Geriatrics

In 2003, the John A. Hartford Foundation Institute for Geriatric Nursing (Hartford Institute), in collaboration with the American Association of Colleges of Nursing, conducted a survey of baccalaureate schools of nursing in the United States to compare gerontological content to baseline data collected by the Hartford Institute in 1997. Since last surveyed in 1997, baccalaureate nursing programs have been the recipients of substantial new resources and initiatives focused on gerontological curriculum enhancement. While these initiatives are ongoing, and some are in an early stage of development, resurveying baccalaureate programs was seen as a means of taking a midcourse "pulse" as to the effectiveness of these efforts. Data suggest that there has been a fundamental shift in baccalaureate curriculum toward incorporation of a greater amount of gerontological content, integration of gerontological content in a greater number of nursing courses, and more diversity of clinical ...

This article presents an up-to-date review of the literature on hormone augmentation in the elderly to help primary care physicians better evaluate and utilize hormone replacement and optimization strategies to benefit their patients. The scientific literature suggests that hormone supplementation with estrogen, progesterone, testosterone, growth hormone, and thyroid hormone has the potential to improve quality of life and to prevent, or reverse, the many symptoms and conditions associated with aging, including fatigue, depression, weight gain,frailty, osteoporosis, loss of libido, and heart disease. Possible long-term side effects are also considered.

Quality of life (QOL) is a popular term that conveys an overall
sense of well-being, including aspects of happiness and satisfaction with life as a whole. It is broad and subjective rather than specific and objective. What makes it so challenging to measure is that, although the term “quality of life” has meaning for nearly everyone and every academic discipline, what it actually means is somewhat different for each individual and group. How do you reach accord about a measure for quality of life? Perhaps the strongest area of a consensus is that quality of life is extraordinarily broad and conceptually complex, yet
measures are most meaningful when they measure key concepts in a logical way and are as precise as possible.

1 Un programme de formation de trois jours sur le sommeil a l'hopital a ete cree en 2008 a l'initiative de l'Association nationale pour la formation permanente du personnel hospitalier, en collaboration avec le ministere de la Sante 1448 soignants ont ete formes grâce a un programme participatif integrant de nouveaux outils pedagogiques interactifs.

The participation rate of older people in the labour market is forecast to increase due to demographic changes afoot. For example, low fertility rates, higher life expectancy, and increases in the retirement age will affect labour availability. The working-age population trends indicate that the age group 55–64 years will expand. This trend is bolstered by policy debate about the sustainability of economic and social support systems for the wider population and necessary strategies to keep older workers in labour markets. Within the UK, as the statutory pension age is placed now at 67, changes affecting the national default retirement age (previously age 60 for women and 65 for men) already mean that many older workers will feature in workplaces past historical expectations. A lack of sensitivity about the adjustments older workers needed, due to age-related changes in health and functional capacities, attests the demoted valuing of ageing workers. Despite a rise in the importance o...

Most elderly people monitoring systems include the detection of abnormal situations, in particular distress situations, as one of their main goals. In order to reach this objective, many solutions end up combining several modalities such as video tracking, fall detection and sound recognition, so as to increase the reliability of the system. In this work we focus on daily sound recognition as it is one of the most promising modalities. We make a comparison of two standard methods used for speaker recognition and verification: Gaussian Mixture Models (GMM) and Support Vector Machines (SVM). Experimental results show the effectiveness of the combination of GMM and SVM in order to classify sound data sequences when compared to systems based on GMM.

WCY Leung, YF Shea, SC Lee, LW Chu
Psychogeriatrics. 2019 Feb 27
doi :  10.1111/psyg.12432

Hyperphagia is characterized by increased food intake, active searching for food in between meals, and loss of satiety. 1-3 It has been observed in patients with impaired cognitive function. In this case series, we describe four patients with Alzheimer's disease (AD) who presented at our clinic with disturbing eating behaviour. A 91-year-old man was admitted after having a poor appetite for 2 weeks. He was known to have diabetes mellitus type 2 and had recently been prescribed gliclazide and metformin. He also presented with a 6-month history of anterograde episodic memory impairment with apraxia, temporal and spatial disorientation, and an inability to bathe. There was no clinical evidence of depression. Physical examination was unremarkable. Thyroid function test, vitamin B 12 level, and folate level were within normal range. Brain computed tomog-raphy showed bilateral medial temporal lobe atrophy. He was clinically diagnosed with AD according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association diagnostic criteria. Neither an active infection nor another identifiable secondary cause was found to have caused the patient's lack of appetite. Met-formin was stopped in view of the limited oral intake. Off-label use of oral megestrol acetate 40 mg twice daily was started, and the patient was discharged with marked improvement of appetite. The patient was admitted for one week. However, he was readmitted with hyperphagia 2 weeks after discharge. His relatives noted an absence of sati-ety, with frequent inappropriate requests for food. He was found searching for food in the kitchen late at night and, on a few occasions, had consumed his dog's canned food. In the absence of any organic causes based on clinical examination and laboratory tests, megestrol acetate was stopped. Hyperphagia gradually subsided a few days later. At our follow-up clinic 8 weeks later, there was no evidence of hyperphagia. Our encounter with the first patient prompted us to review the case records of 94 AD patients (14 with cerebrospinal biomarkers support, 4 80 with 18 F-fluorodeoxyglucose-positron emission tomog-raphy support, and 18 with amyloid load confirmed on 11 C-Pittsburgh compound B positron emission tomography). From these 94 cases, we identified three more AD patients with hyperphagia (Table 1, Appendix S1), meaning the prevalence of hyper-phagia was 4.2% (4/95). There was a predominance of male patients (75%). Hyperphagia developed between 2 weeks and 5 years after the diagnosis of AD and lasted transiently for 2 weeks to 5 months. All cases resulted in an increase in bodyweight. The relatives of these three patients were taught behavioural management techniques, including keeping food out of sight, using distraction techniques, and eating low-calorie snacks. One patient was managed by stopping the causa-tive medication. To the best of our knowledge, medication has not been previously regarded as a potential cause of hyperphagia, and there have been no reported cases of hyperphagia due to the administration of meges-trol. Megestrol is a progestin with anti-androgen activity that is marketed for use as an appetite stimulant in patients with cancer-related cachexia. Occasionally , it has been used off-label in elderly patients with poor appetite due to various causes. Our case demonstrated the drastic effect of megestrol on appetite stimulation, to the extent of hyperphagia or even pica. Previously, 5-hydroxytryptamine receptor 4 was reported to mediate anorexia. 5 Decreased 5-hydroxytryptamine receptor 4 density in the temporal cortex was associated with a higher incidence of hyperphagia in patients with AD. 5 Our case series further suggested that hyperphagia in AD is mostly a transient problem that lasts for months. The

Transitions of care pose significant risks for patients with complex medical histories. There are few experiential medical education curricula targeting this important aspect of care. We designed and tested an internal medicine transitions of care experience integrated into interns' ambulatory curriculum. The program included 1-hour group didactics, a posthospitalization discharge visit in pairs with a home care nurse (cohort 1: 2011-2012; cohort 2: 2012-2013), and a half-day small-group visit to a skilled nursing facility led by a faculty member in geriatrics (cohort 2 only). Both visits had structured debriefings by faculty in geriatrics. For cohort 1, a quantitative follow-up survey was administered 18 to 20 months after the experience. For cohort 2, reflections were analyzed. Thirty-three of 42 second-year residents (79%) in cohort 1 who participated in didactics and a home visit completed the survey. Seventy-six percent (25 of 33) reported increased knowledge of interprofes...

In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U-PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse-led care program. Examination of treatment fidelity is critical to successful translation of evidence-based interventions into practice. To assess treatment delivery, dose and content of nursing care delivered within the nurse-led care program, and to explore if the delivery may have influenced the trial results. A mixed-methods study was conducted. Type and dose of nursing care were collected during the trial. Shortly after the trial, a focus group with nurses was conducted to explore reasons for the observed differences between the type and dose of nursing care delivered. A total of 835 older persons were included in the nurse-led care program. The mean age was 75 years, 64% were female and 53.5%...

SUMMARY Background Dental health is an important determinant of nutritional status, but has not been investigated as a risk factor for dementia. This study aimed to investigate the association between number of teeth, use of dentures and recent-onset dementia. Methods This was ...

To determine the interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia. A cross-sectional reliability study. Nursing homes and an acute care hospital. Four radiologists reviewed 40 mobile chest radiographs obtained from residents of nursing homes who met a clinical definition of lower respiratory tract infections. Radiologists were asked to interpret radiographs with respect to the film quality; presence, pattern, and extent of an infiltrate; and the presence of a pleural effusion or adenopathy. Interrater reliability was evaluated using the intraclass correlation coefficient derived from a 2-way random effects model. On average the radiologists reported that 6 of the 40 films were of very good or excellent quality and 16 of the 40 were of fair or poor quality. When the finding of an infiltrate was dichotomized (0 = no; 1 = possible, probable, or definite) all 4 radiologists agreed on 21 of the 37 chest radiographs. The intraclass correlation coefficient for the presence or absence of infiltrates was 0.54 (95% confidence intervals [CI] 0.38 to 0.69). For the 14 radiographs where infiltrates were observed by all radiologists, intraclass correlation coefficients for the presence of pleural effusions was 0.08 (95% CI -0.10 to 0.41), hilar adenopathy 0.54 (95% CI 0.29 to 0.79), and mediastinal adenopathy 0.49 (95% CI 0.21 to 0.76). In conclusion, the interrater agreement among radiologists for mobile chest radiographs in establishing the presence or absence of an infiltrate can be judged to be "fair." Treatment decisions need to include clinical findings and should not be made based on radiographic findings alone.

The purpose of this brief note is to present a discussion of the first two sessions of a poetry group conducted with moderately to severely cognitively impaired adults in a nursing home. Exercises and techniques used with this population are discussed. Poetry groups such as this may provide joy those who suffer, a chance to re-experience memories, to connect to others, and the creation of moments of increased value and meaning.

Introduction: Presumptive stressful life events scale (PSLES) is used widely in Indian life-event research. The use of PSLES in the elderly has been rather mechanistic, without giving due emphasis on the unique experiences of the elderly, particularly within the context of contemporary social change of family values in India. This research aimed to critically appraise the relevance of PSLES in the elderly. Methodology: The research was part of a larger project on stress, coping, and religiosity in (faith bases) ashram-dwelling elderly. A single consenting ashram for the elderly (for aged > 60 years) consented to the study. Participants were included if they had stayed for more than 6 months and had no impairment that compromised understanding of the research. We used the PSLES (a checklist method) for evaluating life events. We supplemented our exploration with open-ended interviews to evaluate the relevance and salience attributed to these life-events. Results: Ninety-four elderly participated (response rate was 70.15') with a mean (standard deviation) age of 74.56 (7.39) years, equally represented by either gender, with a mean duration of ashram stay of 10.85 years. Most frequent events reported were death in the family, going on a trip/pilgrimage, personal illness, and changes in biological functions. Discussion: PSLES was developed for adult Indians, and its use in the elderly may need modification due to qualitatively and quantitatively varying life events, such as the importance of nonegocentric stress (loss of job of one's child) versus egocentric stress (own hospitalization) or change of salience of events (e.g., lack of son versus daughter). Conclusion: To improve the relevance of PSLES for life-event research and capture the unique experiences of the elderly, suggested modifications are necessary.

Idiopathic Parkinson's disease (PD) is an age-related neuro-degenerative disorder characterized by slowness, stiffness, resting tremor, gait impairment, and postural instability. Levodopa is the most potent pharmacologic agent for symptom management and is associated with an increase in quality of life and longevity for patients with PD, but chronic use causes motor complications. The availability of several newer types of agents--dopamine agonists, monoamine oxidase inhibitors, and catechol-O-methyltransferase inhibitors--gives physicians increased flexibility with regard to first-line therapy, adjunct therapy, and managing or reducing the frequency of motor complications and other side effects associated with chronic levodopa therapy.

Background: India has begun to feel the burden of an aging society. Aging individuals are now living longer with increasing life expectancy and availability of better health facilities but are also requiring more assistance or care to manage their day to day activities. Objective: This paper examines gender differences in the term of care of older parents in India by studying the expected provision of care by family members. Gender differences in care are important, as the socio-cultural environment of India shapes the role of married children. While married sons are expected to provide long-term care for their biological parents, married daughters have limited scope to do so. This paper examines the level of care of the elderly on basis of gender in the family. Method: To conduct the above-mentioned study the present researcher used both quantitative and qualitative methods. Present study has been conducted based on the 2011 census of Kolkata City in the West Bengal, India, 150 res...

BACKGROUND AND SIGNIFICANCE Falls are among the most common and serious problems facing elderly persons. Falling is associated with considerable mortality, morbidity, reduced functioning, and premature nursing home admissions. 1–5 Falls generally result from an interaction of multiple and diverse risk factors and situations, many of which can be corrected. This interaction is modified by age, disease, and the presence of hazards in the environment. 6 Frequently, older people are not aware of their risks of falling, and neither recognize risk factors nor report these issues to their physicians. Consequently opportunities for prevention of falling are often overlooked with risks becoming evident only after injury and disability have already occurred. 7–9 Both the incidence of falls and the severity of fallrelated complications rise steadily after age 60. In the age 65-and-over population as a whole, approximately 35% to 40% of community-dwelling, generally healthy older persons fall a...

Background: Depression is a common public health problem among elders worldwide and is associated with high morbidity and disability. This study aims to assess depression and its associated factors among elderly in old-age homes and a community of Kathmandu district.
Method: A comparative cross-sectional study recruited 122 elderly from old-age homes and a community of Kathmandu district. Depression was measured using the Geriatric Depression Scale-short scale (GDS-15). Socio- demographic and medical history was collected using semi-structured questionnaire. We utilized bivariate logistic regression to assess the association of depression with each variable.
Results: The prevalence of depression among elderly in old-age homes was 74.6% and in community was 41.8%. The study found that elderly residing at old age homes were four (OR=4.087; 95% CI=2.373-7.038) times more likely to have depression than those residing in the community. Age was found to be associated with depression among the respondent of both settings. In old-age homes, not receiving old-age allowance, bad perception of life, bad social relation, having a chronic disease, lack of care from family, stress and weeping as stress coping strategy were associated with depression. In the community, stress, non-involvement in family decision making, feeling of neglect, dysfunctional capability, bad social relation, lesser monthly income had positive relation with depression. Conclusion: Depression is highly prevalent among Nepalese elderly, with higher burden in those living in old-age homes. This emphasizes the need for screening of depression among elderly, to initiate early intervention measures.

Being a low-income country of South Asia region, Bangladesh has been struggling with its health budget for increasing elderly population over the decades. However, concerns regarding the aging population and its impact on country's socioeconomic status have come to the forefront in the policy making and implementation towards national development in recent years. This paper is intended to discuss ethical issues, in context of principlism, that are likely to arise and the means to deal with ethical dilemmas in healthcare of elderly people involving seniors themselves and their service providers whether professionals or family members. To provide the highest level of care, the entire caregiving team needs to form a partnership having the best interest of the elderly people as their focal point while providing loving, appropriate care to enhance their quality of care, their quality of life and their happiness in the latter days of their lives which is coined as 'healthy ageing'.

This chapter focuses on introducing ideas of the creative ageing policy in the context of international and national strategies. It also overviews the best practices at regional and local levels. The chapter suggests that the roots of the creative ageing policy are derived mainly from the countries characterized by Anglo-Saxon capitalism and the liberal model of the welfare state. The chapter also shows that some important ideas, principles, and observations in this paradigm come from the countries of the European Union as well as the states of the Asia-Pacific region.
https://link.springer.com/chapter/10.1057/978-1-137-53523-8_5