The growth of the ageing population and the desires for ageing-in-place have resulted in an ever-increasing need for housing that can support the independent living of the elderly with care needs. As impairments and care needs increase, spatial use typically changes. However, there is limited information on how to accommodate leisure activities and spatial use in private dwellings to inform housing design. Through an ethnographic investigation of 30 high-needs elderly people living independently, patterns of spatial use for personal leisure activities were established. Seven key themes for residents’ perceptions were revealed, which include; comfort in posture, access to sunshine and warmth, facilitating activities to occupy residents, views to outside, control for doing everything from one space, and keeping active. In the design of housing for the high-needs elderly, greater attention should be given to the micro-environment of the main sitting space, to improve occupant control while enhancing comfort and warmth. This paper provides key considerations for housing design, which will help elderly people continue their fulfilled life in their own home as long as possible.
{"title":"Understanding the Spatial Requirements that Facilitate Personal Leisure Activities of the High-Needs Elderly","authors":"Y. Kuboshima, J. McIntosh","doi":"10.30564/JGM.V2I1.2256","DOIUrl":"https://doi.org/10.30564/JGM.V2I1.2256","url":null,"abstract":"The growth of the ageing population and the desires for ageing-in-place have resulted in an ever-increasing need for housing that can support the independent living of the elderly with care needs. As impairments and care needs increase, spatial use typically changes. However, there is limited information on how to accommodate leisure activities and spatial use in private dwellings to inform housing design. Through an ethnographic investigation of 30 high-needs elderly people living independently, patterns of spatial use for personal leisure activities were established. Seven key themes for residents’ perceptions were revealed, which include; comfort in posture, access to sunshine and warmth, facilitating activities to occupy residents, views to outside, control for doing everything from one space, and keeping active. In the design of housing for the high-needs elderly, greater attention should be given to the micro-environment of the main sitting space, to improve occupant control while enhancing comfort and warmth. This paper provides key considerations for housing design, which will help elderly people continue their fulfilled life in their own home as long as possible. ","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83651177","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}
Objective: To explore the the status of happiness and social support of empty nesters in Guangdong Province and analyze the relationship between the above two variables.Method: Totally 1148 empty nesters (776 males, 734 females) from 5 cities in Guangdong province are selected by stratified random sampling and conducted with Memorial University of Newfoundland Scale of Happiness (MUNSH), Social Support Rating Scale (SSRS), Mini-Mental State Examination (MMSE) and a self-edited questionnaire on the general information.Results: The total score of MUNSH is (10.20±6.37). The total score and the scores of the 3 dimensions of objective support, subject support, the use of support in SSRS are (30.79±5.51), (9.24±2.37), (19.38±4.95) and (9.22±2.15) respectively. Multiple variable linear regression show that are positively associated with the total scores of MUNSH (B= .227, .115, .098，.158，.082，respectively, P＜.05). was negatively associated with total score of MUNSH (B=-.097，P＜.05).Conclusion：It suggests that the sort of leisure, gender, progress rank, family characteristics, such as family economic condition and father's career may be related factors of undergraduates life satisfaction.
{"title":"Subjective Well-Being among Empty-Nest Elderly and Its Related Factors：Taking Guangdong Province as an Example","authors":"Yongmei Hou, Zixu Guo, Que Zheng","doi":"10.30564/jgm.v1i3.2225","DOIUrl":"https://doi.org/10.30564/jgm.v1i3.2225","url":null,"abstract":"Objective: To explore the the status of happiness and social support of empty nesters in Guangdong Province and analyze the relationship between the above two variables.Method: Totally 1148 empty nesters (776 males, 734 females) from 5 cities in Guangdong province are selected by stratified random sampling and conducted with Memorial University of Newfoundland Scale of Happiness (MUNSH), Social Support Rating Scale (SSRS), Mini-Mental State Examination (MMSE) and a self-edited questionnaire on the general information.Results: The total score of MUNSH is (10.20±6.37). The total score and the scores of the 3 dimensions of objective support, subject support, the use of support in SSRS are (30.79±5.51), (9.24±2.37), (19.38±4.95) and (9.22±2.15) respectively. Multiple variable linear regression show that are positively associated with the total scores of MUNSH (B= .227, .115, .098，.158，.082，respectively, P＜.05). was negatively associated with total score of MUNSH (B=-.097，P＜.05).Conclusion：It suggests that the sort of leisure, gender, progress rank, family characteristics, such as family economic condition and father's career may be related factors of undergraduates life satisfaction.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78811602","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}
Population ageing is an issue of worldwide importance. People are living longer due to advances in education, technology, medicine, food distribution, and public health. While the COVID-19 pandemic has significant global impacts, in many countries the elderlyface threats and challenges that are unique and disproportionately severe. One such threat is that aging results in a decline in immune function, meaning elderly bodies respond more slowly and less effectively to external threats like COVID-19. Responses at individual, family, community and societal levels should take into account the heightened vulnerability of older adults during this pandemic.
{"title":"Covid-19 and Immunity in the Elderly","authors":"H. Chalise, Ed Rosenberg","doi":"10.30564/jgm.v1i3.2049","DOIUrl":"https://doi.org/10.30564/jgm.v1i3.2049","url":null,"abstract":"Population ageing is an issue of worldwide importance. People are living longer due to advances in education, technology, medicine, food distribution, and public health. While the COVID-19 pandemic has significant global impacts, in many countries the elderlyface threats and challenges that are unique and disproportionately severe. One such threat is that aging results in a decline in immune function, meaning elderly bodies respond more slowly and less effectively to external threats like COVID-19. Responses at individual, family, community and societal levels should take into account the heightened vulnerability of older adults during this pandemic.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76500998","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}
A. Yousaf, K. Singh, Victoria Tavernor, A. Baldwin
Neurosurgical treatment for psychiatric disorders features a long and controversial history. This article explores a ‘spectrum of psychosurgery,’ describing how old-fashioned and controversial prefrontal lobotomy gradually evolved into modern day, mainstream scientific deep brain stimulation (DBS). We focus on the rise, fall and possible re-emergence of psychosurgery as a therapeutic intervention today.We journey through historic indiscriminate use of prefrontal lobotomy, which evoked stern criticism from both public and professionals, through to the development of modern day DBS - performed for patients suffering from severe, treatment resistant symptoms of obsessive-compulsive disorder (OCD), epilepsy and movement disorders.We hope this article will provide a basis for understanding the availability of existing treatment options and potential future opportunities, whilst simultaneously challenging any public/professional preconceptions of psychosurgery, which may indirectly be obstructing patient care.Additionally, we carried out a qualitative survey displayed in WordCloud Format, capturing the intellection of 38 mental health professionals working for North West Boroughs NHS Healthcare Foundation Trust, on ‘psychosurgery,’ ‘prefrontal lobotomy’ and ‘DBS’, which may well reflect wider public opinion.In summary, the article provides a brief, yet comprehensive overview of the controversial history of psychosurgery, present-day practice, and future trends of neurosurgery for psychiatric disorders.
{"title":"Psychosurgery : A history from Prefrontal Lobotomy to Deep Brain Stimulation","authors":"A. Yousaf, K. Singh, Victoria Tavernor, A. Baldwin","doi":"10.30564/jgm.v1i3.1943","DOIUrl":"https://doi.org/10.30564/jgm.v1i3.1943","url":null,"abstract":"Neurosurgical treatment for psychiatric disorders features a long and controversial history. This article explores a ‘spectrum of psychosurgery,’ describing how old-fashioned and controversial prefrontal lobotomy gradually evolved into modern day, mainstream scientific deep brain stimulation (DBS). We focus on the rise, fall and possible re-emergence of psychosurgery as a therapeutic intervention today.We journey through historic indiscriminate use of prefrontal lobotomy, which evoked stern criticism from both public and professionals, through to the development of modern day DBS - performed for patients suffering from severe, treatment resistant symptoms of obsessive-compulsive disorder (OCD), epilepsy and movement disorders.We hope this article will provide a basis for understanding the availability of existing treatment options and potential future opportunities, whilst simultaneously challenging any public/professional preconceptions of psychosurgery, which may indirectly be obstructing patient care.Additionally, we carried out a qualitative survey displayed in WordCloud Format, capturing the intellection of 38 mental health professionals working for North West Boroughs NHS Healthcare Foundation Trust, on ‘psychosurgery,’ ‘prefrontal lobotomy’ and ‘DBS’, which may well reflect wider public opinion.In summary, the article provides a brief, yet comprehensive overview of the controversial history of psychosurgery, present-day practice, and future trends of neurosurgery for psychiatric disorders.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90304408","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 : 2020-06-29DOI: 10.23937/2469-5858/1510092
Kalpana P Padala, Ashlyn M Jendro, Kerrie B Wilson, Prasad R Padala
Coronavirus Disease (COVID-19) related ‘social distancing’ and stay-home recommendations have adversely impacted the ‘behavioral pandemics’ of old age; these include physical inactivity (PI) and lonelinesss [1,2]. To make matters worse, PI and loneliness are intertwined, with one worsening the other. In particular, sedentary behavior and PI are strongly associated with loneliness among those aged 50–81 years [3]. Loneliness is a subjective, stressful, and distressing feeling that results from a perceived loss of companionship and affects over 20% of older adults in the US [4]. Loneliness can cause feelings of social isolation, which has been attributed to more deaths in the US than cancer or stroke [2]. Physical inactivity is high in older adults, with most men (66%) and women (83%) over the age of 65 not meeting physical activity (PA) recommendations. Consequently, PI and health repercussions account for about $117 billion (11%) of US healthcare expenditure annually [5].
{"title":"Technology Use to Bridge the Gap of Social Distancing during COVID-19.","authors":"Kalpana P Padala, Ashlyn M Jendro, Kerrie B Wilson, Prasad R Padala","doi":"10.23937/2469-5858/1510092","DOIUrl":"https://doi.org/10.23937/2469-5858/1510092","url":null,"abstract":"Coronavirus Disease (COVID-19) related ‘social distancing’ and stay-home recommendations have adversely impacted the ‘behavioral pandemics’ of old age; these include physical inactivity (PI) and lonelinesss [1,2]. To make matters worse, PI and loneliness are intertwined, with one worsening the other. In particular, sedentary behavior and PI are strongly associated with loneliness among those aged 50–81 years [3]. Loneliness is a subjective, stressful, and distressing feeling that results from a perceived loss of companionship and affects over 20% of older adults in the US [4]. Loneliness can cause feelings of social isolation, which has been attributed to more deaths in the US than cancer or stroke [2]. Physical inactivity is high in older adults, with most men (66%) and women (83%) over the age of 65 not meeting physical activity (PA) recommendations. Consequently, PI and health repercussions account for about $117 billion (11%) of US healthcare expenditure annually [5].","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/a5/nihms-1656921.PMC7839070.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38836260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-04DOI: 10.5772/intechopen.89385
E. Zawada
Geriatrics has been identified as a subspecialty by virtue of a board certification since the mid-1980s by the American Board of Internal Medicine. The original core of knowledge was primarily the extension of the diagnoses and management of diseases of organ systems to the three age groups over the age of 60 years: youngold was 60–70, old was 70–80, and old-old was over 80 years of age. At that time I became interested in geriatrics by focusing on elders with renal and urology diseases [1]. At the beginning I researched the anatomic and physiologic changes of the kidney and urinary system, and then later each other major organ system of the body. My work in renal and urologic diseases led to editing my first book in the field [2]. As I delved into caring for the elderly, I became exposed to the knowledge of problems which are outside of the individual organ systems like “falls” or problems which affect every organ system like “geropharmacology.” Over the decades since then, the role of the geriatrician who is the primary care provider for the elderly requires knowledge in a multitude of other specialties beyond internal medicine such as ophthalmology, ENT, audiology, neurology, orthopedics, and physiatry. I will present the earliest skills needed for the care of the elderly followed by the newest skills now incorporated into the subject matter of geriatrics. The chapters in this book mostly represent a catalog of the newer skills.
{"title":"Introductory Chapter: Geriatrics","authors":"E. Zawada","doi":"10.5772/intechopen.89385","DOIUrl":"https://doi.org/10.5772/intechopen.89385","url":null,"abstract":"Geriatrics has been identified as a subspecialty by virtue of a board certification since the mid-1980s by the American Board of Internal Medicine. The original core of knowledge was primarily the extension of the diagnoses and management of diseases of organ systems to the three age groups over the age of 60 years: youngold was 60–70, old was 70–80, and old-old was over 80 years of age. At that time I became interested in geriatrics by focusing on elders with renal and urology diseases [1]. At the beginning I researched the anatomic and physiologic changes of the kidney and urinary system, and then later each other major organ system of the body. My work in renal and urologic diseases led to editing my first book in the field [2]. As I delved into caring for the elderly, I became exposed to the knowledge of problems which are outside of the individual organ systems like “falls” or problems which affect every organ system like “geropharmacology.” Over the decades since then, the role of the geriatrician who is the primary care provider for the elderly requires knowledge in a multitude of other specialties beyond internal medicine such as ophthalmology, ENT, audiology, neurology, orthopedics, and physiatry. I will present the earliest skills needed for the care of the elderly followed by the newest skills now incorporated into the subject matter of geriatrics. The chapters in this book mostly represent a catalog of the newer skills.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85495104","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 : 2019-12-04DOI: 10.5772/intechopen.86662
M. A. Ibarra, José Antonio De la Peña Celaya
The management of acute lymphoblastic leukemia is a challenge in patients of any age range. In the elderly patient, this challenge is further complicated by having to take into account the physical, social, psychological, and emotional factors of this age group, which, together with the complex nature of the disease’s biology, give rise to many questions. Although the diagnostic approach of the disease does not differ from that performed in pediatric or young patients, it does in the determination of risk factors and treatment, since many of the determinants of risk have a different value to that assigned in other patients, and, therefore, we cannot apply all available resources in younger patients to facilitate our work. The genetic alterations of ALL are found more frequently in elderly patients, since age is a factor that increases the risk of presenting these alterations. As an example, the prognostic value of the presence of Philadelphia chromosome (t (9:22)) cannot be weighted at the same scale as in pediatric patients. Comorbidities play another important role when it comes to making therapeutic decisions, and there is currently controversy regarding the use of scores designed to determine the physical and physiological status of elderly subjects. Several analyzes have been carried out to define the value and usefulness of these tools in the older patients with ALL; however, work must still be done in this area. The treatment schemes should be adjusted to the needs and specific characteristics of each individual in advanced age. The use of intensive chemotherapy should be discussed within a multidisciplinary team, always considering the benefit of our patients. In the present chapter, the diverse differences in ALL biology will be addressed when compared with those of children and young adults, and with the impact on the different prognostic determinants and their weight at the time of deciding treatment. The need to apply geriatric tools for decision-making and the therapeutic schemes used around the world for elderly people will also be discussed.
{"title":"Overview and Current News in Acute Lymphoblastic Leukemia","authors":"M. A. Ibarra, José Antonio De la Peña Celaya","doi":"10.5772/intechopen.86662","DOIUrl":"https://doi.org/10.5772/intechopen.86662","url":null,"abstract":"The management of acute lymphoblastic leukemia is a challenge in patients of any age range. In the elderly patient, this challenge is further complicated by having to take into account the physical, social, psychological, and emotional factors of this age group, which, together with the complex nature of the disease’s biology, give rise to many questions. Although the diagnostic approach of the disease does not differ from that performed in pediatric or young patients, it does in the determination of risk factors and treatment, since many of the determinants of risk have a different value to that assigned in other patients, and, therefore, we cannot apply all available resources in younger patients to facilitate our work. The genetic alterations of ALL are found more frequently in elderly patients, since age is a factor that increases the risk of presenting these alterations. As an example, the prognostic value of the presence of Philadelphia chromosome (t (9:22)) cannot be weighted at the same scale as in pediatric patients. Comorbidities play another important role when it comes to making therapeutic decisions, and there is currently controversy regarding the use of scores designed to determine the physical and physiological status of elderly subjects. Several analyzes have been carried out to define the value and usefulness of these tools in the older patients with ALL; however, work must still be done in this area. The treatment schemes should be adjusted to the needs and specific characteristics of each individual in advanced age. The use of intensive chemotherapy should be discussed within a multidisciplinary team, always considering the benefit of our patients. In the present chapter, the diverse differences in ALL biology will be addressed when compared with those of children and young adults, and with the impact on the different prognostic determinants and their weight at the time of deciding treatment. The need to apply geriatric tools for decision-making and the therapeutic schemes used around the world for elderly people will also be discussed.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87438189","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 : 2019-12-04DOI: 10.5772/intechopen.84942
C. T. Mituuti, Marcela Maria Alves da Silva, G. Berretin-Félix
Dysphagia is a symptom related to swallowing disorders that impede or hamper safe, efficient, and comfortable oral ingestion. In addition to compromising the swallowing process, dysphagia may impair overall health, the nutritional status, and lung conditions, impacting quality of life as well. Different proposals for the rehabilitation of oropharyngeal dysphagia have been researched over the years. As a therapeutic strategy aimed at the rehabilitation of oropharyngeal dysphagias, the electromyographic (EMG) biofeedback provides improved strength in swallowing and its coordination, understood as the best muscle recruitment during the function, associated with the attention and performance of cortical functions, simultaneously. Neuromuscular electrical stimulation (NMES) is another therapeutic approach used in the rehabilitation of oropharyngeal dysphagia (NMES). NMES has been recommended as an adjunctive modality to improve the results of exercises based on dysphagia therapy. In view of the possibility of using technological resources in the diagnosis and treatment of oropharyngeal dysphagia, this chapter presents the theoretical and procedural framework aimed at the application of EMG biofeedback and NMES as supporting methods in the treatment of oropharyngeal dysphagia, in cases affected by stroke.
{"title":"Neuromuscular Electrical Stimulation and Electromyographic Biofeedback as Adjunctive Modalities in the Treatment of Oropharyngeal Dysphagia in Stroke","authors":"C. T. Mituuti, Marcela Maria Alves da Silva, G. Berretin-Félix","doi":"10.5772/intechopen.84942","DOIUrl":"https://doi.org/10.5772/intechopen.84942","url":null,"abstract":"Dysphagia is a symptom related to swallowing disorders that impede or hamper safe, efficient, and comfortable oral ingestion. In addition to compromising the swallowing process, dysphagia may impair overall health, the nutritional status, and lung conditions, impacting quality of life as well. Different proposals for the rehabilitation of oropharyngeal dysphagia have been researched over the years. As a therapeutic strategy aimed at the rehabilitation of oropharyngeal dysphagias, the electromyographic (EMG) biofeedback provides improved strength in swallowing and its coordination, understood as the best muscle recruitment during the function, associated with the attention and performance of cortical functions, simultaneously. Neuromuscular electrical stimulation (NMES) is another therapeutic approach used in the rehabilitation of oropharyngeal dysphagia (NMES). NMES has been recommended as an adjunctive modality to improve the results of exercises based on dysphagia therapy. In view of the possibility of using technological resources in the diagnosis and treatment of oropharyngeal dysphagia, this chapter presents the theoretical and procedural framework aimed at the application of EMG biofeedback and NMES as supporting methods in the treatment of oropharyngeal dysphagia, in cases affected by stroke.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77582928","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 : 2019-11-04DOI: 10.23937/2469-5858/1510082
G. Andrew, Philips Ashmi A, Casias Michael, Philips Navin, Prosswimmer Geralyn M
Background: The purpose of this project was to conduct pharmacotherapeutic management of patients in the outpatient setting in a standardized manner. A CMR program was implemented at select ambulatory care sites within our healthcare system. This review identified and addressed medication-related concerns in order to optimize disease state management and attain positive patient outcomes. Methods: This prospective review included patients 80 years or older with polypharmacy concerns, categorized as having greater than 10 medications. Evaluation assessed for therapeutic duplications, potential interactions, side effects, inappropriate medications in the elderly, pharmacoeconomic issues and adherence concerns. All data was collected through the outpatient electronic health record. The primary outcome was the number and type of interventions identified through CMR. Secondary outcomes included percent of recommendations accepted, reasons for rejection, types of recommendations, and disease states intervened on. Results: Out of a total of 222 patients, 52 patients did not require any interventions and 250 recommendations were made to the providers on the 170 remaining patients. Currently 82% of recommendations were accepted by providers, with 17% still pending provider acknowledgement, and 1% being rejected. A large majority, 141 recommendations, were made in regards to high risk medications. Conclusion: CMR was shown to be highly effective in identifying appropriate medication interventions in order to optimize patient care. This study provided the framework to move pharmacists into other outpatient sites in the healthcare setting to assist in targeting inappropriate prescribing in the elderly.
{"title":"Implementation of Comprehensive Medication Management Review (CMR) in the Ambulatory Care Setting","authors":"G. Andrew, Philips Ashmi A, Casias Michael, Philips Navin, Prosswimmer Geralyn M","doi":"10.23937/2469-5858/1510082","DOIUrl":"https://doi.org/10.23937/2469-5858/1510082","url":null,"abstract":"Background: The purpose of this project was to conduct pharmacotherapeutic management of patients in the outpatient setting in a standardized manner. A CMR program was implemented at select ambulatory care sites within our healthcare system. This review identified and addressed medication-related concerns in order to optimize disease state management and attain positive patient outcomes. Methods: This prospective review included patients 80 years or older with polypharmacy concerns, categorized as having greater than 10 medications. Evaluation assessed for therapeutic duplications, potential interactions, side effects, inappropriate medications in the elderly, pharmacoeconomic issues and adherence concerns. All data was collected through the outpatient electronic health record. The primary outcome was the number and type of interventions identified through CMR. Secondary outcomes included percent of recommendations accepted, reasons for rejection, types of recommendations, and disease states intervened on. Results: Out of a total of 222 patients, 52 patients did not require any interventions and 250 recommendations were made to the providers on the 170 remaining patients. Currently 82% of recommendations were accepted by providers, with 17% still pending provider acknowledgement, and 1% being rejected. A large majority, 141 recommendations, were made in regards to high risk medications. Conclusion: CMR was shown to be highly effective in identifying appropriate medication interventions in order to optimize patient care. This study provided the framework to move pharmacists into other outpatient sites in the healthcare setting to assist in targeting inappropriate prescribing in the elderly.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44548931","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}
Recent reports have indicated a marked impairment of physical function in patients with acute cardiac disease. In addition, further deterioration in physical activity has been found during hospitalization especially in elderly patients, which may be associated with poor outcome after discharge. In this study, we repeatedly measured gait speed (GS) during hospitalization and evaluated the association of change in GS with mortality after discharge. Methods: From January 2015 to October 2017, we enrolled 445 consecutive patients admitted to our hospital with congestive heart failure and undergoing exercise training during hospitalization. Physical examinations, including a 10 m walking test for measuring gait speed, were performed at the beginning of training (1st time point) and before discharge (2nd time point). Clinical parameters and clinical outcome after discharge during the follow-up period were compared between these groups. Results: Eighty-two participants (18%) showed a decline in GS even after training. In the linear regression analysis, age, poor activities of daily living (ADL) before admission, hand grip strength, controlling nutritional status (CONUT) score, tricuspid annular plane systolic excursion (TAPSE), change in hand grip strength and change in CONUT score were associated with the change in GS. Kaplan-Meier analysis showed the cumulative risk between groups in allcause admission (log-rank test, p = 0.015) and all-cause death (log-rank test, p = 0.035). Conclusion: Worsening gait speed during hospitalization was associated with poor outcome in patients with acute decompensated heart failure.
{"title":"Worsening Physical Function during Hospitalization is Associated with Poor Outcome in Patients with Acute Decompensated Heart Failure","authors":"Sakuragi Satoru, Kodera Nobuhisa, Iida Toshihiro, Yamada Takashi, Nakashima Mitsutaka, Moriwaki Atsushi, Koide Yuji, Wada Tadashi, Kawamoto Kenji, Tanaka Machiko, Katayama Yusuke","doi":"10.23937/2469-5858/1510080","DOIUrl":"https://doi.org/10.23937/2469-5858/1510080","url":null,"abstract":"Recent reports have indicated a marked impairment of physical function in patients with acute cardiac disease. In addition, further deterioration in physical activity has been found during hospitalization especially in elderly patients, which may be associated with poor outcome after discharge. In this study, we repeatedly measured gait speed (GS) during hospitalization and evaluated the association of change in GS with mortality after discharge. Methods: From January 2015 to October 2017, we enrolled 445 consecutive patients admitted to our hospital with congestive heart failure and undergoing exercise training during hospitalization. Physical examinations, including a 10 m walking test for measuring gait speed, were performed at the beginning of training (1st time point) and before discharge (2nd time point). Clinical parameters and clinical outcome after discharge during the follow-up period were compared between these groups. Results: Eighty-two participants (18%) showed a decline in GS even after training. In the linear regression analysis, age, poor activities of daily living (ADL) before admission, hand grip strength, controlling nutritional status (CONUT) score, tricuspid annular plane systolic excursion (TAPSE), change in hand grip strength and change in CONUT score were associated with the change in GS. Kaplan-Meier analysis showed the cumulative risk between groups in allcause admission (log-rank test, p = 0.015) and all-cause death (log-rank test, p = 0.035). Conclusion: Worsening gait speed during hospitalization was associated with poor outcome in patients with acute decompensated heart failure.","PeriodicalId":91314,"journal":{"name":"Journal of geriatric medicine and gerontology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48471652","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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