The Paradoxical Decline of Geriatric Medicine as a Profession.

In this Viewpoint, author Jerry Gurwitz discusses the attrition of geriatric medicine as a profession, attributing it in part to societal attitudes about aging and compounded by the negative effects of lower compensation and lack of career prestige.

La importancia de la geriatría transversal en la cirugía abdominal oncológica / The importance of cross-speciality geriatrics in abdominal oncologic surgery

Introducción. El paciente de edad avanzada es el usuario más frecuente en los centros sanitarios. La Geriatría transversal comparteel proceso asistencial con el cirujano atendiendo la esfera cognitiva, funcional y social del paciente, con el objetivo de optimizar loscuidados (tales como mantenimiento de la independencia funcional, nutrición, detección del deterioro cognitivo…) ofreciendo unacobertura integral y reduciendo complicaciones, costes y estancia hospitalaria de manera sobreañadida. El objetivo del trabajo esdar visibilidad a la contribución que el geriatra puede llevar acabo en los servicios de Cirugía General. Material y métodos. Seriede casos mediante estudio descriptivo retrospectivo en el que se analizaron los pacientes mayores de 75 años intervenidos de cáncerde colón durante el año 2021 en el Hospital Central de la Cruz Roja mediante cirugía programada y su evolución clínica posteriora los 6 meses. Resultados: 10 pacientes (80% mujeres), edad media 76,4 años (±3,2), Escala Cruz Roja Funcional media de 1/5(±0,9), con índice de Barthel modificado 80/100 (±15,2), Escala Cruz Roja Mental de 0/5 (±0,6). Índice de Charlson medio de 4,3puntos (±2,2) con 60% enfermedades cardiovasculares, 20% insuficiencia renal crónica y 20% neumopatías. Destacó la elevadapolifarmacia (100%) y desnutrición (60%) previo a la cirugía. El 50% presentó delirium y el 40% padeció insuficiencia cardiacadescompensada. Conclusiones. La Geriatría transversal ayuda a detectar necesidades silentes y debe participar en la atenciónmulticomponente tanto previa a la cirugía (prehabilitación) como en la hospitalización y seguimiento posterior, colaborando con el cirujano en la atención al paciente crónico complejo geriátrico. (AU)

Introduction. The older patient is the most frequent user in healthcare centers. Cross-speciality geriatrics shares the care processwith the surgeon attending the cognitive, functional and social sphere of the patient, with the aim of optimizing care (such asmaintenance of functional independence, nutrition, detection of cognitive deterioration...) offering a comprehensive coverage andreducing complications, costs and hospital stay in a superadded way. The aim of this study is to give visibility to the contributionthat geriatricians can make in general surgery services. Material and methods. Case series by retrospective descriptive study inwhich patients over 75 years of age operated on for colon cancer during the year 2021 in the Central Hospital of the Red Cross byscheduled surgery and their clinical evolution after 6 months were analyzed. Results: 10 patients (80% women), mean age 76.4years (±3.2), mean Functional Red Cross Scale of 1/5 (±0.9), with modified Barthel index 80/100 (±15.2), Mental Red Cross Scaleof 0/5 (±0.6). Mean Charlson index of 4.3 points (±2.2) with 60% cardiovascular disease, 20% chronic renal failure and 20% pneumopathies. The high polypharmacy (100%) and malnutrition (60%) prior to surgery stood out. Fifty percent presented deliriumand 40% suffered from decompensated heart failure. Conclusions. Cross-speciality geriatrics helps to detect silent needs and shouldparticipate in multicomponent care both prior to surgery, during hospitalization and subsequent follow-up, collaborating with thesurgeon in the care of the geriatric complex chronic patient. (AU)

National Trends and Outcomes Associated With Presence and Type of Usual Clinician Among Older Adults With Multimorbidity.

Importance: Declining primary care visit rates and increasing specialist visit rates among older adults with multimorbidity raise questions about the presence, specialty, and outcomes associated with usual clinicians of care for these adults. Objective: To examine trends in the presence and specialty of usual clinicians and the association with preventive care receipt and spending. Design, Setting, and Participants: This survey study used repeated cross-sectional analyses of Medicare Current Beneficiary Survey data from 2010, 2013, and 2016. Participants were community-dwelling Medicare Advantage and traditional Medicare members with at least 2 chronic conditions. Data were analyzed from March 1, 2020, to February 5, 2021. Main Outcomes and Measures: Trends and factors associated with self-reported usual clinician presence and specialty. Multivariable regression was used to examine associations between usual clinician presence and specialty with preventive care receipt and spending, controlling for respondent sociodemographic and clinical characteristics. Results: A total of 25 490 unweighted respondent-years were examined, representing 90 324 639 respondent-years across the United States. Overall, 58.4% of respondent-years belonged to women, and the mean (SD) age of respondents was 77.5 (7.5) years. From 2010 to 2016, those reporting usual clinicians dropped from 94.2% to 91.0% (P < .001). Across study years, respondents were more likely to report a usual clinician if they were women (adjusted marginal difference [AMD], 2.5 percentage points; 95% CI, 1.5-3.5 percentage points) or had higher income (≥$50 000 vs <$15 000: AMD, 2.2 percentage points; 95% CI, 1.1-3.4 percentage points) and less likely if they were Black beneficiaries (vs White: AMD, -2.8 percentage points; 95% CI, -4.3 to -1.3 percentage points) or had traditional Medicare (vs Medicare Advantage: AMD, -3.2 percentage points; 95% CI. -4.1 to -2.3 percentage points). Among 23 279 respondents with usual clinicians, those reporting specialists as their usual clinicians decreased from 5.3% to 4.1% (P < .001). Across the study period, respondents were more likely to report specialists as their usual clinicians if they had traditional Medicare (vs Medicare Advantage: AMD, 2.3 percentage points; 95% CI, 1.6 to 2.9 percentage points), were Black or non-White Hispanic (Black vs White: AMD, 1.5 percentage points; 95% CI, 0.2 to 2.8 percentage points; non-White Hispanic vs White: AMD, 3.8 percentage points; 95% CI, 1.9 to 5.7 percentage points), or lived in the Northeast (vs Midwest: AMD, 3.6 percentage points; 95% CI, 2.1 to 5.2 percentage points). Compared with those without usual clinicians, respondents with usual clinicians were more likely to receive all examined preventive services, such as cholesterol screening (AMD, 6.7 percentage points; 95% CI, 5.4 to 8.1 percentage points) and influenza vaccines (AMD, 11.6 percentage points; 95% CI, 9.2 to 14.0 percentage points). Among respondents with usual clinicians, those reporting specialist usual clinicians (vs primary care) were less likely to receive influenza vaccines (AMD, -5.6 percentage points; 95% CI, -9.2 to -2.1). Conclusions and Relevance: In this study, older adults with multimorbidity were less likely to have a usual clinician over the study period, with potential implications for preventive care receipt. Our results suggest a key role for usual clinicians, especially primary care clinicians, in vaccination uptake for this population.

Risk factors and management of pulmonary infection in elderly patients with heart failure: A retrospective analysis.

ABSTRACT: Pulmonary infection is common in patients with heart failure, yet the risk factors remain unclear. We aimed to evaluate the clinical characteristics and risk factors of pulmonary infection in elderly patients with heart failure, to provide reference to the prevention of pulmonary infection.This study was a retrospective study design. We included elderly heart failure patient admitted to our hospital from April 1, 2018 to August 31, 2020. The characteristics and clinical data of pulmonary infection and no infection patients were assessed. Logistic regression analyses were conducted to identify the risk factors of pulmonary infections in patients with heart failure.A total of 201 patients were included. The incidence of pulmonary infection in patients with heart failure was 23.88%. There were significant differences in the age, diabetes, New York Heart Association (NYHA) grade, left ventricular ejection fraction (LVEF), C-reactive protein (CRP) between infection and no infection group (all P < .05), and there were not differences in the sex, body mass index, alcohol drinking, smoking, hypertension, hyperlipidemia, length of hospital stay between 2 groups (all P > .05). Logistic regression analyses indicated that age ≥70 years, diabetes, NYHA grade III, LVEF ≤55%, and CRP ≥10 mg/L were the independent risk factors of pulmonary infections in patients with heart failure (all P < .05). Pseudomonas aeruginosa (34.48%), Staphylococcus aureus (19.57%), and Klebsiella pneumoniae (15.22%) were the most common 3 pathogens in patients with pulmonary infection.Heart failure patients with age ≥70 years, diabetes, NYHA grade III, LVEF ≤55%, and CRP ≥10 mg/L have higher risks of pulmonary infections, preventive measures targeted on those risk factors are needed to reduce pulmonary infections.

[Update 2021: Coronavirus pandemic - challenges for geriatrics]. / Update 2021: Corona-Pandemie ­ Herausforderungen für die Geriatrie.

Nobody supposed that after one year of the pandemia, the SARS-CoV-2 Virus and its emerging mutants dominates the press, our lives and the health system as a whole. As for Geriatric Medicine, many things have also changed: The majority of COVID-19 patients are no more the (oldest) old and mortality is less observed in multimorbid persons, as most of them have been vaccinated. (Oldest) old persons are still especially vulnerable to die due to a COVD-19 infection. In longterm care, a significant higher mortality was seen in the former waves, but now, some longterm care facilities have more places that they can fill. This is a situation that many European countries would never have anticipated.Ressource allocationin stormy times is now more openly discussed, especially who should be admitted to intensive care units. This has led to more detailed and new guidelines which may help even when the pandemia is over. Here, some thoughts regarding the care of older adults in times of the pandemia are discussed.

Brain training using cognitive apps can improve cognitive performance and processing speed in older adults.

Managing age-related decrease of cognitive function is an important public health challenge, especially in the context of the global aging of the population. Over the last years several Cognitive Mobile Games (CMG) have been developed to train and challenge the brain. However, currently the level of evidence supporting the benefits of using CMG in real-life use is limited in older adults, especially at a late age. In this study we analyzed game scores and the processing speed obtained over the course of 100 sessions in 12,000 subjects aged 60 to over 80 years. Users who trained with the games improved regardless of age in terms of scores and processing speed throughout the 100 sessions, suggesting that old and very old adults can improve their cognitive performance using CMG in real-life use.

Ageism in COVID-Related Newspaper Coverage: The First Month of a Pandemic.

OBJECTIVES: Media sources have consistently described older adults as a medically vulnerable population during the coronavirus disease 2019 (COVID-19) pandemic, yet a lack of concern over their health and safety has resulted in dismissal and devaluation. This unprecedented situation highlights ongoing societal ageism and its manifestations in public discourse. This analysis asks how national news sources performed explicit and implicit ageism during the first month of the pandemic. METHOD: Using content and critical discourse analysis methods, we analyzed 287 articles concerning older adults and COVID-19 published between March 11 and April 10, 2020, in 4 major U.S.-based newspapers. RESULTS: Findings indicate that while ageism was rarely discussed explicitly, ageist bias was evident in implicit reporting patterns (e.g., frequent use of the term "elderly," portrayals of older adults as "vulnerable"). Infection and death rates and institutionalized care were among the most commonly reported topics, providing a limited portrait of aging during the pandemic. The older "survivor" narrative offers a positive alternative by suggesting exceptional examples of resilience and grit. However, the survivor narrative may also implicitly place blame on those unable to survive or thrive in later life. DISCUSSION: This study provides insight for policy makers, researchers, and practitioners exploring societal perceptions of older adults and how these perceptions are disseminated and maintained by the media.

Geriatrics: Moving forward with 2020 vision.

Geriatricians have long debated the parameters, positioning, and prospects of their specialty. The year 2020 started full of promise as many organizations anticipated assessing themselves using perfect, or 2020, vision. While challenging on several levels, the momentous combination of events in 2020-the COVID-19 pandemic, Racial Justice Movement, and the November elections-provided Geriatric Medicine several opportunities to firmly secure a position in the mainstream. As we reflect on the new perspectives, programs, and partnerships initiated in 2020, five broader lessons emerge that can help safeguard the future of Geriatrics: the field could employ more intentional "direct to consumer" marketing strategies, expand the scope of what it means to be a patient advocate, pursue new strategic partnerships, take the opportunity to address racial injustice, and leverage existing skillsets to expand scope of care for patients. Given the interdisciplinary nature of Geriatrics, it is fitting that many of these lessons build upon this collaborative philosophy and are derived from domains outside of health care. So in an unexpected way, the events of 2020 may actually help Geriatrics see, with 2020 vision, how to remain mainstream. With this new clarity, Geriatrics holds renewed promise to truly become specialists in whole-person care and it is our hope that, with insight from the lessons shared here, the specialty brings this vision to fruition in the current decade and beyond.

Trends in Geriatric Emergency Medicine.

Geriatric emergency medicine has emerged as a subspecialty of emergency medicine over the past 25 years. This emergence has seen the development of increases in training opportunities, care delivery strategies, collaborative best practice guidelines, and formal geriatric emergency department accreditation. This multidisciplinary field remains ripe for continued development in the coming decades as the aging US population parallels a call from patients, health care providers, and health systems to improve the delivery of high-value care. This article educates emergency medicine practitioners and highlights high-value care practice trends to inform and prioritize decision-making for this unique patient population.

The geriatric emergency literature 2020: COVID and beyond.

Older adults are a rapidly growing patient population with unique characteristics and health considerations. Over the past few years, emergency physicians have started to recognize the complexities and importance of Geriatric Emergency Medicine. Several noteworthy elements of their healthcare were brought to the forefront of emergency medicine because this especially vulnerable patient population was disproportionately affected by the pandemic. Clinical topics such as delirium, telehealth, end-of-life care, and elder abuse came into focus; select relevant articles are reviewed. We also highlight equally notable literature which address clinically challenging topics, such as hip fractures and syncope. Finally, articles about improving the experience of and decreasing recidivism in geriatric emergency department patients are reviewed. In short, this review article summarizes geriatric emergency medicine literature that can help you improve your practice while caring for older adults.

Telehealth Use in Geriatrics Care during the COVID-19 Pandemic-A Scoping Review and Evidence Synthesis.

Introduction: Globally, the COVID-19 pandemic has affected older people disproportionately. Prior to the pandemic, some studies reported that telehealth was an efficient and effective form of health care delivery, particularly for older people. There has been increased use of telehealth and publication of new literature on this topic during the pandemic, so we conducted a scoping review and evidence synthesis for telehealth use in geriatric care to summarize learning from these new data. Methods: We searched PubMed, Embase, and the World Health Organization's COVID-19 global research database for articles published between 1 January and 20 August 2020. We included 79 articles that met our inclusion criteria. The information collected has been synthesized and presented as descriptive statistics. Strengths, weaknesses, opportunities, and threats (SWOT) have also been discussed. Results: The articles included in our review provide some evidence of effective provision of preventive, curative, and rehabilitative telehealth services for older people, but they highlight a greater focus on curative services and are mostly concentrated in high-income countries. We identified convenience and affordability as the strengths of telehealth use in geriatric care. Weaknesses identified include the inability of telehealth to cater to the needs of older people with specific physical and cognitive limitations. While the threats of increasing inequity and the lack of standardization in the provision of age-friendly telehealth services remain, we identified opportunities for technologic advancements driven by simplicity and user-friendliness for older people. Conclusion: Telehealth offers futuristic promise for the provision of essential health care services for older people worldwide. However, the extent of these services via telehealth appears to be currently limited in low and low-middle income countries. Optimizing telehealth services that can be accessed by older people requires greater government investments and active engagement by broader participation of older people, their caregivers, physicians and other health care providers, technology experts, and health managers.