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PubMed1997

Two studies of the new nursing education in Sweden: I. The place of gerontology and geriatrics. 2. Student characteristics and expectations.

In the autumn of 1993, a new system of nursing education started in Sweden. A questionnaire was sent to the presidents of all the colleges of nursing, health and the caring sciences, and questions were asked about the part played by gerontology and geriatrics in the new curricula. The responses showed a considerable variety in the amounts of theoretical and clinical education given at the colleges. During the first or second week of their education, the students admitted to three colleges in the Mälaren area answered a questionnaire containing questions about their educational backgrounds, their working experiences in the health care system, why they chose nursing education, their ideas of the tasks that a registered nurse primarily carries out, and their preferences for work after graduation. The result shows a correlation between working experience and the reasons for studies. The students stated a preference for working in emergency care rather than in geriatric care after graduation from college.

Adolescent↗
PubMed1990

Principles of geriatric care.

The increase in the numbers of elderly in the United States, and their projected continued increase to 21% or more of the population by 2030, has provided impetus for the growth of geriatrics. Recognition of change that is age-related rather than disease-related, and the ways in which the elderly differ from their young counterparts is vital in the care of the elderly. A functional approach and appropriate geriatric assessment have been shown to be beneficial to the individual.

Activities of Daily Living↗
PubMed2004

Cutaneous oncologic and cosmetic surgery in geriatric patients.

A wide array of surgical procedures is available to geriatric patients. These interventions can enhance the appearance of patients and facilitate the removal of skin cancers. Pre-existing medical conditions of geriatric patients must be considered comprehensively when selecting and performing cutaneous surgical procedures. Many older patients suffer from a variety of diseases and take a variety of medications and herbal supplements to ameliorate the consequences of such diseases. In general, skin surgery can be performed safely on even very old patients, provided precautions are followed. The biopsychosocial well-being and essence of patients must also be addressed when performing dermatologic surgery. If patients are treated holistically and comprehensively, their surgical experience can be enhanced and their health and appearance improved.

Dermatologic Surgical Procedures↗
PubMed2003

End-of-life care in the critically ill geriatric population.

As the geriatric population in the United States increases and better management of chronic diseases improves survival, more elderly will become critically ill and potentially require treatment in an intensive care unit (ICU). Dan Callahan has written, "... we will live longer lives, be better sustained by medical care, in return for which our deaths in old age are more likely to be drawn out and wild." Although no health care provider hopes for a drawn out and wild death for elderly patients, many geriatric persons will succumb to disease and die after having chosen and received ICU care. Recent data suggest that, on average, 11% of Medicare recipients spend more that 7 days in the ICU within 6 months before death.

Aged↗
PubMed2004

Age associated issues: geriatrics.

The effects of aging on the body are numerous, but the most important point with regard to surgery is to differentiate the effects of aging from those of the pathology associated with a disease process that may also be present in the elderly patient. Studies tend to validate the premise that there are no labs mandated solely because of a patient's age. Rather, the physician should analyze the geriatric patient with reference to the nature of the surgery emergent versus elective; the degree of risk for the surgical procedure itself-that is high-risk, intermediate--risk, or low-risk surgery; while bearing in mind the patient's overall physiologic state. In assessing a patient's overall physiologic state an organ systems based approach focusing on the cardiac, respiratory, renal, hepatic, endocrine, nutritional, and neurologic systems may be warranted and beneficial. In the elderly population one of the key predictors of perioperative complications seems to be the geriatric patient's preoperative condition and preoperative level of functioning.

Age Factors↗
PubMed2000

Geriatric assessment for the rheumatologist.

The population of industrialized countries is aging rapidly. Rheumatologic disorders are the most common illnesses causing functional disability in the elderly and medications for rheumatologic disorders are among the most frequently prescribed. As the population of patients seen by rheumatologists ages, it is important for the rheumatologist to understand the techniques of geriatric assessment that are useful in understanding and treating this special population. This article reviews practical ways to assess function, cognition, affect, directives, and end-of-life care in elderly populations. The article concludes with a "Top Ten" list of geriatric principles for rheumatology fellows to learn.

Aged↗
PubMed2004

A comprehensive geriatric intervention detects multiple problems in older breast cancer patients.

UNLABELLED: Studies of comprehensive geriatric assessment (CGA) have shown the importance of follow-up for effectiveness, but this has not been tested in an oncology clinic. In this pilot study, we enrolled 15 early breast cancer patients, aged 70 and older. They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner, dietitian, social worker, and pharmacist according to risk. Total follow-up was 6 months. Median age of evaluable patients was 79 years (range 72-87). Median number of comorbidities by Cumulative Index Rating Scale-Geriatric (CIRS-G) was 5 (3-9) at baseline. Ten patients were at pharmacological risk, five at psychosocial risk, and eight at nutritional risk. Patients presented on average six problems initially, and three new problems during follow-up. The intervention directly influenced oncological treatment in four cases. It ensured continuity/coordination of care in seven cases. Success rate in addressing problems was 87%. Mean Functional Assessment of Cancer Treatment-Breast (FACT-B) scores improved from 110.5 (S.D. 16.7) to 116.3 (S.D. 16.5) (t=0.025). Function and independence were maintained. CONCLUSIONS: Older patients with early breast cancer have a high prevalence of comorbidity. A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting.

Aged↗
PubMed2001

Assessing psychiatric illness in geriatric patients.

Assessing psychiatric illness in geriatric patients can be difficult for a variety of reasons. First, medical comorbidity may obscure the diagnosis. For example, the patient with multiple chronic illnesses will often have many "vegetative" symptoms of either dementia or depression (e.g., fatigue, loss of energy, poor appetite) attributed to the primary medical condition rather than to an underlying psychiatric illness. Second, the phenomenology of psychiatric illness in the elderly is often different. For example, depression in the elderly is often characterized by prominent anhedonia--loss of interest in virtually everything--and physical complaints leading to an unnecessary medical workup. Third, physicians are often reluctant to diagnose new-onset mental illness in their elderly patients. The fear of stigmatizing the patient or physician discomfort with "psychologic language" often results in underdetection of straightforward psychiatric syndromes. This article will focus primarily on detection of 3 of the most common psychiatric syndromes: dementia, depression, and delirium. The field of geriatric psychiatry has done a good job of characterizing the prevalence (Table I) and clinical features of these syndromes. The problem--briefly addressed here--is how to incorporate some of these findings into a busy clinical practice where there is very little time for the assessment of psychiatric symptoms.

Aged↗
PubMed1984

A prevalence study of antibodies to Legionella spp. in geriatric institutions.

The prevalence of seropositivity to Legionella spp. was studied in inmates and staff members of two geriatric hospitals (Rahel and Sinai); attendants to a geriatric Day Club; and 26 old people with entirely independent households. The sera were examined by indirect immunofluorescence with antigens of six Legionella species (L. pneumophila, L. longbeachae, L. micdadei, L. gormanii, L. dumoffii and L. bozemanii). A titre of greater than or equal to 256 to at least one antigen was obtained in 30.5% of patients and 35.7% of staff members from Rahel; 12.1% of patients and 17.2% of staff members from Sinai; 9.1% of attendants to the Day Club; and none of 26 old people with their own households. All the positive patients from Rahel reacted with L. pneumophila, but only four of seven of the positive patients from Sinai did so; none of the seropositive subjects from the Day Club reacted with this agent. The results indicate intramural exposure to agents of legionellosis, at least for the Rahel Hospital.

Aged↗
PubMed2002

Development of the Chinese version of the geriatric mental state schedule.

OBJECTIVE: To test the validity and reliability of the Chinese Geriatric Mental State Schedule (CGMS) in Taiwanese elders. METHODS: The CGMS has gone through a standardized two-way translation, a pretest phase, and consensus focus group meetings in order to modify relevant culture-related terms of the original English version. The interrater reliability of the CGMS among eight psychiatrists was conducted after a training course was given to them. Diagnoses generated by the CGMS-AGECAT (Automated Geriatric Examination for Computer Assisted Taxonomy) were compared with psychiatric diagnoses according to the DSM-III-R criteria. The sample subjects were aged 65 and over and recruited from a community (n = 36) and an "old age home" (n = 56). RESULTS: Four of the eight diagnostic categories generated by the CGMS-AGECAT had a generalized kappa value of 1.0, and the figures for the remaining four categories were acceptable: .8 for depressive neurosis, .6 for anxiety disorder, .5 for schizophrenia, and .5 for depressive psychosis (generalized kappa = .5). The overall agreement between the CGMS-AGECAT and independent psychiatric diagnosis (based on the DSM-III-R criteria) was satisfactory. CONCLUSION: The CGMS has been found to be a cross-culturally valid and reliable instrument for use in Taiwan.

Aged↗
PubMed2006

Geriatric psychiatry consultations in a Turkish university hospital.

OBJECTIVE: The size of the elderly population is growing rapidly in Turkey. We aimed to characterize geriatric psychiatry consultations to obtain the characteristic pattern of these patients for further interventions. METHOD: A retrospective chart review was undertaken for each patient. RESULTS: One hundred and sixty-six patients with a mean age (+/- S.D.) of 75.5 +/- 6.6 years were included in this study. Most referrals came from the Department of Internal Medicine (42.2%), with sleep problems (42.1%), depression (29.5%) and anxiety (28.3%) being the most common reasons for referral. Hypertension was the most frequent medical diagnosis (53.6%). The mean number +/- S.D.) of medications used by each patient was 4.4 +/- 2.0. The leading psychiatric diagnosis at the end of the assessment was adjustment disorder (31.3%). CONCLUSION: Turkish geriatric psychiatry consultation patients display similar characteristics to elderly patients from other western countries. The main difference comes from diagnosis of adjustment disorder, which may be related to hospital conditions and strong family ties in developing countries.

Aged↗
PubMed1989

Psychiatric profile of the noncompliant geriatric patient in the community.

A pharmacist collected data in an active geriatric outpatient program on 140 patients admitted consecutively over a 1-year period. Compliance was monitored by patient statement, pill counting, and daily written record-keeping of all medications with the help of a pocket diary provided in the program. Weekly pharmacist counseling sessions were then initiated for all patients. After four compliance sessions, two subgroups of patients were identified: 120 compliant patients and 20 patients showing persistent 50% noncompliance. Patients were interviewed by a psychiatrist to develop a profile of the noncompliant patient. This profile may be useful in identifying other noncompliant geriatric patients. Early recognition of this special group of patients in need of directed counseling may help reduce medical misjudgment in prescribing for the frail elderly population.

Aged↗
PubMed1998

Documented evidence of depression in medical and nursing case-notes and its implications in acutely ill geriatric inpatients.

Depression is common among acutely ill elderly medical inpatients. Identification of such depression by geriatric medicine staff would allow early treatment. The impact of a depression screening procedure on documentation of depressive signs and symptoms in the medical and nursing case-notes was examined. Thirty-five sets of medical and nursing case-notes of medically ill elderly inpatients, for whom data from the Brief Assessment Schedule and the short Geriatric Depression Scale (GDS) were also available, were examined for documentation of signs and symptoms of depression, prescription of antidepressants, and referral to the psychogeriatric service. Depressive signs and symptoms were documented in only a few medical (29%) and nursing (11%) case-notes. Only a small number of depressed patients were prescribed antidepressants (20%) or were referred to the psychogeriatric service (13%). The frequency of documentation of depressive signs and symptoms after the screening procedure with the short GDS was associated with subsequent prescription of antidepressants and referral to the psychogeriatric service. The screening procedure itself may increase the general awareness of depressive signs and symptoms and effect its management. These results require replication.

Aged↗
PubMed1998

Practice of geriatric psychiatry and mental health services for the elderly: results of an international survey.

The authors conducted a survey of members of the International Psychogeriatric Association (IPA) to determine the state of development of both the profession of geriatric psychiatry and services for mentally ill elderly. Ratings for both issues were based on a scale of 1 to 4, with 1 being little to no development and 4 being the highest. A rating of 2 was set as the desired minimum, and 12 countries met this goal in both categories, with 6 more countries reaching this goal in service development only. We conclude that although the field of geriatric psychiatry and services for mentally ill elderly are still underdeveloped in much of the world, in many countries they are developed sufficiently enough that the IPA is in an excellent position to provide both information and technical assistance to nations wishing to advance.

Aged↗
PubMed1996

Direct and indirect effects of demographic, medical, and psychological variables on neuropsychological performance in normal geriatric persons: a structural equation model.

The direct and indirect effects of demographic, medical, and psychological variables on neuropsychological performance in elderly individuals were examined using a LISREL structural equation model. One-hundred fifty-six geriatric subjects were individually administered a comprehensive neuropsychological battery, an extensive medical history and demographics questionnaire, and the Neuropsychology Behavior and Affect Profile (a psychological assessment instrument). The model assessed the effects of five independent latent variables (medical history, psychological functioning, global mental status, education, and gender-related functioning) on two dependent latent variables (nonverbal and verbal neuropsychological functioning). The best fitting model revealed that three latent variables (medical history, global mental status, and gender-related functioning) had direct effects on neuropsychological functioning and that all five independent variables exhibited indirect effects. These findings suggest that the influence of demographic variables on neuropsychological functioning for geriatric persons is complex and that certain variables should not be interpreted independently of each other due to their significant moderating influences.

Aged↗
PubMed2001

Geriatric nephrology units: the way of the future.

The emergence of the sub-speciality geriatric nephrology is an exciting development for the future. The main objectives should be to maximise patient independence and minimise deterioration and learn dependent behaviour in this population. To achieve these goals a holistic approach needs to be taken, to the patient, their environment and the efficacy of such units, and this can only be achieved using a multi-disciplinary team approach. In the creation of a geriatric nephrology unit it is important to identify the factors that cause frailty and, if possible, modify or prevent the initial decline using nutritional and other interventions. This requires careful monitoring, not only using the traditional markers of renal disease including urea and creatinine, but also using instruments that measure functional ability. These issues are discussed under the headings prevention, documentation and planning.

Geriatrics↗
PubMed2003

[Intuitive work. Influencing feelings of residents and patients in inpatient and ambulatory geriatric nursing].

The concept of sentimental work by Strauss and collaborators is presented and investigated empirically within the fields of home and out-patient geriatric care by means of questionnaires. The results illustrate that sentimental work is an important component of nursing work. Differences in the use of distinct types of sentimental work are shown. A comparison between sentimental work in home and out-patient geriatric care reveals similarities as well as typical differences.

Adaptation, Psychological↗
PubMed2000

Factors associated with admission to a geriatric hospital in semisuburban southern Japan.

A case-control study was conducted to evaluate the factors associated with admission to a geriatric hospital. Case studied were 13 Japanese elderly who were admitted to a geriatric hospital because their female caregivers had found it impossible to look after them at home. We used 35 pairs of elderly and female caregivers, who were receiving domiciliary visits by nurses, in the catchment area of the hospital. The present study revealed that elderly with dementia (vs without; Odds ratio = 6.69) and with moderately limited activities of daily living (Barthel Index 61 +) (vs severely limited activities of daily living: Barthel Index 0-60; Odds ratio = 6.62), caregivers being a daughter-in-law (vs other kinship; Odds ratio = 6.30), were risk factors.

Activities of Daily Living↗