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Xiao X, Li L, Yang H, Peng L, Guo C, Cui W, Liu S, Yu R, Zhang X, Zhang M. Analysis of the incidence of falls and related factors in elderly patients based on comprehensive geriatric assessment. Aging Med (Milton) 2023; 6:245-253. [PMID: 37711258 PMCID: PMC10498826 DOI: 10.1002/agm2.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
Objective To investigate the incidence of falls in elderly aged 65 years and above among outpatients and inpatients, and to analyze its related factors and identify prevention strategies. Methods A retrospective analysis was conducted on 451 patients aged 65 years and above who received comprehensive geriatric assessment in outpatients and inpatients from the Department of Geriatrics in the Second Xiangya Hospital from March 2021 to March 2022. According to whether there had been at least one fall in the past year, the patients were divided into a fall group and a non-fall group. Data were collected from the We-Chat applet of comprehensive geriatric assessment. A t test and chi-square test were performed to compare the difference between the two groups. Logistic regression analysis was then conducted to identify factors associated with falls. Results (1) The incidence of falls among the outpatient and inpatient was 28.8%. (2) The rate of light, moderate, and heavy dependence on daily living ability and decreased mobile balance ability were higher in the fall group than those in the non-fall group. The average calf circumference in the fall group was significantly lower than that in the non-fall group. (3) The prevalence of diabetes and eye diseases in the fall group was significantly higher than that in the non-fall group. (4) The percentage of insomnia and suspicious insomnia cases in the fall group was higher than that in the non-fall group. The mean scores for dysphagia, frailty, and incontinence were higher and the mean malnutrition score was lower in the fall group than in the non-fall group. (5) Multiple logistic regression analysis showed that frailty, insomnia, and malnutrition were independent influencing factors of fall (OR = 1.955, 1.652, 10.719, P = 0.044, 0.041, 0.025, respectively). Conclusions The incidence of falls among outpatients and inpatients aged 65 years and above is high. Frailty, insomnia, and malnutrition are the main factors influencing falls in these patients.
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Affiliation(s)
- Xun Xiao
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Ling Li
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Huijuan Yang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Lei Peng
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Chunbo Guo
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Wei Cui
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Shunying Liu
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Renhe Yu
- College of Public HealthCentral South UniversityChangshaChina
| | - Xiangyu Zhang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
- Hunan Clinical Medical Research Center for Geriatric SyndromeChangshaChina
| | - Mengxi Zhang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
- Hunan Clinical Medical Research Center for Geriatric SyndromeChangshaChina
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Wong EKC, Day A, Zorzitto M, Sale JEM. Perspectives and experiences of the first geriatricians trained in Canada. PLoS One 2023; 18:e0287857. [PMID: 37410719 PMCID: PMC10325037 DOI: 10.1371/journal.pone.0287857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/14/2023] [Indexed: 07/08/2023] Open
Abstract
Many Canadian-trained geriatricians from the subspecialty's first decade of existence continue to practice today. The objective of this study was to examine the experiences and perspectives of the earliest cohort of geriatricians in Canada. Using qualitative description method, we conducted semi-structured interviews to explore participants' experiences in training and practice. We included geriatricians who trained in Canada between 1980-1989 and were in active clinical practice as of October 2021. Each transcript was coded independently by two investigators. Thematic analysis was used to develop key themes. Fourteen participants (43% female, mean years in practice 35.9) described their choice to enter geriatric medicine, their training process, the roles of a geriatrician, challenges facing the profession and advice for trainees. Two themes were developed from the data: (i) advocacy for the older adult and (ii) geriatrics as "the road less taken". Advocacy was described as the "core mission" of a geriatrician. Participants discussed the importance of advocacy in clinical practice, education, research and disseminating geriatric principles in the health system and society. "The road less taken" reflected the challenges participants faced during training, which led to relatively few geriatricians for the growing number of older adults in Canada. Despite these challenges, participants described rewarding careers and encouraged trainees to consider the profession.
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Affiliation(s)
- Eric Kai-Chung Wong
- Division of Geriatric Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Day
- Division of Geriatric Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Zorzitto
- Division of Geriatric Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joanna E. M. Sale
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Kaur P, Rowland J, Whiting E. The ABCD of the comprehensive geriatric assessment. Med J Aust 2021; 215:206-207.e1. [PMID: 34365650 DOI: 10.5694/mja2.51203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
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Abstract
A personal top ten list of literature about aging and the practice of geriatrics is offered. This is primarily directed at those completing their training in the care of older patients. While acknowledging the limitations of any such exercise, it is hoped that it will engender interest in prior work by and about older persons and their care. Those at the start of their careers in geriatrics are encouraged to read these and other primary contributions, make their own list of essential literature, and incorporate the lessons learned and the examples of prior practitioners into their professional practice.
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Affiliation(s)
- David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
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Merchant RA, Hui RJY, Kwek SC, Sundram M, Tay A, Jayasundram J, Chen MZ, Ng SE, Tan LF, Morley JE. Rapid Geriatric Assessment Using Mobile App in Primary Care: Prevalence of Geriatric Syndromes and Review of Its Feasibility. Front Med (Lausanne) 2020; 7:261. [PMID: 32733901 PMCID: PMC7360669 DOI: 10.3389/fmed.2020.00261] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022] Open
Abstract
With the aging population and consequent increase in associated prevalence of frailty, dementia, and multimorbidity, primary care physicians will be overwhelmed with the complexity of the psychosocial and clinical presentation. Geriatric syndromes including frailty, sarcopenia, cognitive impairment, and anorexia of aging (AA) either in isolation or in combination are associated with an increased risk of adverse outcomes and if recognized early, and appropriately managed, will lead to decreased disability. Primary care practices are often located in residential settings and are in an ideal position to incorporate preventive screening and geriatric assessment with personalized management. However, primary care physicians lack the time, multidisciplinary resources, or skills to conduct geriatric assessment, and the limited number of geriatricians worldwide further complicates the matter. There is no one effective strategy to implement geriatric assessment in primary care which is rapid, cost-effective, and do not require geriatricians. Rapid Geriatric Assessment (RGA) takes <5 min to complete. It screens for frailty, sarcopenia, AA, and cognition with assisted management pathway without the need of a geriatrician. We developed RGA iPad application for screening with assisted management in two primary care practices and explored the feasibility and overall prevalence of frailty, sarcopenia, and AA. The assessment was conducted by trained nurses and coordinators. Among 2,589 older patients ≥65 years old, the prevalence of frailty was 5.9%, pre-frail 31.2%, and robust 62.9%. Fatigue was present in 17.8%, and among them, the prevalence of undiagnosed depression as assessed by the Patient Health Questionnaire (PHQ)-9 was 76.4% and 13.5% of total. The prevalence of sarcopenia was 15.4%, and 13.9% experienced at least one fall in the past year. AA was prevalent in 10.9%. The time taken to do the assessment with defined algorithm was on average 5 min or less per patient, and 96% managed to complete the assessment prior to seeing their doctor in the same session. The RGA app is a rapid and feasible tool to be used by any healthcare professional in primary care for identification of geriatric syndrome with assisted management.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Richard Jor Yeong Hui
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Sing Cheer Kwek
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Meena Sundram
- National University Polyclinics, National University Hospital System, Singapore, Singapore
| | - Arthur Tay
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore
| | - Jerome Jayasundram
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Shu Ee Ng
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Li Feng Tan
- Healthy Ageing Program, Alexandra Hospital, National University Health System, Singapore, Singapore
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
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Dwolatzky T. If Not Now, When? the Role of Geriatric Leadership as Covid-19 Brings the World to Its Knees. Front Med (Lausanne) 2020; 7:232. [PMID: 32574329 PMCID: PMC7243654 DOI: 10.3389/fmed.2020.00232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/05/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Tzvi Dwolatzky
- Geriatric Unit, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Becattini-Oliveira AC, Câmara LCP, Dutra DDF, Sigrist ADAF, Charchat-Fichman H. Performance-based instrument to assess functional capacity in community-dwelling older adults. Dement Neuropsychol 2019; 13:386-393. [PMID: 31844491 PMCID: PMC6907697 DOI: 10.1590/1980-57642018dn13-040004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Functional capacity (FC) is a mediator between neuropsychological functions and
real-world functioning, but there is a lack of evidence of its correlation in
community-dwelling older adults. Objective: The study aim was to determine the
FC level of community-dwelling older adults using the UCSD Performance-based
Skills Assessment (UPSA) and to evaluate correlation with cognitive screening
tests. Methods: Senior center participants were selected according to inclusion
criteria: Portuguese fluency, age ≥60 years and self-reported independent
living. The subject exclusion criteria were: dementia or other DSM-5 diagnoses,
suicidal ideation or intent, non-completion of assessment battery, enrollment in
another psychosocial intervention or pharmacotherapy study. FC level was
determined by the UPSA, brief UPSA (UPSA-B) and Instrumental Activities of Daily
Living scale (IADL’s). The Mini-Mental State Examination (MMSE), Memory of
Figure Test (MFT), Verbal Fluency Test (VFT) and Clock Drawing Test (CDT) were
used for cognitive assessment. A total of 35 subjects that had a mean age of 72
years, were predominantly females(88.6%) and had mean education level of 11.25
years were evaluated. Results: Mean UPSA and UPSA-B scores were 78.5 and 70,
respectively. A statistically significant correlation was observed between the
UPSA and IADL, MMSE and VFT. Conclusion: The UPSA serves as a screening
assessment of FC in community-dwelling older adults, showing a positive
correlation with cognitive screening tests.
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Affiliation(s)
| | | | - Douglas de Farias Dutra
- Psychology Institute, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Helenice Charchat-Fichman
- Psychology Department, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
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Akoria OA. Establishing in-hospital geriatrics services in Africa: Insights from the University of Benin Teaching Hospital geriatrics project. Ann Afr Med 2017; 15:145-53. [PMID: 27549420 PMCID: PMC5402812 DOI: 10.4103/1596-3519.188896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Unawareness of the peculiar healthcare needs of the elderly and resource constraints may be some reasons why until recently, Nigerian hospitals have not been equipped with the human and infrastructural resources required to meet older adults’ special healthcare needs. There is paucity of specialized health services for the elderly in Africa. Nigeria, with a population of over 170 million, did not have any healthcare facility with dedicated services for the elderly until 2012. The University of Benin Teaching Hospital (UBTH) in Nigeria was established in 1973 and created its geriatrics unit in October 2013. A prepared environment and trained interdisciplinary teams are pivotal in providing effective healthcare services for the elderly. The ongoing UBTH geriatrics project aims to provide specialized interdisciplinary health services to older adults and to provide training and continuing professional development in geriatrics for healthcare staff. In developing our inpatient services, we adopted the acute care for elders (ACE) model and worked in tandem with the “ABCs” of implementing ACE units. Results: In the face of limited resources, it was possible to establish a functional geriatrics unit with a trained interdisciplinary team. Family participation is central in our practice. Since October 2013, residents and house officers in internal medicine have been undertaking 4- and 12-weekly rotations, respectively. There is also a robust academic program, which includes once-weekly geriatric pharmacotherapy seminars, once-weekly interdisciplinary seminars, and 2-weekly journal club meetings alternating with seminars on geriatric assessment tools. Conclusions: It is possible to establish geriatric services and achieve best practices in resource-limited settings by investing on improving available human resources and infrastructure. We also make recommendations for setting up similar services in other parts of Africa.
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Affiliation(s)
- Obehi Aituaje Akoria
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo, Nigeria
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