Geriatric Assessment: Evaluation of the level of physical, physiological, or mental functioning in the older population group.Hematopoietic Stem Cell Transplantation: Transfer of HEMATOPOIETIC STEM CELLS from BONE MARROW or BLOOD between individuals within the same species (TRANSPLANTATION, HOMOLOGOUS) or transfer within the same individual (TRANSPLANTATION, AUTOLOGOUS). Hematopoietic stem cell transplantation has been used as an alternative to BONE MARROW TRANSPLANTATION in the treatment of a variety of neoplasms.Geriatrics: The branch of medicine concerned with the physiological and pathological aspects of the aged, including the clinical problems of senescence and senility.Hematopoietic Stem Cells: Progenitor cells from which all blood cells derive.Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Health Services for the Aged: Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.Neuropsychology: A branch of psychology which investigates the correlation between experience or behavior and the basic neurophysiological processes. The term neuropsychology stresses the dominant role of the nervous system. It is a more narrowly defined field than physiological psychology or psychophysiology.Viburnum: A plant genus in the family CAPRIFOLIACEAE. The common name derives from its traditional use for menstrual cramps. It is a source of viburnine, valerianic acid, vibsanin, and ursolic acid. Note that true cranberry is VACCINIUM MACROCARPON.Noble Gases: Elements that constitute group 18 (formerly the zero group) of the periodic table. They are gases that generally do not react chemically.Maze Learning: Learning the correct route through a maze to obtain reinforcement. It is used for human or animal populations. (Thesaurus of Psychological Index Terms, 6th ed)Neuropsychological Tests: Tests designed to assess neurological function associated with certain behaviors. They are used in diagnosing brain dysfunction or damage and central nervous system disorders or injury.Gerstmann Syndrome: A disorder of cognition characterized by the tetrad of finger agnosia, dysgraphia, DYSCALCULIA, and right-left disorientation. The syndrome may be developmental or acquired. Acquired Gerstmann syndrome is associated with lesions in the dominant (usually left) PARIETAL LOBE which involve the angular gyrus or subjacent white matter. (From Adams et al., Principles of Neurology, 6th ed, p457)Adolescent, Institutionalized: An adolescent who is receiving long-term in-patient services or who resides in an institutional setting.Personnel Selection: The process of choosing employees for specific types of employment. The concept includes recruitment.Rivers: Large natural streams of FRESH WATER formed by converging tributaries and which empty into a body of water (lake or ocean).CaliforniaActivities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, or eating.Hospitalization: The confinement of a patient in a hospital.Internet: A loose confederation of computer communication networks around the world. The networks that make up the Internet are connected through several backbone networks. The Internet grew out of the US Government ARPAnet project and was designed to facilitate information exchange.Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature.Questionnaires: Predetermined sets of questions used to collect data - clinical data, social status, occupational group, etc. The term is often applied to a self-completed survey instrument.Ontario: A province of Canada lying between the provinces of Manitoba and Quebec. Its capital is Toronto. It takes its name from Lake Ontario which is said to represent the Iroquois oniatariio, beautiful lake. (From Webster's New Geographical Dictionary, 1988, p892 & Room, Brewer's Dictionary of Names, 1992, p391)Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies.Social Sciences: Disciplines concerned with the interrelationships of individuals in a social environment including social organizations and institutions. Includes Sociology and Anthropology.Geriatric Nursing: Nursing care of the aged patient given in the home, the hospital, or special institutions such as nursing homes, psychiatric institutions, etc.Social Work, Psychiatric: Use of all social work processes in the treatment of patients in a psychiatric or mental health setting.MarylandRespite Care: Patient care provided in the home or institution intermittently in order to provide temporary relief to the family home care giver.Retirement: The state of being retired from one's position or occupation.Housing for the Elderly: Housing arrangements for the elderly or aged, intended to foster independent living. The housing may take the form of group homes or small apartments. It is available to the economically self-supporting but the concept includes housing for the elderly with some physical limitations. The concept should be differentiated from HOMES FOR THE AGED which is restricted to long-term geriatric facilities providing supervised medical and nursing services.BaltimoreHospice Care: Specialized health care, supportive in nature, provided to a dying person. A holistic approach is often taken, providing patients and their families with legal, financial, emotional, or spiritual counseling in addition to meeting patients' immediate physical needs. Care may be provided in the home, in the hospital, in specialized facilities (HOSPICES), or in specially designated areas of long-term care facilities. The concept also includes bereavement care for the family. (From Dictionary of Health Services Management, 2d ed)Hospices: Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family.Physical Therapy Modalities: Therapeutic modalities frequently used in PHYSICAL THERAPY SPECIALTY by PHYSICAL THERAPISTS or physiotherapists to promote, maintain, or restore the physical and physiological well-being of an individual.Gait: Manner or style of walking.Gait Disorders, Neurologic: Gait abnormalities that are a manifestation of nervous system dysfunction. These conditions may be caused by a wide variety of disorders which affect motor control, sensory feedback, and muscle strength including: CENTRAL NERVOUS SYSTEM DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES; NEUROMUSCULAR DISEASES; or MUSCULAR DISEASES.Walking: An activity in which the body advances at a slow to moderate pace by moving the feet in a coordinated fashion. This includes recreational walking, walking for fitness, and competitive race-walking.Parkinson Disease: A progressive, degenerative neurologic disease characterized by a TREMOR that is maximal at rest, retropulsion (i.e. a tendency to fall backwards), rigidity, stooped posture, slowness of voluntary movements, and a masklike facial expression. Pathologic features include loss of melanin containing neurons in the substantia nigra and other pigmented nuclei of the brainstem. LEWY BODIES are present in the substantia nigra and locus coeruleus but may also be found in a related condition (LEWY BODY DISEASE, DIFFUSE) characterized by dementia in combination with varying degrees of parkinsonism. (Adams et al., Principles of Neurology, 6th ed, p1059, pp1067-75)Voice Training: A variety of techniques used to help individuals utilize their voice for various purposes and with minimal use of muscle energy.Biomechanical Phenomena: The properties, processes, and behavior of biological systems under the action of mechanical forces.Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes.Diet Records: Records of nutrient intake over a specific period of time, usually kept by the patient.Reproducibility of Results: The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.Diet: Regular course of eating and drinking adopted by a person or animal.Intellectual Property: Property, such as patents, trademarks, and copyright, that results from creative effort. The Patent and Copyright Clause (Art. 1, Sec. 8, cl. 8) of the United States Constitution provides for promoting the progress of science and useful arts by securing for limited times to authors and inventors, the exclusive right to their respective writings and discoveries. (From Black's Law Dictionary, 5th ed, p1014)Directories as Topic: Lists of persons or organizations, systematically arranged, usually in alphabetic or classed order, giving address, affiliations, etc., for individuals, and giving address, officers, functions, and similar data for organizations. (ALA Glossary of Library and Information Science, 1983)Patents as Topic: Exclusive legal rights or privileges applied to inventions, plants, etc.Economics, Medical: Economic aspects of the field of medicine, the medical profession, and health care. It includes the economic and financial impact of disease in general on the patient, the physician, society, or government.Outpatient Clinics, Hospital: Organized services in a hospital which provide medical care on an outpatient basis.Preoperative Care: Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed)

Association between serum fructosamine and mortality in elderly women: the study of osteoporotic fractures. (1/2563)

Serum fructosamine levels can be used to estimate long-term serum glucose values and can be measured in frozen serum. The authors examined whether fructosamine levels were associated with mortality in a cohort of 9,704 white women (> or = 65 years of age) recruited from September 1986 to October 1988 at four clinical centers in the United States. A random sample of women who had died during a mean of 6 years of follow-up (n = 55) was compared with randomly selected controls (n = 276, 54 of whom had died). Fructosamine assays were performed blinded to vital status. Hazard ratios with 95% confidence intervals were adjusted for age, clinical center, smoking, hypertension, and serum albumin and cholesterol levels. Each standard deviation (46 micromol) increase in fructosamine level was associated with a 1.3-fold (95% confidence interval (CI) 1.0-1.6, p = 0.04) increased rate of all-cause mortality, including a 1.5-fold (95% CI 1.0-2.1, p = 0.03) increase in cardiovascular disease mortality. Elevated fructosamine levels (>285 micromol/liter) were associated with a 4.3-fold (95% CI 1.6-12, p = 0.004) increased rate of cardiovascular mortality; in women without a history of diabetes, the hazard ratio was 4.6 (95% CI 1.3-16, p = 0.02). Fructosamine level, or another indicator of glycemia, should be included when the risk of cardiovascular disease among older patients is evaluated.  (+info)

Characteristics of discrepancies between self-reported visual function and measured reading speed. Salisbury Eye Evaluation Project Team. (2/2563)

PURPOSE: Visual impairment is a risk factor for morbidity in the elderly and is often screened for by self-report. This study evaluates whether there are subsets for whom there is a discrepancy between self-reported and measured function. METHODS: The prevalence of a discrepancy between self-reported difficulty reading a newspaper and measured reading speed was determined in 2520 community-based men and women, aged 65 to 84 years, and the discrepant group characterized by polychotomous regression. RESULTS: Of subjects who reported minimal difficulty reading a newspaper, 10.8% (227/2107) read newsprint-sized text (0.21 degrees) more slowly than 80 words/min, a level previously shown to be necessary for sustained reading. Poor visual acuity, presence of psychiatric symptoms, and less satisfaction with vision were associated with being in the group that read slowly and reported difficulty with reading. Better cognition, better visual acuity, more years of education, white race, and fewer psychiatric symptoms were associated with being in the group that read more quickly and reported minimal difficulty. When reading the text size at which subjects read their fastest, only 2.6% of those with minimal difficulty remained discrepant. These individuals were more likely to have less education, be male, be African American, and have poorer cognitive status than those who did not remain discrepant. CONCLUSIONS: A subset of the elderly population have a substantial discrepancy between self-reported reading difficulty and measured reading speed. In some, this discrepancy may be based on underlying expectations and experiences, and in others it may represent a transition from no visual impairment to visual impairment.  (+info)

Outcomes of routine testing of liver enzymes in institutionalized geriatric patients. (3/2563)

This study sought to identify any benefit of routine liver function tests (LFTs) in chronically ill, geriatric patients and to assess which patients require evaluation for abnormal LFT levels. A retrospective chart review was carried out on 268 consecutive patients (M:F = 1.2, mean age 77 years, range 61-98 years) presenting for acute care from a long-term care facility. All were without jaundice, right upper quadrant pain, pruritus, bruising, or signs of chronic liver disease. The degree of LFT abnormality (aspartate aminotransferase, alanine aminotransferase, total bilirubin, or alkaline phosphatase) during admission was compared to the clinical diagnosis at the time of discharge. The most common diagnoses were pneumonia, urinary tract infection, and peripheral or coronary disease in 186 (60%). Thirty-seven patients (14%) had elevated LFT levels on admission. The levels normalized within 2 days in 26 of these patients, 25 of whom had a history of vascular disease (96%). Of the 11 remaining patients, 4 had coexistent vascular disease (36%), and 5 had LFT levels twice normal (none with vascular disease) and underwent abdominal ultrasound. One patient had a common bile duct stone successfully extracted. Enzyme abnormalities were due to hepatitis B or medication use in 10 of 11 patients. No patient had liver biopsy. All but one of the 268 patients were discharged without further evaluation. Over one year of follow up, no patient returned for a liver-related problem. Based on these findings, only those patients with LFT levels that are twice normal and which do not normalize within 2 days warrant further evaluation. Transient LFT abnormalities may be due to decreased liver perfusion.  (+info)

Outcome measures for routine use in dementia services: some practical considerations. (4/2563)

OBJECTIVES: To work with specialist community teams to assess the practicality and acceptability of identified outcome measures for routine use in dementia services. SETTING: Seven specialist dementia services: four multidisciplinary teams, a specialist service for carers, a community psychiatric nurse team, and a day hospital. SUBJECTS: 20 members of staff from the specialist dementia services including psychiatry, community psychiatric nursing, social work, occupational therapy, Admiral nursing, ward management, geriatric nursing. MAIN MEASURE: A questionnaire designed to assess staff views on the use of six outcome measures in routine practice in terms of practicality, relevance, acceptability, and use in improving care. RESULTS: Each of the outcome measures took 15 to 30 minutes to administer. All were rated as easy to use and as relevant to dementia services and to carers. Staff commented that the measures could be useful in routine practice for structured assessment and service evaluation, but highlighted the need for sensitive use of measures with carers. CONCLUSIONS: These measures consider the main domains of functioning for people with dementia and their carers. The measures are suitable for use in routine practice in dementia services and are acceptable to staff and carers. The project underlined the need for management support, staff ownership of measures, and training in using outcome measures. Staff concerns about service evaluation need to be acknowledged.  (+info)

Strategies to improve the quality of oral health care for frail and dependent older people. (5/2563)

The dental profile of the population of most industrialised countries is changing. For the first time in at least a century most elderly people in the United Kingdom will soon have some of their own natural teeth. This could be beneficial for the frail and dependent elderly, as natural teeth are associated with greater dietary freedom of choice and good nutrition. There may also be problems including high levels of dental disease associated with poor hygiene and diet. New data from a national oral health survey in Great Britain is presented. The few dentate elderly people in institutions at the moment have poor hygiene and high levels of dental decay. If these problems persist as dentate younger generations get older, the burden of care will be substantial. Many dental problems in elderly people are preventable or would benefit from early intervention. Strategies to approach these problems are presented.  (+info)

Staff and patient feedback in mental health services for older people. (6/2563)

OBJECTIVES: To compare the views of patients and staff on the quality of care provided on a psychogeriatric assessment ward over a five year period. To describe the quality improvements which were made as a result of their respective comments. DESIGN: Structured interviews were conducted with both patients and staff to obtain qualitative feedback and suggestions for improvement. An analysis of the percentage of positive and negative comments made by both patients and staff was used to compare the levels of satisfaction on a variety of aspects of the service provided. SETTING: Psychogeriatric inpatient assessment ward. SUBJECTS: 75 patients and 85 staff interviews were conducted. MAIN MEASURES: Structured interviews covering various aspects of service quality. RESULTS: Staff and patients picked up on different aspects of service quality as important. Quality improvements which arose from the interviews were clearly different. Generally patients were more positive about the physical environment and standards of professional care than staff, but less positive about issues of privacy, social interaction, and empowerment. CONCLUSIONS: The perspectives of patients and staff in this area are not interchangeable. Both series of interviews led to several positive changes in the quality of care. Interviews with staff seem to have been valuable in a low morale situation. A structured interview format provided patients with an opportunity to feedback openly and led to changes in service quality which would not otherwise have occurred.  (+info)

Identification and assessment of high-risk seniors. HMO Workgroup on Care Management. (7/2563)

CONTEXT: Many older adults with chronic illnesses and multidimensional needs are at high risk of adverse health outcomes, poor quality of life, and heavy use of health-related services. Modern proactive care of older populations includes identification of such high-risk individuals, assessment of their health-related needs, and interventions designed both to meet those needs and to prevent undesirable outcomes. OBJECTIVE: This paper outlines an approach to the tasks of identifying and assessing high-risk seniors. Intervention identification of high-risk seniors (also called case finding) is accomplished through a combination of periodic screening, recognition of high-risk seniors by clinicians, and analysis of administrative databases. Once identified, potentially high-risk individuals undergo on initial assessment in eight domains: cognition, medical conditions, medications, access to care, functional status, social situation, nutrition, and emotional status. The initial assessment is accomplished in a 30- to 45-minute interview conducted by a skilled professional--usually one with a background in nursing. The data are used to link some high-risk persons with appropriate services and to identify others who require more detailed assessments. Detailed assessment is often performed by interdisciplinary teams of various compositions and methods of operation, depending on local circumstances. CONCLUSION: The rapid growth in Medicare managed care is presenting many opportunities for developing more effective strategies for the proactive care for older populations. Identification and assessment of high-risk individuals are important initial steps in this process, paving the way for testing of interventions designed to reduce adverse health consequences and to improve the quality of life.  (+info)

A population-based study of environmental hazards in the homes of older persons. (8/2563)

OBJECTIVES: This study sought to estimate the population-based prevalence of environmental hazards in the homes of older persons and to determine whether the prevalence of these hazards differs by housing type or by level of disability in terms of activities of daily living (ADLs). METHODS: An environmental assessment was completed in the homes of 1000 persons 72 years and older. Weighted prevalence rates were calculated for each of the potential hazards and subsequently compared among subgroups of participants characterized by housing type and level of ADL disability. RESULTS: Overall, the prevalence of most environmental hazards was high. Two or more hazards were found in 59% of bathrooms and in 23% to 42% of the other rooms. Nearly all homes had at least 2 potential hazards. Although age-restricted housing was less hazardous than community housing, older persons who were disabled were no less likely to be exposed to environmental hazards than older persons who were nondisabled. CONCLUSIONS: Environmental hazards are common in the homes of community-living older persons.  (+info)

  • Shadman told Medscape Medical News that his center doesn't have a formal geriatric assessment clinic, but instead uses clinical trials to test interventions that may help to improve the likelihood of successful transplants for older, higher-risk patients. (
  • Derman described how the University of Chicago established a GA-MDC in which all patients 70 and older who are candidates for an autologous transplant are given cognitive and strength tests, and are then evaluated by a team including a transplant physician and nurse practitioner, a geriatric oncologist, infectious disease specialist, physical and occupational therapists, a nutritionist, and a social worker. (
  • Geriatric assessment has been shown to identify deficits in older autologous transplant candidates, and we and others have shown that this tracks with outcomes," said Benjamin A. Derman, MD, from the University of Chicago, Illinois. (
  • The assessment includes patient-reported surveys prior to the visit, and bedside testing on the day of the visit with a cognitive battery and handgrip testing, followed by visits with the aforementioned clinicians. (
  • Traditionally people with hip fracture are cared for in orthopaedic departments without additional geriatric assessment. (
  • The idea behind the geriatric assessment is to identify and "really work on risks that we know will translate into an inferior outcome later, and you can just try to deal with them before transplant," he said. (
  • Derman described how the University of Chicago established a GA-MDC in which all patients 70 and older who are candidates for an autologous transplant are given cognitive and strength tests, and are then evaluated by a team including a transplant physician and nurse practitioner, a geriatric oncologist, infectious disease specialist, physical and occupational therapists, a nutritionist, and a social worker. (
  • The latter between medical specialist : geriatrician, oncologist, surgeon, radiotherapist, pharmacist, onco-geriatric nurse allows the development of an appropriate individualized therapeutic project for the patient. (
  • City of Hope physicians Arti Hurria, M.D., a geriatric oncologist, and William Dale, M.D., Ph.D. , a geriatrician and palliative care physician, co-chaired the panel that developed the new guidelines. (
  • A review of major studies and the current literature underscored the role of geriatric assessment in making treatment recommendations for patients aged 80 years and older with early and metastatic breast cancer. (
  • In this review, we will discuss the role of geriatric assessment, alternative treatment modalities for older women with triple-negative breast cancer, and other special considerations for this patient population. (
  • Conclusions: Systematic assessment of geriatric domains is needed to aid oncologists in identifying frail patients with poor survival. (
  • All of the patients received a geriatric assessment in this study, but only the oncologists at the practices in the geriatric assessment arm received a summary of the results of the assessment as well as recommendations for how to treat potential problems. (
  • The thrust of this book is to make medical oncologists and other health professionals managing older patients with cancer aware of recent developments in geriatric assessment and in cancer management for the older adult. (
  • In line with the Hospital Authority's corporate direction of seamless healthcare, Shatin Hospital has established a Community Geriatric Assessment Team, Community Psychiatric Team and Psycho-geriatric Outreach Team. (
  • Among all these scores, the Nottingham Hip Fracture Score (NHFS) is one of the most well-known for the prediction of short- and long-term mortality in geriatric hip fracture patients, and has been validated in both western and Asian populations. (
  • The objective of this study was to evaluate the value of geriatric assessment of this population with respect to postoperative complications. (
  • The purpose of this study was to evaluate bone and muscle measurements of peripheral quantitative computed tomography (pQCT) in a geriatric cohort with osteoporosis. (
  • To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture. (
  • Among AF patients receiving AC, relate change in geriatric assessment measures to indicators of successful AC (bleeding, TTR and patient satisfaction) and evaluate whether this association varies by AC type. (
  • Costs and effects of an ambulatory geriatric unit (the AGe-FIT study): a randomized controlled trial. (
  • This is the 3rd topic covered in a four part ambulatory geriatric curriculum that was developed for internal medicine residents. (
  • Treatment decisions for these patients can best be made based on geriatric assessment, estimated life expectancy, whether the treatment goal is prolonged survival or palliation, the potential benefits and toxicities of a specific treatment, and the patient's personal goals for treatment. (
  • A good way of doing this is to incorporate gait assessment with kinesiology taping . (
  • To examine whether the Frontal Assessment Battery is associated with the immediate effects of physical therapy on gait disturbance in patients with Parkinson's disease. (
  • We showed that the subtests of motor learning of the Frontal Assessment Battery might be associated with the immediate effects of physical therapy on gait disturbance in Parkinson's disease. (