Re: Can Comprehensive Geriatric Assessment be Delivered without the Need for Geriatricians? A Formative Evaluation in Two Perioperative Surgical Settings.

available at https://pubmed.ncbi. nlm.nih. gov/30916758 Editorial Comment: Preoperative evaluation of older adults is a crucial component of high quality surgical care. Multiple studies have shown that optimization of underlying comorbid conditions can have positive effects on clinical outcomes in elderly surgical patients. However, numerous evaluation tools are available, and there has been great debate about the ideal method to assess the many different dimensions of geriatric comorbidity, clinical needs and frailty. The Comprehensive Geriatric Assessment (CGA) has often been considered the ultimate standard in geriatrics. This multidimensional evaluation is primarily typically performed by geriatricians and multidisciplinary clinical teams. The authors of this qualitative study sought to determine if nongeriatricians including surgeons could incorporate the concepts of the CGA into preoperative assessment at 2 large teaching hospitals in the United Kingdom. There was great enthusiasm at the start of the trial, although it waned over the 12 months of implementation and evaluation. The authors determined that the period of service development was too long, and there were other competing priorities and time limitations for ongoing use. My interpretation is that the trial was not a failure, but rather an exercise that highlights the great heterogeneity of clinical needs among older adults, and the complexity of preoperative decision making for elderly surgical patients. Other studies have indicated that surgeons and other clinicians can accurately implement quality geriatric evaluations even outside the context of the full CGA. Continuing work on various approaches to augment the evaluation and management of these patients should be encouraged. Tomas L. Griebling, MD, MPH Re: Long-Term Effect of Community-Based Continence Promotion on Urinary Symptoms, Falls and Health Active Life Expectance among Older Women: Cluster Randomised Trial C. Tannenbaum, X. Fritel, A. Halme, E. van den Heuvel, J. Jutai and A. Wagg Department of Geriatrics, Faculty of Medicine, Universit e de Montr eal and Department of Geriatrics, Internal Medicine Resident, McGill University, Montr eal, Qu ebec, Department of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, and Department of Geriatrics, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada, Department of Obstetrics and Gynecology, Facult e de M edecine et Pharmacie, Universit e de Poitiers, Poitiers, France, and Department of Clinical Sciences, Brunel Institute for Ageing Studies, Brunel University, Uxbridge, United Kingdom Age Ageing 2019; 48: 526e532. doi: 10.1093/ageing/afz038 Abstract available at https://pubmed.ncbi. nlm.nih. gov/31220200available at https://pubmed.ncbi. nlm.nih. gov/31220200 Editorial Comment: As the population continues to age, researchers have worked to develop innovative ways to promote healthy aging and address common clinical conditions. Community outreach programs have become a popular method to engage large numbers of older adults on these topics. This study conducted through 184 community organizations in the United Kingdom, Canada and France examined outcomes for improvement in urinary continence, reduction in falls and enhanced 856 GERIATRICS Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. healthy life expectancy. Subjects participated in either a 60-minute group session on incontinence self-management methods (intervention groups) or a more generalized healthy aging seminar (control groups). Randomization was at the community organization level. Statistically significant improvements in continence outcomes were seen among subjects in the intervention groups (15%) compared to the control groups (6.9%). No significant differences were seen in the outcome measures for falls or healthy life expectancy. The authors conclude that delivery of this type of continence promotion and self-help information in group settings is feasible, and improvements seem durable at least in the first year. They found that partnering with community organizations was a useful method to help disseminate this public education. Additional research will continue to refine these types of opportunities not only for incontinence, but potentially for other urological conditions that are common in the geriatric setting. Tomas L. Griebling, MD, MPH Re: A Group-Based Yoga Program for Urinary Incontinence in Ambulatory Women: Feasibility, Tolerability, and Change in Incontinence Frequency over 3 Months in a Single-Center Randomized Trial A. J. Huang, M. Chesney, N. Lisha, E. Vittinghoff, M. Schembri, S. Pawlowsky, A. Hsu and L. Subak Department of Medicine, Department of Epidemiology and Biostatistics, University of California at San Francisco and Department of Obstetrics, Gynecology and Reproductive Sciences, and Department of Physical Therapy, San Francisco State University, San Francisco and Geriatric Medicine, Palo Alto Medical Foundation, and Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California Am J Obstet Gynecol 2019; 220: 87.e1ee13. doi: 10.1016/j.ajog. 2018.10. 031 Abstract available at https://pubmed.ncbi. nlm.nih. gov/30595143available at https://pubmed.ncbi. nlm.nih. gov/30595143 Editorial Comment: Behavioral therapies remain a mainstay of treatment for urinary incontinence in women. These include diet modification, pelvic muscle exercises, timed and scheduled toileting, and other techniques. Yoga has been advocated as a possible complementary strategy that may enhance continence outcomes, although prior studies on this subject are lacking. This randomized controlled trial compared a structured yoga program with twice weekly group classes and once weekly home practice (intervention group) to a more generalized stretching and strengthening group of equal time duration and level of attention (control group). A total of 56 women were randomized, with half in each group. Mean SD age was 65.4 8.1 years (range 55 to 83). All women in both groups received written evidence-based information on self-management methods for incontinence, including pelvic floor muscle exercises and bladder training. Continence was assessed using voiding diaries and validated instruments. Overall, incontinence frequency was decreased by 76% in the yoga group and 56% in the control group (p[0.7). Reduction rates for stress incontinence were 61% in the yoga group and 35% in controls (p[0.045). No differences were seen between the groups in terms of urge incontinence. There were no serious adverse events, and the nonserious events were not attributable to either yoga or control group practices. The authors conclude that yoga may be an option to help engage women more actively in bladder self-help but caution that additional research will be needed to determine if yoga itself has specific benefits compared to other more general physical activity. Tomas L. Griebling, MD, MPH Suggested Reading Diokno A and Yuhico M Jr: Preference, compliance and initial outcome of therapeutic options chosen by female patients with urinary incontinence. J Urol 1995; 154: 1727. GERIATRICS 857 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.