Comprehensive Geriatric Assessment
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Appropriateness of transferring nursing home residents to emergency departments: a systematic review (BMC Geriatrics)

Appropriateness of transferring nursing home residents to emergency departments: a systematic review (BMC Geriatrics) | Comprehensive Geriatric Assessment | Scoop.it

Elderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable.

 

Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital. The definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs.

Sergio Ariño Blasco's insight:

El eterno dilema de la adecuación de la derivación del paciente anciano de residencia. Ante la heterogeneidad de recursos en el sector residencial. Oportunidad para la intervención de "Unidades de Pacientes Frágiles" en los Servicios de Urgencias Hospitalarios

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High‐Risk Comorbidity Combinations in Older Patients Undergoing Emergency General Surgery - Ho - 2019 - Journal of the American Geriatrics Society - Wiley Online Library

High‐Risk Comorbidity Combinations in Older Patients Undergoing Emergency General Surgery - Ho - 2019 - Journal of the American Geriatrics Society - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it
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The NHS long-term plan explained

The NHS long-term plan explained | Comprehensive Geriatric Assessment | Scoop.it
On 7 January, the NHS long-term plan was published setting out key ambitions for the service over the next 10 years. In this explainer, we set out the main commitments in the plan and provide our view of what they might mean, highlighting the opportunities and challenges for the health and care system as it moves to put the plan into practice.
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Effects of Driving Skill Training on Safe Driving in Older Adults with Mild Cognitive Impairment - Abstract - Gerontology 2019, Vol. 65, No. 1 - Karger Publishers

Effects of Driving Skill Training on Safe Driving in Older Adults with Mild Cognitive Impairment - Abstract - Gerontology 2019, Vol. 65, No. 1 - Karger Publishers | Comprehensive Geriatric Assessment | Scoop.it

Background: Driving cessation is strongly associated with adverse health outcomes in the older adults. Although there were numerous documentations of driving rehabilitation in disabled adults, the effects of interventions on safe driving were not clear in older adults with cognitive impairment who had low driving skills. 

 

The driving skill program significantly improved safe driving performance in older adults with cognitive impairment who were at a potentially high risk of a car accident.

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Interventions to Improve Gait in Older Adults with Cognitive Impairment: A Systematic Review - Zhang - 2019 - Journal of the American Geriatrics Society - Wiley Online Library

Interventions to Improve Gait in Older Adults with Cognitive Impairment: A Systematic Review - Zhang - 2019 - Journal of the American Geriatrics Society - Wiley Online Library | Comprehensive Geriatric Assessment | Scoop.it
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Dysphagia in Nursing Home Residents: Management and Outcomes

Dysphagia in Nursing Home Residents: Management and Outcomes | Comprehensive Geriatric Assessment | Scoop.it

To define the prevalence of dysphagia and its associated factors and to investigate the influence of dysphagia and nutritional therapies performed in dysphagic subjects on clinical outcomes, including nutritional status, pressure ulcers, hospitalization, and mortality.

 

Dysphagia is common in nursing home residents, and it is associated with higher mortality. Therefore, early diagnosis and optimal management of dysphagia should become a priority

issue in nursing homes.

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Depth of Anesthesia and Postoperative Delirium. | Anesthesiology | JAMA | JAMA Network

Depth of Anesthesia and Postoperative Delirium. | Anesthesiology | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
Despite advances in medical therapies, the demand for surgery is consistently increasing. Each year, more than 300 million surgical procedures are performed wor
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Anestesia guiada por EEG... sin impacto en incidencia de delirium pero utilizan menor dosis de anestésico y tienen menor mortalidad a 30 días. Probablemente la mortalidad esta relacionada con mayor inestabilidad hemodinámica asociada a dosis superiores de anestésico. 

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Sergio Ariño Blasco's curator insight, February 16, 12:43 PM

Anestesia guiada por EEG... sin impacto en incidencia de delirium pero utilizan menor dosis de anestésico y tienen menor mortalidad a 30 días. Probablemente la mortalidad esta relacionada con mayor inestabilidad hemodinámica asociada a dosis superiores de anestésico. 

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Quality Measurement for Multiple Chronic Conditions | Annals of Internal Medicine | American College of Physicians

Quality Measurement for Multiple Chronic Conditions | Annals of Internal Medicine | American College of Physicians | Comprehensive Geriatric Assessment | Scoop.it
Quality measurement efforts have not historically focused on patients with multiple chronic conditions (MCCs), despite them comprising one quarter of the population and two thirds of health care spending. The Patient Protection and Affordable Care Act (ACA) creates several mechanisms for the Centers for Medicare & Medicaid Services (CMS
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Triple therapy in the management of chronic obstructive pulmonary disease: systematic review and meta-analysis

Objective To compare the rate of moderate to severe exacerbations between triple therapy and dual therapy or monotherapy in patients with chronic obstructive pulmonary disease (COPD).

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources PubMed, Embase, Cochrane databases, and clinical trial registries searched from inception to April 2018.

Eligibility criteria Randomised controlled trials comparing triple therapy with dual therapy or monotherapy in patients with COPD were eligible. Efficacy and safety outcomes of interest were also available.

Data extraction and synthesis Data were collected independently. Meta-analyses were conducted to calculate rate ratios, hazard ratios, risk ratios, and mean differences with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations assessment, development, and evaluation).

Results 21 trials (19 publications) were included. Triple therapy consisted of a long acting muscarinic antagonist (LAMA), long acting β agonist (LABA), and inhaled corticosteroid (ICS). Triple therapy was associated with a significantly reduced rate of moderate or severe exacerbations compared with LAMA monotherapy (rate ratio 0.71, 95% confidence interval 0.60 to 0.85), LAMA and LABA (0.78, 0.70 to 0.88), and ICS and LABA (0.77, 0.66 to 0.91). Trough forced expiratory volume in 1 second (FEV1) and quality of life were favourable with triple therapy. The overall safety profile of triple therapy is reassuring, but pneumonia was significantly higher with triple therapy than with dual therapy of LAMA and LABA (relative risk 1.53, 95% confidence interval 1.25 to 1.87).

Conclusions Use of triple therapy resulted in a lower rate of moderate or severe exacerbations of COPD, better lung function, and better health related quality of life than dual therapy or monotherapy in patients with advanced COPD.

Study registration Prospero CRD42018077033.
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Driving in the Geriatric Population

Driving helps older adults stay mobile and independent. The risk of being injured or killed in a motor vehicle crash increases with age. This trend has been attributed more to an increased susceptibility to injury and medical complications among older drivers rather than an increased risk of crash involvement. Older adults tend to take steps to stay safe on the road. They tend to have a high incidence of seat belt use and a lower incidence of impaired driving. Furthermore, older drivers self-select safer driving conditions by avoiding night, bad weather, and high-speed roads compared with younger drivers.

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Utilization of Geriatric Consultation and Team-Based Care

Geriatric surgical patients experience higher mortality and morbidity rates than their younger counterparts. Three models of geriatric surgical care are described, with a focus on people, plans, and evaluation. These models include geriatric consultation
services, geriatric wards, and geriatric multidisciplinary teams. The optimal careplan should be definitive, aggressive, sustainable, safe, and effective, with consideration for patient treatment preferences and wishes.

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Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people’s perceptions and experiences | Age and Ageing | Oxford Academic

Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people’s perceptions and experiences | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it
AbstractBackground. alcohol presents risks to the health of older adults at levels that may have been ‘safer’ earlier in life. Moderate drinking is associated
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Association of Aspirin With Prevention of Venous Thromboembolism in Patients After Total Knee Arthroplasty Compared With Other Anticoagulants: A Noninferiority Analysis. | Orthopedics | JAMA Surger...

This cohort study examines whether aspirin as a single agent is inferior to other anticoagulation agents for reducing the risk of venous thromboembolism or major bleeding events after unilateral primary total knee arthroplasty.

 

In this study of patients undergoing TKA, aspirin was not inferior to other anticoagulants in the postoperative rate of VTE or death. Aspirin alone may provide similar protection from postoperative VTE compared with other anticoagulation treatments.

 

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Battling against the odds: what does the latest NHS staff survey tell us? | 

Battling against the odds: what does the latest NHS staff survey tell us? |  | Comprehensive Geriatric Assessment | Scoop.it
With the latest NHS staff survey results revealed last week, Candace Imison looks in more detail at some of the findings, the bigger picture the results paint, and what the response should be.
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The NHS crisis of caring for staff

The NHS crisis of caring for staff | Comprehensive Geriatric Assessment | Scoop.it
With high levels of staff turnover, sickness absence and presenteeism prevalent in the NHS, we need to significantly improve the working environments for staff. But how? Michael West reflects on the NHS staff survey and outlines the three core needs that must be met in the workplace.
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Just about...belonging, competence and autonomy 

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Aspiration Pneumonia | NEJM

Aspiration Pneumonia | NEJM | Comprehensive Geriatric Assessment | Scoop.it
Review Article from The New England Journal of Medicine — Aspiration Pneumonia
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¿Cuál es el papel de la valoración geriátrica integral en Oncogeriatría? | Revista Española de Geriatría y Gerontología

¿Cuál es el papel de la valoración geriátrica integral en Oncogeriatría? | Revista Española de Geriatría y Gerontología | Comprehensive Geriatric Assessment | Scoop.it
Sergio Ariño Blasco's insight:

Una revisión sencilla y práctica. Destaca el papel de la VGI en los apartados: de evaluación en sí misma del paciente anciano oncológico, detección de déficits, predicción de toxicidad y mortalidad y para la clasificación de pacientes oncológicos. 

 

Entre estas clasificaciones de paciente oncológico se describe las de Balducci (frágil, fit y vulnerable), Ferrat (frágiles, fit, malnutridos y con deterioro cognitivo-conductual), DAFI (acumuló de déficits 51 variables) y SIOG (en base a estado funcional, cognitivo, estado nutricional y comorbilidad: fit, vulnerable, frail y too sick).

 

La SIOG en su última version del 2017 no incorpora el G8 y evoluciona el G8 a VGI con las dimensiones funcional, comorbilidad y síndromes geriátricos.

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Sergio Ariño Blasco's curator insight, February 16, 12:42 PM

Una revisión sencilla y práctica. Destaca el papel de la VGI en los apartados: de evaluación en sí misma del paciente anciano oncológico, detección de déficits, predicción de toxicidad y mortalidad y para la clasificación de pacientes oncológicos. 

 

Entre estas clasificaciones de paciente oncológico se describe las de Balducci (frágil, fit y vulnerable), Ferrat (frágiles, fit, malnutridos y con deterioro cognitivo-conductual), DAFI (acumuló de déficits 51 variables) y SIOG (en base a estado funcional, cognitivo, estado nutricional y comorbilidad: fit, vulnerable, frail y too sick).

 

La SIOG en su última version del 2017 no incorpora el G8 y evoluciona el G8 a VGI con las dimensiones funcional, comorbilidad y síndromes geriátricos.

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Mild Cognitive Impairment that Does Not Progress to Dementia: A Population‐Based Study - Ganguli - 2019 - Journal of the American Geriatrics Society - Wiley Online Library

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New Chronic Constipation Medication. | Gastroenterology | JAMA | JAMA Network

New Chronic Constipation Medication. | Gastroenterology | JAMA | JAMA Network | Comprehensive Geriatric Assessment | Scoop.it
The FDA has approved a once-daily oral treatment for adults with chronic idiopathic constipation. Prucalopride is a selective serotonin-4 (5HT4) receptor agonis
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Omadacycline for Community-Acquired Bacterial Pneumonia 

Omadacycline for Community-Acquired Bacterial Pneumonia  | Comprehensive Geriatric Assessment | Scoop.it

Omadacycline (video)

Original Article from The New England Journal of Medicine — Omadacycline for Community-Acquired Bacterial Pneumonia

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Appropriateness of transferring nursing home residents to emergency departments: a systematic review (BMC Geriatrics)

Appropriateness of transferring nursing home residents to emergency departments: a systematic review (BMC Geriatrics) | Comprehensive Geriatric Assessment | Scoop.it

Elderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable.

 

Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital. The definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs.

Sergio Ariño Blasco's insight:

El eterno dilema de la adecuación de la derivación del paciente anciano de residencia. Ante la heterogeneidad de recursos en el sector residencial. Oportunidad para la intervención de "Unidades de Pacientes Frágiles" en los Servicios de Urgencias Hospitalarios

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Aspirin for Primary Prevention: Clinical Considerations in 2019. 

Aspirin for Primary Prevention: Clinical Considerations in 2019.  | Comprehensive Geriatric Assessment | Scoop.it
Reducing platelet activity with aspirin and other antiplatelet agents is an important factor in the prevention and management of atherothrombotic vascular event
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Orthopedic Surgery and the Geriatric Patient

Orthopedic Surgery and the Geriatric Patient | Comprehensive Geriatric Assessment | Scoop.it

As more patients live longer, it is probable that an increasing number of geriatric patients will require surgery. An organized, systematic, coordinated, multidisciplinary approach to the perioperative management of these patients will result in fewer complications, improved outcomes, and reduced cost of care. Details are herein provided on the preoperative diagnostic evaluation and assessment as well as perioperative care provided to optimize outcomes. The diagnosis, workup, and treatment of osteoporosis and fragility fractures are presented. The article concludes with a review of the care of the geriatric orthopedic
patient in the posthospital time period.

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Convergent validity of the electronic frailty index | Age and Ageing | Oxford Academic

Convergent validity of the electronic frailty index | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it
AbstractBackground. the electronic frailty index (eFI) has been developed and validated using routine primary care electronic health record data. The focus of
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Sarcopenia: revised European consensus on definition and diagnosis | Age and Ageing | Oxford Academic

Sarcopenia: revised European consensus on definition and diagnosis | Age and Ageing | Oxford Academic | Comprehensive Geriatric Assessment | Scoop.it
AbstractBackground. in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances
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Synopsis of the KDIGO 2017 Clinical Practice Guideline Update | Annals of Internal Medicine | American College of Physicians

Synopsis of the KDIGO 2017 Clinical Practice Guideline Update | Annals of Internal Medicine | American College of Physicians | Comprehensive Geriatric Assessment | Scoop.it
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