Browsing by Subject "Geriatrics"

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  • Puumalainen, Emmi; Airaksinen, Marja; Jalava, Sanni E.; Chen, Timothy F.; Dimitrow, Maarit (2020)
    Purpose This study aims to systematically review studies describing screening tools that assess the risk for drug-related problems (DRPs) in older adults (>= 60 years). The focus of the review is to compare DRP risks listed in different tools and describe their development methods and validation. Methods The systematic search was conducted using evidence-based medicine, Medline Ovid, Scopus, and Web of Science databases from January 1, 1985, to April 7, 2016. Publications describing general DRP risk assessment tools for older adults written in English were included. Disease, therapy, and drug-specific tools were excluded. Outcome measures included an assessment tool's content, development methods, and validation assessment. Results The search produced 15 publications describing 11 DRP risk assessment tools. Three major categories of risks for DRPs included (1) patient or caregiver related risks; (2) pharmacotherapy-related risks; and (3) medication use process-related risks. Of all the risks included in the tools only 8 criteria appeared in at least 4 of the tools, problems remembering to take the medication being the most common (n=7). Validation assessments varied and content validation was the most commonly conducted (n = 9). Reliability assessment was conducted for 6 tools, most commonly by calculating internal consistency (n = 3) and inter-rater reliability (n = 2). Conclusions The considerable variety between the contents of the tools indicates that there is no consensus on the risk factors for DRPs that should be screened in older adults taking multiple medicines. Further research is needed to improve the accuracy and timeliness of the DRP risk assessment tools.
  • Romskaug, Rita; Molden, Espen; Straand, Jorund; Kersten, Hege; Skovlund, Eva; Pitkala, Kaisu H.; Wyller, Torgeir Bruun (2017)
    Background: Polypharmacy and inappropriate drug use is associated with negative health outcomes among older people. Various interventions for improving drug treatment have been evaluated, but the majority of studies are limited by the use of surrogate outcomes or suboptimal design. Thus, the potential for clinically significant improvements from different interventions is still unclear. The main objective of this study is therefore to evaluate the effect upon patient-relevant endpoints of a cooperation between geriatricians and general practitioners on complex drug regimens in home-dwelling elderly people. Methods: This is a cluster randomised, single-blind, controlled trial where general practitioners are invited to participate with patients from their lists. The patients must be 70 years or older, use at least seven different medications and have their medications administered by the home nursing service. We plan to recruit 200 patients, with randomisation at physician level. The intervention consists of three main parts: ( 1) clinical geriatric assessment of the patient, combined with a thorough review of their medications; ( 2) a meeting between the geriatrician and general practitioner, where the two physicians combine their competence and knowledge and discuss the drug list systematically; ( 3) clinical follow-up, depending on the medication changes that have been done. The study period is 24 weeks, and the patients are assessed at baseline, 16 and 24 weeks. The primary outcome measure is health-related quality of life according to the 15D instrument. Secondary outcome measures include physical and cognitive functioning, medication appropriateness, falls, carer burden, use of health services ( hospital or nursing home admissions, use of home nursing services) and mortality. Discussion: Our choice of patient-relevant outcome measures will hopefully provide new knowledge on the potential for clinical improvements after performing comprehensive medication reviews in home-dwelling elderly people receiving polypharmacy.
  • Roitto, Hanna-Maria; Aalto, Ulla Liisa; Söderling, Riikka; Laakkonen, Marja-Liisa; Öhman, Hanna (2020)
    Key summary pointsAim The aim of Delirium Cafe was to try a new learning method to increase awareness of delirium and improve delirium care in an acute hospital setting. Findings Delirium Cafe seems to be both feasible and applicable as a new interactive-learning method in postgraduate medical teaching. Message It is important to create opportunities of stimulating learning. Delirium Cafe is a good example of a model that is both creative and interactive. Purpose The aim of Delirium Cafe was to try a new learning method to increase awareness of delirium and improve delirium care in an acute hospital setting in Helsinki, Finland. Method World Cafe-an active learning method, with four facilitators and four stations covering important aspects of delirium recognition and management, was used. Results 22 junior doctors and 4 members of the senior staff participated in the event on 13th of March 2019, the World Delirium Awareness Day (WDAD). Nobody dropped out during the 1 h training. Feedback on the educational method was positive. Conclusion Delirium Cafe seems to be both feasible and applicable as a new interactive-learning method in postgraduate medical teaching.
  • Kerminen, H.; Jamsen, E.; Jantti, P.; Huhtala, H.; Strandberg, T.; Valvanne, J. (2016)
    Introduction: Comprehensive geriatric assessment (CGA) is one of the most important evaluation tools in geriatrics, but there is variability in its use in different clinical settings. In this study we aimed to clarify how Finnish geriatricians apply CGA in their clinical practice. Methods: We organized a web-based survey among the members of Finnish Geriatricians (n = 248). The questionnaire included items about use and content of CGA. The evaluated domains were assessment of cognition, nutrition and functional ability, evaluation of depression, and measurement of orthostatic blood pressure. Results: Altogether 121 physicians (49%) responded, and the present analysis included 95 geriatricians performing clinical work. Majority of the respondents (94%) used CGA. Of them, 38% performed CGA to all new patients and 62% to selected patients only. Ten respondents (11%) incorporated all five domains into CGA whereas others selected domains according to their clinical judgment. Greater proportion of female than male physicians included evaluation of depression (39% vs. 16%, P = 0.045) and assessment of functional ability (48% vs. 24%, P = 0.01) always in CGA. Respondents, who applied CGA to all new patients, incorporated nutritional assessment (68% vs. 34%, P = 0.002) and measurement of orthostatic blood pressure (76% vs. 54%, P = 0.04) always into CGA more often than those who performed CGA to selected patients only. Respondents' working conditions were not associated with the application of CGA. Conclusions: Majority of the respondents performed CGA to their patients. The content of CGA varied between geriatricians. Incomplete evaluation may lead to inadequate detection of geriatric syndromes and other problems. (C) 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
  • Jämsen, Esa; Lönnroos, Eija; Strandberg, Timo (2017)
  • Strandberg, Timo (2022)
    Eeva Jalavisto esitti vuonna 1953 teesinsä vanhustenhoidosta, alasta jota ei ollut aiemmin erityisesti käsitelty Lääkärilehdessä. Teesit ovat edelleen ajankohtaisia ja osa vasta nyt toteutumassa.