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PubMed2001

Psychosocial assessment of geriatric subjects in Abha City, Saudi Arabia.

Psychosocial assessment of geriatric subjects was carried out through a home-based survey of people aged 65 years and over (n = 810) in the catchment areas of 3 primary health care centres. All the participants had a structured interview and were given a short version of the geriatric depression scale. Depression was found in 17.5% of the subjects, more commonly in women (27.7% versus 12.7%). The combined effect of impaired perceived health status (52.4%) and functional capacity (26.6%), loneliness (4.5%), single status (24.3%), and lack of education (80.5%) explained 23.7% of the variance in depression score by multiple regression analysis. Depression is a problem among the geriatric population in the region, especially women. Periodic home psychosocial screening of geriatrics is recommended.

Activities of Daily Living↗
PubMedDate not supplied

Comprehensive geriatric assessment basics for the cancer professional.

A comprehensive geriatric assessment (CGA) has been a cornerstone of geriatric practice for many years. However, oncology practitioners are still unfamiliar with it. Yet, recent research has shown an important potential to improve the daily care of older cancer patients. The purpose of this article is to review the basic nature of a CGA, its effectiveness, its applicability to cancer patients, and its cost-effectiveness. Cancer is one of the major health problems in our society. Furthermore, the incidence of cancer increases with age. Nowadays, half of the cancers occur beyond the age of 70. Given the aging of the US population, this proportion is expected to increase in the next decades. A challenge for the oncologists is that older people can have a highly variable health status. Yet little is known yet about how to best assess and integrate into decision making the various health problems patients may have. Taking their clues from the experience of geriatricians, geriatric oncologists advocate the use of a comprehensive geriatric assessment (CGA) as one of the tools to deal with this problem. It is, for example, part of the National Comprehensive Cancer Network (NCCN) guidelines for the elderly'. This article offers a primer on CGA for the reader unfamiliar with the approach in an oncologic setting.

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PubMed2003

[The legal position of psycho-geriatric patients in nursing homes and residential homes].

Recently the Law on Formal Admission to Psychiatric Hospitals was evaluated for the second time. This law aims to protect the legal position of psychiatric patients, who have been involuntarily admitted. This patient group includes psycho-geriatric patients who are admitted to residential and nursing homes for which this is indicated. In this article the part of the evaluation concerning the internal legal position of psycho-geriatric patients is reported. This part of the study investigated both the knowledge of the law in practice and its correct application, as well as the suitability of the law for this domain of health care. The conclusion can be drawn that residential and nursing homes are aware of the laws purposes, but health care practitioners find it hard to follow certain aspects of the law's procedures, especially regarding the use of restraints. The main reason for this is that the Formal Admission Law was designed for a psychiatric setting, which cannot easily be translated to the position of psycho-geriatric patients. The suggestion is made that the Government will develop new legislation, which reflects special characteristics of psycho-geriatric care. Meanwhile health institutions have to take measures in order to improve the legal position of patients in this sector.

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PubMed1992

Dental students' self-assessed competence in geriatric dentistry.

This study measured the self-assessed confidence levels of four classes of dental students (n = 172) exposed to both didactic and clinical training regarding geriatric patients. It was found that after completing a two-term (20-week) didactic course in their junior year, and a five-week clinical course with geriatric patients in their senior year, dental students graduating from this university between 1987 and 1990 perceived significant improvements in their abilities to manage geriatric patients in all areas assessed, most notably in their treatment planning skills, in coordinating preventive dentistry programs, in referring patients to appropriate community resources, and in providing dental care in alternative settings. Greatest self-assessed improvements were exhibited between pre-didactic and post-didactic assessments, with a tendency to stabilize rather than improve after the clinical experience. Interestingly, this study found that the students' self-assessed changes between post-didactic training and post-clinical training were significant in only one area--their ability to manage the medical emergencies of elderly patients, including a patient's death in the dental chair. No differences were found between students who completed the clinical course early in their senior year with those who took it later; nor did differences emerge among the four classes. Clinical teaching in geriatrics may be an opportunity to practice skills and reinforce knowledge that has been gained in didactic courses, not necessarily a place to enhance perceived competence.

Analysis of Variance↗
PubMed2004

[Minimal invasive treatment modalities for geriatric pain management].

Geriatric pain is a significant problem in health care, because of multiple disease processes in this aged population their population will increase. Treatment options for the geriatric pain patient include pharmacotherapy, interventional pain management, physical rehabilitation, and/or psychological modalities. The most commonly employed modality for geriatric pain control is pharmacotherapy. However in older patients nonsteroidal anti-inflammatory drugs (NSAIDs) have significant side effects and are the most common cause of adverse drug reactions. In that reason NSAIDs should be used with caution. Opioid analgesic drugs are effective for relieving moderate to severe pain. If weak opioids were found to be ineffective in attenuating pain intensity, then therapeutic nerve blocks or low risk neuroablative pain procedures should be employed prior to recommending strong opioids. A combination of invasive procedures and systemic medications has the distinct advantage of reducing medication intake and its side effects. Currently there is very scant evidence that this is the best treatment option while others have thought that the multidisciplinary approach to geriatric pain may be the most effective.

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PubMed1992

[The geriatric-psychiatric service in Denmark].

The aim of the study was to give a systematic description of the psycho-geriatric service in Denmark as of January 1990. All psychiatric departments and administrations in the 14 counties and the cities of Copenhagen and Frederiksberg, respectively, received a questionnaire regarding the psycho-geriatric services. 97% of the psychiatric departments and all of the counties/municipalities returned the questionnaire, two county administrations did not, however, complete the questionnaire. There was very great variation in the psychogeriatric services offered not only from county to county but also in individual parts of the same county. Seven counties had no psycho-geriatric department, two of these, however, offered community psychiatric treatment. The definitions of psycho-geriatric patients differed considerably, as some used age as criteria but differed in the age-limit chosen, and others used diagnostic criteria which also differed. The existing service concerning both the institutional and community-based treatment differed thus from county to county and within each individual county. The reason for this may be lack of co-ordination between the individual sectors. In general, there appear to be intentions of increasing the community-psychiatric treatment in particular.

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PubMed2005

[The state and models of specialisation in geriatrics in Europe and Hungary].

This article is based on a lecture held in the 1st Debrecen Days of Internal Medicine, in which the author summarizes the situation of specialisation in geriatrics in EU members and Hungary. There are significant differences between countries in this field. Not all EU member countries accept geriatrics as an independent specialty, but the education in graduate level is present uniquely. Geriatrics is accepted as a specialty from 2000 in Hungary and there are nearly 100 geriaters up till now. Higher and higher percentage of european population is in age over 65 years, so the importance of education of geriatrics is a great demand in the near future.

Education, Medical, Continuing↗
PubMed2005

[Teaching and training in geriatric medicine in the European Union].

In 1993 about 20% of the population in the 15 'old' member countries of the European Union (EU) was over 60 years of age and this percentage will increase to more than 25% in 2020. These developments play a key role for the investments in education and training to meet societies needs for health care services. In 2002 about 25% of the medical students in the 'old' EU did not receive any education in geriatric medicine. A question is who will provide the services for older people in related areas, like social care, community care, acute care in the hospitals, long-term care, permanent care and care for psychiatric patients? Geriatric medicine has been recognized as an independent specialty in 8 of the 15 member countries of the 'old' EU. In all EU member states the governments are autonomous regarding all aspects of health care services, including the recognition of specialties and specialist training programmes. A two years training in internal medicine has been recommended in the EU, followed by another four years of training in geriatric medicine. The specialist training has a hospital oriented character, however, it includes also community care and other institutionalised care like nursing homes. The curriculum should contain: biological, social, psychological and medical aspects of common diseases and disturbances in older people. A problem in many EU countries is the shortage of well trained researchers and leading persons for academic positions for geriatric medicine. In a number of countries chairs at the universities remain vacant for long periods of time or even disappear. Good services in the health care for older people need a high quality curriculum and training programme.

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PubMed2005

Geriatric-palliative care units model for improvement of elderly care.

The aim of this research was to indicate the necessity of a new organizational model of health and social care system for the geriatric population in Croatia. Modern geriatrics puts special emphasis on the idea that the care of the elderly should be performed through home care or long-term care institutions, rather than in the acute care hospital departments. The social healthcare of the elderly requires a multidisciplinary approach, as well as teamwork and coordination of institutional and non-institutional departments. Founding of palliative care units is clearly absent from the existing elderly care system. 33% of the total deceased geriatric population within the target area (2000-2002) has passed away in institutions (Dubrovnik General Hospital and nursing homes), what clearly indicates a need for organized palliative care on the stationary level. Nursing homes in Croatia should accept about 4% of the total number of older population (according to the gerontology research). Nevertheless, this research shows that the available capacity of the nursing homes in the Dubrovansko-Neretvanska County is 50% of the projected percentage. The solution might be setting up of palliative-geriatric units in already existing institutions, as shown by the SWOT analysis.

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PubMed2006

[Abdominal emergency surgery in the geriatric patients. Our experience].

The ageing process of general population implies new socio-sanitary problems. Indications for surgical intervention have been modified and enhanced. As far as elective surgery is concerned, the results in elderly subjects do not seem alarming, whereas less satisfactory results have been registered in the patients who underwent an emergency surgical intervention, where nowadays morbidity and mortality still turn out to be high. The Authors have reported their experience of emergency surgery in the geriatric patient. From 1982 to 2002, 718 pts (361 males, 50.3% and 357 females, 49.7%; average age 50 yrs, range 5-92) underwent emergency surgical interventions for abdominal lesions. The pts were subdivided in two groups: group A (> 65 years; 190 pts, 87 males and 103 females; average age 72 yrs, range 66-92); control group B (<65 years; 528 pts, 274 males and 254 females; average age 43 yrs, range 5-65). The results were assessed in terms of morbidity and of the operative and post-operative mortality. Postoperative morbidity proved to be equal to 25.7% (36.3% in the group A, 21.9% in the group B), while intraoperative mortality equal to 0.27%. Postoperative mortality resulted equal to 12.1% (significantly higher in group A pts -- 16.8%- than in group B pts --10.4%). The mortality of the 190 pts belonging to group A was higher in the pts which were presenting respectively 1, 2, 3 or more concomitant diseases. The progressive percentage increase in the number of interventions on elderly pts not only can be due to the demographic increase of old people, but it can also be linked to a change in the surgeon's attitude. At the present time, while elective geriatric surgery implies an acceptable mortality rate (5-8 %), emergency geriatric surgery has not notably modified the prognosis in the last decades and mortality has turned out to be still high (20-30%). We think that it will be possible to obtain better results through geriatric surgery only by reducing emergency interventions as much as possible. In order to do so, it will be important to insist on intervening before the illness, during its natural evolution, requires actions which cannot be postponed. This would lead to positive results not only in terms of mortality and morbidity, which are still considered as the main targets, but also as far as the period of the stay in hospital and costs are concerned.

Abdomen↗
PubMed2006

[Dementia--diagnosis and treatment in a geriatric memory clinic].

INTRODUCTION: Today it is certain that dementia is caused by a disease and not by ageing. The field is within the neurological, psychiatric and geriatric subject areas. In the city of Copenhagen, discovery and treatment of dementia occur on three levels: (1) in general practice, (2) in local memory clinics headed by specialists in geriatrics, neurology and/or psychiatry, and (3) in the memory clinic at H:S Rigshospitalet. In 2000, the geriatric clinic at H:S Bispebjerg Hospital established a local memory clinic. The fact that the clinic was created within a basic speciality other than neurology, as at Rigshospitalet, made it necessary to carry out developmental work. MATERIALS AND METHODS: A descriptive evaluation of 450 consecutive patient courses was performed. The patients were evaluated and treated in the memory unit in the period from 14 March 2001 to 31 December 2004. RESULTS: 330 (73%) of the 450 patients were women, and 120 (27%) were men. The median age was 84 years (range 64-97 years), and the median MMSE score was 24 (range 1-30) at first consultation in the memory unit. A cerebral CT was done on 339 patients (75%), and a SPECT scan was done on 6 patients (1%). 90 patients (20%) were evaluated by a gerontopsychiatrist during the treatment course, and 151 patients (34%) were evaluated by a neuropsychologist. A diagnosis of irreversible dementia was made for 322 patients (72%). CONCLUSION: Most of the patients referred had a MMSE score greater than 20, and even patients with very high MMSE scores may suffer from irreversible dementia. Compared with examinations in Danish memory clinics in the context of neurology, there was a higher number of patients with irreversible dementia. The difference may probably be explained by the average age difference between the patients referred. The threshold of referring for evaluation of cognitive dysfunction may be lower for younger patients than for older patients. The geriatric concept is an appropriate platform for evaluation and treatment of older patients with cognitive dysfunction before such patients are hospitalized on an emergency basis or break down socially. To carry out complete and qualified evaluation and treatment, it is essential to establish local and close cooperation with a gerontopsychiatrist, a neurologist and a neuropsychologist.

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PubMed2006

[Specialties in dentistry. 4. Post-academic specialization in geriatric dentistry].

In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational programme aims at an increase in dentists serving in geriatric care who are well prepared for delivering care. In the programme attention is paid to the special aspects of care delivery and the special somatic, mental, and social characteristics of frail elderly people. The goal is to formulate an individual oral care programme for every frail elderly person. An individual oral care programme may contain 5 different oral care activities: continuing care, prevention, support, treatments, and evaluation. These activities define the scope of specialists in geriatric dentistry. This scope in turn defines the profile of required knowledge and skills, and the profile is the foundation of the educational objectives of the educational programme. The educational programme contains 7 modules: affinity; somatic and mental disabilities; communicative skills and coping with behavioural disturbances; emergency medical care; history taking, assessment, prevention, treatments and evaluation; organization and legislation; scientific training.

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PubMed1990

[Canadian geriatric psychiatry and psychopharmacology 1987-1988].

The paper offers a brief outline of the current state of geriatric psychiatry and psychopharmacology in Canada and partially in the USA. Major trends are described in clinical care, in organization and education, along with some basic historical comments. The important role of self-help groups is sketched. The contents of recent major scientific meetings illustrate the increasing emphasis in research in ageing, geriatric psychiatry and geriatric psychopharmacology. The developments are characterized by intimate connections between basic and applied research, and between clinical observations and experimental neurobiology. The analysis of developments in the current practice and research offers some insight into upcoming treatment strategies. The next decade in geriatric psychiatry will probably belong in particular to molecular biology, genetic, psycho-immunology and psychopharmacology.

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PubMed1990

[The tasks and objectives of geriatric orthopedics].

The ageing of population all over the world including Czechoslovakia where the share of people above 60 years of age is 14-15 per cent of the whole population (by the year 2010 this share should reach 20 per cent and a very frequent incidence of diseases and traumatism of osteoarticular apparatus in elderly people necessitates specialized care of geriatric patients. Geriatric orthopaedics is a combination of the principles of internal medicine and orthopaedics applied on old people. Geriatric orthopaedics deals with 3 major problem areas of diseases in old age: 1. osteoporosis, 2. osteo-arthrosis, 3. traumatism. The author concentrates on the problems of diagnostics, prevention and treatment of osteoporosis as well as on its social and economic aspects. He also deals with the incidence, conservative and surgical treatment of osteo-arthrosis in old age and with the possibilities of its prevention. Presented are the principles of an up-to-date treatment of geriatric traumatism and the rehabilitation based on the author's experience and recent data from the literature.

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PubMed1990

[A specific geriatric regimen. I].

The authors discuss the characteristic and justification of a specific geriatric regime, or geriatric departments, and give an account of their experience assembled in tests of this regime under conditions of the geriatric centre of the Third Medical Clinic, Prague, in particular with regard to the general orientation as regards hospitalization of geriatric patients.

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PubMed1989

[Geriatric medicine in future].

Geriatrics in future will be most concerned with persons aged 80 years or more (very elderly) in Japan. Clinical and pathological features of very elderly patients were reported with comparison to the 65-79 age group. Many very elderly do not show clear-cut clinical signs and symptoms, but have serious underlying diseases. We propose here a concept of "clinical threshold". On evaluating the laboratory data, we must consider the grades of "activity of daily living (ADL)" of the aged patients, because ADL may significantly modify the test results. Furthermore in clinical practice, we should pay attention to both the psychosocial states and physical findings of the patients. "The old age syndrome" proposed by Parker is useful in geriatric medicine. Extensive studies on dementia, especially of Alzheimer's type are required urgently. Molecular biology approaches to this disease have shown great advances in geriatrics. To prevent geriatric disease, well-controlled exercise and diet are important as well as reasonable psychosocial integrity.

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PubMed1989

Competencies required for the practice of geriatric medicine as a consultant physician.

Geriatric medicine in Canada is now being viewed not merely as an academic specialty but, rather, more broadly as a service specialty providing consulting support to other physicians. Any redesigning of training programs will have to be done with this fact in mind. We drew up a list of competencies required for consultant practice in the field and presented them to other practitioners of geriatric medicine and members of the Canadian Society of Geriatric Medicine for feedback. We believe that the resulting list of competencies can be used as a starting point for redesigning training programs in geriatric medicine.

Attitude of Health Personnel↗
PubMed1985

A compendium of objectives for geriatric dentistry.

A two-phase survey was conducted with 82 persons identified as having special knowledge in geriatric dentistry. In Phase 1, they were asked to list competencies required of the geriatric dentist. In Phase 2, they were asked to rate the relative importance of 150 competencies for five different educational settings: dental school, general practice residency, prosthodontic specialty program, geriatric fellowship program, and continuing education. The resulting compendium of objectives suggests that geriatric dentistry should become integrated into general dentistry, with relatively few competencies reserved for specialists.

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