Health policy 2016: implications for geriatric urology.

Science.gov (United States)

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.

Prejudices and elderly patients' personality -- the problem of quality of care and quality of life in geriatric medicine.

Science.gov (United States)

Błachnio, Aleksandra; Buliński, Leszek

2013-08-16

The article discusses the position of elderly patients in medical intervention context. The phenomenon of greying population has changed the attitude towards the old but common observations prove that quality of geriatric care is still unsatisfactory. In order to improve specialists' understanding of ageing, the comparative study on personality among people at different age was designed. The results are discussed in relation to the elderly patient-centred paradigm and in order to counterbalance still present ageist practices. The research involved 164 persons in the early and late adulthood stage ages. Among the old there were the young old (aged 65-74) and the older old (aged 75+). All participants were asked to fill the NEO-FFI. The results prove age-related differences in personality. In late adulthood in comparison to early adulthood there is the decline in openness to experiences. Two traits: agreeableness and conscientiousness increase significantly. Age did not differentiate significantly the level of neuroticism and of extraversion. The results of cluster analyses show the further differences in taxonomies of personality traits at different period of life. The results challenge the stereotypes that present older people as neurotic, and aggressive. The age did not differentiate significantly the level of neuroticism and of extraversion. In general, the obtained results prove that the ageist assumption that the geriatric patients are troublesome is not arguable. This article builds support for effective change in geriatric professional practices and improvement in the elderly patients' quality of life.

Meeting American Geriatrics Society Competencies: Are Residents Meeting Expectations for Quality Care of Older Adults?

Science.gov (United States)

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.

[Geriatrics or geriatricization of medicine : Quo vadis geriatrics?

Science.gov (United States)

Kolb, G F

2017-12-01

This article examines the question whether and how geriatrics will change in the future and whether in view of the demographic changes the trend will go more in the direction of a further expansion of geriatrics or more towards a geriatricization of individual specialist medical fields. The different development of geriatrics in the individual Federal States can only be understood historically and is absolutely problematic against the background of the new hospital remuneration system. Geriatrics is a typical cross-sectional faculty and still has demarcation problems with other faculties but has also not yet clearly defined the core competence. This certainly includes the increasing acquisition of decentralized joint treatment concepts and geriatric counselling services in the future, in addition to the classical assessment instruments. Keywords in association with this are: traumatology and othopedics of the elderly, geriatric neurology and geriatric oncology. Interdisciplinary geriatric expertise is increasingly being requested. Outpatient structures have so far not been prioritized in geriatrics. An independent research is under construction and it is gratifying that academic interest in geriatrics seems to be increasing and new professorial chairs have been established. It is not possible to imagine our hospital without geriatrics; however, there is still a certain imbalance between the clearly increased number of geriatric hospital beds, the representation of geriatrics in large hospitals (e.g. specialized and maximum care hospitals and university clinics), the secure establishment in further education regulations and the lack of a uniform nationwide concept of geriatrics.

Comparison of Lumbosacral Alignment in Geriatric and Non-Geriatric patients suffering low back pain.

Science.gov (United States)

Kocyigit, Burhan Fatih; Berk, Ejder

2018-01-01

Lumbosacral alignment is a crucial factor for an appropriate spinal function. Changes in spinal alignment lead to diminished body biomechanics. Additionally, lumbosacral alignment may affect quality of life, sagittal balance and fall risk in elderly. In this study, we aimed to compare lumbosacral alignment in geriatric and non-geriatric patients suffering from low back pain. A total of 202 (120 male and 82 female) patients who visited to physical medicine and rehabilitation clinic with low back pain between January 2017 and August 2017 were enrolled in this study. Standing lateral lumbar radiographs were obtained from the electronic hospital database. Lumbar lordosis angle, sacral tilt, lumbosacral angle and lumbosacral disc angle were calculated on lateral standing lumbar radiographs. The mean age of the non-geriatric group was 43.02 ± 13.20 years, the geriatric group was 71.61 ± 6.42 years. In geriatric patients, lumbar lordosis angle, sacral tilt and lumbosacral disc angle were significantly smaller (p = 0.042, p = 0.017 and p = 0.017). No significant differences were observed in lumbosacral angle between the groups (p = 0.508). Our study indicates the specific changes in lumbosacral alignment with aging. Identifying these changes in lumbosacral alignment in the geriatric population will enable to create proper rehabilitation strategies.

Psychosocial Issues in Geriatric Rehabilitation.

Science.gov (United States)

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.

Quality of life in older individuals with joint contractures in geriatric care settings.

Science.gov (United States)

Heise, Marco; Müller, Martin; Fischer, Uli; Grill, Eva

2016-09-01

The purpose of this study was to analyze the association between functioning and disability and quality of life (QoL) in older individuals with joint contractures in the geriatric care setting. More specifically, this study aimed to identify determinants of QoL out of a defined set of contracture-related categories of the International Classification of Functioning, Disability and Health (ICF). Participants for this multicenter cross-sectional survey were recruited from acute geriatric rehabilitation hospitals, nursing homes, and community nursing facilities in Germany between February and October 2013. QoL was assessed using the validated German version of the EQ-5D index score and the EQ-5D visual analog scale (VAS). Manual and automatic variable selection methods were used to identify the most relevant variables out of 125 contracture-related ICF categories. A total of 241 eligible participants (34.9 % male, mean age 80.1 years) were included. The final models contained 14 ICF categories as predictors of the EQ-5D index score and 15 categories as predictors of the EQ-5D VAS. The statistically significant ICF categories from both models were 'muscle power functions (b730),' 'memory functions (b144),' 'taking care of plants (d6505),' 'recreation and leisure (d920),' 'religion and spirituality (d930),' 'drugs (e1101),' and 'products and technology for personal use in daily living (e115).' We identified the most relevant ICF categories for older individuals with joint contractures and their health-related quality of life. These items describe potential determinants of QoL which may provide the basis for future health interventions aiming to improve QoL for the patients with joint contractures.

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.

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

Science.gov (United States)

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.

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

Perception of health care providers toward geriatric oral health in Belgaum district: A cross-sectional study.

Science.gov (United States)

Mehta, Nishant; Rajpurohit, Ladusingh; Ankola, Anil; Hebbal, Mamata; Setia, Priyanka

2015-05-01

To access knowledge and practices related to the oral health of geriatrics among the health care providers practicing in urban and rural areas. Older adults have identified a number of barriers that contribute to lack of dental service use. However, barriers that clinicians encounter in providing dental treatment to older adults are not as clear-cut. 236 health professionals (of allopathy, ayurveda, and homeopathy) from urban and rural areas were assessed by means of structured questionnaire related to oral health practices and beliefs. Doctors practicing in urban areas assessed dental care needs more frequently (P = 0.038) and performed greater practices related to oral health of geriatrics (P = 0.043) than the doctors practicing in primary health care (PHC) centers (rural) (P = 0.038). Owing to the relative lack of knowledge among rural practitioners, there is a need to integrate primary health care with oral care in rural areas.

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.

Science.gov (United States)

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.

Geriatric trauma.

Science.gov (United States)

Adams, Sasha D; Holcomb, John B

2015-12-01

The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

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

Directory of Open Access Journals (Sweden)

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.

[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.

Validation of Geriatric Care Environment Scale in Portuguese Nurses

Directory of Open Access Journals (Sweden)

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.

Geritalk: communication skills training for geriatric 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

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.

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.

Hierachy of needs of geriatric patients.

Science.gov (United States)

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

Use of a Geriatric Quality Initiative to Educate Internal Medicine Residents about Delirium and Its Risk Factors.

Science.gov (United States)

Olveczky, Daniele; Mattison, Melissa L P; Mukamal, Kenneth J

2013-06-01

Delirium is a common and debilitating complication of inpatient care for many older adults, yet internal medicine residents often do not recognize delirium or its risk factors. Integrating geriatric education (eg, delirium recognition) with inpatient quality improvement (QI) is not well tested. We developed an educational pilot program within an ongoing hospital-wide geriatric QI initiative (Global Risk Assessment and Careplan for the Elderly-Acute Care [GRACE-AC]). GRACE-AC modifies the inpatient computerized provider order entry system to meet the needs of vulnerable older adults and uses a bedside care checklist to identify patients with possible delirium and promote delirium prevention by checking on the need for "tethers" (intravenous fluids, Foley catheters, and telemetry). Residents were assessed before and after each inpatient rotation by using anonymous electronic surveys. A total of 167 eligible residents (91%) completed prerotation surveys, and 102 (56%) residents completed postrotation surveys. All but the first rotating resident group received a standardized 2-minute educational in-service orientation. In a comparison of postrotation responses before and after implementation of the in-service, the proportion of residents who reported improvement in their ability to recall which patients had tethers increased from 17% to 52% for intravenous fluids (P  =  .004), 28% to 75% for Foley catheters (P < .001), and 21% to 50% for telemetry (P  =  .02). Comparing pre- and postrotation surveys, the proportion of correct responses to questions on haloperidol dosing and the characteristics of delirium increased from 26% to 76% and 31% to 63%, respectively (both P < .001). Our pilot program demonstrated that inpatient geriatric QI initiatives can be successfully merged with a brief educational curriculum.

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)

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

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

Science.gov (United States)

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.

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

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Geriatric syndromes: medical misnomer or progress in geriatrics?

NARCIS (Netherlands)

Olde Rikkert, M.G.M.; Rigaud, A.S.; Hoeyweghen, R.J. van; Graaf, J. de

2003-01-01

Both in geriatric and internal medicine journals, and in medical textbooks certain (aggregates of) symptoms are labelled as 'geriatric syndromes'. In frail elderly patients a large number of diseases present with well-known and highly prevalent atypical symptoms (e.g. immobility, instability,

Geriatric Fever Score: a new decision rule for geriatric care.

Directory of Open Access Journals (Sweden)

Min-Hsien Chung

Full Text Available Evaluating geriatric patients with fever is time-consuming and challenging. We investigated independent mortality predictors of geriatric patients with fever and developed a prediction rule for emergency care, critical care, and geriatric care physicians to classify patients into mortality risk and disposition groups.Consecutive geriatric patients (≥65 years old visiting the emergency department (ED of a university-affiliated medical center between June 1 and July 21, 2010, were enrolled when they met the criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. Thirty-day mortality was the primary endpoint. Internal validation with bootstrap re-sampling was done.Three hundred thirty geriatric patients were enrolled. We found three independent mortality predictors: Leukocytosis (WBC >12,000 cells/mm3, Severe coma (GCS ≤ 8, and Thrombocytopenia (platelets <150 10(3/mm3 (LST. After assigning weights to each predictor, we developed a Geriatric Fever Score that stratifies patients into two mortality-risk and disposition groups: low (4.0% (95% CI: 2.3-6.9%: a general ward or treatment in the ED then discharge and high (30.3% (95% CI: 17.4-47.3%: consider the intensive care unit. The area under the curve for the rule was 0.73.We found that the Geriatric Fever Score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in geriatric patients with fever, although external validation should be performed to confirm its usefulness in other clinical settings. It might help preserve medical resources for patients in greater need.

Feed-back between geriatric syndromes: general system theory in geriatrics.

Science.gov (United States)

Musso, Carlos G; Núñez, Juan F Macías

2006-01-01

Geriatrics has described three entities: confusional syndrome, incontinente and gait disorders, calling them geriatric giants. Aging process also induces changes in renal physiology such as glomerular filtration rate reduction, and alteration in water and electrolytes handling. These ageing renal changes have been named as nephrogeriatric giants. These two groups of giants, geriatric and nephrogeriatric, can predispose and potentiate each other leading old people to fatal outcomes. These phenomenon of feed-back between these geriatric syndromes has its roots in the loss of complexity that the ageing process has. Complexity means that all the body systems work harmoniously. The process of senescence weakens this coordination among systems undermining complexity and making the old person frail.

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.

[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

Development and implementation of an objective structured clinical examination to provide formative feedback on communication and interpersonal skills in geriatric training.

Science.gov (United States)

O'Sullivan, Patricia; Chao, Serena; Russell, Matthew; Levine, Sharon; Fabiny, Anne

2008-09-01

Teaching and assessment of communication and interpersonal skills, one of the American Council for Graduate Medical Education-designated core competencies, is an important but difficult task in the training of physicians. Assessment of trainees offers an opportunity to provide explicit feedback on their skills and encourages learning. This article describes a pilot study in which clinician-educators affiliated with the geriatrics training programs at Beth Israel Deaconess Medical Center and Boston University Medical Center designed and piloted a novel Objective Structured Clinical Examination (OSCE) to assess the communication and interpersonal skills of medical, dental, and geriatric psychiatry fellows. The OSCE consisted of three stations where geriatricians and standardized patients evaluated candidates using specifically designed checklists and an abbreviated version of the Master Interview Rating Scale. Communication skills were assessed through performance of specific "real life" clinical tasks, such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills were assessed through the effect of the communication between doctor and standardized patient on fostering trust, relieving anxiety, and establishing a therapeutic relationship. This pilot study demonstrated that the OSCE format of assessment provides a valid means of evaluating the communication and interpersonal skills of interdisciplinary geriatric trainees and provides a valuable forum for formative assessment and feedback. Given that geriatricians and non geriatricians involved in elder care both need communication and interpersonal skills, this novel OSCE can be used for assessment of these skills in trainees in diverse healthcare subspecialties.

Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

Directory of Open Access Journals (Sweden)

Latour Judith

2009-07-01

Full Text Available Abstract Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs. Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT, were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis. Results Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%. Indicators for the appropriateness of care showed less reliability. Conclusion Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT

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

Science.gov (United States)

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.

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...

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

Science.gov (United States)

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.

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.

Geriatric Helper: An mHealth Application to Support Comprehensive Geriatric Assessment

Directory of Open Access Journals (Sweden)

Samuel Silva

2018-04-01

Full Text Available The Comprehensive Geriatric Assessment (CGA is a multidisciplinary diagnosis approach that considers several dimensions of fragility in older adults to develop an individualized plan to improve their overall health. Despite the evidence of its positive impact, CGA is still applied by a reduced number of professionals in geriatric care in many countries, mostly using a paper-based approach. In this context, we collaborate with clinicians to bring CGA to the attention of more healthcare professionals and to enable its easier application in clinical settings by proposing a mobile application, Geriatric Helper, to act as a pocket guide that is easy to update remotely with up-to-date information, and that acts as a tool for conducting CGA. This approach reduces the time spent on retrieving the scales documentation, the overhead of calculating the results, and works as a source of information for non-specialists. Geriatric Helper is a tool for the health professionals developed considering an iterative, User-Centred Design approach, with extensive contributions from a broad set of users including domain experts, resulting in a highly usable and accepted system. Geriatric Helper is currently being tested in Portuguese healthcare units allowing for any clinician to apply the otherwise experts-limited geriatric assessment.

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.…

Why geriatrics? Academic geriatricians' perceptions of the positive, attractive aspects of geriatrics.

Science.gov (United States)

Cravens, D D; Campbell, J D; Mehr, D R

2000-01-01

Recruitment of geriatrics trainees has been poor, and the current shortage of academic geriatricians is expected to worsen. Although barriers to entering geriatrics practice have been identified, a review of the literature found few studies about why people choose to enter geriatrics. We used qualitative methods to investigate the positive, attractive aspects of geriatrics. Long interviews with six academic geriatricians were taped and transcribed. Transcripts were entered into a textual database computer program and reviewed independently by two investigators. Six themes emerged: 1) traditional learning experiences, 2) value on personal relationships, 3) a perception of distinctive differences, 4) a desire to feel needed personally and societally, 5) prefer democracy versus autocracy, and 6) desire intellectual challenges. Academic geriatrics, therefore, is particularly attractive to people who value enduring relationships, see challenges in complexity, practice social responsibility, prefer working within a multidisciplinary team, and derive satisfaction from making seemingly small but nonetheless important changes in peoples' lives. If further studies validate these findings, they could promote geriatrics as a career, by, for example, identifying students and family practice and internal medicine residents who share these values, beliefs, and attitudes and encouraging them to consider this important field.

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

Science.gov (United States)

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.

Geriatric fall-related injuries.

African Journals Online (AJOL)

Conclusion: The majority of geriatric fall-related injuries were due to fall from the same level at home. Assessment of risk fac- tors for falls including home hazards is essential for prevention of geriatric fall-related injuries. Keywords: Accidental fall, geriatrics, injury, trauma registry. DOI: http://dx.doi.org/10.4314/ahs.v16i2.24.

Geriatric and Student Perceptions following Student-led Educational Sessions

Directory of Open Access Journals (Sweden)

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

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

NARCIS (Netherlands)

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

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

Science.gov (United States)

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.

Geriatric Cardiology: An Emerging Discipline.

Science.gov (United States)

Dodson, John A; Matlock, Daniel D; Forman, Daniel E

2016-09-01

Given changing demographics, patients with cardiovascular (CV) disease in developed countries are now older and more complex than even a decade ago. This trend is expected to continue into the foreseeable future; accordingly, cardiologists are encountering patients with a greater number of comorbid illnesses as well as "geriatric conditions," such as cognitive impairment and frailty, which complicate management and influence outcomes. Simultaneously, technological advances have widened the therapeutic options available for patients, including those with the most advanced CV disease. In the setting of these changes, geriatric cardiology has recently emerged as a discipline that aims to adapt principles from geriatric medicine to everyday cardiology practice. Accordingly, the tasks of a "geriatric cardiologist" may include both traditional evidence-based CV management plus comprehensive geriatric assessment, medication reduction, team-based coordination of care, and explicit incorporation of patient goals into management. Given that the field is still in its relative infancy, the training pathways and structure of clinical programs in geriatric cardiology are still being delineated. In this review, we highlight the rationale behind geriatric cardiology as a discipline, several current approaches by geriatric cardiology programs, and future directions for the field. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

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

Directory of Open Access Journals (Sweden)

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

Science.gov (United States)

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.

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

Elder Specialists: Psychosocial Aspects of Medical Education in Geriatric Care

Science.gov (United States)

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…

Novel ethical dilemmas arising in geriatric clinical practice.

Science.gov (United States)

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.

Geriatric imaging

Energy Technology Data Exchange (ETDEWEB)

Guglielmi, Giuseppe [Scientific Institute Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Italy). Dept. of Radiology; Peh, Wilfred C.G. [Khoo Teck Puat Hospital, Singapore (Singapore). Dept. of Diagnostic Radiology; Guermazi, Ali (eds.) [Boston Univ. School of Medicine, Boston, MA (United States). Dept. of Radiology

2013-08-01

Considers all aspect of geriatric imaging. Explains clearly how to distinguish the healthy elderly from those in need of treatment. Superbly illustrated. Written by recognized experts in field. In the elderly, the coexistence of various diseases, the presence of involutional and degenerative changes, and the occurrence of both physical and cognitive problems represent ''the norm.'' It is therefore important to know how to distinguish the healthy elderly from those in need of treatment as a sound basis for avoiding overdiagnosis and overtreatment. This aspect is a central theme in Geriatric Imaging, which covers a wide range of applications of different imaging techniques and clearly explains both the potential and the limitations of diagnostic imaging in geriatric patients. Individual sections are devoted to each major region or system of the body, and a concluding section focuses specifically on interventional procedures. The book, written by recognized experts in the field, is superbly illustrated and will be an ideal resource for geriatricians, radiologists, and trainees.

Geriatric care: ways and means of providing comfort.

Science.gov (United States)

Ribeiro, Patricia Cruz Pontifice Sousa Valente; Marques, Rita Margarida Dourado; Ribeiro, Marta Pontifice

2017-01-01

To know the ways and means of comfort perceived by the older adults hospitalized in a medical service. Ethnographic study with a qualitative approach. We conducted semi-structured interviews with 22 older adults and participant observation of care situations. The ways and means of providing comfort are centered on strategies for promoting care mobilized by nurses and recognized by patients(clarifying/informing, positive interaction/communication, music therapy, touch, smile, unconditional presence, empathy/proximity relationship, integrating the older adult or the family as partner in the care, relief of discomfort through massage/mobilization/therapy) and on particular moments of comfort (the first contact, the moment of personal hygiene, and the visit of the family), which constitute the foundation of care/comfort. Geriatric care is built on the relationship that is established and complete with meaning, and is based on the meeting/interaction between the actors under the influence of the context in which they are inserted. The different ways and means of providing comfort aim to facilitate/increase care, relieve discomfort and/or invest in potential comfort. Conhecer os modos e formas de confortar percecionadas pelos idosos hospitalizados num serviço de medicina. Estudo etnográfico com abordagem qualitativa. Realizamos entrevistas semiestruturadas com 22 doentes idosos e observação participante nas situações de cuidados. Os modos e formas de confortar centram-se em estratégias promotoras de conforto mobilizadas pelo enfermeiro e reconhecidas pelos doentes (informação/esclarecimento, interação/comunicação positiva, toque, sorriso, presença incondicional, integração do idoso/família nos cuidados e o alívio de desconfortos através da massagem/mobilização/terapêutica) e em momentos particulares de conforto (contato inaugural, visita da família., cuidados de higiene e arranjo pessoal), que se constituem como alicerces do cuidar

Endodontic treatment in geriatric patients

Directory of Open Access Journals (Sweden)

Milly Armilya Andang

2007-11-01

Full Text Available With the increased number of geriatric population, it is predicted that the need for dental treatment also increases. The needs for esthetic factors and function of geriatric patient are maybe similar to young patient. The number of geriatric patients who refuse dental extraction is increasing if there are still other alternative. They can be more convinced when the clinician said that the dental disease experienced is a focal infection so that the loss of the tooth can be accepted as the best option. But if it is possible, they will prefer endodontic treatment, because they want to keep their teeth according to the treatment plan or based on patient's request, as a less traumatic alternative compared to extraction.Endodontic treatment consideration for geriatric patient is quite similar to younger patients. The technique is also the same, although the problem may be bigger. The problem or obstacle that may arise in endodontic treatment for geriatric patient relates to the visit duration, problems during x-ray, problems in defining root canal location, vertical root fracture, and in some cases, decreased pulp tissue recovery ability. Due to the fact that the challenge is quite big, the success of endodontic treatment in geriatric patients needs to be considered. This paper will explain the endodontic treatment prognosis for geriatric patients.

Approach to the pressure sores in geriatric patients

Directory of Open Access Journals (Sweden)

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

[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.

Quality of Life and Spiritual Well-Being in Geriatric Patients With Chronic Depression

Directory of Open Access Journals (Sweden)

Izadmehr

2014-08-01

Full Text Available Background Most people do not appreciate the aging period because of lack of knowledge or unknown backgrounds; therefore, they get affected by chronic mental disorders. Depression is one of the most predominant chronic mental disorders. Objectives In this study, we aimed to examine the relationship between quality of life (QOL and spiritual well-being among geriatric retired employees of the oil industry in Khuzestan, Iran, who had chronic depression. Patients and Methods This was a cross-sectional study on 200 retired employees of the oil industry in Khuzestan, Iran, selected using simple random sampling technique. The variables were measured by three different standard questionnaires, including the QOL questionnaire (SF12, spiritual well-being scale (SWB, and depression scale (GDS. Results The mean age of the study group was 65 ± 4 years. Most of the patients had elementary or middle school level of education (44%. Hypertension was the predominant chronic disease associated with depression (37%. The mean QOL, spiritual well-being, and depression scores were 27.9 ± 6.4, 105 ± 13.8, and 4.2 ± 4.35, respectively. Spiritual well-being had a significant negative correlation with depression (P = 0.0001, indicating that the prevalence of chronic diseases such as depression decreased as spiritual well-being increased. There was also a significant negative correlation between the QOL and depression (P = 0.0001. Conclusions The results of our study showed that chronic depression disorder was significantly correlated with QOL and spiritual well-being of the elderly. To have healthy, independent, and happy geriatrics, it is important to consider such problems.

Evaluation of geriatric changes in dogs

OpenAIRE

Pati, Soumyaranjan; Panda, S. K.; Acharya, A. P.; Senapati, S.; Behera, M.; Behera, S. S.

2015-01-01

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 o...

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

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Building Quality Report Cards for Geriatric Care in The Netherlands: Using Concept Mapping to Identify the Appropriate "Building Blocks" from the Consumer's Perspective

Science.gov (United States)

Groenewoud, A. Stef; van Exel, N. Job A.; Berg, Marc; Huijsman, Robbert

2008-01-01

Purpose: This article reports on a study to identify "building blocks" for quality report cards for geriatric care. Its aim is to present (a) the results of the study and (b) the innovative step-by-step approach that was developed to arrive at these results. Design and Methods: We used Concept Mapping/Structured Conceptualization to…

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...

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

Directory of Open Access Journals (Sweden)

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.

[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 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

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)

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

Recognition of geriatric popular song repertoire: a comparison of geriatric clients and music therapy students.

Science.gov (United States)

VanWeelden, Kimberly; Cevasco, Andrea M

2010-01-01

The purposes of the current study were to determine geriatric clients' recognition of 32 popular songs and songs from musicals by asking whether they: (a) had heard the songs before; (b) could "name the tune" of each song; and (c) list the decade that each song was composed. Additionally, comparisons were made between the geriatric clients' recognition of these songs and by music therapy students' recognition of the same, songs, based on data from an earlier study (VanWeelden, Juchniewicz, & Cevasco, 2008). Results found 90% or more of the geriatric clients had heard 28 of the 32 songs, 80% or more of the graduate students had heard 20 songs, and 80% of the undergraduates had heard 18 songs. The geriatric clients correctly identified 3 songs with 80% or more accuracy, which the graduate students also correctly identified, while the undergraduates identified 2 of the 3 same songs. Geriatric clients identified the decades of 3 songs with 50% or greater accuracy. Neither the undergraduate nor graduate students identified any songs by the correct decade with over 50% accuracy. Further results are discussed.

American Association for Geriatric Psychiatry

Science.gov (United States)

... Position Statements Publications Bookstore American Journal of Geriatric Psychiatry Legislative & Regulatory Agenda AAGP eNews (Members Only) Tools ... Funding Training Resources and Curricula For Clinicians >> Geriatric Psychiatry Identifier Webinar: Billing and Coding Consumer Material Clinical ...

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

Science.gov (United States)

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.

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

Science.gov (United States)

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.

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

Science.gov (United States)

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…

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 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.

[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].

Science.gov (United States)

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.

[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

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

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

Science.gov (United States)

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.

Science.gov (United States)

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.

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.

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

Science.gov (United States)

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

Addressing Geriatric Oral Health Concerns through National Oral Health Policy in India

Directory of Open Access Journals (Sweden)

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

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.

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

Science.gov (United States)

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.

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.

Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

Science.gov (United States)

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

Directory of Open Access Journals (Sweden)

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

OpenAIRE

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

Facilitated Learning to Advance Geriatrics: Increasing the Capacity of Nurse Faculty to Teach Students About Caring for Older Adults.

Science.gov (United States)

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.

Evaluation of geriatric changes in dogs

Directory of Open Access Journals (Sweden)

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

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.

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

Directory of Open Access Journals (Sweden)

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.

Geriatric rehabilitation patients' perceptions of unit dining locations.

Science.gov (United States)

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

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

Science.gov (United States)

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

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

Science.gov (United States)

Smoliner, C; Volkert, D; Wirth, R

2013-01-01

malnutrition and nutrition therapy are underreported in the doctor's letter. Dental care beyond emergency care is rarely provided in 67% of wards and never in 23% of units. The use of validated screening instruments is clearly underrepresented and therapy algorithms are rarely implemented in German geriatric hospital units. There are a variety of nutrition interventions available, but it is unclear how patients at nutritional risk are identified. The data on the efficacy of nutrition therapy in elderly patients are very convincing and the integration of nutrition screening in the basic geriatric assessment seems sensible. The establishment of standardized procedures for nutrition intervention and therapy recommendations in the doctor's letter would be useful to ensure sustainability of nutrition therapy.

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.

MANAJEMENT OF INSOMNIA IN GERIATRIC PATIENTS

Directory of Open Access Journals (Sweden)

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.

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

Science.gov (United States)

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.

Analysis and Management of Geriatric Anxiety.

Science.gov (United States)

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…

Quality of Life in Geriatric Population in a Community Development Block of Kishanganj, Bihar, India

Directory of Open Access Journals (Sweden)

Somenath Ghosh

2017-01-01

Full Text Available Background: Ageing universally affects individual, family, community and society with reduction in quality of life on chronologic, biological, social, and psychological dimensions. Aim and Objectives: The study was done to assess quality of life in physical, psychological, social and environmental domains among elderly population in relation to sociodemographic character. Material and Methods: A cross-sectional study was conducted among census population of 63 elderly individuals in Chanamana village, a community development block of Potia, Kishanganj, Bihar from 1st June –31st July 2014. By interview technique the quality of life was assessed using World Health Organization Quality of Life-BREF (WHOQOL-BREF questionnaire. Mean score was computed and compared by Z -test and one-way ANOVA using SPSS software, version 19.0. Results: Among the study participants with alike gender distribution, majority (68.25% were in age group of 60-69 years, general caste (69.85%, joint family (84.12% and residing with their children (82.54%. Of them 47.62 percent were illiterates and 42.86 percent were still earning. The mean score in the distinct four domains had no significant difference in genders and age groups. Yet, residing with children and belonging to joint family were noted to be significantly improving the scores in all the four domains. Mean scores were also significantly superior in physical, psychological and environmental domains among persons who were married and had their own income. Conclusion: The study showed the quality of life within diverse domains among elderly population need to be addressed with certain socio-demographic factors (joint family, marital status, own earning and children accompanying the geriatric population.

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

Science.gov (United States)

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

WATER AND SALT METABOLISM IN THE GERIATRIC SYNDROMES

Directory of Open Access Journals (Sweden)

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.

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.

Geriatric health policy in India: The need for scaling-up implementation.

Science.gov (United States)

Paul, N Sherin Susan; Asirvatham, Mathew

2016-01-01

In an anticipation of the rising geriatric population in India, the Central government constituted the National Policy for Older Persons in 1999 to promote the health and welfare of senior citizens in India. A major strategy of this policy is to encourage families to take care of their older family members. The policy also encourages voluntary organizations to supplement the care provided by the family and provide care and protection to vulnerable elderly people. The implementation of this policy, particularly in the rural areas, has been negligible and calls for a scaling-up of programs to address the physical, psychological, and social needs of the poor. Due to breakdown of the joint family system and the migration of the younger generation to the towns and cities, the elderly parents in the villages are left to fend for themselves. Too old to work and with little or no source of income, the elders are struggling even to satisfy their basic needs. This article primarily focuses on the various facets of elderly care in India. As a fledgling nation in elderly care, we should take cues from other nations who have pioneered in this field and should constantly evolve to identify and face the various challenges that come up, especially from rural India. The Rural Unit for Health and Social Affairs Department of a well-known Medical College in South India has developed a "senior recreation day care" model which proves to be a useful replicable model to improve the quality of life and nutritional status of the elderly in the lower rungs of society. More than a decade since its inception, it is now the right time to assess the implementation of our geriatric health policy and scale-up programs so that the elderly in our country, irrespective of urban and rural, will have a dignified and good quality life.

[Endoprostheses in geriatric traumatology].

Science.gov (United States)

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.

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

Science.gov (United States)

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.

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.

Practice and Perceived Importance of Advance Care Planning and Difficulties in Providing Palliative Care in Geriatric Health Service Facilities in Japan: A Nationwide Survey.

Science.gov (United States)

Yokoya, Shoji; Kizawa, Yoshiyuki; Maeno, Takami

2018-03-01

The provision of end-of-life (EOL) care by geriatric health service facilities (GHSFs) in Japan is increasing. Advance care planning (ACP) is one of the most important issues to provide quality EOL care. This study aimed to clarify the practice and perceived importance of ACP and the difficulties in providing palliative care in GHSFs. A self-report questionnaire was mailed to head nurses at 3437 GHSFs nationwide. We asked participants about their practices regarding ACP, their recognition of its importance, and their difficulties in providing palliative care. We also analyzed the relationship between these factors and EOL care education. Among 844 respondents (24.5% response rate), approximately 69% to 81% of head nurses confirmed that GHSF residents and their families understood disease conditions and goals of care. There was a large discrepancy between the actual practice of ACP components and the recognition of their importance (eg, asking residents about existing advance directive [AD; 27.5% practiced it, while 79.6% considered it important]; recommending completion of an AD [18.1% vs 68.4%], and asking for designation of a health-care proxy [30.4% vs 76.8%]). The EOL care education was provided at 517 facilities (61.3%). Head nurses working at EOL care education-providing GHSFs practiced ACP significantly more frequently and had significantly fewer difficulties in providing palliative care. A large discrepancy was found between GHSF nurses' practice of ACP and their recognition of its importance. Providing EOL care education in GHSFs may increase ACP practices and enhance respect for resident's preferences concerning EOL care.

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

Science.gov (United States)

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.

Enhancing Geriatric Curriculum in Nursing School

Science.gov (United States)

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.

Science.gov (United States)

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.

[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.

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)

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

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)

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

Science.gov (United States)

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.

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...

American Geriatrics Society

Science.gov (United States)

... 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.

Predicting geriatric falls following an episode of emergency department care: a systematic review.

Science.gov (United States)

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

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.

Reporting quality of conference abstracts on randomised controlled trials in gerontology and geriatrics: a cross-sectional investigation.

Science.gov (United States)

Mann, Eva; Meyer, Gabriele

2011-01-01

Without transparent reporting of how a randomised controlled trial was designed and conducted and of the methods used, its internal validity cannot be assessed by the reader. A congress abstract is often the only source providing information about a trial. In January 2008, an extended CONSORT statement on abstract reporting was published. Its impact has yet to be evaluated. Using a slightly modified CONSORT checklist comprising 17 items, we thus investigated the reporting quality of randomised controlled trials published in the book of abstracts presented at the World Congress of Geriatrics and Gerontology in Paris in July 2009. A total of n=4,416 abstracts was screened for inclusion; n=129 met the inclusion criteria. The overall quality of the abstracts was remarkably poor. The primary outcome was mentioned in 34/129 abstracts (26%), none of the abstracts reported on the procedure of random allocation of participants or clusters, 21/129 abstracts (16%) reported some kind of blinding, and the attrition rate was mentioned in only 12/129 abstracts (9%). The majority of abstracts fulfilled two items: description of intended intervention for each group (102/129; 79%) and general interpretation of results (107/129; 83%). Trial status was reported in all abstracts. Both journal editors and committees organising congresses are requested to define the use of the CONSORT statement as a prerequisite in their guidelines for authors and to instruct reviewers to conduct compliance checks. Medical associations should finally endorse the indispensability of the CONSORT statement and publish it in their journals. Otherwise the intended benefits cannot be fully generated. Copyright © 2010. Published by Elsevier GmbH.

Maximizing the Potential of Internships in Gerontology and Geriatrics

Science.gov (United States)

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…

Educational games in geriatric medicine education: a systematic review

Directory of Open Access Journals (Sweden)

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.

[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.

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

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.

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

Science.gov (United States)

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.

An Overview of Otorhinolaryngeal Problems in Geriatrics

Directory of Open Access Journals (Sweden)

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)

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

Science.gov (United States)

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.

Physical Therapy for Neurological Conditions in Geriatric Populations

Directory of Open Access Journals (Sweden)

Eli Carmeli

2017-12-01

Full Text Available With more of the world’s population surviving longer, individuals often face age-related neurology disorders and decline of function that can affect lifestyle and well-being. Despite neurophysiological changes affecting the brain function and structure, the aged brain, in some degree, can learn and relearn due to neuroplasticity. Recent advances in rehabilitation techniques have produced better functional outcomes in age-related neurological conditions. Physical therapy (PT of the elderly individual focuses in particular on sensory–motor impairments, postural control coordination, and prevention of sarcopenia. Geriatric PT has a significant influence on quality of life, independent living, and life expectancy. However, in many developed and developing countries, the profession of PT is underfunded and understaffed. This article provides a brief overview on (a age-related disease of central nervous system and (b the principles, approaches, and doctrines of motor skill learning and point out the most common treatment models that PTs use for neurological patients.

Physical Therapy for Neurological Conditions in Geriatric Populations.

Science.gov (United States)

Carmeli, Eli

2017-01-01

With more of the world's population surviving longer, individuals often face age-related neurology disorders and decline of function that can affect lifestyle and well-being. Despite neurophysiological changes affecting the brain function and structure, the aged brain, in some degree, can learn and relearn due to neuroplasticity. Recent advances in rehabilitation techniques have produced better functional outcomes in age-related neurological conditions. Physical therapy (PT) of the elderly individual focuses in particular on sensory-motor impairments, postural control coordination, and prevention of sarcopenia. Geriatric PT has a significant influence on quality of life, independent living, and life expectancy. However, in many developed and developing countries, the profession of PT is underfunded and understaffed. This article provides a brief overview on (a) age-related disease of central nervous system and (b) the principles, approaches, and doctrines of motor skill learning and point out the most common treatment models that PTs use for neurological patients.

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.

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

%), flooring (83%), visual aids (73%), and sound level (70%). Seventy-seven percent have staff overlapping with the nongeriatric portion of their ED, and 80% require geriatric staff didactics. Sixty-seven percent of geriatric EDs report discharge planning for geriatric ED patients, and 90% of geriatric EDs had direct follow-up through patient callbacks. The snowball sample identification of U.S. geriatric EDs resulted in 30 confirmed respondents. There is significant variation in the components constituting a geriatric ED. The United States should consider external validation of self-identified geriatric EDs to standardize the quality and type of care patients can expect from an institution with an identified geriatric ED. © 2014 by the Society for Academic Emergency Medicine.

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.)

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

International Nuclear Information System (INIS)

Droz, J.

2004-01-01

subjectively appreciate performance status. Folstein’s Mini Mental State Examination (MMSE) was used to evaluate patient cognitive status. Depressive symptoms were detected with the Geriatric Depression Scale (GDS). Nutritional status was assessed through the Mini-Nutritional Assessment (MNA). The Performance-Oriented Assessment of Mobility instrument provided information on patient physical ability and fall risk. Co morbidity, that corresponds to all medical conditions a patient may have, excluding the disease of primary interest, was assessed using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G). This scale classifies co morbid events by organ system affected, and rates their severity from 0 to 4, with a grading similar to that of the Common Toxicity Criteria scale (none, mild, moderate, severe, extremely severe/life-threatening). This scale has 14 organ system categories and collects information such as the total number of categories involved, total score, severity index (total score/total number of categories involved), the number of categories at level 3 severity, the number of categories at level 4 severity. We also assessed biological functions such as hemoglobin, white blood cell count and differential, creatinine clearance, serum albumin level. Mini-CGA is performed by a multidisciplinary team, including a geriatric ian, a medical oncologist (geriatrics certified), a social worker, a dietician, a physiotherapist, a pharmacist and a research nurse. Each mini-CGA evaluation lasts from ninety to one hundred and twenty minutes. At the end of the procedure, both the geriatric ian and the oncologist draw up an inventory of the different problems identified, and propose an individualized intervention program with specific advice on cancer treatment options

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

Development of geriatric competencies for emergency medicine residents using an expert consensus process.

Science.gov (United States)

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.

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

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

Fried frailty phenotype assessment components as applied to geriatric inpatients

Directory of Open Access Journals (Sweden)

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

Health related quality of life in rheumatoid arthritis, osteoarthritis, diabetes mellitus, end stage renal disease and geriatric subjects. Experience from a General Hospital in Mexico.

Science.gov (United States)

Ambriz Murillo, Yesenia; Menor Almagro, Raul; Campos-González, Israel David; Cardiel, Mario H

2015-01-01

Chronic diseases have a great impact in the morbidity and mortality and in the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases. The aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, end-stage renal disease, geriatric subjects and a control group. We conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met classification criteria for RA, OA, diabetes mellitus, end-stage renal disease; the geriatric subjects group was≥65 years, and the control group≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analogue scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA1C, serum creatinine and urea. We evaluated 290 subjects (control group: 100; geriatric subjects: 30 and 160 for the rest of groups). Differences were detected in baseline characteristics (Prenal disease group (±SD: 48.06±18.84 x/SD). The general health was the principal affected area in RA. The pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±0.76 vs 0.82±0.82, respectively; P=.001). Forty five percent of all subjects had depression. The HRQoL in RA patients is poor and comparable to other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered high impact diseases and therefore should receive more attention. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Gerontology and geriatrics in Dutch medical education.

Science.gov (United States)

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.

[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 ...

Geriatric health policy in India: The need for scaling-up implementation

Directory of Open Access Journals (Sweden)

N Sherin Susan Paul

2016-01-01

Full Text Available In an anticipation of the rising geriatric population in India, the Central government constituted the National Policy for Older Persons in 1999 to promote the health and welfare of senior citizens in India. A major strategy of this policy is to encourage families to take care of their older family members. The policy also encourages voluntary organizations to supplement the care provided by the family and provide care and protection to vulnerable elderly people. The implementation of this policy, particularly in the rural areas, has been negligible and calls for a scaling-up of programs to address the physical, psychological, and social needs of the poor. Due to breakdown of the joint family system and the migration of the younger generation to the towns and cities, the elderly parents in the villages are left to fend for themselves. Too old to work and with little or no source of income, the elders are struggling even to satisfy their basic needs. This article primarily focuses on the various facets of elderly care in India. As a fledgling nation in elderly care, we should take cues from other nations who have pioneered in this field and should constantly evolve to identify and face the various challenges that come up, especially from rural India. The Rural Unit for Health and Social Affairs Department of a well-known Medical College in South India has developed a “senior recreation day care” model which proves to be a useful replicable model to improve the quality of life and nutritional status of the elderly in the lower rungs of society. More than a decade since its inception, it is now the right time to assess the implementation of our geriatric health policy and scale-up programs so that the elderly in our country, irrespective of urban and rural, will have a dignified and good quality life.

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.

Real-time water quality monitoring and providing water quality ...

Science.gov (United States)

EPA and the U.S. Geological Survey (USGS) have initiated the “Village Blue” research project to provide real-time water quality monitoring data to the Baltimore community and increase public awareness about local water quality in Baltimore Harbor and the Chesapeake Bay. The Village Blue demonstration project complements work that a number of state and local organizations are doing to make Baltimore Harbor “swimmable and fishable” 2 by 2020. Village Blue is designed to build upon EPA’s “Village Green” project which provides real-time air quality information to communities in six locations across the country. The presentation, “Real-time water quality monitoring and providing water quality information to the Baltimore Community”, summarizes the Village Blue real-time water quality monitoring project being developed for the Baltimore Harbor.

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.

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

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

Science.gov (United States)

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.

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

Directory of Open Access Journals (Sweden)

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.

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

Directory of Open Access Journals (Sweden)

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.

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

Directory of Open Access Journals (Sweden)

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

Altered Synchronizations among Neural Networks in Geriatric Depression.

Science.gov (United States)

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 care in Europe – the EUGMS Survey part I: Belgium, Czech Republic, Denmark, Germany, Ireland, Spain, Switzerland, United Kingdom

DEFF Research Database (Denmark)

Kolb, G; Andersen-Ranberg, Karen; Cruz-Jentoft, A

2011-01-01

Quality of geriatric care depends on institutional resources e.g. hospitals, medical departments engaged in acute medicine, rehabilitation and long term care but especially in quality and quantity of well educated and trained specialists, i.e. “geriatricians”. This survey initiated by the Academi...

The cost of dysphagia in geriatric patients

Directory of Open Access Journals (Sweden)

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 ...

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

Science.gov (United States)

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.

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.

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.

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.

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

Directory of Open Access Journals (Sweden)

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.

[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...

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

From words to action: visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital.

Science.gov (United States)

Buttigieg, Sandra C; Cassar, Vincent; Scully, Judy W

2013-01-01

The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. The authors draw on solid theoretical frameworks--the complexity theory, team effectiveness model and the social identity theory--to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level.

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.

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

[Encouragement and training of ethical competence in geriatric nursing. A pre-condition of high quality in professional caring process].

Science.gov (United States)

Dettmann, Ulf

2006-02-01

The article makes a case for the necessity of more intensive training in the ethics of geriatric care. It confronts the bias against too much ethical behaviour in daily practice, while also arguing for the liberating and enriching aspects of giving ethical care to the aged. Based on a differentiation between morals and ethics, the essay recognizes the endeavors to achieve moral behaviour in geriatric care, but questions whether in every case the caregivers have sufficient ethical core competence to determine either the appropriateness or the righteousness of their moral actions. The essay discusses what should be understood under "ethical competence" and how ethical competence can be acquired and advanced by schooling.

Nonpharmacological therapeutic techniques to decrease agitation in geriatric psychiatric patients with dementia.

Science.gov (United States)

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.

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

OpenAIRE

Tariq, Humeira; Kloseck, Marita; Crilly, Richard G; Gutmanis, Iris; Gibson, Maggie

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 Septembe...

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

Directory of Open Access Journals (Sweden)

Schwanke, Carla Helena Augustin

2009-01-01

data: A throughout review of the literature found on MedLine and LILACS, as well as textbooks, dissertations, thesis, and government directives was performed. Summary of the findings: Geriatrics is the area of medicine that cares for the health and treatment of diseases in old age, which works with physical, mental, functional and social aspects in the acute, chronic, rehabilitative, preventive and palliative care of the elderly. Geriatrics goes beyond “medicine centered on organs and systems”, offering holistic treatment by interdisciplinary teams with the principal objective of optimizing functional capacity and improvement of quality of life and autonomy of the elderly, which make up the core of this medical specialty. Geriatrics, in daily assistance practice, works with particular questions such as: the heterogeneity of patients and of scenarios of care; concomitance of multiple diseases/disorders (plurimorbidity, including geriatric syndromes (“the giants of geriatrics”; difficulty of identifying all the problems (iceberg phenomenon; polypharmacy; fragility; vulnerability; the various losses that the elderly show; and terminality. Conclusions: Geriatrics refers to the medical specialty responsible for the clinical aspects of aging and for the various forms of health care necessary for the elderly. Because of the complexity allied to the aging process, geriatrics has become an intriguing, challenging and contemporaneous specialty.

[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 ...

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.

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

Science.gov (United States)

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.

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.

Quality of life and compliance in geriatric patients

Directory of Open Access Journals (Sweden)

Igor Kalugin

2017-09-01

Full Text Available Background. Older adults usually have more than one chronic disease. In most cases, each condition requires constant pharmacotherapy. On average, the clinical examination of patients aged 60 and older reveals at least four or five different chronic pathological states in various phases and stages. Disease interference changes the classical clinical picture, increases the number of complications and their severity, affects the quality of life and prognosis, as a result - complicated medical diagnostic process and reduced compliance. The presence in the elderly both mental and physical illness significantly affects the quality of life. Psychological interventions aimed at a patient's awareness of the disease and methods of its treatment, the creation of therapeutic alliance and the prevention of self-medication, according to our hypothesis, contributes to compliance and quality of life improvement in polymorbid elderly patients suffering from mental disorders. Methods. In the study took part 325 patients who underwent inpatient treatment at the gerontopsychiatric department and signed provided informed consent. The study had a design of a randomized controlled clinical trial. Patients were randomized to experimental and control groups in a ratio of 3 to 1 based on age and gender. The study group of 238 people received standard treatment and psychological interventions. A comparison group of 87 people had only standard treatment. Patients were evaluated for quality of life with SF-36 scale and compliance with Morisky Medication Adherence Scale. Results. We have seen significant intergroup differences on the Morisky Medication Adherence Scale in the baseline period. Consequently, its results were not be taken into account in the final analysis. Before treatment patients’ quality of life between the study groups did not differ statistically (p = 0.317. After the treatment, a statistically significant difference in life quality between experimental

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.

Influence of denture improvement on the nutritional status and quality of life of geriatric patients.

Science.gov (United States)

Wöstmann, Bernd; Michel, Karin; Brinkert, Bernd; Melchheier-Weskott, Andrea; Rehmann, Peter; Balkenhol, Markus

2008-10-01

Recent research suggests that there is a correlation between nutrition, oral health, dietary habits, patients' satisfaction and their socio-economic status. However, the dependent and independent variables have remained unclear. This exploratory interventional study aimed to identify the impact of denture improvement on the nutritional status as well as the oral health-related quality of life in geriatric patients. Forty-seven patients who were capable of feeding themselves (minimum age: 60 years) and with dentures requiring repair or replacement were selected from a random sample of 100 residents of two nursing homes. Before and 6 months after the dentures were optimised a Mini Nutritional Assessment (MNA) and a masticatory function test were carried out. Nutritional markers (pre-albumin, serum albumin, zinc) were determined and an OHIP-G14 (Oral Health Impact Profile, German version) was recorded in order to determine the effect of the optimised oral situation on the patient's nutritional status and oral health-related quality of life. Despite the highly significant improvement in masticatory ability after the optimisation of the dentures, no general improvement regarding the nutritional status was observed since the albumin, zinc and MNA values remained unchanged and pre-albumin even decreased. Since masticatory ability and masticatory efficiency are not the only factors affecting this, prosthetic measures alone apparently cannot effect a lasting improvement in nutritional status as masticatory ability and masticatory efficiency are not the only factors of influence. Nutrition is not only a matter of masticatory function, but also depends on other influencing factors (e.g. habits, taste and cultural customs as well as financial and organisational aspects).

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.

[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.

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...

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

Science.gov (United States)

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.

Geriatric epidemiology of trauma in a hospital in Southern Colombia

Directory of Open Access Journals (Sweden)

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.

[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.

Science.gov (United States)

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

ESRD in the geriatric population: the crisis of managed care and the opportunity of disease management.

Science.gov (United States)

Steinman, Theodore I

2002-01-01

The geriatric population with end-stage renal disease (ESRD) is placed at risk with regards to the quality and extent of medical coverage because of the rapidly changing financial environment. Managed care organizations (MCOs) are generally for-profit companies that must focus on the bottom line. While the verbal commitment to quality care is voiced, the financial pressures on MCOs have led to a decrease in coverage of many services and outright denial for some necessary treatments. While denying services, the MCOs have also reduced payments to providers for services rendered. The coverage crisis is compounded by health maintenance organizations (HMOs) quitting Medicare because the reimbursement from the Health Care Financing Administration (HCFA) is less than their costs. Because of the above issues which can potentially impact on the quality of care delivered to the ESRD geriatric population, a new approach to disease management has created the opportunity to improve total patient care to a level not yet achieved in the United States. Disease management encompasses integrated care across all disciplines. Every component of care can be tracked by a dedicated information system. Improvement in outcomes has far exceeded the U.S. Renal Data System (USRDS) benchmark performance measurements with a disease management model approach. The key to success is the health service coordinator (HSC), a senior nurse with many years of ESRD experience. This individual coordinates care across all disciplines and expedites necessary referrals. With rapid attention to patient needs there has been a significant reduction in hospital admissions, hospital length of stay, and emergency room visits. Patient care will steadily improve as the disease management system matures as a consequence of understanding the patients total physical and psychosocial needs.

Teaching Programs in Geriatric Optometry.

Science.gov (United States)

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)

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

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

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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.

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)

Clinical application value of impulse oscillometry in geriatric patients with COPD

Directory of Open Access Journals (Sweden)

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

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.

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

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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.

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.

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

Science.gov (United States)

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.

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.

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

Science.gov (United States)

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

Team Ward Rounds for Quality Improvement in Patient-Centred ...

African Journals Online (AJOL)

In this paper we describe a clinical practice change for evaluation and continuous quality improvement of in-patient services in our ACE unit, such as daily geriatrics (multi disciplinary) team ward rounds preceding traditional ward rounds by other managing teams. The geriatrics team rounds enabled the identification of ...

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.

Science.gov (United States)

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.

Science.gov (United States)

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.

Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial.

Science.gov (United States)

Hoogendijk, Emiel O; van der Horst, Henriëtte E; van de Ven, Peter M; Twisk, Jos W R; Deeg, Dorly J H; Frijters, Dinnus H M; van Leeuwen, Karen M; van Campen, Jos P C M; Nijpels, Giel; Jansen, Aaltje P D; van Hout, Hein P J

2016-03-01

Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of community-dwelling frail older adults. A 24-month stepped wedge cluster randomized controlled trial was conducted between May 2010 and March 2013 in 35 primary care practices in the Netherlands, and included 1147 frail older adults. The intervention consisted of a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Reassessment occurred every six months. Nurses worked together with primary care physicians and were supervised and trained by geriatric expert teams. Complex patients were reviewed in multidisciplinary consultations. The primary outcome was quality of life (SF-12). Secondary outcomes were health-related quality of life, functional limitations, self-rated health, psychological wellbeing, social functioning and hospitalizations. Intention-to-treat analyses based on multilevel modeling showed no significant differences between the intervention group and usual care regarding SF-12 and most secondary outcomes. Only for IADL limitations we found a small intervention effect in patients who received the intervention for 18months (B=-0.25, 95%CI=-0.43 to -0.06, p=0.007), but this effect was not statistically significant after correction for multiple comparisons. The GCM did not show beneficial effects on quality of life in frail older adults in primary care, compared to usual care. This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population. The Netherlands National Trial Register NTR2160. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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

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

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

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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.

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.

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.

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.

Ethical considerations in geriatric neuropsychology.

Science.gov (United States)

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.

Psychosocial work load and stress in the geriatric care

Directory of Open Access Journals (Sweden)

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

Focus group reflections on the current and future state of cognitive assessment tools in geriatric health care

Directory of Open Access Journals (Sweden)

Whitehead JC

2015-06-01

Full Text Available Jocelyne C Whitehead,1 Sara A Gambino,1 Jeffrey D Richter,2 Jennifer D Ryan1,3,41Rotman Research Institute, Baycrest, 2Independent Human Factors Consultant, Toronto, ON, Canada; 3Department of Psychology, 4Department of Psychiatry, University of Toronto, Toronto, ON, CanadaObjective: This study provides insight into the thoughts and opinions of geriatric health-care professionals toward cognitive assessments and the use of emerging technologies, such as eye-tracking, to supplement current tools.Methods: Two focus group sessions were conducted with nurses and physicians who routinely administer neurocognitive assessments to geriatric populations. Video recordings of the focus group sessions were transcribed and a thematic analysis was performed.Results: Participants reported the need for assessment and diagnostic tools that are accessible and efficient, and that are capable of accommodating the rapid growth in the aging population. The prevalence of more complex ailments experienced by older adults has had repercussions in the quality of care that the clients receive, and has contributed to lengthy wait times and resource shortages. Health-care professionals stated that they are hampered by the disjointed structure of the health-care system and that they would benefit from a more efficient allocation of responsibilities made possible through tools that did not require extensive training or certification. Eyetracking-based cognitive assessments were thought to strongly complement this system, yet it was thought that difficulty would be faced in gaining the support and increased uptake by health-care professionals due to the nonintuitive relationship between eyetracking and cognition.Conclusion: The findings suggest that health-care professionals are receptive to the use of eyetracking technology to assess for cognitive health as it would conserve resources by allowing frontline staff to administer assessments with minimal training

Learnt and perceived professional roles of a new type of nurse specialized in Gerontology and Geriatrics, a qualitative study

NARCIS (Netherlands)

Huizenga, Petra; Finnema, Evelyn; Roodbol, Petrie

Aim. To gain insight into a new type of nurse specialized in gerontology and geriatrics, how they find meaning in the care of older persons and how this relates to the seven professional roles derived from the CanMEDS theoretical framework. Background. To promote the quality of care for older

Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture.

Science.gov (United States)

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

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...

[Mobile geriatric rehabilitation in statutory health insurance: Conceptual strategy and results of a nationwide treatment documentation (Part 1)].

Science.gov (United States)

Meinck, Matthias; Pippel, K; Lübke, N

2017-04-01

Insurants have a statutory right to mobile rehabilitation in which a multidisciplinary team carries out treatment in the familiar home environment. Framework recommendations in geriatric medicine were presented by the statutory health insurance (SHI) and a standardized treatment documentation was implemented nationwide. This article presents the conceptual design and selected results from this treatment documentation and reports on the established practice. A total of 1879 anonymized cases of mobile geriatric rehabilitation carried out between 2011 and 2014 from 11 participating institutions were analyzed with respect to patient and process-related features. The patients were on average 81 years old and 61 % were female. The mobile rehabilitation was provided on average over 22 treatment days over a period of 8 weeks and in 84 % of cases following hospital treatment. Of the rehabilitation patients 27 % lived in a care home prior to treatment and 73 % were already allocated to a care level. The statistically significant gain in capacity for self-sufficiency was 18 points on the Barthel index at the end of the rehabilitation. The majority of treatment was provided by physiotherapists and occupational therapists followed by speech therapists and nursing personnel. Relevant differences were detected between the institutions regarding the indications, access route, therapy combinations, treatment frequency, scope and duration. At the same time individual requirements from the framework recommendations were sometimes not met. Even though the treatment documentation does not replace any external mobile rehabilitation quality assurance, it provides transparency in a still very limited range of services that are sometimes differently implemented at institutions. It therefore provides the basis for further development of mobile out-patient rehabilitation in SHI.

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.

Science.gov (United States)

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.

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

Science.gov (United States)

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.

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

Science.gov (United States)

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

Directory of Open Access Journals (Sweden)

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

Sepsis Within 30 Days of Geriatric Hip Fracture Surgery.

Science.gov (United States)

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.

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.

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

Science.gov (United States)

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,

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...

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.

Analysis of cytopenia in geriatric inpatients.

Science.gov (United States)

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

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

. (2) Fostering medical specialists for aging Older people often suffer from many diseases, together with geriatric syndromes with multiple etiologies. Signs and symptoms vary according to each individual, and are often atypical; therefore, the patients visit different hospitals and receive many screening tests and prescriptions at the same time. To solve this problem, an effective screening system carried out by a primary-care doctor, and privacy-preserving medical data sharing among hospitals and clinics are needed. In a geriatric clinical setting, health-care professionals should be aware of the physical traits of older people who often develop not only dementia, but also geriatric syndromes, such as depression, falls and urinary incontinence, so that a holistic approach with consideration of nursing care is required. However, the existing Japanese medical education system is not prepared for medical professionals enabled to respond to the aforementioned requirements. Thus, the fostering of medical professionals who can provide comprehensive care - especially for the oldest-old - such as geriatric specialists and medical professionals who understand the principles of elderly care, is urgently needed. (3) Diagnosis of elderly-specific diseases and reform of medical-care services In Japan, the diagnostic system for elderly-specific diseases, including dementia, and reform of medical care services are markedly delayed. The current status concerning diagnosis, care and nursing should be investigated to collect academic data. In order to accumulate evidence for providing safe elderly care and nursing, the promotion of clinical research and a marked expansion of geriatric medical centers with high-level medical services are eagerly awaited. (4) Promotion of home-based care and multidisciplinary care To reduce the length of stay in acute hospitals, to reduce the physical burden of health-care professionals working at acute hospitals and to meet the demand of older people

Impact of continuous in-home rehabilitation on quality of life and activities of daily living in elderly clients over 1 year.

Science.gov (United States)

Imanishi, Miyuki; Tomohisa, Hisao; Higaki, Kazuo

2017-11-01

To verify the effect of in-home rehabilitation on quality of life and activities of daily living in elderly clients. In this non-randomized controlled intervention trial, elderly participants were separated into a rehabilitation or a non-rehabilitation group (n = 100 each). The non-rehabilitation group received basic in-home nursing care, including assistance with cooking, cleaning, toileting, meals and medication. The rehabilitation group received a physical treatment program provided by a licensed professional once a week and basic nursing care in the home. For each group, quality of life and activities of daily living were assessed approximately every 3 months over a 1-year period. Quality of life was evaluated using the Philadelphia Geriatric Center Morale Scale, and activities of daily living were evaluated based on the Functional Independence Measure. The rehabilitation group showed statistically significant improvements in both quality of life and activities of daily living. In contrast, the non-rehabilitation group, although showing slight improvement in quality of life at 9 months, showed almost no effects at the other time-points and no significant changes in activities of daily living over the course of the study. The results of the present study suggest that long-term continuous in-home rehabilitation might improve quality of life and activities of daily living in elderly clients. Geriatr Gerontol Int 2017; 17: 1866-1872. © 2017 Japan Geriatrics Society.

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

Privately Provided Accommodation Service Quality and Customer Satisfaction

Directory of Open Access Journals (Sweden)

Joshua Mugambwa

2016-04-01

Full Text Available Privately provided accommodation is a growing service in Uganda’s higher education sector due to education liberalization and demand for education. This research took a case study of Nsamizi Training Institute of Social Development (NTISD to determine the relationship between privately provided accommodation service quality and customer satisfaction. Specifically, the objectives of the study were (a to find out the relationship between security and NTISD students’ satisfaction with privately provided accommodation, and (b to find out the hierarchical level of importance of NTISD student satisfaction of the three service quality dimensions (reliability, security, and tangibles with privately provided accommodation. Using quantitative and qualitative modes of data analysis and a sample of 300 students from 20 private hostels, this study established a strong positive significant relationship between security and satisfaction regarding privately provided accommodation. This implies that accommodation service providers should increase the quality of security so as to increase the satisfaction of students regarding privately provided accommodation. The study established the hierarchical order of importance from the most important service quality dimension, respectively, as follows: reliability, security, and tangibles. Therefore, private accommodation service managers should pay extra attention to the dimensions in the same order.

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.

Impact of poor sleep quality and physical inactivity on cognitive function in community-dwelling older adults.

Science.gov (United States)

Nakakubo, Sho; Makizako, Hyuma; Doi, Takehiko; Tsutsumimoto, Kota; Lee, Sangyoon; Lee, Sungchul; Hotta, Ryo; Bae, Seongryu; Suzuki, Takao; Shimada, Hiroyuki

2017-11-01

The purpose of the present study was to examine whether the combination of subjective sleep quality and physical activity is associated with cognitive performance among community-dwelling older adults. Cross-sectional data on 5381 older adults who participated in part of the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes were analyzed. We assessed general cognitive impairment using the Mini-Mental State Examination, and also assessed story memory, attention, executive function and processing speed using the National Center for Geriatrics and Gerontology Functional Assessment Tool. Physical activity was assessed using two questionnaires, and participants were categorized as active or inactive. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and participants were categorized as having poor (PS) or good sleep quality (GS). Participants in the inactive + PS group had worse performances than those in the active + GS group in all cognitive measures (Mini-Mental State Examination: P = 0.008, story memory: P = 0.007, other cognitive measures: P performances than those in the inactive + GS and active + PS groups in the trail-making test, part B, and the symbol digit substitution test (P performances than in the active + GS in the trail-making test, part B, and the symbol digit substitution test (P = 0.002 and P = 0.001, respectively). Inactivity and poor sleep quality were associated with poor cognitive performance among community-dwelling older adults. The combination of poor sleep quality and physical inactivity also worsened cognitive performance. Geriatr Gerontol Int 2017; 17: 1823-1828. © 2017 Japan Geriatrics Society.

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

Science.gov (United States)

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

Science.gov (United States)

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.

Science.gov (United States)

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

Directory of Open Access Journals (Sweden)

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

PROVIDING QUALITY – A KEY TO SUCCESS

OpenAIRE

Oana Staiculescu; Angel-Cristian Staiculescu

2012-01-01

Providing a high quality products and services is a key to business success. That is because high quality promotes customer satisfaction and customer satisfaction has a direct link to business revenue. Clients want quality products and services in order to feel they are getting value for money, especially in these hard economic times. Although it is well known that advertising may win new customers, quality can be the reason to keep them. A good manager is aware that the costs of winning mark...

Anchorage strategies in geriatric hip fracture management

Directory of Open Access Journals (Sweden)

Knobe Matthias

2016-12-01

Full Text Available There is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation in often-osteoporotic bone as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender and surgeon-related factors (experience, correct reduction, and optimal screw placement in the head/neck fragment. For fracture fixation, the anchorage of the lag screw within the femoral head plays a crucial role depending on the implant’s design. Meta-analyses and randomized controlled studies demonstrate that there is a strong trend towards arthroplasty treating geriatric femoral neck fractures. However, for young adults as well as older patients with less compromised bone quality, or in undisplaced fractures, head-preserving therapy is preferred as it is less invasive and associated with good functional results. This review summarizes the evidence for the internal fixation of femoral neck fractures and trochanteric femoral fractures in elderly patients. In addition, biomechanical considerations regarding implant anchorage in the femoral head including rotation, migration, and femoral neck shortening are made. Finally, cement augmentation strategies for hip fracture implants are evaluated critically.

[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.

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

Science.gov (United States)

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.

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...

Healthcare quality management in Switzerland--a survey among providers.

Science.gov (United States)

Kaderli, Reto; Pfortmueller, Carmen A; Businger, Adrian P

2012-04-27

In the last decade assessing the quality of healthcare has become increasingly important across the world. Switzerland lacks a detailed overview of how quality management is implemented and of its effects on medical procedures and patients' concerns. This study aimed to examine the systematics of quality management in Switzerland by assessing the providers and collected parameters of current quality initiatives. In summer 2011 we contacted all of the medical societies in Switzerland, the Federal Office of Public Health, the Swiss Medical Association (FMH) and the head of Swiss medical insurance providers, to obtain detailed information on current quality initiatives. All quality initiatives featuring standardised parameter assessment were included. Of the current 45 initiatives, 19 were powered by medical societies, five by hospitals, 11 by non-medical societies, two by the government, two by insurance companies or related institutions and six by unspecified institutions. In all, 24 medical registers, five seals of quality, five circles of quality, two self-assessment tools, seven superior entities, one checklist and one combined project existed. The cost of treatment was evaluated by four initiatives. A data report was released by 24 quality initiatives. The wide variety and the large number of 45 recorded quality initiatives provides a promising basis for effective healthcare quality management in Switzerland. However, an independent national supervisory authority should be appointed to provide an effective review of all quality initiatives and their transparency and coordination.

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

Science.gov (United States)

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.

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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

Directory of Open Access Journals (Sweden)

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.

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.

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.

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; 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].

Science.gov (United States)

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.

Science.gov (United States)

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.

Prognostic Value of Geriatric Conditions Beyond Age After Acute Coronary Syndrome.

Science.gov (United States)

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

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

Science.gov (United States)

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.

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.

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.

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.

[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

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

Directory of Open Access Journals (Sweden)

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

Evaluating Problems With Footwear in the Geriatric Population.

Science.gov (United States)

Ikpeze, Tochukwu C; Omar, Adan; Elfar, John H

2015-12-01

Foot pathologies are common in nearly 80% of all elderly patients, and studies have indicated inappropriate footwear as one of the major underlying cause. It has been postulated that ill-fitting shoe wear affects plantar pressure, thus exacerbating weak balance. Complications arising from foot pathologies, which include difficulty in maintaining balance, have increased the risk of falls that can result in fractures and other serious injuries. The link between footwear and the onset or progression of certain foot pathologies has emphasized the need to explore and promote preventative measures to combat the issue. Wider and higher toe boxed shoes, along with sneakers, are examples of footwear documented to evenly distribute plantar pressure, increase comfort, and facilitate appropriate balance and gait. Ultimately, the use of appropriate footwear can help to better stabilize the foot, thus reducing the risk of sustaining debilitating physical injuries known to drastically decrease the quality of life among the geriatric population.

Xerostomia in the Geriatric Patient: Causes, Oral Manifestations, and Treatment.

Science.gov (United States)

Ouanounou, Aviv

2016-05-01

Xerostomia, or dry mouth, is common among elderly people and is typically associated with decreased salivary gland function. Causes of xerostomia in the geriatric population have been attributed to the use of medications, chronic disorders, and radiation therapy to the head and neck region. Patients with chronic xerostomia may have multiple oral and dental consequences such as dental caries, periodontal disease, fungal infections, ill-fitting dentures, and taste alterations. Xerostomia can seriously impact quality of life and may alter speech, eating, and swallowing. Current therapeutics for the management of xerostomia are grouped as local and systemic salivary stimulation. This article reviews the main reasons for xerostomia and the complications it causes in the oral cavity. It also discusses the pharmacologic and nonpharmacologic agents used to treat this condition.

Quality of services and quality of life from service providers' perspectives: analysis with focus groups.

Science.gov (United States)

Jenaro, C; Vega, V; Flores, N; Cruz, M

2013-06-01

Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this population. The current study aims to identify service providers' perceptions regarding the quality of life of their clients and the quality of services they provide. It also aims to identify similarities and differences of appraisals among professionals, and to identify associations between supports, quality of life and quality of services. Data were collected from 22 service providers who attended three focus groups (professionals, direct support staff, and managers) from whom 424 comments were analysed. Service providers were asked about the required support for users, the meaning of quality of life for those users, and about features that should characterise quality services. Thematic analysis was employed and transcripts of the sessions were coded according to the dimensions of models on supports, quality of life and quality of services. Chi-squared tests were utilised to test for potential differences among groups. Each professional group has its own priorities concerning required supports. Among the organisation different and potentially conflicting perceptions regarding the meaning of experiencing quality of life coexist. Concerning quality of services, only managers mentioned personal outcomes. Finally, institutionalisation has a negative impact on supports, quality of life and quality of services. It is necessary to move beyond a shared awareness of the negative impact of institutionalisation towards the transformation of services in search of personal quality outcomes. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

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.

Prevalence and predictors of depression and anxiety among the elderly population living in geriatric homes in Cairo, Egypt.

Science.gov (United States)

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.

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 ...

[Presbyastasis and application of vestibular rehabilitation in geriatrics].

Science.gov (United States)

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.

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...

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.

Animal assisted therapy and perception of loneliness in geriatric nursing home residents.

Science.gov (United States)

Vrbanac, Zoran; Zecević, Iva; Ljubić, Marijana; Belić, Maja; Stanin, Damir; Bottegaro, Nika Brkljaca; Jurkić, Gabrijela; Skrlin, Branimir; Bedrica, Ljiljana; Zubcić, Damir

2013-09-01

Use of animals for therapeutic purposes, animal assisted therapy or AAT is a method for improving quality of life for long-term inpatients. The object of this paper was to evaluate dog companionship as a form of AAT and its effects on perception of loneliness in geriatric nursing home residents. The participants were involved in a six-month program of dog companionship three times weekly for 90 minutes. There were 21 residents included in the program, with a mean age of 80 years. Loneliness was measured by the short version of the UCLA Scale of loneliness. Comparison of test results before and after participation in the program showed that dog companionship reduces the perception of loneliness.

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

Directory of Open Access Journals (Sweden)

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

Quality of care in one Italian nursing home measured by ACOVE process indicators.

Directory of Open Access Journals (Sweden)

Claudia Pileggi

Full Text Available To adapt the Assessing Care of Vulnerable Elders Quality Indicators (ACOVE QIs for use in Italy, to assess the adherence to these indicators as reported in the medical records of residents in a nursing home (NH, to compare this adherence for general medical and geriatric conditions, and eventually, to identify the relationships between patients' characteristics and reported processes of care.Two physicians collected the data by reviewing medical records of all NH residents in the previous 5 years, for a period of one year. Patients aged <65 years were excluded. A total of 245 patients were reviewed during the study period. The ACOVE QIs set, developed for NH processes of care, was used to assess the quality of care. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on quality of processes of care by several domains of care in general medical and geriatric conditions.With the exception of diabetes management, quality of processes of care for general medical conditions approached adequate adherence. Care falls substantially short of acceptable levels for geriatric conditions (pressure ulcers, falls, dementia. On the contrary, the recommended interventions for urinary incontinence were commonly performed. Adherence to indicators varied for the different domains of care and was proven worse for the screening and prevention indicators both for geriatric and general medical conditions. Statistical analysis showed disparities in provision of appropriate processes of care associated with gender, age, co-morbidities, level of function and mobility, length of stay and modality of discharge by NHs.Adherence to recommended processes of care delivered in NH is inadequate. Substantial work lies ahead for the improvement of care. Efforts should focus particularly on management of geriatric conditions and on preventive healthcare.

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.

Prevalence of oral soft tissue lesions and medical assessment of geriatric outpatients in North India

Directory of Open Access Journals (Sweden)

Sameer Rastogi

2015-01-01

Full Text Available Introduction: Oral health reflects overall well-being for the elderly population. Compromised oral health may be a risk factor for systemic diseases commonly occurring in old age. Oral health evaluation should be an integral part of the physical examination, and dentistry is essential to qualify geriatric patient care. Aim: To determine the prevalence of oral soft tissue lesions and systemic diseases in institutionalized geriatric population in North India. Materials and Methods: Geriatric patients were clinically evaluated using a standard questionnaire and assessed for known medical illnesses and prevalence of oral soft tissue lesions. Four hundred patients (71% males and 29% females with age ranging from 60 to 100 years were considered in the study group. Twenty-two (33.8% patients were edentulous and seven patients (10.8% were denture wearers. Forty-four (67.69% patients reported with tobacco habits. Results: Most prevalent medical illness reported was diminished vision (15.5%, followed by hypertension (10% and diabetes mellitus (6.25%. Several oral soft tissue lesions were reported among the study population. The most prevalent lesions were leukoplakia (12%, smoker′s melanosis (10%, smoker′s palate (9%, pigmentation on tongue (6%, frictional keratosis (5%, lichen planus (3%, denture stomatitis (2.5%, aphthous ulcers (2%, angular chelitis (1.5%, oral submucous fibrosis (1.5%, melanotic macule (1.5%, candidiasis (1.5%, irritation fibroma (1%, geographic tongue (1%, median rhomboid glossitis (1%, and traumatic ulcer (1%. Conclusion: The findings observed in this population are important and can have a determinant effect on the overall quality of life in this population. This information is a crucial prerequisite for health awareness programs involving the community health workers, oral physicians, and medical professionals.

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

Quality Perception within Corporate E-Learning Providers in Catalonia

Science.gov (United States)

Sangra, Albert; Fernandez-Michels, Pedro

2011-01-01

Purpose: The paper seeks to describe the Catalan corporate e-learning providers from the perspective of quality perception, quality assessment and quality control. Design/methodology/approach: A literature review reveals key aspects of the definition of quality in e-learning. The results of the review constitute the basis for exploratory research…

Geriatric study in Europe on health effects of air quality in nursing homes (GERIE study) profile: objectives, study protocol and descriptive data.

Science.gov (United States)

Annesi-Maesano, Isabella; Norback, Dan; Zielinski, Jan; Bernard, Alfred; Gratziou, Cristina; Sigsgaard, Torben; Sestini, Piersante; Viegi, Giovanni

2013-11-21

Indoor air pollution (IAP) constitutes a major global public health problem requiring increasing efforts in research and policymaking that may have special significance for elderly that are likely to spend most of their day indoors and appear to be particularly susceptible to adverse effects of chemical pollutants and bio-contaminants. Yet, evidence existing on the effects of IAP in elderly is scanty. The Geriatric study in Europe on health effects of air quality in nursing homes (GERIE) study aimed to assess health effects of major indoor air pollutants and thermal conditions in elderly (> 70 years) living stably in nursing homes (NH) across Europe. Respiratory effects were particularly considered as airways and lung constitute the first target of air pollutants. We describe here the rationale and the methods of the GERIE Study. 8 nursing homes were randomly selected in 7 European countries. Twenty individuals were randomly selected in each nursing home. Major indoor and outdoor air chemical pollutants (PM10, PM2.5, PM0.1, formaldehyde, NO2; O3, VOC, CO2) and bio-contaminants (moulds, allergens) were assessed objectively with standardized procedures. Major health status indicators were assessed through a standardized questionnaire, non-invasive clinical tests and blood and urine biomarkers as well as saliva for ADN. The GERIE study has given the opportunity to publish two reviews on respiratory health effects of indoor and outdoor air pollution in elderly. In addition it has provided the inventory of air quality and thermal conditions in 50 nursing homes across Europe and data on respiratory health status in 600 elderly aged 82 years in mean. Major future results will include the relationships between NH environment and health in elderly. The main long-term purpose of the GERIE study is to improve the health of elderly who permanently reside in nursing homes or of those who are exposed to indoor air pollution because of reduced mobility.

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

Association between dental prosthesis need, nutritional status and quality of life of elderly subjects

DEFF Research Database (Denmark)

Pillai, Rajath; Mathur, Vijay Prakash; Jain, Veena

2015-01-01

clinic were recruited in the study. Mini-nutritional assessment (MNA), geriatric oral health assessment (GOHAI) indices, prosthesis need according to WHO criteria, and prosthesis want was recorded along with age, gender, socioeconomic status and posterior occluding pair. RESULTS: Significant associations......To determine the effect of prosthesis need on nutritional status and oral health-related quality of life (OHrQoL) in elderly and to check the disparity between prosthesis need and prosthesis want in the Indian elderly. METHODS: A total of 946 geriatric participants reporting to a geriatric medicine...

Grip strength as a frailty diagnostic component in geriatric inpatients

Directory of Open Access Journals (Sweden)

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

Science.gov (United States)

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…

Controlling urinary tract infections associated with intermittent bladder catheterization in geriatric hospitals.

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Comprehensive geriatric assessment for older adults admitted to hospital.

Science.gov (United States)

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

2011-07-06

Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up. We sought to evaluate the effectiveness of CGA in hospital for older adults admitted as an emergency. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL and AARP Ageline, and handsearched high-yield journals. We searched for randomised controlled trials comparing CGA (whether by mobile teams or in designated wards) to usual care. Two review authors initially assessed eligibility and trial quality and extracted published data. Twenty-two trials evaluating 10,315 participants in six countries were identified. Patients in receipt of CGA were more likely to be alive and in their own homes at up to six months (OR 1.25, 95% CI 1.11 to 1.42, P = 0.0002) and at the end of scheduled follow up (median 12 months) (OR 1.16, 95% CI 1.05 to 1.28, P = 0.003) when compared to general medical care. In addition, patients were less likely to be institutionalised (OR 0.79, 95% CI 0.69 to 0.88, P P = 0.001), and were more likely to experience improved cognition in the CGA group (OR 1.11, 95% CI 0.20 to 2.01, P = 0.02). Subgroup interaction in the primary outcomes suggests that the effects of CGA are primarily the result of CGA wards. Comprehensive geriatric assessment increases a patient's likelihood of being alive and in their own home at up to 12 months.

Polypharmacy as a risk for fall occurrence in geriatric outpatients.

Science.gov (United States)

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.

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.

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

Science.gov (United States)

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.

40 CFR 81.31 - Metropolitan Providence Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... Quality Control Region. 81.31 Section 81.31 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.31 Metropolitan Providence Interstate Air Quality Control Region. The Metropolitan Providence Interstate Air Quality Control Region (Rhode Island-Massachusetts) consists of the...

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

Science.gov (United States)

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.

Do public nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

Science.gov (United States)

Winblad, Ulrika; Blomqvist, Paula; Karlsson, Andreas

2017-07-14

Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier

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

Science.gov (United States)

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.

Falls and Fall-Prevention in Older Persons: Geriatrics Meets Spaceflight!

Science.gov (United States)

Goswami, Nandu

2017-01-01

This paper provides a general overview of key physiological consequences of microgravity experienced during spaceflight and of important parallels and connections to the physiology of aging. Microgravity during spaceflight influences cardiovascular function, cerebral autoregulation, musculoskeletal, and sensorimotor system performance. A great deal of research has been carried out to understand these influences and to provide countermeasures to reduce the observed negative consequences of microgravity on physiological function. Such research can inform and be informed by research related to physiological changes and the deterioration of physiological function due to aging. For example, head-down bedrest is used as a model to study effects of spaceflight deconditioning due to reduced gravity. As hospitalized older persons spend up to 80% of their time in bed, the deconditioning effects of bedrest confinement on physiological functions and parallels with spaceflight deconditioning can be exploited to understand and combat both variations of deconditioning. Deconditioning due to bed confinement in older persons can contribute to a downward spiral of increasing frailty, orthostatic intolerance, falls, and fall-related injury. As astronauts in space spend substantial amounts of time carrying out exercise training to counteract the microgravity-induced deconditioning and to counteract orthostatic intolerance on return to Earth, it is logical to suggest some of these interventions for bed-confined older persons. Synthesizing knowledge regarding deconditioning due to reduced gravitational stress in space and deconditioning during bed confinement allows for a more comprehensive approach that can incorporate aspects such as (mal-) nutrition, muscle strength and function, cardiovascular (de-) conditioning, and cardio-postural interactions. The impact of such integration can provide new insights and lead to methods of value for both space medicine and geriatrics (Geriatrics

Evaluation of chronic stress indicators in geriatric and oncologic caregivers: a cross-sectional study.

Science.gov (United States)

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.

Understanding implementation of comprehensive geriatric care programs: a multiple perspective approach is preferred

OpenAIRE

Vos, J.B.M.; Cramm, Jane; Wijngaarden, Jeroen; Bakker, Ton; Mackenbach, Johan; Nieboer, Anna

2017-01-01

Summary Background The Prevention and Reactivation Care Program (PReCaP) provides a novel approach targeting hospital‐related functional decline among elderly patients. Despite the high expectations, the PReCaP was not effective in preventing functional decline (ADL and iADL) among older patients. Although elderly PReCaP patients demonstrated slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2–0.6]), lower depression (Geriatric Depressio...

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 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

Directory of Open Access Journals (Sweden)

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.

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.

Comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination to prevent functional decline in community-dwelling older persons: protocol of a cluster randomized trial

Directory of Open Access Journals (Sweden)

Suijker Jacqueline J

2012-04-01

Full Text Available Abstract Background Functional decline in community-dwelling older persons is associated with the loss of independence, the need for hospital and nursing-home care and premature death. The effectiveness of multifactorial interventions in preventing functional decline remains controversial. The aim of this study is to investigate whether functional decline in community-dwelling older persons can be delayed or prevented by a comprehensive geriatric assessment, multifactorial interventions and nurse-led care coordination. Methods/Design In a cluster randomized controlled trial, with the general practice as the unit of randomization, 1281 participants from 25 general practices will be enrolled in each condition to compare the intervention with usual care. The intervention will focus on older persons who are at increased risk for functional decline, identified by an Identification of Seniors at Risk Primary Care (ISAR-PC score (≥ 2. These older persons will receive a comprehensive geriatric assessment, an individually tailored care and treatment plan, consisting of multifactorial, evidence-based interventions and subsequent nurse-led care coordination. The control group will receive 'care as usual' by the general practitioner (GP. The main outcome after 12 months is the level of physical functioning on the modified Katz-15 index score. The secondary outcomes are health-related quality of life, psychological and social functioning, healthcare utilization and institutionalization. Furthermore, a process evaluation and cost-effectiveness analysis will be performed. Discussion This study will provide new knowledge regarding the effectiveness and feasibility of a comprehensive geriatric assessment, multifactorial interventions and nurse-led elderly care in general practice. Trial registration NTR2653 Grant Unrestricted grant 'The Netherlands Organisation for Health Research and development' no 313020201

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

The American Geriatrics Society/National Institute on Aging Bedside-to-Bench Conference: Research Agenda on Delirium in Older Adults

Science.gov (United States)

Mikhailovich, Anna

2015-01-01

The American Geriatrics Society, with support from the National Institute on Aging and the John A. Hartford Foundation, held its seventh Bedside-to-Bench research conference, entitled “Delirium in Older Adults: Finding Order in the Disorder” on February 9–11, 2014, to provide participants with opportunities to learn about cutting-edge research developments, draft recommendations for future research involving translational efforts, and opportunities to network with colleagues and leaders in the field. This meeting was the first of three conferences that will address delirium, sleep disorders, and voiding difficulties and urinary incontinence, emphasizing, whenever possible, the relationships and potentially shared clinical and pathophysiological features between these common geriatric syndromes. PMID:25834932

Lower urinary tract symptoms and urinary incontinence in a geriatric cohort - a population-based analysis.

Science.gov (United States)

Wehrberger, Clemens; Madersbacher, Stephan; Jungwirth, Susanne; Fischer, Peter; Tragl, Karl-Heinz

2012-11-01

To assess prevalence and severity of lower urinary tract function in 85-year-old men and women. Little is known on the prevalence of lower urinary tract dysfunction in this geriatric age group, which is now the fastest growing sector of the population worldwide. The Vienna Trans-Danube Aging study (VITA) is a longitudinal, population-based study initiated in 2000 that included men/women aged 75 years living in a well-defined area in Vienna. The main purpose of the VITA study was to identify risk factors for incident Alzheimer's disease. All study participants alive in 2010 were contacted by mail to complete a detailed questionnaire on various aspects of lower urinary tract symptoms (LUTS) and urinary incontinence (UI). The response rate was 68%, resulting in a total of 262 questionnaires available for analysis (men n= 96; women n= 166). All study participants were 85 years of age. Urinary incontinence defined as any involuntary loss during the past 4 weeks was reported by 24% of men and 35% of women (P= 0.04). Stress UI was more frequent in women (39%) than in men (14%, P 0.05). Nocturia more often than twice was more prevalent in men (69%) than in women (49%) (P= 0.02). Overactive bladder, according to International Continence Society criteria, was present in 55% of women and 50% of men. No difference regarding quality of life impairment as the result of LUTS and UI was noticed between sexes. A few co-morbidities were identified to correlate with UI and storage symptoms. These data provide insights into the prevalence and severity of LUTS and UI in individuals in their eighties, to our knowledge the largest population-based study in this age group. Demographic changes in upcoming decades underline the importance of a thorough understanding of lower urinary tract dysfunction in a geriatric population. © 2012 BJU INTERNATIONAL.

Results of Screening of Apparently Healthy Senior and Geriatric Dogs.

Science.gov (United States)

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

Directory of Open Access Journals (Sweden)

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.

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.

Science.gov (United States)

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.

Making the CARE Comprehensive Geriatric Assessment as the Core of a Total Mobile Long Term Care Support System in China.

Science.gov (United States)

Cui, Yanyan; Gong, Dongwei; Yang, Bo; Chen, Hua; Tu, Ming-Hsiang; Zhang, Chaonan; Li, Huan; Liang, Naiwen; Jiang, Liping; Chang, Polun

2018-01-01

Comprehensive Geriatric Assessments (CGAs) have been recommended to be used for better monitoring the health status of elder residents and providing quality care. This study reported how our nurses perceived the usability of CGA component of a mobile integrated-care long term care support system developed in China. We used the Continuity Assessment Record and Evaluation (CARE), developed in the US, as the core CGA component of our Android-based support system, in which apps were designed for all key stakeholders for delivering quality long term care. A convenience sample of 18 subjects from local long term care facilities in Shanghai, China were invited to assess the CGA assessment component in terms of Technology Acceptance Model for Mobile based on real field trial assessment. All (100%) were satisfied with the mobile CGA component. 88.9% perceived the system was easy to learn and use. 99.4% showed their willingness to use for their work. We concluded it is technically feasible to implement a CGA-based mobile integrated care support system in China.

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…

Screening and detection of elder abuse: Research opportunities and lessons learned from emergency geriatric care, intimate partner violence, and child abuse.

Science.gov (United States)

Beach, Scott R; Carpenter, Christopher R; Rosen, Tony; Sharps, Phyllis; Gelles, Richard

2016-01-01

This article provides an overview of elder abuse screening and detection methods for community-dwelling and institutionalized older adults, including general issues and challenges for the field. Then, discussions of applications in emergency geriatric care, intimate partner violence (IPV), and child abuse are presented to inform research opportunities in elder abuse screening. The article provides descriptions of emerging screening and detection methods and technologies from the emergency geriatric care and IPV fields. We also discuss the variety of potential barriers to effective screening and detection from the viewpoint of the older adult, caregivers, providers, and the health care system, and we highlight the potential harms and unintended negative consequences of increased screening and mandatory reporting. We argue that research should continue on the development of valid screening methods and tools, but that studies of perceived barriers and potential harms of elder abuse screening among key stakeholders should also be conducted.

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

Directory of Open Access Journals (Sweden)

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

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.

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.

Provide good air quality for people and improve their productivity

DEFF Research Database (Denmark)

Fanger, Povl Ole

2000-01-01

Three recent independent studies have documented that the quality of indoor air has a significant and positive influence on the productivity of office workers. A combined analysis of the results of the three studies shows a significant relationship between productivity and perceived indoor air...... quality. The impact on productivity justifies a much higher indoor air quality than the minimum levels prescribed in present standards and guidelines. One way of providing air of high quality for people to breathe, without involving excessive ventilation rates and energy use, is to provide "personalized...... air" to each individual. The application of this concept is discussed....

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.

Provider category and quality of care in the Norwegian nursing home industry

Directory of Open Access Journals (Sweden)

Astri Drange Hole

2016-02-01

Full Text Available This paper examines empirically if there is a link between quality of care in the Norwegian nursing home industry and exposure of the industry to competition. Exposing public care to competition implies that the responsibility for providing care services is shared between public authorities and private actors. In Norway, exposure to competition means tender competition. Suppliers bid for a contract issued by the Norwegian authorities for a limited number of years. Quality of care in an institution is the major competitive factor. The provider categories of elderly care are: 1 care provided by institutions run by municipalities, 2 care provided by institutions run by private companies, which have won a tender competition, 3 care provided by institutions run by private companies owned by private families, voluntary religious or idealistic organizations. Nurse-to-patient ratio is used as a proxy for quality of care. The regression analysis indicates a relationship between quality of care and exposure to competition. The quality of care in provider category 2 is significantly lower than in provider category 1, but there are more variations in the quality of care in provider category 1 than in provider category 2. We find the lowest quality of care in provider category 1. There is also a relationship between the quality of care in an institution and the educational level of the staff, the location, the workforce, and the size of an institution. Finally, there is a relationship between the quality of care in an institution and the real and the required capacity, and the financial status in a region.

Plan–Provider Integration, Premiums, and Quality in the Medicare Advantage Market

Science.gov (United States)

Frakt, Austin B; Pizer, Steven D; Feldman, Roger

2013-01-01

Objective. To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. Data Source. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. Study Design. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan–provider integration. Data Collection. With the exception of Medigap premium data, all data were publicly available. We ascertained plan–provider integration through examination of plans’ websites and governance documents. Principal Findings. We found that integrated plan–providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Conclusions. Current policy encourages plan–provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). PMID:23800017

Plan-provider integration, premiums, and quality in the Medicare Advantage market.

Science.gov (United States)

Frakt, Austin B; Pizer, Steven D; Feldman, Roger

2013-12-01

To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration. With the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents. We found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Current policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). © Health Research and Educational Trust.

[Some problems of modern gerontology and geriatrics in the Russian Federation: the sight of the clinical physician].

Science.gov (United States)

Miakotnykh, V S

2012-01-01

This article presents some problems of modern Russian gerontology and geriatrics by eyes of the scientist--the clinical physician having long-term experience in the field. Educational, scientific, practical aspects of gerontology and those stereotypes of understanding of problems of elderly which developed for years are subjected the certain criticism, decades, but in the modern world any more absolutely correspond to a today's reality. It is offered to transform the ideology of the major directions of gerontology, having put at the head of a corner not ideas of prolongation of life as that and carrying out basically actions in relation to seriously ill, but improvements of quality of life, preventive maintenance and treatment of set of the age-related diseases, overcoming of the developed practice of the relation to elderly and senile patients as to persons dependent and demanding the constant help. The author urges the public health governing bodies to reconsider the norms of the geriatric help existing for many years but not meeting modern requirements in the conditions of polyclinic and a hospital and to make more clear and claimed by a society the possibilities and achievements of gerontology.

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…

Evaluation of patients ' satisfaction with quality of care provided at ...

African Journals Online (AJOL)

Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. Objective: This study was aimed at evaluating patientsf satisfaction with quality of care provided ...

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...

Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability.

Science.gov (United States)

Adkar, Shaunak S; Turley, Ryan S; Benrashid, Ehsan; Lagoo, Sandhya; Shortell, Cynthia K; Mureebe, Leila

2017-01-01

The initiation of bundled payment for care improvement by Centers for Medicare and Medicaid Services (CMS) has led to increased financial and performance accountability. As most vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multidisciplinary pathway for the elderly vascular patients, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity bypass (LEB). The 2011-2013 LEB-targeted American College of Surgeons National Surgical Quality Improvement Program database was used for this analysis (n = 5316). Patients were stratified by age <65 (n = 2171), 65-74 (n = 1858), 75-84 (n = 1190), and ≥85 (n = 394) years. Comparisons of patient- and procedure-related characteristics and 30-day postoperative outcomes stratified by age groups were performed with Pearson χ 2 tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. During the study period, 5316 total patients were identified. There were 2171 patients aged <65 years, 1858 patients in the 65-74 years age group, 1190 patients in the 75-84 years age group, and 394 patients in the ≥85 years age group. Increasing age was associated with an increased frequency of cardiopulmonary disease (P < 0.001) and a decreased frequency of diabetes, tobacco use, and prior surgical intervention (P < 0.001). Only 79% and 68% of all patients were on antiplatelet and statin therapies, respectively. Critical limb ischemia occurred more frequently in older patients (P < 0.001). Length of hospital stay, transfusion requirements, and discharge to a skilled nursing facility increased with age (P < 0.001). Thirty-day amputation rates did not differ significantly with age (P = 0.12). Geriatric patients undergoing LEB have unique and potentially modifiable perioperative factors that may improve postoperative outcomes. These

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

Science.gov (United States)

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

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…

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

Science.gov (United States)

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

Gateway to Quality: Online Professional Development for Family Childcare Providers

Science.gov (United States)

Durden, Tonia; Mincemoyer, Claudia; Crandall, Leslie; Alviz, Kit; Garcia, Aileen

2016-01-01

High-quality family childcare (FCC) can positively influence all areas of a child's growth and development. Thus, it is important to invest in efforts to increase quality, including providing professional development to enhance the skills of those caring for children in their homes. This study explores the characteristics of FCC providers who…

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

Science.gov (United States)

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

Directory of Open Access Journals (Sweden)

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

[Gerocomy -- gerontology -- geriatrics. The naming of a modern medical discipline].

Science.gov (United States)

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.

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

Science.gov (United States)

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.

Science.gov (United States)

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.

A clinical study of geriatric dermatoses

Directory of Open Access Journals (Sweden)

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

Directory of Open Access Journals (Sweden)

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

Science.gov (United States)

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.

The Making of Careers, the Making of a Discipline: Luck and Chance in Migrant Careers in Geriatric Medicine

Science.gov (United States)

Bornat, Joanna; Henry, Leroi; Raghuram, Parvati

2011-01-01

The geriatric specialty, unpopular among most UK born and trained medical graduates, provided an opportunity for career development and achievement for those doctors whose training had been non-standard for a variety of reasons. Migrant doctors who have played a substantive role in the UK National Health Service since its inception made an…

Successful cardiopulmonary resuscitation following cardiopulmonary arrest in a geriatric chinchilla.

Science.gov (United States)

Fernandez, Christina M; Peyton, Jamie L; Miller, Mona; Johnson, Eric G; Kovacic, Jan P

2013-01-01

To describe the successful application of CPR in a geriatric chinchilla employing basic and advanced life support measures during cardiopulmonary arrest (CPA). A 13-year-old female intact chinchilla presented to a general and multispecialty referral hospital for a dental procedure. During recovery from anesthesia the patient suffered CPA and CPR was initiated. Noninvasive positive pressure mask ventilation was initiated and external chest compressions were performed. An 18-Ga needle was introduced into the medullary cavity of the right humerus as an intraosseous catheter and provided access for administration of drugs and fluids. After return of spontaneous circulation was noted mannitol was administered via the intraosseous catheter to alleviate suspected increased intracranial pressure. Clinical improvement was noted shortly after administration. Monitoring during the recovery period showed a normal sinus cardiac rhythm and a SpO₂ of 100% while on supplemental oxygen. Neurologic function continued to improve over the following hours. Oxygen therapy was provided via an oxygen cage, and administration of antimicirobials, gastrointestinal protectants, and nutritional supplementation were part of the post resuscitation care. Oxygen therapy was discontinued after 24 hours, during which time normal behaviors were observed and neurologic status was considered appropriate. The patient was discharged 48 hours after CPA. Published reports from clinical practice on the outcomes of CPR for exotic small mammals are limited. This report details the successful outcome of the use of combined basic and advanced life support measures for the provision of CPR in a chinchilla. This report also highlights the utility of an intraosseous catheter for administration of drugs and fluids novel to this species during resuscitation and recovery. To the authors' knowledge this is the first published report of successful CPR following CPA in a geriatric chinchilla. © Veterinary Emergency

Evaluation of awake burr hole drainage for chronic subdural hematoma in geriatric patients: a retrospective analysis of 3 years

Directory of Open Access Journals (Sweden)

Serdal Albayrak

2016-03-01

Conclusion: Surgical interventions under local anesthesia in geriatric patients with chronic subdural hematoma can provide short operation time, early mobilization, early oral intake, avoidance of possible general anesthesia complications. Herewith, this intervention decrease mortality and morbidity in this age group. [Cukurova Med J 2016; 41(1.000: 69-73

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

OpenAIRE

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)].

Science.gov (United States)

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.

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

Falls and Fall-Prevention in Older Persons: Geriatrics Meets Spaceflight!

Directory of Open Access Journals (Sweden)

Nandu Goswami

2017-10-01

Full Text Available This paper provides a general overview of key physiological consequences of microgravity experienced during spaceflight and of important parallels and connections to the physiology of aging. Microgravity during spaceflight influences cardiovascular function, cerebral autoregulation, musculoskeletal, and sensorimotor system performance. A great deal of research has been carried out to understand these influences and to provide countermeasures to reduce the observed negative consequences of microgravity on physiological function. Such research can inform and be informed by research related to physiological changes and the deterioration of physiological function due to aging. For example, head-down bedrest is used as a model to study effects of spaceflight deconditioning due to reduced gravity. As hospitalized older persons spend up to 80% of their time in bed, the deconditioning effects of bedrest confinement on physiological functions and parallels with spaceflight deconditioning can be exploited to understand and combat both variations of deconditioning. Deconditioning due to bed confinement in older persons can contribute to a downward spiral of increasing frailty, orthostatic intolerance, falls, and fall-related injury. As astronauts in space spend substantial amounts of time carrying out exercise training to counteract the microgravity-induced deconditioning and to counteract orthostatic intolerance on return to Earth, it is logical to suggest some of these interventions for bed-confined older persons. Synthesizing knowledge regarding deconditioning due to reduced gravitational stress in space and deconditioning during bed confinement allows for a more comprehensive approach that can incorporate aspects such as (mal- nutrition, muscle strength and function, cardiovascular (de- conditioning, and cardio-postural interactions. The impact of such integration can provide new insights and lead to methods of value for both space medicine and

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

Science.gov (United States)

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.

Quality improvement in neurology: dementia management quality measures.

Science.gov (United States)

Odenheimer, Germaine; Borson, Soo; Sanders, Amy E; Swain-Eng, Rebecca J; Kyomen, Helen H; Tierney, Samantha; Gitlin, Laura; Forciea, Mary Ann; Absher, John; Shega, Joseph; Johnson, Jerry

2014-03-01

Professional and advocacy organizations have long urged that dementia should be recognized and properly diagnosed. With the passage of the National Alzheimer's Project Act in 2011, an Advisory Council for Alzheimer's Research, Care, and Services was convened to advise the Department of Health and Human Services. In May 2012, the Council produced the first National Plan to address Alzheimer's disease, and prominent in its recommendations is a call for quality measures suitable for evaluating and tracking dementia care in clinical settings. Although other efforts have been made to set dementia care quality standards, such as those pioneered by RAND in its series Assessing Care of Vulnerable Elders (ACOVE), practitioners, healthcare systems, and insurers have not widely embraced implementation. This executive summary (full manuscript available at www.neurology.org) reports on a new measurement set for dementia management developed by an interdisciplinary Dementia Measures Work Group (DWG) representing the major national organizations and advocacy organizations concerned with the care of individuals with dementia. The American Academy of Neurology (AAN), the American Geriatrics Society, the American Medical Directors Association, the American Psychiatric Association, and the American Medical Association-convened Physician Consortium for Performance Improvement led this effort. The ACOVE measures and the measurement set described here apply to individuals whose dementia has already been identified and properly diagnosed. Although similar in concept to ACOVE, the DWG measurement set differs in several important ways; it includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care before the advanced stages of illness, and provides evidence-based support

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

Pharmaceutical interventions by collaboration between staff pharmacists and clinical pharmacists and implementation of Joint Commission International Accreditation Standards on medication use may optimize pharmacotherapy in geriatric patients

Directory of Open Access Journals (Sweden)

Chen M

2016-11-01

Full Text Available Meng Chen, Quan Zhou Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaWe read with great interest the prospective study by Cortejoso et al,1 which describes the characteristics of pharmaceutical interventions in two geriatric wards (orthogeriatric ward and geriatric day unit of a general teaching hospital. We strongly agree with their finding that shows the importance of clinical pharmacist involvement in the optimization of pharmacotherapy in elderly patients. Furthermore, we especially appreciate their new and interesting findings that the clinical pharmacist was more frequently requested by physicians and nurses for information about the pharmacotherapy of the patients on the geriatric day unit, compared with the orthogeriatric ward at admission and discharge (5.7% vs 1.2% and 1.7%, respectively, P<0.05, and that the pharmacist asked for more confirmation of the physician orders on the geriatric day unit rather than the orthogeriatric ward (19.8% vs 1.8% and 15.7% at admission and discharge, respectively, P<0.05. We are from a Joint Commission International (JCI-accredited academic medical center hospital with 3200 beds in China. Safe medication management and use are pivotal to patient safety and quality of care on which the state-of-the-art standards of the Joint Commission focus. We would like to share our perspectives in the following paragraphs.View original paper by Cortejoso and colleagues. 

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

Science.gov (United States)

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

Problems and fall risk determinants of quality of life in older adults with increased risk of falling.

Science.gov (United States)

Lin, Sang-I; Chang, Ku-Chou; Lee, Hsuei-Chen; Yang, Yi-Ching; Tsauo, Jau-Yih

2015-05-01

Determine quality of life and its association with fall risk factors in older adults with increased risk of falling. A total of 597 community-dwelling Taiwanese older adults who were screened to have increased risk of falling participated in the present study. The fall risk factors included sociodemographics, physical and psychological function, Timed Up and Go, past fall/medical histories, fear of falling and medications. The Euro QOL EQ-5D was used to measure health-related quality of life. Pain/discomfort was the EQ-5D dimension most frequently reported to be impaired (35%), regardless of the level of fall risk or age groups, followed by mobility (25%). Hierarchical regression analysis showed that Geriatric Depression Scale, Mini-Mental State Examination, physiological function, up-and-go, fear of falling and psychotropic medication were independent predictors for total EQ-5D, explaining 68.37% of the variance. Logistic regression analysis showed that for the five EQ-5D dimensions, Geriatric Depression Scale and Up and Go time were the most common determinants. Pain/discomfort was the leading impairment, and greater Geriatric Depression Scale and longer up-and-go time were the main contributing factors in declines in quality of life in older adults with increased risk of falling. These factors are often modifiable, and their management might be considered a priority in falls prevention. © 2014 Japan Geriatrics Society.

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 Interdisciplinary Geriatric/Gerontological Team in the Academic Setting.

Science.gov (United States)

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.

Science.gov (United States)

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.

Science.gov (United States)

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].

Science.gov (United States)

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.

Protocol for the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study: a pragmatic, randomised clinical trial

Science.gov (United States)

Wildes, T S; Winter, A C; Maybrier, H R; Mickle, A M; Lenze, E J; Stark, S; Lin, N; Inouye, S K; Schmitt, E M; McKinnon, S L; Muench, M R; Murphy, M R; Upadhyayula, R T; Fritz, B A; Escallier, K E; Apakama, G P; Emmert, D A; Graetz, T J; Stevens, T W; Palanca, B J; Hueneke, R L; Melby, S; Torres, B; Leung, J; Jacobsohn, E; Avidan, M S

2016-01-01

Introduction Postoperative delirium, arbitrarily defined as occurring within 5 days of surgery, affects up to 50% of patients older than 60 after a major operation. This geriatric syndrome is associated with longer intensive care unit and hospital stay, readmission, persistent cognitive deterioration and mortality. No effective preventive methods have been identified, but preliminary evidence suggests that EEG monitoring during general anaesthesia, by facilitating reduced anaesthetic exposure and EEG suppression, might decrease incident postoperative delirium. This study hypothesises that EEG-guidance of anaesthetic administration prevents postoperative delirium and downstream sequelae, including falls and decreased quality of life. Methods and analysis This is a 1232 patient, block-randomised, double-blinded, comparative effectiveness trial. Patients older than 60, undergoing volatile agent-based general anaesthesia for major surgery, are eligible. Patients are randomised to 1 of 2 anaesthetic approaches. One group receives general anaesthesia with clinicians blinded to EEG monitoring. The other group receives EEG-guidance of anaesthetic agent administration. The outcomes of postoperative delirium (≤5 days), falls at 1 and 12 months and health-related quality of life at 1 and 12 months will be compared between groups. Postoperative delirium is assessed with the confusion assessment method, falls with ProFaNE consensus questions and quality of life with the Veteran's RAND 12-item Health Survey. The intention-to-treat principle will be followed for all analyses. Differences between groups will be presented with 95% CIs and will be considered statistically significant at a two-sided pAnesthesia to Alleviate Geriatric Syndromes (ENGAGES) is approved by the ethics board at Washington University. Recruitment began in January 2015. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and

38 CFR 52.120 - Quality of care.

Science.gov (United States)

2010-07-01

... good nutrition, hydration, grooming, personal and oral hygiene, mobility, and bladder and bowel... FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.120 Quality of care. Each... Deputy Under Secretary for Health (10N), and Chief Consultant, Geriatrics and Extended Care Strategic...

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

Science.gov (United States)

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

Geriatric simulation: practicing management and leadership in care of the older adult.

Science.gov (United States)

Miller, Sally; Overstreet, Maria

2015-06-01

According to the Centers for Disease Control and Prevention, patients age 65 and older account for 43% of hospital days. The complexity of caring for older adults affords nursing students opportunities to assess, prioritize, intervene, advocate, and experience being a member of an interdisciplinary health care team. However, these multifaceted hospital experiences are not consistently available for all students. Nursing clinical simulation (NCS) can augment or replace specific clinical hours and provide clinically relevant experiences to practice management and leadership skills while caring for older adults. This article describes a geriatric management and leadership NCS. Copyright © 2015 Elsevier Inc. All rights reserved.

Providing Data Quality Information for Remote Sensing Applications

Science.gov (United States)

Albrecht, F.; Blaschke, T.; Lang, S.; Abdulmutalib, H. M.; Szabó, G.; Barsi, Á.; Batini, C.; Bartsch, A.; Kugler, Zs.; Tiede, D.; Huang, G.

2018-04-01

The availability and accessibility of remote sensing (RS) data, cloud processing platforms and provided information products and services has increased the size and diversity of the RS user community. This development also generates a need for validation approaches to assess data quality. Validation approaches employ quality criteria in their assessment. Data Quality (DQ) dimensions as the basis for quality criteria have been deeply investigated in the database area and in the remote sensing domain. Several standards exist within the RS domain but a general classification - established for databases - has been adapted only recently. For an easier identification of research opportunities, a better understanding is required how quality criteria are employed in the RS lifecycle. Therefore, this research investigates how quality criteria support decisions that guide the RS lifecycle and how they relate to the measured DQ dimensions. Subsequently follows an overview of the relevant standards in the RS domain that is matched to the RS lifecycle. Conclusively, the required research needs are identified that would enable a complete understanding of the interrelationships between the RS lifecycle, the data sources and the DQ dimensions, an understanding that would be very valuable for designing validation approaches in RS.

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...

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.

Science.gov (United States)

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.

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.

Assessing the quality of healthcare provided to children.

Science.gov (United States)

Mangione-Smith, R; McGlynn, E A

1998-10-01

To present a conceptual framework for evaluating quality of care for children and adolescents, summarize the key issues related to developing measures to assess pediatric quality of care, examine some existing measures, and present evidence about their current level of performance. Assessing the quality of care for children poses many challenges not encountered when making these measurements in the adult population. Children and adolescents (from this point forward referred to collectively as children unless differentiation is necessary) differ from adults in two clinically important ways (Jameson and Wehr 1993): (1) their normal developmental trajectory is characterized by change, and (2) they have differential morbidity. These factors contribute to the limitations encountered when developing measures to assess the quality of care for children. The movement of a child through the various stages of development makes it difficult to establish what constitutes a "normal" outcome and by extension what constitutes a poor outcome. Additionally, salient developmental outcomes that result from poor quality of care may not be observed for several years. This implies that poor outcomes may be observed when the child is receiving care from a delivery system other than the one that provided the low-quality care. Attributing the suboptimal outcome to the new delivery system would be inappropriate. Differential morbidity refers to the fact that the type, prevalence, and severity of illness experienced by children is measurably different from that observed in adults. Most children experience numerous self-limited illness of mild severity. A minority of children suffer from markedly more severe diseases. Thus, condition-specific measures in children are problematic to implement for routine assessments because of the extremely low incidence and prevalence of most severe pediatric diseases (Halfon 1996). However, children with these conditions are potentially the segment of the

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

The stress response and anesthetic potency of unilateral spinal anesthesia for total Hip Replacement in geriatric patients.

Science.gov (United States)

Zhu, Li; Tian, Chun; Li, Min; Peng, Ming-Qing; Ma, Kun-Long; Wang, Zhong-Lin; Ding, Jia-Hui; Cai, Yi

2014-11-01

Recently, some scholars suggested that it is important to keep a stablehemodynamic state and prevent the stress responses in geriatric patients undergoing total hip replacement (THR). We conducted this randomized prospective study to observe anesthetic potency of unilateral spinal anesthesia and stress response to it in geriatric patients during THR. We compared the effect of unilateral spinal and bilateral spinal on inhibition of stress response through measuring Norepinephrine (NE), epinephrine (E) and cortisol (CORT). Plasma concentrations of NE, E and CORT were determined in blood samples using ELISA (enzyme-linked immunosorbent assays) at three time points: To (prior to anesthesia) T1 (at the time point of skin closure), T2 (twenty-four hours after the operation). Sixty patients were randomly divided into two groups: group A (unilateral spinal anesthesia) and group B (conventional bilateral spinal anesthesia). 7.5tymg of hypobaric bupivacaine were injected into subarachnoid cavity at group A and 12mg hypobaric bupivacaine were given at group B. The onset time of sensory and motor block, loss of pinprick sensation, degree of motor block, regression of sensory and motor blocks and hemodynamic changes were also recorded. These data were used to evaluate anesthetic potency of spinal anesthesia. The results of this experiment show that unilateral spinal anesthesia can provide restriction of sensory and motor block, minimize the incidence of hypotension and prevent the stress responses undergoing THR. It is optimal anesthesia procedure for geriatric patients by rapid subarachnoid injection of small doses of bupivacaine.

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.

Management of the geriatric trauma patient at risk of death: therapy withdrawal decision making.

Science.gov (United States)

Trunkey, D D; Cahn, R M; Lenfesty, B; Mullins, R

2000-01-01

The management of geriatric injured patients admitted to a trauma center includes the selective decision to provide comfort care only, including withdrawal of therapy, and a choice to not use full application of standard therapies. The decision makers in this process include multiple individuals in addition to the patient. Retrospective review of documentation by 2 blinded reviewers of the cohort of patients over a recent 5-year period (1993-1997). Trauma service of a level I trauma center. A convenience sample of patients aged 65 years and older who died, and whose medical record was available for review. Patients were categorized as having withdrawal of therapy, and documentation in the medical record of who made the assessment decisions and recommendations, and to what extent the processes of care were documented. Among 87 geriatric trauma patients who died, 47 had documentation interpreted as indicating a decision was made to withdraw therapy. In only a few circumstances was the patient capable of actively participating in these decisions. The other individuals involved in recommendations for withdrawal of therapy were, in order of prevalence, the treating trauma surgeon, family members (as proxy reporting the patient's preferences), or a second physician. Documentation regarding the end-of-life decisions was often fragmentary, and in some cases ambiguous. Copies of legal advance directives were rarely available in the medical record, and ethics committee participation was used only once. Withdrawal of therapy is a common event in the terminal care of geriatric injured patients. The process for reaching a decision regarding withdrawal of therapy is complex because in most circumstances patients' injuries preclude their full participation. Standards for documentation of essential information, including patients' preferences and decision-making ability, should be developed to improve the process and assist with recording these complicated decisions that often

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 and management status of urologic diseases in geriatric hospitals in South Korea: A field research

Directory of Open Access Journals (Sweden)

Sang Heon Lee

2017-01-01

Full Text Available Purpose: We aimed to investigate the current management status of urologic diseases in geriatric hospitals in South Korea. Materials and Methods: Questionnaire surveys and in-depth person-to-person interviews were conducted at 13 hospitals within the Seoul and Incheon areas. Results: The study was carried out from July to December 2014; 75.6% of patients (1,858/2,458 and 77.5% (779/1,031 of medical personnel responded to our survey. All surveys and interviews were performed by urology specialists, fellows, residents, or nurses. The hospitals included in the study had an average of 215.2 beds (range, 110–367, 189.1 patients (range, 90–345, and 40.2 nurses (range, 10–83. The average number of physicians was 6.2 (range, 3–11, but none of these were certified urologists. Only 4 hospitals provided consultation services for urological disorders. In total, 64% of patients had urological disorders, although only 20.7% of patients were receiving medication. Most patients were being treated using urological interventions; diapers (49.7%, indwelling catheters (19.5%, clean intermittent catheters (12.2%, and external collection urinary drainage (7.9%. However, most interventions were inadequately implemented, and only 17% of the patients had been examined by a certified urologist. Urological complications were found in 20.2% of patients, and secondary complications occurred in 18.8%. Excluding redundant cases, the total prevalence of urological complications was 39.0%. Conclusions: Urologic diseases are poorly managed, and no certified urologists work in geriatric hospitals. Therefore, more designated urologists are needed in geriatric hospitals.

A subacute model of geriatric care for frail older persons: the Tan Tock Seng Hospital experience.

Science.gov (United States)

Chong, Mei Sian; Empensando, Esmiller F; Ding, Yew Yoong; Tan, Thai Lian

2012-08-01

The subacute care unit in Tan Tock Seng Hospital (TTSH) was set up in May 2009. We examined its impact on the transitions at the nexus between hospital and community sectors, patients' discharge destination and functional performance. We studied patients admitted during the initial 6-month period (May to October 2009). Differences in demographics, length of stay (LOS), comorbidity and severity of illness measures, functional outcomes (modified Barthel Index (MBI)) according to discharge destinations were obtained. We also studied the impact of LOS on the geriatric department and the bill size over the pre- and post-subacute implementation periods. Majority of the subacute patients' hospital stay was in subacute care. Of these patients, 44.9% were discharged home, 24.2% to a slow stream rehabilitation (SSR) setting and 29.2% to nursing homes. 16.9% consisted of a subgroup of dementia patients requiring further behavioural and functional interventions, of which 50% managed to be discharged home. Functional gains were seen during subacute stay; with greatest gains observed in the SSR group. There were no differences in overall LOS nor total bill size (DRG-adjusted) for the geriatric medicine department during the first 6 months of operating this new subacute model compared with the prior 4-month period. We propose this subacute model of geriatric care, which allows right-siting of care and improved functional outcomes. It fulfills the role easing transitions between acute hospital and community sectors. In particular, it provides specialised care to a subgroup of dementia patients with challenging behaviours and is fiscally sound from the wider hospital perspective.

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

State of Health and Quality of Life of Women at Advanced Age

Science.gov (United States)

Pinkas, Jarosław; Gujski, Mariusz; Humeniuk, Ewa; Raczkiewicz, Dorota; Bejga, Przemysław; Owoc, Alfred; Bojar, Iwona

2016-01-01

Background Evaluation of the state of health, quality of life, and the relationship between the level of the quality of life and health status in a group of women at an advanced age (90 years of age and older) in Poland. Material/Methods The study was conducted in 2014 in an all-Polish sample of 870 women aged 90 years and older. The research instruments were: the authors’ questionnaire and several standardized tests: Katz Index of Independence in Activities of Daily Living (Katz ADL), Abbreviated Mental Test Score (AMTS), and the World Health Organization Quality of Life (WHOQOL)-BREF. The results of the study were statistically analyzed using significant t-test for mean and regression analysis. Results The majority of women at an advanced age suffered from chronic pain (76%) and major geriatric problems such as hypoacusis (81%), visual disturbances (69%) and urinary incontinence (60%); the minority of women at an advanced age suffered from falls and fainting (39%), stool incontinence (17%), severe functional impairment (24%), and cognitive impairment (10%). On a scale of 1 to 5, women at an advanced age assessed positively for overall quality of life (mean 3.3), social relationships (3.5), and environment (3.2), but negatively for general health, physical health, and psychological health (2.7, 2.7, and 2.8, respectively). The presence of chronic pain and geriatric problems, including urinary and stool incontinences, falls and faint ing, visual disturbances and hypoacusis, significantly decreased overall quality of life; general health, physical health, psychological health, social relationships, and environment. Overall quality of life, general health, physical health, psychological health, social relationships, and environment was correlated with functional and cognitive impairments. Conclusions Quality of life of women at an advanced age decreased if chronic pain, major geriatric problems, or functional or cognitive impairments occurred. PMID:27580565

Dashboard report on performance on select quality indicators to cancer care providers.

Science.gov (United States)

Stattin, Pär; Sandin, Fredrik; Sandbäck, Torsten; Damber, Jan-Erik; Franck Lissbrant, Ingela; Robinson, David; Bratt, Ola; Lambe, Mats

2016-01-01

Cancer quality registers are attracting increasing attention as important, but still underutilized sources of clinical data. To optimize the use of registers in quality assurance and improvement, data have to be rapidly collected, collated and presented as actionable, at-a-glance information to the reporting departments. This article presents a dashboard performance report on select quality indicators to cancer care providers. Ten quality indicators registered on an individual patient level in the National Prostate Cancer Register of Sweden and recommended by the National Prostate Cancer Guidelines were selected. Data reported to the National Prostate Cancer Register are uploaded within 24 h to the Information Network for Cancer Care platform. Launched in 2014, "What''s Going On, Prostate Cancer" provides rapid, at-a-glance performance feedback to care providers. The indicators include time to report to the National Prostate Cancer Register, waiting times, designated clinical nurse specialist, multidisciplinary conference, adherence to guidelines for diagnostic work-up and treatment, and documentation and outcome of treatment. For each indicator, three performance levels were defined. What's Going On, a dashboard performance report on 10 selected quality indicators to cancer care providers, provides an example of how data in cancer quality registers can be transformed into condensed, at-a-glance information to be used as actionable metrics for quality assurance and improvement.

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.

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

Directory of Open Access Journals (Sweden)

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.

Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added

Directory of Open Access Journals (Sweden)

Shea Christopher M

2012-03-01

Full Text Available Abstract Background Health information technology (HIT applications that incorporate point-of-care use of health-related quality of life (HRQL assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients. Methods Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff. Results The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1 duplicative of information gathered via other means during the encounter; (2 specific enough to be useful and/or acted upon, and; (3 useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information. Conclusions Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice

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

Directory of Open Access Journals (Sweden)

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.

Science.gov (United States)

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.