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Geriatric emergencies

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https://www.readbyqxmd.com/read/29325447/longitudinal-association-of-amyloid-beta-and-anxious-depressive-symptoms-in-cognitively-normal-older-adults
#1
Nancy J Donovan, Joseph J Locascio, Gad A Marshall, Jennifer Gatchel, Bernard J Hanseeuw, Dorene M Rentz, Keith A Johnson, Reisa A Sperling
OBJECTIVE: To understand the role of depressive symptoms in preclinical Alzheimer's disease, it is essential to define their temporal relationship to Alzheimer's proteinopathies in cognitively normal older adults. The study objective was to examine associations of brain amyloid beta and longitudinal measures of depression and depressive symptom clusters in a cognitively normal sample of older adults. METHOD: A total of 270 community-dwelling, cognitively normal elderly individuals underwent baseline Pittsburgh compound B (PiB) positron emission tomography (PET) measures of cortical aggregate amyloid beta and annual assessments with the 30-item Geriatric Depression Scale (GDS)...
January 12, 2018: American Journal of Psychiatry
https://www.readbyqxmd.com/read/29318583/geriatric-emergency-department-innovations-transitional-care-nurses-and-hospital-use
#2
Ula Hwang, Scott M Dresden, Mark S Rosenberg, Melissa M Garrido, George Loo, Jeremy Sze, Stephanie Gravenor, D Mark Courtney, Raymond Kang, Carolyn W Zhu, Carmen Vargas-Torres, Corita R Grudzen, Lynne D Richardson
OBJECTIVES: To examine the effect of an emergency department (ED)-based transitional care nurse (TCN) on hospital use. DESIGN: Prospective observational cohort. SETTING: Three U.S. (NY, IL, NJ) EDs from January 1, 2013, to June 30, 2015. PARTICIPANTS: Individuals aged 65 and older in the ED (N = 57,287). INTERVENTION: The intervention was first TCN contact. Controls never saw a TCN during the study period...
January 10, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29318084/how-does-frailty-factor-into-mortality-risk-assessment-of-a-middle-aged-and-geriatric-trauma-population
#3
Sanjit R Konda, Ariana Lott, Hesham Saleh, Sebastian Schubl, Jeffrey Chan, Kenneth A Egol
Introduction: Frailty in elderly trauma populations has been correlated with an increased risk of morbidity and mortality. The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of additional frailty variables to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29314516/southcare-geriatric-flying-squad-an-innovative-australian-model-providing-acute-care-in-residential-aged-care-facilities
#4
Shikha Jain, Peter N Gonski, Jeannette Jarick, Sandra Frese, Sheena Gerrard
This study reviews the outcomes of a model developed to improve the quality of care of residents living within residential aged care facilities (RACF). The Southcare Geriatric Flying Squad saw a total of 640 acutely unwell RACF residents over an 18-month period. Of these, 578 (90.3%) were managed in the RACF avoiding emergency department. Only 35 (5.5%) patients required emergency department transfer and 27 (4.2%) were directly admitted to a medical ward. The service may have reduced emergency presentations by offering rapid assessment and management, choice in place of treatment and level of interventions...
January 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29302017/effectiveness-of-a-pharmacist-led-medication-review-programme-on-medication-appropriateness-and-hospital-readmissions-among-geriatric-in-patients-in-hong-kong
#5
P Kc Chiu, A Wk Lee, T Yw See, F Hw Chan
INTRODUCTION: Geriatric in-patients are at risk of drug-related problems. This study aimed to determine whether a pharmacist-led medication review programme could reduce inappropriate medications and hospital readmissions among geriatric in-patients in Hong Kong. METHODS: A prospective controlled study was conducted from December 2013 to September 2014 in the geriatric unit of a regional hospital in Hong Kong. A total of 212 subjects were allocated to receive either routine care or pharmacist intervention that included medication reconciliation, medication review, and medication counselling...
January 5, 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/29301226/impact-of-pharmacist-conducted-comprehensive-medication-reviews-for-older-adult-patients-to-reduce-medication-related-problems
#6
Whitney J Kiel, Shaun W Phillips
Older adults are demanding increased healthcare attention with regards to prescription use due in large part to highly complex medication regimens. As patients age, medications often have a more pronounced effect on older adults, negatively impacting patient safety and increasing healthcare costs. Comprehensive medication reviews (CMRs) optimize medications for elderly patients and help to avoid inappropriate medication use. Previous literature has shown that such CMRs can successfully identify and reduce the number of medication-related problems and improve acute healthcare utilization...
December 31, 2017: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/29300808/frailty-mind-the-gap
#7
Alison M Mudge, Ruth E Hubbard
Frailty has become the focus of considerable research interest and media attention over the past 15 years. While it has much to offer geriatric medicine, potential pitfalls also need to be acknowledged. The conceptualisation of frailty in very different ways-as a syndrome or a risk state-has created semantic dissonance: the frailest patients by one definition may have early sarcopenia, by another be bedbound and in institutional care. Caution is required in transferring findings between studies enroling these different populations...
December 29, 2017: Age and Ageing
https://www.readbyqxmd.com/read/29299953/general-self-efficacy-as-a-driving-factor-of-post-stroke-depression-a-longitudinal-study
#8
Matthias Volz, Manuel C Voelkle, Katja Werheid
Post-stroke depression (PSD) is the most common psychiatric condition after stroke, affecting one third of survivors. Despite identification of meaningful predictors, knowledge about the interplay between these factors remains fragmentary. General self-efficacy (GSE) is closely linked to PSD, yet direction and magnitude of this relationship remains unclear. The authors assessed the relationship between GSE and depression during the first two years post-stroke while controlling for stable inter-individual differences using continuous time (CT) structural equation modelling (SEM)...
January 4, 2018: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/29279055/chronic-rhinosinusitis-with-nasal-polyps-in-the-elderly-assessing-current-evidence
#9
Gino Marioni, Claudia Zanotti, Giuseppe Brescia
BACKGROUND: The recently reported prevalence of chronic rhinosinusitis (CRS) among people >60 years old was 4.7%, with CRS emerging as the sixth most common chronic condition in the elderly. There is still a dearth of studies that focused on older patients, however, regarding the characteristics of CRS with nasal polyps (CRSwNP). OBJECTIVE: The emerging role of CRSwNP endotyping to enable a tailored medical approach (for elderly patients also) was investigated...
January 1, 2018: Allergy and Asthma Proceedings:
https://www.readbyqxmd.com/read/29275161/aging-inflammation-and-the-environment
#10
REVIEW
Arsun Bektas, Shepherd H Schurman, Ranjan Sen, Luigi Ferrucci
The aging process is driven by interrelated mechanisms that lead to the emergence of characteristic phenotypes that include changes in body composition, energy production and utilization imbalance, homeostatic dysregulation, and neurodegeneration and loss of neuroplasticity. Mainstream theories of aging all recognize that the aging phenotypes result from an imbalance between stressors and stress buffering mechanisms and a resultant loss of compensatory reserve leading to accumulation of unrepaired damage. This in turn results in increased disease susceptibility, reduced functional reserve, reduced healing capacity and stress resistance, unstable health and finally failure to thrive...
December 21, 2017: Experimental Gerontology
https://www.readbyqxmd.com/read/29273607/benzodiazepine-use-and-cognitive-decline-in-the-elderly
#11
REVIEW
Jenna D Picton, Adriane Brackett Marino, Kimberly Lovin Nealy
PURPOSE: Published evidence on the relationship between benzodiazepine exposure and altered cognition in the geriatric population is reviewed. SUMMARY: Benzodiazepines constitute one of the most commonly prescribed medication classes and are used primarily for management of anxiety and insomnia. Despite strong recommendations based on high-quality evidence warning of the potential cognitive adverse effects of benzodiazepine use, particularly in patients 65 years of age or older, published literature suggests that a substantial proportion of the U...
January 1, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29247094/oral-medicine-modification-for-older-adults-a-qualitative-study-of-nurses
#12
Aoife Mc Gillicuddy, Abina M Crean, Maria Kelly, Laura Sahm
OBJECTIVE: Oral medicines are frequently modified (eg, tablets crushed) for older adults. However, these modifications can have clinical, legal and/or ethical implications. Nurses bear responsibility for medicine administration and hence, perform these modifications. The aim of this study was to investigate the knowledge, attitudes and beliefs of nurses about oral medicine modification for older adults. DESIGN: A qualitative study was conducted using semi-structured, face-to-face interviews with nurses providing care to older adults in acute and long-term care settings...
December 14, 2017: BMJ Open
https://www.readbyqxmd.com/read/29237068/screening-for-frailty-in-older-emergency-department-patients-the-utility-of-the-survey-of-health-ageing-and-retirement-in-europe-frailty-instrument-share-fi
#13
Aoife Fallon, Lorna Kilbane, Robert Briggs, Adam Dyer, Shamis Nabeel, Paul McElwaine, Ronan Collins, Tara Coughlan, Des O'Neill, Dan Ryan, Sean P Kennelly
Background: Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for at-risk patients. The SHARE-FI (Survey of Health, Ageing and Retirement in Europe Frailty Instrument) frailty measure, developed for use in the community, has also been used in the emergency department (ED). Aim: To measure frailty, review its prevalence in older patients presenting to ED and compare characteristics and outcomes of frail patients with their non-frail counterparts...
December 11, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/29230501/-development-of-ground-based-physician-staffed-emergency-missions-in-the-city-of-leipzig-from-2003-to-2013
#14
K Bader, M Bernhard, A Gries, M Kaul, R Schröder, A Ramshorn-Zimmer
BACKGROUND: The annual number of physician-based emergency missions reported is continuously increasing. Data from large cities concerning this development over long periods is sparse. MATERIAL AND METHODS: In this retrospective study the charts of all ground-based physician-staffed emergency missions in the city of Leipzig for the first quarters of 2003 and 2013 were analyzed. Patient characteristics, injury and illness severities, mission location, hospital admission rate, as well as emergency interventions were collated...
December 11, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29223180/the-relationship-between-gait-dynamics-and-future-cognitive-decline-a-prospective-pilot-study-in-geriatric-patients
#15
Lisette H J Kikkert, Nicolas Vuillerme, Jos P van Campen, Bregje A Appels, Tibor Hortobágyi, Claudine J C Lamoth
BACKGROUND: Walking ability recently emerged as a sub-clinical marker of cognitive decline. Hence, the relationship between baseline gait and future cognitive decline was examined in geriatric patients. Because a "loss of complexity" (LOC) is a key phenomenon of the aging process that exhibits in multiple systems, we propose the idea that age- and cognition-related LOC may also become manifested in gait function. The LOC theory suggests that even healthy aging is associated with a (neuro)physiological breakdown of system elements that causes a decline in variability and an overall LOC...
December 10, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/29219828/improving-care-for-older-patients-in-the-acute-setting-a-qualitative-study-with-healthcare-providers
#16
C Brouwers, H Merten, M Willems, D J Habraken, F W Bloemers, T H Biesheuvel, L S van Galen, P W B Nanayakkara, C Wagner
BACKGROUND: The proportion of older people needing acute care is rapidly growing, thereby posing an increased burden on the acute care chain. The aim of this study is to gain more insight into the obstacles and potential improvement opportunities of the acute care process for older patients arriving at the hospital. METHODS: Semi-structured interviews were conducted to determine the experiences of 18 different primary (i.e. general practitioner, community nurse) and secondary healthcare professionals (i...
October 2017: Netherlands Journal of Medicine
https://www.readbyqxmd.com/read/29212411/geriatric-traumatic-brain-injury-epidemiology-outcomes-knowledge-gaps-and-future-directions
#17
Raquel C Gardner, Kristen Dams-O'Connor, Molly Rose Morrissey, Geoffrey Manley
This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults...
December 6, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29205261/report-and-research-agenda-of-the-american-geriatrics-society-and-national-institute-on-aging-bedside-to-bench-conference-on-urinary-incontinence-in-older-adults-a-translational-research-agenda-for-a-complex-geriatric-syndrome
#18
Camille P Vaughan, Alayne D Markland, Phillip P Smith, Kathryn L Burgio, George A Kuchel
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside-to-Bench research conference, entitled "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome," October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm disturbance, and urinary incontinence-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions...
December 4, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29204845/six-month-emergency-department-use-among-older-adults-following-jail-incarceration
#19
Jessi Humphreys, Cyrus Ahalt, Irena Stijacic-Cenzer, Eric Widera, Brie Williams
Although the number of older adults who are arrested and subject to incarceration in jail is rising dramatically, little is known about their emergency department (ED) use or the factors associated with that use. This lack of knowledge impairs the ability to design evidence-based approaches to care that would meet the needs of this population. This 6-month longitudinal study aimed to determine the frequency of 6-month ED use among 101 adults aged 55 or older enrolled while in jail and to identify factors associated with that use...
December 4, 2017: Journal of Urban Health: Bulletin of the New York Academy of Medicine
https://www.readbyqxmd.com/read/29203430/optimization-of-perioperative-management-of-proximal-femoral-fracture-in-the-elderly
#20
REVIEW
P Merloz
Proximal femoral fracture in elderly subjects is a major event that is life-threatening in the medium-to-long term. Advanced age, male gender and number of comorbidities largely account for high mortality and require geriatric expertise. Protein-energy malnutrition and bone demineralization increase mortality. Mortality can, on the other hand, be reduced by acting on two variables accessible to medical intervention: daily activities and nutritional status. Functional and neurocognitive assessment allow the risk of dependency to be evaluated, and global geriatric work-up can prevent sudden breakdown of homeostasis...
December 1, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
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