Journal of Geriatrics The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Psychiatric Assessment and Screening for the Elderly in Primary Care: Design, Implementation, and Preliminary Results Sun, 29 Mar 2015 11:16:53 +0000 Introduction. We describe the design and implementation of a psychiatric collaborative care model in a university-based geriatric primary care practice. Initial results of screening for anxiety and depression are reported. Methods and Materials. Screens for anxiety and depression were administered to practice patients. A mental health team, consisting of a psychiatrist, mental health nurse practitioner, and social worker, identified patients who on review of screening and chart data warranted evaluation or treatment. Referrals for mental health interventions were directed to members of the mental health team, primary care physicians at the practice, or community providers. Results. Subjects () comprised 38.2% of the 3940 unique patients seen at the practice during the 4-year study period. 37.1% () screened positive for depression, 26.9% () for anxiety, and 322 (21.4%) screened positive for both. Any positive score was associated with age (), female gender (), and a nonsignificant trend toward living alone (). 8.87% had suicidal thoughts. Conclusions. Screening captured the most affectively symptomatic patients, including those with suicidal ideation, for intervention. The partnering of mental health professionals and primary care physicians offers a workable model for addressing the scarcity of expertise in geriatric psychiatry. Robert C. Abrams, Blanca Boné, M. Cary Reid, Ronald D. Adelman, Risa Breckman, Ronald Goralewicz, Marlena Palombo, Amy Stern, Rouzi Shengelia, and Jeanne Teresi Copyright © 2015 Robert C. Abrams et al. All rights reserved. Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY) Tue, 03 Mar 2015 06:26:36 +0000 Objectives. To conduct cost-effectiveness analyses of urge incontinence treatments for older women. Methods. Decision-analytic models assessed three treatment pathways: (1) limited behavioral therapy (LBT); (2) full behavioral therapy (FBT) with biofeedback; and (3) drug (DRUG), with allowances for crossover options following initial treatments. Model inputs were gathered from published data. Cost data were based on third party payer reimbursement. Outcomes were measured as the number of incontinence episodes avoided and quality-adjusted life years gained (QALYs). Results. At baseline values costs per QALY gained ranged from US$3696 to $10609. LBT was the least costly with the lowest benefit. Switching from LBT to FBT, with the greatest gain, was $415 per additional QALY. DRUG was the most expensive option. Sensitivity analyses showed that only small changes in key inputs were required for DRUG to generate greater gains than FBT. Medication costs had to fall substantially for DRUG to be cost competitive. Conclusion. All treatment strategies provide QALYs gains at a bargain price, compared to the standard of US$50,000 per QALY gained. No single treatment strategy dominated under all conditions. Clinicians should offer multiple treatment options to older women with urge incontinence. Victoria L. Phillips, Ali Bonakdar Tehrani, Holly Langmuir, Patricia S. Goode, and Kathryn L. Burgio Copyright © 2015 Victoria L. Phillips et al. All rights reserved. Community-Based Supports and Services for Older Adults: A Primer for Clinicians Sun, 01 Feb 2015 09:09:31 +0000 Although 20% of adults 60 years and older receive community-based supports and services (CBSS), clinicians may have little more than a vague awareness of what is available and which services may benefit their patients. As health care shifts toward more creative and holistic models of care, there are opportunities for CBSS staff and primary care clinicians to collaborate toward the goal of maintaining patients’ health and enabling them to remain safely in the community. This primer reviews the half-century history of these organizations in the United States, describes the most commonly used services, and explains how to access them. Eugenia L. Siegler, Sonam D. Lama, Michael G. Knight, Evelyn Laureano, and M. Carrington Reid Copyright © 2015 Eugenia L. Siegler et al. All rights reserved. Effect of Mild and Severe Unilateral Knee Joint Pain on Gait in Elderly Females Mon, 08 Dec 2014 00:10:01 +0000 Gait change in the elderly may be a strategy to maintain postural stability while walking. However, gait laterality is accompanied by back pain or an increased risk of a fall. This study aimed to examine group-related differences and gait laterality in elderly females with mild or severe unilateral knee pain. Seventy-five elderly females (66–87 years old) were included, which comprised the following groups: 47 with mild unilateral knee pain and 28 with severe unilateral knee pain. They completed a 12 m walk test with maximum effort. Stance time, swing time, and step length were selected as evaluation parameters. A two-way ANOVA (group leg) was used for analysis. No significant differences were found in interaction or in either main factor of the group and leg. In conclusion, elderly females do not show group-related differences or gait laterality regardless of the degree (mild or severe) of unilateral knee pain. Hiroki Sugiura and Shinichi Demura Copyright © 2014 Hiroki Sugiura and Shinichi Demura. All rights reserved. The Relationship between Health Promoting Behaviors and Quality of Life in Nursing Home Residents in Kayseri Tue, 04 Feb 2014 00:00:00 +0000 Background and Aims. Healthy lifestyle behaviors are the major determinant of both prevention health and health related quality of life. The aim of this study was to examine the relationship between health-promoting behaviors and quality of life of elderly individuals living in nursing homes. Methods. The study was performed between October 2008 and 2009, in the city of Kayseri in Turkey, upon 136 individuals, aged 65 and above, living in the Gazioglu Nursing Home. A sociodemographic questionnaire, Standardized Mini Mental Test, Health Promoting Lifestyle Behaviors Profile (HPLP), and WHOQOL-OLD module were used for the gathering of data. Results. The overall HPLP and quality of life (QoL) scores were and , respectively. More than half of the participants have higher points than the mean QoL scores. The HPLP scores of these subjects were significantly higher compared to those with lower points than mean QoL scores. There was a positive relationship between the overall HPLP and WHOQOL-OLD mean scores, except for the autonomy and sensorial function domains. Conclusions. The study result showed that health-promoting behaviors are positively associated with better quality of life scores in the elderly subjects living in a nursing home. Vesile Şenol, Demet Ünalan, Ferhan Soyuer, and Mahmut Argün Copyright © 2014 Vesile Şenol et al. All rights reserved. Dual Sensory Impairment among Community Dwelling Rural Elderly: Concern for Rehabilitation Wed, 29 Jan 2014 13:39:24 +0000 Background. There is an increase in dual sensory impairment (DSI) (hearing and visual) with increase in elderly population. Most causes of DSI among elderly are treatable. This study determines the prevalence and characteristics of dual sensory impairment among elderly of a rural community. Material and Methods. A cross-sectional study conducted among 175 rural elderly. Visual acuity for distant vision was measured using Snellen E chart. Hearing ability was measured using pure tone audiometry. Results. The prevalence of hearing impairment was 72% and that of visual impairment was 48%. The overall prevalence of DSI among the study subjects was 17.7% and 32.6% depending on whether traditional pure tone average or high-frequency pure tone average was used to define moderate or worse degree of hearing impairment. DSI prevalence increased significantly with increase in age. DSI was higher among widow/ers and illiterates, who did not have any source of income and those who were financially dependent on others compared to their counter groups. Conclusion. Prevalence of DSI is high among community dwelling rural Indian elderly. Individuals with DSI produce unique challenges in rehabilitation. A team approach at primary health care level is necessary to diagnose and rehabilitate elderly thereby enabling them to easily lead an independent life. Deepthi Ramamurthy, Arvind Kasthuri, and Rekha Sonavane Copyright © 2014 Deepthi Ramamurthy et al. All rights reserved. Institutionalization-Free Survival and Health Care Costs among Quebec Community-Dwelling Elderly Patients with Dementia Wed, 29 Jan 2014 07:00:51 +0000 Background. Published data on burden of dementia mainly include patients of third-care facilities. Economic consequences in an outpatient setting remain poorly examined. Objectives. To evaluate institutionalization-free survival and direct health care costs of dementia in the Quebec community-dwelling elderly population. Methods. A retrospective cohort study was conducted using the Quebec administrative claims databases. The cohort included a random sample of patients with treated dementia between January 1, 2000, and December 31, 2009 (). The reference population included elderly patients without dementia matched in age group, gender, and index date. Using a third-party payer perspective, direct costs over 5 years were assessed. Results. Institutionalization-free survival at 5 years was lower in patients with dementia than in elderly without dementia (38.9% and 72.2%, resp.). Over 5 years, difference in mean total direct health care costs per patient was CAD$19,159, distributed into institutionalizations (CAD$13,598), hospitalizations (CAD$3,312), and prescribed medications (CAD$2,320). Costs of medical services were similar (−CAD$96). In the first year of followup, cost differentials were mainly attributable to hospitalizations, while in the last year (year 5) they were due to institutionalizations. Conclusion. This study confirms that dementia is an important socioeconomic burden in the community, the nature of which depends on disease progression. Sarah-Gabrielle Beland, Antoine Pariente, and Yola Moride Copyright © 2014 Sarah-Gabrielle Beland et al. All rights reserved. Hearing Disorders and Sensorineural Aging Wed, 22 Jan 2014 14:26:12 +0000 The physiological age-related hearing loss is defined as presbycusis and it is characterized by reduced hearing sensitivity and problems in understanding spoken language especially in a noisy environment. In elderly the reduced speech recognition is generally caused by a reduction of the cochlear cells in the organ of Corti and degeneration of the central auditory pathways. In order to have a complete management strategy of central and peripheral presbycusis the diagnostic evaluation should include clinical ENT examination, standard audiological tests, and tests of central auditory function. Treatment should include not only the appropriate instruments for peripheral compensation but also auditory rehabilitative training and counseling to prevent social isolation and loss of autonomy. Other common hearing disorders in elderly are tinnitus and hyperacusis which are often undervalued. Tinnitus is characterized by the perception of a “phantom” sound due to abnormal auditory perception. Hyperacusis is defined as a reduced tolerance to ordinary environmental sounds. Furthermore auditory, visual, nociceptive, and proprioceptive systems may be involved together in a possible context of “sensorineural aging.” The aim of this review is to underline the presence of hearing disorders like tinnitus and hyperacusis which in many cases coexist with hearing loss in elderly. Alessandra Fioretti, Otello Poli, Theodoros Varakliotis, and Alberto Eibenstein Copyright © 2014 Alessandra Fioretti et al. All rights reserved. The Phenomenology of Delirium: Presence, Severity, and Relationship between Symptoms Thu, 02 Jan 2014 09:28:36 +0000 Objective. To examine the phenomenological characteristics of delirium based on the Memorial Delirium Assessment Scale (MDAS) in order to explore the presence, severity of, and relationship between symptoms. Methods. An analysis of 100 cases of delirium recruited at Memorial Sloan Kettering Cancer Center (MSKCC) was performed. Sociodemographic and medical variables, the Memorial Delirium Assessment Scale (MDAS) subitems, and Karnofsky Performance Status scale (KPS) were analyzed of respect of the phenomenological characteristics and their interrelationship. Results. The most severe and frequent symptoms were recorded in the cognitive domain, psychomotor behavior, sleep-wake cycle, and disturbance of consciousness. Within the cognitive domain, concentration was the most severely affected task. The severity of impairment in most domains increased with delirium severity, whereas perceptual disturbances and delusions were independent of delirium severity. Advanced age and the prevalence of dementia increased with delirium severity in contrast to the functional status which declined. The presence of perceptual disturbances and delusions was independent of cognitive impairment and psychomotor abnormality, however, associated with the disturbances of consciousness and attention. Conclusion. Cognition, in particular concentration, was the most severely affected domain. Advanced age and the prevalence of dementia contributed to more severe delirium. Perceptual disturbances and delusions were independent of delirium severity; however, they were associated with disturbances of consciousness and attention. Soenke Boettger, Susanne Boettger, and William Breitbart Copyright © 2014 Soenke Boettger et al. All rights reserved.