Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “GERIATRICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 559 records · Page 31Linked to original sources
PubMed2004

Geriatric assessment and comorbidity.

Elderly persons, a rapidly growing population segment, have an increased incidence of cancer. The older cancer patient's clinical evaluation and treatment is influenced by conditions such as disabilities, comorbidity, and functional status, along with tumor type and stage. These conditions and other geriatric syndromes can be identified by comprehensive geriatric assessment to guide therapy and affect prognosis and quality of life. Comprehensive geriatric assessment involves the medical, functional, affective, social, spiritual, and environmental assessments. The medical assessment, which includes a nutrition, vision, hearing, continence, gait and balance, and cognition evaluation, can provide additional information to performance status and comorbidity. Although there are many assessment domains using several instruments, comprehensive geriatric assessment can be focused and efficient, especially with a multidisciplinary team of nurses, social workers, pharmacists, and other personnel. Comorbid illnesses may have complex interactions, with the underlying cancer influencing cancer diagnosis, disease course, treatment-related side effects, and mortality. Many instruments are available for comorbidity measurement, and retrospective studies in elderly cancer cohorts have shown comorbidity to influence survival. However, the ultimate aim would be to use comorbidity and comprehensive geriatric assessments prospectively in the older cancer patient to help predict the suitability and success of treatment with various antineoplastic modalities.

Aged↗
PubMed2001

Psychometric evaluation of a brief geriatric depression screen.

This article is a psychometric evaluation of the experimental Geriatric and Extended Careline Depression Screen (GEDS) for geriatric nursing care residents. The GEDS is a five-item depression screen based on an abbreviated version of the Center for Epidemiological Studies Depression Scale (CES-D). A total sample of 91 male residents over the age of 60 were recruited from a Veterans Administration Nursing Home Care Unit. The Geriatric Depression Scale-Short Form (GDS-SF) was used as a gold standard test to examine the convergent validity of the GEDS. The Discriminant Trait Inventory was used to assess divergent validity and the confounding effects of method variance in this research design. Test-retest reliability, redundance and omission in item content validity were systematically evaluated. A receiver operating characteristics (ROC) curve was used to identify the most effective cut-off score for clinical selection. Reliability was significant, but moderate. Convergent validity with the Geriatric Depression Scale was high. No items were identified as redundant. A review of literature suggested that irritability is an important factor of geriatric depression that had not been included in the original screen. The inclusion of an experimental item to assess irritability, however, did not improve the psychometric properties of the GEDS.

Aged↗
PubMed2004

Doctors' and nurses' observations on the Geriatric Depression Rating Scale.

BACKGROUND: Screening older patients routinely for depression using the Geriatric Depression Scale is recommended, but there is little evidence that this practice is widespread. This study explored doctors' and nurses' attitudes towards the Geriatric Depression Scale in order to identify possibilities for improving practice. DESIGN: structured interviews. SETTING: Acute Care of the Elderly wards in the Royal Liverpool University Hospital. PARTICIPANTS: 20 junior doctors and 25 nurses. RESULTS: Only 10% of respondents would consider using the Geriatric Depression Scale for routine screening. Objections were to process as well as content. The Geriatric Depression Scale was felt to be 'too depressing' for routine use and a barrier to rapport with the patient. In addition to screening for possible depression, doctors and nurses expressed different requirements from a depression scale. Doctors wanted a formal method of rating and documenting symptoms. Nurses required a therapeutic structure within which they could help patients to explore feelings. Nurses also wanted the option of offering counselling for their patients but felt they needed training. CONCLUSIONS: Lack of enthusiasm for the Geriatric Depression Scale reduces its usefulness as a screening tool. A screening method that is more acceptable to nurses and doctors might improve depression screening practice.

Aged↗
PubMed2003

Validation and application of an instrument for measuring patient relatives' perception of quality of geriatric care.

OBJECTIVE: To test and validate a questionnaire concerning patient relatives' perception of the quality of geriatric care. DESIGN: Three anonymous questionnaire studies. SETTINGS: A community-based geriatric care organization and a university hospital in Sweden. STUDY PARTICIPANTS: Three hundred and eighteen relatives of patients within the geriatric care organization and 38 relatives of patients at the university hospital. MAIN OUTCOME MEASURES: A questionnaire composed of eight quality of care indices and an overall quality rating. Reliability and validity estimates were compared between the results from the three surveys. RESULTS: Internal reliability estimates for all indices were >0.65 and consistent over time. Inter-index correlations were >0.60 between certain indices, indicating some overlap. Second order factor analysis resulted in three distinct index groupings: personnel, relative's role, and care content. These three dimensions summarize relatives' perceptions of the quality of geriatric care. CONCLUSIONS: There is a need for a confidential patient relatives' questionnaire in geriatric care. The results revealed good questionnaire reliability and validity. The questionnaire needs to be tested in larger, independent samples in order to validate the indices further.

Aged↗
PubMed1991

Three years of a required geriatrics module for third-year medical students.

The Parker Jewish Geriatric Institute, a teaching nursing home at which an accredited internal medicine geriatrics fellowship is based, co-developed with the Department of Family Practice of the medical school at the State University of New York at Stony Brook a mandatory geriatrics module for third-year medical students. The module's implementation over a three-year period (1985-1987) with 278 medical students is described. The authors conclude that if time and effort are given to the development of a geriatrics curriculum, and if appropriate instructors are chosen, then learning geriatrics in long-term-care settings can be as rewarding and exciting an experience for medical students as their experiences in other clinical settings, even when that learning is required.

Adult↗
PubMed2002

Palliative care module within a required geriatrics clerkship: taking advantage of existing partnerships.

OBJECTIVE: LCME has recently required that all graduating medical students learn about end-of-life care. This program describes the design and integration into an existing geriatrics clerkship of a palliative care module that teaches the foundations of end-of-life and palliative care to medical students. DESCRIPTION: Faculty experts in geriatrics met during a series of weekly meetings in 1999 to design a mandatory four-week-long clinical clerkship in geriatrics. Since the palliative care program is based within the geriatrics department, faculty members with interest and expertise in both geriatrics and palliative care were invited to design a palliative care module that can be integrated into the clerkship. Since LCME does not specify details of what students must learn about end-of-life care, and our goal is to educate and prepare students for any chosen specialty, we wanted to design a basic core curriculum in palliative care that would be useful to any graduating student. After reviewing potential palliative care topics, and given limited curriculum time, we condensed the medical student core curriculum to the following sessions: (1) Systematic Pain Assessment Management, (2) Management of Distressing Symptoms, (3) Communicating Bad News, and (4) Advance Directives. We developed PowerPoint presentations, teaching case vignettes, and a set of reference articles, which can be distributed to students as well as to help faculty teachers prepare for the sessions. Teaching sessions occur in small groups, using case discussions and interactive lectures. Sessions 3 and 4 are co-facilitated by palliative care physicians and ethicists, who use role-plays, reflections, and discussions to teach the topics. At the end of the clerkship, students practice these communication skills with videotaped standardized patient encounters, and debrief with faculty members about their performances and ways to improve their communication skills. DISCUSSION: Palliative care sessions are welcomed by the students, who traditionally have not received much teaching in this area. Even though students have learned about mechanisms regulating pain and other symptoms in the past, they have not learned to assess or treat symptoms in a systematic way. Students often have good questions about the decision-making, legal, and ethical issues that emerge for patients near the end of life. Thus, co-facilitation of physicians with ethicists presents both the practical clinical and the theoretical perspectives, and provides a good model for team teaching. In terms of teaching style, students are more involved and participatory when teachers use case vignettes as compared with slide presentations, even if they are case-based. When using role-plays to teach students how to communicate bad news, we found that students need to feel safe in that environment, need to know they can call for time out when necessary, and want to have seen one done before they are asked to do one.

Clinical Clerkship↗
PubMed1998

Geriatric education: a system approach.

This article describes an institutionwide geriatric educational initiative (called Geriatrics Awareness Month) that provided didactic and formal experiential learning designed for health professionals. From an educational perspective, to learn geriatrics requires systems thinking, and, to learn systems thinking, geriatrics provides an excellent clinical context. The authors evaluated the didactic and experiential aspects of Geriatric Awareness Month. For attendees of didactic sessions, the availability of pocket-sized educational materials was deemed most valuable. Despite busy schedules, house staff were able to make a change in their practice and study the effect of this change.

Aged↗
PubMed2003

Special considerations in geriatric injury.

PURPOSE OF REVIEW: As the elderly population expands and adopts increasingly more active lifestyles, trauma and critical care practitioners will be faced with providing care for greater numbers of severely injured patients. However, because of their associated preexisting medical conditions and poor relative physiologic reserve, geriatric patients have higher mortality rates and poorer long-term functional outcomes than their younger counterparts. A thorough understanding of the causes for these disparate outcomes is critical if successful strategies and treatments for this unique patient population are to be developed. RECENT FINDINGS: The currently available geriatric trauma literature is largely descriptive and retrospective, and does not provide ready explanations or solutions for the substantially worse outcomes experienced by this patient population. It does appear that outcomes are improved by providing early and aggressive care in designated trauma centers, yet undertriage remains a significant problem. Early admission to an ICU has been recommended, but its benefits remain unproved. Significant differences exist between older and younger patients in injury patterns, and in the frequency and type of complications These differences in turn demand prompt diagnostic approaches, aggressive treatment, and unique prevention strategies. SUMMARY: Ironically, the field of geriatric trauma is still in its infancy. Given the relation between advanced age, associated preexisting medical conditions, and poor physiologic reserve, a poor outcome may be inevitable by the time the geriatric patient presents for medical attention. Greater emphasis should therefore be placed on injury prevention efforts in this patient population. There is a dire need for well-designed prospective studies in geriatric trauma.

Aged↗
PubMed1983

Exploratory study to evaluate staff attitudes towards geriatric psychiatry.

This work is part of a larger study carried out at the Murray Royal and Murthly Hospitals within the Tayside Health District. The survey was concerned with staff attitudes towards geriatric psychiatry patients and shows that the nurses in these peripheral hospitals hold a positive attitude towards this area of nursing. These findings appear to contradict the popular opinion held throughout the nursing service, that the geriatric psychiatry nursing area is very unpopular with trained, untrained and learner nurses. In the study by Hooper [Nursing Times (1981) 77 37-40/43-44], anxiety levels among learners towards the geriatric nursing areas were found to be very high. This appears to correlate with Kogan [Journal of Abnormal and Social Psychology (1961) 62, 616-622], which summarized is as follows: Young subjects were imputed to have a more consistently negative view of old people.' By using a series of two precoded questionnaires that the subjects completed, an overview of staff attitudes towards the geriatric psychiatry areas was obtained. The hypothesis on which the study was based was as follows: that a negative view towards geriatric psychiatry would be found among the staff of the Murray Royal and Murthly Hospitals.' However, the findings of this study did not support the hypothesis on any counts and gave a highly positive attitude scale.

Adolescent↗
PubMed1986

A comparison of nursing care requirements of patients in long-term geriatric and acute care nursing units.

It is commonly assumed that elderly patients in long-term care facilities require less total care and less professional care than patients in active 'treatment' settings. However, no objective data have been available to support or refute these assumptions. This study examined patient classification data obtained from eight acute care medical and surgical units and four long-term care geriatric units over a 1-year period. Results indicated that geriatric patients in long-term care units had differing (as opposed to similar) nursing care needs, nursing care requirements of geriatric patients in several long-term care units differed from those of patients in another long-term care unit, geriatric patients in the selected long-term care units required at least as much nursing care as those in the medical surgical units, and the long-term care units had many patients with extensive nursing care requirements but no patients with very complex requirements when compared with the medical/surgical units. The potential impact of these findings on staffing of long-term care units is considerable. Issues relating to reliability, validity and comparability are discussed. There is a great need to utilize standardized, state-of-the-art methods for nursing workload measurement to facilitate comparisons of nursing care requirements of geriatric long-term care patients with those of patients in other areas.

Aged↗
PubMed1993

Geriatric medicine: does teaching alter medical students' attitudes to elderly people?

The development of a questionnaire to assess the attitudes of medical students towards old people is described. Principal components analysis of the responses of 114 first-year medical students revealed two orthogonal factors, named negative attitudes and medical intervention. Scores on these factors were compared among three groups of medical students: first-year students, 64 clinical phase medical students prior to a geriatric medicine course, and 69 medical students who had completed a geriatric medicine course. Negative attitudes scores did not differ between first year and the clinical years, but were reduced after the geriatric medicine course. Scores on the medical intervention factor reduced significantly from first year to the clinical years and were not reduced further by the geriatric medicine course. Women tended to have lower scores on negative attitudes. Medical students appeared to change their attitudes concerning the degree to which medical intervention is appropriate as a result of preclinical or general medical experience. However, their reservations concerning the reward to be gained from working with elderly people were stable over the same periods, but were altered by a course in geriatric medicine.

Aged↗
PubMed2004

Acute and chronic pain in geriatrics: clinical characteristics of pain and the influence of cognition.

OBJECTIVE: This study aimed to identify which of the well-known characteristics of chronic pain patients are seen even in older patients with multiple comorbidities and considerable functional impairments and how cognition influences patients' reports of acute and chronic pain. DESIGN: A cross-sectional study. SETTING: Inpatients of acute and rehabilitation wards of a German geriatric hospital. PATIENTS: Patients with acute (N=36) or chronic (N=55) nonmalignant pain. MEASUREMENTS: A comprehensive assessment was conducted, including a structured pain interview and pain assessments using Folstein's mini-mental state (MMS) examination, the Clock Drawing Test (CDT), a short form of Yesavage's Geriatric Depression Scale (GDS), and Spielberger's State-Trait Anxiety Inventory (STAI). The Barthel Index was used to measure the activities of daily living (ADL) at admittance and discharge. RESULTS: Geriatric patients with chronic pain described more pain sites, used a larger number of pain descriptors, used more analgesics at discharge, and reported both a lower degree of pain reduction during therapy and a lower reduction of disability during hospital stay than did acute pain patients. Anxious and depressive symptoms and difficulty falling asleep tended to be higher in chronic pain patients than in acute pain patients. Cognitively impaired patients described the location of their acute pain as similar to patients with chronic pain and as less precise than did cognitively less-impaired patients. Report of pain intensity and in improvement in the ADL measure were independent of cognitive status. CONCLUSIONS: Geriatric inpatients with chronic pain differ from acute pain patients in pain description, pain reduction during treatment, use of analgesics, and emotional distress. Cognitive impairment seems to change the ability to localize acute pain. In our study, the perception of pain intensity was independent of cognition. Because of the small sample size, further studies are needed to confirm these findings. Multiprofessional, intense rehabilitation programs for geriatric patients with chronic pain are considered of prime importance.

Acute Disease↗
PubMed1981

What is geriatrics? The Swiss experience.

For the Geriatric Institutions of Geneva, geriatrics is not just a convenient term for concealing large gaps in present medical knowledge, but a specialized branch of medicine specifically adapted to the urgent needs of the growing older adult population. These Institutions constitute a 276-bed hospital, an 80-bed extended-care facility, and a large consultation service for ambulatory patients. The staff comprises over 50 physicians and psychiatrists, multidisciplinary paramedical personnel, and a large complement of social workers. The three main goals are to: 1) address the complex medical needs of the older patient; 2) motivate the staff about the specific problems of the elderly and how to deal with them; and 3) promote awareness in the community of the complexity of problems associated with geriatric patients. The model of geriatric health-care delivery developed and practiced in Geneva is "Integrated Medicine." This is not simply a multidisciplinary approach to the multiple disorders of elderly patients, but also a particular philosophy of management with objectives specifically adapted to their unique pathophysiologic, psychiatric and social needs. The model is described as it pertains to preventive medicine, diagnosis, therapeutics, and prognosis. Integrated Medicine is not a panacea, yet it constitutes a step toward developing a health-care delivery system specifically adapted to the geriatric patient.

Aged↗
PubMed1982

A long-term geriatric teaching ward in an acute-care hospital: a three-year experience.

The development and management of a long-term geriatric ward in an acute-care teaching hospital are described. Structure, function, and costs are discussed, and issues of service and medical education are emphasized. A full geriatric team (physician, nurse, social worker, physiotherapist, and occupational therapist) assessed 165 long-term patients in the general wards of the hospital and accepted 98 for admission to the new long-term geriatric ward. Of these, 31 were discharged; 29 per cent went to a facility that encouraged more independent living. Eighteen patients died during their stay in the geriatric ward; autopsies were obtained in 33 per cent--a higher autopsy rate than the average for general hospitals. General hospitals may continue to have large populations of chronically ill patients. This model for a geriatric ward may offer a way of dealing with a difficult situation.

Aged↗
PubMed1983

Effects of geriatric education on the attitudes of medical students.

This study investigated the effects of an educational program in geriatrics on the attitudes of a group of third-year medical students. A survey designed to measure attitudes toward geriatric patient care, aging, and older people was administered to all students before and after their participation in a 25-hour geriatrics education component of a Family Practice Clerkship. Results showed the students' attitudes were significantly improved following the geriatrics training program. Prior training in geriatrics and their specialty preference were also found to have an impact on attitude. The implications of the study for medical education and research are discussed.

Adult↗
PubMed1983

Geriatric medical education: a project in faculty development.

To increase the competence of physicians to practice and teach geriatric medicine, the Office of Geriatric Medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio, offered an 11-week course to interested physicians on the faculty. This course, "Medical Management of the Aged--A State of the Art Symposium for Medical Faculty," was conducted as part of an overall plan of the Office to enhance faculty and curriculum development in geriatrics within the School. The weekly sessions consisted of clinical and research information presented by recognized experts in the field of geriatric medicine. Of the 52 formal registrants, 79 per cent were physicians and were from such fields of specialization as internal medicine, family medicine, and psychiatry. The mean attendance was 37. An overview and evaluation of the geriatric faculty development program is given.

Curriculum↗
PubMed1985

Geriatrics: a selected up-to-date bibliography.

This is the second annual revision of the Geriatrics Bibliography. Approximately two thirds of the old references have been replaced by more current or more detailed articles. The bibliography has been expanded to include several additional topics and over 200 new references. Since the literature pertinent to geriatrics is growing ever more rapidly, it has been necessary to omit many informative articles from the bibliography. Almost all of the references date from the past four years. Preference is given to recent publications, since they provide a list of the important earlier articles. Some articles were selected to highlight current controversies or changes in viewpoint. An occasional review article is cited to amplify geriatric aspects of common diseases. Most of the references deal specifically with an elderly patient population, studies of which, it will be noted, are confounded by questions of "normal" aging as opposed to the concomitants of aging frequent in our society: inactivity, obesity, malnutrition, and psychosocial trauma. A few articles concern diseases remarkably common in the aged but for which no adequate study specifically from a geriatric viewpoint exists; e.g., monoclonal gammopathy, Paget's disease, pulmonary emboli. The references are divided into categories. The first (I) set deals with some possible causes of aging, the second (II) with physiologic decline accompanying aging, the third (III) with the atypical and nonspecific characteristics of illness among geriatric patients, and the fourth (IV) with non-physician services available to the elderly, including ethical quandaries. The remainder of the references are cited by pertinent medical specialty. Within each category, references are divided by disease process. Articles are further subgrouped by aspects of those diseases such as evaluation or therapy.

Aged↗
PubMed1987

State initiatives in geriatric education.

Although the basic requisites of curricula in geriatrics and gerontology have been well developed, and the need for such programs is well established, the support for development of geriatric academic programs has not been commensurate with the need. Barriers to the development of such programs include ageism, financial disincentives, scientific underdevelopment, a dearth of trained faculty, the lack of institutional support, and the declining federal role. One attempt to overcome these barriers and address the tremendous need is the development of state initiatives. In the last decade, several state legislatures have begun to provide support for geriatric education. The purpose of this paper is to analyze the initiatives of state funded university programs in geriatrics and gerontology, with particular emphasis on the California experience. A survey involving 50 states was conducted using two rounds of structured telephone interviews. The survey results found that 44 states did not have any legislatively initiated support for geriatric programs in higher education. Six states did have such programs, they included: Ohio, North Carolina, Kansas, New York, Kentucky, and California. The components of the California program are discussed in further detail. The conclusions were that although these states provide paradigms for the rest of the nation, much more still needs to be done. Several issues raised by the state programs are discussed.

Data Collection↗