OBM geriatrics最新文献

{"title":"The Role of General Medicine in the Evaluation of Frailty in the Elderly Population: Definition of a Standardized Instrument for the Correct Framing of Frailty and Comparison with Currently Existing Instruments for Stratification of Clinical Risk","authors":"F. Robusto, Giovanni Colucci, M. Zamparella, Enrico Maria Pellegrini, Brigida Martucci, P. Iacovazzo, Enza Colucci, M. Minardi, C. Giliberti, V. Bossone, V. Lepore, Stefano Ivis","doi":"10.21926/obm.geriatr.2201192","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2201192","url":null,"abstract":"Frailty is a chronic condition that increases the vulnerability to stressogenic factors and prevents the patient from returning to the preceding condition of homeostasis. This increases the risk of negative outcomes and progressively brings the patient toward disability, leading to higher use of healthcare resources. Clinical risk stratification systems can generally be useful for identifying frail patients from the standpoint of a healthcare system, though General Practitioners (GPs) assume a key and irreplaceable role in the definition and correct diagnosis of frailty. This study developed a standardized instrument (called SVaFra) for the definition of frailty in the elderly population in a general medicine setting and compared it with a few clinical risk stratification tools that have already been validated and are in wide use. In addition, the impact of the application of SVaFra on healthcare outcomes was evaluated. A scientific board composed of experienced GPs, biomedical engineers, and other healthcare professionals, involved in the management of patients suffering from frailty, developed a framework in the form of a questionnaire for the evaluation of frailty by creating four principal groupings of the components that characterize it (clinical complexity, disability, family environment, and management complexity). An observational study, involving 98 GPs from four Italian regions who filled out the questionnaire, was then developed. The doctors were asked to provide a judgment for the four frailty components and the overall frailty. Additionally, a cohort of patients was stratified by applying Charlson Comorbidity Index (CCI) and Drug Derived Complexity Index (DDCI) to administrative databases. The utilization of healthcare resources in the year following the administration of the SVaFra framework with this population was compared with a control group with similar clinical or demographic characteristics. A total of 1,305 frail geriatric patients were identified (males 36.0%; mean age 83.1 ±8.52 years). Regarding the four principal areas used by the GPs to formulate a frailty judgment, the clinical categorization “moderate-severe” was most frequently noted (57.0%). The GPs then specified the following most frequent pathologies: arterial hypertension (76.4%), congestive heart failure (31.5%), dementia (30.7%), diabetes (29.9%), cardiac arrhythmia (27.6%), major depression (25.2%), stroke (22.0%), respiratory insufficiency (22.0%), chronic renal insufficiency (12.6%), management complexity (48.3%), disability (43.2%), and family environment (23.8%). For 165 subjects (12.6%), the GPs expressed an overall frailty judgment of “severe” based on management complexity and disability. Record linkage with administrative databases was possible in 102 cases. The presence of a CCI score of >0 was recorded in only 20 (15.3%) patients identified as frail by GPs, while high DDCI scores were recorded for 88 (86.3%) patients. As for the utilization of healt","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42588508","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":"Adjustment for Covariates of Major Depressive Episodes among Men and Women Aged 65 Years Old and Older","authors":"Areen O` mary, T. Chambers","doi":"10.21926/obm.geriatr.2104185","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2104185","url":null,"abstract":"The current study aimed to examine if sex can significantly predict risk for lifetime major depressive episodes among adults aged 65 and older with and without adjustment for covariate variables of race, education, marital status, health, and poverty. Secondary data was obtained from the National Survey on Drug Use and Health public-use data file to achieve study goals. The study participants were males and females aged 65 years or older. The unweighted sample included 3,969 adults aged 65 years or older, representing a weighted population size of 50,986,065.86 in the US. Lifetime major depressive episode.The study findings confirmed that sex could significantly predict risk for lifetime major depressive episodes among adults aged 65 or older with and without adjustment for health determinants of race, education, marital status, health, and poverty. Four of the five variables, including race, education, health, and poverty, were significant once as covariate variables adjusted for and once as predictor variables. In contrast, marital status was insignificant both as a covariate and a predictor variable. Close attention is required to the adults aged 65 or older at risk for lifetime major depressive episode diagnosis, particularly women, to meet their unique needs.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49623332","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":"Living in an Age of Longevity: Enduring Insights and Perspectives for Embarking on a Quest for Health and Well-Being in Later Life","authors":"T. Seedsman","doi":"10.21926/obm.geriatr.2201195","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2201195","url":null,"abstract":"While increases in life expectancy along with extended longevity can be seen as a success story, there remains the central issue surrounding the health and quality of life for increasing numbers of older people. As populations live longer the idea that older people should be empowered to remain active and productive citizens will be paramount. Questions concerning the meaningfulness, purpose and desirability of living longer present an existential challenge for all and sundry. It is clear, that the speed of population aging has made many existing policies, support services and social structures obsolete and thereby societies worldwide will need to face the profound challenges of rethinking aging and old age in wholly different ways. The need to combat ageism including a re-conceptualization of successful aging is seen to be a critical undertaking to promote healthy and productive aging. In particular, understanding the lived experiences of older people warrants deeper focus surrounding the complex interconnections between agency, social structures and quality of life. Insights and perspectives on human finitude, resilient aging, and self-care are offered for the purpose of highlighting their prospective associations with health outcomes in later life. Human longevity presents new realities demanding serious collaborative conversations on heterogeneity, equity and social justice in the context of a rights-based approach to aging policy.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41858524","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":"The Safety of Oral Telomerase Activator in UV-Induced Skin Cancer with A Review of Telomerase in Aging and Skin Carcinogenesis","authors":"K. Burke, Xueyan Zhou, Yongyin Wang, Huachen Wei","doi":"10.21926/obm.geriatr.2104184","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2104184","url":null,"abstract":"The supplement telomerase activator TA-65 (purified from Astragalus membranaceus) has been shown to retard cellular senescence, boost the aging immune system, and retard age-related symptoms. Lengthened telomeres retard aging, but because cancers often maintain longevity by lengthening telomeres, dietary telomerase activator might possibly increase tumorigenesis. This study investigated whether oral TA-65 effects the timing of onset and/or the incidence of skin cancers induced by UVB-irradiation and whether that possible effect is different if the oral supplementation is begun only after tumors are first detected clinically or if supplementation is begun before initiation of tumors as well as during and after the inciting UVB exposure. Three groups of ten Skh:1 hairless, nonpigmented mice exposed to UVB for twenty weeks were given (1) no supplementation, (2) TA-65 supplementation starting when the first UV-induced skin cancers were clinically observed, after which the UV exposure was terminated, and (3) TA-65 supplementation before, during, and after UV exposure (as more tumors subsequently appeared). Except for two time points when Group 3 had borderline or statistically more tumors ≥ 2mm per mouse, overall, there was no statistically significant difference in the time of onset, the incidence, or the tumor load of skin cancers with TA-65 with either timing, confirming the safety of this anti-aging supplement in this model of the most frequent human malignancy.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48632530","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":"An Overview of Osteoporosis Management","authors":"Nathan S. Jiang, Byron Newton, X. Jiang","doi":"10.21926/obm.geriatr.2104181","DOIUrl":"https://doi.org/10.21926/obm.geriatr.2104181","url":null,"abstract":"Osteoporosis is one of the most common disorders around the world. Osteoporotic fracture especially hip fracture are associated with an increased mortality rate in elders. However, elders with osteoporosis or at high risk of fractures remain largely underdiagnosed and undertreated. The screening, diagnosis, and treatment of osteoporosis must be improved to maintain pace with its fast-growing prevalence. This review will cover risk factors of osteoporosis, screening and diagnosis tools, newfound advancements, current medical treatments including options for special populations of concern, and future research directions.","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47137984","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":"Promoting Quality of Life in Advanced Dementia Care: Reading Buddies Program as Service-learning.","authors":"Scott A Trudeau, Megan E Gately","doi":"10.21926/obm.geriatr.2102169","DOIUrl":"10.21926/obm.geriatr.2102169","url":null,"abstract":"<p><p>The Reading Buddies Program was developed as a service-learning component of an Occupational Therapy Practice with Older Adults course as a collaboration between Tufts University and the VA Bedford Health Care System. The purpose of this service-learning program was to challenge graduate students' implicit biases and improve communication skills when working with older adults with significant cognitive impairments. Through this collaboration, occupational therapy students provided individualized, activity-based care to Veterans with advanced dementia. In this qualitative study, a total of 55 guided reflection papers submitted by students were analyzed using NVivo. Four major themes emerged: \"I was a fish out of water,\" \"I finally took a risk,\" \"And then I thought, maybe I should give myself a little credit,\" and, \"I am still experimenting with how I feel,\" illustrating student outcomes and perceived benefits of participation in the Reading Buddies Program. Each theme reflected the development of clinical reasoning which was the targeted impact. Outcomes confirm service-learning as an effective tool and suggest further use for academic programs, emphasizing the potential of creative partnerships to meet educational goals while providing valuable programming to vulnerable populations.</p>","PeriodicalId":74332,"journal":{"name":"OBM geriatrics","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39565049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","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":" ","pages":""},"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":" ","pages":""},"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":"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":" ","pages":""},"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":" ","pages":""},"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}