of 9) or obese (BCS: 8 to 9 out of 9). Of interest were the serum titers to the following common agents found in vaccines, canine parainfluenza virus (CPIV), canine parvovirus (CPV), canine distemper virus (CDV), canine respiratory coronavirus (CRCoV), and Bordetella bronchiseptica. There were no statistical differences in the antibodies to CPIV, B. bronchispetica, and CRCoV, among the age/weight categories, nor among the age/weight categories and the time, in days, between the date of sample collection and the date of the last recorded vaccination for CPIV, B. bronchiseptica, CPV, and CDV. For CPV, the control dogs had significantly (P obese geriatric dogs. For CDV SN titers, the only statistically significant (P = 0.01) difference was that the control dogs had higher SN titers than the lean geriatric dogs.

Addressing Geriatric Oral Health Concerns through National Oral Health Policy in India

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Abhinav Singh

2015-01-01

Full Text Available There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world’s elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries

Geriatric Family Support and Diabetic Type-2 Glycemic Control

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Shiva Heidari

2008-07-01

Full Text Available Objectives: As the most part of geriatric (65 years and older diabetic care is given at home, family support has an important role in their blood sugar level control care. This study aimed to assess the relationship between family support and blood sugar level control in such elderly suffering type-2 diabetes. Methods & Materials: Via descriptive-correlative study, one hundred fifty geriatric patients with type-2 diabetes, who referred to Institute of Endocrinology and Metabolism in Iran University of Medical Sciences were selected. Samplings based on nonrandomized and convenience. The questionnaire consisted of three sections: demographic data glucose-labeled hemoglobin (HbA1C and received-perceived family support by applying the standard questionnaire of "Diabetes Social Support-Family Version" format. Data were analyzed by SPSS version 15 by using Chi-square and Pierson Tests. Results: Results showed a significant relationship between family support and glycemic control (r=-0.56, P<0.0001. Also there were significant relationships between family support, gender and marital status (P<0.0001. There were also significant relationships between glycemic control and marital status (P=0.02, financial status (P=0.04 and educational level (P=0.05. Conclusion: Findings of this research added further evidence about the impact of family support on the health of older adults with diabetes. These findings suggest using family centered nursing interventions and collaboration of family members in care of the elderly with type-2 diabetes.

Sepsis Within 30 Days of Geriatric Hip Fracture Surgery.

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Bohl, Daniel D; Iantorno, Stephanie E; Saltzman, Bryan M; Tetreault, Matthew W; Darrith, Brian; Della Valle, Craig J

2017-10-01

Sepsis after hip fracture typically develops from one of the 3 potential infectious sources: urinary tract infection (UTI), pneumonia, and surgical site infection (SSI). The purpose of this investigation is to determine (1) the proportion of cases of sepsis that arises from each of these potential infectious sources; (2) baseline risk factors for developing each of the potential infectious sources; and (3) baseline risk factors for developing sepsis. The National Surgical Quality Improvement Program database was searched for geriatric patients (aged >65 years) who underwent surgery for hip fracture during 2005-2013. Patients subsequently diagnosed with sepsis were categorized according to concomitant diagnosis with UTI, SSI, and/or pneumonia. Multivariate regression was used to test for associations while adjusting for baseline characteristics. Among the 466 patients who developed sepsis (2.4% of all patients), 157 (33.7%) also had a UTI, 135 (29.0%) also had pneumonia, and 36 (7.7%) also had SSI. The rate of sepsis was elevated in patients who developed UTI (13.0% vs 1.7%; P sepsis (21.0% vs 3.8%; P Sepsis occurs in about 1 in 40 patients after geriatric hip fracture surgery. Of these septic cases, 1 in 3 is associated with UTI, 1 in 3 with pneumonia, and 1 in 15 with SSI. The cause of sepsis is often unknown on clinical diagnosis, and this distribution of potential infectious sources allows clinicians for direct identification and treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Prognostic Value of Geriatric Conditions Beyond Age After Acute Coronary Syndrome.

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Sanchis, Juan; Ruiz, Vicente; Bonanad, Clara; Valero, Ernesto; Ruescas-Nicolau, Maria Arantzazu; Ezzatvar, Yasmin; Sastre, Clara; García-Blas, Sergio; Mollar, Anna; Bertomeu-González, Vicente; Miñana, Gema; Núñez, Julio

2017-06-01

The aim of the present study was to investigate the prognostic value of geriatric conditions beyond age after acute coronary syndrome. This was a prospective cohort design including 342 patients (from October 1, 2010, to February 1, 2012) hospitalized for acute coronary syndrome, older than 65 years, in whom 5 geriatric conditions were evaluated at discharge: frailty (Fried and Green scales), comorbidity (Charlson and simple comorbidity indexes), cognitive impairment (Pfeiffer test), physical disability (Barthel index), and instrumental disability (Lawton-Brody scale). The primary end point was all-cause mortality. The median follow-up for the entire population was 4.7 years (range, 3-2178 days). A total of 156 patients (46%) died. Among the geriatric conditions, frailty (Green score, per point; hazard ratio, 1.11; 95% CI, 1.02-1.20; P=.01) and comorbidity (Charlson index, per point; hazard ratio, 1.18; 95% CI, 1.0-1.40; P=.05) were the independent predictors. The introduction of age in a basic model using well-established prognostic clinical variables resulted in an increase in discrimination accuracy (C-statistic=.716-.744; P=.05), though the addition of frailty and comorbidity provided a nonsignificant further increase (C-statistic=.759; P=.36). Likewise, the addition of age to the clinical model led to a significant risk reclassification (continuous net reclassification improvement, 0.46; 95% CI, 0.21-0.67; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.09). However, the addition of frailty and comorbidity provided a further significant risk reclassification in comparison to the clinical model with age (continuous net reclassification improvement, 0.40; 95% CI, 0.16-0.65; and integrated discrimination improvement, 0.04; 95% CI, 0.01-0.10). In conclusion, frailty and comorbidity are mortality predictors that significantly reclassify risk beyond age after acute coronary syndrome. Copyright © 2017 Mayo Foundation for Medical Education and

Gait characteristics and their discriminative power in geriatric patients with and without cognitive impairment

NARCIS (Netherlands)

Kikkert, Lisette H. J. C.; Vuillerme, Nicolas; van Campen, Jos P.; Appels, Bregje A.; Hortobagyi, Tibor; Lamoth, Claudine J.

2017-01-01

Background: A detailed gait analysis (e.g., measures related to speed, self-affinity, stability, and variability) can help to unravel the underlying causes of gait dysfunction, and identify cognitive impairment. However, because geriatric patients present with multiple conditions that also affect

[Geriatric health promotion and prevention for independently living senior citizens: programmes and target groups].

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Dapp, U; Anders, J; Meier-Baumgartner, H P; v Renteln-Kruse, W

2007-08-01

Nearly all diseases in old age that are epidemiologically important can be reduced or prevented successfully through consequent changes in individual lifestyle, a systematic provision of measures in primary prevention (i.e. vaccination programmes) and the creation of health promoting settings. However, at the moment the amount of potential for preventative interventions is neither systematically nor sufficiently utilised in Germany. Two different preventative approaches: a) multidimensional advice session in small groups through an interdisciplinary team at a geriatric centre (seniors come to seek advice offered at a centre) or b) multidimensional advice at the seniors home through one member of the interdisciplinary team from the geriatric centre (expert takes advice to seniors home) were tested simultaneously with a well-described study sample of 804 independent community-dwelling senior citizens aged 60 years or over, without need of care and cognitive impairments recruited from general practices. Information about target group specific approaches in health promotion and prevention for senior citizens were retrieved from analyses of sociodemographic, medical, psychological and spacial characteristics of this study sample. The majority of the study sample (580 out of 804 or 72.1%) decided to participate: a) 86.7% (503 out of 580) attended at the geriatric centre and sought advice in group sessions and b) 13.3% (77 out of 580) decided to receive advice in a preventive home visit. A total of 224 seniors (224 out of 804 or 27.9%) refused to participate at all. These three target groups were characterised on the basis of their age, gender, education, social background, health status, health behaviour, use of preventive care, self perceived health, functional disabilities, social net and social participation and distance or accessibility of preventative approaches. The 503 senior citizens who participated in small group sessions at the geriatric centre were

What Kind of Doctor Do You Want to Be? Geriatric Medicine Podcast as a Career Planning Resource.

Science.gov (United States)

Byszewski, Anna; Bezzina, Kathryn; Latrous, Meriem

2017-01-01

For optimal direction in career paths and postgraduate training, students can benefit from information to guide them through options. Using geriatric medicine as a template, the goal was to develop a multimedia podcast resource that can give a clearer picture of what a specialty entails. The project included a survey of existing resources and needs assessment of medical students at the University of Ottawa, Canada. This survey assessed students' knowledge of geriatrics and interest in the field and explored what they foresee as being important to be informed on when considering application to programs. Based on this, interview questions and content were developed for a podcast which was then evaluated. Interviews were conducted with physicians and residents nationwide. Relevant resources and links were added to the podcast. Evaluation demonstrated improved student understanding and interest in geriatric medicine as a career. Point-by-point format for a template on how to develop similar podcasts was developed to assist other specialties looking to develop similar information. As no such framework currently exists, results of this project can serve as a template for other postgraduate programs in developing a multimedia resource for informing prospective trainees.

Teaching Pain Management in Interprofessional Medical Education: A Review of Three Portal of Geriatric Online Education Modules.

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Madaus, Stacy M; Lim, Lionel S

2016-10-01

Chronic pain is an international healthcare crisis that affects an estimated 1.5 billion individuals worldwide, but pain management is not emphasized in the medical school curriculum, and thus supplemental education is essential. The Portal of Geriatric Online Education (POGOe) is a free repository of teaching modules for use by geriatric educators and learners. This article highlights three teaching modules available on this site: It's My Old Back Again: An Approach to Diagnosing and Managing Back Pain in the Older Adult (POGOe ID: 21670), Computer Based Learning Workbook, Third Edition module on Pain Management (POGOe ID: 21036), and Aging Q3 Curriculum on Pain Management of Older Adult Patients (POGOe ID: 21187). These modules were chosen based on their ability to address the major topics that the International Association for the Study of Pain proposes should be included in medical school curricula: mulitdimensional nature of pain, pain assessment and measurement, management of pain, and clinical conditions resulting in pain in older adults. They were also selected for their ability to be adapted for interprofessional education and how well they integrate basic science and clinical principles. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Risk of falls in the rheumatic patient at geriatric age

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Prusinowska, Agnieszka; Komorowski, Arkadiusz; Sadura-Sieklucka, Teresa; Ksi??opolska-Or?owska, Krystyna

2017-01-01

Evaluating the risk of falling of a geriatric rheumatic patient plays an essential role not only in planning and carrying out the physiotherapeutic process. The consequences of falls may be different and, although they do not always result in serious repercussions such as fractures or injuries, it is sufficient that they generate the fear of falling and cause a significant reduction in physical activity. Assessing functional capacity to define the risk of falling is of utmost importance in th...

[The speech therapist in geriatrics: caregiver, technician-researcher, or both?].

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Orellana, Blandine

2015-01-01

Geriatric care mostly consists not in curingthe patient, but supportingthem to the end of their life, giving meaning to care procedures and actions through speech, touch or look and maintaining a connection.The helping relationship is omnipresent and the role of the speech therapist is therefore essential in helping to maintain or re-establish elderly patients' abilityto communicate. However, todaythis role is struggling to define itself between that of the technician-researcher and that of caregiver.

[Fear of falling in a fall clinic for geriatric patients: a pilot study

NARCIS (Netherlands)

Dautzenberg, P.LJ.; Buurman, B.H.; Loonen, A.J.; Wouters, C.J.; Olde Rikkert, M.G.M.

2005-01-01

OBJECTIVE: In this pilot study we want to determine how often fear of falling occurs in geriatric patients visiting a fall clinic and to study the characteristics of fear of falling and its consequences. DESIGN: Retrospective study of patient's records. METHOD: A random sample of 100 medical records

Development of geriatric competencies for emergency medicine residents using an expert consensus process.

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Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

2010-03-01

The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

Periorbital Rejuvenation Surgery in the Geriatric Population

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Ann Yi-Chiun Chuang

2010-09-01

Full Text Available Periorbital aging is an unavoidable, progressive process that is often accompanied by visual obscurations and ocular discomfort. With surgical correction, patients may benefit not only functionally but also psychosocially when an aesthetic outcome is obtained. The periorbital anatomical structures in elderly patients are complex and interlocking, requiring a thorough evaluation and systematic approach. Most elderly patients are reluctant to undergo procedures that require prolonged surgical and recovery times if they think it is only for cosmetic improvement. We review contemporary periorbital surgical methods suitable for a geriatric population, namely procedures that are low-cost, low-risk, with short operative and recovery times, and that have excellent patient acceptability. It is feasible to select procedures that can be customized to the needs of the elderly.

Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups.

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Marschollek, Michael; Gövercin, Mehmet; Rust, Stefan; Gietzelt, Matthias; Schulze, Mareike; Wolf, Klaus-Hendrik; Steinhagen-Thiessen, Elisabeth

2012-03-14

Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1), and to identify high-risk subgroups from the data (aim#2). A data set of n = 5,176 single in-patient episodes covering 1.5 years of admissions to a geriatric hospital were extracted from the hospital's data base and matched with fall incident reports (n = 493). A classification tree model was induced using the C4.5 algorithm as well as a logistic regression model, and their predictive performance was evaluated. Furthermore, high-risk subgroups were identified from extracted classification rules with a support of more than 100 instances. The classification tree model showed an overall classification accuracy of 66%, with a sensitivity of 55.4%, a specificity of 67.1%, positive and negative predictive values of 15% resp. 93.5%. Five high-risk groups were identified, defined by high age, low Barthel index, cognitive impairment, multi-medication and co-morbidity. Our results show that a little more than half of the fallers may be identified correctly by our model, but the positive predictive value is too low to be applicable. Non-fallers, on the other hand, may be sorted out with the model quite well. The high-risk subgroups and the risk factors identified (age, low ADL score, cognitive impairment, institutionalization, polypharmacy and co-morbidity) reflect domain knowledge and may be used to screen certain subgroups of patients with a high risk of falling. Classification models derived from a large data set using data mining methods can compete with current dedicated fall risk screening tools, yet lack diagnostic precision. High-risk subgroups may be identified

Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups

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Marschollek Michael

2012-03-01

Full Text Available Abstract Background Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1, and to identify high-risk subgroups from the data (aim#2. Methods A data set of n = 5,176 single in-patient episodes covering 1.5 years of admissions to a geriatric hospital were extracted from the hospital's data base and matched with fall incident reports (n = 493. A classification tree model was induced using the C4.5 algorithm as well as a logistic regression model, and their predictive performance was evaluated. Furthermore, high-risk subgroups were identified from extracted classification rules with a support of more than 100 instances. Results The classification tree model showed an overall classification accuracy of 66%, with a sensitivity of 55.4%, a specificity of 67.1%, positive and negative predictive values of 15% resp. 93.5%. Five high-risk groups were identified, defined by high age, low Barthel index, cognitive impairment, multi-medication and co-morbidity. Conclusions Our results show that a little more than half of the fallers may be identified correctly by our model, but the positive predictive value is too low to be applicable. Non-fallers, on the other hand, may be sorted out with the model quite well. The high-risk subgroups and the risk factors identified (age, low ADL score, cognitive impairment, institutionalization, polypharmacy and co-morbidity reflect domain knowledge and may be used to screen certain subgroups of patients with a high risk of falling. Classification models derived from a large data set using data mining methods can compete with current dedicated fall risk screening tools, yet lack

Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?

Science.gov (United States)

Maes, Frédéric; Dalleur, Olivia; Henrard, Séverine; Wouters, Dominique; Scavée, Christophe; Spinewine, Anne; Boland, Benoit

2014-01-01

Anticoagulation for the prevention of cardio-embolism is most frequently indicated but largely underused in frail older patients with atrial fibrillation (AF). This study aimed at identifying characteristics associated with anticoagulation underuse. A cross-sectional study of consecutive geriatric patients aged ≥75 years, with AF and clear anticoagulation indication (CHADS₂ [Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack] ≥2) upon hospital admission. All patients benefited from a comprehensive geriatric assessment. Their risks of stroke and bleeding were predicted using CHADS₂ and HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older (age >75 years), Reduced platelet count or function, Rebleed risk, Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk, and Stroke) scores, respectively. Anticoagulation underuse was observed in 384 (50%) of 773 geriatric patients with AF (median age 85 years; female 57%, cognitive disorder 33%, nursing home 20%). No geriatric characteristic was found to be associated with anticoagulation underuse. Conversely, anticoagulation underuse was markedly increased in the patients treated with aspirin (odds ratio [OR] [95% confidence interval]: 5.3 [3.8; 7.5]). Other independent predictors of anticoagulation underuse were ethanol abuse (OR: 4.0 [1.4; 13.3]) and age ≥90 years (OR: 2.0 [1.2; 3.4]). Anticoagulation underuse was not inferior in patients with a lower bleeding risk and/or a higher stroke risk and underuse was surprisingly not inferior either in the AF patients who had previously had a stroke. Half of this geriatric population did not receive any anticoagulation despite a clear indication, regardless of their individual bleeding or stroke risks. Aspirin use is the main characteristic associated with anticoagulation underuse.

The short mean length of stay of post-emergency geriatric units is associated with the rate of early readmission in frail elderly.

Science.gov (United States)

Traissac, Thalie; Videau, Marie-Neige; Bourdil, Marie-José; Bourdel-Marchasson, Isabelle; Salles, Nathalie

2011-06-01

Specific postemergency short-stay geriatric units may decrease length of hospital stay, functional decline, and early readmission rates. The aim of this study was to evaluate risk factors of early rehospitalization in a shortstay geriatric unit. This study was a prospective observational study comprising over one year patients aged over 75 years, admitted to the post-emergency short-stay geriatric unit (Hôpital Saint André, Bordeaux, France) and discharged home. Socio-demographic data, length of hospital stay, and a standardized geriatric assessment were collected for all patients. One month after home discharge, patients were followed-up by phone, and the hospital readmission rate was calculated. descriptive, unvaried and multivariate analyses were carried out. A total of 476 patients were included in this study (mean age 86.5±6 yrs; 154 men, 322 women). Mean length of stay in the post-emergency short-stay geriatric unit was 6.3±2.7 days, and a total of 68 (14.3%) patients were readmitted within one month after home discharge. The readmission rate was associated with a diagnosis of delirium (Odds Ratio (OR) 1.9; 95% CI 1.1-3.3; p=0.02), mean length of stay exceeding 6 days (OR 1.9, 95% CI 1.1-3.5; p=0.02), and decision of home discharge (OR 2.4; 95% CI 1.4-4.1; p=0.002). Short mean lengths of stay were not considered as a risk factor for readmissions within one month, even in frail, dependent, hospitalized elderly persons.

The French Society of Geriatrics and Gerontology position paper on the concept of integration.

Science.gov (United States)

Somme, Dominique; Trouvé, Hélène; Passadori, Yves; Corvez, Alain; Jeandel, Claude; Bloch, Marie-Aline; Ruault, Geneviève; Dupont, Olivier; de Stampa, Matthieu

2014-01-01

The concept of integration, although dating from the 1990s, has only recently appeared in French public health policy. It must be linked with 'coordination', which is the base of most French public policies applied to geriatrics since the 1960s. Herein, we report the French Society of Geriatrics and Gerontology working group's findings according to three axes: definition of integration, objectives of this organisational approach and the means needed to achieve them. Integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, financing, interventions and action-reports on the latter. Integration must be accompanied by a local dedicated professional (the 'pilot'). Results of recent experiments showed that it is possible to implement integrative dynamics in France.

Pre-anaesthetic screening of geriatric dogs

Directory of Open Access Journals (Sweden)

K.E. Joubert

2007-05-01

Full Text Available Pre-anaesthetic screening has been advocated as a valuable tool for improving anaesthetic safety and determining anaesthetic risk. This study was done determine whether pre-anaesthetic screening result in cancellation of anaesthesia and the diagnosis of new clinical conditions in geriatric dogs. One hundred and one dogs older than 7 years of age provided informed owner consent were included in the study. Each dog was weighed, and its temperature, pulse and respiration recorded. An abdominal palpation, examination of the mouth, including capillary refill time and mucous membranes, auscultation, body condition and habitus was performed and assessed. A cephalic catheter was placed and blood drawn for pre-anaesthetic testing. A micro-haematocrit tube was filled and the packed cell volume determined. The blood placed was in a test tube, centrifuged and then analysed on an in-house blood analyser. Alkaline phosphatase, alanine transferase, urea, creatinine, glucose and total protein were determined. A urine sample was then obtained by cystocentesis, catheterisation or free-flow for analysis. The urine specific gravity was determined with a refractometer. A small quantity of urine was then placed on a dip stick. Any new diagnoses made during the pre-anaesthetic screening were recorded. The average age of the dogs was 10.99+2.44 years and the weight was 19.64+15.78 kg. There were 13 dogs with pre-existing medical conditions. A total of 30 new diagnoses were made on the basis of the pre-anaesthetic screening. The most common conditions were neoplasia, chronic kidney disease and Cushing's disease. Of the 30 patients with a new diagnosis, 13 did not undergo anaesthesia as result of the new diagnosis. From this study it can be concluded that screening of geriatric patients is important and that sub-clinical disease could be present in nearly 30 % of these patients. The value of screening before anaesthesia is perhaps more questionable in terms of

[The development and benefits of working together in geriatric short stay units].

Science.gov (United States)

Dumont, Magali

2014-01-01

Ambroise-Paré hospital (AP-HP, 92) set up a new work organisation based on the nurse/nursing auxiliary partnership in the geriatric short stay unit in response to the wishes of the healthcare manager and nursing team. It was introduced over three months and in several stages in order to limit sticking points and support the team in its new practice.

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

Science.gov (United States)

Rolland, Yves; Resnick, Barbara; Katz, Paul R; Little, Milta O; Ouslander, Joseph G; Bonner, Alice; Geary, Carol R; Schumacher, Karen L; Thompson, Sarah; Martin, Finbarr C; Wilbers, Joachim; Zúñiga, Franziska; Ausserhofer, D; Schwendimann, R; Schüssler, S; Dassen, Theo; Lohrmann, Christa; Levy, Cari; Whitfield, Emily; de Souto Barreto, Philipe; Etherton-Beer, Christopher; Dilles, Tinne; Azermai, Majda; Bourgeois, Jolyce; Orrell, Martin; Grossberg, George T; Kergoat, Hélène; Thomas, David R; Visschedijk, Jan; Taylor, Stephanie J C; Handajani, Yvonne S; Widjaja, Nelly T; Turana, Yuda; Rantz, Marilyn J; Skubic, Marjorie; Morley, John E

2014-05-01

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Emerging trends in gerontology and geriatrics: implications for the self-care of the elderly

DEFF Research Database (Denmark)

Hickey, T; Dean, K; Holstein, B E

1986-01-01

people to describe a wide range of personal health behaviors encompassing lay care, self-help, enlightened consumerism, and various preventive measures as antidotes to the impairments of old age. This paper reports some of the outcomes of an international project which reviewed geriatric self...

Determinants of Length of Stay in Stroke Patients: A Geriatric Rehabilitation Unit Experience

Science.gov (United States)

Atalay, Ayce; Turhan, Nur

2009-01-01

The objective was to identify the predictors of length of stay--the impact of age, comorbidity, and stroke subtype--on the outcome of geriatric stroke patients. One hundred and seventy stroke patients (129 first-ever ischemic, 25 hemorrhagic, and 16 ischemic second strokes) were included in the study. The Oxfordshire Community Stroke Project…

Frailty and geriatric syndromes in elderly assisted in primary health care

Directory of Open Access Journals (Sweden)

Vera Elizabeth Closs

2016-06-01

Full Text Available The aim of this study was to describe the association between frailty and geriatric syndromes (GS [cognitive impairment (CI; postural instability (PI; urinary/fecal incontinence (UFI; polypharmacy (PP; and immobility (IM] and the frequency of these conditions in elderly people assisted in primary health care. Five hundred twenty-one elderly participants of The Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS were evaluated. Sociodemographic data, identification of frailty (Fried phenotype and GS were collected. Multinomial logistic regression analysis was performed. The frequency of frailty was 21.5%, prefrailty 51.1% and robustness 27.4%. The frequency of CI was 54.7%, PP 41.2%, PI 36.5%, UFI 14% and IM 5.8%. The odds of frailty when compared to robustness and adjusted for gender, age, depression, self-perception of health, nutritional status, falls, vision and hearing, was significantly higher in elderly with CI, PI and PP. The adjusted odds of prefrail when compared to robustness was significantly higher only in elderly with CI. The most frequently presented number of GS (0-5 was two geriatric syndromes (26.87%. The frequency of frailty was high among elderly in primary health care and was associated with three of five GS (CI - PI - PP.

[Outbreak of follicular conjunctivitis caused by adenovirus in a geriatric centre].

Science.gov (United States)

Artieda, Juncal; Montes, Milagrosa; Vicente, Diego; Martínez, Consuelo; Piñeiro, Luis; Mendiola, Josune

2010-12-01

Adenovirus serotype 4a is a respiratory virus that occasionally causes conjunctivitis. This paper describes an outbreak of follicular conjunctivitis that occurred in a geriatric centre. Outbreak description and epidemiological research through a survey. For the microbiological study conjunctival swabs were collected using viral and bacterial transport media. Adenovirus was detected by real-time polymerase chain reaction. The serotype was determined by sequencing of a fragment of the hexon and E1 genes. In autumn 2008 an outbreak of follicular conjunctivitis caused by adenovirus serotype 4a was detected. Twenty three percent 23% (69/300) of residents and 5% (9/180) of workers in a geriatric centre in Gipuzkoa were affected. The clinical symptoms were of prolonged duration (11±5 days). The temporal association of the cases suggested transmission from person to person. The sanitary measures established (asepsis and frequent hand washing, cleaning and disinfection of objects and surfaces) were effective, interrupting the transmission of the disease within a short period of time. Rapid detection, identification of the causative agent and implementing appropriate control measures can significantly reduce the impact on both health and economic costs of these outbreaks. Copyright © 2009 Elsevier España, S.L. All rights reserved.

Results of operative fixation of unstable ankle fractures in geriatric patients.

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Pagliaro, A J; Michelson, J D; Mizel, M S

2001-05-01

It is widely accepted that operative fixation of unstable ankle fractures yields predictably good outcomes in the general population. The current literature, however reports less acceptable results in the geriatric population age 65 years and older. The current study analyzes the outcome of the surgical treatment of unstable ankle fractures in patients at least 65 years old. Twenty three patient over 65 years old were surgically treated after sustaining 21 (91%) closed and 2 (9%) open grade II unstable ankle fractures. Fractures were classified according to the Danis-Weber and Lauge-Hansen schemes. Fracture type was predominantly Weber B (21/23, 91%), or supination external rotation stage IV (21/23, 91%). Fracture union rate was 100%. There were three significant complications including a lateral wound dehiscence with delayed fibular union in an open fracture dislocation, and two below knee amputations, neither of which was directly related to the fracture treatment. There were three minor complications; one superficial wound infection and two cases of prolonged incision drainage, all of which resolved without further surgical intervention. Complications were associated with open fractures and preexisting systemic disease. These results indicate that open reduction and internal fixation of unstable ankle fractures in geriatric patients is an efficacious treatment regime that with results that are comparable to the general population.

Cognitive and physical resources are important in order to complete a geriatric fall prevention programme.

Science.gov (United States)

Kirchhoff, Marianne; Damgaard, Kirsten

2016-01-01

It is well documented that falls may be prevented, but effectiveness in reducing the risk of falling depends on the uptake of and the adherence to preventive actions. 65+-year-old fallers identified by screening for fall risk were offered referral to a geriatric fall clinic together with fallers referred from general practitioners (GPs). They were assessed to identify individual risk factors for falling, and appropriate interventions were planned, including exercise classes. A total of 811 persons were identified by screening, 342 of whom accepted referral. Furthermore, 176 were referred from GPs. Only 402 of 518 fallers attended the clinic. A total of 65 dropped out by their own request, 29 stopped because they became seriously ill or died. Another 62 patients were discharged before fulfilling the programme as they were unable to participate due to physical or cognitive problems. Indicators of cessation were cognitive or physical weakness. Geriatric fall prevention is resource-consuming both in terms of staff needed and with respect to demands made on the patients, and the frailest part of the fall population cannot comply. It is necessary to differentiate fall prevention services for the population of elderly fallers as interventions in primary healthcare have been shown to be more effective among the most frail elderly fallers. The project received funding from the Danish Ministry of the Interior and Health and from The Fund for Scientific Work in the Geriatric Field within the former Copenhagen Hospital Corporation. not relevant.

[Importance of the detection of dysphagia in geriatric patients].

Science.gov (United States)

Zamora Mur, A; Palacín Ariño, C; Guardia Contreras, A I; Zamora Catevilla, A; Clemente Roldán, E; Santaliestra Grau, J

2018-04-01

Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected. A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia. The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity. Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

A STUDY EVALUATING THE EFFECTS OF BOMBAY HOSPITAL PHYSIOTHERAPY PROGRAM AND CONVENTIONAL PHYSIOTHERAPY EXERCISE PROGRAM ON GERIATRIC PATIENTS PRESENTING WITH CALF PAIN

OpenAIRE

Rohit Subhedar; Pallavi Dave; Priyanka Mishra; Shailee Jain

2015-01-01

Objective: To investigate the effects of (BHP-Program) on geriatric patients with calf pain. Method: This research was designed by evaluating the progress report of Geriatric Physiotherapy patients at Multi-specialty Department of Physiotherapy- Bombay Hospital-Indore. The subjects were the patients receiving Physiotherapy at Multi specialty Physiotherapy Department - Bombay Hospital, Indore. VAS scale was used for the pain evaluation. Pain Scale parameters of 30 Patients of age group 60...

Development of Oral Flexible Tablet (OFT) Formulation for Pediatric and Geriatric Patients: a Novel Age-Appropriate Formulation Platform.

Science.gov (United States)

Chandrasekaran, Prabagaran; Kandasamy, Ruckmani

2017-08-01

Development of palatable formulations for pediatric and geriatric patients involves various challenges. However, an innovative development with beneficial characteristics of marketed formulations in a single formulation platform was attempted. The goal of this research was to develop solid oral flexible tablets (OFTs) as a platform for pediatrics and geriatrics as oral delivery is the most convenient and widely used mode of drug administration. For this purpose, a flexible tablet formulation using cetirizine hydrochloride as model stability labile class 1 and 3 drug as per the Biopharmaceutical Classification System was developed. Betadex, Eudragit E100, and polacrilex resin were evaluated as taste masking agents. Development work focused on excipient selection, formulation processing, characterization methods, stability, and palatability testing. Formulation with a cetirizine-to-polacrilex ratio of 1:2 to 1:3 showed robust physical strength with friability of 0.1% (w/w), rapid in vitro dispersion within 30 s in 2-6 ml of water, and 0.2% of total organic and elemental impurities. Polacrilex resin formulation shows immediate drug release within 30 min in gastric media, better taste masking, and acceptable stability. Hence, it is concluded that ion exchange resins can be appropriately used to develop taste-masked, rapidly dispersible, and stable tablet formulations with tailored drug release suitable for pediatrics and geriatrics. Flexible formulations can be consumed as swallowable, orally disintegrating, chewable, and as dispersible tablets. Flexibility in dose administration would improve compliance in pediatrics and geriatrics. This drug development approach using ion exchange resins can be a platform for formulating solid oral flexible drug products with low to medium doses.

Strategic plan for geriatrics and extended care in the veterans health administration: background, plan, and progress to date.

Science.gov (United States)

Shay, Kenneth; Hyduke, Barbara; Burris, James F

2013-04-01

The leaders of Geriatrics and Extended Care (GEC) in the Veterans Health Administration (VHA) undertook a strategic planning process that led to approval in 2009 of a multidisciplinary, evidence-guided strategic plan. This article reviews the four goals contained in that plan and describes VHA's progress in addressing them. The goals included transforming the healthcare system to a veteran-centric approach, achieving universal access to a panel of services, ensuring that the Veterans Affair's (VA) healthcare workforce was adequately prepared to manage the needs of the growing elderly veteran population, and integrating continuous improvement into all care enhancements. There has been substantial progress in addressing all four goals. All VHA health care has undergone an extensive transformation to patient-centered care, has enriched the services it can offer caregivers of dependent veterans, and has instituted models to better integrate VA and non-VA cares and services. A range of successful models of geriatric care described in the professional literature has been adapted to VA environments to gauge suitability for broader implementation. An executive-level task force developed a three-pronged approach for enhancing the VA's geriatric workforce. The VHA's performance measurement approaches increasingly include incentives to enhance the quality of management of vulnerable elderly adults in primary care. The GEC strategic plan was intended to serve as a road map for keeping VHA aligned with an ambitious but important long-term vision for GEC services. Although no discrete set of resources was appropriated for fulfillment of the plan's recommendations, this initial report reflects substantial progress in addressing most of its goals. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Predicting geriatric falls following an episode of emergency department care: a systematic review.

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Carpenter, Christopher R; Avidan, Michael S; Wildes, Tanya; Stark, Susan; Fowler, Susan A; Lo, Alexander X

2014-10-01

Falls are the leading cause of traumatic mortality in geriatric adults. Despite recent multispecialty guideline recommendations that advocate for proactive fall prevention protocols in the emergency department (ED), the ability of risk factors or risk stratification instruments to identify subsets of geriatric patients at increased risk for short-term falls is largely unexplored. This was a systematic review and meta-analysis of ED-based history, physical examination, and fall risk stratification instruments with the primary objective of providing a quantitative estimate for each risk factor's accuracy to predict future falls. A secondary objective was to quantify ED fall risk assessment test and treatment thresholds using derived estimates of sensitivity and specificity. A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED, EMBASE, CINAHL, CENTRAL, DARE, the Cochrane Registry, and Clinical Trials. Unpublished research was located by a hand search of emergency medicine (EM) research abstracts from national meetings. Inclusion criteria for original studies included ED-based assessment of pre-ED or post-ED fall risk in patients 65 years and older with sufficient detail to reproduce contingency tables for meta-analysis. Original study authors were contacted for additional details when necessary. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality for those studies that met inclusion criteria. When more than one qualitatively similar study assessed the same risk factor for falls at the same interval following an ED evaluation, then meta-analysis was performed using Meta-DiSc software. The primary outcomes were sensitivity, specificity, and likelihood ratios for fall risk factors or risk stratification instruments. Secondary outcomes included estimates of test and treatment thresholds using the Pauker method based on accuracy, screening risk, and the

The influence of work characteristics, emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers.

Science.gov (United States)

Rouxel, Géraldine; Michinov, Estelle; Dodeler, Virginie

2016-10-01

Previous studies have demonstrated that geriatric care employees are exposed to a large number of factors that can affect their levels of job satisfaction and occupational stress. Although working with elderly people is emotionally demanding, little research has been done on the role played by perceptions of emotional display rules, alongside more traditional work characteristics and individual factors, in the prediction of geriatric care employees' wellbeing. The aim of the present study was to examine the role played by work characteristics (job demands, job control, emotional display rules) and individual (affectivity) factors to predict job satisfaction and burnout among French geriatric care nurses. Questionnaires were sent to 891 employees working in 32 geriatric care centers in France. A total of 371 valid questionnaires (response rate: 41.60%) were analyzed using structural equation modeling techniques. Results revealed two main processes of burnout and job satisfaction among women geriatric care workers, namely a salutogenic process and a pathogenic process. As expected, negative affectivity, low job status, perceived negative display rules and job demands are involved in the pathogenic process; while positive affectivity, perceived positive display rules and job control are implied in the salutogenic one. More specifically, as expected, negative affectivity is a positive predictor of burnout, both directly and indirectly through its impact on perceived negative display rules and job demands. Moreover, negative affectivity was negatively related to job satisfaction. Simultaneously, positive affectivity can predict job satisfaction, both directly and indirectly through its impact on perceived positive display rules and job control. Positive affectivity is also a negative predictor of burnout. Practical implications are discussed to support intervention programs that develop healthy workplaces, and also to inform nurses about how to manage emotional display

Geriatric characteristics in randomised controlled trials on antidepressant drugs for older adults: a systematic review

NARCIS (Netherlands)

Benraad, Carolien E. M.; Kamerman-Celie, Floor; van Munster, Barbara C.; Oude Voshaar, Richard C.; Spijker, Jan; Olde Rikkert, Marcel G. M.

2016-01-01

Objective: Meta-analyses of antidepressant drug treatment trials have found that increasing age is associated with a less favourable outcome. Because the prevalence of geriatric characteristics, like disability, medical co-morbidity, malnutrition, cognitive (dys) function and frailty increase with

Geriatric characteristics in randomised controlled trials on antidepressant drugs for older adults : a systematic review

NARCIS (Netherlands)

Benraad, Carolien E. M.; Kamerman-Celie, Floor; van Munster, Barbara C.; Oude Voshaar, Richard C.; Spijker, Jan; Rikkert, Marcel G. M. Olde

Objective: Meta-analyses of antidepressant drug treatment trials have found that increasing age is associated with a less favourable outcome. Because the prevalence of geriatric characteristics, like disability, medical co-morbidity, malnutrition, cognitive (dys) function and frailty increase with

Endoscopic, epidemiologic and clinic characterization of the colorectal cancer in geriatric patients

International Nuclear Information System (INIS)

Umpierrez Garcia, Ibis; Herrera Hernandez Norma; Hernandez Ortega, Ania

2009-01-01

The colorectal cancer is a serious health problem because of its high incidence. In Cuba, this disease is the fourth neoplasm in order of frequency with a rate of 17.1 per 100 000 inhabitants. With the objective of determining the precocious diagnosis of this complaint we carried out a prospective, longitudinal and descriptive study among geriatric patients with colorectal disease assisting to consultation at the policlinic 'Carlos Verdugo' of Matanzas in the period from January 2006 to December 2007. The studied parameters were age, genre, risk facts, presentation forms, localization, and endoscopic diagnosis of the disease. The results showed predominance of female sex (52,1 %), in ages from 60 to 69 years old (59.3 %), predominating risk facts like familiar antecedents (13,5 %), idiopathic ulcerative colitis (8.1 %), and an inadequate diet (35.1 %). The most used diagnostic method was colonoscopy (18 patients), with predominance of the rectosigmoidal cancer (15 cases), being the polypoid one the most common endoscopic kind (13 %). We concluded that generally there is not a precocious diagnosis of the colorectal cancer among geriatric patients, leading to a decrease of the healing possibilities and surviving of these patients

Comprehensive Geriatric Assessment (CGA) based risk factors for increased caregiver burden among elderly Asian patients with cancer.

Science.gov (United States)

Rajasekaran, Tanujaa; Tan, Tira; Ong, Whee Sze; Koo, Khai Nee; Chan, Lili; Poon, Donald; Roy Chowdhury, Anupama; Krishna, Lalit; Kanesvaran, Ravindran

2016-05-01

This study aims to identify Comprehensive Geriatric Assessment (CGA) based risk factors to help predict caregiver burden among elderly patients with cancer. The study evaluated 249 patients newly diagnosed with cancer, aged 70years and above, who attended the geriatric oncology clinic at the National Cancer Centre Singapore between 2007 and 2010. Out of 249 patients, 244 patients had information available on family caregiver burden and were analysed. On univariate analysis, ADL dependence, lower IADL scores, ECOG performance status of 3-4, higher fall risk, lower scores in dominant hand grip strength test and mini mental state examination, polypharmacy, higher nutritional risk, haemoglobin geriatric syndromes were significantly associated with mild to severe caregiver burden. On multivariate analysis, only ECOG performance status of 3-4 (odds ratio [OR], 4.47; 95% confidence interval [CI], 2.27-8.80) and haemoglobin patients were stratified into 3 risk groups with different proportion of patients with increased caregiver burden (low risk: 3.9% vs intermediate risk: 18.8% vs high risk: 39.6%; ppatients with cancer. Using these two factors in the clinic may help clinicians identify caregivers at risk and take preventive action to mitigate that. Copyright © 2016 Elsevier Inc. All rights reserved.

Nature and frequency of medication errors in a geriatric ward: an Indonesian experience

Directory of Open Access Journals (Sweden)

Ernawati DK

2014-06-01

Full Text Available Desak Ketut Ernawati,1,2 Ya Ping Lee,2 Jeffery David Hughes21Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 2School of Pharmacy and Curtin Health Innovation and Research Institute, Curtin University, Perth, WA, AustraliaPurpose: To determine the nature and frequency of medication errors during medication delivery processes in a public teaching hospital geriatric ward in Bali, Indonesia.Methods: A 20-week prospective study on medication errors occurring during the medication delivery process was conducted in a geriatric ward in a public teaching hospital in Bali, Indonesia. Participants selected were inpatients aged more than 60 years. Patients were excluded if they had a malignancy, were undergoing surgery, or receiving chemotherapy treatment. The occurrence of medication errors in prescribing, transcribing, dispensing, and administration were detected by the investigator providing in-hospital clinical pharmacy services.Results: Seven hundred and seventy drug orders and 7,662 drug doses were reviewed as part of the study. There were 1,563 medication errors detected among the 7,662 drug doses reviewed, representing an error rate of 20.4%. Administration errors were the most frequent medication errors identified (59%, followed by transcription errors (15%, dispensing errors (14%, and prescribing errors (7%. Errors in documentation were the most common form of administration errors. Of these errors, 2.4% were classified as potentially serious and 10.3% as potentially significant.Conclusion: Medication errors occurred in every stage of the medication delivery process, with administration errors being the most frequent. The majority of errors identified in the administration stage were related to documentation. Provision of in-hospital clinical pharmacy services could potentially play a significant role in detecting and preventing medication errors.Keywords: geriatric, medication errors, inpatients, medication delivery process

Undergraduate teaching in geriatric medicine using computer-aided learning improves student performance in examinations.

Science.gov (United States)

Daunt, Laura A; Umeonusulu, Patience I; Gladman, John R F; Blundell, Adrian G; Conroy, Simon P; Gordon, Adam L

2013-07-01

computer-aided learning (CAL) is increasingly used to deliver teaching, but few studies have evaluated its impact on learning within geriatric medicine. We developed and implemented CAL packages on falls and continence, and evaluated their effect on student performance in two medical schools. traditional ward based and didactic teaching was replaced by blended learning (CAL package combined with traditional teaching methods). Examination scores were compared for cohorts of medical students receiving traditional learning and those receiving blended learning. Control questions were included to provide data on cohort differences. in both medical schools, there was a trend towards improved scores following blended learning, with a smaller number of students achieving low scores (P learning was associated with improvement in student examination performance, regardless of the setting or the methods adopted, and without increasing teaching time. Our findings support the use of CAL in teaching geriatric medicine, and this method has been adopted for teaching other topics in the undergraduate curriculum.

Effect of in-hospital comprehensive geriatric assessment (CGA in older people with hip fracture. The protocol of the Trondheim Hip Fracture Trial

Directory of Open Access Journals (Sweden)

Taraldsen Kristin

2011-04-01

Full Text Available Abstract Background Hip fractures in older people are associated with high morbidity, mortality, disability and reduction in quality of life. Traditionally people with hip fracture are cared for in orthopaedic departments without additional geriatric assessment. However, studies of postoperative rehabilitation indicate improved efficiency of multidisciplinary geriatric rehabilitation as compared to traditional care. This randomized controlled trial (RCT aims to investigate whether an additional comprehensive geriatric assessment of hip fracture patients in a special orthogeriatric unit during the acute in-hospital phase may improve outcomes as compared to treatment as usual in an orthopaedic unit. Methods/design The intervention of interest, a comprehensive geriatric assessment is compared with traditional care in an orthopaedic ward. The study includes 401 home-dwelling older persons >70 years of age, previously able to walk 10 meters and now treated for hip fracture at St. Olav Hospital, Trondheim, Norway. The participants are enrolled and randomised during the stay in the Emergency Department. Primary outcome measure is mobility measured by the Short Physical Performance Battery (SPPB at 4 months after surgery. Secondary outcomes measured at 1, 4 and 12 months postoperatively are place of residence, activities of daily living, balance and gait, falls and fear of falling, quality of life and depressive symptoms, as well as use of health care resources and survival. Discussion We believe that the design of the study, the randomisation procedure and outcome measurements will be of sufficient strength and quality to evaluate the impact of comprehensive geriatric assessment on mobility and other relevant outcomes in hip fracture patients. Trials registration ClinicalTrials.gov, NCT00667914

Development of a brief validated geriatric depression screening tool: the SLU "AM SAD".

Science.gov (United States)

Chakkamparambil, Binu; Chibnall, John T; Graypel, Ernest A; Manepalli, Jothika N; Bhutto, Asif; Grossberg, George T

2015-08-01

Combining five commonly observed symptoms of late-life depression to develop a short depression screening tool with similar sensitivity and specificity as the conventional, more time-consuming tools. We developed the St. Louis University AM SAD (Appetite, Mood, Sleep, Activity, and thoughts of Death) questionnaire. The frequency of each symptom in the prior 2 weeks is quantified as 0, 1, or 2. Patients 65 years or older from our clinics were administered the AM SAD, the Geriatric Depression Scale (GDS-15), the Montgomery-Asberg Depression Rating Scale (MADRS), and the St. Louis University Mental Status Exam (SLUMS). 100 patients were selected. AM SAD correlation with GDS was 0.72 and MADRS 0.80. AM SAD yielded a sensitivity and specificity of 79% and 62% against diagnosis of depression; of 88% and 62% with GDS-15; and 92% and 71% with MADRS. The AM SAD can be reliably used as a short depression screening tool in patients with a SLUMS score of 20 or higher. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

[Presbyastasis and application of vestibular rehabilitation in geriatrics].

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Costa de Araujo, P; Demanez, L; Lechien, J; Bauvir, P; Petermans, J

2011-03-01

Balance disorders can have a major functional impact among the elderly. The main risk is falling. Three elements are implicated in the loss of balance: vision, proprioception and the vestibular system. This article will discuss mainly vestibular damage and its implications. The assessment of balance disorders, particularly in geriatric patients, is based on validated scales composed of several items. These provide scores and are based on the results of chronometric measurements. They can be useful for the application of Vestibular Rehabilitation (VR), a technique improving the adaptation and autonomy of these patients. Vestibular rehabilitation is therefore part of an overall support, the goal of therapy being to improve daily life and to reduce the risk of falls.

Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology

DEFF Research Database (Denmark)

Rathleff, Camilla Rams; Bandholm, T.; Spaich, Erika Geraldina

2017-01-01

the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, objectively measures the exact training dosage performed. The purpose was to investigate...... feasibility and acceptability of an unsupervised progressive strength training intervention monitored by BandCizer for frail geriatric inpatients. Methods: This feasibility trial included 15 frail inpatients at a geriatric ward. At hospitalization, the patients were prescribed two elastic band exercises...... of 2-min pauses and a time-under-tension of 8 s. The feasibility criterion for the unsupervised progressive exercises was that 33% of the recommended number of sets would be performed by at least 30% of patients. In addition, patients and staff were interviewed about their experiences...

Does adding a dietician to the liaison team after discharge of geriatric patients improve nutritional outcome

DEFF Research Database (Denmark)

Beck, Anne Marie; Tolstrup Andersen, Ulla; Leedo, Eva

2015-01-01

(70 + years and at nutritional risk) at discharge. INTERVENTIONS: Participants were randomly allocated to receive discharge Liaison-Team vs. discharge Liaison-Team in cooperation with a dietician. The dietician performed a total of three home visits with the aim of developing and implementing......OBJECTIVES: The objective was to test whether adding a dietician to a discharge Liaison-Team after discharge of geriatric patients improves nutritional status, muscle strength and patient relevant outcomes. DESIGN: Twelve-week randomized controlled trial. SETTING AND SUBJECTS: Geriatric patients...... an individual nutritional care plan. The first visit took place at the day of discharge together with the discharge Liaison-Team while the remaining visits took place approximately three and eight weeks after discharge and were performed by a dietician alone. MAIN MEASURES: Nutritional status (weight...

Explicit versus implicit evaluation to detect inappropriate medication use in geriatric outpatients.

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Bahat, Gulistan; Ilhan, Birkan; Bay, Ilker; Kilic, Cihan; Kucukdagli, Pinar; Oren, Meryem Merve; Karan, Mehmet Akif

2018-04-19

The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard. Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised. STOPP version 2 criteria were systematically used to assess pre-admission treatments followed by implicit clinical evaluation regarding two questions: Were the STOPP criteria recommendations valid for the individual patient and were there any potentially inappropriate-prescription other than depicted by STOPP version 2 criteria? The underlying reason(s) and associated clinical-features were noted. About 62.6% potentially inappropriate-prescriptions were identified (0.6 per-subject) according to systematic application of STOPP v2 while it was 53.4% (0.5 potentially inappropriate-prescriptions per subject) by clinician's application of STOPP v2. Prevalence of non-compliance was 14.7% in 18 (21.7%) of 83 patients identified by systematic application. Suggestion to stop a drug was not accepted because of need of treatment despite likelihood of anticipated side-effects in about 2/3 and with no-anticipated side-effects in about 1/3 of non-compliances. Not following STOPP v2 was significantly associated with lower functional level. According to clinician's implicit-evaluation, there were an extra 59.2% potentially inappropriate-prescriptions (0.6 per subject) in 80 (38.8%) patients yielding a total of 112.6% potentially inappropriate-prescription. Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient-family preferences. There may be as much as STOPP

THE STUDY OF CARDIAC ABNORMALITY IN GERIATRIC POPULATION OF RURAL CENTRAL INDIA

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Aman Chaturvedi

2017-09-01

Full Text Available BACKGROUND Health care of elderly in the society has emerged as an increasingly important issue in the recent years. As the elderly proportion of our population expands, maintaining health and wellness of the aged will continue to be an important research priority in the near future. This study was undertaken to determine cardiac abnormalities in geriatric population by echocardiography in rural central India. The aim of this study is to map the spectrum of cardiac abnormality in geriatric population of rural central India. MATERIALS AND METHODS The study was carried out on subjects from September 2014 – August 2016. All geriatric subjects i.e. above the age of 60 years who were admitted in medicine ward or who attended medicine OPD were considered for the study. All the preliminary biodata was collected, history taking and physical examination were done, ECG was recorded and finally 2D echo was performed in MMode, 2D echo, Doppler (CW and PW and TDI. All observations were recorded on a standard proforma sheet, statistical analysis was performed and results and conclusions drawn. RESULTS In present study, there was higher prevalence of major diseases. On M-Mode echocardiography, left atrial enlargement, LV hypertrophy/dilatation was found in significant number of subjects. On 2D echo, Myocardial Scarring/Thinning, valvular Degeneration was found significantly higher in elderly males, mitral and aortic calcification was found most frequently with prevalence higher in males. On Doppler echocardiography, diastolic dysfunction was common in elderly with very few subjects having normal diastolic function, most of the subjects having grade II diastolic dysfunction. Aortic, mitral and tricuspid regurgitation was common in elderly, and stenotic lesions of aortic and mitral valve were common. CONCLUSION We recommend that echocardiography should become an investigative norm in the elderly, this will aid in early detection of cardiovascular abnormalities

Relationship Between Mandarin Speech Reception Thresholds and Pure-tone Thresholds in the Geriatric Population

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Chih-Hung Chien

2006-01-01

Conclusion: This study established the agreement between Mandarin SRTs and PTTs in the low tone area of speech frequencies in the geriatric population. In clinical settings, SRT test can be rapidly and easily performed and is relatively inexpensive. It is a vital indicator of the accuracy of PTT measurement.

Fellows' Perceptions of a Mandatory Reflective Electronic Portfolio in a Geriatric Medicine Fellowship Program

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Ruiz, Jorge G.; Qadri, Syeda S.; Karides, Marina; Castillo, Carmen; Milanez, Marcos; Roos, Bernard A.

2009-01-01

Electronic portfolios (ePortfolios) can be useful for evaluating and documenting mastery of competencies. We investigated geriatric medicine fellows' perceptions of an ePortfolio. We conducted surveys and focus groups followed by quantitative and qualitative data analysis. Our study revealed that fellows considered the ePortfolio acceptable and…

Predictors for living at home after geriatric inpatient rehabilitation: A prospective cohort study.

OpenAIRE

Kool, Jan; Oesch, Peter; Bachmann, Stefan

2017-01-01

OBJECTIVE To evaluate patient characteristics predicting living at home after geriatric rehabilitation. DESIGN Prospective cohort study. PATIENTS A total of 210 patients aged 65 years or older receiving inpatient rehabilitation. METHODS Candidate predictors evaluated during rehabilitation were: age, vulnerability (Vulnerable Elders Survey), multimorbidity (Cumulative Illness Rating Scale), cognition (Mini-Mental State Examination), depression (Hospital Anxiety and ...

Anticholinergic burden and cognitive function in a large German cohort of hospitalized geriatric patients.

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Barbara Pfistermeister

Full Text Available Previous studies suggest an association between use of anticholinergic drugs in elderly patients and cognitive impairment. However, there are still limited data on the association of anticholinergic drug use and cognitive impairment as well as contribution of individual drugs to anticholinergic load using large, well-documented patient cohorts treated in geriatric units from Europe.We investigated 797,440 prescriptions to 89,579 hospitalized patients treated in geriatric units within the GiB-DAT database. Data of all patients discharged between 1 January 2013 and 30 June 2015 was included. The Anticholinergic Cognitive Burden (ACB scale was used to classify anticholinergic drugs as definite (score 2 or 3 and possible anticholinergics (score 1. Cognitive function was determined using Mini-Mental State Examination (MMSE and the standardized scale for dementia (4D+S.In two multivariable logistic regression models age, sex, number of drugs and ACB total scores were identified as variables independently associated with cognitive impairment as measured by MMSE (odds ratio per ACB unit 1.114, 95% CI 1.099-1.130 or the diagnosis dementia (odds ratio 1.159 per ACB unit, 95% CI 1.144-1.173, both p < 0.0001. High anticholinergic load was associated with patients with severe cognitive impairment (p < 0.05 for all pairwise comparisons. ACB score 3 anticholinergic drugs contributed 77.9% to the cumulative amount of ACB points in patients with an anticholinergic load of 3 and higher.Using a cross-sectional study design, a significant positive association between anticholinergic drug load and cognitive impairment in European patients treated in specialised geriatric units was found. The most frequently used definitve anticholinergic drugs were quetiapine, amitriptyline and carbamazepine.

Utility of abdominal computed tomography in geriatric patients on warfarin with a fall from standing

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Amit Bahl

2018-01-01

Full Text Available Context: Geriatric head trauma resulting from falls has been extensively studied both in the presence and absence of blood thinners. In this population, however, the prevalence and extent of abdominal injury resulting from falls are much less defined. Aim: We aim to evaluate the utility of abdominal computed tomography (CT imaging in geriatric patients on Warfarin with a recent history of fall. Setting and Design: A retrospective analysis was completed of consecutive geriatric patients who presented to a Level 1 Trauma Center emergency department after fall from standing while taking Warfarin. Methods: Inclusion criteria included age 65 years or older and fall while taking Warfarin. Incomplete medical records were excluded from the study. Data collection included the type of anticoagulant medications, demographics, physical examination, laboratories, CT/X-ray findings if ordered, and final diagnosis on admission. Categorical variables were examined using Pearson's Chi-square where appropriate (expected frequency >5, or Fisher's Exact test. Continuous variables were examined using nonparametric Wilcoxon rank tests. Results: Eight hundred and sixty-three charts were reviewed. One hundred and thirty-one subjects met inclusion criteria. Mean age was 83 years. Nearly 39.6% of patients were male. A total of 48 patients had abdominal CT imaging. Seven of the 131 patients (5.3% had an abdominal injury. Abdominal tenderness was predictive of injury, with 4 of 7 cases with abdominal injury demonstrating abdominal tenderness versus only 10 of 124 cases without abdominal injury demonstrating tenderness (P = 0.003. Abdominal CTs were ordered in 11 of 19 cases of patients that exhibited head trauma yet none of these patients were shown to have sustained abdominal trauma (P = 0.08. There was no association between international normalized ratio level and presence of abdominal injury (P = 0.99. Conclusions: A small percentage of elderly fall patients on

[Gerocomy -- gerontology -- geriatrics. The naming of a modern medical discipline].

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Schäfer, D; Moog, F P

2005-11-25

300 years ago, the lawyer Theodosius Schöpffer coined the notion gerontology. On this occasion, this paper offers terms and corresponding concepts of gerontology which arose in the western tradition: 1. From the Graeco-Roman antiquity until 1750, gerocomy (the care for the elderly) was defined as a branch of medicine, but in practice almost did not exist. Basically, it provided instructions for a way of life in conformity with the physiological circumstances of elderly people. Its implementation was left to the patient. Furthermore, in the early modern times medical treatises dealt more frequently with diseases of the elderly and their therapy. The gerokomia succeeded in evolving a specific technical literature. Yet it failed to get institutionalized. 2. At the beginning of the 20th century, Ignaz Nascher interpreted geriatrics as a counterpart to pediatrics and opposed it to a clinical-pathological consideration of old age before 1900. He aimed at the exploration and treatment of old age as an autonomous physiological entity. Under the influence of the demographic transformation the institutionalization of geriatrics as a interdisciplinary branch within medicine could be realized relatively soon. 3. Around 1930, we experience the recreation of the notion gerontology, initially restricted to medical gerontology. However, with the integration of the non-medical sciences of old age the spectrum and the objectives changed. Today gerontology signifies on a international level a generic term or independent scientific discipline beside medicine. This evolution corresponds with the intentions pursued 300 years ago.

Características de los trabajos científicos nacionales en geriatría y gerontología.1980-2001

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Luis Varela Pinedo

2003-01-01

Full Text Available Objetivo: Describir el estado actual de la Investigación en Geriatría y Gerontología en el Perú y así identificar el amplio campo que aún falta por investigar. Materiales y métodos: El presente es un estudio transversal y descriptivo de las tesis, artículos y publicaciones relativos a geriatría y gerontología realizados a nivel nacional desde 1980 hasta el 2001. Se utilizó una metodología de búsqueda mediante el uso de palabras clave y una selección basada en el cumplimiento de los pasos del proceso metodológico. Resultados: Se encontraron un total de 256 Trabajos de Investigación en Gerontología y Geriatría, 30 trabajos (11.7% de Gerontología y 226 trabajos (88.3% de Geriatría. Una mayor proporción de trabajos fueron realizados en las Universidades Cayetano Heredia (47.9% y San Marcos (23.7% en Lima, seguido de la Universidad San Agustín de Arequipa (19.9%. Se encontró que únicamente un 19.2% de los trabajos se habían publicado. Las tesis de pregrado (69.2% fueron realizadas en mayor número que las de postgrado. Se encontró un mayor porcentaje de trabajos relativos a temas quirúrgicos (12.1%, temas infecciosos (10.2% y temas de enfermería (9.8%. De acuerdo a la clasificación de los estudios, se encontró un alto porcentaje de trabajos de tipo transversal (55.1%, seguidos de los retrospectivos (29.8%. Conclusiones: Los Trabajos de Investigación en Geriatría y Gerontología abarcan fundamentalmente el área clínica, sólo un 19.2% de los trabajos se publica, las tesis de pregrado fueron la principal forma de investigación y la mayor proporción de trabajos fueron descriptivos y de corte transversal. (Rev Med Hered 2003; 14:18-25.

Unsupervised progressive elastic band exercises for frail geriatric inpatients objectively monitored by new exercise-integrated technology-a feasibility trial with an embedded qualitative study

DEFF Research Database (Denmark)

Rathleff, C R; Bandholm, T; Spaich, E G

2017-01-01

feasibility and acceptability of an unsupervised progressive strength training intervention monitored by BandCizer for frail geriatric inpatients. Methods: This feasibility trial included 15 frail inpatients at a geriatric ward. At hospitalization, the patients were prescribed two elastic band exercises......Background: Frailty is a serious condition frequently present in geriatric inpatients that potentially causes serious adverse events. Strength training is acknowledged as a means of preventing or delaying frailty and loss of function in these patients. However, limited hospital resources challenge...... the amount of supervised training, and unsupervised training could possibly supplement supervised training thereby increasing the total exercise dose during admission. A new valid and reliable technology, the BandCizer, objectively measures the exact training dosage performed. The purpose was to investigate...

Effectiveness of individualized fall prevention program in geriatric rehabilitation hospital setting: a cluster randomized trial.

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Aizen, Efraim; Lutsyk, Galina; Wainer, Lea; Carmeli, Sarit

2015-10-01

There is no conclusive evidence that hospital fall prevention programs can reduce the number of falls. We aimed to investigate the effect of a targeted individualized falls prevention program in a geriatric rehabilitation hospital. This was a two-stage cluster-controlled trial carried out in five geriatric rehabilitation wards. Participants were 752 patients with mean age 83.2 years. The intervention was a two-phase targeted intervention falls prevention program. The intervention included an assessment of patient's risk by a risk assessment tool and an individual management that includes medical, behavioral, cognitive and environmental modifications. Patients with moderate risk received additionally orientation guidance, and mobility restriction. Patients determined as high risk were additionally placed under permanent personal supervision. Outcome measures were falls during hospital stay. In both stages of the trial, intervention and control wards were almost similar at baseline for individual patient characteristics. Overall, 37 falls occurred during the study. No significant difference was found in fall rates during follow-up between intervention and control wards: 1.306 falls per 1000 bed days in the intervention groups and 1.763-1.826 falls per 1000 bed days in the control groups. The adjusted hazard ratio for falls in the intervention groups was 1.36 (95 % confidence interval 0.89-1.77) (P = 0.08) in the first stage and 1.27 (95 % confidence interval 0.92-1.67) (P = 0.12) in the second stage. These results suggest that in a geriatric rehabilitation hospital a targeted individualized intervention falls prevention program is not effective in reducing falls.

Prevalence and predictors of depression and anxiety among the elderly population living in geriatric homes in Cairo, Egypt.

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Ahmed, Dalia; El Shair, Inas Helmi; Taher, Eman; Zyada, Fadia

2014-12-01

Anxiety and depression are common in the elderly and affect their quality of life. The rates of depression and anxiety are higher among those living in institutional settings and are usually undiagnosed. The aim of the study was to determine the prevalence and predictors of depression, anxiety and mixed form (i.e. depression and anxiety) in the elderly living at geriatric homes. A cross-sectional study was conducted on 240 elderly participants from four randomly selected geriatric homes in Cairo. A pretested interview questionnaire was used to collect data. A short version of the Geriatric Depression Scale (GDS-15), the Hamilton Anxiety Scale, the Katz scale for Activity of Daily living, the three-item loneliness scale and the Personal Wellbeing Index Scale were used. The prevalence of depression, anxiety and mixed disorder among the studied group were 37.5, 14.2 and 30%, respectively. Old age and the presence of comorbidities were predictors for depression and/or anxiety. Female sex, a lower social class, insufficient income, partial independence and loneliness feeling are significant predictors for depression. Being married and loneliness feeling are significant predictors for anxiety, whereas the functional status is a significant predictor for mixed depression and anxiety. Depression and/or anxiety were found in more than 80% of the studied group. An older age, female sex, insufficient income, a lower social class, a partially independent functional status, the presence of comorbidities, more frequent loneliness feeling and being married or divorced were found to be significant predictors for these problems. This study reflects the need for the screening of the elderly in geriatric homes for depression and/or anxiety, especially among high-risk groups, and developing interventions to prevent and control such problems.

Facilitated Learning to Advance Geriatrics: Increasing the Capacity of Nurse Faculty to Teach Students About Caring for Older Adults.

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Krichbaum, Kathleen; Kaas, Merrie J; Wyman, Jean F; Van Son, Catherine R

2015-06-01

The Facilitated Learning to Advance Geriatrics program (FLAG) was designed to increase the numbers of nurse faculty in prelicensure programs with basic knowledge about aging and teaching effectiveness to prepare students to provide safe, high quality care for older adults. Using a framework to improve transfer of learning, FLAG was designed to include: (a) a workshop to increase basic knowledge of aging and common geriatric syndromes, and effective use of evidence-based teaching/learning strategies; (b) a year-long mentoring program to support application of workshop learning and leading change in participants' schools to ensure that geriatrics is a priority. Both formative and summative evaluation methods were used, and included self-assessment of objectives, program satisfaction, and teaching self-efficacy. FLAG achieved its overall purpose by enrolling 152 participants from 19 states including 23 faculty from associate degree programs and 102 from baccalaureate programs. Self-rated teaching effectiveness improved significantly from pre- to post-workshop each year. Achievement of learning objectives was rated highly as was satisfaction. Transfer of learning was evidenced by implementation of educational projects in home schools supported by mentoring. The FLAG program provided opportunities for nurse educators to learn to teach geriatrics more effectively and to transfer learning to their work environment. Future FLAG programs will be offered in a shortened format, incorporating online content and strategies, adding other health professionals to the audience with the same goal of increasing the knowledge and abilities of educators to prepare learners to provide competent care for older adults. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic.

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Kikkert, Lisette H J; de Groot, Maartje H; van Campen, Jos P; Beijnen, Jos H; Hortobágyi, Tibor; Vuillerme, Nicolas; Lamoth, Claudine C J

2017-01-01

Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric patients to identify fallers with highest sensitivity and specificity with a focus on gait performance. Patients (n = 61, age = 79; 41% fallers) underwent extensive screening in three categories: (1) patient characteristics (e.g., handgrip strength, medication use, osteoporosis-related factors) (2) cognitive function (global cognition, memory, executive function), and (3) gait performance (speed-related and dynamic outcomes assessed by tri-axial trunk accelerometry). Falls were registered prospectively (mean follow-up 8.6 months) and one year retrospectively. Principal Component Analysis (PCA) on 11 gait variables was performed to determine underlying gait properties. Three fall-classification models were then built using Partial Least Squares-Discriminant Analysis (PLS-DA), with separate and combined analyses of the fall risk factors. PCA identified 'pace', 'variability', and 'coordination' as key properties of gait. The best PLS-DA model produced a fall classification accuracy of AUC = 0.93. The specificity of the model using patient characteristics was 60% but reached 80% when cognitive and gait outcomes were added. The inclusion of cognition and gait dynamics in fall classification models reduced misclassification. We therefore recommend assessing geriatric patients' fall risk using a multi-factorial approach that incorporates patient characteristics, cognition, and gait dynamics.

Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic.

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Lisette H J Kikkert

Full Text Available Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric patients to identify fallers with highest sensitivity and specificity with a focus on gait performance. Patients (n = 61, age = 79; 41% fallers underwent extensive screening in three categories: (1 patient characteristics (e.g., handgrip strength, medication use, osteoporosis-related factors (2 cognitive function (global cognition, memory, executive function, and (3 gait performance (speed-related and dynamic outcomes assessed by tri-axial trunk accelerometry. Falls were registered prospectively (mean follow-up 8.6 months and one year retrospectively. Principal Component Analysis (PCA on 11 gait variables was performed to determine underlying gait properties. Three fall-classification models were then built using Partial Least Squares-Discriminant Analysis (PLS-DA, with separate and combined analyses of the fall risk factors. PCA identified 'pace', 'variability', and 'coordination' as key properties of gait. The best PLS-DA model produced a fall classification accuracy of AUC = 0.93. The specificity of the model using patient characteristics was 60% but reached 80% when cognitive and gait outcomes were added. The inclusion of cognition and gait dynamics in fall classification models reduced misclassification. We therefore recommend assessing geriatric patients' fall risk using a multi-factorial approach that incorporates patient characteristics, cognition, and gait dynamics.

Using a Geriatric Mentoring Narrative Program to Improve Medical Student Attitudes towards the Elderly

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Duke, Pamela; Cohen, Diane; Novack, Dennis

2009-01-01

This study examined first-year medical student attitudes concerning the elderly before and after instituting a geriatric mentoring program. The program began and ended with a survey designed to assess students' attitudes toward the elderly. During the mentoring program, students visited the same senior for four visits throughout the academic year.…

Influence of warfarin and low-dose aspirin on the outcomes of geriatric patients with traumatic intracranial hemorrhage resulting from ground-level fall.

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Inamasu, Joji; Nakatsukasa, Masashi; Miyatake, Satoru; Hirose, Yuichi

2012-10-01

Ground-level fall is the most common cause of traumatic intracranial hemorrhage (TICH) in the elderly, and is a major cause of morbidity and mortality in that population. A retrospective study was carried out to evaluate whether the use of warfarin/low-dose aspirin (LDA) is predictive of unfavorable outcomes in geriatric patients who sustain a fall-induced TICH. Charts of 76 geriatric patients (≥ 65 years-of-age) with fall-induced TICH were reviewed. The number of patients taking warfarin and LDA was 12 and 21, respectively, whereas the other 43 took neither medication (non-user group). The frequency of patients with unfavorable outcomes (Glasgow Outcome Scale score of 1-3) at discharge was calculated. Furthermore, variables predictive of unfavorable outcomes were identified by logistic regression analysis. The frequency of patients with unfavorable outcomes was 75% in the warfarin group, 33% in the LDA group and 27% in the non-user group, respectively. The risk of having unfavorable outcomes was significantly higher in the warfarin group compared with the LDA group (P = 0.03) and non-user group (P fall-induced TICH. The risk of TICH should be communicated properly to elderly taking warfarin. The information might be important not only to trauma surgeons who take care of injured elderly, but also to geriatric physicians who prescribe warfarin/LDA to them. © 2012 Japan Geriatrics Society.

Health care: economic impact of caring for geriatric patients.

Science.gov (United States)

Rich, Preston B; Adams, Sasha D

2015-02-01

National health care expenditures constitute a continuously expanding component of the US economy. Health care resources are distributed unequally among the population, and geriatric patients are disproportionately represented. Characterizing this group of individuals that accounts for the largest percentage of US health spending may facilitate the introduction of targeted interventions in key high-impact areas. Changing demographics, an increasing incidence of chronic disease and progressive disability, rapid technological advances, and systemic market failures in the health care sector combine to drive cost. A multidisciplinary approach will become increasingly necessary to balance the delicate relationship between our constrained supply and increasing demand. Copyright © 2015 Elsevier Inc. All rights reserved.