Geriatrics

I agree with the previous recommendations and wanted to add one other consideration. While your primary outcome / objective should drive the choice of specific measurement tailored to your setting and your population,  your secondary outcomes provide a means for additional measures.  Within that sphere consider adding another measure(s) being used in contemporary major studies in your field to allow future outcome comparisons across studies to advance the science of local, national, and cross cultural understanding.

Dear Julia,

If the SPPB is being performed in an acute phase after hip fracture it's understandable the difficult of the patients, and it will be biased as a measure of sarcopenia. I believe that handgrip strength is a good alternative as suggested above.

Kind Regards,

Alessandra

Thank you very much for your answers.

I will specify my question a little further. The above mentioned apps are great programs, but are not intended for research. Therefore they are less suitable for this project.

My idea is to give each admitted patient a tablet during admission. During daytime every hour from start the patient should receive an alert and the NRS should appear on the screen. The patient can select the relevant pain score for that hour, after which the program closes until the next hour point.

I was wondering if such an app exists.

WHO SAGE Waves 1 and 2 include gait speed (normal and rapid pace) and ethnicity/race variables - for China, Ghana, India, Mexico, Russia and South Africa - you are welcome to examine this information at:

http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog

Kathryn, 

I am developing my prospectus for my dissertation that examines the link between physical activity and cognitive function, trying to predict future trends within the U.S. population. As far as the question, my guess would be it depends on which setting offers the most activity for the patient. Go to the individual website for each one may shed some insights.  If you compared the number and types of activities and then compared medical records of patients. Or even ask the staff from each site how their facility impact their patients' health. I am curious as to which setting provides the most activity and independence. Perhaps examining this might lead to an intervention in the design of various facilities.  Even the location such as an urban and a rural setting could impact how much activity an individual might get, as well as the design of the built environment.  My guess, just having an area to walk in could make a difference (some place that is safe and accessible).  So if they offer a gym or a built-in track that could make difference.  Then there is the social aspect of being active as well. 

Jonathan 

The first issue is coming...

You can reach the "ahead of print articles".

http://agingandlongtermcare.com/jvi.aspx?pdir=jaltc&plng=eng&list=inpress

Best

http://web.stanford.edu/dept/psychology/bandura/pajares/014-BanduraGuide2006.pdf

Dear Colleague,

this is a recent article that weighs up the importance of promoting in-hospital mobility while simultaneously avoiding/preventing falls. Hope this could be useful.

Best regards,

    P. Mazzola

Trahan, M. A., Kahng, S., Fisher, A. B., & Hausman, N. L. (2011). BEHAVIOR-ANALYTIC RESEARCH ON DEMENTIA IN OLDER ADULTS. Journal of Applied Behavior Analysis, 44(3), 687–691

you can find more literature in behavioral gerontology special interest group website

https://bgsig.wordpress.com/resources/publications/

kind Elisa,

maybe the old [Spanish !] work might be useful to you

sorry that the normative Italian data are available in the web only as abstract

best regards, Mauro

Thank you for your response.

study attached

I agree with Ratna Prakash

Dear Marianna,

the World Alzheimer Report might be helpful too:

Prince M, Wimo A, GuerchetM, Ali G-C,Wu Y-T, Prina M.World Alzheimer Report 2015: The Global Impact of Dementia: An Analysis of Prevalence. London, England: Alzheimer’s Disease International; 2015.

It is very interesting discussion  for me too. I'm working on a doctoral dissertation on the topic of Protection of human rights and quality of life of elderly people through the institution of advocacy. Slovenia does not have the institute of advocacy for elderly people, and I think that his acquisition coud be a major step forward for the elderly.

Thank you, yes.  Best wishes to you in your work!

Thank you very much Mr.Glenn

Thank you for your answer.

Thank you!

Good Morning:

I agree with Barnabas.

I think this article is important too.

Chad Boult, Steven R. Counsell, Rosanne M. Leipzig and Robert A. Berenson.

The Urgency of preparing Primary Care Physicians to care for Older People with Chronic Illnesses.

Health Affairs   May  2010 vol 29 nº 5  811-818.

Sincerely.

Diana from Perú.

Thank you Dear dr. MN Alhajj.

Those interested may watch this TED Talk:

http://www.ted.com/talks/dan_buettner_how_to_live_to_be_100

Gives a lot of insights into living long.

I agree with you

The New Open Systems Model Memory Loss In Older Adults Related PDF's

General Tips for Improving Face-to-Face Communication With Older Adults. Tips for ... key points. 8 Ask open-ended questions and genuinely listen. ... with older adults, consider switching to models ... sensory loss, decline in memory, slower processing of ..... Gordan-Salant S. Hearing loss and aging: new research.

Hi 

Yes the latest published one is from 2010, however you can find the data from http://qof.digital.nhs.uk/ as gp collects the data around prevalence of hypertension

data : http://www.content.digital.nhs.uk/catalogue/PUB22266

Regards

Hi

nursing journal of Isfahan University of Medical Siences probabaly will pbublish your study

 I agree with Jean-Pierre. <31.0 cm is the standard cut-off point, and this is the cut-off point of the commonly used Mini Nutritional Assessment. 

http://www.mna-elderly.com/forms/mna_guide_english_sf.pdf

Cheers,

Elsa

The Katz Index can be used as a Measure of Activities of Daily Living (ADL). The index has been described as a valid and reliable measure to determine independency level in performing activities of daily living [1]. The assessment is based on the ability to perform an activity without assistance from another person. The Katz Index of ADL includes six basic activities of daily living (BADL): bathing, dressing, toileting, transferring, continence, and feeding. The ability in performing each activity is assessed using a two-point categorical scale: 1= independence and 0 = dependence. The total score ranged from 0 (low function, dependent) to 6 (high function, independent).

1.         Brorsson B, Asberg KH. Katz index of independence in ADL. Reliability and validity in short-term care. Scand J Rehabil Med. 1984;16(3):125-32.

I'm looking into the effectiveness of caffeine, especially when ingestion after creatine supplementation on anaerobic power and isoenzyme creatine kinase in male athletes. is there anyone that could enlighten me on this subject?

Comorbidity, Frailty assessment, Medications and patient's views should be consider along with the age, I believe. Here is a presentation from BGS meeting, 

 http://www.bgs.org.uk/powerpoint/16spring/sharma_vishal_chest_pain.pdf 

Sincerely

Thu

Thank you, Krzysztof, and perhaps I might clarify that cancer is in this mix of potential correlatives only because it seems to have been argued that telomerase introduction appears to pose or increase a risk of immortalizing cells that pose a danger to healthy aging. Perhaps a future respondent here will enlighten us by citing an accessible paper describing research that, in the words of Andrews and Cornell, would show that "a pharmaceutical telomerase activator would be more likely to prevent cancer than to cause it." 

Arthur, my answer is 'no'. Especially if they are on polypharmacy

https://www.researchgate.net/publication/279959831_Effect_of_garlic_on_the_health_and_performance_of_broilers

Plase see this paper:
de Souza Barbosa JF, Zepeda MU, Béland F, Guralnik JM, Zunzunegui MV, Guerra RO. Clinically relevant weakness in diverse populations of older adults participating in the International Mobility in Aging Study.
Age (Dordr). 2016 Feb;38(1):25. doi: 10.1007/s11357-016-9888-z. Epub 2016 Feb 11.

I use the Rikli & Jonesw senior Fitness test to have an comparison what the possibilities are of people of the same age and wath people with demnetia are capable to. Than tehre are people how has an great difference with people with the same age and often has lie that in endurance and balance , but there are alos people with dementia that are capable to hold the level of there age. But overall all people with dementia can move lesser than she should accoring the age .

Succes 

jan van de Rakt

Accepting the consistency of Your Scientific Project and thinking of comprehend the intentions, objectives and purposes of Your Research, I understand it as a project of huge human ambition, both at hominization level as of the humanization of people.
The expansion and human concretion of such a project, being hypercomplex at theoretical and scientific level is, even more, in terms of its practical and concrete implementation.
                1- Early on the working Man should, psychological, affective, emotional, and concretively be prepared for retirement or third age.
                2- The implementation of such a project would become a time bomb or a radical revolution in liberal societies, of pure liberalism or of capitalist neo-liberalism.
                3- At liberal societies / capitalists, organized according to the maximization of economic profit and products sales, it does not matter because wherewithal leave no freedom for man, but only constraints, rigid roles and forced tasks in achieving the objectives, economic and financial profits.
                4. The reach and concretion of the objectives it proposes should be prepared in the interiors of companies, institutions and work organizations. The techniques of such preparations of individuals should make the human live in Himself, reorganize and experience his psycho- corporal Ego, develop their potential emotional investments and rapture in the experiences of their affections. Techniques of Neurolinguistic programming (NLP), BrainGym, Transcendental Meditation, Yoga, etc., etc., will be techniques of efficient mediations.
However, behind all this, and, leading such a behavior of work societies, it is necessary the existence of a Human Philosophy applied to the world of economics, finance and work and a Humanistic Psychology, focused on dimensions and achievements of harmonies and overall accomplishments of man. In Western cultures societies and of robotization tasks and work functions such does not exist in practice. It´s urgent a different hominization process of the entire individual and a different philosophy of education at work and for work.

Hello Wayne,

Here are several other articles you may find helpful if you're still looking for more. Sorry I couldn't locate the pdfs of the first two. From what I've read and from my own clinical experience self-management seems equally effective for older adults as for younger ones. Actually, in clinical experience, I have found older adults to show greater engagement in their self-care.

Best regards,

Leisa

Carnes, D., Homer, K. & Miles, C. (2012) Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review. The Clinical journal …, pp.1–4. Available from: <http://journals.lww.com/clinicalpain/Abstract/2012/05000/Effective_Delivery_Styles_and_Content_for.11.aspx> [Accessed 25 October 2014].

Keefe, F.J., Porter, L., Somers, T., Shelby, R. & Wren, a V (2013) Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. British journal of anaesthesia, 111 (1), pp.89–94. Available from: <http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3690316&tool=pmcentrez&rendertype=abstract> [Accessed 16 November 2014].

Nicholas, M.K., Asghari, A., Blyth, F.M., Wood, B.M., Murray, R., McCabe, R., Brnabic, A., Beeston, L., Corbett, M., Sherrington, C. & Overton, S. (2013) Self-management intervention for chronic pain in older adults: a randomised controlled trial. Pain, 154 (6), pp.824–35. Available from: <http://www.ncbi.nlm.nih.gov/pubmed/23522927> [Accessed 25 December 2014].

So great clues for me. Thank you very much, Dr. Joseph. I will check these research carefully.

What are   "non-urgent ED visits " ? This should be specified  first ,. 

I agree with Michele  G  that involvement of primary care general practitioners is crucial but regretably their knowledge in basic geriatrics is limited,

In relation to the upper age segment, one innovation found in some countries has been the abolition of mandatory retirement (including in the USA, UK, Canada and New Zealand). This has placed constraints on the ability of employers to retire off individuals on the basis of their age alone. In addition, pension reforms in countries including the UK and US have made it easier for individuals to take their pensions and continue working. These changes were hoped to facilitate continued employment; they are discussed in this chapter:

https://www.researchgate.net/publication/292931455_Working_Beyond_Retirement_Age_Lessons_for_Policy

I found some very useful information on age-equivalency of mice and humans on the Jackson Lab website for their research labs.

Figure v3 at https://www.jax.org/research-and-faculty/research-labs/the-harrison-lab/gerontology/life-span-as-a-biomarker.  Based upon maturational and senescence changes, they suggest that mice are mature adults from 3-6 mo, middle aged from 10-14 mo, and old from 18-24 mo, with 50% surviving to 28 mo.  They also have a table comparing maturational rates at different mouse ages relative to humans.

There are certain guidelines or goals that are universal when managing any patient with respiratory failure and those are ensuring adequate oxygen to the tissues and that is accomplished with adequate hemoglob88 - 90%in and a oxygen saturation of at least 88 - 90%,  There are differences when managing ventilator settings as far as the different pathologies.  We need to understand these to try and prevent barotrauma or make it harder to get our patients off the ventilator.  In Asthma patients we need to remember that these patients have sever airflow obstruction and we may need to allow permissive hypercapnia in order to give them enough time to exhale and ovoid stacking breaths and creating AutoPEEP.  This is also true with severe COPD.  Managing all patients that require mechanical ventilation is improved by being able to assess and adjust the ventilator settings to the individual patient needs.  When you know or can assess the underlying pathology or the reason for mechanical ventilation it does help with initial settings and adjustments.  The other change based on recent literature is that there is danger when giving supplemental oxygen when the SpO2 is greater than 95%.   

Hello  Hemal,

I agree with the previous answer, and I believe that CTB can help patients to perform better after surgery.  A paper from 2014, indicated that after decrease in pain and disability (after surgery) was associated with a reduction in catastrophizing and kinesiophobia. In other words, fear of pain (particularly pain), may be the main reason most patients who will not participate Actively in Rehabilitation Protocol after surgery are the ones showing higher levels of kinesiophobia.

During my clinical work in a multi-disciplinary centre, our rehab group identified some patients who performed poorly after surgery. The approach from our OTs were very helpful, not forgetting that family did play an important role.

During our rounds, we had the opportunity to discuss whether patients should be asked about previous experiences with pain and surgery and how long it took for their complete recovery. The number and quality of research suggesting whether prior intervention (CTB) would be effective are very rare. But, I can tell you that those who indicated long recovery after previous joint surgery or any surgery that resulted in some pain or difficulty to be mobile were the ones presenting long term recovery after TKR or THR. Yes, we could not intervene before surgery as we did not have the resources, but because we already expected hard recovery from these patients, our approached was different and that helped to improve and accelerate their recovery and discharge from hospital.

All the best on your research and clinical work,

Dear Kamary, you're quite right: PA's training is a core issue, both from literature and by my work experience

best regards, Mauro

Thanks for your suggestions. I organized and will direct a workshop on the topic during the next forum on long-term care to be held in Bologna on 18 and 19 November 2015. The title is: The quality of life in the nursing homes: appropriateness, perception, communication. An empirical survey.

This review may be of interest: 

http://www.ncbi.nlm.nih.gov/pubmed/23740610

(Skelton et al., 2013. Environmental and behavioural interventions for reducing physical activity limitation in community-dwelling visually impaired older people. Cochrane Database Syst Rev. 2013 Jun 5;6:CD009233. doi: 10.1002/14651858.CD009233.pub2).

What doe you mean APRN and what do you mean by geriatric? Do you mean older than 50? I think you mean advanced nurses but I reckon that the nurse has to be holistic in the true sense of the word and to know the person in front of her and then she or he can work well with an older adult particularly if the person has dementia.

I have written two papers around this question.

The CSNAT has been successfully trialed in Australia and this has been reported in three publications early this year (below). A copy of the tool can be obtained from Gail Ewing: ge200@cam.ac.uk

Aoun SM, Grande G, Howting D, Deas K, Toye C, Stajduhar K, Ewing G. The
impact of the Carer Support Needs Assessment
Tool (CSNAT) in community palliative care
using a Stepped Wedge Cluster Trial. PLos One
2015;10(4):e0123012. DOI:10.1371/
journal.pone.0123012

Aoun SM, Deas K, Toye C, Ewing G, Grande G,
Stajduhar K. Supporting family carers to
identify their own needs in end of life care:
Qualitative findings from a stepped wedge
cluster trial. Palliative Medicine 2015;29(6):
508–17. DOI:10.1177/0269216314566061

Aoun SM, Toye C, Deas K, Howting D, Ewing G, Grande G, Stajduhar K. Enabling a family carer-led assessment of support needs in homebased
palliative care: Potential translation into
practice. Palliative Medicine 2015 April 20; Epub
ahead of print. DOI:10.1177/0269216315583436

Andrew,

The key is to find the brackets for convergent validity (maybe .7 is good) as it should not be too high as well because then someone may question the need for establishing a new questionnaire if already existing one is functioning pretty well on its own.

Hope it helps a bit and good luck

just a quick note, thinking of the floors of the bathrooms aside the rooms in the rehab ward I lead: contrasting yellow and dark gray ... best regards, Mauro Colombo

Thank you Dr. Bianchi.

Yes it is true, because you get poorer when you grow older and cannot visit the doctor so often. 

In my opinion, aging demands a parallel specialization of that achieved for 'gold-standard' adulthood or development, in order to cover the lack of deep knowledge in a big number of critical questions. It's a must. Endocrinology, similarly to psychogeriatry, are the first in line that should take that challenge as an imperative goal to achieve in an aging world.
Suggestion: COST Action and similar international committees can play a role to rise awareness and gather together people interested to develop the wide array of tools needed to update the field in a proper, specialized way.

You should exactly the following items:
  Which function do you want to check? Physical? Mental, cognitive? Social?
If your goal physical performance. There are many tests to assess this area. Do you want to check the overall performance or specific areas such as balance you consider?
These tests generally can be divided into two groups.
Assessment by observation: Sppb, Berg Balance Scale
Self-reported assessment by: Lawton, Barthel index
  The exact target you can choose the kind of tools do help a lot.

The Push tool allows you to monitor how it is healing, so could predict likelihood, not aware of a tool designed specifically for this purpose

Update: "Time to sign the Open Letter" is the head of a new call for support for this initiative, published on EUroScientist:

http://blog.euroscientist.com/time-sign-open-letter/

"During the last six months, you signed the European petition “They have chosen Ignorance”. Today, we think that an ideal occasion has arisen to make our protest more visible – we propose to read it at the Bologna Ministerial Conference, which will be held in Yerevan, Armenia, on the 14th and 15th of May 2015.

The Open Letter, launched in October 2014, has since received considerable support from more than 18 000 individual followers and over 40 research organizations (with more than 100 000 affiliated members). This is the right moment to spread the petition to your colleagues who may not yet have had the opportunity to sign it, thereby increasing the number of signatures before it is presented in mid-May.Nevertheless, this will by no means be the endpoint of the petition, just a milestone on the road of European scientific workers who are acting collectively for the future of science in Europe."

[...]

Thanks everyone for your answers. Hope we can start quickly and publish soon the results! I am crossing my fingers!

From a personal perspective, when my mother was diagnosed I asked the consultant not to use the term 'dementia' as she had a sister whom she had seen deteriorate with the condition and the term scared her.  She was fine with 'memory problems', in fact she said she couldn't remember having memory problems, which is now a family joke.  She has been on donepezil for over 10 years and although her family have known that she has dementia for even longer, she seemed happier never being faced with the dementia word.  This is only our personal experience, and I don't have the background to recommend this for others.  But I do strongly feel it was right for my mother. 

Thank you Mdm Sanchitaji, can you send a sample tool with a picture. Thank you so much for your time and suggestion  

Search 'E280A Presenilan-1 mutation carriers'

A significant decline in the ability to perform dual tasks has been linked to carriers.

Mutation may be a marker to detect Alzheimer's Disease up to 5 years before any symptoms appear.

If you are seeking sources on ways to help older persons transition to retirement, there are many studies on retirement, The Third Age, successful aging, the young-old. A good article to start off would be: 

Ekerdt, David. (2010). Frontiers of Research on Work and Retirement

            The Journal of Gerontology: Psychological Sciences, 65, Pp. 69-80. 

Ekerdt provides a good overview of the field (up to 2009) and a great bibliography.

For literature targeting a lay audience, check out:

 Helen Dennis’s Reading List on Successful Aging: http://emeriti.usc.edu/programs/reading_list/

There are scales that measure INDEPENDENCE, not "dependence."  From these measurements, we determine if the older adult is able to live in the community or does that person require assistance?  ADL, IADL, Frailty Wheel, GDS-SF, Nestle Nutritional Assessment, and add a cognitive assesment such as SLUMS or GP-COG Modified.  Also, if the individual drives, a driving assessment is in order [with simulator].  These assessments must be conducted by an experienced and qualified geriatrician [not a novice or student].  They are available from PAR.  If they approve you to buy them, you can administer them.  Don't be tempted by using bootleg copies, as it could really get you into trouble.  Jan Vinita White, PhD Gerontologist

In the UK they are and have published much on the CDC through their local councils as they are in control of the budgets and home care funding 

Measauring the age-derived bone mass losses at the distal fibula should be useful for sure to know about the metabolic status and turnover of that bone region; but it should be difficult to ascribe any biomechnical role to the obtained data. Little is known about the way the lower end of the fibula works. For sure it can undergo some compression, especially during foot eversion and depending on the position of the foot and ankle. However, that region can also undergo some traction during the foot internal flexion (plant looking inside), while bone mass measurement is only meaningful when it can be mechanically related to some kind of stress analysis. For the worse, the (human) fibula is normally subjected to lots of bending and torsion stresses which, together with the (relatively smaller) compression loads it supports, configurate a very complex pattern. Bone (trabecular) mass determinations at the distal end by HR-QCT should afford little or no information the status of the bone's strucure concerning those kinds of mechanical behavior, and hence it would provide little help to diagnose bone fregility (i.e., to properly diagnose osteoporosis).

Anyawy, it would be quite interesting to know about bone losses at the fibula distal end in aging individuals, just for descriptive purposes and comparison with other bones. In this regard, you will surely find something by using HR-QCT.

Dear Daniel, I think your question per se is wrong. You cannot convert a score from one rating scale into a score from another rating scale. If you have scores from two different scales you can compare them by transforming the scores into z-scores.

This is not a clear question. You first ask about the social impact, which implies the cost to society, then you ask about hospital, primary care, and families. Each represents a different perspective. It is also not clear what you mean by futile? Are you referring to end-of-life care?

Please restructure the question so that we understand exactly what you are asking.

Hi you may also consider to use the sitting rising test that was developed in our lab.  The is a video explaining it at YouTube.  The srt scores had been shown to be a good psychotropic of all cause mortality for those aged 51 to 80 years old. This study was published in the European journal of preventive  cardiology.  

I have some reviews of generic assessments that cover the domain participation of the ICF. I will leave them here and hope u can use them. I am writing a paper about assessments, all linked to the ICF, that measure the participation level with people who have had a lower limb amputation so maybe some of the information can be used with elderly..

Thank you, I will keep that in mind.

Cognition levels decrease with agility.so neuro imaging markers or plasmaprotein markers can be of help.

http://dx.doi.org/10.1016/j.cger.2013.07.006

http://dx.doi.org/10.1007%2Fs11920-013-0360-9

Plasma protein biomarkers of the geriatric syndrome of frailty article in pubmed might be of help

Hi there.

an initiative funded by the Canadian gouvernement and art leasrt in part performed by ICES looked at the prevalence of different neurological diseases, from population studies, survey data and administrative data. Maybe this link could help:

http://www.phac-aspc.gc.ca/publicat/cd-mc/mc-ec/section-3-eng.php#tab3-6

The key is probably the " case manager"  which  , as mentioned above by Joanne ,

is now evolving . Pilot projects as to the responsabilities of this position will probably

give results and recomandations in about 5 years,

http://articles.economictimes.indiatimes.com/2013-01-11/news/36279823_1_new-survey-senior-citizens-security-precautions

http://goo.gl/t7ci03

Gives info on a commercial study in Indian cities

Thanks a lot to all of you for your helpul answers and references. I'm glad to confirm that we're doing it ok, at work we usually consider the cognitive baseline, functional decline and clinical history but we wanted to know if there were any specific tools designed for that. Mainly because sometimes our patients have so severe impairments derived from TBI that is difficult to assess any worsening. Thanks again

This article discusses  age and experience in production of journalism - and difficulties to make use of ageing journalists in context of technological change. it also refers to study on ageing and work life by Ilmarinen.

http://jou.sagepub.com/content/15/7/868.full.pdf+html

Thank you.

Diana.

I've looked for the past few years and haven't found any primary literature that addresses the PT role in identifying polypharmacy (or under utilization of appropriate meds). In 2011 there was a series of articles in GeriNotes, the clinical magazine of the Academy of Geriatric Physical Therapy, that addressed this issue.

The perspective of frailty is a huge advance in the geriatric clinic, but the "non-concept" of which is it, is a big problem. It's like "When we don't know which we're looking for, it's hard to discover a lot of things about it".

At the beginning, we'd a complex syndrome that now, there are so many points of views, such as a multidimensional or a physical syndrome.

I think it's necessary improve researches about this theme, discover relative factors, make some useful and clinicals assessments and think about clinical management of frail and pre-frail seniors.

Hi, Siamak! I'm doing my PHD about frailty and using Fried's phenotype but I agree it's a hard kind of measure of frailty in hospitals. I did a research with seniors who were at school here in Brazil and they haven't had time to do all the Fried's tests, so I used the Edmonton Index and I liked it. I think it's also a valid option.

Detlef,

Thank you for your enlightened response on ethnogerontology in Germany and your thoughts about its limitations as evidenced by your literature search in GeroLit.  And thank you for the articles you culled on ethnogerontology and ethnogeriatrics. It all helps in this journey. 

In many ways that was the state of the art in Germany is much like it was in the US for decades. Much has changed but much remains static. For example, in 1988 I edited a book titled Hispanic Elderly in Transition: Theory, Research, Policy and Practice. It remained the only book on elderly Hispanics for years thereafter. And to date, the number of books on elderly Hispanics/Latinos is few and far between, as is the case  with books on ethnogerontology.  By contrast there is a growing, substantial body of empirical research on elderly Latinos and other minorities that has emerged and made its way into major refereed gerontology and geriatric journals. That is the good news. 

So the good news is that ethnogerontology is expanding, with more robust studies with  mixed methods.  The bad news is that there is an absence of major textbooks in the US and other countries, with sound theory and practice to operationalize the finding of our empirical studies.   In the US (as in Japan, China and many other countries), we are seeing the leading edge of a booming geriatric population unprecedented in our history. The more we know about this diverse geriatric population from social, psychological, biological, cultural and spiritual perspectives, the more integrated this populations will be in our societies.

Thank you again Detlef for your thoughts, research and your strategies for further investigations. It is greatly appreciated. 

Steven

One of the important goals of surgery in elderly patients should be  to restore them to the preoperative functional status after surgery. It is no point to operate on an 80y old patient and render him dependent for the rest of his life. Our results have shown that if there is good pre-operative optimisation, good intra-operative and postoperative care in collaboration with anesthetist, geriatric physicians, physiotherapists, pharmacists, dietiticians and others, a majority of elderly patients have a good functional recovery.

according the Andrew Steptoe et al, there are 3 components contributing the healthy, active and successfull aging: evaluative wellbeing(or life satisfaction), hedonic wellbeing (feeling of happiness, sadness, anger,stress,and pain) and eudemonic wellbeing (sense of purpose and meaning in life). To get more detail of those topics, you can enter the lancet.com November 6,2014. They have a full report on aging

Hope this helps

I am failing to access the article suggested by Jose. can any one help?

Hello Somnath,

Here at Kingston General Hospital we have a program called the Hospital Elder Life Program. The program helps maintain cognitive, physical and emotional well being  in hospitalized elderly patients. The program was designed to prevent delirium and functional/cognitive decline in our hospitalized elderly patients. The program includes elder life nurse specialists, elder life specialist,personal support workers and trained volunteers.Baseline assessments are completed and patient specific interventions/care plans are developed for patients using the HELP protocols. Protocols provided by trained volunteers include daily visitor program with structured cognitive orientation,therapeutic activities program, early mobilization/range of motion exercises, hearing and vision protocols and meal assistance/companionship.CAM screens are completed on admission .The Elder Life Nurse specialists on the team follow patients for duration of hospitalization and work with all disciplines to assist with discharge planning.  We also have two personal support workers that walk all patients over the age of 65 admitted to our medicine program twice a day.    

HELP is an organized, focused intervention with proven results. It reduces the incidence of delirium in hospitalized elderly patients.It maximizes independence at discharge.

The program has been very successful.

If you have any questions about the program please don't hesitate to ask.

Thanks Terry

And I would control for depressed mood! There might be higher levels of depression some of the sample that might also interfer with the cognitive speed and power.