Care for the spiritual dimension provided by caregivers in a nursing home

ABSTRACT Objectives: to understand care for the spiritual dimension provided by caregivers in a Nursing Home. Methods: this is a qualitative research, carried out in a geriatric center of a philanthropic hospital in the city of Salvador, Bahia. Eighteen formal caregivers participated, through a semi-structured interview, between January and February 2019. The data were analyzed in the light of Jean Watson’s Theory of Transpersonal Caring. Results: formal caregivers discuss the spiritual dimension based on older adults’ religious beliefs, encourage religious practices and exercise spiritual care according to older adults’ physical, emotional and spiritual demands. Final Considerations: formal caregivers understand that older adults’ religious or spiritual experiences should be included in their work routine. Care for the spiritual dimension occurs by stimulating faith in God, encouraging religious practices and embracing their beliefs in the face of physical, emotional and spiritual demands.

Health-Related Quality of Life With Trastuzumab Monotherapy Versus Trastuzumab Plus Standard Chemotherapy as Adjuvant Therapy in Older Patients With HER2-Positive Breast Cancer

PURPOSE We report findings on quality of life (QoL) in the RESPECT trial, which compared adjuvant trastuzumab monotherapy with trastuzumab plus chemotherapy in older patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). PATIENTS AND METHODS Patients age 70-80 years with human epidermal growth factor receptor 2-positive surgically treated breast cancer were randomly assigned to receive trastuzumab (T) or trastuzumab plus chemotherapy (T + C). QoL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G), Philadelphia Geriatric Center Morale Scale, Hospital Anxiety and Depression Scale, Patient Neurotoxicity Questionnaire, and Tokyo Metropolitan Institute of Gerontology Index of Competence at baseline and after 2, 12, and 36 months. Comparisons were based on individual changes from baseline and were performed by Fisher’s test or mixed-model repeated-measures. RESULTS Among 275 patients in the parent study, 231 (84%) (average age: 74 years) were included in the analysis. At 2, 12, and 36 months, 198, 177, and 178 patients completed surveys, and the mean FACT-G scores at each survey point were 78.9, 80.4, 82.7, and 79.1 in group T and 79.5, 74.5, 78.4, and 78.5 in group T + C. Compared with group T + C, the proportion of patients showing QoL deterioration (≥ 5 points decrease from baseline in FACT-G) was significantly lower at 2 months (31% v 48%; P = .016) and 12 months (19% v 38%; P = .009). In group T, the Hospital Anxiety and Depression Scale score ( P = .003) and the proportion of severe sensory peripheral neuropathy ( P = .001) were significantly lower at 2 months, and Philadelphia Geriatric Center Morale Scale and Tokyo Metropolitan Institute of Gerontology Index of Competence scores were significantly higher ( P = .024, .042) at 12 months. At 36 months, there were no significant differences in any QoL items. CONCLUSION Detrimental effects of adjuvant chemotherapy on global QoL, morale, and activity capacity lasted for at least 12 months but were not observed at 36 months.

Brody, Elaine Marjorie Breslow

Elaine Marjorie Breslow Brody (1922–2014) was a prolific researcher during a career that spanned six decades at the Philadelphia Geriatric Center, now the Polisher Research Institute. She was a trailblazer and visionary who combined practice and research as a social work practitioner. She served as a mentor and role model for many who were taking professional risks when gerontology was a new area of specialization. She leaves an outstanding legacy of scholarship, research, leadership, and service. She brought honor to the profession.

Morale in Old Age and Its Association with Sociodemographic, Social, and Health-Related Factors in Different Age Groups

Morale can be viewed as a future-oriented optimism or pessimism regarding challenges associated with aging and is closely related to subjective well-being. Promoting morale in old age could be considered to have important implications for aging well, and increased knowledge about morale in different stages of old age is needed. Hence, the aim of this study was to investigate factors associated with morale in different age groups among old people. Data were derived from a survey conducted in 2016, as a part of the Gerontological Regional Database (GERDA). The sample consisted of 9,047 individuals aged between 65 and 86 years from Ostrobothnia and Southern Ostrobothnia in Finland, and Västerbotten in Sweden. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS) and regressed upon a number of sociodemographic, social, and health-related factors using linear regression analyses. The results showed that older age was an independent factor explaining lower level of morale. Additionally, the sociodemographic, social, and health-related variables could explain a large proportion of the variance in morale. Perceived loneliness, having gone through a crisis in life, poor self-rated health, and depression were associated with lower morale, and sleeping well with higher morale, in all age groups. Furthermore, the oldest age groups seem to be more exposed to several risk factors of lower morale identified in this study. Multidimensional interventions targeting especially social and mental health and the oldest-old could therefore be recommended.

Factors determining the choice of a career in geriatrics among students in geriatric in-hospital training: a single-center prospective study of 74 students

Background: To understand the reasons for the lack of attractiveness of the Diploma of Specialized Studies (DSS) in Geriatrics (DSSG), we conducted a study to identify the factors influencing medical students’ choice of their future specialty. In addition, we assessed the impact of in-hospital training (IHT) in the departments of our geriatric center on the students’ choice of their future specialty.Methods: We included all students who passed an IHT course in the geriatric center of our university hospital between 1 May 2018 and 31 October 2018. The data were collected using a questionnaire in two parts: one given before the IHT and the other after. The students were classified into two groups: those considering a career in geriatrics before IHT (GDSSG+) and those not considering it (GDSSG−). Results: Seventy-four students, aged a mean 22 years, were included. Of these students, 26%, were considering the possibility of a career in geriatrics before the IHT course (GDSSG+). This rate significantly increased to 42% after IHT (p=0.04). However, none of the students in GDSSG+ preselected geriatrics as their first option; general medicine was the most frequent option.For more than 92% of the students, the comprehensive care of geriatric patients was an asset. The main drawbacks were diagnostic and therapeutic limitations for 60% of the students, and managing aging, disability, and major neurocognitive disorders (MNCD) for 55%. After IHT, the view of geriatrics improved by 74%.Conclusion: Geriatric IHT improves students' opinions of geriatrics and significantly increases the number of students considering a potential career in geriatrics. However, geriatrics still suffers from a lack of prestige.

A coaching program to improve quality of life in older people in Japan: a randomised controlled trial

As the world's population ages, efforts to improve quality of life (QOL) in old age are gaining public attention. In this study, a programme was conducted for older people with the aim of clarifying their life goals related to QOL and the meaning of their existence, and the effect of the programme in improving QOL was evaluated. Participants were randomly assigned to the intervention or control group after registration. The program consisted of four 90-minute classes. The primary outcome was the Philadelphia Geriatric Center Morale Scale score (PGC), and changes in outcomes were compared between groups. The intervention group had significantly improved PGC scores (P<0.003). Further, the scores of PGC subscales ‘Acceptance of one's own ageing’ and ‘Lonely dissatisfaction’ showed significant improvements after the intervention (P<0.001). The findings suggest the effectiveness of the developed program in improving QOL in people aged ≥65 years.

Evaluation of Direct Oral Anticoagulant Dosing and Monitoring in Two Geriatric Outpatient Clinics

OBJECTIVE: This study was conducted to evaluate direct oral anticoagulants (DOACs) prescribed to elderly patients in an outpatient setting, specifically evaluating if Food and Drug Administration (FDA) -approved dosing recommendations are followed.<br/> DESIGN: This study was a retrospective quality improvement project.<br/> SETTING: This study was conducted at geriatric hospital-based primary care clinics at the University of Pittsburgh Medical Center (UPMC), UPMC Senior Care Institute and UPMC Benedum Geriatric Center.<br/> PATIENTS: Subjects included were 65 years of age or older; had an office visit at UPMC Senior Care Institute or UPMC Benedum Geriatric Center from September 1, 2015, to August 31, 2017; and had a DOAC on their home medications.<br/> INTERVENTIONS: Data were obtained through retrospective chart review.<br/> MAIN OUTCOME MEASURE: The primary objective of the study was to evaluate the appropriateness of dosing of DOACs based on FDA-labeled recommendations.<br/> RESULTS: Of 232 patients included in analysis, 42.7% were found to have dosing inconsistent with FDAlabeled recommendations (47.3% apixaban, 35.8% rivaroxaban, and 31.6% dabigatran). No patients were prescribed edoxaban. The majority (72.7%) were dosed lower than FDA-recommended doses. Of all patients, the most frequent parameter (54.5%) for inappropriate dosing was patients meeting only 1 of 3 dose-reduction criteria when prescribed reduced-dose apixaban. Geriatrician and nongeriatrician prescribers had similar rates of prescribing DOACs with doses inconsistent with FDA-labeled recommendations (44.0% vs. 40.8%; P = 0.62).<br/> CONCLUSION: Results suggest that DOACs used in outpatient geriatric patients are frequently dosed inconsistent with FDA-approved dosing recommendations. Further research is needed regarding clinical outcomes in older patients receiving DOACs and in those with dose adjustments inconsistent with FDA-labeled recommendations.<br/>