Geriatricians have embraced the term "geriatric syndrome," using it extensively to highlight the unique features of common health conditions in older people. Geriatric syndromes, such as delirium, falls, incontinence, and frailty, are highly prevalent, multifactorial, and associated with substantial morbidity and poor outcomes. Nevertheless, this central geriatric concept has remained poorly defined. This article reviews criteria for defining geriatric syndromes and proposes a balanced approach of developing preliminary criteria based on peer-reviewed evidence. Based on a review of the literature, four shared risk factors-older age, baseline cognitive impairment, baseline functional impairment, and impaired mobility-were identified across five common geriatric syndromes (pressure ulcers, incontinence, falls, functional decline, and delirium). Understanding basic mechanisms involved in geriatric syndromes will be critical to advancing research and developing targeted therapeutic options, although given the complexity of these multifactorial conditions, attempts to define relevant mechanisms will need to incorporate more-complex models, including a focus on synergistic interactions between different risk factors. Finally, major barriers have been identified in translating research advances, such as preventive strategies of proven effectiveness for delirium and falls, into clinical practice and policy initiatives. National strategic initiatives are required to overcome barriers and to achieve clinical, research, and policy advances that will improve quality of life for older persons.

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Geriatric Syndromes: Clinical, Research, and Policy Implications of a Core Geriatric Concept

Geriatric syndromes : Clinical, research, and policy implications of a core geriatric concept. Commentary

Objective: The aim was to formulate practice guidelines on the management of hyperglycemia in hospitalized patients in the non-critical care setting. Participants: The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, six additional experts, and a methodologist. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society members, American Diabetes Association, American Heart Association, American Association of Diabetes Educators, European Society of Endocrinology, and the Society of Hospital Medicine reviewed and commented on preliminary drafts of this guideline. Conclusions: Hyperglycemia is a common, serious, and costly health care problem in hospitalized ...

/pdf/management-of-hyperglycemia-in-hospitalized-patients-in-non-rlxd42sa26.pdf

Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline

Dedication We dedicate this book to our family members who complete us. In particular, M. Ben-chohra's dedication is to his wife, Kheira, and his children, Mohamed, Maroua, and Abdelillah; J. Henderson dedicates to his wife, Darlene, and his descendants, Kathy, Contents Preface xi 1. Preliminaries 1 1.1. Definitions and results for multivalued analysis 1 1.2. Fixed point theorems 4 1.3. Semigroups 7 1.4. Some additional lemmas and notions 9 2. Impulsive ordinary differential equations & inclusions 11 2.1. Introduction 11 2.2. Impulsive ordinary differential equations 12 2.3. Impulsive ordinary differential inclusions 24 2.4. Ordinary damped differential inclusions 49 2.5. Notes and remarks 62 3. Impulsive functional differential equations & inclusions 63 3.1. Introduction 63 3.2. Impulsive functional differential equations 63 3.3. Impulsive neutral differential equations 74 3.4. Impulsive functional differential inclusions 80 3.5. Impulsive neutral functional DIs 95 3.6. Impulsive semilinear functional DIs 107 3.7. Notes and remarks 118 4. Impulsive differential inclusions with nonlocal conditions 119 4.1. Introduction 119 4.2. Nonlocal impulsive semilinear differential inclusions 119 4.3. Existence results for impulsive functional semilinear differential inclusions with nonlocal conditions 136 4.4. Notes and remarks 145 5. Positive solutions for impulsive differential equations 147 5.1. Introduction 147 5.2. Positive solutions for impulsive functional differential equations 147 5.3. Positive solutions for impulsive boundary value problems 154 5.4. Double positive solutions for impulsive boundary value problems 159 5.5. Notes and remarks 165 viii Contents 6. Boundary value problems for impulsive differential inclusions 167 6.1. Introduction 167 6.2. First-order impulsive differential inclusions with periodic boundary conditions 167 6.3. Upper-and lower-solutions method for impulsive differential inclusions with nonlinear boundary conditions 184 6.4. Second-order boundary value problems 191 6.5. Notes and remarks 198 7. Nonresonance impulsive differential inclusions 199 7.1. Introduction 199 7.2. Nonresonance first-order impulsive functional differential inclusions with periodic boundary conditions 199 7.3. Nonresonance second-order impulsive functional differential inclusions with periodic boundary conditions 209 7.4. Nonresonance higher-order boundary value problems for impulsive functional differential inclusions 217 7.5. Notes and remarks 227 8. Impulsive differential equations & inclusions with variable times 229 8.1. Introduction 229 8.2. First-order impulsive differential equations with variable times 229 8.3. Higher-order impulsive differential equations with variable times 235 8.4. Boundary value problems for differential inclusions with variable times 241 8.5. Notes and remarks 252 9. Nondensely defined impulsive differential equations & inclusions 253 9.1. Introduction 253 9.2. Nondensely defined impulsive semilinear differential equations with nonlocal conditions 253 9.3. Nondensely defined …

Impulsive Differential Equations and Inclusions

American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus.

Although vaccines against measles have been routinely applied over a quarter of a century, measles is still persistent in Israel, with major epidemics roughly every 5 years. Recent serological analyses have shown that only 85% of Israelis aged 18 years have anti-measles IgG antibodies. Considering the high transmissibility of the virus and the high level of herd immunity required for disease eradication, the Israeli vaccination policy against measles is now being reevaluated. Motivated by theoretical studies of populations in perturbed environments, we examined the possibility of replacing the conventional cohort vaccination strategy by a pulse strategy--i.e., periodic vaccination of several age cohorts at the same time. Numerical studies of a deterministic age-structured model suggest that vaccination, which renders immunity to no more than 85% of the susceptible children aged 1-7 years, once every 5 years will suffice to prevent epidemics in Israel, where infection rate is highest amongst schoolchildren. The model suggests that by using such a strategy the density of susceptible individuals is always kept below the threshold above which recurrent epidemics will be maintained. Analysis of simpler, non-age-structured, models serves to clarify the basic properties of the proposed strategy. Our theoretical results indicate that the advantages and disadvantages of a pulse strategy should be seriously examined in Israel and in countries with similar patterns of measles virus transmission.

https://www.pnas.org/content/pnas/90/24/11698.full.pdf

Pulse mass measles vaccination across age cohorts

Background:Hypoglycemiaduringhospitalizationoccurs in patients with and without diabetes. The aims of this study were to determine the incidence, associated risk factors, and short- and long-term outcome of hypoglycemia among hospitalized elderly patients. Methods:Thisisacase-controlstudyconductedatgeriatric and medicine departments. All patients 70 years or olderwithdocumentedhypoglycemiahospitalizedwithin 1 year (n=281) were compared with a nonhypoglycemicgroupof281elderly,randomlyselectedpatientsfrom the same hospitalized population. Results: Among 5404 patients 70 years or older, 281 (5.2%) had documented hypoglycemia. Compared with thenonhypoglycemicgroup,wefoundthefollowingcharacteristics to be true in the hypoglycemic group: there weremorewomenthanmen(58%vs44%,P=.001);sepsis was 10 times more common (P.001); malignancy was 2.8 times more common (P=.04); the mean serum albumin level was lower (2.8 g/dL vs 3.4 g/dL, P.001); and the mean serum creatinine and alkaline phosphatase levels were higher (P.001 for both). Diabetes was known in 42% of the hypoglycemic group and in 31% of the nonhypoglycemic group (P=.03); 70 patients in the hypoglycemic group were taking sulfonylureas or insulin. Multivariate logistic analysis showed that sepsis, albumin level, malignancy, sulfonyurea and insulin treatment, alkaline phosphatase level, female sex, and creatinine level were all independent predictors of developinghypoglycemia.In-hospitalmortalityand3-month mortality were about twice as high in the hypoglycemic group(P.001).Multivariateanalysisofmortalityfound that sepsis, low albumin level, and malignancy were independent predictors, while hypoglycmia was not. Conclusions:Hypoglycemiawascommoninelderlyhospitalized patients and predicted increased in-hospital 3-and6-monthcumulativemortality.However,inamultivariate analysis, hypoglycemia was not an independent predictor for mortality, implying that it is only a marker.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/755868/ioi20588.pdf

Hypoglycemia as a predictor of mortality in hospitalized elderly patients.

A formal method is provided for predicting the effect on treatment efficacy of cell-cycle-phase-specific drugs, such as the AIDS drug zidovudine (AZT) or the cancer drug cytosine arabinoside (ara-C). Our analysis shows that the elimination of somatic cells or viruses depends not only on the drug's pharmacokinetic and pharmacodynamic properties, but also on the duration of the dosing interval per se and on the life-cycle parameters, that is, the duration of the drug-susceptible life phase, the duration of the whole life cycle, and the proliferation rate. The results support those of simplified models in showing that drug toxicity to the host may be minimized when the dosing interval is an integer multiple of the average cycle time of the host susceptible cells. This prediction has been verified in mice treated with AZT or ara-C.

A theoretical analysis of interval drug dosing for cell-cycle-phase-specific drugs.

Background: Hypoglycemia during hospitalization occurs in patients with and without diabetes. The aims of this study were to determine the incidence, associated risk factors, and short- and long-term outcome of hypoglycemia among hospitalized elderly patients. Methods: This is a case-control study conducted at geriatric and medicine departments. All patients 70 years or older with documented hypoglycemia hospitalized within 1 year (n = 281) were compared with a nonhypoglycemic group of 281 elderly, randomly selected patients from the same hospitalized population. Results: Among 5404 patients 70 years or older, 281 (5.2%) had documented hypoglycemia. Compared with the nonhypoglycemic group, we found the following characteristics to be true in the hypoglycemic group: there were more women than men (58% vs 44%; p = .001); sepsis was 10 times more common (p < .001); malignancy was 2.8 times more common (p = .04); the mean serum albumin level was lower (2.8 g/dL vs 3.4 g/dL, p < .001); and the mean serum creat...

Hypoglycemia as a Predictor of Mortality in Hospitalized Elderly Patients

Objective The authors sought to determine the incidence of delirium, its predisposing and precipitating factors, and its implications for rehabilitation outcomes and mortality in elderly patients. Methods This was a prospective cohort study, conducted in Gedera, Israel, from August 2001 to January 2002, with 137 consecutive patients over age 75, with hip fractures, who were admitted to the orthopedic section of the emergency department. They were evaluated at admission, 1 week after the surgery for hip fracture, and 1 month after surgery. The evaluation included assessments of delirium, cognitive, and functional status, and a wide range of demographic and clinical parameters. Results The cumulative incidence of delirium was 11.4%. No significant difference was found between delirium and non-delirium patients in terms of all demographic, socioeconomic, and perioperative parameters. Mild or moderate cognitive impairment before the fracture and four or more regular medications prescribed to the patient were the only predictive factors for the development of delirium in a multivariate model. Delirium was not a significant predictor of any rehabilitation outcome. Conclusion Results documented that the incidence of delirium after hip fracture in elderly patients is much lower than was reported in several previous studies. Premorbid cognitive impairment was the most significant predisposing factor for the development of delirium. Thorough evaluation of earlier cognitive status could improve the probability of the diagnosis of delirium and pinpoint a limited group of patients for a delirium-prevention approach.

Lutzy Cojocaru

Papers

Pulse mass measles vaccination across age cohorts

Hypoglycemia as a predictor of mortality in hospitalized elderly patients.

A theoretical analysis of interval drug dosing for cell-cycle-phase-specific drugs.

Hypoglycemia as a Predictor of Mortality in Hospitalized Elderly Patients

Low Incidence of Delirium in Very Old Patients After Surgery for Hip Fractures