Geriatric Issues Research Articles

Multidisciplinary palliative care of the older adult: a narrative review.

The aging of society has contributed to individuals living longer with chronic illnesses. This places them at risk to develop cancer. Treating older adults with chronic illnesses and cancer, places strain on oncologists as this group of individuals is heterogenous in nature, differing in their functional status, co-morbidities, etc. Integrating geriatrics into the care of the older adult with cancer has proven to be beneficial in helping to ameliorate the effects of aging and honing oncologic treatment regimens to be effective and efficient. The purpose of this unsystematic review is to demonstrate the importance that geriatricians can have, when participating on a multidisciplinary team (MDT) with oncology, in the administration of holistic palliative cancer care to the older adult; to present geriatric specific issues that are imperative to consider when managing the older adult with cancer; and to consider other members of the MDT inclusive of social work, pharmacy, and nursing. Data were identified by searching PubMed (January 2005 to July 2023) using the following search terms: multidisciplinary care and older adults and cancer care. The search was repeated using geriatrics, MDTs, chronic diseases, elderly. Non-English articles and observational studies were excluded. An additional review of literature was undertaken using relevant references of identified articles. Older adults are heterogenous in the aging process and thus using a geriatrician to perform comprehensive geriatric assessments (CGAs) can help to tailor the palliative care of the older adult with cancer. Providing for better predictions of the success of the proposed treatment. The overarching goal is to maintain the individual's quality of life and independence. MDTs, consisting of nursing, pharmacy and social work in addition to geriatricians and oncologists are instrumental in providing his level of care. Utilizing geriatricians on an MDT with oncology can help to provide the older adult with cancer palliative care that is holistic, effective and efficient in its delivery. While intellectually these models of multidisciplinary care are effective for the older adult with cancer, future research is needed as to the quality, cost-effectiveness and impact this care can have.

Nepal’s Geriatric Health Strategy 2021–2030: A Narrative Review

Abstract Nepal’s national geriatric health strategy 2021–2030 focuses on enhancing the health and well-being of senior citizens by providing comprehensive health services and promoting healthy aging. The strategy addresses the increasing prevalence of chronic conditions and multimorbidities among the older people, emphasizing the need for tailored health-care services. Key priorities include improving access to quality health services, promoting social health insurance, and strengthening family and community support systems. The strategy also aims to integrate geriatric health issues into the national health system, enhance the capacity of health facilities, and ensure gender-equitable and inclusive services. By fostering multisectoral coordination and collaboration, the strategy supports Nepal’s pursuit of universal health coverage and aims to build state capacity to support healthy aging, ensuring that senior citizens can lead active and quality lives.

Is geriatric medicine teaching homogeneous? The analysis of geriatric medicine courses at Polish undergraduate medical programmes.

We aimed to analyse the characteristics of geriatric courses offered to undergraduate medical students in higher educational institutions (HEIs) in Poland. We searched the official websites of the HEIs offering the medical degree programmes and directly contacted the dean's offices and HEIs representatives to retrieve the relevant information. The documents were analysed for course content, teaching methods, duration, and recommended texts. We also checked the obtained curricula for the reference to of the learning objectives related to geriatric medicine, selected from the currently endorsed Polish educational standards (ES) provided by the Ministry of Science and Higher Education. Geriatric medicine courses were obligatory at all included HEIs (n = 19), but the courses differed in structure and content. The courses varied in duration from 11 to 60h and were primarily lecture based. Simulation was utilized at only one HEI and e-learning at two institutions. Out of 315 learning objectives, we acknowledged only 9 as geriatric. They were not always found in all curricula. Two HEIs included self-described learning objectives in their curricula. Across all HEIs, a total of 29 recommended texts (published between 1995 and 2021) were identified, including 2 English-language texts. Geriatric medicine was a mandatory subject for medical students of the included HEIs. However, there was a lack of uniformity in the offered courses. This leaves room for the development of a unified undergraduate geriatrics curriculum to effectively address diverse geriatric issues across Europe. The importance of this matter is highlighted by demographic trends and workforce challenges.

Hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand.

To describe the types of hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand, and to explore head of department (HOD) views on issues in current and future service provision. An electronic survey was sent to HODs of public geriatric medicine departments. Seventy-six (89%) of 85 identified HODs completed the survey. Seventy-one (93%) departments admit inpatients and 51 (67%) admit acute inpatients, with variable admission criteria. Sixty-four (84%) have hospitals with an inpatient general medicine service, and 58 (91%) of these admit older patients with acute geriatric issues. Sixty (79%) departments provide inpatient rehabilitation. Forty (53%) have beds for behavioural symptoms of dementia and/or delirium. Seventy (92%) provide a proactive orthogeriatric service. In terms of out-of-hospital services, 74 (97%) departments have outpatient clinics, 59 (78%) have telehealth and 68 (89%) perform home visits. Forty-five (59%) provide an inreach/outreach service to nursing homes. The most frequent gaps in service provision identified by HODs were acute geriatrics, surgical liaison, a designated dementia/delirium behavioural management unit, geriatricians in Emergency, outreach/inreach to residential care and shared care with some medical specialities. Increasing staff numbers and government policy change were the most frequently identified ways to address these gaps. Geriatric medicine service provision is variable across Australia and New Zealand, with key gaps identified. These findings will inform future directions in implementation of geriatric medicine models of care and discussions with various levels of government about the ongoing development of geriatric medicine services.

Physical frailty predicts cognitive decline among community-dwelling older Japanese women: A prospective cohort study from the Otassha study

BackgroundPhysical frailty and cognitive decline are common issues in geriatrics within an aging society, yet the association between them remains controversial. This study aims to evaluate the association between physical frailty and cognitive decline among community-dwelling older Japanese women. MethodsA prospective cohort study was conducted in an urban area of Tokyo, Japan, involving community-dwelling older adults 65 years or older. Physical frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria, consisting of five components: shrinking, weakness, exhaustion, slowness, and low activity. Participants were classified as robust, pre-frail, or frail based on the presence of one or more criteria. Cognitive decline was defined as at least a three-point decrease in the Mini-Mental State Examination score from baseline. The association between physical frailty and cognitive decline was examined using binomial logistic regression, adjusting for potential confounders. The analysis yielded multivariable odds ratios (ORs) and 95 % confidence intervals (CIs), with robust participants using as the reference group. ResultsA total of 2,122 individuals participated in the baseline survey, with 805 included in the analysis (mean age: 72.9 ± 5.1 years). At baseline, 363 participants were classified as pre-frail, while 32 were classified as frail. During the two-year follow-up period, 68 participants experienced cognitive decline. The multivariable OR (95 % CI) for frailty, using robust as the reference, was 3.50 (1.13, 10.80). Furthermore, a linear relationship was observed between physical frailty and cognitive decline. ConclusionAmong older Japanese women, there exists a dose-response relationship between physical frailty status and cognitive decline.

Health Problems and Illnesses: Overwhelming on Living Conditions of Elderly Individuals

The main objective of this research paper is to acquire an efficient understanding of various types of health problems and how they are overwhelming on living conditions of elderly individuals. The senior citizens are overwhelmed by different types of health problems and illnesses. These are experienced in a major or minor form. The senior citizens are required to be well-versed in terms of different types of methodologies and procedures, which would be facilitating in treating various types of health problems and illnesses. Within rural communities, the health care and medical facilities are not in a well-developed state, whereas, in urban communities, these are in a well-developed state. The senior citizens, migrate to urban communities in order to get their health problems and illnesses treated. As a consequence of promoting good health and well-being, the individuals in old age will render an important contribution in bringing about improvements in their overall quality of lives. The senior citizens in some cases are not ambulatory and are required to depend upon other individuals in order to take care of their needs and requirements. Hence, they are required to form cordial and amiable terms and relationships with other individuals, including family and community members. Hence, it is of utmost significance to take care of different types of health problems and illnesses. Therefore, it is understood on a comprehensive basis that health problems and illnesses are overwhelming on living conditions of elderly individuals. The main concepts that are taken into account in this research paper are, health problems and illnesses are overwhelming in old age, health issues in geriatrics, health issues among senior citizens and measures to be implemented in promoting good health and well-being.

Immigrant’s Cultural Alienation in Elaine Chiew’s Face

This research focuses on the cultural alienation of an elderly Chinese immigrant narrated in Elaine Chiew’s Face (2019). Face is a story that highlights the life of Yun, an elderly Chinese woman who moves to London and feels alienated from her surroundings. To analyze the data, the descriptive qualitative method and Seeman’s theory of alienation (1959) are employed. This research discovers that alienation undergone by elderly can be resulted from powerlessness, meaninglessness, normlessness, isolation, and self-estrangement. Powerlessness rises when the elderly immigrants could not cope with bullying problem, while feeling meaninglessness comes from their inability in doing productive activities like what they had in their home-land. Incapability to adapt with the culture, norms, and values in the host-country results in their normlessness detaching them more from their surroundings. It worsens due to the language barrier, no same-aged friends, and geriatric bladder issues. Lastly, their social functions that do not work well lead them into self-estrangement. The findings of this research show that cultural alienation experienced by elderly immigrants could lead them into identity crisis.

A GERIATRIC EDUCATION COURSE SPANNING COMMUNITY AND HEALTH CARE ENVIRONMENTS

Abstract To address gaps in the geriatrics-trained workforce, we implemented a Geriatric Resource Certificate (GRC) for interprofessional learners from healthcare and community provider settings. This program combines online self-paced didactics, real-time virtual lectures, and a real-world virtual team care planning experience. The education incorporates the 4Ms of the Age Friendly Framework and spans the geriatric experience from healthy aging through end-of-life. It includes Dementia Friends and ECHO sessions. The goal is to training people from a variety of care settings to be resource people regarding geriatric issues, much like the NICHE program in acute care. We had 37 learners who completed evaluations. Practice settings included ACO, Hospice, Emergency Department, nursing homes, hospitals, primary care, Area Agencies on Aging, and other community providers. Overall, the online didactics were rated an average of 4.53 on a 5 point Likert scale and the real-time lectures were rated an average of 4.41. The average score for “the GRC will help me provide care over the continuum” was 4.59. The average for the real team was 4.07, 4.26 for the ECHO, and 4.45 for Dementia Friends. All learners indicated they would refer others to the GRC. These results indicate that the GRC is an effective method to impart basic geriatric training into communities and raise awareness of resources available to assist older adults in maintaining their independence. In this era of high healthcare workforce turnover and staffing shortages, improving geriatric knowledge by training on-site geriatric resource staff is one way to improve care for older adults.

The prevalence and interventions of xerosis cutis among older adults: A systematic review and meta-analysis

BackgroundXerosis cutis in older adults is a geriatric public health issue that severely affects healthy aging, associated with adverse outcomes and increased nursing burden. Skin care plays a significant role in the management of xerosis cutis. AimTo assess the pooled prevalence and interventions of xerosis cutis among older adults. MethodsWe searched ten databases systematically from inception to August 29, 2023. We estimated pooled prevalence of xerosis cutis using Stata 15.0. Results28 articles were included in this review. The pooled prevalence of xerosis cutis was 53 %(95 %CI:36–69 %). We found the prevalence of xerosis cutis was highest in nursing homes and developed countries. The prevalence of xerosis cutis was similar in males and females. The prevalence of mild xerosis cutis and xerosis cutis at lower limbs was relatively high. Regular use of humectant-containing leave-on skin care products and structured skin care regimens were helpful in alleviating xerosis cutis. ConclusionOlder adults are at high risk for xerosis cutis. The research provides health professionals with a basic framework for the prevention and management of xerosis cutis.

Can collaboration among health and social care workers play a role in addressing geriatric care challenges? A qualitative case study in Central Vietnam.

Vietnam's healthcare system offers limited services and facilities for older adults. This study explored the perceptions of health and social care workers regarding geriatric care issues, their impact on older adults and the potential of collaboration for enhancing older adults' health and well-being. This qualitative case study employed 27 focus group discussions and two in-depth interviews with 174 participants in Thua Thien Hue Province, Vietnam. An inductive thematic analysis was conducted. According to the participants, the major challenges that hindered geriatric care consisted of caregiver and care recipient issues, which were identified to constrain care accessibility, resulting in decreased physical, mental and social health. Across different settings and professions, collaboration was considered a routine and natural aspect of daily work. It was perceived that establishing and strengthening collaboration could facilitate improvement in health and social welfare services through the prioritization of needs and enhancement of caregiver skills and training. Collaboration was viewed as ad hoc but indispensable for addressing the identified geriatric care issues that could improve the general health and well-being of older adults. The findings indicate a need for better collaboration in Vietnam, achieved through defined guidelines, training and improved interprofessional education and practice.

EVALUATION OF PHARMACY STUDENTS' KNOWLEDGE AND ATTITUDES REGARDING GERIATRIC CARE

The aim of this study was to evaluate the knowledge and attitudes of Suleyman Demirel University Faculty of Pharmacy 4th grade students about geriatric care. This study is a cross-sectional online survey study The questionnaire was created with the Google form and the study was carried out between May 9 and May 23, 2022. 64.4% of the respondents believed that body fat decreased in the elderly. 17.8% and 23.3% of the respondents, respectively, agreed with the statement that diclofenac and imipramine are inappropriate for the elderly according to the Beer list.83.6% of the respondents believed that older adults have more than one chronic disease, more than one drug, and allergic reactions to drugs. 24.6% of the respondents agreed with the idea that enough attention is paid to geriatric health issues in our country. This study shows that although students' attitudes towards geriatric care are generally sufficient, there are some deficiencies in their knowledge levels. In pharmacy undergraduate education, importance should be given to courses such as rational drug use and geriatric care in the elderly.

Divergence and integration of identification methods for geriatric mental health disorders in nonspecialized institutions—a qualitative study of service providers from different departments in Shanghai, China

Objectives Global epidemiological evidence indicates high rates of mental illness but low rates of diagnosis among older people. In China, service providers identify older adults with mental disorders in varied ways. Taking Shanghai as an example, this study revealed how the identification methods of geriatric mental health disorders in nonspecialized institutions diverge, providing a reference for the integration of services. Methods A purposive sampling method was adopted to conduct semi-structured interviews with 24 service providers from various nonspecialized geriatric mental health care institutions. Interview audio was recorded with consent and converted into verbatim transcripts. The interview data were analysed thematically. Results Although service providers from the health care system tended to apply a biomedical-oriented assessment, those from the social care system typically identified mental disorders among older people based on selective attention and interpersonal relationships. Although there are stark differences, the various identification mechanisms implicitly converge—the relationship with clients has become an important consideration. Conclusion Geriatric mental health issues urgently require the integration of formal and informal care resources. Referring to the idea of task transfer, social identification mechanisms are expected to be a useful supplement to traditional biomedical-oriented identification.

Geriatric curriculum at faculties of medicine in Indonesia

Aim: In Indonesia, the elderly population is growing rapidly and will comprise 35 million in 2035. The aim of this study was to assess how geriatric training is organised in medical faculties in Indonesia. Methods: In 2017, we asked through questionnaires the vice deans of the faculties of medicine about their perceptions towards health and ageing and how they organized the geriatric training in their respective schools. Overall, we obtained data from 32 out of 71 (45.1%) faculties of medicine. Results: All respondents perceived geriatrics as an important issue for faculties of medicine. Only 12 (37.5%) faculties employ geriatric specialists, 28 (87.5%) teach geriatrics at the undergraduate level, and 12 (40.6%) at postgraduate level, whereas 4 (12.5%) universities teach at specialty level. Conversely, at undergraduate level, only 18 (64.2%) faculties include the ‘geriatric giants’, and 5 (17.8%) include ageism. There are 13 (46.4%) geriatric classes implemented through skill laboratories, 5 (17.8%) through geriatric policlinics, and 4 (14.3%) through geriatric wards. Conclusion: Attention to geriatric training among medical schools in Indonesia has to be improved. At national level, there should be a more specific formulation of geriatric competencies and how they can be operationalised. Geriatric training is recommended to prepare lecturers in medical faculties. Related to the content of aging curriculum, geriatric issues, attitudes towards aging, and ageism should be addressed.

Combined Axillary Block with Spinal Block Anaesthesia

<p><strong>Background: </strong>Patients undergoing upper limb trauma surgery have reported various benefits of regional anesthesia over general anesthesia, including better perioperative analgesia, less opiate use, less postoperative nausea and vomiting (PONV), and a shorter post-anesthesia care period. ……………………………..<br /> <strong>Case Illustration: </strong>We reported an evaluation of 72 years old, 165 cm height and 60 kg weight male patient who was planned for open reduction and internal fixation surgery for neglected left radius ulna close fracture and left neglected tibia fibula close fracture that he was beneath follow-up for hypertension (HT), and was using antihypertensive drugs. Preoperative risk of the patient was assessed as with American Society of Anesthesiologists (ASA) with score 3.General anesthesia would be unsafe due to geriatric issue, cardiovascular problem and delayed surgery term, we chosed to utilize combine axillary block with spinal block. we utilized USG guided infusion procedure in arrange to diminish local anesthetic dosage, and minimize error. During surgical procedure there is no hypotension, bradycardia or decreased oxygen saturation. Surgical anesthesia occurred in left hand within 20 minutes after drug delivery and 10 minutes in lower extremity. Surgery complications was not reported particularly related to vascular punction or adjacent anesthetic and nerve block applications. No complaint was detailed from the patient who was watched for 12 hours after the surgery.<strong></strong></p><p class="Default"><strong>Conclusion:</strong> Peripheral nerve block and neuraxial block, when utilized appropriately in combination, appear be able to supplant common anesthesia within the larger part of case.</p>

Prevalence and Risk Factors of Delirium and Subsyndromal Delirium in Older Adults

Background and Aim: Delirium is the most prevalent geriatric issue that is independently associated with poor outcomes in terms of discharge, length of hospital stay, and increased mortality. Subsyndromal delirium (SSD) is defined by the presence of delirium symptoms that do not yet meet the definition of full-blown delirium. The present study aimed to determine the incidence and delirium-related risk factors in older adults. Method: This prospective study was conducted on 420 elderly patients (>60 years) in the Department of Medicine of Benazir Bhutto Hospital Rawalpindi and Liaquat University Medical and Health Sciences, Jamshoro Hyderabad, from April 2021 to December 2021. Study protocol was approved from research and ethical committees of the institutions. The purpose of the study was explained to the participants after taking written informed consent. Patients were classified into three categories are as follows: delirium, subsyndromal delirium, and cases without both delirium and subsyndromal delirium. Detailed history taking, comprehensive geriatric assessment, and clinical examination from each individual were recorded. All the collected data were analyzed using SPSS version 26. Results: Of the total 420 elderly patients, the incidence of delirium and subsyndromal delirium was 96 (22.9%) and 72 (17.1%) respectively. There were 264 (62.9%) male and 156 (37.1%) females. The overall mean age was 68.4± 4.8 years. Delirium and subsyndromal delirium cases were distributed based on the patient’s age were as follows: 62 (64.6%) and 42 (58.3%) in 60-70 years, 24 (25%) and 22 (30.6%) in 71-80 years, and 10 (10.4%) and 8 (11.1%) in >81 year. Of the 96 delirium cases, the incidence of hypoactive type, hyperactive type, and mixed type was 54 (56.3%), 18 (18.8%), and 24 (24.9%) respectively. Based on cognitive assessment, about 36 (8.6%) MMSE score <23, 78 (18.6%) had MMSE score <18, and 54 (12.9%) did not respond to MMSE. The incidence of common comorbidities such as hypertension, chronic liver disease, asthma, ischemic heart disease, cerebrovascular disease, diabetes, and malignancy was 144 (34.3%), 82 (19.5%), 26 (6.2%), 120 (28.6%), 24 (5.7%), 184 (43.8%), and 14 (3.3%) respectively. Conclusion: The present study found that the incidence of delirium and subsyndromal delirium was 22.9% and 17.1% respectively. Adverse outcomes such as increase in length of hospital stay, mortality, and discharge are independently associated with delirium. Efforts to prevent disease may identify patients who require clinical attention. Keywords: Delirium, subsyndromal delirium, risk factors

The Benefits of Integrated Exercise Intervention in Osteoporotic Women with Pre-Sarcopenia or Sarcopenia

目的：骨質疏鬆症與肌少症是高齡社會重要健康議題，與跌倒、骨折有高度相關。惟過去研究少以兩者合併個案進行評估，且運動介入模式多為阻力訓練。研究目的為評估整合性運動對骨質疏鬆症女性合併肌少症前期或肌少症（四肢骨骼肌指數，skeletal muscle index, SMI低於5.7kg/m^2）之效益，以作為骨質疏鬆症合併肌少症照護之參考。方法：採準實驗設計，在區域型醫院招募24位骨質疏鬆症併有肌少症前期或肌少症之婦女為研究對象，分成實驗組與控制組。兩組均接受面對面之營養衛教模式；實驗組進行16週整合性中高強度阻力與敏捷性運動訓練（自覺強度維持6－8分），每週一次，每次120分鐘。評估訓練介入前、後組內之身體組成（體脂肪率、上下肢肌肉量）、肌少症指標（SMI、握力）及功能性體適能（上下肢肌力、動靜態平衡）之變化，並控制年齡以單因子共變數或無母數統計進行組間分析。結果：實驗組12位（63.1±7.7歲）與控制組12位（70.1±6.1歲），兩組除年齡外，在基本資料無明顯差異。組內分析，實驗組體脂肪率、上下肢肌肉量、SMI、握力與上肢肌力均顯著改善；而控制組之體脂肪率、軀幹、右腿與左腿肌肉量均顯著變差，上下肢肌力亦明顯退步。組間分析顯示實驗組相較控制組體脂肪率顯著降低，且SMI、握力、上肢肌力、及下肢肌力之變化量均顯著較控制組提升。兩組在動態及靜態平衡上無顯著差異。結論：合併阻力與敏捷性之整合性運動對骨質疏鬆症合併肌少症前期或肌少症之婦女的身體組成、肌少症指標及上下肢肌力表現有實質提升效益，而無介入運動模式下，控制組在16週內體脂肪率增加、肌力下降。未來經更多著重骨質疏鬆症合併肌少症之實證研究，此整合性運動訓練模式或可作為介入和照護方向參考。Objective: Osteoporosis and sarcopenia are two important geriatric issues highly correlated with falls and frailty fractures in the elderly. Studies in the past rarely investigate the combined case of the two syndromes, and emphasis has been placed mainly on resistance training. This study aimed to investigate the benefits of integrated exercise interventions in osteoporotic women with pre-sarcopenia or sarcopenia (Skeletal Mass Index, SMI＜5.7 kg/m^2). Methods: Twenty-four osteoporotic women with pre-sarcopenia or sarcopenia were recruited from a regional hospital to participate in the quasi-experimental study. They were divided into an integrated exercise group (EG) and a control group (CG) with all participants receiving face-to-face nutrition education. The EG group was required to enroll in a 16-week moderate-to-vigorous intensity exercise program in resistance and agility training (Rating of Perceived Exertion maintained at 6-8 points). Each weekly session lasted for 120 minutes. Changes in body composition (body fat percentage, muscle mass), sarcopenia parameters (SMI, grip strength), and physical fitness (muscle strength, static and dynamic balance) before and after the integrated exercise intervention were analyzed with age as a covariate in the analysis. Results: Except for age, there was no significant difference in the basic characteristics between the EG (n=12; 63.1±7.7 years) and CG (n=12; 70.1±6.1 years) groups. Intragroup analysis showed a reduced body fat percentage , along with significant improvement in SMI, grip strength, and upper limb muscle strength in the EG group. In contrast, the CG group reported an increased body fat percentage, and a significant decrease in the muscle mass in the trunk and lower leg, as well as in the muscle strength in the upper and lower limbs. Intergroup analysis showed that the EG group experienced a significant improvement in body fat percentage, SMI, grip strength, and upper and lower limb muscle strength. There was no significant difference in the results of dynamic and static balance tests between the two groups. Conclusion: The integrated exercise intervention combined with resistance and agility training can substantially improve the body composition, sarcopenia parameters, and upper and lower limb muscle strength in osteoporotic women with pre-sarcopenia or sarcopenia. On the contrary, a significant increase in body fat percentage and a decrease in muscle strength in 16 weeks are likely to occur in the absence of the intervention. In the future, more empirical studies focusing on the combined case of osteoporosis and sarcopenia are needed, and the integrated exercise training in this study may serve as a reference for intervention.

Dementia: Trauma and loss of personhood vs Family as recuperative space.

The paper looks at the exploration in three Indian novels in English, of the hitherto glorified Indian family through the paradigm of dementia, examines the strained space called "home" in the shadow of dementia, and its transformation into a recuperative space with the help of support systems other than immediate family members. These three recent texts have discussed this crippling condition; which earlier authors shied away from. Anuradha Roy's The Folded Earth (2012), Ranjit Lal's Our Nana was a Nutcase (2015), and Pankaj Varma's Silver Haze (2014), focus on the life-changing effects of the deadly disease dementia. These literary texts opt for a non-medical approach through which the person suffering dementia is depicted, rather than dementia itself. The family becomes a narrative prism through which to view the changing equations in relationships, the erosion of the family structure, instead of the specific medical condition. In conclusion, one could say that families become the recuperative space for patients rather than medical facilities for long term care. These writers do not focus much on the medicalisation of dementia or geriatric health issues. They do mention medical treatments, but the spotlight is on the family, not on clinical viewpoints or medical approaches. Key words: Dementia, disorientation, trauma, deterioration, family space, caregivers.

Large-scale evaluation of a computer-based learning program to increase prison staff knowledge on geriatric and end-of-life care

PurposeThe purpose of this study is to continue research and development of the ECAD-P learning system with an emphasis on developing a scalable unit for testing in a larger number of more diverse correctional settings. There are almost 2.3 million US persons incarcerated. Geriatric and end-of-life (EOL) care in corrections is not as equitable as care in the free world. Technological delivery of geriatric training to staff through computer-based learning (CBL) offers a novel approach to improve care and reduce disparities among those who are most vulnerable during confinement.Design/methodology/approachThis mixed methods study built an interactive CBL for multidisciplinary staff to address EOL and geriatric issues in prisons. The CBL was iteratively built and tested prior to launching a full-scale evaluation using a pre/post-intervention design.FindingsEvaluation of the CBL occurred at 7 sites (i.e. 6 state prisons and 1 prison health-care vendor). A total of 241 staff were recruited with 173 completing post-tests. Outcomes were knowledge acquisition regarding care for aging and dying incarcerated persons (i.e. cognitive measure) and attitudes, motivations and values for providing care (i.e. affective measure). Cognitive and affective post-tests were significantly better than at pre-test (all ps < 0.01). ANCOVAs revealed no significant differences for sex or ethnicity.Originality/valueOutcomes reveal that the CBL is acceptable, feasible and usable in corrections. Staff improved their knowledge after receiving the training. Correctional settings face increasing pressures to better address the health care and management needs of aged, chronically ill and dying incarcerated persons. This e-learning holds promise to contribute to better preparation of corrections staff to effectively care for these populations.

Psychiatric Resident Perceptions of Competency in the Management of Social Isolation and Grief in Geriatric Patients

Psychiatric Resident Perceptions of Competency in the Management of Social Isolation and Grief in Geriatric Patients

Geriatric medicine and health care for older people in Australia.

Aged care coverage in Australia is universal but fragmented and has been challenged by government policy to deregulate aged care and open it up to market forces. A recent inquiry into aged care (Royal Commission into Aged Care Quality and Safety) documented the outcome of this policy-substandard care at most levels. The provision of services to older Aboriginal and Torres Strait Islander peoples, who have high prevalence of frailty and cognitive impairment, was also identified as inadequate. The effects of yet to be implemented changes in policy and funding in response to this report remain to be seen. Despite this policy backdrop, geriatricians have contributed to a steady growth in medical services and interventions focussed on specific geriatric issues such as dementia, falls, polypharmacy and orthogeriatrics. These are often driven by, or in collaboration with researchers, and aim to generate research data as well as provide patient care. The numbers of academic geriatricians and other aged care health professionals is increasing, and the training of specialist geriatricians now includes a significant research component.