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PubMed2004

Management and geriatric assessment of cancer in the elderly.

Due to the demographic evolution, the management of elderly patients with cancer currently represents a major challenge for the medical community. Aging may be associated with an increased rate of health problems possibly resulting in a loss of independence. These problems can interfere with cancer treatment strategies. Therefore, treatment decision making requires a multidisciplinary and multidimensional assessment of both the characteristics of the malignant disease and the host's general health status. Several oncological groups have developed specific programs for elderly cancer patients. Based on a multidimensional geriatric assessment tool, they aim to establish the best pattern of care for the population of elderly patients with cancer. Clinical research in geriatric oncology is also a very exciting field, particularly regarding the conception of clinical trials specifically designed for elderly patients. The particular aspects of the management of elderly patients with cancer and some critical challenges of clinical research will be presented and discussed in this review.

Activities of Daily Living↗
PubMed1992

Development of an interview-based geriatric depression rating scale.

The geriatric depression rating scale (GDRS) is a new interview-based depression rating scale designed for use with adults 60 years of age or older. The scale was developed to fill a need for an instrument that would be sensitive to the problems encountered in assessing depression among older adults. The GDRS was designed by using items from the self-report Geriatric Depression Scale (GDS) as topic areas in a structured clinical interview similar to that of the Hamilton Rating Scale for Depression (HRSD). The 35-item rating scale was administered to 68 older individuals with a range of affective disturbance. The scale was found to have internal consistency and split-half reliability comparable to the HRSD and GDS. Concurrent validity, construct validity, external criterion validity, sensitivity, and specificity were all found to be acceptable.

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PubMed1999

A standardized assessment and intervention protocol for managing risk for falls on a geriatric rehabilitation unit.

This article describes the intervention protocols implemented at the Sisters of Charity Hospital of Ottawa, Canada on a 36-bed geriatric rehabilitation unit for managing the risk for falls in patients assessed to be at high, moderate, or low risk. The implementation of tailored protocols is of particular importance on rehabilitation units because staff must balance the treatment goal to increase patient mobility, activity level, and independence with the need to prevent falls. Thus, this article also describes the related standardized criteria and decisional guidelines used in determining patients' level of independence on the unit for each fall-risk category. This article concludes with an outline of practices designed to facilitate safe transfers and completion of activities of daily living among geriatric patients with functional impairments by teaching and promoting the use of behavioral compensatory strategies for disability-related deficits.

Accidental Falls↗
PubMed1999

Geriatric mental health education in Canada SKIPs into the 21st century.

The Skills Immersion Program (SKIP) provides an educational opportunity for staff nurses who face the challenge of caring for residents who present with psychiatric and behavioral problems in long-term care (LTC) facilities within British Columbia, Canada. With the aging population and an increase in the number of individuals waiting for placement in care facilities, care providers are in substantial need of advanced education and training in the field of geriatric psychiatry nursing. Nurses working in LTC facilities in Canada are not prepared to manage the changing acuity levels and complex needs of their residents. The SKIP was developed by nurses, primarily for nurses, at St. Vincent's Hospital in Vancouver, British Columbia, Canada. Nurses who participate in the SKIP acquire an enhanced knowledge base in geriatric psychiatry nursing and gain access to assessment tools that will assist staff to increase the quality of care for their residents.

Canada↗
PubMed2001

Selecting patients for falls-prevention protocols: an evidence-based approach on a geriatric rehabilitation unit.

Geriatric rehabilitation treatment focuses on maximizing functional independence in older adults to facilitate a return to independent living following hospitalization. Rehabilitation professionals must therefore balance the need to foster increasing activity levels among patients while, at the same time, preventing falls and potential injuries. This study investigated measures of patient cognition and aspects of health as predictors of the risk for falls among geriatric rehabilitation patients. Fall rates and patient data were collected over an 18-month period. Data from 98 patients were included in the data set. The number of falls was regressed on the patient data to investigate their predictive power. Analyses were also conducted comparing fallers and nonfallers across the independent variables. Results revealed that the primary diagnosis was the only factor evidencing sufficient power for empirical identification of patients at the greatest risk for falls. The clinical implications of findings, in terms of an evidence-based approach to managing falls risk in this population, are discussed in this article.

Accidental Falls↗
PubMed2003

Geriatric nursing assessment.

Gerontological nursing is a unique area of nursing. The cornerstone of the gerontological nursing process is assessment. In some traditional education models, nurses are taught assessments in general areas, such as cardiology, neurology, urology, and orthopedics. Little emphasis is placed on integrating these systems. A one-day workshop was developed with the objective to further develop the assessment skills of the registered nurse (RN) in continuing care by demonstrating a holistic approach to assessment and care planning. For this workshop, the "giants of geriatric medicine," namely falls, incontinence, confusion, iatrogenic illness, and impaired homeostasis (Cape, 1978) were further developed into a geriatric nursing model to include the psychosocial issues. This model demonstrates a way of assessing and integrating the information known about the resident. To ensure the workshop content was practical for the nurse, existing resident care documentation within the sponsoring organization, The Capital Care Group, was used. Through the education provided in the workshop, the RNs recognized that individualized care is based on full assessment of the resident, integration of the information gathered, and complete documentation.

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PubMed1995

Rehabilitation of geriatric patients.

OBJECTIVE: To describe the role of geriatric rehabilitation, the methods of practice, and the mechanisms underlying integrated care in rehabilitation medicine. DESIGN: We reviewed the rehabilitation-related medical literature and outlined an approach to the evaluation of impairment in older patients and subsequent rehabilitation planning. RESULTS: For optimal rehabilitation of geriatric patients, knowledge of general principles of rehabilitation and key areas affecting the elderly population is important. A rehabilitation program will be most successful if a team approach--including a physician, rehabilitation nurse, physical therapist, occupational therapist, psychologist, medical social worker, and recreational therapist--is used. Attention should be paid to special considerations in older patients (such as the presence of comorbid conditions) and potential barriers to care in order to maximize benefit. CONCLUSION: Rehabilitation of elderly patients can assist in preserving functional independence and improving the quality of life. Assessment and management in an individual patient are best performed by a team approach.

Aged↗
PubMed1992

A memory clinic at a geriatric hospital: rationale, routine and results from the first 100 patients.

OBJECTIVE: To describe the operation of a memory clinic with reference to the referral pattern, patient characteristics and psychiatric diagnoses, frequency of reversible dementias and utility of brief cognitive screening tools in the detection of dementia. DESIGN: All patients underwent cognitive screening tests (Mini Mental Status Examination, Abbreviated Mental Test Score, Organic Brain Syndrome Scale of the Brief Assessment Scale) and two activities of daily living instruments. Psychiatric diagnoses were made according to criteria of the Diagnostic and statistical manual, third edition revised, of the American Psychiatric Association (DSM-III-R). SETTING: A large geriatric hospital. SUBJECTS: First 100 patients referred. RESULTS: The mean age of the patients was 75.5 years and 75 were women. Seventy-four met DSM-III-R criteria for dementia and a further 13 had other organic brain syndromes. No case of reversible dementia which recovered was encountered. The cognitive screening tools had a high correlation (r = 0.85-0.89) with one another but a much lower correlation with the activities of daily living instruments (r = 0.27-0.37). CONCLUSION: Reversible dementias are unlikely to be detected in a memory clinic at a geriatric hospital, but the assessment process may have other benefits which will need to be assessed in prospective research. The clinic population represents a unique resource for further research on dementia.

Activities of Daily Living↗
PubMed1993

Geriatric care management reduces Medicare losses.

Healthcare costs for the elderly are rising rapidly in the United States. One way for a hospital to control these rising costs is to implement a geriatric care management system. The goal of a such a system is to change the way the hospital treats medically complex Medicare patients and, thus, reduce unnecessary hospital costs. Such a system requires a process for identifying elderly patients in need of geriatric care management services, treating them efficiently, and assessing the system itself. An effective process usually results in significant cost savings for the hospital as well as improved patient care and satisfaction.

Aged↗
PubMed2001

[Geriatric problems seen in general practice in patients in nursing homes].

The general practitioner meets in long stay geriatrics polypathologic and frail patients. He is confronted with many problems: Staphylococcus aureus resistant to the methylpenicilline, ulcers of pressure, pain, depression, dementia, falls, etc. He will remain vigilant with ill-treat and the disorders of the nutrition. The communication will be improved by the use of validated scales. The nomination of a doctor coordinator will have to help to promote global geriatric assessment. The demography will involve the number of old patients. Sufficient financial means will have to be released in order to allow everyone to receive care of quality.

Activities of Daily Living↗
PubMed2002

Geriatric medicine programs in India: has the time arrived?

Aging trends in India and the world over are burdening society with the health care and economic problems resulting from an older population. With this in mind, countries are preparing themselves to face the challenges of meeting this burden. India with its huge population and improving life-expectancy should be no exception. The task involves preparation in healthcare to take care of the elderly and train a new generation of physicians in geriatric medicine. The review attempts to address some of these issues and makes pertinent recommendations, based on the author's own experiences in developing a large geriatric program with all necessary components in the last decade.

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PubMed1992

Improving practicing physicians' knowledge of geriatric mental health issues.

Elderly patients are most likely to seek mental health care from primary care physicians. Ironically, recent research findings show that primary care physicians fail to adequately detect mental health problems in their older patients. These findings raise questions about: 1) the adequacy of geriatric mental health training for physicians and 2) the possible methods for improving practicing physicians' knowledge and skills in detecting, treating, and referring patients with mental health needs. With a projected doubling in the number of people older than age 65 in the next 40 years, it is even more important that recognition and treatment of geriatric mental health problems be made a priority for primary care physicians.

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PubMed2004

Sleep: geriatric self-learning module.

The Geriatric Resource Nurse Model is used at the University of Virginia to improve the competency of staff in caring for older adults. Eight self-learning educational modules were developed to address common concerns in hospitalized elders. The Sleep: Geriatric Self-Learning Module is published here, along with a posttest and evaluation form.

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PubMed2004

Pain: geriatric self-learning module.

The Geriatric Resource Nurse Model is used at the University of Virginia to improve the competency of staff in caring for older adults. Eight self-learning educational modules were developed to address common concerns in hospitalized elders. The Pain: Geriatric Self-Learning Module to published here, along with a post-test. This is the second in a four-part publication of self-learning modules.

Acupuncture Therapy↗
PubMed2004

Problems with eating and nutrition: geriatric self-learning module.

The Geriatric Resource Nurse Model is used at the University of Virginia to improve the competency of staff in caring for older adults. Eight self-learning educational modules were developed to address common concerns in hospitalizedelders. The Problems With Eating and Nutrition: Geriatric Self-Learning Module is published here, along with a post test. This is the second in a four-part publication of self-learning modules.

Aged↗
PubMed2005

Immobility: geriatric self-learning module.

The Geriatric Resource Nurse Model is used at the University of Virginia to improve the competency of staff in caring for older adults. Eight self-learning educational modules were developed to address common concerns in hospitalized elders. The Immobility. Geriatric Self-Learning Module is published here, along with a post-test. This is the third in a four-part publication of self-learning modules.

Activities of Daily Living↗
PubMed2005

Confusion: geriatric self-learning module.

The Geriatric Resource Nurse Model is used at the University of Virginia to improve the competency of staff in caring for older adults. Eight self-learning educational modules were developed to address common concerns in hospitalized elders. The Confusion. Geriatric Self-Learning Module is published here, along with a post-test. This is the third in a four-part publication of self-learning modules.

Acute Disease↗
PubMed1990

[A specific geriatric regimen. II].

The authors discuss individual nursing components of the specific geriatric regime. Attention is paid to problems of activation of geriatric patients, cooperation with their families, the system of controlled visits, an individual approach focused on comprehensive solution of the situation in life. Special attention is paid to rationalization of the diagnostic and therapeutic programme with an effort to reduce the administration of tranquillizers.

Aged↗