Latest news with #geriatriccare
Irish Times
a day ago
- Health
- Irish Times
A close shave: Colm Keena on the trials and tribulations of a summer job in St James's hospital
A while ago, while telling a friend about the job I got during the summer after I left school, he appeared shocked when I mentioned that, among other duties, I'd shaved a dead man. The job was that of ward orderly in James St Hospital, Dublin. It was reasonably well paid and came with the bonus of working alongside a load of female student nurses. I was working in the geriatric wards and, still years away from having to shave myself, one of my duties was shaving the patients. This quickly became the cause of some anxiety, not for me, but for the poor patients. The equipment comprised a plastic basin, a bar of soap, a shaving brush, and a razor. After my first few outings, I added a roll of loo paper. I'd soap the men's faces, then set to work with the razor, often as the patient and I indulged in friendly banter. The problem was the nicks. I'd be shaving away and then I'd feel it, the nick, and the patient would too, as evidenced by their flinch. A dribble of blood would begin to mingle with the lather on their cheek as I tore off some loo paper and used it to stem the flow. READ MORE Sweeny Todd, one of the men kindly called me, referring to the fictional London barber who used to murder his customers. One of older wards had six to eight beds on each side of a long, wide room and I have a memory of surveying my morning's work and seeing an array of older men in striped cotton pyjamas, all with brave smiles, the shakes, and spots of bloodied loo paper stuck to their faces. I have no memory of any complaints, and a hazy view that, despite the nicks, they wished me well. Ireland, back then, was a less litigious place. As already mentioned, one of the upsides to the job was the student nurses. I was hugely shy and both delighted and terrified to be working with them. I had lots of different jobs, including giving the men baths, helping with meals, and helping the nurses with various unskilled nursing chores. One day, a few weeks into the job, a nurse came up to me and told me to stop what I was doing and go shave Mr X, who was in another ward. There were some visitors nearby and I motioned the nurse to one side and, speaking quietly, conveyed what I thought was important news. 'Mr X is dead.' She looked at me as if there was no bottom to my stupidity. 'I know he's dead. That's why I want you to shave him.' I fetched my equipment and off I went. The curtains were drawn around the dead man's bed and when I stepped inside it was just me and him. Someone had placed a ribbon around his head to hold his jaw in place until rigor mortis set in. It felt a bit weird, being there, in a tight space, with the body of a man I'd washed and fed over the previous days and weeks. But I decided to get on with it. I removed the ribbon, lathered his face, and started to shave. Pretty soon I felt it, a nick, and I stopped. But no blood emerged. Ah, I said to myself, as the penny dropped. No blood flow. And I proceeded to give him a good close shave. Curiously enough, I felt glad of the opportunity to do him the service. As I remember it, there was quite a good atmosphere on the wards, among both the staff and the patients. Everything I've seen in the years since has bolstered the idea that caring for others, and thereby not having the time to fixate on your own needs, makes humans happy. When doing so as a team, this creates its own, special atmosphere, so that even those receiving the care are positively affected. Or so it seems to me, Sweeny Todd.
Yahoo
17-06-2025
- Health
- Yahoo
New JNCCN Study Showcases how Telehealth Helps Overcome Geographic and Resource Gaps in Cancer Care Globally
Older adults with cancer in Brazil showed better outcomes with telehealth in first-ever randomized trial of comprehensive geriatric assessment and management outside a high-income country. PLYMOUTH MEETING, Pa., June 11, 2025 /PRNewswire/ -- New research in the June 2025 issue of JNCCN—Journal of the National Comprehensive Cancer Network found that older people with cancer had better daily functioning, improved mood, stronger illness understanding, and a higher quality of life if they participated in a telehealth-based care program called Geriatric Assessment-Guided Intervention-Supportive Care (GAIN-S). GAIN-S' supportive care services included personalized fitness training, nutritional support, psychiatric care, and psychosocial assistance, all delivered remotely. The randomized clinical trial focused on 77 adults aged 65-and-older undergoing treatment for a metastatic solid tumor between June 2022 and July 2023 in Brazil. The care providers in the study were primarily located in high-population urban areas, while most patients lived in remote or underserved parts of the country. The patients who participated in the GAIN-S telehealth program demonstrated significant improvement in all measured areas after three months. "Instead of requiring older patients to travel long distances for tailored and specialized care, we brought the expertise to them—ensuring equity in access regardless of geography," said senior author William Dale, MD, PhD, City of Hope, a national U.S. cancer research and treatment organization headquartered in Los Angeles. "It was a win-win for patients, families, and providers, bringing this growing standard of care to many more people using the available resources in an efficient way." "This is especially important in countries with substantial geographic and resource gaps, like Brazil and remote areas in any country," said lead author Cristiane Decat Bergerot, PhD, Oncoclinicas&Co of Sao Paulo. "By bringing supportive care approaches to patients at the beginning of their cancer care journey, we can significantly improve the experience, communication, and outcomes of patients' lives." WhatsApp was used for scheduling appointments and obtaining informed consent for the GAIN-S group. This enabled the team to automatically encrypt messages and have the option to make them disappear after 24 hours for added security. "Social media can be used for anything, including now Comprehensive Geriatric Assessment and Management (CGAM)," commented Martine Extermann, MD, PhD, Moffitt Cancer Center, who was not involved with this research. "Randomized clinical trials have established CGAM as the standard of care approach for optimal outcomes in older patients with cancer and are recommended in the NCCN Guidelines® and others. But CGAM has long been considered a 'niche' activity limited to large academic cancer centers. An increasing number of studies show it can be implemented in a broader practice setting, and now in low- and middle-Income countries as well. Let us spread the benefits of it!" Dr. Extermann wrote a full response to this study, which is also running in the June issue of JNCCN. To read the entire study "Telehealth Geriatric Assessment and Supportive Care Intervention (GAIN-S) Program: A Randomized Clinical Trial" and the corresponding "The Last Word" commentary, visit About JNCCN—Journal of the National Comprehensive Cancer NetworkMore than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside/BroadcastMed. Visit To inquire if you are eligible for a FREE subscription to JNCCN, visit Follow JNCCN at About the National Comprehensive Cancer NetworkThe National Comprehensive Cancer Network® (NCCN®) is marking 30 years as a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to defining and advancing quality, effective, equitable, and accessible cancer care and prevention so all people can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus-driven recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit for more information. Media Contact:Rachel Darwin267-622-6624darwin@ View original content to download multimedia: SOURCE National Comprehensive Cancer Network Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Medscape
09-06-2025
- Health
- Medscape
Managing Weight in Older Adults Isn't About Weight at All
While weight loss is often the goal of weight management, weight management in older adults should go beyond weight loss to focus on functional health outcomes, comorbidity improvements, and harm reduction. Beverly Tchang, MD Weight management in older adults requires greater mindfulness and clinical nuance than in younger populations, owing to the increased risk of potential harm. Aging is commonly accompanied by a rise in medical complexity — older adults are more likely to live with multiple chronic conditions and to take several medications, which adds important layers of consideration when pursuing weight loss interventions. Over 50% of older adults have three or more chronic diseases. These overlapping conditions demand coordinated, multidisciplinary care. Within this context, clinicians must consider how meaningful weight loss might improve obesity-related complications, while also weighing the potential for unintended consequences that can arise from rapid or unmonitored changes in health status. Polypharmacy is a common concern in geriatric care and adds to the complexity of weight management. Among adults aged 65 and older with Medicare insurance, the median number of prescription medications was four. Older patients may be prescribed medications associated with potential weight gain, such as first-generation antihistamines or beta-blockers. Polypharmacy not only increases the risk of adverse drug-drug interactions but also necessitates vigilant monitoring during weight loss, particularly when medications are weight-dependent. A case report on thyrotoxicosis in the setting of 30% weight loss with tirzepatide highlighted the importance of adjusting weight-based medications like levothyroxine. Because obesity is the root cause or contributor to several other cardiometabolic diseases, obesity treatment has been demonstrated to improve several weight-related consequences. The Look AHEAD trial of adults with type 2 diabetes reported an average 8.6% weight loss and associated improvements in blood pressure, lipid profiles, and glycemic status. Obesity pharmacotherapy advances, which now grants access to 15%-20% weight loss thresholds, have been associated with de-escalation of antihypertensive and lipid-lowering therapies. In a secondary analysis of trials for semaglutide 2.4 mg, 34% vs 15% of participants experienced a discontinuation or dose reduction in their anti-hypertensive medication, while maintaining normal blood pressures. While such observational data is insufficient to establish recommendations, they implore attention: As weight loss is achieved, medication regimens should be regularly reviewed for potential deprescribing to reduce the risk of overtreatment, adverse effects, and polypharmacy-related complications. Beyond cardiometabolic disease, sarcopenia— the age-related decline in muscle mass and function — is another critical consideration. Clinicians should focus on evidence-based nutrition and physical activity recommendations demonstrated to preserve lean mass and function. Higher protein intake has been consistently demonstrated to preserve lean mass or improve body composition in the setting of weight loss. High protein diets (ie, greater than 0.8 g/kg/d) are commonly recommended alongside a progressive strength training program. In a weight loss study of adults with obesity, participants were randomized to a high protein supplement vs an isocaloric supplement and participated in a resistance exercise program 3 times/week for 13 weeks. While weight loss and fat mass loss between groups did not differ, those on the higher protein supplement (1.1 g/kg/d of protein) gained 0.4 kg +/- 1.2 kg of appendicular muscle mass while those on the isocaloric supplement (0.85 g/kg/d of protein) lost 0.5 +/- 2.1 kg ( P =.03). Similar studies focusing on resistance training have replicated these benefits across studies. A systematic review and meta-analysis of six randomized controlled trials that enrolled older adults with obesity compared weight loss via caloric restriction alone vs weight loss via caloric restriction plus resistance training; resistance training reduced 93.5% of the lean body mass loss associated with calorie restriction. Additionally, the strength-to-lean body mass ratio improved when resistance training accompanied calorie restriction compared to calorie restriction alone (20.9% vs -7.5%). However, muscle preservation is only half the story. Bone health is an equally important concern during weight loss in older adults. Rapid or sustained weight reduction can have unintended effects on bone density, which in turn can increase the risk of fractures. Few studies have examined the incidence of fracture rate after long-term and sustained weight loss. In the aforementioned Look AHEAD study of adults with type 2 diabetes, no significant difference in incident fracture rate was observed over a median of 9.6 years (373 participants randomized to intensive lifestyle intervention vs 358 randomized to standard diabetes education), but a composite of the first occurrence of a hip, upper arm, or shoulder fracture was found to be 39% higher in the intervention group. Long-term outcome studies examining risk of fractures with medical weight management have not been conducted, but the increased risk of fractures observed among individuals who have undergone bariatric surgery informed guidelines to recommend earlier, repeated osteoporosis screening and higher vitamin D supplementation to optimize bone health. Overall, obesity management in older adults requires a careful and tailored approach that is attentive to comorbidity management and that prioritizes risk mitigation. Increasingly, the effects of obesity on all aspects of a person's quality of life is being recognized, and patients should be informed on how weight loss may interact with coexisting medical conditions, medication regimens, and musculoskeletal health. Clinicians who treat obesity in older adults should be prepared to manage patients across these intersections, or coordinate care with registered dietitian-nutritionists, exercise physiologists, endocrinologists, and primary care professionals.
Yahoo
18-05-2025
- Health
- Yahoo
Boomers have a drug problem, but not the kind you might think
Baby boomers – that's anyone born in the U.S. between 1946 and 1964 – are 20% of the population, more than 70 million Americans. Decades ago, many in that generation experimented with drugs that were both recreational and illegal. Although boomers may not be using those same drugs today, many are taking medications, often several of them. And even if those drugs are legal, there are still risks of interactions and side effects. The taking of multiple medications is called polypharmacy, typically four or more at the same time. That includes prescriptions from doctors, over-the-counter medicines, supplements and herbs. Sometimes, polypharmacy can be dangerous. I am a geriatrician, one of only 7,500 in the U.S. That's not nearly enough to accommodate the surging number of elderly boomers who will need medical care over the next two to three decades – or help in dealing with the potential problems of multiple drug use. We geriatricians know that polypharmacy isn't always bad; multiple medications may be necessary. If you've had a heart attack, you might be on four medications or more – beta-blockers, ACE inhibitors, statins and aspirin, for instance. And that's appropriate. But about half of older adults take at least one medication that's not necessary or no longer needed. Doctors need to periodically reevaluate to make sure each medication is still right for the patient and still the correct dose. During treatment, the patient's weight may fluctuate, either up or down. Even if it stays the same, body composition might change; that occurs as people age. As a result, one may react differently to a drug. That can happen even with a medication a person has been on for years. Polypharmacy often means higher health care costs and more drug interactions. Patients are more likely to miss medications or stop taking them altogether. Sometimes, physical activity diminshes; falls, cognitive impairment, malnourishment and urinary incontinence increase; there may be less ability to do daily tasks. Those on five or more medications have a much higher incidence of having an ADE – an adverse drug event – compared to those using fewer meds. Making matters worse, the symptoms of polypharmacy are sometimes masked and taken as signs of aging. Studies have suggested solutions, with better coordination among care providers being one. Making the pharmacist an integral part of routine care is another. The increasing use of electronic patient records helps. So do smartphone apps, sometimes an easier way for patients and providers to connect. But so far, there's no magic pill, and as researchers and clinicians investigate improvements, much of the burden remains on patients and their families. There are steps you can take to stay safe, however. Regularly clean out the medicine cabinet and get rid of expired medicines or those you're no longer taking. Either throw them away or ask your doctor or pharmacist about the best way to dispose of them. When seeing the doctor, bring in the meds you take and review each one in detail. Make certain you need to continue taking them all and verify the right dose. You can also check the PIMs list, also known as the Beer's List. Published by the American Geriatric Society, it's an index of medications potentially harmful to the elderly. Some are linked to increased risks of side effects, and not a few are sold over-the-counter without prescription. That includes medicines containing antihistamines like diphenhydramine, or Benadryl. In the elderly population, Benadryl carries an increased risk of dizziness, confusion and urinary retention. Medicines that are part of the NSAID family (nonsteroidal anti-inflammatory drugs) are also on the list. In some elderly patients, they can cause high blood pressure or kidney failure. Commonly used medicines in the NSAID family are those containing ibuprofen or naproxen. Just because a medicine is on the Beer's List doesn't mean your doctor was wrong to prescribe it, or that you should stop using it. Instead, use the medication with caution and discuss with your doctor to make sure you need it. Determine with your doctor the lowest useful dose, monitor for side effects, and speak up if you have any. As a geriatrician, I see patients in an outpatient setting, either as their primary care provider or as a specialist consultant. We review medications at every visit: the list, the dose and how often the patient is taking it. A true and accurate medication list is the critical first step in geriatric care. This is especially important during care transitions, such as when a patient is coming out of the hospital or nursing home. Particularly at that time, we find out if the patient is using the medication as prescribed, or taking it more frequently or less or not at all. Which leads to my final piece of advice: If you've strayed with your meds, one way or another, know that we doctors don't judge or punish patients. Just tell us the truth. That's all we want to hear. Then we can move forward together to find the best regimen for you. This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Laurie Archbald-Pannone, University of Virginia Read more: To tackle gendered violence, we also need to look at drugs, trauma and mental health Do we really need to burp babies? Here's what the research says What are heart rate zones, and how can you incorporate them into your exercise routine? Laurie Archbald-Pannone is affiliated with American Geriatrics Society.
