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PubMed1980

Essentials of geriatric care.

The geriatric patient presents a challenge to the primary care provider. Negative attitudes and stereotypes that have been imposed by society are a major block to the successful care of the elderly and need to be examined and changed. The teaching of geriatrics in medical and nursing schools and schools for health-related professions may prevent some of these negative attitudes in the future. The elderly often present with many problems, which are the result of physical changes and multiple losses. These problems are physical, emotional, social, and spiritual. The possibility for resolution of each of these needs should be investigated using a holistic, multidisciplinary team approach, with no need being dismissed simply because of the patient's age. Interventions are directed toward assisting the elderly patient to achieve self-actualization or self-fulfillment and attain and maintain the highest possible level of health, functioning, and quality of life. The physiologic changes that occur with aging result in a deviation from normal in the presentation and progression of disease, in the effects of medications, and in laboratory test results. There are alternatives to institutionalization, and these should be actively sought utilizing community supports. When institutionalization is chosen, rehabilitation should be the goal, if at all possible. Availability and therapeutic listening on the part of the primary care provider are invaluable. More time, energy, and giving of self are needed in order to successfully provide care to the geriatric patient; the challenge is great but the rewards are also great. The elderly are a wise, warm, and wonderful people.

Aged↗
PubMed1982

The risk determination of geriatric problems.

Ten geriatric problems which eventually lead to impairment, disability or handicap with progressive deterioration of bodily structure and function are discussed. At the geriatric clinic at Tygerberg Hospital, Parowvallei, CP, 1150 patients were examined to distinguish the low-risk patients with no serious impairment of health from those suffering from disabilities of moderate nature and severe life-threatening handicaps. The increasing number of geriatric patients attending the clinic and the associated administrative problems have made this study necessary.

Aged↗
PubMed1980

[Geriatric surgery: a clinical and statistical contribution based on five years' experience (author's transl)].

The Authors offer a critical review of their own five-year experience in the field of geriatric surgery, with special attention to actual results obtained. From these data they conclude that the progressive improvement of said results, such as it emerges from the documentation, owes partly to the surgeon's greater ability to cope with geriatric problems in his domain, and partly to increased awareness of the resources of geriatric surgery by the lay population.

Aged↗
PubMed1981

[Geriatric care in a rural practice].

Geriatric care in a rural practice. General practitioners/family physicians are responsible for the continuing care in case of illness and infirmity of about 95% of the population over 65 years old. In the examined practice area the percentage of the population over 65 years old is 11.29, but among the patients of the practice 18.5% are over 65 years old and the consultations come up to a percentage of 21.6. A random test by 100 patients over 65 years old during half a year has given the following facts: There have been 946 consultations, 299 of them as home visits. 18 patients needed 28 hospitalisations with a total of 481 days as in-patients. 6 patients died during the test period. On an average 4.44 diagnoses were needed and 7.63 medicaments prescribed. By 67 patients 85 heavy, acute troubles occurred. These facts show the importance of the geriatric aspects in the primary care. Since the percentage of the older patients is growing also with the growing age of the doctor, it is necessary that more attention must be given in the continuing education to the problems of geriatric care, of multimorbidity, of multimedication and of alternatives to medical therapy.

Adolescent↗
PubMed1995

Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes.

OBJECTIVE: To determine whether a set of factors representing impairments in multiple areas could be identified that predisposes to falling, incontinence, and functional dependence. DESIGN: Population-based cohort with a 1-year follow-up. SETTING: General community. PARTICIPANTS: A total of 927 New Haven, Conn, residents, aged 72 years and older who completed the baseline and 1-year interviews. MAIN OUTCOME MEASURES: At least one episode of urinary incontinence per week, at least two falls during the follow-up year, and dependence on human help for one or more basic activities of daily living. RESULTS: At 1 year, urinary incontinence was reported by 16%, at least two falls by 10%, and functional dependence by 20% of participants. The four independent predisposing factors for the outcomes of incontinence, falling, and functional dependence included slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment). There was a significant increase in each of incontinence, falling, and functional dependence as the number of these predisposing factors increased. For example, the proportion of participants experiencing functional dependence doubled (7% to 14% to 28% to 60%) (chi 2 = 119.8; P < .001) as the number of predisposing factors increased from zero to one to two at least three. CONCLUSIONS: Our findings suggest that predisposition to geriatric syndromes and functional dependence may result when impairments in multiple domains compromise compensatory ability. It may be possible to restore compensatory ability and prevent or delay the onset of several geriatric syndromes and, perhaps, functional dependence by modifying a shared set of predisposing factors. Perhaps it is time to take a more unified approach to the geriatric syndromes and functional dependence.

Accidental Falls↗
PubMedDate not supplied

[Identification of functional deficits in the acute hospital by geriatric assessment].

Functional deficits of elderly patients are often not recognized during routine treatment in acute hospital care. In Germany, there are only limited experiences with the use of standardized assessment-scales in this health care setting. In this study, 112 patients were recruited for a very broad geriatric assessment focused on methodological and practical questions. There were 38.8% with deficits in the ADL and 12.6% with depressive symptoms. Many patients showed low motivational factors such as energy, efficacy and will. Geriatric syndromes such as malnutrition were also very common. In general, many patients in acute care hospitals have functional deficits which are not recognized by the physicians. For many patients, short instruments are sufficient for screening purposes. The effectiveness of a complete geriatric assessment depends mostly on the use of good selection criteria.

Activities of Daily Living↗
PubMed1994

[A general practitioner in a geriatric team. Experiences from a project at the Laerdal County Hospital].

At the local hospital in Laerdal a geriatric team has been established since May 1991, and is organized as a project. Instead of a specialist in geriatrics the hospital has used a general practitioner with some geriatric experience and an interest in elderly patients. The team has also included a nurse, a physiotherapist and an occupational therapist. The services offered by the team have been well received by patients, general practitioners and other health workers in the region. It has now been decided that the team shall continue on a permanent basis from 1994.

Aged↗
PubMed1994

Predicting the health-related values and preferences of geriatric patients.

BACKGROUND: Those who must make health care decisions on behalf of persons who lack decision-making capacity often have too little information. The purpose of this study was to determine whether and to what degree sociodemographic factors, social support, religious involvement, and functional status served as predictors of the health-related values and preferences of geriatric patients. METHODS: A retrospective chart review involving 178 cognitively intact patients enrolled at a geriatric clinic at a university medical center was conducted. Patient variables included age, race, sex, marital status, years of education, participation in formal religious activities, self-reported functional status, and adequacy of social and family support. These were compared with responses to a modified version of the Values History questionnaire, an established method of evaluating patient values that includes advance directives. RESULTS: Patients were likely to value quality (82%) over quantity of life (18%) and the ability to think clearly (64%) over 13 other specific health-related values. They were likely (93%) to want to be taken to a hospital emergency department on losing consciousness or becoming confused. Seventy-eight percent expressed a desire to be resuscitated using cardiopulmonary resuscitation (CPR), and 76% expressed a preference for use of a respirator, if necessary. Most (85%) considered a permanent vegetative state to be worse than death. High functional status predicted a preference for quality of life over length of life and the perception of a persistent vegetative state as worse than death (positive predictive value = 89%). Persons with better social and family support were more likely to accept treatment with CPR or a respirator and less likely to consider a permanent vegetative state to be worse than death. No single patient factor was strong enough to increase the probability of a particular value or preference by more than 17% above baseline. CONCLUSIONS: Sociodemographic and functional status variables are relatively weak predictors of personal values and directives. This reinforces the importance of routinely eliciting patient values and preferences and of updating the information, particularly following changes in functional status or family support. Baseline information regarding the health-related values and preferences of this primary care geriatric clinic population may provide valuable information about the values and preferences of decisionally impaired older patients.

Activities of Daily Living↗
PubMedDate not supplied

[Ambulatory geriatric screening--an overview. I: Concept and methodologic development].

Scientific literature reveals different levels of efficiency in geriatric screening in the primary care setting. Part I of our review deals with the development of geriatric screening up to the implementation of regular health checks in Great Britain. Studies in primary care show that through screening 1-2 previously unknown conditions per patient can be detected, with a particularly high prevalence of unknown problems in the following areas: vision and hearing, continence, mobility, cognitive function, mood, isolation, and lack of help. Further research is still required to transfer the results of screening studies into primary care, particularly in validating instruments of geriatric assessments and selecting risk groups.

Aged↗
PubMed1994

[Geriatric dentistry: medical problems as well as disease- and therapy-induced oral disorders].

As in pediatric dentistry, management of the oral problems in elderly patients does not depend on the development of new technical skills, but rather on the knowledge of: biological, psychological and social aspects of primary (physiological or age-related) and secondary (pathological or disease-related) aging; atypical presentations of disease; multiple pathological conditions (polymorbidity, polypathophysiology, polypharmacy); an underreporting of disease; the importance of functional status; the role of an interdisciplinary team; Geriatric medicine refers to social, psychological and clinical aspects of disease in older adults. Geriatric dentistry deals with the respective aspects concerning oral diseases. Chronic conditions as well as their treatment (e.g. medication) are more common with advancing age. They may have major implications for dental practice, leading to changes in oral health behavior and attitudes of the elderly patient with sometimes detrimental effects on oral health. Therefore, different concepts in prevention, diagnosis and therapy of oral diseases are required for the oral care of older adults. Two important consequences must be considered: Firstly, the medical education of the dentist and the dental team must be improved. The dental team must become a member of the group of health-care professionals caring for an aging population (geriatric medicine) to meet the heterogeneous needs of as much as 75% of our future patients. Secondly, there is great need for education of all health-care professionals dealing with elderly patients about possible negative impacts medicine can have on oral health. Identification and diagnosis of oral disease as well as preventive measures must be stressed.

Aged↗
PubMed1993

A negative trial of inpatient geriatric consultation. Lessons learned and recommendations for future research.

PURPOSE: To determine the effectiveness of inpatient interdisciplinary geriatric consultation provided during hospitalization to frail, elderly subjects. SUBJECTS AND SITE: Admission cohort of 197 men admitted from 1985 through 1989, aged 65 years or more, meeting proxy criteria for frailty, living within follow-up area, without terminal illness, and without prolonged nursing home residence. METHODS AND MEASURES: Randomized controlled trial of inpatient geriatric consultation at a tertiary care Veterans Affairs hospital. Differences were determined between groups in the Physical Self-Maintenance Scale, Instrumental Activities of Daily Living, Mini-Mental State Examination, Morale Scale, and nursing home and health care utilization. RESULTS: No differences were seen between groups in any measure after the intervention or during 1 year of follow-up. Intervention implementation may have been incomplete due to compliance and resource availability. CONCLUSIONS: This trial is not definitive in determining whether geriatric consultation is effective or ineffective. Lessons learned from this research indicate that future studies should target frail subjects, include intervention-specific measures, and be conducted with direct control of comprehensive resources.

Aged↗
PubMed1993

Differences between "geriatric" and "medical" patients aged 75 and over.

We analysed the characteristics of patients aged 75 and over admitted to the geriatric and general medical wards over a three month period in a teaching hospital. Patients admitted to the geriatric wards were slightly older, were more often female, more likely to be admitted during the day and during a week day, more likely to have been seen by their own general practitioner, had more chronic and multiple illness with non-specific presentations, and stayed longer in hospital. Referring doctors seem to discriminate between patients needing geriatric care and those more suitable for general medical care, but there is an overlap in the characteristics of the two groups.

Age Factors↗
PubMed1995

[Favorable development of ability to function in patients during admission in a geriatric unit of a psychiatric hospital].

OBJECTIVE: To evaluate the course of the functional ability in daily living activities, mobility and faecal and urinary continence, and the interrelationship of these features of ability in patients admitted to the geriatric unit of a psychiatric hospital (GAPZ). DESIGN: Retrospective. SETTING: Geriatric unit, Vincent van Gogh Institute of Psychiatry, Venray, the Netherlands. METHOD: Analysis of data obtained from the National Register of Clinical Gerontology from SIG Care Information in Utrecht. For all patients discharged in 1992 the level of functional ability on admission and discharge was determined and compared, using 9 variables. RESULTS: During the stay all but one of the functional status variables improved significantly: washing of upper and lower body, dressing, going to the toilet, eating, urinary (in)continence and mobility (as measured by radius of action and assistance needed). Faecal incontinence did not improve. On average women functioned more independently than men; however, the improvement in functional status was equal for both sexes. There was a hierarchical decline in the event of decreased functional ability. This hierarchical relationship was more prominent at the time of discharge than at the time of admission. CONCLUSION: On average the functional status of the patients evaluated improved during their stay in the geriatric unit of the psychiatric hospital. There appears to be a hierarchy of changes in aspects of functional condition irrespective of the underlying diseases in elderly people.

Activities of Daily Living↗
PubMed1996

Geriatric education in osteopathic medical schools.

To determine if the curricula at the colleges of osteopathic medicine (COMs) are adequately preparing their graduates to meet the challenge of the geriatric demographic imperative, the authors surveyed the 16 COMs using a modified version of a survey conducted by Karuza and colleagues. Results were compared with those obtained from the Karuza and colleagues' survey of 73 allopathic medical schools. Overall, 88% of the COMs reported that they were committed to teaching geriatrics to undergraduate medical students, compared with 72% of the allopathic medical schools. Lack of time and appropriate clinical facilities were the two greatest barriers to committing more time to geriatrics in both osteopathic and allopathic undergraduate medical training programs.

Education, Medical, Undergraduate↗
PubMed1997

Education in geriatric psychiatry.

The UK has seen many significant developments during the last 30 years in geriatric psychiatry, with emphasis on multi-disciplinary working and on the integration of services for the elderly. Accompanying these changes has been a growing public consciousness of the psychiatric disorders of later life and of the needs of old people and their carers. With a huge increase this century in the proportion of very elderly people, care of the elderly has achieved greater recognition in the medical training of both generalists and specialists. Greater emphasis also is being given to gerontology, both social and biological. In this paper the authors examine recent developments in medical education in the UK and show how changing approaches to medical training are shaping developments in geriatric psychiatry education. They describe recent innovations in both teaching styles and assessment methods and consider how developments in Computer Aided Learning can be applied to the teaching of geriatric psychiatry.

Education↗
PubMed1997

History of geriatric psychiatry in Israel.

This article describes the history of a relatively new branch in Israel's psychiatry, geriatric psychiatry. The unique features of Israel are described: a young country with an ancient history, uninterrupted migration waves, including the elderly strata, the reactivation of traumatic experiences in elderly Holocaust survivors and the impact of the security situation in particular on the elderly population. There is a growing awareness of the importance of geriatric psychiatry, in connection with the above features, with a quite rapid development of this branch in the country. Developing services are described, as are research projects and the contribution made by Israel's geriatric psychiatrists in the development of the field.

Geriatric Psychiatry↗
PubMed1997

[Significance of impartial assessment of geriatric brain diseases].

In addition to traditional psychodiagnostic and neuropsychological methods used for assessing cognitive performance and its possible deterioration in the elderly, a number of instruments are available today that allow reliable and valid behavioural assessments to be made of geriatric patients' everyday behaviour. While rating of institutionalized geriatric patients usually focuses on the type and amount of nursing care needed, other areas of behaviour, such as activities of daily life (ADL) and instrumental ADL (IADL), memory, mood, social behaviour and disturbing behaviours are of primary interest in the case of aged individuals living in their own homes. The NOSGER (Nurses' observation scale for geriatric patients), which was introduced a few years ago, allows assessment of six important dimensions of behaviour; the scale can be easily and reliably used by professional nursing personnel as well as by untrained caregivers. The present paper describes the practical use of the instrument as well as possible graphic display of NOSGER findings; furthermore, normative values for five out of six NOSGER dimensions are given.

Activities of Daily Living↗
PubMed1997

The Oncology Geriatric Education Retreat: commentary and conclusions.

The aging of the population will result in more older people with cancer. Thus, it is important to consider mechanisms by which geriatrics content could be incorporated into oncology training. The Oncology Geriatric Education Retreat was held February 21-26, 1997, in San Juan, Puerto Rico, for the discussion of possible approaches to this topic. A series of didactic sessions accompanied by commentaries was held. This was followed by three sets of sessions during which different small groups met simultaneously to discuss approaches to the treatment of specific types of tumors, educational process, and research issues. A general group discussion ensued after each set of sessions. The assembly concluded that incorporating geriatrics content into oncology training was an issue worthy of aggressive pursuit. A number of approaches were suggested, including consultation with the Residency Review Committees, the American Board of Internal Medicine, and other organizations. The importance of developing a research agenda to accompany clinical and educational activities was stressed, as was the importance of acquiring funding for these activities.

Aged↗