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PubMed1992

The roles of general and geriatric medicine in the provision of acute medical care for elderly patients.

To determine whether there are differences between elderly patients admitted acutely to general medicine and those admitted to geriatric medical wards, and whether the patients are appropriately referred, a prospective survey of 426 consecutive patients aged 65 years or over admitted acutely to general medical and geriatric wards over a three month period was performed. A total of 286 patients were admitted to general medicine (GM) and 140 to the geriatric unit (GER). GER patients were older (81.0 v. 75.8 years) and had greater pre-morbid functional impairment and incontinence. Fewer GER patients presented with readily apparent organ specific diagnoses (56% v. 94%). Median length of stay was longer in GER patients (23 days v. 9 days). Variables independently predictive of GER admission were increasing age, increasing duration of illness, poor pre-morbid functional status and prior reliance on a carer. Length of stay was not associated with unit of admission allowing for the variables described above. GER patients are a different population. They have more chronic illness and functional impairment, and are more likely to require multidisciplinary assessment and rehabilitation in addition to treatment of presenting illness. Elderly patients are appropriately referred by General Practitioners (GPs) without a formal admissions policy.

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PubMed2004

Estimating geriatric patient's body weight using the knee height caliper and mid-arm circumference in Hong Kong Chinese.

The use of the knee height caliper is a convenient way to estimate a patient's body weight. However, the equation devised to estimate an individual's body weight was specifically designed for Caucasians and Blacks. Therefore, this study is to assess the suitability of the knee height caliper among Chinese geriatric patients residing in Hong Kong. Over a six-month period, all geriatric patients from an acute care hospital and private nursing home in the Kwun Tong were recruited into the study. Only patients/residents that were considered unstable with ascites; low blood pressure; on cardiac monitors or had respiratory difficulties were excluded. Measurements from the knee height caliper and mid-arm muscle circumference of the patients were necessary for estimating their body weights. The actual body weights measured with calibrated bed, chair or portable scales was compared with the calculated body weights from the equation. A comparison of the mean and linear regression was performed for analysis of the results. A total of 300 geriatric patients (200 females and 100 males) were recruited. The mean MAC and knee height results were as follows: 25.1 cm (SD 3.9) for females and 26.2 cm (SD 3.2) for males; and 45.75 cm (SD 2.09) for females and 48.98 cm (SD 2.09) for males respectively. The mean difference among the male group was 0.4222 (95% CI: -0.54, 1.39) with a mean estimated body weight of 58.1 kg (SD 10.1) and a mean actual body weight of 57.7 kg (SD 9.9). The mean difference among the female group was 2.9649 (95% CI: 2.30, 3.63) with a mean estimated body weight of 51.6 kg (SD 10.9) and a mean actual body weight of 48.6 kg (SD 10.1). A new equation devised from the data is as follows: Chinese males (over 60 years of age) (R-square -0.81) Weight = [knee height (cm) x 0.928 + mid-arm circumference (cm) x 2.508 - age (years) x 0.144] - 42.543 +/-9.9kg of actual weight for 95% of Chinese males; Chinese females (over 60 years of age) (R-square - 0.82) Weight (kg) = [knee height (cm) x 0.826 + mid-arm circumference (cm) x 2.116 - age (years) x 0.133] - 31.486 +/-10.1kg of actual weight for 95% of Chinese females. The results showed that the mean estimated body weight calculated from the knee height equation (for Caucasians) was significantly larger than the mean actual body weight for the Chinese subjects. This study suggests that the knee height caliper is a useful tool for estimating the body weights. However, a multi-center study is necessary to validate the new equation for the elderly Chinese population.

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PubMed2004

[Symptoms of severe digoxin intoxication in patients hospitalized in geriatric wards].

Digoxin is a drug commonly used in geriatrics. The purpose of the study is to present cases of elderly patients hospitalized on the Geriatric Ward of the Provincial Neuro-Psychiatric Hospital "Dziekanka" in Gniezno with extremely high level of digoxin in the blood serum. The study was based on the case history of patients hospitalized on the ward from July 1998 to June 2003. During that time 83 patients (age: 77.4 +/- 8.1 years old, 60 females and 23 males) were suspected to suffer from digoxin intoxication on the basis of their morbid states, and their digoxin level in serum was measured. Furthermore, medical documentation of four patients with extremely high digoxin level was profoundly analyzed. Such is regarded, the level which exceeds by 100% the upper limit of concentration believed to be therapeutic (2 ng/ml) which is 4 ng/ml. The paper also includes a profile of clinical conditions of the patients at the time of their admission to the ward. While analyzing the patients' states, careful attention was drawn to the symptoms that might be caused by digoxin intoxication (changes in the ECG, central nervous system and gastrointestinal tract disturbances). However, because of typical for geriatrics polypathology and not clear characteristic clinical symptoms of majority of pathological syndromes, even severe intoxication may turn out to be impossible to diagnose. In the paper, coexistence of risk factors predisposing to appearance of toxic symptoms such as kidney failure, hypoproteinemia, dehydration, hypoxia, electrolyte abnormalities, drug interactions, and a possibility of improper taking medication were pointed out. It was concluded that lack of specific signs of severe digoxin intoxication among the elderly results in the fact that every worsening in a patient's state of health of an unknown reason treated with digoxin should be suspected as digitalis' glycosides intoxication.

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PubMed2004

[Geriatric assessment in the elderly with heart failure].

Despite recent advances in pharmacotherapy, heart failure represents the major cause of death and hospitalization for elderly people in developed countries. Clinical assessment and management of older patients are often more difficult than in younger ones. Epidemiological studies in geriatrics as well as cardiology setting have demonstrated that elderly heart failure patients are frail and complex individuals, in whom many clinical and non-clinical factors may play a role in determining clinical presentation and prognosis. Thus, management of heart failure in the elderly requires a coordinated, multidimensional and multidisciplinary approach. This article describes the principles of geriatric assessment. Assessment should include the evaluation of comorbidity, cognitive status, functional ability in activities of daily living, psychosocial, environmental and financial factors, and quality of life. Available evidence suggests that geriatric assessment can have a positive effect on patient outcome and overall quality and cost of care.

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PubMed2005

Depression and anxiety in elderly patients as a challenge for geriatric therapeutic team.

Coexistence of many illnesses of various etiology in elderly patients is one of the most important issues of contemporary geriatrics. Frequent coexistence of depression and fear is one of the increasing problems in general clinical picture. Depression and fear are responsible for unclear and non-uniform clinical signs. They may modify the course of many illnesses and make diagnosis difficult. Firstly, the aim of research was to determine the difference of anxiety level in depressed patients compared with patients not suffering from depression. Secondly, examining if there is a dependence between the anxiety level and depression exacerbation. Thirdly, researching what types of physical and somatic signs are most often related to anxiety. Total number of examined patients amounted to 60 persons aged 65 and older. The persons were treated in The Geriatric Clinic of Medical Academy in Bydgoszcz. The patients did not suffer from dementia and their somatic state allowed to examine them. Geriatric Depression Scale (GDS) was used in the research. Anxiety level was examined with Hamilton Anxiety Scale (HAMA). Medical history on the patients current life situations was collected. The patients were divided into two groups of 30 persons based on the GDS examination result. One of the groups gathered patients with the signs of depression in every person while the other grouped those without depression. Examination results proved that the anxiety level in depressed patients is significantly higher than in nondepressed patients. They also showed what kinds of psychical and somatic signs are most often related to anxiety. Taking depression and fear symptoms into consideration makes the therapy proper and causes relief for the patients and makes them feel better. Interdisciplinary approach to treatment of elderly patients, covering medical and nonmedical areas of life can help in limiting the number of recurring hospitalization.

Age Factors↗
PubMed2005

[Fear of falling in a fall clinic for geriatric patients: a pilot study].

OBJECTIVE: In this pilot study we want to determine how often fear of falling occurs in geriatric patients visiting a fall clinic and to study the characteristics of fear of falling and its consequences. DESIGN: Retrospective study of patient's records. METHOD: A random sample of 100 medical records of geriatric patients of the fall clinic of the Jeroen Bosch Ziekenhuis in Den Bosch was systematical examined. RESULTS: The mean age of the patients was 79.8 +/- 6 years. Before visiting the fall clinic, the patients had a history of falling during 34.6 months, and 62% of them visited a hospital due to the consequences of falling. In the fall clinic a mean number of 2.5 probable causes per fall was diagnosed. In this study 31% of the patients had fear of falling. The demographic characteristics and the causes of falling of the patients with or without fear of falling, were almost the same. Patients with fear of falling had a hip prothesis in 26%, whereas patients without fear of falling only in 7% had a hip prothesis (P < 0.05). In patients with fear of falling, in 90% extra diagnostic investigation was needed, whereas in patients without fear of falling extra diagnostic investigation only occurred in 53% (P < 0.01). Finally, patients with fear of falling needed 1.8 more times physical therapy compared to patients without fear of falling (P < 0.01). CONCLUSION: After a fall, fear of falling occurs often in geriatric patients. In this study, no causes for fear of falling could be determinated, although hip prothesis are associated with fear of falling. In patients with fear of falling more medical consumption occurs. In medical practice as in science fear of falling needs more attention.

Accident Prevention↗
PubMed2006

Gender comparisons of function-related dependence pain and insecurity in geriatric rehabilitation.

OBJECTIVE: To evaluate possible gender differences regarding the effect of intervention in geriatric rehabilitation, expressed in terms of change in function-related dependence, pain and insecurity. DESIGN: Comparative study. PARTICIPANTS: A total of 110 women and 44 men undergoing geriatric rehabilitation. METHODS: Performance-based assessments with use of the General Motor Function assessment scale. Non-parametric statistics were mainly used. RESULTS: The women showed higher degrees of function-related dependence, pain and insecurity on admission than the men. Both women and men displayed significant improvement in all 3 variables during the rehabilitation period. However, the positive changes regarding pain and insecurity were according to the analyses of systematic group changes, at a low degree among the men, probably because of the low levels on admission. Gender comparisons of proportions with positive intervention outcome indicated that a significantly larger proportion of the women showed a positive treatment effect after intervention, with a difference in recovery of 19% in dependence, 23% in pain and 33% in insecurity (p<0.05). CONCLUSIONS: Gender differences in disability, with higher degrees of function-related dependence, pain and insecurity among women on admission for geriatric rehabilitation, can be diminished during the rehabilitation period. These promising results may have relevance for the public health of the elderly population.

Activities of Daily Living↗
PubMed2006

Managing a traumatic wound in a geriatric patient.

Clinical management of a wound in a geriatric patient requires an understanding of age-related changes in the skin and the knowledge to make appropriate treatment choices. This case study describes clinical assessment and management of a traumatic hip wound in a 75-year-old patient. In addition to addressing his nutritional status by providing supplements, topical wound care preparations, including papain-urea and castor oil/balsam of Peru/trypsin, were used as a conservative approach to address debridement and periwound skin concerns. Extra vigilance is required to assess wounds in geriatric patients to determine proper wound treatment and achieve optimum results. Additional studies to evaluate optimal treatment strategies in the clinical management of traumatic wounds in the geriatric population are needed.

Accidental Falls↗
PubMedDate not supplied

Influence of dental status on nutritional status of geriatric patients in a convalescent and rehabilitation hospital.

PURPOSE: To investigate 6 dental statuses as risk factors for malnutrition in geriatric patients admitted to a convalescent and rehabilitation hospital. MATERIALS AND METHODS: One hundred twenty (59 men and 61 women) geriatric patients admitted to a convalescent and rehabilitation hospital were recruited. Three biochemical and hematologic parameters (albumin, hemoglobin, and lymphocyte count) were used for analysis. Malnutrition was defined as Body Mass Index (BMI) below 18.5 and albumin level under 35 g/L. The number of natural or prosthetic teeth in the dentate patients, and the presence of one or both dentures in the edentate patients, were recorded. Risk factors associated with malnutrition were investigated, namely: (1) edentulism among all patients, (2) edentulism without a set of complete dentures among all patients, (3) edentulism without a set of complete dentures among the edentate patients, (4) decreased number (< 6) of occluding pairs of natural or prosthetic teeth among the dentate patients, (5) decreased number (< 5) of posterior occluding pairs of natural or prosthetic teeth among the dentate patients, and (6) absence of posterior occluding pairs of natural or prosthetic teeth among the dentate patients. One-way ANOVA and Bonferroni multiple comparisons were used to determine if significant differences in the anthropometric, biochemical, and hematologic parameters existed between the patients with different dental statuses. The odds ratio and significance of 6 dental statuses as risk factors of malnutrition were calculated (P = .05). RESULTS: BMI, albumin, and hemoglobin levels of the malnourished patients were significantly lower than those of nourished patients (P < .05). Lymphocyte count was not significantly different between the 2 patient groups (P > .05). The status of edentate patients without a set of complete dentures compared with other edentate and dentate patients was the only independent risk factor (P < .05) in the 6 statuses studied. CONCLUSION: Primary healthcare workers caring for hospitalized geriatric patients should identify edentate patients without a set of complete dentures for the possibility of malnutrition.

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PubMedDate not supplied

Rationale to integrate comprehensive geriatric assessment for older olds presenting gastro-intestinal disorders.

The prevalence of chronic gastrointestinal symptoms is underestimated. However, complaints consistent with functional gastrointestinal disorders are common in the elderly, but symptoms are a poor predictor of presentation for medical care. Moreover, chronic colonic symptoms appear to interfere with daily living and quality of life in the elderly. Clinicians are questioning about the diagnostic management of frail older adults presenting these common and non specific symptoms. This paper proposes a definition of the "geriatric patient" and gives an overview of recently published literature concerning the concept of comprehensive geriatric assessment. The rationale to integrate comprehensive geriatric assessment for older adults presenting gastro-intestinal disorders is pointed out.

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PubMed1992

Geriatric primary care: a European perspective, Part II.

Europe is considered the parent of geriatric medicine, which was first recognized as a specialty in the United Kingdom. For the benefit of U.S. primary care physicians, GERIATRICS Editor-in-Chief Robert N. Butler, MD, convened a panel of leading European geriatricians in Lausanne, Switzerland, for a discussion of the successes and problems they are encountering in providing medical care to the aging world population. In Part I (Geriatrics 1992; 47 [Jan]:31-41) panelists described the healthcare services available to the elderly. In Part II, they discuss treatment and evaluation of dementia, use of hypnotics, rehabilitation approaches, and dietary and exercise recommendations for the elderly.

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PubMed1991

Balancing acute and long-term care: the mathematics of throughput in departments of geriatric medicine.

The empirical distribution of length of stay of patients in departments of geriatric medicine is fit extremely well by a sum of two exponentials. Most of the patients in a geriatric department are rehabilitated and discharged or they die within a few weeks of admission, but the few who become long-stay patients remain for months or even years. A model is presented for the flow of patients through a geriatric department, which has analogies to models of drug flow in pharmacokinetics. The theoretical model explains why the empirical pattern of length of stay in the occupied beds fits a sum of two exponentials; conversely, the empirical distribution, obtained from the midnight bed state report, can be used to study the effect of various policy decisions on both immediate and future admission rates for the department, and shows the benefits of policies which reduce long-stay patient numbers by improving long-stay rehabilitation.

Acute Disease↗
PubMedDate not supplied

[Good clinical practices in therapeutic trials in geriatrics especially in Alzheimer type senile dementia].

The rules of "Good clinical practices" 1987 and the law of December 20, 1988 concerning biomedical research give guidelines that are difficult to apply in Geriatrics. Pragmatic solutions have to be proposed if we want to avoid delay in clinical research especially in degenerative diseases and in the evaluation of therapeutics in old age. We can focus the problems on the chapter "Responsibilities of the investigator": 1) His professional qualification whereas gerontology in not yet considered as a specialty; 2) Obtention of informed consent in general, especially written informed consent and leaflet informations given to patients; 3) Constitution of staff according to low motivation of nurses to research and low methodological knowledge; investigators' disponibility considering low density of nurses and physicians in geriatric units. Among specific points of "Good clinical practices" for home trials we need a careful selection of general practitioners interested in both geriatrics and therapeutic trials. Finally obtaining pharmacokinetic data in elderly needs probably a clear distinction between two ways: classical pharmacokinetic studies with samples of old healthy paid volunteers and pharmacokinetic study of a population in therapeutic trials.

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PubMed1990

[Basic education in geriatrics is still unequally distributed in Scandinavia].

A survey is in progress of the training in geriatrics given in Europe, and the status of such training in the Nordic countries is reported here. The Nordic countries--particularly Sweden--have a fairly long tradition of basic training in geriatrics and the research possibilities are also comparatively good. But the distribution of professorships, university departments, and basic training in geriatric medicine are still uneven in the Nordic countries.

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PubMed1989

Guidelines for the use of psychopharmaca in geriatric cases.

The use of psychotropic drugs in elderly patients requires special knowledge of both clinician and general practitioner. Considering the pharmacokinetic and pharmacodynamic changes characteristic of the senile organism, relatively few of the great variety of psychotropic drugs may be used in geriatrics. After giving a survey of the kinetics and mechanism of action of drugs from geriatric aspects the use, indications and contraindications, unwanted side-effects, the risks of interactions of neuroleptics, antidepressants, minor tranquillizers and hypnotics have been discussed in detail. The principles of gerontological lithium therapy have been summarized and the clinical importance of the so-called geriatrics (including the so-called nootropics) has been subjected to criticism. The author emphasizes the primary importance of psychotherapy and sociotherapy as adjuvants to psychotropic treatment.

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PubMed1989

Characteristics of geriatric admissions to two medical departments in Singapore.

A survey was conducted to study certain characteristics of geriatric patients admitted to two medical departments in Singapore. The aim was to create awareness as well as to provide a better understanding of these elderly as more and more doctors would have to attend to them. Our results show that about 27% of admissions were geriatric patients. The typical geriatric patient in this study was about 75 years old (mean age 74.6 years) and was likely to present with breathlessness due to heart disease or pneumonia. The overall duration of stay in hospital was 10 days and only about 6% of the patients had "discharge" problems needing assistance from the Medical Social Worker. About one in five patients died in hospital, usually from pneumonia or ischaemic heart disease.

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PubMed1989

Integrating geriatric dentistry into general practice residency programs.

As the proportion of elderly people in society increases, so will the general practitioner's professional contact with the geriatric patient. Such a change will necessitate an alteration in patterns of practice. The "new elderly" are presenting with complicated restorative needs, and they increasingly expect the high quality of dentistry they have received much of their lives. Their expectations will require an enhancement and refinement of the general practitioner's diagnostic and therapeutic skills in geriatric dentistry. Yet the predoctoral dental curriculum is unable to provide the depth of experience and knowledge required. The amount of information that must be assimilated and the type of supervised clinic activities that must be experienced to prepare a student adequately in geriatric oral health care are too extensive to be included in a four-year program. Under the existing dental educational system, the fully skilled, professionally secure, and clinically astute general practitioner capable of managing the complex needs of the elderly will emerge from the general practice residency.

Curriculum↗
PubMed1989

The geriatric nurse practitioner in home care. Challenges, stressors, and rewards.

The geriatric nurse practitioner is an appropriate provider of care for homebound elders. Her scope of practice includes managing acute and chronic illnesses and providing preventive care. It incorporates collaboration as an essential part of practice. The focus on issues of aging assists the geriatric nurse practitioner to differentiate presentation and complications of illness from a younger population and to understand the interrelationship of emotional, physiological, functional, and social factors on outcomes. The challenge to provide home care to homebound elders has intensified as a result of recent changes in the health care system. The expertise of the geriatric nurse practitioner is well suited to address these needs and future issues as the percentage of the elderly population increases.

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