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Complex geriatric care

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https://www.readbyqxmd.com/read/28216284/new-risk-and-protective-factors-for-severe-hypoglycaemia-in-people-with-type-1-diabetes
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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...
December 2016: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/27757231/emergency-department-crowding-in-singapore-insights-from-a-systems-thinking-approach
#19
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
#20
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
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