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PubMed2001

[Treatment of multiple myeloma in elderly patients: consensus of the Geriatric Oncology Working Group of the German Society of Hematologic Oncology and the German Society of Geriatrics].

Treatment of Multiple Myeloma in the Elderly: Consensus of the Cooperative Group of Geriatric Oncology of the DGHO and DGG Multiple myeloma is an illness of old age. Often, in elderly people the diagnosis is delayed by the fact that bone pain, which is the most frequently presenting symptom, is not correctly interpreted because this is a common complaint in the elderly. In contrast to younger patients with multiple myeloma, elderly patients often present with infections at diagnosis. After the diagnosis is established, careful observation is very important. This applies both to patients who require still no therapy and to patients under treatment. In order to optimize the care of older patients, apart from tumor-specific investigations multidimensional geriatric assessment is helpful. This specifically applies for multiple myeloma which predisposes the patient to 'instability' and 'immobility', both belonging to the typical geriatric symptoms. Geriatric assessment may also be helpful in the selection of those elderly patients who are candidates for a possible prognosis-improving experimental intense chemotherapy. For the majority of the elderly patients in need of treatment the standard is melphalan/prednisone accompanied by one of the biphosphonates. Nevertheless, in order to improve prospects also for this group of patients, as many elderly patients as possible should be included into studies. This is the only way to compile valid recommendations for the treatment of elderly patients with multiple myeloma.

Aged↗
PubMed2003

Challenges of current geriatric education-inspired by the Nordic geriatric professors' meetings.

Geriatric educators are faced with several different challenges. The rapid growth of aged population in the Western world has led to a growing need for health and social services and thus, an increased need for trained professionals in this field. In addition, new learning theories and activating learning methods have achieved wide acceptance in academic medicine. How has geriatric education applied these new learning methods? In this article we review the current status of academic geriatric education in Western countries in these respects. We especially review the literature of how geriatric training has been experimenting with the new learning methods.

Aged↗
PubMed1996

[University education in geriatrics. Opinions of teaching staff on undergraduate education in gerontology and geriatric medicine].

Undergraduate education in gerontology and geriatric medicine has become more important because of a progressive increase in the aged population. To assess curricula in geriatric medicine and to survey the opinions of teaching staffs as to the ideal curriculum, a questionnaire was sent to professors of gerontology and geriatric medicine at 14 medical schools. Responses were obtained from all 14 professors. In all medical schools, students are given lectures in the fifth or sixth year, or both. The total number of hours for the lectures varied from a few hours to 40 hours, and contents of the lectures varied between schools. Medical staffs pointed out that little time is allocated to geriatric medicine. They also emphasized the importance of bedside teaching.

Curriculum↗
PubMed1987

The emergence of geriatric assessment units. The "new technology of geriatrics".

Previous studies have suggested that geriatric assessment units may provide important benefits to the care of elderly persons. In early 1985 we surveyed personnel at 104 (91%) of the existing 114 geriatric assessment units associated with medical schools and Veterans Administration medical centers for information on the units' development and operation. Although almost 80% of the units were hospital based, most (61%) provided care for outpatients. Nearly half (47%) began operation in 1983 or later; of those in existence before 1983, two thirds have increased their capacity since then. The types of personnel and their training differed substantially among units. Fifty percent of the physicians had had no formal training in geriatrics. Of the 104 units, 99 (95%) did routine assessment. The estimated time spent per new patient in outpatient units was 2.7 +/- 2.1 (SD) hours. These data suggest that geriatric assessment units are proliferating rapidly, have differing structures, and consume substantial resources. Further efforts are needed to define their optimal structure, targets, and function.

Geriatrics↗
PubMed2000

Preliminary report from the Kansas Hartford Geriatrics Project: a model of community university collaboration in geriatric medicine faculty development.

OBJECTIVES: This paper describes the development, implementation, and participant satisfaction of a faculty development program for community-based clinician educators with competencies in geriatric medicine. DESIGN: One group, ongoing trial. SETTING: University of Kansas School of Medicine, Kansas City, Kansas. PARTICIPANTS: Family physicians and general internists from throughout the state of Kansas (n = 30). INTERVENTION: This is an integrated faculty development curriculum of clinical geriatrics and educational process offered in nine sessions over 3 years. MEASUREMENTS: Project retention, session attendance, and participant satisfaction are the measures of program success. MAIN RESULTS: Project retention at 18 months, the midpoint of this project, has been 87%, with 91% of the retained participants attending all of the sessions to date. More than 95% of the participants have rated each of the first five sessions as highly satisfactory or excellent in meeting their needs as a clinician educator. Satisfaction for on-site and interactive televideo participation has been equally high. CONCLUSIONS: Our preliminary results indicate the Kansas Hartford Geriatrics Project model of community-university collaboration in geriatric faculty development is successful in recruitment and satisfaction of participants. The curriculum is highly attractive and rewarding to faculty. Interactive televideo provides a successful innovation in aging-oriented faculty development.

Community Networks↗
PubMed2002

[The need for training in gerontology and geriatrics among the staff providing services at a geriatric care institution].

The purpose of this qualitative study was to explore and identify the basic training needs of nursing home staff, in terms of attitudes, knowledge and skills required to work effectively with geriatric patients. Three focus groups were performed, two groups of employees, and a group of elderly residents of the institution, in order to explore issues pertaining to the following topics: personal attributes required to work with geriatric patients, basic knowledge and skills needed to provide effective services. Group discussions were transcribed and themes were extracted through consensus reached by the investigators. Results indicated that the interviewed staff lack of formal preparation or continuing education in gerontology or geriatrics. Needs identified were the following: the aging process, caring behaviors, management of common health conditions, administration of medications, transference and mobility of residents, among others. Finding were use to design an educational program aimed in assisting nursing home staff in providing an effective service to their geriatric patients.

Aged↗
PubMed1991

Effectiveness of three types of geriatric medical services: lessons for geriatric psychiatric services.

OBJECTIVES: To determine the effectiveness of geriatric medical services, to identify the types of patients who would benefit from such services, to determine the service components related to positive outcomes and to apply pertinent findings to geriatric psychiatric services. DATA SOURCES: Two databases, MEDLINE and Health Planning and Administration, were searched for relevant articles published from January 1975 to February 1990. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Seventeen reports were located that met the following three inclusion criteria: original research, published in English or French and controlled trial (nonrandomized or randomized) of a geriatric medical service. Fifteen met the validity criteria for intervention studies established by McMaster University, Hamilton, Ont. DATA EXTRACTION: Information about study design, patient selection, interventions, outcome measures and results was systematically abstracted from each report. DATA SYNTHESIS: Abstracted data were compared and contrasted. Most of the external services and some of the hospital units were effective in reducing the number of hospital days an deaths. Consultation services were ineffective. Continuing care appeared to be related to positive outcomes. CONCLUSION: In applying these findings to geriatric psychiatric services priority should be given to the development of external services and the organization of continuing care.

Activities of Daily Living↗
PubMed1998

[Geriatric day clinic. What is the status of an acute geriatric day clinical in the service chain?].

Geriatric care covers a variety of differentiated services and structures, and the well-established system of in- and outpatient treatment has now been expanded to include the day hospital. The 30-bed geriatric day hospital at the "Zentrum für Akutgeriatrie und Frührehabilitation", ZAGF (Center for Acute Geriatric Medicine and Early Rehabilitation) at the Municipal Hospital Munich Neuperlach provides diagnostic and therapeutic services for acute and chronic illnesses with the aim of obviating or shortening hospitalization, helping patients to practise self-help, and preserving social competence. A multi-dimensional interdisciplinary geriatric assessment is used to clarify indications and contraindications, and to plan holistic individual therapeutic strategies.

Aged↗
PubMed1997

Screening for depression among acutely ill geriatric inpatients with a short Geriatric Depression Scale.

BACKGROUND: Depression is not uncommon among acutely ill geriatric inpatients. METHOD: The performances of shorter versions of the Geriatric Depression Scale (GDS) in screening for depression among acutely ill geriatric inpatients were examined. RESULTS: A cut-off of 2/3 gives the best sensitivity (88%) and specificity (75%) for the 10-item version (GDS10). A cut-off of 0/1 gives the best sensitivity (72%) and specificity (90%) for the 4-item version (GDS4). A positive response to item 6 ("Do you often feel helpless?") on the GDS10 gave a sensitivity of 76% and specificity of 75%. Patients found the GDS10 tolerable and acceptable. CONCLUSION: Both shorter versions of the GDS may be utilized in screening for depression among acutely ill geriatric inpatients.

Aged↗
PubMed1995

Age-related geriatric medicine: relevance of special skills of geriatric medicine to elderly people admitted to hospital as medical emergencies.

This study was carried out to find out how many patients aged 75 and over admitted to hospital as medical emergencies had features appropriate to care by physicians in geriatric medicine and to examine the extent of use of specialist facilities by these patients. The purpose was to examine criticisms of age-related admission policies which have focused on misplacement of patients with single diagnoses and lack of access to specialist care. An analysis was made of admission, process and discharge characteristics relevant to the special skills of geriatric medicine, multiple pathology and use of specialist services by 554 patients aged 75 and over. These were collected prospectively, consecutively admitted as medical emergencies via the accident and emergency department of a large district general hospital with an age-related (75 and over) medical admissions policy. 84 patients (15%) had single pathology and no characteristics suggesting the need for specialist geriatric care. 177 (32%) had single pathology and one or more specialized characteristics. 66 (12%) had multiple pathology alone. 227 (41%) had multiple pathology and specialized characteristics. There were 142 specialist referrals in 121 patients (22% of the whole sample). We concluded that the special skills of general physicians specializing in the medical and associated community problems of elderly people are highly relevant to patients aged 75 and over presenting as medical emergencies. There was no evidence of lack of involvement of specialists in their care.

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PubMed1997

[Project geriatric outpatient clinic. A study on geriatric outpatient clinics and patient basis].

In 1996 PROJECT: geriatric outpatient clinic was initiated by the Ministry of Health and Social Affairs. The purpose was to collect more extensive information about geriatric outpatient clinics in Norway with regard to organization of the clinics, the types of activities and the clinics and the patients attending them. Information on the activities in 1995 was collected, and a summary prepared. Detailed records were made of the activities at 15 geriatric outpatient clinics during March 1996: 288 initial contacts and 239 repeat contacts were recorded. Assessment for mental impairment and multimorbidity constituted 41% of the referrals. The average number og patients per opening hour was rather low: 0.7 (range 0.08-2.5). The pay-back for the hospital was low and there was little incentive to operate the clinics.

Aged↗
PubMed1995

Does the use of the Geriatric Depression Scale make redundant the need for separate measures of well-being on geriatrics wards?

Patients (n = 321) on geriatrics wards were asked to complete two or three of four well-being measures: the Geriatric Depression Scale, Philadelphia Geriatric Center Morale Scale, Southampton Self-esteem Scale and the Bradburn Affect Balance Scale. Analyses, including factor analysis, correlations and box-and-whisker plots, were carried out to investigate similarities In patient profiles provided by the different scales. The GDS showed similar profiles to the other measures, particularly the self-esteem scale, discriminating at the 'high' as well as 'low well-being' ends of the scales. These results indicate that, as far as clinical practice is concerned, additional use of such well-being measures may be unnecessary. Examination of different approaches to assessing well- being in clinical practice is required, for example measures of 'life strengths'.

Aged↗
PubMed1992

Geriatric education. Part II: The effect of a well elderly program on medical student attitudes toward geriatric patients.

OBJECTIVE: To assess impact of exposure to healthy elderly on medical students' attitudes toward the elderly. DESIGN: Prospective, randomized, controlled intervention trial. SETTING: Community-based Well Elderly Program. PARTICIPANTS: Ninety-three fourth year medical students on a required Geriatric Medicine clerkship who were assigned to either a tertiary care university medical center or a teaching nursing home. INTERVENTION: Thirty-five students were randomly assigned to participate in a Well Elderly Program and were compared to a control group of 58 students at equivalent sites who did not participate. MEASUREMENTS: Pre- and post-rotation, students were given the Aging Semantic Differential (ASD), a validated geriatric attitudinal scale. MAIN RESULTS: By repeated measures analysis of variance, the difference between pre- and post-rotation ASD scores were most significant for students who participated in the Well Elderly Program; site did not exert a significant interaction effect. CONCLUSION: These results underscore the importance of exposure to healthy older people on effecting positive attitude changes among medical students on geriatrics rotations.

Adult↗
PubMed1994

Geriatric research, education and clinical centers: their impact in the development of American geriatrics.

The GRECC program was established by the VA in 1975 and has been expanded since then to 16 sites. For more than a decade, GRECC staff have made major contributions to advancing the understanding of the aging process and developing approaches that have improved the care of older veterans as well as all frail elderly persons in the United States. Most notably, GRECC staff have been among the leading scientists in the field of aging, have stimulated the growth of some of the highest quality university-based geriatric programs in the country, have provided clinical training in geriatrics to thousands of health professional students and practitioners, and have developed innovative models of geriatric care. The GRECC model of integrating research, education, and clinical activities in a "center of excellence" with specific goals and expectations serves as one of the best examples of how scientific advances can be applied effectively to direct patient care.

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PubMed1989

An ambulatory geriatric evaluation unit in a family geriatric curriculum.

Training in Geriatric Medicine has become increasingly important in the education of family physicians. This paper describes the experience of a community-based Family Medicine residency in developing an ambulatory Geriatric Evaluation Unit (GEU) as part of a comprehensive geriatric curriculum. The experience demonstrates the value of a multidisciplinary team approach, systematic development and integration of additional education activities as effective techniques for training family physicians and ancillary health care providers.

Allied Health Personnel↗
PubMed2001

Geriatric mental health services research: Strategic Plan for an Aging Population: Report of the Health Services Work Group of the American Association for Geriatric Psychiatry.

In November 1999, a working group of the American Association for Geriatric Psychiatry (AAGP) convened to consider strategic recommendations for developing geriatric mental health services research as a scientific discipline. The resulting consensus statement summarizes the principles guiding mental health services research on late-life mental disorders, presents timely and topical priorities for investigation with the potential to benefit the lives of older adults and their families, and articulates a systematic program for expanding the supply of well-trained geriatric mental health services researchers. The agenda presented here is designed to address critical questions in provision of effective mental health care to an aging population and the health policies that govern its delivery.

Aged↗
PubMed1999

[Anesthesia in geriatric patients. The determination of physiological variables for cognitive function in geriatric patients after regional or general anesthesia].

OBJECTIVE: The aim of the present study was to show the influence of the parameters of gas exchange (arterial oxygen pressure paO2, arterial oxygen saturation SatO2) and haemodynamics (arterial systolic and mean blood pressure RRs and MAP) on the restitution of cognitive functions in geriatric patients scheduled for elective hip arthroplasty. METHODS: A total of 30 patients (70 years, ASA II) were randomized to be operated either in regional anaesthesia (n = 15) or general anaesthesia (n = 15). PaO2 (by capillary blood gas analysis), RRs and MAP (by oscillometry) were measured 15 and 90 minutes after arrival in the recovery unit (t1 and t2), 24 and 72 hours postoperatively (t3 and t4), and cognitive functions were tested. Intraoperatively, throughout the day and the first night after surgery we measured satO2 by continuous pulse oximetry. We recorded MAP and RRs by oscillometry every 3 minutes during the operation and every 15 minutes for the rest of that day and night. RESULTS: The parameters of gas exchange and haemodynamics did not differ among the groups. PaO2 was significantly reduced in both groups compared to baseline 24 hours postoperatively (t3) and remained low until 72 hours postoperatively (t4). Nearly all cognitive functions were significantly reduced in both groups compared to baseline 15 and 90 minutes after arrival in the recovery unit (t1 and t2), but recovered on the first postoperative day (t3). Both groups kept deficits in verbal memory and reading capacity up to the third postoperative day (t4). There was no correlation between the physiological parameters and the restitution of the tested cognitive functions. CONCLUSION: The restitution of cognitive functions during the first three postoperative days in geriatric patients scheduled for elective hip surgery does not depend on the anaesthetic technique. According to our results regional anaesthesia does not show any advantage for geriatric patients undergoing elective hip arthroplasty.

Aged↗
PubMedDate not supplied

Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society.

OBJECTIVE: A consensus conference on the diagnosis and treatment of Alzheimer disease (AD) and related disorders was organized by the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society on January 4 and 5, 1997. The target audience was primary care physicians, and the following questions were addressed: (1) How prevalent is AD and what are its risk factors? What is its impact on society? (2) What are the different forms of dementia and how can they be recognized? (3) What constitutes safe and effective treatment for AD? What are the indications and contraindications for specific treatments? (4) What management strategies are available to the primary care practitioner? (5) What are the available medical specialty and community resources? (6) What are the important policy issues and how can policymakers improve access to care for dementia patients? (7) What are the most promising questions for future research? PARTICIPANTS: Consensus panel members and expert presenters were drawn from psychiatry, neurology, geriatrics, primary care, psychology, nursing, social work, occupational therapy, epidemiology, and public health and policy. EVIDENCE: The expert presenters summarized data from the world scientific literature on the questions posed to the panel. CONSENSUS PROCESS: The panelists listened to the experts' presentations, reviewed their background papers, and then provided responses to the questions based on these materials. The panel chairs prepared the initial drafts of the consensus statement, and these drafts were read by all panelists and edited until consensus was reached. CONCLUSIONS: Alzheimer disease is the most common disorder causing cognitive decline in old age and exacts a substantial cost on society. Although the diagnosis of AD is often missed or delayed, it is primarily one of inclusion, not exclusion, and usually can be made using standardized clinical criteria. Most cases can be diagnosed and managed in primary care settings, yet some patients with atypical presentations, severe impairment, or complex comorbidity benefit from specialist referral. Alzheimer disease is progressive and irreversible, but pharmacologic therapies for cognitive impairment and nonpharmacologic and pharmacologic treatments for the behavioral problems associated with dementia can enhance quality of life. Psychotherapeutic intervention with family members is often indicated, as nearly half of all caregivers become depressed. Health care delivery to these patients is fragmented and inadequate, and changes in disease management models are adding stresses to the system. New approaches are needed to ensure patients' access to essential resources, and future research should aim to improve diagnostic and therapeutic effectiveness.

Alzheimer Disease↗