From Frailty to Gerastenia Strandberg, Timo E.; Cederholm, Tommy; Ekdahl, Anne
Journal of the American Geriatrics Society,
October 2019, Letnik:
67, Številka:
10
Journal Article
Globally, the population is ageing and lives with several chronic diseases for decades. A high symptom burden is associated with a high use of healthcare, admissions to nursing homes, and reduced ...quality of life. The aims of this study were to describe the multidimensional symptom profile and symptom burden in community-dwelling older people with multimorbidity, and to describe factors related to symptom burden.
A cross-sectional study including 378 community-dwelling people ≥ 75 years, who had been hospitalized ≥ 3 times during the previous year, had ≥ 3 diagnoses in their medical records. The Memorial Symptom Assessment Scale was used to assess the prevalence, frequency, severity, distress and symptom burden of 31 symptoms. A multiple linear regression was performed to identify factors related to total symptom burden.
The mean number of symptoms per participant was 8.5 (4.6), and the mean total symptom burden score was 0.62 (0.41). Pain was the symptom with the highest prevalence, frequency, severity and distress. Half of the study group reported the prevalence of lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score.
The older community-dwelling people with multimorbidity in this study suffered from a high symptom burden with a high prevalence of pain. Persons with poor vision, likelihood of depression, and diseases of the digestive system are at risk of a higher total symptom burden and might need age-specific standardized guidelines for appropriate management.
Abstract
Background
the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed ...considerably since then and it has therefore become necessary to update these recommendations.
Methods
under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators.
Results
the final recommendations include four different domains: ‘General Considerations’ on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), ‘Knowledge in patient care’ (36 sub-items), ‘Additional Skills and Attitude required for a Geriatrician’ (9 sub-items) and a domain on ‘Assessment of postgraduate education: which items are important for the transnational comparison process’ (1 item).
Conclusion
the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.
Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life.
The aim of this study is to ...explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.
A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79–89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.
The experience of living with a high symptom burden revealed the overall theme, “To adjust and endure” and three sub-themes. The first sub-theme was “To feel inadequate and limited”. Participants reported that they no longer had the capacity or the ability to manage, and they felt limited and isolated from friends or family. The second sub-theme was “To feel dependent”. This was a new and inconvenient experience; the burden they put on others caused a feeling of guilt. The final sub-theme was “To feel dejected”. The strength to manage and control their conditions was gone; the only thing left to do was to sit or lie down and wait for it all to pass.
This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that are possible to treat or improve.
Background
Long‐term cognitive problems are common among elderly patients after surgery, and it has been suggested that inhalation anaesthetics play a role in the development of dementia. This study ...aims to investigate the hypothesis that patients with dementia have been more exposed to surgery and inhalational anaesthetics than individuals without dementia.
Methods
Using 457 cases from a dementia‐registry and 420 dementia‐free controls, we performed a retrospective case‐control study. The medical records were reviewed to determine exposure to anaesthesia occurring within a 20‐year timeframe before the diagnosis or inclusion in the study. Data were analysed using multivariate logistic regression and propensity score analysis.
Results
Advanced age (70 years and older, with the highest risk in ages 80‐84 years) and previous head trauma were risk factors for dementia. History of exposure to surgery with anaesthesia was a risk factor for dementia (OR = 2.23, 95% CI 1.66‐3.00, P < 0.01). Exposure to inhalational anaesthetics with halogenated anaesthetics was associated with an increased risk of dementia, compared to no exposure to anaesthesia (OR = 2.47, 95% CI 1.17‐5.22, P = 0.02). Exposure to regional anaesthesia was not significantly associated with increased risk of dementia (P = 0.13).
Conclusion
In this 20‐year retrospective case‐control study, we found a potential association between dementia and prior anaesthesia. Exposure to general anaesthetics with halogenated anaesthetic gases was associated with an increased risk of dementia.
IntroductionComprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process used to determine the medical, psychological and functional capabilities of frail ...older people. The primary aim of our current study is to confirm whether CGA-based outpatient care is superior than usual care in terms of health-related outcomes, resource use and costs.Methods and analysisThe Geriatric Mobile Team trial is designed as a single-centre randomised, controlled, assessor-blinded (at baseline) trial. All participants will be identified via local healthcare registries with the following inclusion criteria: age ≥75 years, ≥3 different diagnoses and ≥3 visits to the emergency care unit (with or without admittance to hospital) during the past 18 months. Nursing home residency will be an exclusion criterion. Baseline assessments will be done before the 1:1 randomisation. Participants in the intervention group will, after an initial CGA, have access to care given by a geriatric team in addition to usual care. The control group receives usual care only. The primary outcome is the total number of inpatient days during the follow-up period. Assessments of the outcomes: mortality, quality of life, health care use, physical functional level, frailty, dependence and cognition will be performed 12 and 24 months after inclusion. Both descriptive and analytical statistics will be used, in order to compare groups and for analyses of outcomes over time including changes therein. The primary outcome will be analysed using analysis of variance, including in-transformed values if needed to achieve normal distribution of the residuals.Ethics and disseminationEthical approval has been obtained and the results will be disseminated in national and international journals and to health care leaders and stakeholders. Protocol amendments will be published in ClinicalTrials.gov as amendments to the initial registration NCT02923843. In case of success, the study will promote the implementation of CGA in outpatient care settings and thereby contribute to an improved care of older people with multimorbidity through dissemination of the results through scientific articles, information to politicians and to the public.Trial registration number NCT02923843; Pre-results.
Key summary points
Aim
Does comprehensive geriatric assessment (CGA) affect the causes of death and the quality of palliative care when patients receive care at the end of life when in an outpatient ...care setting compared to usual care?
Findings
CGA does not affect the causes of death. CGA affects the frequency of referral to specialised palliative care teams, but CGA does not affect the quality of palliative care given to the patients. These effects are measured in outpatient care settings and in comparison with usual care.
Message
Further studies are needed to evaluate the CGA effects on causes of death and palliative care quality in outpatient care settings.
Purpose
The purposes of this study were to retrospectively study whether comprehensive geriatric assessment (CGA) given to community-dwelling old patients with high health care usage has effects regarding: (1) the cause of death and (2) the quality of the provided palliative care when compared to patients without CGA-based care.
Method
This study includes secondary data from a randomised controlled trial (RCT) with 382 participants that took place in the periods 2011–2013. The present study examines all electronical medical records (EMR) from the deceased patients in the original study regarding cause of death intervention group (IG)
N
= 51/control group (CG)
N
= 66 and quality of palliative care (IG
N
= 33/CG
N
= 41). Descriptive and comparative statistics were produced and the significance level was set at
p
< 0.05.
Results
The causes of death in both groups were dominated by cardiovascular and cerebrovascular diseases with no statistical difference between the groups. Patients in the intervention group had a higher degree of support from specialised palliative care teams than had the control group (
p
= 0.01).
Conclusion
The present study in an outpatient context cannot prove any effects of CGA on causes of death. The study shows that CGA in outpatient care means a higher rate of specialised palliative care, but the study cannot show any effects on the palliative quality parameters measured. Further studies with statistical power are needed.
Abstract How to improve the care of elderly patients with multi-morbidity, regardless of borders between medical specialities and professions, starting from the patients’ point of view and ending ...with a powerful policy document with impact on the political system. A document written by the Swedish Association of Geriatric Medicine, the Swedish Association of General Practice and the Swedish Association of Internal Medicine.
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