Search

The purpose of this study was to examine the impact of an extracurricular geriatric program on medical students' knowledge of, and attitudes toward, the elderly and their interest in studying geriatric medicine. The participants were first-year medical students (n = 137) who joined the Senior Teacher Education Partnership (STEP) program that partnered medical students with community-dwelling elders. Although results show that the STEP program had minimal effect in changing first-year medical students' knowledge of the aged and aging, it did promote a more positive view of the elderly as being functionally independent and socially active. Statistical analyses also revealed that prior interest and participation in the STEP program are significant indicators of students' interest in pursuing geriatric medicine after completing their first year of medical school. (Contains 4 tables.)

At the University of Missouri-Columbia School of Medicine, we developed a voluntary senior-mentor program, the Senior Teacher Educator Partnership (STEP), for first- and second-year medical students. Using qualitative research methods, we examined the impact of STEP on medical students' attitudes and then assessed the congruence of what is learned through STEP with the knowledge, skills, and attitudes needed to provide care to the elderly patient. STEP was found to be a successful strategy for teaching themes of recognizing the elderly within an ecological context, enhancing sympathy and empathy, emphasizing respect for elderly persons, and gaining an appreciation that aging is an individualized process. New areas identified for student learning experiences included understanding the complexity of the health care system and its impact on elderly patients, understanding the payment system, and developing skills in assessment and care coordination. A model is described for continuous enhancement of educational programs to be used to improve educational experience in geriatrics. (Contains 2 tables.)

Background. Scant information exists about the risk of functional decline following treatment of acute illness in the nursing home (NH) setting. The aim of this study was to determine the incidence of short-term (30-day) functional decline among survivors of NH-acquired lower respiratory tract infection (LRI) and the factors that predict such decline, including the role of initial hospitalization. Methods. We used a prospective cohort design to study 781 episodes of LRI in 1044 NH residents in 36 NHs in central Missouri and the St. Louis metropolitan area. Functional decline was defined as a 3-point increase on the Minimum Data Set (MDS) activities of daily living (ADL) long form scale. Results. Of 781 LRI cases who survived to 30 days, the incidence of ADL decline was 28.8%. In a logistic regression model that used generalized estimating equations to adjust for clustering, variables associated with ADL decline included the following: chronic feeding tube use (AOR = 4.54, 95% confidence interval, or CI, 1.61, 12.80), decubitus ulcer (adjusted odds ratio [AOR] = 2.29, 95% CI 1.35, 3.90), shortness of breath (AOR = 2.18, 95% CI 1.44, 3.30), short-term memory problems (AOR = 2.07, 95% CI 1.33, 3.23), decline in self-performance of toilet use in the 24 hours prior to evaluation (AOR = 1.65, 95% CI 1.29, 2.12), age (AOR = 1.02, 95% CI 1.00, 1.05), and baseline ADL score. Addition of treatment variables to the model showed that initial hospitalization was also associated with ADL decline (AOR = 1.90, 95% CI 1.20, 3.00). Residents with ADL decline at 30 days were less likely to recover to their baseline ADL status at 90 days. Conclusions. Many NH residents who survive to 30 days following LRI develop new functional limitations, and such individuals are at risk for ADL decline at 90 days. A limited number of clinical variables may predict short-term functional decline. Initial hospitalization for acute treatment of LRI may increase the risk of subsequent ADL decline among individuals who survive to 30 days.

Researchers have developed a health status indicator that can identify nursing home patients who have a high risk of death from a respiratory tract infection. The indicator includes blood urea nitrogen, white blood cell count, body mass index, pulse rate, activities of daily living status, absolute lymphocyte count, sex, and mood changes., Context Lower respiratory tract infection (LRI) is a leading cause of mortality and hospitalization in nursing home residents, Treatment decisions may be aided by a clinical prediction rule that identifies residents at low and high risk of mortality. Objective To identify patient characteristics predictive of 30-day mortality in nursing home residents with an LRI. Design, Setting, and Patients Prospective cohort study of 1406 episodes of LRI in 1044 residents of 36 nursing homes in central Missouri and the St Louis, Mo, area between August 15,1995, and September 30, 1998. Main Outcome Measure Thirty-day all-cause mortality. Results Thirty-day mortality was 14.7% (n = 207). In a logistic analysis, using generalized estimating equations to adjust for clustering, we developed an 8-variable model to predict 30-day mortality, including serum urea nitrogen, white blood cell count, body mass index, pulse rate, activities of daily living status, absolute lymphocyte count of less than 800/[micro]L (0.8 X 10(9)/L), male sex, and deterioration in mood over 90 days. In validation testing, the model exhibited reasonable discrimination (c = .76) and calibration (nonsignificant Hosmer-Lemeshow goodness-of-fit statistic, P = 54). A point score based on this model's variables fit to the entire data set closely matched observed mortality. Fifty-two percent of residents had low (score of 0-4) or relatively low (score of 5-6) predicted 30-day mortality, with 2.2% and 6.2% actual mortality, respectively. Conclusions Our model distinguishes nursing home residents at relatively low risk for mortality due to LRI. If independently validated, our findings could help physicians identify nursing home residents in need of different therapeutic approaches for LRI.

At the University of Missouri-Columbia School of Medicine, we developed a voluntary senior-mentor program, the Senior Teacher Educator Partnership (STEP), for first- and second-year medical students. Using qualitative research methods, we examined the impact of STEP on medical students' attitudes and then assessed the congruence of what is learned through STEP with the knowledge, skills, and attitudes needed to provide care to the elderly patient. STEP was found to be a successful strategy for teaching themes of recognizing the elderly within an ecological context, enhancing sympathy and empathy, emphasizing respect for elderly persons, and gaining an appreciation that aging is an individualized process. New areas identified for student learning experiences included understanding the complexity of the health care system and its impact on elderly patients, understanding the payment system, and developing skills in assessment and care coordination. A model is described for continuous enhancement of educational programs to be used to improve educational experience in geriatrics. doi:10.1300/J021v27n02_05 [ABSTRACT FROM PUBLISHER]

BACKGROUND. Lower respiratory infections (LRI) are an important cause of morbidity, mortality, and hospitalization of nursing home residents, yet treatment recommendations have primarily been based on the minority who are hospitalized. We sought to prospectively evaluate risk factors for mortality from LRI in community nursing home residents. METHODS. We studied residents of 10 central Missouri nursing homes (910 beds) from January 1994 to September 1994. Attending physicians authorized nurse evaluations of ill residents who showed symptoms of an LRI. Those residents who met the study definition of LRI received a more detailed assessment and follow ups at 30 and 90 days. RESULTS. The 231 evaluations identified 141 LRIs in 121 individuals. Sixteen (11%) residents died within 30 days of evaluation. The most important univariate predictor of 30-day mortality was severe activities of daily living (ADL) dependency (relative risk = 8.8, 95% confidence interval, 2.55 - 30.1). Several other clinical and laboratory findings were also significant predictors. In multivariable logistic regression, ADL dependency, respiratory rate, and pneumonia on chest radiograph independently predicted mortality; the model showed good discriminating ability (c=.83). CONCLUSIONS. For nursing home residents with LRI, ADL dependency is an important mortality predictor. Further research with a larger sample should lead to a useful prediction rule for outcome from nursing home-acquired LRI. [ABSTRACT FROM AUTHOR]

Part III. Focuses on the article `Type 2 Diabetes: Patient Education and Home Blood Glucose Monitoring,' published in the May 1998 issue of the `Geriatrics' journal. Most effective treatment for type 2 diabetes; Prevalence of the disease; Information on home glucose monitoring; Comments made by doctors during a discussion relating to type 2 diabetes.

Part II. Focuses on the importance of treatments for type 2 diabetes, which retain weight reduction and physical activity. Treatment of metabolic defects in type 2 diabetes; Highlights of a discussion on the treatment of type 2 diabetes in primary care. INSET: Update on troglitazone and liver toxicity.

Reports on round table discussion between various medical practitioners on type 2 diabetes mellitus and the impact of this disease on the American population. Factors contributing to the development of this disease; Complications associated with this disease; Challenges posed by the disease; Comments from these individuals. INSET: ADA clinical practice recommendations for 1998.