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PubMed1979

Unblocking beds: a geriatric unit's experience with transferred patients.

A study was made of all patients admitted to a geriatric unit over several years. The admission policy included a high degree of priority to requests for transfer from acute beds, which resulted in transferred patients accounting for 25% of admissions. Unblocking acute beds did not lead to prolonged delay in admitting patients from the community to the geriatric unit. Almost 30% of beds allocated to transferred patients were recovered in 30 days.

Aged↗
PubMed1981

An evaluation of home visiting of patients by physicians in geriatric medicine.

The practice of preadmission home visiting of patients referred to geriatric medicine units has in recent years been criticised as being unnecessary on the grounds that if there is no waiting list there is no need for allocation of priority for admission; as being wasteful of doctors' time; as being resented by general practitioners; and as failing to provide adequate clinical information. The geriatric medicine department at the City Hospital with no waiting list for patients referred by general practitioners has retained home visits for most referrals because of the advantages in terms of acceptability to general practitioners (98-100%); the quantity and quality of information obtained; the usefulness of this information in deciding appropriate management and in planning discharge from hospital; and the provision of a unique teaching opportunity, which is highly valued by students and teachers alike.

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PubMed1992

Prospective study of necropsy audit of geriatric inpatient deaths.

AIMS: To evaluate the accuracy of clinical diagnosis by specialists in geriatric medicine and to compare this with a previous study involving non-specialists. METHOD: Clinical and necropsy diagnoses from consecutive hospital inpatient deaths from the University Department of Geriatric Medicine were analysed for discrepancies at regular audit meetings. Three main categories of diagnosis were considered and any therapeutic implications discussed. RESULTS: Between 1987 and 1989 necropsies were performed on 100 patients (38 men, 62 women, aged 63 to 99 years) from a total of 207 deaths, a necropsy rate of 50%. There was complete agreement between necropsy and clinical diagnoses in 32% of cases. Disagreement involved the main diagnosis in 28%, contributory conditions in 32%, and cause of death in 34%. In 10% of cases the diagnostic discrepancy was considered therapeutically important. Specialist geriatricians correctly diagnosed the main diagnosis in 72% of cases; non-specialists in the previous study were correct in only 47% of cases. CONCLUSION: Specialist geriatricians diagnose elderly people more accurately than non-specialists. But rates of misdiagnosis are still significant and necropsies continue to be a useful form of audit.

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PubMed2003

History of the development of geriatric medicine in the UK.

In this review the development of the specialty of geriatric medicine in the UK is traced from its humble beginnings. Elderly medicine is now thriving and represents the largest group of physician members of the Royal Colleges of Physicians. Geriatric medicine is essentially about optimising the care and wellbeing of older people. A key component of this is teamwork. A successful service for old people depends on the skills of many people, including nurses, therapists, social workers, and others. The contributions made by nurses and other professionals have been immense, but space does not permit a historical review of their important role.

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PubMed2001

Standards of care in geriatric practice.

We propose a set of standards to aid the physician in the care of older patients. These standards are based on the practical experiences of our own group and of others with years of clinical practice in geriatric medicine. The standards also reflect the guidelines, position papers, and deliberations of various organizations concerned with the care of older people. This article does not discuss specific illnesses or the common geriatric syndromes. The proposed standards cover comprehensive care and assessment, especially of vulnerable elders and prevention of disease and disability. We also propose standards for facilitation of care across the health service continuum, care of the nursing home resident, and palliative and hospice care.

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PubMed2004

[Variables associated with functional recovery and post-discharge institutionalization of elderly cared in an average stay geriatric unit].

BASIS: To describe the evolution and results of the rehabilitation of elderly disabled cared in an average stay geriatric unit, and to define the factors associated with functional improvement and post-discharge institutionalization. PATIENTS AND METHOD: Observational longitudinal study in 459 patients with functional disability consecutively hospitalized between May 2000 and December 2001. Basal variables collected included the clinical, functional, mental, and sociodemographic manifestations previous to the admission. The favorable functional response (defined as a functional gain during the admission of > or = 20 points in the Barthel index) and the post-discharge institutionalization were regarded the main result variables. RESULTS: The average age of patients was 80.56 (SD: +/- 7.45) years, 64.9% were women and 81% came from acute hospital units; the main cause of disability was stroke (48.5%) followed by orthopedic pathology (26.2%) and immobility for different causes (23.5%). 72.5% of patients get functional improvement and 16.4% were institutionalized after the discharge. The main independent risk factors for poor functional response found in the multivariate analysis were a scoring in Pfeiffer's cognitive test of 5-7 points (OR: 0.42; 95% CI: 0,22-0.78) and > or = 8 (OR: 0.29; 95% CI: 0.12-0.71), and a scoring in Barthel's index < 60 prior to the deterioration (OR: 0.36; 95% CI: 0.14-0.93). Independent risk factors for institutionalization after the discharge were age (OR: 1.06; 95% CI: 1.01-1.12), and a scoring in the Gijon's sociofamiliar scale > or = 9 (OR: 6.83; 95% CI: 1.91-24.47). A functional disability after the discharge in the Barthel's index < 40 also was independently associated to post-discharge institutionalization (OR: 3,07; 95% CI: 1.04-10.06). CONCLUSIONS: Most of elderly with recent disability benefit functionally from care in specific hospital geriatric units. Moderate or severe cognitive deterioration after hospitalization is associated to lower recovery probability. Very advanced age, higher social precariousness and severe disability after discharge are associated with higher risk of institutionalization.

Aftercare↗
PubMed1995

Prevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision.

The prevalence of visual impairment among elderly patients admitted to hospital is unknown. This group of patients may be particularly at risk from poor vision which could jeopardise their independence. A prospective study of visual imapairment and its aetiology in acute geriatric admissions assessed after the acute illness had settled was performed. Subjects were all patients aged 65 years or over, excluding those chronically confused, admitted to the Department of Geriatric Medicine at the Royal Liverpool University Hospital with an acute medical illness. After the acute illness had settled visual impairment, as defined by the American criteria (best acuity 6/18), was assessed on the ward with a Snellen chart read at 6 m using binocular vision and current glasses. Those patients identified with impaired vision on initial screening were formally assessed in the ophthalmology department to identify the cause. 200 patients were examined. 101 patients (50.5%) had impaired vision. In these patients, correctable refractive errors were present in 40%, cataract in 37% and senile macular degeneration in 14%. Of the 101 patients with impaired vision 79% had a reversible cause. Comparing these results with a recent study in the community showed a much higher incidence for patients admitted to hospital. There was a particularly high prevalence in those elderly patients who were admitted with falls (76%, p = 0.0003). In conclusion, elderly patients, especially those presenting with falls, admitted to hospital have a high prevalence of visual impairment. Visual impairment may be compounding or causing falls.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1996

Management of asthma in the geriatric population.

Asthma remains an important cause of morbidity and mortality for patients of all ages, but it may be of particular concern in geriatric patients as the aging population increases. Asthma may vary in severity from mild to such severity that ventilatory support is required. However, with proper medical management, asthma of most patients can be adequately controlled. Although there are similarities in managing younger patients with asthma, special problems occur in the geriatric population.

Administration, Inhalation↗
PubMed1975

Value of experience of general practice in geriatric medicine.

This is a review of lessons learned during thirteen years in general practice and experience of caring for elderly patients in three different types of practice. Attitudes and relationships with general practitioners as a consultant geriatrician are described. There is comment on the future training of general practitioners in geriatric medicine, the value of prophylactic care and the use of geriatric clinics in health centres. The need is stressed for proper management of acute disease, the better use of drugs and of ancillary services and the correct handling of relatives. Death should be regarded as a positive and not a negative end to life.

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PubMed1995

Effect of hearing enhancement on mental status ratings in geriatric psychiatric patients.

OBJECTIVE: This study looked at the impact of hearing deficits on the assessment of psychopathology in geriatric psychiatric patients. METHOD: Psychiatric functioning and speech discrimination were measured in 21 elderly psychiatric patients in a crossover design. RESULTS: Patients displayed less psychopathology when tested wearing a functioning hearing aid. CONCLUSIONS: Gradual hearing loss may confound the assessment of psychopathology in geriatric psychiatric patients.

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PubMed1998

P300 latency in geriatric depression.

OBJECTIVE: The purpose of this study was to determine if P300 latency is prolonged in geriatric depression and if longer P300 latency and deficits in initiation and errors of perseveration in depressed elderly patients are related to risk factors for vascular disease. METHOD: Geriatric patients with unipolar depression (N = 43) and elderly comparison subjects (N = 24) were assessed for depressive symptoms, cognitive functions, risk factors for vascular disease, and P300 latency. RESULTS: Depressed elderly patients had longer P300 latency than normal elderly subjects. In the depressed patients, P300 latency was related to deficits in initiation and errors in perseveration. Risk factors for vascular disease were associated not only with P300 latency but also with deficits in initiation and errors in perseveration. CONCLUSIONS: Functional impairment of the cortico-striato-pallido-thalamo-cortical pathways from vascular disease, implicated in late-life depressive disorders, may explain not only deficits in initiation and errors in perseveration but also longer P300 latency in depressed elderly patients. These results are preliminary and need further examination with brain imaging and more sensitive neuropsychological measures.

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PubMed2005

Making the case for caregiver research in geriatric psychiatry.

Research on caregiver health has seen a groundswell of interest in the last few years. Unfortunately, most of this literature has appeared in venues not usually seen by psychiatrist-geriatricians. In this article, the authors argue that caregiver research is not only relevant to the geriatric mental health community, but it is especially important to geriatric psychiatry. To do this, they focus on five areas: 1) an overview of caregiver outcomes and metaanalysis of relationships of caregiver distress/psychiatric morbidity with physiological/physical indices; 2) definitions and examples of moderators and mediators of relationships of caregiver status with health indices, including comorbidity of caregiving with psychiatric/medical illnesses; 3) caregiver/care-recipient trajectories and reciprocal relationships among dyads; 4) prospective studies; and, 5) areas to consider in caregiver interventions. Great strides have been made in caregiver research, but much more needs to be done. Psychiatric geriatricians are well placed to advance caregiver research because of their unique training in medicine, psychotherapy, pharmacology, and aging. They hope the discussion of this research will encourage work in this important area.

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PubMed2002

Executive dysfunction in geriatric depression.

OBJECTIVE: The purpose of this study was to characterize the neuropsychological presentation of geriatric depression and to determine whether depression-related executive dysfunction is more pronounced during advanced age. METHOD: The attention and executive functioning of 40 adults with major depression were compared with those of 40 healthy comparison subjects; 20 subjects were 20-60 years old, and 20 were > or =61 years. It was hypothesized that depressed subjects, regardless of age, would perform more poorly than comparison subjects on both attention and executive tasks but that the older depressed adults would evidence significantly greater impairment on executive measures. RESULTS: A significant interaction between age and depressive status was noted for tasks of executive functioning, while no age-depression interaction was found for tasks of selective or sustained attention. Older depressed adults demonstrated the slowest psychomotor speed and the poorest performance on tasks requiring set shifting, problem solving, and initiation of novel responses. CONCLUSIONS: Patients with late-life depression have significant impairment in executive functioning. These findings can guide the development of stimulated functional neuroimaging paradigms that may clarify the pathophysiology of geriatric depression. Timely identification of attentional and executive processes fundamental to the daily functioning of depressed older adults may lead to compensatory strategies that will improve the outcomes of late-life depression.

Adult↗
PubMed2005

The longitudinal course of thought disorder in geriatric patients with chronic schizophrenia.

OBJECTIVE: This study longitudinally assessed previously validated dimensions of thought disorder--verbal underproductivity and disconnection--in geriatric schizophrenia and replicated previous cross-sectional differences in communication disorders. METHOD: Two hundred twenty patients with chronic schizophrenia were assessed with the Thought, Language, and Communication Scale over a mean follow-up period of 2.3 years. RESULTS: Patients had increases in verbal underproductivity but stable scores on disconnection over the follow-up period. Worsening in verbal underproductivity was associated with concurrent worsening in Mini-Mental State Examination scores and older age at baseline. CONCLUSIONS: Verbal underproductivity worsens with aging and is associated with cognitive worsening, although disconnected speech is relatively stable. Some geriatric patients with schizophrenia may lose the skills necessary to report symptoms, leading to the impression that their clinical status is improving.

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PubMed2005

Intensive short-term research training for undergraduate, graduate, and medical students: early experience with a new national-level approach in geriatric mental health.

OBJECTIVE: There is an urgent need for research training in psychiatry at early career stages, especially in geriatric psychiatry. The authors describe their first-year experience with the Summer Training in Aging Research Topics-in Mental Health (START-MH), a new federally funded national-level training program intended to offer intensive short-term research training for undergraduate, graduate, and medical students. METHODS: The funding was used primarily to pay stipends for trainees who spent 10 weeks during the Summer working on research projects under established research mentors. At the end, a workshop brought together all the trainees who presented research posters. RESULTS: Thirty trainees were selected from among 85 applicants. They worked on projects including basic, translational, clinical, or services research. Evaluations from trainees and mentors were uniformly positive. All the trainees reported that the START-MH program enhanced their interest in pursuing a career in geriatric mental health research. Several trainees later submitted their work for presentation or publication. CONCLUSIONS: The initial data suggest that the START-MH program can be a potentially useful model for attracting talented early-career trainees into mental health research.

Aging↗
PubMedDate not supplied

Gender bias in the diagnosis of a geriatric standardized patient: a potential confounding variable.

BACKGROUND: Gender bias has been reported in the diagnosis and treatment of patients with a variety of illnesses. In the context of our 10-station fourth year Objective Structured Clinical Evaluation, we queried whether this could influence diagnosis in a geriatric case. Case writers hypothesized that, due to this bias, the female standardized patient may be diagnosed with depression more often than the male. METHOD: A male or female geriatric standardized patient protrayed a dysphoric widow with mild cognitive impairment. Students examined the patient and documented the clinical encounter and their differential diagnosis. RESULTS: Major depression was diagnosed in 93/107 female standardized patient encounters compared with 58/78 male exams, with the female students contributing most to this difference. DISCUSSION: The potential for gender bias in medical care and in education remains a concern. We need to be mindful of this when designing clinical skills assessments.

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PubMed1992

A geriatric and gerontologic perspective on the effects of medical conditions on older drivers: discussion of Waller.

In discussing Waller's paper, we build on his review of medical conditions and the risk of motor vehicle accidents (MVAs) using principles derived from geriatrics, gerontology, and health services research. Three approaches are suggested. The medical model uses discrete diseases as risk factors, but despite its utility and appeal, this model does not sufficiently characterize health and functional status to be the sole approach, and future investigative efforts should at least consider severity of illness concepts. The functional status model emphasizes a functional and physiological approach to health status, but despite its successful application in geriatric assessment and its investigative promise, functional status can be difficult to measure and has not been validated in relation to MVA risk. Finally we consider a behavioral model and within that framework discuss the relation of depressive and other emotional illnesses as well as social vitality to driving patterns and MVA occurrence.

Accidents, Traffic↗
PubMedDate not supplied

Assessing the nutritional needs of the geriatric patient with diabetes.

The 1994 Nutrition Guidelines reinforce that all nutritional plans for people with diabetes should be individualized, which is particularly important and necessary for elderly patients. The geriatric population poses many unique challenges to the healthcare professional due to physiological changes and many other risk factors that affect nutritional status either directly or indirectly. A thorough nutritional assessment that includes an evaluation of the potential nutritional risk factors described in this article can help in developing an effective and realistic nutritional plan for achieving and maintaining good blood glucose control and good nutritional status in geriatric patients with diabetes.

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