Geriatrics最新文献

Background: The incidence of melanoma is increasing globally. The estimated worldwide incidence is projected to increase from 324,635 cases in 2020 to 510,000 in 2040. In the UK, melanoma accounts for 4% of all new cases of cancer. Melanomas occurring in the skin of the head and neck represent 13% and 23% of cases in women and men, respectively. Prognostic indicators include presence of nodal or distant metastasis, ulceration, and Breslow thickness, where >4 mm thickness predicts poorest overall survival rates. Giant melanomas, a term generally applied to melanomas larger than 5-10 cm, are rare and often have a very poor prognosis. Clinical case: An 82-year-old female presented acutely with a 2-3-day history of delirium and urinary retention in February 2022. In addition, she was noted to have a large fungating growth on her forehead that obscured the bridge of the nose and had been slowly increasing in size for the past year prior to admission. She had initially presented in primary care with a small growth on her forehead but declined further investigations for fear of contracting COVID-19. She consented to having further assessment and management of the forehead mass. A shave biopsy revealed giant nodular melanoma, specifically, the largest melanoma of the face reported in the literature. Remarkably, our patient underwent a successful complete excision and skin grafting, with no evidence of recurrence or distal metastasis after 2 years of follow up. Conclusions: This case highlights the anxieties people felt about contracting COVID-19 when national guidelines recommended shielding that had resulted in further morbidity. Despite poor prognostic factors, clinically and histologically, our patient did not need any systemic anticancer therapy nor radiotherapy. She was well after 2 years follow up without any signs of recurrence.

(1) Background: Frailty is a multifactorial syndrome that significantly impacts the functional abilities of older adults, making them more vulnerable to falls, disabilities, and dependence. Exercise can serve as an effective intervention for pre-frail and frail older adults, improving muscle strength and reducing the risk of falls. This research aims to clarify the physical exercise protocols and their outcomes for this population. (2) Methods: A scoping review was conducted to summarize the evidence on physical activity parameters for frail and pre-frail older adults. The search included primary evidence sources published in PubMed, PEDro, Biomed, Scopus, and Springer, as well as search engines like Google Scholar and Dialnet. The keywords used were ([frailty] OR [frail] AND [exercise]). The PEDro and MINORS scales were used to assess the quality of the evidence and evaluate the risk of bias. (3) Results: Eighteen studies met the eligibility criteria. The most commonly reported exercise program was multicomponent, which included aerobic activities at 70% of the maximum effort and strength exercises at 20% to 80% of the participants' maximum capacity. This approach proved effective for this population. (4) Conclusions: The studies suggest that exercise is a successful intervention strategy for addressing frailty. However, not all the articles provided adequate information regarding the dosing of their interventions.

Background/Objectives: Maintaining functional independence and minimizing disability among older adults living in the community is paramount for mitigating rising care demands. Our study focused on shopping as a critical instrumental activity of daily living (ADL) to explore the association between shopping assistance and functional decline among older individuals receiving support through long-term care insurance (LTCI). Methods: This retrospective, cross-sectional study included 6202 participants aged >65 years living in a Japanese regional town receiving LTCI support, suggesting that they required assistance with local community life. Logistic regression analysis identified several factors associated with shopping assistance among the participants, including physical and cognitive functions, functional ADL, and psychobehavioral symptoms. Results: In male participants, walking dysfunction, short-term memory decline, decreased frequency of going outdoors, and decreased engagement in personal grooming were significantly associated with requiring shopping assistance. Conversely, in female participants, reduced physical function and walking performance were significantly associated with requiring shopping assistance, whereas dependence on personal grooming was less pronounced than in male participants. Conclusions: These findings suggest that, in addition to direct shopping assistance, tailored interventions targeting physical, cognitive, and ADL functions-while considering gender-specific needs-may help older adults maintain independence in shopping activities as part of their daily community life.

Introduction: Despite an established evidence-base for cardiac rehabilitation (CR) improving functional outcomes and quality of life and reducing re-hospitalisation, there is limited research on CR for older cardiac patients, who require rehabilitation the most, as they are often very deconditioned due to aortic stenosis (AS). CR uptake in the UK is limited to 52% with national variability of provision and accessibility, and it is a national priority to increase uptake to 85%. Frequently, research has excluded older populations as they are deemed to be too frail or generally not suitable for inclusion. This study aimed to explore factors that can impact the uptake of CR in octogenarians. Methods: Qualitative interviews were carried out with 20 AS patients (12 female, 8 male), from a large NHS Trust in the North East of England. Results: Four main themes were identified in the data: Perceptions and Understanding, Delivery and Accessibility, Perceived Impact of Exercise and Health and Life Changes, and Transportation. Discussion: The findings suggested that the major factors were the understanding of the nature, purpose and relevance of CR to older patients, whether CR was offered, and the role of social support. Barriers and facilitators can impact uptake based on the mode of delivery and the individual circumstances identified. Future research could explore how to develop CR programmes that overcome the barriers identified in the research, such as education, monitoring strategies, use of telehealth, and home-based elements to create an acceptable and accessible programme for octogenarians.

We report the case of a 78-year-old female patient who received palliative immunotherapy with pembrolizumab and lenvatinib as a treatment of pulmonary and osseous metastatic endometrial carcinoma. Under this therapy, the patient developed dysphagia, thyroiditis with hypothyroidism, myositis, and myocarditis, which required, due to third-degree AV block, the installation of a pacemaker. The patient received high-dose cortisone therapy, a thyroid hormone substitution, and pyridostigmine for symptom control. With this therapy, we saw a significant but not complete regression of symptoms. Ultimately, we could discharge the patient home for an outpatient treatment. The case report is followed by a discussion of the management of immune-related adverse events (irAEs) during pembrolizumab therapy from a geriatric perspective. Elderly patients on pembrolizumab therapy require close monitoring for irAEs, which can present atypically or without symptoms and may be fatal. Non-invasive diagnostics and minimizing hospital stays are essential to preserve the fitness of this vulnerable population.

Background/objectives: The COVID-19 pandemic placed an immense burden on nursing home staff, significantly increasing their workload. How the impact of these challenges on job satisfaction is mitigated by personal and social resources, along with organisational support measures initiated by nursing homes, is investigated in this study.

Methods: In 2021, a cross-sectional survey was conducted among nursing home staff in Rhineland-Palatinate (n = 373). The questionnaire contained parts of standardised instruments (parts of the Copenhagen Psychosocial Questionnaire (COPSOQ), Brief Resilience Scale) and self-developed questions related to support measures such as training, psychological support and work organisation changes. The association of these support measures, as well as personal and social resources (e.g., resilience, social support, sense of community), with job satisfaction was explored. Descriptive, bivariate and regression analyses were conducted.

Results: While various support measures were offered to the nursing home staff, significant gaps remained. Training on hygiene and COVID-19 care was beneficial but not universally available. Similarly, psychological, pastoral and palliative support was lacking for a large portion of nursing home staff. Surprisingly, in the regression analysis, frequent information updates from supervisors were found to be negatively correlated with job satisfaction (p = 0.002). However, some personal and social resources (resilience (p = 0.002), social support (p = 0.001), sense of community at work (p ≤ 0.001), commitment to the workplace (p = 0.019), recognition by management (p ≤ 0.001)), and various support measures (training programmes (p = 0.005), changes in work organisation (p = 0.008), technical measures (p = 0.025)) were positively correlated with job satisfaction.

Conclusions: This study highlights that despite the implementation of various support measures for nursing home staff during the COVID-19 pandemic, significant gaps remained. Notably, a substantial portion of staff members lacked access to crucial support services such as psychological, pastoral and palliative care. Furthermore, healthcare facility managers should prioritise the following support measures, especially during crises: comprehensive training, including resilience training; flexible working arrangements; and recognition for nursing staff. Ultimately, healthcare organisations should aim to create a supportive work environment that fosters a sense of community and belonging among their nursing workforce.

Background: Depression and falls are highly prevalent, interrelated concerns for nursing home (NH) residents. Relationships between depression and falls should guide nurses towards developing evidence-based practices for assessing these conditions together. This study aimed to ascertain NH nurses' clinical practices and perceptions regarding the assessment of depression and fall risk.

Methods: This study was an exploratory descriptive study on the reported practices and perceptions from NH nurses in the canton of Vaud, Western Switzerland. Statistical analyses included descriptive statistics, nonparametric tests and a content analysis of responses to open-ended questions.

Results: The mean age of our 116 responding nurses was 44.6 years old (SD = 11.3), 99 were women and their mean work experience in NHs was 13.1 years (SD = 9.2). The reporting showed that 88.8% of nurses relied on mood observation for assessing depression and 88.8% relied on the history of falls to identify fall risk. Only 75.9% and 61.2% of nurses used validated scales to detect depression and fall risk, respectively. Additionally, 56.9% of participants considered depression to be a significant factor in fall risk.

Conclusion: Validated tools to assess depression and fall risk in NHs should be used more widely. Health policies must support and enhance NH nurses' training and skills.

Background: The comfort of the elderly in hospital settings requires special attention from the health care professionals involved, particularly nurses, since hospitalization often generates suffering and discomfort. In such contexts, it is essential to consider the specific characteristics of the elderly, taking into account their life experiences and their needs, to promote the health, well-being, and comfort of this population. Hence, the present work aimed to explore the nursing interventions that promote comfort among the elderly in hospital settings. Methods: A mixed descriptive exploratory study was conducted through the application of a questionnaire, using intentional non-probabilistic sampling. The study encompassed 55 elderly individuals hospitalized in the medical service of a public hospital located in Lisbon. Results: The results show that the participants perceived a reasonable level of comfort (5.65 ± 6.46). The following categories emerged from the content analysis: (1) physical interventions; (2) psycho-spiritual interventions; (3) socio-cultural interventions; and (4) environmental interventions. Conclusions: These findings help to understand comfort-promoting nursing interventions in the studied population. It was concluded that, to improve care quality, comforting interventions should focus on the elderly patient's individuality, through support activities, empowerment, and the preservation/correction of the surrounding environment. Additionally, the provided care should be based on the real needs, expectations, preferences, and values of the elderly individual.

Background: Post-operative delirium is a dreaded complication after surgery in older patients. The identification of risk factors for delirium and comprehensive geriatric assessment is an extensive part of recent research. However, the preoperative assessment of risk factors, such as impaired cognition, is frequently not standardized.

Methods: A comprehensive preoperative assessment was performed in 421 surgical patients to investigate the impact of preoperative cognitive impairment (PCI) on the risk of delirium and to evaluate appropriate screening tools (Six-item screener (SIS) and clock-drawing test (CDT)).

Results: Both screening tools showed a significantly increased risk of delirium with p < 0.001 (OR 12.5, 95% [6.42; 24.4]) in SIS and p = 0.042 (OR 2.02, 95%CI [1.02; 4.03]) in CDT for existing cognitive impairment. A higher level of care (p < 0.001) and statutory care (p < 0.001, OR 5.42, 95%CI [2.34; 12.6]) also proved to be significant risk factors. The ROC curves of the two tests show AUC values of 0.741 (SIS) and 0.630 (CDT). The COP values for the SIS are 4 points with a Youden index of 0.447; for the CDT, the COP is 2 (Youden index = 0.177).

Conclusions: The recording of PCI should be a central component of the preoperative geriatric assessment. The tools used are simple yet effective and can be easily implemented in routine clinical practice. By reliably identifying patients at risk, the available resources can be personalized and used in a targeted approach.

Background/Objectives: This study aimed to investigate the actual situation of individuals with unknown health conditions (UHCs) and those indifferent to health (IH) among old-old adults (OOAs) aged 75 years and above using the National Health Insurance Database (KDB) system. Methods: A total of 102 individuals with no history of medical examinations were selected from the KDB system in a city in Japan. Data were collected through home visit interviews and blood pressure monitors distributed by public health nurses (PHNs) from Community Comprehensive Support Centers (CCSCs). The collected data included personal attributes, health concern levels, and responses to a 15-item OOA questionnaire. Semi-structured interviews were conducted with seven PHNs. The control group consisted of 76 users of the "Kayoinoba" service (Kayoinoba users: KUs). Results: Of the 83 individuals who could be interviewed, 50 (49.0%) were classified as UHCs and 11 (10.8%) were classified as IH, including 5 from the low health concern group and 6 who refused to participate. In the word cloud generated from the PHNs' interviews, the words and phrases "community welfare commissioner", "community development", "blood pressure monitor", "troublesome", "suspicious", and "young" were highlighted. In the comparison of health assessments between UHCs and KUs, "body weight loss" and "cognitive function" were more prevalent among KUs, and "smoking" and "social participation" were more prevalent among UHCs. Conclusions: The home visit activities of CCSCs utilizing the KDB system may contribute to an understanding of the actual situation of UHCs, including IHs, among OOAs. UHCs (including patients with IH status) had a higher proportion of risk factors related to smoking and lower social participation than KUs.