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Moïsi L, Mino JC, Guidet B, Vallet H. Frailty assessment in critically ill older adults: a narrative review. Ann Intensive Care 2024; 14:93. [PMID: 38888743 PMCID: PMC11189387 DOI: 10.1186/s13613-024-01315-0] [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: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Frailty, a condition that was first defined 20 years ago, is now assessed via multiple different tools. The Frailty Phenotype was initially used to identify a population of "pre-frail" and "frail" older adults, so as to prevent falls, loss of mobility, and hospitalizations. A different definition of frailty, via the Clinical Frailty Scale, is now actively used in critical care situations to evaluate over 65 year-old patients, whether it be for Intensive Care Unit (ICU) admissions, limitation of life-sustaining treatments or prognostication. Confusion remains when mentioning "frailty" in older adults, as to which tools are used, and what the impact or the bias of using these tools might be. In addition, it is essential to clarify which tools are appropriate in medical emergencies. In this review, we clarify various concepts and differences between frailty, functional autonomy and comorbidities; then focus on the current use of frailty scales in critically ill older adults. Finally, we discuss the benefits and risks of using standardized scales to describe patients, and suggest ways to maintain a complex, three-dimensional, patient evaluation, despite time constraints. Frailty in the ICU is common, involving around 40% of patients over 75. The most commonly used scale is the Clinical Frailty Scale (CFS), a rapid substitute for Comprehensive Geriatric Assessment (CGA). Significant associations exist between the CFS-scale and both short and long-term mortality, as well as long-term outcomes, such as loss of functional ability and being discharged home. The CFS became a mainstream tool newly used for triage during the Covid-19 pandemic, in response to the pressure on healthcare systems. It was found to be significantly associated with in-hospital mortality. The improper use of scales may lead to hastened decision-making, especially when there are strains on healthcare resources or time-constraints. Being aware of theses biases is essential to facilitate older adults' access to equitable decision-making regarding critical care. The aim is to help counteract assessments which may be abridged by time and organisational constraints.
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Affiliation(s)
- L Moïsi
- Department of Geriatrics, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, 75012, Paris, France.
- UVSQ, INSERM, Centre de Recherche en Epidémiologie Et Santé Des Populations, UMR 1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France.
- Département d'éthique, Faculté de Médecine, Sorbonne Université, Paris, France.
- Service de Gériatrie Aigue, Hopital St Antoine, 184 rue du Fbg St Antoine, 75012, Paris, France.
| | - J-C Mino
- UVSQ, INSERM, Centre de Recherche en Epidémiologie Et Santé Des Populations, UMR 1018, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
- Département d'éthique, Faculté de Médecine, Sorbonne Université, Paris, France
| | - B Guidet
- Service de Réanimation Médicale, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
- INSERM, UMRS 1136, Institute Pierre Louis d'Épidémiologie Et de Santé Publique, 75013, Paris, France
| | - H Vallet
- Department of Geriatrics, Hopital Saint-Antoine, Assistance Publique Hôpitaux de Paris (AP-HP), Sorbonne Université, 75012, Paris, France
- UMRS 1135, Centre d'immunologie Et de Maladies Infectieuses (CIMI), Institut National de La Santé Et de La Recherche Médicale (INSERM), Paris, France
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Karikari G, Lohrmann DK, Huber L, Adamek M, Omodior O. An application of the reasoned action approach to clinical students' intention toward a career in geriatrics. Nurs Health Sci 2024; 26:e13076. [PMID: 38356094 DOI: 10.1111/nhs.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 02/16/2024]
Abstract
Guided by the reasoned action approach, this study examined select individual, information, and social factors that influence intention toward pursuing a career in geriatrics among 314 clinical medical and nursing students in Ghana. A Poisson regression showed attitude toward older persons was a significant influencing factor of intention to choose a career in geriatrics for medical students (B = 0.015, SE = 0.0048, p = 0.002) but not nursing students (B = 0.009, SE = 0.0145, p = 0.512). Personal interest was, however, a significant influencing factor for both medical and nursing students (B = 0.462, SE = 0.0592, p = 0.000) and (B = 0.015, SE = 0.0048, p = 0.002), respectively. Nursing students with moderate to strong interest were 1.6 times more likely to express an intention to specialize in geriatrics, and medical students were 1.5 times more likely to express an intention to specialize in geriatrics. The results show that the most important factor influencing geriatric career intention is students' personal interest in the field. Evidence-based interventions such as early educational and practice exposure to the field and interactions with older adults are recommended.
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Affiliation(s)
- Grace Karikari
- Department of Indigenous Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - David K Lohrmann
- Applied Health Science Department, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Lesa Huber
- Applied Health Science Department, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Margaret Adamek
- School of Social Work, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Oghenekaro Omodior
- Recreation, Park, And Tourism Studies, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
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Cheung K, Tamura P, Malik Z, Lin J, Cyrus J, Alexander C, Hobgood S. Barriers and motivators to specializing in geriatrics and strategies for recruitment: scoping review. GERONTOLOGY & GERIATRICS EDUCATION 2022:1-17. [PMID: 35603812 DOI: 10.1080/02701960.2022.2078814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
While the barriers to specializing in geriatrics are known, motivators behind why medical trainees choose geriatrics are not as well understood. It is also unknown if recruitment strategies in the literature address these barriers and motivators. The aim of this systematic scoping review is to examine the current literature on recruitment strategies alongside motivators and barriers for specializing in geriatrics. Eligible articles for this scoping review either focused on motivators or barriers among trainees (medical students, resident-physicians, fellows) or recruitment strategies. A scoping search was conducted in MEDLINE, Embase, CINAHL, and PsychINFO. Data was extracted on article characteristics and themes. 88 of 2064 articles were eligible and included. Personal fulfillment emerged as the most common theme for motivators, contrary to prior studies that cite positive role modeling. Financial disincentive remained the most common barrier, followed by limited exposure and "futile" practice. Promising interventions beyond financial compensation include defining geriatrics better, emphasizing the high job satisfaction rates, increasing clinical exposure for medical students, and additional funding for academic centers to recruit academic geriatricians. Policymakers and medical educators should consider multiple strategies that target the motivators, as well as the barriers to pursuing geriatrics.
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Affiliation(s)
- Kelly Cheung
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - Peter Tamura
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - Zeeshan Malik
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - Jason Lin
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - John Cyrus
- Department of Research and Education, Virginia Commonwealth University, Richmond, Virginia, US
| | - Chuck Alexander
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - Sarah Hobgood
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
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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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Factors Determining the Choice of a Career in Geriatrics among Students in Geriatric in-Hospital Training: A Prospective Study of 74 Medical Students. Geriatrics (Basel) 2020; 5:geriatrics5040087. [PMID: 33158253 PMCID: PMC7709624 DOI: 10.3390/geriatrics5040087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
Abstract
To understand why students in the 2nd cycle of medical studies choose to complete a Diploma of Specialized Studies (DSS) in geriatrics, we conducted a study to identify the factors influencing the choice of a future specialty. In addition, we assessed the impact of clinical in-hospital training (CIHT) in a geriatric hospital on the students’ selection of their future specialty. We included all students who completed CIHT in the geriatric facility of our University Hospital between 1 May and 31 October 2018. Data were collected using a two-part questionnaire: one part was given before CIHT and the other after. The students were classified into two groups: those considering a career in geriatrics (CIG) before CIHT, forming the group DSS geriatrics+ (GDSSG+), and those not considering it, constituting the group DSS geriatrics− (GDSSG−). Seventy-four students aged 22 years old were included. Of these students, 26% were considering a CIG before CIHT. This rate increased significantly to 42% after CIHT (p = 0.04). However, none of the students who indicated that they were potentially interested in pursuing geriatrics before CIHT preselected geriatrics as their first option. For more than 92% of the students, the comprehensive care of geriatric patients was an asset. The main drawbacks were diagnostic and therapeutic limitations (60% of students), then managing aging, disability, and neurocognitive disorders (55% of students). After CIHT, the view of geriatrics improved by 74%. In conclusion, geriatric CIHT improves students’ opinions of geriatrics and increases the number of students considering a CIG. However, geriatrics still suffers from a lack of prestige.
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O’Neill D. Generating guardians of the longevity dividend. Age Ageing 2020; 49:932-933. [PMID: 32766752 DOI: 10.1093/ageing/afaa155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Desmond O’Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin 2, Ireland
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