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At least 127 records · Page 7Linked to original sources
PubMed2002

Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study.

PURPOSE: To appraise the performance of Comprehensive Geriatric Assessment (CGA) in elderly cancer patients (> or = 65 years) and to evaluate whether it could add further information with respect to the Eastern Cooperative Oncology Group performance status (PS). PATIENTS AND METHODS: We studied 363 elderly cancer patients (195 males, 168 females; median age, 72 years) with solid (n = 271) or hematologic (n = 92) tumors. In addition to PS, their physical function was assessed by means of the activity of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbidities were categorized according to Satariano's index. The association between PS, comorbidity, and the items of the CGA was assessed by means of logistic regression analysis. RESULTS: These 363 elderly cancer patients had a good functional and mental status: 74% had a good PS (ie, lower than 2), 86% were ADL-independent, and 52% were IADL-independent. Forty-one percent of patients had one or more comorbid conditions. Of the patients with a good PS, 13.0% had two or more comorbidities; 9.3% and 37.7% had ADL or IADL limitations, respectively. By multivariate analysis, elderly cancer patients who were ADL-dependent or IADL-dependent had a nearly two-fold higher probability of having an elevated Satariano's index than independent patients. A strong association emerged between PS and CGA, with a nearly five-fold increased probability of having a poor PS (ie, > or = 2) recorded in patients dependent for ADL or IADL. CONCLUSION: The CGA adds substantial information on the functional assessment of elderly cancer patients, including patients with a good PS. The role of PS as unique marker of functional status needs to be reappraised among elderly cancer patients.

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PubMed1995

[Geriatric pharmacology. Pharmacokinetics and pharmacodynamics in the elderly. Problems with geriatric and nootropic drugs].

The reasons for the increased frequency of adverse drug reactions in the elderly are a decrease in drug elimination, primarily via the kidneys, on the one hand and a decrease in adaptive counterregulatory mechanisms on the other hand that attenuate drug effects in younger subjects. Because of the decreased functional reserve in the aged drugs may adversely affect preexisting chronic diseases. Generally, the possibility that clinical symptoms in the elderly are drug-related has to be considered. Abrupt changes in dosage should be avoided. The indication of drug therapy should be reevaluated periodically. However, advanced age is no reason to withhold necessary medication. The compliance with or adherence to drug therapy may be improved by giving clear, written instructions, simplifying the dosage schedule and reducing the number of drugs, for instance by using combination drugs. Elderly patients are particularly vulnerable to the sedative effects of psychotropic drugs, resulting in cognitive impairment and motor incoordination with an increased risk of falls and hip fracture. There is no rational basis for the use of geriatric drugs that claim to stop or slow the aging process. Also the available evidence does not support the therapeutic value of so-called nootropic or cerebroactive drugs to improve mental function in the elderly.

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PubMed1994

Outcomes of geriatric discharge planning. A quality assurance study from a geriatric rehabilitation ward.

The outcome of a discharge planning procedure at a geriatric rehabilitation ward was studied with an interdisciplinary and multidimensional approach, where medical, nursing, functional and psychosocial factors were included. The patient's own expectations and attitude to functional performance and outcome were explored in an interview at the day of discharge and one month later in a follow-up telephone interview. Data were also collected from registers and medical and professional records. All the 36 patients discharged to their own homes, mostly after home assessment, or to old people's homes were followed up. The median rehabilitation stay was 30 days. Their medical status was stable over time and nursing interventions remained frequent. The functional level was unchanged for 18, and further enhanced for 10 patients. Most patients felt secure at home and received the home help they anticipated. Worries were expressed by one-third on realistic grounds, mainly medical or ideas on the accommodation. Some interventions were required and carried out by the team. Home living was as expected or better for two-thirds of the patients. The timing and the patient's situation at discharge seemed to have been well assessed, with an overall positive outcome after a month at home. Further development of practical multidimensional evaluations adapted to elderly patients is necessary in a quality assurance perspective.

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PubMedDate not supplied

The geriatric obstacle course: a training session designed to help prehospital personnel recognize geriatric stereotypes and misconceptions.

A significant proportion of ambulance transports to the Emergency Department involve elderly patients, and this use of EMS services by the elderly is expected to increase. Emergency medical technicians (EMTs) may have preconceived notions about the behavior they observe in this group of patients, who tend to be difficult to assess. To provide EMTs with the perspective from which their elderly patients view the situations in which they find themselves, we developed and implemented training scenarios in which the EMTs were required to play the role of the geriatric patient. The EMTs' evaluations of the sessions were enthusiastically positive and indicated that the course did enable them to reevaluate their attitudes toward elderly patients. It is our conviction that this type of sensitivity training is an easily implemented and highly valuable method of augmenting the facts and algorithms taught to these prehospital care providers.

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PubMed2006

A comparison of depressive mood of older adults in a community, nursing homes, and a geriatric hospital: factor analysis of Geriatric Depression Scale.

The Geriatric Depression Scale (GDS)-15 was used in 607 adults aged 65+ years living in a community, nursing homes, and a general hospital to explore characteristics of depressive mood in different care settings. Factor analysis of GDS-15 extracted 4 factors labeled unhappiness, apathy and anxiety, loss of hope and morale, and energy loss. The scale scores labeled unhappiness, apathy and anxiety, and loss of hope and morale were negatively correlated with the Barthel Index and the Mini-Mental State Examination scores. The results classified the depressive patterns into 2 types, one fitting the nursing home residents and the other fitting the hospital patients. The dominant factors of the nursing-home type were unhappiness and loss of hope and morale, and the hospital type was highly related with apathy and anxiety. The results indicate an extended utility of the GDS-15 for a deeper understanding of depressive mood in various care settings.

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PubMedDate not supplied

[The Geriatric Concentration Test and correlations with intelligence, memory ability, orientation and professional assessment in geriatric patients between 60 and 85 years of age in a nursing home].

In view of the lack of standardised psychometric procedures in establishing the cerebral efficiency of geriatric patients, it was attempted to develop an aptitude test for this group of patients. The "AUT" was tested on 140 patients at the 1st Medical Department of the Vienna-Lainz nursing home. The values examined, such as completion time, number of correctly cancelled figures, mistakes, as well as the combined result total amount and error percentage correspond, with regard to objectivity and reliability, with the requirements of psychometric procedures. Initial findings show the test to be a good indicator of "general cerebral efficiency" of those questioned, but it is to be noted that most of all the varying ability to concentrate, ability to remember, intelligence, orientation, activity and independence have an influence on the test results.

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PubMedDate not supplied

[Effects of family status on the geriatric hospital or geriatric nursing homes].

The different personal status of patients at home and in the geriatric hospital are presented, especially that of the very old, including those over 100 years. The duration of stay in the hospital is affected by the family situation. Family conflicts and familial overprotection influenced the cave facilities. Gender-based considerations are discussed.

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PubMedDate not supplied

[Intervention measures in geriatrics from the viewpoint of a geriatric clinic with special reference to pharmacotherapy].

The objective of intervention is to produce an improved state of physical, psychological, and sociological well-being. To reach this state a complex therapeutic program is required that offers the best of pharmacotherapy, nutrition, occupational and activity therapies, and the advice of specialists during the course of therapy. Consultations with the patients' family-doctors are also important. The practice of geriatrics will be improved when we include its special considerations in our school curriculum .

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PubMed1986

[The geriatric patient in surgical gynecology. Results of the treatment of geriatric patients--a postoperative quality control].

This paper presents results of a retrospective study covering 506 older women (age range: 60 years and older), who were treated by major gynecologic operations in a twenty-years-period between 1962 and 1981 at the Department of Gynecology and Obstetrics at the District Hospital of Stralsund. The total number of patients operated on during these twenty years was 6,246, the frequency of the operated older women 10.11 per cent. In two control periods (1967-1971 and 1977-1981) there was a slight increased of these patients in the last period from 8.22 per cent to 13.29 per cent. Comparing postoperative outcome and complication rate of the geriatric patients group there is no statistically significant difference to another group of patients (age range: 30-40 years) undergoing gynecologic surgery in 1981. Indications for gynecologic surgery showed age-dependent differences in the two groups. Our conclusions are that retrospective studies concerning clinical assuring of professional quality of medical care are not sufficient enough. As a result of this study we present our concept for medical data processing (documentation) regarding quality-assessment of gynecologic surgical care.

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PubMed1992

Co-ordinating geriatric and general medical services; experience of a geriatric assessment ward in the Royal Infirmary of Edinburgh.

The paper describes the work of an assessment unit setup to provide a service for frail elderly patients admitted to general medical units at the Royal Infirmary of Edinburgh during the period of April 1989 to March 1990. Patients were selected on the basis of diagnosis, mental and physical function, age and social background and transferred to the assessment ward within 24 hours of admission to a medical ward. Most of the 376 patients admitted to the ward had a high level of multiple pathology and physical incapacity and a third had an acute confusional state. The mean length of stay was 19.4 days. There was a 13% mortality with 71% of survivors returning to their own homes. Review of mobility and self care capacity of the group revealed a striking increase in function during their stay in the ward. Factors increasing the likelihood of discharge included having a spouse, receiving support at home, having a low initial dependence rating. Adverse factors included having cerebrovascular disease, having dementia and initial maintenance of urine and faeces.

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