5^th International Conference on Geriatric Medicine & Gerontological Nursing November 14-15, 2016
Atlanta, Georgia, USA

Biography:

Quratulain Syed is a board certified internist and a geriatrician at Grady Memorial Hospital, Atlanta and Assistant Professor of Medicine at Emory University School of Medicine. She completed her residency in internal medicine at Mt. Sinai School of Medicine, NY and a fellowship in geriatric medicine at Loyola University Hospital, Chicago, IL. She is a member of the public education committee of the American Geriatric Society and the disparities task force at the Society of General Internal Medicine. Her clinical and research interests include care transitions in older adults, driving and firearms safety in older adults, elder abuse, polypharmacy and cognitive disorders. She has presented topics related to Geriatrics at the Society of General Internal Medicine annual and regional meetings, and the American Geriatric Society annual meetings during the past few years.

Abstract:

In older adults, disorders of taste and/or smell can affect appetite and oral intake and therefore affect the patient’s ability to maintain optimal nutrition. This can affect the individual’s strength, muscle mass, function, and quality of life. The National Health and Nutrition Examination Survey (NHANES) 2011-2012 reported that more than 5% of the over 142 million US respondents experienced taste disorders and more than 10% experienced smell disorder in the past 12 months. Additionally, older adults are challenged by polypharmacy and multiple comorbid conditions, which can affect their ability to differentiate between various intensities or concentrations of a tastant, leading to an increased intake of salt, sugar and exacerbation of chronic diseases such as heart failure and diabetes.

Learning objectives: At the end of this session, attendees by be able to:

1. Describe the prevalence and etiology of taste disorders.
2. Describe the association between taste and smell disorders and how disorders of smell can affect perception of taste.
3. Initiate work up and develop a treatment plan for patients presenting with taste disorders.

Biography:

Lori Metzger holds a PhD in human development and a master’s degree in nursing with certification as an adult nurse practitioner. She is an assistant professor at the department of nursing teaching across undergraduate and graduate programs for Bloomsburg University of Pennsylvania. Additionally, she is co-founder and co-director of the center for healthy aging. Prior to teaching, she has spent 15 years practicing in home health and hospice caring for older adult’s population. During this time, she has come to appreciate the unique qualities of older adults and the new face of aging.

Abstract:

The telehealth in home health study aimed to determine patient’s satisfaction with technology in home health care as the population continues to age in the presence of chronic disease. Understanding patient’s perceptions regarding technologies in home care allows the practitioner to further understand one’s health belief and facilitate cues to changes in health behaviors towards management of chronic disease. The results of this study provide strength for the use of telehealth in home care and potentially contribute to the demand for reimbursement of telehealth.

Patient satisfaction was examined in older adult patient’s with heart failure in home health care. Eighty-six participants ranging in ages 59-99 with a mean age of 80.7 (sd = 8.9), voluntarily completed a questionnaire (HCSSI-R) of fifteen items. A comparison was made between and telehealth, home health services and usual home health care. An Analysis of Covariance (ANCOVA), frequency distributions and descriptive statistics were completed to answer the research question. A statistically significant difference was found indicating that the telehealth, home health group was more satisfied. When controlling for the demographic information about age, gender, prior home health services and living alone status, there was no significant impact on the patient satisfaction score.

It has been proven that telehealth in home care is cost-effective and produces favorable clinical outcomes in the management of chronic disease (Dansky, Vasey & Bowles, 2008; Hoban, Fedor, Reeder & Chernick, 2013). This study concludes that telehealth in home health care provides for a highly satisfied home health client managing chronic disease.

Biography:

Vered Raz has been graduated from The Wiezmann Institute of Science in Israel as a molecular biologist. She followed up post-doc positions at the University of Pennsylvania, USA, and Wageningen University, The NL. Presently she is having a Lecturer position at Leiden University Medical Centre, department of Human Genetics in The Netherlands. Her research is focused on molecular regulation of aging muscles and the role of RNA processing in aging.

Abstract:

RNA landscape has dynamically changed with age and substantial changes are associated with aging. Age-associated trends of RNA expression profiles could provide an objective description of physiological aging process and molecular signatures of aging could be extracted. Unravelling patterns of age-associated changes could help understanding the process of aging.

A new statistical method has been developed to extract age-associated patterns from RNA expression profiles of cross sectional studies. With this method technical differences between studies can be overcome, and thus tolerating an age-associated comparison between tissues and different biological groups.

The age-associated molecular patterns were found to be different between tissues and tissues may age at different rates. Some tissues may be more resistant for age-associated changes compared with other tissues. In some tissues, like blood and kidney cortex, major molecular changes are restrained around mid-seventies, whereas in other tissues, like skeletal muscles and brain cortex, major changes occur first at midlife and secondary during mid-seventies of age.

Incorporating this data into a health care program could be beneficial to improve healthy aging and decisions for clinical acts in the elderly.

Biography:

Langhit Kurar is a trainee orthopaedic surgeon, specialising in major joint fixation including trauma and is the local trainee representative at Darent Valley Hospital in Dartford, UK. He has presented published work on both ankle fracture management and clinical research on syndromic disease at both national and international level spanning 10 countries. His research has been funded by the University of Bristol and has paved the way to novel treatment regimen for Apert and craniosynostosis syndromes. His educational profile includes published work on undergraduate and postgraduate revision tools. He has organised international conferences as well as adopted numerous managerial roles within his district including academic, teaching, and British Medical Association positions.

Abstract:

INTRODUCTION: Ankle fractures in the osteoporotic patient are challenging injuries to manage, due to a combination of poor soft tissue, peripheral vascular disease and increased bone fragility, often resulting in more complex fracture patterns. I aim to audit current practice and introduce change by producing recommendations to help improve long-term functional outcomes.

PATIENTS AND METHODS: A retrospective 3-week audit was conducted reviewing the results of ankle fracture management in 50 patients aged between 50-80 years. Patients admitted for either manipulation under anaesthesia (MUA)/application of the cast or open-reduction and internal fixation (ORIF) were considered. Medical notes, including discharge summaries were used for data extraction.

RESULTS: From the 50 patients included within the cohort, forty-two patients (84%) underwent surgical intervention, with eight patients (16%) managed non-operatively. Malunion (63%) and failed fracture fixation (25%) were more commonly reported in patients managed non-operatively. Surgery performed by trainee surgeons was unlikely to prolong theatre time with no statistical significance observed with the consultant led cohort (p=0.380). However, incidence of fracture malunion and failed fixation was significantly higher following surgery without consultant supervision in the junior trainee group (p=0.043).

CONCLUSIONS: Poor bone quality and associated co-morbidity can present technical difficulties when managing patients surgically. However, our results have shown considerably improved anatomical reduction rates following internal fixation in eligible patients, irrespective of age or gender.

Biography:

Lene Holst Pedersen is a PhD student at Aarhus University. She is a medical doctor specializing in geriatrics at Aarhus University Hospital. In the spring 2016, she published an article on early geriatric follow-up in the journal European Geriatric Medicine.

Abstract:

As part of a Triple Aim project, we examined the effect of an early geriatric follow-up after discharge in a quasi-randomized controlled trial of geriatric patients (≥75 years) acutely admitted to the emergency department with one of nine diagnoses: pneumonia, COPD, delirium, dehydration, urinary tract infection, constipation, anemia, heart failure, and other infections. The intervention consisted of a follow-up visit to the patient’s home on the first working day after hospital discharge.

The visit was performed by a nurse and a geriatrician and tailored to the patient’s need. The control group was discharged according to standard procedures, which included follow-home or telephone follow-up.

From June 2014 to November 2015, 1330 patients were included. We found a statistically significant reduction in the readmission rate in the intervention group compared to the control group (12% vs. 23%; P < 0.001). The adjusted hazard ratio in the intervention group was 0.50 (95% CI: 0.38-0.65). In the intervention group more patients were discharged directly from the emergency department, instead of being transferred to the geriatric ward, compared to the control group (56% vs 49% p=0.01).The intervention reduced the length of the primary hospital stay median 2 days (1–7) vs. 3 days (1–8) in the control group (p= 0.03). Preliminary data on 30 and 90 day mortality show no statistically significant difference between the groups.

Biography:

Barun Mukhopadhyay has obtained his Ph.D. in Anthropology in 1989 from the University of Calcutta and working at the faculty of the Indian Statistical Institute since 1991. His major areas of interest are aging studies and bioethics. He has published so far 67 papers in reputed journals and conference proceedings. He serves as the consulting/Associate editor of two international journals.

Abstract:

Co-residence of elderly parents with children and grandchildren is believed to be rewarding for satisfactory intergenerational relation. This is very much common in the Indian society. However, the percentage of elderly persons living alone has increased during the past few decades, especially in the urban locales in India. The present study is aimed to evaluate the mental health profile in terms of selected mental health traits in order to examine the relationship between living arrangements and mental health profile of the elderly living in a city and a rural locale in the Indian State of West Bengal. The study is conducted among middle class, educated economically stable Bengalis inhabiting the Salt Lake City, Kolkata and their less-educated, less-economically stable rural counterparts in Paschim Medinipur district, West Bengal, India. The study sample consists of 450 elderly of both sexes aged between 65 and 79 years. Information on mental health traits and type of living arrangement is obtained using interviewer-administered questionnaires. The results clearly indicates the relatively worsened mental health profile of the urban elderly irrespective of sex living in the extended families, measured in terms of loneliness, anxiety, depression, perceived stress, and quality of life compared with those living in nuclear families. Living arrangement, however, doesn’t significantly affect mental health among the rural elderly. The present study interestingly demonstrates the negative aspects of living with children and grandchildren in terms of relative mental health adversity of the elderly in an urban Indian setting, contrary to general expectation in the Indian society

Biography:

Chiung-Jung Wen is an attending physician in the Department of Geriatrics and Gerontology in National Taiwan University Hospital. She completed her PhD training in the Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health of National Taiwan University in Jan 2015. Currently, she is the secretary general of Taiwan Health Evaluation and Promotion Association and also the deputy secretary general of the Taiwan Association of Gerontology and Geriatrics.

Abstract:

Background: To compare the osteoporosis awareness and its association with 10-year fracture risks between young and old breast cancer survivors.

Methods: In 2011 “Pink October” campaign was hosted by the Taiwan Breast Cancer Alliance and the Taiwanese Osteoporosis Association, questionnaires on osteoporosis awareness and Fracture Risk Assessment Tool (FRAX®) variables were distributed. Data from participants ≥40 years of age (N=807) were analyzed. Comparisons were made between those below and above 50 years of age, also among different tertiles of predicted fracture risk groups.

Results: Mean age was 56.0±7.7 years. Only half (52.7%) showed a high level of osteoporosis awareness. Older survivors were more likely to exhibit higher awareness levels (55.0% vs. 44.8%; p <0.05). Moreover, osteoporosis awareness is increased among high predicted 10-year major osteoporosis fracture risk groups. Older survivors (age ≥50 years) also had a higher body mass index, higher prevalence of secondary osteoporosis and higher predicted 10-year fracture risk (p< 0.05).

Conclusion: Osteoporosis awareness levels were higher among older and higher fracture risk breast cancer survivors. Educational program and osteoporosis prevention strategies may start with younger and lower fracture risk breast cancer survivors to increase the awareness in order to reduce under-managements of osteoporosis.

Biography:

Mary R Mulcare completed her medical degree at Columbia University College of Physicians and Surgeons, followed by an Emergency Medicine residency at NewYork-Presbyterian Hospital. She subsequently did a fellowship at Weill Cornell Medicine in Geriatric Emergency Medicine. She is the Assistant Program Director of the NYPH Emergency Medicine Residency and Assistant Director of the Geriatric Emergency Medicine Fellowship at Weill Cornell. Her research has focused on creating and testing an effective pathway for protocol development for improved care of older adults in emergency departments.

Abstract:

Indwelling Urinary Catheters (IUCs) are placed frequently in older adults (aged 65) in the Emergency Department (ED) and carry significant risks. We developed, implemented, and assessed a novel clinical protocol to assist ED providers with appropriate indications for placement, reassessment, and removal of IUCs in this population. This evidence-based clinical protocol was built from an extensive literature review and ED provider focus groups, then implemented by 20-minute scripted slide presentations to providers. Written surveys administered before, after, and at 6-months assessed providers baseline practice and the protocol’s impact. A quantitative analysis compared rates of IUC placement and catheter-associated urinary tract infections (CAUTIs) in the 6 months before and after protocol implementation. 111 EM providers participated in the all three surveys. Participants anticipated that this intervention would reduce rates of IUC use and increase patient safety. At 6-month follow-up, 81% felt the protocol had changed their practice. ED providers correctly identified the appropriate approach for IUC placement in 63% of cases at baseline with an increase of 22% (95% CI: 19, 25%) post-intervention and a maintained increase of 8% (95% CI: 6, 12%) at 6-months. With protocol implementation, an absolute reduction in the use of IUCs of 3.5% (P<0.001) for older adults admitted to the hospital, with 3 CAUTIs reduced to 0 attributable to the ED. Overall, this comprehensive, evidence-based clinical protocol was well received by participants, and was associated with a sustained change in self-reported practice, providing a template for future protocol development and implementation.

Biography:

Nagy A. Youssef is an Associate Professor at the Medical College of Georgia, AU. His primary academic interest include clinical, education and research in treatmentresistant psychiatric disorders especially mood disorders and PTSD and suicide prevention. He is interested in the mechanistic understanding at the environment-genomic interface and brain stimulation interventions of these disorders. He did medical school at Cairo University (Egypt); psychiatry residency and postgraduate fellowship at the University of South Alabama and Yale University; and a research fellowship at both Durham VA and Duke University. He was on the faculty at Duke University before moving to Augusta.

Abstract:

Anxiety (among several other symptoms) has been identified in one prospective study as associated with suicide risk in depressed patients early in treatment. It has been suggested that treatment of anxiety in depression with sedative/hypnotic agents, especially benzodiazepines, may decrease suicide risk. Sedative/hypnotic agents (S/H) including benzodiazepines also have depression and disinhibitory properties which might increase suicide risk. This review addresses these potential risks (and weigh it with any benefits) with regard to suicide.

Pertinent medical literature will be reviewed in depth. The review did not reveal any evidence that using benzodiazepines (or S/H) as an early adjunct to antidepressant treatment of anxious, depressed patients (or otherwise) decreases their suicide risk. There is considerable evidence that S/H produce depressant and/or disinhibitory effects in a small proportion (perhaps 5%) of people who take them. Toxicological data on suicides indicate that a majority of people who commit suicide are under the influence of S/H chemicals (including alcohol) at the time of suicide. Alternatives to sedative/hypnotics should be used if early adjunctive treatment for anxiety in depressed patients is thought to be indicated.

Biography:

Tiffany Clack is a passionate person pursing her childhood dream career in nursing. She’s dedicated to providing care to the older adult population. She obtained a Master
of Science in Nursing degree from University of Texas for Adult & Gerontological Nurse Practitioner and board certified by American Nurse Credentialing Center

Abstract:

The interdisciplinary Transitional Care team at Baylor Scott & White in Dallas, Texas is focused on readmission reduction of patients aged 65 and beyond with a primary inpatient diagnosis of Heart Failure, COPD or Pneumonia. All patients are followed by the registered nurse, licensed masters social worker (LMSW), pharmacist, medical assistant, and advanced practice registered nurse (APRN) for 30 days post hospitalization. Through our remote tele monitoring system, daily health checks are completed and reviewed by the team. High risk patients also receive APRN home visits. Several categories were identified detailing the reoccurring reasons for hospital readmissions. Reasons included patient and system level factors, sociodemographics, as well as communication challenges. Evaluating patients for the development of post-acute care risks was conducted via APRN inpatient geriatric assessment. Second, a post hospitalization telephonic assessment was completed by the team’s LMSW. From October 2015 to May 2016, 162 readmissions were reviewed. The most prevalent reasons contributing to the readmission were:

1. Patient declined services (31%)
2. Insufficient patient and caregiver education (31%)
3. Unpredicted medical emergency (10%)
4. Medication mismanagement (7%)
5. Provider initiated readmission (7%)

Our team developed an action plan that enhances communication with acute & post-acute care providers. This created a more cohesive partnership to combat readmission. In addition to reinforcing the importance of patient adherence, our team educated patients in lifestyle behavior changes. We found this to be relevant to their healthcare treatment plan which resulted in improved quality of life.

Biography:

Phyllis Wright is an assistant professor in the Nell Hodgson Woodruff School of Nursing. An Adult Gerontological Nurse Practitioner, she is the program director for primary care education and the PI on a 5 year grant to develop practitioners experienced in Veteran’s Health Care. Her area of research is 30 day readmission prevention, fiscal policy, and financial education for clinical providers to maximize population health and improve efficient delivery of care.

Abstract:

30 day readmission rates specific to heart failure have barely moved inspite of the million of dollars and energies expended for reduction in rates. The most successful programs have demonstrated a strong palliation component often instituted in acute care setting. However, recommendations for initiating palliative care in stage III and stage IV heart failure in primary care are largely ignored due to provider’s lack of time, reimbursement and metrics that families and patients understand. Developing risk stratification for families to actively complete, such that they can understand the likelihood of a 30 day readmission could be a foundation for informed decision making by provider and patient for transitions not only in care but applied to those in overall decline.

The policy makers and legislative decision makers must have activist providers at all levels to match patient interest, provider expertise, and fiscal reality in care transitions. Active studies that prove consultation services in all patient transition periods saves money in Medicare, enhances patient satisfaction and improves quality of life are needed to justify increasing reimbursement for phone, email, video and face to face services for those who engage in the decision making of the 65+ age group.

Biography:

Li Yang has been graduated from Harbin Medical University. She is a teacher of nursing with the specialties including internal medicine, nursing, social and community nursing and master’s degree in nursing from the Harbin Medical University in China. Later on she obtained her Medical degree in social medicine from Harbin Medical University with subjects “chronic disease management” and then started working in the school of nursing where she has continued his research. Presently she is working at the harbin city in china.

Abstract:

Many factors influence pre-hospital delays in the event of a stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015 and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay, behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after the intervention (P < 0.01). SPDBI, PSSCT, and SPSAT scores were significantly different between the groups (P < 0.01). The interaction between time and intervention method was significant (P < 0.01). According to multivariate repeated-measures analysis of variance, SPDBI, PSSCT, and SPSAT scores were significantly different at each time after intervention (P < 0.05). The comprehensive educational program was significantly effective in decreasing SPDBI, improving knowledge, enhancing stroke pre-symptoms alert, and reducing the possibility of pre-hospital delays.

Biography:

Beyhan Cengiz Ozyurt is currently a PhD student in Ege University department of Geriatrics and concurrently working in Celal Bayar University dept. of Public Health. She has published more than 15 papers in reputed journals.

Abstract:

This study investigated physical and financial abuse in an elderly population of age 65 and older, residing in two different settlement regions (rural and urban) of Manisa Province. The population of this cross-sectional study was 3163 elderly individuals who were living in the region of two randomly selected primary medical services (one at rural area, other at urban area) in April 2015. The sample size was calculated using the software of Epi info 7.0; thereby, 480 elderly individuals were enrolled. Each individual was randomly selected from his/her registration at the Manisa Public Health Department. All data were collected by face-to-face interview and a standardized questionnaire form, that involved sociodemographic characteristics, health and social status, Katz index was used. The rate of participation was 88.9% (n=427). All data were evaluated using descriptive analysis and chi square test. Logistic regression was used for multivariate analysis.

The mean age of the study group was 72.9±6.7. The majority of individuals (86.4%) had a chronic disease for which continuous drug administration was required, 49.6% was women, 35.1% was graduated from elementary school and 23.4% was living alone. More than 79.4% of elderly could have done daily living activities easily, less than 5% were dependant in one or more basic activities of their daily life. Elderly abuse was determined 11.3% of the study group (urban 13.0%, rural 9.6%, p>0.05). Verbal abuse was more common (10.3%). Physical abuse was 5.4% and financial abuse was 2.7%. The risk factors of elderly abuse were being 85 years of age and over, having worse perceived health status, social isolation, insufficient income and lack of accessibility in health care. In conclusion, low rates of physical and financial abuse were found in Manisa.

Biography:

Mark Yassa is a Pre-Medical student at Augusta University, GA. He majors in Medicinal Chemistry in his senior year. His research interests include Clinical Psychiatry and treatment resistant psychiatric disorders. He is a Research Assistant for Dr. Nagy Youssef at the Department of Psychiatry at the Medical College of Georgia. He assists in several studies and in the recently submitted paper entitled “Low Amplitude Seizure Therapy: Proof of Concept study in Humans” as well as in the recently published paper “Racial/Ethnic Differences in the Association of Childhood Adversities with Depression and the Role of Resilience.” Journal of Affective Disorders.”

Abstract:

Depression is one of the leading causes of premature death in the geriatric population, and one of the highest burdens of overall disability. Depression rates are around 13% in primary care settings.

Depressive episodes are still underdiagnosed and undertreated, in the primary care settings. Several factors contribute to this, including lack of detailed knowledge, lack of confidence in treatments, etc. Improving knowledge and confidence in diagnosing depression types in order to improve either treatment or referring patients to psychiatric care would help address this gap, and improve patients’ care and quality of life.

Moreover, bipolar depression can be difficult to distinguish from unipolar. Delays in recognition and referral can lead to further worsening of the disease. Bipolar depression is treated differently than unipolar depression. Improving education of future physicians in the formative years in these areas would consequently impact and improve care for patients.

Aims: 1) To assess student’s level of confidence and knowledge in diagnosing and treating depression before and after a psychiatry clerkship, and any barriers to gaps in knowledge

2) To assess students’ knowledge in differentiating unipolar versus bipolar depression and any barriers to gaps in knowledge.

We are assessing these by an online survey on a website used by Medical College of Georgia for student questionnaires, which is sent to all third year medical students after internal medicine rotation. The survey will be sent through the academic affairs office and students will be notified by email of the availability of the survey if they wish to participate.

Biography:

Nadezhda Korsakova has been graduated as Dr. Med. from Russian People Friendship University (2011), with the specialties including Neurobiology, Ophthalmology, Gerontology. She is the Laureate of State Prize of Chuvash Republic in the field of natural sciences in ophthalmology (2012). She has published more than 31 papers in reputed journals, 4 monography. She has been 7 Patents for the Russian Federation’s invention and were awarded by The Medal after name of Alfred Nobel for the contribution in inventions’ development (2012). As a result of the I All-Russian Competition she was awarded the honorary title ‘The best young Doctor of Science – 2013’

Abstract:

The aim of this study was to investigate the general somatic status and carry on a comparative analysis of the functional activity of the sympathetic and parasympathetic parts of the autonomic nervous system of a patient information of certain types of age-related cataracts. By methods of functional general clinical and ophthalmology diagnostics (P<0.05) it was found for the first time that the predominance of sympathetic effects of the autonomic nervous system and associated with it peculiarities of systemic degenerative changes in the tissues were typical for patients with age-related cortical cataract; in patients with nuclear type of age-related cataract the predominance of parasympathetic effects, triggering the emergence of degenerative changes of dissimilar nature, was revealed. Consequently, the type of forming age-related cataract can be proposed as an available clinical marker of the neurodystrophic process nature, which takes place in the patient’s organism.