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Complex geriatric care

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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
#1
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
#2
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
https://www.readbyqxmd.com/read/27829011/rehabilitation-profiles-of-older-adult-stroke-survivors-admitted-to-intermediate-care-units-a-multi-centre-study
#3
Laura M Pérez, Marco Inzitari, Terence J Quinn, Joan Montaner, Ricard Gavaldà, Esther Duarte, Laura Coll-Planas, Mercè Cerdà, Sebastià Santaeugenia, Conxita Closa, Miquel Gallofré
BACKGROUND: Stroke is a major cause of disability in older adults, but the evidence around post-acute treatment is limited and heterogeneous. We aimed to identify profiles of older adult stroke survivors admitted to intermediate care geriatric rehabilitation units. METHODS: We performed a cohort study, enrolling stroke survivors aged 65 years or older, admitted to 9 intermediate care units in Catalonia-Spain. To identify potential profiles, we included age, caregiver presence, comorbidity, pre-stroke and post-stroke disability, cognitive impairment and stroke severity in a cluster analysis...
2016: PloS One
https://www.readbyqxmd.com/read/27827291/-general-practitioner-and-specialist-elderly-care-medicine-paramount-a-strong-pairing-in-the-care-of-the-vulnerable-elderly
#4
C M P M Verheugt, J F Bastiaans
The Dutch National Care for the Elderly Programme (NPO) was launched as a large-scale project, in which screening for vulnerability, followed by a comprehensive geriatric assessment, played an important role. An oft-cited explanation for the poor effects of the NPO projects is the high quality of Dutch primary care. However, the complexity of frail elderly care raises the question as to whether the competence of a nurse or practice nurse is sufficient to ensure proper care and treatment. Moreover, studies used vulnerability as a risk status, as if vulnerability were reversible...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27807821/age-related-disparity-breast-cancer-in-the-elderly
#5
REVIEW
Rahul Gosain, YaoYao Pollock, Dharamvir Jain
Aging poses an unique opportunity to study cancer biology and treatment in older adults. Breast cancer is often studied in young women; however, much investigation remains to be done on breast cancer in our expanding elderly population. Diagnostic and management strategies applicable to younger patients cannot be empirically used to manage older breast cancer patients. Lack of evidence-based data continues to be the major impediment toward delivery of personalized cancer care to elderly breast cancer patients...
November 2016: Current Oncology Reports
https://www.readbyqxmd.com/read/27769907/growing-relevance-of-cardiac-rehabilitation-for-an-older-population-with-heart-failure
#6
REVIEW
David W Schopfer, Daniel E Forman
Cardiac rehabilitation (CR) is a comprehensive lifestyle program that can have particular benefit for older patients with heart failure (HF). Prevalence of HF is increasingly common among older adults. Mounting effects of cardiovascular risk factors in older age as well as the added effects of geriatric syndromes such as multimorbidity, frailty, and sedentariness contribute to the high incidence of HF as well as to management difficulty. CR can play a decisive role in improving function, quality of life, symptoms, morbidity, and mortality, and also address the idiosyncratic complexities of care that often arise in old age...
October 18, 2016: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/27757231/emergency-department-crowding-in-singapore-insights-from-a-systems-thinking-approach
#7
Lukas K Schoenenberger, Steffen Bayer, John P Ansah, David B Matchar, Rajagopal L Mohanavalli, Sean Sw Lam, Marcus Eh Ong
OBJECTIVES: Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care...
2016: SAGE Open Medicine
https://www.readbyqxmd.com/read/27741965/pharmacotherapies-in-geriatric-chronic-pain-management
#8
REVIEW
Zachary A Marcum, Nakia A Duncan, Una E Makris
Pharmacologic management of chronic pain in older adults is one component of the multimodal, interdisciplinary management of this complex condition. In this article, we summarize several of the key barriers to effective pharmacologic management in older adults and review the existing (albeit limited) evidence for its effectiveness and safety, especially in a medically complex population with multimorbidity. This review covers topical formulations, acetaminophen, oral nonsteroidal antiinflammatory drugs, and adjuvant therapies...
November 2016: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27733902/perception-of-primary-care-physicians-on-the-impact-of-comprehensive-geriatric-assessment-what-is-the-next-step
#9
Pei Chen, Michael A Steinman
Older adults are at high risk of developing multimorbidity, and the high levels of clinical and psychosocial complexity in this population pose special challenges for primary care physicians (PCPs). As a way to improve the care for the older adults, a number of health systems have developed programs to provide comprehensive geriatric assessment (CGA), which generally refers to an intensive interprofessional evaluation and management of geriatric syndromes with the goals of maximizing health in aging. Sternberg and Bentur examined the impact of CGA as perceived by PCPs, the PCPs attitude toward CGA, and their satisfaction with CGA...
2016: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/27715455/assessment-of-geriatric-syndromes-and-physical-function-in-people-living-with-hiv
#10
Meredith Greene, Amy C Justice, Kenneth E Covinsky
: As the number of older adults living with HIV continues to increase, understanding how to incorporate geriatric assessments within HIV care will be critical. Assessment of geriatric syndromes and physical function can be useful tools for HIV clinicians and researchers to help identify the most vulnerable older adults and to better understand the aging process in PLWH. This review focuses on the assessment of falls, frailty and physical function, first in the general population of older adults and includes a specific focus on use of these assessments in older adults living with HIV...
October 7, 2016: Virulence
https://www.readbyqxmd.com/read/27704168/adverse-drug-events-in-patients-with-advanced-chronic-conditions-who-have-a-prognosis-of-limited-life-expectancy-at-hospital-admission
#11
Daniel Sevilla-Sanchez, Núria Molist-Brunet, Jordi Amblàs-Novellas, Pere Roura-Poch, Joan Espaulella-Panicot, Carles Codina-Jané
PURPOSE: Adverse drug events (ADEs) lead to adverse clinical outcomes such as hospitalization. There is little information about the characteristics of ADEs in patients with advanced chronic conditions and have a prognosis of limited life expectancy. This study aimed to evaluate (i) the prevalence of ADEs at the time of admission to hospital, (ii) the causality, severity, and preventability of the ADEs, and (iii) the clinical and pharmacological characteristics associated with the ADEs...
October 4, 2016: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/27696316/-regional-geriatric-care-concept-in-the-district-of-lippe-structural-effects-and-network-formation-in-the-case-management-based-model-project
#12
Charlotte Şahin, Olaf Iseringhausen, Kira Hower, Constanze Liebe, Anja Rethmeier-Hanke, Bernd Wedmann
BACKGROUND: Regional planning of healthcare requires special consideration for the complex needs of elderly, multimorbid people living in a domestic environment. In the District of Lippe, a hospital (Klinikum Lippe) and network of ambulatory care physicians (Ärztenetz Lippe) developed and tested a geriatric care network based on case management for geriatric patients living in a domestic environment. MATERIAL AND METHODS: The establishment of the geriatric care network (e...
September 30, 2016: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/27682420/understanding-implementation-of-comprehensive-geriatric-care-programs-a-multiple-perspective-approach-is-preferred
#13
Annemarie de Vos, Jane-Murray Cramm, Jeroen D H van Wijngaarden, Ton J E M Bakker, Johan P Mackenbach, Anna P Nieboer
BACKGROUND: The Prevention and Reactivation Care Program (PReCaP) provides a novel approach targeting hospital-related functional decline among elderly patients. Despite the high expectations, the PReCaP was not effective in preventing functional decline (ADL and iADL) among older patients. Although elderly PReCaP patients demonstrated slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2-0.6]), lower depression (Geriatric Depression Scale 15; -0...
September 29, 2016: International Journal of Health Planning and Management
https://www.readbyqxmd.com/read/27673575/knowledge-gaps-in-cardiovascular-care-of-older-adults-a-scientific-statement-from-the-american-heart-association-american-college-of-cardiology-and-american-geriatrics-society-executive-summary
#14
Michael W Rich, Deborah A Chyun, Adam H Skolnick, Karen P Alexander, Daniel E Forman, Dalane W Kitzman, Mathew S Maurer, James B McClurken, Barbara M Resnick, Win K Shen, David L Tirschwell
The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease (CVD) is the leading cause of death and major disability in adults aged 75 and older. Despite the effect of CVD on quality of life, morbidity, and mortality in older adults, individuals aged 75 and older have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older adults with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in nursing homes and assisted living facilities...
November 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27631655/what-could-posturography-tell-us-about-balance-problems-in-parkinson-s-disease
#15
Marcos Rossi-Izquierdo, Andrés Soto-Varela, Arne Ernst, Juan Pedro Rubio-Rodríguez, Sofía Santos-Pérez, Ángel Sesar, Miguel Alberte-Woodward, Mónica Guijarro-Del Amo, Elena San Román-Rodríguez, Ana Faraldo-García, Alfonso Zubizarreta-Gutiérrez, Dietmar Basta
OBJECTIVE: Impaired balance in patients with Parkinson's disease (PD) leads to loss of balance and frequent falls. Computerized dynamic posturography allows the assessment of stance tasks whereas mobile posturography analyzes the balance in free-field conditions, where falls among PD patients commonly occur (e.g. sitting down or standing up). The aim of the present study is to assess postural stability in PD patients with both techniques. STUDY DESIGN: Prospective study...
October 2016: Otology & Neurotology
https://www.readbyqxmd.com/read/27616961/outcome-indicators-on-interprofessional-collaboration-interventions-for-elderly
#16
Giannoula Tsakitzidis, Olaf Timmermans, Nadine Callewaert, Veronique Verhoeven, Maja Lopez-Hartmann, Steven Truijen, Herman Meulemans, Paul Van Royen
BACKGROUND: Geriatric care increasingly needs more multidisciplinary health care services to deliver the necessary complex and continuous care. The aim of this study is to summarize indicators of effective interprofessional outcomes for this population. METHOD: A systematic review is performed in the Cochrane Library, Pubmed (Medline), Embase, Cinahl and Psychinfo with a search until June 2014. RESULTS: Overall, 689 references were identified of which 29 studies met the inclusion criteria...
2016: International Journal of Integrated Care
https://www.readbyqxmd.com/read/27613166/incorporating-geriatric-medicine-providers-into-the-care-of-the-older-adult-with-cancer
#17
REVIEW
Allison Magnuson, Beverly Canin, G J van Londen, Beatrice Edwards, Pamela Bakalarski, Ira Parker
A significant proportion of cancer patients and survivors are age 65 and over. Older adults with cancer often have more complex medical and social needs than their younger counterparts. Geriatric medicine providers (GMPs) such as geriatricians, geriatric-trained advanced practice providers, and geriatric certified registered nurses have expertise in caring for older adults, managing complex medical situations, and optimizing function and independence for this population. GMPs are not routinely incorporated into cancer care for older adults; however, their particular skill set may add benefit at many points along the cancer care continuum...
November 2016: Current Oncology Reports
https://www.readbyqxmd.com/read/27563281/ambiguous-participation-in-older-hospitalized-patients-gaining-influence-through-active-and-passive-approaches-a-qualitative-study
#18
Ingrid Nyborg, Kari Kvigne, Lars Johan Danbolt, Marit Kirkevold
BACKGROUND: Patient participation is required by law in Norway and in several western countries. Current participation ideology is based on individualism, which may conflict with the older generation's commonly held values of solidarity and community. Hence, different values and ideologies may come in conflict when older patients receive treatment and rehabilitation in geriatric wards. Participation is a guiding principle in rehabilitation. Criteria for admission of older patients to geriatric wards are complex health problems, acute illness and/or acute physical and/or cognitive functional failure...
2016: BMC Nursing
https://www.readbyqxmd.com/read/27560181/finding-the-primary-care-providers-in-the-specialist-dominant-primary-care-setting-of-korea-a-cluster-analysis
#19
Jin Yong Lee, Sang Jun Eun, Hyun Joo Kim, Min-Woo Jo
OBJECTIVE: This study aimed to identify private clinics that have a potential to perform the role of primary care providers (PCPs) in a primary care setting in Korea where private specialists are dominant. METHODS: The 2013 National Patient Sample claim data of Health Insurance Review and Assessment Service in Korea was used. Two-step cluster analysis was performed using characteristics of private clinics, and patient and utilization characteristics of 27,797 private clinics...
2016: PloS One
https://www.readbyqxmd.com/read/27544014/-the-challenge-of-clinical-complexity-in-the-21st-century-could-frailty-indexes-be-the-answer
#20
Jordi Amblàs-Novellas, Joan Espaulella-Panicot, Marco Inzitari, Lourdes Rexach, Benito Fontecha, Roman Romero-Ortuno
The number of older people with complex clinical conditions and complex care needs continues to increase in the population. This is presenting many challenges to healthcare professionals and healthcare systems. In the face of these challenges, approaches are required that are practical and feasible. The frailty paradigm may be an excellent opportunity to review and establish some of the principles of comprehensive Geriatric Assessment in specialties outside Geriatric Medicine. The assessment of frailty using Frailty Indexes provides an aid to the 'situational diagnosis' of complex clinical situations, and may help in tackling uncertainty in a person-centred approach...
August 17, 2016: Revista Española de Geriatría y Gerontología
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