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Geriatric Emergency

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https://www.readbyqxmd.com/read/28077927/utility-of-self-competency-ratings-during-residency-training-in-family-medicine-education-emerging-countries-findings-from-japan
#1
Michael D Fetters, Satoko Motohara, Lauren Ivey, Keiichiro Narumoto, Kiyoshi Sano, Masahiko Terada, Tsukasa Tsuda, Machiko Inoue
BACKGROUND: Family medicine education-emerging countries face challenges in demonstrating a new program's ability to train residents in womb-to-tomb care and resident ability to provide such care competently. We illustrate the experience of a new Japanese family medicine program with resident self-competency assessments. METHODS: In this longitudinal cross-sectional study, residents completed self-competency assessment surveys online during 2011-2015. Each year of training, residents self-ranked their competence using a 100-point visual analog scale for 142 conditions: acute (30 conditions), chronic (28 conditions) women's health (eight conditions), and geriatrics/home (12 conditions) care; procedures (38 types); health promotion (21 conditions)...
2017: Asia Pacific Family Medicine
https://www.readbyqxmd.com/read/28057200/epidemiology-and-recent-trends-of-geriatric-fractures-presenting-to-the-emergency-department-for-united-states-population-from-year-2004-2014
#2
N K Baidwan, S M Naranje
OBJECTIVES: Fractures in geriatric age group (over 65 years of age) are an important public health issue and frequent causes of emergency room visits. The purpose of this descriptive epidemiological study was to present the epidemiology of geriatric fractures and their trends in the USA using National Electronic Injury Surveillance System (NEISS) database from year 2004-2014. METHODS: National Electronic Injury Surveillance System (NEISS) Database was queried for all fracture injuries from 2004 to 2014 for ages 65 years and above...
January 2017: Public Health
https://www.readbyqxmd.com/read/28054112/-surgical-treatment-of-colorectal-carcinoma-in-the-elderly
#3
J Schuld, M Glanemann
Colorectal carcinoma is one of the most frequent tumor entities worldwide. The treatment of elderly and mostly polymorbid patients is an outstanding challenge in view of the demographic change with a continuously aging community. Due to the demographic changes the numbers of elderly (>65 years) and very old (≥80 years) patients are steadily increasing in surgical cohorts. This has resulted in higher morbidity and mortality rates in comparison to younger patients, with increased wound healing and cardiovascular complications but with comparable numbers of anastomotic insufficiency...
January 4, 2017: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
https://www.readbyqxmd.com/read/28050911/caring-for-elder-patients
#4
Karin Nordström, Tenzin Wangmo
BACKGROUND: Neglect and abuse of elders in care institutions is a recurring issue in the media. Elders in care institutions are vulnerable due to their physical, cognitive, and verbal limitations. Such vulnerabilities may make them more susceptible to mistreatment by caregivers on whom they are heavily dependent. OBJECTIVES: The goal was to understand caregivers' concerns about ensuring correct and proper treatment, as well as their experiences with neglect and abuse of older patients...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28050223/geriatric-homelessness-association-with-emergency-department-utilization
#5
Ana Hategan, Daniel Tisi, Mariam Abdurrahman, James A Bourgeois
BACKGROUND: Homeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs. METHODS: ED encounters at three hospitals in Hamilton (Ont.) were analyzed, and demographic and clinical characteristics of the older homeless (age > 50) vs. younger counterparts (age ≤ 50) were compared during a 24-month period...
December 2016: Canadian Geriatrics Journal: CGJ
https://www.readbyqxmd.com/read/28049616/three-decades-of-comprehensive-geriatric-assessment-evidence-coming-from-different-healthcare-settings-and-specific-clinical-conditions
#6
REVIEW
Alberto Pilotto, Alberto Cella, Andrea Pilotto, Julia Daragjati, Nicola Veronese, Clarissa Musacchio, Anna Maria Mello, Giancarlo Logroscino, Alessandro Padovani, Camilla Prete, Francesco Panza
Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of older adults to develop a coordinated plan to maximize overall health with aging. Specific criteria used by CGA programs to evaluate patients include age, medical comorbidities, psychosocial problems, previous or predicted high healthcare utilization, change in living situation, and specific geriatric conditions. However, no universal criteria have been agreed upon to readily identify patients who are likely to benefit from CGA...
December 31, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28031949/the-effect-of-frailty-should-be-considered-in-the-management-plan-of-older-people-with-type-2-diabetes
#7
REVIEW
Ahmed H Abdelhafiz, Luan Koay, Alan J Sinclair
The prevalence of diabetes is increasing especially in older age due to increased life expectancy. In old age, diabetes is associated with high comorbidity burden and increased prevalence of geriatric syndromes including frailty in addition to micro- and macro-vascular complications. The emergence of frailty may change the natural history of Type 2 diabetes from a progressive to a regressive course with increased risk of hypoglycemia. This may result in normalization of blood glucose levels and lead to a state of burnt-out diabetes in frail older people with significant weight loss...
March 2016: Future Science OA
https://www.readbyqxmd.com/read/28029695/sense-of-control-in-end-of-life-decision-making
#8
Rafael D Romo, Theresa A Allison, Alexander K Smith, Margaret I Wallhagen
OBJECTIVES: To explore how older adults in the community with a limited life expectancy make healthcare decisions and the processes used when they are not in an acute crisis. DESIGN: Grounded theory. SETTING: Medical programs and geriatrics clinics at the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center. PARTICIPANTS: Community-dwelling adults aged 67 to 98 with a life expectancy of less than 1 year (N = 20)...
December 28, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28029586/social-determinants-multimorbidity-and-patterns-of-end-of-life-care-in-older-adults-dying-from-cancer
#9
Siran M Koroukian, Nicholas K Schiltz, David F Warner, Charles W Given, Mark Schluchter, Cynthia Owusu, Nathan A Berger
OBJECTIVE: Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care. METHODS: From the linked 1991-2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age ≥66years who died from cancer (n=835)...
October 28, 2016: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/28026728/-influence-of-the-weather-on-the-incidence-of-fractures-in-the-elderly
#10
F Burget, O Foltán, J Kraus, K Kudrna, M Novák, J Ulrych
PURPOSE OF THE STUDY The incidence of geriatric fractures (proximal femur, distal radius, proximal humerus and thoracolumbar spine injuries) in the population increases with ageing. However, the role of weather conditions, such as icy and slippery winter, should not be overlooked. A deeper insight into this relationship may bring about a better understanding of the fracture aetiology and thus allow for improvement in the prevention of fractures in elderly people. MATERIAL AND METHODS This prospective study included 676 patients (469 women and 207 men) aged 65 and over...
2016: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28017276/patient-journey-in-decompensated-heart-failure-an-analysis-in-departments-of-cardiology-and-geriatrics-in-the-greater-paris-university-hospitals
#11
Florent Laveau, Nadjib Hammoudi, Emmanuelle Berthelot, Joël Belmin, Patrick Assayag, Ariel Cohen, Thibaud Damy, Denis Duboc, Olivier Dubourg, Albert Hagege, Olivier Hanon, Richard Isnard, Guillaume Jondeau, Florian Labouree, Damien Logeart, Nicolas Mansencal, Christophe Meune, Eric Pautas, Yves Wolmark, Michel Komajda
BACKGROUND: Hospitalization for worsening/acute heart failure is increasing in France, and limited data are available on referral/discharge modalities. AIM: To evaluate patients' journeys before and after hospitalization for this condition. METHODS: On 1 day per week, between October 2014 and February 2015, this observational study enrolled 260 consecutive patients with acute/worsening heart failure in all 10 departments of cardiology and four of the departments of geriatrics in the Greater Paris University Hospitals...
December 21, 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28003385/evidence-for-greater-forensic-education-of-all-psychiatry-residents
#12
Howard L Forman, David W Preven
Booth and his colleagues have made an important contribution to the emerging evidence base that shows education in forensic psychiatry topics can improve attitudes toward the field. Given the desinstitutionalization of those with severe mental illness from state psychiatric facilities and the incarceration of many individuals with severe mental illness in correctional facilities, the need to train many more psychiatrists with competence in correctional settings is clear. Simply training more forensic psychiatrists will not both meet the psychiatric needs of incarcerated patients and fulfill the essential roles forensic psychiatrists play in the justice system...
December 2016: Journal of the American Academy of Psychiatry and the Law
https://www.readbyqxmd.com/read/27988927/cardiac-remodelling-in-a-baboon-model-of-intrauterine-growth-restriction-mimics-accelerated-ageing
#13
Anderson H Kuo, Cun Li, Jinqi Li, Hillary F Huber, Peter W Nathanielsz, Geoffrey D Clarke
KEY POINTS: Rodent models of intrauterine growth restriction (IUGR) successfully identify mechanisms that can lead to short-term and long-term detrimental cardiomyopathies but differences between rodent and human cardiac physiology and placental-fetal development indicate a need for models in precocial species for translation to human development. We developed a baboon model for IUGR studies using a moderate 30% global calorie restriction of pregnant mothers and used cardiac magnetic resonance imaging to evaluate offspring heart function in early adulthood...
November 6, 2016: Journal of Physiology
https://www.readbyqxmd.com/read/27986531/patient-function-and-the-value-of-surgical-care-for-kidney-cancer
#14
Hung-Jui Tan, Joseph D Shirk, Karim Chamie, Mark S Litwin, Jim C Hu
PURPOSE: Frailty and functional status have emerged as significant predictors of morbidity and mortality for patients undergoing cancer surgery. To articulate their impact on value (i.e., quality per cost), we compared perioperative outcomes and expenditures according to patient function for older adults undergoing kidney cancer surgery. MATERIALS AND METHODS: Using linked SEER-Medicare data, we identified 19,129 elderly patients with kidney cancer treated with non-ablative surgery from 2000-2009...
December 13, 2016: Journal of Urology
https://www.readbyqxmd.com/read/27959354/delivering-comprehensive-geriatric-assessment-in-new-settings-advice-for-frontline-clinicians
#15
J R Gladman
Over the decades, as the principles of comprehensive geriatric assessment have been established, there have been attempts to apply its principles to settings other than acute hospital medical wards or the general communitydwelling older population, for example, to other settings where older people with infirmity are found. The purpose of this paper is to describe and reflect upon the application of and evidence for comprehensive geriatric assessment in these new settings and give some advice to clinicians about how to optimise their contributions to these processes...
September 2016: Journal of the Royal College of Physicians of Edinburgh
https://www.readbyqxmd.com/read/27942737/prothrombin-complex-concentrates-an-alternative-to-fresh-frozen-plasma
#16
David R Burk, Jordan L Smith, Jason R Wild
Insufficiency fractures are a common cause of morbidity among geriatric patients worldwide. Improved outcomes are known to result from decreased delay to definitive operative fixation and mobilization. Use of warfarin is an important potential cause of delay. The ideal mode of warfarin reversal is currently unknown. Prothrombin complex concentrates (PCCs) offer rapid correction with small infusion volume, both of which are important for elderly patients with multiple comorbidities. The authors present 2 cases of insufficiency fractures occurring in geriatric patients receiving warfarin therapy reversed with a 3-factor PCC...
December 8, 2016: Orthopedics
https://www.readbyqxmd.com/read/27940568/can-consultant-geriatrician-led-comprehensive-geriatric-assessment-in-the-emergency-department-reduce-hospital-admission-rates-a-systematic-review
#17
Samuel Jay, Paula Whittaker, Jerome Mcintosh, Nicholas Hadden
OBJECTIVE: economic and demographic pressures are driving a need to reassess the way in which we care for older patients presenting to emergency departments (EDs). This systematic review seeks to assess the extent to which performing comprehensive geriatric assessment (CGA) in the ED can reduce admission rates. DESIGN: systematic search of both published and unpublished literature to identify studies reporting admission rates following the introduction of consultant geriatrician led teams performing CGA in the ED...
December 9, 2016: Age and Ageing
https://www.readbyqxmd.com/read/27923981/sarcopenia-and-frailty-in-chronic-respiratory-disease-lessons-from-gerontology
#18
Anna E Bone, Nilay Hepgul, Samantha Kon, Matthew Maddocks
Sarcopenia and frailty are geriatric syndromes characterized by multisystem decline, which are related to and reflected by markers of skeletal muscle dysfunction. In older people, sarcopenia and frailty have been used for risk stratification, to predict adverse outcomes and to prompt intervention aimed at preventing decline in those at greatest risk. In this review, we examine sarcopenia and frailty in the context of chronic respiratory disease, providing an overview of the common assessments tools and studies to date in the field...
December 6, 2016: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/27916022/a-wandering-tube
#19
Ina Dubin, Moshe Gelber, Ami Schattner
The predominant causes of acute mechanical small bowel obstruction in geriatric patients are adhesions and hernias, which is not much different than in other adult age groups. Unusual etiologies may be encountered, such as volvulus or gallstone ileus, but a displaced feeding gastrostomy tube is a distinctly rare cause of intestinal obstruction which needs to be considered by emergency physicians as it may be increasingly encountered.
December 5, 2016: CJEM
https://www.readbyqxmd.com/read/27915457/combined-use-of-the-rationalization-of-home-medication-by-an-adjusted-stopp-in-older-patients-rasp-list-and-a-pharmacist-led-medication-review-in-very-old-inpatients-impact-on-quality-of-prescribing-and-clinical-outcome
#20
Lorenz Van der Linden, Liesbeth Decoutere, Karolien Walgraeve, Koen Milisen, Johan Flamaing, Isabel Spriet, Jos Tournoy
BACKGROUND: Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions. OBJECTIVES: Our objective was to evaluate the effect of a pharmacist intervention, consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review on polypharmacy, the quality of prescribing, and clinical outcome in geriatric inpatients...
December 3, 2016: Drugs & Aging
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