Interprofessional student service-learning experiences are integrated into the preventive care of older adult residents of public housing in Appalachia. Receiving a Health Resources and Services Administration grant provided the College of Nursing at East Tennessee State University the opportunity to expand interprofessional clinical experiences for students by partnering with the College of Pharmacy, the College of Clinical and Rehabilitative Health Sciences, and the local public housing authority. Select faculty from each college met and developed a plan to form student teams from all three colleges to conduct in-home comprehensive medical and nutrition assessments and medication chart reviews of high-risk older adults. Following the in-home visit, students and faculty discuss the assessment findings at planned interprofessional meetings. Students present their findings from each discipline's perspective and collaboratively set health priorities and develop intervention strategies and an inclusive follow-up plan. Excerpts from students' reflective narratives discussing the impact of the interprofessional service-learning experiences are shared.

SammanfattningBakgrund: Depression hos äldre personer över 65 år kan relateras till smärta, ensamhet, dödsångest, samsjuklighet eller ålderspensionering. Depression hos äldre är underdiagnostiserats och svårt att upptäcka även om symtom förekommer. Eftersom sjuksköterskor är ansvariga för att lindra smärta och främja hälsa är det viktigt att stödja äldre personer och hitta omvårdnadsstrategier som kan förebygga och lindra symtom vid depression.Syfte: Syftet var att beskriva sjuksköterskors erfarenheter vid vård av äldre personer med depression.Metod: En litteraturstudie med beskrivande design baserad på 10 vetenskapliga artiklar som har sammanställts. Litteratursökningen gjordes via databaserna PsycINFO och PubMed.Huvudresultat Erfarenheterna från sjuksköterskorna visade att tiden med patienterna var avgörande för att upptäcka depression, men på grund av tidsbrist kunde sjuksköterskorna inte alltid prioritera detta. Ett gott samarbete mellan vårdpersonal hade en positiv påverkan på vården av äldre patienter med depression. Relation mellan sjuksköterska och patient var viktigt. För att patienten skulle känna sig trygga skulle sjuksköterskan kommunicera på ett respektfullt sätt samt lyssna på patienten.Slutsats: De omvårdnadsåtgärder som sjuksköterska kan använda sig av vid vård av äldre personer med depression är god relation mellan sjuksköterskan och patient, relationen beskrevs ge möjlighet till patienten att öppna upp sig till sjuksköterskan samt att tillämpa terapeutiska möten för att hjälpa äldre med depression. Tidsbrist berodde på hög arbetsbelastning, vilket påverkade tiden hos den äldre patienten och sjuksköterskor belyste att de inte hade tillräckligt med tid för att uppmärksamma depression. Aktivitetsstimulering kunde förbättra de äldre personernas mentala hälsa. En betydande del av att uppmärksamma depression var gott samarbete och stöd från kollegor och andra yrkesgrupper. / AbstractBackground: Depression in older people over the age of 65 can be related to pain, loneliness, death anxiety, comorbidity or retirement. Depression in the elderly is underdiagnosed and difficult to detect even if symptoms occur. Because nurses are responsible for relieving pain and promoting health, it is important to support the elderly and find nursing strategies that can prevent and relieve symptoms of depression. Aim: The purpose was to describe nurses' experiences in caring for elderly people with depression.Method: A literature study with descriptive design based on 10 scientific articles compiled. The literature search was performed in the PsycINFO and PubMed databases. Main Result: The experience from the nurses showed that the time with the patients was crucial for detecting depression, but due to lack of time, the nurses could not always prioritize this. A good collaboration between care staff had a positive impact on the care of elderly patients with depression. Relationship between nurse and patient was important. In order for the patient to feel safe, the nurse would communicate in a respectful way and listen to the patient.Conclusion: The nursing measures that a nurse can use when caring for elderly people with depression are a good relationship between the nurse and patient, the relationship was described as giving the patient the opportunity to open up to the nurse and to apply therapeutic meetings to help the elderly with depression. Lack of time was due to a high workload, which affected the time of the elderly patient and nurses highlighted that they did not have enough time to pay attention to depression. Activity stimulation could improve the mental health of the elderly. A significant part of paying attention to depression was good cooperation and support from colleagues and other professions.

Background: Community acquired pneumonia causes 5,9% of deaths in elderly South Africans. Mortality rates are increased in those in whom initiation of therapy with an appropriate agent has been delayed. Whereas Mycoplasma pneumoniae and Legionella pneumophila are sensitive to the macrolides or tetracycline, they do not respond to the currently recommended first-line agents for community acquired pneumonia, penicillin or a cephalosporin. It was therefore necessary to assess the prevalence of exposure to these 2 organisms in the elderly in order to determine whether a modification in the recommendations may be justified. Methods: Study population and survey: Subjects were residents of 4 old age homes in Cape Town who were older than 60 years and willing to participate. Written consent was obtained, a demographic and medical history questionnaire was completed, and a sample of blood was drawn. Laboratory methods: The indirect fluorescent antibody tests (Zeus Scientific Inc, New Jersey, USA) were used to detect the presence of antibodies to Mycoplasma pneumoniae and Legionella pneumophila. Results: The participation rate in this study was high, with 88,4% (677/766) taking part. Seropositivity for both of these organisms was low. There were 17 participants (2, 51 %) with antibodies to mycoplasma (IgG only in 8, IgM only in 1, and both IgG and IgM in the remaining 8). Titres were low with only 1 IgM titre of 16, and only 3 IgG titres of 64. Antibodies to Legionella were demonstrated in only 9 participants (1,33%). All these titres were 128 or above. Conclusions: It is concluded that first-line therapy for community acquired pneumonia should adhere to the current guidelines published by the South African Pulmonology Society. There is no indication for the routine use of agents active against Legionella or mycoplasma. Clearly, these antibiotics should be introduced if specific pointers to infection with one of these organisms are found. Because of the low seropositivity rate, the indirect fluorescent antibody test for these 2 agents has a high specificity in this population. This may be of use in making a diagnosis in an acute infection Further studies are required to elucidate the immunological response to these organisms in elderly persons. A further survey should be done to determine the seropositivity rate to these agents in community dwelling elderly.

Due to the fragmented structure of the health organisation in South Africa, there is often difficulty in assuring good co-ordination between in-patient and domiciliary health facilities. This results in the discharge of patients from hospital with poor prospects for the continuity of health care in the community. At Groote Schuur Hospital, approximately 44% of the hospital beds in the white section of the Hospital are occupied by patients in the age group of sixty-five years and over. This group of patients must be regarded as particularly vulnerable with regard to the transition of the care in a hospital to their own home for some of the following reasons: - * The nature of the disease - The chronic and recurrent nature of the degenerative diseases of old age often results in varying degrees of disability. in the aged patient. Many geriatric patients suffer from several unrelated clinical conditions, and thus there is a need to coordinate the many health services required. * Social circumstances - The aged population frequently live alone or with a frail relative, often in poor economic circumstances. * Re-admission rate - The geriatric re-admission rate following discharge is high. As the first principle of geriatric care is to restore independence, and to help patients live away from the hospital environment, the provision of extended care facilities for vulnerable patients is of utmost importance. A structured interview was used to assess the need for extended care facilities of 172 white patients over the age of 60 years who were discharged from Groote Schuur Hospital during March to May of 1981. An attempt was made to evaluate how effectively these needs were being met in the community following discharge. It was found that 34% of the patients interviewed were not getting the nursing care and support in the community which they needed to facilitate rehabilitation. The most vulnerable patients as regards aftercare were: - * The aged * The chronically ill * Patients who live alone or without social support * Patients whose illness leads to temporary or permanent disability * Patients hospitalised for prolonged periods. It was found that the patients interviewed were given insufficient preparation, while still in hospital, for the problems they would be faced with on discharge. No systematic policy exists to ensure that health care staff give adequate information to the patient on discharge from hospital. The ward sister was found to play a vital role in making the preparations for a patient's transfer from hospital to home. A questionnaire was designed to assess the Groote Schuur ward sisters' attitudes towards the importance of discharge planning. An analysis of the ward sisters' response indicated that great variation existed in the attitudes towards the importance of this task. An investigation into the existing community services for geriatric patients was undertaken. An attempt was made to assess the limitations and gaps which exist in the provision of services for the aged. Finally, the role of the recently established Department of Community Liaison at Groote Schuur Hospital was investigated. It was evident that the Community Liaison nurse had proved to be an invaluable member of the health team of a large, specialist hospital such as Groote Schuur. The activities of the Community Liaison nurse led to improved continuity of care for patients needing extended care facilities in the community.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18858号 / 医博第3969号 / 新制||医||1008(附属図書館) / 31809 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福原 俊一, 教授 古川 壽亮, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Title: Ageing of the population and selected aspects of the rationality of drug prescribing of statins in older age (II.) Author: Martina Pekařová Tutor: Assoc. Prof. Daniela Fialová, PharmDr, Ph.D. University: Charles University Faculty: Faculty of Pharmacy in Hradec Králové Department: Department of Social and Clinical Pharmacy INTRODUCTION: In the geriatric population, cardiovascular diseases based on atherosclerosis rank first place in morbidity and mortality. A positive effect on cardiovascular morbidity can generally reduce overall morbidity, polymorbidity, polypharmacotherapy, and prolong the quality of life of older patients. Statins are often underprescribedin the treatment of ATS heart disease in older age or are underdosed in both primary and secondary prevention. The main goals of the diploma thesis was to analyze the rationality of statin prescription in the Czech population of seniors, assessed in the EuroAgeism H2020 project in three different health care settings (acute, outpatient and community pharmacy settings of health care). The aim was to describe various aspects of rational / irrational statine therapy in patients older than 65 years (choice of drugs, drug combinations, dosing timing, indications according to the degree of CVS risk in seniors, and indications in the presence...

Institution/department: Charles University, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy Title of diploma thesis: Rationality of benzodiazepine use in older patients Supervisor: Assoc. Prof. Daniela Fialová, PharmDr. Ph.D. Author: Adriana Magátová Introduction: Benzodiazepines are one of the most commonly prescribed potentially inappropriate drugs (PIMs) in geriatric patients in Europe and are responsible for common problems associated with risky drug prescription in older age (eg, cognitive impairment, falls, orthostatic hypotension, drug dependence, and others). Physiological and pathophysiological changes associated with the aging process, as well as frequent polymorbidity and polypharmacotherapy, are associated with more frequent occurrence of drug-related complications in older age. With the growing proportion of geriatric population, the importance of preventing drug complications in older adults increases. The aim of this study was to compare prescribing habits in the use of BZD and in the use of drug combinations with sedative potential and to determine the association of their use with drug-related risks in geriatric patients in community pharmacy practice in Spain (SP) and the Czech Republic (CZ) and in groups of patients assessed in various healthcare settings...

Introduction: Sarcopenia is a disease with a high prevalence in the elderly population and a significant negative impact on quality of life. Physical activity along with adequate nutritional intervention are key to mitigating these effects. Methods: The research was conducted using a questionnaire survey in which 113 nursing homes participated. The quality of nutritional care in these facilities was determined using a survey. Results: A total of 113 nursing homes were included in the research. Of these, 57% of facilities had a registered dietitian available. Nursing homes assess the presence of malnutrition at least 4 times a year in 74% of cases, of which they most often use changes in weight (80 %) and monitoring of food intake (70 %). Only 50 % of the facilities use validated nutritional screening tool. 83 % of the facilities apply nutritional support, most often in the form of diet modification and sipping (98 %). They use food fortifications less often, in a total of 57 % of facilities. The presence of a registered dietitian is affected by the size of the facility, with the larger ones being available to the registered dietitian at a higher frequency. The presence of a registered dietitian in the facility significantly positively affects the frequency of detection of malnutrition (P = 0.039)....

The purpose of this research was to evaluate whether serum prealbumin levels would serve as a predictor of hospital length of stay for elderly orthopedic patients who underwent hip replacement surgery. The study consisted of a set of 54 patients admitted to a hospital in Bristol, Tennessee. Patients with depleted prealbumin levels, low to low/normal prealbumin levels, or normal prealbumin levels were analyzed. Data collected from a retrospective chart review included: age, length of stay, serum glucose, sodium, potassium, hematocrit, hemoglobin, BUN, creatinine, WBC, prealbumin, and post operative diet consumption. Data were analyzed using analysis of variance for treatment effects. Because of the limited size of the data set, probabilities approaching p<0.10 were considered and levels of p<0.05 were considered significant. The research failed to show a significant relationship between prealbumin levels at admission and length of patient stay during post-operative recovery.