Screening is the first step in identifying and treating alcohol-related problems among the senior population. This study was designed with two purposes. The first was to cross-validate the Senior Alcohol Misuse Indicator (SAMI) with two commonly used screening tools - the CAGE and the Shortened Michigan Alcoholism Screening Test – Geriatric version (SMAST-G). The second purpose was to examine the feasibility of using these tools within a front-line health care worker’s clinical protocol. The effectiveness of each screening tool was assessed by calculating the sensitivity, specificity, and the area under the receiver operating characteristic (AUROC) for each screening tool with a sample of seniors recruited from clinical and community sources (N=87). Participants were classified into different types of drinker with a structured clinical interview (i.e., the Structured Clinical Interview for the DSM-IV and a medical history, including medication list). Seven problem drinkers, 36 at-risk drinkers, 25 non-problem drinkers, and 19 non-drinkers were identified. Among the three screening tools, the SAMI had the highest sensitivity (83.72%) in identifying at-risk drinkers and problems drinkers and best overall performance with the greatest AUROC (0.710), whereas the SMAST-G had the highest specificity (95.45%) in ruling out an alcohol-related problem among participants classified as non-problem drinkers and non-drinkers. Six outreach mental health care workers tested each screening tool at least three times with their senior clientele and rated each tool on a number of characteristics. An ANOVA and post-hoc analyses using the Least Significant Difference (LSD) compared these ratings among the three screening tools. The SMAST-G and CAGE were cited as the easiest to score (p=0.002), while the SMAST-G was cited as the screening tool providing the most clinical information (p=0.047) and the most comprehensive (p=0.019) of the three tools. These results point to the overall effectiveness of the SAMI and the user-friendliness of the SMAST-G as appropriate screening tools for identifying alcohol-related problems among the senior population. Future studies may further examine these two screening tools among as-yet-untested clinical populations (i.e., geriatric mental health outreach patients, cognitively impaired, collateral informants) and how to improve screening tool usage among health care providers. / Thesis (Ph.D, Psychology) -- Queen's University, 2013-08-23 15:11:13.165

No description available.

Class of 2012 Abstract / Specific Aims: The purpose of this study was to assess the attitudes, beliefs and knowledge of pharmacy students regarding geriatric care. Methods: A questionnaire was administered to first, second and third year pharmacy students to assess the impact of geriatric curriculum on students at the University of Arizona College of Pharmacy. The primary grouping variable was whether or not students had previously taken a course focused on geriatrics. Main Results: A total of 193 pharmacy students completed the questionnaire which resulted in a response rate of 64.33%. There is no comparison group for the first year class as all students in this class had never taken a geriatric-focused course. Therefore, no tests for statistical significance could be performed for this class. Students in the second year class who have taken a geriatrics-focused course scored higher than those without course experience on all four of the attitude and beliefs questions (p = 0.104, p = 0.042, p = 0.045, p = 0.025). The same held true for the third year class (p = 0.006, p <0.001, p = 0.050, p = 0.653). Both classes showed a statistically significant increase in knowledge of geriatric care in those students who have previously taken a geriatrics-focused course (p = 0.032 for second years, p = 0.022 for third years). Conclusions: This study showed that pharmacy students at the University of Arizona College of Pharmacy who have previously taken a geriatrics- focused course have more positive attitudes and beliefs regarding geriatric care as well as a stronger knowledge base regarding geriatrics. With an aging population, it is important that pharmacists be knowledgeable and capable of caring for geriatric patients. Thus, we recommend that all pharmacy schools include a geriatrics-focused course as part of the standard curriculum for Pharm D. candidates.

Thesis (M.S.)--Boston University

BACKGROUND: The incidence of liver metastases from colorectal cancer (CLM) is on the rise. Older cancer patients are frequently subject to under-treatment. METHODS: A Markov decision model was built to examine the effect on life expectancy (LE) and quality-adjusted life expectancy (QALE) of four strategies – best supportive care (BSC), systemic chemotherapy (SC), radiofrequency ablation (RFA), and hepatic resection (HR). The model was designed to account for both age and comorbidities. RESULTS: In the base case analysis, BSC, SC, RFA, and HR yielded LEs of 11.9, 23.1, 34.8, and 37.0 months, respectively, and QALEs of 7.8, 13.2, 22.0, and 25.0 months, respectively. Model results were sensitive to several variables including age, comorbidity status, and length of model simulation. CONCLUSION: Hepatic resection may be the optimal treatment strategy for healthy older patients with CLM. Treatment decisions in older cancer patients should be individualized and account for patient age, comorbidities, and values.

BACKGROUND: The incidence of liver metastases from colorectal cancer (CLM) is on the rise. Older cancer patients are frequently subject to under-treatment. METHODS: A Markov decision model was built to examine the effect on life expectancy (LE) and quality-adjusted life expectancy (QALE) of four strategies – best supportive care (BSC), systemic chemotherapy (SC), radiofrequency ablation (RFA), and hepatic resection (HR). The model was designed to account for both age and comorbidities. RESULTS: In the base case analysis, BSC, SC, RFA, and HR yielded LEs of 11.9, 23.1, 34.8, and 37.0 months, respectively, and QALEs of 7.8, 13.2, 22.0, and 25.0 months, respectively. Model results were sensitive to several variables including age, comorbidity status, and length of model simulation. CONCLUSION: Hepatic resection may be the optimal treatment strategy for healthy older patients with CLM. Treatment decisions in older cancer patients should be individualized and account for patient age, comorbidities, and values.

The home health industry's introduction to managed care raises the prospect of reduced access to health care and poor outcomes for a vulnerable segment of our population—the rural elderly. Before effective intervention strategies can be accurately evaluated, a clearer picture of the sociodemographic features and home care service consumption is needed for this understudied group. The study was intended to provide a basis for future research into the evaluation of alternative methods of delivering effective care in terms of outcome and decreased cost for this population. A retrospective descriptive analysis was made of the patient record for the first six months of care from a proprietary home health agency. Eighty-one charts were examined and features such as age, race, gender, socioeconomic level, functional limitations, family support and literacy were analyzed to provide a profile of the patient population. Resource consumption was measured in terms of the type and frequency of disciplines intervening in each case. Comparison was made between the characteristics of the sample and the resource use. The study provided a composite view of the typical patient: Caucasian, literate, low income female, between 70-80 years of age, without family support. No clear linkage between specific characteristics and resource consumption was found; there was a broad range in the numbers of visits made to patients.

Background Incontinence-associated dermatitis (IAD) is a common and preventable condition in older adults with incontinence. People suffering from IAD are usually disdained by individuals, professionals, policy makers, caregivers, and communities. To date, a standard guideline on IAD management is still lacking in Hong Kong. Thus, it is important to develop an evidence-based incontinence-associated guideline for older adults with incontinence in Hong Kong. Objectives This thesis aims to identify the best available evidence for skin care management for people suffering from IAD and to develop an evidence-based practice guideline to reduce the incidence of IAD. Methods Review of literature related to the management of IAD was performed on electronic database according to the inclusion and exclusion criteria. The inclusion criteria included randomized controlled trials and quasi-experiments. In addition, the studies should be in English and should contain the full text. The target participants should be patients aged 60 or above who are suffering from urinary, fecal, or double incontinence and are using diapers. Participants should include cognitively impaired patients, as well as those experiencing skin redness or injury at the perineal or thigh area resulting from incontinence. All non-medical regimens, skin care products, and absorbent diapers or pads designed for managing incontinence related to skin breakdown in older adults with incontinence were also included. The quality of the literatures was assessed according to the checklist provided by the Scottish Intercollegiate Guidelines Network (SIGN) (2011), and the data obtained from the reviewed papers were extracted and summarized in eight tables of evidence. Then, an IAD skin care management guideline was developed based on these pieces of evidence. The transferability, the feasibility, and the cost-benefit ratio of implementing the proposed IAD skin care management guideline were assessed. In addition, the communication plan, the evaluation plan, and the pilot study of the proposed guideline were included in this thesis. Results The proposed IAD skin care management guideline is a structured skin care management program for older adults with incontinence. With the help of the proposed guideline, registered nurses could provide a standard IAD skin care program based on best available evidence. Moreover, reviewed studies show that the IAD severity score, which is used to evaluate the prevalence of IAD, can be reduced by 47 % by implementing the proposed guideline. In addition, a systematic communication plan with stakeholders, an evaluation plan, and a pilot study were designed to examine the feasibility and the transferability of the proposed guideline. Patient outcome is the main outcome measure, and this measure is directly related to the IAD severity score. In this study, the IAD severity score was reduced, indicating that the proposed IAD skin care management program is effective, feasible, and cost-effective in the local setting. Conclusion The proposed skin care management guideline for caring for older adults with IAD was developed based on best available evidence. The prevalence of IAD is expected to be reduced after the implementation of this guideline. / published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

Introduction: Ageing is a phenomenon that has preoccupied the minds of humankind for generations but it was only in the twentieth century that medical care dedicated to the elderly was created. The field of Geriatric Medicine has grown in South Africa and globally, to be recognized as a subspecialty of Internal Medicine in its own right. Physiological changes in the elderly impact on the increased prevalence of non–communicable diseases and the raised burden of disease in this age group. The altered spectrum of diseases in this age group and atypical manifestations of these conditions make geriatric health care truly unique. In spite of the recognition that the elderly have specific medical conditions, a dedicated health care policy to improve geriatric health care is yet to be developed In South Africa. For such a policy to be created, more needs to be known about the causes of mortality and morbidity that contributes to the burden of disease in this age group. Method: A retrospective chart review was conducted on 218 admissions of persons aged 60 years and over to the medical wards of King Edward VIII Hospital. This is a regional facility in Durban, South Africa, that provides mainly secondary and tertiary levels of care. An ethical waiver was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu- Natal and all data sheets were de-identified. A structured data extraction sheet was used to record demographic and clinical data, including the admission diagnoses, presence of concomitant diseases, management and complications of some of these diseases, length of hospitalization and outcome of admission. Results: The study population comprised 191 patients aged 60 years and over, with a mean age of 70.5 ± 7.4 years (range 60 – 90 years). The patients were predominantly female (61.3%) and Black African (83.8%). While the majority of patients had only 1 admission, most were admitted with multiple diagnoses. Four or more diagnoses were recorded for 58.1% of the patients, with 50 patients (26.2%) having four diagnoses and 38 patients (19.9%) having five diagnoses. A history of current smoking was recorded in 38% of males and 7.2% females. Respiratory disease was the most common admission diagnosis (42.7%), followed by cardiac (42.2%) and renal disease (40.4%). An infection was present in 116 cases (53.2%) on admission, the commonest being pneumonia in 71 (61.2%), followed by urinary tract infection in 34 (28%) and septicaemia in 11 (9.5%). Cardiovascular disease was the most common underlying chronic disease, with hypertension being present in 150 patients (68.8%) and cardiomyopathy in 60 patients (25.5%). Of the patients with hypertension, evidence of end organ damage was present in 128 patients (85.3%), with hypertensive heart disease in 97 patients (75.8%), renal disease in 61 patients (47.7%), cerebrovascular disease in 37 patients (28.91%), hypertensive retinopathy in 11 patients (8.6%) and peripheral vascular disease in 5 patients (3.91%). The most common risk factors for congestive cardiomyopathy were hypertension in 55 cases (67%) and diabetes mellitus in 24 cases (40%). In addition, infection was the most common identifiable precipitating factor for cardiac failure in 40 % of cardiac failure cases Eleven patients were on anticoagulant therapy, of which three (27.3%) presented with overwarfarinization. More importantly, eight of the 17 patients (47%) with atrial fibrillation were not on anticoagulants. Neurological disease was present in 27.5% of the admissions with cerebrovascular disease being the most common (75% of all neurological cases) A diagnosis of malignancy was recorded in 13.1% of admissions with the most common primary site being the lung. In eight patients (32 % of those with malignancy) there was evidence of metastatic disease. Men were more likely than women to be admitted with respiratory disease (22.8% vs. 2.2%, p < 0.0001) such as chronic obstructive airways disease (57% vs. 34.5%, p = 0.001). Although pneumonia was more common in men than in women, this did not reach clinical significance (40.5% vs. 28.8%, p = 0.053). In contrast, more women were admitted with arrhythmias (16.5% vs. 6.3%, p = 0.03), congestive cardiac failure (30.2% vs. 15.2%, p = 0.013) and endocrine diseases (23.7% vs. 12.7%, p = 0.048). Renal disease was more common in women than in men, but did not reach statistical significance (44.6% vs. 32.9%, p = 0.060) In the 191 patients, 64 deaths (33.7%) were recorded during hospitalization. The mortality rate was found to be significantly higher in patients with 15 cerebrovascular accidents, acute renal failure, diabetes mellitus, and infection (including pneumonias). Conclusion: This study confirms the high prevalence and disease burden of non-communicable diseases in older patients, with the majority of patients having multiple diagnoses on admission. Hypertension and other cardiovascular diseases were identified as being most common with a high prevalence of target organ damage. Furthermore, in the patients with malignancy metastatic disease was common. These findings suggest that older patients may present late due to a lack of awareness, limited access to appropriate health care, or lack of adequate treatment and screening programmes. In addition to the burden of non-communicable diseases (NCD), infection (particularly pneumonia) emerged as a common cause for admission and mortality. These findings confirm the high burden of non-communicable diseases and their complications in the older population and highlight the need screening programs to improve detection and better management of these conditions. Furthermore the association of a high mortality with infections, finding underscores the need for implementation and adherence to treatment guidelines, and to develop and adhere to vaccination guidelines. Furthermore, training of health care personnel at all levels should be intensified in an attempt to decrease the burden of disease in older persons and to improve their quality of life. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.