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PubMed1983

A teaching catalogue of physical findings developed on the geriatric ward of an acute-care teaching hospital.

A catalogue of physical findings from patients on a geriatric ward run by a Family Practice Centre was developed for the use of both medical educators and students. The collection and organization of the data is described, as well as the ethical problems involved. Advantages to both teachers and students are discussed with respect to the teaching of physical diagnosis. An added benefit of producing and using a catalogue of this nature could be the changing of negative attitudes towards the geriatric patient.

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PubMed1985

A one-year follow-up of patients discharged from geriatrics and general medical units in Wales.

A random sample of patients aged 65 yr and over, admitted as emergencies to the specialties of geriatrics and general medicine in Wales were interviewed 3 and 12 mth after discharge using a postal questionnaire. The characteristics of patients, the preparation they received for discharge and the use made of community services were recorded as were mortality, functional capacity and rehabilitation. Overall geriatrics patients were better prepared for discharge, were given a higher level of service provision and had a more favourable outcome than the general medical patients.

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PubMed1995

Elderly people's adaptability to complete denture therapy: usability of a geriatric behaviour-rating scale as a predictor.

Accurately predicting prognosis of complete denture therapy requires a reasonable estimation of the ability of a patient to adapt. The aim of the current study was to test the usability of a geriatric behaviour-rating scale (BOP) as a predictor of elderly people's ability to adapt after complete denture therapy. Ninety-five complete denture-wearing residents of four nursing homes for somatically handicapped patients were randomly divided into two groups, 48 test subjects for whom replacement dentures were prepared and 47 test subjects whose current dentures were improved on. The results of these treatments were evaluated by comparing the scores on the so-called 'scale of appreciation' (complaints of and (dis)satisfaction with complete dentures) prior to and at 2 and 6 months post-treatment. Univariate correlations were computed between the scores on the 'scale of appreciation' or the differences in scores at the three evaluation-moments and the foremost BOP-subscale (BOP1, infirmity) and some factors that were considered to be of influence on the process of adaptation. The BOP1 was the only factor showing a significant correlation with the 'scale of appreciation' at 2 months posttreatment; this suggests that little infirmity was connected with a low value of complaints of and dissatisfaction with complete dentures or a positive alteration of this value. It is concluded that the BOP1 can be a useful predictor of complete denture therapy in this group of elderly people. A relationship between elderly people's adaptability to complete denture therapy and the BOP or any other geriatric behaviour-rating scale could be possible.

Adaptation, Psychological↗

PubMed2006

Validity of 3 physical performance measures in inpatient geriatric rehabilitation.

OBJECTIVE: To evaluate the construct validity and the responsiveness of 3 measures of physical performance measures as outcome measures for frail older persons. DESIGN: Pre-post design with measures at admission and discharge. SETTING: Three inpatient geriatric rehabilitation programs. PARTICIPANTS: Fifty-two subjects (35 women, 17 men; age, 80+/-8y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical performance measures were Timed Up & Go (TUG) test, two-minute walk test (2MWT), and functional reach. Functional status was measured with the FIM instrument and the Modified Barthel Index. RESULTS: The TUG and 2MWT scores differed significantly in groups of patients using different ambulatory aids (P=.006), whereas no such difference was observed for the functional reach (P=.40). The correlations between the TUG test and FIM and between the 2MWT and FIM were -.59 and .59 (P<.001), respectively, at admission, and -.42 and .47 (P< or =.04), respectively, at admission and discharge. The correlations between functional reach and the FIM were not significant (P> or =.09). Standardized response means were 1.1 for the TUG, 0.7 for the 2MWT, and 0.5 for functional reach. CONCLUSIONS: The TUG test and 2MWT are valid and responsive outcome measures in older persons participating in geriatric rehabilitation. Functional reach was a moderately responsive outcome measure but did not consistently reflect ambulatory or functional status.

Activities of Daily Living↗

PubMedDate not supplied

A polar diagram for comprehensive geriatric assessment.

Comprehensive geriatric assessment has become synonymous with geriatric practice. This includes evaluation of the older person's physical and mental health, and the functional and social status. We propose a new way of representing a person's condition, called the "polar diagram". This shows the subject's scores on the evaluation scales that are arranged in radial positions inside a circle. The outer part of the circle corresponds to the best condition. Gaps between the best condition and the actual scores are easily identified. The diagram can be employed to monitor the subject's condition and to assess any changes in outcomes.

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PubMed2004

Depression and concomitant diseases in a Turkish geriatric outpatient setting.

Depression is an important but inadequately diagnosed mood disorder in elderly. Depressed elderly patients often have chronic concomitant diseases. This paper intended to determine the prevalence of depression and its relation with concomitant disorders and social status among the patients admitted to our geriatric unit. Seven hundred and eighty-nine females and 466 males admitted to our unit were examined for the presence of depression by using the geriatric depression scale (GDS) test. The presence of concomitant diseases was assessed. Depression was diagnosed in 273 patients (21.8%), 193 (70.7%) females and 80 (29.3%) males. Depressed patients suffered from a wide range of other diseases the number and prevalence of which were as follows: Alzheimer's disease (AD) (34; 12.5%), vascular dementia (27; 9.9%), hypertension (HT) (211; 77.3%), diabetes mellitus (DM) (64; 23.4%), osteoporosis (182; 66.7%), atherosclerotic coronary artery disease (CAD) (89; 32.6%), cardiac failure (23; 8.5%), bronchial asthma (8; 2.9%), chronic obstructive pulmonary disease (COPD) (25; 9.2%) and osteoarthritis (133; 48.8%). The correlation between depression and concomitant diseases was statistically significant in hypertensive, demented and osteoporotic patients, as determined in a large elderly population. Previous studies examined the correlation of depression with only one concomitant disease, while we performed the analysis on multiple correlations.

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PubMed2006

ESPEN Guidelines on Enteral Nutrition: Geriatrics.

Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

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PubMed2003

Comorbidity: implications for research and practice in geriatric oncology.

The aging of the population and the emergence of cancer as a major disease of older age require the development of new strategies of cancer management in older adults, in particular, strategies based on the special characteristics of older patients, such as the effects of concurrent health conditions, i.e. comorbidity. This paper is a consideration of the implications of current research on comorbidity for research and practice in geriatric oncology. Subjects include considerations of representative measures of comorbidity; sources of data; screening and early diagnosis; prognosis, treatment, and outcome; and physiological mechanisms. Recommendations for future research include the development of (a) more refined measures of comorbidity; (b) new studies of comorbidity and cancer treatment; (c) investigations of the contributions of comorbidity for geriatric assessment and a new generation of clinical trials, (d) examinations of physiological mechanisms linking comorbidity with health outcomes; and (e) the development of an epidemiology of comorbidity.

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PubMed2006

The abbreviated comprehensive geriatric assessment (aCGA) for use in the older cancer patient as a prescreen: scoring and interpretation.

UNLABELLED: The abbreviated CGA (aCGA) can be used as a prescreening assessment to identify patients who would most benefit from the complete CGA. OBJECTIVE: To develop cutpoints for scoring the aCGA that are consistent with existing limitations as revealed by the full CGA. DESIGN/SETTING: A retrospective chart review of patients at the H. Lee Moffitt Cancer Center. PARTICIPANTS: Over 500 charts between 1995 and 2001 were reviewed on cancer patients 70 and over. MEASUREMENTS: Each of the four domains: functional status (activities of daily living (ADL), instrumental activities of daily living (IADL), depression, using the geriatric depression scale (GDS), and cognition using the mini-mental state examination (MMSE)) are scored separately. RESULTS: For the depression domain, a score of 2 or more toward depression indicates that the entire GDS be administered. For the MMSE, a score of 6 or lower indicates necessity of the entire MMSE. For the ADL/IADL, any deficit on either scale (needs assistance or complete assistance) requires further clinical evaluation using the entire instruments. CONCLUSIONS: These guidelines provide the clinician with parameters to target patients most likely to benefit from more intensive geriatric evaluation.

Activities of Daily Living↗

PubMed2006

Systemic hypoperfusion is associated with executive dysfunction in geriatric cardiac patients.

The present study examines the relationship between systemic hypoperfusion via cardiac output (CO) and neuropsychological performances emphasizing executive function in an aging cohort. Geriatric outpatients with treated, stable cardiovascular disease (CVD) and no history of neurological illness (n=72, ages 56-85) were administered cognitive measures with an emphasis on executive functioning. Echocardiogram findings were used to stratify participants into two groups: low CO (<4.0 L/min) and normal CO (> o r=4.0 L/min). Between-group comparisons were made using ANCOVAs adjusting for systolic blood pressure. The low CO group performed significantly worse than the normal CO group on DKEFS Tower Test and DKEFS Trail Making Test. No significant between-group differences were noted for any of the other cognitive indices. Findings suggest that reduced CO is associated with poorer executive functioning among geriatric outpatients with stable CVD, as the cognitive profile emphasizes a relationship between systemic hypoperfusion and problems with sequencing and planning. The executive dysfunction profile may be secondary to reduced blood flow to vulnerable subcortical structures implicated in frontal-subcortical circuitry.

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PubMed2000

Regional differences in brain monoamine oxidase subtypes in an animal model of geriatric depression: effects of olfactory bulbectomy in young versus aged rats.

Geriatric depression is often associated dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis, and with poor responsiveness to antidepressants that work through inhibition of monoamine reuptake; accordingly, it has been suggested that MAO inhibitors may represent a therapeutic alternative in this group. In the current study, we evaluated expression of MAO subtypes in brain regions of young and aged rats subjected to olfactory bulbectomy (OBX), a procedure that reproduces many of the biochemical and functional changes associated with human depression. Activities of both MAO A and B were elevated in aged rats as compared to young rats in most regions, but not in the midbrain, and the OBX lesion failed to produce any change in this pattern. These results stand in contrast to the differential effects of glucocorticoids, which reduce brain MAO in young animals but induce activity in aged rats. Our results support the view that the aged brain possesses biochemical characteristics that distinguish its monoamine biochemistry from that of young brain, and that these distinctions may work in conjunction with HPA axis dysregulation to influence the etiology and therapy of geriatric depression. The use of appropriate animal models for depression and for disruption of HPA axis function can allow for the testing of potential human biomarkers (such as platelet MAO) that may serve to predict treatment outcome.

Age Factors↗

PubMed1987

Development of a functional assessment questionnaire for geriatric patients: the Comprehensive Older Persons' Evaluation (COPE).

Several sources of data were used to identify questions worthy of inclusion in a functional assessment questionnaire for older patients. Community hospital use of the Functional Assessment Inventory was reviewed to identify questions that discriminated between inpatients and outpatients. Repeated administrations of the Older Americans Resources and Services questionnaire with elderly patients were reviewed to identify questions that discriminated between community and nursing home status and predicted nursing home placement. Twenty clinicians providing geriatric care identified clinically important questions in a modified Delphi survey. Questions were retained if they: were considered clinically essential; discriminated between inpatients and outpatients and between independent living and nursing home status; predicted nursing home placement; and showed changes in responses over 6 months that predicted subsequent nursing home placement. These questions were organized into a brief, clinically relevant functional assessment questionnaire, known as the Comprehensive Older Persons' Evaluation (COPE), that may facilitate the efficient provision of geriatric care.

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PubMed2001

[Geriatric management of the frail elderly with hip fracture may improve their clinical outcome].

BACKGROUND: The treatment of osteoporotic hip fracture requires the intervention of different medical specialties. The purpose of this study was to know the clinical profile of patients with an acute hip fracture referred for assessment and management to a geriatric assessment team (GAT) and the influence of this kind of geriatric care in their hospital outcome. PATIENTS AND METHOD: All patients 65 year-old or older admitted in a teaching hospital for a hip fracture in a 12 month period were included. The clinical, functional, cognitive and social status were assessed at admission and at discharge in both groups: the patients managed by the GAT and the patients that were not. The patients' characteristics of both groups were compared, and a multivariant analysis was applied to search the variables independently associated wit a better clinical course. RESULTS: On admission, the GAT patients (n = 202) were significantly (p < 0.05) older (84.4 vs 81.7 years), had more previous functional impairment (Barthel index 72 vs 79), more previous diseases (5.4 vs 3.3) and medications (3.2 vs 1.9), presented more frequency of cognitive impairment (52 vs 41%), of high surgical risk (54 vs 26%) and more need of social assistance at home (57 vs 38%) than non-referred patients (n = 200). At discharge, GAT patients had better functional status (Barthel index 38.5 vs 34), had been surgically treated (92 vs 84%), had received physiotherapy (83.7 vs 66.5%) and walked more (56.1% vs 33.8%) than others. In the multivariant analysis, the GAT intervention shows like an independent variable associated to higher frequency of surgical treatment (OR 4.21; CI, 2.80-6.34), to recovery of walking ability (OR, 8.26; CI, 5.23-13.04) and to receive more medical diagnosis (OR, 79.69; CI: 55.48-114.45). The GAT intervention was not associated to a longer hospital stay. CONCLUSIONS: The patients with hip fracture in acute phase required for management by a GAT are more complex than those who were not consulted. In these patients GAT intervention improve their clinical outcome and the efficiency of hospital admission.

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PubMed1983

Can readmissions to a geriatric medical unit be prevented?

During the year ending April 2, 1982, 153 patients readmitted to a geriatric medical unit within twelve months of their previous discharge from any hospital in the district accounted for 24.8% of the 617 patients admitted. Readmission of the 153 patients was due to unavoidable clinical deterioration (32%), inadequate medical management (21%), non-compliance of patient (20.2%), social problems (18.3%), or inadequate rehabilitation (8.5%). Readmission could have been prevented in 73 (47.7%) patients. These figures emphasise the importance of greater medical interest in the problems of the aged and support the need for a higher consultant/bed ratio in geriatric medical units to allow more effective management of patients aged 75 years and over.

Age Factors↗

PubMed1983

Integration of geriatric with general medical services in Newcastle.

In west Newcastle upon Tyne hospital geriatric and other acute medical specialty beds are managed as a functionally integrated service. This practice improves the efficiency of use of scarce district general hospital beds and carries other benefits in quality of patient care, experience of junior medical and nursing staff, and in working relationships. In an appropriate setting the integrated model offers an alternative to the more traditional separate development of geriatric services.

England↗

PubMed2002

Pharmacological approaches to cognitive deficits and incontinence (1899-2002): progress in geriatric care.

In planning for the medical needs of our growing population of older adults, it has been assumed that modern pharmacology of common geriatric conditions includes strategies not considered in previous decades. However, examination of the 1899 edition of the Merck Manual demonstrates that many important contributors to geriatric disability had already started to be recognized in the 19th century. Moreover, some of the medications recommended for these conditions in 1899 were based on the same pharmacological principles as 'state-of-the-art' management options available in 2002.

Cognition Disorders↗

PubMed1997

Geriatric care in the late 1990s.

Geriatric health care remains a virtually untapped area in spite of changing public views and scientific knowledge on aging. The number of older dogs and cats will continue to grow into the next century. Owners of older dogs and cats are willing to invest in quality health care services. A geriatric health care program can expand veterinary services in a practice and is a natural extension of pediatric and adult maintenance programs.

Aging↗

PubMed1992

Geriatric emergency medicine: a survey of practicing emergency physicians.

STUDY OBJECTIVES: To evaluate the current status of clinical, educational, social, ethical, and resource issues related to the care of the elderly among practitioners of emergency medicine. DESIGN: A mailed survey instrument. SETTING: None. TYPE OF PARTICIPANTS: Practicing emergency physicians randomly drawn from the membership list of the American College of Emergency Physicians. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 971 surveys were mailed, with 433 usable surveys among the 485 (50%) respondents. The surveyed emergency physicians anticipated a major impact on emergency department patient flow and bed availability in the hospital and ICU as the population ages. For each of seven clinical presentations (abdominal pain, altered mental status, chest pain, dizziness/vertigo, fever without a source, headache, multisystem trauma), 45% or more of the emergency physicians have more difficulty in the management of older compared with younger patients. Most respondents reported that each of these presentations required more time and resources for older patients. The majority believed research, the availability of continuing medical education, and time spent during residency training regarding geriatric emergency medicine was inadequate. CONCLUSION: Practicing emergency physicians are uncomfortable with elderly patients, and this may reflect the inadequacies of training, research, and continuing education in geriatric emergency medicine.

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