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PubMed2003

Passive therapeutic gardens. A study on an inpatient geriatric ward.

A brief history of the link between horticultural activities and care of patients, particularly psychiatric patients, is reviewed in this article. Past research on both passive and active garden activities is examined in terms of physical and psychological benefits to patients. A passive garden intervention on an inpatient geriatric ward is described. Participants in this study were patients on a geriatric inpatient ward in a mid-sized regional hospital in New Zealand. Behavioral observations of patient movement on the ward were used to demonstrate the effects on patient behavior in response to the presence of the conservatory garden. Results showed a positive reaction to the conservatory, which was maintained 6 months after the initial plants were installed. The benefits of such garden installations are discussed, and areas for further research are outlined. Procedures, ethical concerns, and practical considerations of setting up such a conservatory on an inpatient ward are discussed.

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PubMed1995

Geriatric mental health interventions in the home.

Geriatric mental health treatment should be considered an integral part of the services provided by home health care agencies or community mental health centers. Public policy is needed to cover in-home psychiatric services to caregivers and elders, one way to respond effectively to their needs. This policy should include the provision of adequate numbers of geriatric mental health specialists who are specifically trained for work with the aged in their homes.

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PubMed2001

Health care paraprofessionals' awareness of the symptoms of geriatric depression.

1. Depression is not part of the normal aging process. 2. It is important to increase awareness of the symptoms of geriatric depression among health care paraprofessionals. 3. If depressed elderly people are identified and appropriate referrals are made, treatment for depression is available and effective. 4. Health care paraprofessionals can be taught to recognize geriatric depression.

Activities of Daily Living↗
PubMed2004

Geriatric epidemiology: practical considerations when involving elderly subjects in studies.

Geriatric epidemiology deals with the application of epidemiological techniques to the study of elderly persons. It is neither a simple replication of studies carried out in younger adults transposed to another collective nor a departure from basic principles. It is rather the integration of known methods, which should be taken systematically into account during their application to geriatric populations, in order to circumvent the specific problems involved in the study of this growing part of the population. This paper aims to provide an overview of the practical implications of the epidemiological study of the elderly. It is divided in two parts. A concise description of the demographic context underlining the topic relevance is followed by a discussion of the methodological aspects. It attempts to remind potential investigators of some important issues raised while studying older persons and also provide clinicians with criteria for assessing the quality of papers they read on this topic.

Age Factors↗
PubMedDate not supplied

Occupational therapy practice errors in physical rehabilitation and geriatrics settings: a national survey study.

OBJECTIVES: The purpose of this survey study was to investigate occupational therapy practice errors in physical rehabilitation and geriatric practice settings. METHOD: Two hundred and forty-five (245) out of 994 surveyed occupational therapists who have practiced or currently practice in physical rehabilitation or geriatrics settings responded to a self-developed questionnaire. Descriptive statistical analysis was used to describe practice errors as to the types, causes, impact on, and responses of occupational therapists and work sites. Inferential statistical analysis was used to explore the relationships among different variables of interest including: the effect of the number of years of practice experience on the perceived impact of making errors on practice; the relationship between disclosure or nondisclosure of errors; and the types of coping strategies used by occupational therapists and work site administrators' responses to errors. RESULTS: The vast majority of practice errors occurred during the intervention phase of the occupational therapy process. Misjudgment, lack of preparation, and lack of experience were reported as the top three causes of practice errors. Various coping strategies-such as compensating for the errors by voluntarily devoting additional time for care of the patient, making and following a corrective plan, concentrating on the next step, or not letting errors interfere with daily work-were used by the occupational therapists when errors occurred. The types of coping strategies and work site responses appeared to be associated with the disclosure or nondisclosure of errors. CONCLUSION: Errors occur in occupational therapy practice. Making errors has considerable impact on occupational therapists as well as their future practice. However, disclosure of errors can often lead to positive outcomes.

Communication↗
PubMed2006

Student-directed learning in a community geriatrics advanced pharmacy practice experience.

OBJECTIVES: To assess a community geriatrics advanced pharmacy practice experience (APPE) that aimed to improve students' attitudes towards older adults and provide a student-directed learning experience. DESIGN: Students provided blood pressure monitoring and medication counseling to older adults living in a low-income residential facility as part of a required 6-week ambulatory care service-learning APPE. Pre-experience and post-experience essays on students' perceptions of the elderly and their intended and actual learning were retrospectively reviewed using a qualitative process to determine whether the course objectives were met. ASSESSMENT: Many students initially described older adults in factual terms or using negative descriptors. Most expressed a desire to increase their knowledge of diseases commonly occurring in and drugs commonly prescribed for the elderly or to improve specific skills. Many students initially had difficulty articulating clear and measurable learning objectives and appropriate assessment metrics, which are important components of self-directed learning. The final essays revealed many students learned more about the humanistic aspects of care than they had anticipated. CONCLUSION: This community-based geriatrics experience improved students' attitudes towards working with older adults and provided practice in developing and assessing their personal learning objectives.

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PubMed1988

New issues in geriatric care.

The rapid growth of the elderly population has increased the need for improved geriatric care and prevention of disability. For example, the prevalence and severity of osteoporosis can be reduced significantly by the use of estrogen, with or without added progestin, in postmenopausal women. A common and devastating problem of frail elderly persons is urinary incontinence, most cases of which can be classified without referral for urologic services. Appropriate treatment can improve nearly half of all cases of persistent incontinence. Comprehensive geriatric assessment is effective in guiding the treatment of frail elderly patients and leads to significantly improved outcomes under appropriate conditions. The advent of the teaching nursing home has shed light on the medical problems of elderly residents of nursing homes, including malnutrition, dysregulation of water and electrolyte balance, falling, cognitive and affective illnesses, behavior disturbances, infections, and pathogenic drug use. The future application of advanced technology may revolutionize nursing home care.

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PubMed1976

Geriatric care in the United Kingdom: an American perspective.

Geriatric care is a complex and challenging aspect of health care. The United Kingdom, with 13.6% of its population over 65 years of age, compared to 10.1% in the United States, has given special attention to this field. Characteristics of the British system include financing through the National Health Service, existence of a specialty of geriatrics, absence of "nursing homes," emphasis on home care, and avoidance of "heroics" for the terminally ill. While British life expectancy at birth is longer than that for Americans, the opposite is now true for those over 65. The British have made efforts to maximize efficiency in a high-demand, comparatively low-resource context. But there are limits to which professional dedication and patient manipulation can be pushed. Some new policy directions-primarily aimed at prevention and other methods of reducing demand, other than reimposing financial barriers-may have to be explored.

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PubMed1976

A geriatric medical residency program. A four-year experience.

Geriatricians are needed to further improve the health care of elderly Americans. The first formalized geriatric residency program in the United States was developed at the Mount Sinai City Hospital Center in New York, and this has produced a second program at the Jewish Institute for Geriatric Care at Long Island Jewish-Hillside Medical Center, New Hyde Park, New York. The goals of this training are to develop special clinical skills to deal with the medical and psychosocial problems of the elderly, and to achieve the ability to develop health care systems for the elderly. Emphasis is on a multileveled system, including home, outpatient, acute hospital, convalescent unit, and long-term institution care. The training period is 12 to 24 months, after an initial 24 to 36 months of standard internal medicine, thus fulfilling the requirements for board eligibility in internal medicine.

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PubMedDate not supplied

A comparison of results from two mycology laboratories for the diagnosis of onychomycosis: a study of 85 cases in a geriatric population.

An investigative study was performed to compare the results from two mycology laboratories for the diagnosis of onychomycosis in a geriatric population and to determine the possible pharmacologic treatments based on the two laboratories' results. In this study, 85 cases of suspected onychomycosis involving men and women 65 years and older from a nursing home setting in South Florida were used. Samples were taken from the hallux toenail and sent to two different mycology laboratories for fluorescent potassium hydroxide preparation and microscopic examination of a fungal culture. Of the 85 cases studied, the two mycology laboratories reported similar potassium hydroxide preparation results for 58.8% of the patients and similar fungal culture results for genus and species identification for 37.6% of the patients. When the potassium hydroxide preparation and fungal culture results were combined, the two mycology laboratories reported similar results for only 27.1% of the patients. As a result of the two mycology laboratories' findings, the possible US Food and Drug Administration-approved pharmacologic treatments may differ for 43.5% of the patients studied. The discrepancy between the two independent laboratories leaves physicians to question the reproducibility of fluorescent potassium hydroxide preparation and fungal culture analysis in a geriatric patient population for the diagnosis of onychomycosis.

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PubMed2000

A conceptual model for a geriatric fellowship in podiatric medicine.

The number of older individuals living in the United States is projected to increase significantly over the next few decades. To help meet the health-care needs of this growing population, podiatric medicine must assure the public of the availability of specially educated teachers and practitioners who can not only provide direct patient care, but also participate in establishing national policies and priorities pertaining to foot health. Fellowship training, the traditional educational model beyond the first professional degree and residency education, is one means of accomplishing this goal. This article proposes a model for a geriatric fellowship in podiatric medicine. Implementation of such fellowship training in geriatrics can help the podiatric medical profession pursue its mission and fulfill its responsibility to the public.

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PubMed1999

Treating elder neglect: collaboration between a geriatrics assessment team and adult protective services.

Neglect is the most common type of elder maltreatment in the United States. Currently, the only formal intervention available is provided by each state's adult protective service agency (APS). Elder neglect involves a complicated relationship among an indvidual's medical problems, social situation, and ability to function in the environment. Geriatric assessment teams are facile at dealing with such complex cases while APS caseworkers are expert in their ability to identify and confirm neglect. Forming a geriatric team that includes APS caseworkers is a logical and innovative approach to the growing problem of elder neglect.

Adult↗
PubMedDate not supplied

A geriatric nurse practitioner/physician team in a long-term care setting.

A large Massachusetts group practice and affiliated HMO studied the effects of a geriatric nurse practitioner/physician team on quality and cost of health care delivery in a long-term care setting. A geriatric nurse practitioner (GNP) was recruited to work with one physician in three nursing homes. The GNP/MD team made joint routine visits; the GNP provided primary care, including episodic visits as needed. After one year, a retrospective chart review was conducted comparing the periods before and after the implementation of the GNP/MD team. There was a 26% reduction in hospital admissions, and a decrease in the total number of hospital days after the GNP/MD team was implemented. Patients, nursing staff, and physicians all expressed satisfaction with the program. This study suggests that significant cost savings and increased quality of care can result from the implementation of a GNP/MD team in a long-term care facility.

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PubMed1992

An evaluation of pharmacy assessment for geriatric patients.

Evaluation of a pharmacy assessment for geriatric patients on a geriatric assessment and rehabilitation unit is described. The assessment has been developed to identify functional, comprehension and therapeutic problems affecting an elderly patient's ability to self-medicate. The pharmacy assessment identified more obstacles to self-medication than the nursing and medical assessments. The detection of obstacles was particularly apparent in the areas of medication knowledge deficit, complicated medication regimes and the inability to follow directions. The pharmacist made more recommendations than the other health professionals for improving the safety and efficacy of drug therapy and medication compliance (p less than .01). Recommendations included simplification of medication regimes, requesting drug levels or specific lab tests, and the use of compliance aids. Seventy-seven percent of the recommendations made by the pharmacist were acted upon by the physician or nurse. Results of the study demonstrate the pharmacy assessment was the most significant predictor of self-medication success.

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PubMed1994

A drug use evaluation of bedtime sedation in geriatric patients.

A pilot study was designed to assess the feasibility of a shared regional drug use evaluation (DUE) program involving patients. A retrospective DUE on the use of benzodiazepines, chloral hydrate and neuroleptics for bedtime sedation was performed on geriatric patient populations from two hospitals. Regional program staff coordinated the DUE, including development of the criteria and chart review. The participating Pharmacy departments performed the internal administrative and Pharmacy and Therapeutics committee communications. Forty patient charts from two sites were reviewed. The DUE results indicated different rates of drug use and discontinuation of therapy between the two geriatric patient populations. The overall rates of inappropriate drug use were similar. One undesirable clinical outcome occurred. Benzodiazepine use for more than 30 days was high in both groups. Identification of the justification for drug use, dosage reduction and drug discontinuation did not occur in the majority of patients. The pilot study identified areas where use of bedtime sedation could be improved, and allowed development of DUE criteria for future evaluation.

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PubMed1997

Issues in treating the geriatric patient with diabetes.

Diabetes, a disease commonly seen in the young, is more frequently seen in the geriatric age group (older than 65 years of age). This frequency has been estimated at 30 to 50 percent, although because of underdiagnosis, reported cases have approximately a 20 percent occurrence, the majority of which is Type II or non-insulin-dependent diabetes (NIDDM). Although the presentation in older adults is similar to that in younger patients, there are considerations for both evaluation and therapy that are unique to the geriatric patient.

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PubMed1999

Goal attainment scaling in a geriatric day hospital. Team and program benefits.

PROBLEM BEING ADDRESSED: The Geriatric Day Program (GDP) of the Capital Health Region in Victoria, BC, is concerned with effective team processes, accountability for health service outcomes, and improving the quality of programs. The GDP identified a need to improve its interdisciplinary processes and generate useful patient outcome data. OBJECTIVE OF PROGRAM: To determine whether Goal Attainment Scaling (GAS) could be introduced to facilitate interdisciplinary processes and to generate useful health outcome data. MAIN COMPONENTS OF PROGRAM: The GAS procedures were incorporated into clinical routines based on published guidelines. The authors determined GAS outcome scores for patients who completed the program and developed outcome scores for specific geriatric problem areas requiring intervention. Outcome scores were made available to the clinical care team and to program managers for continuous quality improvement purposes. CONCLUSIONS: The GAS process was successfully implemented and was acceptable to clinicians and managers at the GDP. Team processes were thought to be improved by focusing on patient goals in a structured way. The GAS provided data on both patient outcomes and outcomes of interventions in specific problem areas. Accountability for patient care increased. Goal Attainment Scaling provided indicators of care for which clinicians could develop program quality improvements.

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PubMed1983

What is the value of a Geriatric Assessment Unit in a teaching hospital? A comparative study of the management of elderly inpatients.

This study at the Flinders Medical Centre, compared the management of 50 elderly patients, admitted acutely ill to the Geriatric Assessment Unit, with the management of 50 elderly patients admitted, under similar circumstances, to other medical units in the Centre. Patients under the care of the Geriatric Unit had a comparable mean length of stay, were on less medication at discharge, and were more likely to return home to their pre-admission accommodation, compared with patients admitted to other medical units. The multidisciplinary approach adopted in such units, coupled with increased utilization of community based services, appears to significantly limit rates of referral to institutional care.

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