ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06242.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:Because care of end‐stage dementia is a significant clinical problem for which alternative modes of care are needed, this study examined the extent to which hospice programs served dementia patients.DESIGN:A survey of 1694 hospices with 1184 respondents (70%).PATIENTS:Identifed patients had end‐stage dementia, with no concurrent terminal illness.MEASURE:The proportion of end‐stage dementia patients in hospice was measured.RESULTS:Fewer than 1% of hospice patients had a primary diagnosis of end‐stage dementia, and only 21% of the hospices served such patients. However, 7% of hospice patients had a dementia secondary to another terminal illness, and 56% of the hospices served such patients. For 80% of the hospices, the major problem in serving dementia patients was the difficulty in predicting their survival time. A higher proportion of for‐profit hospices served dementia patients (42%) compared with non‐profit programs (22%) or public programs (15%),P<.001.CONCLUSIONS:A national survey of hospices revealed that few patients with primary dementia are currently treated by these programs, unless they have other terminal illnesses. An inability to predict survival was the major reason offered to explain this phenomenon. The higher percentage of patients with secondary dementia in hospice suggests that dementia per se does not make hospice care unfeasible. Similarly, the high proportion of for‐profit hospices that enrolled patients whose dementia was primary implies the fiscal feasibility of providing hospice care for these patients. Further study is needed concerning the determinants of survival time in end‐stage dementia.J Am Geriatr Soc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06243.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06244.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To review the use of ambulatory electrocardiographic monitoring in detecting transient cardiac arrhythmias and myocardial ischemia in older patients and to determine the significance of these findings in predicting future cardiac events.DATA SOURCES:Reports on ambulatory electrocardiographic monitoring's capabilities in the detection and quantification of arrhythmias and myocardial ischemia were identified by multiple searches on the MEDLINE database and citations from relevant articles.STUDY SELECTION:Studies that demonstrated good research methodology were reviewed. Review was limited to studies that used reel‐to‐reel or cassette recorders (not reel‐time monitors).DATA EXTRACTION AND SYNTHESIS:Pertinent data were extracted from the studies, with specific emphasis on studies involving older patients. Prognostic findings were critically analyzed and compared between younger patients and older patients. Differences in prognoses between patients with and without underlying heart disease were assessed.CONCLUSION:Ambulatory electrocardiographic monitoring is a noninvasive procedure that is beneficial in stratifying older patients with heart disease into high and low risk groups for future cardiac events. The presence of complex ventricular arrhythmias or silent myocardial ischemia as documented on 24‐hour monitoring, especially in combination with left ventricular dysfunction or left ventricular hypertrophy, is highly predictive of future cardiac events, including sudden cardiac death and total cardiac mortality. The use of preoperative, intraoperative, and postoperative electrocardiographic monitoring may also be beneficial in stratifying older surgical patients into high and low risks for postoperative cardiac

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06245.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06246.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06247.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06248.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06249.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06251.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06253.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY