Geriatric Day Research Articles

The Role of the Nurse in the Geriatric Day Hospital

The Role of the Nurse in the Geriatric Day Hospital

The role of the social worker with ethnic elderly people in geriatric day hospitals

The role of the social worker with ethnic elderly people in geriatric day hospitals

Measuring Outcomes in Elderly Patients in a Geriatric Day Hospital

Measuring Outcomes in Elderly Patients in a Geriatric Day Hospital

Towards the audit of geriatric day hospitals: a pilot project in West Surrey/North East Hampshire

Following the recommendation of a report on the performance of two geriatric day hospitals (GDHs) in West Surrey and North East Hampshire District Health Authority in 1988, a pilot study was set up to assess the efficacy of a proposed form of audit involving multidisciplinary teams. An outcome measure which consisted of four different scales was developed and agreed upon by the multi-professional team. These scales were used to work out a composite index (Patient Achievement Inventory-PAI). In addition, a new data form was designed for collection of patient data. To carry out this prospective clinical audit, targets were agreed for each patient, and progress was measured against them. Sixty-one (61) patients were studied (30 and 31 per respective hospital). Data form completion was 90 per cent and 81 per cent respectively. The PAI index proved to be reliable (kappa index of agreement = 0.72), and useful as an outcome measure. However, because the PAI index is made up of ordinal scales, it can only be used to measure change within individuals, not between them. The outcome measures, data forms and the continuous audit of these two GDHs proved to be meaningful and acceptable in practice.

The accuracy of self and informant ratings of physical functional capacity in the elderly

To compare the accuracy of self-ratings with informant-ratings of physical functional capacity in the elderly, 150 elderly patients attending a geriatric day hospital (GDH) and their formal and informal community carers were administered a questionnaire about their ability to perform activities of daily living (ADL). Direct observation of the patients' performance by therapists at the GDH was used as a standard, after the reliability and validity of this approach had been evaluated. Self-ratings were shown to be more accurate and less biased than informant-ratings, both for individual ADL and overall functional capacity. The accuracy of all ratings tended to be greater for less complex or physically demanding ADL, and informants tended to consistently underestimate functional capacity. The concurrent validity of the adapted Barthel Index in a self-report format was also demonstrated. Wherever possible, information concerning the physical functional capacity of an elderly subject should in the first instance be sought from the subject himself, as the quality of such information may be superior to that of his carers.

Psychiatric disorders among elderly patients attending a geriatric medical day hospital: Prevalence according to clinical diagnosis (DSM‐III‐R) and agecat

AbstractOne hundred and fourteen elderly medically ill day patients were interviewed in order to assess the prevalance of DSM‐III‐R main psychiatric disorders. Dementia affected 14.0% of the subjects, major depression 20.3%, dysthymic disorder 4.4%, atypical depression 13.2%, other disorders 3.6%. Overall, 60.5% of the patients had a psychiatric disorder. The computerized case designation (AGECAT) showed an acceptable concordance with clinical diagnoses (kappa value for dementia 0.59, for depression 0.58). Some issues related to the high prevalence of major depression are discussed.

Community Care Services. Views of Patients Attending a Geriatric Day Hospital

Community Care Services. Views of Patients Attending a Geriatric Day Hospital

Interdisciplinary care in a geriatric day hospital

Hogan, David B. MD, FACP, FRCPC; Hogan, Janet M. RN; Ferneyhough, Judy RN Nurse; Williams, Shelley BSc(OT); Johnstone-Chapman, Carmen MSW, NRSW; York, Mildred BN, RN; Tomilson, Roxanne MScN Author Information

Music Not Only Has Charms to Soothe, But Also to Aid Elderly in Coping With Various Disabilities

ALTHOUGH illnesses vary, very patient at the geriatric day hospital at The University of Texas Medical Branch (UTMB), Galveston, receives one therapy in common. This therapy is unusual in that it elicits immediate and positive effects in nearly all who receive it and has virtually no contraindications. Furthermore, it costs little more than a song because it is precisely that: a song. I'm in heaven when we're dancing cheek to cheek, Louis Armstrong and Ella Fitzgerald croon. As the tune emanates from the music therapist's portable tape player, 20 geriatric patients seated in two large circles reach out to pat their neighbors' shoulders, look in each others' eyes, and smile. Music for Mobility, Analgesia In what is probably the highlight of their day at this specialized facility (one of only a handful of geriatric day hospitals in the United States [see accompanying article]) these patients are about to begin a

Unique 'Day Hospital' Offers Bridge Between Hospitalization, Return to Independent Living

GERIATRIC PATIENTS who are discharged from inpatient care at University of Texas Medical Branch, Galveston, may have the option of visiting a sort of therapeutic stepping-stone between the hospital and independent community living. A geriatric day hospital, located on the university campus, allows patients to live at home while completing their rehabilitation at the facility 2 or 3 days a week. day hospital, thought to be the first of its kind in the United States, is distinctly different from day-care facilities, whose primary focus, essentially, is to keep content and safe those elderly persons who no longer can function independently. The main thrust of the day hospital is to try to get the patient back to some sort of independent living, says Jan MacGregor, MD, instructor in internal medicine in the university's Division of Geriatric Medicine and the day hospital's primary physician. Independence Has Many Meanings meaning

Geriatric day hospital did not improve functional status or quality of life in elderly persons

Source Citation Eagle DJ, Guyatt GH, Patterson C, et al. Effectiveness of a geriatric day hospital. Can Med Assoc J. 1991 Mar 15;144:699-704.

Effect of aging and other factors on monocyte aryl hydrocarbon hydroxylase activity

A measure of the activity of macrophage drug metabolizing enzymes through assay of peripheral monocytes was used to assess the hepatic enzymatic status and thereby evaluate age related changes in drug metabolism. Blood was obtained from elderly subjects (aged 74.8 ± 5.2, x ̄ ± S.E., n = 16 ) and a young control group (aged 23.5 ± 2.0, n = 27). Monocyte AHH activity was used as an index of liver drug metabolism, ALT activity as an index of liver function, monocyte media IL-1 and as an index of macrophage activation and serum IL-1 levels as a measure of endogenous pyrogenic activity. The medium collected from the cultured monocytes was also assessed for the presence of AHH inhibitory activity. Subjects provided information relating to their age, sex, alcohol consumption, cigarette smoking, recent infection, recent surgery, disease status and medications which could alter drug metabolism. Elderly patients were drawn both from independent seniors living at home and seniors visiting a geriatric day hospital and compared to a control group of young healthy volunteers. Using the experimental design AHH activity did not differ within experimental error between aged (0.832 ± 0.32 nmol/mg prot. per h, n = 16) and young control subjects (if 0.452 ± 0.17, n = 27). ALT activity did not differ between aged (2.83 I.U. ± 0.46) and young (4.24 ± 0.82). Monocyte AHH activity did not differ between males (0.45 ± 0.14, n = 33) compared to females (0.65 ± 0.18, n = 29), but was significantly higher in smokers (2.5 ± 1.0, n = 5) compared to non-smokers (0.35 ± 0.05, n = 52). Mild to moderate alcohol use showed no significant effect on AHH activity. There was no significant difference between the mean level of MCM inhibition of murine hepatocyte AHH between elderly (44.3 ± 8.32%, n = 8) and control (31.5 ± 6.21%, n = 15) subjects, but a larger proportion of the elderly population demostrated such an effect. Serum IL-1 levels (range 0–55.9 pg/ml) were compared to MCM IL-1 and AHH inhibitory activity in the elderly and young group.

Study of constipation in a geriatric hospital, day hospital, dold people’s home and at home

A study of constipation and related factors was carried out in 439 geriatric hospital patients, 183 people living in two old people's homes, and 78 patients visiting a geriatric day hospital. In addition, a cross-sectional survey of constipation and related factors was undertaken in 138 people older than 74 years and 74 people aged 41 to 50 years living at home. Constipation and the use of laxatives were most frequent in the geriatric hospital (79% and 76% respectively), followed by the old people's homes (59% and 60%), the day hospital (29% and 31%), elderly living at home (38% and 20%) and middle-aged living at home (12% and 5%). The results suggest an increased risk of constipation for the persons walking less than 0.5 km daily [relative risk (RR) = 1.7], walking with help (RR = 3.4), chairbound (RR = 6.9) and bedbound (RR = 15.9). The relative risk of constipation increased for the persons living in the old people's homes (RR = 1.7) and the geriatric hospital (RR = 2.2), and also with advancing age (between 75 and 84 years, RR = 2.9; over 84 years, RR = 4.9). The prevalence of constipation was directly correlated to fecal and urinary incontinence.

Outcome of depression in a geriatric medical day hospital

Outcome of depression in a geriatric medical day hospital

Terodiline with bladder retraining for treating detrusor instability in elderly people.

To compare terodiline with bladder retraining against placebo with bladder retraining in the treatment of detrusor instability in frail elderly patients. Randomised, double blind, parallel group study. Treatment lasted for six weeks. Frequency of micturition and episodes of incontinence recorded on diary chart by patients. Incontinence clinic and a geriatric day hospital at two teaching hospitals. 37 frail but ambulant patients, mean (range) age 80.4 (70-89) years with urinary frequency and urge incontinence, due to detrusor instability. Two patients withdrew before the first assessment (one in each group) and one could not complete the diary chart (placebo group). 19 patients received bladder retraining and terodiline 25 mg daily and 18 bladder retraining and placebo. Change in urinary frequency and number of episodes of incontinence after six weeks' treatment. Patient's subjective evaluation of symptoms. Little difference was found in the results of treatment with terodiline and placebo. The change in episodes of incontinence per 24 hours was no different in the two groups (95% confidence interval -0.6 to 1.2; p = 0.75) and the difference between treatments in the change in frequency of micturition per 24 hours (-0.2) was not significant (-1.1 to 1.2; p = 0.76). Ten patients taking terodiline thought they had improved compared with seven receiving placebo; this difference was not significant. Although the number of patients in each group was small and may have been insufficient to detect a drug effect, the possible benefit of terodiline is likely to be small.

The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons

This study evaluated a modified, timed version of the "Get-Up and Go" Test (Mathias et al, 1986) in 60 patients referred to a Geriatric Day Hospital (mean age 79.5 years). The patient is observed and timed while he rises from an arm chair, walks 3 meters, turns, walks back, and sits down again. The results indicate that the time score is (1) reliable (inter-rater and intra-rater); (2) correlates well with log-transformed scores on the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and Barthel Index of ADL (r = -0.78); and (3) appears to predict the patient's ability to go outside alone safely. These data suggest that the timed "Up & Go" test is a reliable and valid test for quantifying functional mobility that may also be useful in following clinical change over time. The test is quick, requires no special equipment or training, and is easily included as part of the routine medical examination.

Physiological concomitants of an "autonomous day programme" in geriatric day care

Sixty-five geriatric patients with a mean age of 74 years (range 61-90) who were referred to the day care unit of a geriatric hospital were randomly allocated to an experimental and a control group in groups of 5-8 patients, respectively. Controls were cared for according to usual routines. Patients in the experimental groups were subject to a new organizational routine. These patient groups constituted a forum for discussion and definition of individual treatment goals. Patients in the experimental and control conditions were observed before as well as 6, 12 and 24 weeks after the start of the treatment, which lasted for twelve weeks. Patients in the intervention programme had significantly lower plasma prolactin levels following the initiation of the programme than patients in the control group. According to literature, an absence of a plasma prolactin elevation during a crisis period may indicate active coping. Such a conclusion was supported by other observations in the study which indicated a progressively more internalized locus of control in the experimental group.

Effectiveness of Physiotherapy in a Geriatric Day Hospital

Summary This paper attempts to clarify the short- and long-term results of physiotherapy for patients attending a day hospital for the elderly. Patients were studied with particular regard to alterations in mobility as it was considered that this was a measure likely to reflect the effectiveness of physiotherapy. A small but beneficial gain in mobility occurred after attendance and was maintained at one and six months after discharge.

An Exploratory Use of the Symptoms Checklist‐90 in a Mixed Geriatric Study Group

There are currently no self-rating scales of general psychopathology in the older population. Such scales can be used to screen patients who may then be referred on for psychiatric assessment. The validity of the Symptoms Checklist-90 (SCL-90), a self-rating scale of general psychopathology widely used in the nongeriatric adult population, was explored in 44 older subjects. It was compared with the Sandoz Clinical Assessment Geriatric (SCAG) scale and a measure of functional disability, the London Psychogeriatric Rating Scale (LPRS). Caregivers to all subjects also rated the degree of difficulty experienced with their care on a four-point scale. Thirty of the subjects attended a geriatric day hospital, and the remaining 14 were waiting to go into long-term care facilities. Symptoms Checklist-90 was not significantly different between the two groups of subjects (day hospital and preinstitutional) after Bonferroni corrections, though SCAG scale and LPRS were (P less than .01 for both). Although SCL-90 was correlated significantly with the SCAG scale (r = .46), it was not significantly correlated with the LPRS. It showed good internal consistency but poor face validity and an inability to differentiate between levels of difficulty for the caregiver. It is concluded that the use of SCL-90 in older people may be limited because of the lack of sensitivity to functional disability and care difficulty. This nevertheless needs to be further explored, perhaps with some modification of the scale for older people.

Relationships between happiness, behavioural status and dependency on others in elderly patients

Feelings of dependency on others were measured, by different scales, in two different samples of elderly people: 33 acute in-patients and 25 attenders at a geriatric day hospital. Findings were similar in each location. Dependent attitudes increased with the duration of patients' previous in-patient experience, and correlated negatively with subjective well-being but not at all with behavioural status. These results are consistent with theories which attribute low morale to feelings of dependence and this, in turn, to the experience of residential care. They are inconsistent with the view that dependence on others is a positive feature of old age. In addition, patients' subjective well-being was completely unrelated to nurse ratings of their behavioural status, and subjective ratings by nurses correlated somewhat with patients' behavioural status but not at all with their subjective well-being.