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PubMed1983

Teaching principles of geriatrics through a home health care rotation.

To provide pharmacy students with ambulatory geriatric training, the University of Georgia School of Pharmacy developed a clinical rotation in home health care. This one-week experience in which students encounter patients in the home environment is offered as part of the four-week required clinical clerkship. While in the home setting the student is exposed to the various medical, social, and economic problems of the elderly and in turn provides the patient with nondispensing pharmaceutical services such as drug use review, drug histories, and patient education. The patients' medication regimens are discussed prospectively and retrospectively at daily conferences with the clinical preceptor and student peers. Students have evaluated the program as valuable in improving their communication skills and their knowledge of drugs and diseases of the geriatric patient.

Education, Pharmacy↗
PubMedDate not supplied

Geriatrics--an eye to the future.

What role will medical group practices play in the future care of the elderly? A four-part program agenda is called for to meet the needs of the increasing number of senior citizens in our communities and promote healthy aging. Also presented here are many interesting facts regarding the characteristics of the geriatric patient, our country's new demographics, and the geriatric assessment units destined for widespread expansion.

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PubMed1986

The impact of a geriatric assessment unit on a psychiatric consultation service in a general hospital.

The opening of a geriatric assessment unit (GAU) in a large general hospital has affected the number of elderly patients referred for psychiatric consultation, the type of psychopathology seen, and the training provided for psychiatric residents and interns on the consultation-liaison service. To examine these changes, the six months prior to the opening of the GAU are compared to the six months immediately following its opening. The number of patients age 65 or older referred and diagnoses made by the consulting psychiatrists were studied. The opening of the GAU significantly increased the number of elderly patients referred for psychiatric consultation. It was found that the GAU offered unique advantages in the assessment and treatment of elderly patients with certain psychiatric problems, and the advantages and limitations of different facilities within the general hospital for the psychiatric assessment and treatment of elderly patients are discussed. A case is presented which illustrates the interplay between the consultation-liaison psychiatrist and the geriatric service in the management of an elderly patient referred for consultation. The experience of this hospital in providing psychogeriatric training for residents and interns on the psychiatric consultation service is reviewed.

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PubMed1987

An innovative approach to geriatric acute care delivery: the Choate-Symmes experience.

Hospitals, like those described in this study, must develop alternative models of health care delivery that allow them to respond to many challenges while providing high-quality health care to geriatric patients. In this program, 10-bed geriatric units were established in two hospitals, and patients age 65 and older were selected at random for admission to the units. Following comprehensive assessment, self-reliance was fostered using individualized interventions. Discharge planning began at admission. A multidisciplinary approach with regular team conferences including families was also used. Results of this approach suggest that such intervention can reduce length of stay without affecting quality of care. This paper describes the delivery model in detail, focuses on issues related to the implementation of the intervention, and highlights the lessons learned by Choate-Symmes personnel through their demonstration of the model.

Activities of Daily Living↗
PubMed1988

Economic considerations in geriatric oral health care: the Canadian experience.

Two different provincial programs for geriatric oral health care are described. Their relevance to the United States requires an understanding of the universal, national hospital (1961), and medical (1971) care programs of Canada and the different sociopolitical philosophy of its people. Ontario's new geriatric preventive dentistry program provides free preventive dental services to elderly residents of collective living centers by province-wide dental public health staff. Although it covers only 7% of Ontario's older population in these centers, initiatives are underway to include other elderly persons and to provide cost subsidization for referred treatment, if required. Since 1973, Alberta has provided, through dentists and denturists in private practice, comprehensive free dental benefits to all residents over 64 years of age. About 38% of eligibles now use the plan annually. Cost escalation per dentist user has been quite modest but less so for denturist users. The future of these two models and the problems associated with them are discussed.

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PubMed1999

[Quality assurance in geriatric medicine].

This article describes the peculiarities of geriatric quality assurance from the view of a clinical setting. Description of structural elements of quality are well known. Improvements in process quality of individual patient care have been sustained by controlled studies on comprehensive geriatric assessment. However, implementation of results from comprehensive assessment into external rating systems for hospital accreditation/certification still needs further research. The documentation of product quality depends on the measurement of patients' independency, activities of daily living and subjective well being.

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PubMedDate not supplied

[Subcutaneous perfusion of hypodermoclysis: a useful rehydration method in geriatrics].

A USEFUL TECHNIQUE IN GERIATRICS: Older people are at high risk of dehydration. In common practice, oral intakes are often inadequate. Intravenous infusion may be difficult and may generate complications. Hypodermoclysis or subcutaneous infusion is a useful technique for the prevention or cure of moderate dehydration in the older subjects. MANY ADVANTAGES AND FEW RISKS: When it is used correctly (i.e. volume and type of solutions, aseptic conditions) and when its contraindications are respected (i.e. emergency situations), hypodermoclysis is a simple technique that is safe, effective and comfortable. It does not need intensive surveillance and can be used both at home or in an institution, thus avoiding hospitalization of older subjects. A TECHNIQUE THAT SHOULD BE DEVELOPED: The numerous advantages of hypodermoclysis in older patients should encourage its wider use in geriatrics.

Age Factors↗
PubMed2000

The geriatric patient: a systematic approach to maintaining health.

The number of persons 65 years of age and older continues to increase dramatically in the United States. Comprehensive health maintenance screening of this population is becoming an important task for primary care physicians. As outlined by the U.S. Preventive Services Task Force, assessment categories unique to elderly patients include sensory perception and injury prevention. Geriatric patients are at higher risk of falling for a number of reasons, including postural hypotension, balance or gait impairment, polypharmacy (more than three prescription medications) and use of sedative-hypnotic medications. Interventional areas that are common to other age groups but have special implications for older patients include immunizations, diet and exercise, and sexuality. Cognitive ability and mental health issues should also be evaluated within the context of the individual patient's social situation-not by screening all patients but by being alert to the occurrence of any change in mental function. Using an organized approach to the varied aspects of geriatric health, primary care physicians can improve the care that they provide for their older patients.

Accidental Falls↗
PubMed2000

[Cognitive prerequisites of geriatric rehabilitation].

Rehabilitation aims at the restoration of maximal independence and autonomy after functional loss due to illness or accident. In old age losses of independence in daily life and autonomy are accounted for up to 60% by personal deficits in cognitive abilities. Functional losses in cognitive abilities represent a higher risk of having an accident or becoming ill. Cognitive performance proves to be predictive for success of rehabilitation, independent of functional state. Using the example of a fracture of the femur it can be shown that sensory and cognitive deficits increase the risk of accidents and that executive abilities co-influence long-term results. Strokes are more frequent if cognitive deficits have existed before and the resulting damages are stronger. Long-term results generally depend on complex abilities like everyday competence, reasoning and memory. Experiences with patients with dementia undergoing a memory training show that learning strategies are rarely generalized. Therefore in rehabilitation specific disorders, as for example cortical or subcortical patterns, have to be treated by different rehabilitation methods in the sense of differential rehabilitation. For this an early neuro-psychological assessment of the geriatric rehabilitation patient is needed. The cognitive-psychological findings only scarcely and insufficiently enter diagnostics and therapy. The diverse cognitive disorders have to be taken in account more frequently in education and differential rehabilitation methods have to be developed for geriatric patients with cognitive deficits.

Activities of Daily Living↗
PubMed2000

[Organization of health care in geriatric psychiatry: a consensus statement].

This consensus statement, originally published in English by the World Health Organization (WHO), has been produced in collaboration with the Section of Geriatric Psychiatry of the World Psychiatric Association (WPA). During a meeting in Lausanne, Switzerland, from November 14 to 16, 1997, led by Dr Nori Graham, the final declaration was prepared by an interdisciplinary group of representatives from the principle international associations concerned. Professor Cornelius Katona and Dr Nori Graham were Co-Rapporteurs. This statement follows an initial consensus document published by the WHO and the WPA defining geriatric psychiatry (1).

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PubMed2000

[Inventory of geriatric psychiatry in Sweden. In short supply where demand does not determine resource allocation].

In 1999 The Swedish Society for Old Age Psychiatry conducted an investigation in all Swedish counties in order to survey existing organizations and resources for medical services intended for elderly people with psychiatric complaints. In some counties there were no out-patient units specifically aimed at elderly people with psychiatric diseases, while more than half had no out-patient units for the large group of elderly with psychiatric ailments other than dementia. The total number of beds was far less than international recommendations. Less than 5 per cent of the total number of Swedish psychiatrists and geriatricians hold positions exclusively for geriatric psychiatry. Access to geriatric psychiatry resources appears to be unevenly distributed, and may be found mainly in or near university cities.

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PubMed1999

[Maximal age of patients as a reflection of health neglect of the geriatric population].

In publications relating to the health of the elderly there are 2 ways of presenting maximal ages, collective (for example: 70+ years) and individual maximal age (for example 70 years). While enabling assessment up to a certain age, data from subjects above the maximal age stated in the research will not be included. From the literature of the past 10 years, there were selected 764 disease parameters (PD) and 177 parameters of aging (PA). Among them 667 (70.9%) and 274 (29.1%) were parameters with collective and exact maximal ages, respectively. The lack of reference by authors to ages above 70 to 79 (or 70+ to 79+) and 80 to 89 (or 80+ to 89+) was calculated from the medical literature, and estimated as significant, and for ages above 80 to 89 was estimated as minimally significant, in regard to their focus on health data in the elderly. In different groups of parameters, 24% to 32% of maximal ages indicated significant and 25% to 65% minimal lack of reference. Maximal ages of PA were higher than those of PD (p < 0.001), so lack of reference to health of the elderly was more significant when PD were studied as compared to PA. Lack of reference was more significant in studies of hospitalized and ambulatory patients and people living within the community. Usually authors checked all the populations of people living in nursing homes, but the total number of parameters relating to the latter, was very small, only 5.1% of the total number of parameters, so the populations of nursing homes did not reach the attention of the researchers. Collective maximal ages are more often used in geriatric journals, including the Journal of the American Geriatric Society, as opposed to general and gerontological journals, although this approach seems to be too sweeping in the assessment of health of the elderly.

Age Factors↗
PubMed2000

Geriatric medicine in practice. An overview.

Older patients with chronic health problems are a common presentation in general practice. The Central Coast Division of General Practice identified 'care of the elderly' as one of the priorities for local membership. This is the first in a series of articles based on the 'Geriatric Attachment Programme', which was jointly developed between the Division of General Practice and the Department of Geriatric Medicine, Central Coast Health. The recent introduction of the Health Assessment and Health Care Plans for the elderly into the Medical Benefit Schedule encourages preventive and anticipatory care. Doing this successfully requires a structured approach. This series will offer a practical guidance approach to enable readers to achieve this goal. In this article we provide an overview of the issues important to the care of the elderly. Subsequent articles deal with specific issues in detail.

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PubMed2000

Assessing health status and outcomes in a geriatric day hospital.

The study objective was to assess the feasibility and usefulness of recommended outcome measures in older people attending a geriatric day hospital for multidisciplinary assessment and rehabilitation. We used the 'Short Form 36' (SF36) questionnaire which had been proposed as a suitable outcome tool for the elderly, as well as standard assessment scales (eg Barthel index). These were administered by interviewers at the start of day hospital attendance and repeated by postal survey three and six months later. Change in overall health status was rated by the clinical team. The study took place in a geriatric day unit based in a support hospital, specialising in assessment and rehabilitation of older people. Participants were older people referred directly from the community, or following an inpatient day, whose assessment indicated a need for multidisciplinary rehabilitation. Stroke and musculo-skeletal disorders were the commonest underlying conditions. There was a high incidence of non-completion on SF36 questions relating to physical and mental function. Subsequent interviews showed that patients found some questions irrelevant. Floor effects were common. In contrast, the standard scales were invariably fully completed. Compared with local population survey data, respondents had low baseline scores on all SF36 dimensions. Differences over time were probably explained by varying methods of administration. In spite of a clinical perception of improved health status during day hospital attendance, both standard and SF36 scores showed overall deterioration. Two conclusions could be drawn from this study. 1. Measures of physical and mental disability and quality of life gave lower results than expected and continued declining over a six month period, even when the clinical team felt that the patient had improved. 2. Administration of SF36 by an interviewer is essential to obtain meaningful results in older people with poor physical health, which should be interpreted with caution. Goal-specific measures may be more useful in this group of patients.

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PubMed1975

[Basic pathology of sigma and rectum in geriatric-gynaecological laparotomies].

This is a report on 49 women with sigmoiditis and 66 women with sigmoido-rectal carcinoma. These cases were collected in 18 women hospitals in West-Berlin over a period of 10 years, from 1960 until 1969. All patients were at least 60 years old. In most of these cases laparotomy was performed for gynaecological reasons. The post-operative mortality was 40.9%. It is pointed out that the whole spectrum of diagnostic procedures was not fully utilized; today laparoscopies and ultrasound are added when indicated. Inflammatory processes of the sigma as well as sigmoido-rectal carcinoma are typical geriatrical diseases that will increase with rising life expectancy thus constituting an important part of the differential-diagnostic section of geriatric gynaecology.

Age Factors↗
PubMed2001

[Physical restraint in geriatric psychology].

The use of physical restraint is a fact which we confront in everyday practice. The objective of this article is to establish some basic operating guidelines in order to prevent the use of physical restraint and which procedures to follow when its use is unavoidable. The authors describe some adequate instances when use of physical restraint may be required and they identify different methods and their procedures. Its use may cause a series of complications, specific risks and general risks, which one needs be aware of in order to prevent them. Considering the importance of having protocols for all these aspects in each center, the authors propose the contents on a clinical report sheet to facilitate a good control of the restraint used for each patient. This article was submitted as an oral report at the 8th Congress of the Catalonian-Balearic Geriatrics and Gerontology Association and at the 4th Conference of Current Practices in Psycho-Geriatrics.

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PubMed2001

[Can ingestion of cranberry juice reduce the incidence of urinary tract infections in a department of geriatric medicine?].

INTRODUCTION: The incidence of urinary tract infections was compared in two geriatric units, where patients were offered cranberry juice and the usual mixed berry juice, respectively. METHODS: In all cases where urinary tract infection was suspected, the doctors noted symptoms and signs used as indication for urinary culture. The urine collected from men was the usual mid-flow specimen, whereas the specimens from women were taken from a bedpan and by catheter. End points were the prevalence of symptoms leading to urine culture, specimens with significant growth of bacteria, and the use of antibiotics. RESULTS: Urine specimens were cultured in 140/338 cases. The reason for culture in 23% was general symptoms and in 62% urinary tract symptoms. A significant growth of bacteria was found in 54% and this information led to antibiotic treatment in 44%. In all cases (n = 55) where bedpan and catheter specimens were taken, the results were identical. CONCLUSION: Cranberry juice in a geriatric department, where the mean stay was 4 weeks, did not influence the incidence of urinary tract infections.

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PubMed2001

[Expert assessment of nursing care need according to SGB XL. Trigger for intervention programs in geriatric rehabilitation].

"Rehabilitation instead of nursing care" is one of the most important entitlements of the social welfare legislation to long-term care. In Germany 1.2 million evaluations per year are done by the experts of the medical review boards of the health insurance funds. As a part of those evaluations the experts also have to discuss the necessity of any kind of rehabilitation procedures. In 1999 according to the experts' opinion only about 12% of the patients need such special support. At first this number seems much too low. We discuss the problems in that social field: Does the demand of the social welfare legislation "prevention and rehabilitation instead of nursing care" not correspond to the real needs or are the circumstances of social policy and medical supply responsible for that low recommendation of rehabilitation programs. This discussion leads to the following consequences: The patients, the members of their family but also the treating physicians must be informed much better than today about diagnostic and therapeutic possibilities for the special diseases of elderly people. All in the game have to prepare concepts, pilot projects and then common solutions for geriatric rehabilitation programs as soon as possible. Politicians, physicians, nursing staff, rehabilitation staff, patients, family members and any other caregivers all have to take responsibility, maybe the liability. Not only German people will be growing older than ever before, which everyone has to recognize as one of the most important facts of our welfare state. To handle this development will be the most serious duty of our community in the future. Therefore, geriatrics has to receive high public attention.

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