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Complex geriatric care

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https://www.readbyqxmd.com/read/28315047/putting-dementia-awareness-into-general-practice-the-cadif-approach
#1
Michael Pentzek, Horst Christian Vollmar, Stefan Wilm, Verena Leve
BACKGROUND: International studies show that dementia is often recognized at later stages in general practice. Pure knowledge-sharing interventions could not change this in a sustainable manner. Concepts for changing attitudes of general practitioners (GPs) are required. OBJECTIVES: What barriers affect GPs' recognition of and diagnostic approach to dementia? What recommendations for a GP-specific diagnostic procedure can be derived from this? METHODS: Metasynthesis of qualitative studies with GPs on barriers to dementia recognition, explication of the "frailty" concept and the diagnostic approach described therein and the development of an approach in cases of suspected cognitive decline in a multiprofessional team...
March 17, 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28302750/the-clinical-frailty-scale-upgrade-your-eyeball-test
#2
Jonathan Afilalo
With the emergence of transcatheter aortic valve replacement (TAVR) as a therapeutic option to treat high-risk older adults suffering from aortic stenosis, the geriatric concept of frailty has assumed mainstream relevance for cardiovascular practitioners. We have eagerly adopted tools to objectify the definition of frailty and accordingly discern good and bad candidates among a pool of complex octogenarians with multiple chronic conditions - a daunting yet mission-critical task. Initial studies published during the first half of this decade revealed that frailty status was one of the top predictors of mid-term mortality and incident disability after TAVR1, leading to its integration in clinical care pathways and predictive risk models...
March 16, 2017: Circulation
https://www.readbyqxmd.com/read/28292582/-profile-and-evolution-of-chronic-complex-patients-in-a-subacute-unit
#3
Neus Gual, Anna Yuste Font, Belen Enfedaque Montes, Carles Blay Pueyo, Remedios Martín Álvarez, Marco Inzitari
OBJECTIVE: To improve the management of geriatric pluripathologic patients in Catalonia, the identification of chronic complex patient (PCC) or patients with advanced chronic disease (MACA) has been promoted. Patients with exacerbated chronic diseases are promoted to be admitted in subacute units (SG) located in intermediate hospitals and specialized in geriatric care, as an alternative to acute hospital. The results of the care process in patients identified as PCC/MACA in SG have not been evaluated...
March 11, 2017: Atencion Primaria
https://www.readbyqxmd.com/read/28288563/is-independence-of-older-adults-safe-considering-the-risk-of-falls
#4
Dorota Talarska, Magdalena Strugała, Marlena Szewczyczak, Sławomir Tobis, Michał Michalak, Izabela Wróblewska, Katarzyna Wieczorowska-Tobis
BACKGROUND: Falls affect approx. 30% of elderly population per year. They cause major injuries and reduce independence of the older adults' functioning. The main objective of the study was to evaluate the degree of independence and find the fall risk factors in the study group. METHODS: The study included 506 - older adults. The study group included patients from GP clinics and members of two senior centers. The study duration was 12 months. Our study tools included EASY- Care Standard 2010 questionnaire, Abbreviated Mental Test Score (AMTS), Index Barthel, Instrumental Activities of Daily Living Scale (IADL), Geriatric Depression Scale (GDS), Timed Up and Go (TUG)...
March 14, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28270122/implementation-of-integrated-geriatric-care-at-a-german-hospital-a-case-study-to-understand-when-and-why-beneficial-outcomes-can-be-achieved
#5
Loraine Busetto, Jörn Kiselev, Katrien Ger Luijkx, Elisabeth Steinhagen-Thiessen, Hubertus Johannes Maria Vrijhoef
BACKGROUND: Many health systems have implemented integrated care as an alternative approach to health care delivery that is more appropriate for patients with complex, long-term needs. The objective of this article was to analyse the implementation of integrated care at a German geriatric hospital and explore whether the use of a "context-mechanisms-outcomes"-based model provides insights into when and why beneficial outcomes can be achieved. METHODS: We conducted 15 semi-structured interviews with health professionals employed at the hospital...
March 7, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28231631/commentary-response-frailty-not-just-about-old-people-reply-to-smith-gd-kydd-a-2017-getting-care-of-older-people-right-the-need-for-appropriate-frailty-assessment
#6
Sunita R Jha, Julee Mcdonagh, Caleb Ferguson, Peter S Macdonald, Phillip J Newton
As highlighted in a recent editorial, the ageing population and burden of frailty amongst those aged 60 years and older represents an impending challenge for individuals and health care systems globally (Smith & Kydd 2017). As frailty is largely considered a geriatric syndrome, research has primarily occurred within elderly community dwelling populations (Fried et al. 2001). However, it is important to highlight that not all older people are frail; and conversely not all younger people are non-frail. With frailty research expanding its scope beyond geriatrics over the last 2 decades, our understanding of this syndrome and its complexities has progressed...
February 23, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28216284/new-risk-and-protective-factors-for-severe-hypoglycaemia-in-people-with-type-1-diabetes
#7
T Wohland, J D Holstein, O M Patzer, M Mende, T Tiemann, C Koch-Tessarek, P Kovacs, A Holstein
AIMS: To evaluate risk factors for severe hypoglycaemia (SH) in patients with type 1 diabetes (T1DM). METHODS AND RESULTS: Retrospective observational and comparative study. All SH occurring between 2007 and 2014 in a German population (Lippe-Detmold) were captured. Characteristics of patients with T1DM and SH were compared with a control group being equivalent concerning age, diabetes duration, HbA1c, comorbidity, and β-blocker treatment. SH was defined as a symptomatic event requiring treatment with intravenous glucose or glucagon administration and being confirmed by a blood glucose measurement of <2...
December 24, 2016: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
https://www.readbyqxmd.com/read/28168829/exploring-dental-student-participation-in-interdisciplinary-care-team-conferences-in-long-term-care
#8
Jeremy Huynh, Leeann R Donnelly, Mario A Brondani
OBJECTIVE: The purpose of this study was to explore how the participation of dental hygiene students in interdisciplinary care conferences conducted in long-term care (LTC) facilities influenced the staff's awareness of oral health, the student's provision of care as well as the student's ability to work on an interdisciplinary team. BACKGROUND: Oral health in LTC continues to be poor despite many educational and clinical interventions. The care of a frail elder requires an interdisciplinary team approach, yet dental professionals are often absent from these teams...
February 7, 2017: Gerodontology
https://www.readbyqxmd.com/read/28125760/resource-use-and-medicare-costs-during-lay-navigation-for-geriatric-patients-with-cancer
#9
Gabrielle B Rocque, Maria Pisu, Bradford E Jackson, Elizabeth A Kvale, Wendy Demark-Wahnefried, Michelle Y Martin, Karen Meneses, Yufeng Li, Richard A Taylor, Aras Acemgil, Courtney P Williams, Nedra Lisovicz, Mona Fouad, Kelly M Kenzik, Edward E Partridge
Importance: Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program...
January 26, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/28117544/specialist-care-of-older-adults-with-hiv-infection-in-the-uk-a-service-evaluation
#10
F V Cresswell, T Levett
OBJECTIVES: There is a clear trajectory towards cohort ageing in the UK. HIV infection is associated with an increased prevalence of traditionally age-related comorbidities and geriatric syndromes. Some HIV services have been proactive in innovating models that cater for adapting needs. We aimed to describe how widespread this practice is and what form such services take. METHODS: We conducted an evaluation of the perceived need for and current provision of specialist ageing services, and the need for formal guidance on monitoring or treatment of older adults with HIV infection...
January 24, 2017: HIV Medicine
https://www.readbyqxmd.com/read/28107120/treatment-of-diabetic-autonomic-neuropathy-in-older-adults-with-diabetes-mellitus
#11
Nataliya Scheinberg, Rebecca L Salbu, Gayotri Goswami, Kenneth Cohen
OBJECTIVE: To review the epidemiology, pathophysiology, screening and diagnosis, and optimal treatment of diabetic autonomic neuropathy (DAN) and its implications in older adults. DATA SOURCES, STUDY SELECTION, DATA EXTRACTION, DATA SYNTHESIS: A search of PubMed using the Mesh terms "diabetes," "type 1," "insulin-dependent," "T1DM," and "diabetic autonomic neuropathy" was performed to find relevant primary literature. Additional search terms "epidemiology," "geriatric," and "risk" were employed...
November 1, 2016: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28098831/a-fast-multimodal-ectopic-beat-detection-method-applied-for-blood-pressure-estimation-based-on-pulse-wave-velocity-measurements-in-wearable-sensors
#12
Maik Pflugradt, Kai Geissdoerfer, Matthias Goernig, Reinhold Orglmeister
Automatic detection of ectopic beats has become a thoroughly researched topic, with literature providing manifold proposals typically incorporating morphological analysis of the electrocardiogram (ECG). Although being well understood, its utilization is often neglected, especially in practical monitoring situations like online evaluation of signals acquired in wearable sensors. Continuous blood pressure estimation based on pulse wave velocity considerations is a prominent example, which depends on careful fiducial point extraction and is therefore seriously affected during periods of increased occurring extrasystoles...
January 14, 2017: Sensors
https://www.readbyqxmd.com/read/28086867/process-evaluation-of-an-integrated-care-pathway-in-geriatric-rehabilitation-for-people-with-complex-health-problems
#13
Irma H J Everink, Jolanda C M van Haastregt, Jose M C Maessen, Jos M G A Schols, Gertrudis I J M Kempen
BACKGROUND: An integrated care pathway in geriatric rehabilitation was developed to improve coordination and continuity of care for community-living older adults in the Netherlands, who go through the process of hospital admission, admission to a geriatric rehabilitation facility and discharge back to the home situation. This pathway is a complex intervention and is focused on improving communication, triage and transfers of patients between the hospital, geriatric rehabilitation facility and primary care organisations...
January 13, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28068906/cherish-collaboration-for-hospitalised-elders-reducing-the-impact-of-stays-in-hospital-protocol-for-a-multi-site-improvement-program-to-reduce-geriatric-syndromes-in-older-inpatients
#14
Alison M Mudge, Merrilyn D Banks, Adrian G Barnett, Irene Blackberry, Nicholas Graves, Theresa Green, Gillian Harvey, Ruth E Hubbard, Sharon K Inouye, Sue Kurrle, Kwang Lim, Prue McRae, Nancye M Peel, Jessica Suna, Adrienne M Young
BACKGROUND: Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital...
January 9, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28065430/informed-consent-in-dental-care-and-research-for-the-older-adult-population-a-systematic-review
#15
REVIEW
Amrita Mukherjee, Alicia A Livinski, Joseph Millum, Steffany Chamut, Shahdokht Boroumand, Timothy J Iafolla, Margo R Adesanya, Bruce A Dye
BACKGROUND: Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue. METHODS: The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases...
January 5, 2017: Journal of the American Dental Association
https://www.readbyqxmd.com/read/28050224/perspectives-from-geriatric-in-patients-with-heart-failure-and-their-caregivers-on-gaps-in-care-quality
#16
Nahid Azad, G Lemay, J Li, M Benzaquen, L Khoury
BACKGROUND: Evidence indicates that care experiences for complex HF patients could be improved by simple organizational and process changes, rather than complex clinical mechanisms. This survey identifies care gaps and recommends simple changes. METHODS: The study utilized both quantitative and qualitative methods at The Ottawa Hospital, Geriatric Medical Unit during a three-month period. RESULTS: Nineteen patients (average age 85, 12 female) surveyed...
December 2016: Canadian Geriatrics Journal: CGJ
https://www.readbyqxmd.com/read/27974304/improving-hip-fracture-outcomes-with-integrated-orthogeriatric-care-a-comparison-between-two-accepted-orthogeriatric-models
#17
Mark Middleton, Bettina Wan, Ruy da Assunçāo
BACKGROUND: our orthopaedic trauma unit serves a large elderly population, admitting 400-500 hip fractures annually. A higher than expected mortality was detected amongst these patients, prompting a change in the hip fracture pathway. The aim of this study was to assess the impact of a change in orthogeriatric provision on hip fracture outcomes and care quality indicators. PATIENTS AND METHODS: the hip fracture pathway was changed from a geriatric consultation service to a completely integrated service on a dedicated orthogeriatric ward...
December 14, 2016: Age and Ageing
https://www.readbyqxmd.com/read/27940568/can-consultant-geriatrician-led-comprehensive-geriatric-assessment-in-the-emergency-department-reduce-hospital-admission-rates-a-systematic-review
#18
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/27869882/-assessment-of-geriatric-patients-care-needs-based-on-sosia-classification-the-reality-of-the-lombardy-region-in-nursing-home
#19
Mariangela Vanalli
The increased demand to care that originates from demographic changes called in Italy a rapid development in Nursing Home with particular emergency the problem of programme the welfare response. It is essential the development of a classification system able to describe the stratification of the case mix on the basis of the care requirements, allowing a remuneration in function of the complexity care. Since 2003, the Lombardy region has introduced a case-mix reimbursement system for nursing homes based on the SOSIA form which classifies residents into eight classes of frailty...
November 2016: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/27868320/predictors-of-rehospitalization-among-older-adults-results-of-the-crime-study
#20
Federica Sganga, Francesco Landi, Stefano Volpato, Antonio Cherubini, Carmelinda Ruggiero, Andrea Corsonello, Paolo Fabbietti, Fabrizia Lattanzio, Ester Manes Gravina, Roberto Bernabei, Graziano Onder
AIM: To assess the predictors of readmission among older adults hospitalized in acute care wards. METHODS: A prospective cohort study was carried out among 921 hospitalized older adults participating in the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) project. The primary outcome of the study was rehospitalization within 1 year after discharge from acute care hospitals. We assessed the participants with a questionnaire including 350 items about demographic, social and clinical characteristics...
November 21, 2016: Geriatrics & Gerontology International
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