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PubMed2001

Nosocomial infections in geriatric long-term-care and rehabilitation facilities: exploration in the development of a risk index for epidemiological surveillance.

OBJECTIVE: To compute a risk index for nosocomial infection (NI) surveillance in geriatric long-term-care facilities (LTCFs) and rehabilitation facilities. DESIGN: Analysis of data collected during the French national prevalence survey on NIs conducted in 1996. Risk indices were constructed based on the patient case-mix defined according to risk factors for NIs identified in the elderly. SETTING: 248 geriatric units in 77 hospitals located in northern France. PARTICIPANTS: All hospital inpatients on the day of the survey were included. RESULTS: Data from 11,254 patients were recorded. The overall rate of infected patients was 9.9%. Urinary tract, respiratory tract, and skin were the most common infection sites in both rehabilitation facilities and LTCFs. Eleven risk indices, categorizing patients in 3 to 7 levels of increasing NI risk, ranging from 2.7% to 36.2%, were obtained. Indices offered risk adjustment according to NI rate stratification and clinical relevance of risk factors such as indwelling devices, open bedsores, swallowing disorders, sphincter incontinence, lack of mobility, immunodeficiency, or rehabilitation activity. CONCLUSION: The optimal index should be tailored to the strategy selected for NI surveillance in geriatric facilities in view of available financial and human resources.

Adult↗
PubMed1982

Attitudes and anxieties of elderly patients on admission to a geriatric assessment unit.

A semi-structured interview schedule has been used to investigate the attitudes and anxieties of 100 lucid elderly patients on admission to a geriatric assessment unit. Results show that most patients are unconcerned by admission to a geriatric unit and expect a favourable outcome. A minority, mainly higher social class patients, or those who do not live with a close relative, are disturbed by the geriatric nature of the ward and in particularly by the presence of confused patients. More than half the group reacted unfavourably to the idea of admission to local authority residential accommodation.

Aged↗
PubMed1986

The role of chest radiography in the evaluation of the 'geriatric giants'.

Three hundred and eighty admissions to a geriatric assessment unit had a routine chest radiograph. Forty-four per cent presented atypically with one or more of Isaacs' 'geriatric giants'--falls, immobility, incontinence or deteriorating mental function. The chest radiograph was abnormal in 164 (44%), of whom 57 had no classical clinical cardiopulmonary features. The chest radiograph was especially useful in the investigation of the geriatric giants, where 22% had evidence of cardiopulmonary disease, in the absence of classical clinical features.

Aged↗
PubMed2002

Geriatric medicine on the web.

A major website has been developed containing almost all of the information doctors require to manage any older medical patient. It caters for geriatricians, for those with an uneven, basic knowledge of geriatric medicine, and for differing international requirements. The validity and reliability of the site were assured by a specialist review board recruited from the American and British Geriatrics Societies, World Health Organisation, and the Pan American Health Organisation. This paper describes the development of the site, and outlines the planning and development process for a further web site. This will allow a doctor's practical knowledge of geriatric medicine to be assessed on-line, in an interactive educational way as a means of continued professional development.

Aged↗
PubMed1989

Platelet subpopulations in adult and geriatric males.

In this study, the authors wanted to investigate the volume, density, and percentage of three platelet subpopulations present in adult and geriatric males. Ninety subjects, between the ages of 20 and 40, were chosen for the adult group and 50 subjects, all older than age 70, were used for the geriatric group. The platelet subpopulations were separated with discontinuous gradients of Percoll. The results obtained from the three platelet subpopulations--low, intermediate, and high density--show different volumes and percentages in both the groups studied. From the information that larger platelets can be expected to have a longer life span, it was possible to hypothesize that platelets found in geriatric males have a reduced average life span. It is also clear that platelets exist that have similar volumes but different densities.

Adult↗
PubMedDate not supplied

Infectious diseases of geriatric inmates.

The number of geriatric inmates is rapidly growing because of more frequent incarceration of older offenders as the number of the elderly in the general population increases nationally. The increase is also due to recent changes in sentencing patterns (e.g., longer sentences and tightened parole) that affect younger, long-term inmates. Geriatric inmates often have chronic medical illnesses that may result in hospitalization for infectious complications. These infectious conditions may be related to factors such as institutionalization (e.g., tuberculosis and influenza), chronic medical illness (e.g., pneumococcal pneumonia), and a history of alcohol or drug use (e.g., hepatitis B virus and retrovirus infection). The epidemiology of these conditions is reviewed. Since infectious complications among geriatric inmates will add stress to a correctional health care system that is already burdened by inmates with AIDS-related illnesses, clinical recognition of these complications and preventive measures are of great importance.

Aged↗
PubMed2003

The effect of meals at different mealtimes on blood pressure and symptoms in geriatric patients with postprandial hypotension.

BACKGROUND: The variability of postprandial hypotension (PPH) during the day in elderly patients is unknown. We examined the effect of meals administered at different mealtimes on postprandial blood pressure (BP) responses in geriatric patients. METHODS: In 14 geriatric patients (6 men and 8 women, aged 66-97) previously diagnosed with PPH, standardized liquid test meals were given in random order at breakfast, lunchtime, or dinnertime on 3 separate days. Systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) were measured with an ambulatory BP device every 10 minutes from 20 minutes before until 90 minutes after each meal. Postprandial symptoms were observed continuously. RESULTS: Significant decreases in SBP and DBP were present after each meal (p <.050). The maximum SBP decrease was significantly smaller at dinnertime (-18 +/- 3 mmHg) than at breakfast (-29 +/- 2 mmHg) or lunchtime (-34 +/- 4 mmHg) (p <.005 between groups). Eight patients showed no PPH in the evening, whereas all patients had PPH after breakfast and lunch. The duration of PPH was significantly shorter (p <.001), and postprandial symptoms were less frequent and less severe after dinner compared to breakfast and lunch. CONCLUSIONS: In geriatric patients, postprandial BP responses show a variation during the day, with significantly less PPH and fewer symptoms in the evening. Clinical implication is that, in the diagnostic process and management of PPH, the variation of the occurrence of PPH during the day should be taken into account. Through adjustment of BP decreasing activities to the time PPH is least prevalent, the risk of developing symptomatic PPH can be reduced.

Aged↗
PubMed2004

Risk factors for geriatric depression: the importance of executive functioning within the vascular depression hypothesis.

BACKGROUND: Results from recent studies addressing the vascular depression hypothesis have been mixed, with cerebrovascular risk factors (CVRFs) predicting depression in some geriatric patients but not in others. The current study seeks to examine executive dysfunction as a potential moderator of the relationship between CVRFs and depressive symptoms. METHODS: Data concerning CVRFs, executive functioning, and depressive symptoms from 77 geriatric rehabilitation patients were incorporated to test the hypothesis that patients with executive dysfunction and greater CVRFs would demonstrate the highest levels of depression over time. CVRFs (diabetes, hypertension, atrial fibrillation) were measured via diagnosis by treating physician. Depression was assessed using the 15-item Geriatric Depression Scale (GDS) at baseline and at 6-month and 18-month follow-ups. Executive functioning was measured at baseline using the Initiation/Perseveration (IP) Subtest of the Mattis Dementia Rating Scale. RESULTS: Multivariate analysis of variance demonstrated a significant statistical interaction between the number of CVRFs and scores on the IP Subtest on depressive symptoms. Patients with two or more CVRFs and lower IP scores demonstrated significantly greater depressive symptoms at baseline and at 18-month follow-up than patients with fewer CVRFs and higher IP scores. The univariate effect at 6 months was not significant. CONCLUSION: The current data suggest that scores on an index of executive functioning may moderate the relationship between CVRFs and depressive symptoms. Interpretation of these findings is provided in the context of the vascular depression hypothesis and related frontostriatal dysfunction. Patients with greater CVRF burden and poor executive functioning may be at particularly high risk for depression.

Aged↗
PubMed2006

Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial.

BACKGROUND: Delirium is a common syndrome with poor prognosis affecting elderly inpatients. Treatment is mainly based on common sense with wide variations in practice. We investigated whether intensified, multicomponent geriatric treatment could improve the prognosis of delirious patients. METHODS: We performed a randomized, controlled trial of 174 patients with delirium in six general medicine units from an acute hospital in Helsinki, Finland. The intervention group received individually tailored geriatric treatment. The primary endpoint was the sum of those deceased individuals and the patients permanently institutionalized. Secondary endpoints included the number of days in hospitals and other institutions, delirium intensity, and cognition. RESULTS: The mean age of patients was 83 years, and 31% had previous dementia. The intervention group (N = 87) received significantly more acetylcholinesterase inhibitors (58.6% vs 9.2%), atypical antipsychotics (69.8% vs 30.2%), specialist consultations (49.4% vs 28.7%), hip protectors (88.5% vs 3.4%), physiotherapy (87.4% vs 47.1%), and fewer conventional neuroleptics (8.0% vs 23.0%) than did the control group (N = 87). During the 1-year follow-up, 60.9% of the intervention group and 64.4% of controls were either deceased or permanently institutionalized (p =.638). The intervention group spent a mean of 126 days in institutions, and the control group 140 days (p =.688). Delirium was, however, alleviated more rapidly during hospitalization, and cognition improved significantly at 6 months in the intervention group. CONCLUSIONS: Faster alleviation of delirium and improved cognition justify good, comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis.

Aged↗
PubMed1975

Comparison of speech and swallowing function in patients with tremor disorders and in normal geriatric patients: a cinefluorographic study.

In a study of vocal tract and esophageal function during speech and swallowing, unmedicated Parkinson patients were found to have specific disorders in oral and esophageal stages of deglutition and a predictable sequence of deterioration in speech. To determine whether these disorders are exclusive to parkinsonism or are typical of all patients with tremor or of geriatric patients in general, a cinefluoroscopic study was initiated to examine the physiology of speech and swallowing in these other patients. Subjects were 10 normal geriatric patients and 10 patients with essential tremor. Results of the studies for these two groups were compared with data from earlier studies on unmedicated Parkinson patients. Parkinson patients showed most severely disordered swallowing and speech function. Patients with essential tremor showed only slight slowing in esophageal transit during swallowing and vocal tremor during speech, but no progressive deterioration. Normal geriatric patients revealed no swallowing or speech disturbances.

Age Factors↗
PubMed1975

Response of institutionalized geriatric mental patients to a twelve-week program of regular physical activity.

Twenty-three geriatric patients from a mental institution were randomly assigned to three groups-a social group, an exercise group, and a control group. Subjects participated in the study for 12 weeks. Heart rate at rest, exercise and recovery, balancing ability, total daily activity level (diary method), and a self-care inventory were recorded for analysis. Data were collected at the start, the 8th and 12th weeks of the study, and 4 weeks after the termination of treatment. A Groups X Sex X Measurement Period factorial design, using multivariate analysis of variance tested the effect of the three factors. The trials effect was significant, as were several univariate tests for the sex effect and group by sex interaction. Data were discussed in terms of programmed physical activity for geriatrics, its value, and the limitations of evaluating such behavior in geriatric populations.

Activities of Daily Living↗
PubMed1987

Post-geriatric evaluation unit follow-up: team versus nonteam.

Twenty-six matched pairs of elderly male patients who had been evaluated in an outpatient geriatric evaluation unit (GEU) were assigned randomly to be followed in either a geriatrics clinic with an interdisciplinary team or a general medical clinic without an interdisciplinary team. Patients were medically stable and living in the community. At 12 months no difference was found in cognitive, affective, or functional status. Both groups of patients had similar frequencies of hospitalization, community placement, use of community services, and number of deaths. These findings suggest that the major benefit from GEUs may be in the initial assessment and treatment rather than in the subsequent care provided by interdisciplinary teams in geriatrics specialty clinics.

Aged↗
PubMed1994

Stochastic models for geriatric in-patient behaviour.

Departments of geriatric medicine engage in two distinct forms of clinical activity: acute/rehabilitative and long-stay care. These are organizationally distinct and have very different resource needs. Current hospital planning models, however, assume that patients all move through the system at the same rate, thereby ignoring this effect of inherent heterogeneity in patient behaviour. The present paper describes the movement of patients through geriatric hospitals by a two-stage continuous-time Markov model, where the stages represent acute/rehabilitative and long-stay patients respectively. Patients are initially admitted to the first stage, from which they may depart from the system, by death or discharge, or move into the second stage, from which they eventually depart by death or discharge (unlikely). Admissions are modelled in two ways: either as replacements for departures or as a Poisson stream. Expressions for the distribution and movement of numbers of patients are derived and evaluated for data from a number of hospitals. Such an approach has the advantage, over previous crude models, of taking into account different types of patients and introducing variability, thus making it possible to extract variances as well as means of numbers of geriatric patients requiring hospital care.

Aged↗
PubMed2006

Number of X-ray examinations performed on paediatric and geriatric patients compared with adult patients.

The age of the patient is of prime importance when assessing the radiological risk to patients due to medical X-ray exposures and the total detriment to the population due to radiodiagnostics. In order to take into account the age-specific radiosensitivity, three age groups are considered: children, adults and the elderly. In this work, the relative number of examinations carried out on paediatric and geriatric patients is established, compared with adult patients, for radiodiagnostics as a whole, for dental and medical radiology, for 8 radiological modalities as well as for 40 types of X-ray examinations. The relative numbers of X-ray examinations are determined based on the corresponding age distributions of patients and that of the general population. Two broad groups of X-ray examinations may be defined. Group A comprises conventional radiography, fluoroscopy and computed tomography; for this group a paediatric patient undergoes half the number of examinations as that of an adult, and a geriatric patient undergoes 2.5 times more. Group B comprises angiography and interventional procedures; for this group a paediatric patient undergoes a one-fourth of the number of examinations carried out on an adult, and a geriatric patient undergoes five times more.

Adolescent↗
PubMed2002

Fast-track eligibility of geriatric patients undergoing short urologic surgery procedures.

UNLABELLED: Our primary objective was to assess the feasibility of geriatric patients (>65 yr) bypassing the postanesthesia care unit (PACU) after ambulatory surgery. A secondary objective was to compare recovery profiles when using three different maintenance anesthetics. Ninety ASA physical status I--III consenting outpatients (>65 yr) undergoing short urologic procedures were randomly assigned to one of three anesthetic treatment groups. After a standardized induction with fentanyl and propofol, anesthesia was maintained with propofol (75-150 microg center dot kg(-1) center dot min(-1) IV), isoflurane (0.7%-1.2% end tidal), or desflurane (3%-6% end tidal), in combination with nitrous oxide 70% in oxygen. In all three groups, the primary anesthetic was titrated to maintain an electroencephalographic-bispectral index value of 60-65. Recovery times, postanesthesia recovery scores, and therapeutic interventions in the PACU were recorded. Although emergence times were similar in the three groups, the time to achieve a fast-track discharge score of 14 was significantly shorter in patients receiving desflurane compared with propofol and isoflurane (22 +/- 23 vs 33 +/- 25 and 44 +/- 36 min, respectively). On arrival in the PACU, a significantly larger percentage of patients receiving desflurane were judged to be fast-track eligible compared with those receiving either isoflurane and propofol (73% vs 43% and 44%, respectively). The number of therapeutic interventions in the PACU was also significantly larger in the Isoflurane group when compared with the Propofol and Desflurane groups (21 vs 11 and 7, respectively). In conclusion, use of desflurane for maintenance of anesthesia should facilitate PACU bypass ("fast-tracking") of geriatric patients undergoing short urologic procedures. IMPLICATIONS: Geriatric outpatients undergoing brief urologic procedures more rapidly achieve fast-tracking discharge criteria after desflurane (versus isoflurane and propofol) anesthesia. Use of isoflurane was also associated with an increased need for nursing interventions in the early recovery period compared with desflurane and propofol.

Aged↗
PubMed1993

Key decisions in marketing plan formulation for geriatric services.

The scope of geriatric services offered by health care institutions has expanded from the traditional hospital, long-term care, and home care services to include a variety of community services in an effort to promote the institution and provide a continuum of care for the elderly. The purposes of this article are to analyze why marketing of geriatric services is such a significant issue in health care today, to identify why a comprehensive management tool such as Service Line Management may be a key component for successful development and marketing of geriatric services, and to analyze the key decisions facing management when formulating a marketing plan.

Aged↗
PubMed2002

Evaluation of a new hands-up ergonomics for chest radiography in geriatric patients.

RATIONALE AND OBJECTIVES: Pneumonia is the leading cause of death after the age of 85 years. Chest radiography (CXR) requires forced inspiration for accurate assessment, but kyphosis, denutrition, muscular weakness, and neurologic disorders limit active inspiration. The aim of this study was to evaluate a new passive expansion technique, by raising the patient's arms above the head, in the radiographic diagnosis of pneumonia. METHODS: During a 10-month period, CXR were performed in 1452 geriatric patients for pulmonary acute disorders in our geriatric university hospital. When fewer than five anterior rib segments were visible on the conventional front view, a second CXR was performed with the patient's arms being raised above the head by a radiologist. The diagnostic questions were: Are more than five anterior rib segments present? Is pneumonia visible? The chest radiographs were independently analyzed (3-step confidence scale) by two radiologists and compared by interobserver kappa-coefficients calculation. RESULTS: One hundred three patients (97 female, 6 male), representing 7% of the examined population, with an average age of 86.5 years (range, 70-104 years) were included. An additional anterior rib segment was visible on the front CXR when the arms were raised above the head (P < 0.001). Pneumonia was diagnosed in 59 patients with high agreement (kappa = 0.84) by the passive expansion technique, whereas the pneumonia infiltrate was visible in only 44 patients with considerably lower agreement (kappa = 0.36) when the arms were positioned along the trunk (P < 0.03). CONCLUSIONS: Raising the arms above the head optimizes the quality of CXR and increases the detection of pneumonia in the geriatric patient. New ergonomics and adequate contention are required.

Aged↗
PubMed1996

How do geriatric patients recover from surgery?

Age is often a marker for comorbid illnesses that may complicate attempts at surgical intervention. Careful selection is important in deciding to recommend surgery for geriatric patients, but selected elderly patients may even benefit from major surgery. Ancillary services, such as nutrition, nursing, and physical therapy, are particularly important components in the postoperative care of geriatric patients. Case series have shown the ability of geriatric patients to recover from major surgical procedures, including cardiac surgery, neurosurgery, and oncologic surgery. In general, advanced age is not a contraindication to surgery but it reinforces the need for careful preoperative evaluation and vigorous postoperative support of the patient.

Aged↗