Discussing age-related functional decline in family medicine: a qualitative study that explores both patient and physician perceptions

Abstract Background evaluating a patient’s functional status and screening for geriatric syndromes by general practitioners (GPs) are increasingly encouraged. This study aimed to explore how older people and GPs define and perceive autonomy and functional decline, patients’ propensity to discuss age-related issues and integration of such topics into routine medical consultations. Methods this qualitative study was conducted in Western Switzerland with older people followed in primary care practices and who participated in a trial assessing the effectiveness of a screening and management tool for geriatric syndromes to prevent functional decline. We interviewed 15 participants (patients ≥75 years old) and five GPs about their screening experience. We used semi-structured grids for data collection and an inductive thematic approach for data analysis. Results participants gave several definitions of autonomy, directly depending on their health status and functional limitations. Implementing various coping strategies, participants also expressed contrasted feelings related to functional decline such as fear, inability to accept and resilience. Functional decline was often perceived as normal ageing; participants were therefore not prompt at discussing age-related issues with their GP. However, screening was perceived positively by both participants and GPs, making addressing sensitive issues and detecting new problems possible. Conclusions a geriatric syndrome-screening intervention was well accepted by both patients and physicians. This type of initiative may be an opportunity to address various age-related issues and to inform patients of existing solutions.

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Factors affecting primary care practitioners’ alcohol-related discussions with older adults: Qualitative study

British Journal of General Practice ◽

10.3399/bjgp.2020.1118 ◽

2021 ◽

pp. BJGP.2020.1118

Author(s):

Bethany Kate Bareham ◽

Jemma Stewart ◽

Eileen Kaner ◽

Barbara Hanratty

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Older People ◽

Focus Groups ◽

Old Age ◽

Later Life ◽

Long Term Conditions ◽

Age Related ◽

Comparison Results ◽

Primary Care Practitioners

Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.

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Evaluation of a Combined HIV and Geriatrics Clinic for Older People Living with HIV: The Silver Clinic in Brighton, UK

Geriatrics ◽

10.3390/geriatrics5040081 ◽

2020 ◽

Vol 5 (4) ◽

pp. 81 ◽

Cited By ~ 1

Author(s):

Tom Levett ◽

Katie Alford ◽

Jonathan Roberts ◽

Zoe Adler ◽

Juliet Wright ◽

...

Keyword(s):

Older People ◽

Demographic Data ◽

Undetectable Viral Load ◽

Service Evaluation ◽

Geriatric Syndrome ◽

People Living With Hiv ◽

Geriatric Syndromes ◽

Geriatric Service ◽

Patient Demographic Data ◽

Living With Hiv

As life expectancy in people living with HIV (PLWH) has increased, the focus of management has shifted to preventing and treating chronic illnesses, but few services exist for the assessment and management of these individuals. Here, we provide an initial description of a geriatric service for people living with HIV and present data from a service evaluation undertaken in the clinic. We conducted an evaluation of the first 52 patients seen in the clinic between 2016 and 2019. We present patient demographic data, assessment outcomes, diagnoses given, and interventions delivered to those seen in the clinic. The average age of attendees was 67. Primary reasons for referral to the clinic included management of complex comorbidities, polypharmacy, and suspected geriatric syndrome (falls, frailty, poor mobility, or cognitive decline). The median (range) number of comorbidities and comedications (non-antiretrovirals) was 7 (2–19) and 9 (1–15), respectively. All attendees had an undetectable viral load. Geriatric syndromes were observed in 26 (50%) patients reviewed in the clinic, with frailty and mental health disease being the most common syndromes. Interventions offered to patients included combination antiretroviral therapy modification, further health investigations, signposting to rehabilitation or social care services, and in-clinic advice. High levels of acceptability among patients and healthcare professionals were reported. The evaluation suggests that specialist geriatric HIV services might play a role in the management of older people with HIV with geriatric syndromes.

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Social position and geriatric syndromes among Swedish older people: a population-based study

BMC Geriatrics ◽

10.1186/s12877-019-1295-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

C. Rausch ◽

Y. Liang ◽

U. Bültmann ◽

S. E. de Rooij ◽

K. Johnell ◽

...

Keyword(s):

Older People ◽

Social Stress ◽

Strong Association ◽

Functional Decline ◽

Financial Stress ◽

Population Based ◽

Social Position ◽

Geriatric Syndromes ◽

Self Reports ◽

Community Dwellers

Abstract Background Older people with a low social position are at higher risk of poor health outcomes compared to those with a higher social position. Whether lower social position also increases the risk of geriatric syndromes (GSs) remains to be determined. This study investigates the association of social position with GSs among older community-dwellers. Methods Three consecutive population-based health surveys in 2006, 2010 and 2014 among older community-dwellers (age 65–84 years) in Stockholm County were combined (n = 17,612) and linked with Swedish administrative registry information. Social position was assessed using registry information (i.e. education, country of origin and civil status) and by self-reports (i.e. type of housing and financial stress). GSs were assessed by self-reports of the following conditions: insomnia, urinary incontinence, functional decline, falls, depressive disorder, hearing or vision problems. Binomial logistic regression analyses were used to estimate the association between social position and GSs after adjusting for age, sex, health status, health behavior and social stress. Results The prevalence of GSs was 70.0%, but varied across GSs and ranged from 1.9% for depression to 39.1% for insomnia. Living in rented accommodation, being born outside the Nordic countries, being widowed or divorced were associated with GS presence. Financial stress was most strongly associated with GSs (adjusted odds ratio, 2.59; 95% CI, 2.13–3.15). Conclusion GSs are highly prevalent among older Swedish community-dwellers with wide variations across syndromes and strong association with all measures of social position, most strikingly that of experiencing financial stress.

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Typology of Family Support in Home Care for Iranian Older People: A Qualitative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126361 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6361

Author(s):

Soheila Shamsikhani ◽

Fazlollah Ahmadi ◽

Anoshirvan Kazemnejad ◽

Mojtaba Vaismoradi

Keyword(s):

Qualitative Study ◽

Home Care ◽

Older People ◽

Family Support ◽

Qualitative Content Analysis ◽

Family Members ◽

World Population ◽

Older Parents ◽

Technological Support ◽

Age Related

The world population is rapidly aging. In older people, age-related biological decline in most body systems causes functional decline, an increase in dependence, and an increased need for support, especially by their family members. The aim of this study was to explore the main aspects of family support for older parents in home care. This qualitative study was conducted using a deductive qualitative content analysis approach. Participants were 21 older parents living in their own homes, as well as four family members of some participants. Data were collected using semi-structured interviews and then were analyzed using the primary matrix developed based on the existing literature. The main aspects of family support for older parents were grouped into five predetermined categories and one new category: “instrumental support”, “financial support”, “psycho-emotional support”, “healthcare-related support”, “informational-technological support”, and “social preference support “. Family support for older people in home care is a multi-dimensional phenomenon. Family members can identify the needs of their older parents and provide them with appropriate support in collaboration with healthcare professionals to enhance their quality of life, autonomy, and satisfaction with life.

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Geriatric syndromes and association with distress in older cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.189 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 189-189 ◽

Cited By ~ 1

Author(s):

Barton J. Sanders ◽

Chao-Hui Huang ◽

Gabrielle Betty Rocque ◽

Grant R Williams ◽

Maria J Pisu ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Functional Disability ◽

Sleep Problems ◽

Functional Decline ◽

Care Utilization ◽

Geriatric Syndrome ◽

Geriatric Syndromes ◽

Early Screening

189 Background: Geriatric syndromes are multifactorial conditions affecting the elderly that are associated with decreased quality of life and poor outcomes. We sought to quantify the prevalence of geriatric syndromes in a group of navigated cancer patients and identify conditions associated with distress. Methods: Distress assessments were conducted between January 2012 and December 2015 on enrollment into the PCCP, a lay-navigation program that serves Medicare recipients in the UAB Health System Cancer Community Network. Assessments were made using a modified Distress Tool, which captures sources of distress in multiple domains. We identified questionnaire items related to common geriatric syndromes including functional decline, sensory impairment, cognitive and mood changes, sleep problems, incontinence, pressure ulcers, and malnutrition. Prevalence of geriatric syndromes was indicated by reported distress for an item that mapped to one of the above syndromes. Results: 8,014 patients were surveyed; 53 % of patients were 65- 74 yoa with 47% > 74 yoa while 52% were female. The most common cancer types were breast (18%), lung (17%), and gastrointestinal (16%). Of all surveyed patients, 1,779 (22%) reported distress related to at least one geriatric syndrome. The most common complaint was decline in functional ability relating to ADLs (11%) and IADLs (7%). Conclusions: Geriatric syndromes, such as functional disability, contribute to distress in older patients with cancer patients. Early screening and identification may lead to timely intervention to help improve quality of life. Further research is needed to describe the relationship between these syndromes and health outcomes, such as their association with health care utilization in older adults with cancer.

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Eye disease in older people

Reviews in Clinical Gerontology ◽

10.1017/s0959259813000105 ◽

2013 ◽

Vol 23 (3) ◽

pp. 234-250 ◽

Cited By ~ 1

Author(s):

Robert MJ Purbrick ◽

John J Ah-Chan ◽

Susan M Downes

Keyword(s):

Older People ◽

Physical Disability ◽

Eye Disease ◽

Pathological Changes ◽

Poor Vision ◽

Age Related ◽

Quality Of Vision ◽

Normal Ageing ◽

Age Related Changes

SummaryAge-related changes affect all structures of the eye, and while age-related changes may influence the quality of vision, it is important to distinguish age-related physiological changes from pathological changes. This is important particularly when identifying pathological changes that may be treatable. The prevalence of visual loss increases substantially after 60 years of age and poor vision is the second most prevalent physical disability in older people. This review describes the normal ageing changes of the eye and outlines common ophthalmic diseases affecting older people. We refer to recent advances in diagnosis and treatment, and relevant current research.

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Perspectives on Frailty Screening, Management and Its Implementation Among Acute Care Providers in Singapore: A Qualitative Study

10.21203/rs.3.rs-116949/v1 ◽

2020 ◽

Author(s):

Xiao Liu ◽

Vivienne Mai Khanh Le ◽

Amber Lim Yew Chen ◽

Emily Jiali Koh ◽

Tu Nguyen ◽

...

Keyword(s):

Public Health ◽

Qualitative Study ◽

Acute Care ◽

Group Discussion ◽

Functional Decline ◽

Adverse Outcomes ◽

Health Concern ◽

Care Providers ◽

Care Givers ◽

Age Related

Abstract Background Frailty has emerged to be a public health concern among aging populations. COVID-19 pandemic has reminded how the frailest individuals are particularly exposed to adverse outcomes. It is important to identify and manage frailty to delay functional decline and reduce unnecessary health utilizations. Our study explored understanding on frailty and practice of frailty screening among different acute care professionals in Singapore, (2) identify barriers and facilitators concerning frailty screening, management and its implementation.Methods A qualitative study using focus group discussion among nurses and individual interviews among physicians from four departments (Accident & Emergency, Anaethesia, General Surgery, Orthopedics) in three acute hospitals from the three public health clusters in Singapore. Participants were recruited through a combination of purposive, convenience and snowball approach with a directed approach by using NVIVO 12.0 to analyse the data. Result Frailty was mainly but inadequately understood as a physical and age-related concept. Screening for frailty in acute care was considered necessary to reduce adverse health outcomes. Specific issues related to screening, management and implementation identified were: cooperation from patient/caregivers, acceptance from healthcare workers/hospital managers, need for dedicated resources, guidelines for follow-up management and consensus on the scope of measurement for different specialties. Conclusion Our findings indicated the need for 1) education program for patients/care givers and stakeholders 2) hospital wide push to adopt and develop a uniform frailty screening tool and process and 3) applying relevant guidelines, developing whole of hospital approach and process for the management of frail patients.

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Frailty in older adults

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0057 ◽

2017 ◽

pp. 429-436

Author(s):

Jeremy Walston

Keyword(s):

Older Adults ◽

Environmental Drivers ◽

Geriatric Syndrome ◽

Geriatric Syndromes ◽

Multiple Measurement ◽

Adverse Health Outcomes ◽

Age Related ◽

Measurement Tools ◽

Novel Approaches

Frailty is most often conceptualized as an age-related medical syndrome with a biological basis that results in substantial vulnerability stressors and adverse health outcomes. It is increasingly thought of as the geriatric syndrome that underlies all other geriatric syndromes. Multiple measurement tools have been developed that have helped to differentiate frail from more robust or resilient older adults; and these tools enabling the characterization of and consequences of frailty, as well as its underlying biology. The recognition of frailty as a condition of advanced vulnerability has led to the development of interventions and novel approaches to integrate frailty into clinical practice. The following chapter describes the conceptualization of frailty, surveys the vast array of tools used to identify frailty, provides demographic information and epidemiological characterizations of causes and consequences of frailty, identifies important biological and environmental drivers of frailty, and describes the clinical efforts underway to better utilize frailty tools.

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Age-related decline in positive emotional reactivity and emotion regulation in a population-derived cohort

10.31234/osf.io/2eypg ◽

2018 ◽

Author(s):

Susanne Schweizer ◽

Jason Stretton ◽

Janna van Belle ◽

Darren Price ◽

Andrew J. Calder ◽

...

Keyword(s):

Emotion Regulation ◽

Older People ◽

Emotional Reactivity ◽

Functional Decline ◽

Well Being ◽

Affective Processing ◽

Cognitive Domains ◽

Age Related ◽

Positive Reactivity ◽

Age Related Changes

Human older age ushers in functional decline across the majority of cognitive domains. A notable exception seems be affective processing, with older people reporting higher levels of emotional well-being. Here we evaluated age-related changes in emotional reactivity and regulation in a representative subsample (n=104; 23-88 years) of the population-derived Cambridge Centre for Ageing and Neuroscience cohort. Performance on a film-based emotion reactivity and regulation task in the MRI scanner showed an age-related decline in positive reactivity, alongside a similar decline in the capacity to down-regulate negative affect. Decreased positivity with age was associated with reduced activation in the middle frontal gyrus. These findings, from the largest neuroimaging investigation to-date, provide no support for age-related increases in positive emotional reactivity.

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Dizziness and vertigo

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0153 ◽

2017 ◽

pp. 1177-1182

Author(s):

Declan Lyons ◽

Avril Beirne ◽

Joanna Lawson

Keyword(s):

Functional Decline ◽

Careful Examination ◽

History Taking ◽

Motor Systems ◽

Age Related ◽

Treatment Plans ◽

Red Flag ◽

Normal Ageing ◽

Physiological Systems

Dizziness is one of the commonest symptoms described by older adults, particularly women, and is associated with reduced quality of life, functional decline, and falls. The term dizziness is used by patients to describe a variety of symptoms, including a hallucination of movement (vertigo), light-headedness, and a true appreciation of unsteadiness associated with gait disorders. Although there are age-related decrements in the somatosensory, visual, vestibular, and motor systems, dizziness should not be regarded as part of normal ageing. Diagnosis can usually be reached without specialist investigations, through focused history taking and bedside clinical assessment, including careful examination of eye movements and the Dix-Hallpike test. The underlying cause may be in one or several physiological systems and this will guide treatment plans. Benign paroxysmal positional vertigo (BPPV) and neuritis are more common than Meniere’s. The presence of red flag symptoms or signs suggesting central vestibular disease will require further imaging.

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