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https://www.readbyqxmd.com/read/28731941/the-biology-of-aging-and-cancer-frailty-inflammation-and-immunity
#1
Xinwen Zhang, Xin Meng, Yiyin Chen, Sean X Leng, Haiyan Zhang
The majority of patients with common malignancies are older adults. Intrinsic complex biological changes of aging along with inflammation, immunosenescence, age-associated chronic diseases, and extrinsic environmental and psychosocial factors have significant impact on not only development and behavior of individual malignancies, but also physiologic reserve and vulnerability of older patients who suffer from them. As a result, clinical practice of geriatric oncology demands integration of careful geriatric assessment and management...
July 2017: Cancer Journal
https://www.readbyqxmd.com/read/28697791/blood-transfusion-in-elderly-patients-with-chronic-anemia-a-qualitative-analysis-of-the-general-practitioners-attitudes
#2
Sylvain Le Calvé, Dominique Somme, Joaquim Prud'homm, Aline Corvol
BACKGROUND: Blood transfusion in chronic anemia is not covered by guidelines specific to older adults. When they consider that this treatment is necessary in elderly patients, French general practitioners (GPs) contact a hospital specialist to plan a transfusion. METHODS: Twenty French GPs were questioned individually regarding their approach to blood transfusion using semi-structured interviews. Each interview was recorded, typed up verbatim and then coded using an inductive procedure by theme, in a cross-over design (two researchers) in two phases: analysis and summary, followed by grouping of the recorded comments...
July 11, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28692142/big-g-and-little-g-geriatrics-education-for-physicians
#3
Kathryn E Callahan, Nina Tumosa, Rosanne M Leipzig
In the July 2016 issue of this journal, Dr. Mary Tinetti proposed that geriatric medicine abandon attempts to increase the numbers of board-certified geriatricians and change focus to the development of a "small elite workforce." What would be gained and what sacrificed by accepting this challenge? We agree that the best clinical use of a scarce resource, specialty trained geriatricians, is to care for frail, complex, severely ill elderly adults and to help design and study novel interventions in research, education, and care models to improve the care of all older adults, but for this to happen, all other providers must attain specific competency in the care of older adults...
July 10, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28687265/contextualizing-myocardial-infarction-comorbidities-and-priorities-in-older-adults
#4
REVIEW
Ashok Krishnaswami, Mathew S Maurer, Karen P Alexander
Cardiovascular care for older adults has become increasingly complex due to a rise in the concurrent comorbidity burden that accompanies senescence. Internists, hospitalists, and cardiologists often encounter geriatric patients with multiple chronic conditions needing acute cardiovascular care. Abnormal cardiac biomarker levels in patients with multiple non-cardiac conditions are a common reason for older adults to enter the hospital. This type of acute coronary syndrome, defined as a non-ST segment elevation myocardial infarction or, more precisely, type 2 myocardial infarction, often leads to substantial consternation...
July 4, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28642040/global-geriatric-oncology-achievements-and-challenges
#5
REVIEW
Enrique Soto-Perez-de-Celis, Nienke A de Glas, Tina Hsu, Ravindran Kanesvaran, Christopher Steer, Ana Patricia Navarrete-Reyes, Nicolo Matteo Luca Battisti, Yanin Chavarri-Guerra, Anita O'Donovan, Jose Alberto Avila-Funes, Arti Hurria
The aging of the population is a global challenge. The number of older adults is rapidly growing, leading to an increase in the prevalence of noncommunicable diseases associated with aging, such as cancer. Worldwide, older adults account for approximately half of all cancer cases, and this proportion is projected to increase globally. Furthermore, the majority of older adults live in less developed regions, where health systems are generally ill-equipped to provide care for complex chronic conditions. Worldwide, there is paucity of geriatric training, and most of the oncology workforce lacks the skills and knowledge to provide comprehensive care for older patients...
June 19, 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/28638938/-geriatric-case-management-at-the-kitchen-table-patient-outcome-of-the-pilot-project-for-a%C3%A2-regional-geriatric-care-concept-in-the-district-of-lippe
#6
Charlotte Şahin, Anja Rethmeier-Hanke, Olaf Iseringhausen, Constanze Liebe, Bernd Wedmann, Kira Hower
BACKGROUND: The interdisciplinary healthcare treatment of the elderly needs to consider their complex needs. There is a need for new structures of care to be tested, as in the model project regional geriatric care (RVG) concept. The aim is to qualitatively improve the treatment of elderly, multimorbid people by the implementation of case management and therefore to promote living in their own home and avoidance of the necessity for care. OBJECTIVE: How can the quality of care of a geriatric care concept be measured and the benefits for the target group be evaluated? MATERIALS AND METHODS: The explorative evaluation study reports patient outcomes for n = 380 participants who underwent geriatric assessment at the beginning of the intervention and again 12 months later...
June 20, 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28635539/an-old-challenge-with-new-promises-a-systematic-review-on-comprehensive-geriatric-assessment-in-long-term-care-facilities
#7
Francesco Panza, Vincenzo Solfrizzi, Madia Lozupone, Maria Rosaria Barulli, Francesca D'Urso, Roberta Stallone, Vittorio Dibello, Alessia Noia, Cristina Di Dio, Antonio Daniele, Antonello Bellomo, Davide Seripa, Antonio Greco, Giancarlo Logroscino
Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic process focused on determining the clinical profile, pathological risk, residual skills, short- and long-term prognosis, and the personalized therapeutic and care plan of the functionally compromised and frail older subjects. Previous evidence suggested that the effectiveness of CGA programs may be influenced by the settings where the CGA is performed [i.e., hospital, post-hospital discharge/ long-term care facilities (LTCF), or community/home] as well as the specific clinical conditions of older frail individuals...
June 21, 2017: Rejuvenation Research
https://www.readbyqxmd.com/read/28625940/prodromal-stage-of-disease-dementia-with-lewy-bodies-how-to-diagnose-in-practice
#8
Frédéric Blanc, Marc Verny
Disease with Lewy bodies or dementia with Lewy bodies (DLB), particularly at the prodromal stage, is a complex disease to diagnose because of different clinical beginnings and variable paths in terms of clinical expression. Thus DLB can be entcountered in different input modes: mild cognitive impairment, depression, acute behavioral disorders, confusion and delirium, or sleep disorders. In the aim to better diagnose the disease, should be sought obviously to search for the key symptoms: fluctuations, hallucinations, extra-pyramidal syndrome, and REM sleep behavior disorder...
June 1, 2017: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
https://www.readbyqxmd.com/read/28607235/meeting-the-current-and-future-health-care-needs-of-sri-lanka-s-ageing-population
#9
Dilhar Samaraweera, Shiromi Maduwage
Sri Lanka is one of the fastest-ageing countries in the world. This rapid demographic transition is expected to result in one quarter of the population being elderly by the year 2041. Profound challenges face the country as a result, especially with respect to planning adequate elderly-oriented services in the social-care and health-care sectors. In response to this need, many initiatives have been put in place to promote and protect the welfare of older people, and these rights have been inscribed in law. Within the health sector, despite the wealth of policies and initiatives in recent years, it is clear that the existing health infrastructure and systems still require strengthening, reorientation and coordination, to meet the needs of the growing population of elderly individuals...
September 2016: WHO South-East Asia Journal of Public Health
https://www.readbyqxmd.com/read/28593039/is-it-time-for-comprehensive-geriatric-assessment-to-move-beyond-primary-care-the-case-for-targeting-medical-sub-specialty-practice
#10
Laura K Byerly, G Michael Harper
Comprehensive geriatric assessment (CGA) as a consultative service for older adults with complex medical and psychosocial challenges has existed for decades. However, studies have often showed inconsistent acceptance and implementation of geriatric recommendations by primary care providers (PCPs) raising doubts about the overall benefits of CGA in this setting. Press and colleagues investigated the patient- and provider-related factors that affect recommendation implementation, and like previous studies, they too found similarly low rates of implementation...
2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/28590144/pharmacological-treatment-of-depression-in-geriatric-chronic-pain-patients-a-biopsychosocial-approach-integrating-functional-restoration
#11
Peter Polatin, Kelley Bevers, Robert J Gatchel
A recent literature review concluded that the comorbidity of chronic pain and depression in adults is approximately 50%-65%. Physical and cognitive declines, concurrent multiple health conditions, and complex medication regimens add to the unique and complex challenges of effectively treating pain in particularly geriatric populations. Interdisciplinary medical intervention and monitoring for psychiatric sequelae, such as depression, cognitive change, and synergistic physical side effects are necessary. Areas covered: This review covers an extensive multi-database wide search of the pharmacotherapy of pain and depression in older adults, including biopsychosocial approaches...
June 14, 2017: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/28583833/profile-and-results-of-frail-patient-assessed-by-advanced-practice-nursing-in-an-emergency-department
#12
Montserrat Solé-Casals, Emilia Chirveches-Pérez, Emma Puigoriol-Juvanteny, Núria Nubó-Puntí, Carolina Chabrera-Sanz, Mireia Subirana-Casacuberta
OBJECTIVES: To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. MATERIAL AND METHODS: Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied...
June 2, 2017: Enfermería Clínica
https://www.readbyqxmd.com/read/28495660/geriatric-patient-safety-indicators-based-on-linked-administrative-health-data-to-assess-anticoagulant-related-thromboembolic-and-hemorrhagic-adverse-events-in-older-inpatients-a-study-proposal
#13
Marie-Annick Le Pogam, Catherine Quantin, Oliver Reich, Philippe Tuppin, Anne Fagot-Campagna, Fred Paccaud, Isabelle Peytremann-Bridevaux, Bernard Burnand
BACKGROUND: Frail older people with multiple interacting conditions, polypharmacy, and complex care needs are particularly exposed to health care-related adverse events. Among these, anticoagulant-related thromboembolic and hemorrhagic events are particularly frequent and serious in older inpatients. The growing use of anticoagulants in this population and their substantial risk of toxicity and inefficacy have therefore become an important patient safety and public health concern worldwide...
May 11, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28388276/a-formative-evaluation-of-a-nurse-practitioner-led-interprofessional-geriatric-outpatient-clinic
#14
Kevin T Hansen, Cheryl McDonald, Sue O'Hara, Leslie Post, Susan Silcox, Iris A Gutmanis
The number of older adults with multiple complex comorbidities and frailty is expected to increase dramatically in the coming decades, which will necessitate a concomitant increase in the need for skilled clinicians who are able to manage complex geriatric needs. Many physicians, however, lack the required formal training, often leading to long wait-lists for specialist clinics. Yet, clinics led by non-physician professionals specialising in geriatric care could decrease these delays. This article describes the development and evaluation of a nurse practitioner-led interprofessional geriatric outpatient clinic (Inter-D Clinic)...
July 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28364996/geriatric-polypharmacy-two-physicians-personal-perspectives
#15
REVIEW
Zhe Chen, Anthony Buonanno
Being a clinical provider in today's health care environment has become complex with more levels of care to negotiate. Who is caught in the middle of this complexity? Senior citizens. As we evolve into the new quality model, new problems and complexities occur. Numerous protocols and guidelines necessitate the initiation of drugs for given diagnoses and aggressive treatments. This article discusses geriatric polypharmacy from two practitioners' viewpoints: Zhe Chen, MD, discusses the point of view of a physician provider, and Anthony Buonanno, MD, discusses providers' roles in their own families...
May 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28364542/defining-aging-phenotypes-and-related-outcomes-clues-to-recognize-frailty-in-hospitalized-older-patients
#16
Maura Marcucci, Carlotta Franchi, Alessandro Nobili, Pier Mannuccio Mannucci, Ilaria Ardoino
Background: Because frailty is a complex phenomenon associated with poor outcomes, the identification of patient profiles with different care needs might be of greater practical help than to look for a unifying definition. This study aimed at identifying aging phenotypes and their related outcomes in order to recognize frailty in hospitalized older patients. Methods: Patients aged 65 or older enrolled in internal medicine and geriatric wards participating in the REPOSI registry...
March 1, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/28353488/management-of-central-venous-access-device-associated-skin-impairment-an-evidence-based-algorithm
#17
Daphne Broadhurst, Nancy Moureau, Amanda J Ullman
Patients relying on central venous access devices (CVADs) for treatment are frequently complex. Many have multiple comorbid conditions, including renal impairment, nutritional deficiencies, hematologic disorders, or cancer. These conditions can impair the skin surrounding the CVAD insertion site, resulting in an increased likelihood of skin damage when standard CVAD management practices are employed. Supported by the World Congress of Vascular Access (WoCoVA), developed an evidence- and consensus-based algorithm to improve CVAD-associated skin impairment (CASI) identification and diagnosis, guide clinical decision-making, and improve clinician confidence in managing CASI...
May 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/28340600/an-evaluation-of-the-comparative-effectiveness-of-geriatrician-led-comprehensive-geriatric-assessment-for-improving-patient-and-healthcare-system-outcomes-for-older-adults-a-protocol-for-a-systematic-review-and-network-meta-analysis
#18
Charlene Soobiah, Caitlin Daly, Erik Blondal, Joycelyne Ewusie, Joanne Ho, Meghan J Elliott, Rossini Yue, Jayna Holroyd-Leduc, Barbara Liu, Sharon Marr, Jenny Basran, Andrea C Tricco, Jemila Hamid, Sharon E Straus
BACKGROUND: Comprehensive geriatric assessment (CGA) is an integrated model of care involving a geriatrician and an interdisciplinary team and can prioritize and manage complex health needs of older adults with multimorbidity. CGAs differ across healthcare settings, ranging from shared care conducted in primary care settings to specialized inpatient units in acute care. Models of care involving geriatricians vary across healthcare settings, and it is unclear which CGA model is most effective...
March 24, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28338866/the-growing-challenge-of-major-trauma-in-older-people-a-role-for-comprehensive-geriatric-assessment
#19
James Michael Fisher, Charlotte Bates, Jay Banerjee
In this commentary article, we describe the impact that an ageing population is having on the nature of major trauma seen in emergency departments. The proportion of major trauma victims who are older people is rapidly increasing and a fall from standing is now the most common mechanism of injury in major trauma. Potential barriers to effective care of this patient group are highlighted, including: a lack of consensus regarding triage criteria; potentially misleading physiological parameters within triage criteria; non-linear patient presentations and diagnostic nihilism...
March 10, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28330452/a-structure-process-and-outcome-evaluation-of-the-geriatric-emergency-department-intervention-model-of-care-a-study-protocol
#20
Elizabeth Marsden, Andrea Taylor, Marianne Wallis, Alison Craswell, Marc Broadbent, Adrian Barnett, Kim-Huong Nguyen, Julia Crilly, Colleen Johnston, Amanda Glenwright
BACKGROUND: Emergency departments are chaotic environments in which complex, frail older persons living in the community and residential aged care facilities are sometimes subjected to prolonged emergency department lengths of stay, excessive tests and iatrogenic complications. Given the ageing population, the importance of providing appropriate, quality health care in the emergency department for this cohort is paramount. One possible solution, a nurse-led, physician-championed, emergency department gerontological intervention team, which provides frontload assessment, early collateral communication and appropriate discharge planning, has been developed...
March 23, 2017: BMC Geriatrics
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