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Clinics in Geriatric Medicine

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https://www.readbyqxmd.com/read/28689574/the-new-geriatric-giants
#1
EDITORIAL
John E Morley
No abstract text is available yet for this article.
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689573/rapid-geriatric-assessment-secondary-prevention-to-stop-age-associated-disability
#2
REVIEW
John E Morley
The Rapid Geriatric Assessment (RGA) measures frailty, sarcopenia, anorexia, cognition, and advanced directives. The RGA is a screen for primary care physicians to be able to detect geriatric syndromes. Early intervention when geriatric syndromes are recognized can decrease disability, hospitalization, and mortality.
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689572/integrating-quality-palliative-and-end-of-life-care-into-the-geriatric-assessment-opportunities-and-challenges
#3
REVIEW
Daniel Swagerty
This article provides an overview of how integrating quality palliative and end-of-life care into geriatric assessment can be a tremendous benefit to older adult patients and their families. Although the quality of palliative and end-of-life care for older adults has improved greatly, there are still many opportunities to improve the quality of life and function for older adult patients in the last few years of their life. More clinical expertise in comprehensive palliative and end-of-life care must be developed and maintained...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689571/dissecting-delirium-phenotypes-consequences-screening-diagnosis-prevention-treatment-and-program-implementation
#4
REVIEW
Joseph H Flaherty, Jirong Yue, James L Rudolph
Delirium is an acute change in attention and awareness that preferentially occurs in older patients with acute illness. This review provides an overview for clinicians with descriptions of the presentations (phenotypes), consequences, diagnosis, and screening of delirium. In addition, this review provides guidance for the challenges posed by delirium in a health care system, including implementation of delirium programs, tools to address the diagnosis and differential diagnosis of delirium, and a review of preventive and treatment studies with a goal of improving clinical practice...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689570/rapid-depression-assessment-in-geriatric-patients
#5
REVIEW
George T Grossberg, David Beck, Syed Noman Y Zaidi
Depression is common in geriatric patients, especially in those with multiple comorbidities and polypharmacy. Depression in older adults is often underdiagnosed and undertreated. Initial screening for depression can easily be accomplished in the waiting room. Yet the clinical interview still remains the gold standard for diagnosing geriatric depression. Key components of the clinical interview are observant watching of the patient for the subtle signs of depression. Clinical interview should be done with sensitivity to the importance of privacy...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689569/rapid-geriatric-assessment-of-hip-fracture
#6
REVIEW
Jesse Zanker, Gustavo Duque
A comprehensive geriatric assessment, combined with a battery of imaging and blood tests, should be able to identify those hip fracture patients who are at higher risk of short- and long-term complications. This comprehensive assessment should be followed by the implementation of a comprehensive multidimensional care plan aimed to prevent negative outcomes in the postoperative period (short and long term), thus assuring a safe and prompt functional recovery while also preventing future falls and fractures.
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689568/falls-in-the-aging-population
#7
REVIEW
Kareeann S F Khow, Renuka Visvanathan
The number of people living beyond 65 years of age is increasing rapidly, and they are at increased risk of falls. Falls-related injuries and hospitalizations are steadily increasing. Falls can lead to fear of falling, loss of independence, institutionalization, and death, inevitably posing a significant burden to the health care system. Therefore, screening of people at risk of falls and comprehensive assessment of older people at high risk of falls are critical steps toward prevention. This review evaluates the current knowledge relating to falls, with particular focus on rapid screening, assessment, and strategies to prevent falls in the community...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689567/cognitive-frailty-mechanisms-tools-to-measure-prevention-and-controversy
#8
REVIEW
Bertrand Fougère, Julien Delrieu, Natalia Del Campo, Gaëlle Soriano, Sandrine Sourdet, Bruno Vellas
Physical frailty is often associated with cognitive impairment, possibly because of common underlying pathophysiologic mechanisms. To stimulate research in this field, the concept cognitive frailty was proposed, emphasizing the important role of brain aging. Cognitive frailty was defined as the presence of cognitive deficits in physically frail older persons without dementia. This subtype of frailty is deemed important, as it may represent a prodromal phase for neurodegenerative diseases and is potentially a suitable target for early intervention...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689566/mild-cognitive-impairment
#9
REVIEW
Angela M Sanford
Mild cognitive impairment (MCI) occurs along a continuum from normal cognition to dementia. A roadblock to earlier diagnosis and potential treatment is the lack of consistency with screening for MCI. Universal screening would be ideal, but is limited. Once a diagnosis of MCI is made, it is important for the clinician to evaluate for reversible causes. At present time, there are no pharmacologic treatments proven to slow or cure progression of MCI to dementia; nonetheless, there is evidence that lifestyle modifications including diet, exercise, and cognitive stimulation may be effective...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689565/anorexia-of-aging-assessment-and-management
#10
REVIEW
Francesco Landi, Anna Picca, Riccardo Calvani, Emanuele Marzetti
Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of age-related nutritional deficits with several adverse outcomes has led to the recognition of a geriatric condition referred to as "anorexia of aging." Anorexia is an independent predictor of morbidity and mortality both in the community and across clinical settings. Multidimensional interventions within personalized care plans currently represent the most effective option to ensure the provision of adequate amounts of food, limit weight loss, and prevent adverse health outcomes in older adults...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689564/sarcopenia
#11
REVIEW
Jean Woo
Sarcopenia refers to age-related muscle loss, defined using a combination of appendicular muscle mass, muscle strength, and physical performance measures. The pathogenesis depends on a balance between positive and negative regulators of muscle growth. Sarcopenia increases the risk for falls, fractures, dependency, use of hospital services, institutionalization, poor quality of life, and mortality. In clinical practice, brief screening tools, such as the 5-item SARC-F score, may be useful. Although pharmacologic treatments are actively being studied, the current mainstay consists of optimizing nutrition status, in particular protein and vitamin D status, and resistance exercises...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28689563/frailty-in-older-persons
#12
REVIEW
Matteo Cesari, Riccardo Calvani, Emanuele Marzetti
Frailty is a clinical state characterized by a decrease of an individual's homeostatic reserves and is responsible for enhanced vulnerability to endogenous and/or exogenous stressors. Such a condition of extreme vulnerability exposes individuals to an increased risk of negative health-related outcomes. Multiple operational definitions of frailty are available in the literature, but none can be indicated as a gold standard. Frailty should be considered a condition of major interest for public health and become the lever for reshaping the obsolete health care systems currently unable to adequately address the clinical needs of aging populations...
August 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364997/inroads-into-polypharmacy-moving-forward-with-tools-deprescribing-and-philosophical-reflection
#13
EDITORIAL
Mary Ann E Zagaria
No abstract text is available yet for this article.
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364996/geriatric-polypharmacy-two-physicians-personal-perspectives
#14
REVIEW
Zhe Chen, Anthony Buonanno
Being a clinical provider in today's health care environment has become complex with more levels of care to negotiate. Who is caught in the middle of this complexity? Senior citizens. As we evolve into the new quality model, new problems and complexities occur. Numerous protocols and guidelines necessitate the initiation of drugs for given diagnoses and aggressive treatments. This article discusses geriatric polypharmacy from two practitioners' viewpoints: Zhe Chen, MD, discusses the point of view of a physician provider, and Anthony Buonanno, MD, discusses providers' roles in their own families...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364995/medication-risk-mitigation-coordinating-and-collaborating-with-health-care-systems-universities-and-researchers-to-facilitate-the-design-and-execution-of-practice-based-research
#15
REVIEW
Kevin T Bain, Calvin H Knowlton, Jacques Turgeon
The high prevalence of inappropriate polypharmacy in geriatric populations is unacceptable. Traditional medication risk mitigation (MRM) strategies have proven to be effective at improving polypharmacy, but these strategies have not consistently translated into positive health outcomes. Enhanced MRM strategies, such as using pharmacogenomics information, are needed, and these strategies need to be tested. A formidable challenge is successfully integrating pharmacogenomic information into clinical practice. As the medication experts on health care teams, pharmacists have a clear role to play in developing, integrating, and assessing enhanced MRM strategies to improve therapeutic outcomes for geriatric patients...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364994/can-managed-care-manage-polypharmacy
#16
REVIEW
Richard G Stefanacci, Taha Khan
Polypharmacy has come to mean the inappropriate use of multiple medications. Polypharmacy can occur as a result of a range of situations, including the excessive application of clinical guidelines, lack of coordination among multiple prescribers, treating adverse drug events, misaligned medications across transitions of care, patient self-treatment, and inappropriate overtreatment. Polypharmacy is a problem because the benefits of a specific medication at the dose and frequency that an individual patient is taking are often outweighed by the costs...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364993/medication-reconciliation-in-long-term-care-and-assisted-living-facilities-opportunity-for-pharmacists-to-minimize-risks-associated-with-transitions-of-care
#17
REVIEW
Linda G Gooen
The transitions of care process involves pharmacists and other members of the health care team who are in a position to collect, review, and analyze medications lists to help improve health care outcomes. Medication reconciliation is a complex process, especially when providing care to elderly population due to increased medication use, the movement of the patient from one health care setting to another, the number of acute and chronic illnesses, and the intervention of multiple health care providers in different facilities...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364992/geriatric-polypharmacy-pharmacist-as-key-facilitator-in-assessing-for-falls-risk
#18
REVIEW
Michelle A Fritsch, Penny S Shelton
This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364991/polypharmacy-and-delirium-in-critically-ill-older-adults-recognition-and-prevention
#19
REVIEW
Erik Garpestad, John W Devlin
Among older adults, polypharmacy is a sequelae of admission to the intensive care unit and is associated with increased medication-associated adverse events, drug interactions, and health care costs. Delirium is prevalent in critically ill geriatric patients and medications remain an underappreciated modifiable risk for delirium in this setting. This article reviews the literature on polypharmacy and delirium, with a focus on highlighting the relationships between polypharmacy and delirium in critically ill, older adults...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364990/polypharmacy-reduction-strategies-tips-on-incorporating-american-geriatrics-society-beers-and-screening-tool-of-older-people-s-prescriptions-criteria
#20
REVIEW
Hedva Barenholtz Levy
There is no single definition of polypharmacy. Use of 5 or more medications commonly is used. An alternative, quantitative definition, such as use of more medications than clinically indicated or use of unnecessary or harmful prescribing, has been proposed. Protocols or algorithms to improve polypharmacy and prescribing in older adults have been developed. The American Geriatrics Society (AGS) Beers Criteria and Screening Tool of Older People's Prescriptions (STOPP) explicit criteria reflect elements that are common across protocols and algorithms...
May 2017: Clinics in Geriatric Medicine
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