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PubMed1997

Geriatric occupational therapy: the uncertain ideology of long-term care.

The search for the good life is used as a framework for understanding the meaning of geriatric practice to occupational therapists. Data consisted of a subset of phenomenological interviews drawn from a nationwide study of 148 occupational therapists in all areas of practice. Narratives of satisfying and dissatisfying experiences with older clients were analyzed to understand the uniqueness of therapists' lived experiences in geriatrics. The realities of practice with older clients--the settings, the meanings and symbols of continuity in old age, and the older client's uncertain future--merge to create an uncertain ideology in geriatric occupational therapy. We suggest that a fundamental task of occupational therapists in geriatrics, as they seek the good life for themselves and their older clients, is to reconcile the realities of practice with traditional rehabilitation ideologies by redefining themselves and their roles in practice.

Adult↗
PubMed1985

Conducting clinical research in geriatric populations.

Clinical research on geriatric populations requires adaptation of traditional methodologies, modification of expectations, and the development of new procedures. Some aspects of research methodology are unique to studies of geriatric populations. Experience in this relatively new area of geriatric research indicates that new partnerships between researchers and long-term care providers are needed. These new relationships require an understanding of the needs of geriatric populations and of the differences between providers of long-term care and of acute-care. Researchers must consider heterogeneity of the population, the probability of multiple diagnoses and treatments, subject attrition, and the possibility of invalid data. Such considerations require extra staff, more time, and increased funding as well as new thinking about study design and protocol implementation.

Aged↗
PubMed1995

Geriatric medicine--maturation or senescence?

Geriatric medicine is at a crossroads. Much time and effort have been given to develop training programs that aim at making physicians better able to care for the multiple and interacting problems affecting the elderly. It appears, however, that the best option at this time is to focus efforts and limited resources on undergraduate- and resident-level training. Fellowship training, given the limited number of well-qualified candidates and limited interest at this time, should largely be aimed at developing a cadre of leaders and role models who in turn will perhaps be more successful than we have been to date in fostering careers in geriatric medicine. Perhaps the increase in numbers of elderly persons will at last become a mandate for action. Presently, most physicians and health care planners recognize that demographic changes will occur, but the reality has not yet hit. In the next few decades, when there are more persons over the age of 85 than in the 65-to-85-year old group, the message may be clearer. Geriatric physicians may be able to teach by example, become administrative leaders, researchers, and makers of public policy for today and years to come. Although one might argue that geriatric medicine has gone through a difficult transition, to maturation and now, in many persons' opinion, has entered senescence, like the elderly patient of today, even in old age, there is grace, room for growth, and yes, even time to learn new tricks.

Aged↗
PubMed1986

The physician assistant and geriatrics: what does the future hold?

The practice of geriatrics promises to change radically over the next 20 years. The elderly population will increase significantly, particularly in the age group older than 75. Hospital and nursing home utilization will expand dramatically, while medical and family manpower will diminish. Government control of medical services will continue to grow particularly through prospective payments. These developments present a challenge to the PA. In the short term, nurse practitioners and government providers may resist the use of PAs in geriatrics. However, within three to five years the ability of the PA to fill many of the geriatric patients' needs should be recognized. The author draws on his practical experience to describe the impact of government involvement on hospital and nursing home utilization and, in that context, some of the future roles open to PAs in geriatric practice.

Aged↗
PubMed1999

Update of geriatric psychiatry practices among American psychiatrists: Analysis of the 1996 National Survey of Psychiatric Practice.

Using data from the 1996 National Survey of Psychiatric Practice from the American Psychiatric Association (APA), the authors updated information on psychiatrists who are high geriatric providers (HGPs). In 1996, HGPs comprised 18% of the sample. Only 23% reported no geriatric patients in their practice, a 51% reduction from 1988-89; the proportion of HGPs is increasing. HGPs were more often male, minority, international medical school graduates, certified in geriatric psychiatry, and not medical school-affiliated. HGPs worked longer hours/week in direct patient care, had more patient visits/week, and saw more new patients/month, spending more time in hospitals and nursing homes and less time in office-based practice, and seeing more patients with mood disorders, psychotic disorders, and other disorders. Medicare was a proportionally higher payment source. Older psychiatrists were likely to have more patients over age 65. Tracking practice activities of HGPs may help inform policy discussion regarding staffing needs for geriatric patients with late-life mental disorders.

Aged↗
PubMed1999

[Psychiatric disorders in the elderly and psychosocial background. A study of geriatric inpatients].

OBJECTIVE: In the past, little attention was paid to psychiatric problems of geriatric inpatients. One reason for this may be that little is known about the necessity and the dimension of psychiatric help in this population. METHODS: Psychiatric morbidity was studied in a sample of geriatric inpatients aged 65 years and older. RESULTS: Dementia was found in 26%, depressive disorders in 22%, alcohol abuse in 11% and benzodiazepine abuse in 2%. 38% had no psychiatric disorder. Dementing disorders were more frequent in older patients, other disorders showed no association to age. Men had a better education level and higher professional positions but more frequent psychiatric disorders than women. Neither social network nor financial situation was related to psychiatric disorders. But chronic somatic diseases were associated with depressive disorders. CONCLUSIONS: Psychiatric disorders are frequent and affect geriatric treatment. A collaboration between psychiatrists and geriatrics should therefore be a necessity and not an exception.

Aged↗
PubMedDate not supplied

Demonstrating the need for oral health education in geriatric institutions.

OBJECTIVES: This review paper discusses the need for an educational component of a preventive oral health care program in geriatric institutions. The content of an education component that can improve the awareness of health care professionals in geriatric institutions with respect to the positive relationship of good oral health to good general health, thereby motivating them to provide adequate oral care, is investigated. METHODS: A literature review was conducted of the following areas: dental health education in nurse training; dental care for the elderly; prevention of dental caries, periodontal diseases and oral cancer; oral hygiene; nursing homes; long-term care facilities, and homes for the aged. The search was conducted through Medline from 1966 to 1998. RESULTS: Overall, there is little information and agreement about the content and structure of oral health education programs in geriatric institutions, although information exists with respect to the effectiveness of methods of oral hygiene and the efficacy of oral care agents. The oral health care needs of the institutionalized elderly are not being met due to health care professionals' demanding workload, a lack of knowledge of the importance of oral health care and apathy, or lack of interest, towards the practical application of oral health care principles. CONCLUSIONS: There is a need to educate all stakeholder groups, including health care professionals, in the importance of mouth care for elderly clients. Dental professionals working in geriatric care should address this need by implementing a preventive oral health care program consisting, not only of examinations and preventive care, but also of an educational component for the allied health care professionals and members of the patient's family. The ultimate goal is for the medical and dental professionals and caregivers to collaborate with an integrated approach to preventing oral disease, thereby improving overall health and quality of life for the institutionalized elderly.

Aged↗
PubMed2000

[Quality assurance in geriatric rehabilitation hospital treatment. Long-term medical and functional outcome].

Clinical geriatric therapy has shown to be beneficial and cost-effective. However, little is known about its long-term results. Based on GEMIDAS (Geriatric Minimal Data Set), a multicenter-Database of the German Federal Association of 140 Clinical Geriatric Institutions, we conducted a one-year-follow-up pilot study focusing on medical and functional results, including needs of technical aids and nursing. Mortality was 16% at 1 year. Two thirds of the deceased had died during the first half year, many with severe stroke. Among the 840 survivors, 81.1% lived in their private housing, 14.5% in nursing homes, 4.4% were actually hospitalized. 37.3% suffered from recurrent diseases such as stroke (5.2%), bone fractures (4.5%), heart attacks (2.1%), severe infections (1.1%), needing hospitalization in 31.9%, repeatedly in 6.9% of the survivors. Technical aids were regularly used in about 80%. Personal help was often necessary and was provided by relatives (66.9%), professional nursing (39.8%), neighbors (5.7%), only 6% of the patients needed no help. The initial functional gain (mean Barthel-Index from 53.4 to 72.3 points) diminished to 59.6 points during follow-up, with similar patterns for most of the single Barthel-items. Our results confirm the initial benefit and clearly show a significant long-term effect of clinical geriatric rehabilitation. For stabilization and further functional improvement, specific and continuous rehabilitation efforts seem to be crucial.

Activities of Daily Living↗
PubMed2001

[Clostridium difficile-associated diarrhea--a growing problem in geriatric care].

From 1994 to 1998 the incidence of Clostridium difficile-associated diarrhoea (CDAD) in the Department of Geriatric Medicine, Huddinge University Hospital increased from 0.5% to 2.2% of all admissions. Corresponding figures for the whole hospital were 0.3% and 0.6%, respectively. The increase in CDAD at the Department of Geriatric Medicine was parallel with a more than doubled consumption of antibiotics. All geriatric patients with CDAD had been treated with antibiotics before onset of diarrhoea. Out of the antibiotic prescriptions 48% were a cephalosporin (mainly cefuroxim). In a matched reference group of geriatric patients 51% had been treated with antibiotics during the hospital stay. The patients with CDAD spent 27 +/- 14 days in hospital as compared to 13 +/- 9 days (P < 0.05) in the reference population.

Aged↗
PubMed2001

[Geriatrics and rehabiliation: role of the hospital in healthcare networks?].

OBJECTIVE: There is no accepted definition of geriatric post-acute or rehabilitation care. The exact role within the healthcare network and the function of units providing such care remain to be clarified. We describe the activity of geriatric post-acute or rehabilitation care units in four French hospitals to identify common features and provide elements of practical interest concerning their role in the healthcare network. METHODS: Data from 4 healthcare institutions in France recorded in the 1999 Medical Information System were analyzed. RESULTS: Geriatric post-acute or rehabilitation units generally provided care for patients over 80 years of age in short-stay wards. These patients were dependent and recovering from an acute illness. In addition to rehabilitation and medical care, given according to the patients' needs, the units also provided social counseling and acute care as in other short-stay wards. A wide variety of pathological conditions was observed. At discharge most patients returned to their home or were transferred to a nursing home. CONCLUSION: Geriatric post-acute or rehabilitation units meet the requirements proposed in French legislation and in addition provide social counseling and acute care services, which is evidence of the deficiencies in the healthcare network in the field of elderly patient care.

Acute Disease↗
PubMed2001

Geriatric oral health issues in India.

An overview of the demographics and oral health status of the elderly population of India is presented. India is a vast country with a population of one billion people. Of this, people older than 60 years constitute 7.6%, which in actual number is 76 million. There are several factors that affect the oral health of elderly. The dentist:population ratio is 1:27,000 in urban areas and 1:300,000 in rural areas, whereas 80% of the elderly population reside in rural India. Forty per cent of the elderly live below the poverty line and 73% are illiterate. Ninety per cent of the elderly have no social security and the dependency ratio is 12.26. Incidence of oral cancer, which is considered an old-age disease, is highest in India, 13.5% of all body cancers are oral cancers. Preventive dental care is almost nonexistent to the rural masses and very limited in urban areas. Above all, there is no orientation of dental graduates towards the special needs of the geriatric population. Recommendations include: the establishment of Continuing Dental Education programmes on geriatric oral care; inclusion of a geriatric component in undergraduate and postgraduate curricula; initiation of a diploma, certificate and degree courses in geriatric dentistry; research on various aspects of ageing and age-related oral health problems; provision of preventive and curative treatment for various oral diseases to the elderly.

Aged↗
PubMed2001

[Three geriatric wards of a psychiatric hospital (GAPZ): a comparison of patient admissions].

The aim of this investigation was the description and comparison of problems of patients admitted to three geriatric wards of a mental hospital. The study took place in the geriatric units at the Vincent van Gogh Institute of psychiatry in Venray, the Netherlands and was retrospective. Data obtained from discharge letters were analysed and the relevant diagnoses and the aetiology of the problems of all patients admitted in 1994 were categorised and compared. This was done bij means of classification systems and models of Fried et al. The problems of patients admitted to the geriatric unit of a mental hospital very frequently appeared to be combined problems of a psychiatric, somatic and/or social nature. In only 58% there was a simple connection between the cause(s) and the current problems. Differences between the three wards were small and non significant. In conclusion, the problems of the patients, admitted to the geriatric units of a mental hospital, did not differ significantly between the three wards. Furthermore, they are complex in terms of diagnosis, aetiology and/or treatment.

Aged↗
PubMed2001

Geriatric syndromes and assessment in older cancer patients.

Older individuals are at risk for adverse events in all settings where cancer is treated. Common geriatric syndromes can complicate cancer therapy, and thus, increase patient morbidity and the costs of care. Furthermore, cancer treatment can worsen geriatric syndromes. It is often difficult to determine whether declining health is a result of cancer treatment or the patient's underlying disease. Baseline assessment of multiple factors may facilitate detection of a decline in the patient's health status, which may be remediable. Geriatric syndromes may substantially affect quality of life and are also important in the prognosis and outcome of cancer therapy. This article reviews the assessment of cognitive syndromes (dementia and delirium), vision and hearing impairment, gait and balance difficulties, malnutrition, incontinence, depression, osteoporosis, sleep disorders, environmental and social issues, and functional decline. Although there are many geriatric domains and many focused assessment tools, assessment does not need to be time-consuming. Streamlined assessment tools have been developed; they are brief, inexpensive, and easily administered, and they may be valuable to the oncologist. Staff such as nurses, social workers, or office personnel could perform these assessments and minimize the impact on the physician's time.

Activities of Daily Living↗
PubMed2002

[Cognitive assessment in geriatric rehabilitation].

Geriatric rehabilitation is a prolonged and expensive process. There is a need to evaluate the rehabilitation potential because of the increasing number of elderly in the population and limited resources. Cognition is one of the components of occupational performance and its evaluation is a crucial part of comprehensive geriatric assessment. Cognitive evaluation is one of the predictors of function among elderly in the community and also assists in predicting their rehabilitation potential during hospitalization. High prevalence of cognitive decline with aging and the difficulties in its early assessment during hospitalization emphasizes the utmost importance of this evaluation in predicting the functional prognosis of the patient. This article reviews the main common tools for cognitive evaluation, which are in use clinically, and also used in research, for geriatric rehabilitation in Israel. These were compared with the principles of dynamic cognitive assessment. We aim to assess the need to add dynamic diagnostic tools to supplement those in common use. This will assist in providing an optimal mechanism for cognitive evaluation during geriatric rehabilitation.

Adult↗
PubMedDate not supplied

Comparison of adult and geriatric psychiatric practice patterns: findings from the American Psychiatric Association's Practice Research Network.

OBJECTIVE: The authors explored diagnostic and treatment patterns for patients under and over age 65 seen by a nationally representative sample of psychiatrists participating in the American Psychiatric Association's Practice Research Network. METHODS: Detailed patient information, including demographic and financial characteristics, diagnoses, service utilization, and treatment, was collected by 383 psychiatrists on 1,026 patients to assess the impact of patient age on pharmacotherapy and psychotherapy service use as well as treatment outcomes. RESULTS: Approximately 15% of the patient sample was over age 65. Compared with patients ages 19-64, a lower percentage of geriatric patients had Axis I comorbidity, but a higher percentage had Axis III comorbidity. Geriatric patients were more often treated in hospital settings, and older patients were less likely to have their visits adversely affected by financial pressures of the healthcare system. Over 60% of patients in both age-groups received antidepressants, but there was a disproportionately increased use of antipsychotics and antianxiety/benzodiazepine medications among geriatric patients. Being age 65+ was a strong predictor for "improved" clinician rating on general assessment scores, but failed to be a predictor of receiving psychotherapy or pharmacotherapy. CONCLUSION: There were important differences between subject groups. Overall, American psychiatrists treat a complex group of geriatric patients suffering from major mental disorders complicated by medical comorbidity. Additional studies would further enhance our understanding of the delivery of mental health services to elderly patients and improve training of psychiatrists who help care for our aging population.

Adult↗
PubMedDate not supplied

Geriatric medical education in Louisiana: current status and future needs.

Despite the impending explosion in the size of American's elderly population, physicians remain undertrained in geriatric medicine. In Louisiana, this training is especially important for the family physician and internist, many of whom practice primarily in rural areas and carry the bulk of nursing home patient care on their shoulders. Louisiana's medical schools offer little in the way of training in geriatric medicine, despite the author's finding that there is a strong interest for such training among practitioners and residents. Meanwhile, at the national level, leaders in geriatric medicine are working to develop new ways to encourage participation in geriatric educational opportunities.

Education, Medical↗
PubMedDate not supplied

Skin changes in geriatric nurses prior to training heralding a particular risk of hand dermatitis.

Irritant skin changes are a well known problem in nursing services. Especially geriatric nurses often complain of hand dermatitis, most likely induced by frequent washing and hand disinfections. In this cohort study, demographic data and skin changes from 521 nurse trainees were recorded. The data of geriatric nurse trainees (n = 149) were compared to that of other nurse trainees (n = 372), mostly of surgery, internal medicine, pediatric and obstetrics. Geriatric nurse trainees were significantly older and had noticeably severer irritant skin changes at the start of the training. Geriatric nurse trainees were more often undergoing retraining, because they had other jobs before. Interestingly, some nurses performed the retraining because they had problems with hand dermatitis in their previous job. More education concerning the risk of irritant dermatitis in health care occupations is desirable, not only for the starting nurse but also for the employment offices.

Adult↗
PubMed1976

[Progress and change in geriatric gynecological surgery (author's transl)].

Two periods of geriatric gynecological surgery (1947-1959 and 1960-1972) at the University Women's Hospital in Hamburg-Eppendorf were compared in regard to the age of the patient, surgical indications, surgical procedure, anesthetic technique, preoperative and postoperative morbidity, length of hospitalization and mortality rate. During a period of 26 years, 1514 women over the age of 60 were treated surgically. During the first period, 489 women were treated, and in the second period, 1,025. This 109.6% increase has been confirmed statistically. The increase in geriatric surgical cases stems basically from the increase in the number of surgical patients over the age of 70. The increase in breast carcinoma during the second period (from 43 to 348 operations) is most conspicuous. This is an increase of 809.3%. On the basis of this disproportionately large increase in breast surgery, more women were treated surgically in the University Women's Hospital in Hamburg-Eppendorf for breast carcinoma during the second period, than for carcinoma of the reproductive organs. Vulva carcinoma and craurosis vulvae were also more frequently considered to be an indication for surgical treatment. The total number of women who were surgically treated for prolapsed uterus and vagina remained more or less constant. In the analyzing the surgical records, it should be emphasized that, in the second observation period, two-thirds of these cases were treated by performing a vaginal hysterectomy with anterior and posterior vaginoplasty. For older patients, palliative surgical measures for prolapsed uterus and vagina were abandoned in favor of more definitive methods. The postoperative morbidity and mortality rate remained more or less constant for both periods. The postoperative period of hospitalization was slightly longer while the preoperative period was slightly shorter. The statistically confirmed increase in geriatric surgery during the last 13 years at the University Women's Hospital in Hamburg-Eppendorf clearly shows how important geriatric surgery has become. The immediate consequences are an increased workload for physicians, nursing staff and physical therapists.

Age Factors↗