Physicians In Geriatric Medicine Research Articles

The IOU Consensus Recommendations for Empirical Therapy of Cystitis in Nursing Home Residents.

To establish consensus recommendations for empirical treatment of uncomplicated cystitis with anti-infectives in noncatheterized older nursing home residents to be implemented in the Improving Outcomes of UTI Management in Long-Term Care Project (IOU) funded by the Agency for Healthcare Research and Quality. Two-round modified Delphi survey. Expert panel of 19 clinical pharmacists. Comprehensive literature search and development/review/edit of draft survey by the investigative group (one geriatric clinical pharmacist, two geriatric medicine physicians, and one infectious disease physician). The expert panel members rated their agreement with each of 31 recommendations for drugs of choice, dosing medications at various levels of renal function, drug-drug interactions to avoid, and duration of therapy by sex on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Consensus agreement was defined as a lower 95% confidence limit of 4.0 or higher for the recommendation-specific mean score. The response rate was 95% for the first round, and three recommendations achieved consensus (dosing for nitrofurantoin and trimethoprim/sulfamethoxazole in those without chronic kidney disease, and drug-drug interaction between trimethoprim/sulfamethoxazole and warfarin). In the second round, 90% responded and reached consensus on an additional eight recommendations (two for nitrofurantoin or trimethoprim/sulfamethoxazole as initial drugs of choice, three for dosing ciprofloxacin, nitrofurantoin, and trimethoprim/sulfamethoxazole at various levels of chronic kidney disease, and three drug-drug interactions to avoid: trimethoprim/sulfamethoxazole with phenytoin and ciprofloxacin with theophylline or with tizanidine). An expert panel of clinical pharmacists was able to reach consensus on a set of recommendations for the empirical treatment of cystitis with oral anti-infective medications in older nursing home residents. The recommendations were incorporated into a treatment algorithm for uncomplicated cystitis in noncatheterized nursing home residents and used in educational materials for health professionals in an ongoing controlled intervention study. J Am Geriatr Soc 67:539-545, 2019.

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.

Therapeutic use of compression stockings for orthostatic hypotension: an assessment of patient and physician perspectives and practices.

Elastic compression stockings (ECS) can be used as a non-pharmacological therapeutic option for older patients with orthostatic hypotension (OH). We aimed to investigate the practices and views of patients and physicians regarding the use of ECS for OH. Two surveys were designed. The first was sent to 90 patients known to have been prescribed ECS for OH. This questionnaire included items related to the frequency of use and issues related to non-compliance. The second was sent to 69 consultant physicians in geriatric medicine. This included items related to prescribing practices and perceived patient compliance. Sixty-seven patients responded (response rate, 74%) and of those 64% were female. Mean age (SD) was 75.1 years (10.5), range 45-91 years. Thirty-three per cent wore ECS daily, whereas 43% never used them. Over half (51%) of the patients reported difficulty in application and 31% reported discomfort. Those aged 75 or older were more likely to report difficulty in application (P=0.003). Forty-eight physicians responded (response rate, 70%). Eighty-nine per cent prescribe ECS for OH. There were significant differences between the frequency of use reported by patients and predicted by physicians (P<0.001), with physicians less likely to predict daily or non-use. Eighty-nine per cent of physicians predicted that difficulty in application was the main reason for non-compliance. Although prescribed frequently, the use of ECS in patients with OH is often limited by issues related to practicality. Physicians correctly predicted the main reasons for non-compliance although underestimated the scale of patient compliance with ECS.

Specialist geriatric medical assessment for patients discharged from hospital acute assessment units: randomised controlled trial

Objective To evaluate the effect of specialist geriatric medical management on the outcomes of at risk older people discharged from acute medical assessment units. Design Individual patient randomised controlled trial...

Assessment of factors that influence physician decision making regarding medication use in patients with dementia at the end of life

This study aimed to evaluate the extent to which patient-related factors and physicians' country of practice (Northern Ireland [NI] and the Republic of Ireland [RoI]) influenced decision making regarding medication use in patients with end-stage dementia. The study utilised a factorial survey design comprising four vignettes to evaluate initiating/withholding or continuing/discontinuing specific medications in patients with dementia nearing death. Questionnaires and vignettes were mailed to all hospital physicians in geriatric medicine and to all general practitioners (GPs) in NI (November 2010) and RoI (December 2010), with a second copy provided 3 weeks after the first mailing. Logistic regression models were constructed to examine the impact of patient-related factors and physicians' country of practice on decision making. Significance was set a priori at p ≤ 0.05. Free text responses to open questions were analysed qualitatively using content analysis. The response rate was 20.6% (N = 662) [21.1% (N = 245) for GPs and 52.1% (N = 38) for hospital physicians in NI, 18.3% (N = 348) for GPs and 36.0% (N = 31) for hospital physicians in RoI]. There was considerable variability in decision making about initiating/withholding antibiotics and continuing/discontinuing the acetylcholinesterase inhibitor and memantine hydrochloride, and less variability in decision making regarding statins and antipsychotics. Patient place of residence and physician's country of practice had the strongest and most consistent effects on decision making although effect sizes were small. Further research is required into other factors that may impact upon physicians' prescribing decisions for these vulnerable patients and to clarify how the factors examined in this study influence prescribing decisions.

Management of a 112-year-old patient with STEMI: A case-based short literature review

We report a case of a 112-year-old patient with segment on ECG (ST) elevation myocardial infarction complicated with acute cardiogenic shock and acute renal failure There is limited outcome data on the management of elderly patients age greater than 80years with acute coronary syndrome On the other hand, geriatric medicine physicians frequently facing to problems after successful coronary intervention such as cognitive impairment increased burden of patients care, polipharmacy related problems. Because the most of randomized controlled studies exclude elderly subjects, optimal management of these subjects remains unclear.

The care of older people during and after disasters: A review of the recent experiences in Queensland, Australia and Christchurch, New Zealand

Two major disasters hit Australasia in February this year. Physicians in Geriatric Medicine were involved, yet disaster management is not core knowledge for geriatricians. However, the experience and evidence described indicates we should increase our awareness of the issues for older people at times of disaster.

Analysis and evaluation of geriatricians' working routines in German hospitals

Geriatricians are physicians who work primarily with the elderly and deal with diseases that often accompany old age, such as Alzheimer's disease. In the last few years, data from questionnaires have demonstrated increasing criticism of geriatricians regarding their working conditions in geriatric medicine. Ideally, such rather subjective statements should be compared to data about work strain that is not merely accurate but also evaluated on an objective real-time basis. Therefore, the aim of the current study is to deliver exact data about geriatricians' work in different geriatric departments to evaluate their working routines and afterwards to optimize their working conditions. An observational real-time study was conducted by shadowing 15 physicians in geriatric medicine individually during weekday shifts at four hospitals in urban German settings. A total of 368 h of observations were recorded by using an ultra-mobile computer. The average workday lasted 9 h 36 min 14 s (95% CI = 9.07:35-10.01:23 h) with a high amount of elderly patients to deal with (M = 18) every day. Overall, they spent 14.75% of each workday on indirect patient care, 7.29% on direct patient care and 13.19% on administrative work. Communication took up 4.68% of geriatricians' time, breaks and disruptions 7.5%. To our knowledge, this is the first real-time analysis on how geriatricians deal with their working demands and how working routines are organized in geriatric hospital departments. Geriatricians' subjective statements on their working conditions have been partially confirmed. Improving geriatricians work flow could increase work efficiency, job satisfaction and quality of care.

The training of geriatricians in the United States: three decades of progress.

During the past 3 decades, significant progress has been made in preparing U.S. physicians to care for the growing elderly population. This paper reviews progress in training and certifying internists and family physicians in geriatric medicine. The establishment of the National Institute on Aging, a series of Institute of Medicine reports, Veterans Health Administration initiatives, and leadership and investment by the public sector and private foundations have supported the development of geriatric medicine training programs. In 1988, the Accreditation Council for Graduate Medical Education initially accredited 62 internal medicine (IM) and 16 family practice (FP) geriatric medicine fellowship programs. By academic year 2001-2002, 120 geriatric medicine fellowships were training 338 fellows. A recent survey of U.S. medical schools found a total of 869 full-time equivalent (FTE) geriatrics faculty members. Their geriatrics programs had a median of 5.0 FTE physician faculty members, with a range of 0 to 42. Recent surveys of IM and FP residency programs found 803 geriatrician faculty members teaching in IM residency programs (53% response rate) and 453 teaching in FP residency programs (75% response rate). From 1988 through 2002, 10,207 Certificates of Added Qualifications in Geriatrics were awarded. The distribution of these practicing geriatricians varied considerably by state, with the national average being 5.5 per 10,000 persons aged 75 and older. Individual state rates ranged from 2.2 to 15.9. Although geriatric medicine training has grown remarkably over the past 3 decades, this growth is still not producing the number of geriatricians needed to care for the growing elderly population. Thus, expanded investment in the training of geriatricians as faculty and practitioners is needed.

U.K. PHYSICIANS'ATTITUDES TOWARD ACTIVE VOLUNTARY EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE

A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization.

Age-Related Geriatric Medicine: Relevance of Special Skills of Geriatric Medicine to Elderly People Admitted to Hospital as Medical Emergencies

This study was carried out to find out how many patients aged 75 and over admitted to hospital as medical emergencies had features appropriate to care by physicians in geriatric medicine and to examine the extent of use of specialist facilities by these patients. The purpose was to examine criticisms of age-related admission policies which have focused on misplacement of patients with single diagnoses and lack of access to specialist care. An analysis was made of admission, process and discharge characteristics relevant to the special skills of geriatric medicine, multiple pathology and use of specialist services by 554 patients aged 75 and over. These were collected prospectively, consecutively admitted as medical emergencies via the accident and emergency department of a large district general hospital with an age-related (75 and over) medical admissions policy. 84 patients (15%) had single pathology and no characteristics suggesting the need for specialist geriatric care. 177 (32%) had single pathology and one or more specialized characteristics. 66 (12%) had multiple pathology alone. 227 (41%) had multiple pathology and specialized characteristics. There were 142 specialist referrals in 121 patients (22% of the whole sample). We concluded that the special skills of general physicians specializing in the medical and associated community problems of elderly people are highly relevant to patients aged 75 and over presenting as medical emergencies. There was no evidence of lack of involvement of specialists in their care.

Revised guidelines for collaboration between physicians in geriatric medicine and psychiatrists of old age

Since 1979, consultants in psychiatry of old age and geriatric medicine have used the excellent guidelines drawn up by Professor T. Arie and agreed by the Standing Joint Committee of the British Geriatrics Society and the Royal College of Psychiatrists to determine which patients each group should be responsible for. Then, as now, there were concerns that some patients might fall between two stools.

Upper gastrointestinal haemorrhage in the elderly: a record of 92 patients in a joint geriatric/surgical unit.

Ninety-two consecutive elderly patients suffering from acute gastrointestinal bleeding were studied over a 3-year period. All were admitted to a specially designated Geriatric/Surgical Ward under the care of consultant physicians in geriatric medicine. The nurses were trained to look after acute surgical and geriatric patients. Patients were aged between 65 and 93 years. All were managed jointly by the surgeons and physicians. Only 13 needed emergency surgery which was preceded by urgent endoscopy. The rest were managed conservatively with intravenous cimetidine and blood transfusions as required. The overall mortality was low at 5.4%. It is concluded that in a series of elderly patients with acute gastrointestinal bleeding the mortality was not high in a unit where the management was conservative and there was joint care between geriatricians and surgeons.

Geriatric medicine. From neonate to toddler.

Over the past five to ten years, geriatric medicine in the United States has grown from a neonate to a toddler, and, like a 2-year-old, it has begun to get into everything! Its importance to a number of specialties—especially internal medicine and family practice but also psychiatry, neurology, and physical and rehabilitative medicine—has been recognized by leaders in each of those fields. For example, on Nov 29, 1981, the American Board of Internal Medicine publicized 11 initiatives it had undertaken to signal the importance it attaches to excellent care of the aged by internists. Similarly, in 1983, the American Academy of Family Physicians developed a first-rate set of guidelines for training family practice physicians in geriatric medicine, which were endorsed by the American Geriatrics Society. The American Psychiatric Association established a Council on Aging some years ago, and the American Academy of Physical Medicine and Rehabilitation formalized a committee on

Collaboration between psychiatrists and physicians in geriatric medicine

Collaboration between psychiatrists and physicians in geriatric medicine

Collaboration between psychiatrists and physicians in geriatric medicine

Collaboration between psychiatrists and physicians in geriatric medicine

Home visiting of patients by physicians in geriatric medicine

Home visiting of patients by physicians in geriatric medicine

Home visiting of patients by physicians in geriatric medicine

Home visiting of patients by physicians in geriatric medicine

Home visiting of patients by physicians in geriatric medicine

Home visiting of patients by physicians in geriatric medicine

An evaluation of home visiting of patients by physicians in geriatric medicine.

The practice of preadmission home visiting of patients referred to geriatric medicine units has in recent years been criticised as being unnecessary on the grounds that if there is no waiting list there is no need for allocation of priority for admission; as being wasteful of doctors' time; as being resented by general practitioners; and as failing to provide adequate clinical information. The geriatric medicine department at the City Hospital with no waiting list for patients referred by general practitioners has retained home visits for most referrals because of the advantages in terms of acceptability to general practitioners (98-100%); the quantity and quality of information obtained; the usefulness of this information in deciding appropriate management and in planning discharge from hospital; and the provision of a unique teaching opportunity, which is highly valued by students and teachers alike.