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Journal of Clinical Medicine Mar 2023Dizziness and vertigo are among the most prevalent complaints in the elderly and have a major negative influence on (i) the perception of the quality of life; and (ii)... (Review)
Review
Dizziness and vertigo are among the most prevalent complaints in the elderly and have a major negative influence on (i) the perception of the quality of life; and (ii) the risk of falling. Due to population aging, particularly in wealthy nations, vertigo represents a growing issue and a serious public health concern. In order to approach the patient correctly and to offer the best treatment options, it is mandatory to identify vertigo's underlying causes. The aim of this paper was to identify the different etiologies of vertigo and possibly their frequency in the elderly population, by reviewing the scientific literature of the last decade (2012-2022). A systematic review was performed according to PRISMA guidelines, searching the Medline database from January 2012 through to December 2022. The search identified 1025 candidate papers, but after the application of specific selection criteria, only five were considered for further analysis. A total of 2148 elderly patients (60-90 y old) presenting with vertigo were reported in the selected papers. A total of 3404 conditions were identified as the cause of vertiginous symptoms, (some patients presented multiple etiologies). All major diagnoses were categorized into different subgroups: the most common origin of vertigo was represented by audio-vestibular disorders (28.4%), followed by cardiovascular (20.4%) and neurological diseases (15.1%). Furthermore, 9.1% of patients were diagnosed with psychiatric conditions, whilst ophthalmologic and musculoskeletal disorders accounted for 7.5% and 6.3% of the cases respectively. Medication adverse effects and metabolic-related diseases were also considered among the causes. For 3.4% of cases the etiology remains unclear. Conclusions: Audio-vestibular disorders represent the most frequent cause of vertigo in the elderly. The etiologies affecting the vertigo patient must be defined in order to identify potential life-threatening conditions, such as cardiovascular and neurological disorders, which according to the data of this review constitute the second and third common causes of vertigo. A multidisciplinary strategy, involving different specialists (such as ENTs, Neurologists, Cardiologists, Geriatricians) is recommended for the correct assessment of these disorders.
PubMed: 36983184
DOI: 10.3390/jcm12062182 -
Aging Clinical and Experimental Research Feb 2020Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based...
BACKGROUND
Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within primary healthcare, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team.
AIM
To appraise the evidence on CGA implemented within the primary care practice.
METHODS
The review followed PRISMA recommendations. Eligible studies reported CGA on persons aged ≥ 65 in a primary care practice. Studies focusing on a single condition were excluded. Searches were run in five databases; reference lists and publications were screened. Two researchers independently screened for eligibility and assessed study quality. All study outcomes were reviewed.
RESULTS
The authors screened 9003 titles, 145 abstracts and 97 full texts. Four studies were included. Limited study bias was observed. Studies were heterogeneous in design and reported outcomes. CGAs were led by a geriatrician (n = 3) or nurse practitioner (n = 1), with varied length and extent of follow-up (12-48 months). Post-intervention hospital admission rates showed mixed results, with improved adherence to medication modifications. No improvement in survival or functional outcomes was observed. Interventions were widely accepted and potentially cost-effective.
DISCUSSION
The four studies demonstrated that CGA was acceptable and provided variable outcome benefit. Further research is needed to identify the most effective strategy for implementing CGA in primary care. Particular questions include identification of patients suitable for CGA within primary care CGA, a consensus list of outcome measures, and the role of different healthcare professionals in delivering CGA.
Topics: Aged; Aged, 80 and over; Geriatric Assessment; Geriatricians; Humans; Outcome Assessment, Health Care; Primary Health Care
PubMed: 30968287
DOI: 10.1007/s40520-019-01183-w -
Gerontology 2023Cancer is a disease of aging and is rapidly becoming the number one cause of mortality in older people. Over their lifetime, one in two men and one in three women will... (Review)
Review
Cancer is a disease of aging and is rapidly becoming the number one cause of mortality in older people. Over their lifetime, one in two men and one in three women will develop a cancer, with half of the risk being beyond the age of seventy. Therefore, cancer is a problem frequently encountered by geriatricians. In this article, we review a few recent progresses that will be of interest to the geriatric community. First, we now have robust evidence that a comprehensive geriatric assessment and management change outcomes in older cancer patients, notably allowing decreased treatment toxicity, better treatment completion, and increased functional outcomes. In gastrointestinal cancers and breast cancer, several recent studies have addressed when treatment intensity can be decreased, and when it cannot. New treatments for acute myeloid leukemia are finally beginning to improve outcomes for older patients and such patients should be referred to oncologists for management. In prostate cancer, new imaging techniques (e.g., PSMA scan) and treatment options can allow better treatment targeting and spare some hormonal and chemotherapy toxicity. Finally, we review recent public policy efforts to address the epidemiologic wave of cancer in older patients on a global scale.
Topics: Male; Aged; Humans; Female; Breast Neoplasms; Geriatric Assessment; Aging
PubMed: 37321185
DOI: 10.1159/000531559 -
World Journal of Gastrointestinal... Jun 2022Recent guidelines recommend that colorectal cancer (CRC) screening after age 75 be considered on an individualized basis, and discourage screening for people over 85 due... (Review)
Review
Recent guidelines recommend that colorectal cancer (CRC) screening after age 75 be considered on an individualized basis, and discourage screening for people over 85 due to competing causes of mortality. Given the heterogeneity in the health of older individuals, and lack of data within current guidelines for personalized CRC screening approaches, there remains a need for a clearer framework to inform clinical decision-making. A revision of the current approach to CRC screening in older adults is even more compelling given the improvements in CRC treatment, post-treatment survival, and increasing life expectancy in the population. In this review, we aim to examine the personalization of CRC screening cessation based on specific factors influencing life and health expectancy such as comorbidity, frailty, and cognitive status. We will also review screening modalities and endoscopic technique for minimizing risk, the risks of screening unique to older adults, and CRC treatment outcomes in older patients, in order to provide important information to aid CRC screening decisions for this age group. This review article offers a unique approach to this topic from both the gastroenterologist and geriatrician perspective by reviewing the use of specific clinical assessment tools, and addressing technical aspects of screening colonoscopy and periprocedural management to mitigate screening-related complications.
PubMed: 35949211
DOI: 10.4251/wjgo.v14.i6.1086 -
The Hastings Center Report Sep 2014The patient's apartment is full of books. A whole shelf is devoted to Virginia Woolf. I ask which novel she likes the best and am surprised when she says The Waves, a...
The patient's apartment is full of books. A whole shelf is devoted to Virginia Woolf. I ask which novel she likes the best and am surprised when she says The Waves, a lyrical book of sensation and consciousness, with hardly a narrative at all. This, I think, is the way to live at ninety-five. She tells me she wants to die. She can see how things are likely to go. She will fall one morning, and paramedics will be summoned to pick her up. Caregivers will be invited into her home. The pain in her knees and back will worsen. Disability is coming, it cannot be avoided, she says, and it would be better if her life were now simply to cease. I struggle to find a name for this state of thinking. A senior geriatrician in my department tells me that she sees elderly patients like mine all the time. What word does she use for these men and women, I ask?
Topics: Aging; Homes for the Aged; Humans; Nursing Homes
PubMed: 25231653
DOI: 10.1002/hast.348 -
Geriatrics (Basel, Switzerland) Apr 2020The older Italian population is posing a challenge in the number of deaths for coronavirus disease 2019 (COVID-19). According to previous data from China, pre-existing...
The older Italian population is posing a challenge in the number of deaths for coronavirus disease 2019 (COVID-19). According to previous data from China, pre-existing health conditions dramatically increase the risk of dying from COVID-19. The presence of multiple diseases in older patients may be considered as a mark of frailty, which increases the person's vulnerability to stress and impairs the multisystemic compensatory effort to restore homeostasis. The clinical complexity associated with the management of frailty may increase the risk of complications during infection as well as the lack of the early recognition of atypical symptoms. There is an urgent need to share expertise and clinical management skills with geriatricians as well as the need for early diagnosis to start treatment at the earliest convenience in the community, with the aim to avoid the collapse of intensive care units.
PubMed: 32357575
DOI: 10.3390/geriatrics5020024 -
European Geriatric Medicine Jun 2021Covid-19 is a true gerontological pandemic, with frailty, multimorbidity and geriatric syndromes being of great importance.
AIM
Covid-19 is a true gerontological pandemic, with frailty, multimorbidity and geriatric syndromes being of great importance.
FINDING
There has been a lack of geriatrician involvement in planning and delivery of care for older people with Covid-19 in many arenas. Lack of mobilisation of geriatric expertise has led to inconsistent policy responses and ageism. The pandemic has shown that medical education and health systems have failed to align training, resources, and systems with current demographic and health usage realities.
MESSAGES
We must take the specific needs of older people into account to position ourselves to provide better care for this group during Covid-19 and beyond.
Topics: Aged; Aged, 80 and over; Ageism; COVID-19; Delivery of Health Care; Evidence-Based Practice; Frail Elderly; Geriatric Assessment; Geriatrics; Health Services for the Aged; Humans; Risk Factors; SARS-CoV-2
PubMed: 33891278
DOI: 10.1007/s41999-021-00500-9 -
Canadian Geriatrics Journal : CGJ Sep 2020The number of older adults with complex health needs in Ontario is growing. The Ministry of Health and Long-Term Care requested a resource mapping project to assess the... (Review)
Review
BACKGROUND
The number of older adults with complex health needs in Ontario is growing. The Ministry of Health and Long-Term Care requested a resource mapping project to assess the current 2018 and projected 2025 number of specialist physician resources.
METHODS
Geriatric specialist physicians were defined as geriatricians, geriatric psychiatrists, and Care of the Elderly (COE) physicians. We determined the current number of geriatricians, geriatric psychiatrists, and COEs and clinical full-time-equivalent complement (CFTE) for geriatric medicine and geriatric psychiatry specialists. We projected the number of new trainees expected to enter practice and the number of physicians expected to retire by 2025. We compared these numbers and projections against established specialist/population ratios for geriatricians and geriatric psychiatrists.
RESULTS
There was a deficit of geriatricians and geriatric psychiatrists (geriatricians: CFTE deficit of 150.5; geriatric psychiatrists: CFTE deficit of 116.3). In 2025, the projected CFTE deficit of geriatricians will increase to at least 210.35 and geriatric psychiatrists to 194.6. Only about 30% of COE physicians work in direct support of specialized services for the elderly.
CONCLUSIONS
There is significant current and anticipated undersupply in the required number of geriatricians, geriatric psychiatrists, and COE physicians to meet anticipated population demand.
PubMed: 32904648
DOI: 10.5770/cgj.23.448 -
Clinics in Geriatric Medicine Feb 2012Care of the older woman with early breast cancer is of particular importance to both the oncologist and geriatrician because of both the prevalence of the disease in... (Review)
Review
Care of the older woman with early breast cancer is of particular importance to both the oncologist and geriatrician because of both the prevalence of the disease in this population as well as the subtleties necessary in individualizing treatment decisions. In general, older women are able to tolerate many of the same modalities of treatment for early breast cancer as younger women, but special consideration must be given to future life expectancy, comorbidities, and other elements that might be identified using a CGA. Both short-term and long-term side effects of cancer therapies can be clinically important in the older woman, and appropriate screening and support for these toxicities are necessary.
Topics: Age Factors; Aged; Aged, 80 and over; Antineoplastic Agents; Breast Neoplasms; Carcinoma; Chemotherapy, Adjuvant; Combined Modality Therapy; Decision Making; Female; Geriatric Assessment; Humans; Life Expectancy; Mastectomy; Radiotherapy, Adjuvant; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 22326036
DOI: 10.1016/j.cger.2011.10.002 -
BMC Primary Care Sep 2022Dementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known...
BACKGROUND
Dementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes. Screening is particularly limited in rural and regional areas, despite high burden and projected growth of dementia in these populations. The current study aimed to implement a new general practitioner (GP) led, multidisciplinary, model of care providing dementia detection and referral pathway to a community-based specialist clinic across six regional general practices.
METHODS
Cross-sectional analysis of dementia screening and referral characteristics in the St Anthony Family Medical Practices group based in the regional area of Loddon-Mallee, Victoria. Data were collected on demographics and relevant medical history. Cognitive state was assessed using the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCog), and Geriatric Depression Scale (GDS). Referrals and referral outcomes were recorded for geriatrician, psycho-geriatrician, or both.
RESULTS
Eight hundred and eighteenth patients over 65 years were screened, accounting for approximately 24.2% of 65 and over presentations for the practice network. Of those screened, 68.9% were indicated for referral and 30.3% of these were successfully referred. Of the indicated patients who received referrals, 34.2% declined. Many who declined referral had intermediate scores on the cognitive assessments utilized.
CONCLUSION
Standardised models of care, integrated within community services, are necessary to improve access to early detection, referral and quality management of dementia. The St Anthony Memory Service model will be invaluable in informing future service development, and in particular the development of services for people living with dementia in rural and regional communities.
Topics: Aged; Ambulatory Care Facilities; Cross-Sectional Studies; Dementia; General Practice; Humans; Mental Status and Dementia Tests
PubMed: 36127660
DOI: 10.1186/s12875-022-01829-1