Subjects -> MEDICAL SCIENCES (Total: 8185 journals)
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GERONTOLOGY AND GERIATRICS (125 journals)                     

Showing 1 - 122 of 122 Journals sorted alphabetically
Activities, Adaptation & Aging     Hybrid Journal   (Followers: 6)
Advances in Alzheimer's Disease     Open Access   (Followers: 8)
Advances in Geriatrics     Open Access   (Followers: 4)
Advances in Gerontology     Partially Free   (Followers: 9)
Advances in Parkinson's Disease     Open Access   (Followers: 2)
Age and Ageing     Hybrid Journal   (Followers: 105)
Aging & Mental Health     Hybrid Journal   (Followers: 42)
Aging and Cancer     Open Access   (Followers: 2)
Aging and Health Research     Open Access   (Followers: 1)
Aging Clinical and Experimental Research     Hybrid Journal   (Followers: 3)
Aging Medicine     Open Access   (Followers: 1)
Aging, Neuropsychology, and Cognition     Hybrid Journal   (Followers: 42)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 54)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6)
American Journal of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 22)
American Journal of Geriatric Psychiatry     Hybrid Journal   (Followers: 19)
Anales en Gerontología     Open Access  
Angewandte GERONTOLOGIE Appliquée     Full-text available via subscription  
Annual Review of Gerontology and Geriatrics     Hybrid Journal   (Followers: 14)
Arthritis und Rheuma     Hybrid Journal  
Australasian Journal On Ageing     Hybrid Journal   (Followers: 12)
Australian Ageing Agenda     Full-text available via subscription   (Followers: 5)
B&G Bewegungstherapie und Gesundheitssport     Hybrid Journal   (Followers: 2)
Biogerontology     Hybrid Journal   (Followers: 1)
BMC Geriatrics     Open Access   (Followers: 17)
Canadian Geriatrics Journal     Open Access   (Followers: 6)
Canadian Journal on Aging     Hybrid Journal   (Followers: 17)
Clinical Gerontologist     Hybrid Journal   (Followers: 3)
Clinics in Geriatric Medicine     Full-text available via subscription   (Followers: 6)
Current Geriatrics Reports     Hybrid Journal   (Followers: 1)
Current Gerontology and Geriatrics Research     Open Access   (Followers: 11)
Dementia and Geriatric Cognitive Disorders     Full-text available via subscription   (Followers: 37)
Dementia and Geriatric Cognitive Disorders Extra     Open Access   (Followers: 20)
Drugs & Aging     Full-text available via subscription   (Followers: 10)
European Geriatric Medicine     Full-text available via subscription   (Followers: 3)
European Journal of Ageing     Hybrid Journal   (Followers: 16)
European Review of Aging and Physical Activity     Open Access   (Followers: 11)
Experimental Aging Research: An International Journal Devoted to the Scientific Study of the Aging Process     Hybrid Journal   (Followers: 2)
Experimental Gerontology     Hybrid Journal   (Followers: 5)
Frontiers in Aging Neuroscience     Open Access   (Followers: 22)
Gait & Posture     Hybrid Journal   (Followers: 17)
Generations     Full-text available via subscription   (Followers: 3)
Geriatric Care     Open Access   (Followers: 4)
Geriatric Medicine in General Practice     Full-text available via subscription   (Followers: 8)
Geriatric Orthopaedic Surgery Rehabilitation     Open Access   (Followers: 5)
Geriatrics     Open Access   (Followers: 3)
Geriatrics & Gerontology International     Hybrid Journal   (Followers: 12)
Geriatrie up2date     Hybrid Journal  
Geriatrie-Report : Forschung und Praxis in der Altersmedizin     Full-text available via subscription  
Gerodontology     Hybrid Journal   (Followers: 2)
Gerokomos     Open Access   (Followers: 1)
Geron     Full-text available via subscription  
Gerontologia     Open Access  
Gerontology     Full-text available via subscription   (Followers: 22)
Gerontology & Geriatrics Education     Hybrid Journal   (Followers: 8)
Gerontology and Geriatric Medicine     Open Access   (Followers: 5)
GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry     Hybrid Journal   (Followers: 5)
GeroScience : Official Journal of the American Aging Association (AGE)     Hybrid Journal   (Followers: 8)
Global Journal of Geriatrics Nursing     Open Access   (Followers: 4)
Hip International     Hybrid Journal  
I Advance Senior Care     Full-text available via subscription  
Immunity & Ageing     Open Access   (Followers: 9)
Innovation in Aging     Open Access   (Followers: 1)
International Journal of Ageing and Later Life     Open Access   (Followers: 1)
International Journal of Aging and Human Development     Full-text available via subscription   (Followers: 11)
International Journal of Alzheimer's Disease     Open Access   (Followers: 8)
JMIR Aging     Open Access  
Journal for Healthcare Quality     Hybrid Journal   (Followers: 28)
Journal of Adult Protection, The     Hybrid Journal   (Followers: 15)
Journal of Aging and Environment     Hybrid Journal   (Followers: 4)
Journal of Aging and Health     Hybrid Journal   (Followers: 28)
Journal of Angiogenesis Research     Open Access   (Followers: 2)
Journal of Applied Gerontology     Hybrid Journal   (Followers: 18)
Journal of Elder Abuse & Neglect     Hybrid Journal   (Followers: 6)
Journal of Frailty & Aging     Hybrid Journal  
Journal of Geriatric Cardiology     Open Access   (Followers: 3)
Journal of Geriatric Mental Health     Open Access   (Followers: 6)
Journal of Geriatric Oncology     Hybrid Journal   (Followers: 2)
Journal of Geriatric Physical Therapy     Hybrid Journal   (Followers: 15)
Journal of Geriatrics     Open Access   (Followers: 1)
Journal of Geriatrics and Palliative Care     Open Access   (Followers: 5)
Journal of Gerontological Social Work     Hybrid Journal   (Followers: 14)
Journal of Mid-life Health     Open Access  
Journal of Military and Veterans Health     Full-text available via subscription   (Followers: 7)
Journal of Parkinsonism and Restless Legs Syndrome     Open Access   (Followers: 2)
Journal of Parkinson’s Disease and Alzheimer’s Disease     Open Access   (Followers: 1)
Journal of Prevention of Alzheimer's Disease     Hybrid Journal   (Followers: 1)
Journal of Religion Spirituality & Aging     Hybrid Journal   (Followers: 7)
Journal of Social Work in End-of-Life & Palliative Care     Hybrid Journal   (Followers: 24)
Journal of the American Geriatrics Society     Hybrid Journal   (Followers: 69)
Journal of the Indian Academy of Geriatrics     Open Access   (Followers: 4)
Maturitas     Hybrid Journal   (Followers: 10)
Medycyna Wieku Podeszłego (Geriatric Medicine)     Open Access  
Mortality: Promoting the interdisciplinary study of death and dying     Hybrid Journal   (Followers: 9)
Neurodegenerative Diseases     Full-text available via subscription   (Followers: 1)
Neuroembryology and Aging     Full-text available via subscription   (Followers: 1)
NOVAcura     Hybrid Journal  
npj Aging and Mechanisms of Disease     Open Access   (Followers: 1)
npj Parkinson's Disease     Open Access   (Followers: 5)
Nursing Older People     Full-text available via subscription   (Followers: 9)
OA Elderly Medicine     Open Access  
Paediatrics & Child Health in General Practice     Full-text available via subscription   (Followers: 5)
Palliative Care & Social Practice     Open Access   (Followers: 3)
Parkinson's Disease     Open Access   (Followers: 12)
Pathobiology of Aging & Age-related Diseases     Open Access  
Physical & Occupational Therapy in Geriatrics     Hybrid Journal   (Followers: 57)
Quality in Ageing and Older Adults     Hybrid Journal   (Followers: 44)
Quality of Life Research     Hybrid Journal   (Followers: 20)
RASP - Research on Ageing and Social Policy     Open Access   (Followers: 4)
Revista Española de Geriatría y Gerontología     Full-text available via subscription  
Senex: Yaşlılık Çalışmaları Dergisi / Senex: Journal of Aging Studies     Open Access  
The Aging Male     Hybrid Journal   (Followers: 2)
The Gerontologist     Hybrid Journal   (Followers: 23)
The Journals of Gerontology : Series A     Hybrid Journal   (Followers: 22)
Topics in Geriatric Rehabilitation     Hybrid Journal   (Followers: 15)
Translational Medicine of Aging     Open Access  
Work, Aging and Retirement     Open Access   (Followers: 4)
Working with Older People     Hybrid Journal   (Followers: 40)
Zeitschrift fur Gerontologie und Geriatrie     Hybrid Journal   (Followers: 1)
Zeitschrift für Gerontopsychologie und -psychiatrie     Full-text available via subscription   (Followers: 1)
Zeitschrift für Palliativmedizin     Hybrid Journal  

           

Similar Journals
Journal Cover
Current Geriatrics Reports
Journal Prestige (SJR): 0.364
Citation Impact (citeScore): 1
Number of Followers: 1  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Online) 2196-7865
Published by Springer-Verlag Homepage  [2469 journals]
  • The 4 M’s: What Every Specialist Should Know

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      Abstract: Abstract Providing individualized care to older adults hinges on understanding their goals. The “Four M’s” - 'What matters most, medication, mentation and mobility - provides a framework for understanding an individual’s health care goals. “What matters most” is perhaps the anchor of the four and is often the most difficult to determine. Starting with understanding “what matters most” to an individuals helps those providing health care align diagnostic and treatment decisions with the patient’s health care preferences.
      PubDate: 2022-09-01
       
  • Nutritional Considerations in Geriatric Orthopedics

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      Abstract: Purpose of Review Malnourished patients are at risk for fragility fractures resulting in postoperative ​complications, increased mortality, and decreased functional status after geriatric orthopedic surgeries. Nutritional status of the older patient can be determined by various screening tools. We aim to review recent literature on nutritional status in preoperative and postoperative evaluations and determine its implications for geriatric orthopedic surgery patients. Recent Findings Malnutrition has been associated with increased orthopedic surgery complications. An individualized nutrition screening and treatment plan can reduce these complications and prevent future fragility fractures. Interleukin-6 is an inflammatory cytokine that may be useful in the prediction of mortality and nutritional status of the patient; however, further research is necessary. Summary A nutritional screening tool can be utilized to determine at-risk individuals. Nutrition should ​be optimized prior to undergoing an orthopedic procedure, and an interdisciplinary team approach is recommended.
      PubDate: 2022-09-01
       
  • Antisense Oligonucleotide Therapeutics for Neurodegenerative Disorders

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      Abstract: Purpose of Review Expanding therapeutic targets from proteins to RNAs opens up new possibilities for neurodegenerative disorders therapeutics development. Recently, a disease-modifying antisense oligonucleotide (ASO) agent was approved for spinal muscular atrophy, suggesting ASOs will fulfill their early promise and become a significant new therapeutic category for neurodegenerative disorders. Recent Findings ASOs are in human subjects testing for Huntington disease, monogenic forms of amyotrophic lateral sclerosis, Alzheimer disease, myotonic dystrophy, Leber congenital amaurosis, Usher syndrome, and retinitis pigmentosum, with many more in preclinical development. Current ASO strategies encompass RNA processing modulation, and RNA target breakdown. Broad ASO mechanism categories are protein restoring versus protein lowering. Individual ASO mechanisms of action range from mutation-specific to impacting many proteins. Summary Current ASOs show great promise in neurodegenerative disorders. Specific ASO designs and mechanisms may be more tenable in this disease area. Preclinical development is already leveraging early knowledge from these initial clinical trials to develop novel ASO cocktails, new ASO chemical modifications, and new ASO RNA and protein targets.
      PubDate: 2022-09-01
       
  • An Approach to Cardiac Syncope in the Elderly Patient

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      Abstract: Purpose of Review Syncope in the geriatric population remains a considerable diagnostic challenge due to its often atypical presentation and multifactorial etiology. This is compounded by the rising incidence of coexisting medical conditions, frailty, and polypharmacy in this population. Patients who have a history of cardiovascular disease or whose presentations have historical factors suggestive of a cardiac etiology should undergo evaluation for potential cardiac causes of syncope. Here we outline a framework for the evaluation of cardiac syncope in the elderly patient. Recent Findings Assessment should include eliciting a detailed history from the patient and available witnesses, confirming a complete medication list, performing a focused physical exam, and obtaining a 12-lead electrocardiogram. Special attention should be paid to signs of orthostatic hypotension, carotid disease, volume overload, valvular disease, cardiac ischemia, and any new arrhythmia. Summary An initial diagnostic framework of comprehensive history-taking, focused examination and early electrocardiography allows for timely triaging and targeted management of syncope while also providing flexibility to guide further diagnostic evaluation, which may include ischemic evaluation, echocardiography, advanced cardiac imaging, and ambulatory cardiac rhythm monitoring.
      PubDate: 2022-08-04
       
  • Challenges and New Insights in the Management of Urinary Incontinence in
           Older Women

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      Abstract: Purpose of Review This article highlights the potential challenges in the management of urinary incontinence in older women. Recent Findings Urinary incontinence is a highly prevalent condition associated with profound morbidity and psychosocial consequences especially among older women. Simple conservative approaches including life-style modification and behavioral management can be quite effective in improving urinary incontinence symptoms. However, options beyond first-line management are limited due to adverse effects related to medications or surgery. Summary Urinary incontinence is a multifactorial condition in older women, and management is often complicated given multiple comorbidities and unique physiologic changes related to aging. The management should be individualized based on the patient's clinical history and goals of therapy. More research is needed to overcome current challenges associated with the management of urinary incontinence in older women. A treatment algorithm that provides safe yet effective treatment options specifically tailored to older women is needed.
      PubDate: 2022-03-31
      DOI: 10.1007/s13670-022-00375-z
       
  • Optimizing Cardiac Performance During the Perioperative Period

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      Abstract: Purpose of Review Perioperative adverse cardiac events commonly affect patients undergoing surgery and are even increasingly more common as patients age. The purpose of this paper is to review recent literature and society guidelines regarding screening and optimizing these patients in the perioperative period. Recent Findings There remains a relative paucity of prospective, randomized control trials regarding cardiac optimization/risk-reduction in patients undergoing noncardiac surgery. Current guidelines are focused primarily on identifying patients at an increased risk of perioperative cardiac adverse events, performing appropriate preoperative work-up, and weighing the risk of cardiac event—with or without preoperative optimization with medications and/or revascularization—against the potential consequences of abstaining from surgery. Summary Numerous risk factors have been identified which increase patients’ risk for perioperative adverse cardiac events such as pre-existing ischemic heart disease or heart failure, advanced age, medical comorbidities, and type of surgery being performed. While cardiac risk stratification for surgery is well-established, the optimization of these patients remains somewhat ambiguous. Further prospective research is needed to address preoperative medical optimization, intraoperative management, and postoperative monitoring and management to reduce these risks.
      PubDate: 2022-02-15
      DOI: 10.1007/s13670-021-00373-7
       
  • Amyloid Cardiomyopathy in Older Adults

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      Abstract: Purpose of Review Wild type transthyretin cardiac amyloidosis (ATTRwt, formerly called senile cardiac amyloidosis) is almost exclusively a disorder of adults over 60 years old and represents a quintessential type of diastolic heart failure in the older adult population. Cardiac amyloidosis is an infiltrative/restrictive cardiomyopathy that causes heart failure, atrial and ventricular arrhythmias, and conduction disease, and is associated with significant morbidity and mortality. Early suspicion by geriatricians including clinical clues or suggestive features when coupled with non-invasive cardiac testing that delineates a discordance between the wall thickness on echocardiography and the voltage on an electrocardiogram along with other suggestive findings on imaging of cardiac amyloidosis is paramount because early treatment can significantly improve prognosis. Recent Findings With the advent of a non-invasive method to diagnose ATTRwt without a biopsy and the development of effective therapies, there is an increasing interest in this condition. Summary The goal of this review is to provide clinical and testing guides and pearls, for early suspicion and detection, and subsequent referral to specialist cardiologists and amyloid specialists for further management and treatment.
      PubDate: 2022-02-12
      DOI: 10.1007/s13670-022-00374-0
       
  • Disparities and Racism Experienced Among Older African Americans Nearing
           End of Life

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      Abstract: Purpose of Review The purpose of this review is to examine racism in healthcare as it relates to older African American adults. We focus on health disparities in old age and medical mismanagement throughout their lifespan. Recent Findings In the United States there have been extensive medical advances over the past several decades. Individuals are living longer, and illnesses that were deemed terminal in the past are now considered chronic illnesses. While most individuals living with chronic illness have experienced better quality of life, this is not the case for many African American older adults. Summary Older African American adults are less likely to have their chronic illness sufficiently managed and are more likely to die from chronic illnesses that are well controlled in Whites. African American older adults also continue to suffer from poorer healthcare outcomes throughout the lifespan to end-of-life.
      PubDate: 2021-12-14
      DOI: 10.1007/s13670-021-00366-6
       
  • Home Based Palliative Care: Known Benefits and Future Directions

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      Abstract: Purpose of Review To summarize key recent evidence regarding the impact of Home-Based Palliative Care (HBPalC) and to highlight opportunities for future study. Recent Findings HBPalC is cost effective and benefits patients and caregivers across the health care continuum. Summary High-quality data support the cost effectiveness of HBPalC. A growing literature base supports the benefits of HBPalC for patients, families, and informal caregivers by alleviating symptoms, reducing unwanted hospitalizations, and offering support at the end of life. Numerous innovative HBPalC models exist, but there is a lack of high-quality evidence comparing specific models across subpopulations. Our wide literature search captured no research regarding HBPalC for underserved populations. Further research will also be necessary to guide quality standards for HBPalC.
      PubDate: 2021-11-25
      DOI: 10.1007/s13670-021-00372-8
       
  • Iron Deficiency in Heart Failure: Characteristics and Treatment

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      Abstract: Purpose of the Review Iron deficiency in heart failure has been associated with impaired functional capacity and quality of life. The purpose of this paper is to review mechanisms of iron homeostasis and current clinical data exploring mechanisms of iron repletion in heart failure. Recent Finding Multiple international societies now advise iron repletion for symptomatic heart failure patients with iron deficiency. Due to the chronic inflammation in heart failure, iron deficiency in heart failure is classically defined as ferritin < 100 µg/L or ferritin 100–300 µg/L and transferrin saturation < 20%. Multiple randomized clinical trials have demonstrated benefit from intravenous iron repletion, though studies have predominantly focused on functional capacity and quality of life. A recent study, AFFIRM-AHF, supports the treatment of iron deficiency identified during acute heart failure admissions, noting a reduction in future heart failure hospitalizations. Studies examining iron repletion in patients with heart failure with preserved ejection fraction are currently in process. Summary Iron homeostasis is maintained predominantly through the regulation of iron absorption, keeping iron levels tightly controlled in the normal state regardless of iron intake. In chronic heart failure however, iron homeostasis becomes dysregulated with resulting iron deficiency in many patients, with and without associated anemia. Iron is a critical element not only for erythropoiesis and oxygen carrying, but also for energy production at the level of the mitochondria and in other cell processes. We thus propose a standardized approach be utilized to screen and treat heart failure patients with iron deficiency.
      PubDate: 2021-11-25
      DOI: 10.1007/s13670-021-00370-w
       
  • Prehabilitation for High-Risk Surgical Patients

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      Abstract: Purpose of Review Prehabilitation of high-risk surgical patients is an evolving area. The purpose of this review is to describe the scope of prehabilitation programs and their impact on surgical outcomes. Recent Findings Prehabilitation interventions optimize a patient for surgery improving physical capabilities, focusing on strengthening respiratory mechanics, enhancing nutrition, and boosting mental strength. There is great variation on how prehabilitation programs are implemented leading to mixed results. The research, specifically in the geriatric population, is promising with a reduction in postoperative complications including mortality. Summary An optimal prehabilitation program should meet the needs of the specific patient population. Based on the available literature, a prehabilitation algorithm that focuses on enhancing a patient’s physical, nutritional, and mental status prior to surgery is proposed. Larger studies are needed to evaluate the impact of prehabilitation programs in high-risk geriatric patients and surgical outcomes.
      PubDate: 2021-11-15
      DOI: 10.1007/s13670-021-00371-9
       
  • Perioperative Pulmonary Support of the Elderly

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      Abstract: Purpose of Review With the projected increase in the geriatric patient population, it is of the utmost importance to understand and optimize conditions in the perioperative period to ensure the best surgical outcome. Age-associated changes in respiratory physiology affect the surgical management of geriatric patients. This review focuses on perioperative pulmonary management of elderly individuals. Recent Findings The physiological changes associated with aging include both physical and biochemical alterations that are detrimental to pulmonary function. There is an increased prevalence of chronic lung disease such as COPD and interstitial lung disease which can predispose patients to postoperative pulmonary complications. Additionally, elderly patients, especially those with chronic lung disease, are at risk for frailty. Screening tools have been developed to evaluate risk and aid in the judicious selection of patients for surgical procedures. The concept of “prehabilitation” has been developed to best prepare patients for surgery and may be more influential in the reduction of postoperative pulmonary complications than postoperative rehabilitation. Understanding the age-associated changes in metabolism of drugs has led to dose adjustments in the intraoperative and postoperative periods, reducing respiratory depression and lung protective ventilation and minimally invasive procedures have yielded reductions in postoperative pulmonary complications. Summary The perioperative management of the geriatric population can be divided into three key areas: preoperative risk mitigation, intraoperative considerations, and postoperative management. Preoperative considerations include patient selection and thorough history and physical, along with smoking cessation and prehabilitation in a subset of patients. Operative aspects include careful selection of anesthetic agents, lung protective ventilation, and choice of surgical procedure. Postoperative management should focus on selective use of agents that may contribute to respiratory depression and encouragement of rehabilitation.
      PubDate: 2021-11-09
      DOI: 10.1007/s13670-021-00369-3
       
  • Protecting our Elders and Developing Equitable Policies During Public
           Health Emergencies: Ethical Recommendations

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      Abstract: Purpose of the Review Experiences of patients, families, healthcare workers and health systems during the COVID-19 pandemic and recent national focus on racial justice have forced a reconsideration of policies and processes of providing care in crisis situations when resources are scarce. The purpose of this review is to present recent developments in conceptualizing ethical crisis standards. Recent findings Several recent papers have raised concerns that “objective” scarce resource allocation protocols will serve to exacerbate underlying social inequities. Older adults and their formal and informal caregivers suffered from intersecting planning failures including lack of adequate stockpiling of personal protective equipment, failure to protect essential workers, neglect of long-term care facilities and homecare in disaster planning and de-prioiritization in triage algorithms. Summary Revision of disaster planning guidelines is urgent. The time is now to apply lessons learned from COVID-19 before another disaster occurs. We present several suggestions for future plans.
      PubDate: 2021-11-05
      DOI: 10.1007/s13670-021-00368-4
       
  • Role of Nutrition in the Elderly Surgical Patient – Review of the
           Literature and Current Recommendations

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      Abstract: Purpose of Review Poor nutritional status is common among inpatients, and particularly so among surgical patients. The problem is even more pronounced among elderly surgical patients, with age itself being an independent risk factor for malnutrition. With older adults representing a large proportion of patients undergoing emergency operations, and with malnutrition contributing to worse surgical outcomes, peri-operative nutritional optimization has garnered significant interest in the surgical literature. We sought to review the literature, specifically over the last five years, regarding the approach to nutritional evaluation and optimization in the pre- and post-operative settings in the elderly surgical patient. Recent Findings Recent research has focused on the pathophysiologic mechanisms that drive cachexia, including inflammatory and endocrine pathways and their interplay in patients subjected to the stress of surgery, as well as on the important differences between cachexia and sarcopenia. Emphasis has been placed on approaching nutritional status in a systematic fashion and on using context-specific validated screening tools in addition to biochemical and anthropometric parameters. In the elective setting, Enhanced Recovery After Surgery (ERAS) pathways have become the norm. With this, the concept of multimodal prehabilitation has been extensively studied and societal recommendations have been made. Summary Elderly surgical patients constitute a particularly vulnerable population who is at risk of poor post-operative outcomes by virtue of both advanced age and poor nutritional status. Serum albumin, BMI, and history of recent involuntary weight loss or poor intake should be supplemented with screening tools such as the Nutritional Risk Screening (NRS-2002) to evaluate each patient’s nutritional risk. Nutritional and physical activity interventions lead to better outcomes, and should be implemented well before surgery and continued in the post-operative setting. It will be interesting and useful in the future to evaluate how these strategies translate to patients undergoing emergency surgery and who therefore do not usually have the benefit of pre-operative optimization.
      PubDate: 2021-10-30
      DOI: 10.1007/s13670-021-00367-5
       
  • Health Professionals Palliative Care Education for Older Adults:
           Overcoming Ageism, Racism, and Gender Bias

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      Abstract: Purpose of review Most aging Americans lack access to specialist palliative care aimed at those experiencing serious illness and/or high symptom burden at end of life. The curricula used by training programs for all healthcare professions should focus on helping learners develop the primary palliative care skills and competencies necessary to provide compassionate bias-free care for adults with serious illness. We believe there is much opportunity to improve this landscape via the incorporation of palliative care competencies throughout generalist healthcare professional programs. Recent findings Several recent publications highlight multiple issues with recruitment and retention of diverse students and faculty into healthcare professional training programs. There are also concerns that the curricula are reinforcing age, race, and gender biases. Due to these biases, healthcare professionals graduate from their training programs with socialized stereotypes unquestioned when caring for older adult minority patients and caregivers. Summary Important lessons must be incorporated to assure that bias against age, race, and gender are discovered and openly addressed in healthcare professional’s education programs. This review highlights these three types of bias and their interrelationships with the aim of revealing hidden truths in the education of healthcare professionals. Ultimately, we offer targeted recommendations of focus for programs to address implicit bias within their curricula.
      PubDate: 2021-10-30
      DOI: 10.1007/s13670-021-00365-7
       
  • “Evaluating and Managing Tardive Dyskinesia in the Older
           Adult”

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      Abstract: Purpose of Review Tardive dyskinesia is an iatrogenic hyperkinetic movement disorder caused by chronic exposure to antidopaminergic agents. The older adult population is particularly vulnerable to developing TD. It is also more difficult to discern the condition given the confounding medical comorbidities that may present at this age including Parkinson’s and other movement disorders that may mimic TD. Recent Findings This paper reviews the most common risk factors, including both modifiable and non-modifiable risk factors. Additionally, the possible causes and proposed pathways of TD and how to correctly diagnose and evaluate TD are discussed. We then focus on how to prevent and manage TD given the current and evolving body of knowledge and evidence. Our stepwise management approach starts by frequent monitoring, discontinuing the culprit antipsychotic, decreasing the dose otherwise; followed by switching to less potent antipsychotics and prescribing VMAT-2 inhibitors. VMAT-2 inhibitors, initially approved for management of Huntington's disease, have been recently showing favorable results in treating other hyperkinetic movement disorders like Tourette’s disease, quickly becoming the first line in the treatment of tardive dyskinesia. The properties of the three different agents belonging to this class: tetrabenazine, deutetrabenazine, and valbenazine will be examined, including side-effect profiles. Finally, recent investigational agents and treatment modalities, including neuromodulation (TMS and DBS) will be reviewed that can be considered when conventional treatment fails or is not tolerated. Summary Older adults treated with antidopaminergic medications are at greatest risk for development of tardive dyskinesia. It is important to recognize risk factors and accurately diagnose TD early. New FDA-approved treatments and investigational agents are now available to manage the condition, however further research to optimally prevent and manage TD in the older adult population remains necessary.
      PubDate: 2021-10-13
      DOI: 10.1007/s13670-021-00364-8
       
  • Correction to: Behavioral Variant Frontotemporal Dementia: Diagnosis and
           Treatment Interventions

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      PubDate: 2021-09-15
      DOI: 10.1007/s13670-021-00363-9
       
  • Review of Grief Therapies for Older Adults

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      Abstract: Purpose of Review The objective of this review is to provide background on common theories of grief, describe the impact of grief on older adults and to introduce various modalities that are currently used and/or being researched for treatment. The objective is also to condense information and identify what has been found beneficial versus what has been found lacking. A brief examination of overlap of other disorders is done. It also will suggest what further research is necessary on this subject, and highlight what research is being done during the COVID-19 Pandemic. Findings The latest research of grief primarily involves refining the definitions of grief. More concrete definitions of grief will help for better screening tools, and thus target interventions more appropriately. There is considerable need for applying it to the unique and real-world COVID-19 pandemic. Summary Grief disorders are relatively common and the symptoms overlap other disorders. Since the treatments differ, identifying grief disorders is important, especially in the elderly who are more susceptible to grief disorders. Therapy improves grief better than medications, but medications will help with any co-occurring disorders. No clear superior therapy has been identified but research continues. The pandemic has highlighted the need to refine the definitions of grief disorders and to treat them effectively.
      PubDate: 2021-09-01
      DOI: 10.1007/s13670-021-00362-w
       
  • Urinary Incontinence in People Living with Cognitive Impairment

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      Abstract: Purpose of Review Urinary incontinence is common in adults with cognitive impairment due to a dementia. There are few data which systematically assess the factors underlying incontinence in this medically complex and vulnerable group and a paucity of evidence by which to guide treatment. This review covers what is known and suggests how to adjust the assessment and management of incontinence in an older adult living with dementia. Recent Findings A dementia diagnosis is not a bar to receiving either adequate assessment or management of incontinence. Pelvic floor muscle therapy is an effective conservative intervention. Conservative interventions combining gait stability and stamina with pelvic floor muscle therapy and prompted voiding are effective but rely on care partner participation. Summary There are a variety of non-pharmacological management strategies that can be employed for persons living with dementia, depending on the individual’s cognitive status and care partner availability. Caution should be used with antimuscarinic therapy in treating overactive bladder and urgency incontinence. However, in many cases, the benefits of antimuscarinic therapy far outweigh the risks. Individualizing management according to the patient’s personal wishes, the degree of available caregiver support and the level of cognitive functioning is paramount to ensure treatment goals and expectations are met.
      PubDate: 2021-08-14
      DOI: 10.1007/s13670-021-00357-7
       
  • Emergent and Non-Emergent Agitation in the Older Adult: Evaluation and
           Management

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      Abstract: Purpose of Review This paper aims to describe the heterogenous presentation of agitation in older adults. It will delve into semiology, diagnosis, classification, as well as treatment options available to address agitation. Recent Findings Agitation is a common and distressing symptom that poses risk to patients and caregivers. In older adults, it is often a manifestation of medical and neuropsychiatric conditions such as dementia, stroke, delirium, psychiatric disorders, catatonia, substance intoxication or withdrawal. Agitation in dementia is defined as excessive motor behavior and verbal or physical aggressive behavior, causing significant disability. Several tools are used to describe it; most notably, the Cohen-Mansfield Agitation Inventory (CMAI). Its evaluation is most complete with the DICE (Describe, Investigate, Create, Evaluate) approach which allows for examination of precipitating factors such as delirium, psychiatric disorders, pain, polypharmacy, constipation, environmental elements, and others. Non-pharmacological management should be attempted first, tailoring the treatment to the precipitants. If these fail, pharmacological treatments, although inherently risky, include non-emergent and emergent options. The former are antidepressants and cognitive enhancers, and the latter include antipsychotics, trazodone, and electroconvulsive therapy (ECT). Benzodiazepine use should be limited to excited catatonia or alcohol withdrawal. Summary Agitation management is as much about addressing unmet needs as it is about treatment of underlying etiologies. A careful and systematic approach is imperative to successful treatment. It allows the clinician to uncover what the patient is unable to convey and minimizes the risk that polypharmacy may bring. More research is needed into methods to quantify, anticipate, and safely treat agitation in older adults.
      PubDate: 2021-07-28
      DOI: 10.1007/s13670-021-00358-6
       
 
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