Limitations of GPT-4 as a geriatrician in geri-oncology case conference: A case series.

Generative pre-trained transformer 4 (GPT-4) is an artificial intelligence (AI) system with a chat interface. The number of studies testing GPT-4 in clinical applications has been increasing. We hypothesized that GPT-4 would be able to suggest management strategies for medical issues in elderly oncology patients, similar to those provided by geriatricians. We compared the responses of GPT-4 to those of a geriatrician for four oncological patients. After these case conferences, none of the patients required admission for medical consultation. In three out of four scenarios, GPT-4 was able to offer a multidisciplinary approach in the first prompt. In all three scenarios, GPT-4 identified medication-related side effects and suggested appropriate medications in the first prompt. However, GPT-4 was unable to suggest initial dosages of medications to be used in the first prompt and was unable to suggest a more humanistic and non-pharmacological approach to anorexia, even with a follow-up prompt. In conclusion, GPT-4 may be used as a screening tool to provide potential rudimentary directions for management, which can then be reviewed by medical professionals before considering a formal consultation for more tailored and refined opinions from specialists.

The perceived value of a geriatrics-surgery co-management program: Perspectives from three surgical specialties.

BACKGROUND: Geriatrics-surgery co-management (GSCM) programs have improved patient outcomes, but little is known about how they change care and whether their value varies by surgical specialty. We aimed to assess GSCM's effects as perceived by Orthopedic Trauma, Trauma, and Neurosurgery clinicians. METHODS: We conducted a mixed-methods study utilizing electronic survey and virtual interviews at Penn Presbyterian Medical Center, an academic trauma center, in Philadelphia, PA. Participants included physicians, advanced practice providers, nurses, social workers, and case managers in the aforementioned specialties. Key measures were perspectives on value of GSCM, its facilitators, specialty most appropriate to manage specified medical issues, and factors affecting use. RESULTS: Of 71 eligible clinicians, 45 (63%) completed the survey and 12 (21%) of 56 purposefully sampled for specialty-role diversity were interviewed. Clinicians across specialties valued GSCM highly and similarly for impact on personal management of older adults (grand mean [standard error, SE] = 4.33 [0.24] out of 5; p = 0.80 for specialty means comparisons), patient care (mean [SE] = 4.47 [0.21]; p = 0.27), patient outcomes (mean [SE] = 4.26 [0.22]; p = 0.51), and specialty overall (mean [SE] = 4.55 [0.23]; p = 0.25) but less so for knowledge growth (mean [SE] = 3.47 [0.29]; p = 0.11). Interviewees across specialties reported that value derived from improved understanding of patient history, management of complex medical conditions, goals of care support, communication with families, and patient discharge facilitation. Interviewees also agreed on program facilitators: aligned stakeholders, shared data-driven goals, champion/administrative support, continuity and availability of geriatricians, and thorough communication. Specialties differed on three issues: (1) who should manage some medical concerns; (2) whether GSCM makes their job easier (significantly easier for Orthopedic Trauma: mean [SE] = 4.75 [0.29] vs. Trauma: mean [SE] = 4.01 [0.19]; p = 0.05); and (3) whether GSCM increases coordination difficulty (more for Neurosurgery: mean [SE] = 2.18 [0.0.58] vs. Orthopedic Trauma: mean [SE] = 0.51 [0.42]; p = 0.03 and Trauma: mean [SE] = 0.89 [0.28]; p = 0.07). Orthopedic Trauma had the most positive impression of GSCM overall. CONCLUSIONS: Clinicians across diverse surgical specialties valued GSCM. Hospitals considering implementation or expansion of GSCM should attend to identified facilitators and may need to tailor to specialty.

Geriatricians, general internists, and potentially inappropriate medications for a national sample of older adults.

BACKGROUND: Older adults are often prescribed medications that are potentially dangerous and geriatricians have specialized training in treating polypharmacy that may benefit these patients. To examine this, we compared potentially inappropriate medication (PIM) prescribing rates between geriatricians and similar general internists in the United States. METHODS: Using national cross-sectional data from 2013 to 2019, we compared annual PIM prescribing rates between 2815 outpatient geriatricians certified by the American Board of Internal Medicine in 1994-2018 and general internists matched 1:1 on IM certification exam score and year, residency exam pass rate, gender, and US birth and/or US medical school. PIM prescribing was based on the Healthcare Effectiveness Data and Information Set (HEDIS) PIM physician annual prescribing measures which consider medications flagged as potentially inappropriate in the American Geriatric Society Beers Criteria® guideline. We also examined prescribing of appropriate alternative medications. Prescribing rates were calculated as the percentage a physician's patients with Medicare fee-for-service part D enrollment seen in the outpatient setting in a given year (mean: 150 patients per physician) with a PIM prescription they prescribed. RESULTS: Across 30,677 physician-year observations, geriatricians were 16.7% less likely (95% confidence interval (CI): -19.8 to -13.7, p < 0.001) to prescribe a PIM (7.2% versus 8.7% of patients respectively) and 2.7% more likely (95% CI: 0.8 to 4.5, p = 0.004) to prescribe an appropriate alternative medication (52.0% versus 50.7% of patients respectively). Lower PIM prescribing was observed for most medication sub-types including central nervous system, anticholinergic, pain, and endocrine medications. In sensitivity analyses, differences in prescribing were similar when comparing recently trained physicians with more experienced physicians. CONCLUSION: Findings suggest geriatricians in the United States prescribe PIMs at lower rates than general internists. This highlights the value geriatricians provide as well as opportunities to embed key principles of geriatric care into internal medicine training and health care delivery systems.

Letter to Our Colleagues Family Practitioners, Geriatricians, and Radiologists to Increase Awareness Regarding Idiopathic Normal Pressure Hydrocephalus.

OBJECTIVE: Idiopathic normal pressure hydrocephalus (iNPH) affects elderly individuals and is characterized by a progressive deterioration of gait, urinary continence, and cognition. In most cases, it is reversible with treatment. INPH is not uncommonly an unrecognized cause of dementia. We wish to raise awareness of iNPH among primary care providers who are seeing these patients first. METHODS: We reviewed the current epidemiological data regarding iNPH as well as epidemiological data regarding Alzheimer disease. We searched for the most sensitive radiological screening test for iNPH. RESULTS: Alzheimer disease comprises 60%-70% of all dementia cases, in 2023 is affecting 6.7 million Americans, about 10.7% of people 65 and older. Epidemiological data from the Scandinavian countries confirmed that 3.7% of people older than 65 have iNPH. Surgical studies confirmed the presence of early Alzheimer's pathology in about 25% of operated patients with iNPH. Useful radiological findings of iNPH include an Evans Index greater than 0.30, and a disproportionally enlarged subarachnoid space hydrocephalus (DESH). However, the callosal angle is thought to represent the best tool to discriminate iNPH from its mimics. CONCLUSIONS: According to the available epidemiological data iNPH is underdiagnosed. We strongly encourage the primary care physicians and geriatricians to ask the radiologist to measure the callosal angle on the initial brain computed tomography (or magnetic resonance) image. If the callosal angle is ≤71°, it is appropriate to refer the patient to neurosurgery for further diagnostic work-up.

Prevalence and associated factors of work impairment among geriatricians during the COVID-19 pandemic in Japan.

AIM: This study investigated work impairment and its associated factors among geriatricians during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study was carried out using an anonymous online survey questionnaire administered to members of the Japanese Geriatric Society between October and December 2022. The questionnaire included questions regarding psychological distress (Kessler Psychological Distress Scale), fear of COVID-19 (Fear of COVID-19 Scale) and work impairment (Work Functioning Impairment Scale). Multivariate logistic regression analyses were carried out to determine the factors associated with work impairment. Causal mediation analyses were performed to delineate the relationship between work impairment, psychological distress and fear of COVID-19. RESULTS: The analytic sample included 386 geriatricians, and work impairment was observed in 24.8% of them. Work impairment was associated with age, prefecture where the institution was located and fear of COVID-19. Mediation analysis showed that the effect of fear of COVID-19 on work impairment was almost completely mediated by psychological distress. CONCLUSION: During the COVID-19 pandemic, work impairment was commonly observed among geriatricians. We found that fear of COVID-19 might cause work impairment; however, this effect was exerted entirely through psychological distress. This implies that interventions to prevent or reduce work impairment among doctors should mainly target psychological distress; however, the fear of COVID-19, if it causes psychological distress, should also be addressed. Managers of hospitals and long-term care facilities must take steps to protect healthcare workers' mental well-being and maintain work productivity. Therefore, understanding the factors related to work impairment might help them devise effective measures. Geriatr Gerontol Int 2024; 24: 215-220.

Characterization in end-of-life care of older people attended by geriatricians / Caracterización de la atención al final de la vida de personas mayores atendidas por geriatría

Background and objective Symptom control at the end of life is essential, and palliative sedation is a viable intervention option for the care of terminally ill patients. This study aims to characterize the elderly population receiving end-of-life care plans and their management with palliative sedation in a geriatric unit at a high complexity hospital. Materials and methods A cross-sectional study was conducted, and a descriptive analysis was performed. Medical records of 163 patients admitted to a high complexity hospital in Bogota, Colombia between January 2016 and December 2019 were reviewed. Results From 163, 141 patients received an end-of-life care plan, and 22 were managed with palliative sedation. The mean age was 84 years, the most frequent cause of death was respiratory infections and 44% of patients had a history of cancer. Prior to admission, functional decline and the presence of moderate to severe dementia were frequently found. About one in ten persons required palliative sedation, which lasted an average of 2.22±5 days. The most common refractory symptom was dyspnea (45.45%), followed by pain (36.36%). Conclusions Palliative sedation is prevalent in the elderly population and characterizing this population can provide increased knowledge to improve end-of-life care (AU)

Antecedentes y objetivos El control de síntomas al final de la vida es fundamental, y la sedación paliativa resulta una opción de intervención en el cuidado de pacientes con enfermedades terminales. El objetivo es caracterizar una población de personas mayores que recibieron un plan de atención del final de la vida, incluyendo sedación paliativa en una unidad de geriatría de un hospital de alta complejidad. Materiales y métodos Estudio de corte transversal, se realizaron análisis descriptivos y se utilizaron métodos de acuerdo con el tipo de variable. Se revisaron las historias clínicas de 163 pacientes entre enero de 2016 y diciembre de 2019 de un hospital de alta complejidad en Bogotá, Colombia. Resultados Sobre 163 pacientes, 141 recibieron plan de atención de final de vida y 22 fueron manejados con sedación paliativa. La edad promedio fue de 84 años y el 58% eran mujeres. La causa de muerte más frecuente fue respiratoria infecciosa; el 44% tenían antecedente oncológico. La declinación funcional previa al ingreso y la presencia de demencia moderada o severa fueron condiciones que frecuentemente se encontraron en quienes se reorientó el esfuerzo terapéutico. Una de cada 10 personas requirió sedación paliativa, cuya duración fue de 2,22±5 días, el síntoma refractario más frecuente fue la disnea (45,45%), seguido de dolor (36,36%). Conclusiones La sedación paliativa resulta frecuente en la población mayor con enfermedades no oncológicas. La caracterización de estas personas promueve el aumento del conocimiento y la preparación para mejorar el manejo del final de la vida (AU)

Assessing frailty in elderly patients with hip fractures: A retrospective review comparing geriatrician and orthopedic trainee assessments.

To assess the correlation of orthopedic surgery residents compared with expert geriatricians in the assessment of frailty stage using the Clinical Frailty Scale (CFS) in patients with hip fractures. A retrospective chart review was performed from January 1, 2015 to December 31, 2019. Patients admitted with a diagnosis of hip fracture were identified. Those patients with a CFS score completed by orthopedic residents with subsequent CFS score completed by a geriatrician during their admission were extracted. Six hundred and forty-eight patients over age 60 (mean 80.5 years, 73.5% female) were admitted during the study period. Orthopaedic residents completed 286 assessments in 44% of admissions. Geriatric medicine consultation was available for 215 patients such that 93 patients were assessed by both teams. Paired CFS data were extracted from the charts and tested for agreement between the 2 groups of raters. CFS assessments by orthopedic residents and geriatrician experts were significantly different at P < .05; orthopedic residents typically assessed patients to be one CFS grade less frail than geriatricians. Despite this, the CFS assessments showed good agreement between residents and geriatricians. Orthopaedic surgery residents are reliable assessors of frailty but tend to underestimate frailty level compared with specialist geriatricians. Given the evidence to support models such as orthogeriatrics to improve outcomes for frail patients, our findings suggest that orthopedic residents may be well positioned to identify patients who could benefit from such early interventions. Our findings also support recent evidence that frailty assessments by orthopedic surgeons may have predictive validity. Low rates of initial frailty assessment by orthopedic residents suggests that further work is required to integrate more global comprehensive care.

[Radical cystectomy in the geriatric population. Tools for screening postoperative complications]. / Cystectomie radicale chez les patients gériatriques. Outils de dépistage des complications postopératoires.

Radical cystectomy is the gold standard for the treatment of muscle-invasive bladder cancer. Advanced age is only a relative criterion when selecting patients eligible for radical cystectomy, and to reduce post-operative complications, the management of an elderly patient requires a multidisciplinary approach. The role of the geriatrician is therefore essential, in collaboration with the urologist, to ensure appropriate follow-up. A series of preoperative screening tests should be used to identify frailer patients who are at high risk of developing complications, so that appropriate follow-up can be carried out.

La cystectomie radicale est le traitement de choix du cancer de la vessie musculo-invasif. L'âge avancé ne représente qu'un critère relatif lors de la sélection des patients éligibles à une cystectomie radicale. Afin de réduire les complications postopératoires, la prise en charge d'un patient âgé nécessite une approche multidisciplinaire. Le rôle du gériatre est donc essentiel, en collaboration avec l'urologue, afin d'assurer un suivi approprié. Une série de tests de dépistage préopératoires identifie les patients plus fragiles, présentant un risque accru de complications, et permet de réaliser un suivi adapté.

[Advanced care planing and end of life decisions - the geriatricians' view]. / Vorsorgeplanung am Lebensende aus geriatrischer Sicht.

Medical progress and the increasing desire for self-determination, even in the most difficult life situations, as well as the associated increasing possibilities of influencing life and dying lead to possibilities but also obligations for individual treatment design. Especially at the end of life, the desire for provision is great and many decisions need to be made in advance or by proxy. In daily dealings with sick or seriously ill people at the end of their lives, it is very helpful if appropriate advance directives have been made and the patient's wishes can be implemented simply and clearly. With the possibility of advance planning for the end of life (Advance Care Planning (ACP)), there is a precautionary and planning concept that will hopefully be used more and more in the future.

Intrinsic Capacity and Active and Healthy Aging Domains Supported by Personalized Digital Coaching: Survey Study Among Geriatricians in Europe and Japan on eHealth Opportunities for Older Adults.

BACKGROUND: The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework. OBJECTIVE: The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers' perspectives about technology-based interventions to support intrinsic capacity. METHODS: A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021. RESULTS: The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff. CONCLUSIONS: There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults.

Enhancing collaboration between geriatricians, oncologists, and pharmacists to optimize medication therapy in older adults with cancer: A position paper from SOFOG-SFPO.

Optimizing anticancer treatment and medication therapy in older patients with cancer requires a multidisciplinary approach, with a strong collaboration between geriatricians, oncologists and pharmacists. While all patients can benefit, some clinical situations seem to be high-priority. Careful attention should be given to patients with cardiovascular comorbidities and/or diabetes, which are prone to decompensate during anticancer treatment and often involve multiple medications. Another great concern is the risk of falls, closely related to polypharmacy, hence the need for a comprehensive medication review. Managing the pharmacological treatment of depression is also challenging and require shared expertise. Finally, pharmacists can prove valuable in situations of adherence difficulties or use of complementary medicines. Collaborative practice should begin at initiation of anticancer treatment and continue throughout the care pathway, as continuous reassessment is essential. Although the integration of pharmacists in multidisciplinary teams is often challenged by funding, collaborative should still be strongly encouraged.

Characterization in end-of-life care of older people attended by geriatricians.

BACKGROUND AND OBJECTIVE: Symptom control at the end of life is essential, and palliative sedation is a viable intervention option for the care of terminally ill patients. This study aims to characterize the elderly population receiving end-of-life care plans and their management with palliative sedation in a geriatric unit at a high complexity hospital. MATERIALS AND METHODS: A cross-sectional study was conducted, and a descriptive analysis was performed. Medical records of 163 patients admitted to a high complexity hospital in Bogota, Colombia between January 2016 and December 2019 were reviewed. RESULTS: From 163, 141 patients received an end-of-life care plan, and 22 were managed with palliative sedation. The mean age was 84 years, the most frequent cause of death was respiratory infections and 44% of patients had a history of cancer. Prior to admission, functional decline and the presence of moderate to severe dementia were frequently found. About one in ten persons required palliative sedation, which lasted an average of 2.22±5 days. The most common refractory symptom was dyspnea (45.45%), followed by pain (36.36%). CONCLUSIONS: Palliative sedation is prevalent in the elderly population and characterizing this population can provide increased knowledge to improve end-of-life care.