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PubMed2004

Well-being and self-assessed health among different groups of female personnel in geriatric care.

UNLABELLED: Educational qualifications are reliable predictors of women's self-assessed health. AIMS: To study possible inequalities in health among women with different educational backgrounds working in geriatric care and to find groups that might need special public health measures. METHODS: In this cross-sectional questionnaire reaching throughout Iceland, the participants were employees in 62 geriatric nursing homes and geriatric hospital wards with 10 or more employees. A total of 1886 questionnaires were distributed. The 84-item questionnaire included questions on demographic and work-related factors, health and life style. Age-adjusted odds ratios (OR) were calculated for work-related psychosocial, physical and health factors, and confidence intervals were set at 95% (95% CI). Registered nurses were taken as a reference category. RESULTS: The response rate was 80%. Registered nurses accounted for 16%, practical nurses 21%, unskilled attendants 44%, cleaning personnel 8% and others 12%. The practical nurses, unskilled attendants and cleaning personnel assessed work as more physically difficult, and more monotonous both physically and mentally, than did the registered nurses, who enjoyed more physical and mental well-being than the others. However, the registered nurses visited doctors as often as the other groups did. CONCLUSIONS: Personnel groups in geriatric care have different physical and psychosocial workloads. The results provide opportunities to guide public health measures for people employed in geriatric care and possibly in other settings, such as hospitals and health care institutions.

Attitude of Health Personnel↗
PubMed2004

[Work strain and well being among different groups of female personnel in geriatric care.].

OBJECTIVE: To study possible inequalities in work strain and well-being among women working in geriatric care and to find out if some groups might need special public health measures. MATERIAL AND METHODS: In this cross-sectional questionnaire reaching throughout Iceland, the participants were employees in 62 geriatric nursing homes and geriatric hospital wards with 10 or more employees. A total of 1886 questionnaires were distributed. The 84-item questionnaire included questions on demographic and work-related factors, health and life style. Age-adjusted odds ratios (OR) were calculated and confidence intervals were set at 95% (95% CI). Registered nurses were taken as a reference category. RESULTS: The response rate was 80%. Registered nurses accounted for 16%, practical nurses 21%, unskilled attendants 44%, cleaning personnel 8% and others 12% of the total group. Men were 4.5% of the group. The practical nurses, unskilled attendants and cleaning personnel assessed work as more physically difficult, and more monotonous both physically and mentally, than did the registered nurses, who enjoyed somewhat more physical and mental well-being than the others. Little difference was found as to visits to doctors. CONCLUSIONS: Various personnel groups of women in geriatric care have different physical and psychosocial workload that is reflected in their well being. The results provide opportunities to guide public health measures for people employed in geriatric care.

English Abstract↗
PubMed1990

[Geriatric hospital facilities].

Nowadays (and prior to any hospital reform), geriatric hospital structures rest on medium or long length stay units and on acute geriatry departments when these are available. However, to limit relations between hospital and the elderly to these three structures would be an oversimplification. The organization of emergency admission units for the elderly, the medico-social preparation of these patients before they return home, the setting up of geriatric consultations in both out-patient clinics and specialized hospital departments are all major topics not to be neglected. Moreover, geriatric day-hospitals offer hospital treatment without accommodation which is a solution desired by many old people. What can be suggested for the mentally deficient or demented old patient admitted to a hospital, if not the cooperative efforts of geriatric and psychiatric teams working in suitable architectural structures? Finally, we must insist on the need for coordination between hospital and non-hospital structures, so that the entire "geriatric network" becomes reality without any break in care between structures.

Aged↗
PubMed1989

[Geriatric day clinics and rehabilitation].

If the present development of our population is not to result in a continued increase in care-requiring elderly people, the building and expansion of geriatric rehabilitation institutions is a matter of urgency. Numerous studies, some of which carried out in our own country, show how successful geriatric rehabilitation can be. Prerequisites are, apart from appropriately equipped facilities, the proper selection of those requiring care, adequate numbers of properly qualified personnel, and early initiation of any treatment needed. Thus, 70 to 80% of those originally scheduled for admission to an old persons' nursing home can be enabled to live more or less independently at home. Apart from geriatric hospitals, geriatric day clinics offer optimal possibilities for rehabilitation. They combine therapeutic effectiveness and economy with the advantage that, during treatment, the elderly person is not completely taken out of his familiar surroundings, which results in an improvement in his motivation to get well again quickly. At the same time, complicating diseases, such as, for example, diabetes mellitus, can be treated under conditions closely similar to those of the patient's subsequent day-to-day situation. In this sense, geriatric day clinics are not only desirable, but urgently needed institutions.

Activities of Daily Living↗
PubMed1985

Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients.

One hundred inpatients scheduled for elective surgery were studied to determine the age-related risk of pulmonary aspiration as indicated by gastric acidity and volume. Twenty-five patients from 6 months to 12 years old were included in the pediatric age group, 50 patients from 18 to 64 years old were included in the adult age group, and 25 patients older than 65 years old were included in the geriatric group. Mean gastric pH was 1.99, 2.40, and 3.32 in the pediatric, adult, and geriatric age groups, respectively; the differences between the three groups were statistically significant. The proportions of patients with pH less than or equal to 2.50 were also significantly different among three groups: 92%, 76%, and 60% in the pediatric, adult, and geriatric age groups, respectively. Mean gastric volumes were 0.49, 0.37, and 0.24 ml/kg and proportions of patients with volumes greater than or equal to 0.40 ml/kg were 60, 32, and 12% in pediatric, adult, and geriatric patients, respectively. Gastric contents with both pH less than or equal to 2.5 and volume greater than or equal to 0.4 ml/kg were seen in 60, 28, and 12% in the three respective groups. Risk of acid aspiration pneumonitis theoretically is present in all age groups, with children being at greatest risk and geriatric patients with least risk. We have also noted a correlation between age and gastric contents because gastric acidity and volume both decreased as age increased. Increasing length of fasting period increased gastric acidity without significant effect on volume.

Adult↗
PubMed1980

[On the problems of geriatric carcinomas (author's transl)].

Generally the cancer of the rectum is one besides several other diseases of the patient; clinically it recedes often far into the background of the actual happening. With increasing age the real geriatric diseases come to the foreground of the clinical findings dominated by the arteriosclerosis in all its variations. Therefore the treatment has to take into account the true secondary diseases besides the cancer. Judging the progress of the illness and the therapeutic effect these facts must be considered. Due to the intanglement of geriatric and oncological symptoms it is impossible to separate geriatrics from oncology. Concerning these connections it seems to be justified to characterize the rectum cancer--and also some other cancers--as a particularly geriatric one. The practical consequence of this hypothesis is a change of therapeutic planning, coordinating oncological and geriatric points of view according to the respective requirements. At this psychological and social-medical problems have to be taken into consideration.

Actihaemyl↗
PubMed1981

Skin blood flow in seated geriatric patients.

A hard seat was equipped with devices sensing arteriolar pulsatile blood flow volume rate, externally developed pressure, and shear, all taken in lateral proximity to the ischial tuberosities of sitting subjects. Tests of 14 geriatric hospitalized patients and 9 healthy young men indicated the following: (1) No young healthy man demonstrated blood flow occlusion at pressure values less than 120mmHg. Of the geriatric hospitalized subjects, 2 occluded at less than 20mmHg. (2) Average shear values developed by the geriatric hospitalized group were 3 times that of the young healthy group. (3) Average pressure values demonstrated by the geriatric hospitalized subjects were roughly equal to those of the younger subjects (roughly 70mmHg). (4) Tipping the seat backwards through 20 degrees produced major benefits to the hospitalized geriatric group in terms of increased blood flow, lessened pressure, and lower shear. The young, healthy group experienced some increase in blood flow with no significant change in sitting reactions when tested in a tipped attitude.

Adult↗
PubMed1994

[Geriatric maladaptation syndrome].

Geriatric maladaptation syndrome is a demonstration of adaptation failure, which is typical for higher age. This failure occurred on the basis of chronic stress caused usually by relevant psychosocial stimulus, with clinical manifestation mainly in cardiovascular or immune systems followed with serious threaten of health and life. A lost of independence, loneliness, change of dwelling-place and living standard, low income, stages of confusion, mental disease, passive life attitude belong to psychosocial risks of the origin of geriatric maladaptation syndrome. Higher age and bad health status belong to biological risks of the origin of geriatric maladaptation syndrome. Clinical image of geriatric maladaptation syndrome has three phases (1. development of stress reaction, 2. full clinical image development of adaptation failure, 3. followed phase of adaptation reaction). It is a set of somatic disorders, which threaten a life of old people. These disorders arose in a consequence of inadequate adaptation to stress life event. Geriatric maladaptation syndrome is significantly different from mentioned adaptation disorders because of its clinical course and frequently unfavourable prognosis. In international classification of diseases it should have an independent item G 43.8.

Adaptation, Psychological↗
PubMed1994

Clinical pearls in optometric management of the geriatric patient.

BACKGROUND: Painstaking attention to detail is absolutely necessary for optometrists to provide the appropriate clinical management of the geriatric patient. METHODS: Clinical management techniques (pearls) are discussed which aid in the diagnosis and treatment of problems specific to geriatric patients. Factors noted in patient presentation are stressed and include physical appearance, ability to move about, and use of other senses. The most commonly occurring eye anomalies occurring in the geriatric population are discussed including iatrogenic drug side effects, pupillary anomalies, extraocular palsies, dry eye, corneal degenerations, refractive error changes, lenticular changes, glaucoma, age-related maculopathy, vitreoretinal disease, and ocular manifestations of systemic disease (vascular occlusive disease, diabetes, ischemic optic neuropathy, other neuro-ophthalmic disease). RESULTS: Conditions relatively rare in the young population occur with regularity in the elderly population and often must be assumed to be present in concert with some typical patient presentations in the geriatric population. CONCLUSIONS: Optometrists as primary health care providers often provide the only avenue individuals with blinding and sometimes life threatening conditions have in managing these conditions. Optometrists managing geriatric patients are required to know what happens to this population from an ocular disease as well as other function and dysfunction standpoint.

Aged↗
PubMed1997

[Uro-gynecologic disorders in female geriatric patients].

As geriatric patients those above 60 years of age are described. Incontinence is not necessarily an associated symptom of old age. In women above 60 years 15-30% suffer from urinary incontinence. With advancing age the prevalence rises to more than 40%. The cause of miction trouble must not be sought only in the urogenital tract, where with advancing age under the influence of atrophic processes typical functional and anatomical changes take place, but also in the sphere of the CNS where in geriatric patients may be the cause of impaired continence. A preliminary classification of urinary incontinence may be made already on the basis of a detailed case-history. Data provided by the patient are usually not sufficient and it is necessary to obtain the required information on the character of incontinence by aimed questions. Furthermore it is of interest what sort of medication the patient is taking at the time, incl. medication she take spontaneously. Sometimes after mere discontinuation of certain drug groups complaints can be markedly reduced or completely eliminated. In the case-history we must always focus attention on risk factors associated with incontinence and questions on the abuse of alcohol are also justified. Somatic examination comprises gynaecological examination for evaluation of the anatomical characteristics at rest and during elevated intraabdominal pressure. Functional geriatric examination is the starting point for optimal care of old people. There is a number of functional geriatric tests. For clinical practice due to its straightforward character Barthel's test of basic everyday activities is useful. Urodynamic examination is not essential in geriatric patients. Information obtained in diagnostic processes may serve as a basis for rational therapy of incontinence. Different urodynamic methods are used in case therapy fails or when the anamnestic data are obscure.

Aged↗
PubMed2004

Effect of nutritional status on clinical outcome in a population of geriatric rehabilitation patients.

BACKGROUND AND AIMS: In a geriatric patient, nutritional status (NS), particularly in the case of malnutrition (M), may influence not only clinical results but also achievement of targets expected by geriatric rehabilitation. The aim of this study was to evaluate the effect of nutritional status (NS) on the occurrence of Adverse Clinical Events (ACE) and on mortality in geriatric rehabilitation patients. METHODS: We retrospectively examined the clinical records of 278 elderly subjects (154 women, 124 men), admitted to a geriatric hospital between September 2000 and December 2001 and evaluated for clinical, functional, cognitive and NS within the first 48 hours of admission. Clinical outcomes (ACE, mortality) were recorded during follow-up. Logistic regression analysis estimated models having mortality or the occurrence of ACE as outcome variables. RESULTS: Malnutrition was detected upon admission in 56.1% of the sample population. Incidence of ACE in malnourished subjects was higher than that in well-nourished patients (28.2 vs 13.1%). Equally, mortality among malnourished subjects was higher than among those whose NS was normal (23.1 vs 9.8%). The logistic regression models were able to predict: 1) mortality from comorbidity (OR 1.43; 95% CI 1.16-1.78; p=0.001) and NS (OR 2.64; 95% CI 1.29-5.4; p=0.008), and 2) occurrence of ACE from comorbidity (OR 1.69; 95% CI 1.36-2.1; p=0.000), cognitive (OR 1.22; 95% CI 1.11-1.35; p=0.000) and nutritional status (OR 2.38; 95% CI 1.19-4.8; p=0.015). CONCLUSIONS: NS emerged as the main independent predictor of both mortality and occurrence of ACE. Although most patients fell into the category of mild/moderate (energy) malnutrition (148/156), a mild deterioration of NS, for instance, reduction in triceps skinfold thickness (TSF) seemed to be sufficient to cause an increase in the incidence of ACE and in mortality.

Activities of Daily Living↗
PubMed2006

Geriatric assessment for oncologists: rationale and future directions.

Sixty percent of all cancer occurrences and seventy percent of cancer mortalities occur in people over the age of 65. As the population ages, there is an emerging need to develop a means for oncologists to characterize the "functional age" of older patients with cancer in order to tailor treatment decisions and stratify outcomes based on factors other than chronological age and to develop interventions to optimize cancer treatment. In this paper, we discuss the formulation of a geriatric assessment for older patients with cancer. The measures included in this assessment were chosen based on their validity, reliability, brevity, adaptability for self-administration, and ability to prognosticate risk for morbidity or mortality in an older patient. The proposed geriatric assessment covers the essential domains of assessment predictive of survival in the geriatric population, is primarily self-administered, and limited personnel time is required. Our eventual goal is to determine if this geriatric assessment measure can identify factors independent of age that predict cancer treatment morbidity and mortality and result in rationale interventions to optimize oncologic care.

Aged↗
PubMed2000

The application of the principles of geriatrics to the management of the older person with cancer.

Is the patient going to die of cancer or with cancer? Is the patient going to suffer pain and disability due to cancer? Is the patient able to tolerate aggressive life-prolonging treatment? This paper tries to reply to the fundamentals of these questions by introducing the multidimensional assessment that evaluates areas where age-related changes are more likely. Chronologic age cannot be used to predict the degree of comorbidity and of functional deterioration of the single individual up to age 85 at least. Assessment of aging includes health, functional status, nutrition, cognition, socio-economic and emotion evaluations. This multidisciplinary assessment is referred to as comprehensive geriatric assessment (CGA). The risk of comorbid conditions increases with age and may result in underdiagnosis: in older patients, new symptoms may not be clearly recognized by the patient and may be dismissed by practitioners as manifestations of preexisting conditions. A meaningful assessment of comorbidity may be obtained with a comorbidity index. The Charlson scale and the Chronic Illness Rating Scale - Geriatric (CIRS-G), have enjoyed the widest acceptance. The Instrumental Activities of Daily Living (IADL) and the Activities of Daily Living (ADL) are the most sensitive assessment of function in older individuals. IADLs include shopping, managing finances, housekeeping, laundry, meal preparation, ability to use transportation and telephone and ability to take medications: in simple words, the IADLs are those skills a person needs to live independently. ADLs include feeding, grooming, transferring, toileting and are the skills necessary for basic living. Though a correlation exists among comorbidity, performance status, ADL and IADL, this correlation is not strong enough to be reflected in a single parameter. The Folstein Mini Mental Status (MMS), is the instrument of most frequent use to screen older individuals for dementia. The main problem with the MMS is lack of sensitivity to early stages of dementia. The Geriatric Depression Scale (GDS), a simple tool that can be completed by most patients at home, doubles the rate of detection of depression. The Mini Nutritional assessment is very sensitive to screen older persons for malnutrition. The risk of polypharmacy increases with age and partly results from the fact that older patients visit different practitioners. A CGA should also include evaluation of the so called Geriatric Syndromes like delirium, incontinence, osteoporosis, all of which represent a hallmark of frailty. The CGA may help the management of older individuals with cancer in at least three areas: detection of frailty, treatment of unsuspected conditions, removal of social barrier to treatment.

Aged↗
PubMed1996

Looking inside the black box of comprehensive geriatric assessment: a classification system for problems, recommendations, and implementation strategies.

OBJECTIVE: To develop and test the inter-rater reliability of a coding system for geriatric problems identified through Comprehensive Geriatric Assessment (CGA) of hospitalized older persons, recommendations generated by the assessment, and implementation strategies for these recommendations. DESIGN: Validation study. SETTING: A health maintenance organization and a geriatrics academic program. PARTICIPANTS: A total of 49 hospitalized older persons, who met at least 1 of 13 inclusionary "targeting" criteria, two geriatricians, and one social worker who coded forms. MEASUREMENTS: Standardized coding of CGA consultation sheets into (1) geriatric problems identified, (2) recommendations, and (3) implementation strategies; inter-rater reliability testing of coding system using two physicians and a social worker. RESULTS: On average, each assessed patient had 4.8 recommendations. The largest percentages of recommendations were for non-physician referrals (18.2%), advance directives (13.4%), medication adjustments (11.5%), diagnostic evaluation/monitoring (11.5%), and community services (10.9%). The proportions of agreement between raters in coding problems ranged from 0.77 to 0.90, in coding recommendations from 0.69 to 0.86, and in coding implementation strategies from 0.68 to 0.83. CONCLUSION: A classification system for measuring some components of the process of care of CGA has satisfactory inter-rater reliability, can be adapted for other settings, and may provide valuable insight into determining which components of CGA confer health benefits.

Aged↗
PubMedDate not supplied

Hierachy of needs of geriatric patients.

BACKGROUND: The aim of the study is to contribute to the improvement of the quality of care of geriatric patients. In order to be able to improve the geriatric care we have to know clearly the needs of the elderly patients. OBJECTIVE: The hierarchy of needs of geriatric patients in clinical circumstances had to be assessed by a psychometric technique based on a motivational approach. METHODS: The process was based on the method of paired comparisons, and a duly composed questionnaire was administered to the geriatric patients who were proven to have consistent thinking and surpassed a pre-established threshold in the Mini Mental State Examination. The evaluation of the responds leads to a numerical derivation (on an interval scale) of the hierarchy of needs. RESULTS: The received hierarchy of needs proved to oppose the general hypothesis of Maslow's motivation theory. CONCLUSION: This may induce a necessary shift in the approach to the care of the elderly, and accentuate the self-actualization and esteem needs beside the overtly emphasized physiological care.

Aged↗
PubMed2003

Teaching geriatric assessment in home visits: the family physician/geriatrician attachment.

BACKGROUND: Geriatric clinical clerkships in Israel teach mostly about the hospitalized elder patient with almost no ambulatory experience. Meanwhile, primary care physicians provide most of the health care to the elderly in the community. This article describes an innovation in the curriculum of the 5th-year family medicine clerkship at the Goldman Medical School of Ben-Gurion University in Israel designed to improve the teaching of geriatrics in the ambulatory setting. DESCRIPTION: During the clerkship, family physicians perform a home visit to one of their home-ridden elderly patients with a small group of medical students. During this visit, a geriatrician from the local hospital is included to the group for teaching purposes. EVALUATION: Most students rated this experience positively as did the family physicians and geriatricians who participated in this experience. CONCLUSIONS: This liaison-attachment teaching experience allows the students to learn aspects of geriatrics that are spared during their geriatric clerkship, allows the family physician to use this opportunity as a consultation for homebound patients, and allows the tertiary care geriatrician to teach in the community.

Ambulatory Care↗
PubMed2005

Integrating long-term care concepts into baccalaureate nursing education: the road to quality geriatric health care.

Increased numbers of aging Americans requires that today's health care professionals be grounded in education that focuses on patient-centered care of older adults. The growing demand for competent geriatric nurses in West Texas, led the School of Nursing (SON) at Texas Tech University Health Sciences Center (TTUHSC) to conduct an in-depth analysis of its baccalaureate curriculum to determine how, when, and where care of older adults was being addressed. A task force appointed by the SON subsequently chose, as a blueprint for curricular redesign, Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care (American Association of Colleges of Nursing & the John A. Hartford Foundation Institute for Geriatric Nursing, 2000). This article describes how the SON task force planned and implemented a new and strengthened geriatric core in its curricula.

Aged↗
PubMed1996

Geriatric health maintenance.

OBJECTIVE: To highlight articles pertaining to geriatric health maintenance and provide clinicians with current evidence supportive of or opposed to screening or treatment for various diseases and conditions. METHOD: We conducted a computer-assisted search of the relevant medical literature and summarized the results of pertinent studies in the elderly population. RESULTS: The geriatric population is progressively increasing in numbers. Unfortunately, no consensus exists about health maintenance in this population. To date, the United States Preventive Services Task Force has made several recommendations about preventive services; however, they did not specifically focus on the geriatric age-group. We outline their guidelines and discuss our clinical practices in a wide variety of encounters with geriatric patients. CONCLUSION: The efficacy of many screening tests and interventions for preventing illness in elderly patients is unclear. As the general population continues to age, further research in this area will be important.

Advance Directives↗