Comprehensive Geriatric Assessment

Ann Intern Med. 2015;162:S1-S34. doi:10.7326/M14-1304

Although effective interventions to improve urinary catheter use have been published, reducing use in hospitals has proved difficult. The 2009 Guideline for Prevention of Catheter-Associated Urinary Tract Infections from the Centers for Disease Control and Prevention (CDC) provides a list of examples of appropriate and inappropriate indications for indwelling urinary catheters to help guide facilities in promoting appropriate use. However, because of the lack of published evidence to guide the indications, the CDC list was based primarily on expert consensus, and some of the indications have been subject to broad and variable interpretation. One example is the “need for accurate measurements of urine output in critically ill patients”, which is often applied to patients who do not need frequent (for example, hourly) measurement of urine output to guide management. In addition, certain conditions, such as chronic urine retention, and nonindwelling catheters were not addressed.

In more than 50% of falls, we found discrepancies between fall incident reports and analysis of video footage on the cause of imbalance and activity while falling. Emerging technologies incorporating video capture or wearable sensors should improve our ability to understand the mechanisms and improve the prevention of falls in LTC.

Purpose of the Study: To determine the overall effectiveness of interventions designed to increase physical activity (PA) behavior among community-dwelling older adults.

Design and Methods: Comprehensive literature searching identified eligible PA intervention studies among community-dwelling adults aged 65 and older, or sample mean age of 70. Diverse study characteristics were extracted and outcome data were duplicate coded. Overall mean effect sizes (ESs) were synthesized using a random-effects model. Heterogeneity of effects was analyzed using Q and I 2 statistics. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression for dichotomous and continuous moderators, respectively.

Results: ESs were calculated from 13,829 primary study subjects. The overall mean ES for two-group posttest comparisons was 0.18 (95% CI 0.10–0.26, p < .001). This represents a difference of 620 steps/day or 73min of PA/week between treatment and control groups. Significant moderators included the use of theory, how interventions were delivered, and cognitive plus behavioral-type intervention components. Non-significant moderators include the type of interventionist, delivery setting, and various measures of intervention dose.

Implications: PA interventions significantly improved PA behavior among community-dwelling older adults. Effective PA interventions may be efficiently delivered using already available resources and personnel. Future PA intervention research should be theoretically based, incorporate more diverse subjects, and compare intervention delivery methods.

Reviews in Clinical Gerontology by Oscar Duems-Noriega and Sergio Arino-Blasco

Patients with difficult venous access or oral intolerance and clinical situations with inadequate response to oral therapy have generated the need for alternative routes of delivery for drugs and fluids.

The purpose of this study was to conduct a systematic review examining the evidence for subcutaneous (SC) administration of drugs and/or fluids.

We used a broad search strategy using electronic databases CINAHL, EMBASE, PubMed and Cochrane library, key terms and ‘Medical Subject Headings’ (MeSH) such as ‘subcutaneous route’, ‘hypodermoclysis’ and the name/group of the most used drugs via this route (e.g. ‘ketorolac, morphine, ceftriaxone’, ‘analgesics, opioids, antibiotics’).

We conclude that the SC route is an effective alternative for rehydration in patients with mild–moderate dehydration and offers a number of potential advantages in appropriately selected scenarios. Experience of administering drugs by this route suggests that it is well tolerated and is associated with minimal side-effects.

Background/Objectives The clinical status of older individuals with multimorbidity can be further complicated by concomitant geriatric syndromes. This study explores multimorbidity patterns, encompassing both chronic diseases and geriatric syndromes, in geriatric patients attended in an acute hospital setting. Design Retrospective observational study. Setting Unit of Social and Clinical Assessment (UVSS), Miguel Servet University Hospital (HUMS), Zaragoza (Spain). Year, 2011

This systematic review evaluates the evidence from randomized, controlled trials (RCTs) and prospective cohort studies on the association of coronary and carotid revascularization, cardiac valve replacement and repair, and ablation for atrial fibrillation on intermediate- and long-term cognitive outcomes in adults aged 65 years or older.

The few eligible studies we identified reported little to no difference in cognitive outcomes between or within treatment groups, although conclusions were usually limited by scant and heterogeneous data and low individual-study quality.

...The discharge assessment data in the MDS 3.0 provide new information to researchers and providers to examine and track ADL performance. Nursing homes can identify and track patients who require more intensive therapies or targeted interventions to achieve functional improvement during their stay. Future research can examine facility-level measures to better understand how ADL improvement varies across facilities

Our animation gives a whistle-stop tour of how the system fits together and busts some myths about what’s really going on – explaining that the underlying causes go much deeper than just A&E and demand a joined up response across all services. A&E is often seen as a service in crisis and is the focus of much media and political interest. But A&E is just the tip of the iceberg – the whole urgent and emergency care system is complex, and surrounded by myth and confusion.

Demographic and epidemiologic transitions have brought a new health care paradigm with the presence of both a, growing elderly population and more people suffering from chronic diseases. Life expectancy is increasing as well as the need for long-term care. Institutional care for the aged population faces economical struggles with consequent quality problems. To facilitate solutions for prolonging independent living, the European Union has awarded funding tofunds an interdisciplinary research and innovation project called “RADIO”. A European consortium, led by the National Center for Scientific Research “Demokritos” (GR), Institute of Informatics and Telecommunication, will develop over the next three years a robotic smart home for unobtrusive, efficient and modular solutions for independent ageing.