Day 2 :
Keynote Forum
Marlene M Rosenkoetter
Augusta University, USA
Keynote: A psychosocial instrument to assess well elderly residing in privatized, residential retirement communities
Time : 09:00-09:35
Biography:
Marlene Rosenkoetter has been a nurse researcher for 35 years with over 300 publications and national/international presentations. She has been a consultant to 50 hospitals and health care systems as well as universities. She is the former Dean of Nursing at the University of North Carolina at Wilmington and the Medical College of Georgia. She has travelled to 30 countries and is widely sought for her expertise in nursing research and geriatric nursing. She has been a clinical practitioner, nurse administrator and academician. She is a member of Sigma Theta Tau and a Fellow of the American Academy of Nursing. She is a Professor Emerita of Augusta University, formerly Georgia Health Sciences University.
Abstract:
When older adults move to retirement communities there are major life transitions that occur. While these communities vary considerably in their focus, the types of housing available, and the services offered, they are primarily designed in the United States for the well elderly who are able to provide for their own basic needs. In Continuing Care Retirement Communities (CCRCs), there is the option of moving from independent living to assisted living and then to skilled care. Residents move their personal belongings, including furniture, to their new home. Services include housekeeping, meals, and care of the apartment and grounds. This transition involves numerous changes and can result in adjustment needs that may or may not be met sufficiently. They must leave their previous home where they have frequently lived for many years, their friends and family, and their community. Their roles change from being the primary provider to having services provided. Responsibilities change from home care to freedom. Their self-esteem can be impacted and support groups change to other older adults and staff in the retirement community. Their use of time and life structure now focuses on the activities of the retirement community and their new surroundings. There are significant changes in their Life Patterns: Roles, Relationships, Self-Esteem, Support Groups, Use of Time and Life Structure. These Life Patterns were used as the conceptual framework for the development of a psychosocial assessment tool to measure the impact of changes upon the transition and adjustment to
residential life in a retirement community. Results from 240 residents in three retirement communities in the south-eastern United States indicated that the instrument can be used effectively to assess the adjustment of these residents. A principal factor analysis with varimax rotation supported the use of the framework as the organizing referent of the instrument, the first published tool for this measurement.
Conceptual Framework - Life Patterns Model
Recent Publications:
- Rosenkoetter, M., McKethan, Looney, S. & T., Chernecky, C. (2016). Assessment of the Psychosocial Adjustment of Well Elderly Residing in Retirement Communities Issues in Mental Health Nursing, Sep 28:1-9 & 13(11),858-867.
- Ayalon, L. & Green, V. (2013). Social ties in the context of the continuing care retirement community. Qualitative Health Research, 23(3), 396-406.
- Earl, J., Gerrans, P., & Halim, V. (2015). Active and adjusted: Investigating the contribution of leisure, health and psychosocial factors to retirement adjustment. Leisure Sciences, 37(4), 354-373.
- Goodwin, J. (2014). Notions of fantasy and reality in the adjustment to retirement. Ageing & Society, 34(4), 569-589.
- Topa, G. (2015). Psychosocial factors in retirement intentions and adjustment: A multi-sample study. Career Development International, 20(4), 384-408.
Keynote Forum
Yoshiro Fujii
Shin Kobe Dental Clinic, Japan
Keynote: Treating elderly bedridden patients with removal dentures
Time : 09:35-10:10
Biography:
Yoshiro Fujii, manager of Shin Kobe Dental Clinic, completed his Ph.D. from Aichi Gakuin University Graduate School. Fujii is a fellow of the International College of Acupuncture and Electro-therapeutics, 100 next era CEOs and 100 Next era Leaders in Asia by Japan Times (2013, 14, 15), an editorial board member on three international journals. He is also an authorized doctor of two Japanese associations, and published sixteen international academic articles.
Abstract:
Recently, clinical evidence indicates that dental treatment can be used to treat systemic conditions. This report was designed to evaluate the efficacy of dental treatment in terms of Activity of Daily Living (ADL) for impaired elderly people. 32 bedridden individuals participated in this study. 18 participants received removable dentures while 14 didn’t. Of the 18 participants who wore
dentures, over 50% improved; 38.9% significantly improved while 16.7% moderately improved. Those in the no-dentures control group (14 patients) reported no improvement. These results support the notion that methods typically used in clinical dentistry may improve ADL for those with systemic conditions like bedridding.
Keynote Forum
Purnima Srinivasan
Health Aim Inc., USA
Keynote: Geriatric health care services and solutions
Time : 10:10-10:45
Biography:
Purnima Srinivasan is passionate about aging and aging services and has served as CEO of Health Aim Inc, which she founded in 2004 serving the seniors in the San Francisco Bay Area, CA, and USA. She has helped seniors, health professionals, facilities with resources, mentoring, consulting and also serving as medical director for home health, hospice, skilled nursing facility in nursing home and as a member of the Board of Directors of Meals on Wheels in the past. She now provides Aging Life care Services, Public Health consultations, a career in writing and public speaking locally and globally! Health Aim Inc believes in education, empowerment, enrichment, encouragement, inspiring and making a genuine difference in people’s lives, a legacy for the future.
Abstract:
From the time we are born, we are aging. Aging is a natural phenomenon of a living cycle. Humans age genetically, socially,
psychologically, spiritually and more, yet they are vulnerable to so many external factors. Where the basic three needs are to be met in terms of – food, clothing and shelter, aging is close as fourth! From the universal right to grow and age, comes the reality of where we are as of NOW. We cannot stop aging and we cannot stop aging services as well. Aging has its own significance or stigma around the world. The services for aging and the aged are or are not quite so. Basic requirements are not met, despite the staggering growth of economy, finance and the knowledge based on research! Here comes the real dilemma, how does one get that started? What goes into the consideration? Where are the keys and locks to those answers and questions? Which equations are essential to aging with dignity and which can wait? What can we learn and grow from and about? If these are some of the questions we share, then as a collective action in individualized countries and coming together globally, we can
make the move, change the dynamics and create a wise and encouraging world for the aging! Brainstorming, collaborations,
targeting, strategic planning involving the various aspects of ‘Geriatrics’ we can birth the movement for Geriatric Services, solutions and sojourns. Inviting the entire portfolio of humankind- from culture to society to needs and wants, we together in our nations and universally create something for the next generations to grow upon. Mind not the hardships we may face, standing today, I personally agree for each of you to begin a dialogue with yourself, in the communities you live and serve!
- Geriatric Diseases | Elderly Care | Geriatric Treatment | Geriatric Mental Health | Geriatric Care Management | Geriatrics
Location: Holiday Inn Edinburgh
Chair
Marlene M Rosenkoetter
Augusta University, USA
Co-Chair
Katsuji Kobayashi
Kanazawa University, Japan
Session Introduction
Siew Tzuh Tang
Chang Gung University, Taiwan
Title: Accurate prognostic awareness facilitates, whereas better quality of life and more anxiety symptoms hinder end-of-life discussions
Time : 11:05-11:30
Biography:
Siew Tzuh Tang has her expertise in understanding prognosis awareness and preferences of EOL care of terminally ill cancer patients and their family caregivers and longitudinal impact of changes of prognosis awareness and preferences of EOL care on patients’ psychological well-being and quality of life, changes in physician-patient EOL discussion during terminally ill cancer patients’ dying process and its impact on subsequent aggressive or hospice care received before death, family caregivers’ caregiving burden, EOL-care decision conflicts and their impact, and how bereaved family caregivers use internal and external resources to overcome challenges during their loved one’s dying process and in bereavement.
Abstract:
Context: Despite growing evidence of the benefits of EOL-care discussions to initiate such discussions early in the advanced cancer trajectory, terminally ill cancer patients either don’t engage in EOL-care discussions or do so only when death is imminent. Most existing studies on patient-reported EOL-care discussions are cross-sectional without exploring the evolution of EOL-care discussions as death approached. Cross-sectional studies also cannot disentangle the impacts of EOL-care discussions on patients’ prognostic
awareness, psychological well-being, and quality of life (QOL) or whether these factors facilitate/hinder EOL-care discussions. Therefore, the purpose of this study was to explore the evolution of patient-physician EOL-care discussions over cancer patients’ last 6 months and to identify factors precipitating or hindering such discussions by arranging time-variant modifiable variables and EOLcare discussions in a distinct time sequence.
Methodology: We examined the evolution and associations of accurate prognostic awareness, functional dependence, physical and psychological symptom distress, and QOL with patient-physician EOL-care discussions among 256 terminally ill cancer patients in their last 6 months of hierarchical generalized linear modeling with logistic regression.
Findings: The prevalence of physician-patient EOL-care discussions increased as death approached (9.2%, 11.8%, and 18.3% for 91-180, 31-90, and 1-30 days before death, respectively) but only reached significance in the last month. A higher likelihood of subsequent physician-patient EOL-care discussions were precipitated by a previous wave of patient-reported accurate prognostic awareness, but hindered by a previous wave of better patient QOL and more anxiety symptoms. Levels of physical symptom distress, functional dependence, and depressive symptoms were not associated with the likelihood of EOL-care discussions.
Conclusion/Significance: Physician-patient EOL-care discussions for terminally ill cancer patients remain exceptional even when death approaches. Physicians can promote EOL-care discussions with cancer patients by cultivating their accurate prognostic awareness early in their disease trajectory when they are physically and psychologically competent, with better QOL.
Prevalence of EOL-care discussion
Recent Publications:
- Harper C (2009) The neuropathology of alcohol-related Hung YN, Liu TW, Wen FH, Chou WC, Tang ST. Escalating healthcare expenditures in cancer decedents’ last year of life: A decade of evidence from a retrospective population-based cohort study in Taiwan. Oncologist, 2017; 22: 460-469.
- Tang ST, Hsieh CH, Chiang MC, Chen JS, Chang WC, Chou WC, Hou MM. Impact of high self-perceived burden to others with preferences for end-of-life care and its determinants for terminally ill cancer patients: A prospective cohort study. Psycho-Oncology.2017; 26: 102-108.
- Tang ST, Chen JS, Chou WC, Chang WC, Wu CE, Hsieh CH, Chiang MC, Kuo ML. Longitudinal analysis of severe anxiety symptoms in advanced cancer patients’ last year of life: Relationships with proximity to death, burden, and social support. Journal of the National Comprehensive Cancer Network, 2016; 14(6):727-34.
- Tang ST, Chang WC, Chen JS, Chou WC, Hsieh CH, Chen CH. Associations of prognostic awareness/acceptance with psychological distress, existential suffering, and quality of life in terminally ill cancer patients’ last year of life. Psycho-Oncology, 2016; 25:455-462.
- Kuo SC, Chou WC, Chen JS, Chang WC, Chiang MC, Hou MM. Tang ST. Longitudinal changes in and modifiable predictors of the prevalence of severe depressive symptoms for family caregivers of terminally ill cancer patients over the first 2 years of bereavement. Journal of Palliative Medicine. 2017, 20(1): 15-22.
Katsuji Kobayashi
Kanazawa University, Japan
Title: Association of psychiatric pictures with cognitive and motor symptoms of lewy body disease - An analysis of 60 MIBG-verified cases
Time : 11:30-11:55
Biography:
Katsuji Kobayashi is the President of the Awazu Neuropsychiatric Hospital, Komatsu, Ishikawa-ken, Japan, 2007-present, Docent of Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa-ken, Japan. From 2007 to present he is Associate professor of Kanazawa University, 2002-2007. He gained a Special Award from the Japanese Society of Geriatric Psychiatry in 2005. Fellowship of the Centre national de la recherche scientifique (CNRS) in Laboratoire de Neuropathologie Laboratoire Raymond Escourolle (1992-1994).
Abstract:
Background: Lewy body disease (LBD) is a collective term of Parkinson’s disease (PD), PD with dementia (PDD), incidental LBD (iLBD), Lewy body dysphagia, pure psychiatric presentation (PPP) and dementia with LBD (DLB). Diagnosis of LBD has suffered from symptomatic heterogeneity because LBD has diverse clinical symptoms that are grouped into four; cognitive disturbance, psychiatric features, motor and non-motor symptoms. PPP may be the fourth subtype in which non-neurological psychiatric symptoms and cognitive disturbance lasted for many years. This study investigates how psychiatric pictures are associated with the other symptom groups in myocardial meta-iodobenzylguanidine (MIBG)-verified subjects with LBD.
Methods: Sixty patients (28 women and 32 men) were classified into three psychiatric pictures; depression-anxiety (Group D: 27patients), isolated visual hallucinations (GroupV: 16 patients) and psychosis (Group P: 17 patients). Fifty six cases were examined by single photon emission tomography (SPECT) study of the brains in which hypoperfusion were found in 37 cases and 19 cases showed no abnormality. After that, we determined final diagnoses; PD, PDD, DLB and PPP with the DSM-IV, the unified Parkinson’s disease rating scale (UPDRS), and Mini-mental state examination (MMSE).
Results: 40% of the Group D patients remained depressive without Parkinsonism and 50% had or developed PD. Most Group P patients developed PDD or DLB. Statistics provided four clusters with combinations of the clinical symptoms and SPECT study. PD-depression and PPP-depression with/without frontal hypoperfusion, PDD-psychosis with temporal hypoperfusion, and DLBvisual hallucination with occipital hypoperfusion. Thus, Group V had DLB and Group D had PD and PPP. Group P had PDD. Motor symptoms were closely associated with cognitive disturbance.
Summary of the four clusters of symptomatic homogeneity with 3D. PD-depression and PPP-depression with/without hypo-frontality, PDD-psychosis with temporal hypoperfusion, and DLB-visual hallucination with occipital hypoperfusion.
Conclusions: PPP is a prodromal depression of PD and also preparative of iLBD. The psychotic feature and visual hallucinations, when complicated by motor symptoms, predicts following dementia. Isolated depression with non-motor symptoms is a risk for PD.
Recent Publications:
- Kobayashi K, Nakano H, Akiyama N, et al: Pure psychiatric presentation of the Lewy body disease is depression-an analysis of 60 cases verified with myocardial meta-iodobenzylguanidine study. International Journal of Geriatric Psychiatry. 30:663-668, 2015.
- Kobayashi K, Sumiya H, Nakano H, et al: Detection of Lewy body disease in patients with late-onset depression, anxiety and psychotic disorder with myocardial meta-iodobenzylguanidine scintigraphy. International Journal of Geriatric Psychiatry 25: 55-65, 2010.
- Kobayashi K, Kitamura T, Sudo S.: Behaviors of phosphorylated microtubules-associated protein tau (tau) – A role in neuronal and glial apoptosis, white matter lesion, topographical accentuation and 14-3-3 protein expression in of neurofibrillary tangles of Alzheimer’s disease and other Tauopathies. In: Figueiredo B, Meléndez F, eds., Neuroscience Research Advances. Nova Science Publishers, NY, 1-33, 2009.
- Kobayashi K, Sudo S, Matsubara R, et al: Subcortical neuroï¬brillary tangles and argyrophilic grains in a case of familial frontotemporal dementia with parkinsonism. Parkinsonism and Related Disorders 14: 513-516, 2008.
- Kobayashi K, Hayashi M, Nakano H, et al: Correlation between astrocyte apoptosis and Alzheimer changes in gray matter lesions in Alzheimer’s disease. Journal of Alzheimer’s disease. 6: 623–632, 2004.
Naiara Ozamiz
University of the Basque Country, Spain
Title: Psychological and relational improvement of students attending to the university for older adults: An experience in the University of the Basque Country
Time : 11:55-12:20
Biography:
Naiara Ozamiz is a professor of medical psychology at the Faculty of Medicine and at the University for over 55 years of the University of the Basque Country. She has worked as a psychotherapist in different day units with patients with personality disorders and psychosis. She has mainly specialized in group psychotherapy, although she has also performed individual and family psychotherapies. In 2013 made her thesis on the personality disorders in the DSM-5. She has published several articles on attitudes towards treatments, personality disorders, psychiatric emergencies and the elderly.
Abstract:
Objective: The aim of the study was to measure the emotional condition and the interpersonal forms of relation in a group of mature students (Aged 55+).
Method: 45 students attending the University of Older Adults in the Basque Country in Bilbao, completed assessments such as the Brief Symptom Inventory (BSI), as well as the Relationships with Others scale (ERA). Socio-demographic data were also collected. Data was analyzed using T tests and multivariate analyses.
Results: Data suggests attending the University for older adults may improve mental health and relationships with others for people.
Conclusion: As life expectancy increases, population ageing is a major global trend and there is a need for societies to become more prepared to improve the quality of life in later decades. We believe it is important to continue creating resources for old people since many people reaching retirement age remain healthy and vital. As such, without psychological health in later life there will be significant problems in all domains of older people’s lives.
Clinical Implications: Since resources such as university for older adults improve the mental health of the elderly is important to continue creating resources for them.
Table 3: Improvement in symptoms BSI
Recent Publications:
- Blazer D (2010) Protection from late life depression. International Psychogeriatrics 22: 171–173.
- Burroughsa H, Lovellb K, Morleyc M, Baldwinc R, Burnsd A, Chew-Grahama C (2005) ‘Justifiable depression’: how primary care professionals and patients view late-life depression? a qualitative study. Medicine & Health. Family Practice 23(3):369-377.
- Jorm AF (2000) Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the life span. Psychological Medicine 30:11–12.
- Eum Y, Yim J, Choi W(2014) Elderly health and literature therapy: a theoretical review. Tohoku Journal of Experimental Medicine 232(2):79-83.
- Laidlaw K (2015) Cognitive Behaviour Therapy for Older People: An Introduction. London, SAGE Publications, 2015.
Tracey Osmond
Scalabrini Village, Australia
Title: Developing Gerontological Nursing (GerNurs) competencies: An e-Delphi study
Time : 12:20-12:45
Biography:
Tracey Osmond is currently the Director, Clinical Governance and Quality, Scalabrini Village, Prior to her current role, Tracey has held a number of positions within the Aged Care sector over the last five years. Tracey has been a Registered Nurse for over 30 years with broad experience in clinical practice, education, management, and senior executive roles across the Health and Aged Care sectors in Australia. Most recently Tracey has held a number of roles in the Aged care sector as outlined above. Prior to these roles she was the CEO of The College of Nursing (2007-2012) where she was instrumental in the successful merger of TCON and RCNA to create the Australian College of Nursing. Tracey’s educational and aged care roles have coalesced to recognise the need for a structured capability framework for registered nurses practising in contemporary aged care environments. This recognition led to the creation of the Nursing in Aged Care Collaborative with like-minded colleagues working in large faith-based, not-for-profit Aged Care organisations which led to the commissioning and co-funding of the Aged Care Nursing Competency Development Project – an e-Delphi study.
Abstract:
Background: The only widely used gerontological nursing competencies were published in the United States. A Nursing in Aged Care Collaborative (NACC) undertook a study to address this gap and developed Gerontological Nursing (GerNur) Competencies for use across Australia.
Aim: This paper presents the findings from an e-Delphi study to develop GerNur Competencies.
Methods: Survey Monkey was used to circulate a draft set of gerontological nursing competencies and seek agreement on priority areas, wording and levels of practice. Using snowball sampling, 409 participants were recruited to the first round: 57% clinicians, 30% managers and 13% academics from 10 countries. At round 5, 139 participants remained.
Findings: With 60% agreement set as the minimum acceptable level, 11 core competencies with 36 domains of practice and two levels of practice were generated:
1. Living Well for Older People across Communities and Groups
2. Maximising Health Outcomes
3. Communicating Effectively
4. Facilitating Transitions in Care
5. Facilitating Choices
6. Partnering with Family Carers
7. Promoting Psychological Well-being and Mental Health
8. Providing Evidence-Based Dementia Care
9. Providing Optimal Pain Management
10. Providing Palliative Care
11. Enabling Access to Technology
Conclusion: This is the first set of gerontological nursing competencies for use in Australia developed from an inductive consultation activity with a range of stakeholders. The GerNur Competencies will be piloted across the NACC organisations. The GerNurs Competencies and accompanying guidelines will be available on a freely accessible website for use by individuals for their professional development and organisations to support their implementation of strategic plans.
eDelphi Responses
Rabia Khalaila
Zefat Academic College, Israel
Title: Compassion fatigue and compassion satisfaction among informal caregivers of older adults, in Arab Israeli
Time : 12:45-13:10
Biography:
Rabia Khalaila worked for 10 years at Hadassah Hospital as a staff nurse, and he was promoted in the last 5 years to be a head nurse in the intensive care unit.
In 2009 he moved to work in the Zefat Academic College. Rabia is the head of the Department of Nursing in Zefat College. His research interests include nursing, social gerontology and nursing education. He published 24 written works mostly in peer review journals and another four papers are in preparation or under review process.
Abstract:
There is extensive professional literature on compassion fatigue among professional caregivers, yet very few studies of the phenomenon among informal family caregivers of an elderly relative. The aims were to examine the association between caregiving burden and compassion fatigue (burnout, secondary traumatization), and compassion satisfaction among informal caregivers; and to examine models of mediation (social support and coping style) and moderating effect (emotional empathy) in these associations. Cross-sectional study studied 300 informal caregivers of an elderly parent from the Arab community in Israel. Data gathering was accomplished through face-to-face interviews in Arabic using structured questionnaires. Linear regression analyses were applied to the hypotheses using bootstrapping models. The results showed about 20%-45% of the caregivers suffer from various symptoms of compassion fatigue. A positive correlation was found between caregiving burden and burnout and secondary traumatization. These associations were found to be partially mediated by disengagement coping and perceived social support. A negative correlation was found between the burden and compassion satisfaction of the care. This association was found to be partially mediated by
disengagement coping. Findings showed that emotional empathy moderates the association between caregiving burden and burnout. The study suggests that compassion fatigue exists among informal caregivers in the Arab community in Israel. The current study shows that compassion fatigue may be reduced by lessening the burden of care, reinforcing social support, and reducing the use of disengagement coping. Decreased emotional empathy by the caregiver is likely to be protection against the harmful effects of caregiving burden on burnout.
On Dulberg
Meir Medical Center, Israel
Title: Palliative care in a nursing home: Is it possible? Integrating palliative care in a nursing home
Time : 13:50-14:15
Biography:
On Dulberg, Internal and Geriatric Medicine Specialist, Medical Director of the “Vera House” nursing home at the Vera Solomons Center and Senior Physician in
the Geriatric Medicine Array at the Meir University Medical Center, Kfar Saba, Israel. Responsible for implementing the principles of palliative medicine in hospitals and has been recently working to integrate such principles within the adult population in the community and institutions.
Abstract:
In Israel, as in other western countries, life expectancy increases. As a result, the number of people suffering from chronic illnesses and conditions causing physical and emotional suffering growing up. Also, there is a steady rise in the number of people requiring assistance with basic Activities of Daily Living (ADL) and the number of people living in long term institutions and nursing home. Although nursing homes can be ideal facilities for supportive care, most of them do not operate upon the principles of palliative care and yet, most end-stage patients are referred to die in hospitals. In Israel, Palliative care is based on the laws of the State of Israel: Governmental Health care Insurance (1995) and the Dying Patient Law (2005). These laws enable a person with an incurable disease, for whom doctors have determined a life expectancy of less than six months, to request the avoidance of treatment that could extend their lives and suffering. Hospitals, health care providers and nursing homes committed to provide palliative care services. Despite such advanced laws, most patients are not actually provided the palliative treatment required.
Objective: Integrating principles of the palliative approach in a nursing home.
Secondary Objective: Reducing end-of-life referrals to emergency rooms and hospitals.
Methods: Integrating the palliative approach in nursing home, including: encouraging to fulfil Preliminary instructions and powers of attorney, training doctors, nurses and multidisciplinary team how to provide palliative care, Balancing symptoms and how to deal with end-of-life situations.
Results: Significant decline in emergency room and hospital referrals: 35% decline in hospital referrals within 4 years. Dramatic decline in hospital death rates and increase in the number of patients dying in the nursing home.
Conclusion: Despite the many challenges of providing palliative care in nursing homes, the process can be implemented in order to reduce suffering, increase patient, staff and family awareness, and significantly reduce unnecessary emergency room and hospital referrals.
Recent Publications:
- Recommendations for a National Plan for Palliative Care and End-of-Life Situations, Joint Israel, Eshel, Ministry of Health 2016.
- (Long Term Population Forecast in Israel 2009-2059: Technical Publication by the Central Bureau of Statistics, 2014)
- Bentur, N., Emanuel, L.L., Cherney, N., 2012. “Progress in Palliative Care in Israel: Comparative Mapping and Next Steps”. Isr J Health Pol Res 1(9):10.1186.
Suhaniya Samarasinghe
Chelsea and Westminster Hospital, UK
Title: Therapeutic challenges in occult malignancy presenting as stroke
Time : 14:15-14:40
Biography:
Suhaniya Samarasinghe received her medical degree from the University of Southampton. She started her postgraduate medical training in the Northern Deanery becoming a member of the Royal College of Physicians, London in 2015. Dr. Samarasinghe began her higher specialist training in Geriatrics and General Internal Medicine as part of the North West London rotation where she worked for two years. It was during this time that she developed an interest in acute and hyper acute stroke.
Abstract:
Ischaemic stroke is a rare first presentation of occult malignancy. Malignancy related hypercoagulability can manifest as acute arterial infarction, non-bacterial thrombotic endocarditis and/or thrombophlebitis. We report three cases of acute ischaemic stroke all presenting within a four-month period. The first patient presented with multiple acute cerebral infarcts. Following an episode of acute hypoxia, the patient had CT pulmonary angiography - this confirmed the presence of multiple bilateral pulmonary emboli. Further imaging showed evidence of metastatic ovarian cancer and renal infarction. The second patient presented with dense left-sided weakness and MRI confirmed right middle cerebral artery (MCA) infarct. CT scan performed for deranged blood tests confirmed bilateral pulmonary emboli, likely hepatic metastases, renal and splenic infarcts and gastrointestinal outflow tract obstruction. Both patients showed progression of their hypercoagulability state despite therapeutic low molecular weight heparin (LMWH) monotherapy. LMWH is the current preferred choice of anticoagulation for venous thromboembolism (VTE) in oncology patients. The third patient presented with an acute stroke on a background of non-rheumatic atrial fibrillation - which is an independent risk factor for stroke. She was on a direct Factor Xa inhibitor on presentation. The patient had a CT scan for an abdominal mass – this showed metastatic pancreatic malignancy. Currently, no studies have specifically addressed the treatment of malignancy related VTE using direct inhibitors.
Conclusion: Possible occult malignancy should be considered in patients with on-going hypercoagulability state despite appropriate anticoagulation. Currently, there is limited data for this patient subgroup and further studies examining anticoagulant choice is needed.
Recent Publication:
Gokce M, Benli E M, Dinc A (2012) Arterial Ischemic Stroke as a First Manifestation of Trousseau’s Syndrome. International Journal of Clinical Medicine 3, 43-45.
Joanna WY Chan
St. Luke’s Hospital, Singapore
Title: Palliative care in the community hospital - A model and case series of patientcentred, community-based care to meet an ageing population's needs
Time : 14:40-15:05
Biography:
Joanna Chan is a Family Medicine-trained Registrar in the Palliative Care Team of St. Luke’s Hospital in Singapore. She has an interest in research pertaining to
Family Medicine and has many publications in the local Family Medicine Journal in Singapore.
Abstract:
Introduction: A rapidly ageing population and rising chronic disease burden in Singapore translates to a higher demand for aged care services, including End-of-Life services. Community hospitals have been recognized as an under-recognized resource with potential to provide the mainstay of support to patients nearing the end of life and their families. St. Luke’s Hospital is a 240-bed community hospital in Singapore. Most of our patients are elderly aged above 65 with multiple medical issues, with a significant number having
life-limiting illnesses. It is also the first community hospital in Western Singapore to have a dedicated Palliative Care Team (PCT).
Aim: We aim to show, via a case series of four patients, examples of how our PCT delivers care to our patients in the setting of a community hospital.
Methods: Our team comprises various medical professionals and allied healthcare providers who work together to provide palliative care services in various settings.
Results: Our Case Series demonstrates that palliative care in the community is varied and meaningful, from managing symptoms such as pain, to dealing with sepsis in end-of-life. At times, psychosocial elements are important as well. They also show that the community hospital’s population of mostly geriatric patients and location within the community, with ample resources from our
allied health partners, allow us to deliver holistic, patient-centred care in line with patient and family’s goals of care.
Future Directions: We hope to extend our services to include an after-office-hours telephone and home-consult service, partner other healthcare providers such as hospitals and nursing homes to expand our capacity, and to train Geriatric and Family Medicine residents to be confident of providing End-of-Life care.
Conclusion: The nation's future healthcare plans have recognized the importance of primary healthcare and has committed to building more primary care facilities in the community. This means that citizens will be able to enjoy the comfort of receiving care in familiar surroundings with a supportive community. The Palliative Care Team in St. Luke's Hospital hopes to demonstrate with our model and case series that a palliative care service anchored in the community hospital setting in Singapore can meet the changing
population healthcare demands by delivering, in the context of the patient's bio psychosocial-spiritual context, care that prioritizes quality of life and respects the dignity in dying.
References:
- Thomas K. Caring for the Dying at Home. Companions on a Journey. Oxford: Radcliffe, 2003
- https://media.capc.org/filer_public/f7/26/f726f090-2b62 47b1a8e03445a897cb73/houston_methodist_st_john_creating_a_staffing_model.pdf
- Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977;196:129-136. https://www.moh.gov.sg/content/dam/moh_web/PressRoom/Highlights/2016/2020%20Healthcare%20Manpower%20Plan.pdf
Lisa PL Low
Caritas Institute of Higher Education, Hong Kong
Title: Ageing carers and their ageing family member with mild-moderate intellectual disability in Hong Kong: What needs and care do they have?
Time : 15:05-15:30
Biography:
Lisa PL Low works as an Associate Professor. Her research interests are gerontology and long-term care, with emphasis on the organization of gerontological care and practices, discharge planning for older patients and family members. Her Ph.D. thesis adopts a constructivist grounded theory approach to explore decisionmaking in residential care homes from the perspectives of older residents, family members and care providers. This work has now been extended to explore family decision-making of older people with mild-moderate dementia and for clients with intellectual disability using predominately qualitative research approaches. As part of her post-doctoral development her intentions are to continue to develop qualitative research approaches and methodologies in her academic and research career.
Abstract:
Statement of the Problem: Understanding the difficulties of the ageing carers in providing care to their ageing family member with an intellectual disability (ID) can help to facilitate the development of appropriate services and interventions to strengthen both parties’ capacity to continue with the duties and obligations associated with filial piety in the Chinese society. However, little is known about the caring needs and types of care provided by ageing family carers when caring for their community-dwelling ageing ID family
members in Hong Kong.
Methodology: This paper presents the qualitative data of 16 ageing family carers who were matched against family members with mild or moderate ID and using a sheltered workshop. Audio-taped interviews lasted 45-60 minute and data were content-analyzed.
Results: Mothers were found to be the major carers, and were either housewife or have retired from work. Since birth, they have provided long-term care to their family member with ID, and witnessed wavering changes in self-care abilities over the years. Indeed, the ID members still had different caring needs that continued to linger into adulthood. The data highlighted a heightened realization of family carers to refocus on the way they have always provided care, and to give considerations to instil strategies that would help the ID members to build greater independence to manage their daily life in later life, especially when both parties are already ageing or are soon-to-be old.
Conclusion: Findings can provide an understanding of the caring needs and types of care that ageing family carers provide to their ageing ID adult who are currently using a sheltered workshop. Further support for the ageing family carers to continue with their caring roles is also highlighted. More data are needed to explore the importance and urgency attached to the different needs and the level of independence or protectiveness family carers prescribe to providing care to their family members with ID.
Recent Publications:
- Low LPL, Chien WT, Lam LW, Wong KYK (2017). A qualitative study protocol of ageing carers’ caregiving experiences and their planning for continuation of care for their immediate family members with intellectual disability. BMC Geriatrics, 17, 81. doi 10.1186/s12877-017-0473-9
- Low LPL (2017). Elucidating understanding to strengthen ageing family carers capacity to continue caring for ID adults: Preliminary analysis from family interviews. Invited symposium ‘Towards an Aging Society: Inclusive Living for People with Intellectual Disabilities’, 16 May.
- Low LPL, Fan KP (2016). Sampling issues using the grounded theory methodology: Applicability to family caregiving research of clients with dementia and intellectual disability. 15th Qualitative Methods Conference, 3-5 May: 24.
Pei Liu
Southeast University, China
Title: Health status and associated factors among the community-dwelling elderly in China
Time : 15:50-16:15
Biography:
Pei Liu is a Professor and his research interests are focused on the health status and associated factors among the elderly in China. He is also interested in the health management model and health care improvement among Chinese elderly.
Abstract:
Statement of the Problem: The objective of this study was to evaluate the health status and associated factors of the elderly Chinese population.
Methodology & Theoretical Orientation: A cross-sectional survey was administered to 849 elderly people aged 60 years and over living in a certain district of Nanjing, China. A health rating scale based on the characteristics of the elderly in China was used. The difference of self-rated health between different groups was tested using an ANOVA, and the associated factors were tested using an ordinal logistic regression.
Findings: The results showed that the general health of the elderly Chinese people studied was not good. The scores of body function, self-care ability, and physical health decreased gradually with age. The scores of men were higher than those of women in terms of emotional personality. The factors associated with the health status of the elderly were education, living mode and marital status. The health status of the elderly Chinese and the associated factors highlighted in this study demonstrated that emotional and social support were more important than financial support for promoting the mental health of the elderly.
Conclusion & Significance: These findings will provide a basis for the development of programmes promoting the health management and healthy ageing of the elderly in China.
Recent Publications:
- Chao JQ, Xie WY, Yang YC, Liu H, Jiang LL, Liu P (2013) The effect of integrated health management model on the satisfaction among Chinese elderly. Archives of gerontology and geriatrics. 57(1):27-31.
- Jin H, Pan N, Mou Y, Wang B, Liu P (2011) Long-term effect of interferon treatment on the progression of chronic hepatitis B: Bayesian meta-analysis and meta-regression. Hepatology Research. 41(6):512-23.
- Jin YL, Liu P, Sun JF, Wang CN, Min J, Zhang YF, et al. (2014) Dietary exposure and risk assessment to lead of the population of Jiangsu province, China. Food Additives and Contaminants Part a-Chemistry Analysis Control Exposure & Risk Assessment. 31(7):1187-95.
- Jin YL, Liu P, Wu YN, Min J, Wang CN, Sun JF, et al. (2014) A systematic review on food lead concentration and dietary lead exposure in China. Chinese Medical Journal. 127(15):2844-9.
- Zhang H, Chao J, Li X, Liu P. (2015) Health Care Utilization and Costs in Patients with Hepatitis B related Disease in Jiangsu, China. Iranian journal of public health. 44(2):297-298.
Marina Gharibian Adra
American University of Beirut, Lebanon
Title: Nursing home quality of life: A theoretical model integrating the views of residents, staff and family members
Time : 16:15-16:40
Biography:
Marina Gharibian is a Clinical Assistant Professor at Hariri School of Nursing, American University of Beirut (AUB). She holds a BS degree in Nursing, a Master’s degree in Physiology from AUB, and a PhD from the University of Manchester, United Kingdom. She is a member of the “Center for Studies on Aging” in Lebanon and her area of expertise is quality of life of older people, specifically older people residing in nursing homes. She is the first nurse in the Lebanon to conduct a qualitative study involving contribution and active participation of older residents. She has more than 25 years of experience in teaching nursing care of adults and older adults, pathophysiology, and critical care nursing. She incorporated gerontology within the nursing curriculum at AUB in view of the growing proportion of the aging population which impels the provision of health care services and various levels of nursing care.
Abstract:
Aim: To explore the perceptions, perspectives and meaning of quality of life for a theoretical sample of older residents, care staff and family caregivers in nursing homes in Lebanon.
Background: To date, little is known about the quality of life and its meanings from middle-Eastern perspective and context. There is also limited knowledge about the care experience of older people living in nursing homes in the Lebanon.
Method: A classic grounded theory study was conducted between 2010-2011 in two nursing homes situated in Beirut. Semistructured interviews were undertaken with a theoretical sample of 20 residents, 8 family caregivers and 11 nursing home staff. Data were analysed using the constant comparative method.
Findings: Constant comparative analysis of data led to the emergence of the core category of “relating” and the linking scheme of “maintaining interrelationships” which comprised of three distinct, but interrelated, basic social processes: ‘maintaining self ’, ‘maintaining identity’ and ‘maintaining continuity’. The dynamics that exists within and between each of these grounded theory processes provides an indicator about the meaning of quality of life for older residents living in such an environment.
Figure 1: Maintaining Self: An Heuristic Outlining Older
Residents’ Perceptions of Quality of Life
Residents’ Perceptions of Quality of Life
Conclusion: This study has made an important contribution to the literature particularly in recognising the role of “relating” and “maintaining interrelationships” in enhancing quality of life in nursing homes in the Lebanon. The contribution of the substantive grounded theory emerging from this study is not solely restricted to helping interpret the everyday experience of quality of life, but also includes implications for policy and practice.
AbdulRahem Ibraheem
World Health Organization | Nigeria
Title: Public awareness and attitude towards palliative care in Nigeria
Time : 16:40-17:05
Biography:
Abdul Raheem IS, is a Nigerian medical doctor with postgraduate training in Public Health. He is a fellow of both Royal Institute of Public Health (London) and National Postgraduate Medical College, Faculty of Public Health (Nigeria). He holds Master degrees in Public Health, Epidemiology & Biostatistics and Public Administration. He specializes in Disease Surveillance, Geriatrics and Epidemiology. His areas of interests are Disease surveillance, Geriatric Epidemiology, Geriatric poly-pharmacy, Geriatric palliative care, End of life care, Care of the Elderly,Health planning and administration . He has more than sixty publications to his credit in both local, National and International Journals. Dr Abdulraheem has served as a Consultant to WHO, UNICEF, NPI, GAVI & FMOH (Nigeria) on Disease Surveillance, Polio Eradication Programme and National Epidemiological review of Communicable Diseases. Currently, Abdulraheem is a Consultant to World Health Organization on Disease Surveillance and Polio Eradication Programme as well as Associate Professor in the Department of Epidemiology & Community Health, College of Medicine, University of Ilorin, Nigeria.
Abstract:
Background: Palliative care is a global public health issue. Studies have reported public inadequate or lack of knowledge and negative perceptions towards palliative care. Given the aging population and associated increase in the number of patients requiring palliative care it is vital to explore the public’s understanding of this concept.
Objective: The aim of this study was to establish the current levels of awareness and attitudes towards palliative care among the general public in Nigeria.
Methods: A community-based cross-sectional study among 6,358 individuals aged over 20 years was conducted between April to September 2016. Information was collected using a structured questionnaire consisting of 15 items. EPI-INFO and SPSS software statistical packages were applied for data entry and analysis. Chi-square and logistic regression were computed to assess statistical association and the level of significance. A p-value of equal or less than 0.05 was considered statistically significant.
Results: A total of 564 responses were obtained (response rate 8.9%). Female gender 388 (68.9%) and previous experience 358 (63.5%) influenced awareness in a positive direction. Respondents 401 (70.1%) who worked in healthcare themselves or who had a close relative or friend who had used a palliative care service were more aware of palliative care and the availability
of different palliative care services. Suggested strategies to enhance awareness and community involvement in palliative care include formulation of appropriate policies and education of policy makers.
Conclusions: Nigeria public awareness and attitude of the concept of palliative care remains insufficient for widespread effective and appropriate palliative care to be accepted as the norm. In particular, those without previous family-related experiences lack awareness. An increased public awareness of palliative care is needed, in order to improve knowledge of and access to services
when required.
Tiziana Candiani
Hospital Cuggiono ASST WEST MI, Italy
Title: Chronic obstructive bronchitis and depression in elderly outpatients
Time : 17:05-17:30
Biography:
Tiziana Candiani was born in Magnago in 1963. She is Head of the Complex Structure of Internal Medicine of Cuggiono Hospital. She is also Head of the
Department's Simple Department of Geriatrics at the "Giuseppe Fornaroli" Hospital in Magenta. She graduated from the University of Milan and subsequently gained specialization in Geriatrics. She has a second specialty in Medical Idrology. She has lent his activity, such as a geriatrician, to the Desio Hospital, and to the Geriatric Assessment Unit of Merate.Since 1998 she has been working at the Ospedaliera Azienda di Legnano. She continues her education by obtaining two diplomas: the Diploma of Training for Medical Managers at Bocconi University in Milan in 2008; The Diploma of Healthcare Director at Eupolis Lombardia - School of Health Care in 2014. From 2008 to 2012 she was a member of the Board of Directors of the Special and Consortium Company for the Services for the Municipalities .She is a contract professor with the University of Milan.
Abstract:
As it is known in recent years the problem of depression in the elderly is growing, on the one hand the increase in the elderly population and on the other the appearance and / or persistence of chronic conditions often disabling that interfere with mood such as COPD (ill, preventable and treatable characterized by a chronic obstruction to the air flow in the intrathoracic airways. The presence of an FEV1 / FVC ratio of less than 0.70, demonstrated by spirometry performed after administration of a bronchodilator, is a necessary criterion to confirm the clinical diagnosis of the disease). The aim of this study was to verify a possible correlation between low mood and COPD in ambulatory elderly subjects.
Methods: From October 2016 to April 2017 we submitted the Geriatric Depression Scale - J.Yesavage (one of the most popular scales for evaluation of depressive symptoms in the elderly, the instrument consists of 30 items which excludes the detection of somatic symptoms and psychotic symptoms, the answers are reciprocating (yes / no), the score ranges from 0 to 30 with a threshold level to 11 place, beyond which are clinically relevant depressive symptoms) to 118 elderly (67M-51F) subjects with age average of 76 related
to the clinic of Pneumology simultaneously undergo spirometry.
Results: Our data in line with other studies show no correlation between depression severity and severity of obstructive, other parameters considered such as sex, BMI and FVC showed no correlations.
Takako Yoshimura
Kyoto Gakuen University, Japan
Title: The relationship between lexical retrieval in discourse and cognitive functions in dementia - In comparison with the elderly population
Time : 17:30-17:55
Biography:
Takako Yoshimura is currently focusing her study on cognitive functions and communication in dementia. This study aims to develop effective interventions to the dementia patients who have every day-life difficulties with efficient communication tools, or augmentative and alternative communication (AAC). She began working as a speech-language pathologist, chiefly as a neuropsychologist, to evaluate patients’ cognitive neuropsychological status such as aphasia, agnosia, apraxia, memory disorders, and involving rehabilitation for patients with stroke, tumor, dementia etc. Since then, she has been working in hospitals and clinics in addition to teaching job at colleges and universities. Her AAC study of dementia is outstanding in that she tries to develop methods to approach surrounding people with patients, such as families, from a perspective of cognitive neuropsychological findings.
Abstract:
Objective & Background: The word production or lexical retrieval in discourse would be deteriorated with age, even though cognitions such as confrontation picture naming, memory functions were intact (Yoshimura et al., 2016). Moreover, deficits in lexical retrieval in written discourse were reported to be an early indicator of Alzheimer’s disease better than other cognitive tests such as confrontation picture naming (Pekkala et al., 2013). Purpose our aim is to explore the relationship between the abilities of lexical retrieval in oral discourse and the cognitive dysfunctions in dementia in comparison with the results in elderly. We sought to examine what aspects of cognitive deficits in dementia would cause deteriorated lexical retrieval in discourse, and to know the commonalities and differences between dementia and elderly.
Methods: We studied nineteen demented patients (age: 69-91). Two discourses tasks, Cookie Theft Picture (CTP) from Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1983) and False Accusation Picture from Visual Perception Test for Agnosia (Brain Function Test Committee, 1997) were conducted. Additionally, other neuropsychological tests such as, Word Fluency Test (Saito et al., 1992), Rey’s auditory verbal learning test (Rey, 1964) and Frontal Assessment Battery (Dubois et al., 2000) were administered. The results of the elderly were referred to a study of Yoshimura et al. (2016).
Results: The number of content words of each discourse task were analyzed; for dementia 12.7±9.7, for elderly 14.8 ± 5.6 (numbers indicate average and standard deviation). The severer the dementia became, the fewer the nouns in discourse were (p<.01). The relationship between lexical retrieval and cognitive functions were different from that of the elderly.
Conclusion and Significance: We discuss the characteristics of oral discourse in dementia in comparison with elderly. Also, we suggest a discourse task as an efficient tool to evaluate an early stage of dementia in clinical settings.
Figure 1: Lexical retrieval declines were
shown in elderly, but this characteristic would
be an early indicator of dementia.
Recent Publications:
- Brain Function Test Committee (1997) Visual Perceptual Test for Agnosia. Tokyo: Shinko Igaku Suppann-sha. Goodglass H, Kaplan E (1983).
- The Boston Diagnostic Aphasia Examination. Boston: Lea & Febi. Gold D et al (1998).
- Measurement and correlates of verbosity in elderly people. Journal of Gerontology 43(2): 27-33. Pekkala S et al (2013).
- Lexical retrieval in discourse: An early indicator of Alzheimer’s dementia. Clinical linguistics & Phonetics 27(12):905-921. Yoshimura T et al. (2016).
- Word production in discourse and cognitive functions in elderly - the implication for the demented population-. International Psychogeriatric Association Asia Region 2016 Meeting Abstract Book 188-189.