Background: The global trend towards an increasing aging population demands for adequate geriatric medical care services to cater for health needs of the aging population seeking clinical care in hospitals. In Uganda, geriatric care as a specialty in medicine is still at infancy stage, and this is further worsened by the fact that the current curricula followed in training health workers lacks a component dedicated to elderly care. There is therefore need to assess knowledge, attitudes and treatment practices of medical doctors towards clinical care for elderly persons. Objective: We aimed to assess knowledge, attitudes and treatment practices of medical doctors towards care for elderly persons accessing clinical care services at hospitals in Kampala. Methods: We conducted a cross sectional descriptive study between April and June 2019 at outpatient’s clinics, inpatients wards and non-communicable disease clinics at selected hospitals in Kampala Capital City Authority Uganda. All medical doctors providing direct clinical care to elderly persons at the selected hospitals and meeting the inclusion criteria were selected using a multi stage clusters ampling method. Those who consented were interviewed using a pre-tested semi structured questionnaire. The Knowledge about Older Persons-Q (KOP-Q) scale and the Older People in Acute Care Survey-United States (OPACSUS) scale were utilized, and responses measured on a Likert scale coded and entered into Microsoft Excel 2010, cleaned and then exported to STATA 13 for analysis. A generalized linear model was used with the family of Poisson and log link with robust standard error to provide prevalence ratio as a measure of association with corresponding 95% confidence intervals and p-values. Ethical clearance was obtained from the respective hospital Institutional Review Boards, Higher Degrees Research and Ethics Committee at Makerere University School of Public Health, and Uganda National Council of Science and Technology. Results: Among the 110 respondents, 73 (66.4%) medical doctors had suboptimal knowledge on clinical care of elderly patients, majority of medical doctors demonstrated a positive attitude towards care of elderly persons and over threequarters 82 (74.5%) of medical doctors did not routinely observe recommended treatment practices when caring for elderly patients. Factors found to be significantly associated with knowledge on clinical care of elderly persons were level of education of medical doctors and frequency of refresher trainings on geriatric care. Similarly, level of education of medical doctors and hospital affiliation were significantly associated with treatment practices when caring for elderly patients. Conclusions: Majority of medical doctors had suboptimal knowledge on geriatric care, with a majority failing to follow routine recommended treatment practices when caring for elderly patients. Recommendations: Therefore, the higher education division of Ministry of Education shoul
{"title":"Knowledge, Attitudes and Treatment Practices of Medical Doctors towards Care of Elderly Patients Accessing Clinical Care at Hospitals in Kampala Uganda","authors":"Orit Daniel, Ntege Patricia, Nakayiwa Dorah, Nambooze Jemimah, Olikira Sebastian, Kabwama Stephen","doi":"10.23937/2469-5858/1510114","DOIUrl":"https://doi.org/10.23937/2469-5858/1510114","url":null,"abstract":"Background: The global trend towards an increasing aging population demands for adequate geriatric medical care services to cater for health needs of the aging population seeking clinical care in hospitals. In Uganda, geriatric care as a specialty in medicine is still at infancy stage, and this is further worsened by the fact that the current curricula followed in training health workers lacks a component dedicated to elderly care. There is therefore need to assess knowledge, attitudes and treatment practices of medical doctors towards clinical care for elderly persons. Objective: We aimed to assess knowledge, attitudes and treatment practices of medical doctors towards care for elderly persons accessing clinical care services at hospitals in Kampala. Methods: We conducted a cross sectional descriptive study between April and June 2019 at outpatient’s clinics, inpatients wards and non-communicable disease clinics at selected hospitals in Kampala Capital City Authority Uganda. All medical doctors providing direct clinical care to elderly persons at the selected hospitals and meeting the inclusion criteria were selected using a multi stage clusters ampling method. Those who consented were interviewed using a pre-tested semi structured questionnaire. The Knowledge about Older Persons-Q (KOP-Q) scale and the Older People in Acute Care Survey-United States (OPACSUS) scale were utilized, and responses measured on a Likert scale coded and entered into Microsoft Excel 2010, cleaned and then exported to STATA 13 for analysis. A generalized linear model was used with the family of Poisson and log link with robust standard error to provide prevalence ratio as a measure of association with corresponding 95% confidence intervals and p-values. Ethical clearance was obtained from the respective hospital Institutional Review Boards, Higher Degrees Research and Ethics Committee at Makerere University School of Public Health, and Uganda National Council of Science and Technology. Results: Among the 110 respondents, 73 (66.4%) medical doctors had suboptimal knowledge on clinical care of elderly patients, majority of medical doctors demonstrated a positive attitude towards care of elderly persons and over threequarters 82 (74.5%) of medical doctors did not routinely observe recommended treatment practices when caring for elderly patients. Factors found to be significantly associated with knowledge on clinical care of elderly persons were level of education of medical doctors and frequency of refresher trainings on geriatric care. Similarly, level of education of medical doctors and hospital affiliation were significantly associated with treatment practices when caring for elderly patients. Conclusions: Majority of medical doctors had suboptimal knowledge on geriatric care, with a majority failing to follow routine recommended treatment practices when caring for elderly patients. Recommendations: Therefore, the higher education division of Ministry of Education shoul","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45117699","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}
Pub Date : 2021-06-23DOI: 10.23937/2469-5858/1510115
Niv Yaron, Kuniavsky Michael, K. Alexander, Bronshtein Olga, Goldschmidt Nethanel, Han ShuLi, Mahalla Hannah
Background: Hip fractures are common among the elderly, due to lack of mobility, osteopenia and hypocalcaemia. Surgery for repairing a fracture in the femoral neck within 48 hours improves the clinical outcome. Objective: To measure the performance rate of hip fracture repair within 48 hours of admission, and the effect on mortality. Methods: The data were obtained from the Israeli National Program for Quality Indicators. The denominator included all the patients 65-year-old or older who was admitted and operated because of hip fracture, and the numerator included those who underwent surgical repair within 48 hours of admission. Results: There has been a significant improvement in the national level of compliance within 48 hour time spanfrom 71% in 2013 to 87% in 2018. The success rate for total hip replacement (THR) was 53%, 68%, 74%, 81%, 79% and 78%, for partial hip replacement (PHR) the success rate was 66%, 76%, 80%, 82%, 84%, and 86%, and for fixation it was 74%, 80%, 85%, 89%, 89% and 89%, for 2013, 2014, 2015, 2016, 2017 and 2018, respectively. The mortality rate within 30 days of the admission was 4% in patients who underwent hip fracture repair within 48 hours of the admission, and 6.1% in the patients who did not, respectively, with odds ratio (OR) of 0.645, 95% CI 0.5730.726, P < 0.0001. Conclusion: We could demonstrate a significant decrease in mortality of patients with hip fracture who underwent hip fracture repair within 48 hours of admission.
{"title":"Performing Hip Fracture Repair within 48 Hours from Admission May Decrease Mortality, the Israeli National Program for Quality Indicators Experience","authors":"Niv Yaron, Kuniavsky Michael, K. Alexander, Bronshtein Olga, Goldschmidt Nethanel, Han ShuLi, Mahalla Hannah","doi":"10.23937/2469-5858/1510115","DOIUrl":"https://doi.org/10.23937/2469-5858/1510115","url":null,"abstract":"Background: Hip fractures are common among the elderly, due to lack of mobility, osteopenia and hypocalcaemia. Surgery for repairing a fracture in the femoral neck within 48 hours improves the clinical outcome. Objective: To measure the performance rate of hip fracture repair within 48 hours of admission, and the effect on mortality. Methods: The data were obtained from the Israeli National Program for Quality Indicators. The denominator included all the patients 65-year-old or older who was admitted and operated because of hip fracture, and the numerator included those who underwent surgical repair within 48 hours of admission. Results: There has been a significant improvement in the national level of compliance within 48 hour time spanfrom 71% in 2013 to 87% in 2018. The success rate for total hip replacement (THR) was 53%, 68%, 74%, 81%, 79% and 78%, for partial hip replacement (PHR) the success rate was 66%, 76%, 80%, 82%, 84%, and 86%, and for fixation it was 74%, 80%, 85%, 89%, 89% and 89%, for 2013, 2014, 2015, 2016, 2017 and 2018, respectively. The mortality rate within 30 days of the admission was 4% in patients who underwent hip fracture repair within 48 hours of the admission, and 6.1% in the patients who did not, respectively, with odds ratio (OR) of 0.645, 95% CI 0.5730.726, P < 0.0001. Conclusion: We could demonstrate a significant decrease in mortality of patients with hip fracture who underwent hip fracture repair within 48 hours of admission.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42741667","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}
Aim. Postoperative delirium (PD) is a common complication of surgery in elderly patients, but its pathophysiological mechanism remains unclear. In order to clarify the role of intraoperative hypotension and fluctuation of blood pressure in the development of PD, we conducted a follow-up study in elderly patients with intraoperative hypotension and fluctuation of blood pressure. Methods. Patients who underwent hip surgery in 2018-2019 were selected. One day before the operation, the mentality of patients were evaluated by Mini-mental State Examination (MMSE), and the sex, age, height and weight of the patients were recorded. Radial artery puncture was performed in all patients before anesthesia, intraoperative SBP, MAP and DBP were recorded, and the surgical events of the patients was recorded. The markers associated with PD (TNF-α, IL-6 and S-100β ) were determined before and after surgery. Perioperative delirium（PD） was assessed by the prevailing standard of assessment, Confusion of Consciousness Assessment (CAM).. Cognitive assessment was evaluated using the Mini-mental State Examination (MMSE). In addition, the timing and type of delirium were recorded. Result. There were 158 patients which were accorded with the inclusion criteria came into the study. The results of our data showed that delirium occurred in 41 patients (25.9%) during the first week after surgery. In the comparison between the PD group and the non-PD group, it was found that the patients with postoperative delirium were older, lower body mass index and higher MMSE score before operation. Intraoperative blood pressure is low, usually more than 30% lower than preoperative blood pressure. The levels of TNF- α, IL-6 and Smur100 β were higher after operation. Conclusion. The increased incidence of postoperative delirium may be related to intraoperative hypotension and intraoperative blood pressure fluctuation. The pathophysiological mechanism may be that hypotension causes low cerebral perfusion, which in turn causes local inflammation in the brain. In addition, postoperative delirium is also more likely to occur in older patients with lower body mass index.
{"title":"Postoperative Delirium in Elderly Patients May Be Associated with Perioperative Blood Pressure Fluctuations","authors":"Daxu Peng, Qingchen Liu, Xiuyang Cao, G. Deng","doi":"10.30564/JGM.V3I1.2892","DOIUrl":"https://doi.org/10.30564/JGM.V3I1.2892","url":null,"abstract":"Aim. Postoperative delirium (PD) is a common complication of surgery in elderly patients, but its pathophysiological mechanism remains unclear. In order to clarify the role of intraoperative hypotension and fluctuation of blood pressure in the development of PD, we conducted a follow-up study in elderly patients with intraoperative hypotension and fluctuation of blood pressure. Methods. Patients who underwent hip surgery in 2018-2019 were selected. One day before the operation, the mentality of patients were evaluated by Mini-mental State Examination (MMSE), and the sex, age, height and weight of the patients were recorded. Radial artery puncture was performed in all patients before anesthesia, intraoperative SBP, MAP and DBP were recorded, and the surgical events of the patients was recorded. The markers associated with PD (TNF-α, IL-6 and S-100β ) were determined before and after surgery. Perioperative delirium（PD） was assessed by the prevailing standard of assessment, Confusion of Consciousness Assessment (CAM).. Cognitive assessment was evaluated using the Mini-mental State Examination (MMSE). In addition, the timing and type of delirium were recorded. Result. There were 158 patients which were accorded with the inclusion criteria came into the study. The results of our data showed that delirium occurred in 41 patients (25.9%) during the first week after surgery. In the comparison between the PD group and the non-PD group, it was found that the patients with postoperative delirium were older, lower body mass index and higher MMSE score before operation. Intraoperative blood pressure is low, usually more than 30% lower than preoperative blood pressure. The levels of TNF- α, IL-6 and Smur100 β were higher after operation. Conclusion. The increased incidence of postoperative delirium may be related to intraoperative hypotension and intraoperative blood pressure fluctuation. The pathophysiological mechanism may be that hypotension causes low cerebral perfusion, which in turn causes local inflammation in the brain. In addition, postoperative delirium is also more likely to occur in older patients with lower body mass index.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79202720","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}
Pub Date : 2021-01-01DOI: 10.23937/2469-5858/1510116
McDonough Carol C
Older adults as a group, globally, have a significantly lower rate of internet use than the overall population. Concerns about this age-based digital divide have increased because of the COVID pandemic, since tele-health has been an effective method of delivering medical care to older adults. This study examines the effects of age perception and network externalities on the internet use decision of ablebodied older adults. Data were obtained by in-person interviews of older adults at senior centers. The results of logistic regressions and Chi square analysis showed that negative age perception significantly reduced the probability of internet use and that positive network externalities were associated with a higher rate of internet use. The paper also comments on whether an age-based digital divide will continue as today’s digital natives become older adults.
{"title":"Do Age Perception and Network Externalities Help to Explain the Age-Based Digital Divide?","authors":"McDonough Carol C","doi":"10.23937/2469-5858/1510116","DOIUrl":"https://doi.org/10.23937/2469-5858/1510116","url":null,"abstract":"Older adults as a group, globally, have a significantly lower rate of internet use than the overall population. Concerns about this age-based digital divide have increased because of the COVID pandemic, since tele-health has been an effective method of delivering medical care to older adults. This study examines the effects of age perception and network externalities on the internet use decision of ablebodied older adults. Data were obtained by in-person interviews of older adults at senior centers. The results of logistic regressions and Chi square analysis showed that negative age perception significantly reduced the probability of internet use and that positive network externalities were associated with a higher rate of internet use. The paper also comments on whether an age-based digital divide will continue as today’s digital natives become older adults.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68751800","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}
Pub Date : 2020-10-22DOI: 10.23937/2469-5858/1510100
Dionísio Antony Soares, Gomes João Filipe, Veríssimo Manuel Teixeira Marques
Purpose: Mistreatment in the elderly people represents an increasing problem in today’s society, making it crucial to understand its true impact. This study aims to evaluate the signs of mistreatment in a population of elderly people admitted and relate them with risk factors. Methods: The data was obtained a questionnaire, with the participation of 100 elderly people The questionnaire was divided into 5 sections, al-lowing the collection of sociodemographic and health data, information on emotional status (Geriatric Depression Scale) and functional status (Katz Index) and the prevalence of abuse indicators with the Question to Elicit Elder Abuse (QEEA) instrument. Results: The analysis of the results concludes that 36% of the participants report at least one indicator of abuse. Emotional abuse (29%) and neglect (24%) are more frequently detected, followed by financial abuse (12%) and physical abuse (5%). When relating the indicators of mistreatment with the other variables, it is concluded that there is an association between the number of mistreatment indicators and female gender, low educational level, depressive symptoms and increased functional dependence. Conclusion: This study is alerting us to the high number of elderly people with signals of mistreatment in CHUC, a central Hospital in Coimbra, Portugal. It is important that the medical and other health professionals become of the issue in order to develop policies capable of minimizing this situation.
{"title":"Elder Abuse: Characterization of a Population Hospitalized in CHUC","authors":"Dionísio Antony Soares, Gomes João Filipe, Veríssimo Manuel Teixeira Marques","doi":"10.23937/2469-5858/1510100","DOIUrl":"https://doi.org/10.23937/2469-5858/1510100","url":null,"abstract":"Purpose: Mistreatment in the elderly people represents an increasing problem in today’s society, making it crucial to understand its true impact. This study aims to evaluate the signs of mistreatment in a population of elderly people admitted and relate them with risk factors. Methods: The data was obtained a questionnaire, with the participation of 100 elderly people The questionnaire was divided into 5 sections, al-lowing the collection of sociodemographic and health data, information on emotional status (Geriatric Depression Scale) and functional status (Katz Index) and the prevalence of abuse indicators with the Question to Elicit Elder Abuse (QEEA) instrument. Results: The analysis of the results concludes that 36% of the participants report at least one indicator of abuse. Emotional abuse (29%) and neglect (24%) are more frequently detected, followed by financial abuse (12%) and physical abuse (5%). When relating the indicators of mistreatment with the other variables, it is concluded that there is an association between the number of mistreatment indicators and female gender, low educational level, depressive symptoms and increased functional dependence. Conclusion: This study is alerting us to the high number of elderly people with signals of mistreatment in CHUC, a central Hospital in Coimbra, Portugal. It is important that the medical and other health professionals become of the issue in order to develop policies capable of minimizing this situation.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45165165","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}
Pub Date : 2020-09-30DOI: 10.23937/2469-5858/1510098
Thompson Nicholas J, Richter Margaret E, Dillon Margaret T, Pillsbury Harold C
Older adults who qualify for cochlear implantation demonstrate significant improvements in speech recognition and quality of life with cochlear implant use. Cochlear implantation is a safe and effective procedure for patients with hearing loss, with some additional medical considerations specific to older adult patients. The indications for cochlear implantation have expanded from cases of bilateral severe-to-profound hearing loss to cases of normal-to-moderate low-frequency hearing sensitivity and severe-to-profound high-frequency hearing loss. The expansion of indications for cochlear implantation was prompted by evidence of low-frequency hearing preservation due to modified electrode array designs and surgical techniques, and significantly improved performance when listening with the combination of acoustic and electric stimulation (EAS) in the same ear. Older adults who underwent cochlear implantation as part of clinical trials investigating the effectiveness of EAS have been shown to experience significantly improved speech recognition and quality of life as compared to preoperative performance with conventional hearing aids. REviEw ARTiClE
{"title":"Cochlear Implantation in Older Adults: Effectiveness and Expanded Indications","authors":"Thompson Nicholas J, Richter Margaret E, Dillon Margaret T, Pillsbury Harold C","doi":"10.23937/2469-5858/1510098","DOIUrl":"https://doi.org/10.23937/2469-5858/1510098","url":null,"abstract":"Older adults who qualify for cochlear implantation demonstrate significant improvements in speech recognition and quality of life with cochlear implant use. Cochlear implantation is a safe and effective procedure for patients with hearing loss, with some additional medical considerations specific to older adult patients. The indications for cochlear implantation have expanded from cases of bilateral severe-to-profound hearing loss to cases of normal-to-moderate low-frequency hearing sensitivity and severe-to-profound high-frequency hearing loss. The expansion of indications for cochlear implantation was prompted by evidence of low-frequency hearing preservation due to modified electrode array designs and surgical techniques, and significantly improved performance when listening with the combination of acoustic and electric stimulation (EAS) in the same ear. Older adults who underwent cochlear implantation as part of clinical trials investigating the effectiveness of EAS have been shown to experience significantly improved speech recognition and quality of life as compared to preoperative performance with conventional hearing aids. REviEw ARTiClE","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45947266","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}
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