European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

INTRODUCTION the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school. METHODS a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum. RESULTS the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes. DISCUSSION a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europe.

Risk factors for depressed mood amongst a community dwelling older age population in England: cross-sectional survey data from the PRO-AGE study.

BACKGROUND The Quality and Outcomes Framework in the United Kingdom (UK) National Health Service previously highlighted case finding of depression amongst patients with diabetes or coronary heart disease. However, depression in older people remains under-recognized. Comprehensive data for analyses of the association of depression in older age with other health and functional measures, and demographic factors from community populations within England, are lacking. METHODS Secondary analyses of cross-sectional baseline survey data from the England arm of a randomised controlled trial of health risk appraisal for older people in Europe; PRO-AGE study. Data from 1085 community-dwelling non-disabled people aged 65 years or more from three group practices in suburban London contributed to this study. Depressed mood was ascertained from the 5-item Mental Health Inventory Screening test. Exploratory multivariable logistic regression was used to identify the strongest associations of depressed mood with a previous diagnosis of a specified physical/mental health condition, health and functional measures, and demographic factors. RESULTS Depressed mood occurred in 14% (155/1085) of participants. A previous diagnoses of depression (OR 3.39; P < 0.001) and poor vision as determined from a Visual Function Questionnaire (OR 2.37; P = 0.001) were amongst the strongest factors associated with depressed mood that were independent of functional impairment, other co-morbidities, and demographic factors. A subgroup analyses on those without a previous diagnosis of depression also indicated that within this group, poor vision (OR 2.51; P = 0.002) was amongst the strongest independent factors associated with depressed mood. CONCLUSIONS Previous case-finding strategies in primary care focussed on heart disease and diabetes but health-related conditions other than coronary heart disease and diabetes are also associated with an increased risk for depression. Complex issues of multi-morbidity occur within aging populations. 'Risk' factors that appeared stronger than those, such as, diabetes and coronary heart disease that until recently prompted for screening in the UK due to the QOF, were identified, and independent of other morbidities associated with depressed mood. From the health and functional factors investigated, amongst the strongest factors associated with depressed mood was poor vision. Consideration to case finding for depressed mood among older people with visual impairment might be justified.

Age-dependent visual exploration during simulated day- and night driving on a motorway: a cross-sectional study

BACKGROUND: Central and peripheral vision is needed for object detection. Previous research has shown that visual target detection is affected by age. In addition, light conditions also influence visual exploration. The aim of the study was to investigate the effects of age and different light conditions on visual exploration behavior and on driving performance during simulated driving. METHODS: A fixed-base simulator with 180 degree field of view was used to simulate a motorway route under daylight and night conditions to test 29 young subjects (25-40 years) and 27 older subjects (65-78 years). Drivers' eye fixations were analyzed and assigned to regions of interests (ROI) such as street, road signs, car ahead, environment, rear view mirror, side mirror left, side mirror right, incoming car, parked car, road repair. In addition, lane-keeping and driving speed were analyzed as a measure of driving performance. RESULTS: Older drivers had longer fixations on the task relevant ROI, but had a lower frequency of checking mirrors when compared to younger drivers. In both age groups, night driving led to a less fixations on the mirror. At the performance level, older drivers showed more variation in driving speed and lane-keeping behavior, which was especially prominent at night. In younger drivers, night driving had no impact on driving speed or lane-keeping behavior. CONCLUSIONS: Older drivers' visual exploration behavior are more fixed on the task relevant ROI, especially at night, when driving performance becomes more heterogeneous than in younger drivers.

Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study

BACKGROUND General practitioners (GPs) are in best position to suspect dementia. Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) are widely used. Additional neurological tests may increase the accuracy of diagnosis. We aimed to evaluate diagnostic ability to detect dementia with a Short Smell Test (SST) and Palmo-Mental Reflex (PMR) in patients whose MMSE and CDT are normal, but who show signs of cognitive dysfunction. METHODS This was a 3.5-year cross-sectional observational study in the Memory Clinic of the University Department of Geriatrics in Bern, Switzerland. Participating patients with normal MMSE (>26 points) and CDT (>5 points) were referred by GPs because they suspected dementia. All were examined according to a standardized protocol. Diagnosis of dementia was based on DSM-IV TR criteria. We used SST and PMR to determine if they accurately detected dementia. RESULTS In our cohort, 154 patients suspected of dementia had normal MMSE and CDT test results. Of these, 17 (11��%) were demented. If SST or PMR were abnormal, sensitivity was 71��% (95 % CI 44-90��%), and specificity 64��% (95 % CI 55-72��%) for detecting dementia. If both tests were abnormal, sensitivity was 24��% (95 % CI 7-50��%), but specificity increased to 93��% (95 % CI 88-97��%). CONCLUSION Patients suspected of dementia, but with normal MMSE and CDT results, may benefit if SST and PMR are added as diagnostic tools. If both SST and PMR are abnormal, this is a red flag to investigate these patients further, even though their negative neuropsychological screening results.

Street crossing behavior in younger and older pedestrians: an eye- and head-tracking study

BACKGROUND: Crossing a street can be a very difficult task for older pedestrians. With increased age and potential cognitive decline, older people take the decision to cross a street primarily based on vehicles' distance, and not on their speed. Furthermore, older pedestrians tend to overestimate their own walking speed, and could not adapt it according to the traffic conditions. Pedestrians' behavior is often tested using virtual reality. Virtual reality presents the advantage of being safe, cost-effective, and allows using standardized test conditions. METHODS: This paper describes an observational study with older and younger adults. Street crossing behavior was investigated in 18 healthy, younger and 18 older subjects by using a virtual reality setting. The aim of the study was to measure behavioral data (such as eye and head movements) and to assess how the two age groups differ in terms of number of safe street crossings, virtual crashes, and missed street crossing opportunities. Street crossing behavior, eye and head movements, in older and younger subjects, were compared with non-parametric tests. RESULTS: The results showed that younger pedestrians behaved in a more secure manner while crossing a street, as compared to older people. The eye and head movements analysis revealed that older people looked more at the ground and less at the other side of the street to cross. CONCLUSIONS: The less secure behavior in street crossing found in older pedestrians could be explained by their reduced cognitive and visual abilities, which, in turn, resulted in difficulties in the decision-making process, especially under time pressure. Decisions to cross a street are based on the distance of the oncoming cars, rather than their speed, for both groups. Older pedestrians look more at their feet, probably because of their need of more time to plan precise stepping movement and, in turn, pay less attention to the traffic. This might help to set up guidelines for improving senior pedestrians' safety, in terms of speed limits, road design, and mixed physical-cognitive trainings.

Predicting 5- and 10-year survival in older women with early-stage breast cancer: self-rated health and walking ability.

OBJECTIVES To determine life expectancy for older women with breast cancer. DESIGN Prospective longitudinal study with 10 years of follow-up data. SETTING Hospitals or collaborating tumor registries in four geographic regions (Los Angeles, California; Minnesota; North Carolina; Rhode Island). PARTICIPANTS Women aged 65 and older at time of breast cancer diagnosis with Stage I to IIIA disease with measures of self-rated health (SRH) and walking ability at baseline (N = 615; 17% aged ���80, 52% Stage I, 58% with ���2 comorbidities). MEASUREMENTS Baseline SRH, baseline self-reported walking ability, all-cause and breast cancer-specific estimated probability of 5- and 10-year survival. RESULTS At the time of breast cancer diagnosis, 39% of women reported poor SRH, and 28% reported limited ability to walk several blocks. The all-cause survival curves appear to separate after approximately 3 years, and the difference in survival probability between those with low SRH and limited walking ability and those with high SRH and no walking ability limitation was significant (0.708 vs 0.855 at 5 years, P ��� .001; 0.300 vs 0.648 at 10 years, P < .001). There were no differences between the groups in breast cancer-specific survival at 5 and 10 years (P = .66 at 5 years, P = .16 at 10 years). CONCLUSION The combination of low SRH and limited ability to walk several blocks at diagnosis is an important predictor of worse all-cause survival at 5 and 10 years. These self-report measures easily assessed in clinical practice may be an effective strategy to improve treatment decision-making in older adults with cancer.

A novel colourimetric technique to assess chewing function using two-coloured specimens: Validation and application

OBJECTIVES Chewing efficiency may be evaluated using cohesive specimen, especially in elderly or dysphagic patients. The aim of this study was to evaluate three two-coloured chewing gums for a colour-mixing ability test and to validate a new purpose built software (ViewGum��). METHODS Dentate participants (dentate-group) and edentulous patients with mandibular two-implant overdentures (IOD-group) were recruited. First, the dentate-group chewed three different types of two-coloured gum (gum1-gum3) for 5, 10, 20, 30 and 50 chewing cycles. Subsequently the number of chewing cycles with the highest intra- and inter-rater agreement was determined visually by applying a scale (SA) and opto-electronically (ViewGum��, Bland-Altman analysis). The ViewGum�� software determines semi-automatically the variance of hue (VOH); inadequate mixing presents with larger VOH than complete mixing. Secondly, the dentate-group and the IOD-group were compared. RESULTS The dentate-group comprised 20 participants (10 female, 30.3��6.7 years); the IOD-group 15 participants (10 female, 74.6��8.3 years). Intra-rater and inter-rater agreement (SA) was very high at 20 chewing cycles (95.00-98.75%). Gums 1-3 showed different colour-mixing characteristics as a function of chewing cycles, gum1 showed a logarithmic association; gum2 and gum3 demonstrated more linear behaviours. However, the number of chewing cycles could be predicted in all specimens from VOH (all p<0.0001, mixed linear regression models). Both analyses proved discriminative to the dental state. CONCLUSION ViewGum�� proved to be a reliable and discriminative tool to opto-electronically assess chewing efficiency, given an elastic specimen is chewed for 20 cycles and could be recommended for the evaluation of chewing efficiency in a clinical and research setting. CLINICAL SIGNIFICANCE Chewing is a complex function of the oro-facial structures and the central nervous system. The application of the proposed assessments of the chewing function in geriatrics or special care dentistry could help visualising oro-functional or dental comorbidities in dysphagic patients or those suffering from protein-energy malnutrition.

GEST��O DO CONHECIMENTO: UM ESTUDO SOBRE A RELA����O ENTRE A LIDERAN��A TRANSFORMACIONAL, A CONVERS��O DO CONHECIMENTO E A EFIC��CIA ORGANIZACIONAL

Este estudo teve como objetivo principal analisar a rela����o entre a Lideran��a Transformacional, a Convers��o do Conhecimento e a Efic��cia Organizacional. Foram considerados como pressupostos te��ricos conceitos consolidados sobre os temas desta rela����o, al��m de recentes pesquisas j�� realizadas em outros pa��ses e contextos organizacionais. Com base nisto identificou-se potencial estudo de um modelo que relacionasse estes tr��s conceitos. Para tal considera-se que as organiza����es que buscam atingir Vantagem Competitiva e incorporam a Knowledge-Based View possam conquistar diferencia����o frente a seus concorrentes. Nesse contexto o conhecimento ganha maior destaque e papel protagonista nestas organiza����es. Dessa forma criar conhecimento atrav��s de seus colaboradores, passa a ser um dos desafios dessas organiza����es ao passo que sugere melhoria de seus indicadores Econ��micos, Sociais, Sist��micos e Pol��ticos, o que se define por Efic��cia Organizacional. Portanto os modos de convers��o do conhecimento nas organiza����es, demonstram relev��ncia, uma vez que se cria e se converte conhecimentos atrav��s da intera����o entre o conhecimento existente de seus colaboradores. Essa convers��o do conhecimento ou modelo SECI possui quatro modos que s��o a Socializa����o, Externaliza����o, Combina����o e Internaliza����o. Nessa perspectiva a lideran��a nas organiza����es apresenta-se como um elemento capaz de influenciar seus colaboradores, propiciando maior din��mica ao modelo SECI de convers��o do conhecimento. Se identifica ent��o na lideran��a do tipo Transformacional, caracter��sticas que possam influenciar colaboradores e entende-se que esta rela����o entre a Lideran��a Transformacional e a Convers��o do Conhecimento possa ter influ��ncia positiva nos indicadores da Efic��cia Organizacional. Dessa forma esta pesquisa buscou analisar um modelo que explorasse essa rela����o entre a lideran��a do tipo Transformacional, a Convers��o do Conhecimento (SECI) e a Efic��cia Organizacional. Esta pesquisa teve o car��ter quantitativo com coleta de dados atrav��s do m��todo survey, obtendo um total de 230 respondentes v��lidos de diferentes organiza����es. O instrumento de coleta de dados foi composto por afirmativas relativas ao modelo de rela����o pesquisado com um total de 44 itens. O perfil de respondentes concentrou-se entre 30 e 39 anos de idade, com a predomin��ncia de organiza����es privadas e de departamentos de TI/Telecom, Doc��ncia e Recursos Humanos respectivamente. O tratamento dos dados foi atrav��s da An��lise Fatorial Explorat��ria e Modelagem de Equa����es Estruturais via Partial Least Square Path Modeling (PLS-PM). Como resultado da an��lise desta pesquisa, as hip��teses puderam ser confirmadas, concluindo que a Lideran��a Transformacional apresenta influ��ncia positiva nos modos de Convers��o do Conhecimento e que; a Convers��o do Conhecimento influencia positivamente na Efic��cia Organizacional. Ainda, concluiu-se que a percep����o entre os respondentes n��o apresenta resultado diferente sobre o modelo desta pesquisa entre quem possui ou n��o fun����o de lideran��a.

Qualidade da Constru����o dos V��nculos entre Filhas Cuidadoras e M��es Idosas Dependentes

Este estudo teve por objetivos: - descrever as dificuldades nas rela����es entre as filhas-cuidadoras e suas m��es idosas dependentes de cuidados, a partir de relatos das filhas; - investigar, a partir dos relatos da hist��ria familiar dessas filhas, a exist��ncia de conflitos pr��vios a necessidade de cuidar, relacionados �� constru����o dos v��nculos; identificar os principais desafios associados assist��ncia ao cuidador familiar de idosos no que tange a resolu����o de conflitos com o idoso dependente. M��todo ��� tratou-se de um estudo qualitativo em que foram apresentados tr��s casos cl��nicos de cuidadoras que haviam sido encaminhados para atendimento psicol��gico pela equipe multiprofissional de um Instituto de Geriatria e Gerontologia, unidade de aten����o secund��ria da Secretaria de Estado da Sa��de de S.P. Os resultados indicaram dificuldades relacionais entre ambas: cuidadoras filhas e m��es idosas. As cuidadoras revelaram sobrecarga f��sica e emocional e grande sofrimento. Todavia, a exist��ncia desses conflitos remontava ��s rela����es anteriores �� atual situa����o de depend��ncia; ficando bastante evidenciado, tanto pelas hist��rias de vida das cuidadoras, quanto pelo conte��do trazido durante o processo terap��utico, a repeti����o das rela����es primeiras estabelecidas entre m��e-filha. O processo psicoterap��utico p��de permitir a essas cuidadoras a compreens��o da necessidade em ter suas falhas ambientais supridas, na medida em que foi propiciado um ambiente favor��vel ao relacionamento humano. Assim, ao observarmos que ao longo do processo as pacientes apresentavam mudan��as significativas, entendemos que a psicoterapia pode figurar como meio preventivo e preserva����o de equil��brio ps��quico.

What do older people understand by mobility-related difficulties?

Despite the centrality of the difficulty concept in the study of disability, there has been little research on its significance from the point of view of people with functional limitations. The main objective of this study was to describe what older people understand when asked about difficulty in undertaking mobility activities. As a secondary objective, we considered whether there are any differences depending on the type of activities, according to the International Classification of Functioning (ICF) mobility domains. Methods: Seventeen community-dwelling men and women aged 70 years old or over were interviewed by means of a questionnaire containing 55 items covering the ICF mobility domains. The participants responded to the items while thinking aloud, saying what led them to give a specific answer about their level of difficulty. Inductive content analysis was conducted and categories, subthemes and themes were identified. Results: Causes of difficulty (pathologies, impairments, symptoms) and accommodations (task modifications and use of aids) were the two themes identified; and their importance (and that of the subthemes included) varied across the types of activity. All the participants said that they had no difficulty in at least one task, despite mentioning changes in the way they performed them. Conclusions: Older people's opinions were consistent with theoretical models of disability and with the standard practice of measuring functional limitations by asking about the degree of difficulty; however, the design of these measures needs to be improved in order to detect perceptions of no difficulty in the presence of task modification.

Caregivers of the frail elderly : a national profile /

Item 491-B-17

Extramural training and career opportunities in aging research.

Mode of access: Internet.

Age words : a glossary on health and aging.

Mode of access: Internet.

New views on older lives : a sampler of NIMH-sponsored research and service programs /

Bibliography: p. 176-181.

OAA profile: the old age assistance client in Chicago

Mode of access: Internet.