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[Geriatric and gerontopsychiatric clinical institutions: results of an empirical study].

A research project was carried out to investigate 138 geriatric and geropsychiatric institutions. In the first instance the object of the study was a comprehensive survey of all clinical institutions in the Federal Republic of Germany specializing in the treatment of geriatric and geropsychiatric patients. The study was carried out since no comparable survey was available. A further aim was the analysis of the data obtained by questionnaire concerning different characteristic of the clinical institutions specializing in the care of the aged. This article presents a summary of the research methods and the most important results of the characteristics surveyed. The results presented inable us to make statements about the buildings and equipment of the institutions surveyed, about those groups of patients treated, the number and qualifications of staff, methods of treatment and about costs. Further information is given about supporting institutions and about planned future alterations.

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PubMed1982

[What is in the future for geriatrics? II].

The authors point out the importance of geriatric medicine in the hospital in its traditional goals and in some new proposals: geriatric case finding, general practitioner's education, teaching in nursing schools, family education, pre-retirement courses etc.

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PubMed1994

Critical care for the geriatric patient.

Approximately one-half of all patients admitted to the intensive care unit are over the age of 65, even though elderly people comprise about 12% of the population. This article defines the special needs of the geriatric patient within the critical care setting. Developing an approach to the care of critically ill geriatric patients based on knowledge of their medical and psychosocial needs is discussed.

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PubMed1993

[The first experiences from a dementia-unit at a geriatric department].

Traditionally, patients suffering from dementia are treated in psychiatric wards. In many geriatric patients, confusion/dementia is one of several problems prohibiting an early return to the previous way of living. To provide the best treatment, one of our geriatric wards was used for these patients. Based on our experiences from the first 58 patients discharged during the period 09.11.89-31.01.91, it was possible to create and secure a stable environment, with suitable activities for the satisfaction of the patients, their families and the staff. A structured procedure, including rating scales, was a great help in disclosing the patients' problems. One quarter of the patients were not demented, but temporarily confused due to other reasons. One third of the demented patients had no public assistance. It was necessary to discharge 60% of the demented and only 10% of the non-demented patients to nursing homes. Sheltered home-like living could be an alternative to the expensive nursing homes.

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PubMed1977

Undergraduate medical education in geriatrics: nursing home experience.

Preclinical medical students undertook an elective course in geriatrics which combined instruction in history taking, physical diagnosis, and problem-oriented assessment of elderly patients in a nursing home. A drug utilization review and specific drug therapy plans were formulated by pharmacy students. The project identified general problems susceptible to institutional as well as individual remedy. The students were led beyond their initial preoccupation with "physical complaints" to interest in pertinent psychological, social, and economic factors. A model of geriatric education for health science students can productively link the health science center and community nursing homes with benefits for the student, the patient, and the nursing home.

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PubMed1997

[Ginseng--no identifiable effect in geriatric rehabilitation].

The consumption of ginseng root has increased greatly in the Western world during the last decades. Because clinical trials have indicated a positive effect of ginseng on physical and psychomotor performance, we have undertaken a trial of Gericomplex to evaluate ginseng as an adjuvant in the treatment and rehabilitation of geriatric patients. The length of stay in hospital and activities of daily living served as the principal study variables, and cognition, somatic symptoms, depression and anxiety were also assessed. No positive effect of Gericomplex as an adjuvant in geriatric rehabilitation was seen.

Activities of Daily Living↗

PubMed1996

What influences physician practice behavior? An interview study of physicians who received consultative geriatric assessment recommendations.

BACKGROUND: Comprehensive geriatric assessment (CGA) in outpatient settings has not been shown to be as effective in reducing mortality and improving health as in hospital settings; this difference has been attributed in part to a lack of direct control over recommendation implementation. OBJECTIVE: To identify inhibiting and facilitating factors in physicians' compliance with consultative CGA recommendations, so that the effectiveness of outpatient CGA might be improved. METHODS: A 49-item questionnaire was administered via the telephone to 87 eligible community primary care physicians in Los Angeles, Calif, whose patients had received consultative outpatient CGAs as part of a study of CGA (response rate, 96%). The questionnaire assessed physician compliance with CGA recommendations, reasons for implementing or not implementing the recommendations, and specific physician attitudes, perceptions, and characteristics. The focus of the interview was the CGA recommendation that was determined to be the "most important" by the evaluating geriatrician. Recommendations addressed geriatric syndromes, general medical problems, or psychiatric conditions. RESULTS: Of the 87 physician respondents, 62 (71%) implemented the most important recommendation. In multivariate analysis, 4 variables were predictive of physician compliance: (1) a patient's request that the recommendation be implemented (odds ratio [OR], 10.8; 95% confidence interval [CI], 1.9-61.3; P = .007); (2) perceived legal liability resulting from nonimplementation of the recommendation (OR, 10.8; 95% CI, 1.1-108.2; P = .04); (3) female physician gender (OR, 9.6; 95% CI, 1.4-67.9; P = .04); and (4) perceived cost-effectiveness of the recommendation (OR, 7.0; 95% CI, 1.6-30.5; P = .01). CONCLUSIONS: Patient behavior, which may be modifiable, was among the strongest determinants of physician compliance with recommended care. Specifically, when patients requested that a recommendation be implemented, physicians were highly likely to comply. Changing patient behavior within the physician-patient relationship as a way of effecting desired changes in physician health care practices merits further attention.

Ambulatory Care↗

PubMed1998

Interpretation of Mini-Mental State Examination scores in community-dwelling elderly and geriatric neuropsychiatry patients.

The purpose of this article is to provide data for advanced interpretation of MMSE performance in community-dwelling elderly persons and in geriatric neuropsychiatry inpatients. Age- and education-corrected cutoff scores, standard errors of measurement and standard errors of difference were computed using previously published population normative data (Crum et al., 1993). The supplementary normative table provides a means of interpreting MMSE performance at a single point in time, or at two testing intervals. These same scores were calculated for a sample of 248 elderly inpatients from the geriatric psychiatry division of a psychiatric hospital. Clinical examples are provided.

Age Factors↗

PubMed1998

Use of hypnotics among patients in geriatric institutions.

A survey of hypnotic use in geriatric institutions outside hospitals was performed in the county of Hordaland, Norway. The data were obtained from the cardex system in 67 institutions and represented administration of hypnotics to the patients on 3 separate days within a week. About 24% of 2802 patients in the institutions used hypnotics. The number of patients treated with hypnotics, the doses administrated and the time of administration were similar for weekends and workdays. About 98% of the hypnotics were used as scheduled, and 41% of the doses administrated were higher than the recommended lowest dose for elderly patients. Long-acting benzodiazepines constituted about 62% of the hypnotics. A significantly higher proportion of patients in old age homes used hypnotics compared to patients in nursing homes (30.7% versus 22.9%, respectively, p < 0.01). Furthermore, higher doses, administration later in the evening and use of additional hypnotics were more common in old age homes compared to nursing homes. The results indicate a need for frequent reevaluation of prescribing of hypnotics in geriatric institutions.

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PubMed1999

Geriatric Depression Screening Scale (GDS) in patients hospitalized for physical rehabilitation.

OBJECTIVE: To determine the prevalence of symptoms of depression and the factors affecting their presence in an elderly population at the start of rehabilitation. To assess changes in the severity of these symptoms during rehabilitation and the correlation between these changes and corresponding changes in the patient's functional state. DESIGN: A population-based prospective study. SETTING: A geriatric ward in a general university hospital in southern Israel. PARTICIPANTS: Two hundred and seventy-six elderly patients hospitalized for physical rehabilitation, 150 following hip fracture (HF) and 126 after stroke. MEASUREMENTS: Symptoms of depression were measured by the Geriatric Depression Screening Scale (GDS). The functional state was assessed using the FIM scale. A broad spectrum of clinical, functional, social and demographic variables was measured using conventional tests. The association between the GDS and these variables was tested by stepwise multiple regression. RESULTS: One hundred and thirteen patients (41%) showed signs of depressions (GDS>10), with 12 (4%) patients having severe symptoms (GDS>20). No significant difference was found between HF and stroke patients in symptoms of depression. Only four of the 41 variables tested were found to be significantly and independently associated with the GDS: pre-event functional state (beta=-0.311, p<0.001), the self-care component of the FIM scale on admission to the hospital (beta=-0.267, p<0.001), living alone (beta=0.149, p=0.015) and impaired visual acuity (beta=0.137, p=0.026). The total variance in GDS accounted for by these four variables (adjusted R-square) was 0. 24. The severity of depression symptoms decreased significantly during rehabilitation and the GDS at discharge was significantly lower than on admission (p=0.008). This change correlated significantly with the corresponding change in functional state (R=-0.15, p=0.03). CONCLUSIONS: Symptoms of depression are common in elderly patients beginning rehabilitation. These symptoms are affected independently, and almost exclusively, by the functional state of the patient, both prior to the event and after its occurrence. The depressed condition improves towards the end of hospitalization and the degree of improvement is correlated with the corresponding change in the patient's functional state.

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PubMed2005

The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients.

BACKGROUND: In geriatric psychiatry assessment scales are often used in clinical praxis in the diagnostic work-up of mental disorders. AIM: To assess whether the state part of the STAI is useful as a case-finding instrument of mental disorders. MATERIALS AND METHOD: Data came from 70 non demented geriatric in-patients in stable clinical condition. Mean age was 83.3 years (range 64-96), and 74.3% were women. The 20-item STAI state instrument was used to measure current anxiety symptoms. Without knowledge of the score on STAI state a psychiatrist examined all patients and set diagnosis according to DSM-IV-TR criteria, but hierarchical rules were not used. Sensitivity, specificity, Likelihood ratio and accuracy were calculated for different cut-points of the mean sumscore on the STAI state. RESULTS: 15.7% of the participants suffered from a mental disorder: GAD = 1, mixed anxiety-depression = 5, depression = 1, dysthymic = 1, adjustment disorder (mixed anxiety-depression) = 1, and personality disorder = 1. The mean STAI sumscore in this group was 56.3 compared with 39.2 in the 59 patients without any psychiatric diagnosis. The optimal cut-off score on the STAI mean sumscore corresponding to the highest accuracy of 0.87 was 55/54 with sensitivity 0.82, specificity 0.88, and LR + 6.8. CONCLUSION: The STAI state scale is a useful instrument for detecting a variety of mental disorders in older people. Further studies should be carried out in different populations.

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PubMed2005

Depression is the predominant factor contributing to morale as measured by the Philadelphia Geriatric Morale Scale in elderly Chinese aged 70 years and over.

OBJECTIVE: To examine factors contributing to the total Philadelphia Geriatric Morale Scale (PGMS) and its two subscales: reconciled ageing and unstrained affect. METHOD: The PGMS was administered to 759 community-living subjects aged 70 years and over. Information regarding socioeconomic status, health conditions, sensory impairment, physical symptoms, social support, activities of daily living as measured by the Barthel Index, life satisfaction, and the Geriatric Depression Score, was collected. Associations between these factors and PGMS and its subscale were examined using univariate analysis (Mann-Whitney; Kruskal-Wallis tests), and multivariate analysis using the classification and regression tree (CART) method. RESULTS: Gender, old age, physical, socioeconomic and social factors were significantly associated with PGMS. There was a strong correlation with GDS (r = 0.77, p < 0.001). In the CART analysis, for both subscales and the total score, GDS was the predominant factor contributing to the score. Other factors include self perception of health, enough expenses, overall satisfaction with life, gender, and constipation. DISCUSSION: The PGMS and GDS are closely related. In addition to the GDS, health perception, life satisfaction, and adequate finance were factors contributing to quality of life in elderly Hong Kong Chinese.

Activities of Daily Living↗

PubMed2003

Accuracy of the 15-item geriatric depression scale (GDS-15) in a community sample of the oldest old.

BACKGROUND: Cognitive impairment is common in the oldest old. This might influence the sensitivity and specificity of the 15-item Geriatric Depression Scale (GDS-15). Few studies, however, have included subjects older than 85 years to evaluate the GDS-15 as a screening instrument for depression. OBJECTIVE: To assess the sensitivity and specificity of the GDS-15 in a community sample of the oldest old. METHODS: Seventy-nine subjects aged 85 and over were enrolled in the study. The GDS-15 and the Mini-Mental State Examination (MMSE) were administered by a trained interviewer. Within two days the Geriatric Mental State (GMS)/AGECAT, was administered to obtain a clinical diagnosis of depression. RESULTS: Eight subjects (10%) were diagnosed with clinical depression. At a cut-off point of 3/4 the sensitivity and specificity of the GDS-15 were 88% and 76% respectively. In the group with MMSE scores of 28 and higher sensitivity was unaffected at all cut-off points while specificity increased. In the group with MMSE scores below 28 sensitivity was also unaffected at all cut-off points while specificity decreased. CONCLUSION: The GDS-15 is a suitable instrument to diagnose depression in the general population of the oldest old. The optimal cut-off point depends on its intended use. In subjects with cognitive impairment the accuracy should be investigated further.

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PubMed2003

A three-factor analytic model of the MADRS in geriatric depression.

OBJECTIVE: Major depression is a heterogeneous disorder, perhaps comprising several clinical subtypes or subgroups of symptoms. This study examined whether items on the Montgomery-Asberg Depression Rating Scale (MADRS) form distinct symptom subgroups among geriatric depressive patients that might form the basis of new outcome measures for tracking treatment effects. METHOD: The study examined a sample of 225 adults age 59 and older diagnosed with major depression. Factor analysis with oblique rotation was used to analyze baseline MADRS item scores. RESULTS: Three distinct interpretable factors were obtained; all ten items loaded <0.60 on a domain. The first factor, dysphoric apathy/retardation, comprised five items: apparent sadness, reported sadness, lassitude, reduced concentration, and inability to feel. Psychic anxiety, the second factor, included three items: inner tension, pessimistic thoughts, and suicidal thoughts. The third factor, vegetative symptoms, resulted from items involving sleep and appetite. CONCLUSIONS: The study produced three interpretable MADRS factors reflecting geriatric depression dimensions that may be useable to monitor focused treatment outcomes.

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PubMed2007

Estimating the costs for a group of geriatric patients using the Coxian phase-type distribution.

The length of stay in hospital of geriatric patients may be modelled using the Coxian phase-type distribution. This paper examines previous methods which have been used to model health-care costs and presents a new methodology to estimate the costs for a cohort of patients for their duration of stay in hospital, assuming there are no further admissions. The model, applied to 1392 patients admitted into the geriatric ward of a local hospital in Northern Ireland, between 2002 and 2003, should be beneficial to hospital managers, as future decisions and policy changes could be tested on the model to investigate their influence on costs before the decisions were carried out on a real ward.

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PubMed1976

Building a comprehensive geriatric health care system: a case study.

This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

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PubMed1988

Geriatric medicine in the United States: new roles for physician assistants.

The problem of adequate medical care for the nation's elderly is mounting as this population grows in numbers. While the overall U.S. population has tripled since 1900, the segment over 65 has increased eightfold. Because of the high incidence of chronic illness in persons over 65, they consume a disproportionate amount of health care. Contributing to the problem are pervasive attitudes of ageism in the U.S. culture (including those of physicians), with the result that old people in the U.S. receive fragmented and often substandard medical care, particularly in nursing homes. Although some stirrings of activity in geriatric medicine are apparent in medical schools, not nearly enough faculty are available to teach courses and the interest of medical students is low. Several trends indicate that physician assistants are prepared to help fill the gaps in health care of the elderly. First, as physician extenders, these allied health professionals have demonstrated that they can perform approximately 80% of primary care tasks carried out by physicians at no sacrifice of quality. Second, a large proportion of the current caseload of physician assistants is patients over the age of 65. Third, physician assistant training programs have incorporated a fivefold increase in geriatric courses into their curricula since 1980, and both students and graduates show a high interest in this field. Finally, reimbursement policies of third party payers indicate a trend toward underwriting more physician assistant services. For example, Medicare Part B recently included payment of physician assistants in nursing homes and hospitals.

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PubMed1986

Rethinking paradigms in geriatric ethics.

This paper calls for a shift away from autonomy as the central value in geriatric ethics. In treatment and experimental settings, differences between older and younger adults are easily attributed to deficiencies on the part of the elderly when autonomy is the central value. Overemphasis on the concept of autonomy skews our understanding of human relationships toward excessively rational models, distracts attention from important physical and social characteristics of aged persons, and results in ethics by default. This paper describes several principles that would be more useful starting points than autonomy in developing a geriatric ethic.

Adult Children↗