Geriatric medicine

Quality of life (QOL) is a popular term that conveys an overall
sense of well-being, including aspects of happiness and satisfaction with life as a whole. It is broad and subjective rather than specific and objective. What makes it so challenging to measure is that, although the term “quality of life” has meaning for nearly everyone and every academic discipline, what it actually means is somewhat different for each individual and group. How do you reach accord about a measure for quality of life? Perhaps the strongest area of a consensus is that quality of life is extraordinarily broad and conceptually complex, yet
measures are most meaningful when they measure key concepts in a logical way and are as precise as possible.

Training courses and workshops:
1. Training courses for elderly caregivers.
2. Intensive training courses in Geriatric Medicine and Gerontology (for physicians and for workers in the field of caring of the elderly).
3. Geriatric training program for the Surgical Specialties.
4. Training program in wounds, ostomy and continence care.
5. Geriatric problems and its relation with language and speech disturbance.

tBackground: Although the effectiveness of low-dose radiotherapy for chronic degenerative and inflam-matory diseases has been documented in previous studies, patient-reported clinical outcomes are rarelyavailable.Objective: This study aimed to determine the effect of low-dose radiotherapy on patients with painfulplantar fasciitis.Method: From 2002 to 2008, 200 patients older than 65 years of age with painful plantar fasciitis weretreated in our hospital. Records from 171 of these patients were available for analysis. All patients weretreated with an identical dose of 3 Gy using identical equipment and techniques. Response was evaluatedwith patient-reported questionnaires and clinical visits.Results: Minimum-term follow-up was 18 months, with mean follow-up at 54 months. Three monthsafter receiving low-dose radiotherapy, 67.3% of patients had no or mild pain, and 57.9% had no or discretemobility restriction. At a mean of 54 months, 61.4% of patients had no or mild pain and 64.9% of patientshad no or discrete mobility restriction; 60.8% of patients reported improved quality of life.Conclusion: Low-dose radiotherapy is effective in most patients with painful plantar fasciitis. Due tominimal side effects and low costs, it represents an excellent treatment option compared to conventionaltherapies or surgery.

This study was performed to asses and establishes the prevalence of Polypharmacy in geriatric population in the Medicine ward of Rajah Muthaiya Medical College and Hospital, Annamalai University, during one year from January 2013 to January 2014. Demographic analyses of this prospective study revealed that out of 520 patients, 342 (65.76%) were males and 178 (34.23%) were females. All the collected prescriptions were scrutinized for Polypharmacy and were categorized as minor Polypharmacy -concurrent use of ≤ 5 drugs; and major Polypharmacy -concurrent use of > 5 drugs. Out of 502 Prescriptions 61(11.73%) prescriptions were minor Polypharmacy and 457(88.26%) prescriptions were major Polypharmacy. The maximum patients were in the age group of 60-64 (38.84%) range lead to a significant increase in the number of medications. The most common diseases associated systems were Cardiovascular system 147 (28.26 %) patients, and followed by Respiratory system 103(19.80%). Our results show that there is a higher prevalence of Polypharmacy among the males than females. The length of hospital stay of geriatric patients is increase in major Polypharmacy compare with minor Polypharmacy. The prevalence of cardiovascular drugs and respiratory drugs were often involved in Polypharmacy among geriatric patients. Polypharmacy is very common among geriatric patient and health care professional’s interventions to improve the optimal use of medication in geriatric could lead to reduction in the drug related problems associated with Polypharmacy.

This very short book entitled Basic course on Gerontology, serves the purpose of providing an overview of the science of aging. As it an introductory volume it provides a broad overview of what has become a vast quantity of scientific material associated with aging, but because of the nature of an introduction it does not cover every concern.

This review is aimed at conferring the efficacy of anticancer property of different phytochemicals from Nayantara (Catharanthus roseus). Cancer is one of public health burden in developed and developing country. Cancer chemo preventive agents, many of which are natural products, are capable of preventing or inhibiting the process of carcinogenesis. Herbal anticancer drug are obtained from Catharanthus roseus is wildly used because of their well defined mechanism of action as anticancer drug. The main alkaloids of Catharanthus roseus is vinca alkaloids which is important for being cancer fighters. There are four major vinca alkaloids in clinical use: vinblastine (VBL), vinorelbine (VRL), vincristine (VCR) and vindesine (VDS). Recently vinflunine is discovered as new anticancer agent of vinca alkaloids. In this review, an attempt has been made to summarize the pharmacological effect of the above plant against anticancer property in a precise way to help the scientist and learners to understand the basis medicinal value of the plant.

Alzheimer's disease (AD) is the most common cause of dementia in older adults and an important public health problem. The purpose of this review article is to provide a brief introduction to AD and the related concept of mild cognitive impairment (MCI). The article emphasizes clinical and neurobiological aspects of AD and MCI that medical students should be familiar with. In addition, the article describes advances in the use of biomarkers for diagnosis of AD and highlights ongoing efforts to develop novel therapies.

Indice PROLOGO Este MANUAL DE GERIATRIA ha sido producido por la Vicerrectoria Académica, a través del Fondo para el Desarrollo de la Docencia y es el resultado de un esfuerzo común realizado por un equipo multidisciplinario. No pretende ser un libro o texto donde los temas se abordan en profundidad y por lo tanto no abarca todos los temas que incluyen la amplia rama de la Gerontología y la Geriatría. El Manual brinda por un lado, la experiencia personal y por otro resume parte de la información internacional para brindar una orientación y visión general, que estimulen al lector para una mayor profundización posterior. Pretende ser una guía útil para los alumnos de las carreras de la Facultad de Medicina (Escuela de Medicina y Escuela de Enfermería) como también de otras Escuelas afines, como también a los docentes que se interesen en saber como enfrentar mejor el desafío que representa el incremento de la población de adultos mayores en nuestra sociedad.

Yaşlılarda Obezite (Obesity in the elderly)
Obezite: Morbidite ve zamansız mortalite riskini artıran sağlıksız, aşırı bir vücut yağı olarak tanımlanır.
Obezite, gelişmiş ülkelerde büyüyen bir salgındır ve yaşlı popülasyonumuzda da artan sorun olmuştur.
Yaşlı erişkinlerde obeziteye istenmeyen bir kronik hastalık yükü, metabolik komplikasyonlar ve kötüleşen bir yaşam kalitesi eşlik etmektedir.
Daha önemlisi; yaşlı erişkinlerde obezite, kırılganlık ve sakatlığa yol açan fiziksel işlevdeki yaşa bağlı düşüşü şiddetlendirmektedir.
Yaşlı kişilerde kilo kaybı için tasarlanan mevcut tedavi, yaşam tarzı müdahalesini (diyet, egzersiz ve davranış değişiklikleri), farmakoterapiyi ve ameliyatı içermektedir.
Mevcut bulgular, obez yaşlı erişkinlerde kilo kaybı tedavisinin, fonksiyonel düşüşü ve tıbbi komplikasyonları önlediğini veya geciktirdiğini ve yaşam kalitesini iyileştirdiğini göstermektedir.
Bununla birlikte, yaşlı yetişkinler için kilo kaybı tedavisi yazan klinisyenler, hastanın kas ve kemik kütlesi üzerindeki olumsuz etkileri göz önünde bulundurmalıdır.

Ege Üniversitesi, Yaşlı Sağlığı Doktora Programı, Yaşlılık ve Spor Dersinde Sunulmuştur.
Presented in Ege University, Elderly Health Doctorate Program, Aging and Sports Course
selmanbolukbasi@yandex.com

Background: Vitamin D deficiency is a very common problem among elderly population. Extra-skeletal functions of vitamin D are an interesting new area of research since the discovery of vitamin D receptors in different extra-skeletal organs and possible links to common geriatric syndromes and problems have been examined. This presentation reviews current knowledge regarding vitamin D possible links to common geriatric syndromes.

Secara ilmiah osteoporosis adalah penyakit rapuh tulang yang ditandai dengan hilangnya kepadatan tulang sehingga tulang mudah patah serta tidak tahan dengan benturan ringan. Dampak rokok terhadap kesehatan tulang belum diketahui pasti apakah penurunan massa tulang memang disebabkan oleh rokok, atau oleh faktor resiko lain. Misalnya secara umum tubuh para perokok cenderung lebih kurus. Berat badan ringan adalah salah satu faktor resiko massa resiko massa tulang rendah. Perokok juga cenderung lebih akrab terhadap alkohol, kurang aktif dan memiliki pola makan yang kurang baik. Dan wanita perokok umumnya memiliki kadar estrogen lebih rendah, dan cenderung lebih cepat mengalami menopause. Namun, beberapa literatur menyebutkan bahwa merokok dapat mengurangi penyerapan kalsium oleh tubuh.

Background:
Individuals with mild cognitive impairment (MCI) have a substantially increased risk of developing dementia due to Alzheimer's disease (AD). In this study, we developed a multivariate prognostic model for predicting MCI-to-dementia progression at the individual patient level.

Methods:
Using baseline data from 259 MCI patients and a probabilistic, kernel-based pattern classification approach, we trained a classifier to distinguish between patients who progressed to AD-type dementia (n = 139) and those who did not (n = 120) during a three-year follow-up period. More than 750 variables across four data sources were considered as potential predictors of progression. These data sources included risk factors, cognitive and functional assessments, structural magnetic resonance imaging (MRI) data, and plasma proteomic data. Predictive utility was assessed using a rigorous cross-validation framework.

Results:
Cognitive and functional markers were most predictive of progression, while plasma proteomic markers had limited predictive utility. The best performing model incorporated a combination of cognitive/functional markers and morphometric MRI measures and predicted progression with 80% accuracy (83% sensitivity, 76% specificity, AUC = 0.87). Predictors of progression included scores on the Alzheimer's Disease Assessment Scale, Rey Auditory Verbal Learning Test, and Functional Activities Questionnaire, as well as volume/cortical thickness of three brain regions (left hippocampus, middle temporal gyrus, and inferior parietal cortex). Calibration analysis revealed that the model is capable of generating probabilistic predictions that reliably reflect the actual risk of progression. Finally, we found that the predictive accuracy of the model varied with patient demographic, genetic, and clinical characteristics and could be further improved by taking into account the confidence of the predictions.

Conclusions:
We developed an accurate prognostic model for predicting MCI-to-dementia progression over a three-year period. The model utilizes widely available, cost-effective, non-invasive markers and can be used to improve patient selection in clinical trials and identify high-risk MCI patients for early treatment.

Die Akademien hoffen, mit dieser Stellungnahme einen Beitrag zu einer notwendigen Diskussion um eine bessere medizinische Versorgung älterer Menschen zu leisten. Eine Diskussion, die auch vor dem Hintergrund des demografischen Wandels möglichst bald beginnen sollte. Die Akademien danken allen Autorinnen und Autoren sowie Gutachterinnen und Gutachtern sehr herzlich für ihre Beiträge. Oster P. Physical training improves motor performance in people with dementia: a randomized controlled trial. J Am Geriatr Soc 2012;60(1):8-15. Heyl V, Wahl HW. Experiencing age-related vision and hearing impairment: The psychosocial dimension. Journal of Clinical Outcome Management 2014;21(7):323-35. Hoffmann TC, Montori VM, Del Mar C. The connection between Evidence-Based Medicine and Shared Decision Making. JAMA 2014;312(13):1295-6. Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 2010;107(31-32):543-51. Hurria A, Wong FL, Villaluna D, Bhatia S, Chung CT, Mortimer J et al. Role of age and health in treatment recommendations for older adults with breast cancer: the perspective of oncologists and primary care providers. J Clin Oncol 2008;26(33):5386-92. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 1999;341(27):2061-7.

Little is known about how optimism differs by age and changes over time, particularly among older adults. Even less is known about how changes in optimism are related to changes in physical health. We examined age differences and longitudinal changes in optimism in 9,790 older adults over a 4-year period. We found an inverted U-shaped pattern between optimism and age both cross-sectionally and longitudinally, such that optimism generally increased in older adults before decreasing. Increases in optimism over a 4-year period were associated with improvements in self-rated health and fewer chronic illnesses over the same time frame. The findings from the current study are consistent with changes in emotion regulation strategies employed by older adults and age-related changes in well-being.

Depression in elderly is di cult to diagnose because the symptoms are atypical; patient, patient’s family, and physicians are rarely aware of the symptoms. The symptoms are usually overlap with somatic symptoms and often underdiagnosed. General practitioner as  rst line in medical service should be able to recognize depression in elderly person. Geriatric Depression Scale can be used to screen depression in senior person, especially those with intact cognitive function. Edwin Nugroho Njoto. Identifying Depression among Elderly.

Objective: To evaluate institutionalized elder women’s performance in the mini-mental state examination. Methods: This cross-sectional
descriptive study was conducted among 34 elder women who were residents in a long term facility in Curitiba, PR. Data were collected with
the mini-mental state examination (MMSE) and analyzed with descriptive statistics. Results: Participants had a mean age of 79.82 ±
8.23 and their overall mean score on the MMSE was 16.62 ± 5.60. The mean score of performance among illiterates and literate participants
were 14.90 and 19.75 points, respectively. The mean score of performance among participants aged 65 to 79 and participants aged 80 and
over were 18 and 15.65 points, respectively. Conclusion: There were a large number of elder women (26.5%) with cognitive impairment.
Lower educational level and advanced age were associated with lower scores on the mini-mental status examination.

O termo demências é utilizado para se referir a condições que afetam a memória, relações sociais e percepção, elas são comumente associadas ao envelhecimento. A Doença de Alzheimer é tida como a principal doença que causa demências. Ao longo dos últimos cinquenta anos, tal doença tem conectado uma série de atores e tecnologias de cuidado de modos diversos e, por vezes, contraditórios. Essa tese trata das formas de nomear e de cuidar das demências, especialmente da Doença de Alzheimer, em diálogo com instituições biomédicas e suas tecnologias. A narrativa é levada, em um primeiro momento, a partir de um centro de medicina público e multidisciplinar, especializado em geriatria e gerontologia, que atua no Distrito Federal e Entorno (DFE). Pelas suas práticas de diagnóstico, cuidado e atenção aos medicamentos e às relações amplas com a doença, desenvolve-se um debate acerca das divergências históricas no diagnóstico e cuidado das demências. Investiga-se, ainda, a quantidade e complexidade medicamentosa no cuidado das demências no contexto pesquisado, traduzida pelo termo interações medicamentosas. Em um segundo momento, a narrativa se desloca a partir de três casas localizadas em diferentes regiões do DFE, as quais se relacionam com o centro pesquisado e com outras instâncias e instituições da saúde públicas e privadas. Junto das lidas diárias e circulações em busca de cuidado das demências, são discutidas as variedades de categorização de sintomas dependendo das instituições e profissionais de saúde consultados, as dificuldades cotidianas para se fazer uma rotina, as vinculações do cuidado de uma doença e do uso de medicamentos com a cidade e os lugares; além dos muitos desafios que ameaçam fragmentar o cotidiano. Por fim, essas duas posições em campo são comparadas e debate-se como o cuidado das demências pode ser compreendido a partir do termo partilha, tanto no sentido do compartilhamento de sentidos, afetos e cotidianos, como na divisão – muitas vezes desigual – de sensibilidades, recursos e afetos políticos.

BACKGROUND Geriatric mental health issues have yet to receive their due recognition in India. Geriatric mental health is plagued by many challenges that prevent the development and progress of its services. The present article is a narrative review that looks at the various challenges faced by geriatric mental health in India. The article describes different specific and general unique challenges faced by geriatric mental health and discusses in detail the nature of each challenge and what must be done to overcome it. The challenges range from demography of Indian aging to sexual issues in the elderly, geriatric depression, dementia care, and the aging lesbian, gay, bisexual, cross-dressers and transgender community. Old age people face special physical and mental health challenges in routine life which are necessary to be recognized and rehabilitate. Mental health problems are often under identified or overlooked by themselves, health-care professionals and even by family members of older people, and the stigma related to mental illness makes people reluctant to seek help. The prevalence of co-morbid condition of illnesses is a powerful demonstration of the link between physical and mental illnesses. Various issues related to policy and research that challenge geriatric mental health are also discussed in this article. The need to incorporate geriatric mental health into primary health care along with the need to train primary care workers and preventive work aimed at suicide prevention in the elderly is stressed. The article addresses these challenges with the aim of positing before the clinician the various challenges faced by geriatric mental health in India in the current era.

Diabetic patients frequently suffer from non-alcoholic steatohepatitis. The current study aimed to investigate the role of curcumin and the response of hepatic stellate cells in streptozotocin (STZ)-induced hepatic damage. Sixty male rats were divided into three groups. The normal control injected with a citrate buffer vehicle and the diabetic control group which was injected intraperitoneally (IP) with a single-dose of streptozotocin (50 mg/kg body weight) and a diabetic group was treated with an oral dose of curcumin at 80 mg/kg body weight daily for 60 days. Results. Curcumin effectively counteracts oxidative stress-mediated hepatic damage and improves biochemical parameters. Alpha-smooth muscle actin (α-SMA) was significantly reduced, and insulin antibodies showed strong positive immunoreactivity with curcumin administration. These results optimistically demonstrate the potential use of curcumin, which is attributed to its antiradical/ antioxidant activities and its potential β-cell regenerative properties. Also, it has the capability to encourage the trans-differentiation of hepatic stellate cells into insulin-producing cells for a period of time. In addition, as it is an anti-fibrotic mediator that inhibits hepatic stellate cell activation and the transition to myofibroblast-like cells, this suggests the possibility of considering curcumin's novel therapeutic effects in reducing hepatic dysfunction in diabetic patients. Body and liver weight of different groups. The mean is given in columns, and error bars represent the standard deviation (SD). Fig. 2 Plasma glucose and insulin of different groups. The mean is given in columns, and error bars represent the standard deviation (SD). Fig. 3 Biochemical parameters of different groups. The mean is given in columns, and error bars represent the standard deviation (SD).

The present study was conducted on ageing people. The sample size consists of 180 Ageing people. 90 male in which 45 were selected from rural area and 45 were selected from urban area, similarly, 90 female were selected for research in which 45 were selected from rural area and 45 were selected from urban area of Ranchi. The data was selected by purposive sampling. Objectives: To find out the prevalence of Health Status among ageing people, To find out the prevalence of Adjustment among ageing people, To examine the relationship between Health Status and Aadjustment among ageing people. Methodology: The data was selected by purposive sampling. Personal Data Questionnaire, the health status scale and adjustment inventory was used to collect the data.
Results: The obtained data were analyzed in terms of the computation of percentage of health status and adjustment and correlation of health status and adjustment among different sample old age people. In rural area health status as low, moderate and high were 51.11%, 33.33% and 15.55% respectively and in urban area health status as low, moderate and high were 55.55%, 34.44% and 10%. Male ageing people were found 58.88%, 30% and 11.11% as low, moderate and high health status respectively. Female ageing people were found 47.77%, 38.88% and 13.33% as low, moderate and high health status respectively. Adjustment as low, moderate and high were found 0.9%, 21.6% and 58.5% respectively in rural area. In Urban area Adjustment as low, moderate and high were 0%, 26.1% and 54.9% respectively. Male ageing people were found 0.9%, 20.7% and 59.4% as low, moderate and high adjustment respectively. Female ageing people were found 0.9%, 27% and 53.10% as low, moderate and high health status respectively. Health status and level of adjustment was found to be positively correlated (r = .35, p < .01) in rural old age people and also found positively associated (r = .44, p < .01) in urban background old age people. Among male and female participants health status was found to be positively correlated with level of adjustment of old age people (r = .39, p < .01; (r = .37, p < .01). Conclusion: Result shows that no difference was found in terms of health status of old age from urban and rural background. Female participants scored low in health status than male participants. No significant difference was found in terms of level of adjustment of old age from urban and rural background. Female and male participants scored almost same on prevalence of level of adjustment of old age people. Health status and level of adjustment was found to be positively correlated in almost all sample groups.
Keywords- Health Status, Adjustment, Ageing People