Geriatrics: Difference between revisions
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==Interventions== | ==Interventions== | ||
It is not clear that home health care helps.<ref>Effects of a home visiting program for older people with poor health status: a randomized, clinical trial in The Netherlands. J Am Geriatr Soc | It is not clear that home health care helps.<ref name="pmid18179482">{{cite journal| author=Bouman A, van Rossum E, Ambergen T, Kempen G, Knipschild P| title=Effects of a home visiting program for older people with poor health status: a randomized, clinical trial in The Netherlands. | journal=J Am Geriatr Soc | year= 2008 | volume= 56 | issue= 3 | pages= 397-404 | pmid=18179482 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=18179482 | doi=10.1111/j.1532-5415.2007.01565.x }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
Exercise can delay decline, even in institutionalized elders/.<ref name="pmid20101011">{{cite journal| author=Dechamps A, Diolez P, Thiaudière E, Tulon A, Onifade C, Vuong T et al.| title=Effects of exercise programs to prevent decline in health-related quality of life in highly deconditioned institutionalized elderly persons: a randomized controlled trial. | journal=Arch Intern Med | year= 2010 | volume= 170 | issue= 2 | pages= 162-9 | pmid=20101011 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20101011 | doi=10.1001/archinternmed.2009.489 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref> | |||
==Prognosis== | ==Prognosis== | ||
Revision as of 04:45, 3 February 2010
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
A normal hospital diet plus 400-mL oral nutritional supplements daily for 6 week improved quality of life among hospitalized elders.[10]
It is not clear whether megestrol or mirtazapine are helpful. [11]
Medicine use
Adverse drug reaction
Polypharmacy
Urinary incontinence
Vision care
Interventions
It is not clear that home health care helps.[12]
Exercise can delay decline, even in institutionalized elders/.[13]
Prognosis
Clinical prediction rules, including the Vulnerable Elders-13 Survey (VES-13)[14], are available for predicting longevity based on current health.[15][16]
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]
- ↑ Gariballa S, Forster S (2007). "Dietary supplementation and quality of life of older patients: a randomized, double-blind, placebo-controlled trial". J Am Geriatr Soc 55 (12): 2030–4. DOI:10.1111/j.1532-5415.2007.01435.x. PMID 17944893. Research Blogging.
- ↑ Fox CB, Treadway AK, Blaszczyk AT, Sleeper RB (April 2009). "Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly". Pharmacotherapy 29 (4): 383–97. DOI:10.1592/phco.29.4.383. PMID 19323618. Research Blogging.
- ↑ Bouman A, van Rossum E, Ambergen T, Kempen G, Knipschild P (2008). "Effects of a home visiting program for older people with poor health status: a randomized, clinical trial in The Netherlands.". J Am Geriatr Soc 56 (3): 397-404. DOI:10.1111/j.1532-5415.2007.01565.x. PMID 18179482. Research Blogging.
- ↑ Dechamps A, Diolez P, Thiaudière E, Tulon A, Onifade C, Vuong T et al. (2010). "Effects of exercise programs to prevent decline in health-related quality of life in highly deconditioned institutionalized elderly persons: a randomized controlled trial.". Arch Intern Med 170 (2): 162-9. DOI:10.1001/archinternmed.2009.489. PMID 20101011. Research Blogging.
- ↑ Min L, Yoon W, Mariano J, Wenger NS, Elliott MN, Kamberg C et al. (2009). "The Vulnerable Elders-13 Survey Predicts 5-Year Functional Decline and Mortality Outcomes in Older Ambulatory Care Patients.". J Am Geriatr Soc. DOI:10.1111/j.1532-5415.2009.02497.x. PMID 19793154. Research Blogging.
- ↑ Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER (2009). "Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the national health interview survey.". J Gen Intern Med 24 (10): 1115-22. DOI:10.1007/s11606-009-1073-y. PMID 19649678. Research Blogging.
- ↑ Lee SJ, Lindquist K, Segal MR, Covinsky KE (2006). "Development and validation of a prognostic index for 4-year mortality in older adults.". JAMA 295 (7): 801-8. DOI:10.1001/jama.295.7.801. PMID 16478903. Research Blogging.