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Concept: Geriatrics

248

Under economic pressure, medicine is increasingly being subjected to the efficiency principles of “Taylorism.” But applying standardization to certain vital aspects of medicine can result in inappropriate and unresponsive care, as well as clinician burnout.

Concepts: Health care, Medicine, Neurology, Geriatrics, Health care system

197

Falls in elderly people are a major health burden, especially in the long-term care environment. Yet little objective evidence is available for how and why falls occur in this population. We aimed to provide such evidence by analysing real-life falls in long-term care captured on video.

Concepts: Geriatrics

182

Safety of evacuation is of paramount importance in disaster planning for elderly people; however, little effort has been made to investigate evacuation-related mortality risks. After the Fukushima Daiichi Nuclear Plant accident we conducted a retrospective cohort survival survey of elderly evacuees.

Concepts: Cohort study, Chernobyl disaster, Actuarial science, Nuclear fission, Geriatrics, Hazard, Emergency evacuation, Three Mile Island accident

169

OBJECTIVE: To evaluate effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older people. DESIGN: Multi-center randomized controlled clinical trial SETTING: Three medical centers and adjacent community health centers in Taiwan. PARTICIPANTS: Community-dwelling elderly who had fallen in the previous year or with risk of fall INTERVENTIONS: After baseline assessment, eligible subjects were randomly allocated into the intervention group (IG) or control group (CG) stratified by Physiological Profile Assessment (PPA) fall-risk level. IG received a 3-month multifactorial intervention program including 8-week exercise training, health education, home hazards evaluation/ modification, along with medication review and ophthalmology/other specialty consult. CG got health education brochures, referrals and recommendations without direct exercise intervention. MAIN OUTCOME MEASURES: Primary outcome was fall incidence within 1-year. Secondary outcomes were PPA battery (overall fall-risk index, vision, muscular strength, reaction time, balance and proprioception), timed up-and-go (TUG), Taiwanese-International Physical Activity Questionnaire, EuroQoL-5D, Geriatric Depression Scale (GDS), and Fall Efficacy Scale at 3 month after randomization. RESULTS: There were 616 participants with 76±7 years, including low risk 25.6%, moderate risk 25.6% and marked risk 48.7%. The cumulative 1-year fall incidence was 25.2% in IG and 27.6% in CG (HR=0.90, 95% CI 0.66-1.23). IG improved more favorably than CG on overall PPA fall-risk index, reaction time, postural sway with eyes open, TUG, and GDS, especially for those with marked fall-risk. CONCLUSIONS: The multifaceted fall prevention program with exercise intervention improved functional performance at 3-months for community-dwelling elders with risk of fall, but did not reduce falls over 1-year follow-up. Fall incidence might have been decreased simultaneously in both groups by heightened awareness engendered during assessments, education, referrals, and recommendations.

Concepts: Epidemiology, Clinical trial, Randomized controlled trial, Physical exercise, Old age, Strength training, Randomness, Geriatrics

167

Many older people living in care homes (long term residential care or nursing homes) are depressed. Exercise is a promising non-drug intervention for preventing and treating depression in this population.

Concepts: Randomized controlled trial, Nursing, Geriatrics, Care of residents, Nursing home, Nursing specialties, Housing

152

The pronounced prevalence of delirium in geriatric patients admitted to the intensive care unit (ICU) and its increased morbidity and mortality is a well-established phenomenon. The purpose of this review is to explore the potential use of dexmedetomidine in preventing or managing ICU delirium in older patients. Articles used were identified and selected through multiple search engines, including Google Scholar, PubMed, and MEDLINE. Keywords such as dexmedetomidine, delirium, geriatric, ICU delirium, delirium in elderly, and palliative were used to obtain the specific articles used for this paper and restricted to articles published in 1990 or later. Articles specifically looking at the use of dexmedetomidine as compared to a study drug and its potential for use in ICU patients, as opposed to overall reviews of dexmedetomidine, were compared. When compared to benzodiazepines for the prevention or treatment of ICU delirium in the elderly, dexmedetomidine was associated with a reduction in delirium, as well as decreased morbidity and mortality. Dexmedetomidine has also been shown to be effective in limiting risk factors associated with ICU delirium such as length and depth of sedation. As opposed to benzodiazepines or opiates, dexmedetomidine provides effective analgesia, sympatholysis, and anxiolysis without causing respiratory depression and allows a patient to more effectively interact with practitioners. The review of these nine articles indicates that these favorable attributes and overall decreased duration and incidence of delirium make dexmedetomidine a viable option in preventing or reducing ICU delirium in high-risk geriatric patients and as a palliative adjunct to help control symptoms and stressors.

Concepts: Geriatrics

151

Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population.

Concepts: Medicine, Demography, Parkinson's disease, Dementia, Geriatrics, Anticholinergic, Haloperidol, James Parkinson

146

Introduction: Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults. MEDLINE and EMBASE databases were searched from January 1, 1986 to June 30, 2013) to identify relevant articles in people aged > 65 years. Areas covered: We present information about: i) prevalence of polypharmacy and unnecessary medication use; ii) negative consequences of polypharmacy; and iii) interventions to improve polypharmacy. Expert opinion: International research shows that polypharmacy is common in older adults with the highest number of drugs taken by those residing in nursing homes. Nearly 50% of older adults take one or more medications that are not medically necessary. Research has clearly established a strong relationship between polypharmacy and negative clinical consequences. Moreover, well-designed interprofessional (often including clinical pharmacist) intervention studies that focus on enrolling high-risk older patients with polypharmacy have shown that they can be effective in reducing aspects of unnecessary prescribing with mixed results on distal health outcomes.

Concepts: Pharmacology, Medicine, Death, Gerontology, Old age, Pharmaceutical drug, Geriatrics, Pharmacy

138

Prior literature on illness management within intimate relationships demonstrates a variety of benefits from supportive partnership. Indeed, much of the earliest research in this field engaged older adults with and without chronic conditions. However, this pioneering literature gave little consideration to relationships in which multiple partners were coping with chronic illness. By contrast, the majority of published manuscripts presented a “sick partner/well partner” model in which caregiving flowed only in one direction. Yet this idea makes little sense in the context of contemporaneous data on population aging and health as a majority of older adults now live with at least one chronic condition. Scholars still have not delved explicitly into the experiences of the vast population of older relationship partners who are managing chronic conditions simultaneously. We thus welcome Gerontology and Geriatric Medicine readers to this special content collection on Aging Partners Managing Chronic Illness Together.

Concepts: Medicine, Gerontology, Old age, Interpersonal relationship, Ageing, Aging, Geriatrics, Elderly care

74

Approximately 5.6 million to 8 million Americans 65 years of age or older have mental health or substance-use disorders, and the Institute of Medicine (IOM) estimates that their numbers will reach 10.1 million to 14.4 million by 2030.(1) Yet the American Geriatrics Society estimates that there are fewer than 1800 geriatric psychiatrists in the United States today and that by 2030 there will be only about 1650 - less than 1 per 6000 older adults with mental health and substance-use disorders. The IOM’s 2012 workforce report on this topic, aptly subtitled In Whose Hands?, confirms that we will never . . .

Concepts: Health care, Medicine, United States, Gerontology, Geriatrics, Psychiatry, Barack Obama, Massachusetts