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Dementia and physical health
Published in Graham A. Jackson, Debbie Tolson, Textbook of Dementia Care, 2019
Comprehensive Geriatric Assessment applied to older people with frailty, including those with dementia improves clinical outcome (reduces mortality and the need for long-term care) and reduces the burden of health and social care.
Living well with frailty
Published in Shibley Rahman, Living with frailty, 2018
Comprehensive geriatric assessment has been proposed as a holistic approach to meeting the needs of older patients. It is defined as ‘a multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological, and functional capability in order to develop a coordinated and integrated plan for treatment and long-term follow-up’ (Ellis et al., 2011). CGA, indicated to explore effectively these multiple domains of health, is indeed the multidimensional and multidisciplinary tool of choice to determine the clinical profile, pathological risk, residual skills, and short- and long-term prognosis to define the personalised therapeutic and care plan of the functionally compromised and frail older individual so as to facilitate clinical decision making (Pilotto et al., 2017). CGA differs from the standard medical evaluation because of its suitability for assessing frail older people with complex problems, emphasis on functional status and quality of life, use of interdisciplinary teams, and quantitative assessment scales (Suijker et al., 2012). Moreover, CGA can vary in intensity from screening assessment (focused on identifying older persons’ problems performed by primary care/community health workers) to thorough diagnostic assessment and management of these problems carried out by a multidisciplinary team with geriatric training and experience (e.g. Pilotto et al., 2009).
The Geriatrician
Published in Stefano Federici, Marcia J. Scherer, Assistive Technology Assessment Handbook, 2017
Martina Pigliautile, Lorenza Tiberio, Patrizia Mecocci, Stefano Federici
The assessment could be implemented by a single geriatrician or by a team of health professionals; in the latter case, the term “comprehensive geriatric assessment” is used. This term was defined by the National Institute of Health (NIH) Consensus Development Conference in 1987 as amultidisciplinary evaluation in which the multiple problems of older persons are uncovered, described, and explained, if possible, and in which the resources and strengths of the person are catalogued, need for services assessed, and a coordinate care plan developed to focus interventions on the person's problems. (NIH Consensus Development Program, 1987)and by Rubenstein as a “a multidimensional interdisciplinary diagnostic process intended to determine a frail elderly person's medical, psychosocial, and functional capabilities and problems in order to develop an overall plan for treatment and long-term follow-up” (Rubenstein, 1995, p. 3). The goals of CGA have been summarized by Rubenstein (1995) as follows: enhancing diagnostic accuracy, optimizing medical treatment, and living location, improving medical outcomes, improving function and quality of life, reducing unnecessary service usage, and arranging long-term care management.
Self-perceived cognitive status and cognitive challenges associated with cardiac rehabilitation management: experiences of elderly myocardial infarction patients
Published in Disability and Rehabilitation, 2022
Thea Liljeroos, Soorej Jose Puthoopparambil, John Wallert, Claes Held, Erik M. G. Olsson
For some patients, social support was of great significance for a well-functioning self-care, this is in line with previous research identifying social support as an important factor for coping and positive change [46]. However, this could potentially indicate a vulnerability over time in the event where social support networks might be lost. Hence, we stress the importance of a continuous assessment of patients’ self-care ability over time, as a part of the patient-centred care that has been recommended for elderly cardiac patients [17]. This assessment should include the overall health and cognitive status, social network, and the objective living conditions (e.g., distance from service and housing), in order to identify individual barriers to a successful self-care. This form of assessment is a key component of Comprehensive Geriatric Assessment programs, where medical, social, and functional needs of older patients are identified and managed [47]. When paired with strong long-term management, Comprehensive Geriatric Assessment has been associated with a positive impact on survival and functional status among elderly patients [48]. Moreover, identifying and strengthening informal caregivers in their roles can be of great value in order to relieve stress, increase health and well-being and promote a well-functioning long-term rehabilitation [49,50].
Could Frailty be an Explanatory Factor of the Association between Depression and Other Geriatric Syndromes in Later Life?
Published in Clinical Gerontologist, 2021
Marcus Kiiti Borges, Richard C. Oude Voshaar, Carla Fernanda de Vasconcellos Romanini, Fabiana Maria Oliveira, Natália Almeida Lima, Marina Petrella, Daniele Lima Costa, José Eduardo Martinelli, Silvana Vieira Bandeira Mingardi, Alaise Siqueira, Marina Biela, Rose Collard, Ivan Aprahamian
Geriatric syndromes are a heterogeneous cluster of clinical problems with one central symptom (e.g. dizziness, cognitive impairment). Definitions and specifications to diagnosis are variable among them (Inouye et al., 2007). A comprehensive geriatric assessment is the most recommended strategy to identify geriatric syndromes, which are usually detected clinically, and it was used in our study with this objective (Inouye et al., 2007). The number of geriatric syndromes was operationalized as the sum of 6 recognized geriatric syndromes, namely cognitive impairment, urinary incontinence, falls, weight loss/anorexia, mobility problems, and dizziness. Geriatric syndromes were not considered in the FI model or in the conceptualization of multimorbidity or in the sum of clinical disease clusters.
Neuropsychological Functioning in Older Adults with Obesity: Implications for Bariatric Surgery
Published in Journal of Nutrition in Gerontology and Geriatrics, 2019
Robert M. Roth, Sivan Rotenberg, Jeremy Carmasin, Sarah Billmeier, John A. Batsis
The rapid increase of older adults with obesity has led to a rise in the number of Medicare beneficiaries in the United States seeking bariatric surgery (10). Bariatric surgery is an effective means of improving medical co-morbidity and is increasingly recognized as an effective therapeutic strategy in older adults (11–13). However, in clinical practice, older age has been associated with a lower likelihood of considering bariatric surgery (14). Consequently, some older adults who could be excellent candidates may not be offered this effective treatment. Batsis and Dolkart suggest that a focus on physiologic rather than chronological age can optimize clinical management of obesity among older adults (15). A comprehensive geriatric assessment incorporating a geriatrician or a provider with knowledge of issues specific to older adults can markedly improve risk-stratification and pre-operative selection by focusing on frailty, polypharmacy, and co-morbid medical issues (15). Living situations, food security, and social support are known social determinants of health that predict adverse post-operative outcomes and can easily be addressed. Advanced care planning, a Joint Commission requirement, can proactively allow discussions of patient and family concerns with respect to outcomes.