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PubMed2002

[Comprehensive geriatric assessment: a useful tool for prevention of acute situations in the elderly].

Comprehensive geriatric assessment is a useful complement to the standard clinical examination of elderly people. It focuses on a systematic evaluation of functional status, dependency, cognitive functions, psychological status, continence, nutritional status and social way of life, administered by a multidisciplinary team. Standardized test, well-validated in the elderly, are used. Most studies have demonstrated the efficacy of geriatric assessment programs in outpatients, hospitalized patients or in emergency unit patients. Mostly useful in frail elderly patients, geriatric assessment results in a decrease in morbidity and dependency, shorter hospital stays and fewer referrals to nursing homes. By introducing adequate medical and social interventions, comprehensive geriatric assessment, even in very old people, is useful in preventing acute situations leading to emergency referrals.

Activities of Daily Living↗
PubMedDate not supplied

[Geriatric Depression Scale as auxiliary diagnostic tool used in patients 55 years and older].

The purpose of this study was to examine the Geriatric Depression Scale translated into Polish for its sensitivity and specificity in relation to obligatory criterions ICD-10. 208 at random select patients from Psychiatry Department and Psychiatry Clinic were included into study. Diagnosis was based on ICD 10 criteria. Geriatric Depression Scale were used in full version containing 30 of questions directed to examined (self-rating). Each questions was read to examined persons. At last 185 persons were included to statistical analysis's. Sensitivity and specificity obtained for critical value equal or higher from 11 points, were 81% and 47% Geriatric Depression Scale is useful tool in initial diagnosis of depression in older people. However one should be clearly to underline, that investigation with Geriatric Depression Scale should start diagnostic process, never while to take place full psychiatric investigations.

Aged↗
PubMedDate not supplied

Evolution of geriatric medicine fellowship training in the United States.

The authors describe the history of subspecialty training in geriatric medicine and geriatric psychiatry, from the time before the formal accreditation of geriatric medicine fellowship programs, in 1988, through the following decade of 2-year accreditation programs, from 1988 to 1997, and then the recent experience with 1-year accredited geriatric medicine programs, from 1998 to the present. They present the history and development of the accrediting organizations, the development of relevant tests and curricula, and the opportunities for grants, funding, and career development, as well as a summary of present status and satisfaction of current practitioners, and provide recommendations for enhancing recruitment and retention.

Aged↗
PubMed1992

Geriatric respite care--present practice and the potential for improvement.

A prospective Audit of patients admitted for geriatric respite care was undertaken. Information was obtained from patients, staff and carers for 125 consecutive admissions over a 20 week period. The 87 clients admitted had a mean age of 79.6 years and 83% had a high physical/mental dependency. In contrast to some previous studies mortality was very low (less than 2%). One hundred and nine (87%) admissions were discharged home. Respite admission bed use was classified as shared care (971 days, n = 19), planned respite (937 days, n = 50) and crisis respite (809 days, n = 18). The shared care and planned group did not show significant differences in patient dependency or carer profile. On a population basis, geriatric respite care was required on a bed per 1,000 population aged 75 and over. Patients viewed as inappropriate for geriatric care were most frequent in the crisis respite group, with the Geriatric Unit at times meeting shortfalls in other services. The sharing of key information between families/carers and community/hospital was, at times, deficient. The need for increased publicity about the service and for a carer support group was identified. Most families were satisfied with the care received but specific ways of improving the service were suggested.

Activities of Daily Living↗
PubMed1992

[Research on aging: geriatric perspectives].

Geriatric efforts have prophylactic effects on further reduction of functional ability at every link in the therapeutic chain by means of interdisciplinary qualitative and quantitative assessment which establishes goal and plans which lead to coordinated action. This results in early diagnosis of multiple pathology, reduction of polypharmacy, confidence on account of good information, continuity on account of coordination between primary and secondary sectors, simultaneous efforts, early interruption of the cascade effect which results in production of helpless patients. By means of clinically controlled trials, effects have been obtained on a number of recently discovered diagnoses requiring treatment, unnecessary medication is withdrawn, conditions of rehabilitation, functional ability, quality of life, employment of bed-days, institutionalization and mortality. It is necessary to state that this is the only age group where the effect is obtained without further expense or where the effort has even resulted in economic savings. In Denmark, research is required as regards how prophylactic health visits to the elderly can best be carried out in all communities, the risk situations (death of a spouse, removal, illness) which require immediate increased efforts and research into how offensive geriatrics is to be established, how rehabilitation is ensured for healthy and sick elderly patients and research into the occurrence and treatment of the five geriatric giants (immobility, instability, incontinence, intellectual reduction and iatrogenesis). More Danish controlled trials are required of the individual components in and the total function of geriatric assessment and rehabilitation and the significance of personal choice when the functional ability is such that dependence on care by others is inevitable and, finally, the conduct and expenses of various arrangements.

Aged↗
PubMed2006

Efficacy of a geriatric oral health CD as a learning tool.

To better prepare professionals to meet the needs of older patients, a self-instructional computer module on geriatric oral health was previously developed. A follow-up study reported here tested the efficacy of this educational tool for improving student knowledge of geriatric oral care. A convenience sampling procedure was used. Sample size calculation revealed that fifty-six subjects were required to meet clinical and statistical criteria. Paired t-test addressed our hypothesis that use of the educational tool is associated with improvement in knowledge. Fifty-eight first-year dental students and nine third-year medical students completed the pre-intervention test and were given the CD-based educational tool. After seven days, all participants completed the post-intervention test. Knowledge of geriatric oral health improved among the sixty-seven students included in this study (p=0.019). When stratified on the basis of viewing the CD-ROM, the subgroup of thirty-eight students who reported not actually reviewing the CD-ROM had no change in their knowledge scores, while the subgroup of twenty-nine students who reported reviewing the CD had a significant improvement in test scores (p<0.001). Use of a self-instructional e-learning tool in geriatric oral health is effective among those students who choose to employ such tools.

Adult↗
PubMed1996

Adhering to inpatient geriatric consultation recommendations.

BACKGROUND: The purpose of this study was to evaluate the rate of and factors associated with attending physicians' adherence to geriatric consultation recommendations in an urban community hospital. METHODS: A retrospective review was performed of the charts of 47 patients referred for inpatient geriatric consultation over the previous 1 1/2-year period. Study variables included patient and attending physician demographics, length of stay in hospital before geriatric consultation, status of patient on discharge, level of expertise of consultant, number of diagnoses per patient, and types and number of recommendations per patient made by consultant and acted upon by attending physicians. RESULTS: The recommendations made included medical (23.4%), medication (28.6%), laboratory (15.8%), radiological (2.6%), nutritional (11.7%), psychosocial (7.7%), skin care (1.6%), rehabilitative (6.4%), and other (2.2%). The percentage of total recommendations acted upon was 55.5%. By multivariate analysis, decreasing length of time prior to consultation was statistically associated with referring physician adherence to consultation recommendations (P=.03). Slightly more than 40% of the variability in adherence was explained by this single variable. CONCLUSIONS: Inpatient geriatric consultations are aimed at providing a comprehensive assessment for attending physicians. Recommendations are acted upon more than 50% of the time. Physician adherence to recommendations does not appear to be dependent on patient or physician demographic variables, but to some extent, adherence is associated with less time in the hospital prior to consultation. This is a relatively new concept in hospital medicine.

Adult↗
PubMed1997

Geriatric assessment in oncology.

With the anticipated growth in the numbers of elderly persons, a higher prevalence of cancers among older persons is expected; as a result, oncologists will treat larger numbers of older persons in their practices. Clinicians caring for older persons with cancer must recognize the heterogeneity of the elderly population and focus their assessments and care plans accordingly. The author reviewed literature and drew conclusions regarding geriatric assessment in several key areas: the medical, cognitive, affective, functional economic, and environmental status of patients; social support for patients; and advance directives. They concluded that for younger and healthier seniors, simple probes for the presence of common geriatric problems may suffice, but traditional means of medical assessment should be supplemented by brief screening for common geriatric conditions and nonmedical issues that are of particular relevance to the health of older persons. Assessment instruments can be used to guide these brief evaluations, but results must be interpreted in the context of the limitations of the instruments used. Patients who are frail or at high risk for functional decline or nursing home placement should receive more extensive evaluation by individual practitioners or by a multidisciplinary team of health care professionals who can provide comprehensive geriatric assessment. By broadening their assessment skills to include domains that are beyond traditional internal medicine and oncology training, oncologists can better serve their older cancer patients.

Aged↗
PubMed1999

The impact of two changes in service delivery on a geriatric psychiatry liaison service.

BACKGROUND: The impact of two changes in service delivery (alteration in the admission policy of the medical unit and the introduction of a formal liaison component to a 'consultation only' liaison geriatric psychiatry service) on the associated liaison geriatric psychiatry service was examined in a naturalistic study. The main null hypothesis was that the referral rate would not be influenced by either change in service delivery. METHOD: The 30-month study period was divided into three phases defined by the two changes in service delivery. The impact of the two changes in service delivery on the (i) referral rate, (ii) reasons for referral, (iii) demographic and clinical characteristics of the referrals and (iv) advice offered after assessment was examined with a retrospective design. RESULTS: There was a significant decline in the number of referrals for each month across the three study phases exclusively accounted for by a decline between phase 2 and phase 3. The number of reasons for referral and management advice offered for social treatments per patient were greater in phase 1 compared to phase 2. The total number of management advice offered for medical treatments per patient was greater in phase 2 compared to phase 3. The cost of a specialist registrar attending a geriatric medicine ward round was more than offset by the associated decline in the number of referrals per month. CONCLUSION: Although this study was not designed as a cost-effectiveness study, the results suggest that the liaison component has the potential to be cost-effective. There is a need for more formal clinical effectiveness and cost-effectiveness studies in liaison geriatric psychiatry.

Aged↗
PubMed2003

Psychosocial risk factors for musculoskeletal symptoms among women working in geriatric care.

BACKGROUND: Nursing is a stressful, physically demanding occupation and a rush setting for musculoskeletal problems. The aim of this study is to explore the extent of the association between psychosocial work characteristics and musculoskeletal symptoms among women working in geriatric care. METHODS: The participants were female employees of all geriatric nursing homes and geriatric hospital wards in Iceland having a staff of 10 or more. A total of 1,886 questionnaires were distributed. The response rate was 80%. RESULTS: Finding the job mentally difficult, mental exhaustion after one's shift, dissatisfaction with supervisors or the flow of information, insufficient influence at work, dissatisfaction with the hierarchy, intense time pressure, lack of solidarity, dissatisfaction with the job, harassment, violence or threats at work; all of the aforementioned gave crude odds ratios (OR) two or above for one or more musculoskeletal symptoms. Mental exhaustion and harassment, violence, and threats were the factors connected with symptoms from all the body regions studied. CONCLUSIONS: The extent of the association of work-related psychosocial factors and musculoskeletal symptoms among the geriatric female nursing staff is substantial and needs to be taken into account by occupational health services and others involved in preventive work. Am. J. Ind. Med. 44:679-684, 2003.

Adolescent↗
PubMed2004

Psychosocial and geriatric correlates of functional status after total hip replacement.

OBJECTIVE: To determine whether psychosocial factors, chronic diseases, and common geriatric problems are associated with poor physical function 3 years after primary total hip replacement (THR). METHODS: We studied a sample of Medicare recipients in Ohio, Pennsylvania, and Colorado (n = 922) who underwent primary THR in 1995 (mean +/- SD age 73.1 +/- 5.6 years, 32% men). Participants completed a questionnaire regarding lifestyle factors, medical history, and quality of life approximately 3 years after the surgery. Physical function was measured using the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index. We assessed the relationship between functional outcome 3 years postsurgery and 4 predictor domains: pain or complications in the operated hip, other musculoskeletal comorbidity, medical factors (obesity, chronic medical comorbidity, rheumatoid arthritis, and such common geriatric problems as falls, poor balance, or incontinence), and psychosocial factors (mental health, regular alcohol consumption, smoking, provider role, living alone, and education). RESULTS: Ten percent of subjects had poor functional status. In a logistic regression model controlling for sex and age, the following factors were associated with an increased risk for poor functional status (in order of importance): pain in the back or lower extremity, severe pain in the operated hip, poor mental health, more than 1 common geriatric problem, obesity, and less than college education. CONCLUSION: Pain in the operated hip was strongly associated with poor functional status 3 years after THR. However, other factors associated with poor functional status were not related to the hip. Our results suggest that a comprehensive assessment of functional status in elderly THR patients should include assessment of common geriatric problems, mental health status, and weight.

Aged↗
PubMed2007

Validation of the Retardation Rating Scale for detecting depression in geriatric inpatients.

OBJECTIVES: Validation in the elderly of the Retardation Rating Scale (RRS), which includes items related to motor and mental retardation but not vegetative items, and may be particularly well-suited for the diagnosis of depression in the elderly. METHODS: One hundred and sixty-five geriatric inpatients (105 depressed), aged 65 and over, without dementia, neuroleptic medication and increased risk of slowed mobility, were assessed with the RRS and three validated 'gold-standard' scales for geriatric depression (Hamilton Depression Rating Scale, Montgomery and Asberg Depression Rating Scale, Geriatric Depression Scale). Factor analysis used varimax rotation, Cronbach's, Spearman's and Ferguson's coefficients and the Mann-Whitney U-test to evaluate construct and internal consistency. Convergent validity and Receiver Operating Characteristics curves were also analyzed. RESULTS: Factor analysis retained three interpretable domains: (1) motor items (45% of the variance); (2) mental items and (3) the cognitive items. Internal consistency was high (alpha = 0.91). Each item was strongly correlated with the total RRS score and associated with depression. The RRS showed good convergent validity and its total score increased with depression severity. A cut-off score of 10 yielded 79% sensitivity and 80% specificity, with 80% of the patients properly classified, that is 15% more than standard observer scales. CONCLUSION: RRS is a valid screening tool for depression and improves recognition of depression in geriatric inpatients.

Aged↗
PubMed2001

Confidence of primary care physicians in assessing the suicidality of geriatric patients.

This study examined the confidence levels of physicians in assessing the risk of suicide among older adults in clinical settings. Of the 300 physicians who were selected from a population of 4980 family practice, internal medicine, and geriatric physicians in Illinois, 63% responded to the mail survey. Several categorical items inquired about specific assessment and treatment approaches, referral resources used, barriers to meeting the mental health needs of older patients, and sources of training in suicide risk assessment. All the training items (suicide assessment in medical school, residency, and CME courses; rating of medical school training; and insufficient training in geriatric mental health) were significantly (p < 0.01) associated with confidence in assessing suicidality. The overall model consisting of six variables explained 57% of the variation in confidence scores [F (6, 130) = 28.48, p < 0.001]. Three variables accounted for 50% of the explained variance: confidence in diagnosing depression, residency training in the assessment of suicide risk, and assessment of the intentional misuse of medication. Confidence in diagnosing depression (beta = 0.38, p < 0.001) was the strongest predictor. More effective mental health care will require specific preparation in treating geriatric patients through the full spectrum of medical training, including medical school, residency, and CME courses. Improved prevention of elderly suicide hinges on the enhancement of clinical skills in diagnosing and treating geriatric depression.

Adult↗
PubMed1989

Comprehensive geriatric assessment: toward understanding its efficacy.

Comprehensive geriatric assessment (CGA) offers health care professionals a technique for multidimensional diagnosis of frail elderly people to plan medical, psychosocial, and rehabilitative care. In the present paper, we provide a brief history of geriatric assessment, a description of the varied organization of geriatric assessment programs (GAPs), and a review of published effectiveness studies of programs worldwide performing comprehensive geriatric assessment. Program diversity has complicated drawing conclusions about the efficacy of CGA from a literature reporting generally positive, but not uniformly significant, results. We suggest that sample size limitations explain much of the variability in findings. Using the techniques of meta-analysis, we evaluate the effect of GAPs on mortality when all controlled trials are considered cumulatively. Meta-analysis of six-month mortality demonstrates a statistically significant 36% reduction of mortality for inpatient CGA programs (odds ratio = 0.64; 95% confidence interval = 0.50 to 0.83), and a 32% mortality reduction for all CGA programs (odds ratio = 0.68; 95% confidence interval = 0.57 to 0.80). Further use of meta-analytic techniques can be employed to clarify the effect of GAPs on other important outcomes (e.g., reduced hospital and nursing home use, improved functional status), and to identify program characteristics best promoting these benefits.

Aged↗
PubMed1991

Study of constipation in a geriatric hospital, day hospital, old people's home and at home.

A study of constipation and related factors was carried out in 439 geriatric hospital patients, 183 people living in two old people's homes, and 78 patients visiting a geriatric day hospital. In addition, a cross-sectional survey of constipation and related factors was undertaken in 138 people older than 74 years and 74 people aged 41 to 50 years living at home. Constipation and the use of laxatives were most frequent in the geriatric hospital (79% and 76% respectively), followed by the old people's homes (59% and 60%), the day hospital (29% and 31%), elderly living at home (38% and 20%) and middle-aged living at home (12% and 5%). The results suggest an increased risk of constipation for the persons walking less than 0.5 km daily [relative risk (RR) = 1.7], walking with help (RR = 3.4), chairbound (RR = 6.9) and bedbound (RR = 15.9). The relative risk of constipation increased for the persons living in the old people's homes (RR = 1.7) and the geriatric hospital (RR = 2.2), and also with advancing age (between 75 and 84 years, RR = 2.9; over 84 years, RR = 4.9). The prevalence of constipation was directly correlated to fecal and urinary incontinence.

Adult↗
PubMed1995

Effects of a geriatric inpatient unit on elderly home care patients: a controlled trial.

This was the first controlled trial to test the value of bringing elderly community-dwelling home care program patients into a hospital geriatric assessment unit. Elderly community-dwelling patients (N = 312; mean age = 78 years) who belonged to a supervised home-care population were randomized into intervention (N = 104) and control groups (N = 208). Patients in the intervention group underwent a comprehensive multidisciplinary geriatric assessment in an inpatient geriatric assessment unit (mean length of stay, 16.5 days). Controls continued with usual home care. At baseline, the two groups were comparable. By three months, the intervention group had more positive changes in general health, continence, housekeeping and satisfaction with care. However, by 12 months, these differences were no longer statistically significant. During the follow-up year, the intervention group had fewer days in health center hospitals. However, since controls had no initial days in the geriatric unit, there was no net difference in cumulative institutional days. We conclude that the benefits of this assessment approach were relatively mild and apparently temporary. More studies of alternative assessment schemes are needed, and different targeting models should be studied.

Activities of Daily Living↗
PubMed1998

Characteristics of geriatric patients related to early and late readmissions to hospital.

The aim of the study was to evaluate which characteristics of geriatric patients account for readmission to hospital, 6 months after discharge. All patients (203 females, 176 males) consecutively admitted over a two-month period to four acute geriatric care units, located in the cities of Chieti, Perugia, Pescara and Prato, participated in the study. Data that could potentially explain early and late readmissions were collected for each patient. Prevalence of diseases and comorbidity were assessed with the Cumulative Illness Rating Scale (CIRS); physical function by self-report (ADL, IADL) and objective (Stand and Walking Speed) measures; cognitive level by MMSE; and depressive symptoms by the Geriatric Depression Scale (GDS). Information on family and social support were also obtained. After discharge, data on hospital readmissions were collected for six months. For each readmitted patient (cases), medical records were reviewed, and supplementary information was obtained from families and general practitioners. Readmissions were classified as "early" (within the first three months), "late" (within the third and sixth month), and "multiple" (2 or more readmissions irrespective of the period). Patients not readmitted (alive at home) were considered as controls. Systematic differences between centers and between periods of readmissions were evaluated using one-way analyses of variance, and Pearson's chi 2 test. Factors related to early, late, and multiple readmission were identified in multivariate logistic regression models. On univariate analysis, patients readmitted over the first three-month period were sicker than controls (CIRS classes 3-4: 52.1% vs 34.1%), had more social problems or behavioral symptoms, and were more functionally impaired (ADL dependencies 3.3 +/- 0.4 vs 2.1 +/- 0.2). Patients who were readmitted between the third and the sixth month after discharge had a significantly higher CIRS total score (p = 0.006). Patients with multiple readmissions had more severe diseases, and more social problems. On multivariate analysis, early readmission was associated with unsatisfactory social conditions, living alone, severity of diseases and cognitive impairment, while late readmission was associated with comorbidity only. Multiple readmissions were related only to social factors, and to hospital admission before the baseline evaluation. The findings of this study suggest that interventions aimed at improving unfavorable social conditions may reduce the rate of rehospitalization in geriatric patients.

Activities of Daily Living↗
PubMed2003

[Desire for death-results of a pilot study with acute geriatric patients].

Desire for death when expressed by patients is extremely demanding to the geriatric team. In an acute geriatric setting with its high proportion of multi morbid patients, decisions about diagnostic and therapeutic measures as well as decisions about restrictions of therapy have vital consequences. In this context, what is the significance of expressions of desire for death? A growing amount of literature has reported about studies on such questions with terminally ill patients. Studies in the field of acute geriatrics are still missing. In the present explorative pilot study, data of ten patients in an acute geriatric setting were collected within a two-month period. Data comprise various dimensions of the expressions of desire for death, and variables of their medical psychiatric, psychological, and psycho-social context. The dimensions of duration, intensity, and concreteness could be differentiated within the expressions of desire for death. In addition, they were each correlated to different context variables. Intensity was associated with experiences of pain. Subjective well-being and social support were relevant to concreteness. Duration was correlated with depression, hopelessness, experienced stress, and functional health. Physical health did not play a significant role. This means that expressions of desire for death do not only occur in the context of extreme health problems. The study has identified differentiated starting points for better understanding the expressions of desire for death and for better intervention. Further study is necessary to confirm these findings within a longitudinal design.

Acute Disease↗