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PubMed2000

[Fundamentals of dentistry for geriatric rehabilitation--an introduction to geriatric dentistry].

The percentage of aged and very old people in the total population is increasing rapidly in industrialized countries. This is an important change which, in particular, affects the areas of dentistry and oral medicine. The problems that this older population group face need to be given more attention and need to be brought more into the forefront of dental and oral medicine. The percentage of the dentate population has increased in Germany, due to the high standard of the dental care. The percentage of the edentulous population has therefore decreased. It has become necessary for those who care for the elderly to adjust to caring for the dentate patient, as opposed to edentulous patient. It is important for all professions involved in the treatment and care of geriatric patients to have an awareness of the basic fundamentals of geriatric dentistry within general rehabilitation. Doctors in particular need to be given training in the detection of caries, peridontal diseases, and denture problems. They should feel confident working with the dentist and his team as partners in the rehabilitation treatment. It is especially important that geriatric hospitals have experience in dentistry and oral hygiene, so that damage to life-long well cared for teeth can be prevented, and so that poor oral hygiene during a hospital stay does not result in dental problems. Dentists and their teams will have to adjust to the treatment of aged and multimorbidic patients. More discussion is also necessary between dentists involved in all areas of geriatric medicine, geriatric dentistry, and geriatric dental public health.

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PubMed2001

[Education, graduate and continuing education in geriatrics and geriatric rehabilitation].

Education and training in geriatric medicine for family doctors and medical specialists, nurses, physio- and ergotherapists, social workers becomes more important. A curriculum in high quality geriatric medicine can help solve the problems coming up with the increasing life-expectancy and with the increasing proportion of elderly depending on care and social services. The development of curricula and programs in high quality geriatric medicine demonstrates that the geriatrician has a special approach to the elderly patient different from traditional medicine. Describing and teaching this special approach to the elderly patient shows the special view of the geriatrician working with elderly patients. A number of barriers to program development must be considered. To successfully implement geriatrics training, geriatric faculties need to have adequate protected time to plan, administer and teach the curriculum. It is very important to implement geriatrics training in universities and medical institutes.

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PubMed2005

[The establishment of geriatric intervention group and geriatric assessment at emergency of Henri-Mondor hospital].

BACKGROUND: The official French demographic previsions are a growing number of the older than 75 years elderly people. The Emergency services face this demographic evolution. We describe the establishment of the geriatric intervention group at the emergency of the Henri-Mondor university hospital at Creteil (France) and analyse the results of the geriatric assessment at the short unit care during the first four months. METHODS: We analysed the results of the geriatric assessment of 206 patients during the first four months, by considering the final unit care. The geriatric assessment evaluates functional abilities, cognitive status and thymic function with elderly people validated tests and subjective assessment of nutrition status and the sensorial functions. RESULTS: The statistical analysis of the geriatric assessment results was significant among the different hospitalized groups of patients, for the cognitive status, the nutritional risk and the walk and standing evaluation. CONCLUSION: The results of the geriatric assessment at emergency showed cognitive impairment and gait abnormality in elderly patients were at risk of hospitalization.

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PubMed1983

A comparison of placement outcomes of geriatric cohorts receiving care in a geriatric assessment unit and on general medicine floors.

To assess whether care in a geriatric assessment unit using a multidisciplinary team approach with rehabilitative emphasis impacted on patient placement outcomes, a historical prospective study was initiated using records of geriatric assessment unit patients admitted during a one-year period (n = 62). A second, diagnostically similar general medicine unit cohort was also sampled (n = 62). Placement outcomes of the two groups were compared. All study patients were 75 years of age or older, stratified by source of admission, and controlled for comparability using diagnostic grouping. The geriatric assessment unit admitted 92 per cent of its patients from home; the general medicine unit, 82 per cent. As a result of expanded rehabilitative, respite, and terminal care promoted by the geriatric assessment unit staff, mean length of stay was 36 days, whereas it was 13 days in the general medicine unit (P less than 0.001). There was no significant difference between the two units with respect to hospital deaths, post-hospitalization discharges to home or nursing homes, or patient locations (home versus nursing home) six months after admission. Although improvements in patient independence may have been achieved through the efforts of a multidisciplinary team approach utilizing the geriatric assessment unit, they were not sufficient to significantly increase the proportion of patients placed at home. Superiority in placement outcome may be demonstrated only by geriatric assessment unit use of selective admission criteria.

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PubMed1993

Geriatric psychiatry: training guidelines and their application. Section on Geriatric Psychiatry of the Canadian Psychiatric Association.

Geriatric psychiatry is now a mandatory part of psychiatric residency education in Canada. Educational requirements in geriatric psychiatry were updated by the Royal College of Physicians and Surgeons of Canada in 1988, and guidelines were developed in more detail in 1989 by the Section on Geriatric Psychiatry of the Canadian Psychiatric Association (CPA). These guidelines are presented here together with a survey, conducted in the fall of 1991, of all 16 Canadian psychiatry residency programs. Thirteen of the training centres now require residents to have a formal rotation in geriatric psychiatry, generally three months in length. Residents are exposed to elderly patients in other services, such as consultation/liaison, but these services may not include formal teaching in geriatric psychiatry. Most programs have a seminar series in geriatric psychiatry and have training guidelines similar to those of the CPA. However, it is not clear how closely these are being followed, since it was felt in almost one-third of all programs that there was an insufficient number of teachers to fulfill the training requirements. In addition, a number of training directors felt that the objectives were too comprehensive to be met in the three month period. Earlier studies in the field are reviewed, implications of the current findings are discussed, and suggestions are made for further research.

Canada↗
PubMed2006

Evaluation of pharmacotherapy in geriatric patients after performing complete geriatric assessment at a diagnostic day clinic.

BACKGROUND: Elderly patients often take multiple drugs. It is known that polypharmacy, i.e. use of five or more drugs, may lead to drug interactions and adverse events. However, undertreatment of conditions or illnesses is also a concern in geriatric patients. A centralised review of both diagnoses and medication may play a key role in optimising pharmacotherapy in geriatric patients. The aims of this study were to evaluate the quality and appropriateness of medication after performing a complete geriatric assessment (CGA) and medication review at a diagnostic geriatric day clinic, to investigate reasons for drug changes, and to determine whether medication review leads to a reduction in the number of drugs used. METHODS: A chart review was performed in 702 patients (mean age 82.0 years, range 57.1-104.1 years) who underwent a CGA at a diagnostic geriatric day clinic. Medication at admission, changes in medication and reasons for changes were noted. RESULTS: Vitamins, for example folic acid and vitamin B(12) (cyanocobalamin), and trimethoprim for urinary tract infections were the most frequently started medications after CGA and medication review. The number of drugs used was reduced in only a minority of patients (11.7%); reasons for discontinuation were a diagnosis that was no longer relevant (38.8%), adverse events (33.2%) and identification of better pharmacotherapeutic options (22.0%). In 69.2% of the cases a new diagnosis was the reason for starting a new medication, followed by osteoporosis prophylaxis (15.0%) and improvement in pharmacotherapy (10.6%). At admission, patients were taking a mean number of 4.6 drugs (range 0-17). A mean of 0.8 drugs (range from reduction of 5 to addition of 7) had been added per patient, resulting in a mean number of 5.4 (range 0-18) prescribed drugs at discharge. CONCLUSION: Evaluation of medication in patients after performing CGA at the geriatric day clinic investigated resulted in relevant medication changes. The main reason for prescribing new drugs was a new diagnosis. Absence of a relevant medical indication was the main reason for stopping drugs. CGA and medication review resulted in a mean net addition of 0.8 drugs per patient.

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PubMed1999

Training osteopathic geriatric academicians: impact of a model geriatric residency program.

The need for osteopathic geriatric academic leaders who are educators and researchers is well recognized. The University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine's Geriatric Residency program, a federally funded Faculty Training Project in Geriatric Medicine and Dentistry, has served as a model program in the osteopathic medical professional since its inception in 1989. Targeting internal medicine and family medicine physicians interested in academic careers in geriatrics, the program promotes interdisciplinary training, which develops clinical, research, and teaching/administrative skills. A survey of program graduates assessed their perceptions about the field of geriatrics and the impact of training on career choice and level of satisfaction. Results indicated that 100% of the former trainees entered the field of geriatrics; 57% hold full-time faculty appointments at an osteopathic medical school, and 43% practice as clinical geriatricians. Of those in an academic setting, all taught medical students and housestaff and were involved in research. All of the respondents wee satisfied with their career choice, although 71% indicated that a higher salary and greater respect for the discipline would further enhance their satisfaction. Greater than half perceived the need for additional geriatricians and ranked complexity of care, lower salaries, inadequate reimbursement, and indebtedness after medical school as significant barriers to entering the field. This program has been successful in training academic geriatricians, it has created role models for students, and it has responded to the shortage of osteopathic academic and clinical geriatricians. Financial incentives and reimbursement that is commensurate with complexity of care would serve to attract more trainees to this important primary care discipline.

Clinical Competence↗
PubMed2000

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Adult↗
PubMed1982

[Specialism in geriatrics and training as a geriatrician. The development of geriatrics as a medical specialty].

Two geriatricians--Belgian and Dutch--have attempted to define their ideas and principles regarding clinical geriatrics based on their work. They strongly recommend the establishment of geriatric hospital departments which are in level and prestige equal to other hospital departments. As attending specialist the geriatrician is responsible for the overall-management of elderly patients with multiple pathology, delicate balances, specific clinical syndromes, mutual involvement of somatic and mental disorders, loss of functions, etc. The execution of this task is based on clinical expertise, knowledge of specific provisions for the elderly in the community and on teamwork with the nursing and paramedical staff of the geriatric department who know how to deal with geriatric patients. Close co-operation with other specialists is necessary to guarantee the quality of the care. Geriatricians and other specialists need to complement each other. In addition it is necessary that the geriatrician select one or more areas of special interest in the extensive professional field in order to carry out clinical research. It is important that geriatric patients are not admitted in hospital departments where they happen to be referred to, but where they have the best chance of recovery. As the geriatric department offers a specific approach, it is recommended that the very old will be admitted there in the first place unless they urgently need other specialist treatment. The elderly who are in serious distress as far as general care is concerned, but do not need hospital expertise, have to be taken care of in other ways.

Education, Medical, Graduate↗
PubMed2005

Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG).

BACKGROUND: As more and more cancers occur in elderly people, oncologists are increasingly confronted with the necessity of integrating geriatric parameters in the treatment of their patients. METHODS: The International Society of Geriatric Oncology (SIOG) created a task force to review the evidence on the use of a comprehensive geriatric assessment (CGA) in cancer patients. A systematic review of the evidence was conducted. RESULTS: Several biological and clinical correlates of aging have been identified. Their relative weight and clinical usefulness is still poorly defined. There is strong evidence that a CGA detects many problems missed by a regular assessment in general geriatric and in cancer patients. There is also strong evidence that a CGA improves function and reduces hospitalization in the elderly. There is heterogeneous evidence that it improves survival and that it is cost-effective. There is corroborative evidence from a few studies conducted in cancer patients. Screening tools exist and were successfully used in settings such as the emergency room, but globally were poorly tested. The article contains recommendations for the use of CGA in research and clinical care for older cancer patients. CONCLUSIONS: A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used.

Advisory Committees↗
PubMed1978

[Geriatric gynecology. A contribution to geriatric gynecology with special reference to postoperative mortality].

A contribution to geriatric gynecology with special consideration of postoperative mortality. Almost imperceptibly, essential progress has been made within recent years in the field of surgical geriatric gynecology. The attempt was made, after enumerating the specific problems of geriatric gynecology, to deal systematically with surgical geriatric gynecology. From 1960 to 1969 in West-Berlin, 7151 major operations in 60-year-old women and older were performed in 17 gynecological hospitals. Complete records were available in 6658 cases. Evaluating them, we were able to substantiate effectively the clinical actuality of surgical geriatric gynecology as a component of geriatric gynecology.

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PubMed2001

[Health services research in geriatrics and geriatric rehabilitation from the national and international viewpoint].

In Germany, health services research geriatric problems is not of major scientific and political importance. Focusing on geriatrics, it is essential to produce good data concerning efficacy, effectiveness and costs of the interventions. Otherwise, the discussion about the allocation of resources in the German health care system will take place without good arguments for special geriatric interventions. Prerequisite for this goal is the definition of adequate endpoints targeting functional deficits and the operationalization of multi- and comorbidity. Another problem is research focused on the "black box" of specific geriatric interventions. A special German situation is the distinction between acute and rehabilitative geriatric settings where very similar patients are treated. For this reason, it is essential for the geriatrician in the German context to focus more on health services research to demonstrate with scientific evidence their important contribution for the care of the elderly.

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PubMed2003

Geriatric medicine training for family practice residents in the 21st century: a report from the Residency Assistance Program/Harfford Geriatrics Initiative.

Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. With support from the John A. Hartford Foundation of New York City, the American Academy of Family Physicians (AAFP) implemented in 1995 a multi-part project to improve the amount and quality of geriatric medicine education received by family practice residents. This report summarizes the initial results of the regional geriatric medicine curriculum retreats for residency directors. The goals of the retreats were to build recognition among the residency directors of the skills that future family physicians will require to be successful providers of primary care to older adults and to allow the residency directors to identify and develop solutions to barriers to improving geriatric medicine training for residents. Forty-six program directors participated in the three retreats between February 2000 and February 2001. The participants represented 52 programs and rural tracks in all geographic regions, small and large programs, and urban and rural settings. The program directors developed a consensus on the geriatric medicine knowledge, skills, and attitudes that should be expected of all family practice residency graduates; developed a list of basic, required educational resources for each family practice residency program; and proposed solutions to common obstacles to successful curriculum development.

Attitude of Health Personnel↗
PubMed1987

Interface of geriatric medicine and geriatric psychiatry.

Proper care of rapidly growing numbers of elderly individuals, particularly the oldest-old, whose numbers are increasing more than any other subgroup, requires an integration of geriatric psychiatry and geriatric medicine on the clinical level. This dictates that educational programs at the medical school and residency level include both medical and psychiatric aspects of aging and that fellowship programs which are based in one discipline provide a meaningful exposure to the other. Nonetheless, it is highly unlikely that a single specialty of geriatrics will be developed which includes both psychiatry and medicine, and much more likely that the individual disciplines will maintain their identity and separate training programs. Specific clinical facilities being developed, such as geriatric assessment units and geriatric hospitals, will increasingly provide a creative environment for interdisciplinary interactions of psychiatrists and internists committed to the proper care of the elderly. It is through the experience of these emerging clinical units and joint clinical research programs that the further integration of the two subspecialties is likely to be forged.

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PubMed2003

Geriatric medicine curriculum consultations for family practice residency programs: american academy of family physicians residency assistance program/hartford geriatrics initiative.

Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. These programs have an average of only seven full-time equivalent physician faculty. This report summarizes results of the Residency Assistance Program/Hartford Geriatric Initiative (RAP/HGI) geriatric medicine curriculum consultations for family practice (FP) residency programs conducted from 1996 to 2001. This project was developed as part of the RAP in family practice. Ten experienced FP educators were selected and trained as special consultants. Between 1996 and 2001, 39 FP residency programs participated in the 1- to 4-day RAP/HGI consultations. The programs were diverse in size and location. The consultations reached 308 family practice residency faculty members involved in training 807 residents. Program evaluations of the consultants were uniformly in the very good to excellent range, with a mean rating of 4.6 (5-point scale, with 5 indicating excellent). At the end of the initial consultation visit, the residency program faculty and the consultant developed short-term goals for geriatrics program development. Eighty-five percent (33/39) of the programs submitted their curriculum goals in writing. The mean number of goals per program was 4.8 (range = 3-11). Of the 33 programs with written goals, follow-up was documented for 29 programs. Seventy-nine percent of the programs' self-defined educational goals were met during the 6 to 12 months of follow-up (range 50-100%). Ten of the programs implemented all of their educational goals. The RAP/HGI project demonstrated that achievable geriatric medicine curriculum improvements could occur as part of an onsite consultation process.

Connecticut↗
PubMed2004

Using standardized patients to assess the geriatrics medicine skills of medical students, internal medicine residents, and geriatrics medicine fellows.

PURPOSE: Medical schools and residency programs are placing additional emphasis on including clinical geriatrics competencies within their curricula. An eight-station, Geriatric Medicine Standardized Patient Examination (GSPX) was studied as a method to assess bedside geriatrics clinical skills over the continuum of medical education from medical school through residency and fellowship training. METHOD: The GSPX was administered to 39 medical students, 49 internal medicine residents, and 11 geriatrics medicine fellows in 2001-02. Reliability of standardized patient (SP) checklists and rating scales used to assess examinees' performance was measured by Cronbach's alpha. Validity was measured by surveying the examinees' assessment of fairness, individual case length, difficulty, and believability, and by faculty standard setting for each level of trainee. RESULTS: Reliability was high (alpha =.89). All levels of examinees found the SPs to be believable, station lengths to be adequate, and rated the GSPX as a fair assessment. Students rated the cases as more difficult. Previous experience with similar real patients increased significantly with level of training (Pearson's r =.48, p <.0001). Faculty set passing scores that increased from students to residents to fellows. However, GSPX scores decreased with level of training (r = -.25, p =.01). CONCLUSION: The GSPX is a reliable measure of geriatrics medicine skills with adequate face validity for examinees at all levels. However, GSPX scores did not increase with level of training, suggesting that a single form of the examination cannot be used across the continuum of training. Potential modifications to the GSPX that might provide more discrimination between levels of training are currently being explored.

Clinical Competence↗
PubMed1992

A prospective evaluation of the Geriatric Depression Scale in an outpatient geriatric assessment center.

OBJECTIVE: To prospectively evaluate the Geriatric Depression Scale (GDS) in cognitively intact and impaired patients undergoing outpatient geriatric assessment. SUBJECTS: One hundred ninety-four geriatric patients evaluated in a 1-year period. SETTING: The outpatient Geriatric Assessment Center of the University of Nebraska Medical Center. MEASUREMENTS: The 30-item GDS was completed by all patients. The patients were then evaluated by one of three geriatric psychiatrists who were blind to the GDS results. The prospective clinical diagnosis of major depression was compared to the GDS results. Patients were categorized as cognitively impaired or intact on the basis of the Mini-Mental State Examination. Data were analyzed using ROC curves. An optimal cutoff was identified which was the total score on the GDS with the highest combined sensitivity and specificity. RESULTS: ROC curve analyses showed good agreement between the clinical diagnosis and the GDS in both cognitively intact and impaired subjects. Cognitively intact, euthymic patients reported a mean of 8.4 symptoms, while cognitively impaired, euthymic patients, reported a mean of 8.7. Cognitively intact, depressed patients reported a mean of 14.7 symptoms, while cognitively impaired, depressed patients reported a mean of 15.0. CONCLUSIONS: This study provides further evidence that the GDS is as accurate a screening test for depression in cognitively impaired as in intact patients.

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