Approach to the Geriatric Patient

2014 ◽  
Author(s):  
Tia Kostas ◽  
Mark Simone ◽  
James L Rudolph
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Task Force ◽  
Functional Dependence ◽  
Geriatric Care ◽  
Assessment Process ◽  
Age Group ◽  
Older Individuals ◽  
Geriatric Population ◽  
General Internists

As of 2012, over one in eight Americans is over the age of 65, and this number is rising, particularly in the 85+ age group. This segment of the population has a rate of hospitalization three times higher than that for persons of all ages. General internists and family medicine physicians provide a large portion of care for this age group and should therefore be comfortable using a comprehensive approach to geriatric assessment. This review describes general considerations regarding geriatric care, including the process of taking a functional history and clinical implications of geriatric care. The geriatric assessment process is discussed in terms of physical, cognitive, social, and medical domains. The benefits of geriatric assessment in primary care, specialty care, and hospitalized patients are described. Tables outline activities of daily living, sensory changes with aging, major causes of visual impairment in the geriatric population, major neurocognitive disorder diagnostic criteria, medications to avoid or use with caution based on Beers criteria and Screening Tool of Older individuals’ Potentially inappropriate Prescriptions criteria, U.S. Preventive Services Task Force–recommended services relevant to older adults, and vaccinations in older adults. Figures illustrate the key vulnerabilities of older adults; outcomes linked to functional dependence; common disorders associated with cognitive concerns; domains of cognition and examples of impairment in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition; the social and medical domains of geriatric assessment; barriers to medication adherence in older patients; and resources for medication appropriateness in older adults. This review contains 8 highly rendered figures, 8 tables, 110 references, and 5 MCQs.

Approach to the Geriatric Patient

2014 ◽  
Author(s):  
Tia Kostas ◽  
Mark Simone ◽  
James L Rudolph
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Task Force ◽  
Functional Dependence ◽  
Geriatric Care ◽  
Assessment Process ◽  
Age Group ◽  
Older Individuals ◽  
Geriatric Population ◽  
General Internists

As of 2012, over one in eight Americans is over the age of 65, and this number is rising, particularly in the 85+ age group. This segment of the population has a rate of hospitalization three times higher than that for persons of all ages. General internists and family medicine physicians provide a large portion of care for this age group and should therefore be comfortable using a comprehensive approach to geriatric assessment. This review describes general considerations regarding geriatric care, including the process of taking a functional history and clinical implications of geriatric care. The geriatric assessment process is discussed in terms of physical, cognitive, social, and medical domains. The benefits of geriatric assessment in primary care, specialty care, and hospitalized patients are described. Tables outline activities of daily living, sensory changes with aging, major causes of visual impairment in the geriatric population, major neurocognitive disorder diagnostic criteria, medications to avoid or use with caution based on Beers criteria and Screening Tool of Older individuals’ Potentially inappropriate Prescriptions criteria, U.S. Preventive Services Task Force–recommended services relevant to older adults, and vaccinations in older adults. Figures illustrate the key vulnerabilities of older adults; outcomes linked to functional dependence; common disorders associated with cognitive concerns; domains of cognition and examples of impairment in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition; the social and medical domains of geriatric assessment; barriers to medication adherence in older patients; and resources for medication appropriateness in older adults. This review contains 8 highly rendered figures, 8 tables, 110 references, and 5 MCQs.

Approach to the Geriatric Patient

2018 ◽  
Author(s):  
Tia Kostas ◽  
Mark Simone ◽  
James L Rudolph
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Task Force ◽  
Functional Dependence ◽  
Geriatric Care ◽  
Assessment Process ◽  
Age Group ◽  
Older Individuals ◽  
Geriatric Population ◽  
General Internists

As of 2012, over one in eight Americans is over the age of 65, and this number is rising, particularly in the 85+ age group. This segment of the population has a rate of hospitalization three times higher than that for persons of all ages. General internists and family medicine physicians provide a large portion of care for this age group and should therefore be comfortable using a comprehensive approach to geriatric assessment. This review describes general considerations regarding geriatric care, including the process of taking a functional history and clinical implications of geriatric care. The geriatric assessment process is discussed in terms of physical, cognitive, social, and medical domains. The benefits of geriatric assessment in primary care, specialty care, and hospitalized patients are described. Tables outline activities of daily living, sensory changes with aging, major causes of visual impairment in the geriatric population, major neurocognitive disorder diagnostic criteria, medications to avoid or use with caution based on Beers criteria and Screening Tool of Older individuals’ Potentially inappropriate Prescriptions criteria, U.S. Preventive Services Task Force–recommended services relevant to older adults, and vaccinations in older adults. Figures illustrate the key vulnerabilities of older adults; outcomes linked to functional dependence; common disorders associated with cognitive concerns; domains of cognition and examples of impairment in theDiagnostic and Statistical Manual of Mental Disorders, fifth edition; the social and medical domains of geriatric assessment; barriers to medication adherence in older patients; and resources for medication appropriateness in older adults. This review contains 8 highly rendered figures, 8 tables, 110 references, and 5 MCQs.

Approach to the Geriatric Patient

2017 ◽  
Author(s):  
Tia Kostas ◽  
Mark Simone ◽  
James L Rudolph
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Task Force ◽  
Functional Dependence ◽  
Geriatric Care ◽  
Assessment Process ◽  
Age Group ◽  
Older Individuals ◽  
Geriatric Population ◽  
General Internists

As of 2012, over one in eight Americans is over the age of 65, and this number is rising, particularly in the 85+ age group. This segment of the population has a rate of hospitalization three times higher than that for persons of all ages. General internists and family medicine physicians provide a large portion of care for this age group and should therefore be comfortable using a comprehensive approach to geriatric assessment. This review describes general considerations regarding geriatric care, including the process of taking a functional history and clinical implications of geriatric care. The geriatric assessment process is discussed in terms of physical, cognitive, social, and medical domains. The benefits of geriatric assessment in primary care, specialty care, and hospitalized patients are described. Tables outline activities of daily living, sensory changes with aging, major causes of visual impairment in the geriatric population, major neurocognitive disorder diagnostic criteria, medications to avoid or use with caution based on Beers criteria and Screening Tool of Older individuals’ Potentially inappropriate Prescriptions criteria, U.S. Preventive Services Task Force–recommended services relevant to older adults, and vaccinations in older adults. Figures illustrate the key vulnerabilities of older adults; outcomes linked to functional dependence; common disorders associated with cognitive concerns; domains of cognition and examples of impairment in theDiagnostic and Statistical Manual of Mental Disorders, fifth edition; the social and medical domains of geriatric assessment; barriers to medication adherence in older patients; and resources for medication appropriateness in older adults. This review contains 8 highly rendered figures, 8 tables, 110 references, and 5 MCQs.

Approach to the Geriatric Patient

2018 ◽  
Author(s):  
Tia Kostas ◽  
Mark Simone ◽  
James L Rudolph
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Task Force ◽  
Functional Dependence ◽  
Geriatric Care ◽  
Assessment Process ◽  
Age Group ◽  
Older Individuals ◽  
Geriatric Population ◽  
General Internists

As of 2012, over one in eight Americans is over the age of 65, and this number is rising, particularly in the 85+ age group. This segment of the population has a rate of hospitalization three times higher than that for persons of all ages. General internists and family medicine physicians provide a large portion of care for this age group and should therefore be comfortable using a comprehensive approach to geriatric assessment. This review describes general considerations regarding geriatric care, including the process of taking a functional history and clinical implications of geriatric care. The geriatric assessment process is discussed in terms of physical, cognitive, social, and medical domains. The benefits of geriatric assessment in primary care, specialty care, and hospitalized patients are described. Tables outline activities of daily living, sensory changes with aging, major causes of visual impairment in the geriatric population, major neurocognitive disorder diagnostic criteria, medications to avoid or use with caution based on Beers criteria and Screening Tool of Older individuals’ Potentially inappropriate Prescriptions criteria, U.S. Preventive Services Task Force–recommended services relevant to older adults, and vaccinations in older adults. Figures illustrate the key vulnerabilities of older adults; outcomes linked to functional dependence; common disorders associated with cognitive concerns; domains of cognition and examples of impairment in theDiagnostic and Statistical Manual of Mental Disorders, fifth edition; the social and medical domains of geriatric assessment; barriers to medication adherence in older patients; and resources for medication appropriateness in older adults. This review contains 8 highly rendered figures, 8 tables, 110 references, and 5 MCQs.

scholarly journals How Is Geriatric Assessment Used in Clinical Practice for Older Adults With Cancer? A Survey of Cancer Providers by the American Society of Clinical Oncology

2020 ◽  
pp. OP.20.00442
Author(s):  
William Dale ◽  
Grant R. Williams ◽  
Amy R. MacKenzie ◽  
Enrique Soto-Perez-de-Celis ◽  
Ronald J. Maggiore ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Online Survey ◽  
Task Force ◽  
Statistical Significance ◽  
Geriatric Oncology ◽  
Perceived Barriers ◽  
Patients With Cancer ◽  
Change Behavior ◽  
American Society

PURPOSE: For patients with cancer who are older than 65 years, the 2018 ASCO Guideline recommends geriatric assessment (GA) be performed. However, there are limited data on providers’ practices using GA. Therefore, ASCO’s Geriatric Oncology Task Force conducted a survey of providers to assess practice patterns and barriers to GA. METHODS: Cancer providers treating adult patients including those ≥ 65 years completed an online survey. Questions included those asking about awareness of ASCO’s Geriatric Oncology Guideline (2018), use of validated GA tools, and perceived barriers to using GA. Descriptive statistics and statistical comparisons between those aware of the Guideline and those who were not were conducted. Statistical significance was set at P < .05. RESULTS: Participants (N = 1,277) responded between April 5 and June 5, 2019. Approximately half (53%) reported awareness of the Guideline. The most frequently used GA tools, among those aware of the Guideline and those who were not, assessed functional status (69% v 50%; P < .001) and falls (62% v 45%; P < .001). Remaining tools were used < 50% of the time, including tools assessing weight loss, comorbidities, cognition, life expectancy, chemotherapy toxicity, mood, and noncancer mortality risk. GA use was two to four times higher among those who are aware of the Guideline. The most frequent barriers for those who reported being Guideline aware were lack of resources, specifically time (81.7%) and staff (77.0%). In comparison, those who were unaware of the Guideline most often reported the following barriers: lack of knowledge or training (78.4%), lack of awareness about tools (75.2%), and uncertainty about use of tools (75.0%). CONCLUSION: Among providers caring for older adults, 52% were aware of the ASCO Guideline. Some domains were assessed frequently (eg, function, falls), whereas other domains were assessed rarely (eg, mood, cognition). Guideline awareness was associated with two to four times increased use of GA and differing perceived barriers. Interventions facilitating Guideline-consistent implementation will require various strategies to change behavior.

THE FEASIBILITY OF STANDARDISED GERIATRIC ASSESSMENT TOOLS AND PHYSICAL EXERCISES IN FRAIL OLDER ADULTS

2017 ◽  
pp. 1-4
Author(s):  
A.D. Jadczak ◽  
N. Mahajan ◽  
R. Visvanathan
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Assessment Tools ◽  
Geriatric Population ◽  
Frail Older Adults ◽  
Physical Exercises ◽  
Sf 36 ◽  
Cognitive Screen

Geriatric assessment tools are applicable to the general geriatric population; however, their feasibility in frail older adults is yet to be determined. The study aimed to determine the feasibility of standardised geriatric assessment tools and physical exercises in hospitalised frail older adults. Various assessment tools including the FRAIL Screen, the Charlson Comorbidity Index, the SF-36, the Trail Making Test (TMT), the Rapid Cognitive Screen, the Self Mini Nutritional Assessment (MNA-SF) and the Lawton iADL as well as standard physical exercises were assessed using observational protocols. The FRAIL Screen, MNA-SF, Rapid Cognitive Screen, Lawton iADL and the physical exercises were deemed to be feasible with only minor comprehension, execution and safety issues. The TMT was not considered to be feasible and the SF-36 should be replaced by its shorter form, the SF-12. In order to ensure the validity of these findings a study with a larger sample size should be undertaken.

scholarly journals Geriatric principles for patients with cancer

2021 ◽  
Vol 15 ◽  
Author(s):  
Ana Patricia Navarrete-Reyes ◽  
Karla Animas-Mijangos ◽  
Jimena Gómez-Camacho ◽  
Yoselin Juárez-Carrillo ◽  
Ana Cristina Torres-Pérez ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Cumulative Effect ◽  
Treatment Decision ◽  
Physiological Age ◽  
Older Individuals ◽  
Treatment Decision Making ◽  
Patients With Cancer ◽  
Health Related

Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.

scholarly journals Hallucinations in Older Adults: A Practical Review

2020 ◽  
Vol 46 (6) ◽  
pp. 1382-1395 ◽  
Author(s):  
Johanna C Badcock ◽  
Frank Larøi ◽  
Karina Kamp ◽  
India Kelsall-Foreman ◽  
Romola S Bucks ◽  
...  
Keyword(s):  
Older Adults ◽  
Service Providers ◽  
Aged Care ◽  
Assessment Tools ◽  
Future Research ◽  
Age Group ◽  
Older Individuals ◽  
Physical And Mental Health ◽  
Management Guidelines ◽  
And Training

Abstract Older adults experience hallucinations in a variety of social, physical, and mental health contexts. Not everyone is open about these experiences, as hallucinations are surrounded with stigma. Hence, hallucinatory experiences in older individuals are often under-recognized. They are also commonly misunderstood by service providers, suggesting that there is significant scope for improvement in the training and practice of professionals working with this age group. The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management guidelines. We conclude with a brief summary including suggestions for service and training providers and future research.

Geriatric Assessment in Older Adults with Multiple Myeloma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3601-3601
Author(s):  
Tanya M Wildes ◽  
Sascha Tuchman ◽  
Kathryn M. Trinkaus ◽  
Graham Colditz
Keyword(s):  
Older Adults ◽  
Multiple Myeloma ◽  
Functional Status ◽  
Geriatric Assessment ◽  
Functional Dependence ◽  
Psychological State ◽  
Geriatric Syndromes ◽  
Treatment Toxicity ◽  
Factors Associated

Abstract Introduction: Multiple myeloma (MM) is a disease of older adults, yet standard baseline assessments do not include assessment of physiologic age or frailty. In older adults with cancer, geriatric assessment (GA) predicts treatment toxicity and survival. In MM, frailty is associated with treatment discontinuation, toxicity and survival (Palumbo Blood 2015). Studies of patient preferences have shown that maintenance of independence in daily activities is a high priority in older adults with serious medical conditions (Fried NEJM2002) We sought to examine GA factors associated with 1) autologous stem cell transplant (ASCT) eligibility and 2) increased functional dependence over follow-up. Methods: Patients (pts) with newly diagnosed MM aged 65 and older were enrolled in a prospective cohort study at 2 institutions. Pts underwent a brief, primarily self-administered geriatric assessment (GA) at baseline, 3- and 6-months of follow-up. GA included functional status (instrumental activities of daily living/IADLs), medications, cognition (Short Blessed Test), psychological state (Mental Health Inventory), the Timed Up and Go physical performance test (TUG) and the Charlson comorbidity index (CCI). Analyses were performed using SAS v9.4/Stata 14.1. Descriptive and inferential statistics were used to summarize and compare groups, as appropriate. Results: 40 pts enrolled, with a median age of 69.5 (range 65-84). 77.5% were white, 12.5% black and 10% other/unknown. 62.5% were male. Median MD-rated Karnofsky performance status (KPS) was 80 (range 50-100). Geriatric syndromes were common, with 62.5% of patients reporting dependence in one or more IADLs, 47.5% with one or more comorbidities, 28.5% reported one or more falls in the prior 6 months and 10% screened positive for cognitive impairment. Median number of medications was 9 (range 1-23). 26 pts (65%) were felt to be ASCT candidates by the treating physician, who was blinded to the GA. Factors associated with MD-determined ASCT candidacy were: fewer comorbidities (mean CCI 0.6 vs. 1.9. p=0.0065), higher MD-rated KPS (71% MDKPS ≥80 vs 47%, p=0.021 ) and faster TUG (mean 11.9 seconds vs 15.8, p=0.013). While 26 were considered eligible, only 21 pts (52.5%) ultimately underwent ASCT [attrition due to pt preference (2), progression (1), failed mobilization (1) and unknown (1)]. Increasing age (OR 0.77/year, 95%CI 0.601-0.988) and IADL dependence (OR 0.043, 95% CI 0.004-0.464), but not KPS or comorbidities, were independently associated with decreased odds of actually undergoing ASCT. We also examined factors associated with changes in functional status in the 36 patients who completed 6-month follow-up. 6 pts (16.7%) had a 2 point increase in dependence in IADLs. In a generalized linear model, undergoing ASCT and baseline comorbidities were independently associated with higher IADL scores at 6-months (p=0.036, p=0.033 respectively). All patients with an increase in IADL scores (increased functional dependence) had a change in treatment regimen due to toxicity. Age, International Staging System Stage, gender, deletion 17p and disease progression were not associated with increased functional dependence. Development of peripheral neuropathy was not associated with IADL dependence or falls. Conclusions: GA reveals that geriatric syndromes are common in older adults with multiple myeloma. GA may provide a framework to objectively define transplant eligibility. Increased functional dependence is associated with baseline comorbidities and undergoing ASCT. Further study is needed to examine the utility of GA in predicting treatment toxicity and survival. Disclosures Wildes: Carevive Systems: Consultancy.

Filling a missing link: the influence of portrayals of older characters in television commercials on the memory performance of older adults

2010 ◽  
Vol 30 (5) ◽  
pp. 897-912 ◽  
Author(s):  
GERBEN J. WESTERHOF ◽  
KAROLIEN HARINK ◽  
MARTINE VAN SELM ◽  
MADELIJN STRICK ◽  
RICK VAN BAAREN
Keyword(s):  
Older Adults ◽  
Older People ◽  
Memory Performance ◽  
Age Group ◽  
Older Individuals ◽  
Television Commercials ◽  
Media Portrayals ◽  
Impaired Memory ◽  
Negative Effect ◽  
Over Time

ABSTRACTThe portrayal of older characters in television commercials has over time become more varied and positive. This study examines how different portrayals of older characters relate to self-stereotyping, a process through which older individuals apply their beliefs about older people in general to themselves and behave accordingly. The study thereby seeks to connect, as few have previously done, cultural studies and critiques of media portrayals with psychological studies of the effects of self-stereotyping. Sixty participants aged 65–75 years were primed with television commercials that portrayed older characters in different ways: ‘warm and incompetent’, ‘warm and competent’, and ‘cold and competent’. It was hypothesised that priming with warm/incompetent portrayals would have a negative effect on memory performance because such representations match the dominant stereotype, and that the effect would occur only among older people who identify with their own age group. It was found that the participants who identified with their own age group did indeed show impaired memory performance after priming with warm/incompetent portrayals, but also that the same effect was found after priming with warm/competent portrayals. The findings are discussed in terms of resistance against stereotyping by older individuals themselves as well as by media producers.

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