Geriatric medicine

2016 ◽  
Keyword(s):  
Older People ◽  
Complex Disease ◽  
Geriatric Medicine ◽  
Complex Interventions ◽  
Screening Tools ◽  
Fluctuating Course ◽  
Multiple Causation ◽  
Clinical Questions ◽  
Geriatric Team

Geriatric medicine is a complex specialty often complicated by factors such as multiple causation, chronic fluctuating course, and attendant functional and social factors. Such complex aetiology mandates multifactorial assessments and multifactorial interventions. Not all older people need the skills of a specialist geriatric team, but appropriate skills must either be embedded within systems managing older people, or else effective screening tools developed that enable non-specialists to recognize patients who benefit from more specialist assessment. Older people, as a group, face the greatest burden of disease and stand to benefit most from quality research—yet there is less of it. Determining the effect of complex interventions on heterogeneous populations afflicted by complex disease is inherently difficult and is made more so by high fatality, difficult follow-up, and cognitive impairment. Such patients are routinely excluded from trials that seek answers to simpler—but less common and less important—clinical questions.

A pilot study examining the profile of older people on clozapine

2018 ◽  
Vol 26 (6) ◽  
pp. 619-623
Author(s):  
Jen Benbow ◽  
Anne PF Wand ◽  
Brett Simpson
Keyword(s):  
Cognitive Impairment ◽  
Side Effects ◽  
Older People ◽  
Social History ◽  
Geriatric Medicine ◽  
Executive Dysfunction ◽  
Screening Tools ◽  
The Mean ◽  
Considerable Morbidity ◽  
And Function

Objective: The primary aim was to comprehensively describe the characteristics of a cohort of older people taking clozapine. Method: Participants aged ⩾ 60 had a geriatric assessment including full medical, medication and social history. Standardized screening tools for cognition, function, comorbidity and antipsychotic side effects were administered and descriptive statistics utilized. Results: Thirteen patients were eligible to participate and 10 were assessed. The mean age was 69 years. The mean clozapine dose was 309 mg/day and mean duration of use was 10 years. All participants had executive dysfunction, and half had cognitive impairment. The mean number of co-morbid conditions was five. Seven people met the criteria for polypharmacy. Eight people experienced moderate–severe antipsychotic-related side-effects. The majority demonstrated impaired physical functioning. Conclusions: This cohort of older people taking clozapine experienced considerable morbidity, functional and cognitive impairment. We suggest routine screening of cognition and function in clozapine patients aged ⩾ 60 years. Those screening positive should be considered for further assessment by Older Person’s Mental Health Services and/or a Geriatric Medicine service.

Monogenic Diabetes: Genetics and Relevance on Diabetes Mellitus Personalized Medicine

2020 ◽  
Vol 16 (8) ◽  
pp. 807-819 ◽  
Author(s):  
Madalena Sousa ◽  
Jácome Bruges-Armas
Keyword(s):  
Diabetes Mellitus ◽  
Complex Disease ◽  
Clinical Manifestations ◽  
Neonatal Diabetes ◽  
Monogenic Diabetes ◽  
Diabetes Genetics ◽  
Individualize Treatment

Background: Diabetes mellitus (DM) is a complex disease with significant impression in today's world. Aside from the most common types recognized over the years, such as type 1 diabetes (T1DM) and type 2 diabetes (T2DM), recent studies have emphasized the crucial role of genetics in DM, allowing the distinction of monogenic diabetes. Methods: Authors did a literature search with the purpose of highlighting and clarifying the subtypes of monogenic diabetes, as well as the accredited genetic entities responsible for such phenotypes. Results: The following subtypes were included in this literature review: maturity-onset diabetes of the young (MODY), neonatal diabetes mellitus (NDM) and maternally inherited diabetes and deafness (MIDD). So far, 14 subtypes of MODY have been identified, while three subtypes have been identified in NDM - transient, permanent, and syndromic. Discussion: Despite being estimated to affect approximately 2% of all the T2DM patients in Europe, the exact prevalence of MODY is still unknown, accentuating the need for research focused on biomarkers. Consequently, due to its impact in the course of treatment, follow-up of associated complications, and genetic implications for siblings and offspring of affected individuals, it is imperative to diagnose the monogenic forms of DM accurately. Conclusion: Currently, advances in the genetics field allowed the recognition of new DM subtypes, which until now, were considered slight variations of the typical forms. Thus, it is imperative to act in the close interaction between genetics and clinical manifestations, to facilitate diagnosis and individualize treatment.

scholarly journals A machine learning approach for predicting suicidal thoughts and behaviours among college students

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Melissa Macalli ◽  
Marie Navarro ◽  
Massimiliano Orri ◽  
Marie Tournier ◽  
Rodolphe Thiébaut ◽  
...  
Keyword(s):  
Mental Health ◽  
College Students ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Screening Tools ◽  
Receiver Operating Curve ◽  
Depression Symptoms ◽  
Suicidal Thoughts ◽  
One Year

AbstractSuicidal thoughts and behaviours are prevalent among college students. Yet little is known about screening tools to identify students at higher risk. We aimed to develop a risk algorithm to identify the main predictors of suicidal thoughts and behaviours among college students within one-year of baseline assessment. We used data collected in 2013–2019 from the French i-Share cohort, a longitudinal population-based study including 5066 volunteer students. To predict suicidal thoughts and behaviours at follow-up, we used random forests models with 70 potential predictors measured at baseline, including sociodemographic and familial characteristics, mental health and substance use. Model performance was measured using the area under the receiver operating curve (AUC), sensitivity, and positive predictive value. At follow-up, 17.4% of girls and 16.8% of boys reported suicidal thoughts and behaviours. The models achieved good predictive performance: AUC, 0.8; sensitivity, 79% for girls, 81% for boys; and positive predictive value, 40% for girls and 36% for boys. Among the 70 potential predictors, four showed the highest predictive power: 12-month suicidal thoughts, trait anxiety, depression symptoms, and self-esteem. We identified a parsimonious set of mental health indicators that accurately predicted one-year suicidal thoughts and behaviours in a community sample of college students.

scholarly journals Screening tools for common mental disorders in older adults in South Asia: a systematic scoping review

2021 ◽  
pp. 1-12
Author(s):  
Lachlan Fotheringham ◽  
Stella-Maria Paddick ◽  
Evelyn Barron Millar ◽  
Claire Norman ◽  
Ammu Lukose ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Older People ◽  
Diagnostic Accuracy ◽  
South Asia ◽  
Scoping Review ◽  
Validation Studies ◽  
Common Mental Disorders ◽  
Global Mental Health ◽  
Depression Scale ◽  
Screening Tools

ABSTRACT Objectives: Common mental disorders (CMDs), particularly depression, are major contributors to the global mental health burden. South Asia, while diverse, has cultural, social, and economic challenges, which are common across the region, not least an aging population. This creates an imperative to better understand how CMD affects older people in this context, which relies on valid and culturally appropriate screening and research tools. This review aims to scope the availability of CMD screening tools for older people in South Asia. As a secondary aim, this review will summarize the use of these tools in epidemiology, and the extent to which they have been validated or adapted for this population. Design: A scoping review was performed, following PRISMA guidelines. The search strategy was developed iteratively in Medline and translated to Embase, PsychInfo, Scopus, and Web of Science. Data were extracted from papers in which a tool was used to identify CMD in a South Asian older population (50+), including validation, adaptation, and use in epidemiology. Validation studies meeting the criteria were critically appraised using the Quality Assessment of Diagnostic Accuracy Studies – version 2 (QUADAS-2) tool. Results: Of the 4694 papers identified, 176 met the selection criteria at full-text screening as relevant examples of diagnostic or screening tool use. There were 15 tool validation studies, which were critically appraised. Of these, 10 were appropriate to evaluate as diagnostic tests. All of these tools assessed for depression. Geriatric Depression Scale (GDS)-based tools were predominant with variable diagnostic accuracy across different settings. Methodological issues were substantial based on the QUADAS-2 criteria. In the epidemiological studies identified (n = 160), depression alone was assessed for 82% of the studies. Tools lacking cultural validation were commonly used (43%). Conclusions: This review identifies a number of current research gaps including a need for culturally relevant validation studies, and attention to other CMDs such as anxiety.

scholarly journals Vitamin Intake and Loss of Muscle Mass in Older People with Type 2 Diabetes: A Prospective Study of the KAMOGAWA-DM Cohort

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2335
Author(s):  
Fuyuko Takahashi ◽  
Yoshitaka Hashimoto ◽  
Ayumi Kaji ◽  
Ryosuke Sakai ◽  
Yuka Kawate ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Older People ◽  
Vitamin B12 ◽  
Muscle Mass ◽  
Vitamin B1 ◽  
Vitamin D Intake ◽  
Glucagon Like Peptide 1

The aim of this prospective cohort study was to examine the relationships between the intakes of various vitamins and the loss of muscle mass in older people with type 2 diabetes (T2DM). The change in skeletal muscle mass index (SMI, kg/m2) (kg/m2/year) was defined as follows: (SMI at baseline (kg/m2) − SMI at follow-up (kg/m2))/follow-up period (year). The rate of SMI reduction (%) was calculated as follows (the change in SMI (kg/m2/year)/SMI at baseline (kg/m2)) × 100. The rate of SMI reduction ≥ 1.2% was considered as the loss of muscle mass. Among 197 people with T2DM, 47.2% of them experienced the loss of muscle mass at the 13.7 ± 5.2 month follow-up. Vitamin B1 (0.8 ± 0.3 vs. 0.8 ± 0.3 mg/day, p = 0.031), vitamin B12 (11.2 ± 8.3 vs. 13.4 ± 7.5 μg/day, p = 0.049), and vitamin D (16.5 ± 12.2 vs. 21.6 ± 13.0 μg/day, p = 0.004) intakes in people with the loss of muscle mass were significantly lower than those without. Vitamin D intake was related to the loss of muscle mass after adjusting for sex, age, exercise, alcohol, smoking, body mass index, SMI, glucagon-like peptide-1 agonist, sodium glucose cotransporter-2 inhibitor, insulin, HbA1c, creatinine, energy intake, and protein intake (adjusted odds ratio 0.93, 95% confidence interval: 0.88–0.97, p = 0.003). This study showed that vitamin D intake was related to the loss of muscle mass in older people with T2DM. Vitamin B12 intake tended to be related to the loss of muscle mass, although vitamin A, vitamin B2, vitamin B6, vitamin C, and vitamin E intake were not related.

scholarly journals 83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Yang ◽  
Z Hui ◽  
S Zhu ◽  
X Wang ◽  
G Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Older People ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Medication Knowledge ◽  
Management Intervention ◽  
Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P < 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

scholarly journals Establishing a nurse-led thyroid cancer follow-up clinic

2021 ◽  
Vol 30 (4) ◽  
pp. S28-S35
Author(s):  
Andrew Fishburn ◽  
Nicola Fishburn
Keyword(s):  
Thyroid Cancer ◽  
Complex Disease ◽  
Disease Recurrence ◽  
Patient Survey ◽  
Safe Patient Care ◽  
Face To Face ◽  
Number Of Patients ◽  
Risk Of Disease

Thyroid cancer is a complex disease requiring management by a large multidisciplinary team. The number of patients with a diagnosis of thyroid cancer is significantly increasing year-on-year, and traditional models of consultant-led follow up are no longer sustainable. Although nurse-led cancer follow-up clinics are becomining increasingly common, thyroid cancer nurse-led follow-up clinics are rare. An excellent understanding of the disease, treatment and management of risk of disease recurrence is essential for safe patient care, and is discussed in this article. The clinic discussed uses the skill set of head and neck nurse specialists, including psychological support, coping strategies for long-term side effects of treatment and non-medical prescribing. A patient survey of the service revealed high levels of patient satisfaction and a desire to continue face-to-face consultations rather than telephone clinics.

scholarly journals Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Samantha Chakraborty ◽  
Bianca Brijnath ◽  
Jacinta Dermentzis ◽  
Danielle Mazza
Keyword(s):  
Qualitative Research ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Best Practice ◽  
International Guideline ◽  
Novel Approach ◽  
Clinical Questions ◽  
Key Questions

Abstract Background There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. Methods We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. Results A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Conclusions Guideline developers can apply this protocol to develop clinically relevant guideline questions.

scholarly journals Transitions between levels of dependency among older people receiving social care – a retrospective longitudinal cohort study in a Swedish municipality

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Magnus Zingmark ◽  
Fredrik Norström
Keyword(s):  
Cohort Study ◽  
Older People ◽  
Social Care ◽  
Early Stage ◽  
Cox Proportional Hazards Model ◽  
Longitudinal Cohort Study ◽  
Longitudinal Cohort ◽  
Home Help ◽  
Over Time

Abstract Background Knowledge is scarce on how needs for home help and special housing evolve among older people who begin to receive support from municipal social care. The purpose of this study was to describe baseline distributions and transitions over time between levels of dependency among older persons after being granted social care in a Swedish municipality. Methods Based on a longitudinal cohort study in a Swedish municipality, data was collected retrospectively from municipal records. All persons 65 years or older who received their first decision on social care during 2010 (n = 415) were categorized as being in mild, moderate, severe, or total dependency, and were observed until the end of 2013. Baseline distributions and transitions over time were described descriptively and analysed with survival analysis, with the Kaplan-Meier estimator, over the entire follow-up period. To test potential differences in relation to gender, we used the Cox-Proportional hazards model. Results Baseline distributions between mild, moderate, severe, and total dependency were 53, 16, 24, and 7.7%. During the first year, between 40 and 63% remained at their initial level of dependency. Among those with mild and moderate levels of dependency at baseline, a large proportion declined towards increasing levels of dependency over time; around 40% had increased their dependency level 1 year from baseline and at the end of the follow-up, 75% had increased their dependency level or died. Conclusions Older people in Sweden being allocated home help are at high risk for decline towards higher levels of dependency, especially those at mild or moderate dependency levels at baseline. Taken together, it is important that municipalities make use of existing knowledge so that they implement cost-effective preventative interventions for older people at an early stage before a decline toward increasing levels of dependency.

scholarly journals Protocol for the Process Evaluation of a Complex, Statewide Intervention to Reduce Salt Intake in Victoria, Australia

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 998 ◽  
Author(s):  
Kathy Trieu ◽  
Stephen Jan ◽  
Mark Woodward ◽  
Carley Grimes ◽  
Bruce Bolam ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Complex Disease ◽  
Salt Intake ◽  
Complex Interventions ◽  
Reduction Process ◽  
Population Based ◽  
Structured Interviews ◽  
Salt Reduction ◽  
Campaign Evaluation ◽  
Reduced Salt

Systematic reviews of trials consistently demonstrate that reducing salt intake lowers blood pressure. However, there is limited evidence on how interventions function in the real world to achieve sustained population-wide salt reduction. Process evaluations are crucial for understanding how and why an intervention resulted in its observed effect in that setting, particularly for complex interventions. This project presents the detailed protocol for a process evaluation of a statewide strategy to lower salt intake in Victoria, Australia. We describe the pragmatic methods used to collect and analyse data on six process evaluation dimensions: reach, dose or adoption, fidelity, effectiveness, context and cost, informed by Linnan and Steckler’s framework and RE-AIM. Data collection methods include routinely collected administrative data; surveys of processed foods, the population, food industry and organizations; targeted campaign evaluation and semi-structured interviews. Quantitative and qualitative data will be triangulated to provide validation or context for one another. This process evaluation will contribute new knowledge about what components of the intervention are important to salt reduction strategies and how the interventions cause reduced salt intake, to inform the transferability of the program to other Australian states and territories. This protocol can be adapted for other population-based, complex, disease prevention interventions.

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