Geriatric Care (geriatric + care)

Distribution by Scientific Domains

Selected Abstracts

Computerized Physician Order Entry with Clinical Decision Support in the Long-Term Care Setting: Insights from the Baycrest Centre for Geriatric Care

Paula A. Rochon MD
Although computerized physician order entry (CPOE) has been successfully implemented in many acute care hospitals, few descriptions of its use in the long-term care (LTC) setting are available. This report describes the experiences of one LTC facility in developing and implementing a CPOE system with clinical decision support (CDS). Even when a facility has the necessary resources and "institutional will," many challenges are associated with the implementation of this application. The system was designed to meet the needs of healthcare providers in the LTC setting, in particular by informing prescribing decisions, reducing the frequency of prescribing and monitoring errors, and reducing adverse drug event rates. Based on experience adopting this technology early, 10 insights are offered that it is hoped will assist others who are considering the implementation of CPOE systems with CDS in the LTC setting. [source]

Capturing the power of academic medicine to enhance health and health care of the elderly in the USA

William R Hazzard
As in Japan, the US population is aging progressively, a trend that will challenge the health-care system to provide for the chronic, multiple and complex needs of its elderly citizens. and as in Japan, the US academic health enterprise has only belatedly mounted a response to that challenge. Herein is reviewed a quarter of a century of the author's personal experience in developing new programs in gerontology and geriatric medicine from a base in the Department of Internal Medicine at three US academic health centers (AHC): The University of Washington (as Division Head), Johns Hopkins University (as Vice-Chair), and Wake Forest University (as Chair). Rather than to build a program from a new department of geriatrics, this strategy was chosen to capture the power and resources of the department of internal medicine, the largest university department, to ,gerontologize' the institution, beginning with general internal medicine and all of the medical subspecialties (the approach also chosen to date at all but a handful of US AHC). The keystone of success at each institution has been careful faculty development through fellowship training in clinical geriatrics, education and research. Over the same interval major national progress has occurred, including expanded research and training at the National Institute on Aging and the Department of Veterans Affairs, and accreditation of more than 100 fellowship programs for training and certification of geriatricians. However, less than 1% of US medical graduates elect to pursue such training. Hence such geriatricians will remain concentrated at AHC, and most future geriatric care in the USA will be provided by a broad array of specialists, who will be educated and trained in geriatrics by these academic geriatricians. [source]

Improving geriatric mental health nursing care: Making a case for going beyond psychotropic medications

Philippe Voyer
ABSTRACT Providing high-quality mental health nursing care should be an important and continuous preoccupation in the gerontological nursing field. As the proportion of elderly people in our society is growing, the emphasis on high-quality care will receive increasing attention from administrators, politicians, organized groups, researchers and clinical nurses. Recent findings illustrate unequivocally the important contribution of nurses to achieving the goal of high-quality geriatric care. However, the quality of care for the elderly with psychological difficulties has not been addressed. The objective of this article is to illustrate that while nurses can accomplish much to improve the well-being and mental health of the elderly, their skills are often underutilized. Psychotropic drugs are often the first-line interventions used by health-care professionals to treat mental health concerns of elderly persons. Alternative therapies that could be implemented and evaluated, such as psychological counselling, supportive counselling, education and life review, are infrequently used. Nevertheless, current scientific data suggest that it would be very advantageous if nurses were to play a dominant role in the care of elderly people who are depressed or experiencing sleep pattern disturbances. The same can be said about elderly chronic users of benzodiazepines, as well as those with cognitive impairment. Evidence for the use of psychotropic medications as a viable treatment option for the elderly both in the community and in the long-term care setting who are experiencing mental health challenges is examined. Alternative non-pharmacological approaches that nurses can use to augment care are also briefly discussed. [source]

Altered skin blood perfusion in areas with non blanchable erythema: an explorative study

Margareta Lindgren
Abstract Non blanchable erythema, i.e. stage I pressure ulcer, is common in patients in acute and geriatric care and in nursing homes. Research has shown that this type of lesions is prone to develop into more severe pressure ulcers. The peripheral skin blood perfusion is of major importance for the development of pressure ulcers. The aim of this study was to explore the peripheral skin blood perfusion over time, in areas with non blanchable erythema and in corresponding undamaged areas on the opposite side of the body. A total of 19 measurements were performed, over time, using a laser Doppler perfusion imager. The blood flow distribution profiles over areas with non blanchable erythema and undamaged skin were found to be different. As the area of the non blanchable erythema decreased, the blood perfusion distribution profiles gradually became more heterogeneous; an area of high blood perfusion in the centre of the lesions was seen and the perfusion successively decreased closer to the edge. These results indicate that there are differences in blood perfusion between skin areas of non blanchable erythema and undamaged skin. The results also indicate that the visible redness in areas with non blanchable erythema is related to altered blood perfusion. The skin blood perfusion also seems to increase in relation to the size of the non blanchable erythema. [source]

A New Paradigm for Clinical Investigation of Infectious Syndromes in Older Adults: Assessing Functional Status as a Risk Factor and Outcome Measure

Kevin High
Abstract Adults aged 65 and over comprise the fastest growing segment of the U.S. population, and older adults experience greater morbidity and mortality due to infection than young adults. While this factor is well established, most clinical investigation of infectious diseases in the aged focuses on microbiology, and crude endpoints of clinical success such as cure rates or mortality, but often fails to assess functional status, a critical variable in geriatric care. Functional status can be evaluated as a risk factor for infectious disease or an outcome of interest following specific interventions utilizing well-validated instruments. This paper outlines the currently available data suggesting a link between infection, immunity and impaired functional status in the elderly, summarizes commonly employed instruments used to determine specific aspects of functional status, and provides recommendations for a new paradigm in which clinical trials of older adults include functional assessment. [source]

Do We Need to Create Geriatric Hospitals?

Muriel R. Gillick MD
During a single illness episode, the sickest, frailest older patients are often treated in multiple distinct sites, including the emergency room, the intensive care unit, a general medical floor, and a skilled nursing facility. Such frequent transfers involve changes in physician, changes in nursing care, the rewriting of orders, and physical dislocation, all of which can adversely affect outcomes. This system, although efficient, increases the chance of medical errors, promotes delirium, and undermines the doctor-patient relationship. Partial solutions include a team approach to care, an electronic medical record, and substitution of home for hospital care. A more comprehensive solution is to create a geriatric hospital for treatment of the most common medical and surgical problems and for provision of rehabilitative or skilled nursing care. Designing new institutions for geriatric care will require new legislation and a new set of regulations but should be considered for the oldest and frailest patients. [source]

Quality of institutional care of older people as evaluated by nursing staff

Arja Isola
Aims., The aim of this paper was to report on the quality of institutional nursing of older people as evaluated by nursing staff in 2001 and to compare the responses with those obtained in 1998. Background., The healthcare division of one Finnish city authorised an outside survey of long-term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of care of older people were issued. A re-survey was conducted in 2001, using the same criteria of quality assessment. Methods., A survey research method was used. All the seven institutions providing long-term geriatric care, including a total of 53 wards, participated. In 1998, a total of 607 questionnaires was returned. The response percentage was 786%. In 2001, a total of 573 questionnaires was returned. The response percentage was 768%. Results., The staff considered their possibilities to help geriatric patients best in the domain of physical care and slightly less good in the domain of psychosocial care. The differences in staff estimates between the two years were very small. More than 90% of the respondents considered their knowledge of physical care adequate. The nursing staff's evaluations were roughly similar in 1998 and 2001. More than 98% of the respondents considered the helping of older people important or moderately important in the other subdomains except sexual expression. According to the nursing staff, intentional or unintentional negligence in care was more common than physically or psychically offensive conduct. Observations concerning maltreatment had increased from 1998 to 2001. The staff reported both physical and mental fatigue. Nevertheless, the nursing staff appeared to be quite content with their current workplaces. Relevance to clinical practice., The findings indicated that geriatric care mostly aims to respond to the physical needs of older people. Nursing should, therefore, be developed and improved because mere satisfaction of physical needs is not enough to guarantee a good quality of life for older people in long-term institutional care. [source]

Screening, Diagnosis, and Clinical Care for Depression

ANP-C, Mary Jo Goolsby EdD
Depression is an extremely common condition, which usually responds well to prescribed treatment. Many patients have undiagnosed depression or related illnesses. There are a variety of screening tools that can be applied in practice settings. It is recommended that adult patients be screened for depression in practice sites able to coordinate the actual diagnosis and treatment of depression. This column reviews two sets of recommendations specific to the screening, diagnosis, and treatment of depression. Readers are invited to submit suggestions for future CPG columns and manuscripts reviewing CPGs. NPs interested in contributing to the column are invited to contact the column editor, Dr. Goolsby, to discuss their ideas. JAANP's readership is broad, covering all NP specialties. CPGs applicable to any areas of care can be submitted (from acute care to long term care, from neonatal care to geriatric care). [source]

Geriatric Emergency Medicine with Integrated Simulation Curriculum

Chris Doty
Our initiative is a replicable model curriculum that teaches emergency geriatric care principles utilizing didactics and immersive simulation. Simulated scenarios encompass principles specific to geriatric care. Major curricular principles include: 1) respect for patients' autonomy, 2) accommodating patients' physical and cognitive limitations, 3) appropriate resource utilization, and 4) accurate symptom recognition and clinical decision-making. These four basic principles are incorporated throughout the curriculum and specifically during three simulated scenarios: 1) a patient with respiratory distress in the setting of end-stage cancer and end-of-life teaches topics pertaining to living wills, health care proxies and DNR orders; 2) a fallen patient requiring a trauma evaluation and safe discharge teaches resource utilization, complex evaluation of home environment, social support principles, access to medical care concepts, and utilization of institutional social services; 3) a patient with altered mental status caused by polypharmacy and sepsis teaches geriatric diagnostic and intervention challenges. Faculty teach specific clinical tactics such as minimizing distractions, frequent reorientation, minimal use of urinary catheters and "tethering" devices, prompt triage and medical screening exams, and coordinating disposition with family, nursing, and clerical staff. The curriculum also includes large classroom didactics incorporating active learning via live streamed simulation into the resident conference room. We developed an internet-based tool to manage the curriculum and track resident participation. The tool stores and sends educational handouts via email and displays digital media (e.g., radiographs, EKGs) on screen during lectures and simulation sessions. Learning objectives are measured and reinforced with pre- and post-curriculum test questions. [source]