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  • ISSN: 2378-9409
    Volume 1, Issue 4
    Editorial
    Rakesh Garg1* and Uma Hariharan2
    There exists no magic wand that can completely reverse or halt the physiological process of aging. Geriatric anaesthesia is emerging as a highly dedicated branch of perioperative medicine, especially since the number of people entering the 65 years plus bracket is steadily increasing. The incidence of co-morbidities and thus the need of polypharamacy rise with increasing age, especially after the age of 80 years [1,2].
    Research Article
    Ritabelle Fernandes1,2*, Mya Moe Hla2, Merlita Compton2, Chuan Chang3, Kamal Masaki1 and Michael C. Hosokawa4
    Abstract: Memory clinics are lacking in the state of Hawaii, access to dementia assessment is limited. The objective of this study was to establish a culturally appropriate model of Memory Clinic in a Patient-Centered Medical Home (PCMH) and assess the impact on healthcare utilization. An inter-professional team of geriatrician, geriatric medicine fellows, gerontologist, psychiatrist, lawyer, interpreters, and dietician provided comprehensive dementia assessment in a group visit setting. This clinic was conducted once a month in partnership with the geriatric medicine fellowship continuity clinic. The goals of the Memory Clinic were comprehensive dementia assessment and caregiver empowerment irrespective of the ability to pay. The Memory Clinic was conducted in a federally qualified health center setting of a PCMH. Over a period of two years, 51 patients were seen. Average age was 75 years and 67% were women. Seventy-five percent were Filipino ethnicity followed by Micronesians, Samoans and other Asians. Fifty percent had completed advance care directives, with copies filed in the electronic health record. Sixty-five percent had Medicare; of these 27% had both Medicare and Medicaid. There was no significant reduction in emergency room or hospital visits among the participants. The rate of foster home or care home placement did not increase significantly over time, with 87.5% of seniors were still able to live at home. The Memory Clinic in a primary care setting improved access to dementia care. Inter-professional teams in a PCMH are highly effective in care coordination for persons with mild cognitive impairment and dementia.
    Yoshihisa Hirakawa* and Kazumasa Uemura
    Abstract:
    Background: Care managers play a key role in the multidisciplinary community care team that provides support to seniors who require direct care services, care coordination, and daily living improvement assistance. Yet, a few reports have indicated that non-medical care managers are often unable to communicate efficiently with medical professionals. The aim of the present study is to explore the attitudes of non-medical care managers towards reporting to, contacting, and consulting physicians.
    Methods: We collected qualitative data through eight-person discussions. Eight non-nurse care managers took part in a 45-minute discussion on reporting to, contacting, and consulting physicians. We used the KJ method as a qualitative research tool.
    Results: The KJ labels were organized into nine groups: 1) Poor communication skills and mindset; 2) Avoiding direct contact with physicians; 3) Acquiring the skills to report to, contact and consult physicians; 4) I feel more confident consulting a doctor if he approaches me first; 5) I prefer to consult a doctor through a nurse, thereby avoiding direct contact; 6) Home doctors seem more approachable than hospital doctors; 7) Once in a while I come across doctors who are quite accessible; 8) I feel very grateful when a physician responds politely to a request of mine; 9) I want to be able to communicate with doctors on a daily basis.
    Conclusions: Our results suggest that the physician/care manager communication gap is a key issue in community settings, and highlight important technical and emotional factors contributing to this gap.
    Livia Maria Santiago1,2*, Cleber Nascimento do Carmo1,2, Daniele Bittencourt Ferreira1,2 and Ines Echenique Mattos2
    Abstract: In the literature about health and ageing, there is a small number of investigations focusing socio-demographic and health characteristics of institutionalized older adults. This cross-sectional study aimed to analyze relationships between functionality, socio-demographic and health conditions in elderly individuals living in long stay institutions and to evaluate differences among residents living in cities of the Southeast and Middle West regions in Brazil. We used correspondence analysis to explore joint relationships between functionality limitations, socio-demographic conditions and health conditions and to identify the profile of the studied population. We surveyed 760 individuals, over half of which were male (52.6) while nearly 40.0% were 80 years old or older. Most of them showed dependence in instrumental activities of daily living (81.2) and cognitive deficit (73.3). We were able to identify three distinct profiles in the studied population. The group from Rio de Janeiro and Campo Grande was the youngest and healthiest; the group from Cuiaba was characterized by illiteracy and reading problems and comprised individuals with cognitive deficit and IADL-dependent and the last one (Juiz de Fora) comprised the oldest, most debilitated and least healthy individuals. This heterogeneity of profiles could be partially explained by socio-demographic and cultural contexts that lead to institutionalization of older adults in each city, indicating the possibility of different interventions aiming to prevent and reduce functional dependency, which would take into account specific features of targeted groups of elderly individuals.
    Short Communication
    Anatoliy I. Yashin1,2, Deqing Wu1, Konstantin G. Arbeev1, Liubov S. Arbeeva1, Igor Akushevich1, Alexander Kulminski1, Irina Culminskaya1, Eric Stallard1 and Svetlana V. Ukraintseva1,2*
    Abstract:
    Background: Correcting for the potential effects of population stratification is an important issue in genome wide association studies (GWAS) of complex traits. Principal component analysis (PCA) of the genetic structure of the population under study with subsequent incorporation of the first several principal components (PCs) in the GWAS regression model is often used for this purpose.
    Problem: For longevity related traits such a correction may negatively affect the accuracy of genetic analyses. This is because PCs may capture genetic structure induced by mortality selection processes in genetically heterogeneous populations.
    Data and Methods: We used the Framingham Heart Study data on life span and on individual genetic background to construct two sets of PCs. One was constructed to separate population stratification due to differences in ancestry from that induced by mortality selection. The other was constructed using genetic data on individuals of different ages without attempting to separate the ancestry effects from the mortality selection effects. The GWASs of human life span were performed using the first 20 PCs from each of the selected sets to control for possible population stratification.
    Results: The results indicated that the GWAS that used the PC set separating population stratification induced by mortality selection from differences in ancestry produced stronger genetic signals than the GWAS that used PCs without such separation.
    Conclusion: The quality of genetic estimates in GWAS can be improved when changes in genetic structure caused by mortality selection are taken into account in controlling for possible effects of population stratification.
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