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Pfeuffer N, Radicke F, Leiz M, Moon K, Hoffmann W, van den Berg N. Outpatient geriatric health care in the German federal state of Mecklenburg-Western Pomerania: a population-based spatial analysis of claims data. BMC Health Serv Res 2024; 24:458. [PMID: 38609972 PMCID: PMC11010346 DOI: 10.1186/s12913-024-10888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Due to unidentified geriatric needs, elderly patients have a higher risk for developing chronic conditions and acute medical complications. Early geriatric screenings and assessments help to identify geriatric needs. Holistic and coordinated therapeutic approaches addressing those needs maintain the independence of elderly patients and avoid adverse effects. General practitioners are important for the timely identification of geriatric needs. The aims of this study are to examine the spatial distribution of the utilization of outpatient geriatric services in the very rural Federal State of Mecklenburg-Western Pomerania in the Northeast of Germany and to identify regional disparities. METHODS Geographical analysis and cartographic visualization of the spatial distribution of outpatient geriatric services of patients who are eligible to receive basic geriatric care (BGC) or specialized geriatric care (SGC) were carried out. Claims data of the Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania were analysed on the level of postcode areas for the quarter periods between 01/2014 and 04/2017. A Moran's I analysis was carried out to identify clusters of utilization rates. RESULTS Of all patients who were eligible for BGC in 2017, 58.3% (n = 129,283/221,654) received at least one BCG service. 77.2% (n = 73,442/95,171) of the patients who were eligible for SGC, received any geriatric service (BGC or SGC). 0.4% (n = 414/95,171) of the patients eligible for SGC, received SGC services. Among the postcode areas in the study region, the proportion of patients who received a basic geriatric assessment ranged from 3.4 to 86.7%. Several regions with statistically significant Clusters of utilization rates were identified. CONCLUSIONS The widely varying utilization rates and the local segregation of high and low rates indicate that the provision of outpatient geriatric care may depend to a large extent on local structures (e.g., multiprofessional, integrated networks or innovative projects or initiatives). The great overall variation in the provision of BGC services implicates that the identification of geriatric needs in GPs' practices should be more standardized. In order to reduce regional disparities in the provision of BGC and SGC services, innovative solutions and a promotion of specialized geriatric networks or healthcare providers are necessary.
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Affiliation(s)
- Nils Pfeuffer
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
| | - Franziska Radicke
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Maren Leiz
- Jade University of Applied Science, Ofener Straße 16, 26121, Oldenburg, Germany
| | - Kilson Moon
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Wolfgang Hoffmann
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Neeltje van den Berg
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
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Arai H, Chen LK. Aging populations and perspectives of geriatric medicine in Japan. Glob Health Med 2024; 6:1-5. [PMID: 38450117 PMCID: PMC10912807 DOI: 10.35772/ghm.2024.01001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 03/08/2024]
Abstract
It is well known that Japan's population is aging, and the number of people older than 75 years is increasing significantly. Since older people, especially old individuals, are often multimorbid and cannot be always successfully treated and cared for by individual organ-specific treatment, it is essential to utilize knowledge of geriatrics when treating such older patients. Therefore, it is indisputable that education on geriatric medicine is extremely important in Japan, which is the country with the largest aging population. However, the number of universities in Japan that offer geriatrics courses is decreasing. This means that many medical students become doctors without learning the essential characteristics of medical care for older patients despite the need for prompt treatment of older patients in clinical practice in Japan, which is a major obstacle to the development of geriatric medicine in Japan. Here, we review the current status of geriatrics in Japan and overseas and consider the future of geriatrics education to provide holistic and cost-effective medical care for older patients and improve their quality of life and well-being.
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Affiliation(s)
- Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taiwan
- Taipei Municipal Gan-Dau Hospital (managed by Taipei Veterans General Hospital), Taiwan
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3
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Chen LK. The global landscape of geriatric medicine: Successes and shortcomings. Arch Gerontol Geriatr 2023; 115:105224. [PMID: 37837791 DOI: 10.1016/j.archger.2023.105224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
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4
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Leinert C, Fotteler M, Kocar TD, Dallmeier D, Kestler HA, Wolf D, Gebhard F, Uihlein A, Steger F, Kilian R, Mueller-Stierlin AS, Michalski CW, Mihaljevic A, Bolenz C, Zengerling F, Leinert E, Schütze S, Hoffmann TK, Onder G, Andersen-Ranberg K, O’Neill D, Wehling M, Schobel J, Swoboda W, Denkinger M. Supporting SURgery with GEriatric Co-Management and AI (SURGE-Ahead): A study protocol for the development of a digital geriatrician. PLoS One 2023; 18:e0287230. [PMID: 37327245 PMCID: PMC10275448 DOI: 10.1371/journal.pone.0287230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Geriatric co-management is known to improve treatment of older adults in various clinical settings, however, widespread application of the concept is limited due to restricted resources. Digitalization may offer options to overcome these shortages by providing structured, relevant information and decision support tools for medical professionals. We present the SURGE-Ahead project (Supporting SURgery with GEriatric co-management and Artificial Intelligence) addressing this challenge. METHODS A digital application with a dashboard-style user interface will be developed, displaying 1) evidence-based recommendations for geriatric co-management and 2) artificial intelligence-enhanced suggestions for continuity of care (COC) decisions. The development and implementation of the SURGE-Ahead application (SAA) will follow the Medical research council framework for complex medical interventions. In the development phase a minimum geriatric data set (MGDS) will be defined that combines parametrized information from the hospital information system with a concise assessment battery and sensor data. Two literature reviews will be conducted to create an evidence base for co-management and COC suggestions that will be used to display guideline-compliant recommendations. Principles of machine learning will be used for further data processing and COC proposals for the postoperative course. In an observational and AI-development study, data will be collected in three surgical departments of a University Hospital (trauma surgery, general and visceral surgery, urology) for AI-training, feasibility testing of the MGDS and identification of co-management needs. Usability will be tested in a workshop with potential users. During a subsequent project phase, the SAA will be tested and evaluated in clinical routine, allowing its further improvement through an iterative process. DISCUSSION The outline offers insights into a novel and comprehensive project that combines geriatric co-management with digital support tools to improve inpatient surgical care and continuity of care of older adults. TRIAL REGISTRATION German clinical trials registry (Deutsches Register für klinische Studien, DRKS00030684), registered on 21st November 2022.
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Affiliation(s)
- Christoph Leinert
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
| | - Marina Fotteler
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Thomas Derya Kocar
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
| | - Dhayana Dallmeier
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Hans A. Kestler
- Institute for Medical Systems Biology, Ulm University, Ulm, Germany
| | - Dennis Wolf
- Institute for Medical Systems Biology, Ulm University, Ulm, Germany
| | - Florian Gebhard
- Department for Orthopedic Trauma, Ulm University Medical Center, Ulm, Germany
| | - Adriane Uihlein
- Department for Orthopedic Trauma, Ulm University Medical Center, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychiatry II, Section of Health Economics and Health Services Research, Ulm University, Guenzburg, Germany
| | - Annabel S. Mueller-Stierlin
- Department of Psychiatry and Psychiatry II, Section of Health Economics and Health Services Research, Ulm University, Guenzburg, Germany
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - André Mihaljevic
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | | | | | - Elena Leinert
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Sabine Schütze
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Instituto Superiore di Sanità, Rome, Italy
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Desmond O’Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
| | - Martin Wehling
- Working Group FORTA, Faculty of Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Johannes Schobel
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Walter Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Michael Denkinger
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
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Fagard K, Deschodt M, Geyskens L, Willems S, Boland B, Wolthuis A, Flamaing J. Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals. Eur Geriatr Med 2023; 14:239-249. [PMID: 36690884 PMCID: PMC9870777 DOI: 10.1007/s41999-023-00748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE To explore geriatric care for surgical patients in Belgian hospitals and geriatricians' reflections on current practice. METHODS A web-based survey was developed based on literature review and local expertise, and was pretested with 4 participants. In June 2021, the 27-question survey was sent to 91 heads of geriatrics departments. Descriptive statistics and thematic analysis were performed. RESULTS Fifty-four surveys were completed, corresponding to a response rate of 59%. Preoperative geriatric risk screening is performed in 25 hospitals and systematically followed by geriatric assessment in 17 hospitals. During the perioperative hospitalisation, 91% of geriatric teams provide non-medical and 82% provide medical advice. To a lesser extent, they provide geriatric protocols, geriatric education and training, and attend multidisciplinary team meetings. Overall, time allocation of geriatric teams goes mainly to postoperative evaluations and interventions, rather than to preoperative assessment and care planning. Most surgical patients are hospitalised on surgical wards, with reactive (73%) or proactive (46%) geriatric consultation. In 36 hospitals, surgical patients are also admitted on geriatric wards, predominantly orthopaedic/trauma, abdominal and vascular surgery. Ninety-eight per cent of geriatricians feel that more geriatric input for surgical patients is needed. The most common reported barriers to further implement geriatric-surgical services are shortage of geriatricians and geriatric nurses, and unadjusted legislation and financing. CONCLUSION Geriatric care for surgical patients in Belgian hospitals is mainly reactive, although geriatricians favour more proactive services. The main opportunities and challenges for improvement are to resolve staff shortages in the geriatric work field and to update legislation and financing.
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Affiliation(s)
- Katleen Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium.
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Competence Centre of Nursing, University Hospitals Leuven, Leuven, Belgium
| | - Lisa Geyskens
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Sarah Willems
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium
| | - Benoît Boland
- Department of Geriatric Medicine, University Hospital Saint-Luc, Brussels, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Dienst Geriatrie UZ Leuven, Herestraat 49, Box 7003 35, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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6
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Deniau N, Natali JP. [The role of private geriatricians in the health care system (2/2): comprehensive qualitative analysis using semi-structured interviews]. SOINS. GERONTOLOGIE 2023; 28:26-32. [PMID: 36870760 DOI: 10.1016/j.sger.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Private geriatricians report heterogeneous practices, while the specialty as a whole is questioning its model. We conducted semi-structured interviews to understand how private geriatricians viewed their role in the health care system. They report a certain homogeneity in their conception of their role, which corresponds to that of geriatricians as a whole: there seems to be a professional identity for geriatrics.
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Affiliation(s)
- Nicolas Deniau
- Université de Versailles Saint-Quentin-en-Yvelines, 55 avenue de Paris, 78035 Versailles, France; UFR Simone-Veil-Santé, 2 avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France
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7
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Deniau N, Natali JP. [Role of private geriatricians in the health care system (1/2): quantitative descriptive analysis by questionnaire]. SOINS. GERONTOLOGIE 2023; 28:17-25. [PMID: 36870759 DOI: 10.1016/j.sger.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Private practice geriatrics is a little known practice modality. We conducted a questionnaire survey to try to describe the role of private geriatricians in the health care system. Although few in number, private geriatricians report very different practices, including their conception of their role. This is the first monograph on the activity of private geriatricians, and the results have motivated us to propose a comprehensive analysis of this role.
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Affiliation(s)
- Nicolas Deniau
- Université de Versailles Saint-Quentin-en-Yvelines, UFR Simone Veil-Santé, 2 avenue de la Source-de-la-Bièvre, 78180 Montigny-le-Bretonneux, France
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8
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Mitike H, Yimam W, Goshiye D, Kumar KP. Knowledge, Attitudes, Practices, and Associated Factors Towards Care of Elderly Patients among Nurses. SAGE Open Nurs 2023; 9:23779608231159631. [PMID: 36865754 PMCID: PMC9972063 DOI: 10.1177/23779608231159631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 02/04/2023] [Indexed: 03/02/2023] Open
Abstract
Background Ethiopia's elderly care service is relatively young and little is known about the practices or readiness of nurses to provide care. Nurses need to have good knowledge, a positive attitude, and experience when it comes to caring for the elderly or patients who are chronically providing quality care. This study aimed to assess the knowledge, attitudes, and practices towards care for elderly patients and associated factors among nurses working in adult care units of public hospitals in Harar, 2021. Methods An institutional-based descriptive cross-sectional study was conducted from February 12 to July 10, 2021. A simple random sampling technique was used to select 478 study participants. Data were collected by trained data collectors using a pretested self-administered questionnaire. From the pretest, Cronbach's alpha for all items was above 0.7 for all items. Data were entered into Epi Data v.4.6 and exported to the Statistical Package for Social Science Version 26 for binary logistic regression analysis. A P-value of 0.05 was used to declare a significant association between variables. Results The study revealed that 311 (69%) had inadequate knowledge. Having a first degree and an unfavorable attitude towards nurses showed a statistically significant association with nurses' inadequate knowledge. A total of 275 (61.0%) nurses were found to have an unfavorable attitude and were significantly associated with having a diploma and first degree, learning in a private organization, 6 to 10 years of experience, lack of training, and inadequate knowledge of nurses. A total of 297 (65.9%) study units had inadequate practice towards the care of elderly patients. Nurses' practices showed a significant association with the type of hospital, work experience, and adherence to guidelines with a response rate of 94.4%. Conclusion The majority of nurses had inadequate knowledge, an unfavorable attitude, and inadequate practice towards the care of elderly patients. Having a first-degree and an unfavorable attitude with inadequate knowledge, lack of training and inadequate knowledge, unfavorable attitudes and less than 11 years of experience, working in non-academic hospitals, and unavailability of guidelines with inadequate practices were significantly associated.
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Affiliation(s)
- Hailye Mitike
- Department of Nursing, College of Medicine and Health Sciences,
Gigjiga University, Gigjiga, Ethiopia
| | - Wondwossen Yimam
- Department of Comprehensive Nursing, College of Medicine and Health
Sciences, Wollo University, Dessie, Ethiopia,Wondwossen Yimam Hussien, Department of
Comprehensive Nursing, College of Medicine and Health Sciences, Wollo
University, Dessie, Ethiopia.
| | - Debrnesh Goshiye
- Department of Pediatrics and Child Health Nursing, College of
Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kumar Prem Kumar
- Department of Adult Health Nursing, College of Medicine and Health
Sciences, Wollo University, Dessie, Ethiopia
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Pujol Farriols R, Geli Fabrega M. [Medical generalism. Past, present and future]. Med Clin (Barc) 2023; 160:129-132. [PMID: 36243568 DOI: 10.1016/j.medcli.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Ramon Pujol Farriols
- Decano de la Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya, Vic, Barcelona, España.
| | - Marina Geli Fabrega
- Directora General de la Fundació d'Estudis Superiors en Ciències de la Salut (FESS), Universitat de Vic-Universitat central de Catalunya, Vic, Barcelona, España
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Fox S, Reid N, Gordon EH, Janda M, Hubbard RE. What do geriatricians think about Comprehensive Geriatric Assessment? A survey of Australian and New Zealand geriatricians. Australas J Ageing 2022; 42:127-139. [PMID: 36324247 DOI: 10.1111/ajag.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite Comprehensive Geriatric Assessment (CGA) being central to the work of geriatricians, little is known about geriatricians' views on CGA. This study was designed to understand how geriatricians conceptualise and practise CGA, and whether differences exist between groups (more experienced geriatricians vs. less experienced geriatricians and registrars; those practising in rural vs. metropolitan environments; in private vs. public sectors). METHODS An anonymous 90-item electronic questionnaire was emailed to members of the Australian and New Zealand Society for Geriatric Medicine. RESULTS There were 243 respondents (response rate 19%). Respondents stated that core features of CGA were multidimensional assessment (89%), implementation of a management plan (84%), and involvement of a geriatrician (70%). Important features in predicting CGA success were ability to implement health management recommendations (55%), and ease of communication with general practitioners (46%), and with the multidisciplinary team (45%). Functional decline (88%) and frailty (88%) were thought to predict patients likely to benefit from CGA, compared to age (48%) or multimorbidity (19%). Junior consultants and registrars were less likely to prioritise the importance of clinical leadership (10% vs. 30%), and more likely to report the importance of a structured format (17% vs. 7%) to CGA effectiveness. CONCLUSIONS There was some agreement about the core features of CGA and who is likely to benefit, but little agreement on features that predict CGA success. Further research that explores these points of difference would be helpful.
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Affiliation(s)
- Sarah Fox
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
- The Prince Charles Hospital Brisbane Queensland Australia
| | - Natasha Reid
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Emily H. Gordon
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
- Princess Alexandra Hospital Brisbane Queensland Australia
| | - Monika Janda
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
| | - Ruth E. Hubbard
- Centre for Health Services Research The University of Queensland Brisbane Queensland Australia
- Princess Alexandra Hospital Brisbane Queensland Australia
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Choi JY, Lee JY, Shin J, Kim CO, Kim KJ, Hwang IG, Lee YG, Koh SJ, Hong S, Yoon SJ, Kang MG, Kim JW, Kim JH, Kim KI. COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS): a protocol of pragmatic trials within a cohort. BMJ Open 2022; 12:e060913. [PMID: 35914913 PMCID: PMC9345040 DOI: 10.1136/bmjopen-2022-060913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is an increased demand for services for hospitalised older patients with acute medical conditions due to rapidly ageing population. The COMPrehensive geriatric AsseSSment and multidisciplinary team intervention for hospitalised older adults (COMPASS) study will test the effectiveness of comprehensive geriatric assessment (CGA) and multidisciplinary intervention by comparing it with conventional care among acute hospitalised older adults in Korea. METHODS AND ANALYSIS A multicentre trial within a cohort comprising three substudies (randomised controlled trials) will be conducted. The intervention includes CGA and CGA-based multidisciplinary interventions by physicians (geriatricians, oncologists), nurses, nutritionists and pharmacists. The multidisciplinary intervention includes nutritional support, medication review and adjustment, rehabilitation, early discharge planning and prevention of geriatric syndromes (falls, delirium, pressure sore and urinary retention). The analysis will be based on an intention-to-treat principle. The primary outcome is living at home 3 months after discharge. In addition to assessing the economic effects of the intervention, a cost-utility analysis will be conducted. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the ethics committees of Seoul National University Bundang Hospital and each study site. The study findings will be published in peer-reviewed journals. Subgroup and further in-depth analyses will subsequently be published. TRIAL REGISTRATION NUMBER KCT0006270.
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Affiliation(s)
- Jung-Yeon Choi
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Yeon Lee
- Yonsei University College of Nursing, Seoul, Korea
| | - Jaeyong Shin
- Preventive Medicine and Institute of Health Service Research, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
| | - Chang Oh Kim
- Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Kwang Joon Kim
- Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - In Gyu Hwang
- Internal Medicine, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
| | - Yun-Gyoo Lee
- Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su-Jin Koh
- Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Soojung Hong
- Internal Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Sol-Ji Yoon
- Internal Medicine, Kangwon National University Hospital, Chuncheon, Kangwon, Korea
| | - Min-Gu Kang
- Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwang-ju, Korea
| | - Jin Won Kim
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jee Hyun Kim
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Il Kim
- Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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12
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O’Neill D. Refashioning the uneasy relationship between older people and geriatric medicine. Age Ageing 2022; 51:6568536. [PMID: 35437599 DOI: 10.1093/ageing/afab281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 12/14/2022] Open
Abstract
A notable feature of most medical specialties is close joint working between patient advocacy groups and specialist societies in furthering improvements in policy and services. While growing old is not a disease, nor too is being a child, and the engagement of advocacy and international bodies such as UNICEF with paediatricians is well established and recognised. Yet almost eight decades after the founding of geriatric medicine, it is clear that this type of relationship does not hold for the advocacy bodies representing those we serve, as well as the wider constituency of older people. Geriatricians are an extraordinary resourceful and imaginative group, and a more effective promotion of our role as guardians of the longevity dividend is vital to a more positive and mutually beneficial relationship with older people and society. This will require a redirection of our focus to a more critical stance on our origins as a discipline, our relationship with ageing across the lifespan and with older people and a fuller engagement with the broader concepts of gerontology in training and research to develop a refreshed articulacy for, the opportunities arising from gerontologically attuned healthcare.
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Affiliation(s)
- Desmond O’Neill
- Medical Gerontology , Centre for Ageing, Neuroscience and the Humanities, , Dublin, D24 NR0A, Ireland
- Trinity College Dublin , Centre for Ageing, Neuroscience and the Humanities, , Dublin, D24 NR0A, Ireland
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Romero-Ortuno R, Stuck AE, Masud T. The giants of education in geriatric medicine and gerontology. Age Ageing 2022; 51:6532277. [PMID: 35187575 DOI: 10.1093/ageing/afac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
In 2014, the European undergraduate curriculum in Geriatric Medicine was published to cover the minimum requirements that a medical student should achieve by the end of medical school. In 2019, the European postgraduate curriculum in Geriatric Medicine outlined the minimum recommended training requirements to become a geriatrician at specialist level in the EU. The postgraduate dimension of Geriatric Medicine education is a highly relevant topic for all, since most physicians-independently of their specialty-are inevitably involved in the care of older patients, but for most physicians, geriatrics is not part of their postgraduate generalist or specialty training. A key area for postgraduate education remains the provision of Geriatric Medicine competencies to all specialties outside geriatrics. There is also need for wider educational initiatives to improve the gerontological education of patients and the public. Bernard Isaacs famously coined the expression 'geriatric giants' or the four clinical I's: Intellectual impairment, Incontinence, Immobility, and Instability. However, non-clinical giants exist. In education, we face challenges of Investment, Inspiration, Integration, and Interprofessionality; and in research, we need to attract Interest and Income, and generate Innovation and Impact. Without strengthening the links between all giants, we will not be able to achieve the ambition of age-attuned societies. A key goal for gerontological education is to enhance everyone's understanding of the wide diversity underlying the 'older people' demographic label, which will ultimately promote services and societies that are more responsive and inclusive to the needs of all older adults, irrespective of their health status.
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Affiliation(s)
- Roman Romero-Ortuno
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin D08 NHY1, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin D08 NHY1, Ireland
| | - Andreas E Stuck
- Geriatrics Department, Inselspital and University of Bern, Bern 3010, Switzerland
| | - Tahir Masud
- Department of Health Care for Older People (HCOP), Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Department of Geriatric Medicine, Odense University Hospital, Odense 5000, Denmark
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14
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Angrist M, Yang A, Kantor B, Chiba-Falek O. Good problems to have? Policy and societal implications of a disease-modifying therapy for presymptomatic late-onset Alzheimer's disease. LIFE SCIENCES, SOCIETY AND POLICY 2020; 16:11. [PMID: 33043412 PMCID: PMC7548124 DOI: 10.1186/s40504-020-00106-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
In the United States alone, the prevalence of AD is expected to more than double from six million people in 2019 to nearly 14 million people in 2050. Meanwhile, the track record for developing treatments for AD has been marked by decades of failure. But recent progress in genetics, neuroscience and gene editing suggest that effective treatments could be on the horizon. The arrival of such treatments would have profound implications for the way we diagnose, triage, study, and allocate resources to Alzheimer's patients. Because the disease is not rare and because it strikes late in life, the development of therapies that are expensive and efficacious but less than cures, will pose particular challenges to healthcare infrastructure. We have a window of time during which we can begin to anticipate just, equitable and salutary ways to accommodate a disease-modifying therapy Alzheimer's disease. Here we consider the implications for caregivers, clinicians, researchers, and the US healthcare system of the availability of an expensive, presymptomatic treatment for a common late-onset neurodegenerative disease for which diagnosis can be difficult.
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Affiliation(s)
- Misha Angrist
- Initiative for Science and Society and Social Science Research Institute, Duke University, Durham, North Carolina 27708-0222 USA
| | | | - Boris Kantor
- Duke University Department of Neurobiology, Durham, North Carolina 27710-3209 USA
| | - Ornit Chiba-Falek
- Duke University Department of Neurology, 311 Research Drive, Durham, North Carolina 27710-2900 USA
- Duke Center For Genomic And Computational Biology, Durham, USA
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15
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Welch C, McCluskey L, Wilson D, Moorey H, Majid Z, Madden K, McNeela N, Richardson S, Burton J, Taylor J, Masoli J, Ronan L, Torsney K, Lochlainn MN, Cox N, Lim S, Todd O, Hale M, Lunt E, Willott R, Healy R, Makin S, Gaunt V, Jelley B, Walesby K, Hernandez N, Alsahab M, Giridharan K, Alme KN, Cedeño Veloz BA, Lal R, Jasper E, Subramanian MS, Matchekhina L, Lamloum M, Briggs R. Growing research in geriatric medicine: a trainee perspective. Age Ageing 2020; 49:733-737. [PMID: 32516393 DOI: 10.1093/ageing/afaa052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Indexed: 11/13/2022] Open
Abstract
Growing research in geriatric medicine is a priority area. Currently, involvement of geriatricians in research lags behind other specialties. The reasons for this are multifactorial, but a lack of training infrastructure within geriatric medicine higher specialist training is contributory. This is widespread across European countries and internationally. The Geriatric Medicine Research Collaborative (GeMRC) offers an opportunity to engage trainees in research, regardless of their previous individual research experiences. Utilising national trainee networks, GeMRC is able to conduct large-scale projects within short periods of time that can have real impact upon patient care. We consider that embedding GeMRC within higher specialist training with formal college support will assist to upskill trainee geriatricians in research methodology. Collaboratives are internationally recognised across disciplines. Expansion across European and international countries offers the opportunity for international collaboration in geriatric medicine. International trainee-led networks will enable the conduct of large-scale global projects in geriatric medicine.
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Affiliation(s)
- Carly Welch
- University of Birmingham Research Laboratories, Edgbaston, Birmingham B15 2GW, UK
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Landi F, Barillaro C, Bellieni A, Brandi V, Carfì A, D'Angelo M, Fusco D, Landi G, Lo Monaco R, Martone AM, Marzetti E, Pagano F, Pais C, Russo A, Salini S, Tosato M, Tummolo A, Benvenuto F, Bramato G, Catalano L, Ciciarello F, Martis I, Rocchi S, Rota E, Salerno A, Tritto M, Sgadari A, Zuccalà G, Bernabei R. The New Challenge of Geriatrics: Saving Frail Older People from the SARS-COV-2 Pandemic Infection. J Nutr Health Aging 2020; 24:466-470. [PMID: 32346682 PMCID: PMC7118362 DOI: 10.1007/s12603-020-1356-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Affiliation(s)
- F Landi
- Francesco Landi, MD, PhD, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Catholic University of the Sacred Heart, L.go F. Vito 8, Rome 00168, Italy, Phone: +39 (06) 5190028, e-mail:
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Theou O, Andrew M, Ahip SS, Squires E, McGarrigle L, Blodgett JM, Goldstein J, Hominick K, Godin J, Hougan G, Armstrong JJ, Wallace L, Sazlina SG, Moorhouse P, Fay S, Visvanathan R, Rockwood K. The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty. Can Geriatr J 2019; 22:64-74. [PMID: 31258829 PMCID: PMC6542581 DOI: 10.5770/cgj.22.357] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity. Methods In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale. In Phase 2, feedback was sought from health professionals and the general public. In Phase 3, 366 participants completed preliminary testing on the revised draft, including 162 UK paramedics, and rated the scale on feasibility and usability. In Phase 4, following translation into Malay, the final prototype was tested in 95 participants in Peninsular Malaysia and Borneo. Results The final scale incorporated 14 domains, each conceptualized with 3–6 response levels. All domains were rated as “understood well” by most participants (range 64–94%). Percentage agreement with positive statements regarding appearance, feasibility, and usefulness ranged from 66% to 95%. Overall feedback from health-care professionals supported its content validity. Conclusions The PFFS is comprehensive, feasible, and appears generalizable across countries, and has face and content validity. Investigation into the reliability and predictive validity of the scale is currently underway.
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Affiliation(s)
- Olga Theou
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada.,National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, South Australia
| | - Melissa Andrew
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | | | - Emma Squires
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Lisa McGarrigle
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Judah Goldstein
- Emergency Health Services Nova Scotia, Halifax, NS, Canada.,Department of Emergency Medicine, Division of EMS, Halifax, NS, Canada
| | | | - Judith Godin
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Glen Hougan
- Nova Scotia College of Art and Design University, Halifax, NS, Canada
| | - Joshua J Armstrong
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Lindsay Wallace
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shariff Ghazali Sazlina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Paige Moorhouse
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Sherri Fay
- Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre of Research Excellence in Frailty and Healthy Ageing, University of Adelaide, South Australia.,Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
| | - Kenneth Rockwood
- Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine, Nova Scotia Health Authority, NS, Canada
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Sánchez E, Formiga F, Cruz-Jentoft A. [The increasing relevance of physical performance in global geriatric assessment]. Rev Esp Geriatr Gerontol 2018; 53:243-244. [PMID: 30072182 DOI: 10.1016/j.regg.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Elisabet Sánchez
- Departmento de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS) , Madrid, España.
| | - Francesc Formiga
- Programa de Geriatría, Departamento de Medicina Interna, Hospital Universitari Bellvitge IDIBELL, L' Hospitalet de Llobregat, Barcelona, España
| | - Alfonso Cruz-Jentoft
- Departmento de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS) , Madrid, España
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