摘要:

Objective:To compare plasma levels of insulin‐like growth factor‐I (IGF‐I, also termed somatomedin C) in polio survivors and healthy control subjects and to determine their relation to selected clinical characteristics.Design:Cross sectional study.Setting:Polio survivors living in the community recruited from the Wisconsin Polio Support Group.Participants:A total of 124 polio survivors (49 males and 75 females), ages 35 to 77 years, and 261 healthy control subjects (139 males and 122 females) of similar age.Measurements:Plasma IGF‐I levels were compared in polio survivors and age‐matched control subjects. In the polio survivor group, the relation of IGF‐I to selected clinical characteristics was examined before and after adjusting for co‐variates.Results:Statistical analyses showed that the IGF‐I concentrations were significantly lower in the polio survivors than in the controls. This difference was reflected in the means and standard errors of the two groups (0.45 ± 0.02 vs 0.60 ± 0.02 units/mL,P<0.01). Plasma IGF‐I below 0.35 units/mL in adults indicates little or no growth hormone secretion. In polio survivors, 38% of the plasma IGF‐I values were<0.35 units/mL compared with 19% in the healthy group. Univariate analysis showed that IGF‐I in the polio survivors was significantly correlated with age, gender, and body mass index, and with dependency, pain, and difficulty in the activities of daily living (ADLs). The correlations with ADL dysfunction were independent of the correlations with age, gender, and body mass index. IGF‐I level did not correlate with the subjective report of recent decline in functional status.Conclusion:Lower levels of IGF‐I are seen in polio survivors, and this finding correlates with ADL dysfunction. The hy‐posomatomedinemic tendency of polio survivors may have an adverse effect on their neuromuscular

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07456.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To determine whether nocturnal respiratory abnormality (cyclic oxygen desaturation and tachycardia) is associated with nocturnal myocardial ischemia in older individuals with ischemic heart disease.Design:Non‐invasive monitoring on a single occasion.Setting:Tertiary care referral hospital.Patients:Thirty four consecutive older (68.5 ± 6 yrs) patients referred for elective abdominal or carotid reconstructive vascular surgery.Results:Seven patients (21%) had moderately severe nocturnal respiratory abnormality, defined by more than 50 dips in arterial oxygen saturation and increases in heart rate during the night. Two of these seven had clinical risk factors for ischemic heart disease and had nocturnal myocardial ischemia. Ten patients (29%) developed ischemia at some time during the study, of whom seven hand known ischemic heart disease, hypertension, and/or angina. Those with increased nocturnal ischemia showed very low frequency (1–2 cycles per minute) cyclic heart rate oscillations and repetitive nocturnal episodes of arterial oxygen desaturation, similar to patients with sleep apnea.Conclusion:Repetitive nocturnal cyclic arterial desaturation and cyclic increases in heart rate are associated with nocturnal myocardial ischemia in individuals with clinical risk factors for ischemic heart disease. Further investigation in a large patient sample utilizing non‐invasive monitoring of saturation, heart rate, and blood pressure may provide definitive evidence regarding causation of some of the nocturnal myocardial ischemia occurring in older individuals with vascular d

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07457.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To determine the alterations in glucose metabolism that occur in patients with Alzheimer's Disease (AD).Design:Cross‐sectional comparison of AD and healthy controls.Setting:A University teaching hospital.Patients:Healthy controls (n= 14, BMI: 24.9 ± 0.5 kg/M2, age 73 ± 1 years) and patients with AD (n= 12, BMI: 23.9 ± 1.0 kg/M2, age 72 ± 1 years). All controls and patients with AD had a normal history and physical examination, a negative family history of diabetes, and took no medications.Measurements:All patients and controls underwent an assessment of their dietary intake and physical activity, a 3‐hour oral glucose tolerance test (OGTT), and a 2‐hour hyperglycemic glucose clamp study.Results:Total caloric intake (AD: 27.1 ± 1.3 kcal/kg/day; Control: 23.6 ± 1.6 kcal/kg/day;P= ns) and intake of complex carbohydrates (AD: 5.9 ± 0.4 kcal/kg/day; Control: 6.5 ± 0.3 kcal/kg/day;P= ns) were not different between groups. Leisure time physical activity was greater in controls (AD: 2970 ± 411 kcal/week; Control: 5229 ± 864 kcal/week;P<0.05). Patients with AD had higher fasting glucose (AD: 5.9 ± 0.2 mmol/L; Control: 5.1 ± 0.1 mmol/L;P<0.01) and insulin (AD: 144 ± 20 pmol/L; Control: 100 ± 6 pmol/L;P<0.05) values. In response to the OGTT, the area under the curve for glucose and insulin was similar in both groups. During the hyperglycemic clamp, steady‐state glucose values were higher in the Alzheimer's patients (AD: 11.5 ± 0.2 mmol/L; Control: 10.9 ± 0.1 mmol/L,P<0.01). First‐ and second‐phase insulin responses were similar in each group. The insulin sensitivity index (units: mL/kg.min per pmol/L × 100), a measure of tissue sensitivity to insulin, was reduced in the patients with AD (AD: 0.59 ± 0.06; Control: 0.79 ± 0.07;P<0.05).Conclusions:We conclude that early AD is characterized by alterations in peripheral glucose metabolism, which may relate, in part, to al

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07458.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To assess the validity of several equations for estimating creatinine clearance in a large sample of high‐functioning, community‐dwelling elderly.Design:Serum and 12‐hour urine samples were collected and assayed for creatinine using the Jaffe total chromagen method. Fifteen clearance‐estimating equations were evaluated for bias, accuracy, correlation with measured clearance values, and frequency of erroneous placement into renal function categories. Stepwise regression modeling and reliability testing were performed on a split sample to construct and assess a novel creatinine‐clearance‐estimating equation.Setting:New Haven, Connecticut, East Boston, Massachusetts, and a five‐county region in and around Durham, North Carolina.Participants:A subsample of community‐dwelling men and women (age range 70–79 years) from the Established Populations for Epidemiological Studies of the Elderly was screened for physical and cognitive functioning and placed into high‐, medium‐, and low‐functioning groups (n= 1354). High‐functioning respondents who provided blood and complete urine samples (n= 762) were included in the present study.Results:In general, estimated creatinine clearance was more closely correlated to measured values in males than in females. Most equations underestimated creatinine clearance, with average bias ranging from—33.1 mL/min to +19.6 mL/min. Predictive accuracy ranged from 18.2 mL/min to 38.0 mL/min. Equations were variable in their erroneous placement of individuals into renal function categories. Regression modeling yielded an equation which contained novel components but failed to provide better estimates of creatinine clearance than those already available.Conclusions:The equations evaluated here provide unacceptable predictions of creatinine clearance in normally aging individuals. We advocate the use of serum drug concentration measurements when available and encourage investigation into timed urine collections of short duration as alternatives to clearance‐estima

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07459.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To examine physicians' attitudes toward and knowledge concerning driving in older persons.Design:Questionnaire survey.Measurements:A questionnaire was sent to physician members of the American Geriatrics Society (n= 5009). The questionnaire explored physicians' practice characteristics, general approach to record keeping, frequency of behavior toward educating, counseling, and reporting patients to authorities when deemed appropriate, and their personal understanding of driving issues and physician responsibilities within the state in which they practice.Results:A response rate of 48% was obtained. There was a lackofconsensus among physicians, with a broad range of attitudes and practices dealing with this growing public health concern. Physicians generally believed that they had a legal responsibility to assess driving ability but were uncertain about how to assess driving competence and their responsibility toward their senior patients who drive.Conclusions:Physician practices concerning the appropriate management of older drivers vary widely. Physicians should be aware that medical literature is available to aid in the evaluation of the elderly driver with medical impairments. In addition, physicians should consider referring their elderly patients to driver refresher courses to improve or maintain their driving skills. More research is needed to help guide health professionals in assessing the frail elder with multiple medical impairments and decreasing the crash risk for the older driver.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07460.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To evaluate whether poor oral health is a potentially reversible contributor to the development of significant involuntary weight loss in elderly rehabilitation patients.Design:Survey (cross‐sectional study).Setting:Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.Patients:One hundred ten consecutive admissions to the GRU, of whom 99% were male and 80% were white. The average age of the study patients was 77 years.Measurements:At admission each patient completed a comprehensive medical, neuro‐psychological, social, nutritional, and dental assessment. Previous weights were documented by review of old medical records. Involuntary weight loss was considered significant if it was greater than 5% of pre‐weight‐loss weight within 6 months or 10% of pre‐weight‐loss weight within 1 year. Of the 97 variables evaluated, the strongest predictors of significant involuntary weight loss prior to GRU admission were identified using univariate and multivariate (stepwise logistic regression) analyses.Results:The number of general oral problems was the best predictor of significant involuntary weight loss within 1 year prior to GRU admission, followed by household income, age, smoking status, adequacy of nutrient intake prior to admission, and education. When all six of the variables were included in the stepwise logistical regression analysis, the model had a sensitivity of 63.2%, a specificity of 91.1%, and overall predictive accuracy of 86.2%. The number of general oral problems was also a strong predictor of significant weight loss within 6 months prior to GRU admission.Conclusions:Poor oral health may be an important contributing factor to the development of significant involuntary weight loss among the frail elderly. If this is true, it places even greater emphasis on the need for maintaining an optimal state of oral health in our elder

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07461.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To investigate the relationship between cognitive and behavioral impairments in Alzheimer's disease (AD) and to examine whether the addition of cerebrovascular disease modifies that relationship.Design:Correlational analysis.Setting:An outpatient dementia clinic.Patients:An autopsy‐confirmed series of 28 patients with AD and 16 patients with mixed Alzheimer and vascular dementia (MIX).Measurements:Neuropsychological and behavioral tests during life: Mini‐Mental State (MMS), Blessed Dementia Scale (BDS), Haycox Dementia Behavior Scale (HDBS), and two non‐cognitive functional scales derived from the BDS and HDBS.Results:In the AD group, MMS scores correlated significantly with scores on the BDS, HDBS, and two non‐cognitive functional scales. In the MIX group, however, no significant relationship was observed between MMS scores and scores on any of the behavioral measures.Conclusions:These observations suggest that in AD, cognitive and behavioral impairments progress simultaneously. However, with the addition of a vascular component to the dementing process, cognitive and behavioral impairments may progress more indepe

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07462.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To examine the utility of brief screening instruments for alcoholism and depression in the frail elderly medical outpatient.Design:Cross‐sectional examination.Setting:Coffey Geriatric Outpatient Clinic, The Mount Sinai School of Medicine, New York City.Subjects:Convenience sample of 84 consenting male and female outpatients over 62 years of age.Measurements:The Michigan Alcohol Screening Test (MAST), CAGE questionnaire, and the Geriatric Depression Scale (GDS).Results:Four subjects (5%) scored positive for alcoholism on the MAST, all of whom had been previously identified by the geriatric clinic staff. In contrast, the CAGE only identified 1 (1.4%) alcoholic subject. Thirty‐two percent of subjects scored positive for depression on the GDS, yet only one‐third of these depressed patients had been previously identified by the geriatric team as depressed. Among the depressed outpatients, 19% were labeled anxious and received anxiolytics from the geriatric medical staff.Conclusions:Whereas brief alcohol screening instruments to detect alcoholism did not augment the geriatrician's clinical assessment, screening for depression with the GDS may be an important adjunct to the identification of depression in geriatric medical pat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07463.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:Determination of whether nonthyroidal factors affect the diagnostic value of free thyroxine estimation in geriatric patients.Design:Survey.Participants:A convenience sample of 381 non‐selected, chronic, hospitalized geriatric patients over 60 years of age (I = relatively good health; II = relatively poor health; III = bad health; subgroups “sine therapia,” ie, patients receiving no drugs that affect FT4) and 180 20–40 year old healthy persons.Measurements:Thyrotropin‐releasing hormone test; thyrotropin (TSH); free thyroxine (FT4, measured in part by two parallel methods) estimation in a screening study; and thy‐roxine‐binding globulin and thyroxine‐binding‐inhibitor activity measurements.Results:The normal FT4 ranges of the euthyroid geriatric (n= 210) and healthy young groups were similar. In the “sine therapia” euthyroid patients, FT4 decreased with age but increase with the severity of illness. High FT4 levels with non‐suppressed TSH were more frequent in patients in poor and bad health. (I = 6/112; II = 14/140; III = 13/74;P<0.01). The serum thyroxine‐binding‐inhibitor activity of euthyroid geriatric patients correlated with the severity of their clinical state (I = 6.22 ± 5.65 (13); II = 7.40 ± 4.33 (23); III = 10.04 ± 5.50 (16) μg merthiolate equivalent/μL; ANOVA with log‐transformed values: F(2.51)= 3.50,P<0.05). The mean FT4 was higher in 36 heparin‐treated patients (22.81 ± 4.67 pmol/L) than in the 193 “sine therapia” patients (19.03 ± 4.23 pmol/L; ‐P<0.001). In a convenience subsample of 240 patients, a weak inverse correlation was found between FT4 and the thyroxine‐binding globulin (r= −0.14,P<0.02). Only 5/11 patients with low free thyroxine had hypothyroidism, while 11/46 patients with elevated free thyroxine had hyperthyroidism.Conclusions:There is no need to modify the normal free thyroxine range for hospitalized geriatric patients. Clinical condition, drug treatment, and, to a lesser extent, age are factors that significantly affect the diagnostic value of FT4 in hospitalized chronic geriatric patients, decreasing the specificity of the test

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07464.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To assess the effect of mild senile dementia of the Alzheimer type (SDAT) on driving ability.Design:Cross‐sectional study with correlation analysis.Setting:A university‐based Alzheimer's Disease Research Center, which evaluates community‐living older adult volunteers, and the university's Program in Occupational Therapy.Participants:Healthy elderly controls (n= 13) and subjects with very mild (n= 12) and mild (n= 13) SDAT. Dementia severity was staged by the Washington University Clinical Dementia Rating.Measurements:The driving ability of participants on the in‐car road test was scored independently by a driving instructor, blinded to the study design and to the dementia status of the subjects, and an unblinded occupational therapist. Interview‐based perceptions of driving ability were obtained independently from the subjects and their collateral sources. Attentional and visuospatial performances of the subjects were assessed prior to the road test.Results:All control and very mild SDAT subjects were judged to be “safe” drivers (ie, passed the in‐car road test), but five (40%) of the mild SDAT subjects had driving impairment sufficient to “fail” the road test. Neither subject self‐assessment nor caregiver perceptions of driving ability consistently predicted driving performance. Attentional task performance correlated well with road test results.Conclusions:Some SDAT subjects retain “safe” driving skills. The greater the dementia severity, the greater the likelihood of poor driving ability. Performance‐based (road test) evaluations are necessary to properly determine driving skills at present, but attention and other cognitive screening m

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb07465.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY