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Complex geriatric care

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https://www.readbyqxmd.com/read/29336006/the-place-of-frailty-and-vulnerability-in-the-surgical-risk-assessment-should-we-move-from-complexity-to-simplicity
#1
Mario Barbagallo, Ligia J Dominguez, Domenico Cucinotta
Due to aging of the world population, older patients accessing health services are becoming continuously more frequent. This has increased the interest in assessing frailty and vulnerability in all specialties and general medicine. Although the term frailty has been recognized for over 30 years, there is not yet a universally recognized definition, and different care providers assess frailty and vulnerability with dissimilar tools, from very complex to very simple validated scales. Being treated with respect and dignity at the right time and place is the key message, as well as after undergoing a global evaluation both in urgency/emergency and in programmed surgery for all older surgical patients...
January 15, 2018: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/29335033/should-capacity-assessments-be-performed-routinely-prior-to-discussing-advance-care-planning-with-older-people
#2
Oleg Kiriaev, Emme Chacko, J D Jurgens, Meagan Ramages, Phillipa Malpas, Gary Cheung
BACKGROUND: People with dementia receive worse end of life care compared to those with cancer. Barriers to undertaking advanced care planning (ACP) in people with dementia include the uncertainty about their capacity to engage in such discussions. The primary aim of this study was to compare the Advance Care Planning-Capacity Assessment Vignette tool (ACP-CAV) with a semi-structured interview adapted from the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The secondary aim was to identify demographic and cognitive functioning variables that may predict whether a person has capacity to discuss ACP...
January 16, 2018: International Psychogeriatrics
https://www.readbyqxmd.com/read/29325184/-distal-humerus-fracture-in-the-elderly
#3
Johannes E Plath, Stefan Förch, Thomas Haufe, Edgar Johann Mayr
Distal humerus fractures show increasing incidence with age. Due to preexisting osteoporosis, the surgeon is regularly confronted with complex comminuted intraarticular fractures. The maintenance of autonomy in daily life and avoidance of permanent care dependency is a dogma in the care of geriatric patients. Accordingly, a stable post-operative situation that allows early functional post-operative treatment is mandatory, especially in the elderly patient. Open reduction and stable internal fixation using double plate osteosynthesis are the current osteosynthetic standard of treatment...
January 11, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/29317368/interdisciplinary-care-model-independently-decreases-use-of-critical-care-services-after-corrective-surgery-for-adult-degenerative-scoliosis
#4
Owoicho Adogwa, Aladine A Elsamadicy, Amanda R Sergesketter, Michael Ongele, Victoria Vuong, Syed Khalid, Jessica Moreno, Joseph Cheng, Isaac O Karikari, Carlos A Bagley
OBJECTIVE: Interdisciplinary management of elderly patients requiring spine surgery has been shown to improve short and long-term outcomes. The aim of this study is to determine whether an interdisciplinary team approach mitigates use of intensive care unit (ICU) resources. METHODS: A unique co-management model for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Peri-operative Optimization of Senior Health Program(POSH) was launched with the aim of improving outcomes in elderly patients(>65-years-old) undergoing complex lumbar spine surgery...
January 6, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29316345/factors-related-to-frailty-among-the-elderly-in-south-korea-a-3-year-longitudinal-study
#5
Jin-Kyoung Park, Jong-Eun Lee
PURPOSE: To examine factors associated with frailty among the young-old elderly (YOE) and old-old elderly (OOE). METHODS: This longitudinal study with a 3-year follow-up included 486 participants who received home care services. FINDINGS: Precipitous weight loss and depression in the YOE and worsening of complex mobility and depression in the OOE were associated with worsened frailty over the 3-year period. CONCLUSIONS: To prevent frailty, we suggest weight-loss prevention programs for the YOE, lower-limb exercise programs for the OOE, and depression management programs for both groups...
January 5, 2018: International Journal of Nursing Knowledge
https://www.readbyqxmd.com/read/29302797/proactive-care-of-older-people-undergoing-surgery
#6
Judith Partridge, Magda Sbai, Jugdeep Dhesi
The number of older patients undergoing surgery is increasing due to changing demographics, surgical and anaesthetic advances and shifts in patient expectations of healthcare. The benefits of surgery in older people are well documented and include symptom control and increased life expectancy. However, older surgical patients present not only with the index pathology requiring surgery but with concurrent age related physiological decline, multimorbidity and geriatric syndromes. These additional issues increase the risk of adverse postoperative outcome, in particular of postoperative medical and functional complications...
January 4, 2018: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/29301226/impact-of-pharmacist-conducted-comprehensive-medication-reviews-for-older-adult-patients-to-reduce-medication-related-problems
#7
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/29289543/comparison-of-3-frailty-instruments-in-a-geriatric-acute-care-setting-in-a-low-middle-income-country
#8
Sumika Mori Lin, Márlon Juliano Romero Aliberti, Sileno de Queiroz Fortes-Filho, Juliana de Araújo Melo, Ivan Aprahamian, Claudia Kimie Suemoto, Wilson Jacob Filho
OBJECTIVE: Comparison of frailty instruments in low-middle income countries, where the prevalence of frailty may be higher, is scarce. In addition, less complex diagnostic tools for frailty are important in these settings, especially in acutely ill patients, because of limited time and economic resources. We aimed to compare the performance of 3 frailty instruments for predicting adverse outcomes after 1 year of follow-up in older adults with an acute event or a chronic decompensated disease...
December 27, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29280644/does-the-presence-of-pressure-ulcers-entail-high-risk-of-negative-outcomes-in-geriatric-rehabilitation-results-from-a-retrospective-cohort-study
#9
Francisco J Tarazona-Santabalbina, Miquel Àngel Mas, Sebastià J Santaeugènia, Ana Maria Alventosa, Manoli García, Albert Monterde, Alicia Gutiérrez, Joan Cunill
AIM: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. METHODS: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit...
November 16, 2017: Nutrición Hospitalaria: Organo Oficial de la Sociedad Española de Nutrición Parenteral y Enteral
https://www.readbyqxmd.com/read/29228293/providing-mental-health-care-for-the-complex-older-veteran-implications-for-social-work-practice
#10
Gayle Clark, Susan Rouse, Heather Spangler, Jennifer Moye
Mental health conditions are underdiagnosed and undertreated in older veterans, as with all older adults. Social workers bring an important perspective to the interdisciplinary team for the care of older veterans with mental health conditions. In this study authors assessed 50 older veterans referred for mental health treatment (mean age = 74.52 years, SD = 6.48) with standardized measures of depression, posttraumatic stress disorder (PTSD), and cognitive impairment. At initial assessment, 24 percent had moderate depression, 30 percent had PTSD, and 62 percent (n = 31) had (mostly mild) cognitive impairment based on cut scores...
December 8, 2017: Health & Social Work
https://www.readbyqxmd.com/read/29198046/is-treatment-of-geriatric-hip-fracture-patients-cost-covering-results-of-a-prospective-study-conducted-at-a-german-university-hospital
#11
Rene Aigner, Juliana Hack, Daphne Eschbach, Steffen Ruchholtz, Matthias Knobe, Richard Dodel, Benjamin Buecking
INTRODUCTION: Hip fractures have increased medical and socio-economic importance due to demographic transition. Information concerning direct treatment costs and their reimbursement in Germany is lacking. MATERIALS AND METHODS: Four hundred two hip fracture patients older than 60 years of age were observed prospectively at a German University Hospital. Treatment costs were determined with up to 196 cost factors and compared to the reimbursement. Finally, statistical analysis was performed to identify clinical parameters influencing the cost-reimbursement relation...
December 2, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/29190658/screening-tools-to-identify-patients-with-complex-health-needs-at-risk-of-high-use-of-health-care-services-a-scoping-review
#12
Valérie Marcoux, Maud-Christine Chouinard, Fatoumata Diadiou, Isabelle Dufour, Catherine Hudon
BACKGROUND: Many people with chronic conditions have complex health needs often due to multiple chronic conditions, psychiatric comorbidities, psychosocial issues, or a combination of these factors. They are at high risk of frequent use of healthcare services. To offer these patients interventions adapted to their needs, it is crucial to be able to identify them early. OBJECTIVE: The aim of this study was to find all existing screening tools that identify patients with complex health needs at risk of frequent use of healthcare services, and to highlight their principal characteristics...
2017: PloS One
https://www.readbyqxmd.com/read/29189383/sinai-abbreviated-geriatric-evaluation-development-and-validation-of-a-practical-test
#13
Mark R Katlic, JoAnn Coleman, Kamran Khan, Susan E Wozniak, Joseph H Abraham
OBJECTIVE: To develop and validate a simple geriatric screening tool that performs as well as more complex assessments BACKGROUND:: Many tools that predict treatment risk in older adults are impractical for routine clinical use. METHODS: We prospectively conducted comprehensive preoperative evaluations on 1025 patients age ≥75 years who presented to Sinai Hospital of Baltimore for major elective surgery, then retrospectively reviewed patients' medical records for occurrence of postoperative outcomes...
November 16, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/29186782/forging-a-frailty-ready-healthcare-system-to-meet-population-ageing
#14
Wee Shiong Lim, Sweet Fun Wong, Ian Leong, Philip Choo, Weng Sun Pang
The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization's World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered...
November 24, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29183638/-proposed-development-of-a-geriatric-oncology-unit-times-of-change-our-reality
#15
Francisco Javier Martínez Peromingo, Carlos Oñoro Algar, M Elena Baeza Monedero, Cristina González de Villaumbrosia, Diego Real de Asua Cruzat, Raquel Barba Martín
Age is one of the main risk factors for the development of cancer. It is expected that the progressive aging of the population will have an unprecedented impact on the incidence of various tumours. In fact, the management of elderly cancer patients is already a major public health problem in developed countries. However, elderly patients have systematically been excluded from cancer drug studies or protocol development. This has left health professionals in uncharted territory, without proper tools to address the multiple difficulties that arise in the treatment of these patients...
November 25, 2017: Revista Española de Geriatría y Gerontología
https://www.readbyqxmd.com/read/29115922/the-prevalence-of-dementia-in-a-portuguese-community-sample-a-10-66-dementia-research-group-study
#16
Manuel Gonçalves-Pereira, Ana Cardoso, Ana Verdelho, Joaquim Alves da Silva, Manuel Caldas de Almeida, Alexandra Fernandes, Cátia Raminhos, Cleusa P Ferri, A Matthew Prina, Martin Prince, Miguel Xavier
BACKGROUND: Dementia imposes a high burden of disease worldwide. Recent epidemiological studies in European community samples are scarce. In Portugal, community prevalence data is very limited. The 10/66 Dementia Research Group (DRG) population-based research programmes are focused in low and middle income countries, where the assessments proved to be culture and education fair. We applied the 10/66 DRG prevalence survey methodology in Portugal, where levels of illiteracy in older populations are still high...
November 7, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/29090032/the-psychological-abuse-of-the-elderly-a-silent-factor-of-cardiac-decompensation
#17
Adina Carmen Ilie, Anca Iuliana Pîslaru, Ioana Dana Alexa, Adriana Pancu, Ovidiu Gavrilovici, Aliona Dronic
Abuse of the elderly is a major issue debated worldwide. The most commonly identified form of abuse is the physical abuse. It is also the most frequently studied in the medical literature. However, at least six types of elder abuse are identified, and physical abuse is found in a small proportion of the cases. The consequences of abuse are frequent and, by prolonging hospitalizations, they will be associated with high costs of medical services, and patient's lack of self-confidence which, in time, may lead to social isolation, somatization, anxiety, depression, and suicide attempts...
June 2017: Mædica
https://www.readbyqxmd.com/read/29083443/health-promotion-and-preventive-care-intervention-for-older-community-dwelling-people-long-term-effects-of-a-randomised-controlled-trial-rct-within-the-lucas-cohort
#18
L Neumann, U Dapp, W von Renteln-Kruse, C E Minder
OBJECTIVES: An RCT of a health promotion and preventive care intervention was done in 2001-2002. Here, long-term analyses based on 12 years of follow-up of survival and of change in functional competence between intervention and control group are presented. Positive 1-year results (significantly higher use of preventive services and better health behaviour) were presented earlier. DESIGN: Parallel group randomised controlled trial (RCT) with 878 participants in the intervention and 1,702 participants in the control group...
2017: Journal of Nutrition, Health & Aging
https://www.readbyqxmd.com/read/29077231/disseminating-and-sustaining-emergency-department-innovations-for-older-adults-good-ideas-deserve-better-policies
#19
Alexander X Lo, Kevin Biese
No abstract text is available yet for this article.
October 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29052288/implementation-of-a-gerontology-nurse-specialist-role-in-primary-health-care-health-professional-and-older-adult-perspectives
#20
A I I King, M L Boyd, L Dagley, D L Raphael
AIMS AND OBJECTIVES: To explore an innovative primary healthcare gerontology nurse specialist role from the perspectives of older people and health professionals. BACKGROUND: Primary care is struggling to meet the needs and demands of complex older people. New models which incorporate holistic assessment and care coordination are necessary. DESIGN: A qualitative descriptive general inductive design was used. METHODS: Older people at risk of health and functional decline were identified and received a comprehensive gerontology assessment and care coordination...
October 20, 2017: Journal of Clinical Nursing
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