Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “GERIATRICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,009 records · Page 56Linked to original sources
PubMed2002

Geriatric considerations in the diagnosis and management of overactive bladder.

Numerous considerations affect the diagnosis and management of overactive bladder (OAB) in older patients, including neurologic and cardiovascular disorders, musculoskeletal conditions, diabetes, and psychiatric disorders. Older patients are commonly prescribed multiple medications, and many medications can contribute to OAB symptoms and/or interact with drug treatment for OAB. In addition to chronic illnesses and related medications, several factors outside the lower urinary tract can play an important part in managing OAB in older patients. These factors include mobility disorders, cognitive impairment, bowel habits, and fluid intake. Moreover, OAB often does not occur in isolation in the geriatric population. Estrogen deficiency and sphincter weakness in women, prostatic enlargement and obstruction in men, and impaired bladder contractility in both sexes are common and can have prominent effects on management. The diagnostic evaluation of geriatric patients with OAB can usually be accomplished with a basic assessment, without more invasive and expensive procedures. Treatment depends on numerous factors, ranging from comorbidities and functional status to transportation, finances, and patient and caregiver preferences. Adverse effects of bladder-relaxant medications can be bothersome and exacerbate existing conditions common in older patients (eg, constipation, glaucoma, gastroesophageal reflux, and dementia). Setting realistic goals for treatment and communicating them clearly to older patients and their caregivers are crucial for patient satisfaction. There are myriad opportunities for research designed to improve the management of OAB in the geriatric population.

Aged↗
PubMed1998

The contribution of cognitive impairment, medical burden, and psychopathology to the functional status of geriatric psychiatric inpatients.

In order to define the contributions of cognitive impairment, medical burden, and psychopathology to the functional status of geriatric psychiatric patients, a forward-looking, retrospective study of 106 consecutive admissions to a geriatric psychiatric unit at the Houston Veterans Affairs Medical Center Hospital was done. It was found that psychopathology and cognitive status, but not medical burden, contributed to the variance in functional status of geriatric psychiatric inpatients for both admission scores and for changes in scores during hospitalization. Improvements in cognitive state and psychopathology were associated with improvements in functional status during hospitalization.

Aged↗
PubMed2003

Evidence-based practices in geriatric mental health care: an overview of systematic reviews and meta-analyses.

At least 20% of people over the age of 65 suffer from mental disorders. It is anticipated that the number of older Americans with psychiatric disorders will double over the next 30 years. There is, however, substantial unmet need. The recent Surgeon General's Report on Mental Health, a Report on Mental Health from the Administration on Aging, and an expert consensus statement underscore the need to plan for the challenge of providing services for elderly people with major mental disorders. Among the greatest challenges is the expertise gap that affects clinicians practicing in routine clinical settings. This gap reflects inadequate training in geriatrics and a failure to incorporate contemporary clinical research findings and known evidence-based practices (EBPs) into usual care. This article provides an overview of the emerging evidence-base supporting the efficacy of empirically-validated geriatric mental health interventions for major geriatric mental health disorders, including systematic EBP reviews, meta-analytic studies, and expert consensus statements. Cautions and limitations regarding the reliance on randomized, controlled trials, meta-analyses, and systematic reviews also are presented.

Aged↗
PubMed1997

Origin and transmission of methicillin-resistant Staphylococcus aureus in an endemic situation: differences between geriatric and intensive-care patients.

Imported vs. hospital-acquisition of MRSA was assessed in > 6000 patients at a large tertiary care teaching hospital. About five percent (5.1%) of patients carried MRSA on admission, mostly without clinical symptoms; the highest percentage (11.6%) being in geriatric patients. Hospital-acquisition of MRSA occurred in 1.7% of patients and was particularly high in intensive-care units (5.2%). Phenotype and genotype analysis of 158 MRSA strains isolated from 61 patients revealed a cluster of closely related strains in the hospital-acquired MRSA infections and the close relationship of this cluster to the regional epidemic MRSA strain. The MRSA strains imported by geriatric patients were genetically different, did not spread between geriatric patients and were only a minor source of nosocomial infection.

Age Distribution↗
PubMed1997

Recognition of depression in geriatric ED patients by emergency physicians.

STUDY OBJECTIVE: To prospectively evaluate identification of geriatric depression by emergency physicians and to assess the utility of a self-rated depression scale to improve case-finding in geriatric patients presenting to the ED. METHODS: We conducted an observational survey of geriatric ED patients who presented to an urban, university-affiliated public hospital. A brief self-rated depression scale was administered to 101 patients aged 65 years or older. Emergency physicians, blinded to depression scale scores, prospectively rated the likelihood of depression in these patients. Our main outcome measures were prevalence of depression (in accordance with a predetermined cutoff score for detecting depression) and the emergency physicians' clinical recognition of depression. RESULTS: Thirty patients (30%; 95% confidence interval [CI], 21% to 39%) met the predetermined criteria for depression. Age, sex, race, and education were not significantly different between depressed and nondepressed patients. Patients who categorized their health as good were less likely to be depressed than those who considered their health poor or fair (18% versus 37%; 95% CI for difference of 19%, 10% to 35%). Recognition of depression by emergency physicians was poor, with a sensitivity of 27% (95% CI; 12% to 46%), specificity of 75% (95% CI, 63% to 84%), and positive predictive value of 32% (95% CI, 27% to 41%). Only 13% (95% CI, 4% to 31%) of depressed patients were referred for further mental health evaluation. CONCLUSION: Depression is common in older ED patients but often goes unrecognized by emergency physicians. Use of a brief depression scale can improve case-finding in this age group, leading to appropriate referral for further management.

Aged↗
PubMed1997

Antibody protection to diphtheria in geriatric patients: need for ED compliance with immunization guidelines.

STUDY OBJECTIVE: Because 50% to 70% of geriatric patients have been shown to have nonproductive levels of tetanus antibodies, we postulated that this population might also have inadequate levels of diphtheria antibodies. Emergency physicians have the opportunity to immunize patients against tetanus and diphtheria. We sought to determine the seroprevalence of diphtheria antibodies in patients older than 65 years and to assess compliance with immunization guidelines in EDs. METHODS: Enzyme-linked immunosorbent assay for diphtheria antibodies was conducted in 58 outpatients of geriatric medical facility aged 65 years or older. We considered titers greater than .1 IU/mL protective. Eighteen ED personnel, ages 25 to 40 years, served as comparison subjects. The preparation used for immunization of injured patients--tetanus toxoid or tetanus and diphtheria toxoids adsorbed for adult use--was determined by means of a telephone survey of 64 New York City EDs. RESULTS: The mean age of our patients was 80 years (range, 65 to 95 years). Their mean diphtheria antibody titer was .17 IU/mL (range, .04 to .54 IU/mL). Thirty-three percent (19 of 58; 95% confidence interval [Cl], 21% to 54%) of patients had inadequate levels of diphtheria antibodies. We found no significant differences between protected and nonprotected patients with respect to age, sex, medical history, or military service. Patients with nonprotective levels of diphtheria antibodies were more likely to have inadequate tetanus antibody titers. Sixty-eight percent of patients without protection from diphtheria (13 of 19; 95% Cl, 48% to 88%) were also unprotected from tetanus, and 33% (13 of 39; 95% Cl, 19% to 47%) o those with adequate diphtheria antibodies had nonprotective levels of tetanus antibodies (P = .012). All 18 ED personnel had adequate diphtheria and tetanus antibodies. The telephone survey revealed that 30% (19 of 64) of EDs use only tetanus toxoid for immunization of injured patients. CONCLUSION: A significant percentage of geriatric patients have inadequate diphtheria antibodies. Emergency physicians must comply with immunization guidelines for injured patients to assure adequate protection from both tetanus and diphtheria.

Adult↗
PubMed1993

[Prospective evaluation of specialized consultations in a geriatric university hospital].

In a prospective study carried out over a 3 month period we analysed the views of consultants and residents taking part in 771 consultations to patients admitted to the Geriatric University Hospital of Geneva with the help of visual analogue scales. 27 medical subspecialties were involved. Both consultants and residents agreed that most of the consultations were useful for the elderly patient and for postgraduate teaching and learning. But the residents thought that consultations were more important for the patients' welfare than for the residents' education. Residents showed a tendency to underestimate crucial aspects of geriatric medicine (in particular the autonomy of the elderly patient) in preference to more "classical" medical preoccupations (diagnosis and treatment). Consultants were aware of the specificity of geriatric pathology but restricted their teaching during the intervention to what was requested by the resident.

Aged↗
PubMed1999

Utility of clinical characteristics in identifying depression in geriatric ED patients.

We will determine if clinical characteristics can be useful in identifying depression in geriatric Emergency Department (ED) patients. We have provided a cross-sectional observational study of geriatric patients presenting to an urban university-affiliated public hospital. A brief self-rated depression scale (SRDS) was used to identify depression. Clinical characteristics, examined retrospectively, included chief complaint, chronic illnesses, mode and time of arrival and discharge disposition. Relative prevalence of depression was calculated for these clinical characteristics. 70 (27%; 95% CI, 22% to 32%) of 259 patients were found to be depressed by the SRDS. Patients with nonspecific chief complaints were more commonly depressed than patients with system-specific chief complaints, but not significantly (relative prevalence 1.6; 95% CI, 1.0 to 2.4; p = 0.19). The relative prevalence of depression also did not vary significantly when analyzed by specific chronic illness (P = 0.42) except cardiac disease (1.6; 95% CI, 1.1 to 2.4), PM or night arrival (1.3; 95% CI, 0.8 to 2.3; p = 0.17), ambulance use (1.1; 95% CI, 0.7 to 1.7; p = 0.88), or need for medical admission (1.0; 95% CI, 0.7 to 1.5; p = 0.97). Depression is common in geriatric ED patients. Clinical characteristics fail to identify elderly ED patients who are likely to be depressed. Use of a brief SRDS can aid in recognition of depression in this group.

Aged↗
PubMed2003

Surgical considerations in the geriatric patient.

The geriatric patient has a high incidence of foot deformities and may be considered a good surgical candidate if healthy and psychologically ready for the surgical procedure. Foot problems in the geriatric population that may require surgical intervention can be grouped into approximately five categories, including (1) localized orthopedic disorders (ie, bunions, hammer toes, and so on); (2) skin and nail problems (ie, onychomycosis); (3) degenerative and inflammatory arthritis; (4) diabetic foot disorders; and (5) neuromuscular disease. However, age-related changes in cardiovascular, pulmonary, and renal function increase the risk of perioperative complications. The higher rates of complications seen in the older surgical patients result in part from existing comorbidity and age-associated changes in organ function. Extensive procedures depending on good bone healing for success should usually not be attempted on older patients. Office surgery for the geriatric patient should involve only the simplest procedures and should be kept to a minimum because of the increased possibility of postoperative complications. In the hospital there is better preoperative evaluation, operating room conditions, and postoperative care.

Aged↗
PubMedDate not supplied

Maximizing therapist effectiveness with geriatric hand patients.

The "graying of America" is resulting in higher proportions of older persons utilizing the health care system. Current trends indicate that the geriatric population represents a growing portion of the hand therapy patient population. Appreciating the unique needs of the geriatric hand patient and developing an appropriate treatment program require special interventions that may seem unappealing due to the likelihood of prolonged initial treatment time. However, such steps can strongly enhance therapist effectiveness, patient compliance, and ultimate outcome. The purposes of this paper are: (1) to address frustrations that may be encountered in the treatment of some elderly hand patients; (2) to introduce the reader to the phenomenon of age bias; (3) to present a well-accepted and effective assessment tool of memory, orientation, and ability to follow commands as these competencies pertain to hand therapy; (4) to address concepts in the gerontology literature that can be applied clinically as treatment guidelines to boost treatment effectiveness; and, finally, (5) to suggest communication techniques to use with the elderly hand patient. Maximizing therapist effectiveness with geriatric hand patients will serve to reinforce the dignity and value of this unique population.

Aged↗
PubMedDate not supplied

Mobility screening as part of a community-based geriatric assessment.

This article provides an overview of the basic components of mobility and encourages home care practitioners to include mobility screening as a part of geriatric assessment. Mobility is viewed as an integrated and interdependent function of physical, mental, emotional, and social capacities, and therefore encourages an interdisciplinary approach to assessment of basic mobility problems and needs. The discussion includes mobility-related operational definitions and measurements, reasons to perform a mobility screen, how to incorporate the components of basic mobility into a geriatric mobility screen, and factors that significantly distinguish in-home assessment from a clinic- or institution-based geriatric mobility assessment.

Activities of Daily Living↗
PubMed2000

Decreased working memory and processing speed mediate cognitive impairment in geriatric depression.

BACKGROUND: While neuropsychological dysfunction is common in geriatric depression, not all aspects of cognition are equally affected. It has been suggested that depressed patients are impaired only in tasks that make heavy demands on processing resources and that a resource decrement therefore underlies the neuropsychological decrements seen in geriatric depression. The present study examined whether processing resources in the form of working memory and information processing speed are decreased in depression and whether a decrease in these resources actually mediates neuropsychological impairment. METHODS: Measures of processing resources were administered to elderly depressed patients prior to treatment and to age-matched controls. Patients whose depression remitted were retested as were the controls. Subjects also received neuropsychological tests of episodic memory and visuospatial performance. RESULTS: Depressed patients performed significantly worse on measures of both processing speed and working memory. While performance on these measures improved in patients whose depression remitted, the amount of improvement was no greater than that seen in the controls with repeat testing. Hierarchical regression analyses showed that depression explained a significant amount of variance on the neuropsychological tasks. However, if the variance associated with processing resources was removed first, depression no longer accounted for a significant amount of neuropsychological variance. CONCLUSIONS: Processing resources are decreased in elderly depressed patients and this decrease in resources appears to mediate impairments in several areas of neuropsychological functioning including episodic memory and visuospatial performance. The resource decrement persists after remission of the depression and thus may be a trait marker of geriatric depression.

Aged↗
PubMed2004

The clinical and demographic characteristics of elderly patients of Polish origin newly referred to a geriatric psychiatry service.

OBJECTIVE: To compare the clinical, demographic, social and service utilization characteristics of elderly Poles with indigenous elders. SETTING: A geriatric psychiatry service in an urban area. METHODS: All newly referred patients to a West London geriatric psychiatry service were studied. The uptake of service and clinical, demographic, social and service utilization characteristics of elderly Poles and indigenous elders were compared after extracting information from case-notes. RESULTS: Twelve percent of all referrals were of Polish origin. This figure is considerably higher than 4% of all community-dwelling elderly being of Polish origin in Ealing. There were no differences in clinical, demographic, social and service utilization characteristics between Polish and indigenous patients with a few exceptions. Elderly Poles were more likely to be married (p < 0.005) and indigenous elders were more likely to be single (p < 0.05). Elderly Poles were more likely to be advised to take out power of attorney (p < 0.014). Elderly Poles were less fluent in English (p < 0.0005). CONCLUSIONS: Newly referred elderly Poles accessed and utilized the geriatric psychiatry service resources and social services at least as equitably as indigenous elders.

Aged↗
PubMed1993

The impact of geriatric medical services on mental state.

The purpose of this paper was to determine the impact of geriatric medical services on mental state by reviewing all controlled trials of such services. Two computer data bases were searched for relevant articles published from January 1980 to August 1990, and the bibliographies of retrieved articles were searched for additional references. Eleven reports were located that met the four inclusion criteria: original study, published in English or French, controlled trial (nonrandomized or randomized) of a geriatric medical service, and inclusion of at least one measure of mental state in the study. Ten reports met the validity criteria for intervention studies. There was little evidence that geriatric medical services improved the mental state of aged patients; all trials had limitations in design and measures. These findings challenge mental health professionals in two ways: first, services must be developed to address the apparently unmet mental health needs of aged medical patients; second, research methods must be developed to measure the impact of these services.

Activities of Daily Living↗
PubMed1994

Geriatric rehabilitation in the United States and the Federal Republic of Germany: a comparison.

Similarities and differences in the way geriatric rehabilitation is viewed in the Federal Republic of Germany and in the United States are highlighted. The philosophy and goals of geriatric rehabilitation in both countries are basically similar. However, there are some differences, particularly in practice applications and in how the historical and social contexts of each country influence what is emphasized. This article traces the relevant knowledge components and practice application in each country and makes some comparisons. In addition, differences in how members of the geriatric team function are described, as well as the varying educational preparations of team members. Developments in both countries suggest that substantial integration of knowledge already has taken place. The continuation of this trend should bode well for the future.

Activities of Daily Living↗
PubMed1998

Impact of geriatric home screening services on mental state: a systematic review.

The purpose of this report was to determine the impact of geriatric home screening services on mental state. Two computer databases, MEDLINE and HealthSTAR, were searched for relevant articles published from January 1975 to June 1997, and the bibliographies of retrieved articles were searched for additional references. Seven trials were located that met the four inclusion criteria: (a) original study; (b) published in English or French; (c) controlled trial (randomized or nonrandomized) of a geriatric home screening service; and (d) the trial included 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. Two trials reported a small effect on morale or self-perceived health and five trials reported no effect. Thus, there was little evidence that geriatric home screening services had an impact on the mental state of aged subjects.

Aged↗
PubMed2001

Developing a Bayesian belief network for the management of geriatric hospital care.

Resource management is an essential feature of hospital management. This is especially true for geriatric services, as older people often have complex medical and social needs. Hospital management should benefit from an explanatory model that provides predictions of duration of stay and destination on discharge. We describe how a Bayesian belief network models the behaviour of geriatric patients using predictive variables: personal details, admission reasons and dependency levels. This approach is illustrated using data on 4,722 patients admitted to geriatric medicine at St. George's Hospital, London; distributions of the patient outcome given typical values of the predictive variables are provided.

Aged↗
PubMed2002

Ethical issues in geriatric medicine: a unique problematic?

It is commonly believed that geriatric medicine generates a distinctive set of ethical problems. Implicated are such issues as resource allocation, competence and consent, advance directives, medical futility and deliberate death. It is also argued that it would be unjust to allow the elderly to compete with younger populations for expensive and scarce healthcare resources because the elderly "have already lived," and that treating them the same as these other populations would diminish the available resources unfairly, prolong a life of inevitably failing health and result in increased health care expenditures. In fact, however, this perception of ethical uniqueness is mistaken. Differences in medical conditions, demographics and aetiology should not be allowed to obscure the fact that ethical issues in geriatric medicine are essentially the same as those faced in any other area of health care, and that the solutions that are adopted in the geriatric context must be consistent with the ethical principles that are followed elsewhere. The paper argues that the root of the mistaken perception lies in the abandonment of the Hippocratic mandate of medicine and in an unreflective adherence to the belief that medical advances are inevitably beneficial. It is suggested that a return to patient-centred medicine and the use of ethics impact analyses before introducing medical advances may be ethically appropriate.

Aged↗