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Biomedical subjects

J N Kvale

Publications and source records attributed to J N Kvale.

At least 19 recordsLinked to original sources
PubMed2001

Emotional impact of retirement on physicians.

The current study sought to identify the factors underlying physicians' decision to retire, describe the emotional impact of retirement on physicians, measure quality of life in retirement, and identify coping strategies used by retired physicians. A questionnaire was sent to all 689 retired members of the Harris County Medical Society, and 323 (47%) responded. Data were analyzed using SPSS. Physicians overwhelmingly indicated positive reasons for retirement, although one third said that loss of autonomy and control in medical practice were factors. Participants were satisfied with retirement and enjoyed low levels of stress and depression. Spousal and personal health had the largest negative impact on retirement. Being prepared emotionally significantly affected physicians' attitudes. Longitudinal studies and research on the impact of managed care on the retirement experience are needed. Younger physicians need to be prepared for the emotional impact of retirement.

Adaptation, Psychological↗
PubMed1995

The importance of geriatrics to family medicine: a position paper by the Group on Geriatric Education of the Society of Teachers of Family Medicine.

The role of geriatrics and geriatricians in family medicine remains unsettled. Despite a rapidly aging population, a tremendous shortage now exists of faculty with interest and expertise in geriatrics. Relatively few family practice residents choose to enter geriatric fellowship programs, and federal funding for such programs has been reduced. Despite accreditation requirements, residency programs are not always able to provide the range of geriatric experiences needed to properly prepare graduates to provide care for the broad range of older patients. Medical students' exposure to geriatrics remains limited. The Group on Geriatric Education of the Society of Teachers of Family Medicine believes that family medicine faculty must recognize and be committed to the notion that geriatrics is integral to family medicine. Both undergraduate and residency training programs should emphasize experience with geriatric patients in multiple settings. In particular, the nursing home should not be the main focus of geriatric training. The small number of certified geriatric faculty will be able to provide leadership, but a broad range of faculty must become involved in teaching geriatrics. Faculty development activities and continuing education programs to foster the necessary expertise will be essential to the accomplishment of this task.

Aged↗
PubMed1994

Agreement between telephone survey and medical record data for the elderly patient.

OBJECTIVE: This study compares agreement between telephone survey and ambulatory medical record data for an elderly patient population. METHODS: Medical records and telephone survey responses are used to compare health status (chronic medical condition, symptomatology, and functional status) of 142 elderly patients randomly selected from a family practice residency and a geriatric fellowship practice. Chart abstraction was performed by two resident and two faculty physicians after a training period designed to assure high inter-reviewer reliability. Telephone surveys were completed by two professional interviewers. Health status measures were taken from standard, published instruments. The kappa statistic was used to measure the agreement between medical record and survey data. RESULTS: Overall, there is little agreement between the medical record and the telephone survey results on chronic medical condition, symptomatology, and functional status. CONCLUSIONS: Medical records abstractions and telephone survey methodologies did not yield comparable health status data when applied to the same elderly patient population. Functional status assessment and symptomatology are particularly problematic, but even the presence or absence of chronic diseases is often inconsistent in the two data sources.

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PubMed1993

Common gynecologic problems after age 75.

Management of gynecologic problems in women aged 75 and over can be challenging. Appropriate examination and evaluation differs from that for younger women, and these patients are often poor surgical candidates. The most common presenting conditions include stress incontinence, atrophic changes of the vulva and vagina, and pelvic relaxation with uterine prolapse. Several techniques for nonsurgical management are available, including topical and systemic drug therapy and use of products and aids that increase comfort and encourage independence.

Age Factors↗
PubMed1989

Nutrition for the elderly.

Nutrition in the older person is complex because of changing physiology, changes caused by multiple chronic diseases, changes induced by pharmacologic agents, and commonly, failing protein/caloric intake. This article is designed to explain the mechanisms of these processes and to suggest pragmatic and practical responses in the management of the older patient.

Aged↗
PubMed1988

Religious activities and attitudes of older adults in a geriatric assessment clinic.

Few studies have examined the prevalence, salience, and impact of religious beliefs, activities, and commitment among medical patients in later life. Surveys of the U.S. population aged 65 years and over reveal a high frequency of such beliefs and activities, which are reported to play a significant role in their lives. In this study, the religious beliefs, activities, and motivations of 106 consecutive patients (mean age 74.4 years) attending a geriatric outpatient clinic were examined. A high prevalence of orthodox Christian beliefs, religious community activity, private devotional activity, and intrinsic religious orientation was found. Levels of religious activity and intrinsic orientation were lower among patients with cancer, chronic anxiety, depressive symptoms, and those who smoked cigarettes or consumed moderate to large amounts of alcohol. Intrinsic religiosity was lower among men with hypertension. Patients with mild to moderate dementia tended to have higher levels of intrinsic religious orientation. The results of this study suggest that religion is a powerful cultural force in the lives of older medical patients and is integrally related to both mental and physical health.

Aged↗
PubMed1987

Resuscitation of the elderly.

Concerns about quality of life and the cost of medical care raise questions about the effectiveness of cardiopulmonary resuscitation (CPR) efforts. This study explores the role of age in resuscitation outcome by focusing on the CPR experience of all patients age 75 years and older in a community hospital during a one-year period. Data are based on a retrospective study of the medical records of 86 such patients. While 41 percent survived the initial resuscitation effort, only 23 percent regained conscious functioning, 12 percent left the hospital, and only 7 percent survived to be discharged from the hospital and were alive one year later. None of the 26 patients over the age of 85 survived resuscitation. Among the 75 to 84-year-old patients, the diagnosis of acute onset arrhythmia and dementia were associated with a better survival prognosis. Crude estimates of cost based on charges for crash carts, intensive care, and bed rates totalled over $100,000; over one-half the amount was allocated to the 21 patients who were unconscious before finally dying the hospital. The study suggests the importance of continuing discussion about quality of life and cost implications of resuscitation of elderly patients.

Aged↗
PubMed1986

Alzheimer's disease.

The variety of etiologic theories suggests that Alzheimer's disease may be multifactorial in origin. While the diagnosis is certain only at autopsy, a careful history and physical examination combined with relatively simple studies can exclude multi-infarct dementia and reversible forms of dementia, such as pseudodementia. Staging the clinical course facilitates management decisions. The family physician should provide as much nurturance as possible to family members who are caring for patients with this disease.

Alzheimer Disease↗
PubMed1984

Psychoactive drugs and the frail elderly patient.

Rational use of psychoactive drugs in frail elderly patients requires an understanding of the physiologic changes produced by aging and chronic disease. Other drugs being used and the patient's nutritional status and lifestyle also must be considered. Affective disorders and thought disorders may be effectively treated with much lower doses of appropriate psychoactive drugs than those commonly prescribed. Benzodiazepines are poorly tolerated by old persons because of paradoxic responses and frequent adverse reactions.

Aged↗
PubMedDate not supplied

Health and poverty among elderly persons: a community-oriented primary care survey.

Providing health care for independent-living elderly persons is important, yet family physicians often lack accurate information about needs and access to care. The Community-Oriented Primary Care (COPC) approach and health status models from health services research provide a framework for assessing need and access to care. Personal interviews were conducted with 990 noninstitutionalized elderly persons in Youngstown, Ohio. Results showed that poverty, gender, and race were not strongly related to health status as measured by numbers of symptoms, functional status, or subjective health status. In addition, elderly persons had fewer health care needs and greater access to care than expected. Simple models of health status, need, and access do not seem to apply. The study shows the usefulness of COPC in planning health services; however, more effort is needed to refine measures of health status, need, and access.

Aged↗
PubMedDate not supplied

Geriatric fellowships in family medicine: status and directions.

The American Board of Medical Specialties recently approved the concept of certificates of added qualifications in geriatrics within both internal medicine and family practice. Certification requirements have been worked out for each training model, and questions have quite naturally arisen addressing whether the developing family practice model is substantially different from the longer established internal medicine model. A survey was made of 12 family practice based geriatric fellowship programs. Program directors were asked how they felt family practice geriatrics differed from internal medicine geriatrics in approaches to patient care and training and in areas of research interests. Information was also gathered about program size, length of training, and operational status. Eight fellowship programs were found to be active at the time of the survey, but only two for more than six months. Of the eight functioning programs, four were currently without fellows--a forewarning, perhaps, of potential recruitment problems for additional programs under development. Survey responses indicated a universal feeling among directors of family practice geriatric programs that their model does serve a unique function. Within the "distinguishing characteristics" most frequently noted, an emphasis on psychosocial and family issues can be identified. This emphasis can also be seen in the suggestions for distinctive research, with an indication of special interest in the delivery of health care.

Curriculum↗