Specialists In Geriatric Medicine Research Articles

Characterization of patients admitted to specialized geriatric acute care hospital units with the German version of the Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening-instrument: a cross-sectional study

BackgroundThe Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening tool records major geriatric problems, originally applied in the emergency department. Particularly, the distinction of compensated and uncompensated problems is an interesting and new approach. Therefore, we translated the SEISAR in German language and used it to characterize patients in specialized geriatric hospital wards in Germany and to gather initial experience regarding its usability and practicability.MethodsThe tool was translated by three independent specialists in geriatric medicine and backtranslated for quality-assurance by a non-medical English native speaker. In a second step, 8 acute care geriatric hospital departments used the translated version to characterize all consecutive patients admitted over a period of one month between December 2019 and May 2020 at time of admission.ResultsMost of the 756 patients (78%) lived in an own apartment or house prior to hospital admission. Participants had on average 4 compensated and 6 uncompensated problems, a Barthel-Index of 40 pts. on admission with a median increase of 15 points during hospital stay, and a median length of stay of 16 days in the geriatric hospital department.ConclusionSEISAR is an interesting standardized brief comprehensive geriatric assessment tool for the identification of compensated and uncompensated health problems in older persons. The data of this study highlights the number, variability, and complexity of geriatric problems in patients treated in specialized acute care geriatric hospital wards in Germany.Trial registrationGerman Clinical trial register (DRKS-ID: DRKS00031354 on 27.02.2023).

Asynchronous Consultations in Geriatric Psychiatry: Experiences in a Rural Academic Health System

More Americans are living longer and entering old age than ever before. The number of adults age 65 years and older in the United States (US) is projected to grow to more than 83.7 million by 2050. Today's 65-year-olds can expect to live, on average, another 19.4 years. However, the outcomes of extending longevity have not kept pace with the US healthcare system's ability to improve mental and cognitive well-being. The 2012 Institute of Medicine (IOM) report estimates that 14%–20% of the elderly population is afflicted by a mental health or substance use condition, including dementia-related behavioral and psychiatric symptoms. Despite this clear growing demographic need, the number of physicians formally trained in geriatric psychiatry and geriatric medicine is shrinking, limiting the availability of specialty care to this vulnerable demographic. This disparity is magnified in rural settings and/or historically disadvantaged areas/populations where access to geriatric psychiatrists and geriatric medicine specialists may be severely limited, if available at all.This session will cover the development, implementation, and preliminary outcome measures of two asynchronous geriatric psychiatry consultation programs, one EMR based e-consultation program and one on-demand telephone consultation program, that have been developed by geriatric psychiatrists at Dartmouth-Hitchcock Medical Center. Our aim is to demonstrate how similar asynchronous geriatric psychiatry consultation programs could be feasibly implemented at essentially any site or within any health system to begin to address the limited availability of specialty geriatric psychiatry expertise, especially in rural and/or historically disadvantaged areas/populations.

Palliative medicine trainees be should learn about frailty: meta-synthesis and Delphi study to establish curriculum content

ObjectivesFrailty is common and highly associated with morbidity and mortality, a fact that has been highlighted by COVID-19. Understanding how to provide palliative care for frail individuals is an international...

Binita Kane: sharing hidden histories in heritage and health

After violence broke out in his village in what is now Bangladesh, in the years following the 1947 Partition of India, Binita Kane's father Bim Bhowmick left India for the UK. “I saw newspaper articles from the time about how the village was burning and people were being slaughtered. The fact that my Hindu family escaped was just a miracle in itself”, says Kane, “but the circumstances under which a Muslim family risked their own lives to help them was just incredible…I feel the narrative that's been passed down the generations is largely one of hatred. We have really lost the narrative of neighbours sheltering neighbours, generations of Hindus, Sikhs, Muslims, and so many others living together side by side.” Her father eventually became a specialist in geriatric medicine who worked for almost 50 years in the UK National Health Service (NHS). “As a refugee, my dad lived in absolute poverty. His brother and sister died, his father died of a treatable disease…Just somehow, through the kindness of strangers and his own determination, he managed to carry on with his studies.” Their family story featured in a 2017 BBC documentary series on the Partition of India. “I was the first member of my family in over 70 years to go back to the place from where my then very young father fled in terror”, she says.

Unmet Needs for Geriatric Medicine and Care of the Elderly Physicians Work Force in Canada.

Although the current low workforce availability of care of the elderly (COE) physicians, geriatric medicine specialists, and geriatric psychiatrists is undeniable, the ongoing demographic shift means this situation will only worsen. This evolving crisis is outlined clearly in the article “Updated Inventory and Projected Requirements for Specialist Physicians in Geriatrics” by Basu et al. found in this issue of the Canadian Geriatrics Journal.

Decision-Making on Referral to Primary Care Physiotherapy After Inpatient Stroke Rehabilitation

ObjectiveThis study aimed to acquire insight into the decision-making processes of healthcare professionals concerning referral to primary care physiotherapy at the time of discharge from inpatient stroke rehabilitation. DesignA generic qualitative study using an inductive thematic analysis was performed. Semi-structured interviews were conducted following an interview guide. SettingSecondary care centers in the Netherlands: neurology departments of nine hospitals and (geriatric) rehabilitation centers. ParticipantsNineteen healthcare professionals (physiotherapists, specialist in geriatric medicine, physiatrist, physician assistant) participated in the study. All were involved in the decision for referral to primary care physiotherapy. ResultsDuring the inpatient period, healthcare professionals gather information to form a complete picture of the stroke survivor as a basis for decision-making. The decision on referral is influenced by personal factors and home environment of the stroke survivor, organizational factors within the care setting, and the intuition and feeling of social responsibility of the individual healthcare professional. ConclusionsAfter inpatient rehabilitation, many elements are considered that may influence referral to primary care physiotherapy. Presently, there is no consensus concerning referrals. The final decision depends on the individual physiotherapist and care setting. Healthcare professionals mentioned the importance of movement behavior, although there is no consensus if secondary prevention is a primary task of the physiotherapist. More research is needed to identify risk factors for functional decline in order to develop a referral policy that addresses primary care physiotherapy to the right group of stroke survivors.

Recommendations for the management of COVID-19 pandemic in long-term care facilities.

Long-term care facilities (LTCF) and their vulnerable residents are particularly affected by the coronavirus disease 2019 (COVID-19) pandemic. Estimates from various countries suggest that 3–66% of all COVID-19 deaths were residents of LTCF, of which 80% died in their facilities. Despite these significant numbers, recommendations for LTCF for the prevention and medical care of residents during the COVID-19 pandemic are still lacking. These recommendations are based on the existing literature and the expertise of the authors who are specialists in geriatric medicine. The recommendations are addressed to LTCF management, their operators, physicians working in LTCFs and also politicians, to provide the necessary framework conditions. We are confident that our recommendations will offer important help and guidance for LTCFs as well as their physicians. Adherence to these recommendations is likely to improve the outcomes and care of residents in long-term facilities during the COVID-19 pandemic.

Complications with focus on delirium during hospital stay related to femoral nerve block compared to conventional pain management among patients with hip fracture – A randomised controlled trial.

IntroductionPatients with hip fracture often suffer complications leading to increased mortality and morbidity. Pain management are important, but opioids has many side effects. The aim of this study was to investigate whether Femoral Nerve Block (FNB) can reduce complications during hospital stay, with special focus on delirium compared to conventional pain management with opioids among patients with hip fracture, including those with dementia. Patients & MethodsIn a randomized controlled trial involving patients >70 years with hip fracture (trochanteric and cervical), including those with dementia. Preoperatively, patients (n=236) were consecutively assigned to receive FNB and opioids if required (intervention group, n = 116) or conventional pain management using opioids if required (control group, n = 120). Delirium was set according to different assessments and DSM-IV-TR criteria. Other complications were set by a specialist in geriatric medicine and a trained research nurse according to a predefined protocol. ResultsMost patients, 157 (66%), were women, mean age was 84 (±6.7) years and 109 (46%) patients had dementia disorders. Forty-four patients (38.9%) developed delirium preoperatively in the intervention group compared to 59 (49.2%) patients in the control group (p=0.116). Common postoperative complications were pre- and postoperative delirium, nutritional problems, anaemia, constipation and urinary tract infection with no significant difference between the groups. In the subgroup analysis among patients with dementia, a large proportion developed delirium postoperative (96.3%) and they had a long duration of delirium during hospital stay (5.9 ±1.8), however no difference between the groups. ConclusionDespite less preoperative pain and need of opioids, FNB did not reduce the incidence of complications. However, a preoperative FNB may result in less preoperative delirium, but this should be further investigated. As pain treatment, FNB is a good alternative with few documented adverse effects in order to reduce pain and opioids among patients with hip fracture.

Developing evidence-based guidance for assessment of suspected infections in care home residents

BackgroundThe aim of this study was to update and refine an algorithm, originally developed in Canada, to assist care home staff to manage residents with suspected infection in the United Kingdom care home setting. The infections of interest were urinary tract infections, respiratory tract infections and skin and soft tissue infection.MethodWe used a multi-faceted process involving a literature review, consensus meeting [nominal group technique involving general practitioners (GPs) and specialists in geriatric medicine and clinical microbiology], focus groups (care home staff and resident family members) and interviews (GPs), alongside continual iterative internal review and analysis within the research team.ResultsSix publications were identified in the literature which met inclusion criteria. These were used to update the algorithm which was presented to a consensus meeting (four participants all with a medical background) which discussed and agreed to inclusion of signs and symptoms, and the algorithm format. Focus groups and interview participants could see the value in the algorithm, and staff often reported that it reflected their usual practice. There were also interesting contrasts between evidence and usual practice informed by experience. Through continual iterative review and analysis, the final algorithm was finally presented in a format which described management of the three infections in terms of initial assessment of the resident, observation of the resident and action by the care home staff.ConclusionsThis study has resulted in an updated algorithm targeting key infections in care home residents which should be considered for implementation into everyday practice.

European Academy for medicine of ageing session participants' report on malnutrition assessment and diagnostic methods; an international survey

Malnutrition and nutrition-related diseases are associated with hospital admissions, disability, institutionalization, and mortality in older people. Specialists in Geriatric Medicine and nutrition evaluate nutritional status as part of the comprehensive geriatric assessment; however, malnutrition still remains under-recognized and under-managed. Our survey explored nutrition assessment approaches used in daily clinical practice by geriatricians across Europe. A 19-item survey on methods and instruments for malnutrition assessment in geriatric settings, and details of any national guidelines, was sent to 40 postgraduate fellows of the European Academy of Medicine of Aging (EAMA, 2017-2019 class). Thirty-six of the 40 eligible EAMA participants, representing 14 European countries, responded. In clinical practice, MNA and MNA-SF were most frequently used for screening (44.1%, 52.9%, respectively) and diagnosing (45.7%, 40.0%) malnutrition. Weight loss (n=36, 100%), body mass index (n=30, 85.7%), and low energy/food intake (n=27, 77.1%) were the most frequent clinical variables considered. The absolute and relative amount of weight loss, and over what time period, varied widely. These routinely considered clinical factors contribute to validated GLIM, ASPEN-AND and ESPEN criteria for diagnosis of malnutrition, but these criteria were seldom used (GLIM=0%, ASPEN=0%; n=9, ESPEN=25.7%). National guidelines were available in 9 of the 14 countries, and generally recommended MNA and MNA-SF for community-dwelling and hospitalized older patients. Albumin was often suggested as a nutritional marker. Nutritional assessment is systematically performed in geriatrics; but differs widely among geriatricians and countries. Harmonizing guidelines with the new international consensus might provide best-evidence care for older people across Europe.

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.

The Doctor in the Family.

The Doctor in the Family Ronald W. Pies There is a saying in the Talmud: "A man cannot say to the Angel of Death, I wish to arrange my affairs before I die." When swift and sudden, death gives us no time to sign papers and pack our bags. But sometimes, the Angel of Death loiters and lingers. He acts like an unwelcome house guest who takes over the spare room, but bides his time—even sitting at the family dinner table with a self–satisfied smirk. That's how it was in my mother's final days, as she endured, over many months, the slow, choking off of life–blood that is aortic stenosis. Despite many discussions with me—her "son the doctor"—my mother refused potentially life–saving valve surgery. At the age of 88, she was not about to—as she put it—"let some surgeon put a piece of a pig inside my heart!" (This was in the years before the newer, trans–catheter valve replacement techniques had been fully developed). To make matters worse, my mother had developed severe rectal prolapse, which surgery was unable to repair and which caused her significant pain. "I'm like The Wreck of the Hesperus!" my mother said with her gallows humor, alluding to Longfellow's famous poem of shipwreck (" . . . the cruel rocks, they gored her side/Like the horns of an angry bull . . ."). My wife and I had flown down to south Florida and settled into our hotel, fully expecting that we would be present during my mother's final hours. Her physician—a specialist in geriatric medicine—had counseled the family that the end was near, and my mother's home hospice nurses had said the same. But after three weeks, the Angel of Death still refused to strike the final blow—or perhaps my [End Page E6] mother, with her native stubbornness, had informed the Angel that she was not ready. Trained as a psychiatric social worker, my mother was a tough, strong–willed, independent woman. While raising three children, she managed to obtain her bachelor's and master's degrees by driving 50 miles twice a week to the University of Buffalo, often braving both dark of night, and the brutal, western New York winters. In short, my mother was no push–over. She was going to wrestle with malakh ha–mavet—Hebrew for the Angel of Death—and was in no hurry to depart the life she loved. Unfortunately, her epic struggle put my siblings and me in a difficult position. For one thing, my mother would rarely accept the pain medication urged upon her by the hospice nurses, and, at times, by her physician son. This should not have surprised her family. Even during her many years of good health, my mother was reluctant to take so much as an aspirin for a headache. Though born in the U.S., my mother belonged, in spirit, to that generation of tough, Eastern European Jews who believed in enduring and surmounting pain—and who also had a healthy (and sometimes not–so–healthy) skepticism, regarding medication, no matter what the doctor advised. In my family, it was a blessing to raise a doctor, but not necessarily to listen to one! Bearing with my mother's pain was hard on the family. Though she was resolutely stoic in her final days, there were occasions when we could hear her cry out, obviously in pain. The home hospice nurses did their best to cajole her into taking a tablet of hydrocodone, but they rarely succeeded. The nurses knew I was a physician, but I deliberately avoided second–guessing their interventions or trying to "micro–manage" their decisions. My mother told us she wanted her head to be "clear" and that the medication made her "foggy." So we comforted her as best we could with classical music and hand–holding. We hear a great deal these days about "death with dignity." This has come to mean, for many people, a "right" to have a physician assist in a terminally ill person's death, by prescribing a lethal medication. One day, a month or so before my mother died...

Perspectives and Challenges for Geriatric Medicine

Korean society is aging rapidly. Overall, 13.1% of the Korean population was elderly (age ≥ 65 years) in 2015, and this rate is expected to reach 40.1% in 2060. To prepare for this change, the Korean government has developed a long-term care insurance service and supports regional medical centers for the aged. It has established laws about life-sustaining treatment and directives to improve end-of-life care. Although the long-term care insurance currently provides ‘in-home service’ and ‘aged care facilities,’ it does not cover rehabilitation hospitals, which can prevent elderly individuals from accessing certain medical services. With the changing demographics, medical care requires change. Conventional medical care must be upgraded to provide suitable care for an aged society. It is important to support the activities of daily living, rather than simply prolonging life. This will require providing home- and community-oriented medical care to improve quality of life. It will also be necessary to train more geriatricians who understand the characteristics of elderly patients, provide comprehensive geriatric assessments, and lead other physicians in team-based medicine. Internists are already engaging in multidisciplinary collaboration and end-of-life care, which are critical qualities of leading geriatricians. Further discussion and consensus is needed regarding the training of geriatric medicine specialists in Korea. Keywords: Geriatric medicine; Aging 중심 단어: ë ¸ì¸ì˜í•™; ê³ ë ¹í™”

Methodology for senior-proof guidelines: A practice example from the Netherlands.

Evidence-based guidelines constitute a foundation for medical decision making. It is often unclear whether recommendations in general guidelines also apply to older people. This study aimed to develop a methodology to increase the focus on older people in the development of guidelines. The methodology distinguishes 4 groups of older people: (1) relatively healthy older people; (2) older people with 1 additional specific (interfering) comorbid condition; (3) older people with multimorbidity; and (4) vulnerable older people. The level of focus on older people required may be determined by the prevalence of the disease or condition, level of suffering, social relevance, and the expectation that a guideline may improve the quality of care. A specialist in geriatric medicine may be involved in the guideline process via participation, provision of feedback on drafts, or involvement in the analysis of problem areas. Regarding the patient perspective, it is advised to involve organisations for older people or informal carers in the inventory of problem areas, and additionally to perform literature research of patient values on the subject. If the guideline focuses on older people, then the relative importance of the various outcome measures for this target group needs to be explicitly stated. Search strategies for all the 4 groups are suggested. For clinical studies that focus on the treatment of diseases that frequently occur in older people, a check should be made regarding whether these studies produce the required evidence. This can be achieved by verifying if there is sufficient representation of older people in the studies and determining if there is a separate reporting of results applying to this age group.

Jeste Works to Reverse Negative Notions of Aging

Jeste Works to Reverse Negative Notions of Aging

The Health of Geriatrics in Canada —More Than Meets the Eye

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Specialist physicians in geriatrics-report of the canadian geriatrics society physician resource work group.

BackgroundAt the 2011 Annual Business Meeting of the Canadian Geriatrics Society (CGS), an ad hoc Work Group was struck to submit a report providing an estimate of the number of physicians and full-time equivalents (FTEs) currently working in the field of geriatrics, an estimate of the number required (if possible), and a clearer understanding of what has to be done to move physician resource planning in geriatrics forward in Canada.MethodsIt was decided to focus on specialist physicians in geriatrics (defined as those who have completed advanced clinical training or have equivalent work experience in geriatrics and who limit a significant portion of their work-related activities to the duties of a consultant).ResultsIn 2012, there are 230–242 certified specialists in geriatric medicine and approximately 326.15 FTE functional specialists in geriatrics. While this is less than the number required, no precise estimate of present and future need could be provided, as no attempts at a national physician resource plan in geriatrics based on utilization and demand forecasting, needs-based planning, and/or benchmarking have taken place.ConclusionsThis would be an opportune time for the CGS to become more involved in physician resource planning. In addition to this being critical for the future health of our field of practice, there is increasing interest in aligning specialty training with societal needs (n = 216).

The prevalence of stroke and the association between stroke and depression among a very old population

There are few studies comparing those who have had and have not had a stroke among those aged 80 years and over, the very old. The aim of this paper was to investigate the prevalence of stroke and the association between stroke and depression in a very old population. This paper is based on cross-sectional data from a population-based study performed between 2005 and 2007. Half of those aged 85 years, all 90-, and 95-year-olds and older in eight urban and rural municipalities in northern Sweden and Finland were invited to participate. A sample of 601 individuals who participated fully in the study was selected. Data were collected through assessments, structured interviews and investigation of medical charts. A specialist in geriatric medicine determined disease status for depression based on medical records and results from the Geriatric Depression Scale (GDS)-15, the Montgomery Åsberg Depression Rating Scale (MADRS) and the Organic Brain Syndrome (OBS) scale, and for stroke based on medical records and reported disease. The prevalence of stroke was 21.5%. The prevalence of depression was 50.4% among those with stroke compared to 34.3% among those without stroke (OR 1.944, p<0.001). In a logistic regression model adjusted for several demographic variables, diseases and functional level, stroke was independently associated with depression (OR 1.644, p=0.038). A large proportion of those with depression, both with and without stroke, were not receiving antidepressant medication. In conclusion, the stroke prevalence was high and stroke showed a strong association with depression among very old people.

Handbook of Pain Relief in Older Adults: An Evidence‐Based Approach

This is a book of 14 chapters in just over 200 pages that is half authored and half edited by a specialist in Geriatric Medicine. The writing style is clear and easy to follow. I liked the presentation of the material and the layout within the individual chapters. This was pleasingly consistent throughout the book demonstrating tight editorial control of this multi-author work.

Interview: Imaging in Alzheimer’s Disease

Professor Nordberg speaks to Cara Sutton, Commissioning Editor Professor Nordberg completed her predoctoral training at Uppsala University, Uppsala, Sweden, and then commenced a post-doctoral position in the Department of Pharmacology, Uppsala University, where she was appointed Associate Professor in 1979 and Senior Lecturer in 1982. In 1984 she obtained her license to practice medicine and in 1992 became a specialist in geriatric medicine. In 1992 she was also appointed as a professor at Karolinska Institutet, Stockholm, Sweden. Professor Nordberg has trained 21 PhD students to their thesis and hosted 22 foreign post-docs in her laboratory. She is presently supervisor of five PhD students and four post-docs. Professor Nordberg has been awarded numerous awards including The Luigi Amaducci award in Alzheimer´s disease in 2001, the Lifetime Achievement Award at the ICAD conference in 2002, Imaging award of Alzheimer association in 2004, and the Alois Alzheimer award in 2006, and has published more than 390...