The quality of geriatric rehabilitation from the patients' perspective: a scoping review.

BACKGROUND: the efficacy and outcomes of geriatric rehabilitation (GR) have previously been investigated. However, a systematic synthesis of the aspects that are important to patients regarding the quality of GR does not exist. OBJECTIVE: the aim of this scoping review was to systematically synthesise the patients' perspective on the quality of GR. METHODS: we followed the Scoping Review framework and gathered literature including a qualitative study design from multiple databases. The inclusion criteria were: a qualitative study design; a geriatric population; that patients had participated in a geriatric rehabilitation programme and that geriatric rehabilitation was assessed by the patient. The results sections of the included studies were analysed using a thematic analysis approach. RESULTS: twenty articles were included in this review. The main themes identified were: (i) the need for information about the rehabilitation process, (ii) the need for telling one's story, (iii) the need for support (physical, psychological, social and how to cope with limitations), (iv) the need for shared decision-making and autonomy, (v) the need for a stimulating rehabilitation environment and (vi) the need for rehabilitation at home. CONCLUSION: in this study, we identified the aspects that determine the quality of rehabilitation from the patient's perspective, which may lead to a more holistic perspective on the quality of GR.

Age-based entitlement: An ageist practice or a tool for combatting ageism?

Researchers in gerontology have addressed the way age-based arrangements may communicate stereotypical and devaluing images of older people, thereby linking high age to frailty and dependence. The present article considers proposed reforms to the Swedish eldercare system designed to guarantee people over 85 the right to move into a nursing home regardless of their needs. The purpose of the article is to investigate older people's views on age-based entitlement in light of this proposal. What might the consequences of implementing the proposal be? Does it communicate devaluing images? Do the respondents consider it a case of ageism? The data consists of 11 peer group interviews with 34 older individuals. Bradshaw's taxonomy of needs was used to code and analyze data. Four positions on the proposed guarantee were identified: care should be arranged (1) according to needs, not age; (2) according to age as a proxy for needs; (3) according to age, as a right; and (4) according to age, to combat "fourth ageism", meaning ageism directed towards frail older persons, i.e. persons in the fourth age. The notion that such a guarantee might constitute ageism was dismissed as irrelevant, while difficulties in getting access to care were presented as the real discrimination. It is theorized that some forms of ageism posited as theoretically relevant may not be experienced as such by older people themselves.

[The role of private geriatricians in the health care system (2/2): comprehensive qualitative analysis using semi-structured interviews]. / Rôle des gériatres libéraux dans le système de santé (2/2) : analyse qualitative compréhensive par entretiens semi-dirigés.

Private geriatricians report heterogeneous practices, while the specialty as a whole is questioning its model. We conducted semi-structured interviews to understand how private geriatricians viewed their role in the health care system. They report a certain homogeneity in their conception of their role, which corresponds to that of geriatricians as a whole: there seems to be a professional identity for geriatrics.

[What are the barriers to private practice in geriatrics?] / Quels sont les freins à l'exercice libéral de la gériatrie ?

Liberal geriatrics is not developed in France. However, given the aging of the population and the benefits of specialized care for elderly patients, the increase in this activity could be beneficial. For a liberal activity in geriatrics to be established, it would be necessary to better define the role of the geriatrician in the follow-up of patients, to inform during the studies of this possibility of exercise and that a real adapted nomenclature be put in place.

[Presbyphagia and swallowing disorders]. / Presbyphagie et troubles de la déglutition.

Swallowing disorders, which are frequent in geriatrics, are linked to multiple pathologies: cancer, stroke, neurocognitive disorders, acute confusion, vigilance disorders, etc. They can have serious consequences and therefore require special care. From the identification of the disorders by the doctor, the nurse, the caregiver, to the speech therapy assessment, through the adaptation of the diet by the dietician, the management of swallowing disorders concerns all the medical and paramedical staff. The aim of this article is to present the main existing recommendations to promote the patient's feeding despite the presence of these disorders.

[Role of private geriatricians in the health care system (1/2): quantitative descriptive analysis by questionnaire]. / Rôle des gériatres libéraux dans le système de santé (1/2) : analyse quantitative descriptive par questionnaire.

Private practice geriatrics is a little known practice modality. We conducted a questionnaire survey to try to describe the role of private geriatricians in the health care system. Although few in number, private geriatricians report very different practices, including their conception of their role. This is the first monograph on the activity of private geriatricians, and the results have motivated us to propose a comprehensive analysis of this role.

[Private geriatrics: an experience in Guadeloupe]. / Gériatrie libérale : une expérience vécue en Guadeloupe.

Although geriatric medicine is now commonplace in university hospitals, it is less common in private practice. In Guadeloupe, a geriatric medicine service operating as a weekday hospital has been created in a polyclinic to support patients and general practitioners. This activity is an example of private practice in geriatric medicine and completes the care offer of the geriatric network.

Contemporary adult gerontology acute care nurse practitioner (AGACNP) practice: Findings from the 2020 American Association of Critical Care Nurses AGACNP practice analysis survey.

BACKGROUND: National standards for nurse practitioner licensure require certification programs to conduct practice analyses to ensure that certified nurse practitioners possess the necessary knowledge for entry-level practice. The practice analysis for the American Association of Critical Care Nurses Certification Corporation (AACN Cert Corp) adult-gerontology acute care nurse practitioner (AGACNP) credential is performed every five years by the AACN Certification Corporation. PURPOSE: The AACN Cert Corp conducted a practice analysis to confirm that current AGACNP practice is reflected in the ACNPC-AG test plan, and the examination is congruent with 2008 consensus model guidelines. This work describes findings from the 2020 AACN Cert Corp practice analysis and changes in AGACNP practice and academic preparation based on the survey data. METHOD: In 2020, AACN Cert Corp volunteer subject matter experts (SMEs) developed a survey of practice activities and competencies relevant to AGACNP practice. Patient care activities and competencies were rated by AGACNP respondents for criticality and frequency. AACN SMEs reviewed criticality and frequency ratings to determine the patient care problems, skills/procedures, and competencies to include in the updated AACN Cert Corp ACNPC-AG test plan. RESULTS: The 2020 AGACNP practice analysis survey and subsequent review resulted in the retention of 33 skills and procedures, 165 patient care problems, and all national competencies in the final ACNPC-AG test plan. CONCLUSIONS AND IMPLICATIONS: The 2020 AACN Cert Corp AGACNP practice analysis survey describes possible changes in AGACNP practice and academic preparation that have occurred since the 2016 survey, findings that may be associated with the ongoing COVID-19 pandemic.

Drug_SNSMiner: standard pharmacovigilance pipeline for detection of adverse drug reaction using SNS data.

As society continues to age, it is becoming increasingly important to monitor drug use in the elderly. Social media data have been used for monitoring adverse drug reactions. The aim of this study was to determine whether social network studies (SNS) are useful sources of drug side effects information. We propose a method for utilizing SNS data to plot the known side effects of geriatric drugs in a dosing map. We developed a lexicon of drug terms associated with side effects and mapped patterns from social media data. We confirmed that well-known side effects may be obtained by utilizing SNS data. Based on these results, we propose a pharmacovigilance pipeline that can be extended to unknown side effects. We propose the standard analysis pipeline Drug_SNSMiner for monitoring side effects using SNS data and evaluated it as a drug prescription platform for the elderly. We confirmed that side effects may be monitored from the consumer's perspective based on SNS data using only drug information. SNS data were deemed good sources of information to determine ADRs and obtain other complementary data. We established that these learning data are invaluable for AI requiring the acquisition of ADR posts on efficacious drugs.

Developing new hospital-at-home models based on Comprehensive Geriatric Assessment: Implementation recommendations by the Working Group on Hospital-at-Home and Community Geriatrics of the Catalan Society of Geriatrics and Gerontology / Desarrollo de nuevos modelos de hospitalización a domicilio basados en la valoración geriátrica integral: recomendaciones del grupo de trabajo de Hospitalización a domicilio y geriatría comunitaria de la Sociedad Catalana de Geriatría y Gerontología para su implementación

Last decade, the Government of Catalonia have urged an integrated care strategy for planning the care model to older populations living with frailty, multimorbidity and advanced illnesses. Based on international evidence that was reviewed by a group of experts from the Catalan Society of Gerontology and Geriatrics, we summarised some recommendation to adapt hospital-at-home care to older populations in our system. We defined Comprehensive Geriatric Assessment (CGA) hospital-at-home (HaH) as a specialised home hospitalisation service formed by interdisciplinary teams, characterised by using the clinical methodology of CGA, and by adapting geriatric units’ protocols for the provision of person-centred care at home. Main benefits of CGA-HaH in these populations are: response to heath crises according to individualised care plans based on the situational diagnosis carried out by Primary Care teams; provision of a comprehensive health and social approach tailored to the complexity of cases and situations; and adaptation of multipurpose hospitalisation, by working on different person-centred care, aspects, such as caregivers support on care provision, focusing on function or home adaptation. (AU)

En la última década el gobierno de Cataluña ha diseñado un plan estratégico de atención integrada para planificar la atención del subgrupo de pacientes mayores con fragilidad, multimorbilidad y enfermedad avanzada, con la intención de mejorar la salud y el manejo clínico. Guiándonos en la evidencia internacional, revisada por un grupo de expertos de la Societat Catalana de Geriatria i Gerontologia, revisamos recomendaciones para adaptar los modelos a la población mayor de nuestro sistema. Así, definimos la hospitalización a domicilio geriátrica o basada en la valoración geriátrica integral (VGI) como una hospitalización a domicilio especializada basada en equipos interdisciplinares que utilizan la VGI como instrumento de trabajo de manera similar a las unidades de hospitalización geriátricas. Estas intervenciones ofrecen beneficios en responder a crisis de salud dando continuidad al diagnóstico situacional y a los planes individualizados planteados por los equipos de atención primaria, en realizar una valoración integral de la complejidad en todos sus aspectos, y en ofrecer una hospitalización integral centrada en la persona, trabajando aspectos como el apoyo a los cuidadores en la atención, la recuperación funcional y la adaptación del domicilio. (AU)

Con E de enfermera... GERIÁTRICA / With E for nurse... GERIATRIC

La Enfermería es una profesión muy vocacional, Alma Matilla tenía claro que la elegiría al ser la labor fundamental del cuidado. Matilla ha pasado por varias áreas, incluida la Geriatría, una especialidad muy importante que muchas veces no está reconocida ni suficientemente valorada. Hablamos con ella sobre su experiencia con mayores, el porqué de dedicarse a ellos y la visión que tiene de esta especialidad.(AU)

Identification of Factors Affecting the Increased Percentage of CGA Recommendations among Patients on Geriatric Ward.

In Poland, the elderly population is noticeably increasing every year. Therefore, the current healthcare system has to rise to the challenge of treatment and prevention strategies targeting elderly persons. Based on the Vulnerable Elders Survey (VES-13 scale), consisting of international and validated scales, we put effort into identifying the factors affecting the increased percentage of CGA (Comprehensive Geriatric Assessment) recommendations by healthcare system physicians. The study group involved 78 patients from the Department of Geriatrics, Wroclaw Medical University, Poland, aged 60-91 (median Me = 81 years old). Of the studied patients, 51 were recommended for CGA (51/78; 64.6%). A statistically significant association was observed between CGA recommendation and age (p < 0.001); the likelihood of a CGA recommendation increased with age. Furthermore, the increased CGA recommendation was observed among geriatric patients with: (a) frailty syndrome (OR = 11.2, CI95% 2.88-43.5, p < 0.001), (b) high risk of malnutrition or malnutrition (OR = 3.87; CI95%, 1.00-14.9, p = 0.04), (c) low mental status (OR = 3.32, CI95% 1.22-9.09, p = 0.029), (d) low ability to perform basic daily duties (according to ADL scale-OR = 12.6, CI95% 1.57-101, p = 0.004 and IADL scale-OR = 4.71, CI95% 1.72-12.9, p = 0.003), and (e) fall risk (OR = 15.0, CI95% 4.67-48.3, p < 0.001). Moreover, homocysteine levels increased with age (p = 0.003) and decreased with sleep duration (p = 0.043). Taken together, all these factors seem to be important when implementing treatment programs adjusted to the individual geriatric patient.

Updating the British Geriatrics Society recommended undergraduate curriculum in geriatric medicine: a curriculum mapping and nominal group technique study.

BACKGROUND: medical education must adapt to meet the challenges and demands of an ageing population, ensuring that graduates are equipped to look after older patients with complex health and social care needs. Recommended curricula in geriatric medicine in the United Kingdom and Europe offer guidance for optimal undergraduate education in ageing. The UK version, written by the British Geriatrics Society (BGS), requires updating to take account of innovations in the specialty, changing guidance from the General Medical Council (GMC), and the need to support medical schools preparing for the introduction of the national Medical Licensing Assessment (MLA). METHODS: the BGS recommended curriculum was mapped to the most recent European curriculum (2014) and the MLA content map, to compare and contrast between current recommendations and nationally mandated guidance. These maps were used to guide discussion through a virtual Nominal Group Technique (NGT), including 21 expert stakeholders, to agree consensus on the updated BGS curriculum. RESULTS: the curriculum has been re-structured into seven sections, each with 1-2 overarching learning outcomes (LOs) that are expanded in multiple sub-LOs. Crucially, the curriculum now reflects the updated GMC/MLA requirements, having incorporated items flagged as missing in the mapping stages. CONCLUSION: the combined mapping exercise and NGT have enabled appropriate alignment and benchmarking of the UK national curriculum. These recommendations will help to standardise and enhance teaching and learning around the care of older persons with complexity.

The state of acute care postgraduate training: Faculty observations.

ABSTRACT: The benefits to postgraduate training programs (PTPs) for nurse practitioners (NPs) in all populations are being well established in the literature. As health care systems and teams evolve, acute care NPs (neonatal, pediatric, and adult-gerontology) are providing more specialized care to increasingly complex patients. As educators and clinicians, we recognize that acute care PTPs are playing an important role in preparing NPs to work to the top of their scope and training. This article provides our perspectives on the merits of PTPs for adult-gerontology acute care NPs and provides guidance for counseling NPs who are interested in acute care PTPs.

Instrument Evaluation: Attitudes Toward Older Adults and Intent to Work in Geriatrics.

ABSTRACT: Despite the increasing demand for nurses in geriatrics, interest lags in working with older adults. The Carolina Opinions on the Care of Older Adults instrument assesses attitudes toward older adults, with one subscale assessing intention to work with older adults. The instrument was used in a pretest/posttest study with prelicensure students enrolled in a gerontological nursing course. Posttest scores showed an improvement in attitudes toward older adults. The geriatric career choice subscale showed no pretest/posttest changes. The Carolina Opinions on the Care of Older Adults instrument is a suitable measure to assess changes in attitudes and intention to work with older adults.

Sustainable Health-Related Quality of Life in Older Adults as Supported by the vINCI Technology.

The vINCI technology represents an innovative instrument developed specifically but not exclusively for older adults by technology researchers together with a medical team specialized in geriatrics and gerontology. It was designed to be independently and effortlessly used by older adults in the comfort and safety of their own environment. It is a modular and flexible platform that can integrate a large array of various sensors and can easily adapt to specific healthcare needs. The pilot study tested sensors and standardized instruments capable of evaluating several care-related parameters and of generating personalized feedback for the user dedicated to optimizing physical activity level, social interaction, and health-related quality of life. Moreover, the system was able to detect and signal events and health-related aspects that would require medical assistance. This paper presents how the innovative vINCI technology improves quality of life in older adults. This is evidenced by the results obtained following the clinical validation of the vINCI technology by older adults admitted to the Ana Aslan National Institute of Gerontology and Geriatrics (NIGG) in Bucharest.