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PubMed1983

Assessment of a geriatric exercise programme using ambulatory electrocardiography.

The purpose of this study was to assess the efficacy as well as the immediate possible cardiovascular risk of a geriatric exercise programme, administered without prior medical screening or evaluation of the exercise capacity of the participants, in improving cardiorespiratory fitness. Ambulatory electrocardiography performed during exercise on 6 randomly selected male participants in a physiotherapist-controlled geriatric exercise programme revealed heart rates of 72-97/min, values unlikely to produce significant improvements in cardiorespiratory fitness. This low-intensity exercise session did not induce any ischaemic ST-segment displacements, or arrhythmias displaying the generally accepted criteria for premonitory arrhythmias known to precede the development of ventricular fibrillation. However, subsequent stress testing, performed at the lower threshold intensity of exercise needed to elicit a significant physiological training effect, resulted in an adverse cardiac response in 3 subjects, of whom 2 were asymptomatic. We conclude that the geriatric exercise programme under investigation would be unlikely to result in improved cardiorespiratory fitness in the majority of participants, but if such a programme is to be implemented in a safe manner in a geriatric population, prior medical screening including exercise testing is mandatory.

Aged↗
PubMed1982

The pneumatic post-amputation mobility aid in geriatric rehabilitation.

Several disadvantages of rigid temporary dressings for geriatric amputees led to the trial of a relatively new kind of pylon--the Pneumatic Post-Amputation Mobility Aid (PPAM). Thirty-five geriatric amputees who were referred to a geriatric rehabilitation hospital participated in the study. Thirty-three of these patients learned to walk with the device easily and safety. The below-knee amputees achieved independent gait with a walker as early as their second treatment. The above-knee and the double below-knee amputees required closer supervision. The inexpensive price of the PPAM, its handiness, the possibility of treating several patients with the same device, and the lack of negative side effects, point to the advantages of this kind of pylon for geriatric patients.

Aged↗
PubMed1995

Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale.

BACKGROUND: Many scales have been developed to assess depression, but they are often too lengthy to be of practical use in general practice consultations. AIM: A study was undertaken to investigate the feasibility, reliability and diagnostic value of the geriatric depression scale and its shorter versions for screening in general practice. METHOD: A total of 586 consecutive consulting patients aged 65 years and over were studied in nine general practices in the west of the Netherlands (13 doctors). The 30-item version of the geriatric depression value was compared with the diagnostic interview schedule as a reference test. RESULTS: The reference test indicated a major depression in six patients while 27 patients had a dysthymic disorder (that is, a chronic mild depression). Five per cent of patients required help for 50% of the questions on the geriatric depression scale. The diagnostic value of the 30-item, 15-item, 10-item and four-item versions did not differ significantly, but the one-item version performed no better than chance. Two items discriminated best between patients who were and who were not depressed (P < 0.05), only one of which was included in a previously proposed four-item version of the scale. The reliability of the proposed four-item version was 0.64, the reliability of the other versions ranging from 0.70 to 0.87. CONCLUSION: The results for the different versions of the geriatric depression scale suggest the use of a 10-item or a four-item version. For practical purposes, the smallest subset would be the most desirable: the four-item version. These scales may be better suited for exclusion rather than inclusion purposes. The feasibility of screening for depression in elderly people in a general practice setting is discussed in the light of the results of the study.

Aged↗
PubMed1993

Neuroleptic prescriptions for acutely ill geriatric patients.

BACKGROUND: Use of neuroleptic medication by the general population of acute care hospitals and in geriatric populations in long-term care has been described. This study examines the use of neuroleptics in acutely ill medical/surgical geriatric patients. METHODS: Chart review was performed for geriatric patients prescribed a neuroleptic drug during a 2-month study period. Patient characteristics, indications for drug use, and evaluations of cognitive or behavioral dysfunction were noted. For the patients who received only haloperidol, the type of order was described and prescription strategies were identified. RESULTS: Ninety-one (10.7%) of 848 patients received a neuroleptic order. They were older and stayed longer than the rest of the geriatric population. Fifty-eight percent were demented or delirious but 31.9% were simply described as agitated or had no reason identified for drug use. Haloperidol was the sole neuroleptic prescribed for 91.2% of patients. The rationale behind the strategies for drug prescription (loading, maintenance, sporadic) was not clear. CONCLUSION: This study raises concerns about the quality of documentation around drug use and the adequacy of diagnostic evaluation prior to drug prescription. The strategies of drug treatment do not consistently reflect a working knowledge of the pharmacology of the drug or a diagnosis-based plan of treatment. Future research should focus on physician education and the efficacy of diagnosis and management of the agitated elder.

Acute Disease↗
PubMed1994

[The effectiveness of geriatric interconsultation in elderly patients admitted to traumatology].

OBJECTIVE: To determine the effect of inpatient geriatric consultation in elderly orthopedic patients. DESIGN: Before-after intervention trial. SETTING: Tertiary care university hospital in Madrid (Spain). PATIENTS: All patients older than 64 years admitted to the orthopedic department during one year before (481 patients) and six months after (283 patients) the establishment of geriatric consultation. INTERVENTION: A geriatric consultation team (attending physician and fellow) evaluated, and actively treated when appropriate, most of the patients; follow-up ensued when need until clinical stability or death. MAIN OUTCOME MEASURES: In-hospital mortality, length of hospital stay and transfers to other departments. RESULTS: There was no difference in sex (percent males 23% vs 24%), age (79.2 vs 79.1 years), or length of stay (27.7 vs 26.3 days). Lower in-hospital mortality (9.36% vs 4.95%, p = 0.017) and more transfers to other departments (4.99% vs 12.37%, p = 0.0007) occurred in the study group. CONCLUSIONS: This model of geriatric consultation achieved a lower mortality in orthopedic elderly patients. Length of stay did not change, but there was a higher rate of transfers to other departments. Further controlled studies are needed.

Aged↗
PubMed1994

[15 years of geriatric day care clinics in Germany].

Day hospital treatment for psycho-geriatric patients in the Federal Republic of Germany started in 1976. At present (October 1991) 13 psychogeriatric day hospitals are established. The day hospitals offer a wide range of diagnostic and therapeutic strategies. Though they are expected to be of great importance especially for the elderly, day hospitals don't play a significant part within the care system for psycho-geriatric patients in Germany. It seems to be recommendable, to establish more psycho-geriatric day hospitals, especially together with an out-patient department and an information centre ("Geronto-psychiatrisches Zentrum"). In addition the care system should be supplied with day centres, in particular for those patients suffering from chronic paranoid psychosis or dementia; the medical care of out-patients should be improved. Besides that the efficacy of day hospital treatment for psycho-geriatric patients should be evaluated.

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PubMed1994

[Rehabilitation of the geriatric patient].

As the twentieth century draws to a close, people in the western industrialized countries have a longer life expectancy. As more people live longer, the proportion of the population that is handicapped and susceptible to chronic diseases is also increasing. Geriatrics has become an accepted medical specialty concerned with the very old. It seeks, through general and targeted measures, to enhance the lives of these handicapped people and enable them to be more independent. This is best done in a modern geriatric clinic with an attached day-care clinic. Only when an experienced multidisciplinary team basing its work on careful geriatric assessment determines the rehabilitation goal, evaluates the potential, and implements a definite programme can the maximum success be anticipated. Specialized orthopaedic-geriatric units working together can achieve the most satisfactory results for effective rehabilitation of elderly patients after orthopaedic surgery.

Activities of Daily Living↗
PubMed1993

Geriatric oncology.

The rapid increase in persons aged 65 and older will account for 20% of the total United States population by the year 2030. The incidence of malignancy likewise increases with advancing age. These factors are likely to result in an epidemic of geriatric cancer cases. Physicians should become knowledgeable on current issues in geriatric oncology which include: how to appropriately select geriatric patients with malignancies for surgical, medical or radiotherapeutic intervention; age as a bias for treatment selection; toxicities from cancer therapy in the elderly and how they can be modified; cancer screening and prevention measures in the elderly, and the special issues of informed consent and pain control in the geriatric cancer patient.

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PubMed1993

The pattern of geriatric admissions in the medical wards at the Kenyatta National Hospital.

In a one year period (March 1990 to March 1991) the pattern of diseases in geriatric patients (over 60 years of age) admitted to the medical wards at Kenyatta National Hospital (KNH) was studied. In all, there were 1296 patients (M:F = 1.7:1) in this age group forming 11.5% of all admissions during the study period. 1008 (77.8%) of the geriatric patients were between 60 and 79 years of age. Most of the admissions (86.4%) were first admissions. The mean number of diseases per geriatric patient was 1.4. Hypertension and Cardiomyopathy were the commonest single diseases recorded, making up 43.9% of all diseases in this patient population. The commonest neurological diagnosis was stroke, which occurred in a setting of hypertension or cardiomyopathy in all the patients in whom it was diagnosed. The mean duration (+/- 2SD) of stay in the hospital in this patient population was 43 (+/- 19) days. Eighty eight (6.8%) of the patients died, the commonest cause of death being heart failure due to cardiomyopathy or hypertensive heart disease. It is concluded that geriatric patients form a sizeable proportion of our medical admissions and that a large proportion suffer from diseases of the cardiovascular system. It is thus recommended that further studies be carried out on the pattern of diseases in such patients and optimal management strategies for their ailments be outlined.

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PubMed1997

[Rehabilitation for musculoskeltal disorders in geriatric patients].

Aging is typically accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness in any organs. Musculoskeltal system is one of the most involved organs in geriatric patients. Appropriate roles in geriatric rehabilitation for musculoskeltal disorders should be emphasized not only to treat the disorders, but also to prevent many complications cause by specific disease or injury. Representative management methods in geriatric rehabilitation are introduced in this section. Rest is often effective, especially in the acute phase of illness or injury. However, cautions should be paid in disuse syndrome which may be produced by prolonged bed rest. Major manifestations in this syndrome includes muscle weakness and atrophy, joint contracture, decubitus, osteoporosis, ectopic ossification, cardiovascular impairment, pneumonia, urological and mental problems. Physical agents such as heat, cold, light and pressure have been used as therapeutic agents. Electrical stimulation is often effective in the treatment of low-back pain syndrome. Traction is the act of drawing, or a pulling force. Its mechanism to relieve pain seems to immobilize the injured parts, to increase peripheral circulation by massage effect and to improve muscle spasm. Brace is very effective to control acute pain in musculoskeltal system. However, long-term wear of brace should be avoided to prevent the disuse syndrome. Exercise is one of the most important rehabilitation modalities. This includes stretching and muscle strengthening programs. Education of body mechanism in activity of daily living is essential in rehabilitation of geriatric patients.

Activities of Daily Living↗
PubMed1998

[Control of nosocomial infections by multiresistant bacteria in geriatric services].

Geriatric wards have a higher prevalence of infection than surgical or acute medical wards, and multiresistant organisms contribute a nonnegligeable proportion of infections in elderly inpatients. The measures used to prevent nosocomial infections in geriatric wards are the same as in other types of wards. They include identifying and ensuring the technical and geographic isolation of colonized and infected patients. Health care providers should be informed of the situation, and antimicrobials used with discernment to avoid the selection of multiresistant organisms. Implementation of these measures is made difficult by architectural factors, the fact that many geriatric patients require assistance in all the activities of daily living, and the long duration of stays in geriatric wards. Additional measures are probably essential to achieve long-term control of nosocomial infections. Insufficient attention has been given to health care providers' perceptions of nosocomial infection and to defining the tasks actually performed by these providers.

Bacteria↗
PubMed1994

A home-based geriatric assessment, follow-up and health promotion program: design, methods, and baseline findings from a 3-year randomized clinical trial.

Controlled trials in a number of countries have documented benefits from different types of in-home assessment and treatment programs for various subgroups of elderly persons. We have developed a program to test, using a randomized controlled design, the concepts of in-home comprehensive geriatric assessment (CGA) coupled with follow-up, health education, and preventive care in an urban United States community. The intervention includes yearly in-home CGA by geriatric nurse practitioners (GNPs), who provide, following discussions with physician geriatricians, lists of specific recommendations for health and well-being enhancement. The GNPs provide follow-up visits quarterly and regular telephone contacts to improve compliance. We recruited for our trial 414 home-living subjects aged 75 years and over, 215 randomized to the intervention group and 199 to the control group. Subjects were generally representative of the overall elderly population of the city of Santa Monica, a seaside suburb of Los Angeles. Extensive baseline data (medical, functional, psychosocial and environmental) were collected from subjects prior to randomization, using validated instruments whenever possible. Follow-up data were collected from each subject every 4 months by trained research assistants throughout the 3-year intervention follow-up period. Our study was designed to assess effects of the intervention on the hypothesized outcomes of health status, functional status, psychosocial parameters, and service utilization. Careful documentation of the intervention will enhance our ability to make process-outcome comparisons. Preliminary analysis reveals that the in-home CGA uncovered many important health deficits for most subjects resulting in a number of substantial recommendations. We are confident that when it is completed, this study will succeed in answering important remaining questions about the feasibility and effectiveness of establishing a geriatric in-home prevention and health promotion program in the United States based on principles of CGA.

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PubMed1995

A multicenter randomized trial of comprehensive geriatric assessment and management: experimental design, baseline data, and six-month preliminary results.

Between October 1992 and July 1993, 11 Northern Italian geriatric departments systematically screened 1386 inpatients hospitalized for at least 10 days. Of those screened, 74% (N = 1019) were excluded by one or more of 7 exclusion criteria; 32% (N = 118) of the 367 remaining subjects failed to meet more than 1 of 8 inclusion criteria. The 11 Geriatric Evaluation Units (GEUs) examined the remaining eligible 249 inpatients with a uniform comprehensive geriatric assessment (CGA) plan, which included a number of validated assessment scales. Of those evaluated, 39% (N = 97) were ineligible for the study because of being unwilling, noncompliant, too sick or "not truly frail", and the remaining 152 (11% of all patients screened) were randomly enrolled in two groups; 79 were assigned to the GEU (experimental group), and 73 to standard care in the National Health Care System (control group). At entry there was no statistically significant difference between the two groups. At 6 months, preliminary results are encouraging; GEU patients had a lower mortality than controls (2 vs 8, 2.5% vs 10.9%; p < 0.05). Slight differences were seen in both clinical-cognitive-affective-functional status and the use of health and social care resources. Only 3 subjects dropped out, 8 refused further follow-up, and 3 went to a nursing-home. We conclude that a standardized selection plan can recognize frail elderly inpatients and that GEU care seems to achieve good results.

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PubMed2003

Geriatric medicine in the European Union: unification of diversity.

The numbers of older people in the European Union are increasing and, with their associated health needs, there is a requirement for the specialty of Geriatric Medicine to be available throughout Europe. At present, specialists in Geriatric Medicine are not recognised in some of the European Union member countries. It is imperative that training in Geriatric Medicine should take place throughout Europe, starting at undergraduate level and progressing through postgraduate training. There must be a programme of continuing medical education and personal development. This paper highlights some of these challenges and suggests a possible way forward.

Accreditation↗
PubMed1993

Comprehensive geriatric assessment: a meta-analysis of controlled trials.

There is disagreement on the usefulness of comprehensive geriatric assessment (CGA) due to conflicting results from individual trials. We did a meta-analysis on 28 controlled trials comprising 4959 subjects allocated to one of five CGA types and 4912 controls. Published data were supplemented with reanalysed data provided by the original investigators. We calculated combined odds ratios of important outcomes by pooling data from individual trials with multivariate logistic regression. Combined odds ratio (95% confidence interval) of living at home at follow-up was 1.68 (1.17-2.41) for geriatric evaluation and management units, 1.49 (1.12-1.98) for hospital-home assessment services, and 1.20 (1.05-1.37) for home assessment services. Covariate analysis showed that programmes with control over medical recommendations and extended ambulatory follow-up were more likely to be effective. Our analysis suggests that CGA programmes linking geriatric evaluation with strong long-term management are effective for improving survival and function in older persons.

Activities of Daily Living↗
PubMed2004

[Treatment of cancer and hematological malignancy in elderly people: oncogeriatrics as a discipline for the future (Part I): geriatric evaluation and management of solid tumors].

PURPOSE: Fifty percent of cancer arise in people older than 65 year-old. Most clinical trials in cancer treatment are limited in patients younger than 65 year-old. We review literature describing particularity of cancer treatment in elderly patients. CURRENT KNOWLEDGE AND KEY POINTS: Therapeutic decisions should be based on an estimation of the patient's life expectancy, and risks and benefits should be weighted up accordingly. Geriatric oncology is made of a geriatric evaluation of patient and of knowledge of clinical trial about elderly patients. FUTURE PROSPECTS AND PROJECTS: We present in this issue the principle of geriatric evaluation and the results of recent clinical trial on elderly cancer patients.

Age Factors↗
PubMed2000

Geriatric psychiatry and managed care.

A wide gap exists in the American health care system between what we know good geriatric mental health care services should look like and the types of services generally available. Cost effective treatment requires a continuum of care in which geriatric psychiatry and primary care geriatric services are integrated in an aggressively case managed model. MCOs have the infrastructure and tools at their disposal to make this work, but they must incorporate into their programs and approaches expert knowledge of the unique clinical problems of the frail elderly.

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PubMed2003

The frailty syndrome: a critical issue in geriatric oncology.

Evidence exists that the geriatric intervention guided by Comprehensive Geriatric Assessment (CGA) has positive effects on a number of important health outcomes in frail older patients. Although a number of observational studies, editorials, special articles and clinical reports, suggest that CGA should be used to guide the assessment and clinical decision-making in older cancer patients, there is limited support to this view in the literature. Older patients that are diagnosed with cancer are usually healthier and less problematic than persons of the same age who are randomly sampled from the general population. In these persons, the cancer dominates the clinical picture and, therefore, instruments especially tuned for the frail elderly may provide little information. The concept of the frailty syndrome, characterized by high susceptibility, low functional reserve and unstable homeostasis, has recently received a lot of attention by the geriatric community. A CGA approach, which also evaluates elements of the frailty syndrome, may be of great interest for those oncologists who want to identify older patients likely to develop severe toxicity and severe side effects in response to aggressive treatment. Improvements in the definition of the frailty syndrome may profit from the clinical experience of oncologists.

Adaptation, Physiological↗