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PubMed1990

Geriatric educational programs.

Information on the geriatric patient is needed in the curricula of all health professional programs. During the 1988 Academy Meeting a Symposium on the Graying of America: Optometric Considerations, was held. The following paper will: (1) summarize a recent survey of geriatric education in the United States schools and colleges of optometry, (2) describe two continuing education projects on gerontology conducted for practicing optometrists, and (3) discuss two recently completed projects involving the training of optometric faculty.

Aged↗
PubMed2002

Comprehensive geriatric assessment: making the most of the aging years.

The elderly population is the most rapidly growing segment of our population. This group utilizes the highest proportion of medical care of any age group. Comprehensive geriatric assessment involves the evaluation of the physical, psychosocial and environmental factors that impact on the well-being of older individuals. The use of an organized approach with objective measurements helps target key areas of functional status. Important areas include the evaluation of activities of daily living, cognition, mood, social supports, gait and falls, nutrition, sensory impairments, incontinence, polypharmacy, elder abuse, pressure sores, pain, and advance directives. The provision of primary and secondary prevention is also increasingly important for older individuals. The components of a successful geriatric assessment program are outlined, with suggestions to improve compliance.

Activities of Daily Living↗
PubMedDate not supplied

Creation of a geriatric workshop for nursing assistants and patient-care associates.

This article explores the development of a geriatric workshop to enhance the knowledge base of patient-care associates and nursing assistants to promote optimal geriatric nursing care. The unlicensed support staff plays an integral role in delivering a large percentage of nursing care. Therefore, it is essential to cultivate and foster their knowledge and skills, so that the older adult population will receive exemplary care.

Aged↗
PubMedDate not supplied

Geriatric competencies for RNs in hospitals.

Nurses in staff development are responsible for assuring nurses' competence in the delivery of care. Older patients are the predominant population in hospitals, yet there are no instruments that specifically assess the competency of nurses to deliver care to older patients. This article reports on the development and testing of an instrument, Geriatric Competencies for RNs in Hospitals, and makes recommendations as to how staff development educators can use the geriatric competency instrument with staff nurses.

Adult↗
PubMed2006

Population pharmacokinetics in geriatric psychiatry.

Although geriatric patients are the major recipients of drugs, most research during drug development is conducted in healthy younger adults. Safe and effective drug therapy in the elderly requires an understanding of both drug disposition and response in older individuals. One of the major issues in studying the elderly relates to the ability to study a large number of people in a minimally invasive way. Population pharmacokinetics can be used to model drug concentrations from a large population of sparsely sampled individuals. Population pharmacokinetics characterizes both the interindividual (between-subject) and intraindividual (within-subject) variability, and can identify factors that contribute to pharmacokinetic and pharmacodynamic variability. Population pharmacokinetics can be used to aid in designing large clinical trials by simulating virtual data based on the study design. It can also be used to assess consistency of drug exposure and evaluate its effect on clinical outcome. This article reviews the methods used in pharmacokinetic modeling, as well as providing examples of population pharmacokinetic modeling, highlighting its application to geriatric psychiatry.

Adult↗
PubMed1995

Inhalation anaesthesia at the extremes of age: geriatric anaesthesia.

No single anaesthetic technique is superior for all elderly patients, although the prognosis is improved if minor surgical procedures are performed with local anaesthesia rather than with general or major regional anaesthesia. If general anaesthesia is required, which specific inhalation anaesthetic can improve the prognosis of the geriatric patient? The low solubility of desflurane and its resistance to biodegradation would seem to recommend its use in the geriatric patient. However, these theoretical advantages remain to be adequately documented.

Aged↗
PubMed2004

Multidimensional geriatric evaluation in elderly cancer patients: a practical approach.

Management of cancer in the elderly population is currently perceived as one of the major challenges for clinical research in medical oncology. Multidisciplinary evaluation of the malignant disease and multidimensional assessment of the host represent the key element for correct decision making. Standard methods developed by pioneer geriatric oncologists will be summarized in this review, along with some practical suggestions on when and how they should be employed. Future perspectives concerning some critical issues in multidimensional geriatric assessment will be discussed as well.

Aged↗
PubMed1980

Setting performance goals in geriatric nursing.

Behavioural techniques are increasingly being applied in the geriatric field as part of a broader emphasis on psychological and social treatments in the care of the elderly. The nurse is in the best position to analyse a patient's performance and manage an intervention programme; however, some nurses have had little experience of autonomously diagnosing problems and setting performance goals. The authors argue that it is important to set such goals and give examples of how performance may be objectively specified, prerequisites made explicit, criteria for success defined and the consequences of goal attainment or non-attainment discussed with those most concerned. A complex situation drawn from the geriatric setting which was used as part of a teaching workshop to help nurses define suitable targets for intervention is described in the Appendix.

Aged↗
PubMed1989

Geriatric versus general medical wards: comparison of patients' behaviours following discharge from an acute care hospital.

The objective of this study was to explore, from a nursing perspective, the effectiveness of geriatric wards in preparing elderly patients for discharge from an acute care hospital. A convenience sample of 40 patients aged 70 years or older was obtained from three geriatric medical wards and two general medical wards of a large British teaching hospital. Data were collected immediately prior to discharge, and after 6 and 13 weeks following discharge. No meaningful differences were found between the two patient-groups in their ability to cope with activities of daily living following discharge. The majority of deaths and/or hospital readmissions occurred within 6 weeks of discharge. A major concern identified in both groups was patients' lack of knowledge about medications and their side-effects. A need for more effective teaching programmes for elderly patients was identified.

Activities of Daily Living↗
PubMed1991

Demographical, sociomedical and physical characteristics in relation to malnutrition in geriatric patients.

The purpose of this study was to describe and compare demographical, sociomedical and physical characteristics between protein-energy malnourished and non-malnourished geriatric patients on admission. According to the International Statistical Classification of Diseases, 104 malnourished patients were age-, gender- and diagnosis-matched with 104 non-malnourished patients. Data were collected from patients' medical records. The patient's condition was assessed by a modified Norton scale on admission. No differences were seen in marital status, type of dwelling, previous need for help service, residence before admission, and dependence on assistance with ADL function. The malnourished patients had a greater consumption of diuretics (47%; P less than 0.05) and a lower consumption of analgesics (29%; P less than 0.05) than the non-malnourished patients (33% and 42% respectively). In the malnourished group, impaired conditions in activity (83%; P less than 0.05), and general physical condition (78%; P less than 0.01) were observed compared to the non-malnourished group (69% and 60% respectively). The malnourished patients had less sufficient food intake (41% vs 21%; P less than 0.01) and fluid intake (25% vs 10%; P less than 0.01) than non-malnourished patients. This study indicates that demographical characteristics and primary ADL-functions are of minor importance for the development of protein-energy malnutrition in geriatric patients. Observation of the patients' physical condition and drug consumption seemed more important on admission.

Activities of Daily Living↗
PubMed1979

A new undergraduate teaching course in geriatric medicine.

The construction of a new teaching course in geriatric medicine is described. Course objectives are established, and teaching arrangements designed to meet these objectives. The course takes place late in the medical curriculum when students have some knowledge of clinical medicine, therapeutics and pathology. Particular features of the course include residential attachments in hospital departments of geriatric medicine and coordinated teaching with the departments of general practice and mental health. The attainments and methods of assessment are then discussed.

Curriculum↗
PubMed1983

A new approach to course development in geriatric medicine.

A new course in Geriatric Medicine was initially conducted in four District General Hospitals, ten students attending each centre. The course, in the second clinical year, was established in the Department of Geriatric Medicine at Birmingham University by Professor Isaacs. The interview technique described was used from the outset as a means of formative evaluation. Undergraduates were randomly selected from each centre at the end of a course, and the results incorporated into a written report which was corrected by the students and distributed to the tutors. The results proved invaluable in evaluating students needs, attitudes and responses to the course. The interview gave unique information not obtainable from questionnaires, essays or exam questions, and enhanced the students feelings of participation in course development. Overall the information seems reliable and consistent and a valuable tool in curriculum design. The time involved was not excessive and leads us to recommend this approach as one method for continuing curriculum development which involves both the students and the tutors.

Attitude of Health Personnel↗
PubMed1988

Undergraduate teaching of geriatric medicine in the United Kingdom: changes in the years 1981-1986.

A follow-up survey of undergraduate teaching of geriatric medicine was carried out in 1986. All 27 clinical medical schools responded. Geriatric medicine is taught to all medical students in 25 and to only a proportion of students in two. Fifty-nine per cent of schools have academic departments teaching for a mean of 89 hours compared with 33 hours in non-academic departments--an overall mean of 68 hours. The subject is taught by various methods with 70% of teaching time spent on bedside clinical instruction. Other aspects of institutional and community care are often covered. The subject is examined in 18 schools. New academic departments are planned at four schools, and an increase in teaching time planned in five. To meet the needs of the population of the next century, reconsideration of curricula in some of the medical schools is recommended.

Curriculum↗
PubMed2004

Picking behaviour in cognitively impaired residents in geriatric settings: prevalence of the behaviour and characteristics of the residents.

This paper presents the findings of a point prevalence study performed at all geriatric settings within a county in Northern Sweden. The aims of the study were twofold: to investigate the prevalence of picking behaviour in cognitively impaired residents in various kinds of geriatric care settings and describe the characteristics of the residents, and to investigate how the residents who exhibit picking behaviour are experienced by their care providers. The study comprises 1928 cognitively impaired residents. The prevalence of picking behaviour was found to be 17%. Multivariate analyses showed that behavioural and psychiatric symptoms such as 'often stands at the outer door and wants to go out', 'wanders alone or with other patients back and forth', 'aggressive threats to patients and staff' and being 'manic' and 'fearful' were associated with picking behaviour. Other factors associated with picking behaviour were 'taking part in daily tasks', 'can walk without assistance' and imposing a high psychological workload. Furthermore, residents who exhibited picking behaviour were experienced by care providers as more uncertain and unhappier than residents who did not behave in this way.

Activities of Daily Living↗
PubMed1975

Medical planners and the geriatric imperative.

The health needs of old people demand a change in the attitudes of physicians and social planners. There is a great gap between complicated models for health care and the delivery of that care to the ill elderly. Physicians should have better training in geriatrics in better and more coordinated facilities. Home health services are important. However, it is essential to avoid false starts and to adhere to sound principles. This is the job of the planners rather than the prophets; it is the geriatric imperative.

Delivery of Health Care↗
PubMed1976

Geriatric psycho-social history outline.

The details of a Geriatric Psycho-Social History Outline for use with the institutional aged are presented. All health care facilities require background information on the patient at the time of admission, but with long-term facilities a more comprehensive psycho-social history is needed. The Outline provides a basis for obtaining information in five categories: 1) identification (detailed, observational and attitudinal); 2) referral source; 3) background; 4) family constellation or environmental factors; and 5) finances. Its comprehensiveness requires more than one pre-admission interview. It is aimed at reducing morbidity and mortality rates following admission to long-term facilities. If the aged person becomes somewhat familiar with the institution before admission, he is less susceptible to accelerated physiologic and psycho-social deterioration and death. Because of constant growth in the field of gerontology, new and improved instruments must be devised to help carry the load. The Geriatric Psycho-Social History Outline is for use as a guide to those who require such information if they are to function at maximum efficiency.

Aged↗
PubMed1979

Erythrocyte parameters in the elderly: an argument against new geriatric normal values.

Erythrocyte parameters in 292 unselected geriatric patients were studied retrospectively. Statistically significant mean decreases compared to the laboratories' normal mean values were found in the red blood cell count (RBC), hemoglobin level, hematocrit, and mean corpuscular hemoglobin concentration; there also was a slight increase in mean corpuscular volume and mean corpuscular hemoglobin. However, when 17 patients with a hemoglobin level less than 10 gm/dl or a hematocrit reading less than 35 percent were excluded, all of the mean values for erythrocyte parameters fell within the normal range. In 71 percent of these 17 patients the etiology of the anemia was documented. Although one cannot definitely exclude a slight change in erythrocyte parameters with aging, it is concluded that the establishment of so-called new geriatric norms is premature, as the population studied included patients with various diseases. Good medical practice dictates continued evaluation and monitoring of patients in whom erythrocyte values are outside the established normal ranges.

Aged↗
PubMed1979

Clinical pharmacy involvement in geriatric health clinic at a high-rise apartment center.

During an initial 9-week period of involvement in the operation of a health clinic for ambulatory geriatric patients in three high-rise apartment complexes, the activities and opportunities for a pharmacist and pharmacy students were documented. For 120 of the 550 geriatric residents of the center, medication histories were completed during the study period. These 120 patients reported a total of 270 medical problems. They were taking 366 prescription drugs (average, 3.9 per patient). During the 9-week study, 43 drug interactions were documented, and about 25 percent of the patients interviewed complained of some untoward drug effect. The opportunities for pharmacist involvement and the educational opportunities for pharmacy students were demonstrated. The period since the initial 9-week study has shown even greater acceptance and utilization of the pharmacy services, with an increased number of visits by patients.

Ambulatory Care Facilities↗