scholarly journals ABOUT THE BASICS OF COMPREHENSIVE GERIATRIC ASSESSMENT

2019 ◽  
Vol 9 (4) ◽  
pp. 245-252
Author(s):  
L. M. Farkhutdinova
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Sinus Node ◽  
Elderly Person ◽  
The Body ◽  
Stress Factors ◽  
Lymphoid Tissues ◽  
Age Related ◽  
Increased Risk

The article covers the principles of comprehensive geriatric assessment — an interdisciplinary diagnostic procedure aimed at developing a plan of treatment, long-term monitoring and support of an elderly person. The components of a comprehensive geriatric assessment, including the determination of physical, functional, psychological and social status of the subject, are reflected. During the process of analyzing the patient’s physical status, the age-related features of the functioning of various organs and systems, knowledge of which is necessary for the development of a targeted geriatric care strategy, should be taken into account. Involution of the respiratory organs is characterized by a decrease in the respiratory surface, atrophic processes in the mucous and lymphoid tissues, and an increased risk of developing bronchoobstructive syndrome. Degenerative sclerotic changes in the cardiovascular system contribute to the development of circulatory failure, sinus node dysfunction, increased sensitivity to stress factors, orthostatic hypotension, etc. With age, the secretory function of the gastrointestinal tract decreases, and the functional ability of the liver is limited. Reducing the reserve capacity of the kidneys provokes the development of inflammatory processes and contributes to the dehydration of the body. In older people, the risk of developing diabetes, hypothyroidism and hyperparathyroidism increases. The growth of connective tissue in the blood-forming organs limits the functionality of the blood system. Age-related changes in the musculoskeletal system are characterized by a decrease in muscle mass and the development of osteoporosis. Drug therapy is also being analyzed, since polypharmacy in the elderly is associated with a particularly high risk of developing side effects of the drugs. Assessment of the functional status implies the determination of the self service ability and the degree of a person’s independence from the help of others by his/her ability to perform basic functions, activities in everyday life and instrumental activity. The psycho emotional status is judged by the emotional background of the patient and his/her cognitive functions. Social and household status is estimated by the living conditions of an elderly person. Based on the results of a comprehensive geriatric assessment, an individual management plan is drawn up, the implementation of which is possible with the combined efforts of the geriatrician and a team of medical specialists, relatives, and social workers.

Perioperative comprehensive geriatric assessment: what do we need to know?

2019 ◽  
Vol 80 (5) ◽  
pp. 258-262
Author(s):  
Simon Trundle ◽  
Mevan Gooneratne ◽  
Andrew Rogerson ◽  
Jugdeep Dhesi
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Preoperative Assessment ◽  
Postoperative Outcomes ◽  
Ageing Population ◽  
Optimization Strategy ◽  
Age Related ◽  
Improved Outcomes ◽  
Increased Risk ◽  
Surgical Setting

As a consequence of an ageing population greater numbers of elderly patients are presenting for both elective and emergency surgery. These older patients typically present with an increased burden of age-related problems and multimorbidity, which is associated with an increased risk of adverse postoperative outcomes. Traditional preoperative assessment models are adept at discerning patients' suitability for anaesthesia and surgery, but there is minimal focus on improving postoperative outcomes. Comprehensive geriatric assessment is a multidisciplinary approach used both to assess existing ‘known’ pathology and to screen for previously undiagnosed issues across medical, functional, social and/or psychological domains. This diagnostic phase then leads to the development and implementation of an individualized ‘optimization’ strategy across these domains. There is emerging evidence that comprehensive geriatric assessment and optimization in the surgical setting leads to improved outcomes, and it is reasonable to conclude that it would benefit the patient's long-term health.

scholarly journals Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Nicola Veronese ◽  
Lee Smith ◽  
Ekaterini Zigoura ◽  
Mario Barbagallo ◽  
Ligia J. Dominguez ◽  
...  
Keyword(s):  
Older People ◽  
Fracture Risk ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Prognostic Index ◽  
Knee Oa ◽  
Increased Risk ◽  
Cox's Regression ◽  
Clinical Fractures ◽  
Osteoarthritis Initiative

Abstract Summary In this longitudinal study, with a follow-up of 8 years, multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment, significantly predicted the onset of fractures in older people affected by knee osteoarthritis. Purpose Frailty may be associated with higher fracture risk, but limited research has been carried out using a multidimensional approach to frailty assessment and diagnosis. The present research aimed to investigate whether the MPI, based on comprehensive geriatric assessment (CGA), is associated with the risk of fractures in the Osteoarthritis Initiative (OAI) study. Methods Community-dwellers affected by knee OA or at high risk for this condition were followed-up for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidity, medication, quality of life, and co-habitation status was used to calculate the MPI. Fractures were diagnosed using self-reported information. Cox’s regression analysis was carried out and results are reported as hazard ratios (HRs), with their 95% confidence intervals (CIs), adjusted for potential confounders. Results The sample consisted of 4024 individuals (mean age 61.0 years, females = 59.0%). People with incident fractures had a significant higher MPI baseline value than those without (0.42 ± 0.18 vs. 0.40 ± 0.17). After adjusting for several potential confounders, people with an MPI over 0.66 (HR = 1.49; 95%CI: 1.11–2.00) experienced a higher risk of fractures. An increase in 0.10 point in MPI score corresponded to an increase in fracture risk of 4% (HR = 1.04; 95%CI: 1.008–1.07). Higher MPI values were also associated with a higher risk of non-vertebral clinical fractures. Conclusion Higher MPI values at baseline were associated with an increased risk of fractures, reinforcing the importance of CGA in predicting fractures in older people affected by knee OA.

scholarly journals Prevalence of osteoporosis in hysterectomised as compared to non-hysterectomized women in 7th decade of life

2018 ◽  
Vol 7 (5) ◽  
pp. 1974
Author(s):  
Saba Shamim ◽  
Manju Lal ◽  
Rana Shamim
Keyword(s):  
Postmenopausal Women ◽  
Bone Mineral ◽  
The Body ◽  
Public Health Issue ◽  
Mineral Density ◽  
Bone Mineral Loss ◽  
Age Related ◽  
Increased Risk ◽  
Prevalence Of Osteoporosis ◽  
Mineral Loss

Background: Osteoporosis is considered as a major public health issue with fragility fractures of the hip, vertebrae and distal radius being the most important consequences. It has been said to be an age-related degenerative process. However, postmenopausal women develop this disease due to age-related bone mineral loss as well as due to declining levels of estrogen in the body following menopause leading to increased risk of fractures. Objectives of this study were to find out the prevalence of osteoporosis in hysterectomised and non-hysterectomised postmenopausal women in 7th decade of life.Methods: Descriptive cross-sectional study done on a total of 66 postmenopausal women who were in their 7th decade of life. They were divided into two groups, one consisting of 36 women who underwent natural menopause and the other group of 30 women who had surgical menopause. The bone mineral density of both the groups was measured using DEXA scan and comparison was done between these study groups.Results: Out of 30 hysterectomised subjects, 24 (80%) were found to be having osteoporosis, 6 (20%) had osteopenia and none had normal BMD. While out of 36 subjects in the non-hysterectomised group, 14 (38.88%) had osteoporosis, 16 (44.44%) had osteopenia and 6 (16.66%) subjects had normal BMD. Significant relation (p-value 0.001) was found on comparison of the study groups. In addition, significant positive correlation was between BMD and BMI whereas negative correlation was seen between BMD and parity.Conclusions: Hysterectomy was found to increase the incidence of osteoporosis. Obesity was found to have protective effect against bone mineral loss while increasing parity had a negative relation with BMD.

scholarly journals Comprehensive Geriatric Assessment in the Emergency Department for Identifying Elderly Individuals at Risk of Hip Fracture

2021 ◽  
Author(s):  
Pei-Ying Lin ◽  
Hsien-Hao Huang ◽  
David Hung-Tsang Yen
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Hip Fracture ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Handgrip Strength ◽  
Elderly Individuals ◽  
Female Sex ◽  
Asian Patients ◽  
Increased Risk

Abstract Background Hip fracture (HF) is a major challenge for healthcare systems in terms of increased costs and lengths of stay, and it has been estimated that by 2050, half of the projected 6.26 million global HFs will occur in Asia. Owing to the high morbidity and mortality associated with HF in elderly individuals, it is crucial to recognize at-risk elderly patients in the ED so that special precautions and preventive measures can be taken. While comprehensive geriatric assessment (CGA) has been shown to improve outcomes and prevent secondary fractures in elderly individuals with HF in outpatient settings, there is a lack of data to support the use of CGA in the emergency department (ED) to identify elderly Asian patients who are at risk of HF. Aim To identify the characteristics of elderly Asian patients in the ED who have an increased risk of HF via CGA. Methods A case-control study was conducted in the ED at Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from October 2018 to December 2019. Patients ≥75 years old with and without HF were compared using data obtained from CGAs conducted by trained nurses. Results A total of 85 HF patients (cases) and 680 non-HF patients were enrolled, among whom 85 non-HF control individuals (controls) were selected by simple random sampling. HF occurred more frequently in women and in patients with depressive symptoms. An association between decreased handgrip strength and HF risk, especially in men, was also identified (P < 0.001). The variables independently associated with the presence of HF in the multivariate analysis were female sex (odds ratio (OR) = 2.937; 95% CI = 1.519-5.677) and decreased handgrip strength (OR = 3.739; 95% CI = 1.641-8.519). Conclusions By performing CGAs in the ED, we found that female sex and decreased handgrip strength were associated with HF risk. Therefore, we propose that targeted assessment of handgrip strength in female patients aged ≥75 years in the ED may identify those at greatest risk of HF, resulting in improved emergency care for geriatric patients.

Integrating Comprehensive Geriatric Assessment Into HIV Care Systems in Indonesia: A Synthesis of Recent Evidence

2020 ◽  
Vol 26 (1) ◽  
pp. 9-16
Author(s):  
Linlin Lindayani ◽  
Irma Darmawati ◽  
Heni Purnama ◽  
Bhakti Permana
Keyword(s):  
Health Care ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Health Care Professionals ◽  
Hiv Care ◽  
Geriatric Syndrome ◽  
People Living With Hiv ◽  
Age Related ◽  
Care Systems ◽  
Living With Hiv

Combination antiretroviral therapy (cART) has improved the health and life expectancy of people living with human immunodeficiency virus (HIV). Comorbidities and geriatric syndrome are more prevalent in patients with HIV than in the general population. As a result, people living with HIV may face unique characteristics and needs related to aging. Health-care systems need to prepare to encounter those issues that not only focus on virology suppression and cART management but also chronic non-AIDS comorbidities and geriatric syndrome. However, there are limited data on geriatric assessment among people living with HIV. The purpose of this article is to present findings of a literature search that integrate age-related issues in HIV care management for health-care professionals caring for people living with HIV in Indonesia to consider. Integrating comprehensive geriatric assessment (CGA) into HIV care is essential. However, some critical issues need to be considered prior to implementing CGA in HIV primary care, including social vulnerability, economic inequality, and aging-related stigma. Developing guidelines for implementing CGA in HIV primary clinics remains a priority. Studies of HIV in the aging population in Indonesia need to be conducted to understand the burden of geriatric syndrome.

scholarly journals Morphological changes in the broiler chickens liver at use of “Karsilin” in conditions of infectious-toxic hepatitis modelling

2018 ◽  
Vol 20 (88) ◽  
pp. 102-107
Author(s):  
T. I. Fotina ◽  
G. A. Zon ◽  
Ye. V. Vashchyk
Keyword(s):  
Broiler Chickens ◽  
Toxic Hepatitis ◽  
Morphological Changes ◽  
The Body ◽  
Stress Factors ◽  
Feed Supplement ◽  
Perivascular Edema ◽  
And Control ◽  
Timely Warning

In poultry farms, at the conditions of rapid intensification of production, a lot of stress factors, such as infectious, technological, fodder, medication and others, act on the bird organism, and the main burden is borne by the liver. Therefore, timely warning and control of liver disease is very important. One of the marker infections with a potent pathogenic toxic effect on the liver and the bird organism as a whole is pseudomonosis. Objective: study of morphological changes in the liver of broiler chickens at the use of “Karsilin” in the conditions of modeling of infectious-toxic hepatitis for the determination of hepatoprotective action. We conducted a histological examination of the liver of intact chickens (intact control); chickens infected with the strain of P. aeruginosa microorganisms (control pathology); chickens, for which the “Karsilin” or Thiotriazolin was used with preventive-therapeutic purposes at infecting P. aeruginosa. Microscopic picture of liver samples infected with P. aeruginosa chicks corresponds to moderately expressed non-specific reactive hepatitis with morphological signs: disorganization of the hepatic beams pattern, hydrocytic and fatty hepatocyte dystrophy, small foci necroses, inflammatory cellular infiltration; proliferative, stagnant processes, perivascular edema and hyperemia in the system of the hepatic triad. The use of “Karsilin” at experimental pseudomonosis reduced the intensity of pathological processes: the severity of hepatocyte dystrophy was less than 71%, and necrotic changes in hepatocytes and violations of the beam pattern were less than 75% compared with the control pathology. Feed supplement “Karsilin” demonstrates hepatoprotective effect, which is expressed by preventing or significantly reducing the intensity of the manifestation of dystrophic, necrotic, infiltrative and proliferative processes in hepatocytes and in the hepatic triad in conditions of infectious-toxic hepatitis caused by the pathological action of P. aeruginosa toxins in the body of chicken broilers. Feed supplement “Karsilin” on the activity of protective and regenerative action is not inferior, and according to many indicators, the comparison preparation Thiotriazolin prevails.

Detecting Disabilities in Older Patients With Cancer: Comparison Between Comprehensive Geriatric Assessment and Vulnerable Elders Survey-13

2010 ◽  
Vol 28 (12) ◽  
pp. 2046-2050 ◽  
Author(s):  
Andrea Luciani ◽  
Gilda Ascione ◽  
Cecilia Bertuzzi ◽  
Desirè Marussi ◽  
Carla Codecà ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Activities Of Daily Living ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Older Patients ◽  
Reliability And Validity ◽  
Patients With Cancer ◽  
Age Related ◽  
Time Required

PurposeComprehensive geriatric assessment (CGA) is a multidimensional method used by geriatricians and oncologists to detect and evaluate multiple age-related problems and to plan and coordinate interventions. Because its main drawback is the time required, efforts have been made to evaluate screening instruments suitable for preliminarily assessing elderly patients. The main aim of this study was to establish the accuracy of the Vulnerable Elders Survey-13 (VES-13) in predicting the presence of abnormalities revealed by CGA.Patients and MethodsPatients age ≥ 70 years with a histologically or cytologically confirmed diagnosis of a solid or hematologic tumor underwent both CGA and a VES-13 assessment, and the reliability and validity of VES-13 were analyzed.ResultsFifty-three percent of the 419 elderly patients with cancer (mean age, 76.8 years) were vulnerable on VES-13; the rates of disabilities on CGA and activities of daily living (ADLs)/instrumental activities of daily living (IADLs) scales were 30% and 25%, respectively. The sensitivity and specificity of VES-13 were 87% and 62%, respectively, versus CGA and 90% and 70%, respectively, versus ADL/IADL scales.ConclusionsOn the basis of our data, VES-13 is highly predictive of impaired functional status and can thus be considered a useful preliminary means of assessing older patients with cancer before undertaking a full CGA.

scholarly journals Integrating Comprehensive Geriatric Assessment for people with COPD and frailty starting pulmonary rehabilitation: the Breathe Plus feasibility trial protocol

2021 ◽  
Vol 7 (1) ◽  
pp. 00717-2020
Author(s):  
Lisa Jane Brighton ◽  
Catherine J. Evans ◽  
Morag Farquhar ◽  
Katherine Bristowe ◽  
Aleksandra Kata ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Randomised Controlled Trial ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Feasibility Trial ◽  
Process Data ◽  
Increased Risk ◽  
Randomised Controlled

One in five people with COPD also lives with frailty. People living with both COPD and frailty are at increased risk of poorer health and outcomes, and face challenges to completing pulmonary rehabilitation. Integrated approaches that are adapted to the additional context of frailty are required.The aim of the present study is to determine the feasibility of conducting a randomised controlled trial of an integrated Comprehensive Geriatric Assessment for people with COPD and frailty starting pulmonary rehabilitation.This is a multicentre, mixed-methods, assessor-blinded, randomised, parallel group, controlled feasibility trial (“Breathe Plus”; ISRCTN13051922). We aim to recruit 60 people aged ≥50 with both COPD and frailty referred for pulmonary rehabilitation. Participants will be randomised 1:1 to receive usual pulmonary rehabilitation, or pulmonary rehabilitation with an additional Comprehensive Geriatric Assessment. Outcomes (physical, psycho-social and service use) will be measured at baseline, 90 days and 180 days. We will also collect service and trial process data, and conduct qualitative interviews with a sub-group of participants and staff. We will undertake descriptive analysis of quantitative feasibility outcomes (recruitment, retention, missing data, blinding, contamination, fidelity), and framework analysis of qualitative feasibility outcomes (intervention acceptability and theory, outcome acceptability). Recommendations on progression to a full trial will comprise integration of quantitative and qualitative data, with input from relevant stakeholders. This study has been approved by a UK Research Ethics Committee (ref.: 19/LO/1402).This protocol describes the first study testing the feasibility of integrating a Comprehensive Geriatric Assessment alongside pulmonary rehabilitation, and testing this intervention within a mixed-methods randomised controlled trial.

scholarly journals Importance of toxic metabolite mineralization in ensuring physiological aging and human longevity

2020 ◽  
pp. 65-73
Author(s):  
С.Н. Шатохина ◽  
Д.С. Уварова ◽  
В.Н. Шабалин
Keyword(s):  
Blood Serum ◽  
Biological Fluids ◽  
The Body ◽  
Toxic Metabolite ◽  
Physiological Aging ◽  
Toxic Metabolites ◽  
Endogenous Intoxication ◽  
Age Related ◽  
Middle Molecules

Актуальность. Долголетие человека с высоким качеством жизни является одной из наиболее важных проблем мирового значения. Долгожители представляют собой биологическую элиту человеческой популяции, что заставляет проводить углублённые исследования факторов, обеспечивающих физиологическое старение и долголетие человека. Одним из таких факторов является способность организма нейтрализовать токсические свойства метаболитов посредством минерализации. Цель: выявить биологические особенности организма долгожителей по критерию соотношения показателей эндогенной интоксикации и минерализации эндотоксинов по сравнению с пациентами среднего, пожилого и старческого возраста. Материалы и методы. Материалом для исследования являлись биологические жидкости (сыворотка крови, моча, ротовая жидкость). В качестве основного применён метод клиновидной дегидратации биологических жидкостей. Как вспомогательные использованы методы: определение молекул средней массы в сыворотке крови; определение высокомолекулярной фракции циркулирующих иммунных комплексов в сыворотке крови и метод рентгеноспектрального микроанализа структур твёрдой фазы мочи и ротовой жидкости. Результаты. Установлено, что естественное возрастное увеличение количества токсических метаболитов в организме человека значительно опережает повышение нейтрализующей токсины биоминерализационной активности. Однако пациенты старше 85 лет представляют исключение из этой закономерности: рост биоминерализационной активности в данной возрастной группе адекватен росту эндогенной интоксикации. Это обеспечивает более высокую резистентность организма к токсическим метаболитам и определяет большую продолжительность жизни. Заключение. Структура фаций биологических жидкостей даёт возможность интегрально оценивать текущей уровень эндогенной интоксикации в соотношении с биоминерализационной активностью организма. Background. Longevity with a high quality of life is one of the most important goals of global significance. Centenarians represent a biological elite of the human population, which encourages conducting in-depth studies of factors that provide physiological aging and longevity of people. One of these factors is the body’s ability to neutralize toxicity of metabolites through mineralization. Aim. To identify biological characteristics of a long-liver’s body by the criterion of intoxication to endotoxin mineralization ratio as compared to patients of middle, elderly, and senile age. Methods. Cuneiform dehydration of biological fluids was used as the main method. Auxiliary methods included determination of middle molecules in blood serum; determination of high-molecular fraction of circulating immune complexes in blood serum; and the x-ray spectral microanalysis of urine and oral fluid. Results. The natural, age-related increase in the number of toxic metabolites in the human body significantly precedes the increase in toxin-neutralizing biomineralization activity. However, centenarians (patients older than 85) are an exception to this pattern: in this age group, the growth of biomineralization activity is adequate to the growth of endogenous intoxication. This provides a higher resistance of the body to toxic metabolites and determines a longer life expectancy. Conclusion. The structure of facies of biological fluids allows integral evaluation of the current level of endogenous intoxication in relation to the biomineralization activity in the body. Long-livers were shown to have a higher ability to neutralize endotoxins through biomineralization, which provides them with a longer lifespan.

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