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PubMed1998

Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: a comparison across treatment sites.

OBJECTIVE: Although many geriatric patients with schizophrenia have been referred to nursing home care, little is known about their characteristics. Across nursing home and chronic hospital settings, the authors directly assessed poor outcome geriatric patients with schizophrenia and contrasted their cognitive, symptomatic, and adaptive functioning to that of acutely admitted patients with a better outcome over the lifetime course of the illness. METHOD: The subjects were 97 chronically hospitalized patients with schizophrenia, 37 patients with chronic schizophrenia who lived in nursing homes, and 31 acutely admitted geriatric patients with schizophrenia. These patients were rated with the Positive and Negative Syndrome Scale, tested with a neuropsychological battery, evaluated with the Mini-Mental State examination, and rated on a scale of social and adaptive deficits, the Social Adaptive Functioning Evaluation scale. RESULTS: Each group of patients proved discriminable from the other two: nursing home patients displayed the most severe adaptive deficits, and acutely admitted patients were the least cognitively impaired. Cognitive impairment was the strongest predictor of adaptive deficits for all three groups, and negative symptom differences among the groups were smaller than differences in cognitive impairment. Nursing home patients had the least severe positive symptoms, and the acutely ill and chronic hospital patients did not differ on positive symptoms. CONCLUSIONS: Cognitive impairment is a predictor of both overall outcome and specific adaptive deficits. These data suggest that interventions aimed at cognitive impairment may have an impact on overall functional status. In comparison, positive symptom severity is less strongly correlated with overall adaptive outcome and is uncorrelated with specific deficits in adaptive skills.

Age Factors↗
PubMed2001

Hippocampal and anterior cingulate activation deficits in patients with geriatric depression.

OBJECTIVE: The authors assessed frontotemporal function in patients with geriatric depression, a debilitating and increasingly prevalent disorder that has not been examined with brain activation paradigms. METHOD: Six depressed elderly patients and five healthy comparison subjects underwent high-sensitivity [(15)O]H(2)O positron emission tomography scans during a paced word generation task and a resting condition. RESULTS: Bilateral activation deficits were noted in the dorsal anterior cingulate gyrus and hippocampus of the depressed geriatric patients relative to the comparison subjects. Patients had memory deficits that correlated with lower hippocampal activity during both rest and activation. CONCLUSIONS: These initial findings suggest that hippocampal and dorsal anterior cingulate hypoactivation may constitute contributing neural substrates of geriatric depression. They also suggest that hippocampal dysfunction is related to the memory dysfunction characteristic of this disorder.

Age Factors↗
PubMed2004

Community psychiatrists who see geriatric patients: what's training got to do with it?

OBJECTIVE: This study examines the issues influencing psychiatrists' decisions to provide care to the under-served geriatric population. METHODS: Community-based psychiatrists who see geriatric patients participated in focus group discussions exploring factors that influence the characteristics of their current practices. RESULTS: Personal themes, environmental issues and quality of residency training emerged as important factors interacting in eventual practice choice. Major influences within training programs included teachers, diverse patient exposure and high-quality essential skills teaching. CONCLUSION: Residency program curricula might capitalize on these to better prepare residents and enhance the likelihood of graduates eventually choosing to incorporate geriatric patients into their practices.

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PubMed2002

Prevalence and correlates of elder abuse and neglect in a geriatric psychiatry service.

OBJECTIVE: To determine the prevalence and correlates of 4 types of elder abuse and neglect in a geriatric psychiatry service. METHOD: We conducted a cross-sectional retrospective chart review of new in- and outpatients seen by the Montreal General Hospital Division of Geriatric Psychiatry in one calendar year. RESULTS: Abuse or neglect was suspected or confirmed in 20 (16%) of 126 patients, comprising financial abuse in 16 (13%), neglect in 7 (6%), emotional abuse in 5 (4%), physical abuse in 3 (2%), and multiple abuse in 7 (6%). On bivariate analysis, patients living with nonspouse family, friends, or other persons were significantly more likely to have suffered abuse than were those living with their spouse or in a supervised setting (OR 10.5; 95%CI, 2.3 to 47.8); widowed, divorced, or separated patients were significantly more likely to have suffered abuse than were married patients (OR 4.7; 95%CI, 1.02 to 22.0). Nonsignificant trends included female sex (OR 4.1; 95%CI, 0.89 to 18.6); alcohol abuse (OR 2.1; 95%CI, 0.71 to 6.2); behaviour problems (OR 1.9; 95%CI, 0.71 to 5.2); and chronic cognitive impairment (OR 1.4; 95%CI, 0.55 to 3.8). Although living situation with nonspouse family, friends, or others and marital status of widowed, divorced, or separated were significantly associated with abuse when examined in separate logistic regression models, both were nonsignificant when examined together, suggesting collinearity. Both were retained in the model because they probably represent different aspects of vulnerability. The final model included living situation with nonspouse family, friends, or others (OR 6.1; 95%CI, 0.75 to 49.5) and widowed, divorced, or separated marital status (OR 2.4; 95%CI, 0.21 to 26.8). Nonsignificant trends included female sex (OR 2.6; 95%CI, 0.45 to 14.4); alcohol abuse (OR 2.2; 95%CI, 0.59 to 7.9); and lowest quartile on the Global Assessment of Functioning (GAF) scale (GAF < 35; OR 2.0; 95%CI, 0.64 to 6.0). CONCLUSIONS: The practical implications of our study are that elder abuse and neglect are common among patients referred to geriatric psychiatry services, that such services should have access to multidisciplinary expertise and resources to deal with abuse, and that certain situations may signal higher risk. In our setting, the situation of living with nonspouse family, friends, or other persons in a nonsupervised setting and a history of family disruption by widowhood, divorce, or separation were significant correlates of abuse. Suggestive but nonsignificant trends of potential importance (OR > or = 2.0) included female sex, alcohol abuse, and lowest quartile of functional status. Study limitations include a cross-sectional retrospective chart review design, a clinically derived sample, a small sample size, and a lack of structured instruments for several variables.

Aged↗
PubMed1987

Geriatric referrals to a psychiatric consultation-liaison service.

Geriatric patients constitute a significant proportion of referrals to a psychiatric consultation-liaison service, accounting for 29% of referrals in the present study. Organic mental disorders, the most common psychiatric diagnosis, were identified in 51% of geriatric referrals. The next most common psychiatric conditions were affective disorders and adjustment disorders, each of which were diagnosed in 17% of geriatric referrals. Transfers to in-patient psychiatry were unusual and the most common recommendations were for psychotropic medications, further medical investigations, and for psychosocial and behavioural interventions to be carried out by the ward staff. Although more specialized psychogeriatric units and community treatment resources are necessary, it is likely that the general hospital setting will continue to be important in the diagnostic assessment and short-term management of medical-psychiatric problems in the elderly.

Age Factors↗
PubMed1994

Mandatory training in geriatric psychiatry: can programs deliver the goods?

There have been a number of recent attempts to establish guidelines and curricula for training of general psychiatry residents in geriatric psychiatry. However, concerns have arisen as to whether or not many training programs have the resources necessary to train residents using these guidelines. In an attempt to determine how closely training guidelines are adhered to, the Division of Geriatric Psychiatry at the University of Toronto anonymously surveyed all general psychiatry residents completing their mandatory training in geriatric psychiatry between June 1992 and July 1993 (N = 30). The supervisors of these residents were surveyed anonymously as well (N = 15). The response rate was 83% for the residents and 80% for staff. In general, the training guidelines were closely adhered to except possibly for the required number of patient contact hours per week. The author concludes that when training guidelines are developed which include consideration of appropriate program resources and the number of residents required to train, residents and supervisors adhere closely to these guidelines.

Aged↗
PubMed1994

The future of geriatric psychiatry.

The author first reviews some of the main forces and historical developments that have shaped the young specialty of geriatric psychiatry. Emphasis is placed on the integrative and collaborative nature of the psychiatry of old age. This includes its relationship with the parent field of psychiatry, geriatric medicine and the broader field of gerontology. An outline of the future for the field is presented which highlights the need for academic credibility and responsiveness to service delivery issues. Because future trends in mental health delivery are likely to continue to give priority to the severely mentally ill and to emphasize cost-effectiveness, geriatric psychiatrists are well poised to meet the challenges of the coming generation. However, a strong future depends ultimately on the ability of the field to recruit bright young psychiatrists who bring inquisitiveness, enthusiasm and a social commitment to a vulnerable elderly population.

Aged↗
PubMed1996

[Psychometric properties of the French version of the Modified Mini-Mental State (3MS) in elderly patients evaluated in geriatric psychiatry].

OBJECTIVE: This research evaluates the psychometric properties of the French version of the Modified Mini-Mental State (3MS), an instrument for the screening of dementia, in a sample of patients seen in geriatric psychiatry. METHODS: Subjects (N = 94, 63 to 93 years of age) were outpatients of a service in geriatric psychiatry. In addition to the 3MS, a battery of tests evaluating the cognitive functioning and depressive symptomatology was administered. RESULTS: Test-retest reliability coefficient was 0.87 for a subsample of 35 subjects. An exploratory factor analysis revealed 4 factors accounting for 63.2% of the variance. Cut-off scores of 79 to 80 (with years of education > or = 8) and 71 to 72 (with years of education < or = 7) presented the best combination sensitivity/specificity, respectively 0.80 and 0.96. CONCLUSIONS: This study documents the psychometric properties of the French version of the 3MS for use in patients seen in geriatric psychiatry, in suggesting cut-off scores which take into account the level of education. This study underlines the influence of sociodemographic variables on test performance.

Aged↗
PubMed1998

Geriatric psychiatry outreach practices in the province of Ontario: the role of the psychiatrist.

OBJECTIVE: To determine the mode of practice of multidiscliplinary and interdisciplinary teams in the field of geriatric psychiatry in the province of Ontario with specific reference to the role of the psychiatrist on the teams. METHOD: Teams were identified, and a simple questionnaire was developed and submitted to every team at an annual conference. RESULTS: Responses were obtained from 38 out of 47 teams. The composition of the teams is variable as regards size and represented discliplines. Nine teams do not have psychiatrists directly affiliated with them. Eighteen teams, 4 of which are based in teaching hospitals, have fewer than 1 full-time equivalent (FTE) psychiatrist. Among these teams, 4 have fewer than 0.1 FTE psychiatrist and 10 have fewer than 0.5 FTE psychiatrist. Eleven teams include between 1 and 1.5 FTE psychiatrists on their staff. Four teams (10.5%) require that the initial assessment of all patients be undertaken by a psychiatrist. In 18 (47%) of the teams, assessment by a psychiatrist can be infrequent or nonexistent. Discussion of the referral with a psychiatrist occurs in the majority of teams, but in a significant minority (10 [27%]), this occurs quite infrequently or not at all. CONCLUSION: Geriatric psychiatry outreach practices in Ontario involve many different disciplines in the assessment and follow-up of geriatric psychiatry patients, often without the ready availability of psychiatric input. We applaud the expanding roles of different disciplines in this practice. We are concerned, however, at the paucity of psychiatrists working in this field.

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PubMed1997

Neuropsychological predictors of adaptive kitchen behavior in geriatric psychiatry inpatients.

This study examined the degree to which demographic variables, psychiatric diagnosis, depression rating, and neuropsychological test performance predict adaptive kitchen behavior in geriatric psychiatry patients and normal elderly volunteers. Amixed group of 27 participants including 8 normal volunteers and 19 geriatric psychiatry inpatients underwent psychiatric evaluation, neuropsychological testing, and a kitchen skills assessment conducted in a natural setting. Both depression and dementia were prevalent among patients. The kitchen skills assessment was abnormal in 69% of patients, compared to none of the normal volunteers. Estimated premorbid IQs, psychiatric diagnosis, and neuropsychological test scores significantly predicted the pass/fail status on the kitchen skills assessment, but there was no effect for age, education, gender, or depression. The discriminant function analysis classified 92% of cases, and the canonical correlation coefficient was .84. Of the neuropsychological tests employed in the study, two tests involving visuospatial processing and attention were retained in the discriminant function analysis. The results are consistent with previous studies that suggest that visuospatial tasks are more predictive of instrumental activities of daily living than are cognitive tasks emphasizing verbal and memory abilities. In addition, we conclude that neuropsychological test data are useful and valid for the purpose of guiding clinical judgments regarding activities of daily living in geriatric psychiatry patients.

Activities of Daily Living↗
PubMedDate not supplied

Studies of comprehensive geriatric assessment in patients with cancer.

BACKGROUND: The comprehensive geriatric assessment (CGA) has been developed to individually assess the health status of older patients. METHODS: This article reviews the findings regarding the impact of a comprehensive geriatric assessment (CGA) on treatment and outcomes in patients with cancer. RESULTS: Several geriatric variables have been linked with the prognosis of older cancer patients, thus challenging the role of ECOG performance status in this population. A CGA may detect multiple untreated or undertreated problems in cancer patients. Although results are preliminary, some studies suggest that CGA may influence cancer treatment decisions and have a prognostic impact on patients with this disease. CONCLUSIONS: More work is needed to simplify such assessments to make them more feasible and to determine when they should be used during a patient's clinical course.

Aged↗
PubMed2005

Advancing geriatrics education: evaluation of a new curricular initiative.

BACKGROUND: This study describes the development of a required 1-week curricular program in geriatric medicine for 3rd-year medical students and presents 3 years of evaluation data. DESCRIPTION: Successful aging, heterogeneity of the aging population, and comprehensive geriatric assessment were emphasized. In addition to didactic sessions, students participated in panel discussions and small group case conferences, and performed history and physical examinations on older patients. EVALUATION: Students' acquisition of knowledge about geriatric medicine was assessed with pre-and posttests; posttest scores showed statistically significant improvement. Because attitudes toward older patients can impact the care provided, students' completed pre- and postattitude assessment scales. Attitude measures were repeated for 2 student cohorts, 1 and 2 years after completion of the program. Independent t tests comparing mean pretest and posttest scores revealed significant improvement in students' attitudes, which were maintained when attitudes were retested. Standardized mean difference scores were computed to measure the relationship between the educational intervention and students' attitude measures. CONCLUSIONS: Time in the medical school curriculum is scarce, but these results indicate that significant improvements can be made in medical students' attitudes toward and knowledge of older patients in 1 week.

Adult↗
PubMed2000

The modern geriatric day hospital.

Geriatric day hospitals have played a major role in the rehabilitation of older people, although the evidence base has proved thin. As the provision of geriatric medicine changes, they need to develop new roles such as responding to subacute crises, providing specialist services and ensuring comprehensive geriatric assessment before long-term care.

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PubMed1989

The effects of a program for faculty development in geriatrics for physician assistant teachers.

A Geriatric Education for Physician Assistant (PA) Faculty program enrolled teachers from 21 of the 55 PA training programs in the country to participate in three-week training sessions at Stanford University. The faculty trainees took part in lecture/discussion, audio-visual review, clinical training, and individual conferences. They prepared a lecture and a complete geriatric teaching plan for their home program, and were assigned a text and numerous articles to read. Measures of effect of the training found the following: a significant increase in knowledge scores, although the trainees came into the program with relatively high scores; a heightened awareness and increased positive attitudes toward aging; high ratings of performance on a functionally oriented comprehensive health assessment; and augmented geriatric curriculum and clinical training in their home PA programs.

Curriculum↗
PubMed2003

Organizational issues in establishing geriatrics interdisciplinary team training.

The John A. Hartford Foundation-supported geriatrics interdisciplinary team training (GITT) initiative was a bold attempt to create a new educational agenda for the health professions. Although some components of GITT were previously in place at the eight institutions that participated in the Hartford initiative and at other institutions (e.g., Department of Veterans Affairs), never before has geriatrics interdisciplinary team training been so systematically planned, implemented, or evaluated. This paper focuses on four organizational factors essential to the establishment of a geriatrics interdisciplinary team training program: (1) organizational readiness to implement GITT, including the needs and existing resources of the organization; (2) partnerships, specifically the relationships between academic and clinical organizations; (3) institutional support, the tangible and intangible sources of support necessary at multiple levels within the organization; and (4) structure, the administrative and organizational requirements for team training programs. An analysis of these four factors and the influences upon them can help facilitate the successful implementation of interdisciplinary training programs at institutions considering this educational approach.

Aged↗
PubMed2004

Using online modules is a multi-modality teaching system: a high-touch high-tech approach to geriatric education.

Making geriatric education available to rural faculty/preceptors, students, and practitioners presents many challenges. Often the only options considered for educating those in the health professions about geriatrics are either traditional face-to-face courses or distance education programs. The purpose of this paper was to examine the use of Web-based modules or courses and other distance learning technology in concert with traditional learning modalities. The Mountain State Geriatric Education Center explored the use of a multi-modal approach within a high-touch, high-tech framework. Our findings indicate the following: it is important to start where participants are ready to begin; flexibility and variety are needed; soliciting evaluative feedback from participants is valuable; there is a need to integrate distance learning with more traditional modalities; and a high-tech, high-touch approach provides a format which participants find acceptable, accessible, and attractive. This assertion does not rule out the use of technology for distance education but rather encourages educators to take advantage of a wide range of modalities, traditional and technological, to reach rural practitioners, faculty, and students.

Computer-Assisted Instruction↗
PubMed2006

Interdisciplinary educational approaches to promote team-based geriatrics and palliative care.

Despite the increasing public demand for enhanced care of older patients and those with life-threatening illness, health professionals have had limited formal education in geriatrics and palliative care. Furthermore, formal education in interdisciplinary team training is limited. In order to remedy this situation, proactive interventions are being undertaken so that education and training in palliative care is being embedded within the training of physicians, nurses, social workers, as well as other associated health team members. This article discusses various educational approaches to interdisciplinary team-based geriatric and palliative care, highlighting the interdisciplinary didactic and clinical educational opportunities offered by an Interprofessional Palliative Care Fellowship Program, as well as an Associated Health Training Program at the Geriatrics Research, Education, and Clinical Center, Bronx Veteran's Medical Center. The article further describes the educational initiatives in palliative care offered through the Veteran's Integrated Service Network (VISN). Innovative educational strategies are discussed within the context of the existing literature on interdisciplinary health care team training.

Education, Professional↗
PubMed2006

Objective Structured Video Examinations (OSVEs) for geriatrics education.

The Medical College of Wisconsin (MCW) and the Wisconsin Geriatric Education Center (WGEC) are committed to developing educational materials for primary care physicians in training. In response to the opportunity created by the Accreditation Council for Graduate Medical Education (ACGME) competency mandate, an MCW-led interdisciplinary working group has developed competency-linked video-based assessment tools for use in primary care residency training programs. Modeled after the Objective Structured Clinical Examinations (OSCE), used as part of the medical licensing examination process, we created geriatric-focused Objective Structured Video Examinations (OSVEs) as a strategy to infuse geriatrics into residency training. Each OSVE tool contains a 1-3 minute video trigger that is associated with a series of multiple choice and/or constructed response questions (e.g., fill in the blank). These questions assess residents' understanding of video-demonstrated ACGME competencies including professionalism, systems-based practice, communication, and practice-based learning. An instructor's guide and scoring key are provided for each tool. Response to the OSVEs has been overwhelmingly enthusiastic including greater than 90% commitment by statewide faculty to use the tools in residency training.

Aged↗