Elder abuse and neglect: a survey of Irish general practitioners.

The objective of this study was to survey general practitioners (GPs) in Ireland regarding their experience with elder abuse. A random sample of 800 GPs were mailed a survey in March 2010, with a reminder in May 2010, yielding a 24% response rate. The majority, 64.5%, had encountered elder abuse, with 35.5% encountering a case in the previous year. Most were detected during a home visit. Psychological abuse and self-neglect were most common. Most GPs in Ireland have encountered cases of elder abuse, most were willing to get involved beyond medical treatment, and 76% cited a need for more education.

Impact of a global quadratic potential on galactic rotation curves.

We present a conformal gravity fit to the 20 largest of a sample of 110 spiral galaxies. We identify the presence of a universal quadratic potential V(κ)(r)=-κc²r²/2 with κ=9.54×10⁻54 cm⁻² induced by cosmic inhomogeneities. When V(κ)(r) is taken in conjunction with both a universal linear potential V(γ0)(r)=γ0c²r/2 with γ0=3.06×10⁻³° cm⁻¹ generated by the homogeneous cosmic background and the contribution generated by the local luminous matter in galaxies, the theory then accounts for the rotation curve systematics observed in the entire 110 galaxies, without the need for any dark matter whatsoever. Our study suggests that using dark matter may be nothing more than an attempt to describe global effects in purely local galactic terms. With V(κ)(r) being negative, galaxies can only support bound orbits up to distances of order γ0/κ=100kpc, with global physics imposing a limit on the size of galaxies.

National profiling of elder abuse referrals.

BACKGROUND: there is little consistent data on patterns of reporting of elder abuse in Europe. Between 2002 and 2007, the Irish Health Service Executive developed dedicated structures and staff to support the prevention, detection and management of elder abuse without mandatory reporting. Public awareness campaigns, staff training and management briefings heightened awareness regarding this new service. Central to this process is the development of a national database which could provide useful insights for developing coordinated responses to elder abuse in Europe. OBJECTIVE: to report the rate of referrals of elder abuse, patterns of elder abuse and outcomes of interventions related to a dedicated elder abuse service in the absence of mandatory reporting. METHODS: data on all referrals were recorded at baseline by a national network of Senior Case Workers dedicated to elder abuse, with follow-up conducted at 6 months and/or case closure. All cases were entered on a central database and tracked through the system. The study design was cross-sectional at two time points. RESULTS: of 1,889 referrals, 381 related to self-neglect. Of the remaining 1,508, 67% (n = 1,016) were women. In 40% (n = 603) of cases, there was more than one form of alleged abuse. Over 80% of cases referred related to people living at home. At review 86% (n = 1,300) cases were closed, in 101 client had died, 10% of these clients had declined an intervention. Cases are more likely to be open longer than 6 months if substantiated 36 versus 21% in the closed cases. Consultation with the police occurred in 12% (n = 170) of cases. The majority of clients (84% n = 1,237) had services offered with 74% (n = 1,085) availing of them. Monitoring, home support and counselling were the main interventions. CONCLUSION: the number of reported cases of abuse in Ireland indicates an under-reporting of elder abuse. The classification of almost half of the cases as inconclusive is a stimulus to further analysis and research, as well as for revision of classification and follow-up procedures. The provision of services to a wide range of referrals demonstrated a therapeutic added benefit of specialist elder abuse services. The national database on elder abuse referrals provides valuable insight into patterns of elder abuse and the nature of classification and response. The pooling of such data between European states would allow for helpful comparison in building research and services in elder abuse.

A physician's perspective: elder abuse and neglect over 25 years.

Twenty-five years of involvement with elder abuse and neglect has yielded mixed results. The contribution by physicians to elder abuse, in contrast with child abuse, has been very limited. Physicians, despite being in an advantaged position to intervene, lag behind other professionals in reporting. Potential remedies include identification of abuse as a syndrome to allow for reimbursement, increased education and research funding, and a greater advocacy role by physician organizations.

Initiating and sustaining a standardized pain management program in long-term care facilities.

OBJECTIVES: To identify current pain management practices in the long-term care setting; and, implement and evaluate a comprehensive pain management program in the long-term care setting. DESIGN: An interventional pilot study. SETTING: Community-based long-term care facilities. METHODS: This study was conducted in two phases. Phase I consisted of interviewing long-term care facility administrators to ascertain current pain management policies and practices. This information was used to develop the Phase II intervention that involved collecting benchmark data, creating or modifying pain policies and procedures, implementing a pain management program and presenting educational programs. MEASUREMENTS: Interviews with long term care administrators; facility and resident demographic data; chart audits for pain assessment and management data; pharmacy audits; telephone surveys. RESULTS: Pain management policies and practices were inadequate prior to the study intervention. No facilities had policies or procedures that required ongoing (daily, weekly, etc.) pain assessment. Only one facility had mechanisms in place for measuring the presence or intensity of pain in their non-verbal, cognitively-impaired residents. Following the pain management program intervention, pain assessment significantly increased. and treatment for pain was provided for the vast majority of those indicating pain. All sites had a standardized pain assessment program in place one-year post-study completion. CONCLUSIONS: Standardized pain management programs are critical to improving pain management in long-term care settings. Improvement in long-term care pain management can be obtained through a comprehensive pain management program that involves staff education, changes in pain policies and procedures, and identifying pain management as a quality indicator.

Behavior disorders of dementia: recognition and treatment.

Psychosis may pose a greater challenge than cognitive decline for patients with dementia and their caregivers. The nature and frequency of psychotic symptoms varies over the course of illness, but in most patients, these symptoms occur more often in the later stages of disease. Management of psychosis requires a comprehensive nonpharmacologic and pharmacologic approach, including an accurate assessment of symptoms, awareness of the environment in which they occur, and identification of precipitants and how they affect patients and their caregivers. Nonpharmacologic interventions include counseling the caregiver about the nonintentional nature of the psychotic features and offering coping strategies. Approaches for the patient involve behavior modification; appropriate use of sensory intervention; environmental safety; and maintenance of routines such as providing meals, exercise, and sleep on a consistent basis. Pharmacologic treatments should be governed by a "start low, go slow" philosophy; a monosequential approach is recommended, in which a single agent is titrated until the targeted behavior is reduced, side effects become intolerable, or the maximal dosage is achieved. Atypical antipsychotics have the greatest effectiveness and are best tolerated. Second-line medications include typical antipsychotics for short-term therapy; and, less often, anticonvulsants, acetylcholinesterase inhibitors, antidepressants, and anxiolytics. Goals of treatment should include symptom reduction and preservation of quality of life.

Treatment of edema.

Edema is the result of an imbalance in the filtration system between the capillary and interstitial spaces. The kidneys play a key role in regulating extracellular fluid volume by adjusting sodium and water excretion. Major causes of edema include venous obstruction, increased capillary permeability, and increased plasma volume secondary to sodium and water retention. A systematic approach is warranted to determine the underlying diagnosis. Treatment includes sodium restriction, diuretic use, and appropriate management of the underlying disorder. Leg elevation may be helpful in some patients. Loop diuretics often are used alone or in combination. In patients with New York Heart Association class III and IV congestive heart failure, spironolactone has been found to reduce morbidity and mortality rates. In patients with cirrhosis, ascites is treated with paracentesis and spironolactone. Dihydropyridine-induced edema can be treated with an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker. Lymphedema occurs when a protein-rich fluid accumulates in the interstitium. Compression garments and range-of-motion exercises may be helpful in patients with this condition.

Infantile colic.

Infantile colic can be distressing to parents whose infant is inconsolable during crying episodes. Colic is often defined by the "rule of three": crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy. The physician's role is to ensure that there is no organic cause for the crying, offer balanced advice on treatments, and provide support to the family. Colic is a diagnosis of exclusion that is made after performing a careful history and physical examination to rule out less common organic causes. Treatment is limited. Feeding changes usually are not advised. Medications available in the United States have not been proved effective in the treatment of colic, and most behavior interventions have not been proved to be more effective than placebo. Families may turn to untested resources for help, and the physician should offer sound advice about these treatments. Above all, parents need reassurance that their baby is healthy and that colic is self-limited with no long-term adverse effects. Physicians should watch for signs of continuing distress in the child and family, particularly in families whose resources are strained already.