Infusing geriatrics in Indian Health Service general primary care clinics: Extending VA workforce development training.

As federal partners, the Veterans Health Administration (VA) and the Indian Health Service (IHS) agreed to share resources, such as education. The VA Geriatric Scholars Program, a workforce development program, provides one of its training programs on team-based primary care of elders to clinicians working in IHS and Tribal Health Programs. The practical impact of that training is described.

Dementia and Falls Management in Underserved Populations: The Cognition and Mobility Care Management Program.

Background/objectives: Cognitive and mobility impairments are common and underdiagnosed chronic conditions that afflict community-dwelling older adults. This study describes the organization, implementation, and evaluation of an intervention for underserved and ethnically diverse older patients with dementia and/or falls risk.

Design: Observation, baseline and 1 year after intervention.

Derivation and Validation of a Geriatric-Sensitive Perioperative Cardiac Risk Index.

Background: Surgical patients aged 65 and over face a higher risk of cardiac complications from noncardiac surgery. The Revised Cardiac Risk Index (RCRI) and the Gupta Myocardial Infarction or Cardiac Arrest (MICA) calculator are widely used to predict this risk, but they are not specifically designed to predict MICA in geriatric patients. Our hypothesis is that a new geriatric-sensitive index, derived from geriatric data, will capture this population's unique response to risk factors.

Development and Validation of a Geriatrics Knowledge Test to Evaluate Geriatrics Fellowship Programs.

Background/objectives: Although the Accreditation Council for Graduate Medical Education requires that geriatrics fellowship programs be evaluated, evaluation is challenging because of lack of appropriate instruments. The purpose of this study was to develop and validate a geriatrics knowledge test appropriate for evaluation of geriatrics fellowship programs.

Design: Initial and replication cross-sectional validation studies.

Do SSRIs play a role in decreasing bone mineral density?

Osteoporosis is expected to increase as our population pyramid shifts toward old age. It is associated with increased risk of fractures, leading to complications of limitation of ambulation, loss of independence, and chronic pain. Depression is also a common occurrence in the elderly population.

A synopsis of phosphate disorders in the nursing home.

Elderly patients are at an increased risk of developing both hypophosphatemia and hyperphosphatemia. Renal insufficiency predisposes elderly patients to elevated serum concentrations of phosphate. On the other hand, poor dietary intake and loss of phosphorus in the urine can lead to deficiency states.

Apathy: a common psychiatric syndrome in the elderly.

Apathy, or a lack of motivation, has been increasingly recognized as a distinct psychiatric syndrome. Apathy is primarily a dysfunction of the frontal-subcortical circuit and is associated with various neuropsychiatric disorders including Alzheimer's disease. Apathy is associated with a number of adverse outcomes, including apparent cognitive impairment, decreased daily function, poor insight into one's own functional and cognitive impairment, and poor outcome from rehabilitation treatment.

Nonsurgical treatment for rotator cuff injury in the elderly.

Shoulder pain is a common musculoskeletal complaint in the general population. The elderly population is often afflicted, and rotator cuff problems are among the most common causes of shoulder pain seen in primary care practices. The prevalence of shoulder pain in the elderly has been estimated to range from 21% to 27%, and the prevalence of rotator cuff tear increases with advanced age.

Encouraging geriatric medicine fellows to write review articles: a description of our experience.

Medical education in the United States develops many skills, but writing is not usually one of them. At the UCLA Multicampus Division of Geriatrics, we recently instituted a project that attempts to provide the opportunity for each of our Geriatric Medicine fellows to write and publish a review article. We report our experiences of the first 3 years of this program in an effort to share our successes, our shortcomings and our impressions.

The utility of PET brain imaging in the initial evaluation of dementia.

Given the challenges and benefits of timely and accurate diagnosis of neurodegenerative disorders and the importance of appropriate subsequent treatments, physicians and patients alike desire tools that aid in diagnosing dementia as early and as precisely as possible. One of these tools may be functional brain imaging, specifically positron emission tomography (PET). Recent technological advancements, ongoing research studies, and approval for reimbursement by various insurance companies and Medicare, under certain circumstances, have led to an increased interest in the use of this tool in the evaluation of dementia.

Orthostatic hypotension in the nursing home setting.

Orthostatic hypotension is a common condition among nursing home (NH) residents. NH residents tend to have multiple disease processes and tend to be on multiple medications associated with orthostatic hypotension and are predisposed to a myriad of negative clinical consequences, most notably falls. This article discusses a commonsense approach to diagnosis, evaluation, and treatment of patients with this disorder, with an emphasis on nonpharmacological interventions, such as patient and staff education.

What is the proper use of hemoglobin A1c monitoring in the elderly?

Diabetes mellitus (DM) is a major health problem for the aging population. Glycemic control is fundamental to the management of diabetes, as glycemic levels are closely linked to development of diabetes-related complications. Measurement of the hemoglobin A1c (A1c) to assess chronic glycemic control is an integral component of diabetes care.

Falls in the nursing home: are they preventable?

Introduction: Falls are prevalent in elderly patients residing in nursing homes, with approximately 1.5 falls occurring per nursing home bed-years. Although most are benign and injury-free, 10% to 25% result in hospital admission and/or fractures.

What is the proper use of hemoglobin A1c monitoring in the elderly?

Diabetes mellitus (DM) is a major health problem for the aging population. Glycemic control is fundamental to the management of diabetes, as glycemic levels are closely linked to development of diabetes-related complications. Measurement of the hemoglobin A1c (A1c) to assess chronic glycemic control is an integral component of diabetes care.

Falls in the nursing home: Are they preventable?

Introduction: Falls are prevalent in elderly patients residing in nursing homes, with approximately 1.5 falls occurring per nursing home bed-years. Although most are benign and injury-free, 10% to 25% result in hospital admission and/or fractures.

Can we prevent aspiration pneumonia in the nursing home?

Aspiration pneumonia is a significant cause of morbidity, hospitalization, and mortality in the nursing home population. Patients who aspirate have three times higher mortality than patients who do not aspirate. We discuss the factors known to increase the risk of aspiration and its consequences, and recognize some of the preventive measures for aspiration pneumonia.

Falls in the nursing home: are they preventable?

Introduction: Falls are prevalent in elderly patients residing in nursing homes, with approximately 1.5 falls occurring per nursing home bed-years. Although most are benign and injury-free, 10% to 25% result in hospital admission and/or fractures.

Current controversies in endocrinology: screening of asymptomatic elderly for subclinical hypothyroidism.

Thyroid disorders are common in elderly patients. In fact, the most common form of thyroid dysfunction in the elderly is subclinical hypothyroidism. Subclinical hypothyroidism is a biochemical state characterized by an increased serum thyroid-stimulating hormone and normal levels of serum-free T4 and free T3.

Can we prevent aspiration pneumonia in the nursing home?

Aspiration pneumonia is a significant cause of morbidity, hospitalization, and mortality in the nursing home population. Patients who aspirate have three times higher mortality than patients who do not aspirate. We discuss the factors known to increase the risk of aspiration and its consequences, and recognize some of the preventive measures for aspiration pneumonia.