Geriatric Assessment

We aimed to thoroughly search and identify studies referring to risk factors associated with postoperative delirium (POD) in patients undergoing open as well as endoscopic urological surgery. Methods: The review after a systematic literature search included 5 studies. Results: The incidence of POD was reported to be between 7.8 and 30% depending on the type of the urologic surgery, while in the majority of the studies the onset happened on the first postoperative day and the symptoms lasted 3 ± 0.8 days. Seventeen different risk factors for POD were identified and presented in detail. Conclusion: The Mini-Mental State Examination score and older age were significantly associated with the development of POD. However, the Confusion Assessment Method is very well validated against the diagnosis of delirium from the specialists.

Objective. To examine why older age groups have worse functional health literacy. Methods. Home interviews were conducted with community-dwelling elderly persons ( n ϭ 2,774) to determine demographics, years of school completed, newspaper reading frequency, chronic diseases, and health status. Participants completed the Short Test of Functional Health Literacy in Adults (S-TOFHLA, range 0-100) and the Mini Mental State Examination (MMSE). Results. Mean S-TOFHLA scores declined 1.4 points (95% CI 1.3-1.5) for every year increase in age ( p Ͻ .001). After adjusting for sex, race, ethnicity, and education, the S-TOFHLA score declined 1.3 points (95% CI 1.2-1.4) for every year increase in age. Even after adjustment for performance on the MMSE, the S-TOFHLA score declined 0.9 points (95% CI 0.8-1.0) for every year increase in age ( p Ͻ .001). Differences in newspaper reading frequency, visual acuity, chronic medical conditions, and health status, did not explain the lower literacy of older participants. Discussion. Functional health literacy was markedly lower among older age groups even after adjusting for differences in MMSE performance, newspaper reading frequency, health status, and visual acuity. Future studies should prospectively examine whether functional literacy declines with age and whether this is explained by declines in cognitive function.

Introduction: Hearing and vision loss among long- term care (LTC) residents with dementia frequently goes unnoticed and untreated. Despite negative consequences for these residents, there is little information available about their sensory abilities and care assessments and practices seldom take these abilities or accessibility needs into account. Without adequate knowledge regarding such sensory loss, it is difficult for LTC staff to determine the level of an individual's residual basic competence for communication and independent functioning. We will conduct a scoping review to identify the screening measures used in research and clinical contexts that test hearing and vision in adults aged over 65 years with dementia, aiming to: (1) provide an overview of hearing and vision screening in older adults with dementia; and (2) evaluate the sensibility of the screening tools. This scoping review will be conducted using the framework by Arksey and O'Malley and furthered by methodological enhancements from cited researchers. We will conduct electronic database searches in CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. We will also carry out a 'grey literature' search for studies or materials not formally published, both online and through interview discussions with healthcare professionals and research clinicians working in the field. Our aim is to find new and existing hearing and vision screening measures used in research and by clinical professionals of optometry and audiology. Abstracts will be independently reviewed twice for acceptance by a multidisciplinary team of researchers and research clinicians. Ethics and dissemination: This review will inform health professionals working with this growing population. With the review findings, we aim to develop a toolkit and an algorithmic process to select the most appropriate hearing and vision screening assessments for LTC residents with dementia that will facilitate accurate testing and can inform care planning, thereby improving residents' quality of life.

Building both strength and endurance has been a challenge in exercise training in the elderly, but dietary supplements hold promise as agents for improving muscle adaptation. Here, we test a formulation of natural products (AX: astaxanthin, 12 mg and tocotrienol, 10 mg and zinc, 6 mg) with both anti-inflammatory and antioxidant properties in combination with exercise. We conducted a randomized, double-blind, placebo-controlled study of elderly subjects (65-82 years) on a daily oral dose with interval walking exercise on an incline treadmill. Forty-two subjects were fed AX or placebo for 4 months and trained 3 months (3×/week for 40-60 min) with increasing intervals of incline walking. Strength was measured as maximal voluntary force (MVC) in ankle dorsiflexion exercise, and tibialis anterior muscle size (cross-sectional area, CSA) was determined from magnetic resonance imaging. Greater endurance (exercise time in incline walking, >50%) and distance in 6 min walk (>8%) accompan...

The objective of this research is to provide a comprehensive review of the methodological issues concerning the assessment of driving behaviour in the elderly. For this purpose, older driver behaviour indicators are examined, including cognitive functions critical for safe driving (including the impact of cerebral diseases) as well as older drivers’ behaviour characteristics. In the next step all available experiment types of driving behaviour are explored, such as naturalistic driving experiments, driving simulator experiments, on road experiments, in depth accident investigations and surveys on opinion and stated behaviour. Finally, general issues regarding the analysis challenges of experiments based on older drivers are discussed. More specifically, the experiment design, driver behaviour indicators and data analysis are discussed and the critical issues of data reliability and validity when testing older drivers are analysed while appropriate recommendations regarding each diff...

Background: Elderly patients with advanced non-small-cell lung cancer (NSCLC) may derive similar benefit from platinum-based chemotherapy as younger patients. Quality of life (QoL) and comprehensive geriatric assessment (CGA) is often advocated to assess benefits and risks. Patients and methods: A total of 181 chemotherapy-naive patients [ ‡70 years, performance score (PS) of 0-2] with stage III-IV NSCLC received carboplatin and gemcitabine (CG) (n = 90) or carboplatin and paclitaxel (CP) (n = 91) every 3 weeks for up to four cycles. Primary end point was change in global QoL from baseline compared with week 18. Pretreatment CGA and mini geriatric assessment during and after treatment were undertaken. A principal component (PC) analysis was carried out to determine the underlying dimensions of CGA and QoL and subsequently related to survival. Results: There were no changes in QoL after treatment. The number of QoL responders (CG arm, 12%; CP arm, 5%) was not significantly different. CGA items were only associated with neuropsychiatric toxicity. Quality-adjusted survival was not different between treatment arms. The PC analysis derived from nine CGA, six QoL and one PS score indicated only one dominant dimension. This dimension was strongly prognostic, and physical and role functioning, Groningen Frailty Indicator and Geriatric Depression Scale were its largest contributors. Conclusions: Paclitaxel or gemcitabine added to carboplatin did not have a differential effect on global QoL. CGA was associated with toxic effects in a very limited manner. CGA and QoL items measure one underlying dimension, which is highly prognostic.

Family carers play an important role in providing care for frail older Australians. Carers have increased rates of depression, burden and poor physical health compared with non-carers. Physical activity has been shown to improve outcomes; however there is limited research investigating outcomes in older carers and less on physical activity for both the carer and care recipient. Research question: Does a home-based individualised physical activity intervention designed for both the carer and care recipient improve depression severity in older carers? Participants and setting: 273 community-dwelling carers with depressive symptoms and their care recipients will be recruited for a randomised controlled trial. Baseline assessment will consist of functional, psychological, and physical measures and information about service use. Intervention and control: Participants will be randomised to receive either a physical activity program (intervention), a social support program (social control), or usual care (control). The intervention and social control groups will have five home visits over six months. Measurements: All participants will be re-assessed after completion of the program and then six months later to evaluate sustainability of outcomes. The primary outcome measure is the 15-item Geriatric Depression Scale for carers. Secondary outcomes include physical measures for carers and care recipients, carer burden, carer satisfaction, care recipient depression, and cost-effectiveness. All assessors will be blind to group allocation. Discussion: This study has the potential to demonstrate that physical activity interventions can be delivered simultaneously to older carers and care recipients to improve mental and physical outcomes.

Objective: to examine the clinical evidence reporting the prevalence of sarcopenia and the effect of nutrition and exercise interventions from studies using the consensus definition of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). Methods: PubMed and Dialog databases were searched ( January 2000-October 2013) using pre-defined search terms. Prevalence studies and intervention studies investigating muscle mass plus strength or function outcome measures using the EWGSOP definition of sarcopenia, in well-defined populations of adults aged ≥50 years were selected. Results: prevalence of sarcopenia was, with regional and age-related variations, 1-29% in community-dwelling populations, 14-33% in long-term care populations and 10% in the only acute hospital-care population examined. Moderate quality evidence suggests that exercise interventions improve muscle strength and physical performance. The results of nutrition interventions are equivocal due to the low number of studies and heterogeneous study design. Essential amino acid (EAA) supplements, including 2.5 g of leucine, and β-hydroxy β-methylbutyric acid (HMB) supplements, show some effects in improving muscle mass and function parameters. Protein supplements have not shown consistent benefits on muscle mass and function. Conclusion: prevalence of sarcopenia is substantial in most geriatric settings. Well-designed, standardised studies evaluating exercise or nutrition interventions are needed before treatment guidelines can be developed. Physicians should screen for sarcopenia in both community and geriatric settings, with diagnosis based on muscle mass and function. Supervised resistance exercise is recommended for individuals with sarcopenia. EAA (with leucine) and HMB may improve muscle outcomes.

To determine what effect driving cessation may have on subsequent health and well-being in older adults. Systematic review of the evidence in the research literature on the consequences of driving cessation in older adults. Community. Drivers aged 55 and older. Studies pertinent to the health consequences of driving cessation were identified through a comprehensive search of bibliographic databases. Studies that presented quantitative data for drivers aged 55 and older; used a cross-sectional, cohort, or case-control design; and had a comparison group of current drivers were included in the review. Sixteen studies met the inclusion criteria. Driving cessation was reported to be associated with declines in general health and physical, social, and cognitive function and with greater risks of admission to long-term care facilities and mortality. A meta-analysis based on pooled data from five studies examining the association between driving cessation and depression revealed that drivin...

OBJETIVO: Identificar indicadores da institucionalização de idosos. MÉTODOS: Estudo de casos e controles com 991 idosos em Pelotas, RS, de 2007 a 2008. Os casos (idosos institucionalizados; n = 393) foram detectados por meio de um censo em todas as instituições de longa permanência para idosos da cidade. Os controles populacionais (n = 598) foram selecionados de forma aleatória, por meio de um amplo inquérito de saúde. Na comparação dos grupos, foram empregados os testes qui-quadrado de Pearson e tendência linear na análise bruta e o modelo de regressão logística binária na análise ajustada, com medidas de efeito expressas em odds ratio. RESULTADOS: A institucionalização foi mais freqüente no sexo feminino (OR = 1,96; IC95% 1,31;2,95). Idosos com idade avançada (OR = 3,23 e OR = 9,56 para faixas etárias de 70-79 e > 80 anos, respectivamente), que viviam sem companheiro (solteiros, separados e viúvos), não possuíam escolaridade formal e apresentavam incapacidade funcional para ati...

The relations between patterns of emotional experience, emotion inhibition, and physical health have been little studied in older adults or ethnically diverse samples. Testing hypotheses derived from work on younger adults, the authors examined the relations between negative affect and emotion inhibition and that of illness (hypertension, respiratory disease, arthritis, and sleep disorder) in a sample ( N ϭ 1,118) of community-dwelling older adults from four ethnic groups: U.S.-born African Americans, African Caribbeans, U.S.-born European Americans, and Eastern European immigrants. Participants completed measures of stress, lifestyle risk factors, health, social support, trait negative emotion, and emotion inhibition. As expected, the interaction of ethnicity with emotion inhibition, and, to a lesser extent, negative affect, was significantly related to illness, even when other known risk factors were controlled for. However, the relations among these variables were complex, and the patterns did not hold for all types of illness or operate in the same direction across ethnic groups. Implications for emotionhealth relationships in ethnically diverse samples are discussed.

The goals of this study were to collect normative data on asymptomatic, ambulatory, community-dwelling adults on a standard diagnostic test of vestibular function in balance and to determine if their responses differ significantly from younger adults. Subjects were divided into four age groups, 18-44 years (young), 45-69 years (middle-aged), 70-79 (old), and 80-89 (elderly). Subjects were seen in the neurotologic diagnostic laboratory at a tertiary care facility. Their dynamic balance was tested under a variety of sensory conditions using the EquiTest (NeuroCom), a standard diagnostic test. The data from one subtest, the Sensory Organization Test (SOT) were evaluated. These data showed significant age-associated declines in overall score and changes in movement strategy. These results suggest that those parts of the vestibular system involved with balance have age-related declines through the end of the life span, even in asymptomatic people, and that these changes do not level off but continue into the ninth decade. Therefore, when elderly people are evaluated for balance disorders age-appropriate norms should be used. These results also suggest that declines in motor performance on laboratory tests are not directly related to reduced independence in essential activities of daily living in elderly people.

Delirium in older medical inpatients. A one year follow up study Background: Delirium is an important problem in older medical inpatients. Aim: To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. Material and Methods: Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. Results: Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No signifi cant differences were seen in readmission rates. Conclusions: Delirium was signifi cantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients. (Rev Med Chile 2012; 140: 847-852).

Case note data were obtained for 186 elderly primary care attenders who also completed the 15 item Geriatric Depression Scale (GDS15). The presence or absence in the case notes of a current or past diagnosis of depression, of current treatment of depression, and of a number of clinical features of depression were noted. Case notes were also rated for the presence or absence of contraindications to the use of tricyclic antidepressants (TCAs) and to serotonin-specific reuptake inhibitors (SSRIs). Whereas 65 (35%) patients were rated as 'cases' of depression on the GDS15, only 28 (15%) had a current case note diagnosis of depression and 37 (20%) had one or more current symptoms of depression recorded in the case notes. Patients rated by their GP as having one or more current symptoms of depression scored higher on the GDS15 (P < 0.05) and were more likely to be categorized as a GDS case (P = 0.05). There was no significant relationship between GDS caseness and a current case note diagnosis of depression. Seventy-three patients (39%) had a past history of depression and 53 (28.5%) patients had previously been treated with antidepressants. The former was significantly associated with GDS caseness (P < 0.05). Twenty-four patients (13%) were currently on antidepressants, 19 of them receiving adequate doses (equivalent to at least 75 mg of amitriptyline). Current antidepressant treatment was not associated with GDS 'caseness'. A significantly higher proportion of patients (both in the sample as a whole and in the subgroup of GDS15 depression 'cases') had a medical condition or were taking a drug that mitigated against the use of TCAs than was the case for SSRIs.

Neuropsychiatric symptoms are common in patients with Alzheimer disease (AD). Treatment for both AD and psychiatric disturbances may affect the clinical observed pattern and comorbidity. The authors aimed to identify whether particular neuropsychiatric syndromes occur in untreated patients with AD, establish the severity of syndromes, and investigate the relationship between specific neuropsychiatric syndromes and AD disease severity. Cross-sectional, multicenter, clinical study. A total of 1,015 newly diagnosed, untreated outpatients with AD from five Italian memory clinics were consecutively enrolled in the study from January 2003 to December 2005. All patients underwent thorough examination by clinical neurologists/geriatricians, including neuropsychiatric symptom evaluation with the Neuropsychiatric Inventory. Factor analysis revealed five distinct neuropsychiatric syndromes: the apathetic syndrome (as unique syndrome) was the most frequent, followed by affective syndrome (anxie...

Relative and absolute muscle mass and muscle strength are used as diagnostic criteria for sarcopenia. We aimed to assess which diagnostic criteria are most associated with physical performance in 180 young (18-30 years) and 281 healthy old participants (69-81 years) of the European study MYOAGE. Diagnostic criteria included relative muscle mass (total or appendicular lean mass (ALM) as percentage of body mass), absolute muscle mass (ALM/height squared and total lean mass), knee extension torque, and handgrip strength. Physical performance comprised walking speed, Timed Up and Go test (TUG), and in a subgroup physical fitness. Diagnostic criteria for sarcopenia and physical performance were standardized, and the associations were analyzed using linear regression models stratified by age category, with adjustments for age, gender, and country. In old participants, relative muscle mass was associated with faster walking speed, faster TUG, and higher physical fitness (all p<0.001). Absolute muscle mass was not associated with physical

Objectives: A better understanding of the essential components of frailty is important for future developments of management strategies. We aimed to assess the incremental validity of a Comprehensive Model of Frailty (CMF) over Frailty Index (FI) in predicting self-rated health and functional dependency amongst near-centenarians and centenarians. Design: Cross-sectional, community-based study. Setting: Two community-based social and clinical networks. Participants: One hundred twenty-four community-dwelling Chinese near-centenarians and centenarians. Measurements: Frailty was first assessed using a 32-item FI (FI-32). Then, a new CMF was constructed by adding 12 items in the psychological, social/family, environmental, and economic domains to the FI-32. Hierarchical multiple regressions explored whether the new CMF provided significant additional predictive power for self-rated health and instrumental activities of daily living (IADL) dependency. Results: Mean age was 97.7 (standard deviation 2.3) years, with a range from 95 to 108, and 74.2% were female. Overall, 16% of our participants were nonfrail, 59% were prefrail, and 25% were frail. Frailty according to FI-32 significantly predicted self-rated health and IADL dependency beyond the effect of age and gender. Inclusion of the new CMF into the regression models provided significant additional predictive power beyond FI-32 on self-rated health, but not IADL dependency. Conclusions: A CMF should ideally be a multidimensional and multidisciplinary construct including physical, cognitive, functional, psychosocial/family, environmental, and economic factors. Ó 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. With aging, frailty increases the risk of adverse health outcomes when an individual's diminished strength, endurance, and physiological reserve results in the person's inability to withstand environmental stressors. The consequences of frailty are perhaps the major obstacle to healthy and disability-free life years in old age, while consuming a significant proportion of societal resources. Clarity on the operational definition and components of frailty is important for clinical care, research, and policy planning. From the many attempts to systematically review the growing numbers of frailty assessment tools, 2e4 2 of the most commonly used validated approaches are (1) the Frailty Phenotype 5 ; and (2) the Deficit Accumulation model (Frailty Index, FI). The Frailty Phenotype is based on 5 clinical criteria indicating the physical manifestation of physiological aging, including excessive weight loss, exhaustion, slow gait speed, weak handgrip, and sedentary behavior. The FI originally composed of over 70 items indicating cumulative physical and cognitive comorbidities. More recently, shorter lists of 30e40 variables have been validated, such as the 36-item scale in Song et al 7 or the 39-item scale by Gu et al, 8 without loss of predictive power. The essential components that constitute frailty and how these components interact to exacerbate functional disability, comorbidity, and perceived health status are unresolved. Increasingly, researchers and practitioners are also proposing that frailty should shift its focus from organ-or disease-based approaches toward one that is based upon the well-being of the whole person. 9e11 Table summarizes the various commonly used frailty assessment tools and their range of core components in the different domains, including physical, The authors declare no conflicts of interest.

Objective: Very old adults may be physically frail, but they do not necessarily experience poor subjective health.The authors hypothesized that the relationship between frailty and subjective health is moderated by depression for very old people. Methods: In a cross-sectional study, a survey administered was by a face-to-face interview to 129 community-dwelling older adults aged 95-108. Measurements included the fiveitem FRAIL scale, the Geriatric Depression Scale Short-Form (GDS), and a subjective health rating. Hierarchical multiple regressions were conducted to test the moderation effects, adjusting for age, gender, living arrangement, perceived socioeconomic status, and cognition. Results: The interaction effect between frailty and depression was significant. Inspection of the simple slopes revealed that those who were more depressed had a more negative frailty-subjective health relationship.There was no significant moderation effect for a withdrawal-apathy-vigor dimension of the GDS. Conclusion: Our findings suggest a protective psychological mechanism may enable very old adults to maintain an optimistic view of their health despite their increasing physical and functional limitations.

Background: Hypoglycaemia is a side effect of strict diabetes control, especially in the geriatric population above sixty, who constitute approximately 100 million of the Indian population. This study was undertaken to explore the risk factors of hypoglycaemia in elderly in patients. Materials and Methods: Ninety patients who were found to have hypoglycaemia either at admission or while admitted were enrolled. Their risk factors were compared with Ninety age and sex matched inpatients admitted to medical wards who did not experience hypoglycaemia. Results: The duration of diabetes was significantly longer (13.4 ± 9.2 vs. 8.1 ± 5.7 years; P = 0.012) in the group which experienced hypoglycaemia. The mean glycated haemoglobin was significantly lower in the group which experienced hypoglycaemia (6.73 ± 1.12 vs. 7.61 ± 1.17; P = 0.002). Out of the 90 patients who developed hypoglycaemia 27 were asymptomatic. Infection and renal failure were significantly higher in the study group. On multivariate analysis, infection was the only significant precipitating factor. With strict blood glucose control, elderly patients are at high risk of hypoglycaemia. The risk is higher if the patients have renal failure and infection. Diabetic therapy in elderly people should be adjusted in such a way to prevent hypoglycaemia.

Combination active antiretroviral therapy prevents HIV from replicating and ravaging the immune system, thus allowing people to age with this disease. Unfortunately, the synergistic effects of HIV and aging can predispose many to become more at-risk of developing cognitive deficits which can interfere with medical management, everyday functioning, and quality of life. The purpose of this article is to describe the role of cognitive reserve and neuroplasticity on cognitive functioning in those aging with this disease. Specifically, the role of environment and the health of these individuals can compromise cognitive functioning. Fortunately, some cognitive interventions such as prevention and management of co-morbidities, cognitive remediation therapy, and neurotropic medications may be of value in preventing and rehabilitating the cognitive consequences of aging with HIV. Novel approaches such as cognitive prescriptions, transcranial direct stimulation, and binaural beat therapy may also be considered as possible techniques for cognitive rehabilitation.

This 5-wk, open-label, comparative study investigated the effects of quetiapine and haloperidol on behavioural, cognitive and circadian rest-activity cycle disturbances in patients with Alzheimer&#39;s disease (AD). Out of a total of 30 patients enrolled in the study, there were 22 completers, 11 in the quetiapine group (mean age 81.9+/-1.8 yr, mean baseline MMSE 19.9+/-1.3, mean dose 125 mg) and 11 in the haloperidol group (mean age 82.3+/-2.5 yr, mean baseline MMSE 18.1+/-1.3, mean dose 1.9 mg). As shown in the Neuropsychiatric Inventory, both medications reduced delusion and agitation, whereas quetiapine additionally improved depression and anxiety. Haloperidol worsened aberrant motor behaviour and caused extrapyramidal symptoms. In the Consortium to Establish a Registry for Alzheimer&#39;s Disease (CERAD) neuropsychological test battery which assessed cognitive parameters, quetiapine improved word recall; significant interaction terms revealed differences between quetiapine and ...

Objectives Today, geriatric care is one of the most important issues in health systems. The present study aimed to evaluate the integrated geriatric care program (IGCP) in a health center in Yazd, Iran, based on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. Methods & Materials This is a cross-sectional study conducted at Imamshahr Health Center in Yazd in 2023. Data were collected in two phases. In the first phase, the data on all program indicators from 2016 to 2022 were extracted from the electronic health records of older adults in the health center and were then forecasted for 2023 by applying the time-series analysis. In the second phase, nine healthcare providers from the health center completed a RE-AIM framework-based researcher-made questionnaire. R software, version 4.2.2 and SPSS software, version 26 were used for data analysis. Results The changes in indicators from 2016 to 2022, except for 2020 and 2021, were gradually increasing. The total care rate in 2022 was only 15.4%. The mean scores (out of 100) for the RE-AIM domains were 34.26±15.28 for reach, 49.51±12.08 for effectiveness, 58.64±32.41 for adoption, 72.11±9.98 for implementation, and 55.71±12.26 for maintenance. Friedman's test results showed a significant difference among the scores of different dimensions (P=0.002). Conclusion The IGCP performance from 2016 to 2022 in Yazd was poor in the RE-AIM domains of reach and effectiveness; however, its overall performance was relatively favorable. The results of this study can help policymakers in the field of geriatric care in Iran to identify the shortcomings of the IGCP to improve the program and remove the existing barriers.

Objectives: to study (i) the prevalence of geriatric conditions in community-dwelling older persons at increased risk of functional decline and (ii) the extent to which older persons recognise comprehensive geriatric assessment (CGA)-identified conditions as relevant problems. Methods: trained registered nurses conducted a CGA in 934 out of 1209 older persons at increased risk of functional decline participating in the intervention arm of a randomised trial in the Netherlands. After screening for 32 geriatric conditions, participants were asked which of the identified geriatric conditions they recognised as relevant problems. Results: at baseline, the median age of participants was 82.9 years (interquartile range (IQR) 77.3-87.3 years). The median number of identified geriatric conditions per participant was 8 (IQR 6-11). The median number of geriatric conditions that were recognised was 1 (IQR 0-2). Functional dependency and (increased risk of) alcohol and drug dependency were the most commonly identified conditions. Pain was the most widely recognised problem. Conclusion: CGA identified many geriatric conditions, of which few were recognised as a problem by the person involved. Further study is needed to better understand how older persons interact with identified geriatric conditions, in terms of perceived relevance. This may yield a more efficient CGA and further improve a patient-centred approach.

Objectives: to study (i) the prevalence of geriatric conditions in community-dwelling older persons at increased risk of functional decline and (ii) the extent to which older persons recognise comprehensive geriatric assessment (CGA)-identified conditions as relevant problems. Methods: trained registered nurses conducted a CGA in 934 out of 1209 older persons at increased risk of functional decline participating in the intervention arm of a randomised trial in the Netherlands. After screening for 32 geriatric conditions, participants were asked which of the identified geriatric conditions they recognised as relevant problems. Results: at baseline, the median age of participants was 82.9 years (interquartile range (IQR) 77.3-87.3 years). The median number of identified geriatric conditions per participant was 8 (IQR 6-11). The median number of geriatric conditions that were recognised was 1 (IQR 0-2). Functional dependency and (increased risk of) alcohol and drug dependency were the most commonly identified conditions. Pain was the most widely recognised problem. Conclusion: CGA identified many geriatric conditions, of which few were recognised as a problem by the person involved. Further study is needed to better understand how older persons interact with identified geriatric conditions, in terms of perceived relevance. This may yield a more efficient CGA and further improve a patient-centred approach.

Ao colega Hugo, fraterno companheiro neste percurso. Aos colegas Tazi, Loyola, Divane, Jussara e Karla, sempre prontos a ajudar. A minha colega e amiga Magda Maria Campos Pinto, "porto confiável" na ancoragem diária. À Elida Mara, minha secretária, sempre pronta e paciente. Aos meus irmãos e sobrinhos, pelo carinho e interesse, constante suporte afetivo. Aos amigos, familiares e colegas da Associação Mineira de Psiquiatria, pelo apoio e incentivo permanentes. Ao Prof. Matoso, competente e cuidadoso na revisão. Meu reconhecimento aos meus pacientes, pela rica contribuição que concedem ao meu saber. vii E ainda minha consideração a todos os que estiveram comigo e, de alguma forma, foram capazes de permanecer, engrandecendo-me e incitando-me a prosseguir. Felizmente, são tantos que eu não conseguiria nomeá-los. Aos meus filhos, que estiveram ao meu lado nesta caminhada, dividindo tarefas e me fazendo feliz na certeza de estar "SempreViva", e ao Cadu, que partilha conosco a sua serenidade e nos enriquece. A todos os que construíram e constroem o PROJETO BAMBUÍ, pessoas capazes de desenvolver um trabalho a um só tempo cientificamente rigoroso e fundamentado no respeito pelo ser humano, o que se revela na generosa e franca participação da comunidade. viii SUMÁRIO Apresentação .

Introducción: El estudio analiza las fortalezas individuales y sociales de niños, niñas y adolescentes (NNA) en situación de callejización, utilizando la Escala de Evaluación Emocional y de Comportamiento, segunda edición (BERS-2), Escala de Evaluación para Jóvenes. Método: Para tal efecto se realiza una investigación cuantitativa transversal con un solo momento de recolección de datos, aplicando la BERS-2 a 20 NNA del Centro del Muchacho Trabajador de Cotocollao (CMT) en la ciudad de Quito – Ecuador. Resultados: Los resultados obtenidos indican que el 90% de NNA del CMT tienen un puntaje de fortalezas emocionales y de comportamiento en el promedio y sobre el promedio. Conclusiones:  Los hallazgos permiten afirmar que es posible identificar fortalezas en cualquier grupo humano, independientemente de su situación de vulnerabilidad, y que la BERS-2 es un instrumento útil y pertinente para dicha medición.

institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. a retrospective cohort study of people admitted to a single large Scottish teaching hospital. 100 individuals admitted to the acute hospital from home and discharged to a care home. a single researcher extracted data from ward-based case notes. people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14-231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reaso...

Guro Hanevold Bjørkløf Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Department for Mental Health Research and Development, Division for Mental Health and Addiction, Vestre Viken Hospital Trust, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of science and Technology, NTNU, and Norwegian National Advisory Unit on Ageing and Health 2017

To profile participants based on reported outdoor physical activity barriers using a data-driven approach, describe the profiles and study their association with unmet physical activity need. : Cross-sectional analyses of 848 community-dwelling men and women aged 75-90 living in Central Finland in 2012. Barriers to outdoor physical activity and unmet physical activity need were enquired with a questionnaire. The latent profiles were identified by profiling participants into latent groups using a mixture modeling technique on the multivariate set of indicators of outdoor physical activity barriers. A path model was used to study the associations of the profiles with unmet physical activity need. RESULTS: Five barrier profiles were identified. Profile A was characterized with minor barriers, profile B with weather barriers, profile C with health and weather barriers, profile D with barriers concerning insecurity, health and weather; and profile E with mobility and health barriers. The participants in the profiles differed in the proportion of individual and environmental barriers. The risk for unmet physical activity need was highest among people whose severe mobility difficulties restricted their outdoor physical activity. CONCLUSION: Outdoor physical activity barriers reflect the imbalance in personenvironment fit among older people, manifested as unmet physical activity need.

In spite of the high prevalence of psychiatric disorders among elderly residents in nursing homes, only a small number of patients in need of specialist care are referred to a psychiatric consultant. The aim of this research was to evaluate the consultation activity and the appropriateness of referral to psychiatric assessment. Data were collected and analysed on consultation carried out over a two-year period in a RSA (Residenza Socio-Assistenziale) in Northern-Italy. Data were catalogued with reference to: patients, consultation, diagnosis and recommended medications. Statistical correlation analysis by means of Spearman test and signification test was carried out. Residents referred to psychiatric consultation at least once were 112 (14.5% of all residents). Reason for referral were: depression (17.2%), delusions and hallucinations (14%), agitation (34.8%), aggressive behaviour (23.5%) and disturbances of sleep (6.8%). Most frequent diagnoses were organic, including symptomatic, ...

In spite of the high prevalence of psychiatric disorders among elderly residents in nursing homes, only a small number of patients in need of specialist care are referred to a psychiatric consultant. The aim of this research was to evaluate the consultation activity and the appropriateness of referral to psychiatric assessment. Methods: Data were collected and analysed on consultation carried out over a two-year period in a RSA (Residenza Socio-Assistenziale) in Northern-Italy. Data were catalogued with reference to: patients, consultation, diagnosis and recommended medications. Statistical correlation analysis by means of Spearman test and signification test was carried out. Residents referred to psychiatric consultation at least once were 112 (14.5% of all residents). Reason for referral were: depression (17.2%), delusions and hallucinations (14%), agitation (34.8%), aggressive behaviour (23.5%) and disturbances of sleep (6.8%). Most frequent diagnoses were organic, including symptomatic, mental disorders (33.9%), mood disorders (22.3%) and schizophrenia, schizotypal and delusional syndromes (18.8%). No psychiatric diagnosis was found only in 1.8% of cases, thus confirming high sensibility of referring physicians. A statistically significant correlation was found when comparing referrals for depression or delusions and allucinations or sleep disturbances and diagnostic confirmation of such symptoms by specialistic assessment (respectively 49.8%, 52.7% and 19.6%). Correlation between psychotic symptoms and the consequent prescription of antipsychotic drugs had a significant if somewhat modest value (24%) while correlation between depression symptoms and prescription of antidepressant drugs was more noticeable (66.5%). Main reason for referral to psychiatric consultation resulted to be the presence of agitation, a non-specific symptom often difficult to attribute. Data concerning depression confirm tendency to underestimating this diagnosis in the elderly. Furthermore, symptomatic reasons for referral did not always correspond to subsequent diagnostic definitions by psychiatric consultants, therefore demonstrating modest predictive power.

Objectives: to determine the prevalence of under-nutrition using brief screening methods and to determine the relation between these results and (1) those of a more standard nutritional assessment and (2) discharge outcomes. Design: prospective study. Subjects: 65 (21 males) patients older than 65 years. Setting: sub-acute care facility. Measurements: the Mini Nutritional Assessment, standard nutritional assessment, 'rapid screen' and discharge outcome. Results: the prevalence of under-nutrition was high, ranging from 35.4% to 43.1%, depending on the screening method used. Compared to the standard nutritional assessment the 'rapid screen' consisting of (1) body mass index < 22 kg/m 2 ; and/or (2) reported weight loss of > 7.5% over the previous 3 months and the two-tiered Mini Nutritional Assessment process (atrisk subjects (46% of total) further evaluated using standard nutritional assessment) had sensitivities of 78.6 and 89.5% and speciWcities of 97.3 and 87.5% respectively in diagnosing under-nutrition. Under-nourished patients as identiWed by the standard nutritional assessment (50.0% (under-nourished) versus 21.6% (nourished); P = 0.017), the two-tiered Mini Nutritional Assessment process (50.0% (under-nourished) versus 21.6% (nourished); P = 0.017) and the rapid screen (56.5% (under-nourished) versus 21.4% (nourished); P = 0.004) were more likely to be discharged to an acute hospital or an accommodation with increased support (poor discharge outcomes) than nourished patients. Conclusion: all screening methods identiWed patients more likely to have a poor discharge outcome. The highly speciWc but less sensitive 'rapid screen' may be the best method in facilities with limited resources as it can be easily incorporated into nursing/medical admissions and avoids biochemical investigations in all patients. The more sensitive two-tiered Mini Nutritional Assessment is better if resources permit.

Background: One of the most serious complications among cancer patients is Acute Kidney Injury (AKI). This study aimed to detect the AKI incidence in cancer patients, to discover which clinical factors could increase the risks of AKI, and to assess the effect of AKI on in-hospital mortality, length of stay. Methods: This prospective cohort study was conducted on 276 malignant patients (AKI: 40 cases and no AKI: 236 cases). Serum creatinine, blood urea, complete blood count, uric acid, Electrolyte'' potassium, sodium, calcium'', urine analysis with comment on RBCs cast, liver function test'' ALT, AST, Albumin and bilirubin'' were measured every three weeks, and urine albumin creatinine ratio was done before chemotherapy and after finishing treatment. Results: pre-existing comorbidities including hypertension (HTN), diabetes (DM), and coronary heart disease are significant predictors for increased risk of AKI in cancer patients. Patients with hyponatremia, hypokalemia and hyperuricemia shared a significantly higher risk of AKI (a OR = 2.95, 2.49, and 3.01). Cox regression analysis revealed that HTN and DM also increased the mortality risk when adjusting demographic and clinical features. The mean survival rate was significantly lower in group with AKI compared to group without AKI (16.331 versus 19.589). AKI stage II and III had longer median length of hospital stay compared to stage I. (In our studied patient, there is high admission rate of patient with cancer to intensive care units, and most of critically ill patients with cancer are susceptible to AKI and the incidence of requiring kidney Replacement Therapy. The most common risk factors that developed with cancer patient was septic shock, exposure to nephrotoxins as "chemotherapy", severe dehydration due to associated vomiting and GIT upset, and others All of this risk factor are precipitating factor for AKI. Incidence of AKI itself will cause high mortality rate among cancer patient in compared with ill patient without cancer, and also the need for Renal Replacement Therapy entails high mortality rate. So, according to our results, we find mean survival rate in cancer patient with AKI is lower than that in patient without AKI.) Conclusion: The in-hospital mortality was 5% in cancer patients with AKI. The severe AKI was associated with poor clinical outcome, long hospital stays and high daily costs. Pre-existing comorbidities and electrolyte disturbances are the predicting factors for AKI incidence.

We describe the implementation of a care pathway for patients with fractured neck of femur (NOF) using Lean and Six Sigma principles. After introduction of the Lean pathway, 32 patients out a total of 86 (37%) with fractured NOF were admitted to the Trauma Ward within 4 hours presentation to the hospital; prior to implementation this was 16 patients out of a total of 59 (27%). Post-Lean an earlier mean theatre start time of 8.40am was achieved, resulting in a 38 minute increase in daily theatre time. An additional 52 patients (12%) received surgery within 24 hours of admission, resulting in 1 night length of stay reduction. Lean methodology proved an effective method to guide change resulting in an improved journey for the patient and significant workflow gains.

Tenemos un sentido de gratitud con las personas que estuvieron de alguna u otra forma manifestando su apoyo en este proceso, en especial a nuestra familia, quienes sirvieron de sostén en momentos que parecían difíciles. A nuestro asesor, el docente Juan Paulo Múnera, quien nos brindó de la manera más cálida y respetuosa posible sus conocimientos, quien fue un gran guía en nuestro proceso, el cual nos aportó enseñanzas valiosas que quedarán presentes en nuestra vida profesional como personal.

Background and Purpose: Studies indicate that age is associated with deterioration in physical function and a concomitant decrease in health-related quality of life (HRQL). The contribution of physical function to HRQL in nonagenarians (ages 90-99) is unknown. The purposes of this study were to examine age-related changes in physical function and HRQL among community-dwelling nonagenarians and to determine the relationship between their physical function and HRQL. Methods: Seventy-four community-dwelling nonagenarians participated. The Continuous Scale Physical Function Performance Test-10 (CS-PFP10) was used to measure their physical function and the Short Form (SF)-36 was used to measure their HRQL. Pearson correlations were used to assess associations among age, physical function, and HRQL scores. Results: Age was inversely associated with the upper body flexibility (r = -.365, p = .001) subscale of the CS-PFP10, but not significantly associated with any other physical function or HRQL score. Significant associations between physical function and HRQL were limited to those between upper body flexibility and the physical function subscale (r = .424, p < .001) and physical function component summary score (r = .376, p = .001) of the SF-36. Conclusion: These data suggest that upper body flexibility continues to decline during the 10th decade of life and has implications for influence on aspects of HRQL in this segment of the population.

This study examines the relative importance of fitness versus fatness in predicting mortality in elderly populations aged 70 years and over, and whether fitness may account for the 'paradoxical' relationship between better survival and increasing weight. Four thousand community-living Chinese men and women aged 65 years or over were recruited and stratified so that approximately 33% were in each of the age groups: 65-69, 70-74, and 75 or above. Medical history, height, weight, waist-hip ratio, body composition using DEXA, and walking speed were obtained. They were followed up for a mean of 7.0 years to ascertain death. Compared with the high fitness category, those in the moderate and low categories have a 43% and 68% increased risk of mortality at 7 years adjusting for multiple confounders. When mortality risk according to various fatness indicators was examined, only the lowest quartile of BMI, BFI, and FLMR conferred statistically significant increased risk. Fitness categories were significantly associated with all fatness indicators. The finding of fewer people in the high fitness category among the highest quartiles of other fatness indicators suggests that fitness is not the underlying mechanism for the obesity paradox. Within each quartile of fatness indicator, there was a significant trend towards reduced mortality with increasing fitness. In conclusion, the study confirms the beneficial effects of cardiorespiratory fitness on mortality but does not explain the 'obesity paradox'. The findings underscore the importance of maintaining physical fitness through exercise and reconfirm the importance of weight maintenance in reducing mortality risk.

This study aimed to estimate the quartile distribution on the cognitive assessment of normal elderly with low education as measured by the Cambridge Cognitive Examination (CAMCOG). A sample of 292 elderly (&gt; 65 years of age), screened for dementia and depression, were assessed using the CAMCOG. The CAMCOG scores of normal subjects (n = 206) were stratified according to age (65-69, 70-74, 75-79, &gt; 80) and schooling (illiterate, 1-4, and &gt; 5 years of formal education). Mean age was 72.8 (± 3.5) and mean schooling was 3.5 years (± 3). The mean score on the CAMCOG was 71 (± 12.7). The scores at the first quartile for illiterate/1-4 years of schooling were 58/62 (65-69 years), 52/63 (70-74 years), 48/67 (75-79 years) and 46/64 (&gt; 80 years), respectively. There was a significant difference in the CAMCOG quartiles according to education and age. This study provides normative data on the CAMCOG of elderly people with low educational levels which may be clinically useful.

The objective of the study was to evaluate health aspects in elderly individuals in social, institutional, and home care in Poland. Methods: A total of 300 elderly individuals in care in Poland were included in the study. The subjects were divided into three groups: residents of long-term care institutions (group I), residents of adult day-care homes (group II), and community-dwelling subjects (group III). Each group consisted of 100 subjects. Questionnaires evaluating the following physical and mental dimensions of health were used: SF-36 Health Survey, basic activities of daily living, instrumental activities of daily living, Geriatric Depression Scale, and Mini-mental state examination. Results: It was found that the health aspects of the elderly varied depending on whether care was provided in an institutionalized or a home environment, and the lowest health status was found in the elderly receiving in-home care. Furthermore, home-based elderly indicated significant limitations in performing basic activities of daily living and instrumental activities of daily living, as well as a higher prevalence of depression and cognitive impairment. The elderly in long-term institutionalized care, both in a residential home and adult day-care homes, were characterized by a better physical and mental health status than those receiving in-home care. It seemed that worse health status, including the more frequent depression occurrence and cognitive function disorders in the elderly using the nursing care at their homes, was related to their multimorbidity, loneliness, and too-short duration of the care during the day.

RATIONALE -Frailty Syndrome is a clinical condition defined by elderly vulnerability to adverse events like falls, hospitalizations and death because of the reduction on reserve and resistance to stress resulting in a decline of physiological systems. Frail evaluation includes three or more criteria such as unintentional weight loss, weakness, slowness, exhaustion and low activity. OBJECTIVES -Evaluate epidemiological aspects of Frailty Syndrome in elderly community living in Fortaleza, Ceará. METHODS -It is a transversal study that evaluated a sample of elderly (n=1061) in an urban area of Fortaleza, Ceará. This survey was composed by a structured questionnaire and performance tests. Social, economic and demographic information were collected and chronic degenerative diseases were evaluated by self-report. All ancients were tested for five criteria of frailty: weakness, slow walking speed, low physical activity, unintentional weight loss and selfreported exhaustion, e classified in frail, intermediate and not frail having 3 or more, 1 or 2 and none of the frailty criteria respectively. RESULTS -Most of elderly were female (72%) and were in age between 60 to 69 years (45,8%). Marital status of being without partner like, divorces/single (22,6%) and widow (35%), were more common in the studied population. In living arrangement, most of elderly lives with three generations (37,9%). Frailty was diagnosed in 16,2%, intermediate 10% and 73,7% was not Frail. Variables of social, economic and demographic characteristics showed that frailty elderly is older, lower education and income, also live alone; in contrast, robust were younger and have higher education and income. Just Cancer and Depression have similarity between frail phenotype and robust one (p>0,05). Cardiovascular (Hypertension and Myocardial infarction), Metabolic (Diabetes Mellitus) and Neurological diseases were associated with frail elderly. Frailty diagnosis has shown association with falls, hospitalization and disability. CONCLUSIONS -The frailty prevalence in this study was high and had association with unfavorable social, demographic and economic aspects like poor income and low education. Living arrangements with families multinuclear with dependence in elderly incomes were seen by the similarity between the individual and familiar income. Frailty is a clinical condition with directly relation with number or self-reported chronic disease like cardiovascular, neuropsychiatric, neoplastic and rheumatologic ones. Elderly classified in frail category has association with deleterious events to ageing such as falls, loss of functional capacity and hospitalization. In this context, appears an opportunity to studies in control of criteria wich defines frailty to elderly health promotion. Physical inactivity and slowness were the most prevalents aspects in frail population which can be approached in prevention of outcomes.

To analyze the methods of treatment and outcome of hip fractures in Lithuania. Methods: This population-based retrospective study was performed collecting the data from all orthopaedic inpatient departments in Lithuania. The records of subjects, who were hospitalized because of primary hip fracture (ICD-10 codes S72.0, S72.1 and S72.2) at the age over 40 years in 2010, were examined. Methods of treatment were conservative and surgical, while the latter was divided into fixation by screws, plate or intramedullary nail (IN), and total hip arthroplasty (TA). The outcomes included death, transfer to another department, discharge home or long-term hospital, and rehabilitation. Results: In 2010, 2626 hip fractures occurred in Lithuania. The most common method used was osteosynthesis: fixation by plate accounted for 41.4%, screw -21.1%), and by INin 3.4% of cases. TA was used in 25.9% and conservative treatmentin 8.1% of patients. After fixation by screws, plates and IN, the majority of patients were discharged home (42.5%, 35.8% and 37.8%, respectively) or to long-term care hospital (24.5%, 22% and 32.2%, respectively). Otherwise, after TA, 70.1% of patients underwent rehabilitation. Among patients treated conservatively, 39.7% were transferred to another department, ant their mortality rate was highest (4.2%). Number of deaths was lowest after treatment with screws (0.7%). Conclusion: In 2010, in Lithuania, the majority of patients with hip fracture were treated with osteosynthesis using the external fixation. Rehabilitation was more often outcome of treatment using total hip arthroplasty, as compared to osteosynthesis.