FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2014508118> ?p ?o ?g. }

• W2014508118 endingPage "219" @default.
• W2014508118 startingPage "218" @default.
• W2014508118 abstract "The 80-year-old is not simply the 45-year-old, 35 years later. This truism is the essence of geriatric medicine and demands clinical approaches that are age-relevant and function oriented.1–7 These geriatric medical approaches are not meant to substitute for “classical” clinical approaches but rather to expand the diagnostic reach and uncover the complexities. The importance of diligently obtaining the elderly person's lengthy history, often from a variety of sources, is obvious. The physical exam is more important than ever since the history may not be totally obtainable and laboratory studies have their limitations. The identification of several simultaneous illnesses and problems is the usual outcome of the clinical assessment of the older person. Medical training needs to emphasize the likelihood and importance of detecting multiple problems in the elderly patient. The single unifying diagnosis and pathophysiology occurs less frequently than it does in younger patients, and the “major” diagnosis often fails to explain the quality of life and outcome of therapies. The “not-so-classical” geriatric medical approaches include: (1) assessment of functions (walking, mental status, transferring, and other activities of daily living and related social functions such as bill paying, hygiene, and social contacts); (2) attention to advance directives focused on resuscitation, prolonged tube or IV feeding, and institutionalization; (3) acknowledgement of time as a significant matter to the elderly who require and want more time from their clinicians; (4) awareness of the frequently different modes of presentation of illness in the elderly; and (5) involvement in the changing phases of illness and places of care, including home care, nursing home, and hospital. One of the most striking differences between the younger patient and the elderly is the matter of the “chief complaint”; for the elderly, it is usually “chief complaints.”6,8–11 In addition, relatives, friends, and/or health aides often render their differing views of the patient's chief problems(s). On the other hand, the clinician has his traditional and often overly narrow focus on the chief problem. The frequent discrepancies in perspective among the patient, caregiver, and clinicians are impressive as is the additive nature of these problems. In this issue of the JAGS, the paper by Fried et al12 emphasizes in a novel and imaginative categorization the core of geriatric medical approaches to the many facets of the older patients' clinical presentations. These investigators have established five models or clinical patterns which they believe encompass most of the clinically complex and subtle presentations evidenced by the elderly. Beyond the standard category of the medical model, they classify elderly presentations into the “synergistic morbidity” model; the “attribution” model and its variant, the “facilitating complaint,” including “caregiver collapse”; the “causal chain” model; and the “unmasking event” model. These categories were developed from a retrospective chart review of outpatients seen at a geriatric assessment center and then validated in a prospective study of patients seen at the same outpatient geriatric center. Less than 50% of presentations fit into the medical model. These insightful designations and phrases could lead to enhanced care, more appropriate training, and new research. To be effective, we will need, as has been apparent for some time, a change in reimbursement which recognizes the assessment phase of care. For example, additional time is needed to properly evaluate the subtle presentations of the elderly patient, and team effort is frequently necessary to achieve proper multilevel therapies. Notable in the study population in the Fried et al paper was the paucity of falls, incontinence, or cognitive decline as chief complaints in the population. These ubiquitous problems were not unmasked in the evaluation process. The authors voice surprise that these conditions, known to be associated with advanced age, were rarely evident as chief complaints. They express the hope that increased education of lay people will lead to patients and families giving more visibility to these problems. More to the point is the need for improved skills by clinicians and revised training programs emphasizing change in the traditional approach to history taking which, in its classical form, would rarely detect such problems. The authors, at times, interchange the concepts of accuracy of diagnoses with accuracy of classification of presentation. Though this new model is a fine conceptual framework and is useful in categorizing and alerting clinicians to the dynamics of patient experience and symptomatology, excess attention to classification of presentation could lead to inattention to the diagnoses of illness, an excessive swing away from traditional medical approaches. The challenge is to integrate the classic medical approach with the functional, psychosocial, and environmental aspects of the older person's state of health. An alternative and perhaps preferable phrase to keynote the geriatric evaluation is “chief concern,” eg, what are you concerned and worried about? To make salient the “concerns” of patients and/or caregivers, clinicians will need enhanced diagnostic training and new program responses appropriate to these newly expressed concerns, previously somewhat obscured from attention. Will clinicians, particularly non-geriatricians, utilize this innovative taxonomy? We won't know for a while, but there is room for doubt unless the training system and the reimbursement system change. Another problem is that five categories may prove too cumbersome for practical application. However, a change in our approach to patients is clearly essential. The model may prove inadequate for many patients of all age groups, but especially for those chronically ill and very old. The analysis, pioneered by Fried et al, of the factors contributing to the clinical presentations of the elderly deserves to be widely utilized. Such an approach should lead to new cost effective and human effective health care for the elderly." @default.
• W2014508118 created "2016-06-24" @default.
• W2014508118 creator A5017665963 @default.
• W2014508118 date "1991-02-01" @default.
• W2014508118 modified "2023-10-03" @default.
• W2014508118 title "Resolving Complexity in Geriatrics" @default.
• W2014508118 cites W1983878913 @default.
• W2014508118 cites W2013161818 @default.
• W2014508118 cites W2061492586 @default.
• W2014508118 cites W2094089705 @default.
• W2014508118 cites W2151186028 @default.
• W2014508118 cites W2325978292 @default.
• W2014508118 cites W2466217504 @default.
• W2014508118 doi "https://doi.org/10.1111/j.1532-5415.1991.tb01631.x" @default.
• W2014508118 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/1991955" @default.
• W2014508118 hasPublicationYear "1991" @default.
• W2014508118 type Work @default.
• W2014508118 sameAs 2014508118 @default.
• W2014508118 citedByCount "0" @default.
• W2014508118 crossrefType "journal-article" @default.
• W2014508118 hasAuthorship W2014508118A5017665963 @default.
• W2014508118 hasBestOaLocation W20145081181 @default.
• W2014508118 hasConcept C118552586 @default.
• W2014508118 hasConcept C141071460 @default.
• W2014508118 hasConcept C164429055 @default.
• W2014508118 hasConcept C20387591 @default.
• W2014508118 hasConcept C2776236459 @default.
• W2014508118 hasConcept C2777601897 @default.
• W2014508118 hasConcept C2777880217 @default.
• W2014508118 hasConcept C38652104 @default.
• W2014508118 hasConcept C41008148 @default.
• W2014508118 hasConcept C54183767 @default.
• W2014508118 hasConcept C71924100 @default.
• W2014508118 hasConcept C74909509 @default.
• W2014508118 hasConceptScore W2014508118C118552586 @default.
• W2014508118 hasConceptScore W2014508118C141071460 @default.
• W2014508118 hasConceptScore W2014508118C164429055 @default.
• W2014508118 hasConceptScore W2014508118C20387591 @default.
• W2014508118 hasConceptScore W2014508118C2776236459 @default.
• W2014508118 hasConceptScore W2014508118C2777601897 @default.
• W2014508118 hasConceptScore W2014508118C2777880217 @default.
• W2014508118 hasConceptScore W2014508118C38652104 @default.
• W2014508118 hasConceptScore W2014508118C41008148 @default.
• W2014508118 hasConceptScore W2014508118C54183767 @default.
• W2014508118 hasConceptScore W2014508118C71924100 @default.
• W2014508118 hasConceptScore W2014508118C74909509 @default.
• W2014508118 hasIssue "2" @default.
• W2014508118 hasLocation W20145081181 @default.
• W2014508118 hasLocation W20145081182 @default.
• W2014508118 hasOpenAccess W2014508118 @default.
• W2014508118 hasPrimaryLocation W20145081181 @default.
• W2014508118 hasRelatedWork W1548648709 @default.
• W2014508118 hasRelatedWork W1982904285 @default.
• W2014508118 hasRelatedWork W2001960351 @default.
• W2014508118 hasRelatedWork W2016258181 @default.
• W2014508118 hasRelatedWork W2084128845 @default.
• W2014508118 hasRelatedWork W2167879839 @default.
• W2014508118 hasRelatedWork W2892934986 @default.
• W2014508118 hasRelatedWork W2920978234 @default.
• W2014508118 hasRelatedWork W3045744146 @default.
• W2014508118 hasRelatedWork W4214799196 @default.
• W2014508118 hasVolume "39" @default.
• W2014508118 isParatext "false" @default.
• W2014508118 isRetracted "false" @default.
• W2014508118 magId "2014508118" @default.
• W2014508118 workType "article" @default.