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PubMed1985

Pathways to long-term geriatric hospital care.

This paper describes the pathways that are taken to long-term geriatric hospital care. Information was collected for 160 people currently receiving such care, and it was found that 110 different pathways were taken to a long-term geriatric bed. The most commonly experienced accommodation settings were acute hospital care, and living in the community with some form of disability but no domiciliary services, which were also the most frequent ways of beginning the pathways. The ends of the pathways were characterized by acute hospital care, short-term geriatric or convalescent care and rest or residential care. Domiciliary services had been used by less than half of the sample, and many of these appeared to have been receiving only a minimal level of support. This paper also examines the role of the assessment and rehabilitation unit, and seeks to comment on how services designed to reduce the demand for long-term geriatric care have been used.

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PubMed1983

Identification and definition of the geriatric patient in a teaching hospital.

A consulting service in geriatric medicine was established at Groote Schuur Hospital on 1 November 1981. The first 100 patients referred were compared with 100 patients of 65 years of age and over, selected randomly from the wards from which the referrals were coming, with a view to identifying characteristics of the geriatric patient appropriate to local needs. The findings are discussed against a background of the requirements for adequate care of the elderly, the need to teach geriatric medicine to those whose functions include care of the elderly, and some of the wider social implications in ensuring as equitable a distribution of service as possible. In conclusion a definition of the geriatric patient is offered.

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PubMed1982

Dental student attitudes towards the elderly and training in geriatric dentistry.

From analysis of the relationships between geriatrics, gerontology, dental education and dental practice three major questions arise about barriers to the creation of a strong subdiscipline of geriatric dentistry (1) Why is the dental care utilization of the elderly comparatively low despite their high objective needs for dental care? (2) Why has the dental profession failed to move into the potential market created by the elderly thereby leaving geriatric dentistry comparatively underdeveloped? (3) Why do training programmes in geriatric dentistry fail to change significantly the attitudes of dental students towards the elderly? Answers to these questions indicate the need for specific structural and attitudinal changes if the barriers are to be eliminated.

Adult↗
PubMedDate not supplied

[Organization forms for clinical geriatrics].

In Germany the insight in the usefulness or necessity of clinical geriatrics as a medical specialty promotes changes in organization only with delay. This description of the working facilities for geriatricians in Great Britain stresses geriatric wards, attachment of geriatricians to acute medical wards and geriatric day hospitals. Difficulties and possibilities of development in british geriatrics are presented so far as they are of account for the actual german situation.

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PubMed1981

[The specialism geriatrics and education for geriatrist].

The future education for a geriatrician in the Netherlands will have to take into account both the scientific-gerontological character (physically, mentally and socially) and the clinical character of clinical geriatrics. The education will have to take place in the geriatric department of an academic hospital. It should include geriatrics, internal medicine, neurology, and long term care of chronically ill elderly. It will be necessary to find a professor who is an expert both clinically and scientifically abroad, e.g. in Great Britain. The author argues for relatively extensive 'medium stay' departments for geriatrics in hospitals in order to provide enough possibilities for training geriatricians and a better connection between hospitals, nursing homes and homes for the aged.

Academic Medical Centers↗
PubMedDate not supplied

Follow-up of comprehensive geriatric assessment in a family medicine residency clinic.

BACKGROUND: The objective of this study was to evaluate the effect of outpatient geriatric consultation by referring academic physicians and to verify the results of a previous study. METHODS: We conducted a retrospective review of charts of 37 patients referred for geriatric consultation during a 7-month period of a university- and community-hospital-affiliated family practice residency clinic in urban northeast Washington, DC. The consultation involved team assessment, which led to formal recommendations to the attending physician. Main outcome measures included total number and category of recommendations made, as well as a total number and category of recommendations adhered to by referring physicians. RESULTS: There were 29 women and 8 men with an average age of 79.1 years; 5 were white and 32 were African-American. For the 23 patients for whom follow-up could be determined, the mean number of total diagnoses per patient was 11.4 (SD 3.5). The mean total number of recommendations made per patient was 18.1 (SD 5.9). The mean total number of recommendations acted upon per patient by referring physicians was 9.5 (SD 4.4). The recommendations fell into the following categories: rehabilitative 64 percent, radiologic 57.1 percent, laboratory 56.9 percent, total medication 55.6 percent, medical 50 percent, health maintenance 47.1 percent, social service 46.2 percent, sensory 33 percent, other 28.6 percent, educational 20 percent, and nutritional 14.3 percent. CONCLUSIONS: Multidisciplinary geriatric assessment in an academic outpatient setting provides a comprehensive assessment for faculty and resident physicians in training. Recommendations will be adhered to only 50 to 70 percent of the time, possibly because of the demographic and socioeconomic mix and overall health of the patient population, health care priorities of the referring physician, and costs and availability of various interventions. Physicians in training should be exposed through continuing medical education to various aspects of geriatric assessment.

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PubMedDate not supplied

[Geriatric assessment--case finding by screening hospitalized patients].

The effectiveness of geriatric assessment depends on patient selection. A simple screening procedure should facilitate the detection of appropriate patients by recording functional impairments and geriatric risks. We studied the feasibility of, and the information from the screening, and the recommendations of assessments derived from the screening. The screening revealed an average of five findings in 245 of 247 patients consecutively admitted. The most frequent problems were impaired activities of daily living and mobility, and impaired memory. Geriatric assessment was recommended to 44% of newly hospitalized patients. These patients were older, with more of them living at home and alone, and nearly half of them had five or more findings in the screening with chronic problems being predominant. The screening procedure is feasible. It appears useful and reasonable to select patients for geriatric assessment while they are in hospital.

Activities of Daily Living↗
PubMedDate not supplied

[Diagnostic house call within the scope of inpatient geriatric assessment].

The value of a diagnostic home visit as part of hospital-based geriatric assessment was examined in a prospective study. 141 subjects admitted from home to the geriatric hospital and showing functional decline with risk of nursing home placement underwent a comprehensive geriatric assessment and a diagnostic home visit. In 19.1% of the patients, the diagnostic visit resulted in a change of time, and in 14.9% in a change of location of discharge. Up to seven problems were newly discovered (mean 2.1). To maintain independence up to six technical aids were prescribed (mean 2.3). The most common recommendations were related to safety (59.2% of all cases). In 89.3% the diagnostic home visit was judged necessary by the home intervention team. A follow-up visit after 3 months revealed that about 80% of all recommendations were implemented and approximately the same amount of technical aids were still used. The diagnostic home visit allows individual prescription of technical aids, when necessary. It contributes meaningful information to the geriatric assessment process and helps to achieve successful in-hospital therapy and discharge planning. It can be recommended especially for elderly patients at risk for losing their independence.

Activities of Daily Living↗
PubMed1995

Impact of continued geriatric outpatient management on health outcomes of older veterans.

BACKGROUND: Although previous trials have proved inpatient-based geriatric assessment to be beneficial, to our knowledge, the effectiveness of outpatient geriatric assessment has not been established. We examined the effectiveness of an outpatient geriatric evaluation and management (GEM) clinic. METHODS: Hospitalized veterans aged 65 years or older with impairment of activities of daily living, chronic disease, polypharmacy, or two or more hospitalizations in the previous year were randomized to an outpatient GEM team clinic (n = 60) or usual care (n = 68). After an initial comprehensive assessment, they received long-term management in the geriatric clinic. Principal outcomes included health status (mortality, hospitalizations, health perception, and medications), function (activities of daily living, instrumental ADL, and social activity), affect (Center for Epidemiologic Studies-Depression test score and life satisfaction), and cognition (Mini-Mental State examination score). RESULTS: At randomization, no significant differences were noted between the groups. The average age of the patients was 71 years (range, 65 to 93 years). At 1 year following randomization, GEM clinic patients compared with subjects receiving usual care had significantly improved health perception, took fewer medications despite increased number of diagnoses, reported greater social activity, had improved Center for Epidemiologic Studies-Depression scale scores, and had higher life satisfaction scores. There was a trend toward improved performance of activities of daily living for GEM clinic patients. The GEM clinic patients had a 54% lower mortality (6.8% vs 14.9%). Overall, no differences were observed in the total number of hospitalizations between the groups. CONCLUSIONS: The combination of long-term management following comprehensive outpatient assessment significantly improved aspects of health status (including health perception and medications), function (including social activity), and affect (including depression and life satisfaction) for older veterans and may influence mortality and function.

Activities of Daily Living↗
PubMed1994

The perceived needs of practicing optometrists in geriatric continuing education.

BACKGROUND: A survey of American Optometric Association members in the states of Kentucky and Illinois was undertaken to determine the perceived need areas for continuing education in the field of optometric geriatrics and gerontology. METHOD: The membership was surveyed on which of a 23 possible courses were of the most interest and need. A total of 332 questionnaires were returned and analyzed. The respondents were largely younger practitioners (mean age 41) who had not taken a specific course in geriatrics during optometry school (56 percent). RESULTS: A large majority (79 percent) indicated that they would attend courses with geriatric content at regional and state continuing education. Courses with heavy optometric content were preferred over those with more general gerontology content. The most desired courses were in geriatric pharmacology and ocular disease. Coursework in medical epidemiology and systemic conditions affecting the older adult were the most needed in the area of general gerontology.

Adult↗
PubMed1994

Effectiveness of an inpatient geriatric service in a university hospital.

OBJECTIVE: To assess the effectiveness of an acute interdisciplinary inpatient geriatric service in a university hospital. DESIGN: Prospective randomized control study. SETTING: Large urban university hospital. PATIENTS: 40 consecutive inpatients, randomized for inclusion on the geriatric service (study patients, n = 20) or to continue usual hospital care (control patients, n = 20) from among the geriatric consult population. MAIN OUTCOME MEASURES: Subjects were followed for changes in length of stay, hospital costs, diagnostic testing, pharmacy use, functional status, discharge disposition, and readmission within 30 days after hospitalization. RESULTS: Mean age of patients study 79.2 years (control 73.9 years). Sixty percent of study patients went home and 30% to nursing homes (control 20% home, 65% nursing homes) P = .03. Total length of stay mean 20.3 days study (control 32.7 days), length of stay after randomization mean 7.7 days study (control 11.2 days), mean overall hospital costs $23,906 study (control $45,189), and mean hospital costs after randomization study $4,671 (control $9,404) were not significantly different by F-tests due to wide variability. Laboratory use was reduced with mean 4.4 tests study (control 16.9) P = .01 and mean laboratory costs $263 study (control $828) P = .02. Functional ability improved (scale 1-7) with mean improvement study 0.8 (control 0.3) P = .09. Mean number of medications were lower in the study group by 30% P = .02; mean cost of medications at discharge was reduced with study $38 (control $112); and mean pharmacy charges after randomization decreased $462 study (control $1,268) P = .06. Readmission 30 days after discharge was not significantly different (study 21%, control 33%). CONCLUSIONS: An interdisciplinary acute geriatric service can be cost effective in providing care to elderly patients in a university hospital. It can improve outcomes measured by decreased laboratory and pharmacy usage, improved functional status, and discharge to a lesser level of care without increasing length of stay or early readmission after discharge.

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PubMed1993

Education in geriatrics: a required curriculum for medical students.

The mandatory geriatrics and gerontology curriculum at The Mount Sinai School of Medicine in New York includes two modules for first- and second-year students and a four-week block experience for fourth-year students. The first-year curriculum emphasizes socioeconomic, psychosocial, biomedical, and attitudinal issues. The second-year experience serves as an introduction to clinical geriatrics. The fourth-year clerkship allows students to further develop their fund of geriatric knowledge, learn specific geriatric skills, and build on their internal medicine foundation, integrating new knowledge and skills and developing into comprehensive practitioners who can apply the team approach to address all the medical, functional, psychosocial, and ethical aspects of caring for the elderly.

Curriculum↗
PubMed1993

[Disruptive behavior; what is it, how prevalent is it and how much nursing care does it require in geriatric departments?].

The purpose of the study was to examine disruptive behaviors in elderly patients, to find out the prevalence of disruptive behaviors and the most disruptive behavior for staff and to examine nursing interventions in these situations. The data were collected with a questionnaire. The respondents on the survey were special nurses, nurses, mental health nurses and licensed nurses (N = 287). This type of study cannot be generalized to a larger population of geriatric care facilities without bearing in mind that the population studied was not representative of the general population of all geriatric care facilities. Our results show that problems of mobility, incontinence, dressing, language and passivity were among the top five most frequently occurring on geriatric wards. Nursing personnel identified physical aggression as the most disruptive behavior for them. The results of this study suggest that disruptive behaviors occur at rates which are clinically significant in a geriatric care setting. Research into the etiology and treatment of disruptive behaviors is in a most preliminary stage. Research is also needed on the potential for training nursing staff in the use of simple and positive behavioral procedures.

Adult↗
PubMed1996

Needs for CME in geriatrics. Part 1: Perceptions of patients and community informants.

OBJECTIVE: To describe the needs of physicians for continuing education in geriatrics as perceived by patients and community informants. DESIGN: Cross-sectional survey by mail and in-person interviews. SETTING: Organizations working with the elderly in the community and patients in a primary care population in Calgary. PARTICIPANTS: Key informants working with the elderly in the community, including managers and providers of physical, psychosocial, educational, or mental health services to the elderly, and the first two geriatric patients visiting physicians after telephone contact from study investigators were surveyed. Twenty-five of 27 key community informants and 32 of 61 geriatric patients responded. MAIN OUTCOME MEASURE: Potential topics for continuing medical education. RESULTS: The 10 most frequently identified topics were communication, time management, attitudes to the elderly, medication, continuity of care, mental health, medical management of complicated cases, knowledge of community resources, health promotion, and compassion. Patients were more concerned than key informants about the process of care. Key informants were concerned about the technical aspects of care. CONCLUSIONS: The process of care as well as technical aspects of care must be addressed in continuing education in geriatrics for physicians.

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PubMedDate not supplied

Formal geriatric assessment, An imperative for the older person with cancer.

PURPOSE: The authors evaluate the role of cognitive, functional, and affective geriatric assessment measures in elderly cancer patients, and analyze the associations between these factors, stage of malignancy, and cancer treatment choices. DESCRIPTION: Fifty consecutive patients older than 65 years of age who were referred to the Geriatric Oncology Clinic at the University of New Mexico Health Sciences Center in Albuquerque were evaluated using standard geriatric assessment tools. Each person underwent a complete history and physical examination. An extensive chart review established the type of cancer, stage at diagnosis, and treatment modalities used. The Karnofsky performance status scale score also was determined at this initial evaluation. RESULTS: The group had a mean age of 74.9 years; 60% were women and 40% were men. The most common cancers were breast (28%) and prostate (16%). Fifty-two percent of the patients had localized disease and 48% had distant disease. Seventy-four percent had received treatment by the time of the initial assessment, with 62% undergoing combination therapy. The most common noncancer diagnoses were cardiovascular disease, hypertension, and osteoarthritis. Scores on standardized measures indicated that the majority of patients were independent. Those who did not receive treatment were more functionally impaired than those who received treatment. Twenty-seven percent of the sample were impaired cognitively and 24% were depressed. There were no statistical differences in functional, cognitive, or affective status between stages of disease for specific malignancies. CLINICAL IMPLICATIONS: Age alone is a poor predictor of outcome in cancer treatment and is an inappropriate factor by which to exclude persons with cancer from clinical trials. Treatment decisions based on age alone may lead to inadequate treatment. In this report, functional dependence was more prevalent in nontreated patients and was unrelated to the stage of disease. These results support the need for formal geriatric assessment, including measures of cognitive, functional, and affective status, in elderly persons with cancer. Further studies on the role of functional, cognitive, and affective status at the time of cancer diagnosis, as well as how these parameters might alter treatment decisions, are warranted. In addition, further investigation to identify which of these multiple variables influence treatment outcome are needed.

Activities of Daily Living↗
PubMedDate not supplied

[Medical education, graduate and continuing education of physicians in geriatrics in Germany--current status].

Due to the importance of geriatrics which has been generally accepted in the inpatient medical care for many years, geriatrics has now been included into the amended Model Regulations of Postgraduate Medical Training (novellierte Muster-Weiter-bildungsordnung) in the form of the optional postgraduate training "clinical geriatrics". Thus geriatrics has the chance of being broadly accepted and standing the test in clinic and practice where our colleagues are working.

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PubMed1998

Recognition of neurologic diseases in geriatric inpatients.

OBJECTIVES: To determine the prevalence of neurologic disease and the diagnostic impact of neurologic consultation on a geriatric inpatient unit. MATERIAL AND METHODS: Consecutively admitted patients were prospectively assessed by a neurologist and by medical house staff on a geriatrics unit over a 4-month period. Neurologic diagnoses were compared. RESULTS: Fifty-eight men, aged 76.4+/-8.7 years old (mean+/-SD), had 1.4+/-1.1 new or revised neurologic diagnoses made by the neurologist. The prevalence of neurologic disorder was: gait or balance disorder (90%); cognitive disorders (71%); neuromuscular disorder (59%); cerebrovascular disorder (38%); and extrapyramidal disorders (22%). New diagnoses were made by the neurologist among the cognitive (40%), neuromuscular (36%) and cerebrovascular disorders (19%). CONCLUSIONS: Neurologic disease is highly prevalent in geriatric inpatients. A neurologist's assessment resulted in altered diagnoses suggesting that neurologists should play a role in geriatric assessment and in education of health professionals caring for the elderly.

Activities of Daily Living↗
PubMed1998

[Ambulatory geriatric assessment of 2116 in poor elderly].

BACKGROUND: Geriatric assessment quantifies medical, functional, mental and social capabilities and alterations of elders and is the first step to initiate specific intervention programs. AIM: To report the initial geriatric assessment of a program aimed to help poor elders living in Metropolitan Santiago. SUBJECTS AND METHODS: Two thousand one hundred sixteen free living subjects aged 65 to 99 years old (711 males) were subjected to an assessment using a simple geriatric score validated abroad and used previously in Chile. The resulting score ranges from 0 (better) to 5 (worst). RESULTS: Eighty eight percent of elders did not have problems in the functional evaluation. Subjects over 75 years old needed occasional support for the daily activities with higher frequency than younger subjects (12 and 5.4% respectively, p < 0.001) and had a higher frequency of major functional limitations (7.8 and 3.2% respectively, p < 0.001). Mental assessment was considered normal in 89.4% of subjects. Those over 75 years old had a higher frequency of memory disturbances (11.4 and 6.5% respectively) and cognitive alterations (4.6 and 1.8% respectively). Indefinite social support could be received by 84% of subjects, but 7.4% did not have access to this resource. CONCLUSIONS: Geriatric assessment of poor elders gives useful information to identify those subjects that require community help.

Age Distribution↗