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PubMed1989

[Geriatric rehabilitation].

With an ever increasing percentage of old people in the population it is important to consider that this patient group has special health problems and represents a new challenge to the health service. Geriatric rehabilitation will be an important field in medical care of the elderly. The article describes the organisation and working methods of a geriatric rehabilitation unit at Ullevål Hospital, Oslo. The article describes the results of rehabilitation in an old and disabled group of patients. To achieve good results in geriatric rehabilitation it is important to change traditional hospital and working routines. Experiments in this field should be encouraged.

Aged↗
PubMed1987

The development of geriatric curricula in U.S. dental schools, 1979-1984.

When data from a 1984 survey of U.S. dental schools were compared with data from a similar survey of the same schools completed in 1979, an increase in the teaching of geriatric dentistry to dental students was observed. While more topics are being taught in more schools, the depth and coverage are variable. Multivariate analyses revealed that more topics were likely to be taught if a course in geriatrics existed, if the course had existed since 1979, and if the course director was a dentist. Factors associated with the establishment of a course between 1979 and 1984 were that the school was located in a state with a large geriatric population and that financial assistance for patients through state or local government was available.

Curriculum↗
PubMed1986

A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations.

As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n = 93) groups. In the control group, only 27.1% of the actions that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore, relatively high compliance can be achieved with recommendations made by a geriatric consultation team, thereby overcoming the first barrier to the establishment of such a service.

Aged↗
PubMed1987

Education in geriatric medicine.

Geriatric medicine, the branch of general medicine concerned with the clinical, preventive, remedial and social aspects of illness in the elderly and with the maintenance of their health became of importance with the advent of the British National Health Service which uncovered an immense amount of illness among older people. This and the future demographic changes prompted the teaching of medical students gerontology i.e., the study of the ageing process and geriatric medicine. Attempts at preventing illness and at diagnosing disease early were made to try to maintain and, where possible, to improve the health of older people by such methods as motivation, pre-retirement training and early ascertainment of illness. Symptoms of disease change with advancing age and diagnosis becomes difficult due to atypical and insidious symptomatology while the common occurrence of multiple pathology can unfortunately encourage polypharmacy. Specialised instruction in geriatric medicine is thus desirable and the recommendation is made that every medical school should create an academic unit in this subject to provide undergraduate and postgraduate teaching about the process of ageing and the clinical problems of older people with additional instruction on the general management of the elderly both in their own homes and in the essential and varied institutional settings. As well as medical students many other groups such as nurses, paramedicals, social workers and all those who care for the elderly benefit from training.

Curriculum↗
PubMed1987

Geriatric medicine in Singapore: quo vadis?

In this review article, the demography of Singapore and future needs for medical care for the elderly are discussed. Tracing the history of the development of the specialty in UK, the following conclusions can be drawn: Home visits for assessment by specialists can avoid many unnecessary hospital admissions by using existing community services. Elderly people fare badly in acute sectors of hospitals. Elderly people respond to, and need, rehabilitation. The elderly are poor reporters of illness. There have been, and still are, misunderstandings between general physicians and physicians in geriatric medicine as to their roles and the future of the specialty. The role of geriatric medicine versus general medicine is defined. The possibilities for the future role of geriatric medicine in Singapore are discussed. The present use of medical services by the elderly and financial implications are reviewed. Suggestions are made for research into a comprehensive type of medical care for the elderly in Singapore.

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PubMed1987

[On medical responsibility in geriatric psychiatry].

In recent years, three new disciplines have progressively emerged, namely geriatric psychiatry, psycho-geriatrics and psycho-gerontology. At this time, problems of responsibility in geriatric psychiatry have tended to make physicians hesitate between two extremes: one the one hand, a refusal to take seriously the care of the elderly mentally ill, and on the other hand, a tendency towards activism and a medical ideology characterized by globalization and reductionism. It must be said, in the physician's favour, that, not only had he to learn to free himself from the ideological strangle-hold of a pseudo-scientific line of thought, but also he was having to cope with the reemergence of his own existential preoccupations as a result of his own contact with the elderly patient. It is in this difficult endeavour that a number of situations are described and discussed; these situations are of interest to psychiatry in general from the point of view of medical responsibility. Some of these are to do with the use the physician makes of concepts he has created and diffused without controlling their implementation. Others cast doubt on care management. Finally, others enable us to question more effectively the current drift in thinking amongst professionals and consumers.

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PubMedDate not supplied

A model for teaching medical students ambulatory care geriatrics.

Several recent articles have called attention to the negative attitudes which are fostered by teaching geriatrics primarily in a long-term care facility. A transportable model has been developed using a multidisciplinary team for teaching ambulatory care geriatrics in a clinic within a congregate housing facility. This model has contributed to more positive attitudes towards geriatrics health care on the part of the students.

Ambulatory Care↗
PubMed1986

Are geriatric units needed for elderly patients with hip fractures?

To assess the need for a multidisciplinary geriatric unit in the treatment of elderly patients with hip fractures, we reviewed the charts of all patients aged 60 years or older who were treated for hip fractures in five hospitals in Hamilton, Ont., between August 1982 and September 1983. We hypothesized that discharge to a different location from that before admission would indicate reduced functional status and classified the reasons for a change in residence as poor patient motivation, need for rehabilitation, compromised ambulation, postoperative complications and inevitable deterioration. We believed that geriatric care would be most beneficial to those in the first three groups. Of the 327 patients with hip fractures 40 (12%) died before discharge. Of the 287 surviving patients 149 (52%) had been discharged by 4 weeks, and only 29 (10%) remained in hospital by 12 weeks. Of the 287, 44 (15%) were discharged to a different location from that before admission: in 75% the cause appeared to be inevitable deterioration (57%) or postoperative complications (18%). The remaining 25% needed rehabilitation and were all sent to appropriate facilities. None of the patients with ambulation problems or poor motivation required an increased level of care. We could not show a need for geriatric care in our population; possible explanations are discussed.

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PubMed1987

Geriatric medicine in Grahamstown.

A developing interest in improved care of the aged by the authorities of Settlers' Hospital in Grahamstown led to an invitation to the Geriatric Unit of the University of Cape Town in March 1984 to visit the hospital. The impressions gained on this visit indicated a need to expand hospital-based geriatric medicine into total community care of the elderly. Data were gathered concerning 50 acutely ill and 31 long-stay elderly black patients in Settlers' Hospital. These findings and the recommendations of various committees are discussed against the background of a model for the delivery of better geriatric care throughout the country. The most urgent necessity for Grahamstown appeared to be provision of better care for aged black people in the community.

Black or African American↗
PubMed1985

Geriatric dentistry in the predoctoral curriculum.

A survey was conducted among U.S. dental schools to determine the status of geriatric dentistry in the curriculum. Since a comparable, independent study was done in 1979, there has been significant growth in formalized didactic courses and less reliance on incorporating geriatric content as lectures or other components of existing courses. The growth in specialized courses was accompanied by an increased tendency to supplement the clinical topics with others relating to social and behavioral aspects of treating geriatric patients.

Curriculum↗
PubMed1985

An information service in a geriatric unit.

A major deficiency during the initial stages of development of a geriatric unit was a lack of easily available information concerning facilities and services already existing in the community. A postal survey undertaken in conjunction with the Cape Peninsula Organization for the Aged resulted in the production of an information manual of services available to the elderly in the Cape Peninsula. In the introduction to this manual an invitation was extended to readers to direct requests for information to the Geriatric Unit at the Medical School of the University of Cape Town. This paper reports on the first 50 enquiries received, as a result of which 73 items of advice or information were given. Unmet community needs were revealed in 9 instances. Useful assistance was known to have resulted on 30 occasions, consisting, in the main, of arrangements initiated for appropriate residential placement, for geriatric and psychogeriatric assessments and for domiciliary assessments by community nursing sisters or social workers, sometimes assisted by an occupational therapist or physiotherapist. Those who care for the aged at home need to be put in touch with correct sources of relevant information, and this appears to have constituted an additional and useful function of our information service.

Geriatrics↗
PubMedDate not supplied

[The geriatric day clinic: report on a stay in Glasgow].

In the United Kingdom Geriatric day hospitals perform an increasing part of the medical care of the elderly since the early 1950 s. This report is based on a stay in 1978 to study the 8 geriatric day hospitals working in Glasgow. An account is given of equipment, staff, program, and function within the medical care system. The special possibilities of clinic-related therapeutic teams can be used, whereas unevitable side effects of common clinic care like immobilisation, institutionalisation can be avoided. Day clinic care is in agreement with the main intention of modern geriatrics -- to maintain or recover the patient independent, its success reacts upon this intention in a confirming way. An international comparison in this respect is not complimentary for the situation in the GFR.

Activities of Daily Living↗
PubMed1981

[Possibilities of rehabilitation in the geriatric hospital (author's transl)].

Rehabilitation is with medicine and nursing care an inseparable part of the modern geriatrics. In opposition to other medical subjects there is no certain direction. Generally joy of life, self-confidence and independence should be the aim of geriatric rehabilitation. In the geriatric hospital a particular classification has been proved: Rehabilitation with the most serious sick, reduced and bedridden aged patient and actual rehabilitation-generally and at special diseases. A special care of the rehabilitated patients after discharge from hospital has to be wished.

Aged↗
PubMed1984

An interdisciplinary teaching program in geriatrics for physician's assistants.

An interdisciplinary curriculum committee within the Division of Family Medicine, Stanford University Medical Center, developed and taught a beginning course in clinical geriatrics for medical students and student physician's assistants, physical therapists, and nurse practitioners. Through a series of Saturday classes held in community facilities serving seniors, physician's assistant students had the opportunity to learn clinical geriatrics from a faculty team including a physician's assistant, physician, nurse, physical therapist, social worker, gerontologist, and health educator. Local seniors served as consumer consultants and models of health and vigor. This interdisciplinary approach was modeled by the faculty to demonstrate the need for a team approach to deliver quality care to seniors. In this well-received course, the role of the physician's assistant in health care was made evident to their future physician employers and physical therapy co-workers through faculty modeling as well as through informal contacts and patient conferences. Older people constitute a growing and increasingly medically underserved population. Team training may serve to stimulate physician's assistant students to include geriatrics in their career plans while educating their future physician employers about their role.

Curriculum↗
PubMedDate not supplied

Geriatrics: a specialty in search of specialists.

This paper explores the historical reasons why geriatrics has failed to become a popular specialty in America. Focusing upon the nineteenth and early twentieth centuries, it examines the medical theories and ideas that led to the creation of a specialty in the diseases of old age. According to Haber, these beliefs caused many would-be geriatricians to be extremely reluctant to devote themselves to the new field. While such physicians were often convinced that a separate practice for the old was both theoretically valid and necessary, they were far less sure of the ultimate usefulness of their work. The prevailing model of senescence portrayed old age as a progressive, incurable disease, and the elderly as the most difficult and trying of patients. Medically, as well as economically, geriatrics seemed to have little appeal. The author concludes that these beliefs still influence many physicians' conception of geriatrics; it remains a specialty in search of specialists.

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PubMed1984

Geriatric team dynamics: the dietitian's role.

In 1980, a geriatric consultation team was formed at Massachusetts General Hospital to meet the complex medical, psychological, rehabilitative, nutritional, and social needs of geriatric patients. This team strives to provide elderly patients with the comprehensive care necessary to potentiate return to maximum independent functioning and to change attitudes of primary caretakers toward care of geriatric patients through increased recognition of the elderly as a heterogeneous group. The team consults on patients with changes in mental status, need for physical rehabilitation, "failure to thrive," or need for definitive planning for posthospital disposition. The dietitian conducts nutritional screening of each patient, is a nutrition resource for team members, and promotes collaboration in nutrition care planning. When the dietitian communicates nutrition concerns, goals, and care plans for patients to other health professionals, they use the information to reinforce her recommendations and integrate nutrition components into their care plans. A multidisciplinary approach has resulted in earlier identification and evaluation of functional ability, more comprehensive individualized care planning, and a reduced percentage of readmissions.

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PubMed1984

Education in geriatrics in physical medicine residency training programs.

The number of aged persons in the United States is rising steadily. Rehabilitation medicine is becoming increasingly involved in providing the care necessary to keep aging individuals in good health so that the onset of late life disability can be delayed and social independence be maintained for as long as possible. For this reason, education in geriatric rehabilitation must become an essential part of training programs for residents in physical medicine and rehabilitation. The curriculum of these programs must be broad based and must include many of the general aspects of geriatric medicine even though they may relate only peripherally to rehabilitation. One faculty member should be charged with the responsibility of organizing the educational program. He should maintain liaison with faculty members of other departments who have expertise in the problems of the aging. Some of the teaching can be done by lectures and seminars but much of it should be carried out in clinical settings such as in-patient facilities, out-patient departments, home health services and day-care programs. Nursing homes might offer suitable training facilities provided that adequate supervision and teaching are available. Every effort should be made to overcome prejudices that may exist with regard to the care and rehabilitation of a geriatric population.

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PubMed1983

Teaching geriatric medicine at the Queen's University of Belfast.

Undergraduate teaching at the Queen's University, Belfast, takes place in the fourth year of a five year curriculum. It lasts three weeks and this is divided into two parts. First, held within the university department, is topic-based teaching including seminars, discussions, case histories and visits. The second phase of two weeks consists of attachment of two to four students to geriatric medical units both in and outside Belfast. The whole of this module is situated within a combined course involving community medicine, general practice, geriatric medicine and mental health lasting 12 weeks and involving one-third of the year of 150 students each time. In addition to the three weeks teaching in geriatrics, joint discussion groups are held.

Education, Medical, Undergraduate↗