Geriatrics

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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

For more information, see: Accidental fall.

Caregiver burden

Continuity and coordination of care

Dementia

For more information, see: Dementia.

Depression

For more information, see: Major depressive disorder.

Either the PHQ-9 or the Geriatric Depression Scale can be used for diagnosis.[7][8]

End-of-life care

For more information, see: Death.

Decision making can be assessed with the Aid to Capacity Evaluation (ACE).[9]

Frailty

Frailty can be defined as having three or more of the criteria of Fried:[10]

  • Walking speed diminished
  • Exhaustion during three days of the prior week
  • Grip strength diminished
  • Weight loss of 1 kilogram or more in the last three months
  • Physical activity in lowest quintile

Reduced walking speed may be the most important marker.[11]

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.[12] However, another controlled trial of a more intensive education program combined with consultation did reduce restraints.[13] 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.[14]

Malnutrition

A normal hospital diet plus 400-mL oral nutritional supplements daily for 6 week improved quality of life among hospitalized elders.[15]

It is not clear whether megestrol or mirtazapine are helpful. [16]

Medicine use

For more information, see: drug.

Adverse drug reaction

For more information, see: Adverse drug reaction.

Polypharmacy

For more information, see: Polypharmacy.

Geriatric consultation for inpatients may reduce medications by a variable amount.[17] One study reported significant benefit. Another study reported small benefit, but effect on clinical outcomes is not certain.[18]

Urinary incontinence

Vision care

Interventions

It is not clear that home care service helps.[19]

Exercise can delay decline, even in institutionalized elders.[20]

Prognosis

Clinical prediction rules, including the Vulnerable Elders-13 Survey (VES-13)[21], are available for predicting longevity based on current health.[22][23] These have been reviewed(http://www.eprognosis.org/). [24]

References

  1. National Library of Medicine. Geriatrics. Retrieved on 2007-12-05.
  2. 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. 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).
  4. GRACE Team Suggestions. Retrieved on 2007-12-11. (complete pdf)
  5. Shekelle PG, MacLean CH, Morton SC, Wenger NS (2001). "Acove quality indicators". Ann. Intern. Med. 135 (8 Pt 2): 653–67. PMID 11601948[e]
  6. 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]
  7. Phelan E, Williams B, Meeker K, Bonn K, Frederick J, Logerfo J et al. (2010). "A study of the diagnostic accuracy of the PHQ-9 in primary care elderly.". BMC Fam Pract 11: 63. DOI:10.1186/1471-2296-11-63. PMID 20807445. PMC PMC2940814. Research Blogging.
  8. Williams JR, Hirsch ES, Anderson K, Bush AL, Goldstein SR, Grill S et al. (2012). "A comparison of nine scales to detect depression in Parkinson disease: which scale to use?". Neurology 78 (13): 998-1006. DOI:10.1212/WNL.0b013e31824d587f. PMID 22422897. PMC PMC3310315. Research Blogging.
  9. Sessums LL, Zembrzuska H, Jackson JL (2011). "Does this patient have medical decision-making capacity?". JAMA 306 (4): 420-7. DOI:10.1001/jama.2011.1023. PMID 21791691. Research Blogging.
  10. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. (2001). "Frailty in older adults: evidence for a phenotype.". J Gerontol A Biol Sci Med Sci 56 (3): M146-56. PMID 11253156[e]
  11. Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B (2010). "The assessment of frailty in older adults.". Clin Geriatr Med 26 (2): 275-86. DOI:10.1016/j.cger.2010.02.002. PMID 20497846. Research Blogging.
  12. 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.
  13. 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]
  14. 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]
  15. 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.
  16. 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.
  17. Gallagher PF, O'Connor MN, O'Mahony D (2011). "Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria.". Clin Pharmacol Ther 89 (6): 845-54. DOI:10.1038/clpt.2011.44. PMID 21508941. Research Blogging.
  18. Pope G, Wall N, Peters CM, O'Connor M, Saunders J, O'Sullivan C et al. (2011). "Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.". Age Ageing 40 (3): 307-12. DOI:10.1093/ageing/afq095. PMID 20817937. Research Blogging.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK (2012). "Prognostic indices for older adults: a systematic review.". JAMA 307 (2): 182-92. DOI:10.1001/jama.2011.1966. PMID 22235089. Research Blogging.