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PubMed1989

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

STUDY OBJECTIVE: To evaluate the impact of a geriatric consultation team on the functional status of hospitalized elderly patients. DESIGN: Randomized controlled clinical trial. SETTING: University-affiliated referral Veterans Administration Medical Center. PATIENTS: 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. INTERVENTION: 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. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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 addition to advice if improvements are to be made.

Activities of Daily Living↗
PubMed2000

Using the comprehensive geriatric assessment technique to assess elderly patients.

OBJECTIVE: To review the concept, components, and characteristics of the Comprehensive Geriatric Assessment technique. DATA SOURCES: Medline and non-Medline literature search. STUDY SELECTION: The following key words were used: Comprehensive Geriatric Assessment; all available years of study were reviewed. DATA EXTRACTION: Studies that assessed the Comprehensive Geriatric Assessment technique's benefits were examined. DATA SYNTHESIS: By using the Comprehensive Geriatric Assessment programme, accurate diagnoses can be made, treatable illness can be screened for, therapeutic plans can be formulated, and the optimal placements of patients can be achieved. Assessment should be performed at each level of geriatric care; various well-validated scales are used to measure the activity of daily living of patients. The Comprehensive Geriatric Assessment programme can improve functional status; reduce the use of medications, nursing homes, and medical services; and reduce mortality rates. Most studies confirm that a successful programme requires careful patient targeting, implementation of the programme by attending physicians, and patient adherence to the recommendations made. CONCLUSION: A well-targeted Comprehensive Geriatric Assessment programme and the control of patients' adherence to recommendations are effective in improving the well-being of elderly patients.

Activities of Daily Living↗
PubMed2003

Geriatrics in the new millennium, Israel.

Since the early 1980s demographic changes compelled Israel's health system to dedicate efforts to establish modern geriatric services. This task was performed with the help of governmental and non-governmental institutions and was coordinated by the Division of Geriatrics and Long-Term Care Diseases of the Ministry of Health. Today, 20 years later, as a result of those efforts, geriatrics and geriatric services in Israel are thriving. Qualified staff, including physicians who specialized in geriatrics, are working to maintain a high quality of care in various geriatric settings. However, more resources should be allocated for research in order to maintain and to continue to develop geriatric medicine in Israel.

Aged↗
PubMed1992

The teaching of geriatric dentistry in Canada.

Very little is known about the current status of geriatric training programs at Canadian universities because of the scarcity of information published on the subject. A study of the geriatric dentistry training programs offered by Canada's 10 dental schools has been completed. Its intent was to determine what type of educational activities in geriatric dentistry have either been offered in the past, are being offered now, will be offered in the next academic year, or are planned for the next five years. The results indicate that the 10 schools are doing very little in this regard. To keep pace with the level of geriatric dentistry training currently being offered in the United States, the dental profession must convince Canadian faculty members that the teaching of geriatric dentistry is crucial to both the undergraduate student and the graduate dentist. Continuing education in geriatric dentistry could be used to meet the oral health needs of our frail and dependent senior citizens. Geriatric dentistry must be taught at all levels of the profession so that this special clientele can receive the necessary treatment either within or outside of the dental office.

Aged↗
PubMed1992

Designing and evaluating an episodic, problem-based geriatric curriculum.

BACKGROUND: Medical school geriatric training has been directed primarily at improving students' attitudes and knowledge about elderly patients. This study evaluated a clinical problem-based geriatric course for medical students. METHODS: The two-semester geriatric course was presented to 136 second-year medical students. Faculty taught students about clinical reasoning in ambulatory geriatrics using written cases, patient-actors, literature reviews, lectures, and discussions. At the end of the course, students' clinical activity was evaluated using audiotaped interviews with standardized geriatric patients. A questionnaire examined students' knowledge, attitudes, and their evaluation of the course. RESULTS: All 136 students completed the post-course standardized patient interview, and 105 (77%) completed questionnaires. Students rated the course favorably and had high confidence scores for ability to assess geriatric problems. Students' knowledge increased during the course compared to a precourse examination (P less than .05). Evaluation of post-course standardized patient interviews revealed that students who scored higher on the knowledge test tended to ask more psychosocial questions during the interview (r = 0.38). Students who scored higher on the attitude test spent more time eliciting patients' feelings during the interview (r = 0.38). Those with lower scores on the attitude test spent more time asking factual, nonpsychosocial questions (r = 0.28). CONCLUSIONS: A clinical problem-based geriatric course for preclinical medical students can be successful in improving students' knowledge. Attitudes and knowledge effect the questions a student asks during the medical interview.

Attitude of Health Personnel↗
PubMed1991

[The geriatric clinical picture in a department of internal medicine].

In order to assess the proportion of geriatric patients in a medical department, all of the inpatients admitted to the Medical Department of Hørsholm Hospital during the period 19.3.1987-15.4.1987 were assessed in view of the geriatric clinical picture. The criteria for assessment as a geriatric patient were established in advance and included: Presence of several medical problems inhibition of functions and social problems and an estimated need for prolonged hospitalization to solve these problems, including rehabilitation. Out of 191 inpatients, 15 (8%) were considered to be geriatric patients. These 8% were all aged 60 years or more, were hospitalized for an average of 23 days and used 21% of the total number of bed days. The remaining patients aged more than 60 years were hospitalized for an average of nine days and comprised 47% of the total number of inpatients and used 49% of the bed days. The geriatric patients differed, in addition, from the other patients aged over 60 years in that 85% compared with 58% were readmitted within a period of two years. No difference in the mortality was observed during a period of two years. This investigation supports previous suppositions about the proportion of geriatric patients and indicates that assessment as to whether a geriatric patient is concerned or not may be made already during the first 24 hours in hospital.

Aged↗
PubMed1987

[Perspective on continued development in geriatrics].

The Health Department (WVC) has given the National Hospital Institute (NZI) the task to conduct a study with respect to geriatric wards in general hospitals. In the final report of the NZI the recommendation was made to officially acknowledge clinical geriatrics in general hospitals as a function. Geriatric wards as well as geriatric policlinics are necessary in every region. In this article the researchers advise to apply the insights and experiences of geriatric wards and policlinics to other wards in general hospitals, especially wards where many elderly patients stay. The function and position of clinical geriatrics need to be specified in relation to other institutions for the care of the elderly and in particular to nursing homes. In the Netherlands the nursing homes also have a rehabilitation function. So a more permanent dialogue is necessary between clinical geriatrics and other institutions.

Aged↗
PubMed1987

Training in geriatrics for future dietitians.

Inclusion of geriatric training for future dietitians was assessed through a questionnaire mailed to directors of all internship programs and coordinated undergraduate programs (CUPs) accredited by The American Dietetic Association. All respondents, internship programs (70%) and CUPs (77%), included some exposure to geriatrics. Ninety-six percent of the CUPs included geriatric-related topics in undergraduate courses. Of the 95% internship programs providing class sessions on geriatrics, most included 6 hours or less. Major topics related to nutrition assessment; physical, social, and psychological needs; diet-related diseases; and nutrition programs benefiting the elderly. Fifty-one percent of the CUPs and 23% of the internship programs trained students 3 weeks or more in a geriatric setting, while 45% and 72%, respectively, trained 2 weeks or less. Nursing homes were the primary site of training. The most frequently required activities included identifying specific needs of the elderly in relation to other adults, completing diet histories, and presenting nutrition education to a geriatric population. The question remains as to whether the quantity and type of geriatric experiences currently included are sufficient to keep pace with the increasingly aging population.

Dietetics↗
PubMed1984

[Clinical geriatrics, quo vadis? Careful considerations of the future of a new specialty].

It is something of a rope-dancer's trick to try to indicate what future is to expect for a young and controversial specialism like clinical geriatrics. Even so, it is a challenge to those who are directly involved. In the expectations we have of geriatrics we deal not only with the geriatric department of a general hospital (GAAZ), the clinical geriatrician's workshop, as such, but also with its place and functioning in the total chain of geriatric care. The most desirable distribution of clinical geriatricians and their departments is discussed; this is followed by a cautious quantitative prognosis. A different effort has been made to indicate how the policy of recognition of geriatricians and the existence of clinical geriatrics are closely interconnected. Within their curriculum the Universities are expected to see it as an educative and stimulating task for them to promote geriatrics in general and clinical geriatrics particularly.

Education, Medical, Graduate↗
PubMed1982

[Contributions to the specialty geriatrics. The geriatrician--tolerated or appreciated?].

In this article an outline for the development of geriatrics in the Netherlands is given based on experiences in the United States and Great Britain. From the beginning geriatrics should be brought upon "first class' level in order to avoid the development of a "second class' specialism - unwanted and not respected by other specialists. Therefore in the author's opinion geriatrics should start in the universities as a part of the total education, training and research in medical gerontology which contains not only (somatic) geriatrics, but also physiology, pathology, psychogeriatrics, neurology, general practice and social medicine. To begin with we should start with specialists in internal medicine who make their daily job in geriatrics. New style geriatricians could be educated and gradually take over the posts of the geriatricians of the "first hour' after 5 to 10 years. When an internal ward is changed into a geriatric ward, the modification should not only contain the indication shields, but also include a change of attitude towards elderly patients, more nurses (one on every patient), a psychogeriatric consultant, a social worker, a geronto-psychologist and facilities for disturbed patients, etc. In future geriatricians could be employed on geriatric assessment units in general hospitals, psychogeriatric assessment units in mental hospitals and as consultants in nursing-homes, residential homes and social-psychogeriatric (ambulant) services.

Academic Medical Centers↗
PubMed1996

[Geriatric consultations in a general hospital].

The increasing numbers of the elderly admitted to general hospitals, and the complexity of their problems, has increased the need for geriatric consultations. We evaluated geriatric consultations given at the Wolfson Medical Center by the geriatricians of Shmuel Harofeh Hospital. Data on 6-months of consultations in medical, surgical, urologic, neurologic, orthopedic and intensive care departments were evaluated. 7,910 elderly (65 years and over) were admitted during this period, representing 58% of all admissions; 742 (9.4%) were targeted for geriatric consultation. The largest number of consultations (525) were in the medical wards, but the highest rate of consultations was in the orthopedic ward for rehabilitation after operations for hip fractures. The selection of patients for geriatric consultation at Wolfson Hospital was done by the staff of each ward. This method differs from that in most general hospitals abroad, where selection is by geriatric teams. Despite this difference, our data show that the rates of consultations were similar. Also, the multidisciplinary teams consisted of members of the staff of each ward and the geriatric consultant. The method of geriatric consultations presented is easy to set up, simple to operate, efficient and appreciated by the medical staff of the departments.

Aged↗
PubMed1997

Referral to specialized geriatric services. Which elderly people living in the community are likely to benefit?

PROBLEM BEING ADDRESSED: As the Canadian population ages, family physicians encounter increasing numbers of elderly people with medical, functional, psychological, and social difficulties. In the past two decades, most regions of Canada have developed systems of specialized geriatric services, available on a consultative basis, to assist family physicians evaluating and managing elderly patients with these difficulties. For many family physicians, however, it is often unclear which of their elderly patients are likely to benefit from referral to these geriatric services. OBJECTIVE OF PROGRAM: Using an interdisciplinary approach, specialized geriatric services seek to optimize health, maximize function, promote independence, and prevent or delay institutionalization of elderly people. Yet not all elderly people benefit from referral to specialized geriatric services. This article offers a clear and clinically practical framework to help family physicians identify elderly patients in their practices who are likely to benefit from referral to specialized geriatric services. MAIN COMPONENTS OF PROGRAM: By synthesizing previous work on the concept of frail elderly persons into a 2 x 2 matrix, the level and intensity of geriatric intervention most appropriate for different segments of the elderly population is clarified. CONCLUSIONS: Using the simple approach described in this article, family physicians should be able to use available geriatric resources easily and efficiently to optimize the health and function of their elderly patients.

Activities of Daily Living↗
PubMed2006

Correlates of unrecognized depression among hospitalized geriatric patients.

OBJECTIVES: The goal of this study was to assess the level and analyze the determinants of under-recognition of symptomatic depression by geriatricians in hospitalized geriatric patients. METHODS: This was a prospective study of 155 patients who were consecutively hospitalized in the geriatric unit of an academic hospital. The diagnosis of symptomatic depression was established, in a parallel blinded manner either by one psychogeriatrician using a geriatric depression scale and the DSM-IV criteria for depression or by one geriatrician using a global assessment score included in a comorbidity index or by both. RESULTS: The psychogeriatrician diagnosed symptomatic depression in 67 of the 155 patients (43%). In contrast, the geriatrician identified symptomatic depression in 29 (19%) of the 155 patients, one of whom was not diagnosed with depression by the psychogeriatrician. Thus the geriatrician failed to identify 39 patients who were diagnosed with depression by the psychogeriatrician. CONCLUSIONS: In this study of hospitalized geriatric patients, a geriatrician failed to recognize more than half of those who were diagnosed with symptomatic depression by a psychogeriatrician. Uncontrolled comorbidity and therapeutics may be misleading factors in diagnosing depression. The presence of a psychogeriatrician in a geriatric unit could prevent underestimation of depressive symptoms among geriatric patients.

Aged↗
PubMed2006

Ethically justified clinical strategies for promoting geriatric assent.

OBJECTIVE: To develop ethically justified clinical strategies for promoting geriatric assent with a focus on the application of professional virtues. METHOD: The concept of geriatric assent was extended to all geriatric patients incapacitated by cognitive impairments, including dementias, and practical clinical steps for promoting geriatric assent were developed. RESULTS: A four step-process for promoting geriatric assent is proposed by balancing the principles of beneficence and respect for autonomy within the context of the psychiatrist's virtues. These four steps include identifying the patient's long-standing values and preferences; assessing plans of care in terms of biopsychosocial safety and independence along with the patient's values and preferences; protecting remaining autonomy; and cultivating the professional virtues of steadiness, self-effacement, and self-sacrifice when making decisions that risk the patient's future health and safety. CONCLUSIONS: In promoting geriatric assent, psychiatrists are obligated to support and directively counsel the patient's surrogate to adopt care plans that promote the patient's values and preferences to the extent possible. These clinical strategies for promoting geriatric assent should serve to enhance the patient's remaining sense of integrity and dignity. These strategies should also protect remaining health status and therefore protect remaining autonomy.

Aged↗
PubMedDate not supplied

On the significance of geriatric medicine departments in Italy.

The aging of population has been characteristic for the industrial countries during the last years. It is essentially due to two factors: the increase of life span and the decrease of births. Today the health conditions of the older population are better than in the past, but in octagenarians morbidity and disability globally increased. Therefore, aging of the population involves also more expenses for all the health care services, i.e., both for each older patient's family, and for the community. In departments of geriatric medicine it is right to consider two kinds of patients: older patient and geriatric patient. Multidimensional assessment and global intervention performed by a multidisciplinary team can obtain much better results for the geriatric patients, than the traditional medical strategies. Several reviews show also that departments of geriatric medicine achieve better results, than of the common internal medicine. Geriatric medicine departments have different aspects not only in the treatment of diseases, but also in supporting a global assistance, which aim also at rehabilitating the patient. Because of this central role and indispensability of the geriatric specialists, their work in the network of services should be obligatory, since only a continuous and global care can guarantee significant results for the geriatric patients.

Aged↗
PubMed1996

Geriatric use of emergency medical services.

STUDY OBJECTIVE: To quantify use by geriatric patients of emergency medical services (EMS) compared with that by young adult patients. METHODS: We conducted a retrospective, consecutive case series over a 6-month period in a suburban, all-paramedic municipal EMS system serving 76,500 residents, of whom approximately 15% are 65 years of age or older and 33% are between 25 and 45 years old. Patient age, the sole entry criterion, was used to distinguish two groups: the young adult group, defined as patients 25 to 45 years old; and the geriatric group, defined as patients 65 years or older. RESULTS: Of the 2,712 patients whose cases were reviewed during the study period, 1,734 (65%) met the entry criterion. The geriatric group (n=1,043) accounted for 39% of the total call volume, compared with the young adult group (n=690), which accounted for 25% of total call volume. Patients in the young adult group were 7.3 times more likely to have been in a motor vehicle accident, whereas the GP group was 2.6 times more likely to have cardiorespiratory complaints, 1.8 times more likely to have fallen, and 1.7 times more likely to have minor medical problems requiring transportation and more frequently required advanced life support (ALS) care (54% versus 33%) (P<.001 for all comparisons). Scene times for geriatric patients were found to be longer than those for young adults (ALS, P<.001; basic life support [BLS], P<.05). However, costs billed to the patient were greater for young adults for all care rendered (BLS, P<.001; ALS, P<.05). CONCLUSION: Use by geriatric patients of EMS differed significantly from that by young adults. Geriatric patients used EMS more frequently and required more ALS care than did young adults. Although geriatric patients required longer scene times for EMS care, young adults incurred greater charges for service. These findings, although perhaps system specific, speak to the need for ongoing analysis of EMS health care delivery to better serve a population increasing in age.

Adult↗
PubMed2003

Cognitive impairment decreases postural control during dual tasks in geriatric patients with a history of severe falls.

OBJECTIVES: To investigate the influence of dual tasks, cognitive strategies, and fear of falling on postural control in geriatric patients with or without cognitive impairment and with a history of falls resulting in injury. DESIGN: Experimental three-group design. SETTING: Geriatric hospital. PARTICIPANTS: Twenty young healthy adults (mean age+/-standard deviation=25.4+/-4.4), 20 geriatric patients with a history of severe falls without cognitive impairment (mean age=82.6+/-5.5, mean Mini-Mental State Examination (MMSE) score=27.8+/-2.0) and 20 geriatric patients with a history of severe falls and cognitive impairment (mean age=83.2+/-5.5, mean MMSE=19.2+/-3.3). MEASUREMENTS: Motor performance: sway area and lateral and anterior-posterior sway angles. Cognition: semiautomated calculation steps (serial 2 forward) and nonautomated calculation derived from MMSE (serial 7 retro). Motor and cognitive performances were examined as single and dual tasks. Strategy decision, fear of falling, and subjective perception of motor and cognitive performance were assessed as covariates for dual-task performances. RESULTS: Motor performance decreased significantly during all dual tasks in geriatric patients with cognitive impairment and a history of falls resulting in injury. Cognitive performance was different depending on the task and group. Choice of cognitive strategies or fear of falling did not influence the dual-task performances. CONCLUSION: Even simple additional tasks substantially decrease postural stability due to attention-related cognitive deficits in cognitively impaired geriatric patients with a history of severe falls. The findings may help to explain the increased incidence and severity of falls in geriatric patients with cognitive impairment and a history of falls resulting in injury.

Accidental Falls↗
PubMed2002

When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma.

BACKGROUND: As the U.S. population ages, the number of geriatric trauma victims will continue to grow. Outcomes are known to be worse for these patients, in large part because of preexisting conditions (PECs). The specific impact of various PECs on outcome in geriatric trauma has not been well studied because of heterogeneous data sets and sample sizes. METHODS: We sought to define the impact of clinical variables and PECs on mortality in geriatric trauma by analyzing a large statewide trauma database. We defined geriatric trauma patients as those age > or = 65. Isolated hip fractures were excluded. We used multiple logistic regression to determine the effect of 21 different PECs on 30-day in-hospital mortality. RESULTS: Data were abstracted from 33,781 patient records. Overall mortality was 7.6%. For each 1-year increase in age beyond age 65, odds of dying after geriatric trauma increased by 6.8% (95% confidence interval, 6.1-7.5%). When presenting vital signs, Glasgow Coma Scale score, and ISS were controlled, PECs with the strongest effect on mortality were hepatic disease (odds ratio [OR], 5.1), renal disease (OR, 3.1), and cancer (OR, 1.8). Chronic steroid use increased the odds of death after geriatric trauma (OR, 1.6), whereas Coumadin therapy did not. CONCLUSION: Considered independently, these data are insufficient to allow withdrawal of care, but this information may be a useful component to help in guiding families faced with difficult decisions after geriatric trauma.

Accidental Falls↗