OBM geriatrics最新文献

{"title":"Routines and Structure in the Assessment of Visuospatial Neglect in Rehabilitation Facilities: Current Practice in the Netherlands and the United Kingdom","authors":"Martine S. Bosma, M. A. Caljouw, J. Benfield, Laura Edwards, T. Nijboer, W. Achterberg","doi":"10.21926/OBM.GERIATR.2101163","DOIUrl":"https://doi.org/10.21926/OBM.GERIATR.2101163","url":null,"abstract":"Visuospatial neglect (VSN) adversely impacts both the length of rehabilitation and activities of daily living (ADL) of patients after stroke and can reduce their participation in community activities. Therefore, it is important to assess VSN after stroke in neurorehabilitation facilities. The process of assessing VSN comprehensively in current geriatric rehabilitation remains unclear. This study examined the process of VSN in post-stroke assessment emphasizing the details of the (systematic) routines and structure of VSN assessment in current geriatric rehabilitation facilities in the Netherlands and rehabilitation facilities in the United Kingdom (UK). Health care professionals in geriatric rehabilitation facilities in the Netherlands (n = 6) and in stroke and neurorehabilitation facilities in the UK (n = 6) were interviewed. VSN was not routinely assessed in any of the geriatric rehabilitation facilities in the Netherlands, and only in half of the neurorehabilitation facilities in the UK. Healthcare teams in the Netherlands detected no patients with VSN over a two month period. Several VSN assessment tools were employed. Neuropsychological tests were most frequently used. Nine interviewees indicated the need to improve the process of VSN assessment in actual practice. The suggestions focused on improving the process of assessing VSN and developing relevant knowledge development and training. This study showed that in current rehabilitation practice, VSN was not always assessed in a routine (every stroke patient) and structured (who, when, and, which tests) manner. VSN was not routinely assessed with more than one test (neuropsychological and during daily activities), contrary to best practice recommendations. VSN remains probably underrecognized, especially in geriatric rehabilitation facilities. It is important to improve the current process, including selecting the most appropriate tools for assessing VSN.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42944991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological Management of Spontaneous Intracerebral Hemorrhage in Older Adults","authors":"Sandler Melissa, B. Gretchen, Almohaish Sulaiman","doi":"10.21926/OBM.GERIATR.2101161","DOIUrl":"https://doi.org/10.21926/OBM.GERIATR.2101161","url":null,"abstract":"Pharmacological management of intracerebral hemorrhage in adult patients over 65 years of age requires special considerations due to differing clinical presentations, underlying organ dysfunction, and more complex medical histories and medication profiles. A literature review of articles focusing on the age-specific pharmacological management of intracerebral hemorrhage was conducted. Treatment approaches and clinical outcomes specific to older adults were evaluated and therapeutic considerations for this population are summarized. Older adults were commonly included in trials regarding reversal of anticoagulants and antiplatelet agents and these results are generalizable to older adults. Underlying organ dysfunction should frequently be considered throughout the treatment of intracerebral hemorrhage in older adults. Older adults with intracerebral hemorrhage should be managed similarly to younger adult patients; however, consideration of age-related comorbidities and physiological differences is critically important for optimizing patient care.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43307288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Recommendations to Address Dementia Workforce Development Needs","authors":"J. Weiss, N. Tumosa, Roberta Espinoza, E. Bragg, J. Morgan, J. Flatt, E. McConnell, Grace C Whiting","doi":"10.21926/OBM.GERIATR.2101162","DOIUrl":"https://doi.org/10.21926/OBM.GERIATR.2101162","url":null,"abstract":"This policy paper presents workforce development recommendations for research, clinical care and public stakeholders as they plan future research activities to strengthen the workforce to support the healthcare and social needs of persons living with dementia and their families and caregivers. To create these recommendations, the 2020 National Research Summit on Care, Services and Supports for Persons with Dementia and Their Caregivers (2020 Summit) convened a Workforce Development Stakeholder Workgroup. The Stakeholder Workgroup consisted of an interprofessional team of health professionals from academia, professional organizations, and the federal government with expertise in dementia workforce development. The resulting ten workforce development recommendations represent four themes: (1) Accountability by addressing progress towards implementing the 2017 Research Summit on Care, Services, and Supports for Persons with Dementia and their Caregivers (2017 Summit) workforce recommendations; (2) Improving recruitment, retention, and job quality for direct care workers; (3) Creating a tech-savvy and culturally competent workforce; and (4) Developing educational core competencies, domains and milestones. These recommendations will positively impact the ability of persons living with dementia and their caregivers to access person- and family-centred dementia care that promotes independence and quality of life among those navigating their dementia journey.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42445985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spousal Dementia Grief: A Research Report from the Two-Track Model of Dementia Grief Project","authors":"A. Manevich, S. Rubin, R. Ben-Hayun, J. Aharon-Peretz, Michael Katz, Human Resilience","doi":"10.21926/OBM.GERIATR.2101160","DOIUrl":"https://doi.org/10.21926/OBM.GERIATR.2101160","url":null,"abstract":"Caregiving for a loved one suffering from cognitive decline involves coping with many challenges and losses. This experience increases the risk of worsening the physical and mental health of the caregiver and has been the subject of a substantial number of studies focusing on the stress and burden of the primary caretaker. Theory and research on the grief reactions experienced by the family members, however, continues to lag in terms of the attention given to the behavioral and psychological burden of caregivers. This study aimed for a deeper understanding of the emotional processes in an individual involved in caring and caregiving for a spouse suffering from cognitive decline, through the prism of the Two-Track Model of Dementia Grief (TTM-DG). The TTM-DG emphasizes the continuous emotional attachment to the loved one suffering from cognitive decline (Track II), along with a medico-psychiatric perspective associated with stress, trauma, and changes in life (Track I). In this research project, we examined the degree to which spouses of cognitively impaired, deceased, and healthy partners showed differences and perceptible patterns considering the elements associated with the model and their interrelationship. These elements include behavioral characteristics of the clinical patients suffering from cognitive decline, objective circumstances of the caregiving situation, personality measures of attachment of the caring spouse, and a range of measures assessing psychological well-being and spousal relationship. The current study is a part of a larger ongoing project in Israel to address loss and grief among caregiving family members whose loved ones suffer from cognitive decline. The findings reported in the current paper are based on data derived from self-report questionnaires (i.e., socio-demographic variables, problematic behaviors in patients, objective burden, social support, physical health status, attachment patterns, depression, dementia grief, and relationship satisfaction). Participants in the sample size of 49 came from three groups: (a) spouses of patients suffering from cognitive decline, (b) widowers of deceased dementia sufferers, (c) and a control group of similarly aged participants whose spouses have no cognitive or functional impairment. Examination of the research hypotheses was done by running correlations and one/two-way analyses of variance (ANOVA). Behavioral disorders in the affected spouse correlated positively with the objective burden of the caring/caregiving spouse and with outcome variables. That is, biopsychosocial functioning (Track I) and the ongoing attachment bond with the ill spouse (Track II); objective burden correlated positively with depression and dementia grief, but not with relationship satisfaction; poor caregiver’s physical health was associated positively with depression and dementia grief, but not with relationship satisfaction; social support correlated positively with low levels of depression and dem","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41366670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of the Development of Carotid Artery Atherosclerosis upon Oxidative Stress using Infrared Spectroscopy and Scanning Electron Microscopy","authors":"J. Anastassopoulou, I. Mamarelis, T. Theophanides","doi":"10.21926/obm.geriatr.2104180","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2104180","url":null,"abstract":"In the present study, Fourier-transform infrared (FTIR) spectroscopy and Scanning Electron Microscopy (SEM) were used to investigate the formation and development of carotid artery atherosclerosis. The FTIR spectra showed that with the progression of atheromatic plaque formation, the collagen changed its native structure from ɑ-helix to random coil, amyloid, and cross-links. The infrared spectra and SEM analysis of carotid arteries showed that higher than 65% of the atheromatic plaque in patients with stenosis consisted of calcium carbonate, which lies inside foam cells. However, as the stenosis progresses, these deposits of calcium phosphate become more prevalent. A thorough analysis of the SEM images highlighted that mineral deposits preferred the carboxyl groups of amino acids. The intensity and shape changes in FT-IR spectra in the region of 1200-900 cm-1 were related to elevated serum glucose and uric acid levels, the formation of advanced glycation end products (AGEs), and the involvement of free radicals during atherosclerosis.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45153853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Care Decision-Making for Patients with Advanced Dementia: An Exploratory Study Using Cognitive Task Analysis","authors":"Meira Erel, E. Marcus, F. Ganz","doi":"10.21926/OBM.GERIATR.2101159","DOIUrl":"https://doi.org/10.21926/OBM.GERIATR.2101159","url":null,"abstract":"Decision-making by medical and health care staff forms the core of professional practice. Thought processes, including non-clinical considerations, significantly impact how clinical decisions are made. Such considerations become more relevant when addressing end-of-life care decisions for patients with advanced dementia (PAD). Though palliative care is recommended for this population, its implementation tends to vary. Given the medical staff’s significant influence in guiding clinical decisions, we examined thought processes that accompany staff decisions. We used Cognitive Task Analysis (CTA) to analyze interviews conducted with 15 physicians and 11 nurses working in acute care wards in Central Israel. Participants were interviewed regarding their clinical decision-making in a hypothetical scenario of a PAD who presents with an acute, potentially life-threatening medical problem. Moral judgment orientation was the primary factor affecting clinical decision-making for advanced dementia, with a pronounced dichotomous split between deontological and utilitarian approaches. This polarization was highly associated with the medical specialty. Practitioners in surgical wards tended to focus on the patient’s current medical condition, as an isolated or disease-centered illness perspective, supported by deontological moral lines of thinking. This perspective was contrary to that of staff in medical wards who mostly treated the patient from a holistic perspective with a patient-focus approach, supported by utilitarian moral lines of thinking. Although all respondents presented the patient or family as primary decision partners, the practitioners were motivated to make decisions based on unit hierarchies or positions of authority figures. Therefore, clinical end-of-life decisions are influenced by different thinking processes of the health staff and several non-clinical factors. The moral thinking paradigm was found to be associated with a professional orientation. Understanding the subjective, non-clinical aspects of decision-making for PAD might improve end-of-life care in this population.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41885980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Brain Stimulation – Therapeutic Possibilities in Alzheimer's Disease","authors":"Ethan Fitzgerald, Dorian M Kusyk, N. Tomycz","doi":"10.21926/OBM.GERIATR.2102170","DOIUrl":"https://doi.org/10.21926/OBM.GERIATR.2102170","url":null,"abstract":"Alzheimer’s Disease (AD) is the leading cause of dementia worldwide, and represents a significant cause of cognitive decline, disability, and mortality. Ongoing clinical trials continue to investigate β-amyloid targeted therapy with unclear benefit, and we are currently limited to symptomatic treatment. Therefore, there is a salient need for the development of novel, potentially disease-modifying therapeutic strategies such as deep brain stimulation. This manuscript reviews Deep Brain Stimulation in Alzheimer’s Disease, describing the pathophysiology of the disease in terms of disordered neural circuitry, and a detailed discussion on trails of stimulation of the fornix, the nucleus basalis of Meynert and the ventral striatum/ventral capsule for the treatment of this dementia.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41498913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-Blind, Placebo-Controlled, Randomized Clinical Trial Demonstrates Telomerase Activator TA-65 Decreases Immunosenescent CD8+CD28- T Cells in Humans","authors":"G. Singaravelu, Edison Nj Usa Independent consultant, C. Harley, J. M. Raffaele, Pratheesh O. Sudhakaran, A. Suram, Murphys Ca Usa Independent consultant, New York Ny Usa PhysioAge","doi":"10.21926/OBM.GERIATR.2102168","DOIUrl":"https://doi.org/10.21926/OBM.GERIATR.2102168","url":null,"abstract":"TA-65 is a small molecule telomerase activator extracted from Astragalus species. A previous observational study suggested that TA-65 decreased the number of immunosenescent cells in healthy subjects. Here we examined the impact of TA-65 in a much larger randomized, double-blind, and placebo-controlled study. This study aims to evaluate the effects of TA-65 on senescent CD8+CD28- T cells in healthy subjects. This was a randomized, double-blind, placebo-controlled, and multi-arm parallel trial in 500 healthy subjects. Subjects, clinical staff, and primary outcome assessors were blinded until the database lock. A total of 500 healthy volunteers were randomly allocated, 100 subjects each, into one of the five groups; placebo, TA-65 (100 Units) qd, TA-65 (250 Units) qd, TA-65 (500 Units) qd, or TA-65 (250 Units) b.i.d. Change in the immunosenescence biomarker after nine months was measured. The intention-to-treat analysis of the primary outcome measure included all the randomized subjects (n = 500). Per-protocol analysis of the primary outcome measured included 93% of the randomized subjects (n = 424). Multilevel analysis revealed a significant decrease in the CD8+CD28- T cells with TA-65 intervention compared to the placebo group (p<0.05). Intervention by 100 units and 250 units of TA-65 qd led to a decrement of CD8+CD28- T cells by 28 cells/μl, while the intervention by 500 units of TA-65 led to a decrement of CD8+CD28- T cells by 22 cells/μl; the placebo intake led to an increment of CD8+CD28- T cells by 4.38 cells/μl. None of the serious adverse events (9) were deemed related or were unlikely to be related to the product. Adverse events (AEs), ranging from mild to moderate severity were, observed in 34.6% of the subjects. Oral intake of TA-65 significantly decreased CD8+CD28- T cells.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49435498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysphagia in the Older Age Setting","authors":"Asaad G Ishak, S. Cherukuri, Giancarlo Diaz, R. McCallum","doi":"10.21926/obm.geriatr.2103174","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2103174","url":null,"abstract":"Dysphagia, or difficulty swallowing, is a common condition, especially among the elderly population and can become debilitating. As we age, there are subtle changes in esophageal motility, but by no means is dysphagia ever considered to be a normal result of aging. Dysphagia usually presents with a variety of accompanying symptoms ranging from regurgitation during meals, mild discomfort, to severe chest pain. It can be challenging to localize the dysphagia from the history. The underlying etiology may become evident during subsequent investigations. It is essential to be able diagnose dysphagia as early detection is associated with decreased morbidity and in some cases mortality. In addition, early detection through clinical suspicion, confirmatory imaging or endoscopic evaluation is important as it can lead to early intervention with proper management depending on the underlying etiology, resulting in economic benefit and reduced medical costs. There are various causes of dysphagia, with the majority being benign, but a physician should always be aware of red flags present which may signal more serious causes, such as an underlying malignancy. Our goal in this review article is to focus on detecting the clinical signs of dysphagia and review appropriate further evaluation and update on management of this potentially serious condition in order for elderly patients to achieve an optimal quality of life.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44403239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysphagia in Inclusion Body Myositis, A Disease of the Elderly","authors":"N. Goyal, T. Mozaffar","doi":"10.21926/OBM.GERIATR.2101154","DOIUrl":"https://doi.org/10.21926/OBM.GERIATR.2101154","url":null,"abstract":"Inclusion body myositis is one of the most common acquired myopathies seen in the aging population. The muscle weakness is of insidious onset, frequently starting in the legs, but over time gradually progresses to eventually involve all skeletal muscles of the limbs, face, swallowing and respiratory muscles, leading to significant morbidity and mortality. Complications resulting from dysphagia are the leading cause of poor quality of life and mortality, while highly prevalent, are still underappreciated and underrecognized. This review highlights the importance of understanding the urgent need for recognizing and improving the evaluation, outcome measures and therapeutic options of dysphagia in inclusion body myositis patients.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43003569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}