Problems In Geriatric Patients Research Articles

Osteosynthesis or arthroplasty of fractures near the knee joint in geriatric patients - a clinical-economical comparison.

The treatment of fractures of the tibial plateau or distal femur often represents a severe problem in geriatric patients. In particular, complex fracture types and concomitant severe osteoporosis are confronted with inferior results following internal fixation. Therefore, primary arthroplasty is increasingly propagated for such particular cases. In 16 patients suffering from fractures of the distal femur or tibial plateau were treated either by internal fixation (n = 8) or primary arthroplasty (n = 8). The outcome of each case was retrospectively analysed according to clinical and economic criteria. In the investigated geriatric patients, primary arthroplasty was significantly superior to internal fixation regarding mobilisation and range of motion without being inferior in cost-effectiveness. Compared to internal fixation, primary arthroplasty represents an efficient and cost-effective therapeutical option for the treatment of complex fractures of the distal femur or tibial plateau of the elderly patient.

Treatment of benign prostatic hyperplasia in geriatric patients-use and limitations of existing guidelines

The demographic developments of western society and the resulting increase in the number of very old patients in urology represents achallenge for the design of clinical studies and, consequently, recommendations of guidelines. While in internal medicine there is already asubspecialization with afocus on the treatment of elderly and multimorbid patients, in urology there is hardly any subspecialization into the problems of geriatric patients. Thus, using acase study as an example, the treatment decisions for benign prostatic hyperplasia (BPH) in geriatric patients are discussed. In addition the available evidence from the literature and guidelines are presented in order to assiste in daily management of geriatric patients with lower urinary tract symptoms and to critically discuss potential fields of application and limitations of the existing guidelines. In this context, we also examine the challenges when choosing adrug therapy and in deciding which of the manysurgical options should be used.

Comparison of Malnutrition Screening Tools for Use in Hospitalized Older Adults (OR36-02-19)

ObjectivesMalnutrition is a common problem in geriatric patients that often goes unrecognized. Undernutrition is a primary health concern for older adults due to associations with increased mortality, complications, and length of hospital stay. Yet, there is no consensus on which malnutrition screening tool should be used for hospitalized older adults. Therefore, the objective of this study was to determine which screening tool is best to rapidly detect malnutrition in hospitalized older adults so that patient outcomes may be improved. MethodsOlder adult patients (n = 211; ≥65 yrs old) were enrolled during acute hospitalization. Testing occurring within 72 hours of admission and included the following screening tools included: Malnutrition Screening Tool (MST), Mini Nutritional Assessment Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening 2002 (NRS-2002), and Geriatric Nutritional Risk Index (GNRI). These screening tools were compared to a malnutrition diagnostic tool, the Subjective Global Assessment (SGA). ResultsAccording to SGA, 49% of patients were at risk of being malnourished. The other screening tools indicated a wide range of malnutrition prevalence, from 18% (MST) to 76% (MNA-SF). MST (93%) and MUST (92%) were highest in sensitivity. NRS-2002 had moderately good sensitivity (71%). MNA-SF and GNRI had poor sensitivity, eliminating them as good screening tools for hospitalized elderly patients. Of the remaining tools, NRS-2002 had the highest specificity (77%). MST and MUST had poor specificity (31%, 39%, respectively), eliminating them as good screening tools for hospitalized elderly patients. The remaining screening tool, NRS-2002, had moderately good positive and negative predictive values (76%, 72%, respectively). It also had the highest kappa (0.479). Overall, NRS-2002 had the best agreement to SGA and showed moderately good sensitivity, specificity and predictive values. ConclusionsOur data suggests NRS-2002 is the best malnutrition screening tool for rapid detection of malnutrition in elderly hospitalized patients, when compared to the diagnostic tool, SGA. Future research is needed to determine which screening tool is most effective for use in different settings. Additional research can assist in standardizing malnutrition criteria and care processes. Funding SourcesNational Dairy Council, National Institutes of Health-National Center for Advancing Translational Sciences, and UTMB Claude D. Pepper OAIC. Supporting Tables, Images and/or Graphs▪

The Impact of Physical Exercise on Brain-Derived Neurotrophic Factor (BDNF) Level in Elderly Population

BACKGROUND:Memory function disorder is a major health problem in geriatric patients. Physical exercise has the potency to decrease the incidence of many degenerative and chronic health problem, related to cognitive deterioration (dementia).AIM:This research aimed to observe the effect of physical exercise in various doses and duration on memory function by analysing the role of Brain-Derived Neurotrophic Factor (BDNF) as a regulatory protein affected by exercise.METHODS:This was an analytical observational study with a cohort design. Thirty participants were included in each group, classified as exercise and non-exercise group. The exercise was in the form of jogging for at least fifteen minutes every day. The observation was done for sixty days. Cognitive function assessment was done by using the Mini-Mental State Examination (MMSE) questionnaire. Meanwhile, the BDNF level was assessed by ELISA. Statistical analysis was done using Independent T-test.RESULTS:Exercise group showed better MMSE score (28.56 ± 1.76), and a higher concentration of BDNF (235.34 ± 12.56 pg/mL), both were statistically significant.CONCLUSION:Physical exercise was able to maintain geriatric cognitive function performance by BDNF protein regulation.

COMMON HEALTH PROBLEMS IN GERIATRIC PATIENTS: A CROSS-SECTIONAL HOSPITAL BASED STUDY

Background: The health problems of elderly are often nonspecific and the pattern of disease keeps changing. Therefore, it is essential to know the burden of disease especially in developing countries so that policy could be made to overcome the morbidity associated with it. The present study was done to identify the geriatric health problems in Geriatric patients coming to Geriatric clinic in a tertiary care centre.
 Methods: A hospital based cross-sectional study was carried in Geriatric clinic with patients aged over 60 years in 100 patients. Basic demographic data and clinical history was taken by physician. Categorical variables were summarized by percentages. Associations were explored with odds ratio (OR) and 95% confidence intervals (CIs).
 Results: Out of 100 patients 61 were males and 39 were females. Visual impairment was the most common handicap with prevalence of 89%, with males more affected than females. Weight loss was there in 47% of patients. Forty two percent has depression and 41% has arthritis. Apart from these uncorrected hearing impairment was present in 46% of patients. Urinary complaints were more common in males.
 Conclusion: It was found that elderly population has all kind of ailments so a multidispliniary approach should be there in every Geriatric Clinic so that each co-morbid condition can be taken care off.

Anemia in the aged is not ageing related: position paper on anemia in the aged by the "working group anemia" of the German Geriatric Society (DGG).

Anemia in the aged is a frequent but still under-estimated problem in geriatric patients. However, in recent years increasing research on anemia in the aged has improved awareness and interest in this clinically relevant problem. Guidelines for diagnostic and therapeutic steps are now required to improve the treatment of anemic aged patients. For encouraging the development of diagnostic and therapeutic recommendations, the "working group anemia" of the German Geriatric Society (DGG) has issued a position paper on anemia in the aged, based on the current literature. The statements are (1) that anemia has to be considered a highly prevalent but not a physiologic finding in aged persons; (2) that reference values for hemoglobin concentration are independent of age, indicating that WHO reference values for anemia definition are valid for aged persons; (3) that anemia in the aged is associated with functional and cognitive impairment based on comprehensive geriatric assessment (CGA), requiring diagnosis and treatment.

Home-Based Comprehensive Medication Reviews: Pharmacist's Impact on Drug Therapy Problems in Geriatric Patients.

To evaluate the effects of pharmacist-conducted, home-based comprehensive medication reviews (CMRs) on drug therapy problems (DTPs) in geriatric patients. Pre-/postintervention study. Grocery store chain affiliated with three independent living facilities. Twenty-five older adults using pharmacy delivery services for at least three chronic medications. A pharmacist conducted a home-based CMR for each participant. DTPs were identified across 13 categories. Patients received a medication action plan post-CMR. A follow-up patient phone call was completed two weeks following the appointment. Patient profiles were reviewed for three months postintervention for changes in DTPs. Changes in DTPs per patient and changes in five Centers for Medicare & Medicaid Services triple-weighted Star Rating performance measures. The average DTPs identified per patient were reduced from 3.4 ± 2.06 to 1.48 ± 1.68 (P < 0.05) DTPs three months postintervention. The most common categories identified-nonadherence and incorrect administration/ technique-were significantly reduced (P = 0.012 and P = 0.010, respectively). One Star Rating performance measure significantly improved: 68% of patients taking hypertension medications were adherent at baseline and 91% were adherent three months post-CMR (P = 0.016). Pharmacist-provided, home-based CMRs reduced the average number of DTPs per patient. The most common categories of DTPs identified-nonadherence and incorrect administration/technique-were reduced postintervention.

External fixation in the elderly

Orthopaedic trauma is an increasingly common problem in geriatric patients. As demands of daily life and recreational activities are increasing in these patients, surgeons need to be able to manage geriatric fractures to achieve good functional results. Reduced bone quality in the elderly presents a considerable challenge and may preclude the use of established surgical stabilisation techniques that are performed in younger trauma patients. Furthermore, pre-existing medical conditions and considerable comorbidities in the elderly could complicate standard surgical procedures that younger patients would be offered. In this respect, application of external fixators represents a validated, minimally-invasive treatment opportunity. This review article summarises the use of external fixation in geriatric trauma patients for wrist fractures, proximal femoral fractures, pelvic fractures, and ankle fractures. Modern modifications, like pin coating with hydroxyapatite, and aspects of pin care will be discussed.

Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients

Malnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal. This study combines two methods using both qualitative and quantitative analysis. Patients (n=43; 82.5±7.5yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients. The prescribed diet differed significantly (P<0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff. Patients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.

Adverse drug reactions due to antipsychotics and sedative-hypnotics in the elderly

Psychotropic drugs are commonly used to manage mental and behavioral problems in geriatric patients. This is, however, accompanied by the risk of developing adverse drug reactions (ADRs), impacting the safety with which the drug can be used. In this article, we provide an overview of the factors associated with the ADRs due to psychotropic medication in the elderly, and the ADRs associated with the use of antipsychotics and sedative-hypnotics in the geriatric population. For this, literature searches were conducted through MEDLINE, PubMed, and Google Scholar using keyword terms: Geriatric, elderly, safety, adverse events, ADRs, antipsychotic, names of individual antipsychotics, benzodiazepine, sedative, hypnotic, zolpidem, zaleplon, zopiclone. Research data indicate that antipsychotics are associated with an increased risk of metabolic syndrome, thromboembolism, cerebrovascular and cardiac events, pneumonia, fractures, and increased mortality. Among antipsychotics, aripiprazole seems to have fewer ADRs while other antipsychotics (typical and atypicals) have reports of troublesome side effect profiles. Sedative-hypnotics are associated with a risk of falls, fractures, cognitive impairment, and may increase the risk of developing dementia with long-term use. The risk of these complications is present with both benzodiazepines and medications such as zolpidem and zopiclone.

Evaluation of infections in geriatric patients at intensive care unit

Background: Infection is a major problem among hospitalized geriatric patients due to reduced immune functions and comorbidities. The course of infections seen in this group are more serious than young people. Duration of hospitalization, morbidity and mortality rates are high. The aim of this study is to evaluate geriatric infections and infection agents in geriatric patients. Methods & Materials: The study was performed in January 2012–December 2012 for one year at Izmir Tepecik Education and Research Hospital. Infections and causative agents among hospitalized patients over 65 years old at Anaesthesiology and Reanimation Intensive Care Unit were evaluated, retrospectively. Data of the patients was achieved from the infection control comitee records. Results: A total of 294 patients were followed-up at intensive care unit during study period. One hundred and seventy six patients (60.8%) who were over 65 years old, enrolled into the study. Infection was detected in 77 (43.7%) of the geriatric patients. The most common infection was ventilatory associated pneumonia (68.8%), following urinary tract infection (32.4%), primary bacteremia (31.3%), catheter related bacteremia (11.6%), pneumonia (6.4%) and skin and soft tissue infections (5.1%). In deep tracheal aspirate cultures, 104 microorganism were isolated. The most common isolated microorganisms were A. baumannii (39.4%) and P. aeruginosa (28.8%). In 35 positive urine cultures, E.coli and P. aeruginosa were both the most prevalent bacterias (20%). The most common primary bacteremia agents were coagulase negative staphylococci (26.9%), A. baumannii (19.2%), E. faecium (15.3%). A. baumannii (30%) was the major cause of catheter related bacteremia. Sputum culture yielded P. aeruginosa (54.5%) and A. baumannii (27.2%) mostly in patient with pneumonia. Tissue biopsy cultures revealed seven (42.8%) isolates of K. pneumoniae. Conclusion: Hospital-acquired infections are major health problem in geriatric patients especially in intensive care units. Cause of infections are predominantly polymicrobial resistant agents such as A. baumannii and P. aeruginosa. Judicious use of antibiotics, limitation of invasive instruments, applying infection control measures can reduce the morbidity and mortality due to infections

Gynecologic Problems in Geriatric Patients

Gynecologic Problems in Geriatric Patients

Infectious Spondylitis: Characteristics of Geriatric Patients and Significance of Surgery

Infectious Spondylitis: Characteristics of Geriatric Patients and Significance of Surgery The goal of this study is to identify the characteristics and common problems of geriatric patients with infectious spondylitis and to explore possible solutions for them.

Optimizing drug therapy in patients with advanced dementia: A patient-centered approach

BackgroundAdvanced dementia is a prevalent health problem in geriatric patients. These patients usually suffer from several chronic diseases, frequently leading to an end-of-life situation lasting months or years, generating complex and often inappropriate medication regimens. ObjectivesDescribe the re-orientation of drug therapy in patients with advanced dementia utilizing a systematic medication review process. MethodsThis non-experimental pre-post analysis included all patients with advanced dementia admitted to acute geriatric unit (AGU) over one year. Medications were reviewed by a multidisciplinary team and together with the patient caregivers; new therapeutic objectives based on end-of-life care principles were established. Medications were classified as preventive, therapeutic, or symptomatic. The average number of medications per patient pre- and post-admission was compared. ResultsWe included 73 patients (mean age 86.1years, mean Barthel Index: 14.5/100). At admission, patients had a mean of 7.27 drugs compared to 4.82 at discharge (66.85% reduction, P<0.05). The main drugs withdrawn were cardiovascular and hematological (35.76%). Drugs for prevention decreased by 66.85% (from 1.8 to 0.6, P<0.05) and those for symptomatic care decreased by 17,52% (from 2.34 to 1.93, P<0.05). ConclusionMedication therapy plans in patients with advanced dementia often do not meet their therapeutic goals. The proposed methodology is a useful tool to assess therapeutic appropriateness.

Körperliche Belastung und Beziehungsprobleme

Suicide is a serious mental health problem in old age. Suicide ideation and life weariness are important psychopathological issues in geriatric medicine, although suicide ideation does not primarily depend on the severity of any physical disease. Despite these facts, insight into the internal psychological state of suicidal geriatric patients is still limited. This study examines intrapsychic and psychosocial issues in suicidal geriatric inpatients. A semistructured interview concerning suicide ideation in old age was used to interview 20 randomly chosen, acutely suicidal clinically geriatric inpatients aged 60 years and older. The control group comprised 20 nonsuicidal patients. Hamilton Depression Scale 21 scores (HAMD 21; patient mean 17.3, control mean 6.1), suicidal ideation and psychiatric treatments differed significantly between the groups. In contrast to lifetime suicidal ideation, the discovery of a physical disease was the primary trigger for current suicidal ideation, followed by interactional conflicts. Patients would rather speak with family or friends than professionals about their suicidal ideation. Suicidal ideation should be recognised as an important psychological problem in geriatric patients with interpersonal conflicts. Specific help and training for relatives is recommended.

Factors responsible for noncompliance to drug therapy in the elderly and the impact of patient education on improving compliance

Background Noncompliance to drug therapy, a common problem in geriatric patients, adversely affects disease outcomes. In India, data addressing noncompliance in elderly patients, the factors responsible for it and possible solutions for the problem are very limited.

Health and nursing problems of elderly patients related to bio-psycho-social need deficiencies and functional assessment

Elderly population is characterized by larger need for social welfare and medical treatment than other age groups. Along with aging, there is a number of emerging health, nursing, caring, psychological and social problems. Complexity of these problems results from overlapping and advancing involutional changes, multi-illness, decreased functional efficiency and other factors. The aim of the study was the assessment of health problems in geriatric patients as well as bio-psycho-social need deficiencies in a view of selected parameters of functional efficiency. The research group consisted of the Chair and Clinic of Geriatrics, 186 women and 114 men, 300 persons in total. The research was carried out using a diagnostic poll method with the application of the Activities of Daily Living (ADL) questionnaire of assessment of daily efficiency on the basis of the Katz Scale; the Care Dependency Scale (CDS) questionnaire used to measure the level of the care dependency and human needs, Norton's bed sores risk assessment scale, the Nursing Care Category (NCC) questionnaire applied to assess the need for nursing care. In most patients the results unveiled manifestations of three or more illnesses. Functional efficiency was at low and average level. Half of the subjects were endangered by risk of bed sores as well as showed high need fulfillment deficiency. The highest level of the deficiency was observed in patients in the eldest age group as well as suffering from multi-illness. Material status, education, place of residence or gender showed no significant influence on the level of need fulfillment.

Edema Management in Long Term Care

Introduction/Objective: Edema is a chronic and common problem in geriatric patients that increases risk for leg wounds, alters comfort, and affects mobility. The treatment of edema leads to an increasing financial burden on the healthcare system. In our facility, we needed a well-defined, effective, economically reliable solution to manage edema and its morbidities. Our solution was to create a multidisciplinary Edema Program that consisted of: 1) Monthly Clinic, which would assist in the diagnosis, management, and treatment of lower extremity edema 2) LN Staff Education, to update nursing staff skills, and standardize the use of compressive devices to control costs and improve end results Through this program, our goal was to maintain skin integrity, prevent wounds, increase mobility, and improve patient comfort through intense evaluation and management of severe lower extremity edema.

Sequential use of teriparatide and risedronate in multifractured severe osteoporosis: Clinical results at 30 month F.U

Background: Fractures are a significant problem in geriatric patients, and understanding the evidence for benefit and possible harm of osteoporosis treatments is critical to appropriate management of this patient population.Objective: The purpose of this article was to review the evidence and treatment considerations related to use of the approved osteoporosis treatments in the United States across the continuum of ages in the geriatric population.Methods: MEDLINE and the Web of Science were searched to find English-language articles published from 2000 through July 2009. Search terms included: practice guideline, osteoporosis, calcium, vitamin D, pharmacoeconomics, ethnicity, and treatment. The generic names of each of the osteoporosis treatments approved in the United States were searched to find relevant clinical trials and randomized controlled trials (RCTs). Pivotal trials that included fracture data or focused specifically on elderly patients (≥60 years of age) were selected. Bibliographies in the identified articles were searched for additional articles, and the prescribing information for each of the approved treatments was reviewed.Results: Many osteoporosis studies have a mean patient age >60 years, but data for older patients are limited. Subanalyses of older patient groups have found risedronate to be beneficial for vertebral fractures in patients aged 70 to 79 years (absolute risk reduction [ARR], 8.4%; P < 0.001) and teriparatide to be beneficial for both vertebral (ARR, 6.4%; P < 0.05) and new nonvertebral fragility fractures (ARR, 9.9%; P < 0.05) in women aged ≥75 years. However, no RCTs of geriatric patients who were either nonambulatory or had multiple comorbidities were identified in the literature.Conclusions: Evidence indicates that the osteoporosis treatments currently available in the United States are beneficial for treating osteoporosis in geriatric patients. However, data are limited for the oldest patients (≥80 years) and those with significant comorbidities. Because of the limited availability of data for geriatric patients with significant comorbidities, the properties of the various agents, including efficacy, tolerability, and potential contraindications, should be considered carefully for each geriatric patient.

Undiagnosed malnutrition and nutrition-related problems in geriatric patients.

Malnutrition is common in geriatric patients and associated with poor outcome. If recognised, effective treatment is possible. In recent years, low nutritional awareness among health care professionals (HCPs) has been deplored with respect to the general hospital population. The aim of the present cross-sectional study was to assess to which extent malnutrition and nutrition-related problems are documented by physicians and nursing staff in geriatric patients and whether nutrition support is used in daily clinical routine. Patient's characteristics, nutritional status (BMI, Subjective Global Assessment, Mini Nutritional Assessment) and several nutrition-related problems (e.g. weight loss, poor appetite, chewing and swallowing problems) were assessed in 205 patients consecutively admitted to the geriatric ward of a community hospital on the first day after admission. After discharge, all documented information in the medical folders about nutritional status, nutrition-related problems and nutrition support was systematically collected. According to BMI (< 22 kg/m(2)) and Subjective Global Assessment (C), malnutrition was observed in 25.4 %, according to Mini Nutritional Assessment (< 17 points) in 30,2 % of the patients. In daily routine, clinical judgement of nutritional status by physicians was performed in 187 patients (91.2 %) of whom 6.4 % (5.9 % of all) were classified as malnourished. Weight was documented in 54.1 %, height in 25.9 %. BMI was not calculated. Nutrition-related problems were present in up to half of the patients and only partly documented by HCPs. Seventeen patients (8.3 %) received nutrition support, mostly in the form of oral supplements (3.9 %), followed by enteral (2.9 %) and parenteral nutrition (1.5 %). Despite high prevalence rates among geriatric patients, malnutrition and nutrition-related problems are rarely recognised and treated. In order to improve nutritional care, routine screening and standard protocols for nutritional therapy should be implemented in geriatric hospital wards.