The purpose of the present study was to attempt to use the principles of behavior therapy and group psychotherapy to enhance social adjustment of the geriatric patients in an institutional environment. There are several factors positively related to satisfactory adjustment to old age such as educational level, marital status, employment history, religion, health, and membership in groups.

Class of 2012 Abstract / Specific Aims: To review overall quality of life (QOL) in active geriatric patients and to observe different attitudes toward aging in the student comparison groups. Subjects: Current students, regardless of academic year, attending the University of Arizona College of Pharmacy with a university email account. Methods: Data was collected using an electronic questionnaire. A link to the questionnaire was sent out via email to all University of Arizona, College of Pharmacy students. Another email containing the link to the questionnaire was sent two weeks after the initial notification. The questionnaire consisted of 36 questions requesting students to express their perspective on the health status, mental status and physical abilities of the elderly. Main Results: Geriatric patients tended to have a more positive view on their overall health when compared to students' perceptions of geriatric QOL (86.7% versus 35.7%, P <0.05). Students were also more likely to have the perception that geriatric patients had limitations in regular activities due to physical health and emotional problems when compared to the actual responses of older adults (72.6% versus 40.0%, P <0.05; and 60.0% versus 16.7%, P <0.05; respectively). There was a significant difference (P<0.05) between responses from students and geriatric patients to every question. Conclusions: There appears to be a noteworthy difference between pharmacy student perceptions of geriatric QOL and actual older adult QOL responses that may warrant an educational intervention.

It was the goal of this study to examine the ecological validity of a number of measures of mental status for geriatric individuals. Subjects were 40 alert, ambulatory male VA patients. Mental status instruments included the Mini-Mental State Examination (MMSE), the Wechsler Memory Scale (WMS) and the Vocabulary subtest of the WAIS-R. Measures of functional behavior included the Woodcock-Johnson Scales of Independent Behavior (SIB) and the Parachek Geriatric Behavior Rating Scale (PGBRS). Significant relationships were found between the MMSE and the SIB, between the WMS and the SIB, and between the WMS and the PGBRS. It was found that estimation of functional behavior can be enhanced significantly through the use of battery of mental status instruments.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / IntroduÃÃo â DepressÃo à um dos transtornos psiquiÃtricos mais comuns em pessoas idosas, estando associada à maior morbimortalidade e aumento de custos. Apesar disto, 30 a 50% dos casos permanece nÃo identificada e sem tratamento, o que tem motivado o desenvolvimento de instrumentos de rastreamento a serem utilizados na prÃtica clÃnica. Um dos mais amplamente utilizados à a Escala de DepressÃo GeriÃtrica (Geriatric Depression Scale â GDS) que tem sido amplamente validada em amostras de serviÃos especializados e terciÃrios. Poucos estudos em outros paÃses, e nenhum no Brasil, no entanto, avaliaram o desempenho da GDS em nÃvel primÃrio de saÃde, o que torna incerta a generalizaÃÃo dos resultados para esse contexto, onde a maioria das pessoas idosas com depressÃo à efetivamente atendida. Objetivos â determinar a validade da GDS, nas versÃes 30, 15, 4 e 1 itens, em nÃvel primÃrio de saÃde, atravÃs de estimativa da sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e razÃo de verossimilhanÃa. Identificar os melhores pontos de corte dos escores da GDS, em suas diferentes versÃes, para rastreamento de depressÃo em nÃvel primÃrio de saÃde. MÃtodo â Estudo transversal, com 220 pacientes idosos consecutivamente atendidos em quatro unidades primÃrias de saÃde. Foram aplicados um questionÃrio que forneceu uma visÃo global do perfil da populaÃÃo estudada; a Escala de DepressÃo GeriÃtrica (GDS) e a Entrevista ClÃnica Estruturada para Transtornos do Eixo I do DSM-IV (SCID-I), assumido como padrÃo-ouro. Os dois primeiros instrumentos foram aplicados por um entrevistador treinado e a SCID por mÃdico psiquiatra. Resultados â A prevalÃncia de EpisÃdio Depressivo Maior e/ou transtorno distÃmico foi de 17,27%. O melhor ponto de corte da GDS 30 foi 10/11 (caso/nÃo caso) que revelou sensibilidade = 92,1% (IC 95% = 77,5 - 97,9%), especificidade = 79,7% (IC 95% = 72,9 â 85,1%), acurÃcia = 81,8% e razÃo de verossimilhanÃa = 4,5. O melhor ponto de corte da GDS 15 foi 4/5 com sensibilidade = 86,8% (IC 95% = 71,1 â 95,1%), especificidade = 82,4% (IC 95% = 75,9 â87,5%), acurÃcia = 83,1% e razÃo de verossimilhanÃa = 4,9. O da GDS-4 foi 0/1 com sensibilidade = 84,2%(IC 95% = 68,1-93,4%), especificidade = 74,7% (IC 95% = 67,7 â80,7%), acurÃcia = 76,30% e RazÃo de verossimihanÃa = 3,9. A GDS-1 teve uma sensibilidade de 52,6% (IC 95%=36,0 - 68,7%). ConclusÃes: A GDS-30 à um Ãtimo instrumento de rastreamento para episÃdio depressivo maior e/ou transtorno distÃmico, em unidades de atenÃÃo primÃria, dado sua alta sensibilidade e alto valor preditivo negativo. As versÃes reduzidas com 15 e 4 itens demonstraram ser bons testes de rastreamento, com a vantagem de requererem menos tempo para aplicaÃÃo. O uso sistemÃtico da GDS, em unidades de atenÃÃo primÃria de saÃde, à recomendado para que haja uma maior identificaÃÃo desses casos, permitindo tratamento adequado / Introduction â Depression is one of the major potentially treatable psychiatric disorders affecting geriatric patients. At primary care facilities up to 30-50% of depressed patients are misdiagnosed and therefore not treated adequately. Recognition of depression is best improved by routine screening using efficient and easily applicable instruments. One of the most widely used instruments, the Geriatric Depression Scale (GDS), has been sufficiently validated in samples from specialized or out-sourced services. However, few studies, none of them from Brazil, have evaluated the performance of the GDS at the level of primary care in which most geriatric patients with depression are treated, making it hard to generalize existing results to this context. Objectives â 1) to determine the sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio in relation to the GDS comparing findings to structured clinical interviews for disorders of Axis I of the DSM-IV (SCID-I); 2) to build a Receiver Operator Characteristic Curve (ROC) determining the ideal cut-off point for primary care patients; 3) to determine the prevalence of episodes of major depression in geriatric primary care patients; 4) to identify the socio-demographic profile of geriatric primary care patients; 5) to examine geriatric patients presenting with episodes of depression and/or dysthymic disorders while taking anti-depressants. Method â cross-sectional study involving 220 geriatric patients from four health facilities. A questionnaire providing a global profile of the study population was applied, as well as the GDS and structured clinical interviews for disorders in Axis I of the DSM-IV (SCID-I). The first two instruments were applied by a trained interviewer and the SCID (gold standard) was applied by a trained psychiatrist. Results â The prevalence of episodes of major depression and/or dysthymic disorders was 17.27%. The best cut-off point with GDS-30 was 10/11 (case/non-case) with a sensitivity of 92.1% (CI 77.5â97.9), specificity 79.7% (CI = 72.9â85.1), accuracy 81.8% and likelihood ratio 4.5. The best cut-off point with GDS-15 was 4/5 with a sensitivity of 86.8% (CI = 71.1â95.1), specificity 82.4% (CI = 75.9â87.5), accuracy 83.1% and likelihood ratio 4.9. The best cut-off point with GDS-4 was 0/1 with a sensitivity of 84.2% (CI = 68.1â93.4), specificity 74.7% (CI = 67.7â80.7), accuracy 76.30% and likelihood ratio 3.9. With GDS-1 the sensitivity was 52.6% (CI = 36.0â68.7%). Conclusions â GDS-30 is an excellent screening instrument for episodes of major depression and/or dysthymic disorders at primary care facilities due to its high sensitivity and high negative predictive value. Reduced versions with 15 and 4 items proved good screening tests requiring less time to be applied. The systematic use of GDS at primary care facilities is recommended in order to identify a greater number of cases of depression and thereby offer a more adequate treatment.

Introduction: Population is demographically aging and proportion of older adults in the society increases. Also the number of sick persons raises, and the high consumption of drugs and polypharmacotherapy in old age are global problems. The definition of polypharmacotherapy is not uniform. Most commonly it is defined as the use of 5 or more drugs simultaneously. In the scientific literature we also see the term "excessive polypharmacotherapy". This is defined as the use of 10 or more drugs simultaneously. Polymorbidity, irrational indications, wrong diagnostics of drug-related problems, but also changes in pharmacokinetics and pharmacodynamics common in the old age contribute to polypharmacotherapy. It is important that pharmacotherapy in the old age must be simple, effective and safe. Methods: Using the electronic database PubMed, all studies on the subject "Polypharmacotherapy in Old Age" published in 2005-2015 were reviewed. The data were summarized in tables. Studies that included causal factors (predictors) of polypharmacotherapy were also evaluated. The most frequently prescribed drugs in geriatric patients with polypharmacotherapy were recorded in a separate table. Results: In this diploma thesis, the prevalence of polypharmacotherapy was compared from 81 studies. We found that the...

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Digitalis in one of the most frequently prescribed drugs, especially to elderly people. The prescription of cardiac glucosides (1978) was studied by using statistics from Apoteksbolaget (the National Corpora­tion of Swedish Pharmacies). There was a threefold difference in the sales of cardiac glucosides per 1000 inhabitants in the different primary care areas. Digoxin was prescribed to 90-98 per cent of the patients, with considerable variations in the dosages. Many other factors besides the cardio-vascular morbidity were likely to cause these differences. Maintenance digitalis therapy has lately been questioned. In a retro­spective study, digitalis was discontinued in 141 geriatric patients without contraindications to digitalis withdrawal. Digoxin treatment seemed to be unnecessary in 108 patients (81 per cent), followed up two months after digoxin withdrawal. A long-term study (mean: 20,5 months) was carried out in these 108 patients. Digitalis therapy was reinstituted in 30 of 99 patients, equally distributed on the basis of clear, possible or uncertain indications. Significantly more patients (p&lt; 0,001) with atrial fibrillation compared with sinus rhythm were restarted. A prospective, randomized, double-blind placebo- controlled study in 39 out of 66 geriatric patients confirmed the results of the retrospective study. During a two-month period 32 of 37 patients (86 per cent) managed without digitalis. Eighteen out of 66 patients (27 per cent) presented contraindications to digoxin with­drawal. Those who needed digitalis were restarted mainly during the first nonth (mean: 18 days) following digoxin withdrawal. Digitalis intoxication has been studied earlier, mainly in hospitalized patients. A clinical examination and ECG of a random sample of out­patients treated with digoxin shewed that about 5 per cent were certainly intoxicated and about 2 per cent suspected of being intoxi­cated. Elderly patients are said to be more sensitive to digitalis. Eleven per cent of 66 geriatric patients were found, without doubt, to be digitalis intoxicated. The mean serum digoxin concentration was significantly higher in eight toxic patients compared with non-toxic patients, but 75 per cent of the toxic patients had serum digoxin con­centrations within or below therapeutic range. Five of these intoxi­cated patients did not need maintenance digitalis therapy. A questionnaire of 361 patients in Skellefteå and Uppsala revealed that about 45 per cent had taken digitalis for more than five years. Approximately 85 per cent took one tablet daily and stated compliance. About one fifth did not know why they were taking digoxin and about half of the patients were uncertain if they were improved, by digitalis therapy. Although digitalis intoxication is such an important clinical problem, some 55 per cent did not know about digitalis's side-effects and some 50 per cent stated that no or insufficient information had been given. Only 15 per cent were satisfied with the information they had received. A significant negative correlation between digoxin dosages and the age of the patients was found. / <p>Diss. Umeå : Umeå universitet, 1983, härtill 7 uppsatser</p> / digitalisering@umu

Titel: Sjuksköterskans erfarenhet av akut konfusion hos äldre i akutsjukvård – En kvalitativ intervjustudie. Bakgrund: Äldre som vårdas i akutsjukvård har en incidens mellan 11–51% att utveckla akut konfusion under vårdtiden. Tillståndet är förenat med en ökad sjuklighet och dödlighet hos äldre. Multifaktoriella orsaker ligger bakom att äldre drabbas. Akut konfusion är en klinisk diagnos, idag finns inga biomarkörer eller undersökningar som kan identifiera tillståndet. Akut konfusion kräver en tidig upptäckt, snabb utredning och ett medicinskt omhändertagande, god omvårdnad och en anpassad vårdmiljö för att patienten skall återhämta sig. Syfte: Att beskriva sjuksköterskans erfarenhet av att upptäcka, förebygga och vårda patienter med akut konfusion i akutsjukvård. Design: En kvalitativ intervjustudie med fem sjuksköterskor verksamma i geriatrisk akutsjukvård på två sjukhus i södra Sverige. Resultat: I resultatet framkom tre kategorier; strategier för att identifiera och bedöma tecken på akut konfusion, strategier och hinder för förebyggande insatser och god omvårdnad vid akut konfusion, förslag på förbättringar i vården av äldre med akut konfusion. Sjuksköterskan använde sig av observation, kommunikation och inhämtning av information från journal och anhöriga för att identifiera akut konfusion. En helhetssyn i omvårdnaden, kontinuitet i vårdkontakten, anpassning av vårdmiljön och anhörigas delaktighet var viktiga faktorer för att förebygga akut konfusion och ge god omvårdnad. Hindrande faktorer orsakades av brister i vårdmiljön, för lite resurser och tid samt bristande kunskap hos övrig vårdpersonal kring lämplig bemötande och förhållningssätt. Slutsats: Ett evidensbaserat screeninginstrument som identifierar olika konfusionstillstånd skulle underlätta bedömning och dokumentation för sjuksköterskor. En personcentrerad vård som bygger på att omvårdnaden planeras utifrån en helhetssyn och en kontinuitet i vårdkontakten samt att anhöriga görs mera delaktiga i vården förespråkas av sjuksköterskorna. Vårdmiljön skall anpassas, vara lugn och stödjande till sin utformning. Personal som arbetar med konfusoriska patienter behöver ha mer kunskap om lämpligt bemötandet och förhållningssätt för att underlätta patientens återhämtning. / Title: Nurses experience of acute confusion in elderly patients in acute emergency care- A qualitative interview study. Background: The elderly cared for in emergency care have an incidence between 11–51% to develop acute confusion during the care period. The condition is related to increased morbidity and mortality among the elderly. Multifactorial causes lie behind the elderly being affected. Acute confusion is a clinical diagnosis, at present there are not biomarkers or examinations that can identify the condition. Acute confusion requires early awareness, swift investigation, medical care and well adapted health care environment in order for the patient to recover. Purpose: To describe nurses experiences in detecting, preventing and caring for patients suffering from acute confusion in emergency care. Design: A qualitative interview with five nurses working within geriatric emergency care at two hospitals in the south of Sweden. Result: Three categories emerged in the result; strategies to identify and assess signs of acute confusion, strategies and hinders for preventative measures and good nursing upon acute confusion, and improvement proposals for the care of elderly suffering from acute confusion. Nurses used observation, communication, and gathering of information from medical records and relatives in order to identify acute confusion. A comprehensive view in care, continuity in contacts, adaption of health care environment and relatives engagement were important factors to prevent acute confusion and provide good nursing. Hindering factors were a result of shortcomings in the health care environment, insufficient resources and time, and lack of knowledge among other requisite staff regarding appropriate reception and approach. Conclusion: An evidence-based screening instrument which identifies various states of confusion would render assessment and documentation easier for nurses. Personal centered care built upon that such is planned based on a comprehensive view and continuity in contacts, and that relatives are more engaged in care, is advocated by the nurses. Health care environment shall be adapted, be calm and supportive in form. Staff that work with confused patients need more sufficient knowledge regarding appropriate reception and approach to render patient recovery easier.

This thesis deals with the security system care services and other related services, including informal care for seniors in the Czech Republic. The aim of the work is to evaluate, describe and offer a closer understanding of nursing as a basic social care service in connection with the principle of shared care in a natural home environment for seniors as the ideal form of care for the elderly at present and due to the demographic development in the future. The thesis is divided into a theoretical and a practical part. The theoretical part covers three main topics: day care service system in the Czech Republic, seniors as a target group of caring and sharing and municipalities and their role in caring for the elderly. The practical part is devoted to the research, which focuses on the relationship of care services and communities from the perspective of potential service users, ie. the elderly. A combination of qualitative and quantitative research methods is used in the research and interprets the results of the survey conducted among the elderly in three senior clubs in Prague 17. The research complements the findings mentioned in the theoretical part.