Urgent needs of caregiving in ageing populations with Alzheimer's disease and other chronic conditions: Support our loved ones.

The ageing process begins at birth. It is a life-long process, and its exact origins are still unknown. Several hypotheses attempt to describe the normal ageing process, including hormonal imbalance, formation of reactive oxygen species, DNA methylation & DNA damage accumulation, loss of proteostasis, epigenetic alterations, mitochondrial dysfunction, senescence, inflammation, and stem cell depletion. With increased lifespan in elderly individuals, the prevalence of age-related diseases including, cancer, diabetes, obesity, hypertension, Alzheimer's, Alzheimer's disease and related dementias, Parkinson's, and other mental illnesses are increased. These increased age-related illnesses, put tremendous pressure & burden on caregivers, family members, and friends who are living with patients with age-related diseases. As medical needs evolve, the caregiver is expected to experience an increase in duties and challenges, which may result in stress on themselves, and impact their own family life. In the current article, we assess the biological mechanisms of ageing and its effect on body systems, exploring lifestyle and ageing, with a specific focus on age-related disorders. We also discussed the history of caregiving and specific challenges faced by caregivers in the presence of multiple comorbidities. We also assessed innovative approaches to funding caregiving, and efforts to improve the medical system to better organize chronic care efforts, while improving the skill and efficiency of both informal and formal caregivers. We also discussed the role of caregiving in end-of-life care. Our critical analysis strongly suggests that there is an urgent need for caregiving in aged populations and support from local, state, and federal agencies.

Teaching methods fostering enjoyment and creativity in medical education.

The journey towards becoming a physician has always been a test of diligence and patience in perfecting the science and art of treating patients. This learning continues well-beyond medical school, requiring a life-long pursuit for acquiring and refining medical knowledge with advances in science and technology. After completing medical school and residency, however, many clinicians report feelings of dissatisfaction and disillusionment with their career path citing lack of autonomy, increased government regulations, and long hours. Although a complex challenge, encouraging creativity and enjoyment during medical education can provide future physicians new skills to advance their medical knowledge while maintaining their personal satisfaction and enjoyment. In this article, we examine examples of how empowering medical education to be enjoyable provides the foundation for producing healthier and more engaged clinicians in the workforce and beyond.

Medications in long-term care: when less is more.

Attention has been drawn to the potential risks of several medications in the long-term care setting. Most of these medications deemed as inappropriate affect the central nervous system and are indicated only for select populations with specific conditions. Many of these drugs are prescribed without clear indications and continued indefinitely without critical decision-making about the potentially salutary effects of discontinuing medications. This article describes the increasing awareness of potentially inappropriate prescribing in the long-term care setting and reviews the rationale for why various types of medications are deemed inappropriate, with a focus on agents that affect central nervous system functioning.

Prescription drug misuse/abuse in the elderly.

One quarter of the prescription drugs sold in the United States are used by the elderly, often for problems such as chronic pain, insomnia, and anxiety. The prevalence of abuse may be as high as 11 percent with female gender, social isolation, depression, and history of substance abuse increasing risk. Screening instruments for prescription drug abuse have not been validated in the geriatric population. Benzodiazepines, opiate analgesics, and some skeletal muscle relaxants may result in physical dependence; however, tolerance, withdrawal syndrome, and dose escalation may be less common in the older patient. Lower doses may decrease the risk of abuse and dependence; however, fear of abuse often results in a failure to adequately treat symptoms such as anxiety, pain, and insomnia.

Residents-as-teachers programs in psychiatry: a systematic review.

OBJECTIVES: Because psychiatry residents have important roles as teachers and significant opportunities to contribute to medical student education, we set out to: identify all randomized control trials (RCT) for residents' teaching skills programs in psychiatry and to identify the efficacy of those interventions for improving teaching skills; identify the strengths and weaknesses of the available studies across medical disciplines; and identify currently available methods for enhancing residents' teaching skills for residents training in psychiatry. METHODS: The published English-language literature was searched using PubMed, Social Sciences Index, and PsycINFO databases, with key search words including: residents, teaching skills, residents as teachers, psychiatry, and assessments. Both RCT and controlled, nonrandomized trials of residents' teaching programs directed to enhance residents' teaching skills were selected and critically appraised. RESULTS: Of 13 trials identified and reviewed, most included residents in internal medicine. Only one included psychiatry residents and assessed their ability to teach interviewing skills to medical students. Along with other studies, this study demonstrated improvement in residents' teaching skills. Overall, interventions and outcome measures were heterogeneous while the quality of methodologies varied. Five studies were of higher quality, representing examples of quality educational research. Several described group differences, blinding, good follow-up, and use of valid, reliable tools. CONCLUSIONS: Only one trial exists that incorporated psychiatry residents. Significant opportunity to advance educational research in this field exists. Psychiatry residency program directors should incorporate high-quality methodologies and can benefit from the findings of trials in other disciplines.

Alcohol use in the elderly: beyond the CAGE. Part 2: Screening instruments and treatment strategies.

Recognition of the prevalence of alcohol problems in older patients has led researchers to develop and standardize screening instruments specifically intended for use in the elderly. While the CAGE questionnaire is the most commonly used screening instrument for alcohol use disorders, its usefulness in the geriatric patient has been questioned. Other tools, such as the Alcohol Use Disorders Identification Test (AUDIT), Michigan Alcohol Screening Test-Geriatric Version (MAST-G), and the Alcohol-Related Problems Survey (ARPS) may have additional use in this population. Brief interventions have been shown to be effective in producing sustained abstinence or reducing levels of consumption, thereby decreasing hazardous and harmful drinking. Clinicians may identify specific changes in the medical management of the individual that will reduce risk regardless of drinking behavior.

Alcohol use in the elderly: beyond the CAGE. Part 1 of 2: prevalence and patterns of problem drinking.

It has been estimated that 33% of adults age 65 and older have consumed alcohol during the preceding month; 25% of these drinkers (31% of men, 19% of women) drink daily and approximately 10% drink five drinks on one occasion. Alcohol misuse, with or without dependence, increases an older patient's risks of physical and mental problems. Yet hazardous drinking often is not identified in the elderly because ageism, denial, coexisting disabilities, and the unique pattern of late-onset drinking frequently mask its presence and complicate the diagnosis.

Assessment of competencies in physicians-in-training through the delivery of a community-based health curriculum using distance learning.

Academic physicians must master the elements of curriculum development and evaluation specific to defined competencies in postgraduate medical education. Six fellows in primary care medicine, working as a peer group with a faculty mentor, designed and evaluated a distance-learning project that included resident physicians. Professionalism, interpersonal skills and systems-based medical practice skills were measured with original instruments designed by the peer group. By the process of evaluation and revision in a peer-group setting and with mentorship from program faculty, experiential learning enhanced the training of future academic physicians. This paper describes the background, process and statistical results of their work.

An integrative review on current evidence of testosterone replacement therapy for the andropause.

OBJECTIVES: This paper examines the evidence supporting testosterone replacement in aging males. Confounding factors contributing to low testosterone levels and challenges to diagnosis of the andropause will also be considered. METHODS: A thorough review using an integrative approach citing published literature and the ongoing work of the authors. A search was performed using National Library of Medicine PubMed. Electronic and print journals available at the Texas Medical Center library were also considered. RESULTS: Information based on collective trials in older men has added to evidence for benefits and side effects of testosterone replacement inferred from studies in younger hypogonadal patients and animal models. In general, most investigators agree with short-term safety but long-term safety is unknown. Testosterone therapy in aging males improves body composition, certain domains of brain function and may also decrease cardiovascular risk in biological models. Measurable clinical effects are less apparent. Potential risks include erythrocytosis, edema, gynecomastia, and prostate stimulation. The possibility of increased risk of clinically significant prostate cancer and cardiovascular disease has been considered. CONCLUSION: The search continues for an ideal replacement androgen and larger long-term studies are needed. At this time, androgen replacement is on a case-by-case basis and prostate cancer screening should be completed prior to instituting therapy. Routine androgen replacement therapy for aging males will have significant economic implications, and is not currently recommended.