Day 2 :
Keynote Forum
Julianne Wright
University of Indianapolis, USA
Keynote: Valvular heart disease and the older adult
Time : 10:00- 10:30
Biography:
Julianne Wright has completed her DNP this past spring from the University of Southern Indiana. She is an Assistant Nursing Professor from the University of Indianapolis in Indiana. Her research has focused on improving assessment skills in nursing, improving the surveillance for significant findings and best patient outcomes. She has over 30-years’ experience in critical care and medical-surgical nursing at the bedside and working closely with adult patients and the older adult.
Abstract:
Valvular heart disease (VHD) constitutes a pathologic process affecting cardiac output, direction of blood flow through the heart and pooling of blood around the valves. These conditions are precursors to poor tissue perfusion, peripheral edema, pulmonary edema and emboli, all of which can cause cardiovascular and cerebrovascular complications. A gap in the care of patients with these conditions is the lack of accurate auscultation of heath sounds. Due to increasing life-expectancy in the United States and prevalence of obesity VHD is expected to become a cardiac epidemic needing early detection to evaluate and minimize adverse effects on heart function. The purpose of the discussion will be to cultivate higher expectations in healthcare for cardiovascular surveillance through cardiac auscultation and by other means, facilitating early detection and prevention of cardiovascular and cerebrovascular complications in the older adult. Data collections on cardiac murmurs and subsequent nursing documentation revealed a significant skill deficit in cardiac auscultation in nursing and readily corrected with aneducational in-service. The discussion will also include the various therapy options and the quality of life for the older adult with valvular heart disease
Keynote Forum
Elizabeth Andersen
The University of British Columbia, Canada
Keynote: Nursing home models and modes of service delivery: A review of outcomes
Time : 10:30-11:00
Biography:
Elizabeth Andersen PhD, RN, is an Assistant Professor in the School of Nursing, Faculty of Health and Social Development, University of British Columbia. Her research is focused on exploring specific components of nursing home cultural change models and their effects on residents, families, and paid caregivers. She is especially interested in the working conditions and expanding roles of more marginalized nursing home employees (care aides).
Abstract:
Within contemporary approaches to nursing home care, the staff composition and task allocation influence paidcaregiver experiences, and in turn affect the quality of care provided to residents. In this presentation, I will profile several different models of nursing home care with their associated modes of service delivery, and summarize the varied reports of effectiveness of these models and modes of service delivery. While anecdotalevidence supports the Eden Alternative® Neighbourhood or Household models, empirical support for the consistent assignment mode of service delivery within the Eden Neighbourhood or Household models is notextensive. More persuasive evidence supports the more advanced Eden Greenhouse model with its embedded flexible assignment policies and self-managed teams of care aides. Flexible assignments are a design element of the Alzheimer’s Disease and Related Disorders Society (ADARDS) model as well. Although consistentassignments for paid caregivers continue to be targeted by organizations, self-managed teams and flexibleassignments may be more ideal modes of nursing home service delivery, especially now, as the average age,frailty level, and acuity level of nursing home residents is increasing.
- Track 5: Clinical Geriatrics & Track 7: Nutrition & Ageing
Location: Salon-D
Chair
Julianne Wright
University of Indianapolis, USA
Co-Chair
Guillermina Solis
The University of Texas, USA
Session Introduction
Monica Gyimah
Kingston General Hospital
Canada
Title: “Difficult Patientsâ€: What can they teach us?
Time : 11:15-11:40
Biography:
Monica Gyimah graduated with Master of Social Work degree from Carleton University, Ottawa, Ontario, Canada in 2007. She has worked on the acute Medicine Service, in the Emergency Department and “Medicine Short Stay Unit” for 6 years doing crisis interventions and discharge planning. In the last 2.5 years Monica has been working strictly with the Alternate Level of Care (ALC) patients many of who have Dementia, Parkinson’s, and other complex medical conditions. Prior to being a social worker Monica had completed a Masters Degree in Social Geography and had worked at Western and Queen’s Universities and has co-authored at least two publications.
Abstract:
Most clinicians have probably dealt with patients they would rather not encounter. These patients are variously referred to as “uncooperative,” “noncompliant,” “demanding,” “patients with thick charts,” or “high maintenance,” among others. Typically, interactions between clinicians and such patients are deemed unsatisfactory. Some studies estimate that “difficult” interactions constitute about 15% of all physician-patient interactions (Davies, 2013; Hull & Broquet, 2007; Dudzinski & Timberlake 2006). This paper discusses such difficult interactions and what clinicians could learn from them. While some of the difficult interactions may be blamed on patients, clinicians and the health care culture are also partly responsible (Davies, 2013; Dudzinski &Timberlake 2006). In many cases patients are only attempting to understand and maintain control over their care through personal advocacy. In doing so, they are often misunderstood and are labelled as “uncooperative” or “difficult.” Some clinicians’ perceptions of “good patients may be attributed to whether the patient goes along with proposed care plans and treatments and/or not questioning clinicians. Such “good patients” are those who allow clinicians to be the experts, determining the terms of their care. My question is whether the culture of “clinicians know best” constitutes good, collaborative care. Could these “difficult patients” teach us anything about ourselves and our service provision? Are there benefits to the behaviours of these apparently difficult patients? Perhaps they may present opportunities for improving communication and care delivery. In order to deliver effective and efficient patient-centered care it is incumbent upon us to develop approaches that would help us understand and effectively communicate with these patients.
Guillermina Solis
The University of Texas, USA
Title: Fall injuries in older adult men and its implications for public policy and services support
Time : 11:40-12:05
Biography:
Guillermina Solis completed her PhD in Interdisciplinary Health Science in 2010, from The University of Texas at El Paso and her Post Doctoral Fellowship at the University of Utah in 2012. She is an Assistant Professor in the University of Texas at El Paso. The focus of her research is fall injuries in older adults and the utilization of emergency services leading to identifying gaps of appropriate health service utilization to improve physical function. She has presented her work at national & international conferences and collaborated with other health disciplines addressing geriatric topics. She is a practicing geriatric nurse practitioner where she sees the opportunity to explore health issues affecting older adults
Abstract:
Background: Unintentional falls and related injuries among older adults are heralded as a public health concern. One out of three older adults requires medical care post fall increasing the demand for health services and social support at all levels. Sex differences resulting from falls have been identified. Men have a high rate hospitalizations and mortality. A gap in knowledge exists in gender specific, social and environmental risk factors. Purpose: This study analyzed the circumstances and outcomes of fall injuries in men who accessed the community emergency medical system (EMS) in El Paso, Texas after a fall. Methodology: A 12 month retrospective quantitative study of community dwelling older adults who sought services from EMS after injury was conducted. Men (N=418) 55 years old and older were included in the analysis of circumstances, place of fall, time; injuries sustained and designated acuity level. Descriptive statistics and non-parametric analysis were conducted to identify relationships among variables. Results: The average age was 74±11.8, majority were Hispanic, most fell outdoors had highest acuity level, head and upper body injuries were common and majority fell during early mornings. Fall circumstances and time among men 80+ years old differed from younger group. Discussion: The prevalence of outdoor falls and acuity level coupled with the difference in circumstances of fall injury in the 80+ warrants further studies of older men and fall injuries. Results reflect a need to develop culturally congruent strategies for prevention and work in collaboration with public health agencies to evaluate social and environmental risks that contribute to fall injuries and develop policies that creates an “aging” friendly community. An interdisciplinary approach for creating innovative methods for fall prevention and support of post fall care to aid in recovery process is a promising way to reduce the problem.
Wendy Stoelting-Gettelfinger
University of Indianapolis, USA
Title: The partnership between primary and palliative care: A collaboration that can facilitate interdisciplinary care to improve patient outcomes
Time : 12:05-12:30
Biography:
Wendy Stoelting-Gettelfinger completed her JD in 1993 with joint PhD in nursing in 1999 from Indiana University. She is the Coordinator for the Family Nurse Practitioner program at the University of Indianapolis and works as a Family Nurse Practitioner (FNP) in a comprehensive primary care practice. While she coordinates palliative and end-of-life services for her primary care patients, she recently experienced these issues on a personal level through the loss of her parents and developed an increased appreciation for the difference that palliative care can make to enhance quality of life for patients and their families.
Abstract:
An effective partnership between primary care and palliative care is crucial to improving the quality of life for many patients and their families. Innovative solutions must be developed to address the current shortage of palliative care specialists. One viable solution is the partnership between palliative and primary care referred to as “primary palliative care”. Primary care providers including advance practice nurse providers (primary care providers) are in a unique position to manage symptoms, assist families with treatment plan decisions and make early referrals to coordinate interdisciplinary care with the ultimate goal of reducing patient suffering and improving quality of life. Primary care providers often have long-term relationships with their patients and an insightful understanding of family dynamics. Primary care providers are in a trusted position to assist families with difficult care decisions without infringing upon their autonomous rights. Unfortunately, primary care providers depending upon their background and expertise may or may not be knowledgeable in the difference between palliative care and end-of-life services. Understanding these key differences as well as the differences between primary, secondary and tertiary palliative care is fundamental for primary providers to provide appropriate care. Educating primary care providers regarding the key role that they can play in coordinating interdisciplinary palliative primary care is the first step to providing comprehensive, un-fragmented care for patients needing palliative care services. Understanding that palliative care can improve outcomes, save health care dollars while improving quality of life is essential to successful interdisciplinary partnerships and coordination of palliative care services.
Tania e Silva Pulicano Lacerda
Universidade Cidade de Sao Paulo, Brazil
Title: Singularities in Dental Prosthetic Rehabilitation for Alzheimer Patients
Time : 12:30-12:55
Biography:
Tania e Silva Pulicano Lacerda has completed her Master in Odonthology at the University of São Paulo. She is also Assistant Professor of the São Paulo City University, UNICID-SP as well as the São Leopoldo Mandic Graduate Centre, São Paulo.
Abstract:
This work aims at presenting the singularities of Alzheimer patients in regards to their prosthetic rehabilitation. In order to recognize such challenges since the very beginning, professionals must establish a clear interdisciplinary communication with patients as well as their family members and caretakers. In general, techniques for making dentures and implants for such patient are the same used in a healthy one. However, what needs to be recognized is in the stage of the disease: The patient can have masticator and swallowing dysfunctions which may demand parenteral nutrition. Thus, the planning of treatments will be altered according to the general physical state of the patient, his or her degree of dependence on others and life expectancy. In later stages, masticatory and swallowing functions have to be observed, once the patient may develop dysphagia needing for example to remove the inferior prosthesis. Taking into account the difficulties of hygiene that these patients may encounter due to restriction in their motor and cognitive skills, periodical evaluations of their oral health, teeth when present and mucosa are extremely important. As a final remark, an interdisciplinary approach will be focused: The nutritionist can suggest proper diets based on the time patients have been using the prosthesis, adding in a lot of cases, supplements to avoid malnutrition. Furthermore, one cannot forget the muscles involved in the entire process as well as the necessity of having the support of a speech pathologist that will help by guaranteeing a better masticatory efficiency.
Si Ching Lim
Changi General Hospital, Singapore
Title: Nutrition and the role of tube feeding among the elderly
Time : 13:55-14:20
Biography:
Si Ching LIM has graduated from University of Bristol, UK in 1992, and worked as a Nephrologist for 6 years before specializing Geriatric Medicine. She is Board certified Geriatrician in 2006. She is currently working in Changi General Hospital in Singapore with a keen interest in medical education, holding an Adjunct Assistant Professor post with National University of Singapore (NUS) and Dukes-NUS. She is also Faculty member for Senior Residency Programme Sing health for both Internal Medicine and Geriatric Medicine. She has 4 (+1) publications.
Abstract:
Nutritional disorders are common among the elderly. Under-nutrition is common among the community dwelling elderly and the incidence approaches 85% among the institutionalized elderly. The predisposing factors for under-nutrition are multiple among the elderly. Nutritional disorders are often missed by the clinicians and yet it carries with it huge impact on the patients’ quality of life, morbidity, mortality, length of hospital stay, increases risk of hospital acquired complications, pressure sores, etc. Screening for malnutrition is quick and reliable and it allows for early interventions before further decline in nutritional status occurs especially during the course of hospital stay. Interventions in terms of food fortification, meal modification and oral nutritional supplement showed favorable outcome. In addition to general calorie intake, protein intake among the elderly also needs to be looked at since the elderly often takes inadequate amount of protein in their diets. The daily recommended protein intake is higher for elderly to optimize muscle mass, strength and function. Micronutrients intake among the elderly are also important especially among the elderly who are unable to obtain nutrient rich foods. Role of tube feeding among the elderly with inadequate oral intake due to various causes of dysphagia and recurrent aspiration are often fought with controversies. The role of improving nutrition versus the negative impact, quality of life and complications of tube insertion are often difficult decisions for clinicians as well as patients and their next of kin.
M A Li-na
Capital Medical University, China
Title: Morning blood pressure surge is associated with decreasing cognitive function in elderly patients with essential hypertension
Time : 14:20-14:45
Biography:
Ma Li-na is currently an attending Doctor focusing on Aging in Department of Geriatrics, Xuan Wu Hospital, Capital Medical University. She is currently interested in studying cognitive impairment for individuals with hypertension. She has 10+ years of research experience in health and aging. She was awarded the National Scholarship for Graduate students in China. She is a co-author of four books. As a first author, recent publications include 14 SCI journal articles focusing on cognitive impairment, insulin resistance and other chronic diseases in elderly patients.
Abstract:
Aim: To explore the association between morning blood pressure surge and cognitive function in elderly patients with essential hypertension. Methods: 107 patients submitted to 24 hours ambulatory blood pressure monitoring were categorized as with morning blood pressure surge (MBPS) group (n=40) and non morning blood pressure surge (NMBPS) group (n=67). Total cholesterol, body mass index (BMI) was determined and MMSE was measured. Results: BPS in MBPS was higher than that in NMBPS (P<0.05). MMSE in MBPS was lower than that in NMBPS (25.98±2.03 vs. 28.86±1.81, P<0.01). Conclusion: Morning blood pressure surge is closely related with the cognitive impairment in elderly patients with essential hypertension.
Zulfiqar Abrar-Ahmad
Reims University School of Medicine, France
Title: Hypervitaminia B12 vitamin in geriatric oncology: Real marker in the diagnosis and prognosis of malignant diseases in the elderly Zulfiqar Abrar-Ahmad, Reims University
Time : 14:45-15:10
Biography:
Zulfiqar Abrar-Ahmad studied at Reims University of Medicine University. He is currently working in the Department of Internal Medicine and Geriatrics, UMG1, CHU Reims. He has published more than 14 papers in medical journals.
Abstract:
Background: No consensus defined what to do before the finding of high vitamin B12. Serious diseases are nevertheless associated. Method: We illustrate these issues in this case. Result: A patient of 92 years was admitted for treatment of an inflammatory syndrome and an overdose of anticoagulants. We noted asthenia and conjunctival jaundice. Laboratory tests revealed a jaundiced cholestasis and cytolysis accompanied by an inflammatory syndrome. We also found a hypervitaminia B12 to 1642 pg / ml (normal rate: 191-663 pg / ml). Morphological examinations (ultrasound, CT) were used to detect dilatation of intrahepatic and extrahepatic upstream stenosis of the extra-pancreatic bile duct, with an undercover aspect of the hilum, and portal vein stenosis, evoking a probable ampulloma or a malignancy of the biliary extrahepatic main track. Unfortunately, the patient died a few days later. Discussion: Hypervitaminia B12 is associated with serious diseases represented mainly by solid neoplasms, blood disorders and liver diseases, and has been repeatedly described as a tumor marker of poor prognosis. In geriatrics, high levels of B12 are associated with increased mortality. Some authors emphasize the performance of the assay of vitamin B12 in patients with neoplastic diseases particularly among the elderly, as decision-making arguments when in pursuit of a cure and / or performing diagnostic tests, this correlates with the standardized geriatric evaluation. Conclusion: The rate of vitamin B12 could be a real marker in the diagnosis/prognosis of these diseases, and should not be neglected in geriatric oncology.
Biography:
Michael J Sigal is the Dentist-in-Chief at the Mount Sinai Hospital and the Director of the Dental Program for Persons with Special Needs / Medically compromised and the Co-Director of the Hospital Dental Residency Program. He was graduated from the Faculty of Dentistry University of Toronto with DDS in 1979, completed one year hospital dental residency at the Mount Sinai Hospital, Toronto, then Diploma in Pedodontics and the Masters of Science Degree both at the Faculty of Dentistry, University of Toronto. He worked as a Full time academic staff in Pediatric Dentistry since 1984. Currently He is Full Professor with tenure and Head of the Discipline and Director of the specialty program in Pediatric Dentistry since 1993
Abstract:
Due to the increase in the elderly population the management of these individuals as they age will continue to present a challenge to the healthcare team. Many elderly will have some or all of their teeth due to improved dental care throughout their lives. Oral hygiene and oral care in the elderly, especially frail elderly is generally poor. However the continuance of good oral health is essential to the maintenance of the elderly individual’s quality of life and to prevent infections which may affect their general health. The maintenance of good oral health has the potential to reduce the incidence of community acquired pneumonia. This presentation will present an overview of the relationship between oral and general health in the elderly patient and then provides an overview regarding oral assessment, treatment and prevention of dental disease.
Au Shu Yi Lydia
Ng Teng Fong Hospital, Singapore
Title: Challenges of caring for a frail hospitalized elderly
Biography:
Lydia Au completed herMRCP degree in 1997 andher geriatrics subspecialty degree in 2003. She has a special interest in hip fracture management, osteoporosis and clinical quality. She had additional post graduate training in orthogeriatrics in Sydney, Australia; leading and participating in the setting up of a pilot orthogeriatric service, the ACE unit as well as research and oral presentation in nutrition in the older patient with hip fracture. She currently heads the geriatric service in the newest health cluster in Singapore and is instrumental in leading and developing good standards of clinical quality for Geriatrics, in addition to implementing a successful Geriatrics Training programme for post graduates and undergraduates
Abstract:
An acute hospital admits a disproportionately large number of older patients; many of them frail. The cornerstone of an acute geriatric care involves stabilizing acute medical issues so that timely rehabilitation of the frail older person prevents further deterioration of the physical function. Functional decline has significant negative consequences for these patients. A proactivemodel selecting older patients with the potential to benefit from intensive inpatient geriatric assessment, rehabilitation, management and treatment services to restore function allows for focused use of limited resources. Creating an understanding of the challenges of aging, multiple hospital hazards and frailty impeding successful management will be identified. The principles underlying the organization for rehabilitation and a safe discharge; together with careful attention to special needs present commonly in the elderly will effect expedient and full integration back into the community; will be outlined.
Rubens Nazareno Garcia
University of Itajai Valley – Univali
Brazil
Title: Geriatric Dentistry: the challenge of promoting health and quality of life for people
Biography:
Rubens Garcia had his DDS at Dental School in Pontifical Catholic University of Parana (1986); MSc degree (2000) and PhD degree (2006) at Dental Materials in Dental School of Piracicaba; and Postdoctoral training at Department of Oral Health Sciences in Tokyo Medical Dental University (2013). He is professor at Public Health, Dental Materials and General Clinic at Dental School of University of Itajai Valley – Univali and Dental School of University of Joinville Region – Univille. He also has his own private office in Itajai, SC. He has large experience in Restorative Dentistry, Preventive Dentistry, Dental Materials, Public Health and Geriatric Dentistry.
Abstract:
Improving the quality of life in old age will require teeth retention and the need for restorative care. The dental materials are very important in this process. The glass ionomer cements are largely used to restorations Class V without cavity preparation. These materials have biologic compatibility and fluoride release, and increasing use, specially to light-cured cements, also has been made of their anticariogenic properties in treating geriatric patients. Other product has been recently introduced in the market, as the self-adhesive resin cements, which exhibited a favorable bonding capability and mechanical properties, becoming easier and faster the cementation of prosthetic pieces. Regarding to resin composites, there are many possibilities of treating geriatric patients. The recent nanosized materials promote very good polishing, specially important to avoid gingiva problems. The highly aesthetic light-curing restorative composites in gingiva shades were recently introduced in Dentistry. They also can be used in Class V restorations, especially in cases of retreating gingiva as a result of periodontal disease. Also the self-adhering composites, all-in-one products, can represent other possibility of treating people with limited mouth opening, having an easier and faster treatment. There are many materials to treat dentin hypersensitivity that is typically found in patients whose dentin has become exposed by gingival recession, periodontal therapy or loss of tooth enamel due to toothbrush abrasion, erosion or tooth wear. Ideally, the use of new materials and technologies, combined with a suitable reception to the patients, this is the real rule to promote health and happiness to geriatric patients.