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Laudisio A, Marzetti E, Franceschi F, Bernabei R, Zuccalà G. Disability is associated with emergency room visits in the elderly: a population-based study. Aging Clin Exp Res 2015; 27:663-71. [PMID: 25680781 DOI: 10.1007/s40520-015-0324-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 01/24/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Emergency room (ER) visits and hospitalizations of elderly subjects with chronic comorbidities, often disabled, are increasing. AIMS The aim of the present study was to assess whether among older subjects functional disability is associated with increased ER visits and hospitalization rates. METHODS We assessed the association of functional ability with 1-year ER visits and hospitalization rates in all 342 subjects aged 75+ living in Tuscania (Italy) in 2004. Functional ability was estimated using the Katz' activities of daily living (ADLs), and the Lawton and Brody scale for the instrumental activities of daily living (IADLs). Functional disability was defined as the dependence for two or more ADLs or IADLs. RESULTS According to Cox regression, disability in ADLs was associated with increased risk of ER visits (RR 2.12; 95 % CI 1.11-4.08; P = .023) but not of hospital admission (RR 1.50; 95 % CI .80-2.80; P = .208). Also, in Poisson regression, ADLs disability predicted the number of ER visits (IRR 2.56; 95 % CI 1.48-4.40; P = .001). DISCUSSION Disability is associated with increased risk of ER visits, but not of subsequent hospitalization in community-dwelling elderly, independent of clinical conditions. Dedicated studies are needed to evaluate the impact of social interventions for disabled elderly on ER access rates. CONCLUSIONS Emergency Departments should implement innovative triage procedures to identify older patients with disability who gain access to ER, to recognize and classify any unmet social needs.
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Affiliation(s)
- Alice Laudisio
- Department of Gerontology, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
| | - Emanuele Marzetti
- Department of Gerontology and Geriatrics, Catholic University of Medicine, Rome, Italy
| | | | - Roberto Bernabei
- Department of Gerontology and Geriatrics, Catholic University of Medicine, Rome, Italy
| | - Giuseppe Zuccalà
- Emergency Department, Catholic University of Medicine, Rome, Italy
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102
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Bahat G, Soyluk O, Tufan F, Karan MA. Might excess body weight be beneficial for the community-dwelling older people? Disabil Health J 2015; 8:467-8. [PMID: 26275492 DOI: 10.1016/j.dhjo.2015.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/02/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Gulistan Bahat
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34390 Istanbul, Turkey.
| | - Ozlem Soyluk
- Istanbul Medical School, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Capa, 34390 Istanbul, Turkey
| | - Fatih Tufan
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34390 Istanbul, Turkey
| | - Mehmet Akif Karan
- Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Istanbul University, Capa, 34390 Istanbul, Turkey
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103
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Camina-Martín MA, de Mateo-Silleras B, Malafarina V, Lopez-Mongil R, Niño-Martín V, López-Trigo JA, Redondo-del-Río MP. Nutritional status assessment in geriatrics: Consensus declaration by the Spanish society of geriatrics and gerontology nutrition work group. Maturitas 2015; 81:414-9. [DOI: 10.1016/j.maturitas.2015.04.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/29/2015] [Indexed: 12/23/2022]
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Maxwell CA, Miller RS, Dietrich MS, Mion LC, Minnick A. The Aging of America: A Comprehensive Look at over 25,000 Geriatric Trauma Admissions to United States Hospitals. Am Surg 2015; 81:630-6. [DOI: 10.1177/000313481508100630] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 2001 study on geriatric trauma by trauma center (TC) status was based on 1989 Medicare data. The purpose of this study was to compare 1989 findings with a 2009 sample, and to examine patient characteristics and outcomes by TC status. From 2009 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS) data, we examined a geographically representative sample ( n = 25,512) of injured older adults (>/= age 65) admitted to 127 TCs and non-TCs in 24 states. Data analysis included descriptive statistics for eight patient characteristics and four outcome variables (mortality, discharge disposition, length of stay, and total charges). χ2 tests were conducted to examine differences between 1989 and 2009 for age groups, gender, and mortality. Higher percentages of patients were in older age groups in 2009, however mortality declined overall (4.8% vs 3.4%, P < .001). Consistent incremental patterns of differences were observed among TC levels for all patient characteristics and outcomes. Level I TCs admitted highest percentages of: lower age groups, males, nonwhite race, motor-vehicle related trauma, and intracranial injuries. Non-TCs admitted highest percentages of oldest age groups, comorbidities, falls, femur neck fractures, and patients requiring OR procedures. Although Level I TCs had higher lengths of stay and total charges, a higher percentage of patients were discharged home. Despite a growing number of patients in older age groups, inpatient mortality declined over two decades. Level I TCs are managing patients at highest risk for decompensation and mortality; a significant percentage of patients are going to non-TCs.
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Affiliation(s)
| | - Richard S. Miller
- Division and Trauma and Surgical Critical Care, Nashville, Tennessee
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105
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Yates P, Miaskowski C, Cataldo JK, Paul SM, Cooper BA, Alexander K, Aouizerat B, Dunn L, Ritchie C, McCarthy A, Skerman H. Differences in Composition of Symptom Clusters Between Older and Younger Oncology Patients. J Pain Symptom Manage 2015; 49:1025-34. [PMID: 25582681 DOI: 10.1016/j.jpainsymman.2014.11.296] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/13/2014] [Accepted: 11/22/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Older oncology patients have unique needs associated with the many physical, psychological, and social changes associated with the aging process. The mechanisms underpinning and the impact of these changes are not well understood. Identification of clusters of symptoms is one approach that has been used to elicit hypotheses about the biological and/or psychological basis for variations in symptom experiences. OBJECTIVES The purposes of this study were to identify and compare symptom clusters in younger (<60 years) and older (≥60 years) patients undergoing cancer treatment. METHODS Symptom data from one Australian study and two U.S. studies were combined to conduct this analysis. A total of 593 patients receiving active treatment were dichotomized into younger (<60 years) and older (≥60 years) groups. Separate exploratory factor analyses (EFAs) were undertaken within each group to identify symptom clusters from occurrence ratings of the 32 symptoms assessed by the Memorial Symptom Assessment Scale. RESULTS In both groups, a seven-factor solution was selected. Four partially concordant symptom clusters emerged in both groups (i.e., mood/cognitive, malaise, body image, and genitourinary). In the older patients, the three unique clusters reflected physiological changes associated with aging, whereas in the younger group the three unique clusters reflected treatment-related effects. CONCLUSION The symptom clusters identified in older patients typically included a larger and more diverse range of physical and psychological symptoms. Differences also may be reflective of variations in treatment approaches between age groups. Findings highlight the need for better understanding of variation in treatment and symptom burden between younger and older adults with cancer.
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Affiliation(s)
- Patsy Yates
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | | | - Janine K Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Kimberly Alexander
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Bradley Aouizerat
- School of Nursing, University of California, San Francisco, California, USA; Institute for Human Genetics, University of California, San Francisco, California, USA
| | - Laura Dunn
- School of Medicine, University of California, San Francisco, California, USA
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California, USA
| | - Alexandra McCarthy
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Helen Skerman
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
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106
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Vasilevskis EE, Simmons SF. Simple solutions may not work for complex patients: A need for new paradigms in geriatric hospital medicine. J Hosp Med 2015; 10:343-4. [PMID: 25641782 PMCID: PMC4412786 DOI: 10.1002/jhm.2327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Eduard E Vasilevskis
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee; Department of Medicine, Center for Health Services Research, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Center for Quality Aging, Vanderbilt University, Nashville, Tennessee
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107
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Han P, Suarez-Durall P, Mulligan R. Dry mouth: A critical topic for older adult patients. J Prosthodont Res 2015; 59:6-19. [DOI: 10.1016/j.jpor.2014.11.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/05/2014] [Indexed: 11/24/2022]
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108
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Bahat G, Muratlı S, İlhan B, Tufan A, Tufan F, Aydin Y, Erten N, Karan MA. Body mass index and functional status in community dwelling older Turkish males. Aging Male 2015; 18:228-32. [PMID: 26134728 DOI: 10.3109/13685538.2015.1061493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Disability is utmost important on an aging population's health. Obesity is associated with increased risk for disability. On-the-other-hand, higher-BMI is reported as associated with better functionality in older people in some reports defined as "obesity paradox". There is some evidence on differential relationship between body weight status and functionality by living setting gender, and different populations. We studied the relation between body mass index and functionality in Turkish community dwelling older males accounting for the most confounding factors: age, multimorbidity, polypharmacy and nutritional status. This is a cross-sectional study in a geriatric outpatient clinic of a university hospital. Functionality was assessed with evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutrition was assessed by mini-nutritional assessment test. Two hundred seventy-four subjects comprised our study cohort. Mean age was 74.4 ± 7.1 years, BMI was 25.8 ± 4.4 kg/m(2). Linear regression analysis revealed significant and independent association of lower BMI with higher ADL and IADL scores (B = 0.047 and B = 0.128, respectively) (p < 0.05) and better nutritional status (B = 1.94 and B = 3.05, respectively) (p < 0.001) but not with the total number of medications. Higher IADL score was associated with younger age and lower total number of diseases (B = 0.121, B = 0.595, respectively) (p < 0.05) while ADL was not. We suggest that lower BMI is associated with better functional status in Turkish community-dwelling male older people. Our study recommends longitudinal studies with higher participants from different populations, genders and living settings are needed to comment more.
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Affiliation(s)
- Gulistan Bahat
- a Department of Internal Medicine, Division of Geriatrics , Istanbul Medical School, Istanbul University , Istanbul , Turkey
| | - Sevilay Muratlı
- a Department of Internal Medicine, Division of Geriatrics , Istanbul Medical School, Istanbul University , Istanbul , Turkey
| | - Birkan İlhan
- a Department of Internal Medicine, Division of Geriatrics , Istanbul Medical School, Istanbul University , Istanbul , Turkey
| | - Asli Tufan
- a Department of Internal Medicine, Division of Geriatrics , Istanbul Medical School, Istanbul University , Istanbul , Turkey
| | - Fatih Tufan
- a Department of Internal Medicine, Division of Geriatrics , Istanbul Medical School, Istanbul University , Istanbul , Turkey
| | - Yucel Aydin
- a Department of Internal Medicine, Division of Geriatrics , Istanbul Medical School, Istanbul University , Istanbul , Turkey
| | - Nilgun Erten
- a Department of Internal Medicine, Division of Geriatrics , Istanbul Medical School, Istanbul University , Istanbul , Turkey
| | - Mehmet Akif Karan
- a Department of Internal Medicine, Division of Geriatrics , Istanbul Medical School, Istanbul University , Istanbul , Turkey
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109
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Leskinen R, Laatikainen T, Peltonen M, Levälahti E, Antikainen R. Self-Reported Walking Difficulty Predicts Late-Life Mortality in Finnish War Veterans: Results from the Veteran 1992 Project Survey. J Am Geriatr Soc 2014; 63:118-23. [DOI: 10.1111/jgs.13201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Riitta Leskinen
- Oulu City Hospital; Oulu Finland
- Department of Geriatrics; Institute of Health Sciences; University of Oulu; Oulu Finland
- Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Oulu Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare; Helsinki Finland
- Institute of Public Health and Clinical Nutrition; University of Eastern Finland; Kuopio Finland
- Hospital District of North Karelia; Joensuu Finland
| | | | - Esko Levälahti
- National Institute for Health and Welfare; Helsinki Finland
| | - Riitta Antikainen
- Oulu City Hospital; Oulu Finland
- Department of Geriatrics; Institute of Health Sciences; University of Oulu; Oulu Finland
- Medical Research Center Oulu; Oulu University Hospital and University of Oulu; Oulu Finland
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110
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Bahat G, Tufan F, Bahat Z, Tufan A, Aydin Y, Akpinar TS, Erten N, Karan MA. Observational cohort study on correlates of mortality in older community-dwelling outpatients: The value of functional assessment. Geriatr Gerontol Int 2014; 15:1219-26. [PMID: 25511256 DOI: 10.1111/ggi.12422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2014] [Indexed: 12/30/2022]
Abstract
AIM To analyze correlates of mortality with admission features/factors in older community-dwelling outpatients. METHOD This is an observational cohort study including 608 patients aged >60 years admitted to the geriatrics outpatient clinics of a university hospital. On admission, demographic characteristics, history of smoking-alcohol consumption, individual comorbidities, individual drugs, number of comorbidities, number of drugs and the components of comprehensive geriatric assessment (functional status, nutritional status, depression and cognition screening) of the patients were recorded. Survival status was assessed through the related official website. The relationship between mortality and recorded parameters were analyzed individually by univariate analyses. Consequently, stepwise forward Cox regression analysis was carried out to detect independent correlates for mortality (for those variables statistically significantly related to mortality.) RESULTS The mean age was 73.8 ± 6.9 years. 66.6% of participants were female. The mean follow-up time was 40.4 ± 25.3 months. The mortality rate was 17.8%. Correlates of mortality were calculated using univariate analysis. They were age, sex, nutritional status, activities of daily living (ADL), instrumental ADL, diabetes mellitus (P < 0.001 for all), suspected dementia (P = 0.002), hyperlipidemia (P = 0.048) and total number of diseases (P = 0.025). Independent correlates of mortality were advanced age (HR 1.10, 95% CI 1.06-1.13; P < 0.001, low ADL score (HR 1.22, 95% CI 1.12-1.32; P < 0.001), the presence of diabetes (HR 2.64, 95% CI 1.78-3.91, P < 0.001), male sex (HR 1.68, 95% CI 1.13-2.49; P = 0.01) and suspected dementia (HR 1.51, 95% CI 1.02-2.22; P < 0.05). CONCLUSION In the present study--taking many factors into consideration--the variables associated with mortality were advanced age, low ADL score, presence of diabetes, male sex and suspected dementia. Functional status emerged as the second most significant factor associated with higher mortality--after advanced age. The present study highlights the importance of functional assessment in geriatric outpatient clinics.
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Affiliation(s)
- Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Fatih Tufan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Zumrut Bahat
- Department of Radiation Oncology, Karadeniz Technical University Medical Faculty, Trabzon, Turkey
| | - Asli Tufan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Yucel Aydin
- Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Timur Selcuk Akpinar
- Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Nilgun Erten
- Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Mehmet Akif Karan
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
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111
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Takata Y, Ansai T, Soh I, Awano S, Nakamichi I, Akifusa S, Goto K, Yoshida A, Fujii H, Fujisawa R, Sonoki K. Cognitive function and 10 year mortality in an 85 year-old community-dwelling population. Clin Interv Aging 2014; 9:1691-9. [PMID: 25336934 PMCID: PMC4199981 DOI: 10.2147/cia.s64107] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The relationship between mortality and impaired cognitive function has not been thoroughly investigated in a very elderly community-dwelling population, and little is known about the association of disease-specific mortality with Mini-Mental State Examination (MMSE) subscale scores. Here we evaluated these data in Japanese community-dwelling elderly. In 2003, 85 year-olds (n=207) were enrolled; 205 completed the MMSE for cognitive function and were followed-up for 10 years, during which time 120 participants died, 70 survived, and 17 were lost to follow-up. Thirty-eight deaths were due to cardiovascular disease, 22 to senility, 21 to respiratory disease, and 16 to cancer. All-cause mortality decreased by 4.3% with a 1-point increase in the global MMSE score without adjustment, and it decreased by 6.3% with adjustment for both sex and length of education. Cardiovascular mortality decreased by 7.6% and senility mortality decreased by 9.2% with a 1-point increase in the global MMSE score with adjustment for sex and education. No association was found between respiratory diseases or cancer mortality and global MMSE score. All-cause mortality also decreased with increases in MMSE subscale scores for time orientation, place orientation, delayed recall, naming objects, and listening and obeying. Cardiovascular mortality was also associated with the MMSE subscale of naming objects, and senility mortality was associated with the subscales of time orientation and place orientation. Thus, we found that impaired cognitive function determined by global MMSE score and some MMSE subscale scores were independent predictors of all-cause mortality or mortality due to cardiovascular disease or senility in 85 year-olds.
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Affiliation(s)
- Yutaka Takata
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Toshihiro Ansai
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Inho Soh
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Shuji Awano
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Ikuo Nakamichi
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Sumio Akifusa
- Department of Oral Health and Environment, School of Oral Health Science, Kyushu Dental University, Kitakyushu, Japan
| | - Kenichi Goto
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Akihiro Yoshida
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Hiroki Fujii
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Ritsuko Fujisawa
- Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Kazuo Sonoki
- Department of Oral Health and Environment, School of Oral Health Science, Kyushu Dental University, Kitakyushu, Japan
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112
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Body composition analysis in older adults with dementia. Anthropometry and bioelectrical impedance analysis: a critical review. Eur J Clin Nutr 2014; 68:1228-33. [DOI: 10.1038/ejcn.2014.168] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/17/2014] [Indexed: 02/02/2023]
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113
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Naeim A, Aapro M, Subbarao R, Balducci L. Supportive care considerations for older adults with cancer. J Clin Oncol 2014; 32:2627-34. [PMID: 25071112 DOI: 10.1200/jco.2014.55.3065] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The treatment of cancer presents specific concerns that are unique to the growing demographic of elderly patients. Because the incidence of cancer is strongly correlated with aging, the expansion of supportive care and other age-appropriate therapies will be of great importance as the population of elderly patients with cancer increases in the coming years. Elderly patients are especially likely to experience febrile neutropenia, complications from chemotherapy-induced nausea, anemia, osteoporosis (especially in patients diagnosed with breast or prostate cancer), depression, insomnia, and fatigue. These issues are often complicated by other chronic conditions related to age, such as diabetes and cardiac disease. For many patients, symptoms may be addressed both through lifestyle management and pharmaceutical approaches. Therefore, the key to improving quality of life for the elderly patient with cancer is an awareness of their specific needs and a familiarity with emergent treatment options.
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Affiliation(s)
- Arash Naeim
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland.
| | - Matti Aapro
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
| | - Rashmi Subbarao
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
| | - Lodovico Balducci
- Arash Naeim, Rashmi Subbarao, University of California Los Angeles, Los Angeles CA; Lodovico Balducci, Moffitt Cancer Center, Tampa FL; Matti Aapro, The Multidisciplinary Oncology Institute of Clinique de Genolier, Genolier, Switzerland
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114
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Medikamentöse Therapie im Alter. Z Gerontol Geriatr 2014; 47:276-8. [DOI: 10.1007/s00391-014-0652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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115
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Ungar A, Ceccofiglio A. Prospective registry of symptomatic severe aortic stenosis in octogenarians: a need for intervention. J Intern Med 2014; 275:605-7. [PMID: 24450536 DOI: 10.1111/joim.12206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- A Ungar
- Geriatric Cardiology and Medicine, AOU Careggi, Firenze and University of Florence, Florence, Italy
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116
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Pickard S. Frail bodies: geriatric medicine and the constitution of the fourth age. SOCIOLOGY OF HEALTH & ILLNESS 2014; 36:549-563. [PMID: 25650444 DOI: 10.1111/1467-9566.12084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clinical discourses of frailty are central both to the construction of the social category of the fourth age and to the role and identity of hospital geriatric medicine. However, the influence of such clinical discourses is not just from science to the social sphere and nor do these discourses have their source in a putative truth of the old body but emerge from an interplay between physiological facts, discourses of governmentality, productive processes associated with late modern capitalism and the professional ambitions of geriatric medicine. The article explores this interplay in the two key discourses of frailty that have emerged in the clinical literature during the past 15 years, that of the phenotype and the accumulation of deficits, respectively. Outlining the development of the discourse of senescence from its origins to the more recent emergence of a nosological category of frailty the article explores how these key discourses capture the older body according to particular sets of norms. These norms link physiological understanding with broader discourses of governmentality, including the professional project of geriatric medicine. In particular, metaphorical representations in the discourses of frailty convey key cultural and clinical assumptions concerning both older bodies and old age more generally.
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Affiliation(s)
- Susan Pickard
- Department of Sociology, Social Policy and Criminology, University of Liverpool
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117
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Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, Espaulella J, Espinosa J, Constante C, Mitchell GK. Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: a cross-sectional study. Palliat Med 2014; 28:302-11. [PMID: 24403380 DOI: 10.1177/0269216313518266] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Of deaths in high-income countries, 75% are caused by progressive advanced chronic conditions. Palliative care needs to be extended from terminal cancer to these patients. However, direct measurement of the prevalence of people in need of palliative care in the population has not been attempted. AIM Determine, by direct measurement, the prevalence of people in need of palliative care among advanced chronically ill patients in a whole geographic population. DESIGN Cross-sectional, population-based study. MAIN OUTCOME MEASURE prevalence of advanced chronically ill patients in need of palliative care according to the NECPAL CCOMS-ICO(©) tool. NECPAL+ patients were considered as in need of palliative care. SETTING/PARTICIPANTS County of Osona, Catalonia, Spain (156,807 inhabitants, 21.4% > 65 years). Three randomly selected primary care centres (51,595 inhabitants, 32.9% of County's population) and one district general hospital, one social-health centre and four nursing homes serving the patients. Subjects were all patients attending participating settings between November 2010 and October 2011. RESULTS A total of 785 patients (1.5% of study population) were NECPAL+: mean age = 81.4 years; 61.4% female. Main disease/condition: 31.3% advanced frailty, 23.4% dementia, 12.9% cancer (ratio of cancer/non-cancer = 1/7), 66.8% living at home and 19.7% in nursing home; only 15.5% previously identified as requiring palliative care; general clinical indicators of severity and progression present in 94% of cases. CONCLUSIONS Direct measurement of prevalence of palliative care needs on a population basis is feasible. Early identification and prevalence determination of these patients is likely to be the cornerstone of palliative care public health policies.
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Affiliation(s)
- Xavier Gómez-Batiste
- 1The Qualy Observatory/WHO Collaborating Centre for Palliative Care Public Health Programmes (WHOCC), Institut Català d'Oncologia (ICO), Barcelona, Spain
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118
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Hajjar RR, Atli T, Al-Mandhari Z, Oudrhiri M, Balducci L, Silbermann M. Prevalence of aging population in the Middle East and its implications on cancer incidence and care. Ann Oncol 2014; 24 Suppl 7:vii11-24. [PMID: 24001758 DOI: 10.1093/annonc/mdt268] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Middle Eastern population is aging rapidly, and as aging is the main risk factor for cancer, the incidence and prevalence of that disease are increasing among all the populations in the region. These developments represent huge challenges to national and community-based health services. At the current state of affairs, most Middle Eastern countries require the cooperation of international agencies in order to cope with such new challenges to their health systems. The focus and emphasis in facing these changing circumstances lie in the education and training of professionals, mainly physicians and nurses, at the primary, secondary and tertiary levels of health services. It is imperative that these training initiatives include clinical practice, with priority given to the creation of multidisciplinary teams both at the cancer centers and for home-based services.
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Affiliation(s)
- R R Hajjar
- Department of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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119
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van der Steen JT, Radbruch L, Hertogh CMPM, de Boer ME, Hughes JC, Larkin P, Francke AL, Jünger S, Gove D, Firth P, Koopmans RTCM, Volicer L. White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliat Med 2014; 28:197-209. [PMID: 23828874 DOI: 10.1177/0269216313493685] [Citation(s) in RCA: 568] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dementia is a life-limiting disease without curative treatments. Patients and families may need palliative care specific to dementia. AIM To define optimal palliative care in dementia. METHODS Five-round Delphi study. Based on literature, a core group of 12 experts from 6 countries drafted a set of core domains with salient recommendations for each domain. We invited 89 experts from 27 countries to evaluate these in a two-round online survey with feedback. Consensus was determined according to predefined criteria. The fourth round involved decisions by the core team, and the fifth involved input from the European Association for Palliative Care. RESULTS A total of 64 (72%) experts from 23 countries evaluated a set of 11 domains and 57 recommendations. There was immediate and full consensus on the following eight domains, including the recommendations: person-centred care, communication and shared decision-making; optimal treatment of symptoms and providing comfort (these two identified as central to care and research); setting care goals and advance planning; continuity of care; psychosocial and spiritual support; family care and involvement; education of the health care team; and societal and ethical issues. After revision, full consensus was additionally reached for prognostication and timely recognition of dying. Recommendations on nutrition and dehydration (avoiding overly aggressive, burdensome or futile treatment) and on dementia stages in relation to care goals (applicability of palliative care) achieved moderate consensus. CONCLUSION We have provided the first definition of palliative care in dementia based on evidence and consensus, a framework to provide guidance for clinical practice, policy and research.
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Affiliation(s)
- Jenny T van der Steen
- 1Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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120
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Poor oral health, a potential new geriatric syndrome. Gerodontology 2014; 31 Suppl 1:17-24. [DOI: 10.1111/ger.12086] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 12/01/2022]
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121
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Kimmick G, White H. Getting beyond screening for frailty in older patients with cancer. J Geriatr Oncol 2014; 5:8-10. [DOI: 10.1016/j.jgo.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/18/2013] [Indexed: 11/29/2022]
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122
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Affiliation(s)
- Hyung Joon Yoo
- Division of Endocrinology & Geriatrics, Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
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123
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Chronic kidney disease (CKD) is an independent risk factor for long-term care insurance (LTCI) need certification among older Japanese adults: A two-year prospective cohort study. Arch Gerontol Geriatr 2013; 57:328-32. [DOI: 10.1016/j.archger.2013.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/16/2013] [Indexed: 11/21/2022]
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124
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Won C, Yoo H, Yu S, Kim C, Dumlao L, Dewiasty E, Rowland J, Chang H, Wang J, Akishita M, Tan TL, Lum C, Prakash O. Lists of geriatric syndromes in the Asian-Pacific geriatric societies. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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125
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Life satisfaction and frailty in community-based older adults: cross-sectional and prospective analyses. Int Psychogeriatr 2013; 25:1709-16. [PMID: 23830492 DOI: 10.1017/s1041610213000902] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Frailty may be associated with reduced life satisfaction (LS). The objectives of this paper are to determine if (1) frailty is associated with LS in community-dwelling older adults in cross-sectional analyses; (2) frailty predicts LS five years later; and (3) specific domains of LS are preferentially associated with frailty. METHODS This paper presents analysis of an existing population-based cohort study of 1,751 persons aged 65+ who were assessed in 1991, with follow-up five years later. LS was measured using the terrible-delightful scale, which measures overall LS and LS in specific domains. Frailty was measured using the Brief Frailty Instrument. Analyses were adjusted for age, gender, education, and marital status. RESULTS Frailty was associated with overall LS at time 1 and predicted overall LS at time 2. This was seen in unadjusted analyses and after adjusting for confounding factors. Frailty was associated with all domains of LS at time 1, and predicted LS at time 2 in all domains except housing and self-esteem. However, the effect was stronger for LS with health than with other domains for both times 1 and 2. CONCLUSIONS Frailty is associated with LS, and the effect is strongest for LS with health.
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Lechleitner M, Hoppichler F. [Gender aspects of malnutrition and associated sequelae. Prevention and therapy]. Z Gerontol Geriatr 2013; 46:511-6. [PMID: 23929193 DOI: 10.1007/s00391-013-0535-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Malnutrition is related to a range of secondary complications. The prevalence of many of these sequelae is higher in elderly women than in men, thus resulting in a higher level of impairment and reduced quality of life. Multiple factors lead to the development of malnutrition and socioeconomic causes, such as poverty among the elderly and isolation, are more common in elderly women. The age-associated loss of muscle mass is more pronounced in women than in men and the risk of developing sarcopenia and frailty is increased. The prevalence of sarcopenic obesity is higher in women than in men. Malnutrition increases the risk of osteoporosis and about 80 % of all osteoporosis patients are women. Furthermore, low serum levels of vitamin D correlate more closely to a poorer cognitive outcome in elderly women than they do in men. The prevention, early diagnosis and therapy of malnutrition is of great clinical importance, particularly to preserve physical functional capacity and thus quality of life in elderly women.
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Affiliation(s)
- M Lechleitner
- Landeskrankenhaus Hochzirl, Anna Dengel-Haus, 6170, Zirl, Österreich.
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127
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Lonsdale DO, Baker EH. Understanding and managing medication in elderly people. Best Pract Res Clin Obstet Gynaecol 2013; 27:767-88. [PMID: 23850054 DOI: 10.1016/j.bpobgyn.2013.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/05/2013] [Indexed: 12/18/2022]
Abstract
Ageing alters drug handling by the body (pharmacokinetics) and response to medications (pharmacodynamics). Multiple comorbidities increase the risk of adverse drug reactions and medication burden, with increased potential for drug interactions. Elderly people are seldom included in clinical trials, so underestimation of benefits and overestimation of risk may lead to under-treatment. Cognitive and functional changes associated with ageing may make it difficult for elderly people to adhere to treatment regimens. In this review, we consider these issues, with particular reference to drugs prescribed for gynaecology patients (the 'gynaecology formulary'). It will focus on key areas of gynaecological practice, including prescribing anticholinergic drugs, hormone treatments and anticancer drugs, and perioperative issues relating to anaesthesia, analgesia and anticoagulation. Implications of common comorbidities, including osteoporosis, diabetes mellitus and cardiovascular disease, for prescribing in gynaecological patients will also be considered.
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Affiliation(s)
- Dagan O Lonsdale
- Clinical Pharmacology Unit, Division of Biomedical Sciences, St George's University of London, Mailpoint J1A, Cranmer Terrace, London SW17 0RE, UK
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128
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Wang SY, Shamliyan TA, Talley KM, Ramakrishnan R, Kane RL. Not just specific diseases: Systematic review of the association of geriatric syndromes with hospitalization or nursing home admission. Arch Gerontol Geriatr 2013; 57:16-26. [DOI: 10.1016/j.archger.2013.03.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/11/2013] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
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Arendts G, Lowthian J. Demography is destiny: an agenda for geriatric emergency medicine in Australasia. Emerg Med Australas 2013; 25:271-8. [PMID: 23759050 DOI: 10.1111/1742-6723.12073] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2013] [Indexed: 11/28/2022]
Abstract
The present paper presents an agenda for geriatric emergency medicine research, education and policy development. Herein we will argue: Population ageing is the definitive health policy challenge in Australasia, and the greatest stressor for emergency medicine posed by population ageing is the disproportionate contribution of older people to hospital occupancy. ED practices and models of care may on occasions contribute to rather than reduce high hospital occupancy in older people, benefitting neither individual patients nor the community at large. Geriatric emergency medicine priorities can be conceptualised using a simple framework, and this process will facilitate a research and policy focus on how to achieve equivalent or improved care for older people with less hospital occupancy.
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Affiliation(s)
- Glenn Arendts
- Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, WA, Australia.
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130
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131
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Gnjidic D, Le Couteur DG, Blyth FM, Travison T, Rogers K, Naganathan V, Cumming RG, Waite L, Seibel MJ, Handelsman DJ, McLachlan AJ, Hilmer SN. Statin use and clinical outcomes in older men: a prospective population-based study. BMJ Open 2013; 3:bmjopen-2012-002333. [PMID: 23474793 PMCID: PMC3612783 DOI: 10.1136/bmjopen-2012-002333] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this analysis was to investigate the relationship of statins with institutionalisation and death in older men living in the community, accounting for frailty. DESIGN Prospective cohort study. SETTING Community-dwelling men participating in the Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS Men aged ≥70 years (n=1665). MEASUREMENTS Data collected during baseline assessments and follow-up (maximum of 6.79 years) were obtained. Information regarding statin use was captured at baseline, between 2005 and 2007. Proportional hazards regression analysis was conducted to estimate the risk of institutionalisation and death according to statin use (exposure, duration and dose) and frailty status, with adjustment for sociodemographics, medical diagnosis and other clinically relevant factors. A secondary analysis used propensity score matching to replicate covariate adjustment in regression models. RESULTS At baseline, 43% of participants reported taking statins. Over 6.79 years of follow-up, 132 (7.9%) participants were institutionalised and 358 (21.5%) participants had died. In the adjusted models, baseline statin use was not statistically associated with increased risk of institutionalisation (HR=1.60; 95% CI 0.98 to 2.63) or death (HR=0.88; 95% CI 0.66 to 1.18). There was no significant association between duration and dose of statins used with either outcome. Propensity scoring yielded similar findings. Compared with non-frail participants not prescribed statins, the adjusted HR for institutionalisation for non-frail participants prescribed statins was 1.43 (95% CI 0.81 to 2.51); for frail participants not prescribed statins, it was 2.07 (95% CI 1.11 to 3.86) and for frail participants prescribed statins, it was 4.34 (95% CI 2.02 to 9.33). CONCLUSIONS These data suggest a lack of significant association between statin use and institutionalisation or death in older men. These findings call for real-world trials specifically designed for frail older people to examine the impact of statins on clinical outcomes.
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Affiliation(s)
- Danijela Gnjidic
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
- Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Sydney, New South Wales, Australia
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- ANZAC Institute, Concord Hospital, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Tom Travison
- Departments of Medicine and Biostatistics, Boston University, Boston, Massachusetts, USA
| | - Kris Rogers
- Department of Intramural Research, The Sax Institute, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Waite
- Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Markus J Seibel
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- ANZAC Institute, Concord Hospital, Sydney, New South Wales, Australia
| | - David J Handelsman
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- ANZAC Institute, Concord Hospital, Sydney, New South Wales, Australia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
- Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Gómez-Batiste X, Martínez-Muñoz M, Blay C, Amblàs J, Vila L, Costa X, Villanueva A, Espaulella J, Espinosa J, Figuerola M, Constante C. Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Support Palliat Care 2012; 3:300-8. [PMID: 24644748 DOI: 10.1136/bmjspcare-2012-000211] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Palliative care (PC) has focused on patients with cancer within specialist services. However, around 75% of the population in middle-income and high-income countries die of one or more chronic advanced diseases. Early identification of such patients in need of PC becomes crucial. In this feature article we describe the initial steps of the NECPAL (Necesidades Paliativas [Palliative Needs]) Programme. The focus is on development of the NECPAL tool to identify patients in need of PC; preliminary results of the NECPAL prevalence study, which assessed prevalence of advanced chronically ill patients within the population and all socio-health settings of Osona; and initial implementation of the NECPAL Programme in the region. As first measures of the Programme, we present the NECPAL tool. The main differences from the British reference tools on which NECPAL is based are highlighted. The preliminary results of the prevalence study show that 1.45% of the total population and 7.71% of the population aged over 65 are 'surprise question' positive, while 1.33% and 7.00%, respectively, are NECPAL positive, and surprise question positive with at least one additional positive parameter. More than 50% suffer from geriatric pluri-pathology conditions or dementia. The pilot phase of the Programme consists of developing sectorised policies to improve PC in three districts of Catalonia. The first steps to design and implement a Programme to improve PC for patients with chronic conditions with a public health and population-based approach are to identify these patients and to assess their prevalence in the healthcare system.
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Affiliation(s)
- Xavier Gómez-Batiste
- The Qualy Observatory/WHO Collaborating Centre for Palliative Care Public Health Programs (WHOCC-ICO), Catalan Institute of Oncology (ICO), Barcelona, Spain
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