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PubMed2001

Integrating behavior change theory into geriatric case management practice.

Case management practices have continued to grow despite a lack of clear evidence of their efficacy. With the expanding segment of the elderly population, there is a critical need to develop and identify programs that will address the many needs of the aging. Geriatric Case Management has been the avenue selected by many health care providers to address these issues, focusing on maintaining health status and improving linkages with medical and community resources. Studies testing the effectiveness of these models have failed to demonstrate their effectiveness in reducing depression, reducing acute care service use, and improving or maintaining health status. The Geriatric Case Management models presented in these lack an evidence-based, theoretical framework that provides definition and direction for case management practice. This article introduces behavior change theories as a method of structuring and delineating the case management intervention. The Transtheoretical Model and the Theory of Planned Behavior are discussed and methods of integrating these theories into practice are discussed.

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PubMed2006

Geriatric enrichment: guaranteeing a place for aging in the curriculum.

Two years ago, the School of Social Work embarked upon a new and challenging initiative to create sustainable structural changes that enrich gerontological learning experiences for all our BSW and MSW students, faculty, fieldwork instructors and community practitioners. We envisioned that participation in this initiative would enable us to expand and embed geriatric content in the undergraduate and graduate curriculum, to increase our geriatric fieldwork placement opportunities, to evaluate and enhance our teaching and learning resources on aging, and to develop two new aging specific courses. Having reached our third year of operation, we find ourselves reflecting on what have been our successes, what could we have done differently, and where do we go in the future. This article will describe our process of developing a model of curriculum change that will guarantee a place for aging in both our undergraduate and graduate curricula.

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PubMed1990

New programs for advanced training in dental geriatrics.

The unprecedented increase in the number and percentage of Americans who are older than the age of 65 is presenting the health care system with unique diagnostic, therapeutic, fiscal, and ethical challenges. Chronic disease, complex pharmacotherapeutic regimens, and psychosocial and physical dysfunction are prevalent in this age group. The dental profession is faced not only with an increase in the number and complexity of older patients, but with the fact that growing numbers of older patients are retaining a greater proportion of their natural dentitions for longer periods. To help meet the need for increased professional skill to deal with these issues, the Health Resources and Services Administration of the Department of Health and Human Services is supporting 23 medical school based geriatrics training programs, designed expressly for physicians and dentists. The programs offer a mixture of experiences in: clinical care of the elderly in a variety of settings; design and conduct of research relevant to geriatric and gerontologic issues; enhancement of pedagogical skills; and program administration. Physicians and dentists share many of the training experiences, providing both groups with unique insights into the presentation and management of their patients' problems, and an enriched awareness of each other's contributions to the care of the elderly.

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PubMed2004

Relationship between type of treatment and degree of wound healing among institutionalized geriatric patients with stage II pressure ulcers.

The prevention and treatment of pressure ulcers has always been of paramount concern to geriatric health care providers. The purpose of this study was to examine the relationship between two types of treatments and the degree of wound healing among status post-cerebral vascular accident (CVA) institutionalized geriatric patients with stage II pressure ulcers. Wound dressings were evaluated according to the National Pressure Advisory Panels Pressure Ulcer Scale for Healing (NPUAP, 1997). Fifty long-term care residents were recruited for the study in Queens, New York. A convenience sample was randomly assigned to either of the treatment protocols: polymeric membrane dressing (polymem) or the antibiotic ointment and dry clean dressing (DCD). The findings from the study revealed a significant difference in wound healing scores in the polymeric membrane-dressing group. These findings are limited due to the small sample size and they cannot be generalized to other populations. As this is an initial study, further research is recommended

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PubMed2005

The value of comprehensive geriatric assessment.

Comprehensive geriatric assessment (CGA) provides guidance in planning care for elderly patients. The goals of CGA include reduction of health care cost, early recognition and treatment of geriatric syndromes and improved survival and quality of life for patients. Evidence from randomized controlled studies has identified the value of CGA and some of its limitations. Studies of CGA in institutional settings and in home care provide the basis for specific interventions to targeted groups of high-risk patients. Strategies for fall prevention, appropriate use of pharmacotherapy, and prevention of in-hospital delirium have grown out of the application of this multidisciplinary tool. Future research focused on a more precise definition of the potential financial benefits of CGA may facilitate the task of communicating its value to decision makers.

Accidental Falls↗
PubMed2005

Improving elder care by integrating geriatric expertise into medicare: a proposal.

The Medicare programme already funds a large proportion of the medical care for older Americans. However, geriatricians are an underutilized resource for improving the quality of care delivered with Medicare funding, particularly to the most complex patients. Recent legislative changes will increase the involvement of the Medicare programme in the area of outpatient medications. This offers an important opportunity to bring geriatric consultation to bear on a broad range of geriatric prescribing issues, including polypharmacy, pharmacological undertreatment and inappropriate prescription choice.

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PubMed2003

Colonization of the oral cavity by Candida species: risk factors in long-term geriatric care.

The population of elderly people in hospitals for long-term geriatric care presents many risk factors for nosocomial infection by Candida species. The aim of this work was to reduce the risk of C. albicans nosocomial infections starting from colonization of the oral cavity. The population of concern was the patients in long-stay geriatrics units; a sample of 110 people was selected by drawing lots. The clinical and biological parameters of each patient included in the study were recorded. The oral cavity was colonized by Candida spp in 67% of cases. The distribution of the strains showed that C. albicans was the most frequently identified strain, followed by C. glabrata; of the 73 patients with at least one strain of Candida spp., 47 had a clinically diagnosed candidiasis (64.4%). The wearing of dentures was not statistically linked with the development of oral candidiasis. Detecting which patients have been colonized, identifying the risk factors and applying preventive measures should reduce the probability of elderly people falling into the vicious circle of infection-malnutrition-immune-depression.

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PubMedDate not supplied

[Influence of socio-health variables on the cognitive state of mind of the geriatric patients of a health centre].

BACKGROUND: To determine the influence of age, education, admission in nursing homes and chronic diseases (arterial hypertension, diabetes, hyperlipidaemia, anxiety and depression) on the cognitive state of the population over 65 years of age. MATERIAL AND METHODS: A study was made of a geriatric outpatient population (patients living at home or institutionalised) with chronic diseases, who showed cognitive deterioration and depressive symptoms. The cognitive mini-exam (CME) and the geriatric depression scale (Yesavage) were administered. RESULTS: One hundred and forty-seven patients participated, with an average age of 71.4 years and a similar proportion of men (74; 50.3%) and women (73; 49.7%). Thirty-four subjects (23.1%) were living in nursing homes. The most prevalent diseases were hypertension (50%), anxiety-insomnia (30%), diabetes (22%), arthrosis (22%), depression (13%) and hypercholesterolaemia (12%). Half of the patients (79; 53.7%) were following treatment with more than three medicines; 60 (40.6%) with between two and three medicines, and only 8 (5.5%) were taking no medication. The percentage of subjects living in an institution increased with age. The consumption of medicines was also higher amongst the more elderly. The scores on the cognitive scale (CME) decrease with age and were also lower amongst subjects who live in institutions (above all if they suffer from depression). The patients who took psychotropics had lower scores on the CME. Although performances on the CME are lower amongst subjects with a low level of education, the differences do not reach statistical significance. The presence of hyperlipidaemia also decreased the results of the CME. CONCLUSIONS: The socio-health factors that altered performance negatively in the cognitive mini-exam are advanced age and institutionalisation. These results are also significantly influenced by depressive disease, hyperlipidaemia and the consumption of medicines that affect the cognitive state.

Age Factors↗
PubMed2001

Intraocular pressure measurements obtained as part of a comprehensive geriatric health examination from cats seven years of age or older.

OBJECTIVE: To determine intraocular pressure (IOP) in cats > or = 7 years of age undergoing a routine comprehensive geriatric health examination. DESIGN: Prospective study. ANIMALS: 538 cats (1,068 eyes). PROCEDURE: IOP was measured by applanation tonometry following instillation of 0.5% proparacaine. RESULTS: Mean +/- SD IOP for all eyes was 12.3 +/- 4.0 mm Hg (range, 4 to 31 mm Hg). Mean age was 12.3 +/- 2.9 years. Intraocular pressure did not vary significantly cross-sectionally with age. However, in 78 cats, IOP was measured more than once, and follow-up measurements were significantly less than initial measurements (mean time between measurements, 9.4 +/- 3.0 months). The most useful tonometric criteria for identifying ocular abnormalities on the basis of IOP was an IOP > or = 25 mm Hg (mean + 3 SD) or a difference in IOP between eyes > or = 12 mm Hg. Eight cats met these criteria, and 5 of these cats had ophthalmic abnormalities. Low IOP was a nonspecific indicator of the presence of ocular abnormalities, as 111 cats had an IOP < or = 8 mm Hg, but only 2 had uveitis. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that IOP measurements can be a useful addition to a comprehensive geriatric health examination in cats > or = 7 years of age, especially when combined with an ophthalmic examination. Cats without ocular abnormalities that have lOP > or = 25 mm Hg or a > or = 12 mm Hg difference in IOP between eyes should have tonometry repeated or be referred to an ophthalmologist for further evaluation before beginning antiglaucoma treatment.

Aging↗
PubMed1977

Relationship between the Geriatric Interpersonal Evaluation Scale and the WAIS Verbal Scale.

27 psychogeriatric patients at Harlem Valley Psychiatric Center were tested by separate examiners on the WAIS Verbal Scale and the Geriatric Interpersonal Evaluation Scale to determine the relationship between these two tests. The sample was restricted to patients who were judged clinically to be "in contact," i.e., oriented as to time, place, and person. The correlation between the WAIS Verbal IQs and the geriatirc scale raw scores was .80; correlations with the individual verbal subscale scores ranged from .58 to .76. Relative advantages and disadvantages of the geriatric scale are discussed.

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PubMedDate not supplied

Evaluation of a geriatric mental health training program for nursing personnel in rural long-term care facilities.

Although mental illness among elderly living in nursing homes is a substantial and growing concern, the behavioral problems associated with mental illness or threats to mental health are not well understood, tolerated, or effectively managed by nursing home staff. As a result, resident care and quality of life, and staff morale often suffer. The need for geriatric mental health training in long-term care settings has become increasingly apparent. Psychiatric/mental health nurses are in an advantageous position to address this current need and future challenge through the development, implementation, and evaluation of geriatric mental health education and training programs in long-term care settings. This article describes one such innovative training effort, designed to improve the quality of psychosocial care provided by nursing personnel in rural long-term care settings, and highlights evaluation outcomes related to participant satisfaction, staff knowledge, and attitudes.

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PubMed1992

The growth of gerontology & geriatrics in the United States.

Since the confirmation of the Older American's Act (OAA) in 1965, the growth of gerontology and geriatrics, has literally come of age in the United States. Although individual aging courses were offered in higher education prior to passage of the OAA, few gerontology programs had been established. On campuses where gerontology courses were available, they represented electives connected with a pre-existing discipline, such as social work or family studies. However, 1965 was a watershed year for gerontology instruction since it heralded the provision of federal funding support, beginning with that of the Administration on Aging (AoA), to help develop, pilot, and oversee gerontological programs in American institutions of higher learning. Initially, instruction was at an undergraduate level, but later gerontology degree programs were established at the master's level, with the first gerontology degree program originating at North Texas State University, in 1967. This program was followed a year later (1968) by a program at the University of South Florida. While funding from AoA began in 1966, funding from other federal agencies (e.g., the Bureau of Health Professions (BHP); the National Institute on Aging (NIA); the National Institute of Mental Health (NIMH), Mental Disorders of Aging Branch; and the Veteran's Administration (VA))--the five agencies that became the basis for a 1984 and 1987 Report on Education and Training in Geriatrics and Gerontology,--did not begin until the mid 1970s. The mid 1970s reflected the growing awareness of the demographic shift in America and around the world, particularly in developed nations.(ABSTRACT TRUNCATED AT 250 WORDS)

California↗
PubMed1997

[Geriatrics in the new program for initial postgraduate medical training in Japan].

Until 1993, initial postgraduate medical training in Japan was conducted only at university hospitals or other teaching hospitals. In 1994, the number of types of training sites was expanded to include health centers, nursing homes, and extended care facilities, which gave trainees chances to understand primary medical care in various settings, providing in-home as well as other non-hospital medical services. Since the new program seemed to increase training opportunities in geriatric medicine, questionnaires regarding the new program were sent by mail to all teaching hospitals in Japan (261); 213 responded. The results showed that 29 hospitals already had a program of care for the aged. The teaching sections were mainly internal medicine, psychiatry and rehabilitation medicine. Fifty hospital had plans to include care for the aged in their program in the near future. The number of programs that includes training in care for the aged is gradually increasing. It is hoped that during their initial postgraduate training many young doctors will come to recognize the importance of geriatric medicine.

Education, Medical, Graduate↗
PubMed2004

[Present status and perspective of comprehensive geriatric assessment in Japan].

Comprehensive geriatric assessment (CGA) is an important strategy to maintain activities of daily living and quality of life of elderly patients. It assesses physiological, psychosocial, and cognitive aspects of elderly. To carry it out effectively, not only is accurate the assessment but also to do appropriate recommendation and implementation are essential. In Japan, although the concept of CGA has been introduced and evaluated for elderly patients and also employed essentially in long-term care insurance, its application in the acute care setting of the elderly is still limited. This report, examines the present status and perspective of CGA application in Japan, through experiences in our university hospital and analysis of presentations from the Annual Meeting of the Japan Geriatric Society 2003.

Activities of Daily Living↗
PubMed2004

[Incidence of adverse drug reactions in geriatric wards of university hospitals].

Adverse drug reactions (ADR) in elderly people, which have been shown to increase with age, are often attributed to functional decline and polypharmacy. A multi-institutional retrospective survey was undertaken to investigate the current status of ADR in geriatric wards of university hospitals. The inpatient database from 2000 to 2002 in 5 university hospitals was studied, and a total of 1,289 patients were analyzed. The incidence of ADR, as determined by attending physicians, was 9.2% on the whole but varied from 6.3% to 15.8% among the institutions. The factors significantly related to ADR were number of diagnoses, number of geriatric syndromes, number of prescribed drugs, increase of more than two drugs during admission, longer hospital stay, emergency admission, depression and apathy. These results are mostly consistent with previous reports and will provide important information on pharmacotherapy in elderly people.

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PubMed2006

[Role of specialists in geriatric medicine--overview of world trends--].

Rapid ageing of the society inevitably increases the demand for specialists in the healthcare of older people. Under these circumstances, how geriatricians work as specialists in the framework of healthcare services is becoming an urgent concern for those who are engaged in the healthcare for the elderly. Although some similarities can be identified in the development of geriatrics medicine across the countries, actual roles of geriatricians and the definitions of their specialties seem to vary depending on the healthcare systems of each country. Current issues related to the speciality of geriatric medicine are discussed.

Education, Medical↗
PubMed1989

Korean version of the Geriatric Social Readjustment Questionnaire: cross-cultural comparison between Koreans and Americans in the perception of life events.

The purpose of this study was to construct a Korean version of the Geriatric Social Readjustment Questionnaire (K-GSRQ), to investigate its applicability to the elderly and to compare cross-cultural differences in the perception of the life events between Koreans and Americans. The K-GSRQ consists of 33 items. Most of the life events considered as crucial in old age were similar in ranking in comparison between Koreans and Americans. Some differences in ranking can be attributed to the differences in Socio-cultural backgrounds. The K-GSRQ was applied to controls, neurotic cases and cases with physical illnesses. The result suggest that the Korean version of the Geriatric Social Readjustment Questionnaire is applicable for the study of the health status of the elderly in Korea.

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PubMed2001

Measuring quality of care with an inpatient elderly population. The geriatric resource nurse model.

Nurses provide health services to an increasing number of older adults in acute care settings. Acute care nurses are committed to giving patients the highest quality care while recognizing the importance of delivering care in a cost-effective manner. In this study, a unit-based, nurse-centered geriatric program is evaluated. The program is designed to enhance the knowledge and skill of staff nurses in providing care to elderly patients. Both quantitative and qualitative methods are used to assess geriatric resource nurses' (GRNs) influence on quality and cost outcomes of the elderly participants. Patients age 65 years and older were randomly selected from two general medical units of a major academic tertiary care center in the southeastern United States. Data were collected during an 18-month period in 1996 and 1997. A total of 129 participants provided data for quantitative analysis. A subset of 34 participants (17 from the unit where GRNs were on staff and 17 from a control unit) was interviewed about their experience during hospitalization. This information was analyzed for common themes and trends using appropriate qualitative techniques. Demographic variables and common measures of illness severity and complexity showed comparable patient populations on the two units. However, results of quantitative analyses indicated significant differences between groups on admission for several of the health status measures. Participants on the unit without GRNs were found to have more problems with pain, incontinence, and mobility. Administrative measures showed the number of patients readmitted to the hospital within 31 days of discharge and the length of stay associated with this initial readmission were significantly lower on the unit with GRNs. The use of vest-type physical restraints was also less frequent on this unit. Elderly patients in both groups indicated they have special needs related to normal aging changes and chronic illnesses, resulting in higher levels of fragility and decreased energy reserves. They identified specific functional areas for which help was needed. These include assistance with bathing, eating, sleeping, mobility, and elimination. Fewer participants on the intervention unit reported decline in activities of daily living (ADL) function during hospitalization than did control participants. Participants in both groups stressed the importance of nurses' demonstrating understanding and caring when working with older individuals.

Aged↗