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Health Professionals Palliative Care Education for Older Adults: Overcoming Ageism, Racism, and Gender Bias. 老年人的健康专业姑息治疗教育:克服年龄歧视、种族主义和性别偏见。
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2021-01-01 Epub Date: 2021-10-30 DOI: 10.1007/s13670-021-00365-7
Shena B Gazaway, Michael D Barnett, Ella H Bowman, Deborah Ejem, Erin R Harrell, Cynthia J Brown, Marie Bakitas

Purpose of review: Most aging Americans lack access to specialist palliative care aimed at those experiencing serious illness and/or high symptom burden at end of life. The curricula used by training programs for all healthcare professions should focus on helping learners develop the primary palliative care skills and competencies necessary to provide compassionate bias-free care for adults with serious illness. We believe there is much opportunity to improve this landscape via the incorporation of palliative care competencies throughout generalist healthcare professional programs.

Recent findings: Several recent publications highlight multiple issues with recruitment and retention of diverse students and faculty into healthcare professional training programs. There are also concerns that the curricula are reinforcing age, race, and gender biases. Due to these biases, healthcare professionals graduate from their training programs with socialized stereotypes unquestioned when caring for older adult minority patients and caregivers.

Summary: Important lessons must be incorporated to assure that bias against age, race, and gender are discovered and openly addressed in healthcare professional's education programs. This review highlights these three types of bias and their interrelationships with the aim of revealing hidden truths in the education of healthcare professionals. Ultimately, we offer targeted recommendations of focus for programs to address implicit bias within their curricula.

回顾的目的:大多数美国老年人缺乏针对那些在生命末期经历严重疾病和/或高症状负担的人的专科姑息治疗。所有医疗保健专业培训项目使用的课程应侧重于帮助学习者发展初级姑息治疗技能和能力,以便为患有严重疾病的成年人提供富有同情心的无偏见的护理。我们相信,通过将姑息治疗能力纳入全科医疗保健专业项目,有很多机会可以改善这种状况。最近的发现:最近的一些出版物强调了在医疗保健专业培训项目中招聘和保留不同学生和教师的多个问题。还有人担心,这些课程正在强化年龄、种族和性别偏见。由于这些偏见,医疗保健专业人员在照顾老年少数族裔患者和护理人员时,毫无疑问地从他们的培训项目中毕业,带有社会成见。总结:必须纳入重要的经验教训,以确保在医疗保健专业人员的教育计划中发现并公开解决对年龄、种族和性别的偏见。这篇综述强调了这三种类型的偏见及其相互关系,目的是揭示医疗保健专业人员教育中隐藏的真相。最后,我们为项目提供有针对性的重点建议,以解决课程中的隐性偏见。
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引用次数: 4
Protecting our Elders and Developing Equitable Policies During Public Health Emergencies: Ethical Recommendations. 在突发公共卫生事件中保护老年人和制定公平政策:伦理建议。
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2021-01-01 Epub Date: 2021-11-05 DOI: 10.1007/s13670-021-00368-4
Elizabeth Chuang, Shena Gazaway, Erin R Harrell, Ronit Elk

Purpose of the review: Experiences of patients, families, healthcare workers and health systems during the COVID-19 pandemic and recent national focus on racial justice have forced a reconsideration of policies and processes of providing care in crisis situations when resources are scarce. The purpose of this review is to present recent developments in conceptualizing ethical crisis standards.

Recent findings: Several recent papers have raised concerns that "objective" scarce resource allocation protocols will serve to exacerbate underlying social inequities. Older adults and their formal and informal caregivers suffered from intersecting planning failures including lack of adequate stockpiling of personal protective equipment, failure to protect essential workers, neglect of long-term care facilities and homecare in disaster planning and de-prioiritization in triage algorithms.

Summary: Revision of disaster planning guidelines is urgent. The time is now to apply lessons learned from COVID-19 before another disaster occurs. We present several suggestions for future plans.

审查目的:2019冠状病毒病大流行期间患者、家属、卫生保健工作者和卫生系统的经验,以及最近国家对种族正义的关注,迫使人们重新考虑在资源稀缺的危机局势中提供护理的政策和程序。本综述的目的是介绍伦理危机标准概念化的最新发展。最近的发现:最近的几篇论文提出了“客观的”稀缺资源分配协议将加剧潜在的社会不平等的担忧。老年人及其正式和非正式照顾者遭受规划失误的困扰,包括缺乏足够的个人防护装备储备,未能保护关键工作人员,在灾害规划中忽视长期护理设施和家庭护理,以及在分诊算法中优先次序下降。摘要:修订灾害规划指南迫在眉睫。现在是时候在另一场灾难发生之前应用从COVID-19中吸取的经验教训了。我们对未来的计划提出了几点建议。
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引用次数: 1
Perioperative Pulmonary Support of the Elderly. 老年人围手术期肺部支持。
IF 1.1 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2021-01-01 Epub Date: 2021-11-09 DOI: 10.1007/s13670-021-00369-3
Catherine Entriken, Timothy A Pritts

Purpose of review: With the projected increase in the geriatric patient population, it is of the utmost importance to understand and optimize conditions in the perioperative period to ensure the best surgical outcome. Age-associated changes in respiratory physiology affect the surgical management of geriatric patients. This review focuses on perioperative pulmonary management of elderly individuals.

Recent findings: The physiological changes associated with aging include both physical and biochemical alterations that are detrimental to pulmonary function. There is an increased prevalence of chronic lung disease such as COPD and interstitial lung disease which can predispose patients to postoperative pulmonary complications. Additionally, elderly patients, especially those with chronic lung disease, are at risk for frailty. Screening tools have been developed to evaluate risk and aid in the judicious selection of patients for surgical procedures. The concept of "prehabilitation" has been developed to best prepare patients for surgery and may be more influential in the reduction of postoperative pulmonary complications than postoperative rehabilitation. Understanding the age-associated changes in metabolism of drugs has led to dose adjustments in the intraoperative and postoperative periods, reducing respiratory depression and lung protective ventilation and minimally invasive procedures have yielded reductions in postoperative pulmonary complications.

Summary: The perioperative management of the geriatric population can be divided into three key areas: preoperative risk mitigation, intraoperative considerations, and postoperative management. Preoperative considerations include patient selection and thorough history and physical, along with smoking cessation and prehabilitation in a subset of patients. Operative aspects include careful selection of anesthetic agents, lung protective ventilation, and choice of surgical procedure. Postoperative management should focus on selective use of agents that may contribute to respiratory depression and encouragement of rehabilitation.

审查目的:随着老年患者人数的预计增加,了解并优化围手术期的条件以确保最佳手术效果至关重要。与年龄相关的呼吸生理变化会影响老年患者的手术管理。本综述重点关注老年人围手术期的肺部管理:与衰老相关的生理变化包括对肺功能有害的物理和生化改变。慢性肺部疾病(如慢性阻塞性肺病和间质性肺病)的发病率增加,使患者容易出现术后肺部并发症。此外,老年患者,尤其是患有慢性肺部疾病的患者,有虚弱的风险。目前已开发出一些筛查工具来评估风险,帮助明智地选择患者进行外科手术。术前康复 "概念的提出是为了让患者为手术做好最佳准备,在减少术后肺部并发症方面,术前康复可能比术后康复更有影响力。了解了与年龄有关的药物代谢变化,就可以在术中和术后调整剂量,减少呼吸抑制和肺保护性通气,而微创手术则可以减少术后肺部并发症。术前注意事项包括患者选择、全面的病史和体格检查,以及戒烟和对部分患者进行术前康复训练。手术方面包括谨慎选择麻醉剂、肺保护性通气和手术方法的选择。术后管理应侧重于选择性使用可能导致呼吸抑制的药物并鼓励康复。
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引用次数: 0
Review of Grief Therapies for Older Adults. 老年人悲伤治疗综述。
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2021-01-01 Epub Date: 2021-11-18 DOI: 10.1007/s13670-021-00362-w
Charisse Colvin, Mirnova Ceide

Purpose of review: The objective of this review is to provide background on common theories of grief, describe the impact of grief on older adults and to introduce various modalities that are currently used and/or being researched for treatment. The objective is also to condense information and identify what has been found beneficial versus what has been found lacking. A brief examination of overlap of other disorders is done. It also will suggest what further research is necessary on this subject, and highlight what research is being done during the COVID-19 Pandemic.

Findings: The latest research of grief primarily involves refining the definitions of grief. More concrete definitions of grief will help for better screening tools, and thus target interventions more appropriately. There is considerable need for applying it to the unique and real-world COVID-19 pandemic.

Summary: Grief disorders are relatively common and the symptoms overlap other disorders. Since the treatments differ, identifying grief disorders is important, especially in the elderly who are more susceptible to grief disorders. Therapy improves grief better than medications, but medications will help with any co-occurring disorders. No clear superior therapy has been identified but research continues. The pandemic has highlighted the need to refine the definitions of grief disorders and to treat them effectively.

综述目的:本综述的目的是提供关于悲伤的常见理论的背景,描述悲伤对老年人的影响,并介绍目前使用和/或正在研究的各种治疗方法。目的还在于压缩信息,并确定哪些是有益的,哪些是不足的。对其他疾病的重叠作了简要的检查。它还将提出关于这一主题的进一步研究的必要性,并强调在COVID-19大流行期间正在进行的研究。研究发现:最新的悲伤研究主要涉及对悲伤定义的细化。更具体的悲伤定义将有助于更好的筛选工具,从而更适当地进行目标干预。有必要将其应用于独特的和现实世界的COVID-19大流行。总结:悲伤障碍是相对常见的,其症状与其他障碍重叠。由于治疗方法不同,识别悲伤障碍是很重要的,特别是对更容易患悲伤障碍的老年人。治疗比药物更能改善悲伤,但药物也会对任何同时发生的疾病有所帮助。目前还没有明确的更好的治疗方法,但研究仍在继续。大流行突出表明,有必要完善悲伤障碍的定义,并对其进行有效治疗。
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引用次数: 1
Home Based Palliative Care: Known Benefits and Future Directions. 基于家庭的姑息治疗:已知的好处和未来的方向。
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2021-01-01 Epub Date: 2021-11-25 DOI: 10.1007/s13670-021-00372-8
Benjamin Roberts, Mariah Robertson, Ekene I Ojukwu, David Shih Wu

Purpose of review: To summarize key recent evidence regarding the impact of Home-Based Palliative Care (HBPalC) and to highlight opportunities for future study.

Recent findings: HBPalC is cost effective and benefits patients and caregivers across the health care continuum.

Summary: High-quality data support the cost effectiveness of HBPalC. A growing literature base supports the benefits of HBPalC for patients, families, and informal caregivers by alleviating symptoms, reducing unwanted hospitalizations, and offering support at the end of life. Numerous innovative HBPalC models exist, but there is a lack of high-quality evidence comparing specific models across subpopulations. Our wide literature search captured no research regarding HBPalC for underserved populations. Further research will also be necessary to guide quality standards for HBPalC.

综述的目的:总结最近关于家庭姑息治疗(HBPalC)影响的关键证据,并强调未来研究的机会。最近的研究发现:HBPalC具有成本效益,并使患者和护理人员在整个医疗保健连续体中受益。总结:高质量的数据支持HBPalC的成本效益。越来越多的文献支持HBPalC通过减轻症状、减少不必要的住院治疗和在生命结束时提供支持,为患者、家庭和非正式护理人员带来益处。有许多创新的HBPalC模型存在,但缺乏高质量的证据来比较不同亚群的特定模型。我们广泛的文献检索没有发现关于服务不足人群HBPalC的研究。还需要进一步的研究来指导HBPalC的质量标准。
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引用次数: 7
Disparities and Racism Experienced Among Older African Americans Nearing End of Life. 在接近生命尽头的老年非洲裔美国人中经历的差异和种族主义。
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2021-01-01 Epub Date: 2021-12-14 DOI: 10.1007/s13670-021-00366-6
Siobhan P Aaron, Shena B Gazaway, Erin R Harrell, Ronit Elk

Purpose of review: The purpose of this review is to examine racism in healthcare as it relates to older African American adults. We focus on health disparities in old age and medical mismanagement throughout their lifespan.

Recent findings: In the United States there have been extensive medical advances over the past several decades. Individuals are living longer, and illnesses that were deemed terminal in the past are now considered chronic illnesses. While most individuals living with chronic illness have experienced better quality of life, this is not the case for many African American older adults.

Summary: Older African American adults are less likely to have their chronic illness sufficiently managed and are more likely to die from chronic illnesses that are well controlled in Whites. African American older adults also continue to suffer from poorer healthcare outcomes throughout the lifespan to end-of-life.

综述的目的:本综述的目的是研究医疗保健中的种族主义,因为它与老年非洲裔美国人有关。我们关注老年人的健康差异和整个生命周期的医疗管理不善。最近的发现:在过去的几十年里,美国的医学取得了广泛的进步。人们的寿命越来越长,过去被认为是绝症的疾病现在被认为是慢性疾病。虽然大多数患有慢性疾病的人都经历了更好的生活质量,但对于许多非裔美国老年人来说,情况并非如此。总结:年长的非裔美国人的慢性疾病不太可能得到充分的管理,他们更有可能死于白人控制良好的慢性疾病。非裔美国老年人在整个生命周期直至生命终结的过程中,也继续遭受较差的医疗保健结果。
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引用次数: 5
Evaluation and Management of Alcohol use Disorder among Older Adults. 老年人酒精使用障碍的评估与管理
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2021-01-01 Epub Date: 2021-07-24 DOI: 10.1007/s13670-021-00359-5
Pallavi Joshi, Karen T Duong, Louis A Trevisan, Kirsten M Wilkins

Purpose of review: The prevalence of alcohol use disorder (AUD) among older adults in the United States is rising, but remains underdiagnosed, underreported, and inadequately managed. This review highlights the medical, social, and cultural factors of AUD in older adults and provides guidelines for its screening, evaluation, and management.

Recent findings: The COVID-19 pandemic has created additional challenges and barriers to care, as older adults may have disproportionate worsening of anxiety, depression, and substance use resulting from increased isolation related to physical distancing and shelter-in-place guidelines.

Summary: All older adults should be routinely screened for AUD with standardized screening tools. If a patient's screening results are positive, a clinician should conduct a brief assessment, which may be supplemented by laboratory tests. Most older adults at risk for alcohol misuse do not need specialized SUD treatment, but most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Medications for the treatment of AUD in older adults include naltrexone, acamprosate, disulfiram, gabapentin and topiramate. Psychosocial treatments, including mutual help groups, are equally important.

综述目的:美国老年人中酒精使用障碍(AUD)的患病率正在上升,但仍未得到充分诊断、报告不足和管理不足。本综述强调老年AUD的医学、社会和文化因素,并为其筛查、评估和管理提供指导。最近的发现:COVID-19大流行给护理带来了额外的挑战和障碍,因为与保持身体距离和就地避难指南相关的隔离加剧,老年人的焦虑、抑郁和药物使用可能会不成比例地恶化。总结:所有老年人都应该使用标准化的筛查工具进行常规AUD筛查。如果患者的筛查结果呈阳性,临床医生应进行简短的评估,并可辅以实验室检查。大多数有酒精滥用风险的老年人不需要专门的SUD治疗,但大多数人可以从筛查,短暂干预和转诊治疗(SBIRT)中受益,以防止药物滥用发生。治疗老年人AUD的药物包括纳曲酮、阿坎普罗酸、双硫仑、加巴喷丁和托吡酯。包括互助小组在内的社会心理治疗也同样重要。
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引用次数: 7
Mobility in Acute Care for Geriatric Patients with Orthopedic Conditions: a Review of Recent Literature 老年骨科患者急性护理中的活动能力:近期文献综述
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2020-12-01 DOI: 10.1007/s13670-020-00347-1
Madison N. Peck, Amy K. Holthaus, Katelyn Kingsbury, Marka Salsberry, Vijay Duggirala
{"title":"Mobility in Acute Care for Geriatric Patients with Orthopedic Conditions: a Review of Recent Literature","authors":"Madison N. Peck, Amy K. Holthaus, Katelyn Kingsbury, Marka Salsberry, Vijay Duggirala","doi":"10.1007/s13670-020-00347-1","DOIUrl":"https://doi.org/10.1007/s13670-020-00347-1","url":null,"abstract":"","PeriodicalId":38089,"journal":{"name":"Current Geriatrics Reports","volume":"9 1","pages":"300 - 310"},"PeriodicalIF":1.2,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s13670-020-00347-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41390444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Effect of prehabilitation in older adults undergoing total joint replacement: An Overview of Systematic Reviews. 老年人全关节置换术的康复效果:系统综述。
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2020-12-01 Epub Date: 2020-11-24 DOI: 10.1007/s13670-020-00342-6
Gustavo J Almeida, Samannaaz S Khoja, Boris A Zelle

Purpose of review: To review and discuss the findings of systematic reviews that synthesized the evidence on the effect of preoperative exercises (prehabilitation) on postoperative functional recovery in older adults undergoing total knee or hip joint replacement.

Recent findings: Ten systematic reviews (8 meta-analyses) were included in this review. Findings from the systematic reviews indicated that prehabilitation decreases length of hospital stay but does not improve postoperative functional recovery in older adults undergoing joint replacement. Individual studies in the systematic reviews varied considerably in prehabilitation protocol, assessment timepoints, and outcome measures. Most importantly, systematic reviews did not assess the outcomes pre-post prehabilitation as this timepoint was not addressed in most individual studies. Therefore, it is not known whether the prehabilitation programs improved outcomes preoperatively.

Summary: There is a need to develop comprehensive prehabilitation protocols and systematically assess the preoperative and postoperative effectiveness of prehabilitation protocols on functional outcomes (i.e., self-reported and performance-based) in older adults undergoing total joint replacement.

综述目的:回顾和讨论系统综述的结果,这些综述综合了术前锻炼(预适应)对老年人全膝关节或髋关节置换术后功能恢复的影响。最新发现:本综述纳入了10项系统综述(8项荟萃分析)。系统综述的研究结果表明,康复治疗减少了接受关节置换术的老年人的住院时间,但并不能改善其术后功能恢复。系统综述中的个别研究在康复方案、评估时间点和结果测量方面差异很大。最重要的是,系统评价没有评估康复前后的结果,因为这个时间点在大多数个体研究中没有得到解决。因此,尚不清楚康复方案是否能改善术前预后。总结:有必要制定全面的康复方案,并系统地评估术前和术后康复方案对老年人全关节置换术的功能结果(即自我报告和基于表现的)的有效性。
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引用次数: 9
Type 2 Diabetes and Mediterranean Diet in Older Adults: a Brief Review of the Evidence 老年2型糖尿病和地中海饮食:证据综述
IF 1.2 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2020-11-18 DOI: 10.1007/s13670-020-00340-8
Eirini Mamalaki, V. Balomenos, N. Scarmeas, M. Yannakoulia
{"title":"Type 2 Diabetes and Mediterranean Diet in Older Adults: a Brief Review of the Evidence","authors":"Eirini Mamalaki, V. Balomenos, N. Scarmeas, M. Yannakoulia","doi":"10.1007/s13670-020-00340-8","DOIUrl":"https://doi.org/10.1007/s13670-020-00340-8","url":null,"abstract":"","PeriodicalId":38089,"journal":{"name":"Current Geriatrics Reports","volume":"9 1","pages":"237 - 241"},"PeriodicalIF":1.2,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s13670-020-00340-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45506646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Current Geriatrics Reports
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