In this Viewpoint, author Jerry Gurwitz discusses the attrition of geriatric medicine as a profession, attributing it in part to societal attitudes about aging and compounded by the negative effects ...of lower compensation and lack of career prestige.
Abstract
Background
Various patient demographic and clinical characteristics have been associated with poor outcomes for individuals with coronavirus disease 2019 (COVID-19). To describe the ...importance of age and chronic conditions in predicting COVID-19-related outcomes.
Methods
Search strategies were conducted in PubMed/MEDLINE. Daily alerts were created.
Results
A total of 28 studies met our inclusion criteria. Studies varied broadly in sample size (n = 21 to more than 17,000,000). Participants’ mean age ranged from 48 years to 80 years, and the proportion of male participants ranged from 44% to 82%. The most prevalent underlying conditions in patients with COVID-19 were hypertension (range: 15%–69%), diabetes (8%–40%), cardiovascular disease (CVD) (4%–61%), chronic pulmonary disease (1%–33%), and chronic kidney disease (range 1%–48%). These conditions were each associated with an increased in-hospital case fatality rate (CFR) ranging from 1% to 56%. Overall, older adults have a substantially higher case fatality rate (CFR) as compared to younger individuals affected by COVID-19 (42% for those <65 vs 65% > 65 years). Only one study examined the association of chronic conditions and the risk of dying across different age groups; their findings suggested similar trends of increased risk in those < 65 years and those > 65 years as compared to those without these conditions.
Conclusions
There has been a traditional, single-condition approach to consideration of how chronic conditions and advancing age relate to COVID-19 outcomes. A more complete picture of the impact of burden of multimorbidity and advancing patient age is needed.
Geriatric Medicine as a Profession—Reply Gurwitz, Jerry H
JAMA : the journal of the American Medical Association,
01/2024, Letnik:
331, Številka:
2
Journal Article
Recenzirano
Gurwitz shares his reply to the letter of doctors Michel and Ecarnot regarding geriatic medicine as a profession and that they correctly suggest that the viewpoint of the author reflected only a US ...perspective. Certainly, much can be learned from other countries, where greater attention is paid to geriatrics in medical education, there is less variation in physician compensation across specialties, and, most importantly, attitudes about aging and the care of older adults may differ from those in the US. He also thank Dr Fulmer and Dr Crupi and colleagues for highlighting the importance and promise of the age-friendly health systems movement and other initiatives. Fulmer is correct that he is not the first to write the story of the challenges facing the profession of geriatric medicine. Mary Tinetti, MD, who was among a group of geriatricians that originated the principles underlying age-friendly health care, previously described the geriatric paradox.
Injuries from falls are major contributors to death and complications in older adults. In this pragmatic, cluster-randomized trial, a multifactorial intervention that was administered by nurses did ...not result in a significantly lower rate of first adjudicated serious fall injury than enhanced usual care.
The prescribing cascade revisited Rochon, Paula A; Gurwitz, Jerry H
The Lancet (British edition),
05/2017, Letnik:
389, Številka:
10081
Journal Article
Recenzirano
A prescribing cascade begins when a drug is prescribed, an adverse drug event occurs that is misinterpreted as a new medical condition, and a subsequent drug is prescribed to treat this drug-induced ...adverse event (figure). We first described the idea of a prescribing cascade in The Lancet in 1995,1 and expanded on this concept in The BMJ in 1997.2 The identification and interruption of prescribing cascades is an important, actionable, and underappreciated opportunity to improve medication safety in older people.
Weight Loss in Newly Admitted Nursing Home Residents With Obesity Zhang, Ning; Field, Terry; Mazor, Kathleen M ...
The journals of gerontology. Series A, Biological sciences and medical sciences,
2023-Jun-01, 2023-06-01, 20230601, Letnik:
78, Številka:
6
Journal Article
Recenzirano
The prevalence of obesity (body mass index ≥ 30) among nursing home residents has been increasing, but there has been little research on weight change in this population. We examined resident ...characteristics associated with substantial weight loss among nursing home residents with obesity.
Using data from the Minimum Data Set 3.0, this retrospective study included long-stay nursing home residents with obesity newly admitted to a facility in 2014 who had annual assessments in 2015. Substantial weight loss was defined as a loss of ≥10% body weight within a year. Multivariate regression analyses were conducted to identify factors associated with weight loss, including demographic characteristics, medical conditions, and functional limitations in activities of daily living (ADL).
Among 59782 newly admitted nursing home residents with obesity, 23% experienced substantial weight loss during their first year in the nursing home. Moderate ADL dependency (odds ratio OR = 1.42, 95% confidence interval CI: 1.31-1.53), severe ADL dependency (OR = 1.83; 95% CI: 1.67-1.99), severe mobility impairment (OR = 1.15; 95% CI: 1.04-1.23), and severe cognitive impairment (OR = 1.13; 95% CI: 1.07-1.19), as well as cancer (OR = 1.10; 95% CI: 1.01-1.20), heart failure (OR = 1.06; 95% CI: 1.01-1.11), end-stage renal disease (OR = 1.17; 95% CI: 1.11-1.23), and bowel incontinence (OR = 1.19; 95% CI: 1.14-1.25) were associated with weight loss.
Substantial weight loss is common among nursing home residents with obesity over a 1-year period following admission, and these residents have a greater burden of functional and cognitive impairment and specific medical conditions. These findings suggest the need to further elucidate the clinical implications of weight loss among this population.
PDF
