This study evaluated beliefs regarding 25 content areas essential to the primary care of older adults and attitudes toward aging held by first-yearmedical students and Internal Medicine residents. A survey of 136 medical students and 61 Internal Medicine residents was conducted at an academic health-center. Beliefs were assessed by the 25-item Geriatrics Clinician-Educator Survey. Gap scores reflecting the difference in ratings between self-rated importance and knowledge were calculated. Attitudes toward aging was assessed by the Images of Aging Scale. Students and residents expressed similar beliefs about the importance of content areas, but students provided lower ratings in knowledge. Students reported larger gap scores in areas that reflected general primary care (e.g., chronic conditions, medications), whereas residents reported larger gap scores in areas that reflected specialists' expertise (e.g., driving risk, cognition, psychiatric symptoms). Attitudes toward aging did not differ appreciably between students and residents. Our findings suggest that primary care topics applicable for any age demographic were rated as most important by first-year medical students and Internal Medicine residents. Topics relevant to older populations--particularly those requiring specialists' knowledge of or requiring sensitive discussion with older adults-were rated as less important and were less well-mastered.

• Klíčová slova
• Attitudes, geriatrics education, primary care,
• MeSH
• geriatrie * výchova   metody   MeSH
• kultura MeSH
• kurzy a stáže v nemocnici metody   MeSH
• lidé MeSH
• postoj zdravotnického personálu MeSH
• primární zdravotní péče * metody   normy   MeSH
• senioři MeSH
• stárnutí psychologie   MeSH
• studenti lékařství psychologie   MeSH
• zdraví - znalosti, postoje, praxe MeSH
• zdravotní služby pro seniory * organizace a řízení   normy   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, U.S. Gov't, Non-P.H.S. MeSH

BACKGROUND: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

• Klíčová slova
• Dehydration, Geriatrics, Guideline, Malnutrition, Obesity, Recommendations,
• MeSH
• geriatrie * MeSH
• kvalita života MeSH
• lidé MeSH
• nutriční podpora MeSH
• podvýživa * diagnóza   prevence a kontrola   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH

We compared attitudes toward aging of students from several health professions (N = 1,156: 286 medical, 275 pharmacy, 213 undergraduate nursing, 160 graduate nursing, 139 Internal Medicine residents, 49 physical therapy, and 34 physician assistant), and assessed the construct validity of the Image of Aging Scale. Physical therapy and graduate nursing students reported more positive attitudes toward aging in comparison to all other health professions (all p <.001). Differences in attitudes were not strongly affected by demographic variables, clinical exposure, desire to pursue primary care, or interest in providing care to older adults. The Image of Aging Scale yielded good internal reliability and adequate construct validity for health professions students. Health professions students' attitudes toward aging largely reflect the students' professional training, rather than student characteristics or career goals. The Image of Aging Scale is a robust measure of attitudes toward aging in health professions students and in older adults.

• Klíčová slova
• Ageism, attitudes about older patients, geriatrics workforce enhancement program, student attitudes,
• MeSH
• geriatrie * výchova   MeSH
• lidé MeSH
• postoj zdravotnického personálu MeSH
• postoj MeSH
• průzkumy a dotazníky MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• stárnutí MeSH
• studenti lékařství * MeSH
• studenti ošetřovatelství * MeSH
• studium ošetřovatelství bakalářské * MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, U.S. Gov't, P.H.S. MeSH

BACKGROUND: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

• Klíčová slova
• Dehydration, Geriatrics, Guideline, Malnutrition, Nutritional care, Recommendations,
• MeSH
• dehydratace terapie   MeSH
• enterální výživa MeSH
• geriatrie metody   MeSH
• lidé MeSH
• nadváha terapie   MeSH
• parenterální výživa MeSH
• podvýživa terapie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• společnosti lékařské MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH
• Geografické názvy
• Evropa MeSH

• Klíčová slova
• GERIATRICS *,
• MeSH
• geriatrie * MeSH
• Publikační typ
• časopisecké články MeSH

We established a Geriatrics Workforce Enhancement Program (GWEP) clinic to enhance resident training on comprehensive preventive care and chronic disease management, and to increase the number of older patients who received Medicare Annual Wellness Visit (AWV) preventive services. A total of 1,104 patients were tracked at baseline and during the intervention period. Patients were grouped into two categories: Adult (aged 55-64) and Senior (aged 65+). Clinical quality measures were monitored by electronic health record and tracked through monthly reports at baseline (May 2018) and during the intervention period (July 2018-June 2019). In the Senior group, the proportion of patients receiving the Medicare AWV increased after GWEP began (p <.001). Additionally, the Senior group showed significant improvements in the frequency of body mass index assessments (p = .04), colorectal cancer screenings (p < .001), advance directive documentation (p < .001), cognitive screenings (p < .001), and pneumococcal vaccinations (p < .001). In the Adult group, a trending increase was seen in influenza vaccinations (p = .06). Curricular innovations including the establishment of a GWEP clinic in our residency outpatient center, development of new educational materials, and use of a nurse coordinator resulted in significant improvements in the percentage of older adults who received the Medicare AWV benefit and preventive health performance metrics.

• Klíčová slova
• Medicare annual wellness visit, preventative health,
• MeSH
• geriatrie * výchova   MeSH
• lidé MeSH
• Medicare * MeSH
• pracovní síly MeSH
• senioři MeSH
• služby preventivní péče MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Spojené státy americké MeSH

Older subjects are at increased risk of partial or complete loss of independence due to acute and/or chronic disease and often of concomitant protein caloric malnutrition. Nutritional care and support should be an indispensable part of their management. Enteral nutrition is always the first choice for nutrition support. However, when patients cannot meet their nutritional requirements adequately via the enteral route, parenteral nutrition (PN) is indicated. PN is a safe and effective therapeutic procedure and age per se is not a reason to exclude patients from this treatment. The use of PN should always be balanced against a realistic chance of improvement in the general condition of the patient. Lower glucose tolerance, electrolyte and micronutrient deficiencies and lower fluid tolerance should be assumed in older patients treated by PN. Parenteral nutrition can be administered either via peripheral or central veins. Subcutaneous administration is also a possible solution for basic hydration of moderately dehydrated subjects. In the terminal, demented or dying patient the use of PN or hydration should only be given in accordance with other palliative treatments.

• MeSH
• činnosti denního života MeSH
• domácí ošetřování MeSH
• domovy pro seniory MeSH
• enterální výživa MeSH
• geriatrie * normy   MeSH
• kontraindikace MeSH
• kvalita života MeSH
• lidé MeSH
• nutriční stav MeSH
• parenterální výživa * škodlivé účinky   normy   MeSH
• pečovatelské domovy MeSH
• podvýživa terapie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• služby domácí péče MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH

• MeSH
• geriatrie * MeSH
• lidé MeSH
• senioři MeSH
• zdravotní služby pro seniory * MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Geografické názvy
• Československo MeSH

AIM: To compare the effects of exergames (EGs) using the Xbox Kinect™ device and home exercise (HE) on balance, functional mobility, and quality of life of individuals aged 65 years or older. METHOD: One hundred participants who met the inclusion criteria were randomized to the EG or HE group. The EG group took part in a 6-week programme using the Xbox360Kinect™ device, and the HE group took part in a 6-week balance exercise programme at home 5 days a week. The Berg Balance Scale (BBS) was used to assess balance, the Timed Up and Go (TUG) test was used to evaluate functional walking, and the Short Form 36 (SF-36) was used to assess quality of life. RESULTS: Forty-eight participants in the EG group and 42 participants in the HE group completed the study. The groups were similar in terms of age, sex, and pretreatment values of BBS, TUG, and SF-36. Although the BBS scores of both groups improved significantly (all p<0.05), the post-treatment scores of the EG group were better than those of the HE group. The TUG scores improved only in the EG group (p<0.05). The increase in the BBS scores and decrease in the TUG test scores were significant only in the EG group (all p<0.05). A significant improvement was also observed in the quality of life parameters of physical functioning, social role functioning, physical role restriction, general health perceptions, and physical component scores in the post-exercise evaluations of the EG group. The participants commented that they found the EG programme very entertaining. CONCLUSION: The EG can be considered a safe, entertaining and sustainable alternative to HE programmes, and it may have positive effects on balance, functional walking and quality of life in geriatric subjects.

• Klíčová slova
• balance, exergames, geriatrics, quality of life, walking,
• MeSH
• geriatrické hodnocení MeSH
• kvalita života * MeSH
• lidé MeSH
• omezení pohyblivosti MeSH
• posturální rovnováha fyziologie   MeSH
• senioři MeSH
• terapie cvičením metody   MeSH
• ukazatele zdravotního stavu MeSH
• videohry * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

Analysis of goals and approaches in teaching geriatrics and gerontology for undergraduate medical students according to literature and personal 6 years experience. A proposal of "two module model" with introductory module of general gerontology in first years of studium (stress on communication, reflection of the elderly as human beings, their limitations, risks, and needs, lectures for medical students as well as for students of nursing, occupational therapy and so on to support team approach). Advanced module of "proper medical geriatrics" in late clinical years of studium (to stress atypical character of diseases, investigation, differential diagnosis and importance of acute care for elders units).

• MeSH
• geriatrie výchova   MeSH
• kurikulum MeSH
• lidé MeSH
• studium lékařství pregraduální * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH