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Geriatric emergencies

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https://www.readbyqxmd.com/read/29165543/identification-of-older-adults-with-frailty-in-the-emergency-department-using-a-frailty-index-results-from-a-multinational-study
#1
Audrey-Anne Brousseau, Elsa Dent, Ruth Hubbard, Don Melady, Marcel Émond, Éric Mercier, Andrew P Costa
Objective: frailty is a central concept in geriatric medicine, yet its utility in the Emergency Department (ED) is not well understood nor well utilised. Our objectives were to develop an ED frailty index (FI-ED), using the Rockwood cumulative deficits model and to evaluate its association with adverse outcomes. Method: this was a large multinational prospective cohort study using data from the interRAI Multinational Emergency Department Study. The FI-ED was developed from the Canadian cohort and validated in the multinational cohort...
November 20, 2017: Age and Ageing
https://www.readbyqxmd.com/read/29156247/humor-doesn-t-retire-improvisation-as-a-health-promoting-intervention-for-older-adults
#2
Lucy A Morse, Linda Xiong, Vanessa Ramirez-Zohfeld, Seltzer Anne, Becca Barish, Lee A Lindquist
As our population ages and aging in place continues to remain a priority of older adults, identifying novel ways to promote the wellbeing of older adults and reduce isolation is of the utmost importance. The Second City is a Chicago-based comedy improvisation organization that provides training in improvisation. One of their training courses, Humor Doesn't Retire, specifically teaches adults 55 and over, on improvisation. This study sought to explore the experiences of older adults enrolled in Humor Doesn't Retire, and to characterize any benefits that older adult participants perceived following participation in the comedy improvisation course...
October 28, 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/29133497/comparative-associations-between-measures-of-anti-cholinergic-burden-and-adverse-clinical-outcomes
#3
Wen-Han Hsu, Yu-Wen Wen, Liang-Kung Chen, Fei-Yuan Hsiao
PURPOSE: No consensus has been reached regarding which anticholinergic scoring system works most effectively in clinical settings. The aim of this population-based cohort study was to examine the association between anticholinergic medication burden, as defined by different scales, and adverse clinical outcomes among older adults. METHODS: From Taiwan's Longitudinal Health Insurance Database, we retrieved data on monthly anticholinergic drug use measured by the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden Scale (ACB), and the Drug Burden Index - Anticholinergic component (DBI-Ach) for 116,043 people aged 65 years and older during a 10-year follow-up...
November 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/29122598/effects-of-eus-guided-intratumoral-injection-of-oligonucleotide-stnm01-on-tumor-growth-histology-and-overall-survival-in-patients-with-unresectable-pancreatic-cancer
#4
Makoto Nishimura, Miho Matsukawa, Yuko Fujii, Yoko Matsuda, Tomio Arai, Yasutoshi Ochiai, Takao Itoi, Naohisa Yahagi
BACKGROUND AND AIMS: Carbohydrate sulfotransferase 15 (CHST15) promotes tumor growth and invasion and is considered to be an emergent therapeutic target for pancreatic cancer. The aim of this study was to evaluate the safety and efficacy of EUS-guided fine-needle injection (EUS-FNI) of STNM01, the double-stranded RNA oligonucleotide that specifically represses CHST15, for use in patients with pancreatic cancer. METHODS: Six patients with unresectable pancreatic cancer, treated at Tokyo Metropolitan Geriatric Hospital, were used in this open-labeled, investigator-initiated trial...
November 6, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/29107461/vignettes-and-viewpoints-from-a-professional-autobiography
#5
EDITORIAL
Jeffrey M Lyness
In this professional autobiography, the author describes factors contributing to important decisions in his academic geriatric psychiatry career. Major inflection points included embarking on clinical research and later deciding to focus more on leadership roles in education and in faculty affairs. The discussion then examines themes that have emerged in reviewing this career arc, including the value of: the variety and social connectedness inherent in the academic life; cultivation of interpersonal relationships and best efforts as much as possible; an open mind ready to (collegially) seize new opportunities; and family, friends, and avocational pursuits as complements to one's profession...
October 4, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29103414/using-music-to-reduce-anxiety-among-older-adults-in-the-emergency-department-a-randomized-pilot-study
#6
Laura Belland, Laura Rivera-Reyes, Ula Hwang
BACKGROUND: An emergency department (ED) visit may be distressing and anxiety-provoking for older adults (age > 65 years). No studies have specifically evaluated the effect of music listening on anxiety in older adults in the ED. OBJECTIVE: The objective of this pilot study was to evaluate the effect of music listening on anxiety levels in older ED patients. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This was a randomized pilot study in the geriatric ED of an urban academic tertiary medical center...
November 2017: Journal of Integrative Medicine
https://www.readbyqxmd.com/read/29099474/nurses-perceptions-of-psychosocial-care-and-barriers-to-its-provision-a-qualitative-study
#7
Cassandra Siyun Chen, Sally Wai-Chi Chan, Moon Fai Chan, Suk Foon Yap, Wenru Wang, Yanika Kowitlawakul
BACKGROUND: Psychosocial care is the culturally sensitive provision of psychological, social, and spiritual care through therapeutic communication. Current evidence suggests that effective psychosocial care improves patients' health outcomes and quality of life. PURPOSE: The aim of this study was to explore nurses' perceptions and experiences in providing psychosocial care to patients and to identify the related barriers and challenges. METHODS: An exploratory qualitative design using semistructured, individual, face-to-face interviews was adopted...
December 2017: Journal of Nursing Research: JNR
https://www.readbyqxmd.com/read/29099110/deterioro-cognitivo-en-adultos-mayores-con-vih-sida-y-s%C3%A3-ndrome-de-fragilidad
#8
Alfonso Zamudio-Rodríguez, Sara Aguilar-Navarro, José Alberto Avila-Funes
In 2014, 17% of newly diagnosed HIV infection cases in the United States were made in people over 50 years of age; actually, it is expected that in the near future this population group will be the most affected. This epidemiological change can be explained by the increased incidence of HIV infection in people over 50 years, but also by its higher prevalence due to treatment advances. As HIV infection has become a chronic one, new challenges have emerged. For instance, early-onset "geriatric syndromes," such as frailty, have been recognized in these patients...
2017: Gaceta Médica de México
https://www.readbyqxmd.com/read/29097857/like-the-eye-of-the-tiger-inpatient-psychiatric-facility-exclusionary-criteria-and-its-knockout-of-the-emergency-psychiatric-patient
#9
Veronica Tucci, John Liu, Anu Matorin, Asim Shah, Nidal Moukaddam
Context: Over 6% of all emergency department (ED) visits in the United States involve primary mental health or behavioral issues. The patients are stabilized in the ED but frequently require admission to an inpatient psychiatric unit or institution for longer term treatment and management. To facilitate this process, an emergency physician (EP) must first "medically clear" the patient as stable for transfer. At present, there is no interdisciplinary consensus regarding the necessary elements of the medical clearance or stability assessment process...
October 2017: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/29094499/emergency-medicine-in-the-extreme-geriatric-era-a-retrospective-analysis-of-patients-aged-in-their-mid-90s-and-older-in-the-emergency-department
#10
Martin Müller, Meret E Ricklin, Stefan Weiler, Aristomenis K Exadaktylos, Spyridon Arampatzis
AIM: In the coming years, older individuals will comprise an increasing share of emergency department (ED) admissions, due to the unprecedented and continuing demographic changes. The primary aim of the present study was to identify causes and risk factors for ED admission and hospitalizations in the oldest old. METHODS: We analyzed data of consecutive patients aged in their mid 90s and older (aged ≥94 years) admitted to the ED department of the University Hospital of Bern, Bern, Switzerland, between 2000 and 2010...
November 2, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/29094496/knowledge-gap-regarding-dementia-care-among-nurses-in-taiwanese-acute-care-hospitals-a-cross-sectional-study
#11
Pei-Chao Lin, Mei-Hui Hsieh, Meng-Chin Chen, Yung-Mei Yang, Li-Chan Lin
AIM: The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. METHODS: This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling...
November 2, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/29084321/frailty-phenotype-and-neuropsychological-test-performance-a-preliminary-analysis
#12
Terrie B Ginsberg, Leonard Powell, Arif Patel, Sheina Emrani, Anita Chopra, Thomas Cavalieri, David J Libon
Context: Frailty is a common problem that affects adults older than 65 years. Correlations between the frailty phenotype and neuropsychological impairment have not been thoroughly researched. Objective: To examine the association between frailty phenotype, neuropsychological screening test results, and neuropsychological domains known to characterize patients with mild cognitive impairment and dementia. Methods: This retrospective medical record analysis consisted of ambulatory patients aged 65 years or older seen in an outpatient geriatric practice...
November 1, 2017: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/29084129/analysis-of-incidents-of-violence-in-a-large-italian-hospital
#13
Dimitri Sossai, Francesco Stefano Molina, Mario Amore, Giovanna Ferrandes, Elena Sarcletti, Gabriella Biffa, Simone Accorsi, Martino Belvederi Murri, Marzia Jole Tomellini, Francesco Copello
INTRODUCTION: An increase in the rate of non-fatal violence events, from 20.65/10,000 in 2012 to 22.81/10,000 in 2014, was observed at the IRCCS Ospedale Policlinico San Martino in Genoa. OBJECTIVES: To analyze the incidence and outcome of the phenomenon of violence, by identifying the type of aggressive event and the ward in which it occurred, assuming that the occurrence is evenly distributed and not only limited to the psychiatric or to the emergency department...
October 27, 2017: La Medicina del Lavoro
https://www.readbyqxmd.com/read/29079066/anticoagulated-trauma-patients-a-level-i-trauma-center-s-response-to-a-growing-geriatric-population
#14
Mark D Mason, Sarah K Spilman, Elizabeth A Fuchsen, Sherry D Olson, Richard A Sidwell, James R Swegle, Sheryl M Sahr
BACKGROUND: Injured older adults often receive delayed care in the emergency department (ED) because they do not meet criteria for trauma team activation (TTA). This is particularly dangerous for the increasing number of patients taking anticoagulant or antiplatelet (AC/AP) medication at the time of injury. OBJECTIVES: The present study examined improvements in processes of care and triage accuracy when TTA criteria include an escalated response for older anticoagulated patients...
October 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29077231/disseminating-and-sustaining-emergency-department-innovations-for-older-adults-good-ideas-deserve-better-policies
#15
Alexander X Lo, Kevin Biese
Older adults often visit the emergency department (ED) with chief complaints that understate or detract from their true complex health care needs. These needs are frequently missed because addressing them requires a time-consuming effort that is antithetical to the (necessarily) rapid, complaint-specific protocols of the ED. Key ED performance indices (e.g., length of stay; through-put) also create a disincentive against undertaking comprehensive geriatric assessments when not clearly germane to the chief complaint...
October 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29070036/comparing-clinician-descriptions-of-frailty-and-geriatric-syndromes-using-electronic-health-records-a-retrospective-cohort-study
#16
Laura J Anzaldi, Ashwini Davison, Cynthia M Boyd, Bruce Leff, Hadi Kharrazi
BACKGROUND: Geriatric syndromes, including frailty, are common in older adults and associated with adverse outcomes. We compared patients described in clinical notes as "frail" to other older adults with respect to geriatric syndrome burden and healthcare utilization. METHODS: We conducted a retrospective cohort study on 18,341 Medicare Advantage enrollees aged 65+ (members of a large nonprofit medical group in Massachusetts), analyzing up to three years of administrative claims and structured and unstructured electronic health record (EHR) data...
October 25, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/29066874/optimization-of-drug-therapy-in-elderly-individuals-admitted-to-a-geriatric-unit
#17
Antoine Piau, Yoann Huet, Adeline Gallini, Laurine Andre, Bruno Vellas, Fati Nourhashemi
BACKGROUND: A substantial share of adverse drug events involves inappropriate prescribing (IP). Specialized geriatric units are supposed to pay particular attention to prescribing appropriateness and to promoting a higher prescribing quality. OBJECTIVE: The objective of this study was to evaluate the reality of such assessment and optimization in real life (usual care) in a population of elderly individuals admitted to a geriatric unit. METHOD: This is an observational study including all older patients admitted to an acute geriatric unit over a 6-month period...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29034078/recent-advances-in-cancer-surgery-in-older-patients
#18
REVIEW
Siri Rostoft, Riccardo A Audisio
Age is the most important risk factor for the occurrence of cancer, and a declining mortality from heart disease and other non-cancer causes leaves an older population that is at high risk of developing cancer. Choosing the optimal treatment for older cancer patients may be a challenge. Firstly, older age and associated factors such as comorbidities, functional limitations, and cognitive impairment are risk factors for adverse effects of cancer treatment. Secondly, older patients are often excluded from clinical trials, and current clinical guidelines rarely address how to manage cancer in patients who have comorbidities or functional limitations...
2017: F1000Research
https://www.readbyqxmd.com/read/29032788/using-the-bergman-paris-question-to-screen-seniors-in-the-emergency-department
#19
Antoine Lague, Philippe Voyer, Marie-Christine Ouellet, Vale Rie Boucher, Marianne Giroux, Mathieu Pelletier, E Milie Gouin, Raoul Daoust, Simon Berthelot, Miche le Morin, Thien Tuong Minh Vu, Jacques Lee, Audrey-Anne Brousseau, Marie-Jose E Sirois, Marcel E Mond
OBJECTIVES: In the fast pace of the Emergency Department (ED), clinicians are in need of tailored screening tools to detect seniors who are at risk of adverse outcomes. We aimed to explore the usefulness of the Bergman-Paris Question (BPQ) to expose potential undetected geriatric syndromes in community-living seniors presenting to the ED. METHODS: This is a planned sub-study of the INDEED multicentre prospective cohort study, including independent or semi-independent seniors (≥65 years old) admitted to hospital after an ED stay ≥8 hours and who were not delirious...
October 16, 2017: CJEM
https://www.readbyqxmd.com/read/29023081/frailty-predicts-adverse-outcomes-in-older-people-with-diabetes
#20
Joanna Ulley, Ahmed H Abdelhafiz
The greatest proportional increase in the number of people with diabetes by age group is predicted to occur in those aged 60 to 79. In older people living with diabetes, geriatric syndromes, which indicate frailty, are emerging as a third category of complications in addition to the traditional microvascular and macrovascular sequelae. Frailty is defined by the presence of three or more phenotypes (weight loss, weakness, decreased physical activity, exhaustion and slow gait speed). The presence of one or two phenotypes describes a pre-frail state, and the absence of phenotypes describes a non-frail person...
January 2017: Practitioner
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