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PubMed1992

Geriatric education. Part I: Efficacy of a mandatory clinical rotation for fourth year medical students.

OBJECTIVES: To describe the curriculum of a mandatory, fourth-year geriatrics clerkship and assess its impact on medical students' knowledge of geriatric medicine and attitudes toward the elderly. DESIGN: One group, before/after trial. SETTING: Mount Sinai School of Medicine of the City University of New York. PARTICIPANTS: Entire fourth year class of medical students (n = 127). INTERVENTION: Four-week-long clinical geriatrics clerkship. MEASUREMENTS: Pre- and post-rotation: test of knowledge; Aging Semantic Differential (ASD) attitude scale; Modified Maxwell-Sullivan attitude scale; questionnaire. MAIN RESULTS: Seventy percent of students found the rotation to be educationally valuable; however, only one-third of students would have taken the clerkship had it not been required. Mean geriatric knowledge score increased by 18.7% (P less than 0.001). Mean ASD attitude score did not change significantly (130.5 +/- 19.2 pre-rotation versus 126.6 +/- 18.8 post-rotation, P = 0.15), but students started the rotation with a neutral attitude. Over 90% of students agreed they would welcome elderly into their future practice. CONCLUSION: If a national curricular goal is to improve medical students' knowledge of geriatric medicine, required rather than elective rotations may be in order.

Adult↗
PubMed1993

Mid-career faculty development awards in geriatrics: does retraining work?

OBJECTIVE: To evaluate the success of a mid-career physicians faculty retraining in geriatric medicine. DESIGN: Written survey of participants in the John Hartford Foundation's Mid-Career Faculty Development Program (1984-1988). SETTING: Four well established geriatric fellowship training programs. PARTICIPANTS: The 29 physicians who received John Hartford Foundation awards. RESULTS: Twenty-one (87%) of 24 respondents felt that the fellowship year had either a "major" or "significant" impact on their careers, and 87% also spend a significant portion of their time training others in geriatrics. CONCLUSION: This 4-year experiment in mid-career faculty retraining in geriatrics suggests that this approach is a viable alternative to traditional 2-year fellowships for helping to reduce the shortage of faculty in geriatric medicine.

Consumer Behavior↗
PubMed1995

The reliability and validity of the Geriatric Depression Rating Scale administered by telephone.

OBJECTIVE: To evaluate prospectively the reliability and validity of the Geriatric Depression Scale administered by telephone (T-GDS) in patients undergoing outpatient comprehensive geriatric assessment. SUBJECTS: A total of 101 geriatric patients were evaluated in a 1-year period at the outpatient Geriatric Assessment Center of the University of Nebraska Medical Center. METHODS: The 30-item GDS was completed by all patients on three occasions: by telephone several days before their assessment, face-to-face during their assessment visit, and several days later, again by phone. During their assessment, all patients were evaluated by one of three geriatric psychiatrists who were blind to all GDS results. The test-retest reliability of the T-GDS was measured by comparing the results of the two phone interviews. The construct validity of the T-GDS was estimated by comparing the results of the initial T-GDS to the GDS obtained during the comprehensive assessment. The criterion validity of the T-GDS was estimated by comparing the results of the T-GDS with the clinical diagnosis of depression assigned by the psychiatrists. RESULTS: The individual items of the initial T-GDS showed substantial concordance with the second T-GDS (kappa range 0.35-0.75, mean = 0.52), and with the assessment GDS (kappa range 0.29-0.75, mean = 0.52). One item showed evidence of bias when comparing the two T-GDSs, and two items when comparing the initial T-GDS to the GDS done during the assessment. The mean number of symptomatic responses was not significantly different for the T-GDS versus assessment administration but did decline slightly when comparing the two T-GDSs. ROC curve analyses showed good agreement between the clinical diagnosis and the T-GDS. CONCLUSION: The GDS appears to maintain its reliability and validity when administered via telephone and thus may be useful for a variety of epidemiological and clinical purposes.

Activities of Daily Living↗
PubMed1997

Use of digoxin, diuretics, beta blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers in older patients in an academic hospital-based geriatrics practice.

OBJECTIVE: To investigate the prevalence of and indications for digoxin use and the prevalence of beta blocker and calcium channel blocker use in older patients with previous myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension in an academic hospital-based geriatrics practice. DESIGN: A retrospective analysis of charts from 528 unselected older patients, seen from June 1995 through July 1996 at an academic hospital-based geriatrics practice, was performed to investigate the prevalence of digoxin use and indications for digoxin use, the prevalence of beta blocker and calcium channel blocker use in older patients with previous myocardial infarction or coronary artery disease (CAD), and the prevalence of use of diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers in older patients with hypertension. SETTING: An academic hospital-based, primary care geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians. PATIENTS: A total of 416 women and 112 men, mean age 81 +/- 8 years (range 58 to 101), were included in the study. MEASUREMENTS AND MAIN RESULTS: Ninety-two of the 528 patients (17%) were taking digoxin. Recorded indications for digoxin were atrial fibrillation with or without congestive heart failure (CHF) in 39% of patients, CHF with sinus rhythm and abnormal left ventricular ejection fraction (LVEF) in 18% of patients, a clinical assessment of CHF with sinus rhythm and no recorded measurement of LVEF in 20% of patients, paroxysmal atrial fibrillation in 14% of patients, and coronary artery disease (CAD) in 9% of patients. Of 121 patients with previous myocardial infarction, 23 (19%) were prescribed beta blockers, and 54 (45%) were taking calcium channel blockers. Of 173 patients with CAD, 41 (24%) were treated with beta blockers, and 79 (46%) were taking calcium channel blockers. LVEF was not recorded in the charts of 90 of 121 patients (74%) with prior myocardial infarction and of 125 of 173 patients (72%) with CAD. Of 480 older patients with hypertension, 154 (37%) were treated with diuretics, 55 (13%) were treated with beta blockers, 160 (38%) were treated with ACE inhibitors, and 197 (47%) were treated with calcium channel blockers. CONCLUSIONS: In 528 older patients seen in an academic hospital-based geriatrics practice, the prevalence of digoxin use was 19%. Appropriate indications for digoxin were documented clearly in the charts of 53 of 92 patients (57%). Calcium channel blockers were used more often than beta blockers in patients with previous myocardial infarction or CAD. Calcium channel blockers were the most frequently used antihypertensive drugs.

Academic Medical Centers↗
PubMed1997

Underutilization of beta-blockers in older patients with prior myocardial infarction or coronary artery disease in an academic, hospital-based geriatrics practice.

OBJECTIVE: To investigate the prevalence of beta-blocker use in older persons with prior myocardial infarction (MI) or coronary artery disease (CAD) without contraindications to beta-blockers in an academic hospital-based geriatrics practice. DESIGN: A retrospective analysis of charts from all older patients seen during January 1996 through March 1997 at an academic, hospital-based geriatrics practice was performed to investigate the prevalence of beta-blocker use in older patients with prior MI or CAD without contraindications to beta blockers. SETTING: An academic, hospital-based, primary care geriatrics practice staffed by fellows in a geriatrics training program and full-time faculty geriatricians. PATIENTS: One hundred thirty-nine women and 84 men, mean age 82 +/- 8 years (range 67 to 96), were included in the study. MEASUREMENTS AND MAIN RESULTS: Of 233 patients with CAD, 53 patients (23%) were receiving beta-blockers. Of 180 patients with CAD not receiving beta-blockers, 34 patients (19%) had contraindications to beta-blockers. Of 199 patients with CAD without contraindications to beta-blockers, 53 patients (27%) were receiving beta blockers. Of 162 patients with prior MI, 38 patients (23%) were receiving beta-blockers. Of 124 patients with prior MI not receiving beta-blockers, 19 patients (15%) had contraindications to beta-blockers. Of 143 patients with prior MI without contraindications to beta-blockers, 38 patients (27%) were receiving beta-blockers. CONCLUSIONS: There is marked underutilization of beta-blockers in treating older patients with prior MI or CAD in an academic, hospital-based geriatrics practice.

Adrenergic beta-Antagonists↗
PubMed1998

A two-year follow-up of geriatric consults in the emergency department.

OBJECTIVE: To characterize the population and provide a 2-year follow-up for those patients for whom a geriatric consult was requested in the emergency department (ED) of an acute care hospital. BACKGROUND: Older people tend to use health services, including the ED, disproportionately. This phenomenon has implications for medical services as the number of older people continues to increase. To our knowledge, long-term follow-up of patients for whom ED geriatric consultation was requested has not been described. SETTING: The emergency department of a 628-bed tertiary care university hospital in Montreal, Canada. SUBJECTS: 326 older patients examined in the ED by a geriatric consult team (GCT). METHODS: The records kept by the GCT during a 12-month period were reviewed retrospectively, and the patient cohort was followed for 2 years by telephone or review of hospital charts. Mortality, rate of revisit to ED, readmission to hospital, and final disposition were examined. RESULTS: The study revealed a particularly high hospital admission rate (63.5%) among those older people consulted by the GCT. The high prevalence rates for the classic geriatric syndromes of falls, incontinence, iatrogenic events, and confusional states suggest a need to address these problems early in their presentation, preferably beginning in the ED. A 2-year follow-up exhibited high mortality rates (33.7%) as well as a long-term institutionalization rate of 52%. CONCLUSION: The older patients seen in the ED of the acute care hospital for whom multidisciplinary geriatric consult is requested constitute a high-risk population. Within 2 years after initial consultation, many are dead and more than half have been institutionalized. The results of our follow-up imply the need for multidisciplinary intervention early on in the course of an older patient's ED visit as well as close follow-up after hospital discharge.

Aged↗
PubMed2005

Do-not-resuscitate policy on acute geriatric wards in Flanders, Belgium.

OBJECTIVES: To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation. DESIGN: Structured mail questionnaires. SETTING: All 94 acute geriatric wards in hospitals in Flanders in 2002 (the year Belgium voted a law on euthanasia). PARTICIPANTS: Head geriatricians. MEASUREMENTS: A questionnaire was mailed about the existence, development, and implementation of the DNR policy (guidelines and order forms), with a request to return copies of existing DNR guidelines and DNR order forms. RESULTS: The response was 76.6%, with hospital characteristics not significantly different for responders and nonresponders. Development of DNR policy began in 1985, with a step-up in 1997 and 2001. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. Geriatric wards in private hospitals implemented their policy later (P=.01) and more often had order forms (P=.04) than those in public hospitals. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process. CONCLUSION: Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions.

Aged↗
PubMed2006

Effectiveness of a geriatric medical student scholars program: a qualitative assessment.

In 2003, the University of Cincinnati College of Medicine initiated a 4-year Geriatric Medical Student Scholars (GMSS) program in which a selected group of 14 medical students participated in a variety of extracurricular geriatrics-related activities such as one-on-one mentoring and discussion groups. These students were also required to compose journal entries describing GMSS program-related activities using a semistructured on-line computer program designed specifically for this purpose. The reflective journals, in combination with the American Geriatrics Society (AGS) competencies, were used to evaluate the degree to which the GMSS program achieved its goal of enhancing students' understanding of the complex health and social challenges facing older adults. Using a confirmatory qualitative analysis strategy, the AGS competencies served as an a priori codebook to evaluate the student journal entries. Of the original 53 AGS competencies identified as being relevant for a first- or second-year medical student, 74% were used at least one time, and only 26% were never used. These findings strongly suggest that the GMSS program successfully moved this group of first- and second-year medical students closer to at least understanding the content of many of the AGS competencies by providing them with geriatrics-related experiences and a geriatrics-related framework they could draw on when participating in curricular and extracurricular activities. The findings also point to the potential value of using reflective journaling as a tool for conducting process evaluation of medical education interventions.

Education, Medical↗
PubMed2005

Geriatrics for residents in the surgical and medical specialties: implementation of curricula and training experiences.

In 1994, under the leadership of the late Dennis Jahnigen, the American Geriatrics Society, with support of the John A. Hartford Foundation, began a project to improve the amount and quality of geriatrics education that surgical and related medical specialty residents receive. The targeted disciplines initially were general surgery, emergency medicine, gynecology, orthopedic surgery, and urology and, later, anesthesiology, ophthalmology, otolaryngology, physical medicine and rehabilitation, and thoracic surgery. A key element of this project was to develop model programs within surgical and related specialty residency education. The Geriatrics Education for Specialty Residents (GESR) program has supported 29 residencies to pilot methods for integration of geriatrics within residency programs, encouraged and inspired development of curricular content, and helped to develop faculty leaders to support these efforts in the long term and at a national level. This paper describes the GESR program, the status of curriculum development, steps for other programs to use in developing a geriatrics education program, and some of the common barriers likely to be encountered during implementation along with solutions to those barriers.

Aged↗
PubMedDate not supplied

The status of geriatric education in dental hygiene curricula.

To assess the status of geriatric education in dental hygiene curricula, a pretested survey was sent to a 55% random sample of the 198 US dental hygiene programs. Of the 109 surveys mailed, a 90% response rate showed that geriatric didactic material is most frequently presented via occasional lectures, rather than in a formal course or an organized series of presentations. Seventy-five percent of the programs have a geriatric clinical component. Baccalaureate programs and programs longer than 2 years are more likely than associate programs and programs shorter than 2 years, respectively, to teach geriatrics in a more formalized setting. There is no significant difference in the way geriatric material is presented between hygiene programs that are and are not within dental schools.

Aged↗
PubMed2026

Molecular determinants of antimicrobial resistance in Klebsiella pneumoniae isolates among geriatric patients in Chattogram, Bangladesh: a cross-sectional study.

Klebsiella pneumoniae (KPN) infections pose heightened risks in the geriatric population due to weakened immunity, prevalent comorbidities, potential exposure in long-term care settings, and increased likelihood of antibiotic resistance (ABR). The study focused on the prevalence and antibiotic resistance of KPN infections, the presence of ABR genes in KPN, and the genomic characterization of KPN obtained from geriatric patients in Chattogram. A total of 543 specimens were collected from four hospitals in Chattogram, along with demographic data from hospital records. Genomic DNA was extracted from multi-drug-resistant (MDR) KPN, and the presence of ABR genes, blaTEM-1, sul-1, aadB, blaNDM-1, blaSHV-11, and phoE was identified. To characterize the KPN genomes, two MDR KPN isolates were subjected to whole-genome sequencing (WGS), and the data were analyzed using bioinformatics tools to identify genomic determinants of ABR. KPN exhibited high resistance to ceftazidime (96%), cefuroxime (92%), and cefixime (83%), but sensitivity to colistin (79%) and amikacin (75%). MDR KPN was mostly detected in sputum (36%) and urine (27%) specimens, where the prevalence of ABR genes, blaTEM-1, sul1, aadB, blaNDM-1, and blaSHV-11 were 28.2%, 17%, 6.17%, 56%, and 48% of these strains, respectively. These genomes exhibited distinct profiles for sequence types, ST420 and ST277 in Kpn007 and Kpn016, respectively, and ABR genes (qnrS1, blaCTX-M-15, and blaSHV-27), virulence factors (ybt, iuc1, iro1), and contained both K (K20, K46) and O antigens (O1, O3b). MDR KPN in the geriatric population poses a serious health concern due to their increased vulnerability to infections and limited treatment options, requiring careful management.IMPORTANCEMultidrug resistance (MDR) and the hypervirulence nature of Klebsiella pneumoniae (KPN) in geriatric patients pose a critical health concern in nosocomial infections worldwide and result in high clinical complexity and mortality. The study investigated the factors for KPN infections and analyzed antimicrobial resistance profiles. More than 60% of Klebsiella pneumoniae isolates from geriatric patients were resistant to third- and fourth-generation cephalosporins, and most isolates carried blaNDM-1 and blaSHV-11 genes. Analyzing whole genomes of two KPNs, Kpn007 (ST277) was identified as a hypervirulent strain with aerobactin and yersinia siderophores, contributing to virulence, and Kpn016 (ST420) carried fluoroquinolone (qnrS1), ESBL (blaCTX-M-15 and blaSHV-27) resistance. Both genomes contained K antigens (K20 and K46) and O antigens (O1 and O3b).

Humans↗
PubMed1976

Can geriatrics survive?

Geriatrics has consistently failed to attract enough staff, and hence geriatric units often cannot provide a full service for the elderly. Meanwhile beds in general medical units may be blocked by elderly patients. This division between geriatric and medical units is arbitrary and wasteful. There are no clinical processes or techniques unique to geriatrics, which is probably why the specialty is unattractive; few doctors want to confine their attention only to the elderly. Geriatrics as a separate specialty should therefore be largely abandoned and the care of the elderly reintegrated into general medicine.

Aged↗
PubMed1995

Psychiatric screening in geriatric primary care: should it be for depression alone?

Depression in the elderly is highly prevalent, associated with functional disability and increased medical costs, and treatable; however, it is infrequently recognized and treated. The Agency for Health Care Policy and Research has advocated, therefore, increased case-finding efforts for depression in primary geriatric care. Anxiety, substance, and somatoform disorders in the elderly are similarly prevalent, associated with disability and cost, treatable, and also infrequently detected and treated. We believe that psychiatric case-finding in geriatric primary care should attend to these disorders, therefore, as well as to depression. In the present study, we examined whether the association between depressive and nondepressive forms of psychopathology was similar in geriatric and nongeriatric medical patients. We also examined the relationship between each type of pathology and health care utilization and global ratings of physical and mental health. In a VA hospital general medical outpatient clinic, 508 patients completed the SCREENER, which is a brief self-report questionnaire that screens for a range of psychiatric disorders, along with a self-report questionnaire regarding subjective health and medical care utilization. Of these patients, 98% were male, and the median age was 63 years. Patients aged 63 and over were compared to younger patients. In both geriatric and younger adult patients, we found substantial comorbidity between depressive and nondepressive forms of pathology. Moreover, in both age groups, there were significant associations between both depressive and nondepressive symptoms and fair-to-poor self-rated physical and mental health and increased medical care utilization. Approximately half of the cases of nondepressive disorders in the elderly were not comorbid with depression, and thus would not have been detected by screening for depression alone. Therefore, psychiatric case finding in primary care of geriatric males should be directed at anxiety, substance, and somatoform disorders, as well as at depression, for treatment resources to be triaged to maximally decrease morbidity and cost.

Age Factors↗
PubMed2004

Assessing geriatrics in undergraduate medical education: two different approaches.

Most medical schools do not have a separate course in geriatrics, but rather incorporate geriatrics into existing courses. Tracking and assessing curriculum content is more difficult in this setting. This paper describes and compares two approaches to assess curriculum content in geriatrics: a survey of course directors and a course objectives review. The results suggest that course directors report more geriatric content when asked as part of a regular survey than they identify as specific course objectives. Course objectives may be more reflective of the actual emphasis placed on aging-related material in courses. These two approaches appear to be complementary. Medical educators may find both self-report and course objective analysis to be useful and complementary in tracking geriatric material in the undergraduate medical curriculum.

Aged↗
PubMed2004

Integrating geriatric content into a medical school curriculum: description of a successful model.

Most medical school curricula do not equip students with adequate attitudes, knowledge and skills to care for elderly populations. We describe an effective geriatric curricular infusion model compatible with preserving the overall curricula schema. Course and clerkship directors, staff and faculty from the Office of Educational Development, Center on Aging, curriculum committee and Associate/Assistant Deans of Education, and faculty from the schools of medicine, nursing, and allied health collaborated in the effort. Each of these components and institutional financial commitment were critical to successful basic science and clinical geriatric content infusion addressing the American Geriatric Society (AGS) Core Competencies. Delivery modalities included problem- based learning cases, lectures, standardized patient portrayals for teaching and assessment, and experiential activities with elderly. Assessments were conducted and outcomes tracked in several ways, including: (1) annual course reviews, focus groups, and student evaluations; (2) mandatory geriatrics 4th year graduation competency exam; and, (3) AAMC Graduation Questionnaire responses. Initial data indicate that student knowledge and competencies have increased with increasing exposure in the desired areas, and support infusion as a viable approach to enhancing gerontology and geriatric curricular content.

Aged↗
PubMed1995

Effectiveness of a Finnish geriatric inpatient assessment. Two-year follow up of a randomized clinical trial on community-dwelling patients.

OBJECTIVE: To determine whether need for services could be reduced and functional status and satisfaction improved by assessing and rehabilitating aged patients on a geriatric inpatient ward. DESIGN: A randomized clinical trial with a two-year follow-up. SETTING: Geriatric unit with 8 beds in a Finnish central hospital. PATIENTS: 312 selected community-dwelling patients were assigned to the intervention group (N = 104) and the control group (N = 208). INTERVENTIONS: The intervention patients were individually assessed and rehabilitated in a geriatric ward. The control group received usual home care. MAIN OUTCOME MEASURES: Services, institutionalization, mortality, ADL, IADL and satisfaction. RESULTS: At one year, the intervention group had fewer days in health centre hospitals than controls (13.7 vs. 22.7), but only the intervention group had the geriatric inpatient stay (16.5 days). No significant differences were found for cumulative institutionalization or mortality over 24 months. At three months, the intervention group experienced a more positive change than controls in continence (P < 0.05), housekeeping (P < 0.05) and satisfaction (P < 0.01). CONCLUSION: The effectiveness of comprehensive geriatric inpatient assessment and rehabilitation on community-dwelling patients is mild. More targeting and more follow-up interventions are needed.

Activities of Daily Living↗
PubMed2002

[Trends geriatric disease research evaluated by long-term longitudinal study].

The number of patients with geriatric diseases will rapidly increase in our aging society. Geriatric diseases tend to progress chronically and disturb the daily activity of the elderly patients. Care for the elderly patients requires a great deal of manpower. The prevention and treatment of geriatric disease are urgent issues that must be addressed. A comprehensive longitudinal study of aging and geriatric disease was started at the National Institute for Longevity Sciences (NILS) in 1997. The participants of the NILS longitudinal study of aging (NILS-LSA) were 2,267 men and women from a local community population. The participants are examined at the NILS and followed up every two years. An outline of the system and examinations of the NILS-LSA is shown. The latest results from the NILS-LSA research including geriatric disease-related genotypes and risk factors for mild cognitive impairment (MCI) are also presented.

Aged↗
PubMed2006

[Role of certified geriatric medical doctors in university hospitals in Japan].

The role of certified specialists in geriatric medicine in Japanese University Hospitals is discussed in this section. First, they should act as geriatric general physicians to provide a comprehensive medical care for elderly patients against a background complicatedly divided medical departments in university hospitals. Second, they should create attractive undergraduate programs for geriatric education in medical schools and training programs in geriatric medicine for doctors to develop certified specialists in geriatric medicine in the future. Finally, they should perform clinical research to provide an evidence to construct better social policies to keep older people healthy.

Aged↗