Research on geriatrics education in medical undergraduate education / 中华医学教育探索杂志

With the advent of an aging society, there is an urgent need to strengthen geriatrics education. The geriatrics curriculum for the medical undergraduates has not been set out nationally. Through literature review, drawing on and summarizing the advanced experience of geriatrics education in the world, this paper puts forward the teaching objectives and requirements, teaching implementation and teaching assessment suggestions of geriatrics education for medical undergraduates. It was hoped that this would arouse more medical educators to participate in the discussion, so as to promote the formulation of geriatrics medicine and gerontology syllabus for medical undergraduates in China.

A survey and an intervention study on Chinese medical students' willingness to pursue a career in geriatrics / 中华老年医学杂志

Objective:To explore the attitudes of Chinese medical students toward the elderly and their willingness to practice in geriatrics, and to investigate the influence of geriatrics education on their attitudes.Methods:Medical students studying diagnostics in four medical universities were enrolled in a cross-sectional survey and, for the intervention study, graduate trainees from non-geriatrics specialties taking a geriatrics course were interviewed before and after the course.An electronic questionnaire was used to collect general information, the experience of interacting with the elderly, attitudes towards the elderly and the willingness to develop careers in geriatric medicine.Changes in attitudes towards the elderly and their willingness to practice in geriatrics before and after the 40-hour geriatric medicine course were compared.Results:A total of 648 medical students completed the cross-sectional survey, with the highest score in compassion for the elderly(3.54±0.54)and the lowest score for medical services for elderly patients(3.36±0.78). Only 2.2%(14/648)of the students showed strong interest in geriatric medicine.The results of the intervention from 42 graduate trainees showed that the average scores of revised Geriatric Attitude Scale(r-GAS)were 3.80±0.43 and 3.92±0.40 before and after the course, respectively, and the difference was statistically significant( t=2.148, P=0.038). At the end of the course, 7 trainees(16.7%, 7/42)showed great interest in geriatrics, significantly different from 2 trainees(4.8%, 2/42)before the course( χ2=8.211, P=0.025). Conclusions:Chinese medical students show a serious lack of interest in geriatrics, and geriatrics education can improve their attitudes towards the elderly and their willingness to work in geriatrics.With the rapid population aging in China, it is urgent to strengthen the education of geriatric medicine.

Clinical features and esophageal motility characteristics of patients with esophagogastric junction outflow obstruction / 中华消化杂志

Objective To analyze the clinical features and esophageal motility characteristics of patients with esophagogastric junction outflow obstruction (EGJOO).Methods From January 2015 to January 2018,at Affiliated Hospital of Zunyi Medical College,the clinical data of 663 outpatients with various gastrointestinal symptoms were collected.Gastroscopy and esophageal high resolution manometry (HRM) were performed to exclude gastrointestinal organic lesions.The 120 patients were divided into EGJOO group (71 cases) and non-EGJOO group (49 cases).Furthermore,according to integrated relaxation pressure (IRP) the 71 EGJOO patients were divided into mild group (41 cases),moderate group (20 cases) and severe group (10 cases).Independent sample t test and one-way analysis of variance were performed for statistical analysis.Results Among 71 EGJOO patients,43.7％ (31/71) showed post sternal heartburn or acid regurgitation,32.4％ (23/71) showed obstruction or dysphagia,21.1％ (15/71) showed chest pain,21.1％ (15/71) showed other atypical symptoms such as hiccups and bloating,and 5.6％ (4/71) showed upper abdominal pain.The IRP,lower esophageal sphincter (LES) length,LES resting pressure and intrabolus pressure (IBP) of the EGJOO group were higher than those of the non-EGJOO group ((18.24 ± 3.07) mmHg (1 mmHg =0.133 kPa) vs.(10.92 ± 2.37) mmHg,(3.47 ± 0.85) cm vs.(3.11 ±0.80) cm,(32.33 ±9.11) mmHg vs.(21.31 ±6.55) mmHg,(6.22 ±3.74) mmHg vs.(4.69 ± 2.68) mmHg),and the differences were statistically significant (t =-13.947,-2.303,-7.706 and-2.626;all P ＜ 0.05).The LES relaxation rate and distal contractile integral (DCI) of the EGJOO group were lower than those of the non-EGJOO group ((44.03 ±9.86)％ vs.(53.86 ±11.33)％,(1410.13± 794.23) mmHg·s·cm vs.(1 741.86 ±894.16) mmHg · s · cm),and the differences were statistically significant (t =5.046 and 2.136,both P ＜ 0.05).The LES resting pressure of the mild group was higher than that of the moderate group ((30.76 ±9.23) mmHg vs.(29.69 ±5.87) mmHg);the LES resting pressure of the moderate group was lower than that of the severe group ((29.69 ± 5.87) mmHg vs.(42.02 ± 9.23) mmHg);and the differences were statistically significant (both Tamhane test,P =0.012 and 0.011).The IBP of the mild group was lower than that of the moderate group and the severe group ((5.16 ± 3.41) mmHg vs.(8.02 ± 2.58) mmHg and (7.46 ± 3.48) mmHg),and the differences were statistically significant (both least-significant difference test,both P ＜0.05).The DCI of the mild group was lower than that of the moderate group ((1 241.41 ± 606.12) mmHg · s · cm vs.(1 438.55 ± 644.74) mmHg· s· cm),and the difference was statistically significant (Tamhane test,P =0.011).Conclusions Heartburn,acid reflux and dysphagia are common clinical symptoms in EGJOO patients.The weaker the peristalsis of the esophageal body of EGJOO patients,the more obvious of dysphagia.Increased IBP is an indirect manifestation of esophagogastric junction relaxation disorder.

Effects of enteral nutrition and lactalbumin on muscle mass and function in the elderly / 中华老年医学杂志

Objective To explore the effect of calories supplement or protein supplement on the skeletal muscle in the elderly.Methods The ambulatory elderly (≥65 yrs) with reduced handgrip strength and/or gait speed were enrolled,who did not suffer from any neurological or arthritic disease impairing mobility,or any severe pulmonary or heart disease,or chronic kidney failure.The subjects were recruited with their written informed consent from clinical practices in five hospitals in China.The subjects were randomized to control group(n=26),nutrition supplementation (Nutren 400 kcal/ d) group (n=27) or protein supplementation(Biopro Protein 20 g/d) group (n=21).All the subjects were given healthy lifestyle education.The physical performances i.e.gait speed and handgrip strength were measured at baseline and at 2 and 3 months of followed up.Lean soft tissue mass (muscle mass) was measured by BIA at baseline and at 3 months of follow-up.Results A total of 74 subjects completed the trial,including 26 in controls,27 in Nutren,and 21 in protein group.At the end of the trial,the changes from baseline in appendicular muscle mass were-490.0 g (95％CI:-801.9--245.5,P=0.001)in control group,90.0 g (95％CI:-346.8--442.0,P=0.241) in Nutren group,and 290.0 g (95％CI:-746.6-20.1,P=0.007) in protein group.There were no significant difference in above indices among the three groups (P=0.051),except between Nutren group and control group (P=0.020).The handgrip strength and gait speed in the three groups were improved obviously as compared with those at baseline,but not statistically significant between different groups.Conclusions Caloric supplementation group may have greater effect in maintaining muscle mass than the protein supplement group in the elderly.Both the caloric supplement and the protein supplement produce no additional effect on muscular function as compared with healthy lifestyle education.

Overlap syndrome of dementia, depression and delirium in elderly patients: a report of 16 cases / 中华老年医学杂志

Objective To analyze the clinical characteristics and prognosis of the overlap syndrome of dementia,depression and delirium coexistence in two or three of them (the 2D's or 3D's) in elderly patients,in order to raise awareness.Methods Clinical data of 16 patients aged ＞65 years diagnosed with the 2D's or 3D's admitted to Peking Union Medical College Hospital from 2010 to 2014 were analyzed and relevant literatures were reviewed.Results Patients with the 2D's or 3D' s accounted for 10％ of the elderly demented patients and 3％ of the elderly depressive patients.16 patients [11 females and 5 males,median age 82 years and mean age (80±6) years] were enrolled,with 7 cases of dementia with depression,6 cases of delirium superimposed on dementia,2 cases of the 3D's,and 1 case of coexisting depression and incident delirium.The Charlson comorbidity index of the 16 patients was (3.0± 1.5).(4.0± 1.6) kinds of geriatric syndromes were found,and the most common were falls (62％),sleep disorders (56％),frailty (50％),polypharmacy (43 ％),and malnutrition (37％).Disability was identified in 14 (88％) patients on admission.Delirium was observed in 9 patients (56 ％),with 7 cases of hyperactive delirium and 2 cases of hypoactive delirium.Coexisting underlying dementia was identified after episodes of delirium in 6 cases.16 patients all received corresponding intervention during hospitalization period.During a mean follow-up period of (15±13) months,62 ％ of the patients had more impaired physical function (ADL score reduction≥ 1),and 43％ of the patients had more impaired cognitive function (MMSE score reduction≥3).Two patients were transferred to long-term care facilities and one patient died during follow-up.The readmission rate was 50％ within 1 year after discharge.Conclusions The domestic report of overlap syndrome of dementia,depression and delirium is rare.Patients with the coexistence of the 2D's or 3D's are more commonly combined with geriatric syndromes,which results in further cognitive and physical function impairment with a higher re-admission rate.We should pay attention to the follow-up in elderly patients with delirium for screening dementia.

Malnutritional risk and nutritional support in geriatric inpatients / 中华老年医学杂志

Objective To investigate the prevalence of malnutrition and nutritional support and interventions in geriatric inpatients.Methods The elderly patients (aged ≥ 65 years)from the geriatric demonstration ward were consecutively enrolled from July 2010 to January 2012.MiniNutritional Assessment-short form (MNA-SF) was performed after admission,and data of nutritional support were collected.Results A total of 179 patients were enrolled in this study.According to MNA-SF,42 cases (23.5％)were rated as malnutrition,and 55 cases (30.7％) were rated as at risk of malnutrition.Totally,45 patients received nutritional support.50.0％ (21/42) patients with malnutrition,and 29.1％ (16/55) patients at risk of malnutrition received nutritional support.As to the route of nutrition therapy,the ratio of the enteral to parenteral to combination of enteral and parental nutrition was 4.4 ∶ 1.0 ∶ 1.0.Conclusions The incidence of malnutrition is high in the geriatric inpatients,and routine nutritional risk screening and assessment are essential for the elderly patients.Nutritional support and other comprehensive treatment are in great need,and the enteral nutrition is appropriate and preferred.

The implementation of comprehensive geriatric assessment / 中华老年医学杂志

Comprehensive geriatric assessment (CGA) conducts comprehensive assessment of many aspects of health and well-being of an older patient including medical,functional,nutritional,psychiatric and behavioral issues and needs as well as family and social support.CGA is typically conducted by a multidisciplinary team led by a geriatrician.Based on the CGA findings,appropriate recommendations are provided to the patient and family.This paper introduces the CGA concept and its content,targeted population,and implementation methods.It will also describe clinical studies focusing on the effectiveness and utility of CGA.

Identification and treatment of delirium in elderly patients / 中华老年医学杂志

Delirium is a common disorder in aged people.Although it is in poor prognosis,delirium still has been under-recognized and inappropriately evaluated and treated.The clinical aspects of delirium on epidemiology,diagnosis,risk and precipitating factors,prevention and treatment were introduced in this paper.

Attaching great importance to polypharmacy in elderly patients / 中华老年医学杂志

Based on the ongoing clinical experiences at our outpatient pharmacy and geriatrics multidisciplinary inpatient and outpatient services,we believe that polypharmacy among elderly patients is serious and pervasive in China.This observation is supported by the findings from literature review.To help address this serious issue in senior care,we recommend to gain better understanding of age-related physiological changes of the elderly as well as those in pharmacokinetics and pharmacodynamics,and to conduct prescription review and medication reconciliation.The multi-and interdisciplinary approach employed by modern geriatrics care model,involving doctors,pharmacists and nurses,should further help address this issue and promote rational use of pharmaceuticals in the elderly patients.