Group Of Geriatric Patients Research Articles

Long-term clinical outcomes of drug-eluting stents vs. bare-metal stents in Chinese geriatric patients.

Background & objectiveLittle is known about the relative efficacies of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and bare-metal stents (BMS) in elderly patients. The objective of this study was to evaluate the clinical outcome for geriatric patients who received either DES or BMS.MethodsFrom January 2002 to October 2005, 199 consecutive Chinese geriatric patients (≥ 75 years old) underwent PCI with coronary DES or BMS implantation at our institution. We analyzed the major clinical end points that included all-cause mortality, cardiovascular death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, and bleeding complications.ResultsThe three-year cumulative rates of all-cause mortality, cardiovascular death, and myocardial infarction were significantly lower in the DES group (6.3%, 3.6%, 5.4%) compared with the BMS group (16.2%, 11.5%, 14.9%; P < 0.05). No significant differences were found in the three-year cumulative rate for target lesion revascularization (6.3% vs. 4.6%, P = 0.61) or stent thrombosis (3.6% vs. 2.3%, P = 0.70). Likewise, there were no statistically significant differences in the cumulative rate for intracranial hemorrhage, or major and minor hemorrhage at three years.ConclusionsDES-based PCI was associated with a significant reduction in the three-year cumulative rate of all-cause mortality, cardiovascular death, and myocardial infarction compared with BMS, without increased risk of TLR, stent thrombosis, or bleeding complications at three years in this group of Chinese geriatric patients.

Aminoglycosides use in elderly population: A retrospective observational study in 38 centers in France

for influenza, 14.9% (n: 23) for tetanus, 11.7% (n: 18) for pneumococcus. The percentage of patients who were vaccinated for once, twice and thrice were 61.3%, 29%, 9.7%, respectively. Considering chronic disease, there wasn’t a statistically significant difference among the pneumococcus, tetanus and influenza vaccination rates in the patients. Conclusion and discussion.– We determined that the vaccination rates of influenza, pneumococcus and tetanus in geriatric patient groups were lower than indicated.

Nurse’ prediction prevention and management on post-operative delirium in geriatric patients with hip fracture: The development of a protocol to guide care

BackgroundA high prevalence for the development of delirium after hip fracture was found in the group of geriatric patients. The National Institute for Health and Clinical Excellence has introduced a guideline for the management delirium (NICE, 2010). Protocols composed of detection, prevention and management of post-operative delirium required some adaptation to meet the needs of local nurses. AimA protocol with a nursing care plan referenced from an international guideline and other literature was developed to predict, prevent and manage post-operative delirium for geriatric patients with hip fracture. MethodsThe literature suggests numerous risk factors are associated with post-operative delirium and its preventive interventions were adopted to develop the protocol and nursing care plan. FindingsSix major risk categories included mental and behavioural influence, sensory impairment, physiological influence, immobility influence, electrolyte disturbance and infection influence. These were used for screening patients, accompanied by various preventive interventions. A protocol was developed to strive for the best management of geriatric patients receiving hip fracture surgery from admission to discharge. ConclusionsThe protocol incorporated with the Risk Assessment for Management of Postoperative delirium (RAMP) care plan was adapted for staff to implement in their local clinical area. Further study is required to determine its effectiveness on the prevention of the development of post operative delirium (POD) in the future.

A depressive endophenotype of mild cognitive impairment and Alzheimer's disease.

BackgroundAlzheimer’s disease (AD) is a devastating public health problem that affects over 5.4 million Americans. Depression increases the risk of Mild Cognitive Impairment (MCI) and AD. By understanding the influence of depression on cognition, the potential exists to identify subgroups of depressed elders at greater risk for cognitive decline and AD. The current study sought to: 1) clinically identify a sub group of geriatric patients who suffer from depression related cognitive impairment; 2) cross validate this depressive endophenotype of MCI/AD in an independent cohort.Methods and FindingsData was analyzed from 519 participants of Project FRONTIER. Depression was assessed with the GDS30 and cognition was assessed using the EXIT 25 and RBANS. Five GDS items were used to create the Depressive endophenotype of MCI and AD (DepE). DepE was significantly negatively related to RBANS index scores of Immediate Memory (B=-2.22, SE=.37, p<0.001), visuospatial skills (B=-1.11, SE=0.26, p<0.001), Language (B=-1.03, SE=0.21, p<0.001), Attention (B=-2.56, SE=0.49, p<0.001), and Delayed Memory (B=-1.54, SE = 037, p<0.001), and higher DepE scores were related to poorer executive functioning (EXIT25; B=0.65, SE=0.19, p=0.001). DepE scores significantly increased risk for MCI diagnosis (odds ratio [OR] = 2.04; 95% CI=1.54-2.69). Data from 235 participants in the TARCC (Texas Alzheimer’s Research & Care Consortium) were analyzed for cross-validation of findings in an independent cohort. The DepE was significantly related to poorer scores on all measures, and a significantly predicted of cognitive change over 12- and 24-months.ConclusionThe current findings suggest that a depressive endophenotype of MCI and AD exists and can be clinically identified using the GDS-30. Higher scores increased risk for MCI and was cross-validated by predicting AD in the TARCC. A key purpose for the search for distinct subgroups of individuals at risk for AD and MCI is to identify novel treatment and preventative opportunities.

Arterial hypertension and electrocardiographic diagnosis of left ventricular hypertension in the group of geriatric patients with coronary heart disease living in the far north

As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among geriatric patients is isolated systolic arterial hypertension (ISAH). The comparison of two ethnic groups of the population has showed higher levels of systolic and diastolic blood pressure (SBP and DBP) in the group of patients of non-indigenous nationality, rather than Yakut patients. Correlation was recorded in the group of non-indigenous patients as they age. Significant increase in the level of SBP was identified in the group of senile and long-livers than in the elderly. Detection of ECG signs of LVH showed the lowest specificity of Cornell voltage criterion comparing to Sokolow-Lyon criterion with its more often occurrence. ECG-signs of left ventricle hypertrophy are significantly more often established by Sokolow-Lyon criterion for men, Cornell voltage—for women. Correlation has been found between the presence of LVH and combination of Cornell voltage criterion with both Gubner-Ungerleider and Sokolow-Lyon criteria.

Quantitative analysis of periodontal pathogens present in the saliva of geriatric subjects

PurposeAt present, information regarding periodontal disease in geriatric patients is scarce. The purpose of this study was to quantify the periodontal pathogens present in the saliva of Korean geriatric patients and assess the relationship between the bacterial levels and the periodontal condition.MethodsSix putative periodontal pathogens were quantified by using a real-time polymerase chain reaction assay in geriatric patient groups (>60 years) with mild chronic periodontitis (MCP), moderate chronic periodontitis (MoCP), and severe chronic periodontitis (SCP). The copy numbers of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, and Prevotella intermedia were measured.ResultsIt was found that the bacterial copy numbers increased as the severity of the disease increased from MCP to SCP, except for P. intermedia. For P. intermedia, it was found that samples in the MCP group yielded the largest amount. It was also found that the quantities of P. gingivalis, T. forsythia, and T. denticola, the so-called "red complex" bacteria, were lower than those of F. nucleatum, A. actinomycetemcomitans, and P. intermedia in all of the samples.ConclusionsCollectively, the results of this study suggest that the levels of P. gingivalis, T. forsythia, F. nucleatum, and T. denticola present in saliva are associated with the severity of periodontal disease in geriatric patients.

Preconsent Video-Assisted Instruction Improves the Comprehension and Satisfaction in Elderly Patient Visiting Pain Clinic

BackgroundElderly patients visiting pain clinic may be at greater risk of misunderstanding the explanation because of age-related cognitive decline. Video instruction may provide a consistent from of teaching in a visual and realistic manner. We evaluated the effect of educational video on the patient understanding and satisfaction in a group of geriatric patients visiting pain clinic.MethodsNinety two patients aged more than 60 years old who were scheduled for transforaminal epidural block were recruited. After exposure to either video or paper instruction process, each patient was asked 5-item comprehension questions, overall satisfaction and preference question. During follow-up period, number of outpatient referral-line call for further explanation was counted.ResultsWe observed significantly better comprehension in the video education compared with paper instruction (P < 0.001). Patient satisfaction was also higher in the video group (P = 0.015), and patients visiting pain clinic were more preferred video instruction (P < 0.001). Proportion of referral-line call for further explanation were similar (P = 0.302).ConclusionsVideo approach to instruction process before consent improves treatment comprehension in geriatric patient visiting pain clinic.

Handgrip strength measurement as a predictor for successful dry powder inhaler treatment

More than 10% of elderly people suffer from chronic obstructive pulmonary disease (COPD). Drug treatment for COPD involves inhalants. Dry powder inhalers (DPIs) have proven easiest for the elderly to use. Their effectiveness is dependent, however, on the inspiratory flow which can be generated, and it is unclear which geriatric assessment parameter permits inspiratory flow to be assessed. In a randomly generated group of geriatric hospital patients, manual strength was measured as a complement to basic geriatric assessment and inspiratory flow assessed using a Turbohaler trainer. A total of 87 (27%) men (mean age 81 ± 7 years) and 231 (73%) women (mean age 82 ± 8 years) were included in the study. The threshold value of 40 l/min for minimum inspiratory flow was achieved by 194 (61%) of the patients. Manual strength was the only assessment parameter to correlate with the minimum inspiratory flow achieved. ROC analysis produced a threshold value for manual strength of 10 kg. The sensitivity and specificity for this threshold value were 70% each, while the positive and negative predictive values were 79% and 84%, respectively. A threshold value of 10 kg for manual strength enables the inspiratory flow achievable by elderly patients to be predicted satisfactorily. This is the only parameter which correlates sufficiently with inspiratory flow. Manual strength should be measured in all geriatric patients with COPD and should be taken into account when deciding whether or not to initiate differential treatment.

Valutazione qualitativa e quantitativa della placca batterica in pazienti geriatrici sottoposti a trattamento ortodontico-protesico

Objectives The purpose of this study is to assess qualitative and quantitative changes in the bacterial flora of the oral cavity in a group of geriatric patients receiving preventive dental care in the Milan School. Materials and methods Before undergoing orthodontic therapy, geriatric patients are enrolled in a preventodontic program that includes an initial 4-month phase of education, motivation, and prevention. During this period, the patient attends hygiene training sessions and, when necessary, receives a more complete periodontal evaluation. The program is divided into six levels, and the patient is allowed to repeat each level three times. The study included a sample of 42 patients. Samples of plaque obtained from the lingual surfaces of tooth 46 at various stages of the preventive program were evaluated quantitatively and qualitatively. Results The study shows that progression through the various phases of the program was accompanied by significant decreases in the plaque index. The qualitative assessment revealed decreases in total cocci and bacilli. Conclusions This study demonstrates the importance of the dental hygienist who accompanies the patient throughout the preventive protocol. The role of the hygienist is to educate, motivate, and reinforce the motivation of the patient whose mouth is often in suboptimal condition at the beginning of the orthodontic therapy.

P02-212 - Genetical realtions of social loneliness in geriatric patients

Loneliness affects both psychical and physical health and among geriatric patients can be serious. Social loneliness, anxiety-related personality traits, risk of developing depression, alcoholism or suicidal behavior could be associated with a functional variant in the serotonin transporter. Serotonin transporter gene length polymorphism (5-HTTLPR) is associated with changes of serotonin transporter activity and is one of the major factors which contribute to the etiology of many psychiatric disorders. The aim of the study was to found possible differences in distribution of variants in two groups of geriatric patients (average age 80 years).Group of 300 probands were examined for 5-HTTLPR variants. Blood samples were randomly collected from 150 elderly males and 150 elderly females. The elderly individuals were not related and lived in the same geographic region as the control newborns and the young adults. Two groups were defined - ambulatory (apparently healthy, 65 males and 70 females) and non-ambulatory (have no people who could take care about them, having chronic diseases and depend on geriatric care, 85 males and 80 females) people. Bialelic and trialelic dividing of 5-HTTLPR was considered. Length polymorphism was analyzed (L or S variant) and single nucleotide polymorphism was detected (LA or LG variant).A significant difference was found in allele distribution of 5-HTTLPR in two groups of patients. Ambulatory group of patients had higher occurrence of L allele and also LA allele. The results of the study suggest that social loneliness may have some personality predictors that may have its genetical correlates.

A comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorphanol in combination with bupivacaine for endoscopic urological surgery.

Background:The objective of the present study was to compare the onset, degree and recovery time of sensory and motor block and hemodynamic effects of intrathecal bupivacaine alone and bupivacaine with sufentanil or butorphanol in endoscopic urological surgeries.Methods:In a randomized, double-blind study, 90 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective endoscopic urological surgeries under spinal anesthesia, were allocated into three groups of 30 each. Patients received either 2.5 ml of 0.5% hyperbaric buypivacaine 12.5 mg (Group A), 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 10 μg sufentanil (Group B) or 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 25 μg butorphanol (Group C). Vital parameters, level, duration and regression of sensory block and motor block and side-effects were recorded and compared.Statistical Analysis:Analysis of variance (ANOVA), post hoc test and Chi-square test were used.Results:Intrathecal addition of sufentanil/butorphanol prolonged the duration of sensory block (DOSB) compared with bupivacaine alone (DOSB being 156.83±23.83 min, 170.87 ± 22.21 min and 171.17 ± 23.99 min in groups A, B and C, respectively) without altering the duration of motor blockade. Bromage score 3 was achieved in 100%, 90% and 54.4% patients in groups A, B and C, respectively. The time to first request for analgesia was 112 ± 46.3 min, 323 ± 65.0 min and 299 ± 73.9 min in groups A, B and C, respectively. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus (60%).Conclusions:The analgesia was significantly prolonged in groups B and C; group C had a less-intense motor block. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus. Thus, this combination of butorphanol with low-dose bupivacaine is especially beneficial in the geriatric group of patients who have multiple co-morbid conditions.

The anterolateral approach to the proximal humerus for nonunions and delayed unions

Nonunions of proximal humerus fractures can be disabling as a result of pain, deformity and instability, and are often found in geriatric patients with poor bone quality. There are relatively few studies examining the treatment of nonunions of the proximal third of the humerus and the ideal treatment and surgical approach remains unclear. This case series reports the successful use of the anterolateral acromial approach for treatment of the symptomatic proximal third humerus nonunions in a geriatric group of patients with clear challenges as a result of patient comorbidities and bone quality.

Ist das Alter ein Risikofaktor für laparoskopische kolorektale Operationen?

The aims of this study were to evaluate the results of laparoscopic colorectal surgery in elderly patients and compare them with the results of open procedures. An analysis of a prospectively collected database of 705 patients who underwent in the period between January 2001 and December 2006 elective laparoscopic (LAC) or open (OC) colorectal surgery was performed. The primary end point was the morbidity rate, which was analysed in relation to the age (≤ 75 years, > 75 years) and operative technique (laparoscopic, open). During the study period, 360 elective laparoscopic and 345 elective open colorectal operations were performed. 140 patients (20%) were older than 75 years (geriatrics), 60 of whom underwent laparoscopic and 80 open surgery. Both groups of patients (laparoscopic vs. open) were comparable in basic parameters. Mean operative time for laparoscopic colorectal resections was not longer (LAC 141 ± 46 min vs. OC 137 ± 57 min, n. s.); even in cases of simple stoma formation it was significantly shorter (LAC 42 ± 19 min vs. OC 78 ± 32 min, p = 0.004). In the group of younger patients (≤ 75 years) the open approach was associated with a statistically significant increase of postoperative morbidity (LAC 26% vs. OC 34%, p = 0.039). In the group of geriatric patients (> 75 years) the open approach was associated with a significantly high incidence of postoperative morbidity (LAC 27% vs. OC 48%, p = 0.012) too. In the laparoscopically operated patients, the morbidity rate did not differ in both age groups (older than 75 years 27% vs. younger than 75 years 26%, n. s.). Conversely, open procedures in elderly patients were associated with a significant increase of postoperative complications (morbidity) compared to younger patients (older than 75 years 48% vs. younger than 75 years 34%, p = 0.033). On account of the lower incidence of post-operative complications, the laparoscopic approach should be indicated in colorectal surgery for geriatric patients.

Depression in Parkinson's disease: clinical-epidemiological correlates and comparison with a controlled group of non-parkinsonian geriatric patients

To evaluate and compare the frequency and severity of major depression in patients with Parkinson's disease and in individuals older than 60 years without neurological, rheumatological and/or oncological comorbidities. We studied 50 patients with Parkinson's disease older than 60 years and 50 geriatric patients. Subjects with scores of Mini Mental State Examination indicating cognitive impairment were excluded. We used Diagnostic Statistical Manual of Mental Diseases-IV criteria to diagnose major depression and the Hamilton Depression Scale and the Beck Depression Inventory to rate it. The Unified Parkinson's Disease Rating Scale part 3 and the Hoehn and Yahr Scale were used to evaluate the motor severity of Parkinson's disease. Major depression was found in 42% of Parkinson's disease patients and in 10% of the geriatric patients (p < 0.001). The scores of the Hamilton Depression Scale and the Beck Depression Inventory were higher in Parkinson's disease patients (p < 0.001). Depressed Parkinson's disease patients had longer duration of Parkinson's disease (p = 0.020) and higher scores on the Unified Parkinson's Disease Rating Scale part 3 (p = 0.029) and the Yahr Scale (p = 0.027). The frequency (42%) and severity of major depression were higher in Parkinson's disease patients. Longer duration of Parkinson's disease, higher scores on the Unified Parkinson's Disease Rating Scale part 3 and the Hoehn and Yahr Scale were significantly associated with major depression.

Bloodstream Infections in a Geriatric Cohort: A Population-Based Study

Purpose Health care-associated infections are those that do not meet the definition of nosocomial but are acquired by patients with extensive exposure to the health care system placing them at higher risk for resistant organisms. This category is particularly common among elderly patients. The objective of this study was to describe and compare the epidemiologic characteristics of community-acquired, health care-associated and nosocomial bloodstream infections in a geriatric population. Methods A population-based, retrospective study of all patients aged 65 years or greater with positive blood cultures (n = 636) identified between January 1, 2003 and December 31, 2005 in Olmsted County, Minnesota. Exposures and clinical information were ascertained through complete chart review, utilizing the resources of the Rochester Epidemiology Project. A total of 347 incident patients with bloodstream infection were identified. Bloodstream infections were described as community-acquired, health care-associated or nosocomial using standardized definitions. Variables analyzed included source, isolate, risk factors, and mortality. Results The distribution of bloodstream infection cases that were community-acquired, health care-associated, and nosocomial was 159 (46%), 151 (44%), and 37 (10%), respectively. The prevalence of methicillin-resistant Staphylococcus aureus among S. aureus isolates was 54% and 44% for health care-associated and nosocomial cases, respectively. Fourteen-day mortality among bloodstream infection cases was the same in health care-associated and nosocomial infections (15% vs 14%), and was less in community-acquired (6%) cases ( P = .04). Conclusions The category of health care-associated infection identified a unique group of geriatric patients at increased risk of methicillin-resistant Staphylococcus aureus infection and with increased mortality.

Nutritional screening and perceived health in a group of geriatric rehabilitation patients

(i) To perform a nutritional screening using the Nutritional Form For the Elderly and relate the results to perceived health in a group of geriatric rehabilitation patients; and (ii) to compare the screening results and nurses' nutritional notes in the nursing documentation. Undernutrition is an under-recognized problem among older patients. Using a screening instrument is a way to detect patients at risk for undernutrition. A cross-sectional study conducted in Sweden. A sample of 147 geriatric rehabilitation patients was consecutively included and was interviewed with the screening instrument, questions about background variables, perceived health and health-related issues. Higher screening scores indicate higher risk for undernutrition. Parametric and nonparametric statistical tests were used. When nurses' nutritional notes in the nursing documentation were corresponding to the content in any of the response alternatives for each screening item, the notes were marked as existent. The screening results showed that 55% of the patients were at medium risk and 14% at high risk for undernutrition. Patients in perceived ill health had higher screening scores than those in perceived good health. Associations were also found between receiving help, perceiving helplessness, not being active and not feeling satisfied and higher screening scores. The content of nine of 15 items in the instrument was mentioned in a number of nursing records. The prevalence of older patients at medium or high risk for undernutrition was high. To be at high risk for undernutrition was associated with perceived ill health. Nurses' nutritional notes in the nursing documentation showed deficiencies, indicating that all patients at medium or high risk for undernutrition were not identified. The results suggest that nurses need a screening instrument to highlight older nutritional at-risk patients in need of further awareness and investigation.

Estimating the costs for a group of geriatric patients using the Coxian phase‐type distribution

The length of stay in hospital of geriatric patients may be modelled using the Coxian phase-type distribution. This paper examines previous methods which have been used to model health-care costs and presents a new methodology to estimate the costs for a cohort of patients for their duration of stay in hospital, assuming there are no further admissions. The model, applied to 1392 patients admitted into the geriatric ward of a local hospital in Northern Ireland, between 2002 and 2003, should be beneficial to hospital managers, as future decisions and policy changes could be tested on the model to investigate their influence on costs before the decisions were carried out on a real ward.

Serum albumin and comorbidity relative to rehabilitation outcome in geriatric stroke, and possible links with stroke etiology

Factors that describe the disability status of the stroke patient on discharge are important when starting a rehabilitation program, both from a psychosocial and a financial point of view. The objective of this study was to assess how comorbidity and serum albumin levels relate to rehabilitation outcome in geriatric stroke patients. Another aim was to assess whether stroke etiology (ischemic or hemorrhagic) influences these links. Medical records of 80 patients (68 ischemic and 12 hemorrhagic strokes) older than 65 years, who had suffered their first stroke, were investigated. Functional performance levels at admission and discharge were evaluated using the Functional Independence Measure (FIM). Length of stay in hospital was recorded. Serum albumin levels and comorbidity scores on admission were noted. Correlations between these variables and differences between the groups categorized according to stroke etiology were analyzed. In the group of geriatric stroke patients as a whole, serum albumin level was correlated with FIM score at admission and discharge. Comorbidity score was negatively correlated with length of stay. In the ischemic stroke subgroup, serum albumin level was positively correlated with length of stay and with functional gain, and comorbidity score was negatively correlated with functional gain. Analysis of the data for the hemorrhagic stroke subgroup revealed none of these correlations. It was concluded that serum albumin level and comorbidity are useful indices in geriatric ischemic stroke patients for predicting functional outcome and time spent in rehabilitation.

Initial evaluation of a computer-based medication management tool in a geriatric clinic

Background: Optimal management of medication regimens remains a challenge for elderly patients and their providers. Tools that aid communication and adherence can be valuable but often do not meet expectations. Objective: The purpose of this article was to describe the development and preliminary evaluation of a computer-based medication management tool, the Visual Medication Profile (VMP), and to report initial feedback from geriatric patient and provider focus groups. Methods: For VMP development, an interdisciplinary team (ie, physicians, nurses, pharmacists, computer analysts, and programmers) designed the fully automated, Web-based intervention that integrates the Veterans Affairs Medical Center (VAMC) computer pharmacy system with the computerized patient record system. In addition to development of the required technology, a mixed methods design and a convenience sample were used to collect pilot data related to patient-provider issues about medication management, and the acceptance, feasibility, and usefulness of the VMP. This involved the use of focus groups and a pilot study group. Results: First, the interdisciplinary team developed the VMP by integrating data from the pharmacy database, the patient's database, and a pill photograph database. Second, patients and providers in the focus groups discussed medication management issues and evaluated a sample VMP. Patients (n = 8; mean age, 76 years; 5 black, 3 white) noted the following medication management problems: (1) not understanding the information provided by the physician; (2) multiple providers; and (3) unpronounceable names of medications. Providers (n = 8 [4 physicians, 4 nurse practitioners]) noted that patients and providers use different language to discuss medications; that there is a lack of congruence between patients' self-report of current medications and their medical record; and that there are severe time constraints for clinic appointments and concern regarding introducing a new clinical tool. Both groups favored a VMP-like tool to improve communication. In the VMP prototype pilot study, a patient-specific VMP was developed for each of 6 subjects (mean age, 79.7 years; 3 black, 3 white) from the outpatient geriatric clinic. Congruence rates ranged from 51% to 100%. Five of the 6 subjects participated in follow-up. The nurse's telephone log from the pilot study revealed that although 4 out of the 5 subjects and/or caregivers reported that they favored the VMP as a medical management tool, the use of the VMP at home varied considerably. Conclusions: The VMP is a promising tool for use by both patients and providers to improve medication management. Although it was developed in the VAMC system, its Web-based platform has the potential for export to other systems.

Erforderliche Kompetenzen der Geriatrie aus Sicht des Kompetenz-Centrums Geriatrie

The geriatric patient is defined by a high specific risk that is taken into account by the special geriatric treatment concept. This risk relates to suffering from the permanent and significant loss of earlier functional independence caused by relatively trivial accessory conditions or other changes to the personal situation or falling in need of or increasing the need for care. It results from the geriatric patient's limited reserve capacities that are caused by physiological age-related limitations of organ and organ system reserves and/or manifested or at least latent functional impairments. A rather narrow definition of the geriatric patient based on this specific risk is a key criterion for the future systematic integration of geriatric care into the health service. In such a definition, use of the age component alone is adequate only from a very old age on. The high-risk group of geriatric patients narrowly defined in such a way also calls for primary medical geriatric case management: from commencement of a treatment throughout its entire course, from therapy to rehabilitation to longterm and outpatient care. This comprises first and foremost an comprehensive geriatric assessment and a treatment oriented primarily towards achieving quality of life and independence, medical treatment control including a systematic risk management system, continuous patient support, even in case of other temporary, specific treatments, the individual use of early rehabilitative treatments and the coordination of secondary treatment initiatives. Positioning geriatrics in the health care system in such a way means that the required skills extend beyond a general knowledge of geriatric medicine. Above all, high generic treatment expertise and experience in geriatric rehabilitation are also needed. Additionally, the guide and support function of the geriatrician demands a willingness to take special medical and ethical responsibility and an abundant ability to integrate and communicate. The education, training and development initiatives for attaining geriatric qualifications must satisfy these requirements. Lasting efficient geriatric care concepts also call for the appropriate skills in primary medical outpatient care.