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PubMed2006

Geriatric education across 94 million acres: adapting conference programming in a rural state.

Montana, a predominantly rural state, with a unique blend of geography and history, low population density, and cultural diversity represents the challenges for program development and implementation across remote areas. The paper discusses two statewide multidisciplinary geriatric education programs for health professionals offered by the recently established Montana Geriatric Education Center (MTGEC); use of telecommunications technology; collaborations with Geriatric Education Centers (GECs) and the Montana Healthcare Telemedicine Alliance (MHTA); and training outcomes, insights, and implications for continuing education of health professionals who practice in hard-to-reach regions. In addition, data from a statewide needs assessment are presented specific to preferred format. The MTGEC training model that combined traditional classroom and videoconference increased attendance by twofold and may be adapted in other regions to train providers in remote areas of the U.S.

Adult↗
PubMed2006

The Senior Mentor Program at the University of South Carolina School of Medicine: an innovative geriatric longitudinal curriculum.

This paper describes development, implementation, and evaluation strategies of a longitudinal geriatric curriculum, the Senior Mentor Program (SMP). The rationale for exposing undergraduate medical students to healthy, community-dwelling older adults is to use the relationship and activities as vehicles for improving knowledge of aging and providing students experience with aging as a stage and process. The University of South Carolina School of Medicine's major aim in geriatrics is to prepare students to become skilled physicians in care of older adults. The SMP is embedded into the curriculum. The program introduced medical students to healthy older adults, presented selected health care issues in this population, integrated material early in the curriculum, acquainted students with longitudinal patient care, and introduced students to older adults' living arrangements. The SMP is an effective means of infusing geriatric content into the medical school curriculum and positively affects mentors' and students' attitudes toward each other. This has implications for medical and professional schools, such as nursing, social work, and physical therapy.

Adult↗
PubMed2006

From aging . . . to saging- the Ohio State Senior Partners Program: longitudinal and experiential geriatrics education.

Ohio State College of Medicine began its Senior Partners Program (SPP) in 2001 as part of its commitment to integrate geriatric education throughout all four years of the medical curriculum. For participating senior partners and medical students, the SPP has signified a journey through a continuum of aging. Initial evaluations suggest that students have gained appropriate knowledge, skills, and attitudes to care for seniors responsively and cost effectively. Perhaps most important is the attitude change that this experience has brought about in the students, who are now substituting the health model for the traditional disease model of aging, and who have learned to lay aside their stereotypes of aging. Student debriefings and faculty evaluations indicate improved learning of geriatric skills and knowledge associated with the SPP. Ongoing program modification and evaluation will help guide Ohio State's next steps in geriatrics education.

Adult↗
PubMed2006

Building on the life-span perspective: a model for infusing geriatric social work.

The growth in the older adult population and the demand for better trained geriatric social workers challenge the existing curricula of social work programs. The Geriatric Enrichment Grant funded by the John A. Hartford foundation has provided financial support for curricular reform. Curriculum reform is a challenging undertaking at any level. Each program and educational institution experiences the process of curriculum reform in unique ways. This paper describes one program's experience of curriculum reform for the purpose of infusing geriatric content.

Aged↗
PubMed2001

Potential adverse drug events in an indigent and homeless geriatric population.

OBJECTIVE: To identify potential adverse drug events (ADEs) in a geriatric ambulatory population using the modified Beers criteria. METHODS: This is a cross-sectional study of an indigent and homeless geriatric population served by a network of six primary healthcare clinics with clinical pharmacy services. Medical records of patients > or = 65 years old visiting the clinics between December 1999 and April 2000 were retrospectively reviewed by a clinical pharmacist. Medications meeting the modfied Beers criteria were evaluated for the most common drug classes involved, severity potential, and dose or disease state restrictions. Following the identification of medications meeting Beers criteria, the pharmacist left a written recommendation regarding use of alternative drugs or doses in the medical record. Physician acceptance of pharmacy recommendations was also evaluated. RESULTS: Medical records of 146 patients (71.9% women, average age 72.6 +/- 6.7 y) were reviewed. Overall, 52 patients (35.6%) had 70 medications with the potential for causing an ADE based on the modified Beers criteria The most commonly identified medication classes were narcotic analgesics (20.0%), antihypertensives (20.0%), and antihistamines (14.3%). Fifteen of these medications (21.4%) had a high severity potential. Identified medications met the following modified Beers criteria: 41.4% were inappropriate in a specific disease state, 38.6% were inappropriate for the elderly, 10.0% exceeded maximum dosage guidelines, and 10.0% were inappropriate for both the elerly and the patients disease state. Approximately 60% of pharmacy recommendations were accepted by physicians. CONCLUSIONS: The modified Beers criteria are a useful tool for reviewing medical records to identify potential ADEs in an ambulatory geriatric population.

Aged↗
PubMed2003

Mortality rate of chronically ill geriatric patients with subnormal serum thyrotropin concentration: a 2-yr follow-up study.

We investigated the natural course of subclinical thyroid dysfunctions in geriatric patients, especially regarding their association with mortality rate. Ninety-three randomly selected chronically ill geriatric patients 64- 87 (median: 77) yr of age participated in the screening study with a 2-yr follow-up. Serum thyrotropin (thyroid- stimulating hormone [TSH]), free thyroxine, triiodothyronine, and antibodies against thyroid peroxidase were measured. During the follow-up, patients with suppressed TSH levels who were otherwise euthyroid (untreated) had a higher mortality rate than patients with normal TSH (5/8 vs 18/64; p < 0.05). The initial clinical state of these two subgroups did not differ significantly. Two-thirds of patients with treated hyperthyroidism died. The mortality rate of patients with initially subnormal but not suppressed TSH level was average and did not differ statistically from either the euthyroid or the hyperthyroid groups. Only 1 of 13 euthyroid patients with positive thyroid antibody titers developed a subsequent subclinical hypothyroidism. Subclinical hyperthyroidism was found to be associated with a higher mortality rate in chronically ill geriatric patients, which justifies screening for thyroid dysfunction and treatment of subclinical hyperthyroidism. In addition, a subnormal but measurable TSH was not indicative regarding the future development of hyperthyroidism. Finally, during the 2-yr follow-up, antibody positivity in the euthyroid cases did not prove to be predictive for the subsequent development of hypothyroidism.

Aged↗
PubMed1998

Streptogramins and their potential role in geriatric medicine.

Despite advances in antimicrobial chemotherapy over recent decades, morbidity and mortality secondary to infection continues to rise. In addition, the incidence of infection caused by resistant organisms has also increased. Concurrently, the elderly are living longer than prior generations, often with disabling chronic diseases. The more debilitated of the geriatric population are at greater risk for infection, and more likely to acquire or develop antimicrobial resistant organisms. Gram-positive organisms are a source of resistance and commonly cause infection in older patients. Whereas resistance is a concern in all patients, in the elderly this is magnified by limitations in treatment options because of differences in pharmacokinetics and tolerance as compared with younger counterparts. Pharmacokinetic differences include changes in drug distribution and may arise as a result of diminished end organ function. Age-related decreases in renal function often impact on commonly prescribed antimicrobials. In addition, the elderly are more susceptible to drug-drug interactions because polypharmacy is common in this patient population. Streptogramins may offer a useful alternative in the treatment of infections in the elderly due to their coverage of organisms commonly causing infections in this population and because of their favourable pharmacokinetic profiles. While published experience is limited, streptogramins are not appreciably eliminated by the kidney and, therefore, they are less subject to age-related changes in renal elimination. What is required is multi-dose pharmacokinetic analysis of streptogramins in geriatric populations and subset analysis of patient use data on file. The following will provide the reader with the most recently presented data on streptogramin use and their potential. While focusing on potential use in the elderly, we have cited data and issues which we believe will be relevant in the geriatric population.

Aged↗
PubMed2006

Drug use in a geriatric long-term care setting: comparison between newly admitted and institutionalised patients.

BACKGROUND AND OBJECTIVE: Advanced age, co-morbid diseases, functional dependence and frailty are associated with polypharmacy and overall high health expenditures. Polypharmacy is commonly defined as the concomitant ingestion of four or more medications, particularly in community-dwelling patients, but the number of drugs being taken by institutionalised and hospitalised patients may be as high as ten. The aim of this study was to compare drug use in newly admitted patients (AP) to a geriatric medical centre for long-term care (LTC) with that of institutionalised patients (IP) at the centre. METHODS: A cross-sectional study was conducted, between January 2001 and December 2002, in 324 functionally dependent and cognitively impaired elderly patients (> or = 65 years of age), consisting of 167 IP (127 females, 40 males) staying at the centre for > or = 3 months and 157 (117 females, 40 males) consecutive new admissions for LTC. All patients underwent a comprehensive geriatric assessment, which included a structured medical history, history of drug use, physical examination and functional and cognitive examinations. Overall drug use, drug categories and the basis of use (regular and/or as needed) were compared between the two groups of patients. The pattern of drug use was defined as use of drugs either on a 'regular' basis or on an 'as needed' basis at any time during the 3 weeks preceding the comprehensive geriatric assessment. RESULTS: IPs were younger, more dependent, more cognitively impaired, had more co-morbidity and had nonsignificantly higher overall drug use than APs. APs used drugs mainly on a 'regular' basis. All of the IPs and most (97%) of the APs were taking drugs according to regular regimens. However, advanced age in IPs was associated with lower overall drug use, predominantly of medications taken on a 'regular' basis, and higher use of drugs taken on an 'as needed' basis, whereas in APs, advanced age was associated with higher use of both types of medications. CONCLUSION: IPs used more drugs on an 'as needed' basis, probably because of closer medical supervision of these patients than those in the community. Better knowledge of the patient's medical condition and treatment, together with better monitoring in the community through patient caregiver instruction, on the one hand, and computerisation of medical data accessible to all healthcare providers, on the other hand, might reduce drug use on a regular basis and, consequently, the costly and adverse effects of polypharmacy.

Aged↗
PubMed1996

Geriatric psychiatry at the interface of consultation-liaison psychiatry and primary care.

OBJECTIVE: This article describes the evolution of a primary care geriatric psychiatry program which serves clinical, educational, and research functions. METHODS: Program development proceeded through stages of liaison using research, focusing on primary care attendings, and developing the common interest of geriatrics. RESULTS: Collaborative research with external funding has continued. A geriatric psychiatry primary care fellowship program was established. Clinical activity is based on consultation-liaison work in nursing homes, an outpatient dementia clinic, a general hospital medical service, and the outpatient clinic. Fellows are involved in training both psychiatry and primary care residents. CONCLUSIONS: Necessary components of a successful collaboration include: 1) primary care physicians with an interest in and aptitude for psychiatric issues; 2) delivery of service and training based on an assessment of the primary care site's needs; 3) a physical presence in the primary care site.

Geriatric Psychiatry↗
PubMed1992

Comparison of the Hamilton Depression Rating Scale and the Geriatric Depression Scale: detection of depression in dementia patients.

The present longitudinal prospective study compared results from the Geriatric Depression Scale with those from the Hamilton Depression Rating Scale for 30 dementia patients. The criterion measure was presence of depression as indicated by the psychiatric diagnosis. The psychiatrist and physician's assistant made the Hamilton ratings while the psychology staff administered the Geriatric Depression Scale. The two measures were statistically unrelated from Times 1 and 2 (rs = .26 and .41). Eleven (37%) patients were depressed and nine received antidepressant medications. Sensitivity ratings were 82% and 9%, respectively, and specificity ratings were 88% and 92%, respectively. Possible explanations for the success of the Geriatric Depression Scale and lack of success of the Hamilton ratings in detecting depression in this population are discussed.

Aged↗
PubMed1998

Correlations between scores on Chinese versions of long and short forms of the Geriatric Depression Scale among elderly Chinese.

A total of 187 elderly Chinese from the community were interviewed with the Chinese versions of the Geriatric Depression Scale-the long form and the short form. The scores on a proposed new version of the short form were also calculated. Cronbach alpha for the Geriatric Depression Scale-long form was .86. The correlations were significant between scores on the long and short forms (r = .94, p < .05) and between these on the long and new short forms (r = .91, p < .05). Cronbach coefficient alpha for the short form was .77 and for the new short form .81. Results of our study indicated that responding by these elderly persons on both short forms is acceptably internally consistent in comparison with those on the original Geriatric Depression Scale.

Aged↗
PubMed1998

Confirmatory factor analysis of the nurses' observation system for geriatric referrals.

The Nurses' Observation System for Geriatric Referrals is a 30-item observational scoring system for geriatric inpatients. As constructed, it is scored into six subscales of five items each; however, these six factors have not been empirically validated. A confirmatory factor analysis, performed on a sample of 218 completed forms for 218 geriatric inpatients, did not support the six original factors. Exploratory factor analysis gave a five-factor solution that partially replicated the scale's original factors but which also indicated important differences for interpretation and clinical use.

Aged↗
PubMed1992

The aging of the aged: challenges for gerontology & geriatrics in the United States.

It comes as no surprise that global graying will be one of the most pressing issues of the coming century. The most rapidly growing age group in all developed countries is the one with persons aged 85 and older. Often referred to as the "oldest old", the aging of the aged reflects a universal concern being experienced in the United States as well as in other industrialized countries, such as Japan. This paper addresses the challenges that such changes present for gerontology and geriatrics. Contextual projections of population trends and of life expectancy, as well as actual health care costs and estimated government health care expenditures will be compared for the United States and for Japan. Among the geriatric challenges being confronted are (1) the need to separate aging from disease, (2) the need for more geriatric centers and available geriatricians to serve the aged, (3) the introduction of health care strategies of prevention and case management, (4) responses to the notion of health care rationing, and (5) the ultimate importance of research ranging from the biological and molecular to the behavioral, social, and health service delivery. Global aging presents a gerontological imperative that may best be understood by examining policy recommendations and future policy decisions.

Aged↗
PubMed1998

[Usefulness and problems of percutaneous endoscopic gastrostomy in a geriatric hospital].

Usefulness and problems of percutaneous endoscopic gastrostomy (PEG) placement in a geriatric hospital where most patients were severely demented or bed-ridden were evaluated. The variables examined were acute complications, chronic complications, restraint of patients before and after PEG placement, change in physical activity, and ability of oral intake. Results showed that both acute and chronic complications were not rare, but these problems are not peculiar to geriatric hospitals. Quality of life (QOL) was clearly improved. Restraint could be reduced or stopped in 65.2% of restrained patients after PEG tube placement, activity was improved in 55.5% of patients, and oral intake became possible in 14.0% of patients. There were also some improvements in the management of PEG, as the incidence of self-extubation decreased, and tube exchange became easier. In conclusion, it is possible to insert and manage the PEG tubes even in geriatric hospitals, and PEG tubes are quite useful in managing patients with chronic disease and in improving QOL.

Aged↗
PubMed2000

[Why do medical students not have a geriatrics textbook?].

To study the opinions of medical students on textbooks of geriatrics, we made a questionnaire for 5th-year medical students. All students had their own textbook (s) of internal medicine, and nearly half of the students had textbook (s) of physical examination. However, only 3.6% of students had their own textbook of geriatrics. The reasons for not having a textbook of geriatrics were as follows: 1) no understanding which textbook is better (59.1%), 2) no need to have a textbook (15.5%), 3) no appropriate textbooks (4.1%), and 4) others (17.6%). The most important point for choosing a textbook was as follows: 1) information from friends or seniors (38.9%), 2) looking by oneself (47.7%), 3) recommendation of a teacher (9.8%), and 4) others (3.6%).

Adult↗
PubMed2004

[Geriatric medicine and long-term care insurance].

Long-term care insurance (LCI) started from April 2000 in Japan. LCI now occupies a central position in the health care of the aged. We reviewed all original papers and reports on LCI published in 1996-2002. At the end of 2002, we searched for papers on LCI in a computer database using the keyword of LCI, and found 3,606 papers. Authors and contents of each paper were categorized using 54 kinds of keywords. Frequent authors were government agencies, care managers, physical therapists, and physicians. When we analyzed these papers according to the places where LCI was used, more than 50% of reports concerned LCI at home. Most frequent keywords were Government/LCI system. Regional health, Physician' assessment and grades for care. Care management, Care manager, and Rehabilitation. Care manager was less observed after the start of LCI. In contrast, the use of keywords including Care service. Dementia, Geriatric syndrome, Nurse, Institutional medicine, Hospital care, Medicine for the aged, Terminal care, Dialysis therapy, Abuse of the aged, and Caregiver burden were increased after LCI. At the beginning of LCI, main concerns are on the new LCI system. However, more individual issues in the care of the aged are now discussed. New issues such as Abuse of the aged and Caregiver burden have been recently raised. From these observations, the role of geriatric medicine seems also to be changing after the induction of LCI. We would now contribute actively to crucial aspects of LCI, such as comprehensive assessment of the aged, functional medical network with care staffs, and new therapeutic approaches to each geriatric syndrome.

Aged↗
PubMedDate not supplied

Development, implementation, and evaluation of a geriatric nurse education program.

Substantial gaps exist between the number of older adults requiring competent geriatric care and the number of nurses able to provide it. The purpose of this study was to develop, implement, and evaluate a geriatric nurse education program to ensure nurses meet the needs of the increasing elderly population. Establishing partnerships between individuals in academia and those in a clinical practice was imperative in the development of the program. Content for the program was created with the assistance of a geriatric nursing consultant and approved by the State Nurses Association. The program was piloted with 18 participating nurses. Using paired ttests, pretests and posttests revealed significant improvements in the level of knowledge and attitudes toward older adults. As a result of the program, participants showed improved attitudes toward and increased knowledge of older adults' needs, and further program development and dissemination are planned nationally and abroad.

Aged↗
PubMed1992

The level and focus of geriatric nursing content in ADN and BSN programs.

The didactic and clinical focus of geriatric curriculum content within both associate (ADN) and baccalaureate (BSN) schools of nursing in California was reviewed. Geriatric nursing content experts confirmed the detail of a geriatric nursing curriculum, then determined which of the content items were basic to both educational levels, and which might be appropriately deferred to programs of baccalaureate preparation. Nurse educators may use the results of this study to guide curriculum development in both depth and breadth of content.

California↗