Practice Of Geriatric Medicine Research Articles

Geriatric medicine and Olympic elite sports-parallels and philosophies.

The 30th Olympiad took place in July 2024. At first glance, sports science and training of elite athletes may appear to be of little relevance to geriatric medicine. However, there are important parallels between the practice of geriatric medicine and elite sports and lessons that we can learn from our sports science colleagues. Elite athletes and older people are operating at the margins of physiological capacity. Both benefit from tailored, scientifically informed training programmes delivered and monitored by a multidisciplinary team. There are parallels between the comprehensive geriatric assessment and the philosophy of marginal gains pioneered by British Cycling. Insights into the biology of skeletal muscle function are beginning to translate into the development of clinical interventions and substances that offer an unfair advantage in sport by improving muscle strength and physical performance may be of therapeutic benefit in sarcopenia. The 2024 Olympics provide an opportunity for us to learn lessons for excellence in our research and provide an opportunity to promote exercise across the life course-important for healthy ageing.

Integrating a Standardized Self-Report Tool into Geriatric Medicine Practice during the COVID-19 Pandemic: A Mixed-Methods Study.

Specialized geriatric services care for older adults (≥ 65 years of age) with dementia and other progressive neurological disorders, frailty, and mental health conditions were provided both virtually and in person during the pandemic. The objective of this study was to implement a software-enabled standardized self-report instrument - the interRAI Check-Up Self-Report - to remotely assess patients. A convergent, mixed-methods research design was employed. Staff found the instrument easy to use and the program-level metrics helpful for planning. Most patients urgently needed a geriatrician assessment (72%) and had moderate to severe cognitive (34%) and functional impairments (34%), depressive symptoms (53%), loneliness (57%), daily pain (32%), and distressed caregivers (46%). Implementation considerations include providing ongoing support and facilitating intersectoral collaboration. The Check Up enhanced the geriatric assessment process by creating a system to track all needs for immediate and future care at both the patient and program level.

Preventive Strategies in Geriatric Medicine: A Comprehensive Review

Majority of people above age of 60 live in rural areas with lack of adequate health services, economic and social services, andhaving limited work opportunities for this group of people. The growing trends towards the nuclear family making childrenlive in the city or abroad are putting the elderly parents under vulnerability. The goal of geriatric medicine is to enhance thequality of life for aged by focusing on prevention and comprehensive management of age-related disorders. The proportion ofgeriatric (age above 60 years) populations has been increasing day by day. It was 11.3% in 2022 (Bangladesh Bureau ofStatistics, 2023). Therefore, geriatricians have the prospective wider scope to help their clients in maintaining their health,independence, and well-being in particular. Aged people suffer from multiple health problems like; weakness, tooth problem,hearing problem, vision problem, body ache, back pain, rheumatic pain and stiffness in joint, dementia, prolonged cough,breathing difficulty, asthma, palpitation, high blood pressure and micturation difficulties in addition to long term noncommunicablediseases, in addition to psychological & social problems in particular. These groups of people are vulnerable toabuse, isolation, economy, illness emotion, family burden including decrease body resistance, chronic diseases, and detachedfamily members. In addition absence of strong social security system, less employment opportunity, high treatment cost, andabsence of adequate health facilities for elderly, lack of laws for elderly people, and friendly environments in the society. In thiscontext improved geriatric medicine practice can enhance the quality of life for the aged by focusing on prevention andcomprehensive management of age-related disorders through holistic approach. Geriatricians would be able to help theirconsumers in maintaining their health, independence, and well-being by well trained & coordinated multidisciplinary teamapproach utilizing all levels of health care delivery system in the country in particular.

Private geriatrics: an experience in Guadeloupe

Although geriatric medicine is now commonplace in university hospitals, it is less common in private practice. In Guadeloupe, a geriatric medicine service operating as a weekday hospital has been created in a polyclinic to support patients and general practitioners. This activity is an example of private practice in geriatric medicine and completes the care offer of the geriatric network.

Learning experiences of adaptive experts: a reflexive thematic analysis

Whilst adaptive experts have well-researched beliefs and attitudes towards learning, what is unclear are the interactions that occur within the learning environment that constitute their learning experiences. The practice of geriatric medicine emphasises the interdisciplinary care of complex frail older adults. Our study sets out to understand the learning experiences of adaptive experts in geriatric medicine by examining how interactions at the intra-personal, inter-personal and organisational levels contributed to the development of adaptive expertise. We conducted an exploratory qualitative study through semi-structured interviews of 16 geriatricians experts from a tertiary hospital in Singapore. Data were analyzed via reflexive thematic analysis. The core essence of the learning experiences was described as a journey of ‘knowing when we do not know’, which was characterised by three themes: (i) Anchoring ethos of person-centric care where the experts drew upon their values to develop a holistic view of the patient beyond the medical domain, (ii) Enabling stance of being curious where their curiosity and openness to learning was nurtured through the practice of reflection, and with the benefit of time as a commodity and for development of expertise, and (iii) Scaffolding organisational culture of inquiry where an environment that is supportive of learning is built on the culture of psychological safety and the culture of mentoring. Taken together, our study highlighted the importance of interactions at the intra-personal, inter-personal and organisational levels in the learning experiences of adaptive experts.

Standardized Self-Report Tools in Geriatric Medicine Practice: A Quality Improvement Study

Comprehensive geriatric assessment (CGA)—a multidimensional diagnostic process to determine medical, cognitive, and functional capacity—has historically included a narrative history supplemented by use of tools to assess domains such as mood or cognition based on assessor preference. This approach to CGA likely works to assess individuals but with increasing clinical complexity and frailty among older adults, a non-standardized approach may mean that key issues are not assessed, and program quality cannot be determined. The COVID-19 pandemic added to these challenges as social distancing practices meant limited face-to-face appointments and use of phone and video assessments. This quality improvement study implemented the interRAI Check-Up Self-Report instrument through a software platform in a specialized geriatric services practice. The instrument can be used over the phone and summarizes specific health problems and needs as well as information about caregiver status and financial trade-offs. Focus groups were also conducted with specialized geriatric services interprofessional team to explore their experiences with implementation. The descriptive analysis of the self-report data revealed expected geriatric issues, such as cognitive and functional impairment, falls and pain. Clients were also commonly experiencing medical instability, cardiorespiratory symptoms, communication impairments, and elevated risk for emergency department visit. Staff found the self-report tool feasible, easy to use, efficient, and the program-level metrics helpful for program planning. In conclusion, introduction of a standardized self-report enhanced CGA by creating a systematic method to flag, track, and prioritize all areas of need for immediate and future care planning at both the client and program level.

Does the frailty phenotype at the age of 66 to 71 predict death? A 14-year survival analysis of the Lc65+ study.

Frailty is a health characteristic resulting from the loss of physiological reserve of multiple organs, leading to exposure to adverse outcomes, and is possibly reversible in its earliest stages. It is identified by a specific phenotype that contributes to the practice of geriatric medicine, where it is considered a potential target for preventive action. This phenotype has recently attracted interest in other medical specialties for risk assessment before stressful interventions in older adults. Whereas frailty is unusual in sexagenarians, pre-frailty is common. This longitudinal study aimed to evaluate the significance of fulfilling at least one criterion of the frailty phenotype in the late sixties as a predictor of short- and long-term mortality in males and females. Data came from the first sample of the Lc65+ cohort, representative of the community-dwelling Lausanne population born between 1934 and 1939 (n = 1315). After baseline assessment of the five criteria of Fried's frailty phenotype (shrinking, exhaustion, muscular weakness, motor slowness and low physical activity) in 2005 (age 66-71 years), deaths were recorded over 14 years. We separated individuals into non-frail (fulfilling 0 criterion) and (pre-)frail (1+ criteria). The relationship between the phenotype and mortality was investigated graphically using Kaplan-Meier survival curves and quantified in Cox models. Multivariable analyses incrementally controlled age, socioeconomic and health characteristics. The prediction of fully adjusted models was evaluated using the Harrell's C index. Overall, 401 persons (30.5%) were (pre-)frail at baseline. A quarter of the 1315 participants died over 14 years (n = 336, 25.6%). The mortality rate was significantly higher in males in the (pre-)frail subgroup only. Survival curves showed a significant effect of (pre-)frailty on the risk of dying for both sexes. The effect of (pre-)frailty on mortality was stronger during the first 4 years of the follow-up. In males, it was significant both in short (0-4 years) and longer (>4-14 years) terms. In females, it was significant in the short term only. In all models, the estimated effect was stronger in males. The fully adjusted model was fairly predictive of death in the short term both in males (Harrell's C 0.79) and females (0.75). The significantly higher mortality of individuals presenting 1+ frailty criteria supports the appropriateness of a systematic assessment of the frailty phenotype at the age of 66-71 years. In both females and males, early identification of pre-frailty has the potential to limit or reverse the development of frailty and extend lifespan through adequate individual management.

Editorial introductions

Editorial introductions

Start low, go slow, but look far: the case of geriatric medicine in Balkan countries.

To present an insight of the situation of geriatric medicine in Balkan countries, as it was presented in the context of the 2nd pre-congress seminar of the 16th European Geriatric Medicine Society (EuGMS) Congress Athens 2021. Representatives from 8 Balkan countries (Albania, Croatia, Greece, Republic of North Macedonia, Romania, Serbia, Slovenia, Turkey) answered 3 questions to reflect the state of geriatric medicine in their country: education on geriatrics; systems/methods for assessment of functional status and frailty; pre-operative risk assessment. An open discussion followed. Undergraduate education in geriatric medicine seems underestimated in medical faculties of Balkan countries, whereas a high heterogeneity is observed at a post-graduate level. Only a few Balkan countries have geriatric medicine as a recognized medical specialty or subspecialty. Functional status and frailty are only sporadically assessed, and pre-operative risk assessment is very rarely performed with a geriatric focus. Scarcity of expertise and structures relevant to geriatric medicine seems to be common. Developing a training curriculum and geriatrics-related structures are two interconnected aspects. Cooperation among physicians and multidisciplinary teams are essential for the practice of geriatric medicine. A functional geriatric network is eventually necessary and ambulatory geriatric expertise is probably a feasible and clinically relevant starting point. Providing pragmatic solutions to the pressing challenges in variable clinical settings, supplementing and working in harmony with existing components of each health system, is probably the most convincing strategy to gain political support in developing geriatric medicine. Balkan countries share common experiences and challenges in developing geriatrics. Whilst the principles of geriatric medicine are perhaps universal, proposed solutions should be adapted to each country's specific circumstances. Cooperation of the Balkan countries could promote in each the development of geriatric medicine. EuGMS is willing to foster relevant actions.

Standard of practice in geriatric medicine for pharmacy services

Standard of practice in geriatric medicine for pharmacy services

Editorial introductions

Editorial introductions

184 A National Survey of Clinicians who Assess People with Suspected Dementia: Service Characteristics and Practice

Abstract Background The Irish National Dementia Strategy (2014) identified timely diagnosis and intervention as a priority area. The National Dementia Office established a Dementia Diagnostic Project to develop a framework for diagnostic services nationally. As part of preparatory work, a national survey explored baseline peri-diagnostic practice in geriatric medicine, neurology and psychiatry of old age services. Methods A survey was developed by the project steering group, piloted, and then distributed to all 86 Geriatricians, 39 Neurologists, and 34 Psychiatrists of Old Age Psychiatrists in Ireland. Two reminder e-mails were sent. Results In total, 56 clinicians responded (response rate 35%). The majority (74%) saw 1-20 people with suspected dementia (PwSD) per month. Most referrals came from General Practitioners or other physicians; but rarely from Health and Social Care Professionals. Most people were referred specifically for their memory complaint, rather than a co-morbidity. Waiting times for urgent review varied between 24 hours and 4 years; neurology services had the longest waiting times. Only 30% saw PwSD in a dedicated clinic; about the same proportion saw PwSD in their own home; or in residential care settings. About half reported assessing people with intellectual disability and suspected dementia, mainly the neurologists. The Montreal Cognitive Assessment was the most commonly used cognitive tool (89%), followed by the Addenbrook’s Cognitive Examination (56%). Only 17% commonly used functional brain imaging in diagnosis, mainly neurologists; half of respondents ‘never’ or ‘rarely’ used cerebrospinal fluid analysis. Multidisciplinary input was mainly from Occupational Therapists (61%), Psychology/Neuropsychology (52%), and Nursing disciplines (33%). When asked which discipline would most benefit their diagnostic service, neurologists all chose psychology input; geriatricians selected a range of disciplines. Conclusion The significant variability within current services who see PwSD, in terms of multidisciplinary involvement, waiting times, setting, and supporting investigations, supports the need for a national diagnostic framework.

Moving Frailty Toward Clinical Practice: NIA Intramural Frailty Science Symposium Summary.

Frailty has long been an important concept in the practice of geriatric medicine and in gerontological research, but integration and implementation of frailty concepts into clinical practice in the United States has been slow. The National Institute on Aging (NIA) Intramural Research Program and the Johns Hopkins Older Americans Independence Center sponsored a symposium to identify potential barriers that impede the movement of frailty into clinical practice and to highlight opportunities to facilitate the further integration of frailty into clinical practice. Primary and subspecialty care providers, and investigators working to integrate and translate new biological aging knowledge into more specific preventive and treatment strategies for frailty provided the meeting content. Recommendations included a call for more specific language that clarifies conceptual differences between frailty definitions and measurement tools; the development of randomized controlled trials to test whether specific intervention strategies for a variety of conditions differently affect frail and non-frail individuals; development of implementation studies and therapeutic trials aimed at tailoring care as a function of pragmatic frailty markers; the use of deep learning and dynamic systems approaches to improve the translatability of findings from epidemiological studies; and the incorporation of advances in aging biology, especially focused on mitochondria, stem cells, and senescent cells, toward the further development of biologically targeted intervention and prevention strategies that can be used to treat or prevent frailty. J Am Geriatr Soc 67:1559-1564, 2019.

Early Implementation of Dedicated Geriatric Training for Internal Medicine Resident Physicians

The practice of geriatric medicine is an integral component of residency training in internal medicine. In fact, the Accreditation Council for Graduate Medical Education (ACGME) in Internal Medicine specifies that training programs should have a dedicated geriatric education coordinator, and residents should have an assignment in geriatrics with sufficient clinical exposure. Such an assignment exposes residents to clinical experience in both outpatient geriatric clinics and assisted nursing facilities. Despite being an integral element of patient care, specific geriatric training is often scheduled in senior years of residency. We surveyed internal medicine residents at a tertiary teaching hospital to assess their exposure and level of comfort with geriatrics in various settings.

Growing research in geriatric medicine

Academic geriatric medicine activity lags behind the scale of clinical activity in the specialty. A meeting of UK academic geriatricians was convened in March 2018 to consider causes and solutions to this problem. The meeting highlighted a lack of research-active clinicians, a perception that research is not central to the practice of geriatric medicine and a failure to translate discovery science to clinical studies. Solutions proposed included better support for early-career clinical researchers, schemes to encourage non-University clinicians to be research-active, wider collaboration with organ specialists to broaden the funding envelope, and the need to co-produce research programmes with end-users. Solutions to grow academic geriatric medicine are essential if we are to provide the best care for the growing older population.

Medical Directors: Why Do You Abdicate Your Advocacy With Nursing Homes?

Medical Directors: Why Do You Abdicate Your Advocacy With Nursing Homes?

European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

Backgroundthe European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations.Methodsunder the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.Resultsthe final recommendations include four different domains: ‘General Considerations’ on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), ‘Knowledge in patient care’ (36 sub-items), ‘Additional Skills and Attitude required for a Geriatrician’ (9 sub-items) and a domain on ‘Assessment of postgraduate education: which items are important for the transnational comparison process’ (1 item).Conclusionthe current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.

Geriatric medicine in China: The past, present, and future.

Geriatric medicine in China started to develop as a medical specialty in the 1950s and has now become an extensive national healthcare network for the elderly. As population aging accelerates and the number of senior citizens keeps rising, major issues of healthcare delivery for this segment need to be addressed. Inequality in access to quality health care continues to exist between the public and private sectors and between urban centers and rural areas. The education and practice of geriatric medicine also face a range of problems, such as inadequate teaching of geriatrics‐related subjects in the medical education curriculum, the design of residency and fellowship programs, and the integration of geriatric principles into clinical practice. Government commitment, investment from the private sector, and improvement in geriatric medicine professionals’ knowledge and skills are required to bring geriatric care to a higher level.

Editorial introductions

Editorial introductions

New horizons in geriatric medicine education and training: The need for pan-European education and training standards

The ageing population ought to be celebrated as evidence for the efficacy of modern medicine, but the challenge that this demographic shift presents for 21st century healthcare systems, with increasing numbers of people living with multi-morbidity and frailty, cannot be ignored. There is therefore a need to ensure that all healthcare professionals grasp the basic principles of care of older people. In this paper, we make a case for the development of pan-European education and training standards for the field of geriatric medicine. Firstly, the challenges which face the implementation and delivery of geriatric medicine in a systematic way across Europe are described – these include, but are not limited to; variance in geriatric medicine practice across Europe, insecurity of the specialty in some countries and significant heterogeneity in geriatric medicine training programs across Europe. The opportunities for geriatric medicine are then presented and we consider how engendering core geriatric medicine competencies amongst nongeriatricians has potential to bridge existing gaps in service provision across Europe. Finally, we consider how work can proceed to teach sufficient numbers of doctors and health professionals in the core knowledge, skills and attitudes required to do this. To safeguard the future of the specialty across Europe, we contend that there is a need to strive towards harmonisation of post-graduate geriatric medicine training across Europe, through the establishment of pan-European education and training standards in the specialty.