Freddi Segal-Gidan

The process of care in preventive in-home comprehensive geriatric assessment.

OBJECTIVES: To describe the process of care of a program of in‐home comprehensive geriatric assessment (CGA) and to determine: (1) if there are major findings in all domains of CGA (medical, functional, mental health, and social/ environmental), (2) if there is a continued clinical yield when CGA is repeated annually, and (3) factors that affect patient adherence with recommendations from CGA.

Alzheimer's disease management guideline: update 2008.

Frequent review and update of guidelines are necessary for them to remain current and useful for clinical practices. This second revision of the postdiagnostic management of Alzheimers disease (AD) guideline by the California Workgroup was prompted by significant advances in knowledge about appropriate care management, including pharmacologic and nonpharmacologic approaches to treatment of the disease, accompanying behavioral problems, and functional decline. The focus remains explicitly on primary care, where the majority of it occurs for those with AD and other dementias.

Retinal microvascular abnormalities and cognitive function in Latino adults in Los Angeles.

Purpose: Retinal vessels may provide a readily accessible surrogate approach to study vascular disease in brain small vessels. Previous epidemiologic studies of retinal microvascular abnormalities and cognition have not included large numbers of Latinos who have a high prevalence of diabetes and hypertension. Methods: We used data from 809 elderly Latino participants in the Los Angeles Latino Eye Study (LALES) to assess whether retinal vessel caliber and microvascular abnormalities are cross-sectionally associated with lower cognitive function. Cognitive screening was conducted with the Cognitive Abilities Screening Instrument-Short form (CASI-S) and in-depth testing with the Spanish English Neuropsychological Assessment Scales (SENAS). Retinal photographs were used to identify retinopathy signs and measure retinal vessel caliber. Results: A total of 65.8% had high blood pressure, 34.5% had diabetes; self-reported diagnoses of heart attack, heart failure, angina and stroke were rare. Retinal calibers and any retinopathy were not associated with the CASI-S, total SENAS or any SENAS cognitive factors assessed as continuous variables. The odds of a low CASI-S score were two times higher in subjects with generalized arteriolar narrowing (OR = 2.04, 95% CI = 1.14, 3.66), and one and half times as high in those with both generalized arteriolar narrowing and retinopathy signs (OR = 1.49, 95% CI = 0.47, 4.75) though this result was based on only four cases with both risk factors and confidence limits were wide and included the null. Conclusion: Retinal microvasculature imaging may provide insights into small blood vessel influences on cognition in Latino populations. Additional studies in diverse populations and prospective settings are needed.

Assessment of Student Interprofessional Education (IPE) Training for Team-Based Geriatric Home Care: Does IPE Training Change Students’ Knowledge and Attitudes?

Our study assesses changes in students’ knowledge and attitudes after participation in an interprofessional, team-based, geriatric home training program. Second-year medical, physician assistant, occupational therapy, social work, and physical therapy students; third-year pharmacy students; and fourth-year dental students were led by interprofessional faculty teams. Student participants were assessed before and after the curriculum using an interprofessional attitudes learning scale. Significant differences and positive data trends were noted at year-end. Our study suggests that early implementation, assessment, and standardization of years of student training is needed for optimal interprofessional geriatric learning. Additionally, alternative student assessment tools should be considered for future studies.

Factors Influencing Driving Status in an Older Latino Population

Objective: The study aims at examining factors associated with driving status and self-reported driving difficulty, with particular attention to vision and cognitive impairment. Method: This study uses cross-sectional data from 421 elderly Latino participants in the Los Angeles Latino Eye Study (LALES) along with cognitive screening, and comparison is by driving status (currently driving, used to drive, never drove) and self-reported difficulty driving among current drivers. Results: Current drivers were more educated and reported better health.Those who never drove were less acculturated.Those who gave up driving had more visual impairment and lower scores on mental status testing. Self-reported difficulties among current drivers were associated with more health problems but not cognitive difficulties. Discussion: Elderly Latinos have a lower driving rate than the general older population. There are significant differences between older Latinos who continue to drive versus those who never drove or have stopped driving. Poorer cognitive performance and poorer vision are associated with driving cessation.

Knowledge and attitude change in physician assistant students after an interprofessional geriatric care experience: a mixed methods study.

Purpose: To examine changes in physician assistant (PA) student attitudes and knowledge about interprofessional education (IPE) after participation in a longitudinal community‐based curriculum. Methods: Second‐year PA students participated in an interprofessional geriatrics curriculum. Faculty‐facilitated IPE teams met three times and assessed one adult patient longitudinally over 8 months. Attitudes of student participants and their nonparticipating peers (comparison group) were assessed pre‐ and postcurriculum using the validated Readiness for Interprofessional Learning Scale (RIPLS). Reflections submitted by participants after each session were analyzed thematically. Results: No significant differences in RIPLS scores were found compared with baseline for either group; participating students had significantly higher baseline scores compared with nonparticipating students. Qualitative analysis of participant reflections revealed two major themes: “roles and scope of practice of other health professions”; and “applicability of team‐based care to practice” with a temporal change in theme pattern over one year. Conclusion: Volunteer student participants had a more positive attitude toward interprofessional learning than nonparticipants. Primary learning occurred about roles of other professions and the value of team‐based care. The mixed evaluation methodology allowed examination of attitudes, knowledge, and underlying (“informal” or “hidden”) learning.

Postoperative confusion in older adults

ABSTRACT The development of postoperative confusion in older patients is increasingly being recognized as clinically significant because it is becoming more common as the population ages. Postoperative delirium and postoperative cognitive dysfunction differ in time course of development. Risk factors other than age include certain medications as well as anesthesia (both the type and amount used). Postoperative delirium and postoperative cognitive dysfunction appear to increase a patients risk for developing dementia. Routine preoperative screening may help to identify patients with preexisting cognitive impairment who are at greatest risk for developing postoperative delirium or postoperative cognitive dysfunction.

Elder care: immunization schedules and screening after age 65 years.

LEARNING OBJECTIVES • Describe special considerations in providing preventive health care to the elderly • Discuss the role of immunizations in preventing severe infectious disease in older adults • Review the need to assess the risk/benefit of secondary prevention/screening recommendations • Understand the common geriatric syndromes of cognitive decline, falls, and urinary incontinence Preventive medicine goals for older adults focus on reducing disease‐specific morbidity, decreasing disability, and improving quality of remaining life.