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2072 results in Geriatrics

Page 30 of 104

  • 10 - Environmental and social contexts

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 159-170

  • Summary

    Learning outcomes

  • Outline principles of sound environmental design that enable maximising abilities and support limitations.

  • Describe the application of evidence-based designs in varying contexts: the home, community, residential care and acute care.

  • Discuss the application of principles of participatory involvement to the design of buildings for people with dementia.

  • Discuss how an interprofessional education and interprofessional practice approach may enhance environmental design and participatory engagement.

    • Key terms

  • environmental design

  • interprofessional education (IPE)

  • interprofessional practice (IPP)

  • knowledge translation (KT)

    • Introduction

    What do the people who provide care to people with dementia share? Values, attitudes, skills - perhaps; but there is one that they cannot avoid sharing - the building that the person with dementia is occupying.

    Environmental design

    It seems fair for me to say, after 30 years of working in the field, that the appreciation of the impact of the building on the success of care is somewhat limited. This is not because we lack information on how to reduce the disabilities experienced by people with dementia by designing enabling buildings.

    In fact, we have the benefit of a reasonably extensive literature on the subject (Fleming & Purandare, 2010; The King’s Fund, 2012; Garre-Olmo et al., 2012 ; Zuidema et al., 2010 ; van Hoof et al., 2010; Verbeek et al., 2009; Calkins, 2009). The findings from this literature can be organised around 10 principles of environmental design (Fleming & Bennett, 2013) and these have been summarised in Table 10.1 .

  • 2 - The journey of dementia

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 37-48

  • Summary

    Learning outcomes

  • Discuss the course of the disease from health to illness to death.

  • Discuss the importance of acknowledging the social, emotional and spiritual aspects of a person living with dementia.

  • Discuss the significance of the person’s life lived before the onset of dementia.

  • Consider the impact of the journey of dementia on family and friends.

    • Key terms

  • Alzheimer’s disease

  • dementia

  • neurocognitive disorder (NCD)

  • personality

    • Introduction

    The journey of dementia can be described as follows:

  • something is not right;

  • diagnosis;

  • course;

  • transitions;

  • end of life;

  • life stories;

  • the family experience.

    • Mace and Rabins (1981) made four connected statements about dementia:

  • there is damage to the brain;

  • the person is still there;

  • the family is also affected;

  • there are things we can do.

    • This chapter will expand on the first three statements and allude to the last.

    As health or care professionals, we should always remember that people have lived 60 or 70 years before the onset of dementia – it does not define them. Each of us comes in and out of people’s lives in just this small portion. Really we might be a bit important but in the totality we are just a small-bit player.

  • Foreword

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp v-vi

  • Summary

    Over the past decade there has been a signii cant movement towards interprofessional practice (IPP) and education within health care, as a key strategy to increase the effectiveness of health care delivery. Recent studies and systematic reviews have shown that IPP is well received by clinicians, can change their perceptions and attitudes, and is related to improvements in knowledge, skills and collaborative practice. There is a growing body of research showing the positive impact of IPP approaches on healthcare processes, patient satisfaction and clinical outcomes.

    For people living with dementia and their carers, there will be many critical points across the trajectory of disease when they will seek – or be offered - advice, treatment, care and support. The organisation, delivery and quality of the health care they receive, and the important relationships that are formed in the process, can make the difference between a seamless healthcare journey that enhances overall quality of daily life or a fragmented, stressful series of encounters that makes the journey more dificult. Recent international and Australian initiatives in interprofessional dementia care have illustrated the potential benefits of this type of approach to the complex range of needs and issues that occur for people living with dementia and their carers.

  • 4 - Evidence-based practice

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 63-80

  • Summary

    Learning outcomes

  • Identify the challenges of applying evidence-based practice to health workplaces.

  • Discuss the role of interprofessional education in supporting the translation of evidence into practice within dementia care.

  • Describe the barriers and enablers of knowledge translation and evidence-based practice.

    • Key terms

  • evaluation

  • evidence-based practice (EBP)

  • interprofessional education (IPE)

  • knowledge translation (KT)

  • power

    • Introduction

    The concept of evidence-based practice (EBP) has become the gold standard for health care as it envisions that new and innovative findings (ideas, treatments, technology and methods) will be incorporated into the education of health care teams and thus will lead to improvements in real-world practice with the application of current knowledge. It makes sense that we look to the research literature (peer reviewed and published studies), evaluate what we find, and use evidence in our planning and our ways of doing things. The Oxford Centre for Evidence-Based Medicine (Howick et al., 2011) has developed a hierarchy of likely best evidence with five levels of evidence from strongest to weakest: systematic reviews, randomised controlled trials, cohort studies, case series and clinical/mechanistic reasoning. They link the evidence to whether it is being used for diagnosis, prognosis, therapy and prevention, or economic decision analysis. Eccles and colleagues (1998) used three evidence categories to develop guidelines for the primary care management of dementia: They are:

  • I well-designed randomised controlled trials, meta-analyses or systematic reviews;

  • II well-designed cohort or case control studies;

  • III uncontrolled studies or external consensus.

  • 7 - Developing collaborative skills

  • Dawn Forman, Curtin University, Perth, Dimity Pond, University of Newcastle, New South Wales
  • Book:
    Care of the Person with Dementia
    Published online:
    06 August 2018
    Print publication:
    15 September 2015, pp 105-114

  • Summary

    Learning outcomes

  • Review the collaborative skills required for interprofessional practice for people with dementia.

  • Consider how these skills are introduced into the working environment.

  • Discuss the factors that may affect staff resilience and the sustainability of good practice.

    • Key terms

  • capabilities

  • communication

  • dementia

  • interprofessional

  • interprofessional collaboration (IPC)

  • interprofessional teamwork

  • resilience

  • sustainability

  • teamwork

    • Introduction

    In Chapter 1 , we looked at the competencies and capabilities that have been derived by various groups working in this area internationally. We noted that capability tools, to measure whether individuals in teams have these skills, continue to be developed and refined. In this chapter, we revisit these capabilities by asking how these could be introduced into an interprofessional team working with individuals who have dementia and how, with these skills, the team can become resilient to change and therefore can ensure an interprofessional culture that can be sustained by an organisation.

    Interprofessional capabilities

    There are a number of models and interprofessional capability tools that have been developed internationally. Interestingly, the same capabilities (with different emphases according to the country and the environment in which they have been developed) seem to be included in some way in these tools:

  • client-centred;

  • collaborative working;

  • reflection;

  • cultural awareness;

  • organisational competence;

  • leadership skills;

  • communication;

  • role clarification;

  • professionalism;

  • conflict resolution;

  • ethics and values.

Care of the Person with Dementia
  • Interprofessional Practice and Education
  • Dawn Forman, Dimity Pond
  • Published online:
    06 August 2018
    Print publication:
    15 September 2015
  • Care of the Person with Dementia responds to the urgent need for health practitioners to take an innovative approach to the challenge of dementia. The first Australian text of its kind, it combines evidence-based resources with interprofessional education and practice, exploring the ethical, social and environmental repercussions of dementia to provide a comprehensive overview of dementia care in an Australian context. The text is structured around a model of interprofessional education and practice (IPE) tailored to dementia care. This model incorporates the context of care, an important element missing from other recognised models of IPE. Throughout the book, principles of IPE are explained within the context of dementia, drawing on exemplars from a body of current, well-researched and evaluated dementia practice. Written by experienced academics, and providing national and international perspectives, this is a unique and crucial resource to develop collaborative skills and professional knowledge in the management of dementia.

  • Cancer in the older person

  • Emma Kelly, Peter Stephens
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 3 / August 2015
    Published online by Cambridge University Press:
    24 August 2015, pp. 172-180
    Print publication:
    August 2015

  • The challenges of treating malignant disease in the elderly population have gained greater prominence over the last 5–10 years. Developed nations all have ageing populations, and cancer in older people is an increasing physical and financial burden on both healthcare systems and populations.

    When assessing oncology patients, oncologists have traditionally used the Eastern Cooperative Oncology Group or Karnofsky performance status. However, it has been shown that sometimes this does not detect potential problems in older patients, and that a comprehensive geriatric assessment may be a better tool. However good surgeons and oncologists are at adapting their services for older patients, there is little value if they are inappropriately referred or filtered out by either primary or secondary care.

    Surgery forms the basis of most curative treatment options. The elderly have more peri-operative risk factors including multiple co-morbidities, poly-pharmacy, malnutrition, frailty, cognitive dysfunction and an increased anaesthetic risk, which can create obstacles.

    Treating older patients with systemic cytotoxic therapy often relies on extrapolating evidence from younger patients. In previous decades, the majority of trials had upper age limits of 65 or 70 years. More recent trials normally include patients of all ages, and entry is based on performance status. Radiotherapy may be chosen as a potentially curative option in patients with an operable tumour, who are unfit. However, oncologists should not underestimate the burden that multiple frequent visits to hospital for treatment may have on an elderly patient population.

    This article looks at the assessment of elderly oncology patients, referral patterns, surgery, systemic therapies, radiotherapy, supportive therapies and long-term side-effects from treatment.

  • Pain in older people with frailty

  • Lesley Brown, John Young, Andrew Clegg, Anne Heaven
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 3 / August 2015
    Published online by Cambridge University Press:
    03 November 2015, pp. 159-171
    Print publication:
    August 2015

  • In this review we identified cohort and cross-sectional studies that assessed pain in community-dwelling older people (>65 years) reliably characterized as frail. Secondly, we considered biologically plausible mechanisms that may alter pain perception, or contribute to, or exacerbate pain in an older person with frailty. Thirdly, we considered specific implications of pain management for this group of people. From the limited data from the seven included studies, it would appear that the presence of pain is higher in older people with frailty compared with people characterized as pre-frail or not frail. Thus older people reporting pain are more likely to be frail. However, a lack of prospective data precludes inferences about the direction of the relationship: that is whether pain or frailty is the antecedent. Further research is needed to understand the direction of the relationship, and to identify appropriate pain management strategies for older people with frailty.

  • Non-pharmacological management of sexual behaviours that challenge in dementia

  • Hazel Thornton, Rosslyn Offord
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 3 / August 2015
    Published online by Cambridge University Press:
    03 November 2015, pp. 194-201
    Print publication:
    August 2015

  • A literature search was conducted to identify and evaluate non-pharmacological interventions available for people living with dementia, who present with sexual behaviours that challenge. A lack of research implementing and evaluating clinical interventions was identified, and the search was broadened to include discussion papers relating to sexuality and dementia. This included work both with couples affected by dementia at home, and with staff in institutional care settings. The papers identified come from a range of countries, with wide variation in care settings and practices. Literature suggests sexual behaviours that challenge in dementia are best understood within the broader context of behavioural and psychological symptoms of dementia (BPSD). There is a consensus highlighting the importance of training staff to recognize the sexual needs of people with dementia and to develop clear policy and guidelines to support staff in managing potential challenges. Few authors attempted to include the perspectives of either care partners or the person with dementia.

  • Does cognitive reserve moderate the association between mood and cognition? A systematic review

  • Carol Opdebeeck, Catherine Quinn, Sharon M Nelis, Linda Clare
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 3 / August 2015
    Published online by Cambridge University Press:
    03 November 2015, pp. 181-193
    Print publication:
    August 2015

  • The evidence regarding the association between mood and cognitive function is conflicting, suggesting the involvement of moderating factors. This systematic review aimed to assess whether cognitive reserve moderates the association between mood and cognition in older people. Cognitive reserve was considered in terms of the three key proxy measures – educational level, occupation, and engagement in cognitively stimulating leisure activities – individually and in combination. Sixteen studies representing 37,101 participants were included in the review. Of these, 13 used a measure of education, one used a measure of occupation, two used a measure of participation in cognitively stimulating activities, and one used a combination of these. In general, cognitive reserve moderated the association between mood and cognition, with a larger negative association between mood and cognition in those with low cognitive reserve than in those with high cognitive reserve. Further research utilizing multiple proxy measures of cognitive reserve is required to elucidate the associations.

  • Transport, driving and ageing

  • Desmond O’Neill
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 2 / May 2015
    Published online by Cambridge University Press:
    16 June 2015, pp. 147-158
    Print publication:
    May 2015

  • Transport is the invisible glue that holds our lives together, an under-recognized contributor to economic, social and personal well-being. In public health terms, the medical profession had previously allowed itself to focus almost exclusively on the downsides of transport. However, the research basis for transport, driving and ageing is steadily evolving and has important academic and practical considerations for gerontologists and geriatricians. For gerontologists, teasing out the critical role of transport in the health and well-being of older people is an imperative, as well as the key challenges inherent in transitioning from driving to not driving. The safe crash record of a group with significant multi-morbidity allows us to focus on the remarkable strategic and adaptive skills of older people. From a policy perspective, strictures on older drivers are an exemplar of institutionalized ageism. For geriatricians, a key challenge is to develop strategies for including transportation in our clinical assessments, formulating effective strategies for assessment of medical fitness to drive, incorporating enabling techniques, giving due consideration to ethical and legal aspects, and developing and promoting multi-modality and alternative transportation options.

  • Fear of falling assessments in older people with dementia

  • Chantel Cox, Michael Vassallo
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 2 / May 2015
    Published online by Cambridge University Press:
    21 May 2015, pp. 98-106
    Print publication:
    May 2015

  • Fear of falling (FoF) is a common condition in older age. However, there is a paucity of research on its prevalence, impact and treatment in older people with dementia. People with dementia have an increased risk of falls which present a significant threat to their independence, as well as having a significant economic impact on health and social services. This review outlines the key issues in relation to FoF, current guidelines and assessment tools and their use for people with dementia. Further research needs to be completed in both addressing the specific assessment barriers that people with dementia may face regarding the use of current FoF tools, with further exploration surrounding the individual's experience of FoF and how this may be impacting upon their quality of life and functionality. Until a well-validated method has been developed, clinicians need to utilize available tools as guidelines, seek the assistance of proxies at all stages of the care journey, and use clinical judgement to assess FoF in patients with dementia.

  • Subcutaneous fluid and drug delivery: safe, efficient and inexpensive

  • Oscar Duems-Noriega, Sergio Ariño-Blasco
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 2 / May 2015
    Published online by Cambridge University Press:
    23 June 2015, pp. 117-146
    Print publication:
    May 2015

  • 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.

  • Small intestinal bacterial overgrowth in older people

  • Syed Amer, Huma S Manzar
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 2 / May 2015
    Published online by Cambridge University Press:
    15 June 2015, pp. 81-85
    Print publication:
    May 2015

  • Small intestinal bacterial overgrowth (SIBO) is a condition in which non-native bacteria and/or native bacteria are present in increased numbers in the small bowel, resulting in excessive fermentation, inflammation or malabsorption. Patients with SIBO vary in presentation, from being only mildly symptomatic to suffering from chronic diarrhoea, weight loss and malabsorption. A number of diagnostic tests are currently available, with aspiration of the small intestinal fluid being the gold standard. Treatment encompasses a multimodal approach including treatment of the underlying disease, nutritional support and antibiotic therapy. In this review, we discuss the risk factors, clinical manifestations, diagnosis and treatment of SIBO in older people.

  • Hospital readmissions in frail older people

  • Emily Craven, Simon Conroy
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 2 / May 2015
    Published online by Cambridge University Press:
    29 April 2015, pp. 107-116
    Print publication:
    May 2015

  • The majority of hospital in-patients are older people, and many of these are at increased risk of readmission, which can be an adverse outcome for the patient. Currently there is poor understanding as to how best to reduce the risk of readmission. We searched MEDLINE, EMBASE and the Cochrane library for high quality review articles about readmissions. Each review was quality assessed by two reviewers. Grouped data and evidence from original papers is cited with 95% confidence intervals when possible. Nine review studies of sufficient quality were included. Two addressed risk factors for readmission, which included: age, poor functional status prior to admission, length of stay during the index admission, depression, cognitive impairment, malnutrition, social support and social networks/support. The seven other reviews addressed interventions to reduce readmission, which included: discharge planning, post-discharge support, post-discharge case management, and nutritional supplementation. It is possible to identify older people at risk of readmission using well-established risk factors; discharge planning, post-discharge support and nutritional interventions appear to be effective in reducing readmission. Combined interventions appear to be more effective than isolated interventions.

  • Ageing, exercise and the chemistry of inflammation

  • SC Allen
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 2 / May 2015
    Published online by Cambridge University Press:
    29 April 2015, pp. 73-80
    Print publication:
    May 2015

  • Exercise has a complex influence on the biochemical markers of inflammation that includes suppression of pro-inflammatory cytokines and promotion of anti-inflammatory cytokines. The magnitude of this effect is large for prolonged activity at high work rates. People who are able to perform regular mild–moderate exercise have lower baseline pro-inflammatory cytokine levels that appear to be associated with a number of health benefits, including reduced all-cause mortality. These effects extend into old age. Interleukin-6 (IL-6), a pleiotropic myokine released by active muscle cells, appears to play a central role in these observed phenomena, though the mechanisms of action are intricate and incompletely understood. The minimum threshold of the exercise–cytokine dose–response, if any, has not been clearly characterized. Therefore, the potential to influence cytokine activity and reduce age-associated inflammation in very aged or frail people able to perform only very low levels of physical activity is unknown.

  • The effect of sarcopenic obesity on cardiovascular disease and all-cause mortality in older people

  • Janice L Atkins, S Goya Wannamethee
  • Journal:
    Reviews in Clinical Gerontology / Volume 25 / Issue 2 / May 2015
    Published online by Cambridge University Press:
    29 April 2015, pp. 86-97
    Print publication:
    May 2015

  • Obesity is a major public health problem with increasing prevalence worldwide. It is well recognized as a risk factor for cardiovascular morbidity and mortality in adult populations. Obesity prevalence is also increasing with age, and this may be particularly important in an ageing population. Ageing is associated with an increase in visceral fat and a progressive loss of muscle mass. Sarcopenia has been defined as the age-associated loss of skeletal muscle mass and has been associated with metabolic impairment, cardiovascular disease (CVD) risk factors, physical disability and mortality. Sarcopenia is often associated with obesity. Sarcopenic obesity is a new category of obesity in older adults who have high adiposity coupled with low muscle mass. Thus sarcopenia with obesity may synergistically increase their effect on metabolic disorders, CVD and mortality. This review focuses on the effects of sarcopenic obesity on the risk of cardiovascular disease and mortality in older adults.

  • 3 - Investigating older people's lives at the end of the twentieth century

  • Peter G. Coleman, University of Southampton, Christine Ivani-Chalian, Maureen Robinson
  • Book:
    Self and Meaning in the Lives of Older People
    Published online:
    05 May 2015
    Print publication:
    27 April 2015, pp 16-28

  • Summary

    In this chapter, we explain our selection of forty cases for individual study from members of the Southampton Ageing Project (1977–8 to 2002–3) and briefly comment on their general characteristics. We then survey the self-descriptions that were provided over the first ten and more years of the study. This is followed by an account of the methods we followed in the final ten years in assembling and analyzing material to produce detailed individual case studies. Finally, we provide an introduction to our present accounts of the cases in the subsequent chapters.

    Participants included in the case analysis

    Although we only received concentrated funding for case study analysis in 1995, we began to identify and interview in depth selected members of our sample from 1990 onwards, when the sample was all aged over seventy-seven years. In 1995–6, we were able to complete case study accounts on each of the twenty-eight remaining participants. Together with those cases that we had begun beforehand and who had died in the intervening years, we succeeded in composing a total of forty case analyses (twenty-three women and seventeen men). In most cases, we conducted a further interview in which we checked our written conclusions with the participants and invited their comments. Later interviews were also conducted with surviving members of the sample by the first author as well as by the second or third author who had interviewed them regularly over the preceding years.

    Brief descriptive details on each case, including year of birth, principal occupation, age at leaving full-time education and age at death, are provided in the Appendix. Pseudonyms replace the original names in the Appendix and throughout the text. The majority of the sample (twenty-seven of forty) were still married when we first interviewed them in 1977–8, and all had been married at one time in their lives. Three persons were divorced or separated.

Page 30 of 104