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PubMed2004

Poor mental and physical health differentially contributes to disability in hospitalized geriatric patients of different ages.

OBJECTIVE: To evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge. METHOD: Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms. RESULTS: Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired. CONCLUSION: Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability.

Activities of Daily Living↗
PubMed2001

High prevalence of anxiety symptoms in hospitalized geriatric patients.

OBJECTIVE: To examine the prevalence of anxiety symptoms in hospitalized geriatric patients. DESIGN: Controlled cross-sectional study. SUBJECTS: Ninety-eight geriatric in-patients and 68 healthy home-dwelling controls of similar age recruited from senior citizen centres. OUTCOME MEASURE: Anxiety measured as a current emotional state by Spielberger's State-Trait Anxiety Inventory (STAI). RESULTS: The geriatric patients scored significantly higher than the controls. Applying Spielberger's recommended cut-off of 39/40 on the STAI sumscore, 41% of the female and 47% of the male geriatric patients might be suspected of suffering from significant anxiety symptoms. Patients with chronic obstructive pulmonary disease tended to score higher; otherwise no relationship was found between the STAI sumscore and type of chronic somatic disease, nor between the STAI sumscore and number of drugs in regular use. CONCLUSIONS: STAI proved feasible for use in the elderly. The scoring on the STAI is high in geriatric in-patients. Further studies are needed to clarify to what extent this relates to a high prevalence of anxiety disorders.

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PubMed2002

A survey of the views of geriatric psychiatrists in the United Kingdom on the use of electroconvulsive therapy to treat physically ill people.

BACKGROUND: One of the main concerns about ECT is its use for people with concurrent medical illnesses. Geriatric psychiatrists are more often likely to encounter this situation in working with older age groups. Drawing on the collective experience of all UK geriatric psychiatrists may allow a better understanding of the use of ECT for people with major medical illness. METHODS: A postal questionnaire was used to seek the views of all consultant geriatric psychiatrists in the UK on the use of ECT in the presence of major illness. The questionnaire was developed from previous literature on the subject, a previous pilot study, published guidelines and clinical experience of the authors. RESULTS: Geriatric psychiatrists most often favour bilateral ECT. They are likely to carry out physical examination, chest X-ray, ECG, haemoglobin estimation, urea and electrolytes, thyroid and liver function tests in medically ill people before considering ECT. They are more likely to change their ECT assessment procedures when dealing with medical illness, rather than any other aspect of treatment, and are unlikely to change any aspect of ECT treatment in someone of advanced age. CONCLUSIONS: Geriatric psychiatrists see their roles in relation to ECT as primarily that of assessment, and rely on others to advise on anaesthetic drug use, treatment technique, concurrent drug treatment and post-ECT management. It is important that the ECT consultant and ECT anaesthetist are aware of their role and prepared to offer appropriate advice. The role of the ECT consultant in relation to the responsible medical officer requires clarification.

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PubMed2003

A comparative study of stress and burnout among staff caregivers in nursing homes and acute geriatric wards.

OBJECTIVE: To compare levels of stress and burnout among staff caregivers in nursing homes and acute geriatric wards of general hospitals. METHODS: A cross-sectional survey was conducted in three nursing homes (total of 522 beds, 270 caregivers) and nine geriatric sections of general hospitals (total of 371 beds, 280 caregivers). Staff caregivers were asked to answer a four-part questionnaire made up of socio-demographic data, the General Health Questionnaire (GHQ-12), the Maslach Burnout Inventory (MBI) and the Stressful Events Questionnaire (SEQ). RESULTS: 355 carers (172 from nursing homes, 183 from acute geriatric wards) answered the questionnaire (response rate 66%). Bivariate analysis reveals that general hospital carers show higher GHQ scores, higher MBI-Depersonalisation (DP) and Emotional Exhaustion (EE) sub-scores and lower MBI-Personal Accomplishment sub-scores. Stressful Events (as revealed by the SEQ) are more frequently reported by general hospital carers, particularly events related to patients' behavioural disorders. Multivariate analysis shows that general hospital work-setting, professional role, female gender and patient/carer ratio are significant explanatory variables of a high MBI-EE sub-score, while general work setting and disability are the best explanatory variables of a high MBI-DP sub-score. Professional role and general hospital work-setting are independent factors in a low MBI-Personal Accomplishment (PA) sub-score. CONCLUSION: These results appear to show that levels of stress and burnout among staff caregivers are moderate in acute geriatric wards, but significantly higher than in nursing homes. This suggests that increasing the rate of trained staff and improving staff support-for instance by the implementation of Consultation-Liaison (C-L) Psychiatry and/or continuing education programmes-could be needed mostly in acute geriatric wards.

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PubMed2003

Geriatric depression in Nigerian primary care attendees.

OBJECTIVE: To determine the rate and correlates of geriatric depression in two primary care facilities within a teaching hospital in Nigeria. METHOD: 202 older people were screened using the Geriatric Depression Scale (GDS). The Geriatric Mental State schedule (GMS) was administered to participants who scored above the cut-off on the GDS in order to assess psychopathology. Diagnosis of depression was based on ICD-10 criteria as well as the GMS-AGECAT program. RESULTS: The rate of geriatric depression in primary care was found to be 7.4%. Severe depression was only 1.5%. Very low income and subjective report of poor health were significantly associated with depression in the cohort. AGECAT recognition of depression was comparable to that by the ICD-10 (k = 0.7). CONCLUSION: The study is the first known study of geriatric depression in primary care in Nigeria. The rates are comparable with rates obtained in other countries. Specific correlates of depression in the older Nigerians identified included poor self-assessed health and low income.

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PubMed2006

Adherence of academic geriatric practitioners to osteoporosis screening guidelines.

OBJECTIVES: To examine the bone mineral density (BMD) testing habits of geriatricians and geriatric fellows at the University of Connecticut fellowship training program to evaluate their adherence screening guidelines. DESIGN: Retrospective chart review. SETTING: University based academic geriatric practice in Farmington, CT. PARTICIPANTS: Chart review of two hundred female patients over age 65 under care of seven faculty geriatricians and eight geriatric fellows in training. MEASUREMENTS: Data collected included BMD testing status, patient's osteoporosis risk factors and functional status. RESULTS: Physicians ordered BMD tests in 151 (76%) patients; 128 (64%) had a bone mineral density test within three years. A personal history of fracture was the only osteoporosis risk factor that correlated to higher rates of osteoporosis testing. Physicians were more likely to order BMD screening in younger patients (92% in 65-74 vs. 74% in ages 85+, P=.031), patients independent in activities of daily living (72% vs. 32, P=.002), and patients without dementia (70% vs.37%, p=.007). BMD testing results found 82% with osteopenia or osteoporosis. CONCLUSIONS: A geriatric group that is highly attuned to bone health demonstrated more optimal adherence to OP testing guidelines for all "at-risk" older women and better than reported previously. Functional status more strongly predicted BMD testing than osteoporosis risk factors. This study suggests that with improved physician education and familiarity with the disease, high rates of BMD testing for earlier identification of geriatric patients at risk for osteoporosis are achievable.

Activities of Daily Living↗
PubMed1994

Geriatric clinical training in medical schools.

The primary purpose of geriatric training in medical school is to improve the care of the elderly by practitioners in every specialty, by increasing their knowledge base and fostering interest in older patients. A secondary goal is to interest some students in geriatrics as a career. For > 10 years, leaders in medicine and medical education have strongly recommended clinical geriatric training for medical students, but only a few programs have been implemented. Geriatrics educational experiences must be required; otherwise, not enough medical students will elect to take these courses. Although we still do not know which model best provides this experience, evaluations of existing programs suggest that geriatrics can be taught in both long-term care and acute settings, involving well-designed curriculum and interested faculty. More studies are needed, but exposure to well elderly and community-based programs may also improve attitudes toward the elderly and thereby further improve their medical care.

Clinical Competence↗
PubMed1991

Oxidation-reduction (redox) potentiometry in blood in geriatric conditions: a pilot study.

Oxidation-reduction (redox) potentials in blood were measured potentiometrically in 36 elderly people: 26 long-stay patients in a nursing home and 10 healthy elderly people (controls). The geriatric patients were obviously more affected by various chronic geriatric conditions, clearly used more medications, and had much higher quantitative invalidity scores (help index) compared to the control group. The average redox potential (Eh) in the geriatric patients was significantly (p less than 0.001) higher (300 mV +/- 24) than that in the control group (269 mV +/- 19). Repeated measurements showed some intraindividual variability of Eh. The pH in blood and a number of haematological and anthropometrical parameters did not differ significantly, except for the haemoglobin content, which was somewhat lower in the geriatric group (p less than 0.02). Eh did not correlate with the haemoglobin content. In addition, no effects of age or sex on the value of Eh were found. It was concluded that the general physical condition of the geriatric patients could be responsible for an increase of Eh, although drug effects and nutritional factors could not be excluded. Eh can be regarded as a measure for the balance of oxidant and reductant component in tissue fluids. Comparison between the Eh of younger and healthy elderly people indicates that this balance is apparently unaltered in healthy elderly persons, although elderly people may be more susceptible to disturbance by disease conditions, possibly as a result of a decreased homeostatic capacity of the redox balance. As many redox components play a role in the biochemistry of oxy-radicals, one may speculate on the possible value of Eh in relation to oxy-radical tissue damage.

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PubMed2004

Statements on the interdependence between the oncologist and the geriatrician in geriatric oncology.

Geriatric oncology is defined by the multidimensional and multidisciplinary approach of the elderly cancer patients. Autonomy, beneficence, non-maleficence and justice are the four fundamental principles on which are based the treatment objectives and practical management of these patients. The comprehensive geriatric assessment is the tool the most likely to detect the functional problems in these elderly patients. The standard oncologic managements of cancer are applicable to these patients. However treatment plan and geriatric interventions must be tailored to each individual patient characteristics. Thus a strong interdependence between oncologic and geriatric teams is warranted. This implies specific teaching programs during initial medical studies and in the setting of continuous medical education. Furthermore, such worldwide teaching programs may help to the implementation of geriatric oncology programs which is only based, to date, on personal experiences as described in this report.

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PubMed2005

Incorporating geriatrics into the respiratory care curriculum.

The absolute number of adults over the age of 65 years is increasing nationwide and worldwide. Older adults today are more independent and self-sufficient than persons of that age were a generation ago. An increased incidence of acute and chronic disease results in relative morbidity but less mortality in those aged 65 years and older. The decision to incorporate or infuse education in geriatrics into existing respiratory care classes is not difficult. Implementation may be a little more challenging, but gradually adding geriatric components to courses over time is a perfectly reasonable way to introduce students to their future patient population. Fortunately, a growing number of elderly individuals desire to treat pathology rather than accept it as an inevitable consequence of aging. For these reasons, respiratory therapists have been brought into the realm of geriatric medicine, more by default than by organizational planning. The most passionate converts to the important role of geriatrics are physicians, nurses, and therapists who have recently attempted to shepherd their own aging parents through a health care system. If that experience that leads to these conversions could be measured and communicated, the world at large might be convinced of the value of education in geriatrics.

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PubMed2003

State of the art in geriatric rehabilitation. Part II: clinical challenges.

OBJECTIVES: To examine common clinical problems in geriatric rehabilitation and to make recommendations for current practice based on evidence from the literature. DATA SOURCES: A CINAHL database and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search was completed by using the Cochrane database. STUDY SELECTION: One author reviewed the references for relevance and another for quality. A total of 336 articles were considered relevant. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports on a small number of patients. DATA EXTRACTION: The following areas were the major geriatric rehabilitation subtopics identified in the search: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. This article focuses on the latter 5 subtopics. The literature was reviewed by using a level-of-evidence framework. Level 1 evidence was a randomized controlled trial (RCT) or meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts, descriptive studies, or reports of expert committees. DATA SYNTHESIS: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic according to the level of evidence in the specific area. In cases in which several articles were written on a topic with similar conclusions, we selected the articles with the strongest level of evidence, thereby reducing the total number of references. CONCLUSIONS: Frail older patients with hip fracture should receive geriatric rehabilitation. They should also be screened for nutrition, cognition, and depression. Older persons should receive nutritional supplementation when malnourished. If severe dysphagia occurs in stroke patients, gastrostomy tube feeding is superior to nasogastric tube feeding.

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PubMed2006

[Lung cancer in the elderly: performance status and/or geriatric indices?].

INTRODUCTION: Demographic aging poses a problem of management in patients over 65 years old with lung cancer (LC). Performance status (PS) is an index of global activity that, in part, determines treatment. Geriatric indices allow a multifactorial assessment of the elderly subject. The aim of our study is to evaluate whether PS correlates with the geriatric indices in elderly patients with lung cancer. METHODS: In a single centre prospective study the geriatric indices (ADL, IADL, PINI, MMS) and the Charlson score (CS) were measured before treatment. RESULTS: Forty one patients aged 75.7 +/- 6.6 years were included in the study. PS 3-4 was found in 15% of patients and 44% had stage IV disease. Half of them were ADL dependent and 95% were IADL dependent. A MMS<24 was found in 29% and 17% had a PINI > 20. The CS was 2.7 +/- 2.1. There was a correlation between PS and the geriatric indices but no correlation between PS and CS. CONCLUSION: PS is significantly correlated with the geriatric indices but is independent of CS. PS appears to be a good parameter for the assessment of global activity in the elderly subject with LC.

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PubMed2005

Geriatric medical education and training in the United States.

Medical education in geriatrics is an important requirement to ready the profession to provide comprehensive health care to the world's and also Taiwan's aging population. The predoctoral curricula and postdoctoral training programs in the United States were developed and supported by government agencies and professional education societies. Geriatric medical education in American medical schools has improved in the past 20 years, yet is still facing many challenges. The purposes of this paper are to review the current progress of, and propose some main principles and policies for the development of geriatric medical education and current progress in the United States. Geriatric medical education should be mandatory to adequately prepare medical students, residents, fellows, and practicing physicians to treat the elderly. The current progress and practice of geriatric medical education at the University of Texas Health Science Center at San Antonio are presented as an example.

Certification↗
PubMed2003

Geriatric urology.

Urology is one of the surgical specialties that has been most affected by the growing demographic of older adults in the United States. Urological problems are common in elderly people, and care of patients aged 65 and older represents a large proportion of many urologists' practices. However, this has also presented unique challenges to the development of the field of geriatric urology as an identified subspecialty. Until recently, formal educational requirements and opportunities in geriatric urology were limited. In addition, there is a paucity of basic science and clinical research related specifically to urological problems in older adults, despite the growing numbers of patients in this age group. This article reviews recent efforts to increase the activity, content, and visibility of the field of geriatric urology. Curriculum materials have been developed for urology training programs, research needs have been assessed and targeted, and a new professional organization (the Geriatric Urology Society) has been established. Current activities in the field of geriatric urology at the local, regional, and national levels, and goals for the future are reviewed.

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PubMed1999

The difference between Japan and other countries, in particular the United Kingdom, in views regarding the teaching of geriatrics to undergraduate medical students.

OBJECTIVES: To examine differences in views on geriatrics education at the undergraduate level between Japan and other industrialized countries, including the United Kingdom. DESIGN: We conducted a nationwide survey of professorial staff responsible for undergraduate education in all medical schools in Japan, and an international survey of 37 medical schools and geriatric institutes in other industrialized countries, including 16 medical schools in the United Kingdom. RESULTS: The results indicate that undergraduate education in geriatrics in Japan emphasizes the theoretical aspects of the aging process and the features of diseases in the elderly, and lacks attention to the practical aspects of care. In contrast, geriatrics education in the United Kingdom and other countries places emphasis on practical aspects of the care of the elderly. CONCLUSIONS: The introduction of practical aspects of management and care of the elderly to the undergraduate education programme in geriatrics in each medical school in Japan is strongly recommended. This is especially important to meet the needs of the rapid demographic shift towards an older population in this country.

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PubMed1997

Development and validation of a geriatrics knowledge test for primary care residents.

This study reports the development and preliminary validation of an instrument to measure geriatrics knowledge of primary care residents. A 23-item test was developed using questions selected from the American Geriatrics Society's Geriatrics Review Syllabus. Ninety-six internal medicine and family practice residents, 14 geriatrics fellows, and 11 geriatrics faculty members participated in the study. Findings support the reliability (Cronbach's alpha = 0.66) and validity (content and "known groups") of this short test. Predictive validity and sensitivity of the test to changes in knowledge will have to be further explored as residents progress through their training.

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PubMed2001

An introduction to geriatrics for first-year medical students.

OBJECTIVE: To prepare medical students to better serve their older patients while raising awareness of geriatrics as a career choice. DESIGN: To determine the impact of a new educational program, attitudinal assessments were administered to the group before and after participation in the program and to a comparison group of nonintervention students. SETTING: University of Texas Health Science Center, San Antonio. PARTICIPANTS: Two hundred and three first-year medical students. MEASUREMENTS: Student response on a scale of one to six regarding four constructs: attitudes and beliefs about providing medical care for older people, knowledge and beliefs about aging, interest in pursuing clinical geriatrics, and interest in pursuing aging research. RESULTS: Four factors were consistently formed in the analysis process: beliefs about physical decline; comfort with older people; beliefs about career opportunities; and interest in geriatric research. The intervention group made significant gains in two areas: comfort with older people and understanding of physical decline in aging. Two new factors emerged in post-test data. CONCLUSIONS: The impact of the program was mixed. Although awareness of geriatrics and comfort with older people was increased, there was little change in career aspirations. Students in the program increased their awareness of physical decline in old age, setting the stage for teaching them about the physician's role with regard to function, and learned that geriatrics is a low-status specialty.

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PubMed2002

Geriatric depression, antidepressant treatment, and healthcare utilization in a health maintenance organization.

OBJECTIVES: To assess the separate effects of depressive symptoms and antidepressant treatment on healthcare utilization and cost. SETTING: Social Health Maintenance Organization (HMO) at HealthPartners in Minnesota. PARTICIPANTS: Geriatric Social HMO enrollees were screened for depressive symptoms using the 30-item Geriatric Depression Scale. A stratified sample was created, composed of geriatric enrollees with depressive symptoms, with antidepressant prescriptions, or with neither (n = 516). DESIGN: Regression analyses were conducted with separate equations for utilization and charge outcome variables, both outpatient and inpatient (log-transformed). The Charlson Comorbidity Index, age, and gender served as covariates. MEASUREMENT: Depressive symptoms were identified through the Diagnostic Interview Schedule. Antidepressant treatment was determined from the HMO pharmacy database. RESULTS: Having depressive symptoms was associated with a 19 increase in the number of outpatient encounters and a 30 increase in total outpatient charges. Antidepressant treatment was associated with a 32 increase in total outpatient charges but was not significantly associated with number of outpatient encounters. Depressive symptoms and antidepressant therapy were not significantly associated with inpatient utilization or charges. CONCLUSION: This study found that patients with depressive symptoms generated more outpatient health care and higher charges but not necessarily more inpatient care. Our findings suggest that programs targeted to geriatric patients whose depression is comorbid with other chronic medical conditions might be cost-effective and particularly appropriate for geriatric care.

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