family medicine, primary care, nursing home medicine, long term care, geriatrics

OBJECTIVES: Frailty is a multidimensional syndrome. However, typical frailty scales used in oncology clinics assess physical impairment and/or malnutrition but do not consider the social domain. Our study aimed to clarify the relationship between preoperative social frailty and overall survival (OS) and cancer-specific survival (CSS) among older patients with gastrointestinal cancer. DESIGN: This was a prospective cohort study. SETTING AND PARTICIPANTS: This single-center study recruited 195 patients with gastrointestinal cancer scheduled for curative surgery and aged >60 years...

OBJECTIVES: Dying in a hospital is highly stressful for older adults and families. Persons with dementia who are hospitalized are particularly vulnerable to negative outcomes. The objective of this study is to fill an evidence gap on whether the 2015 Dutch long-term care reforms were effective in increasing deaths at home while avoiding increases in hospital deaths for the total population aged ≥65 years and by dementia status. DESIGN: We used annual cross-sectional, nationally representative data from 2012 to 2017...

OBJECTIVES: This study presents the design of an integrated, proactive palliative care pathway covering the full care cycle and evaluates its effects using 3 types of outcomes: (1) physician-reported outcomes, (2) outcomes reported by family, and (3) (utilization of) health care outcomes. DESIGN: A clustered, partially controlled before-after study with a multidisciplinary integrated palliative care pathway as its main intervention. SETTING AND PARTICIPANTS: after assessment in hospital departments of oncology, and geriatrics, and in 13 primary care facilities, terminally ill patients were proactively included into the pathway...

One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+)...

Patients in long-term care (LTC) homes face barriers to accessing specialist advice. Electronic consultation (eConsult) has the potential to improve access for these patients. We used a multi-method approach to evaluate adoption of the Champlain BASE eConsult service in LTC homes across Eastern Ontario, Canada. We conducted a cross-sectional study of all eConsults submitted by primary care providers (PCPs) working at LTC homes between January 1, 2018 and December 31, 2018. Service use data were collected and descriptive statistics were calculated...

BACKGROUND: To explore clinician choice of whether to discuss prognosis with their frail older patients. DESIGN: Qualitative interview study. SETTING: Primary care clinicians were recruited from nursing homes, community-based clinics, and academic medical centers. PARTICIPANTS: Three geriatric nurse practitioners, nine geriatricians, five general internists, and three family medicine physicians with a mean age of 44 and a mean 12 years in practice...

The elderly population (i.e., persons aged > or = 65 years) in the United States is rapidly expanding and will nearly double in number over the next 30 years. It is estimated that >40% of persons aged > or = 65 years will require care in a long-term care facility (LTCF), such as a skilled nursing facility (SNF), at some point during their lifetime. For the most part, residents of LTCFs are very old and have age-related immunologic changes, chronic cognitive and/or physical impairments, and diseases that alter host resistance; therefore, they are highly susceptible to infections and their complications...

The majority of community-based nursing facilities in the United States have part-time medical directors whose basic training is either in primary care, internal medicine, or family practice. Some medical directors have a Certificate of Added Qualification in Geriatric Medicine. Very few have received formal training in medical direction in long-term care. This article presents information on the demographics of community medical staffs and medical directors, administrative and medical staff relationships, committee responsibilities, policies and procedures, teaching and research, community activities, and resources of value that should enhance the ability of part-time medical directors to perform more effectively and increase the knowledge of other health professionals about the complex role of the medical director in community-based nursing facilities...