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Geriatric Patients (geriatric + patient)

Distribution by Scientific Domains

Medical Sciences	94%

Distribution within Medical Sciences

Geriatric Medicine	42%
Psychiatry	21%
7 Other Subdomains	37%

Selected Abstracts

CHICKENPOX IN A GERIATRIC PATIENT

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2006
Christos G. Savopoulos MD
No abstract is available for this article. [source]

VALIDITY AND RELIABILITY OF QUANTITATIVE GAIT ANALYSIS IN GERIATRIC PATIENTS WITH AND WITHOUT DEMENTIA

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2007
Marianne B. Van Iersel MD
No abstract is available for this article. [source]

Zolpidem Dependence in a Geriatric Patient: A Case Report

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009
Spyridi Styliani MD
No abstract is available for this article. [source]

Hypertension, white matter change and response to cholinesterase inhibitors in Alzheimer's disease

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2005
Peter J. Connelly
Abstract Background Cholinesterase inhibitors are used to treat mild to moderate Alzheimer's disease. Their role in patients with concurrent cerebrovascular disease has been less well studied, and the influence of vascular risk factors on response to treatment is uncertain. We investigated the effect of hypertension and white matter lesions (WML) on response. Methods A retrospective sample of 160 consecutive out-patients who had blood pressure measured and the presence or absence of WML recorded at baseline and who completed six months treatment with a cholinesterase inhibitor was studied. Subjects scored either zero or one on the Modified Hachinski Ischaemic Scale. Subjects were assessed using the Mini-Mental State Examination (MMSE), the Digit Symbol Substitution test (DSST) and both the Instrumental Activities of Daily Living (IADL) and Social Behaviour (SB) sub-scales of the Nurses Observation Scale for Geriatric Patients (NOSGER). Results 43.9% of the total study population were classified as good responders using our criteria. Neither the presence of hypertension nor the presence of WML alone influenced outcome. However, there was a statistically significant interaction between blood pressure and WML on outcome variables on multiple analysis of variance (MANOVA) (F(4,,139),=,5.60, p,<,0.0005). Subjects with both hypertension and WML deteriorate to a significantly greater extent in IADL and SB scores than any other group (p,<,0.05 in each case). This effect could not be explained by age or by smoking status. Conclusion Our results support the hypothesis that there is an interaction between hypertension and WML that adversely influences functional change during cholinesterase inhibitor treatment. Our results are a contrast to suggestions that subjects with vascular disease show a better response to cholinesterase inhibitors. We recommend careful exploration of factors that may influence outcome. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Incidence of In-Hospital Falls in Geriatric Patients Before and After the Introduction of an Interdisciplinary Team,Based Fall-Prevention Intervention

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007
Wolfgang Von Renteln-Kruse MD
Falls are among the most common unwanted events in older hospital inpatients, but evidence of effective prevention is still limited compared with that in the community and in long-term care facilities. This article describes a prevention program and its effects on the incidence of falls in geriatric hospital wards. It was a prospective cohort study with historical control including all 4,272 patients (mean age 80, 69% female) before and 2,982 (mean age 81, 69% female) after introduction of the intervention. The intervention included fall-risk assessment on admission and reassessment after a fall; risk alert; additional supervision and assistance with the patients' transfer and use of the toilet; provision of an information leaflet; individual patient and caregiver counseling; encouragement of appropriate use of eyeglasses, hearing aids, footwear, and mobility devices; and staff education. Measurements included standardized fall-incidence reporting, activity of daily living and mobility status, number of falls and injurious falls, and number of patients who fell. Before the intervention was introduced, 893 falls were recorded. After the intervention was implemented, only 468 falls were recorded (incidence rate ratio (IRR)=0.82, 95% confidence interval (CI)=0.73,0.92), 240 versus 129 total injurious falls (IRR=0.84, 95% CI=0.67,1.04), 10 versus nine falls with fracture (IRR=1.40, 95% CI=0.51,3.85) and 611 versus 330 fallers. The relative risk of falling was significantly reduced (0.77, 95% CI=0.68,0.88). A structured multifactorial intervention reduced the incidence of falls, but not injurious falls, in a hospital ward setting with existing geriatric multidisciplinary care. Improvement of functional competence and mobility may be relevant to fall prevention in older hospital inpatients. [source]

Geriatric Patients Improve as Much as Younger Patients from Hospitalization on General Psychiatric Units

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004
Mark B. Snowden MD
Objectives: To determine whether geriatric patients aged 65 and older on general adult psychiatric units improve as much as younger patients, over what duration their improvement occurs, and their risk of readmission. Design: Cohort study. Setting: Inpatient psychiatric unit of an urban, university-affiliated, county hospital from January 1993 through August 1999. Participants: A total of 5,929 inpatients. Measurements: Standardized, routine assessments by attending psychiatrists included the Psychiatric Symptom Assessment Scale (PSAS) on admission and discharge. Discharge scores, length of stay (LOS), and risk of readmission within 1 year were modeled for the groups using multiple regression analyses. Results: Geriatric patients constituted 5% (n=299) of the 5,929 admissions. In multivariate analysis, geriatric status was not associated with discharge PSAS scores. Median LOS was longer for geriatric patients (16 days) than younger patients (10 days, P<.001), especially in older women (14 days) and geriatric patients with mild medical illness severity (13 days vs 11 days in those with moderate-to-severe medical illness). Geriatric patients were as likely to be readmitted within 1 year of discharge as younger patients. Conclusion: Geriatric patients on general inpatient psychiatry units improved as much as younger patients. Their longer LOS was associated with milder medical illness severity. There may be a role for more specialized care of elderly women or geriatric patients with mild to moderate medical illness to improve the efficiency of their care. [source]

Longitudinal Treatment Outcomes for Geriatric Patients with Chronic Non-Cancer Pain at an Interdisciplinary Pain Rehabilitation Program

PAIN MEDICINE, Issue 9 2010
Kathleen M. Darchuk PhD
Abstract Objective., This study examined depression, pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary pain rehabilitation center compared with middle and younger age groups. Design., Quasi-experimental time series. Setting., Interdisciplinary pain rehabilitation center at a tertiary referral medical center. Patients., In total, 411 patients with chronic non-cancer pain completed the pain rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+; n = 78); middle-age (ages 40,59; n = 230) and younger (ages 18,39; n = 141). Intervention., A 3-week outpatient interdisciplinary pain rehabilitation program based on a cognitive-behavioral model that incorporates opioid withdrawal. Outcome Measures., The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies-Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results., Older patients reported reduced depression, catastrophizing, pain severity, and pain interference (P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social functioning at discharge and follow-up (P < 0.001). Improvement in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reductions in analgesic use were observed in all groups. Conclusion., Interdisciplinary pain rehabilitation incorporating opioid withdrawal can improve long-term psychological, social and physical functioning for geriatric chronic pain patients. [source]

A comparison of psychiatric consultation between geriatric and non-geriatric medical inpatients

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2009
Sarah E. Schellhorn
Abstract Objective The authors examine changes in psychiatric referral patterns for geriatric inpatients since last reported in the United States, more than 20 years ago, and compare geriatric psychiatric referrals to those of a non-geriatric cohort. Method Retrospective study comparing psychiatric diagnosis, treatment and aftercare of younger (ages 18,60 years, n,=,474) and older (>60 years, n,=,487) patients seen in psychiatric consultation in a large, urban, university-based tertiary care hospital setting. Results Compared to previous reports in the literature, this cohort contains a notably higher percentage of the ,old-old' (>80 years), reflecting the general aging of those who are hospitalized. Compared to younger patients, geriatric inpatients were more commonly referred for psychiatric consultation, but overall rates of referral remain low (<4%). Geriatric patients were diagnosed with dementia and delirium more frequently; with substance dependence less frequently; and were just as likely to be diagnosed with depression. Geriatric patients were also more likely to receive atypical antipsychotic medications and less likely to receive benzodiazepines than younger patients. In patients diagnosed with depression, psychiatric follow-up is more likely relegated to outpatient geriatricians and nursing homes. Conclusions Consulting psychiatrists frequently encounter geriatric patients and, given patterns of diagnosis and aftercare, should play a major role in medical staff education and in development of enhanced in-hospital and aftercare services, including psychiatric liaison. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Geriatric Patients Improve as Much as Younger Patients from Hospitalization on General Psychiatric Units

Geropsychiatric consultation in a general hospital in Taiwan

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2005
YEONG-YUH JUANG md
Abstract, The aim of this study was to characterize clinically significant issues in a psychiatric consultation service for geriatric inpatients in a general hospital in Taiwan. This was a case-control study. During a 5-month period, 100 geriatric (age ,65 years) inpatients consecutively referred for consultation-liaison psychiatric service from non-psychiatric departments formed the study group. Another 100 medical inpatients, also referred for consultation-liaison to the psychiatric service, but aged 17,50, formed the control (non-geriatric) group. The diagnosis, demography, reason for referral, symptomatology, and other clinical characteristics were determined by consensus between two psychiatrists. Psychiatric diagnosis was made according to criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The geropsychiatric consultation rate was 0.9%. Geriatric patients constituted 20.1% of all psychiatric referrals. Common reasons for referral of geriatric inpatients were confusion (32%), depression (17%), disturbing behaviors (14%), and psychosis (14%). The most common psychiatric disorder among geriatric patients was an organic mental disorder (79%), followed by a depressive disorder (13%). More geriatric patients suffered from cancers and cerebrovascular diseases than non-geriatric patients. The geriatric group was more likely to have multiple physical illnesses. Organic mental disorder and depressive disorders are the most common psychiatric diagnoses in the geropsychiatric consultation service of the authors. In the authors' experience, both psychotropic medication treatment and psychosocial intervention are important in geropsychiatric consultation. [source]

Intravascular papillary endothelial hyperplasia of the lower lip: surgical approach and review of the literature

GERODONTOLOGY, Issue 4 2009
A. Cohen
Objective:, A review of the literature for intravascular papillary endothelial hyperplasia is presented along with a case report of a geriatric patient. Review of the literature:, Intravascular papillary endothelial hyperplasia (IPEH) is a reactive benign lesion of vascular origin, which is caused by an excessive proliferation of endothelial cells. Only a few cases with IPEH in the oral cavity have been recorded in the literature, reporting the lower lip as the main site. The treatment of choice mentioned in the literature is simple excision. Case report:, In this case, an IPEH of the lower lip of a 79-year-old male was treated by a sclerosing agent, which was injected into the lesion, causing compression and fibrosis of the blood vessels, followed by a careful dissection and excision. Intra-operatively no bleeding occurred. Post-operatively an excellent aesthetic result was achieved, without recurrence. Conclusion:, The use of sclerotherapy followed by surgery in mixed type intravascular papillary endothelial hyperplasia can provide an acceptable aesthetic result with minimal intra-operative bleeding. [source]

Cast titanium overlay denture for a geriatric patient with a reduced vertical dimension

GERODONTOLOGY, Issue 4 2005
Satyabodh Guttal
An older patient reporting to the dental surgery for his/her dental treatment is becoming a common occurrence. Improved oral hygiene has meant that teeth are retained for a longer time, along with the potential problems of attrition, decreased vertical dimension, temporomandibular joint discomfort/strain, and poor aesthetics. The case in question is that of a 65-year-old male patient who had severe attrition in the lower arch, temporomandibular joint pain and reduced vertical dimension. The maxillary arch had previously been restored with a fixed partial prosthesis. For restoration of the lower teeth, a removable cast titanium overlay denture was fabricated incorporating an increased vertical dimension. Porcelain facings were placed to restore the aesthetics of the anterior teeth. The titanium was cast in a semi-automatic electric arc, pressure type casting machine. A titanium overlay denture with porcelain facing on the anterior teeth may provide a means of restoring a patient's concerns regarding aesthetics and function. [source]

Olanzapine associated weight gain, Hyperglycemia and Neuroleptic Malignant Syndrome: case report

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2002
Rhonda Malyuk
Abstract We describe here a case of olanzapine associated weight gain, hyperglycemia and neuroleptic malignant syndrome in a 64 year-old woman with a significant medical history. Eighteen weeks after initiating olanzapine, Mrs X lost glycemic control, exhibited signs and symptoms consistent with neuroleptic malignant syndrome and gained 8.9 kg. We suggest that utilization of olanzapine in the less medically stable geriatric patient be implemented with vigilant monitoring for such complications mentioned above. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Gabapentin withdrawal syndrome in the presence of a taper

BIPOLAR DISORDERS, Issue 3 2005
Kien T Tran
Objective:, To report a case report of a geriatric patient with a 5-year history of gabapentin use for enhanced bipolar control, who was tapered off of gabapentin over 1 week. The patient displayed unique withdrawal symptoms after the taper of gabapentin. Methods:, The patient is an 81-year-old white female with a life-long history of schizoaffective disorder with bipolar type I tendencies who had been prescribed gabapentin for 5 years. Results:, The patient displayed moderate upper respiratory tract infection symptoms and somatic complaints 1 day after termination of gabapentin. These symptoms gradually worsened until 10 days after, at which time she acutely developed severe mental status changes, severe somatic chest pain, and hypertension. Physical examination, electrolytes, electrocardiogram, computerized tomography, magnetic resonance imaging, and magnetic resonance angiography were all normal. Upon reintroduction of gabapentin, the patient returned to baseline within 1,2 days. Conclusions:, Gabapentin is widely utilized currently for the chronic treatment of recalcitrant migraines, bipolar illness, pain, and epilepsy. It has a wide therapeutic index with few side effects and drug interactions, is not hepatically metabolized, and is excreted by the kidneys. Past reports have suggested that some withdrawal symptoms can present after 1,2 days upon abrupt discontinuation of gabapentin after chronic use within young to middle-aged patients. These symptoms mimic that of alcohol and benzodiazepine withdrawal purportedly due to a similar mechanism of action. Unique to this case is that this geriatric patient developed debilitating withdrawal symptoms after a gradual, week-long taper of gabapentin along with flu-like symptoms. It is proposed herein that a gabapentin taper should follow a course similar to that of a benzodiazepine taper , slowly and over a period of weeks to months. [source]

How is geriatrics different from general internal medicine?

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2004
Thomas E Finucane
Geriatrics and general internal medicine overlap greatly: most sick patients seen by a generalist are elderly and geriatricians care for nearly the full spectrum of diseases seen in internal medicine. Differences between the two disciplines can be seen in the areas of patient care, research and administration. As a group, geriatric patients are different from young adults because they are more likely to have multiple chronic illnesses, to depend on others, to be frail and to die in the near future. Each of these characteristics requires special knowledge on the part of the physician. The research agenda in geriatrics extends from attempts to find the molecular basis of sarcopenia and frailty to clinical research on the support of caregivers, who are themselves critically important to patients. In the US, nursing homes are required to have medical directors; this position is largely administrative and requires a distinct set of knowledge and attitudes. Clinical care, research and administrative efforts must all respond to the enormous number of patients who will develop cognitive impairment over the next three decades. Because the number of elderly patients so far exceeds the ability of geriatricians to provide care, education and ,geriatricizing' other specialties will also be an important mission for geriatricians. Proper reimbursement presents a serious challenge to physicians who care for the frail elderly. If geriatricians take care of the frailest, sickest and most vulnerable patients, but reimbursement mechanisms cannot recognize this fact, then all geriatricians will soon go bankrupt. [source]

Interleukin-6 (G-174C) and tumour necrosis factor-alpha (G-308A) gene polymorphisms in geriatric patients with chronic periodontitis

GERODONTOLOGY, Issue 1 2010
A. M. Costa
doi:10.1111/j.1741-2358.2009.00291.x Interleukin-6 (G-174C) and tumour necrosis factor-alpha (G-308A) gene polymorphisms in geriatric patients with chronic periodontitis Background and objective:, Periodontitis is a chronic inflammatory disease, and genetic factors may have an important role in its severity. Polymorphisms in the promoter regions of the interleukin-6 (IL-6) and tumour necrosis factor-, (TNF-,) genes have been reported to cause changes in the production of these cytokines. The aim of this study was to evaluate the possible role of IL-6 (G,174C) and tumour necrosis factor (G,308A) polymorphisms, in the severity of chronic periodontitis in an elderly population. Materials and methods:, In this study, a group of 65 elderly women, comprising 17 patients with moderate chronic periodontitis, 21 with severe chronic periodontitis and 27 healthy patients were selected. DNA was isolated from all subjects, and polymerase chain reaction was used to study the IL-6 and TNF-, gene polymorphisms. Results:, The results of this study showed a significant difference in the allele and genotype frequencies of IL-6 gene polymorphism between patients with periodontal disease and controls. Subjects carrying the G/G genotype of IL-6 were most severely affected by periodontitis. The TNF-, gene polymorphism showed no association with chronic periodontitis between patients and controls. Conclusion:, The results suggest that the IL-6 gene polymorphism may be associated with chronic periodontitis, and that TNF-, gene polymorphism may not be involved in the progression of chronic periodontitis in the population of elderly Brazilian women. [source]

A comparison of psychiatric consultation between geriatric and non-geriatric medical inpatients

Detection of Mild Hyposalivation in Elderly People Based on the Chewing Time of Specifically Designed Disc Tests: Diagnostic Accuracy

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2009
DrOdont, Isabelle Madinier DDS
OBJECTIVES: To compare sialometry with chewing time (including swallowing) of specifically designed disc tests. DESIGN: Index test versus reference standard (sialometry; 60 patients); reliability study (10 patients). SETTING: Outpatient dental clinic and geriatric ward, Nice University Hospital, France. PARTICIPANTS: Thirty adults and 30 older patients (mean ages 47 and 84). INTERVENTION: Index test assessment in patients with and without hyposalivation. MEASUREMENTS: Data from medical files, interviews and oral examination were collected. Sialometry (stimulated salivary flow rate (SSFR) mL/min) and disc chewing times (seconds) were measured. RESULTS: Sialometry was too long and was inappropriate for five of the 30 older persons. Chewing times were negatively correlated to sialometry results (Spearman correlation coefficient (R)=0.77, P<.001). The threshold to diagnose hyposalivation (SSFR <1 mL/min) was 40 seconds (area under the receiver operating characteristic curve (AUC)=0.921, 100% sensitivity, 72% specificity). Twenty-seven subjects with a SSFR less than 1.5 mL/min had a chewing time longer than 40 seconds, suggesting that mild hyposalivation and eating difficulties were related (AUC=0.941, 93% sensitivity, 88% specificity). Mean chewing time was greater with xerostomia (51.9 vs 30.7 seconds, P<.001) but not with dental pain (39.5 vs 39.9, P=.96). Masticatory percentage (e.g., pairs of antagonistic teeth) had no effect on chewing time (SSFR <1 mL/min, AUC=0.921; SSFR <1.5 mL/min, AUC=0.950). Reliability was better for the disc test than for sialometry (intraclass correlation 0.85 vs 0.70). CONCLUSION: This disc test was conceived to detect mild hyposalivation in geriatric patients with impaired dental health. Early detection of hyposalivation could help to suppress or avoid xerostomia-inducing drugs and to prevent oral infections and dental caries. [source]

Improving Medical Student Attitudes Toward Older Patients Through a "Council of Elders" and Reflective Writing Experience

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2009
Glenda R. Westmoreland MD
In an effort to reduce "agism" which is prevalent among medical trainees, a new geriatrics educational experience for medical students aimed at improving attitudes toward older patients was developed. Each 90-minute Older Adult Session included four components: initial reflective writing exercise; introduction to the session; 75-minute dialogue with the "Council of Elders," a group of active, "well" older adults; and final reflective writing exercise. The new session was provided to 237 first- and second-year medical students during the 2006/07 academic year at Indiana University School of Medicine. Session evaluation included comparing scores on the 14-item Geriatrics Attitude Scale administered before and after the session, identifying attitude changes in the reflective writing exercises, and a student satisfaction survey. Student responses on the Geriatrics Attitude Scale after the session were significantly improved in seven of 14 items, demonstrating better attitudes toward being with and listening to older people and caring for older patients. Analysis of the reflective writings revealed changing of negative to positive or reinforced positive attitudes in 27% of medical students, with attitudes not discernable in the remaining 73% (except one student, in whom positive attitudes changed to negative). Learner satisfaction with the Older Adult Session was high, with 98% agreeing that the session had a positive effect on insight into the care of older adults. A Council of Elders coupled with a reflective writing exercise is a promising new approach to improving attitudes of medical students toward their geriatric patients. [source]

Use of Antibiotics in Elderly Patients with Exacerbated COPD: The OLD-Chronic Obstructive Pulmonary Disease Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2006
Raffaele Antonelli Incalzi MD
OBJECTIVES: To verify how frequently geriatric patients hospitalized for exacerbated chronic obstructive pulmonary disorder (COPD) had not been given antibiotics at home and to identify the relationship between the patient's condition and the prescribing practice. DESIGN: Observational study. SETTING: General medicine acute care wards. PARTICIPANTS: Four hundred fifty-nine elderly patients admitted to the hospital because of exacerbated COPD. MEASUREMENTS: Indices of severity of COPD exacerbation, such as age, St. George Respiratory Questionnaire (SGRQ) score, number of exacerbations in the previous year, and Cumulative Illness Rating Scale score were considered in the analyses. RESULTS: Ninety (19.6%) patients had an antibiotic prescribed before admission. The prescription was not associated with older age and was weakly associated with greater comorbidity. Having more than four exacerbations (odds ratio (OR)=2.16, 95% confidence interval (CI)=1.27,3.66) and a SGRQ symptoms subscore greater than 70 (OR=1.61, 95% CI=1.0,2.68) were independent correlates of the use of antibiotics before admission, although 67% of patients reporting more than four exacerbations in the previous year and 73.1% of patients with a SGRQ symptoms subscore greater than 70 had not been given any antibiotic prescription at home. CONCLUSION: The majority of older patients hospitalized for exacerbated COPD had not been given antibiotics at home, although they had at least one index of exacerbation severity. [source]

Geriatric Patients Improve as Much as Younger Patients from Hospitalization on General Psychiatric Units

Antimicrobial Resistance and Aging: Beginning of the End of the Antibiotic Era?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2002
Thomas T. Yoshikawa MD
Throughout the history of mankind, infectious diseases have remained a major cause of death and disability. Although industrialized nations, such as the United States, have experienced significant reductions in infection-related mortality and morbidity since the beginning of the "antibiotic era," death and complications from infectious diseases remain a serious problem for older persons. Pneumonia is the major infection-related cause of death in older persons, and urinary tract infection is the most common bacterial infection seen in geriatric patients. Other serious and common infections in older people include intra-abdominal sepsis, bacterial meningitis, infective endocarditis, infected pressure ulcers, septic arthritis, tuberculosis, and herpes zoster. As a consequence, frequent prescribing of antibiotics for older patients is common practice. The large volume of antibiotics prescribed has contributed to the emergence of highly resistant pathogens among geriatric patients, including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci, and multiple-drug-resistant gram-negative bacilli. Unless preventive strategies coupled with newer drug development are established soon, eventually clinicians will be encountering infections caused by highly resistant pathogens for which no effective antibiotics will be available. Clinicians could then be experiencing the same frustrations of not being able to treat infections effectively as were seen in the "pre-antibiotic era." [source]

Medical Comorbidity and Rehabilitation Efficiency in Geriatric Inpatients

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2001
C Psych, Louise Patrick PhD
OBJECTIVES: To measure and describe medical comorbidity in geriatric rehabilitation patients and investigate its relationship to rehabilitation efficiency. DESIGN: Prospective, multivariate, within-subject design. SETTING: The Geriatric Rehabilitation inpatient unit of the SCO Health Service in Ottawa, Canada. MEASUREMENTS: The rehabilitation efficiency ratio, based on gains in functional status achieved with rehabilitation treatment, and the length of stay were computed for all patients. Values were regressed on the scores of the Cumulative Illness Rating Scale (CIRS), the Mini-Mental State Examination, and the Geriatric Depression Scale to establish predictive power. RESULTS: The findings suggest that geriatric rehabilitation patients experience considerable medical comorbidity. Sixty percent of patients had impairments across six of the 13 dimensions of the CIRS, whereas 36% of patients had impairments across 11 of the 13 dimensions. In addition, medical comorbidity was negatively related to rehabilitation efficiency. This relationship was significant even after controlling for age, cognitive status, depressive symptoms, and functional independence status at admission. CONCLUSION: Medical comorbidity was a significant predictor of rehabilitation efficiency in geriatric patients. Comorbidity scores> 5 were prognostic of poorer rehabilitation outcomes and can serve as an empirical guide in estimating a patient's suitability for rehabilitation. Medical comorbidity predicted both the overall functional change achieved with rehabilitation (Functional Independence Measure gains) and the rate at with which those gains were reached (rehabilitation efficiency ratio). [source]

The Medical Interview: Differences Between Adult and Geriatric Outpatients

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2001
Sandeep Mann MD
BACKGROUND: There is a perception that primary care physicians spend less time with older patients and little is known about physician and older patient satisfaction during clinical encounters. OBJECTIVE: To determine how primary care interviews of geriatric patients differ from those of other adults. DESIGN: Descriptive, analytic study. SETTING: Ten primary care sites in the United States and one in Canada, including public, voluntary, and private clinics and practices. PARTICIPANTS: Of the 544 patients, 45.6% were 65 and older and 17.8% were 75 or older. There were 127 participating physicians. MEASUREMENTS: Encounters were audiotaped and analyzed. Patients and physicians also completed exit questionnaires. RESULTS: Interview length increased significantly with age for men but not for women. Physician satisfaction did not change as patient age increased. Patient satisfaction, on the other hand decreased with age among women but not for men. Although physicians' and younger patients' perceptions of health were moderately associated, there was no association for men ages 75 and over. CONCLUSIONS: There is no evidence that physicians spend less time or are more uncomfortable with older patients. Both physician and male patient satisfaction remain stable with increasing patient age, despite greater disparity in patient and physician perceptions of health. Older female patients are less satisfied with physician visits than their younger counterparts, in the absence of changes in interview length or disparities between older female patients and their physicians in health perception. [source]

The Neuropsychological Impairment Scale,Senior: A procedure for evaluating awareness disturbance in geriatric patients

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 3 2001
William E. O'Donnell
The Neuropsychological Impairment Scale,Senior (NIS-S) is a 30-item, orally administered questionnaire for geriatric patients about symptoms of cognitive impairment, affective disturbance, and defensiveness. Clinical and nonclinical norms are described along with validity and reliability information. A procedure is presented for comparing a patient's self-reported cognitive impairment with scores on performance testing, which gauges whether the patient is over- or under-reporting cognitive deficits. © 2001 John Wiley & Sons, Inc. J Clin Psychol 57: 423,427, 2001. [source]

Pilgrims From Marseille, France, to Mecca: Demographics and Vaccination Status

JOURNAL OF TRAVEL MEDICINE, Issue 2 2007
Philippe Gautret MD
A cohort of 461 Hajj pilgrims to Mecca departing from Marseille was surveyed. Most of travelers originated from North Africa and one third were geriatric patients. An overall low rate of vaccination was observed. The proportions of travelers without correct vaccination were 67% for influenza, 70% for tetanus, 75% for diphteria and poliomyelitis, and 87% for pertussis and hepatitis A. [source]

Review article: benefits and risks of chemotherapy in elderly patients with metastatic colorectal cancer

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2009
E. MITRY
Summary Background, Although metastatic colorectal cancer (mCRC) is largely a disease of older individuals, our understanding of disease processes and their optimal treatment has been gained through trials with populations largely confined to younger individuals. Aim, To identify through a review issues specific to geriatric patients with mCRC (physiological changes associated with aging, burden of coexisting illnesses, altered drug pharmacokinetics and functional impairment) and assess challenges to elderly patients posed by malignancy and exposure to cytotoxic medication. Methods, Our literature search for indexed articles published between 2000 and May 2008 employed terms including irinotecan, oxaliplatin, elderly, mCRC, targeted agents and biologicals. Results, Underrepresentation of older patients in clinical trials makes it difficult to extrapolate findings to older age groups. However, some trials have demonstrated that elderly patients can achieve survival benefits and toxicity comparable to younger patients, although dosage modifications may be required. Conclusions, Currently, benefits with pharmacological therapy are suggested but not proven in the elderly population. Although concurrent illnesses and disabilities can complicate treatment decision making, chronological age alone should not disqualify these patients with mCRC from receiving optimal treatment similar to that offered to their younger cohorts. [source]

Longitudinal Treatment Outcomes for Geriatric Patients with Chronic Non-Cancer Pain at an Interdisciplinary Pain Rehabilitation Program

Psychometric Properties of Commonly Used Low Back Disability Questionnaires: Are They Useful for Older Adults with Low Back Pain?

PAIN MEDICINE, Issue 1 2009
Gregory E. Hicks PT
ABSTRACT Objectives., To evaluate the psychometric properties of two commonly used low back pain (LBP) disability questionnaires in a sample solely comprising community-dwelling older adults. Design., Single-group repeated measures design. Setting., Four continuing care retirement communities in Maryland and in Virginia. Participants., Convenience sample of 107 community-dwelling men and women (71.9%) aged 62 years or older with current LBP. Outcome Measures., All participants completed modified Oswestry Disability (mOSW) and Quebec Back Pain Disability (QUE) questionnaires, as well as the Medical Outcomes Survey Short-Form 36 questionnaire at baseline. At follow-up, 56 participants completed the mOSW and the QUE for reliability assessment. Results., Test,retest reliability of the mOSW and QUE were excellent with intraclass correlation coefficients of 0.92 (95% confidence interval [CI]: 0.86, 0.95) and 0.94 (95% CI: 0.90, 0.97), respectively. Participants with high pain severity and high levels of functional limitation had higher scores on the mOSW (P < 0.0001) and QUE (P < 0.001) scales than other participants, which represents good construct validity for both scales. The threshold for minimum detectable change is 10.66 points for the mOSW and 11.04 points for the QUE. Both questionnaires had sufficient scale width to accurately measure changes in patient status. Conclusions., It appears that both questionnaires have excellent test,retest reliability and good construct validity when used to evaluate LBP-related disability for older adults with varying degrees of LBP. Neither questionnaire appears to have superior psychometric properties; therefore, both the Oswestry and Quebec can be recommended for use among geriatric patients with LBP. [source]