Management Of Geriatric Patients Research Articles

P-083 Optimizing Transition of Care in Geriatric Patients With Inflammatory Bowel Disease through the use of an Observed Structured Clinical Examination

The management of geriatric patients with inflammatory bowel disease (IBD) is becoming increasingly complex with an aging population. A comprehensive transition of care from the inpatient to the outpatient setting is a key aspect of effective management of these patients. Training those who implement that transition is critically important. The Observed Structured Clinical Examination (OSCE) is a well-validated tool for assessing trainee performance, is uniquely capable of gauging fellows’ interpersonal communication skills and can have a role in assessing disease-specific knowledge in a standardized manner. Here, we report the results of the first OSCE designed to evaluate gastroenterology (GI) fellows’ ability to manage these complex patients as they transition them from the inpatient to outpatient care setting. Twelve second-year adult GI fellows from 5 fellowship programs participated in a 4 case OSCE focused on caring for patients with IBD. Previously validated OSCE checklists were used to assess the GI fellows’ performance. The goal of the geriatric OSCE station was to evaluate the patient’s knowledge of his disease, to assess his values regarding therapeutic options, to educate him on medication interactions and side effects, and to address potential functional limitations to care upon discharge. Checklists were scored independently by a physician-observer and the Standardized Patient, who both provided feedback to the fellow immediately following each case. A 3, 4, and 5-point Likert Scale (LS) was used to assess performance. Each fellow was scored across multiple domains and score reports were provided. Fellows received fair scores in information gathering (median score of 2, range 2–3 on a LS from 1–3, with a score of 1 representing “not proficient” and 3 “well done”). Fellows also excelled in the area of professionalism (median score of 4, range 4–5 on a LS from 1 to 5 with a score of 1 representing “unprofessional” and 5 “complete professionalism”). Fellows did not adequately assess plans for monitoring and adjusting therapy or reviewing medication interactions (median of 2, range 2–3 on a LS from 1 to 3, with a score of 1 representing “not proficient” and 3 “well done”). Items pertaining to transition of care including discharge planning, home safety and the need for home services were inadequately addressed (median of 2, range 2–3 on a LS from 1 to 3, with a score of 1 representing “not proficient” and 3 “well done”). Global communications scores were suboptimal (median of 2, range 1–4 on a LS from 1 to 4 with score of 1 representing “not proficient” and 4 “well done”). Fellows also received low ratings for skills associated with caring for IBD medical knowledge (median of 2, range 1–4 on a LS from 1 to 4, with a score of 1 representing “not proficient” and 4 “well done”). To our knowledge, this is the first OSCE designed to evaluate transition of care in the management of geriatric patients with IBD. This OSCE identified limitations to an optimized patient interaction and has the potential to help prepare fellows to facilitate safer, more effective management of this group of IBD patients

The importance of caregivers in improving the care of geriatric oncology patients.

223 Background: Geriatric patients with cancer have special needs. The diagnosis of cancer is stressful for patients and their caregivers. A new age of medicine has emerged to facilitate caregivers in aiding elderly oncology patients through oncology programs. Many caregivers need support themselves. The purpose of this study is to evaluate our geriatric oncology program’s effectiveness and to demonstrate specific factors that caregivers believe have the greatest positive impact. The aim is to determine different interventions that can be implemented to help caregivers of geriatric oncology patients. Methods: This is a qualitative study that used a questionnaire completed by caregivers of patients enrolled in a geriatric oncology program directed towards easing the stressors encountered when caring for patients. Caregivers rated the effectiveness of the program by responding to 12 statements and 2 open-ended questions via telephone. Results: There were 94 patients in the program from November 2012 to November 2013. After excluding patients that did not meet criteria 71 caregivers were available. Analysis of results from 37 out of 71 caregivers enrolled identified six areas that the program most helped them with: time management of caregivers (82.8%), delivery of decision-making information (97.3%), resources available to caregivers and patients (88.23%), establishing goals of care (94.59%), and pain control for patients (100%). 83.78% of respondents agreed that the well-being and quality of their life improved with the program. Analysis on the patient survey conducted for the same time period also showed significant improvement. Conclusions: Caregivers play a vital role in cancer management of geriatric patients. In order to help both the patients and their caregivers, programs have emerged focusing on the teamwork of social workers, clinicians, and counselors. Caregivers express that this approach helps them effectively provide care to patients, and helps them get through this stressful period. The specific areas found to be most positively impacted by this type of organized program are what oncology departments may focus on in order to improve quality of life for caregivers which may ultimately improve the patient’s care.

Abstract 628: The Therapeutic Effect Of Indian Classical Music on Physiological And Psychological Parameters Of Hypertension in Geriatric Patients

Background: Old age is associated with cardiovascular problems including isolated systolic hypertension and uncontrolled hypertension. Poly pharmacotherapy especially in geriatric patients can cause side effects due to drug interactions and there is a need for less pill burden and adjuvant therapy. The basis of calming effect of Indian classical music finds its mention even in mythological anecdotes. Moreover, music therapy is safe, inexpensive and non-invasive. Aim: To evaluate the effect of Indian classical music as evidence based treatment for hypertension and anxiety level reduction. Method: Pre-selected 60 geriatric patients (60-85years) were randomly assigned to Study Group(SG){n=30}and Control Group(CG){n=30}.The SG, in addition to conventional treatment, received 20 minutes of pre-recorded Indian classical music therapy for 4 sessions. The CG received standard treatment alone. Blood pressure (BP), pulse rate (PR) and respiratory rate (RR) were taken before and after each session. Psychological assessment was done at the start and at the conclusion of final session. Results: Comparing pre and post parameters of all the sessions, the intervention resulted in a statistically significant reduction in BP and RR in both groups and significant reduction in PR only in the SG. Further analysis revealed a more statistically significant reduction in BP, PR and RR and anxiety levels in the SG as compared to CG after music session. Conclusion: This study indicates the use of Indian classical music as an innovative therapeutic approach in modern era for prevention or in conjunction with antihypertensive medications for blood pressure management in geriatric patients.

The clinical features of foreign body aspiration into the lower airway in geriatric patients.

PurposeTo analyze the clinical features of foreign-body aspiration into the lower airway in geriatric patients.Patients and methodsThe clinical data of 17 geriatric patients with foreign-body aspiration were retrospectively analyzed and compared with 26 nongeriatric adult patients. The data were collected from Peking University First Hospital and Anhui Chest Hospital between January 2000 and June 2014.Results(1) In the geriatric group, the most common symptoms were cough and sputum (15 cases, 88%), dyspnea (six cases, 35%), and hemoptysis (four cases, 24%). Five patients (29%) in the geriatric group could supply the history of aspiration on their first visit to doctor, a smaller percentage than in the nongeriatric group (13 cases, 50%). Only three cases in the geriatric group were diagnosed definitely without delay. Another 14 cases were misdiagnosed as pneumonia or lung cancer, and the time of delayed diagnosis ranged from 1 month to 3 years. Complications due to delay in diagnosis included obstructive pneumonitis, atelectasis, lung abscess, and pleural effusion. (2) Chest computed tomography demonstrated the foreign body in three cases (21%) in the geriatric group, which was lower than the positive proportion of detection in the nongeriatric group (nine cases, 35%). The most common type of foreign body in the geriatric group was food, such as bone fragments (seven cases, 41%) and plants (seven cases, 41%), and the foreign body was most often lodged in the right bronchus tree (eleven cases, 65%), especially the right lower bronchus (seven cases, 41%). Flexible bronchoscopy removed the foreign body successfully in all patients.ConclusionThe clinical features of foreign-body aspiration in geriatric patients are usually more obscure than in nongeriatric adults, which may lead to long delay in diagnosis. Flexible bronchoscopy is safe and useful for early diagnosis and effective management in geriatric patients. We suggest flexible bronchoscopy as the first-line approach to similar patients, especially those with aspiration history and unexplained pneumonia.

Comminuted Pelvic Fracture With Retroperitoneal Bleed in a Geriatric Patient

The case study presented involved an 87-year-old Hispanic man who was transferred to the emergency department (ED) of an acute care hospital. The patient was complaining of left hip pain and hitting his head. The patient had fallen backward upon standing from a wheelchair, lost his balance, and suffered an occipital laceration with hematoma. There was a brief loss of consciousness after hitting his head. An external pelvic stabilizer was placed on the patient's pelvis in an attempt to stabilize the comminuted pelvic fractures. Because of the patient's comorbidities and unstable condition, the consulting physician specialists determined that the patient was not a surgical or interventional candidate. Self-tamponed of retroperitoneal bleeding occurred without intervention of angiogram with embolization or laparotomy. A decision was made among the patient, the patient's stepchildren, and the attending physicians for a do-not-resuscitate order. The patient was then transferred to a palliative care unit outside the hospital. This case discusses the physiological changes in geriatric patients and the management of geriatric patients with pelvic trauma and retroperitoneal bleeding.

Geriatrische Urologie: Besonderheiten der palliativen Harnblasenlangzeitdrainage im Kontext der „Geriatrischen I's“

In situations at the interface of urology and geriatric medicine the palliative management of geriatric patients with urinary incontinence of voiding dysfunction occupies a central position. Influencing factors that need to be considered by the surgically active urologist are not only the high age and the thus associated vulnerability of the geriatric patient but also other aspects such as the patient's wishes, the expectations of care-giving relatives and the sexual situation. In this light a strict and individually adapted indication for placing a palliative indwelling catheter is mandatory. First of all, all other treatment options should be explored, for the placement itself particularly sparing and low-risk procedures such as suprapubic catheter placement in nephrostomy technique should be employed. After placement of the catheter special attention must be paid to the hygienic care of the deviation in order to avoid complications and subsequent diseases.

Management of Geriatric Patient with Epulis Fissuratum Using Liquid Nitrogen Cryosurgery: A Case Report

The aim of this report is to present a case showing the treatment of Epulis fissuratum in relation to an ill fitting denture, in a debilitated geriatric patient with a novel technique using liquid nitrogen cryosurgery. Management of geriatric patients can be quite challenging due to the presence of various diseases. Epulis fissuratum associated with an ill fitting denture greatly hinders mastication and produces discomfort and pain to the patient. The liquid nitrogen cryosurgery can be used effectively in its management, due to its excellent haemorrhage control and postoperative healing. A 71-year-old male reported with Epulis fissuratum in the vestibular sulcus, which was associated with an ill- fitting denture. The patient was a known hypertensive and diabetic, presently on anti-coagulant therapy with previous history of myocardial infarction. Liquid nitrogen cryosurgery was used for the treatment of the lesion. During the procedure, nil haemorrhage was achieved and the postoperative healing was satisfactory. Liquid nitrogen cryosurgery hence can be used effectively in debilitated geriatric patients as it has the boon of achieving excellent haemostasis, good healing with minimal postoperative oedema and pain, maintaining an aseptic environment. This novel technique can be effectively used by dentists in the treatment of Epulis fissuratum besides it can also be used in treatment of other oral soft tissue pathologies achieving a plethora of benefits.

The role of percutaneous cholecystostomy in the management of geriatric patients with acute cholecystitis

The role of percutaneous cholecystostomy in the management of geriatric patients with acute cholecystitis

An Orthogeriatric Collaborative Intervention Program for Fragility Fractures: A Retrospective Cohort Study

This retrospective cohort study aims to investigate the impact of regular pre- and postoperative geriatric input into the management of geriatric patients with hip fracture, with specific interests in morbidity and mortality. Patients with hip fracture (n = 548) older than 60 years were identified within a 2-year period. In the first year, the patients (n = 270) were managed mainly by orthopedics and this group constituted the control group. In the second year, this group of patients (orthogeriatric group, n = 278) had reviews by orthopedic surgeons and geriatricians (physicians specializing in medicine for the elderly), within 48 hours of admission and regularly thereafter. The main outcomes measured included demographics, length of hospital stay, postoperative complications, mortality, and functional outcomes. Data were collected from records of acute and rehabilitation admissions, and outpatient consultations. The admission to operation time for those in the orthogeriatric group was shorter by 17% (p = 0.02). The percentage of patients deceased at 12 months postoperative was 11.5% for the orthogeriatric group and 20.4% for the conventional group (p = 0.02). A higher percentage of patients in the orthogeriatric group remained independent for daily living activities (24.5%) when compared with the conventional group (23.7%; p = 0.02). In addition to existing evidence that postoperative orthogeriatric collaboration improves mortality and functional outcomes in older patients with hip fractures, this study suggests that allowing preoperative geriatric input in this model of care can produce even more superior results.

Allergic diseases in the elderly.

Demographic distribution of the population is progressively changing with the proportion of elderly persons increasing in most societies. This entails that there is a need to evaluate the impact of common diseases, such as asthma and other allergic conditions, in this age segment. Frailty, comorbidities and polymedication are some of the factors that condition management in geriatric patients. The objective of this review is to highlight the characteristics of allergic diseases in older age groups, from the influence of immunosenescence, to particular clinical implications and management issues, such as drug interactions or age-related side effects.

Anesthetic Management in Geriatric Patients for Urologic Surgery: A Descriptive Retrospective Study

Anesthetic Management in Geriatric Patients for Urologic Surgery: A Descriptive Retrospective Study

The Changing Profile of Patients Who Used Emergency Department Services in the United States: 1996 to 2005

Because of the vital role of emergency departments (EDs) in the US health care system, it is important to monitor the changes in the patient mix over time to identify existing problems and ways to improve the system. The current study aimed to identify raw and population-adjusted time trends for demographic characteristics, socioeconomic characteristics, access to care, utilization of care, and general health of ED users and heavy ED users. Ten years' worth of nationally representative data was derived from the Medical Expenditure Panel Survey, 1996 to 2005. Raw time trends of various patient characteristics for ED users, nonusers, and heavy users were estimated to demonstrate changes in ED patient mix. Population-attributable fraction was used to generate population-adjusted trends that elucidate the net changes in subpopulations' propensities to ED use in relation to those of the general population. Between 1996 and 2005, the total number of noninstitutionalized individuals who used ED services increased from 34.2 to 40.8 million. That is, the proportion of ED users in the US population increased from 12.7% to 13.8%. Increasing proportions of elderly and those who perceived themselves to be in poor or fair physical health among ED users, particularly heavy users, were found in both raw and population-adjusted trends. Several subpopulations demonstrated increasing levels of ED use after population adjustment: blacks, patients within 100% to 199% of the federal poverty line, patients with only Medicare, patients with greater than or equal to 2 types of insurance, and patients with at least 1 inpatient stay. Decreasing population-adjusted trends were found in the proportions of female patients, Hispanics, patients at greater than or equal to 200% of the federal poverty line, the uninsured, and patients with only private insurance, respectively. EDs play a larger role in the management of geriatric patients over time. The increasing burden of the aging population in the EDs poses challenges in the training of future emergency physicians, care for older patients, public health insurance, and health care system reform.

Urinary Incontinence Management in Geriatric Patients

To review prevalence, causes, types, and appropriate therapy to treat urinary incontinence (UI) in geriatric patients. Selection and extraction from a PubMed/MEDLINE, English-language literature search from 2000 to the present using the search terms urinary incontinence and geriatrics. UI is a prevalent condition in geriatric patients. Unmanaged UI decreases quality of life and increases the risk of perineal skin breakdown, which can lead to painful skin irritation and pressure sores. Identifying the type of UI, and treating or eliminating transient causes as a result of acute conditions or medications, are initial steps in appropriate management. Health professionals can identify medication-related causes by reviewing the patient history, diagnoses, symptoms, and medication regimen. Chronic UI is often caused by physiological changes in the bladder; increasing age also can result in changes in bladder and urethral compliance. Other UI risk factors include impaired function, cognition, mobility, and dexterity as well as neurodegenerative damage that affect the patient's ability to toilet or recognize the need to toilet. Chronic or persistent UI is classified as stress, urge, overflow, functional, or mixed. Treatment options for chronic UI are discussed in detail. Pharmacists can have a positive impact on this condition by recommending appropriate medication changes and pharmacologic and nonpharmacologic treatments.

Aging Population Will Need New Care Model

Aging Population Will Need New Care Model

Der geriatrische Patient im Rettungsdienst - Besonderheiten der notärztlichen Versorgung

The prehospital management of geriatric patients involves an understanding of the physiology of aging and necessitates the special acknowledgement of diagnosis and treatment of emergencies in the elderly. It is essential to keep in mind the prevention of an underestimation of the severity of disease and the necessity of an adequate therapy. The prehospital management of moribund patients gains special importance.

The Years [2006-2007] were Allocated To Pain Management In Geriatric Patients: What About Their Mental Health?

The Years [2006-2007] were Allocated To Pain Management In Geriatric Patients: What About Their Mental Health?

Geriatric dentistry education in European dental schools

As the numbers of elderly adults continue to grow within European populations, the need for dental students to be trained in the management of geriatric patients becomes increasingly important. Many dental schools have developed training programmes in geriatric dentistry in response to the changing oral health needs of older adults. The purpose of this on-line survey was to identify the current status of geriatric dentistry education in European dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the Internet, and 194 dental schools in 34 European countries were invited to participate. Data from completed questionnaires were submitted to the investigators via email from 82 schools in 27 countries (42% response rate). Thirty-six percent of schools offered a specific geriatric dentistry course that included didactic teaching or seminar groups, 21% taught geriatric dentistry by means of organised presentations in the curriculum, and 36% taught the subject by occasional lectures. 7% of schools did not teach geriatric dentistry at all. A clinical component to the geriatric dentistry curriculum was reported by 61% of schools and 18% reported operating a specific geriatric dentistry clinic within the school. Of those providing clinical geriatric dentistry training, it was provided within the school in 45% of cases, with a further 29% of schools providing training both within the school and at a remote location. Seven percent of schools operated a mobile dental clinic for treating geriatric patients. Twenty-eight percent of schools had a geriatric programme director or a chairman of a geriatric section and 39% indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has clearly established itself in the curricula of European dental schools although the format of teaching the subject varies widely. It is of concern that geriatric dentistry was not taught at all in 7% of schools. No data are available concerning whether or not geriatric dentistry is taught in the 58% non-responding schools.

Evidence-based Annotated Bibliography on the Rehabilitation Management of Geriatric Patients With Cardiopulmonary Conditions

Evidence-based Annotated Bibliography on the Rehabilitation Management of Geriatric Patients With Cardiopulmonary Conditions

Physical therapy and exercise in pain management

Physical therapy and exercise are fundamental to the interdisciplinary approach to pain management in the elderly. Physical modalities used in combination with exercise provide pain relief and help to prevent future pathology and physiologic changes in the elderly that often result in significant pain syndromes. This article provides an overview of effective modalities for pathology prevention, treatment of pain, and restoration of function that are the basis for pain management in geriatric patients.

Factors that limit pain relief and increase. (Union Memorial Hospital, Baltimore, MD) Geriatrics 2000;55:46–54.

This article discusses chronic pain in individuals who are 65 years of age and older. The importance of achieving adequate pain management in geriatric patients is discussed. Factors that limit pain control are listed and explained. Emphasis is placed on what role depression, anxiety, and dementia have in the patient's perception of pain as well as the need to avoid adverse drug reactions in a population that can be complicated to treat for pain.