Geriatrics: Difference between revisions
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Common and important clinical issues for elders have been proposed.<ref name="pmidpending">Steven R. Counsell et al., “Geriatric Care Management for Low-Income Seniors: A Randomized Controlled Trial,” JAMA 298, no. 22 (December 12, 2007), http://jama.ama-assn.org/cgi/content/abstract/298/22/2623 (accessed December 11, 2007).</ref> These issues are advance care planning, health maintenance, medication management, difficulty walking/falls, chronic pain, urinary incontinence, depression, hearing loss, visual impairment, malnutrition or weight loss, dementia, and caregiver burden. Protocols for these issues are available.<ref name="titleGRACE Team Suggestions">{{cite web |url=http://iucar.iu.edu/research/gracesuggestions.html |title=GRACE Team Suggestions |accessdate=2007-12-11 |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}} ([http://iucar.iu.edu/research/graceteamsuggestions.pdf complete pdf])</ref> | Common and important clinical issues for elders have been proposed.<ref name="pmidpending">Steven R. Counsell et al., “Geriatric Care Management for Low-Income Seniors: A Randomized Controlled Trial,” JAMA 298, no. 22 (December 12, 2007), http://jama.ama-assn.org/cgi/content/abstract/298/22/2623 (accessed December 11, 2007).</ref> These issues are advance care planning, health maintenance, medication management, difficulty walking/falls, chronic pain, urinary incontinence, depression, hearing loss, visual impairment, malnutrition or weight loss, dementia, and caregiver burden. Protocols for these issues are available.<ref name="titleGRACE Team Suggestions">{{cite web |url=http://iucar.iu.edu/research/gracesuggestions.html |title=GRACE Team Suggestions |accessdate=2007-12-11 |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}} ([http://iucar.iu.edu/research/graceteamsuggestions.pdf complete pdf])</ref> | ||
The ACOVE project has created indicators for the quality of care for 22 impactful issues in geriatrics.<ref name="pmid11601948">{{cite journal |author=Shekelle PG, MacLean CH, Morton SC, Wenger NS |title=Acove quality indicators |journal=Ann. Intern. Med. |volume=135 |issue=8 Pt 2 |pages=653–67 |year=2001 |pmid=11601948 |doi=|url=http://www.annals.org/cgi/content/full/135/8_Part_2/653}}</ref><ref name="pmid11601946">{{cite journal |author=Wenger NS, Shekelle PG |title=Assessing care of vulnerable elders: ACOVE project overview |journal=Ann. Intern. Med. |volume=135 |issue=8 Pt 2 |pages=642–6 |year=2001 |pmid=11601946 |doi=|url=http://www.annals.org/cgi/content/full/135/8_Part_2/642}}</ref> | The ACOVE project has created indicators for the quality of care for 22 impactful issues in geriatrics.<ref name="pmid11601948">{{cite journal |author=Shekelle PG, MacLean CH, Morton SC, Wenger NS |title=Acove quality indicators |journal=Ann. Intern. Med. |volume=135 |issue=8 Pt 2 |pages=653–67 |year=2001 |pmid=11601948 |doi=|url=http://www.annals.org/cgi/content/full/135/8_Part_2/653}}</ref><ref name="pmid11601946">{{cite journal |author=Wenger NS, Shekelle PG |title=Assessing care of vulnerable elders: ACOVE project overview |journal=Ann. Intern. Med. |volume=135 |issue=8 Pt 2 |pages=642–6 |year=2001 |pmid=11601946 |doi=|url=http://www.annals.org/cgi/content/full/135/8_Part_2/642}}</ref> These topics include [[depression]], [[diabetes mellitus type 2]], [[heart failure]], [[hypertension]], [[coronary heart disease]], [[osteoarthritis]], [[osteoporosis]], [[pain]] management, [[pneumonia]], pressure ulcers, preventive care, [[stroke]] and [[atrial fibrillation]]. In addition, the list includes the following (with the inclusion of caregiver burden) that are more specific to geriatric care: | ||
===Accidental falls=== | ===Accidental falls=== | ||
{{main|Accidental fall}} | {{main|Accidental fall}} | ||
===Caregiver burden=== | |||
===Continuity and coordination of care=== | |||
===Dementia=== | ===Dementia=== | ||
{{main|Dementia}} | {{main|Dementia}} | ||
===End-of-life care=== | |||
===End of life=== | |||
{{main|Death}} | {{main|Death}} | ||
===Hearing loss=== | |||
===Restraints in the hospital or nursing home=== | ===Hospital care=== | ||
====Restraints in the hospital or nursing home==== | |||
The effect of educating health care providers is not clear. One randomized controlled trial found that an "educational program for nurses combined with consultation with a nurse specialist" did not improve care.<ref name="pmid17067376">{{cite journal |author=Huizing AR, Hamers JP, Gulpers MJ, Berger MP |title=Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial |journal=BMC Geriatr |volume=6 |issue= |pages=17 |year=2006 |pmid=17067376 |doi=10.1186/1471-2318-6-17}}</ref> However, another controlled trial of a more intensive education program combined with consultation did reduce restraints.<ref name="pmid9180659">{{cite journal |author=Evans LK, Strumpf NE, Allen-Taylor SL, Capezuti E, Maislin G, Jacobsen B |title=A clinical trial to reduce restraints in nursing homes |journal=J Am Geriatr Soc |volume=45 |issue=6 |pages=675–81 |year=1997 |pmid=9180659 |doi=}}</ref> However, this study did not account for clustering effect and should be considered a controlled before and after study which is less rigorous. A third trial which used the "A.G.E. dementia care program" (Activities, Guidelines for psychotropic medications, and Educational rounds) showed a reduction in restraints.<ref name="pmid8537594">{{cite journal |author=Rovner BW, Steele CD, Shmuely Y, Folstein MF |title=A randomized trial of dementia care in nursing homes |journal=J Am Geriatr Soc |volume=44 |issue=1 |pages=7–13 |year=1996 |pmid=8537594 |doi=}}</ref> | The effect of educating health care providers is not clear. One randomized controlled trial found that an "educational program for nurses combined with consultation with a nurse specialist" did not improve care.<ref name="pmid17067376">{{cite journal |author=Huizing AR, Hamers JP, Gulpers MJ, Berger MP |title=Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial |journal=BMC Geriatr |volume=6 |issue= |pages=17 |year=2006 |pmid=17067376 |doi=10.1186/1471-2318-6-17}}</ref> However, another controlled trial of a more intensive education program combined with consultation did reduce restraints.<ref name="pmid9180659">{{cite journal |author=Evans LK, Strumpf NE, Allen-Taylor SL, Capezuti E, Maislin G, Jacobsen B |title=A clinical trial to reduce restraints in nursing homes |journal=J Am Geriatr Soc |volume=45 |issue=6 |pages=675–81 |year=1997 |pmid=9180659 |doi=}}</ref> However, this study did not account for clustering effect and should be considered a controlled before and after study which is less rigorous. A third trial which used the "A.G.E. dementia care program" (Activities, Guidelines for psychotropic medications, and Educational rounds) showed a reduction in restraints.<ref name="pmid8537594">{{cite journal |author=Rovner BW, Steele CD, Shmuely Y, Folstein MF |title=A randomized trial of dementia care in nursing homes |journal=J Am Geriatr Soc |volume=44 |issue=1 |pages=7–13 |year=1996 |pmid=8537594 |doi=}}</ref> | ||
===Malnutrition=== | |||
===Medicine use=== | |||
{{main|drug}} | |||
====Adverse drug reaction==== | |||
{{main|Adverse drug reaction}} | |||
====Polypharmacy==== | |||
{{main|Polypharmacy}} | |||
===Urinary incontinence=== | |||
===Vision care=== | |||
==References== | ==References== | ||
Revision as of 18:07, 17 December 2007
Geriatrics is defined as "the branch of medicine concerned with the physiological and pathological aspects of the aged, including the clinical problems of senescence and senility."[1]
Healthy aging
Maintenance of leisure activities that involve cognitive or physical-activity is associated with reduced risk of dementia.[2]
Physical fitness, as measured by maximal treadmill exercise test duration, correlates with longevity in the elderly.[3]
Common clinical issues
Common and important clinical issues for elders have been proposed.[3] These issues are advance care planning, health maintenance, medication management, difficulty walking/falls, chronic pain, urinary incontinence, depression, hearing loss, visual impairment, malnutrition or weight loss, dementia, and caregiver burden. Protocols for these issues are available.[4]
The ACOVE project has created indicators for the quality of care for 22 impactful issues in geriatrics.[5][6] These topics include depression, diabetes mellitus type 2, heart failure, hypertension, coronary heart disease, osteoarthritis, osteoporosis, pain management, pneumonia, pressure ulcers, preventive care, stroke and atrial fibrillation. In addition, the list includes the following (with the inclusion of caregiver burden) that are more specific to geriatric care:
Accidental falls
Caregiver burden
Continuity and coordination of care
Dementia
End-of-life care
Hearing loss
Hospital care
Restraints in the hospital or nursing home
The effect of educating health care providers is not clear. One randomized controlled trial found that an "educational program for nurses combined with consultation with a nurse specialist" did not improve care.[7] However, another controlled trial of a more intensive education program combined with consultation did reduce restraints.[8] However, this study did not account for clustering effect and should be considered a controlled before and after study which is less rigorous. A third trial which used the "A.G.E. dementia care program" (Activities, Guidelines for psychotropic medications, and Educational rounds) showed a reduction in restraints.[9]
Malnutrition
Medicine use
Adverse drug reaction
Polypharmacy
Urinary incontinence
Vision care
References
- ↑ National Library of Medicine. Geriatrics. Retrieved on 2007-12-05.
- ↑ Verghese J, Lipton RB, Katz MJ, et al (2003). "Leisure activities and the risk of dementia in the elderly". N. Engl. J. Med. 348 (25): 2508–16. DOI:10.1056/NEJMoa022252. PMID 12815136. Research Blogging.
- ↑ 3.0 3.1 Xuemei Sui et al., “Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults,” JAMA 298, no. 21 (December 5, 2007), http://jama.ama-assn.org/cgi/content/abstract/298/21/2507 (accessed December 5, 2007). Cite error: Invalid
<ref>tag; name "pmidpending" defined multiple times with different content - ↑ GRACE Team Suggestions. Retrieved on 2007-12-11. (complete pdf)
- ↑ Shekelle PG, MacLean CH, Morton SC, Wenger NS (2001). "Acove quality indicators". Ann. Intern. Med. 135 (8 Pt 2): 653–67. PMID 11601948. [e]
- ↑ Wenger NS, Shekelle PG (2001). "Assessing care of vulnerable elders: ACOVE project overview". Ann. Intern. Med. 135 (8 Pt 2): 642–6. PMID 11601946. [e]
- ↑ Huizing AR, Hamers JP, Gulpers MJ, Berger MP (2006). "Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial". BMC Geriatr 6: 17. DOI:10.1186/1471-2318-6-17. PMID 17067376. Research Blogging.
- ↑ Evans LK, Strumpf NE, Allen-Taylor SL, Capezuti E, Maislin G, Jacobsen B (1997). "A clinical trial to reduce restraints in nursing homes". J Am Geriatr Soc 45 (6): 675–81. PMID 9180659. [e]
- ↑ Rovner BW, Steele CD, Shmuely Y, Folstein MF (1996). "A randomized trial of dementia care in nursing homes". J Am Geriatr Soc 44 (1): 7–13. PMID 8537594. [e]