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PubMed2003

Care dependency: testing the German version of the Care Dependency Scale in nursing homes and on geriatric wards.

The purpose of this study was the psychometric evaluation of the German version of the dependency scale in nursing homes and on geriatric wards. The 15-item scale was originally developed in the Netherlands for assessing the care dependency of demented and mentally handicapped patients. Data of 81 nursing home residents and of 115 geriatric patients were collected. Residents and patients were assessed several time by professionals and nonprofessionals. Reliability was determined by Cronbach's alpha, showing very good results with values of 0.94 and 0.98. Inter-rater and intrarater reliability show moderate to substantial Kappa values. Criterion validity was examined by comparing the data of the scale with the German nursing personal regulation and the German statutory insurance. The results show that the scores of the Care Dependency Scale correlate to the scores of the two classifications. In general, the German version of the scale can be recommended for use in nursing homes and on geriatric wards.

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PubMed2001

Physician confidence and interest in learning more about common geriatric topics: a needs assessment.

OBJECTIVE: To assess physicians' confidence in and interest in learning more about 18 specific geriatric topics. DESIGN: Written survey. SETTING: Annual meetings of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP). PARTICIPANTS: Seven hundred and fifty-eight physicians (547 ACP members, 211 AAFP members). MEASUREMENTS: For each topic, participants rated their confidence in performance, their peers' need for education, and their interest in learning more, using a five-point Likert scale. RESULTS: Survey participants were on average 16 years out of medical school and 61% were in a community primary care practice that included many geriatric patients on a primarily fee-for-service basis. High levels of interest in learning more about dementia, functional assessment, urinary incontinence, and sensory impairment were found. A substantial correlation (r =.44, P <.0001) between the proportion of seniors reported in the physicians' practice and confidence in performance in the areas surveyed was identified. CONCLUSIONS: These findings provide useful information on the physician-learner's perception of needs, which is important in the design of effective continuing education efforts in geriatrics.

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PubMed2002

Implementation of consultative geriatric recommendations: the role of patient-primary care physician concordance.

OBJECTIVES: To examine the effect on primary care physicians' implementation and their patients' adherence behaviors of patient-physician concordance about recommended geriatric health care. DESIGN: Case-series, independent interviews of patients and their physicians about their perceptions of the patients' health and the comprehensive geriatric assessment (CGA). SETTING: Community. PARTICIPANTS: Community-dwelling older patients (n = 111) who received consultative outpatient CGA and their primary care physicians. MEASUREMENTS: Concordance variables were generated using physician and patient responses to 10 questions on health- and CGA-related perceptions. An overall concordance score was generated by summing the total number of items on which patients and physicians agreed. Measures of the two dependent variables (physician implementation of and patient adherence to CGA recommendations) were by self-report. RESULTS: In multiple logistic regression analyses, overall concordance between patient and physician proved to be a significant and powerful predictor of physician implementation of (adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6-4.6, P <.001) and patient adherence to (OR = 2.7, 95% CI = 1.7-4.2, P <.001) CGA recommendations, controlling for patient and physician gender and age, patients' functional status, duration of the patient-physician relationship, and frequency of visits in the previous year. Further analysis revealed that mutual patient-physician concordance on health-related perceptions was a significant predictor of these outcomes, whereas individual patient or physician perceptions were not. CONCLUSION: Concordance between older patients and their primary care physicians is a powerful predictor of physician implementation of and patient adherence to outpatient consultative CGA recommendations. Future research should focus on ways physicians can assess and negotiate patient-physician agreement on geriatric healthcare recommendations.

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PubMedDate not supplied

Geriatric alcohol abuse: a national epidemic.

Substance abuse is a widely identified problem in our society. Alcohol abuse is the most problematic, yet most undertreated. Primary care practitioners often do not screen the geriatric population appropriately for at-risk drinking, so the condition goes undiagnosed. This oversight is complicated by the fact that many manifestations of alcohol abuse do not present themselves until well into the disease process. This article explores the practitioner's role in geriatric alcohol abuse assessment and treatment and the impact of geriatric alcohol abuse on society.

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PubMed2001

The impact of geriatric post-discharge services on mental state.

OBJECTIVE: To determine the impact of geriatric post-discharge services on mental state. METHODS: Three computer databases, MEDLINE, HealthSTAR and the Cochrane Database of Systematic Reviews were searched for relevant articles; the bibliographies of retrieved articles were searched for additional references. RESULTS: 11 trials were located that met the four inclusion criteria: (i) original study; (ii) published in English or French; (iii) controlled trial (randomized or non-randomized) of a geriatric post-discharge service; and (iv) including at least one measure of mental state. All trials met most of the validity criteria for intervention studies of the Evidence-Based Medicine Working Group. Three trials reported a small effect on emotional state or self-perceived health and eight trials reported no effect. CONCLUSION: There is little evidence that geriatric post-discharge services have an impact on the mental state of aged subjects. Future services and studies should be designed to address the issue of mental state outcomes in this population.

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PubMed1993

Quality of rehabilitation care in two inpatient geriatric settings.

The study assessed the quality of care in 410 geriatric patients admitted for rehabilitation following a hip fracture (53%) or stroke (47%) to two types of inpatient setting: geriatric departments in general hospitals (GDs) and free-standing geriatric hospitals (GHs), 45% and 55% of patients, respectively. The assessment of care was based on two outcome criteria, change in functional status (Barthel Index) and patient destination on discharge. Findings suggest that rehabilitation performed in GHs had some advantage over that in GDs although the cost of stay in GHs is half of that in GDs, and GHs seem to be also more cost-efficient. The finding indicates one way in which assessment of quality contributes to health policy and planning.

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PubMed2005

Geriatric interdisciplinary team training program: evaluation results.

Geriatric interdisciplinary team training has long been a goal in health education with little progress. In 1997, the John A. Hartford Foundation funded eight programs nationally to create Geriatric Interdisciplinary Team Training (GITT) programs. Faculty trained 1,341 health professions students. The results of the evaluation, including presentation of new measures developed to assess interdisciplinary knowledge, are presented, and the implications of the program as a model of interdisciplinary education are discussed. Evaluation data from 537 student trainees are presented. At posttest, GITT trainees demonstrated improvement on all measures of attitudinal change, no change on the geriatric care planning measure, and a change in some of the questions on the test of team dynamics that varied by discipline. Changes were greatest for all the attitudinal measures with the self-reported Team Skills Scale indicating the most significant change--a change that is significant across medicine, nursing, and social work trainees.

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PubMed1999

Clinical experience with Goal Attainment Scaling in geriatric care.

OBJECTIVES: This article presents a qualitative evaluation of the utility of Goal Attainment Scaling (GAS) in geriatric care. GAS is an individualized outcome measure particularly suited for clients with multiple complex problems, such as are commonly served by geriatric programs. METHODS: Semistructured interviews were completed with 24 clinicians in four hospital or community-based geriatric services where GAS has been used. An inductive analysis was used to identify themes. RESULTS: GAS was described as resulting in shorter lengths of stay, more focused care, and improved team functioning. GAS was perceived as having greater use for functional (versus medical) goals, when clinicians had more direct control over treatments, when patients were involved in goal-setting, and when goals were set by an interdisciplinary team. DISCUSSION: GAS has affected both care practices and patient outcomes. This study illustrates the clinical impacts an outcome measure can have, as well as the use of qualitative methods for this type of research.

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PubMed2005

Shifting the paradigm in geriatric care management: moving from the medical model to patient-centered care.

Studies of Geriatric Care Management Programs have had mixed results at best. Little evidence exists to attest to the effectiveness of these programs in improving patient outcomes and decreasing avoidable acute care service use. In response to these data, Kaiser Permanente's Geriatric Care Management program initiated a randomized trial to test an integrated, multifaceted depression treatment model within the care management framework and it's ability to detect and treat moderately and severely depressed older adults. This paper presents case studies of the geriatric care managers' practice changes associated with this intervention as well as case studies of two depressed clients, their experiences and outcomes associated with this study. Implications of this model are discussed.

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PubMed2005

Toward understanding the clinical aspects of geriatric case management.

Despite the prominence of complex psychosocial problems in aging clients, geriatric case management has generally emphasized the provision of concrete resources and services as its primary function. However, some of the literature as well as the findings of this study, point to competent case management as being contingent on interventions that successfully address key psychosocial problems. This paper presents a qualitative study involving experienced geriatric care managers. Psychosocial problem and intervention categories are identified as well as overarching themes with significant implications for practice. The paper argues that a grounded, thorough, well-explicated and generalizable model for clinically-focused geriatric case management practice is necessary; it also suggests additional research towards the development of such a model.

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PubMed1976

[Experiences from a function as consultant of geriatrics in a district schwerin (author's transl)].

Consultant of geriatric, district. There is given an organizational model in complex care of the elderly in the district of Schwerin. The continuous care of the elderly, adequate to their requirements, wishes, problems, and difficulties by complex measures is an important part for the realization of the social-political tasks of the SED and government. Especially in the district of Schwerin there are a lot of initiatives and already good results of effects in principle. For the further improvement of the medical and social care for the aged is based in a foundation of a special working groups of general practioners in the district of Schwerin which coordinates all activities in this field. In this working group and its activities participate all local geriatrics (Kreisfachberater für Geriatrie) under the chiefment of the district consultant of geriatrics.

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PubMed1976

[Geriatric care commitee (author's transl)].

The medical and social care of the aged is a substantial task of General Practitioners in the GDR Public Health. Increasing consideration must be given to the individual social situation. According to Public Health directives covering all sectors of geriatric care we built a "geriatric care Commitee" whose members are a G.P., a geriatric welfare worker, the district nurses, a representative of the local plant health organisation and one of the elected munifipal council members. Tasks are described and achieved results are related. Significance of purposely coordination of all sectors participating in care for the aged is stressed.

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PubMed1998

Geriatric problems and their management. The nursing perspective.

Geriatric problems and its Nursing care is not like any other speciality which deals with one group of diseases. Older adults suffer from various disabilities and diseases. Geriatric group will lose memory power, bearing, eyesight, etc. The Nurse who deals with geriatric patients is expected to be well versed in all the aspects. She approaches the patients through Nursing process. She plans and directs the day-to-day Nursing care according to the situation that arises. Because of the scientific knowledge and modern techniques acquired by the Nurses and health care workers they are able to give a fairly comfortable life to the elderly people.

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PubMed2003

[Treatment with antidepressants in geriatric departments. Occurrence and record keeping].

INTRODUCTION: The aim of the present study was to describe the occurrence of antidepressant treatment in geriatric departments in Denmark and assess the notes of the patient records in connection with prescription. MATERIAL AND METHODS: Patient records for consecutively referred patients in seven geriatric departments were examined and basic information was noted. For users of antidepressants further information about the treatment was noted. RESULTS: A total of 1211 patients records were examined and out of these 338 patients were in treatment with antidepressants (29.7%). The users of antidepressants used more drugs on their discharge from the hospital. For 61.8% (209/338) of the users the treatment had started before the admission and in more than three-fourths the treatment remained unchanged at their discharge, in 9% the treatment was discontinued. 38.2% (129/338) started their treatment during the admission. Depression was stated as being the main reason in 54% of those who continued an ongoing treatment, and in 78% of those who started their treatment during admission. In 98.4%, the beginning of treatment with antidepressants was based upon the file notes. In 34.8% of the records of ongoing treatment no file notes were given. DISCUSSION: Treatment with antidepressants is common in geriatric departments and most often it is a question of continuation of a treatment that had started before the admission. The study shows that there is a need for an optimization of the file notes.

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PubMedDate not supplied

Fostering student interest in geriatric nursing: impact of senior long-term care experiences.

Preparing nurses to meet the care needs of an expanding aging population is a challenge for nursing. Student experience in long-term care is typically limited to initial practicums. Students are rarely able to appreciate the complexity, challenge, and rewards of geriatric nursing. Few students seek geriatric nursing roles upon graduation, and care facilities report an inability to fill current vacancies. This article describes the integration of long-term care experiences into senior year community health practicums and reports on a qualitative analysis to evaluate the project's impact on student attitudes and intentions toward geriatric nursing roles.

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PubMed1991

[Computerized graphic techniques in the interdisciplinary information communication in geriatrics].

Geriatric research shows that multidimensional assessment (MA) is the best method of approaching the complex functional problems of elderly subjects which are characterized by a close interdependence of clinical, social and mental factors. A correct and standardized communication of the results and the indications deriving from this complex interdisciplinary system is essential to enable the operators, despite their different professional backgrounds, to become involved in ensuring the health and welfare of their patients using integration and coordination criteria which are appropriate to the patient's individual situation. In this context, a computerized MA programme, known as "Senior", has been designed. The programme provides two communication sheets of data with different professional orientations: I) geriatric assessment sheet for doctors and other medical staff; II) graphic geriatric assessment sheet for non-medical operators. In practice, these assessment sheets are a useful backup in providing continuity between in- and out-patient programmes.

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PubMed1977

Future geriatric needs in South Africa. Hospital and teaching aspects.

Noteworthy factors in geriatric care, derived from experience in a geriatric clinic, are that symptoms are often wrongly attributed to the ageing process; the aged are often overtreated and subjected to unnecessary diagnostic procedures; and functional abilities of the elderly and social factors are important in planning comprehensive care for the aged. To render total care the services of a visiting sister attached to the clinic are an absolute necessity. The elderly are often prematurely discharged from hospital. The combination of multiple pathology, functional derangement and social factors necessitates a period of aftercare which entails physiotherapy, occupational therapy and the services of a social worker. Medical students, nurses, students in social work, psysiotherapists, and occupational therapists should be enlightened on gerontology and geriatrics during their undergraduate years.

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PubMed1993

The geriatric evaluation and treatment unit: a model site for acute care of the frail elderly, education, and research.

Geographically based inpatient geriatric units are an increasingly common organizational approach throughout the world for the care of the hospitalized frail elderly with complex, multidisciplinary acute care needs. The unit provides comprehensive and efficient quality care to these patients by bringing together, in a geographically based unit, specialists from a multiplicity of disciplines to provide needed services in a coordinated manner. To accomplish its goals, the unit employs experts in geriatric medicine, nursing, social work, psychiatry, and other disciplines in a team approach to comprehensive assessment. The education of medical students, medical housestaff, and geriatrics fellows is a critical function of the unit. The unit also serves as a site for research in improving the care of the hospitalized frail elderly.

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