Geriatric Issues Research Articles

Finnish and Turkish Nursing Students’ Attitudes Toward the Elderly

Introduction: This study was aimed to compared nursing students’ attitudes toward the elderly at two universities in Finland and Turkey. Materials and methods: A descriptive and comparative design was used. The study population included first and second year nursing students (N=1124). From this population, we selected a sample of 345 students, each of whom agreed to participate. We collected study data from a questionnaire form and the Kogan’s Attitudes Toward Older People scale. Results: The students’ mean age was 21.1 ± 4.2 and 83.5% were females. Considering the low dimensions, the Finnish students’ positive mean score was 59.3 ± 6.2 and that of the Turkish students was 60.6 ± 8.8. The mean negative score of Finnish students was 62.4 ± 5.5 and that of Turkish students was 59.1 ± 9.7. The Finnish students’ negative attitude mean score was statistically higher than that of the Turkish students (p < 0.005). Conclusion: Nursing students’ attitudes toward the elderly were moderate. Adding more curricula focused on geriatrics and geriatric patient care into the nursing education program, symposiums, panels, and conventions and increasing the available in-service training on geriatric issues is important to positively improve these students’ attitudes toward the elderly.

Prevalence of frailty and its associated factors in older hospitalised patients in Vietnam

BackgroundFrailty is an emerging issue in geriatrics and gerontology. The prevalence of frailty is increasing as the population ages. Like many developing countries, Vietnam has a rapidly ageing population. However, there have been no studies about frailty in older people in Vietnam. This study aims to investigate the prevalence of frailty and its associated factors in older hospitalised patients at the National Geriatric Hospital in Hanoi, Vietnam.MethodsProspective observational study in inpatients aged ≥60 years at the National Geriatric Hospital in Hanoi, Vietnam from 4/2015 to 10/2015. Frailty was assessed using the Reported Edmonton Frail Scale (REFS) and Fried frailty phenotype.ResultsA total of 461 patients were recruited (56.8% female, mean age 76.2 ± 8.9 years). The prevalence of frailty was 31.9% according to the REFS. Using the Fried frailty criteria, the percentages of non-frail, pre-frail and frail participants were 24.5, 40.1 and 35.4%, respectively. Factors associated with frailty defined by REFS were age (OR 1.05 per year, 95% CI 1.03–1.08), poor reported nutritional status (OR 4.51, 95% CI 2.15–9.44), and not finishing high school (OR 2.18, 95% CI 1.37–3.46). Factors associated with frailty defined by the Fried frailty criteria included age (OR 1.07 per year, 95% CI 1.05–1.10), poor reported nutritional status (OR 2.96, 95%CI 1.43–6.11), not finishing high school (OR 1.58, 95% CI 1.01–2.46) and cardiovascular disease (OR 1.76, 95% CI 1.16–2.67).ConclusionsWhile further studies are needed to examine the impact of frailty on outcomes in Vietnam, the observed high prevalence of frailty in older inpatients is likely to have implications for health policy and planning for the ageing population in Vietnam.

Blood transfusion in elderly patients with chronic anemia: a qualitative analysis of the general practitioners\u2019 attitudes

BackgroundBlood 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.MethodsTwenty 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.ResultsThe criteria for transfusion were hemoglobin level < 8 g/dL and cardiac comorbidities. Some geriatric issues, such as cognitive disorder or dependence, were considered, either as aspects of frailty favoring transfusion or as markers of reduced life expectancy that limit care. Falls and fear of an unpleasant death from anemia prompted GPs to order blood transfusion. The patient’s family provided guidance, but the patient was not routinely consulted. The specialists were rarely asked to participate in decision making. GPs’ perceptions were ambivalent: they considered transfusion to be extraordinary and magical, but also pointless since its effects are transient.ConclusionThe decision to give a transfusion to an elderly patient with chronic anemia is deemed complex, but GPs seem to take it alone, sometimes guided by the patient’s family. The drawing up of an advance care plan could help involve the patient in decision making.

Sustainability of a proactive geriatric trauma consultation service

Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012-December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.

Nurses’ attitudes and knowledge of the geriatric age issue

AimThe research aim was to map attitudes and knowledge of nurses regarding the issue of geriatric age and to find the influence of selected determinants influencing nurses’ knowledge. DesignThe work has a design of a cross-sectional quantitative study that is performed based on a questionnaire survey. MethodologyThe research group was formed of 100 nurses who were classified in the sample based on intentional selection. The quantitative research was performed with the help of two methodologies. The nurses’ attitudes towards seniors were measured based on the Fraboni Scale of Ageism (FSA); we gathered information regarding the nurses’ knowledge about the issue of geriatric age by the means of a questionnaire of our own structure. The influence of the selected determinants influencing the nurses’ knowledge of the geriatric age issue was verified based on the statistical tests: the Kruskal-Wallis test and the Spearman correlation coefficient. ResultsWith the help of the FSA questionnaire we found that 72% of the nurses have a slightly positive view of the elderly, i.e. almost no ageist attitudes. We found a medium level of ageist attitudes and thus slightly negative views of the elderly in 28% of the nurses. The knowledge level regarding the geriatric age issue in 14% of the nurses was excellent, in 36% of them it was very good, 29% had good knowledge, it was satisfactory in 12% and dissatisfactory in 9%. Based on the statistical tests, we found a correlation between the age (p=0.009), length of professional practice (p=0.017), and education (p=0.007) of the nurses and their knowledge of the geriatric age issue. ConclusionThe research results point to the need of comprehensive education for nurses in the area of geriatrics and gerontology with an emphasis on an individual approach and non-generalisation of individuals within the whole senior population.

Surgery in the older person: Training needs for the provision of multidisciplinary care

Introduction Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. Methods We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. Findings The number of older people undergoing surgery is increasing at a rate faster than the proportion of older people in the overall population. Management of the older surgical patient throughout the surgical pathway forms part of the Specialty Training Curriculum for Geriatric Medicine. While 'surgery in childhood' continues to form part of the general surgical higher training syllabus, surgery in the later years of life does not. There are limited postgraduate courses and training opportunities currently available to surgeons in this field. There is clear societal need to address perioperative care for older surgical patients, which has proved successful in some centers. Moreover, surgical trainees support the inclusion of geriatric medicine issues into their training. Conclusions The ageing population requires a multidisciplinary perioperative approach, with dedicated and appropriately trained clinicians and allied health care professionals to improve outcomes.

Evaluation and establishment of a ward-based geriatric liaison service for older urological surgical patients: Proactive care of Older People undergoing Surgery (POPS)-Urology.

To assess the impact of introducing and embedding a structured geriatric liaison service, Proactive care of Older People undergoing Surgery (POPS)-Urology, using comprehensive geriatric assessment methodology, on an inpatient urology ward. A phased quality improvement project was undertaken using stepwise interventions. Phase 1 was a before-and-after study with initiation of a daily board round, weekly multidisciplinary meeting, and targeted geriatrician-led ward rounds for elective and emergency urology patients aged ≥65 years admitted over two 1-month periods. Outcomes were recorded from medical records and discharge documentation, including length of inpatient stay, medical and surgical complications, and 30-day readmission and mortality rates. Phase 2 was a quality improvement project involving Plan-Do-Study-Act cycles and qualitative staff surveys in order to create a Geriatric Surgical Checklist (GSCL) to standardize the intervention in Phase 1, improve equity of care by extending it to all ages, improve team-working and streamline handovers for multidisciplinary staff. Phase 1 included 112 patients in the control month and 130 in the intervention month. The length of inpatient stay was reduced by 19% (mean 4.9 vs 4.0 days; P = 0.01), total postoperative complications were lower (risk ratio 0.24 [95% confidence interval 0.10, 0.54]; P = 0.001). A non-significant trend was seen towards fewer cancellations of surgery (10 vs 5%; P = 0.12) and 30-day readmissions (8 vs 3%; P = 0.07). In Phase 2, the GSCL was created and incrementally improved. Questionnaires repeated at intervals showed that the GSCL helped staff to understand their role better in multidisciplinary meetings, improved their confidence to raise issues, reduced duplication of handovers and standardized identification of geriatric issues. Equity of care was improved by providing the intervention to patients of all ages, despite which the time taken for the daily board round did not lengthen. This is the first known paper describing the benefits of daily proactive geriatric intervention in elective and emergency urological surgery. The results suggest that using a multidisciplinary team board round helps to facilitate collaborative working between surgical and geriatric medicine teams. The GSCL enables systematic identification of patients who require a focused comprehensive geriatric assessment. There is potential to transfer the GSCL package to other surgical specialties and hospitals to improve postoperative outcomes.

Assessing Educational Needs in Geriatric Care in Ophthalmology: A Single Academic Institution Study

Purpose The purpose of this study was to assess the educational needs in geriatric care among practicing and training eye care providers at a single academic institution, the Flaum Eye Institute, at the University of Rochester Medical Center. Methods Data were collected using a voluntary and anonymous electronic survey that was distributed to 35 training and practicing eye care providers. Results Of the 35 distributed surveys, 27 (77%) were returned. Respondents included 6 residents-in-training and 17 practicing providers, based on those who reported demographics. Overall, respondents reported that most of their patients were older than 65 years (mean, 66.4%). Notably, 63% of providers felt they received very little to no prior education in geriatric care. Only 46.4% reported having a moderate level of interest in geriatric issues. While respondents reported high confidence levels in many geriatric domains, they reported moderate to low confidence levels in several others, including conducting cognitive and functional assessments, assessing and reducing the risk for falls and driving accidents, recognizing depression, and understanding the roles of long-term care and home services, social supports, and geriatric rehabilitation. Differences were also observed in confidence levels between residents-in-training and practicing providers in several geriatric domains. Conclusion At this single academic institution, current practicing and training ophthalmologists reported having limited prior education in geriatric care and identified many opportunities for geriatric education. While larger-scale studies need to be conducted to produce more generalizable results, this pilot study serves as a guide to augment geriatric education and training of ophthalmologists and improve the quality of eye care for the rapidly growing aging U.S. population.

Utilization of Old Age Homes and Geriatric Issues in India

Utilization of Old Age Homes and Geriatric Issues in India

Normative Scores for Standard Neuropsychological Tests in the Oldest Old From the French Population-Based PAQUID Study.

There is an obvious lack of validated norms for elderly persons aged 85 and older for the large majority of the neuropsychological tests used in clinical practice. Yet this range of "oldest-old" individuals drastically increases worldwide and is the more likely to develop dementia. Providing clinicians validated and updated norms to accurately evaluate cognitive functioning in this population is an important issue in geriatrics. This study provides normative scores for 7 neuropsychological tests commonly used in clinical practice. Data were collected in a sample of 283 subjects aged 85 and older, included in the PAQUID study, a population-based cohort conducted in France. Normative scores were calculated according to 2 age ranges and 2 educational levels, and are presented in percentiles. The norms provided in the present study involve 7 tests that are widely used in the neuropsychological assessment of geriatrics populations and should be of help for clinicians.

Physical frailty predicts medical expenses in community-dwelling, elderly patients: Three-year prospective findings from living profiles of older people surveys in Korea

BackgroundWith an aging population, medical expenses for elderly patients are increasing rapidly. Frailty is currently considered an important issue in geriatrics. The purpose of this study was to investigate the effect of frailty on medical expenses in elderly Korean patients. Material and methodsData were gathered from the 2008 and 2011 living profiles of older people surveys (from August 11, 2008 to February 20, 2012) and included 5303 community-living Korean men and women, aged 65 years or older. The five-item frailty index was comprised of items on weight loss, exhaustion, weak grip strength, slow walking speed, and low physical activity. Frailty data were extracted from the 2008 living profiles of older people survey, and out-of-pocket medical expenses data were extracted from the 2011 living profiles of older people survey. A generalized linear model was used to analyze the correlation between frailty and medical expenses after adjusting for sociodemographics, health behavior, and health status factors. ResultsBaseline frailty assessments grouped patients as robust (43.3%), prefrail (49.3%), and frail (7.4%). After adjusting for sociodemographics, health behavior, and health status variables, frailty was found to increase out-of-pocket medical expenses (robust: ref., prefrail: β=0.087 and P<0.001, frail: β=0.143 and P<0.001). ConclusionOur findings suggested that frailty is an independent predictor of increasing medical expenses in community-dwelling elderly patients.

Medical Students in a Dementia Care Facility: an Enhanced Geriatric Psychiatry Experience.

The 2012 Institute of Medicine report “The Mental Health and SubstanceUseWorkforce For Older Adults: InWhoseHands?” describes the burgeoning population of elderly in the USA and the critical shortage of clinicians trained to meet their mental health-care needs [1]. The report makes specific recommendations for strengthening the nation’s geriatric mental health workforce and urges development of model curricula for the entire spectrum of health-care providers who care for older adults. With the current shortage of specialist physicians in this field, in the future most geriatric mental health care will be provided by non-specialists. It is imperative that medical school education include an enhanced focus on preparing future physicians to address the mental health needs of older patients. Negative attitudes and stigma toward older patients with dementia are pervasive among medical students and other health professions [2]. Despite the tremendous demand for geropsychiatric care for people with dementia, the number of medical school graduates choosing to enter the field of geriatric psychiatry is woefully inadequate [3]. Studies document that clinical encounters with older patients have a positive effect on students’ sensitivity to geriatric issues and attitudes toward older people [2, 4]. In one study, researchers suggest that geriatric psychiatry programs create exemplary initiatives in the early years of medical education [5]. We developed an educational innovation, the Enhanced Geropsychiatric Experience (EGE) for third yearmedical students in a dementia care facility, which exposed students to patients with dementia with behavioral and psychological symptoms. Goals included increasing student participation and comfort, changing negative attitudes towards patients with dementia, and piquing student interest in the field of geriatric psychiatry.

Do Surgical Trainees Believe They Are Adequately Trained to Manage the Ageing Population? A UK Survey of Knowledge and Beliefs in Surgical Trainees

Increasing numbers of older patients are undergoing surgery. Older surgical patients are at a higher risk of perioperative complications and mortality. Multimorbidity, frailty, and physiological changes of ageing contribute to adverse outcomes. These complications are predominantly medical, rather than directly surgical. Guidelines recommend preoperative assessment of comorbidity, disability, and frailty in older patients undergoing surgery and closer perioperative collaboration between surgeons and geriatricians. We conducted a survey to assess knowledge and beliefs of surgical trainees toward common perioperative problems encountered in older surgical patients. Paper-based survey. Unselected UK surgical training-grade physicians (CT1-ST8) attending the 2013 Congress of The Association of Surgeons of Great Britain and Ireland, Glasgow, UK, May 1-3, 2013. A total of 160 eligible UK surgical trainees attending the conference were invited to participate in the survey. Of them, 157 participated. Of the trainees, 68% (n = 107) reported inadequate training and 89.2% (n = 140) supported the inclusion of geriatric medicine issues in surgical curricula. Of the respondents, 77.2% (n = 122) were unable to correctly identify the key features required to demonstrate mental capacity, and only 3 of 157 respondents were familiar with the diagnostic criteria for delirium. Support from geriatric medicine was deemed necessary (84.7%, n = 133) but often inadequate (68.2%, n = 107). Surgical trainees support closer collaboration with geriatric medicine and shared care of complex, older patients (93.6%, n = 147). UK surgical trainees believe that they receive inadequate training in the perioperative management of complex, older surgical patients and are inadequately supported by geriatric medicine physicians. In this survey sample, trainee knowledge of geriatric issues such as delirium and mental capacity was poor. Surgical trainees support the concept of closer liaison and shared care of complex, older patients with geriatric medicine physicians. Changes to surgical training and service development are needed.

Systemic model of chronic benzodiazepine use among mature adults

Objectives: Our goal was to build a systemic model of chronic use among community-dwelling mature benzodiazepine (BZD) users. BZDs are commonly prescribed for symptoms of anxiety and/or insomnia despite their documented side effects over time.Method: We conducted in-depth interviews with 23 mature (50 years and over) users, 14 women and 9 men, as well as 9 general practitioners and 11 pharmacists. We chose the grounded theory approach for our analysis.Results: Results yielded a systemic model of chronic BZD use, illustrating onset and maintenance of use, and taking into account individual life context, intervening conditions (e.g. family and doctor--patient interactions) and structural factors (medicalization, ageism, influence of the media and pharmaceutical industry, etc.). Based on our findings, we suggest that intervention should go beyond medical issues and extend to the individual's perception of aging in the modern society, as well as attitudes of families and health professionals regarding long-term BZD use. Family members should be involved in the weaning process and adoption of new life habits. General practitioners should be better trained regarding geriatric psychosocial issues and offer alternatives to prescribe psychotropic drugs such as cognitive behavior therapy for insomnia. Also, as a society, we should reconsider the highly medicalized stance we take to compensate for age-related losses. The influential role of the pharmaceutical industry in the process is discussed.Conclusion: We conclude that a predominantly biomedical perspective on human development diminishes patient-centered care within a socially contextualized, individual perspective.

Ethical issues in Geriatrics

Ethical issues in Geriatrics

Profile of cognitive impairment and health status of the elderly in a sub-Saharan African community: relevance to public policy and health service design

Background: There is scanty report on the cognitive impairment and health status of the elderly in the sub-saharan African community. Objective: This study is to investigate the pattern of cognitive impairment and health morbidities among the elderly in a sub-Saharan African community. Methods: A household survey was conducted among 350 elders. They were interviewed with a questionnaire to ascertain their socio-demographic and health status information. Subsequently, the modified Mini-Mental State Examination [MMSE] was administered to elicit cognitive impairment based on cut-off score ≥13. Results: The mean MMSE score among participants was 20.7(±5.3) and about one-tenth of them 38(10.9%) had cognitive impairment. Of the study sample, 44% reported physical health morbidities; hypertension (23.2%), diabetes mellitus (10%) and visual impairment (5.4%) were the most frequently occurring morbidities. Cognitive impairment was associated with increasing age and most prevalent among the middle olds [70-79 years] ( p <0.001), while formal education seems protective ( p =0.022). Likewise, those with formal education were more likely to report medical illnesses ( p =0.004). Following logistic regression to control for effects of confounders, absence of formal education (Odd Ratio [OR] =0.465; 95% Confidence Interval [95%CI] =0.207-1.046) and increasing age ([OR] =6.617; 95%CI= 3.129- 13.993) were independent predictors of impairment in cognitive function. Conclusion: A high burden of cognitive impairment along with health morbidities was prevalent among the elderly; while increasing age and formal education were the identifiable determinants. Evolvement of public policies, health resource planning and service design to address geriatric health issues using age-related prioritization model are advocated. Similarly, the promotion of population literacy is indicated as it seems to have positive, long-lasting socioeconomic as well as health effects into old age. Further research is also justified. Keywords: Africa; Cognitive impairment; Health service; Morbidity; Public policy

Developing a curriculum map for suicide prevention in geriatric education. Preventing suicides among elderly

Nowadays, using curriculum mapping is dramatically increased in planning education programs of medical faculties in the world. The aim of present study was to develop a curriculum map for geriatric education after analyzing mostly seen forensic health problems in elderly. In Izmir Forensic Group Presidency, characteristics of geriatric age group autopsies were evaluated retrospectively between January and December 2006. We identified suicide as one of the most predominant health problems and developed a curriculum map for geriatric education for prevention of elderly suicide. Analysis of the total 1595 patients, 150 (9.4%) were in the geriatric population. 95 patients (63.3%) were male (mean age 73.3±6.5), and 55 (36.7%) were women (mean age 76.2±7.2). The origins of deaths were as fallows; natural (n=67, 44.7%), suicide (n=22, 14.7%), home accidents (n=16, 10.7%), homicide (n=12, 8%), traffic accidents (n=11, 7.3%) unidentified (n=21, 14%). We gave high priority in the interest of designing a curriculum map for preventing suicide deaths in elderly. We emphasize that development of education programs for prevention of forensic geriatric deaths (suicides, accidents, etc.) will be increasingly needed in 21 th century. Development of new theories and concepts in designing education programs in the field of geriatrics has forced medical educators to update their geriatrics curriculum plans. Present study addresses how to design a curriculum map as a reference in planning medical education programs on different emerging geriatric issues.

Cancer treatment in elderly patients: evidence and clinical research

In 2020 the percentage of patients with a diagnosis of cancer in people with more than 65 years will exceed 70% and 28% in ethnic minorities. The treatment of cancer in these populations is challenging for the oncologists due to socio-economic issues such as poverty, reduced access to the hospital care, level of education. The clinical pathway "diagnosis-treatment-cure", typical of the care of young patients has to be integrated in elderly patients with a more individualized treatment by means of comprehensive geriatric assessment (CGA). IADL (Instrumental Activities of Daily Living) have the best predictive role in oncological setting and their impairment significantly correlate with overall survival, chemotherapy toxicities and thirty days postoperative morbidities. The CGA is universally accepted as the most appropriate instrument to analitically evaluate the age related problems of elderly patients. The role of CGA is crucial to identify geriatric issues not easily diagnosed, to predict treatment toxicities, functional or cognitive decline, post operative complications and to estimate life expectancy. The CGA items are predictive of severe toxicity, however it is not clearly established which are the best performers and the best cut-offs points. Today CGA is integrated with physical performance tests (the most widely used is the "time up and go" test) and laboratory assay of Interleukin 6 and D-Dimer that correlate with mortality and physical decline. There are few prospective studies that evaluated the role of CGA in treatment choice. The first is a phase II study in solid tumors, the second is a haematological trial on non Hodgkin lymphoma. The largest trial is a 571 patients observational series that confirmed the role of CGA in decision making. The administration of CGA is time consuming and consequently some screening tools were developed. VES-13 is a 13 items tool that explores prevalently the functional status and the self reported health status. VES-13 showed a good sensibility (87.3%) but a low specificity (62%) with respect to CGA for the diagnosis of patients with disabilities. Overcash et al. proposed an abbreviated form of CGA using a reduced number of items of ADL, IADL, MMSE and GDS. There was a good correlation between complete and reduced scales (coefficient of correlation 0.8). G8 is a screening tool composed of 8 questions that explore functional, cognitive and nutritional status. The score with the best equilibrium between sensibility and specificity was 14 (sensibility 85% and specificity 65%). In the first observational trial age, hystotype, chemotherapy dose, haemoglobin (man: 11 g/dL; women: 10 g/dL), creatinine clearance less than 34 mL/min (Jelliffe formula), earing problems, at least a fall in the last six months, walking problems, low social activity, were related to a major risk of toxicity; in another trial IADL, diastolic blood pressure, LDH and MAX2 index were predictive of haematological toxicity, while performance status, Mini-Mental Status score, Mini-Nutritional Assessment (MNA) score and MAX2 index were predictive of non haematological toxicity. Based on these parameters a 0-2 score was developed. A recent "position article" of EORTC (European organization for Research and Treatment of Cancer) and SIOG analyzed the pro and the contra of the use of some indicators in elderly patients. The overall survival (OS) frequently used in classical clinical trial could give wrong messages as there are some competitive risks of death in elderly patients. Another important indicator is the disease specific survival (DSS). Concerning the design of clinical trials, a possible strategy is to enrol elderly patients without upper age limit and to plan stratification. An interesting trial design is the so called "extended trial" that allow to re-open the arm of a trial in which a too low number of older patients was enrolled.

Patient-reported geriatric symptoms as risk factors for hospitalization and emergency department visits.

There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year.

Poor functional recovery after delirium is associated with other geriatric syndromes and additional illnesses.

Delirious individuals are at increased risk for functional decline, institutionalization and death. Delirium is also associated with other geriatric syndromes, behavioral care issues, and new illnesses. The objectives of this study were to determine how often certain geriatric syndromes, care issues, and additional diagnoses occur in delirious individuals, and to see whether they correlate with worse functional recovery. Consecutive delirious older medical in-patients (n = 343) were followed for the occurrence of geriatric syndromes (falls, pressure ulcers, poor oral intake, and aspiration), care issues (refusing treatments or care, need for sitters, security services, physical restraints, and new neuroleptic medications) and additional diagnoses occurring after the third day of admission. Poor functional recovery was defined by any one of death, permanent institutionalization or increased dependence for activities of daily living (ADLs) at discharge or three months after discharge from hospital, elicited through chart review or a follow-up telephone interview. Poor functional recovery was seen in 237 (69%) delirious patients. Geriatric syndromes and additional illnesses were common and associated with poor functional recovery (falls in 21%, adjusted OR 2.27; possible aspiration in 26%, adjusted OR 3.06; poor oral intake in 49%, adjusted OR = 2.31; additional illnesses in 38%, adjusted OR 3.54). Care issues were also common (range 9%-54%) but not associated with poor recovery. Geriatric syndromes, behavioral care issues and additional illnesses are common in delirium. Future studies should assess whether monitoring for and intervening against geriatric syndromes and additional illnesses may improve functional outcomes after delirium.