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Geriatric evaluation and management

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https://www.readbyqxmd.com/read/29783091/mind-at-home-streamlined-study-protocol-for-a-randomized-trial-of-home-based-care-coordination-for-persons-with-dementia-and-their-caregivers
#1
Quincy M Samus, Betty Smith Black, Melissa Reuland, Jeannie-Marie S Leoutsakos, Laura Pizzi, Kevin D Frick, David L Roth, Laura N Gitlin, Constantine G Lyketsos, Deirdre Johnston
BACKGROUND: Dementia is associated with high health care costs, premature long-term care (LTC) placement, medical complications, reduced quality of life, and caregiver burden. Most health care providers and systems are not yet organized or equipped to provide comprehensive long-term care management for dementia, although a range of effective symptoms and supportive care approaches exist. The Maximizing Independence at Home-Streamlined (MIND-S) is a promising model of home-based dementia care coordination designed to efficiently improve person-centered outcomes, while reducing care costs...
May 18, 2018: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/29782209/practical-assessment-and-management-of-vulnerabilities-in-older-patients-receiving-chemotherapy-asco-guideline-for-geriatric-oncology
#2
Supriya G Mohile, William Dale, Mark R Somerfield, Mara A Schonberg, Cynthia M Boyd, Peggy S Burhenn, Beverly Canin, Harvey Jay Cohen, Holly M Holmes, Judith O Hopkins, Michelle C Janelsins, Alok A Khorana, Heidi D Klepin, Stuart M Lichtman, Karen M Mustian, William P Tew, Arti Hurria
Purpose To provide guidance regarding the practical assessment and management of vulnerabilities in older patients undergoing chemotherapy. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature. Results A total of 68 studies met eligibility criteria and form the evidentiary basis for the recommendations. Recommendations In patients ≥ 65 years receiving chemotherapy, geriatric assessment (GA) should be used to identify vulnerabilities that are not routinely captured in oncology assessments...
May 21, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/29759834/utility-of-frailty-assessment-for-elderly-patients-undergoing-cardiac-resynchronization-therapy
#3
Maciej Kubala, Laurence Guédon-Moreau, Frédéric Anselme, Didier Klug, Geneviève Bertaina, Sarah Traullé, Otilia Buiciuc, Arnaud Savouré, Momar Diouf, Jean-Sylvain Hermida
OBJECTIVES: The aim of this study was to evaluate the impact of frailty in the elderly on response to cardiac resynchronization therapy (CRT). BACKGROUND: CRT has been shown to improve symptoms and outcome of patients with congestive heart failure (HF) and impaired left ventricular ejection fraction (LVEF). The impact of frailty on the results of CRT is unknown. METHODS: Frailty defined as <14 of 17 points using the ONCODAGE (Outil de dépistage gériatrique en oncologie) G8 score was assessed before device implantation in candidates for CRT who were >70 years of age...
December 26, 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29753150/identification-of-asymptomatic-frailty-vertebral-fractures-in-post-menopausal-women
#4
S Pizzato, C Trevisan, P Lucato, G Girotti, M Mazzochin, B M Zanforlini, G Bano, F Piovesan, A Bertocco, F Zoccarato, M Dianin, E Manzato, G Sergi
PURPOSE: Vertebral fractures are associated with persistent pain, disability and mortality. However, around two thirds of women with vertebral fractures are unaware of them. We aimed to analyze which factors could mostly be associated to the presence of vertebral fractures in post-menopausal women, and evaluate the effectiveness of current screening criteria for the detection of vertebral fractures in an outpatient setting. METHODS: We evaluated 1132 post-menopausal women referred to the osteoporosis outpatient clinic of the Geriatrics Department of Padova...
May 9, 2018: Bone
https://www.readbyqxmd.com/read/29748342/impact-investigating-the-impact-of-models-of-practice-for-allied-health-care-in-subacute-settings-a-protocol-for-a-quasi-experimental-mixed-methods-study-of-cost-effectiveness-and-outcomes-for-patients-exposed-to-different-models-of-allied-health-care
#5
Freya Coker, Cylie M Williams, Nicholas F Taylor, Kirsten Caspers, Fiona McAlinden, Anita Wilton, Nora Shields, Terry P Haines
INTRODUCTION: This protocol considers three allied health staffing models across public health subacute hospitals. This quasi-experimental mixed-methods study, including qualitative process evaluation, aims to evaluate the impact of additional allied health services in subacute care, in rehabilitation and geriatric evaluation management settings, on patient, health service and societal outcomes. METHODS AND ANALYSIS: This health services research will analyse outcomes of patients exposed to different allied health models of care at three health services...
May 10, 2018: BMJ Open
https://www.readbyqxmd.com/read/29714994/issues-in-geriatric-care-alzheimer-disease
#6
Kathy Kemle, Richard J Ackermann
Alzheimer disease (AD) occurs in 8.8% of older US adults and is the sixth leading cause of death among older adults. Medicare annual wellness visits require screening for cognitive impairment but do not specify screening methods. Numerous screening instruments are available. If results are positive, evaluation with well-validated assessment tools is needed. If cognitive impairment is confirmed, laboratory tests and imaging studies should be obtained to rule out reversible etiologies. If patients meet diagnostic criteria for AD, clinicians should educate patients and families on the expected course and help them complete advance directives...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29704045/recommended-care-received-by-geriatric-hip-fracture-patients-where-are-we-now-and-where-are-we-heading
#7
Deborah Seys, An Sermon, Walter Sermeus, Massimiliano Panella, Luk Bruyneel, Paulo Boto, Kris Vanhaecht
INTRODUCTION: Despite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance-performance analysis for prioritizing interventions to improve the in-hospital management of these patients. MATERIALS AND METHODS: A secondary data analysis was conducted on the in-hospital treatment of 540 geriatric hip fracture patients in 34 hospitals in Belgium, Italy, and Portugal...
April 27, 2018: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/29697000/advancements-in-the-management-of-medically-less-fit-and-older-adults-with-newly-diagnosed-acute-myeloid-leukemia
#8
Laura C Michaelis, Heidi D Klepin, Roland B Walter
Treating acute myeloid leukemia (AML) in older adults remains daunting. The unique biology often renders conventional chemotherapies less effective. Accurately predicting the toxicities of treatment is another unresolved challenge. Treatment planning thus requires a good knowledge of the current trial data and familiarity with clinical tools, including formal fitness and geriatric assessments. Both obstacles - disease biology and patient fitness - might be easier overcome with specific, AML cell-targeted agents rather than traditional cytotoxic chemotherapy...
April 26, 2018: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29675629/-geriatric-trauma-center-dgu%C3%A2-evaluation-of-clinical-and-economic-parameters-a-pilot-study-in-a-german-university-hospital
#9
M Knobe, B Böttcher, M Coburn, T Friess, L C Bollheimer, H J Heppner, C J Werner, J-P Bach, M Wollgarten, S Poßelt, C Bliemel, B Bücking
BACKGROUND: Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. OBJECTIVE: The aim of the current prospective cohort study was the clinical and economic evaluation of fragility fracture treatment pathways before and after the implementation of a geriatric trauma center in conformity with the guidelines of the German Trauma Society (DGU)...
April 19, 2018: Der Unfallchirurg
https://www.readbyqxmd.com/read/29670988/reducing-complications-and-overall-healthcare-costs-of-hip-fracture-management-a-retrospective-study-on-the-application-of-a-diagnostic-therapeutic-pathway-in-the-cosenza-general-hospital
#10
M Loizzo, F Gallo, D Caruso
BACKGROUND: Diagnostic Therapeutic Pathways (DTPs) are multidisciplinary plans designed by each healthcare organization for a specific category of patients to reduce the variability of professional behaviors and to ensure greater safety and better overall healthcare outcomes. Hip fractures are a frequent traumatic injury, particularly in the elderly, and DTPs recommend early surgical intervention, often not done due to organizational challenges and bureaucracy. Medical conditions suggesting a delay are not frequent, however long waiting times not only increase the risk of complications and mortality, but also increase the number of diagnostic test and physician consultations...
May 2018: Annali di Igiene: Medicina Preventiva e di Comunità
https://www.readbyqxmd.com/read/29651598/geriatric-assessment-for-older-patients-with-non-small-cell-lung-cancer-daily-practice-of-centers-participating-in-the-nvalt25-eldapt-trial
#11
Elisabeth J M Driessen, Judith G M van Loon, Huub A Maas, Anne-Marie C Dingemans, Maryska L G Janssen-Heijnen
INTRODUCTION: Geriatric assessment (GA) for older patients with lung cancer could provide insight into vulnerability, cognitive impairment, and risk of toxicity. Discontinuation and complications of intensive treatment could potentially be prevented in vulnerable and frail patients. This study aimed to evaluate current clinical practice of GA for older patients with lung cancer in the Netherlands and identify potential hurdles for implementation. METHODS: Pulmonologists and radiation oncologists participating in the NVALT25-ELDAPT trial completed an online questionnaire regarding current practice of GA, added value of GA for treatment decision-making and logistic barriers for patients with non-small cell lung cancer...
April 12, 2018: Lung
https://www.readbyqxmd.com/read/29625940/incidence-of-drug-interactions-in-intensive-care-units-in-tertiary-care-settings-classification-facts-and-measures
#12
Hina Hasnain, Huma Ali, Farya Zafar, Ali Akbar Sial, Shazia Alam, Anwar Ejaz Beg, Rabia Bushra, Mehwish Rizvi, Maqsood Ahmed Khan, Huma Shareef, Ghazala R Naqvi, Anum Tariq
Drug-drug interactions (DDIs) are extremely significant concern, particularly in sensitive population including pediatric and geriatric. Propensity for the development of DDIs is high in patients admitted at intensive care units (ICU). This study was conducted to evaluate the DDIs incidence, facts and measures in ICU. From a total of 150 cases studied for ICU patients, with the mean age of 56.37±12.45 years, 55.33% were male and the rest were female 44.66%. The demographic information like age, gender and main diagnosis details of study participants that were extracted from the patients' clinical record...
March 2018: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29624089/geriatric-interdisciplinary-team-training-2-0-a-collaborative-team-based-approach-to-delivering-care
#13
Maryanne M Giuliante, Sherry A Greenberg, Margaret V McDonald, Allison Squires, Ronnie Moore, Tara A Cortes
Interprofessional collaborative education and practice has become a cornerstone of optimal person-centered management in the current complex health care climate. This is especially important when working with older adults, many with multiple chronic conditions and challenging health care needs. This paper describes a feasibility study of the Geriatric Interdisciplinary Team Training 2.0 (GITT 2.0) program focused on providing interprofessional care to complex and frail older adults with multiple chronic conditions...
April 6, 2018: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/29616624/invasive-strategy-and-frailty-in-very-elderly-patients-with-acute-coronary-syndromes
#14
Isaac Llaó, Albert Ariza-Solé, Juan Sanchis, Oriol Alegre, Ramon López-Palop, Francesc Formiga, Francisco Marín, María T Vidán, Manuel Martínez-Sellés, Alessandro Sionis, Miguel Vives-Borrás, Joan Antoni Gómez-Hospital, Josep Gómez-Lara, Gerard Roura, Pablo Díez-Villanueva, Iván Núñez-Gil, Jaume Maristany, Lluis Asmarats, Héctor Bueno, Emad Abu-Assi, Àngel Cequier
AIMS: Current guidelines recommend an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes (NSTEACS). The role of an invasive strategy in frail elderly patients remains controversial. METHODS AND RESULTS: The LONGEVO-SCA registry included unselected NSTEACS patients aged ≥80 years. A geriatric assessment was performed during hospitalization, including frailty. We evaluated the impact of an invasive strategy during the admission on the incidence of cardiac death, reinfarction or new revascularisation at 6-months...
April 3, 2018: EuroIntervention
https://www.readbyqxmd.com/read/29610916/should-this-patient-receive-prophylactic-medication-to-prevent-delirium-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#15
Anjala V Tess, Melissa L P Mattison, Joshua R Leo, Eileen E Reynolds
In 2015, the American Geriatrics Society released recommendations for prevention and management of postoperative delirium, based on a systematic literature review and evaluation of nonpharmacologic and pharmacologic approaches by an expert panel. The guidelines recommend an interdisciplinary focus on nonpharmacologic measures (reorientation, medication management, early mobility, nutrition, and gastointestinal motility) for prevention and consideration of this strategy for acute management. They also recommend optimizing nonopioid medication as a means to manage pain and avoiding benzodiazepines other than to treat substance withdrawal...
April 3, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29609624/can-education-improve-clinical-practice-concerning-delirium-in-older-hospitalised-patients-results-of-a-pre-test-post-test-study-on-an-educational-intervention-for-nursing-staff
#16
Eveline L van Velthuijsen, Sandra M G Zwakhalen, Ron M J Warnier, Ton Ambergen, Wubbo J Mulder, Frans R J Verhey, Gertrudis I J M Kempen
BACKGROUND: Delirium is a common and serious complication of hospitalisation in older adults. It can lead to prolonged hospital stay, institutionalisation, and even death. However, it often remains unrecognised or is not managed adequately. The aim of this study was to evaluate the effects of an educational intervention for nursing staff on three aspects of clinical practice concerning delirium in older hospitalised patients: the frequency and correctness of screening for delirium using the 13-item Delirium Observation Screening score (DOS), and the frequency of geriatric consultations requested for older patients...
April 2, 2018: BMC Medical Education
https://www.readbyqxmd.com/read/29589223/an-analysis-of-the-inclusion-of-medications-considered-potentially-inappropriate-in-older-adults-in-chemotherapy-templates-for-hematologic-malignancies-one-recommendation-for-all
#17
Amy Zhou, Holly M Holmes, Arti Hurria, Tanya M Wildes
BACKGROUND: There remains a paucity of data regarding the use of potentially inappropriate medications (PIMs) in the supportive management of older adults undergoing chemotherapy. Raising awareness among healthcare providers regarding the frequency of their use and potential toxicities may help to minimize the risks to patients. OBJECTIVE: The aim of this study was to evaluate the frequency of six specific classes of medications considered PIMs by the American Geriatrics Society Beers Criteria that are commonly included in the National Comprehensive Cancer Network (NCCN) chemotherapy order templates for hematologic malignancies...
March 27, 2018: Drugs & Aging
https://www.readbyqxmd.com/read/29575094/the-relationship-between-frailty-and-polypharmacy-in-older-people-a-systematic-review
#18
REVIEW
M Gutiérrez-Valencia, M Izquierdo, M Cesari, Á Casas-Herrero, M Inzitari, N Martínez-Velilla
AIM: Frailty is a complex geriatric syndrome resulting in decreased physiological reserves. Frailty and polypharmacy are common in older adults and the focus of extensive studies, although little is known about the impact they may have on each other. This is the first systematic review analyzing the available evidence on the relationship between frailty and polypharmacy in older adults. METHODS: Systematic review of quantitative studies. A comprehensive literature search for publications in English or Spanish was performed on MEDLINE, CINAHL, the Cochrane Database and PsycINFO in September 2017 without applying restrictions on the date of publication...
March 25, 2018: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29573155/determining-discharge-destination-in-geriatric-evaluation-and-management-units-is-progressive-goal-attainment-a-better-early-indicator-of-discharge-destination-than-improvement-in-functional-independence-measure-scores
#19
Susan Black, Caitlin Nicholas, Susan Cotton, Kim Brock
AIM: To determine whether progress in goal attainment is a more responsive measure of functional improvement than the Functional Independence Measure, and whether it is a more accurate predictor of discharge destination in the early phase of a Geriatric Evaluation and Management episode. METHODS: The present study was a prospective audit of goal achievement, functional ability and discharge destination. A total of 83 patients were included in this study. Logistic regression was carried out with the outcome variable discharge destination (home vs residential care), and the predictors being goal attainment, age at admission and change in the Functional Independence Measure motor function scale from admission to 2 weeks...
March 23, 2018: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/29558928/the-relationship-between-poor-nutritional-status-and-progression-of-aortic-calcification-in-patients-on-maintenance-hemodialysis
#20
Teppei Okamoto, Shingo Hatakeyama, Hirotake Kodama, Hirotaka Horiguchi, Yuka Kubota, Koichi Kido, Masaki Momota, Shogo Hosogoe, Yoshimi Tanaka, Tooru Takashima, Fumitada Saitoh, Tadashi Suzuki, Chikara Ohyama
BACKGROUND: Although aortic calcification has a significant negative impact on prognosis in patients on hemodialysis (HD), risk factors for aortic calcification progression remain unclear. The aim of this study was to investigate the relationship between malnutrition and aortic calcification progression in patients on HD. METHODS: Between April 2015 and October 2016, we treated 232 patients on HD. Of those, we retrospectively evaluated data from 184 patients who had had regular blood tests and computed tomography (CT) scans...
March 20, 2018: BMC Nephrology
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