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PubMed2001

Contemporary management of comorbid anxiety and depression in geriatric patients.

Anxiety and depression in elderly people are major public health problems in the United States. Recognition and treatment of these conditions will likely gain more attention in the next 30 to 50 years because of the projected growth of the geriatric population. As in many younger patients, the most common presentation of anxiety in elderly patients is comorbid anxiety and depression. Although age is not a risk factor for either anxiety or depression, factors associated with aging--such as increased medical burdens and loss of independence--are substantial risk factors for development of these conditions. Moreover, there is a close association in older people between untreated mental illness and exacerbation of physical illness. Some of the newer antidepressants are more appropriate long-term options for the treatment of comorbid anxiety and depression than either benzodiazepines or tricyclic antidepressants. The newer antidepressants can decrease symptoms, improve quality of life, and potentially promote healthier outcomes in geriatric patients who have comorbid anxiety and depression and/or comorbid mental and physical illness.

Age Factors↗
PubMedDate not supplied

[Groups of resource utilization in acute care units and average length of stay at geriatrics services].

BACKGROUND: In recent years, Patient Classifications Systems (PCS's) have been implement in Spain for the purpose of gauging the "hospital product". However, the most conventional systems are not very well-suited to the senior citizen population, among whom illness-related disability is a determining factor with regard to explaining the usage of resources and the results of the health care provided. Therefore, the idea was brought forth of implementing a system in units providing senior citizen care which would entail this parameter, that is, the Resource Usage Groups (RUG's), analyzing the characteristics and differences in the RUG-related spread in four Geriatrics Units. METHODS: A cross-sectional study based on consecutive cutoff points in periods longer than the average stay in each unit, the patients admitted in the acute care units and average stay in the Geriatrics Unit of the Hospital Monte Narango (HMN) (n = 318), Hospital Central de la Cruz Roja (HCCR) (n = 384), Hospital General de Guadalajara (HG) (n = 272) and Hospital Virgen del Valle (HVV) (n = 390), with regard to the spread thereof according to the RUG-T18 classification. The possible differences among the hospitals in question were analyzed by means of the chi-square statistical test (SPSS for Windows). RESULTS: For the overall sample, the patients were divided into groups R, S and C of the classification, groups P and B being represented to a very small degree, differences having been found to exist among the different hospitals. Hence, the HCCR is that which handles the largest percentage of patients in the R group (47.64% vs. 23.66% at HMN; 20.57% at HG and 20.53% at HVV) and a smaller percentage of patients in the S Group (3.12% vs. 6.40% at HMN; 9.92% at HG and 9.76% at HVV) and the C Group (48.94% vs. 76.29% at HMN; 66.89% at HG and 68.36% at HVV). Differences were likewise found to exist in the individual analysis for the acute care units and average length of stay. CONCLUSIONS: The resource usage groups can be useful with regard to ascertaining differences in the health care loads in hospital care for senior citizens.

Acute Disease↗
PubMed2001

[Teaching of geriatrics and gerontology at medical schools].

Analysis of goals and approaches in teaching geriatrics and gerontology for undergraduate medical students according to literature and personal 6 years experience. A proposal of "two module model" with introductory module of general gerontology in first years of studium (stress on communication, reflection of the elderly as human beings, their limitations, risks, and needs, lectures for medical students as well as for students of nursing, occupational therapy and so on to support team approach). Advanced module of "proper medical geriatrics" in late clinical years of studium (to stress atypical character of diseases, investigation, differential diagnosis and importance of acute care for elders units).

Curriculum↗
PubMedDate not supplied

Advanced practice geriatric nursing education. New options in Kansas.

Knowledgeable practitioners with the skills needed to serve in a variety of clinical settings are the primary objective of the Adult-Geriatric Advanced Nursing Program and the FNP elective, Advanced Practice Nursing Care of the Frail Elderly. The continued blending of long term and acute care settings will further cloud and challenge the school responsible for educating APNs in the care of older adults, particularly the frail elderly. Education needs to provide flexibility for students through new service designs such as interactive computer courses. Nurses with an orientation to the future should consider geriatric nursing education.

Aged↗
PubMed2002

Chronic pain. Clinical management of common causes of geriatric pain.

Effective management of chronic pain in older persons is attainable, although unnecessarily elusive. A host of factors can impede assessment and drug management, including impaired cognitive function, multiple potential causes of pain, pharmacokinetics and pharmacodynamics unique to the geriatric population, and clinician anxiety regarding analgesic addiction. In the geriatric population, some of the most prevalent chronic pain management cases involve osteoarthritis, low back pain, and neuropathy. Effective pain management is achieved with analgesics (acetaminophen and nonsteroidal anti-inflammatory drugs), opioids, non-opioid agents (e.g., tricyclic antidepressants, anticonvulsants) and invasive techniques (corticosteroid epidural injections/nerve blocks).

Aged↗
PubMed2002

Competence-to-stand-trial evaluations of geriatric defendants.

This descriptive study compares geriatric defendants (n = 57) found competent to stand trial (n = 36) with those found incompetent (n = 21). A review of the records of 57 consecutive pretrial geriatric detainees who underwent competence-to-stand-trial evaluation was conducted. The review included comparison of demographic and historical variables, mental status examination (MSE) elements, and trial abilities. Incompetent subjects were older and more frequently had dementia, but did not necessarily have other psychiatric illnesses. Deficits in orientation, memory, abstraction, concentration, calculation, and thought process were associated with incompetence. Deficits in orientation and memory correlated most highly with incompetence. Trial-related deficits associated with incompetence included failure to understand Miranda warnings, legal charges, potential penalties, roles of court officers, pleas, and plea-bargaining and inability to consult with an attorney and be self-protective. The ability to maintain appropriate courtroom behavior was not different between groups. The inability to consult with an attorney and understand Miranda was most predictive of incompetence-to-stand-trial opinions.

Aged↗
PubMedDate not supplied

[Perspectives of research in gerontology and geriatrics: review of the literature].

This exploratory descriptive study aimed at identifying and analyzing the tendencies and perspectives regarding research in the areas of gerontology and geriatrics. Initially, authors completed a bibliographical review of the Lilac's Data Bank and publications from 1980 to 2000 found at the University of São Paulo at Ribeirão Preto College of Nursing Library. Authors presented the results in tables and graphs, emphasizing the studies on geriatrics--54%. Regarding the approach, authors found, in the last decade (1990 to 2000), an increase of studies in the areas of Biology (32%), Human Resources (18%), Social (17%), Psychology (9.8%), Holism (4.0%), excepting Ethics that remained with the same rate in both periods (0.8%). With respect to the research type, the qualitative ones were predominant (49.2%). Thus, authors concluded that there is an increasing interest of professionals in the area due to the demographic and epidemiological transitions and also regarding the capacitation of human resources to work with the elderly.

Geriatrics↗
PubMedDate not supplied

Geriatric air medical transport: a program review.

INTRODUCTION: The purpose of this study is to descriptively review the air medical transport of geriatric patients within the provincial air medical program of Nova Scotia. METHODS: This study was based on a retrospective review of charts from March 14, 1996, to February 24, 1998, and included patients 65 years or older transported by air ambulance. All trauma and nontrauma missions were included in the program's adult services component (more than 15 years old). The total population served is approximately 1 million. RESULTS: Fifty-nine geriatric patients were transported from a total of 175 adult missions during the study period, representing 33.7% of the adult services total. Nontrauma missions numbered 48 (81.3%), with the remainder (11, 18.6%) being trauma. Overall mortality in our study cohort was 32.2%. CONCLUSION: Air medical transport usually is associated with trauma transport of the younger patient. This program review demonstrates that one-third of adult air medical transports in this province are for patients older than 65 who are critically ill, though often with nontrauma conditions, and are associated with a high mortality rate. Air medical transport programs should have strategies, education, and protocols that reflect the unique pathophysiology of the elderly.

Aged↗
PubMed2002

[Saliva secretion and oral health in a hospitalized geriatric population in Israel].

Saliva secretion decreases with age, although not regarded as caused solely by age. The decrease is associated among others, with diseases and medications. The aim of the study was to assess saliva secretion, dentition and oral pathologies in a hospitalized geriatric population in a genera hospital. The secretion was measured by 2 methods: saliva collection at rest and sugar cube test. 125 patients agreed to participate, with an average age of 75. They had an average of 6 diagnoses, and took 6 medications. They had 6 teeth in average, with 52% edentulous. Salivary excretion was found to be 15% low according to the saliva secretion and According to the sugar cube test, 20% suffer from xerostomia. However, no statistically significant correlations were found to age, medications, diagnoses, or number of teeth. The study population was hospitalised for short term in a general hospital, and quickly returned to the community. Therefore, we can conclude that salivary excretion is low in the geriatric population in the community, especially among those who suffer from illnesses, who need short terms hospitalization. The health care personnel should be aware of this situation and recommend saliva substitutes and stimulants.

Age Factors↗
PubMed2002

[Oto-rhino-laryngology and geriatrics in the Ivory Coast].

Geriatrics medicine develops more and more as a specialized branch of medicine. We report a prospective study of 69 cases of geriatric patients hospitalized in the ENT department of Treichville's teaching hospital from 1996 till 2001. The frequency of hospitalization was estimated at 6.5%. The cohort consisted of 48 males (69.5%) and 21 females (30.5%) with an overall average age of 66.5 years. The majority of the patients lived in the city of Abidjan (61%) with a low socio-economic level (54%). 50.7% were married and 75.4% lived in a house-bold of several persons. The main lesions were at the level of the larynx (36.2%) and nose and sinuses (21.7%) cancers (52%) were more frequent. The patients were little dependent (84%), however 11.6% presented with psychological troubles. Associated pathologies were identified in 18.8% of case. The age, dependence and pathology determined the average duration of stay and the mode of exit. Mortality, of tumoral cause (cancer of the larynx), was estimated at 11.6%. An improved service requires a mutli-disciplinary approach an ORL-based presentative programme and prospective multicentre studies.

Aged↗
PubMedDate not supplied

Admission criteria in short-term geriatric assessment units: a Delphi study.

BACKGROUND: In recent years, short-term geriatric care units that operate using an interdisciplinary approach have been established in Quebec and elsewhere, in order to provide frail elderly persons with better health care. The purpose of this study is to determine criteria that target the greatest number of individuals most likely to benefit from hospitalization in this type of care unit. METHODS: A Delphi survey was conducted. The panel of experts consisted of 54 physicians and nurses working in short-term geriatric care units in Quebec. Three questionnaires were mailed and 4-level Likert scales were used. Median values, and 25th and 75th percentiles to a maximum of 2, were chosen a priori as the definition of consensus. RESULTS: The survey used 14 inclusion criteria and 17 exclusion criteria. Inclusion criteria were divided into two categories and exclusion criteria were divided into four. INTERPRETATION: A typical clinical profile of a patient who should be admitted to a STGCU emerges: an elderly person presenting multiple pathologies, acute or sub-acute functional disability, and often related psychosocial problems. The instrument developed by this project is a practical guide for professionals in STGAUs as well as those responsible for allocating resources in the health care system.

Aged↗
PubMed1992

The role of the geriatric consultation team in an acute care hospital.

One of the most important health issues of this decade is the provision of effective health care for the elderly. The overwhelming needs of this increasing population segment add to growing hospital expenditures. Hospitals must develop new ways to provide quality health care to the acutely ill elderly. The special needs of this group are too complex to be addressed by a single discipline. A geriatric team approach can provide a comprehensive, cost-effective means of improving the quality of care provided. This care delivery model can result in positive outcomes for the geriatric patient.

Aged↗
PubMedDate not supplied

[Study of the uni-dimensionality of the Yesavage-Brinck geriatric depression scale. Comparison between classical methods and Rasch's model].

The authors present a contribution to the french validation of the self-rating questionnaire of the depression in the elderly proposed by Yesavage and Brink (1982), the Geriatric Depression Scale (30 items). This study focusses on the assessment of the homogeneity and of the unidimensionality of this scale. 99 aged women living in old-people homes or attending a geriatric somatic day-hospital, not known to be psychiatrically ill, filled the GDS and were interviewed by either a psychiatrist or by a clinical psychologist. This interview yielded 44 cases of Major Depressive Disorder or of Dysthymia (DSM III). Firstly, we have applied the classical correlational methods of assessment of scale Reliability and Construct Validity: Cronbach's coefficient alpha and item-total correlations (homogeneity) and Principal Component Analysis (PCA) without rotation. Then, we have performed a Rasch Model Analysis: this method which belongs to the general frame of Latent Trait Theory relies on a probabilistic model of subject's response to individual questions. In the Rasch model, the response probability of a given subject to a given item is a logistic function of the difference between the item location parameter and the subject location parameter along a single continuous latent dimension. Our results have shown that the Cronbach's alpha was very high (.902) and that the item-total correlations were quite satisfactory (mean .470), thus giving a strong impression of homogeneity (similar to unidimensionality for many authors).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Is dental education in step with current geriatric health promotion initiatives?

As dramatic changes in U.S. society continue to stress our health care system, we must consider new strategies to meet the oral health needs of older individuals. Several recent national initiatives, including the Healthy People 2000 health objectives and the Surgeon General's Workshop on Health Promotion and Aging, provide measurable health objectives and suggestions for educational activities in the area of geriatric oral health promotion. Using these and other recent documents like "Practitioners for 2005, An Agenda for Action for U.S. Health Professional Schools," we can evaluate current educational programs in geriatric dentistry, as well plan programs and health promotional activities that meet the future needs of dental professionals and the patients they serve.

Aged↗
PubMed2003

The development of geriatric psychiatry services in Singapore.

Singapore is ageing rapidly and the need to develop a comprehensive range of psychiatric services for the elderly is urgent. To cater to the increase in the number of elderly with mental health problems, a multi-pronged, collaborative approach to developing services is necessary. Over the last decade, the development of such services has been initiated by the Department of Geriatric Psychiatry, Woodbridge Hospital and Institute of Mental Health, and effected through dynamic elderly networks consisting of health, social and voluntary organisations. This has facilitated the integration of psychogeriatric services within the overall framework of elderly services. With the establishment of the Integrated Framework of Healthcare of the Elderly by the Ministry of Health in 2000, the importance and effectiveness of building partnerships in service provision have been demonstrated. The challenge for the future is to attract and retain geriatric-trained healthcare professionals, enhance their training in the early diagnosis and management of psychiatric disorders in the elderly, improve the support of family caregivers and expand the range of quality psychogeriatric services.

Aged↗
PubMed2003

[Current problems in geriatrics and radiology. Teleradiology: organization and evaluation].

The realization of radiological examinations in the elderly population must be adjusted to the needs of patients that usually have health problems and very little patience. Its organization must be thought as a whole: appointment, reception of an awaited patient, human accompaniment allowing good cooperation, nursing support, and prompt availability of reports. Adapted equipment facilitates the examination: stretchers to raise and carry invalid patients, digital radiography. Structural linking of radiology and geriatric units with a departmental support avoids the isolation of medical and ancillary staff, reinforce the bonds with geriatricians and facilitates the access to CT before any contrast-enhanced (barium, iodinated) examination. Teleradiology is a complementary tool of making the medical support available and reinforce the interactivity with geriatricians. The simplicity of the questions in current geriatrics makes it possible to use teleradiology in daily practice.

Aged↗
PubMed1992

PEN&PAD (Geriatrics): a Collaborative Patient Record System for the shared care of the elderly.

The PEN&PAD (Geriatrics) project seeks to develop a Collaborative Patient Record System for the hospital based shared care of the elderly. The goal of the project is to produce a single, integrated information system which is both useful and usable by the different practitioner groups involved in geriatric care. A User Centred Design methodology is proposed which makes users and human issues central to the design and development process. Preliminary results indicate that the specification of a Minimum Basic Data Set as the basis of a shared record system is infeasible and undesirable. An architecture is presented which illustrates how the diversity between the different disciplines may be preserved in a Collaborative Patient Record System.

Geriatrics↗
PubMedDate not supplied

[Relatives of hospitalized geriatric patients: their needs of information, counseling, and access].

The perception of needs of relatives of patients admitted to geriatric units was investigated by interviewing 70 relatives of patients admitted to the geriatric ward of Verona hospital, over 45 consecutive days. The self compiled questionnaire used for the survey included a list of 22 potential needs referring to three categories: information, counselling and accessibility. Relatives were asked to rate them, on a scale from 1 to 4, according to the perceived priority and level of satisfaction. The relatives rank as most important the information need: the need of receiving information on the illness and its' course; of being contacted and informed on every clinically relevant change in health-illness status and being sure that the patient receives the best possible care. The level of satisfaction for information, counselling and accessibility is low. The perception of needs is influenced by the level of education or the relative.

Aged↗