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PubMed1994

Compliance with social and safety recommendations in an outpatient comprehensive geriatric assessment program.

BACKGROUND: A unique contribution of a comprehensive outpatient geriatric assessment is its focus on social and safety issues in the frail elderly. The impact of such programs depends on the caregiver and/or patient complying with safety and social recommendations offered by the assessment team. Compliance in this setting has not been previously described. METHODS: A telephone survey was conducted of self-reported compliance in 124 frail geriatric patients with a high prevalence of dementia 3-21 months after completing a comprehensive geriatric assessment program at the University of California, San Diego, Medical Center. RESULTS: The social and safety recommendations constituted 52.8% of all the recommendations offered. The overall compliance rate (total number of safety and social recommendations followed/total number offered x 100) was 50.2% (95% CI: 43.7-56.6). Highest compliance was achieved with recommendations to complete a prior directive for health care (80.6%) and to wear a medic-alert bracelet (57.5%). Patients complied poorly with recommendations to change a living situation (36.2%). Analysis of variance showed compliance to increase with time between the assessment and survey. Stratifying for time, we found higher compliance in patients with greater impairment in functional or cognitive status. Most noncompliance was due to disagreement with the recommendations offered or failure to implement acceptable recommendations. CONCLUSIONS: Compliance with social and safety recommendations offered in a comprehensive geriatric assessment program approximates compliance observed in other clinical settings. In this setting compliance increases over time. When controlled for time, impairment in functional or cognitive status is associated with greater compliance.

Accidents, Home↗

PubMed1980

A conceptual framework for teaching geriatrics in a family medicine residency.

There is increasing recognition of the need for educational programs in geriatric medicine, a previously neglected area of medical education. Such training is particularly important in family medicine residencies because primary care physicians have provided the bulk of health care to the elderly and probably will continue to do so. There are many advantages to using a competency-based curriculum model in developing such an educational program in geriatric medicine. The competency-based model clearly states educational objectives and identifies pertinent instructional resources and evaluation methods. A competency-based curriculum model is described which divides competencies under four major goals: understanding principles of geriatric medicine, obtaining and interpreting data, managing geriatric patients, and working as a member of a health care team. Sample objectives for each goal are described, and experience using this model in a family residency is reviewed.

Competency-Based Education↗

PubMed1981

A nontraditional geriatric teaching model: interprofessional service/education sites.

Recognizing the consistent increase in the numbers of Americans age 65 and over, medical educators must prepare their students to provide quality health care to the geriatric population in order to meet future medical needs adequately. The University of Maryland School of Medicine, in cooperation with the five other campus professional schools, is striving to meet this challenge with a comprehensive, interdisciplinary geriatric training program for students entering the health care professions. The curriculum model includes discipline-specific and interdisciplinary basic minimum competencies for providing satisfactory geriatric care associated with a variety of curriculum processes designed to assure students' realization of these competencies. The educational process as presented is offered as a potential operational model for medical educators interested in the development of geriatric curriculum design.

Aged↗

PubMed1992

Consensus among geriatric experts on the components of a complete nursing-home admission assessment.

Standards of practice for nursing-home admissions have not been established, and it is not known if geriatric clinicians agree on the components of an appropriate patient-admission evaluation. This study describes the consensus expressed by experts in clinical geriatrics regarding the most important components of nursing-home admission assessments. Directors of all geriatric-nurse-practitioner and geriatric-medicine fellowship programs (n = 79) were sent a two-round questionnaire asking them to describe and rate the components of a "complete admission assessment for every elderly patient entering a nursing home." Nurse practitioners and physicians ranked medication review, evaluation of urinary incontinence, mental status, vision and bowel status the highest, and gave them equal priority. Routine laboratory tests were not included among the highest-ranked items by either nurses or doctors. An enhanced assessment focusing on the functional consequences of diseases rather than on the traditional "head-to-toe" systems approach emerged as the most appropriate assessment for elderly nursing-home patients.

Aged↗

PubMed1994

Ability of a computerized geriatric assessment to predict need for change in living status among elderly living at home.

The objective of this study was to determine the ability of a software program used in a primary care physician's office to predict the need for alternate living arrangement in a cohort of community-dwelling elderly. An analysis was conducted involving 124 consecutive patients between February 10, 1990, and December 20, 1991, in my private medical practice. These patients, all older than 65 years, underwent a computer-assisted geriatric assessment. Two scales--the Geriatric Functional Rating Scale (GFRS) and the Functional Assessment Screening Questionnaire (FASQ)--were compared for their accuracy at predicting change in living status during the 12- to 24-month period following the assessment. Similar analysis of the Tinetti gait and balance test was also performed. Ten and one-half percent of subjects (n = 13) required a change in living status during the study period. Ten went to nursing homes and three joined relatives' households. The GFRS was 62% accurate (8/13) and the FASQ was 54% (7/13) accurate in predicting this change. Abnormality in both gait and balance was predictive 77% (10/13) of the time. Combining all three parameters raised the successful prediction rate to 85% (11/13). Neither GFRS, FASQ, nor gait/balance testing was predictive of death. A computer software program designed to facilitate performance of geriatric assessments in primary care physicians' offices has a high rate of predictive capability relative to future need for change in living status among community-dwelling elderly. Further studies comparing this software program with traditional geriatric assessment protocols are suggested.

Activities of Daily Living↗

PubMed1997

The first Summer Research Institute in Geriatric Psychiatry.

In July 1995, the American Association for Geriatric Psychiatry (AAGP) sponsored the first annual week-long Summer Research Institute (SRI) in Geriatric Psychiatry, at the University of California, San Diego. The NIMH-funded SRI was intended for promising postresidency and postdoctoral fellows, as well as junior faculty persons interested in research careers in geriatric psychiatry. The SRI focused on the tools needed to begin, maintain, and succeed on that career path and has been followed by continued communication between trainees and faculty. The SRI was highly successful, judging from the participants' evaluations, as well as the trainees' accomplishments in terms of publications and research funding during 1 year of follow-up. The SRI provides a useful model for an approach to bridging and shortening the transition period from fellowship to first research funding and of ensuring a continued flow of new investigators in geriatric psychiatry.

Academies and Institutes↗

PubMed2006

A network-based geriatric rehabilitation programme: study design and baseline characteristics of the patients.

The objective of this paper is to present the design and participants of an ongoing randomized controlled trial on a network-based geriatric rehabilitation programme, targeted at frail elderly persons with progressively declining health and a high risk of institutionalization. Forty-one municipalities, seven rehabilitation centres and a total of 741 frail elderly (65+years) community-living persons participated in the study. Assessments included measurements of physical capacity (balance, handgrip strength, walking speed), Functional Independence Measure, Geriatric Depression Scale, 15 Dimension quality of life questionnaire and Mini Mental State Examination. Questionnaires covered physical, social and psychological factors. The participants were old (mean age 78 years, range 65-96) and mainly female (86%). They were physically frail and most of them (66%) had experienced deterioration of health within 1 year. The majority lived alone (72%) and received regular help from other people (99%). The mean Mini Mental State Examination and Geriatric Depression Scale scores were 25.2 and 4.1 points, respectively. Depressive mood (Geriatric Depression Scale>6 points) was found in 17% and declined cognitive function (Mini Mental State Examination<24 points) in 28% of the participants. Differences between the randomized intervention and control groups were insignificant. Since the number of participants is sufficient statistically, the prospects for evaluating the effectiveness of the programme, and identifying potential benefactors, are good.

Activities of Daily Living↗

PubMed2004

Research agenda for geriatric rehabilitation.

The Research Agenda Setting Process is a joint endeavor by the American Geriatrics Society and the Hartford Foundation to increase geriatric expertise in the surgical and related specialties. This article provides the results of the Research Agenda Setting Process project on research needs in geriatric rehabilitation, which included a systematic review of the literature and a group consensus process. Explicit research questions and methodologies were developed for three cross-cutting research needs in geriatric rehabilitation and for the rehabilitation of eight specific conditions affecting older individuals.

Aged↗

PubMed1984

Geriatric rehabilitation on an acute-care medical unit.

This study examined a geriatric rehabilitation pilot project on an acute-care medical unit. Over a 6-week period, using a 35-item geriatric rating scale and a mental assessment tool, changes in behaviours of 23 patients admitted to the geriatric rehabilitation module were compared to changes in behaviours of 10 elderly patients on a regular medical unit. The patients' demographic characteristics, their nursing and medical diagnoses, and discharge patterns were reviewed. Significant changes in behaviours of patients on the rehabilitation model included: increased ability to care for themselves, to maintain balance, and to communicate with others; decreased restlessness at night; decreased confusion; decreased incidence of incontinence; and improved social skills. The paper describes the geriatric rehabilitation programme and discusses implications for nursing of elderly patients in acute-care hospitals.

Activities of Daily Living↗

PubMed2004

Geriatric rehabilitation nursing: developing a model.

In this paper, we describe a geriatric rehabilitation nursing model developed on the basis of the nursing and rehabilitation literature. That literature comprised some 120 articles addressing the rehabilitation of elderly patients and the work done by nurses in that process, various philosophical questions and the results of geriatric rehabilitation. One-third of these articles has been evaluated on the strength of the articles' evidence, and these are discussed in this paper. The findings show that the main factors in geriatric rehabilitation nursing are the patient with health or functional problems and the nurse with professional values, knowledge and skills. The patient is part of a family and the nurse works as part of a multidisciplinary team. In the geriatric rehabilitation process, the patient and the nurse work in close interaction. The aims of rehabilitation depend upon the patient's commitment to the objective and upon the nurse's commitment to help the patient achieve that objective. A health orientation, goal-oriented work, nursing decision-making and a rehabilitative approach to work are all central to this effort. Work is organized in multidisciplinary teams where nurses have equal responsibilities with other professional staff. Testing and development of the model is ongoing.

Aged↗

PubMed2004

Registered Nurses' perceptions of geriatric rehabilitation nursing in three Scandinavian countries.

This study describes Registered Nurses' perceptions of geriatric rehabilitation nursing as well as their experiences of working in the rehabilitation of older patients in Denmark, Finland and Norway. The aim was to gain deeper insights into how Registered Nurses think about geriatric rehabilitation nursing and how their perceptions differ in these countries. The data were collected among 600 Registered Nurses using a structured questionnaire with five background items and 88 geriatric rehabilitation nursing items. The response rate was 65%. Data analysis was with SPSS statistical software. Geriatric rehabilitation nursing was experienced as something that required knowledge and experience, patience and creativity, as well as professional skills. The nurses talked with their patients about their rehabilitation goals, but not all nurses were aware of those goals. Progress in the rehabilitation process was evaluated on a daily basis and results were noted in the patients' records. The nurses motivated patients by giving them positive feedback, by preventing pain, by pausing to share with the patients their joy about progress, and by giving the patients the opportunity to cope with daily activities. The Registered Nurses in Denmark were more team oriented and they set out the goals in the patient's records more often than their colleagues did in Finland and Norway.

Adult↗

PubMed2006

Brief report: Brief instrument to assess geriatrics knowledge of surgical and medical subspecialty house officers.

PROBLEM: Initiatives are underway to increase geriatrics training in nonprimary care disciplines. However, no validated instrument exists to measure geriatrics knowledge of house officers in surgical specialties and medical subspecialties. METHODS: A 23-item multiple-choice test emphasizing inpatient care and common geriatric syndromes was developed through expert panels and pilot testing, and administered to 305 residents and fellows at 4 institutions in surgical disciplines (25% of respondents), emergency medicine (29%), medicine subspecialties (19%), internal medicine (12%), and other disciplines (15%). RESULTS: Three items decreased internal reliability. The remaining 20 items covered 17 topic areas. Residents averaged 62% correct on the test. Internal consistency was appropriate (Cronbach's alpha coefficient=0.60). Validity was supported by the use of expert panels to develop content, and by overall differences in scores by level of training (P<.0001) and graded improvement in test performance, with 58%, 63%, 62%, and 69% correct responses among HO1, HO2, HO3, and HO4s, respectively. CONCLUSIONS: This reliable, valid measure of clinical geriatrics knowledge can be used by a wide variety of surgical and medical graduate medical education programs to guide curriculum reform or evaluate program performance to meet certification requirements. The instrument is now available on the web.

Clinical Competence↗

PubMed1978

The evolution of geriatric medicine.

The evolution of geriatric medicine has been associated with increasing knowledge about aging--social, psychologic and biologic--and its effect on the clinical presentation of illness. It also has been associated with varying patterns of the historical development of medical care in different countries. Overall, two main forms of geriatric medicine are developing worldwide--one an accredited specialty practiced within a State medical service, the other based in large hospitals for the aged where physicians train themselves but are not accredited. The system of geriatric care in Great Britain is described and the importance is emphasized of: 1) assessment before admission, 2) progressive care of the patient, and 3) the day hospital. Future developments in relation to internal medicine and family practice are considered. Research into the causes of atheromatous vascular disease and senile dementia is of fundamental importance for the whole future of geriatric medicine.

Accreditation↗

PubMed1980

Characteristics of family practitioners with large geriatric practices.

Little has been reported on the characteristics of physicians presently serving the health needs of the elderly. In this report, generated from a survey of Florida family practitioners, physicians and with large geriatric practices are compared to physicians with practices composed primarily of younger patients. Family physicians with large geriatric practices are older, and treat more chronic disease than do their peers. However, they consult the same professional journals and texts in caring for their patients, refer patients to specialists at the same rate, and have the same office facilities as do their colleagues who treat chiefly younger patients. The family physician with a large geriatric case load is less likely to have a predominantly outpatient practice and more likely to be involved with hospitalized patients. Data from the census and health manpower studies suggest that family physicians will care for substantial number of elderly patients in the future. Continuing education which addresses issues in geriatrics may help to attain optimal health care for the elderly.

Age Factors↗

PubMed1982

Studies in geriatric education: II. educational materials and programs.

There has recently been an increase in educational programs and materials in geriatrics, but their quality and content have not been adequately assessed. This study concerns important objectives and core contents in geriatric education, with a review of training programs, books, and audiovisual materials. Specific areas of need for printed and audiovisual materials are identified. Medical student and graduate level programs were found to address relatively few objectives. Geriatric fellowship programs, although having more extensive coverage, had some notable deficiencies. This information may be of use to those conducting training programs or preparing educational material in geriatrics.

Aged↗

PubMed1982

Studies in geriatric education: I Developing educational objectives.

This study reports on the development of a comprehensive set of objectives for the education of undergraduates, graduates, and fellows in geriatric medicine. The objectives were derived from reviews of available educational materials and programs, and their significance was validated through consensus techniques that included over 100 workers with special expertise in geriatrics and gerontology from the United States. Canada, and the United Kingdom. A related and supplementary investigation, which also used consensus methods, uncovered ten general and disease-specific objectives considered to be essential outcomes of the education of geriatric fellows. Academic departments and specialty and subspecialty organizations should find the total set of objectives useful for planning and evaluating educational programs in geriatrics.

Canada↗

PubMed1984

Clinical geriatric research: still in adolescence.

Clinical investigators face formidable methodologic and ethical challenges in the study of elderly people. To define problems specific to geriatric research the fundamental elements of clinical research are outlined and considerations important to a geriatric study population are identified. Because of the underestimated biologic variation of elderly people, the evaluation of new interventions in one older population may be difficult to generalize to all older people. Inasmuch as older people represent a study population with a lifetime of cumulative exposures for various diseases such as cancer, historical cohort studies are particularly suitable research designs. Despite these advantages, the retrospective study of certain interventions research designs. Despite these advantages, the retrospective study of certain interventions in older people, for example cardiopulmonary resuscitation, requires thoughtful attention to avoid strong and often subtle selection biases. Issues of informed consent and the presence of multiple, comorbid illnesses, especially relevant to clinical trials, are problematic in studying geriatric conditions. Recently, instruments measuring function and disability have been used extensively by investigators in geriatric research, but the precise way to quantify these observations remains controversial. Testing artifacts may be considerably greater in older persons than in many of the populations in which the instruments have been validated. Finally, certain statistical assumptions and inferences may be inappropriate in the study of older people.

Activities of Daily Living↗

PubMed1985

Use of a structured functional assessment format in a geriatric consultative service.

Interdisciplinary team assessment may not be feasible in the consultative setting because of scarce institutional resources. We explored the extent to which a physician-administered multifaceted assessment could meet the needs of a geriatric consultative service and also provide for the comprehensive functional assessment of elderly patients. Fifty-one consecutive patients, mean age 78, were evaluated. Domains measured included physical and mental health, socioeconomic resources, and activities of daily living. Despite a majority of consult requests for transfer of seemingly stable patients, unrecognized remediable problems were identified in most cases. Compliance with the consultant's recommendations was consistently poor, averaging less than 33% for all of the domains assessed. Nine of the study patients subsequently were transferred to the care of an interdisciplinary team on the geriatric assessment unit. Numbers and types of problems identified by the geriatric consultation using a structured assessment format allows for the comprehensive and efficient disclosure of pertinent management issues. Improved compliance with consultant recommendations may be effected by better education of care providers to the special needs of the geriatric population.

Activities of Daily Living↗