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PubMed2001

[Screening for thyroid disease. Occurrence of hypothyroidism and hyperthyroidism in patients admitted to a geriatric department].

INTRODUCTION: The aim of this study was to evaluate whether screening of all geriatric patients for thyroid disorders should be recommended and to assess the prevalence of thyroid dysfunction in a geriatric population. MATERIAL AND METHODS: From 1 April 1997 to 31 March 1998, all patients above 60 years of age admitted to the ward of geriatric medicine at Copenhagen University Hospital, Glostrup were screened for thyroid disease with a sensitive TSH assay. RESULTS: Of 480 patients with no former history of thyroid disease, three (0.6%) were found to have hypothyroidism (elevated TSH and free T4 below normal) and started treatment with Eltroxin. Twenty-three patients (4.8%) had elevated TSH with normal values of T3 and free T4 (subclinical hypothyroidism). Forty-nine patients (10.2%) had TSH values below normal with normal T3 and free T4 (subclinical hyperthyroidism). Four patients (0.8%) had TSH values below normal and elevated T3 and/or free T4 and isotope uptake studies showed multinodular goitre. None of these patients was treated. Of the 34 patients (6.2%) with known thyroid dysfunction ten patients had their treatment adjusted and two patients started treatment. DISCUSSION: We found that less than 1% of the patients had an unrecognised thyroid disease that required treatment. The total prevalence of thyroid dysfunction was 7.2%. One third of the patients with a known thyroid disease needed their treatment adjusted. We would not recommend screening for thyroid dysfunction of all geriatric patients, but we would advocate better monitoring of patients already in treatment.

Aged↗
PubMedDate not supplied

Laparoscopic cholecystectomy for acute cholecystitis in geriatric patients.

Although acute cholecystitis (AC) in many centers is routinely treated by laparoscopic cholecystectomy (LC), the outcome of LC for AC in geriatric patients (75 years or more) remains almost unstudied. All 32 geriatric patients undergoing a cholecystectomy for histologically proven AC in a teaching hospital during a six-year period were studied retrospectively. Median preoperative duration of symptoms was eight days and median preoperative hospital stay was six days. Preoperative ERCP was performed in 22 patients with successful sphincterotomy and common bile duct (CBD) stone retrieval in 11 patients. Overall twelve patients (37%) had CBD stones and 14 patients (44%) had gangrenous cholecystitis at operation. Twenty-seven patients underwent a LC with a conversion rate of 26%, a complication rate of 41% and a mortality rate of 3.7%. Five patients were judged unstable for a laparoscopic approach and underwent a straight open cholecystectomy. Although the latter were at higher risk (higher APACHE II scores), their outcome except for longer intensive care unit stays, was not different from laparoscopically treated patients. Lack of superiority of laparoscopic over open cholecystectomy in the present study seemed due to clinical characteristics of AC in geriatric patients which may lead to late diagnosis and treatment. Preoperative ERCP by further delaying surgery may contribute to loose any potential benefit of an early laparoscopic procedure. The place of preoperative ERCP and the timing of LC in geriatric patients with AC therefore may need to be redefined.

APACHE↗
PubMed1999

Staff and administration perspectives in a one-year geriatric rehabilitation developmental process.

A health care reform for senior citizens took effect in 1992 in Sweden. Shortcomings as regards geriatric rehabilitation were identified and, in 1995, governmental grants were assigned to local developmental projects. The aim of this study was to report the staff and administration perspectives in a geriatric rehabilitation developmental process over a 1-year period. In all, 782 staff and 45 administration respondents took part. The investigation was based on questionnaires and series of interviews. Significant positive changes with respect to collaboration between the authorities involved were demonstrated at the administrative level, while the most positive results at staff level concerned competence development in the group of employees without college education. A positive process as regards geriatric rehabilitation has started in the study district, indicating that governmental grants assigned for the stimulation of developmental activities are beneficial. Official goals for geriatric rehabilitation, points of departure for the organization of rehabilitation services and the content of general and specialized rehabilitation programmes are pinpointed as some of the areas deserving further attention.

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PubMed2003

[Optimization of geriatric help for urban and rural residents of the Ulianovsk region].

The problem of ageing of the population presupposes the necessity of essential in medico-social services activity and the creations of some uniform coordinated help system for the slderly within the framwork of public health sevices anf social protection. On the basis of the carried out analysis of demographic, social, economic and medical parameters we have developed the plan of geriatric service in Ulyanovsk area. Ulyanovsk Regional Clinical Hospital of War Veterans took the leading part in this work. For the period of 1993-1997 there have been created three regional geriatric centres with branches of day-time departments for 75 places each as structural division of Ukyanovsk regional clinic hospital. In 1999 on the basis of local hospitals in rural areas we opened two interdistrict geriatric centres for 50 and 40 places as divisions of URCHWV. In their structure there are round-the-clock and day-time places, rooms of nurse care, rooms and services for rendering medical, pyschological and social rehabilitation. One-place cost in 2001 has made 210 roubles, that is 1.5-2 times lower, than in city hospitals. As a result of the carried out treatment 88.3% of patients left the hospital with improvement, 9.6% of them--without changes and 1.7%--with deterioration. This form of specialized medical geriatric help to the person living in the countryside, which includes stationary help, stationary-substituted technologies, rooms of a nurse care, social and labour rehabilitation, proves its solvency and expediency in medical and pharma-economic aspects and may be recommended to introduction in practical public health services.

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PubMed1992

[The safety of geriatric anesthesia].

UNLABELLED: Perioperative abnormalities and complications were reviewed in 556 geriatric patients retrospectively to assess the safety of geriatric anesthesia. Preoperatively, the percentages of cases with cardiovascular and pulmonary abnormalities were 49.6% (276 cases) and 21.8% (121 cases) respectively. 77 percent of out patients (428 cases) were in the ASA class II physical status. The most common intraoperative complication was blood pressure instability and the incidence was noted to be of 34.8% (130 cases) with general anesthesia and of 15.8% (26 cases) with regional anesthesia. With general anesthesia, incidence for postoperative events such as non-fatal complications (i.e., sore throat and eye dryness), cardiovascular abnormalities and pulmonary disorders were found to be 39.0% (146 cases), 22.2% (83 cases) and 6.2% (23 cases) respectively. With regional anesthesia, the most common postoperative event was blood pressure instability (incidence: 21.2%, 35 cases). Total mortality rate of the first 15 postoperative days was 2.0% (11 cases). Mortality rate in elective and emergency surgery was 1.1% (5 cases) and 6.8% (6 cases) respectively. Causes of death were mainly related to illness deterioration (cancer and infection) or location of surgery. Death due to anesthetic mishap was nil in this study. IN CONCLUSION: Most geriatric patients had more than one system or one organ dysfunction before operation. Cardiovascular instability was the most common intraoperative complication. Postoperative mortality correlates closely with the preoperative ASA physical status. Mortality rate was significantly higher in emergency cases than in elective cases. A thorough pre-operative assessment and proper perioperative management are mandatory in geriatric anesthesia.

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PubMed1992

Outcomes of geriatric depression.

Improvement in the methodology of longitudinal investigations and increasing research interest in depressive disorders led to findings of clinical and heuristic importance. Outcomes, such as chronicity of depression, relapse, recurrence, and development of dementia, appear to be predicted by different clinical and laboratory findings. Chronicity of depression may be predicted by long duration of the current or previous episodes, coexisting medical illness, high severity of depression, nonmelancholic presentation, delusions, and perhaps cognitive impairment and neuroradiologic abnormalities. Predictors of relapse and recurrence of geriatric depression include multiple previous depressive episodes, high severity of illness, "double depression," presence of "exit" events, and intercurrent medical illnesses. Development of dementia may be predicted by a transient dementia syndrome during a depressive episode ("pseudodementia"), onset of the first depressive episode in the senium, and neuroradiologic abnormalities such as cortical atrophy and rapidly evolving ventricular enlargement. Long-term antidepressant treatment, if not controlled by a research protocol, usually is of low intensity and has a questionable effect on the outcome of depression over a long period of time. For this reason, naturalistic treatment studies are useful for identifying subgroups of depressives and time periods of high risk for specific adverse outcomes. This knowledge is particularly important in frail elderly populations who are vulnerable to side effects of antidepressant treatments. The next step is to conduct controlled-treatment studies and examine the capability of antidepressant treatments to prevent adverse outcomes in the high-risk populations identified through naturalistic treatment studies. Controlled-treatment studies can provide findings that clinicians can use to assess the risk-benefit ratio of continuation and maintenance treatments of geriatric depression. The heuristic importance of knowing the outcome of geriatric depression is that it permits identification of clinically and, to some extent, biologically-homogeneous groups. Given the absence of specific and sensitive laboratory tests, outcome is perhaps the "next best thing" to brain autopsy for subclassifying geriatric depression. Biologic measures of structural and functional abnormalities can then be used in homogeneous subgroups for the pursuit of pathophysiologic or etiologic studies.

Aged↗
PubMed1992

Geriatric mania.

Some general themes emerge from available information concerning manic states and bipolar disorders in late life: heterogeneity of both clinical features of the manic episode and of antecedent illness course; late average age at illness onset; lower rate of affective illness in families of late-onset cases; association of medical and neurologic illness and drug treatments with late-onset cases; utility of lithium salts for acute, continuation, and maintenance treatment; changes in lithium pharmacokinetics associated with aging, disease, and drugs resulting in increased plasma concentration/dose ratios. Geriatric manic states and bipolar disorders present opportunities for research. Investigation may illuminate the nature of mood disorders across the age spectrum, lead to better diagnosis and management in the elderly, and suggest strategies for prevention based on insights into pathophysiologic and pathogenetic mechanisms. Strategies that can be pursued include: longitudinal studies to evaluate differences in affective, cognitive, and other outcomes in geriatric patients with late-onset compared with early-onset illness; studies of psychopathology, family history, and illness course in organic mood disorder, manic; retrospective categorization when cognitive impairment accompanies acute episodes; studies of mania occurring in the context of dementing illness; application of neuroimaging and other laboratory measures to geriatric manic states; contrast of clinical and laboratory findings in early-onset geriatric patients and young adult patients to assess effect of age; definition of lithium concentration-effect relationships in regard to efficacy and toxicity in patients with and without cognitive impairment/dementia.

Aged↗
PubMed1992

Emotional dysfunction in a geriatric population: staff observations and patients' reports.

This study was designed to determine the following about a geriatric rehabilitation population: (1) the relationship between patients' self-reports of depression and anxiety and staff observations of compromised participation in treatment secondary to emotional dysfunction; (2) the relationship of observations among different disciplines; and (3) changes that may occur to staff observations during the patient's hospitalization. The Geriatric Depression Scale, the depression and anxiety subtests of the Brief Symptom Inventory, and the Modified Mini-Mental State Exam were administered to geriatric patients on admission to and discharge from two DRG-exempt acute rehabilitation units. In addition, day nurses, evening nurses, occupational therapists, and physical therapists rated the same geriatric patients on how frequently their emotional functioning interfered with rehabilitation. Significant correlations were obtained between staff observations and patients' reports of emotional dysfunction, with occupational therapists' ratings generally the most highly correlated with patients' reports. At admission, day and evening nurses reported significantly greater patient emotional dysfunction than did occupational therapists, who reported significantly greater emotional dysfunction than did physical therapists. These differences, however, were not evident by time of discharge. Thus, staff members can provide reliable information to mental health professionals in determining the effect of emotional functioning on rehabilitation participation. However, level of compromised participation secondary to emotional dysfunction reported by staff appears to be contingent on which rehabilitation discipline is asked and when during the patient's hospitalization the inquiry is made. Also, patients who generally participated less in treatment tended to be older, depressed women with less education and greater cognitive impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2007

Shared geriatric mental health care in a rural community.

INTRODUCTION: A pilot project in shared mental health care was initiated to explore opportunities to increase the capacity of the rural primary care system as a resource for older people with mental health needs. This was done within a framework for the delivery of best practices in geriatric mental health outreach. METHODS: Shared-care strategies combining education and clinical consultation between mentor psychiatrists and family physicians were implemented and then evaluated after one year to identify key factors in the success of approaches to shared mental health care for older people in a rural setting. RESULTS: Results provided new insights into shared care between primary care and specialty geriatric mental health services, rural geriatric mental health service delivery, developmental phases in service learning approaches, and building knowledge networks to promote continuing best practices. CONCLUSION: The results from the project's process evaluation have been integrated into the development of a permanent shared geriatric mental health care service for the rural setting. Preparation for an outcome evaluation that will focus on the impact on patient care has also been initiated.

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PubMed1991

Geriatric optometry questionnaire.

A national survey of American Optometric Association Low Vision Section members was conducted by the newly formed Geriatrics and Low Vision Committee during the fall of 1989. The "Geriatric Optometry Questionnaire" was designed to establish a greater understanding of the nature of comprehensive professional services for the unique needs of visually impaired older persons. Of the 481 surveys mailed, 289 were returned for a response rate of 60 percent. Seventy-eight percent of the respondents had completed their formal optometric education after 1970. Results indicated that geriatric optometric care is predominantly delivered in private practices and in low vision agencies. Approximately 69 percent of the patients are above the age of 65, with the majority of those being under 85. Although the average initial low vision appointment lasts 60-90 minutes, this generally represents the low vision examination and evaluation of low vision devices only. Complete ocular health assessments combined with low vision evaluations are provided by only 33.5 percent. While 80 percent of the optometrists responding take psychosocial histories, only 60 percent routinely refer patients for social services and rehabilitative training. Similarly, 57 percent of those responding referred patients for independent daily living skills instruction and only 53 percent for orientation and mobility training. These data suggest that optometrists have not yet completely incorporated the multidisciplinary approach to geriatric health care and that continuing education in this area is needed.

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PubMed1990

Geriatric rehabilitation.

Aging is not a disease, nor are there any diseases exclusive to old age. There are physiological changes that occur with aging that lead to functional impairment and eventually death. The geriatric patient usually has several medical problems under treatment concurrently. Therapeutic and technical procedures used in the rehabilitation of geriatric patients are essentially the same as those used in the general practice of rehabilitation medicine. Successful rehabilitation of geriatric patients requires a cooperative and dynamic involvement of all the team professionals, patient and family. Treatment of an elderly stroke patient is outlined as an example of geriatric rehabilitation.

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PubMed1979

[The geriatric day hospital (author's transl)].

The author surveys the development of geriatric care in Great Britain and describes the relationship between geriatric medicine and psychogeriatrics. Both specialties have evolved within the system of progressive patient-care day hospitals. The responsible ministry lays down a norm of two places in both the psychogeriatric unit and geriatric days hospitals to every one thousand people aged 65 and over. The author presents the range of functions of the geriatric day hospital as well as its role within the framework of facilities caring for the aged.

Aftercare↗
PubMed1990

Impact of a pharmacist on medication discontinuation in a hospital-based geriatric clinic.

The effect of a pharmacist on drug prescribing in a hospital-based geriatric clinic was studied. On July 1, 1987, a geriatric clinical pharmacist began participating in a geriatric ambulatory-care clinic at a Veterans Administration medical center. In this retrospective study, patients who had been seen at the clinic a minimum of every two months during both the control period (January 1 through June 30) and the study period (July 1 through December 31) were included. During the study period, the pharmacist reviewed each patient's medication profile and assessed whether drug dosages should be adjusted or medications should be discontinued. The pharmacist and the geriatrician who coordinated care at the clinic reviewed the cases before changes were made. The total number of prescription and nonprescription medications (excluding one-time orders for short-term therapy) was determined for each time period, as well as the average number of prescriptions per patient. Those drugs most frequently associated with adverse drug reactions (ADRs) in the elderly were analyzed separately. During the control period, the 72 patients in the study group received 414 prescriptions, 246 of which were for medications associated with ADRs in the elderly. During the study period, there was a 32% reduction in the total number of prescriptions; the number of medications associated with ADRs in the elderly was reduced by 42%. A direct cost savings of +3872, or +53.75 per patient, was realized over the six-month study period. The addition of a pharmacist to the staff of a hospital-based geriatric clinic resulted in a 32% reduction in the total number of medications prescribed.

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PubMedDate not supplied

[Geriatrics in the acute care hospital].

Since 1985, a graded system of medical care has served as a model at the III. Medical Clinic, Antonius hospital, Velbert-Neviges, FRG; Geriatric I (diagnostic, therapeutic, and intensive medicine), Geriatric II (therapy unit), and Geriatric III (day clinic) have not only reflected diagnostic and therapeutic improvements but they have also changed daily hospital operational requirements. Because of the structural adjustment of the hospital geriatric patients receive better care and patient-care costs are reduced.

Acute Disease↗
PubMed1989

Disease profiles for white and black adult and geriatric patients. An analysis of 2,008 hospital medical admissions.

A prospective analysis of 2,008 discharge diagnoses revealed important differences in disease incidence between black and white adult and geriatric patients treated in the Department of Medicine, Frere Hospital, East London. Among geriatric patients the major differences were the increased incidences among blacks of tuberculosis, pulmonary circulatory disorders and cardiomyopathy, as opposed to ischaemic heart disease, cerebrovascular disorders and chronic obstructive pulmonary disease among whites. Among blacks hypertension was less common than had been expected and occurred predominantly in females. Tuberculosis affected 14% of blacks but only 1.6% of whites. It was also the commonest cause of medical deaths and responsible for 31% of deaths of black patients. Analysis of age patterns showed that 68% of whites and 31% of blacks were over 60 years old; 18% of whites and 3% of blacks were over 80 years old. These figures indicate the need to extend hospital facilities for geriatric patients, and for more comprehensive training in geriatric medicine for doctors and nurses.

Adult↗
PubMed1977

Long term study of hypnotic medication in geriatric patients. A study of dixyrazine, nitrazepam and amylobarbitone.

The hypnotic effect of dixyrazine (a phenothiazine derivate), nitrazepam and amylobarbitone was studied during six months in 52 geriatric inpatients (17, 16 and 19 in each group, respectively) with a mean age of 78 years. The variables registered were the percentage of patients asleep at 10 pm and 6 am and the observed number of awakenings. Certain mental and somatic variables were rated according to a schedule for geriatric behaviour. The observations were made every two to three weeks. No systematic significant change with time was observed for any of the three drugs for the percentage of patients asleep at 10 pm or 6 am or for the number of awakenings. Nor was any difference found between the three drugs in respect of these variables. There was no significant change in somatic or mental variables according to the geriatric rating schedule. The results indicate that dixyrazine, nitrazepam and amylobarbitone retain their hypnotic effect in geriatric patients during continuous use for a six-month period. No side effects were observed that influenced the patient' behaviour. The results do not support the view that barbiturates, i.e. amylobarbitone are inappropriate as hypnotics in the elderly patient.

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PubMed1987

Geriatric assessment teams.

In geriatric care, a form of teamwork is the recommended modality because of the complex biopsychosocial needs of the patient. The goal of geriatric assessment programs is to establish an intensive assessment of older adults which requires the competencies of several coordinated disciplines. Not only do teams have the capacity to assess patients in much greater depth but also patients share different information with different providers. The composition of the team is dictated by the needs of the patient population in accordance with resources available. Next, one must identify a method of team practice in order for interactions to take place. The method of functioning determines what kind of team it is, ranging from independent functioning with minimal formal interfacing to interdependent activity interspersed with formal and informal interactions. In initiating a geriatric assessment program, one needs to determine which tasks demand interdisciplinary collaboration, which require interdisciplinary consultation, and which can be performed using a matrix or extended team model. In this model, the core team is supplemented by other disciplines as determined by the team, predicated on patient problems. Teams can profit from training, which can help with choosing an appropriate model, establishing a manual of procedure, and managing interactive issues and problems. This can occur early in the team's formation, or when a team takes on new members. The minimal level of team development would include establishing program goals, delineating professional responsibilities and roles, and implementing a system for exchanging and documenting information about patient plans. Saving input to share only in team meeting is inefficient, so health care teams need to recognize the importance of informal interchanges. It is still a matter of conjecture about what team works best with which patients under what circumstances or conditions. Multiple randomized clinical trials with teams will give us more information in this regard. In the meantime, organizers of geriatric assessment programs will have to make decisions based on clinical practice in the team development field and extrapolations from related health care team studies.

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PubMed1979

[Geriatric gynecology with special reference to malignant tumors].

After the enumeration of every single problem encountered in the geriatric gynecology, it has been proved, that the malignant tumors of such cases are of a special significance. according to the epidemiological facts of the Austrian Cancer-Registration-Statistics between the years 1971--1975 (even if the cancer of cervix uteri is excluded) more than 60% of the cases are still seen in the geriatric group. Increasing risk (by rate of incidence) of malignant tumors of internal genitals or the breast in aged women is also known and is proved to be very specific. Inspite of the progress won in geriatric surgical gynecology, the post-operative complications are still the negative factors, which limitate the success. Therefore today radiotherapy of the malignant tumors especially in geriatric-gynecological patients is gaining more and more importance.

Age Factors↗