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 1,063 records · Page 59Linked to original sources
PubMedDate not supplied

Geriatric assessment and management protocols: issues for home infusion therapy providers.

The accurate assessment of patients' health, functional abilities, and sociobehavioral status is essential for providing quality, cost-effective infusion services to home-based elders. Baseline and ongoing assessment identifies serious current, emerging, and potential problems, and facilitates interventions to prevent significant comorbidities and premature mortality. Three types of assessment (screening, intermediate or evaluation, and comprehensive) have been used successfully with geriatric populations across a variety of settings to improve patient outcomes. Further, Medicare now requires the completion of an OASIS assessment for the reimbursement of home health services to all seniors. Geriatric assessment has been found to improve care quality and cost effectiveness, but protocol development and evaluation can be challenging. Home infusion therapy providers, encouraged to implement and evaluate evidence-based assessment and management protocols, question the usefulness of these protocols, especially for short-term geriatric patients. Research, education, and policy strategies can be used to overcome the many barriers to developing quality, cost-effective assessment and management protocols for elderly home infusion therapy recipients.

Aged↗
PubMedDate not supplied

Geriatric assessment with focus on instrument selectivity for outcomes.

More than one half of all cancers in developed countries occur in patients aged 70 years and older. Therefore, in recent years, there has been a growing interest in integrating a comprehensive geriatric assessment into the management of these patients with cancer. This review article emphasizes the data gathered so far on the correlation between such an assessment and outcome in patients with cancer. The most developed data relate to functional status and comorbidity. Geriatric instruments appear more sensitive than classic oncological instruments in measuring functional status. There is also good evidence that as a patient's age advances, comorbidity affects in an increasing fashion their survival and cancer management. Some evidence is beginning to appear as to the impact a comprehensive geriatric assessment could have on the oncologic management of older patients with cancer.

Activities of Daily Living↗
PubMed2006

Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare.

OBJECTIVES: To assess the impact of a specifically designed model of orthopedic-geriatric cocare on hip fracture (HF) outcomes. SETTING: Tertiary teaching hospital (level I trauma center). DESIGN: Prospective observational study with a retrospective (historical) control. Data on 951 consecutive patients 60 years of age or older admitted to the authors' institution with a nonpathologic HF over a 7-year period (1995 to 2002) were analyzed. Between 1995 and 1997, medical problems were managed by a geriatric medicine (GM) consultation-only service (retrospective audit). In 1998, a GM registrar began overseeing daily medical care with weekly geriatrician consultant review (prospective study). Outcomes for 2 time periods were compared: a 3-year period before (no GM; 504 patients) and a 4-year period after (GM; 447 patients) the introduction of GM cocare. MAIN OUTCOME MEASUREMENTS: Postoperative medical complications, mortality, length of stay, discharge destination, use of thromboprophylaxis, and antiosteoporotic treatment. RESULTS: While comparing 2 periods (GM and no GM), significant reductions in postoperative medical complications and comorbid conditions (in total 49.5% vs. 71.0%, P<0.001) and mortality (4.7% vs. 7.7%, P<0.01) occurred and rehospitalization to medical wards within 6 months decreased (28% vs. 7.6%). However, no differences were observed in median length of hospital stay (10.8 vs. 11.0 days) or in discharge destination. Antiosteoporotic treatment (12% to 69%) and specific thromboprophylaxis (63% to 94%) increased in the GM period. CONCLUSIONS: Orthopedic-geriatric cocare for the older patients with HF was associated with significant reductions in morbidity and mortality, and increases in optimal postoperative care. Options for further improvement of orthopedic-GM cocare need to be investigated.

Aged↗
PubMed2006

Structural neuroimaging research methods in geriatric depression.

Geriatric depression consists of complex and heterogeneous behaviors unlikely to be caused by a single brain lesion. However, there is evidence that abnormalities in specific brain structures and their interconnections confer vulnerability to the development of late-life depression. Structural magnetic resonance imaging methods can be used to identify and quantify brain abnormalities predisposing to geriatric depression and in prediction of treatment response. This article reviews several techniques, including morphometric approaches, study of white matter hyperintensities, diffusion tensor imaging, magnetization transfer imaging, t2 relaxography, and spectroscopy, that have been used to examine these brain abnormalities with a focus on the type of information obtained by each method as well as each method's limitations. The authors argue that the available methods provide complementary information and that, when combined judiciously, can increase the knowledge gained from neuroimaging findings and conceptually advance the field of geriatric depression.

Aged↗
PubMed1994

Reasons for uses of physical restraint and alternatives to them in geriatric nursing: a questionnaire study among nursing staff.

This study is part of a major research project that is concerned with disruptive behaviour among elderly patients and the use of physical restraint in geriatric nursing. The purpose of this study was to describe the use of physical restraint and alternatives as reported by professional nurses. The data were collected by a structured questionnaire. Nursing staff (n = 287) from a geriatric unit of a health centre, a nursing home, and the medical and psychiatric clinics of a university hospital in one city in central Finland, volunteered for the study. The clear majority (85%) of the nurses stated that physical restraint had been used on the ward during the week preceding the questionnaire. Reasons cited most often for restraint use were reduced physical and cognitive capacity of demented patients. The most common alternative was to try to understand the reasons for the elderly patient's disruptive behaviour. A major challenge for future research and for field experiments is to provide new alternatives to the use of physical restraint in geriatric nursing.

Aged↗
PubMed1996

Serum protein electrophoresis: potential test for use in geriatric companion animal health programmes.

The electrophoretic patterns of 117 serum samples from 37 clinically healthy old dogs (age: 10.0 +/- 2.5 years, mean +/- SD) 47 old dogs (age: 9.7 +/- 2.0 years) with different diseases, 18 clinically healthy young dogs (age: 2.9 +/- 1.6 years) and 15 young dogs (age: 2.0 +/- 1.0 years) with different diseases were evaluated using agarose as a supporting matrix. Three major electrophoretic patterns were identified after densitometric scanning. The first pattern was a predominant pattern for the young healthy dogs (found in 67% of dogs in that group) and was considered normal for healthy dogs. The second pattern had relatively higher proportions of beta and gamma globulins (polyclonal immunoglobulinaemia) and was a predominant pattern among the old healthy dogs (found in 51% of dogs in that group). The findings regarding the second pattern appear to suggest that they had been exposed to antigens during their lives and that they had a well developed and responsive humoral immune response. The third pattern was characterized by high levels of alpha globulins, it was the most common pattern in the old diseased dogs (found in 70% of the dogs in that group). The third pattern was considered to indicate an inflammatory response among old dogs when compared to young dogs (P < 0.01). These patterns appear to suggest that because of aging and/or accumulated injury geriatric dogs will have high levels of polyclonal gamma-globulinaemia or acute phase reactants. The observed patterns, especially the one showing high levels of alpha-globulins, could be a valuable parameter in the search for individuals requiring special attention and thus for the establishment of health programmes for geriatric dogs. With further effort, serum protein electrophoresis might prove to be a useful test for the evaluation of geriatric companion animals for diagnostic, prognostic and therapeutic reasons.

Aged↗
PubMed2006

Patient perspective on quality of geriatric care and rehabilitation--development and psychometric testing of a questionnaire.

The aim was to develop and test a questionnaire for use in telephone interviews concerning patient evaluation of geriatric care and rehabilitation. Instrument development was performed comprising qualitative interviews, construction of items, content validation, pilot study and data collection for evaluation of care and rehabilitation, clinical utility, reliability and construct validity. Qualitative interviews were performed with 12 elderly participants. The qualitative interviews formed the basis for the construction of 45 items. An expert panel performed a content validation of the questionnaire resulting in a revised version. A pilot study comprised 29 participants recently discharged from geriatric wards and the main data collection comprised 221 participants. Inclusion criteria were being able to perform a telephone interview and willingness to participate. Clinical utility was examined through questions to the interviewers, answered in writing. Cronbach's alpha coefficient was 0.79. According to a factor analysis and the evaluation of clinical utility, the underlying dimensions of the final revised questionnaire concern 'Respect and safety', 'Information and participation' and 'Rehabilitation interventions', scored in 18 items. In addition, one global item concerns satisfaction with care, resulting in 19 items in total. The revised questionnaire was named PaPeR, Patient Perspective on care and Rehabilitation. The questionnaire is considered valid, reliable and judged to have good clinical utility. The time consumption for the telephone interview is about 10-20 minutes. The questionnaire is useful in defining areas for potential quality improvement in geriatric wards.

Aged↗
PubMed2006

Uncovering frustrations. A qualitative needs assessment of academic general internists as geriatric care providers and teachers.

BACKGROUND: General internists commonly provide medical care for older adults and geriatric education to trainees, but lack the necessary knowledge and skills to fulfill these tasks. OBJECTIVE: Assess the geriatric training needs of academic general internists in 3 hospital systems in Portland, OR. DESIGN: Ten focus groups and 1 semi-structured interview. Interview transcripts were analyzed using thematic analysis, a well-recognized qualitative technique. PARTICIPANTS: A convenience sample of 22 academic general internists and 8 geriatricians from 3 different teaching hospitals. MEASUREMENTS: We elicited stories of frustration and success in caring for elderly patients and in teaching about their care. We asked geriatricians to recount their experiences as consultants to general internists and to comment on the training of Internists in geriatrics. RESULTS: In addition to deficits in their medical knowledge and skills, our Internists reported frustration with the process of delivering care to older adults. In particular, they felt ill prepared to guide care transitions for patients, use multidisciplinary teams effectively, and were frustrated with health care system issues. Additionally, general internists' approach to medical care, which largely relies on the medical model, is different from that of geriatricians, which focuses more on social and functional issues. CONCLUSIONS: Although our findings may not be broadly representative, improving our general internists' abilities to care for the elderly and to teach learners how to do the same should address deficits in medical knowledge and skills, barriers to the processes of delivering care, and philosophical approaches to care. Prioritizing and quantifying these needs and measuring the effectiveness of curricula to address them are areas for future research.

Academic Medical Centers↗
PubMed2006

Perceived needs for geriatric education by medical students, internal medicine residents and faculty.

CONTEXT: Traditional methods of setting curricular guidelines using experts or consensus panels may miss important areas of knowledge, skills, and attitudes that need to be addressed in the training of medical students and residents. OBJECTIVE: To seek input from medical students and internal medicine residents ("trainees") on their perception of their needs for training in Geriatrics. DESIGN: Two assessment methods were used (1) focus groups with students and residents were conducted by professional facilitators and the transcripts analyzed for areas of agreement and divergence and (2) geriatric medicine experts and ward attendings were surveyed to examine training gaps raised by trainees during Geriatric Guest Attending Rounds. RESULTS: Trainees perceived training gaps in caring for elderly patients in the areas of (1) recognizing and addressing the complex, multifactorial nature of illness; (2) setting priorities and goals for work-up and intervention; (3) communication with families and with patients with cognitive disorders; (4) assessment of a patient for discharge from the hospital and the services at different sites in which patients may receive care. They recounted feeling overwhelmed by complex patients and social situations while acknowledging the special aspects of connecting with older patients. The gaps identified by trainees differ from and complement the curriculum guidelines set by expert recommendations. CONCLUSION: Trainees identified gaps in skills and knowledge leading to trainee frustration and potentially adverse outcomes in caring for elderly patients. Development of curriculum guidelines should include assessment of trainees' perceived learning needs.

Attitude of Health Personnel↗
PubMed1978

Geriatrics program for medical students. II. Impact of two educational experiences on student attitudes.

In an innovative program in geriatrics for undergraduate medical students, the preliminary report concerned attitudes toward the aged among health care personnel. This follow-up report concerns the stability of, and changes in medical students' attitudes toward the aged after participation in one of the following types of geriatric educational experience: 1) a Family Practice clerkship, or 2) a selective course in Medical Humanities. Although both experiences resulted in positive changes in general attitudes, the one that emphasized empathy toward the elderly along with observation of healthy aged persons produced more positive feelings about rehabilitation potential. Implications for the geriatric training of physicians are discussed in the light of these findings.

Attitude of Health Personnel↗
PubMed1978

Interest in geriatrics at a university Department of Medicine.

To estimate available resources for teaching geriatrics to medical students, a survey of the members of a university Department of Medicine was undertaken. Information was elicited in six areas: 1) personal data, 2) characteristics of each physician's clinical practice, 3) potential interest in a Division of Geriatrics, 4) the comparative levels of aggressiveness indicated in the management of an old patient versus a young one, 5) the attitude of physicians toward the elderly, and 6) a rough measure of knowledge of the demographic characteristics of the elderly. The results suggest that a significant number of faculty members of a university medical school would indeed be interested in teaching and research in the field of geriatrics.

Adult↗
PubMed1978

Albert Mueller-Deham: distinguished geriatric clinician.

Modern geriatrics is the product of notable clinicians, past and present. However, recognition has been unequal. Pioneers whose publications were pre-eminent in their time have not received adequate identification. In consequence, the field is poorer for such neglect. Albert Mueller-Deham (1881-1971) of Vienna did excellent work in geriatrics. His clinical abilities were based on long staff attendance at a major hospital and by his insistence on attendance, with his staff, at autopsies. His key textbook was published in 1937 in German. His career in Austria was disrupted by political forces but, with energy and ability, he continued it with distinction in the United States. After retirement at age 70, he turned to social writings. A bio-bibliography of this noteworthy man is based on several letters, a personal narrative that he wrote in response to questions about his years in geriatrics, notes from one of his staff, and recollections by his co-author in 1942 of the revised American edition of the book. Students of aging can benefit by recourse to his classical text with its group of clinical principles.

Austria↗
PubMed1979

Geriatric medicine: model for computer-oriented research analysis.

It is important to have accurate information derived from basic data about geriatric patients, not only for clinical management but to anticipate changes in the demand for services and the taking of preventive action. A model is presented for computer-oriented analysis. The collection of data is designed to cover the specific physical, physiologic and social needs of the patients both in the hospital and in the community. It must also support effective action about these needs which involve not only usage of existing facilities but the planning of preventive measures and adjustment of the provision for care. In addition, it must support clinical research when necessary. Geriatric records have specific problems, not only those of the patient's identity and clinical data but also the maintenance of psychologic and social information so that the requirements for long-term care can be assessed. This type of record facilitates comparison between groups of patients and allows measurement of inter-hospital performance relating to medical care and the planning of social programs in the community. Such records furnish the background of a more detailed statistical analysis for indicating the direction of national policy. By this means the prevalence of medical, psychologic and social demand can be studied and various preventive actions taken, including the monitoring of geriatric facilities.

Computers↗
PubMed1980

Gerontologic and geriatric training in medical school: curricular preferences shown by medical students, educators, and general practitioners.

The need for incorporating gerontologic and geriatric training into the education of medical students is evident. Two main obstacles are the lack of educator knowledge in planning such training, and negative attitudes toward aging and the aged. Curriculum planning requires a design for the goals/objectives, the content, and the delivery vehicles. This article concerns chiefly the delivery vehicles, a subject which has received little attention in the literature. Negative attitudes on the part of students and their educators may defeat the incorporation of geriatric training into the curriculum. To assist in reducing these obstacles, a study was conducted for the purpose of providing data to educators which might facilitate the design of a delivery component for a medical student curriculum in gerontology and geriatrics. Senior medical students, their educators, and some general practitioners were surveyed in randomized groups, to determine: 1) their preferences for delivery vehicles in such a curriculum, 2) their attitudes toward aging and the aged, and 3) relevant demographic variables. The results are discussed from the viewpoint of the potential impact of these factors on their preferences and on the creation of obstacles to curriculum incorporation.

Aged↗
PubMed1981

Development of a geriatric behavioral self-assessment scale.

Described is the development of a self-rating geriatric behavioral scale modeled after the Sandoz Clinical Assessment-Geriatric (SCAG). This new Self-Assessment Scale-Geriatric (SASG) provides a valid and reliable measure of behavioral pathologic changes for the selective screening of elderly patients who manifest mile to moderate symptoms of dementia. Further use and refinement of this new measuring device are required to confer on it the maximum possible accuracy.

Dementia↗
PubMed1982

Faculty resources for teaching geriatric medicine.

Self-administered questionnaires were sent to all faculty and staff members of the departments of internal medicine and psychiatry in a school of medicine. The questionnaires asked for information about personal characteristics, practice characteristics, and interest in teaching geriatrics. Included also were measures of knowledge about aging and attitudes toward the elderly. Responses were received from 25 per cent of the faculty. Results indicated that 40 per cent wanted no involvement in teaching geriatrics. Of the remainder, most preferred a consultant's role on a clinical service. Despite extensive experience with elderly patients, respondents showed modest scores on knowledge, but there was little stereotyping of elderly patients. Implications for establishing a training program in geriatrics are discussed.

Adult↗
PubMed1983

Psychologic assessment technology for geriatric practice.

Psychologic assessment is an integral aspect of the comprehensive functional assessment of geriatric patients. Medical areas in which psychologic testing and evaluation can be of significant service in the diagnosis and formulation of treatment plans include psychiatric and neurologic disturbances, psychosomatic disorders, circulatory diseases (especially hypertension), diabetes, chronic pain, sexual dysfunctions, and gastrointestinal problems. In the effort to gain an understanding of the total patient, it is important to clarify the effect of physical condition on a person's psychologic reactions as well as the impact of psychologic states on his/her biologic status. This orientation is particularly important in dealing with elderly patients because the interaction between the physical and the psychologic in this age group is exceedingly strong and significant. Despite the fact that research in the psychology of the aged is of long standing, the attention given by clinical psychologists to the provision of services to geriatric patients has been quite limited until recently. Many psychologic tests have been developed during the past 70 years, but relatively few of them have been standardized for use with the aged. Of late, however, this has been changing. Several tests have been adapted, and some new ones have been organized with the needs and characteristics of the aged in mind. Closer attention has been paid to psychometric principles in the development of the tests, leading to the organization of useful norms and the demonstration of proper levels of reliability and validity. Accordingly, the state of the art of psychologic assessment of the aged is currently rather limited, but the outlook for the near future appears encouraging. In evaluating the condition of a geriatric patient, the clinical psychologist normally generates data through observations, testing, and interviewing. The resulting report covers the following areas: 1) adaptation to the examination and behavioral characteristics during the procedure, 2) cognitive functioning, 3) visual motor coordination and perception of spatial relationships, and 4) personality characteristics and mental health status. Data for the first area are normally derived by the examiner from observations and subjective impressions of the patient's behavior. For each of the other areas the information is obtained through standardized tests. In this discussion, some of the principal assessments that are currently available are reviewed and evaluated for their usefulness with the aged.

Aged↗
PubMed1983

An interdisciplinary geriatric consultation service: a controlled trial.

The structure and function of a newly created interdisciplinary Geriatric Consultation Team (GCT) are described. The GCT was introduced on a single medical unit, where consultations were given to 46 consecutive patients aged 75 years and over. The GCT patients had, on the average, 5.5 illnesses and were receiving 3.7 medications. Anemia (50 per cent), were hypoalbuminemia (65 per cent), and elevated blood urea nitrogen (BUN) (58 per cent) were frequent. Functional assessment showed frequent dependence on others for assistance with ambulation (59 per cent), transfers (54 per cent), and dressing (52 per cent); cognitive impairment was found in 52 per cent and clinical depression in 11 per cent of the patients. In comparison with control units, the GCT increased use of physical therapy by 357 per cent, occupational therapy by 390 per cent, and speech therapy by 300 per cent without increasing length of stay. In comparison with control subjects, GCT patients had no decrease in hospital readmission rates (43 per cent) over 10.5 months of follow up. It was concluded that a GCT in an acute-care hospital promotes geriatrics, teaches interdisciplinary teamwork, improves awareness of functional problems of patients, and increases use of rehabilitative services, but does not decrease the high rate of readmission of hospitalized geriatric patients.

Aged↗