摘要:

These pilot data suggest that driving among individuals with incapacitating dementing illness may be an unrecognized, potentially serious problem. A simple 20‐item screening questionnaire was administered to 72 referrals to the Dementia Research (outpatient) Clinic of the Johns Hopkins Hospital. Thirty percent of the patient sample had at least one accident since the onset of symptoms of dementia. An additional 11% were reported by caregivers to have “caused” acci

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04394.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A survey of drug‐related admissions of patients aged 50 years and older was conducted at the Health Sciences Centre, Winnipeg to determine the interrelationship of risk factors, and isolate the effect of age. All nonelective medical admissions were prospectively assessed to determine the role of drug therapy as a contributory factor. Of the 863 eligible admissions, 162 exhibited at least one drug‐related adverse patient event (DRAPE) at the time of hospitalization. This accounted for 19% of the admissions (23% of 718 admissions that involved prescription drugs). Although adverse drug reactions were responsible for many DRAPEs (48%), intentional noncompliance (27%), treatment failure (19%), alcohol (14%), and medication error (10%) were also frequent contributing causes. Drugs commonly implicated in DRAPEs were systemic steroids, digoxin, nonsteroidal anti‐inflammatory agents, α‐methyldopa, calcium channel blockers, β‐blockers, theophylline, furosemide, sympathomimetics, thiazides, and benzodiazepines. The risk of a DRAPE was related to the number of diseases prior to admission(r =0.81;P<.026) and the number of drugs used(r =0.77;P<.001). Age was not correlated with the risk of a DRAPE. Females had significantly more adverse drug reactions, although sex was not a predictor for overall

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04395.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

We analyzed factors associated with the discharge diagnosis of delirium among 1,285 patients admitted to a major teaching hospital during a 2‐year period, developed a model to classify the risk of developing delirium on the basis of clinical and diagnostic data, and tested the model on 471 patients admitted during the subsequent year. Using the multivariate technique of recursive partitioning, we identified four factors that distinguished 80% of all cases of delirium: 1) a urinary tract infection at any time during the hospital stay (odds ratio = 3.1; 95% confidence interval = 2.02–4.58); 2) no urinary tract infection, but low serum albumin on admission (odds ratio = 2.4; 95% confidence interval = 1.43–3.99); 3) neither urinary tract infection nor low serum albumin, but elevated white blood cell count on admission (odds ratio = 1.99; 95% confidence interval = 1.18‐3.37); 4) none of these risk factors, but proteinuria on admission (odds ratio = 1.82; 95% confidence interval = 2.25–2.66). Patients without any of these four risk factors had the lowest probability of developing delirium during their hospital stay. Among individuals with delirium, in‐hospital mortality and hospital charges were higher. The model developed accurately characterized the risk of delirium when it was tested on patients admitted to the same hospital during the subs

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04396.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Psychiatric symptoms attributable to vitamin B12deficiency have been described for decades. The earlier reports are for the most part in accord with more recent ones, despite being diagnostically less specific in psychiatric and hematologic terms. These symptoms seem to fall into several clinically separate categories: slow cerebration; confusion; memory changes; delirium, with or without hallucinations and/or delusions; depression; acute psychotic states; and (more rarely) reversible manic and schizophreniform states.While there still remain abundant hematologic, psychiatric, neurologic, or nutritional reasons for obtaining a serum vitamin B12level, its use in the investigation of the etiology of a patient's dementia seems unjustified. However, acute or subacute changes in a demented patient's mental status, specifically a clouding of their consciousness, may make such testing advisable as part of the complete workup of their delirium regardless of a normal hematologic picture.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04397.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

This empirical study reports the proportion of hospitalized elderly patients who were identified as frail. As a part of a randomized controlled trial, standardized criteria were developed to target the frail hospitalized elderly for geriatric consultation. Twelve‐hundred patients aged 65 years and older admitted to the medical and surgical services at the Palo Alto Veterans Administration Medical Center were screened. Because of administrative exclusions of the randomized controlled trial (eg, short stay, lived too far away), 749 (62%) were excluded from the clinical screening process. The remaining 451 patients received clinical screening. Of these patients, almost two thirds (64%) were considered “too independent” to benefit from geriatric consultation (ie, independent in activities of daily living with short term illness), while 12% were judged “too impaired” to benefit (ie, had severe dementia or terminal cancer). Only 24% of those clinically screened (9% of the entire sample) were considered appropriate for geriatric consultation. Strikingly, over 42% of those patients aged 76 or older, were judged “too independent.”These data suggest that a large majority of the hospitalized elderly may be too well to benefit from geriatric consultation, thus making targeting by age alone inefficient. A realistic estimate of the percentage of hospitalized patients appropriate for geriatric intervention lies somewhere between 18% (the combined percentage of those found appropriate and those already enrolled in geriatric programs) and 24% (the proportion of the clinically evaluated group found appropriate). Targeting of subjects may be accomplished inexpensively using the authors' explicit criteria. Such targeting may help focus the use of interdisciplinary geriatric expertise on those

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04398.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04399.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

One hundred fifty‐one patients aged 70–89 years underwent a variety of open heart surgical procedures during a period of 1 year. We divided these patients into two groups: Group A was comprised of 127 patients between 70 and 79 years of age. In group B, 24 patients were between 80 and 89 years of age. These patients underwent elective open heart surgery. Information was retrieved retrospectively from the computerized data pool of the cardiothoracic registry in our institution. Statistical analysis in these two groups revealed no significant differences in any of the evaluated factors. We concluded that age should not be a contraindication for cardiac operati

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04400.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04401.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04402.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

With the graying of America, more older persons will be driving. Physiological changes associated with normal aging and diseases that commonly affect the elderly may compromise their ability to drive safely. Although all states have regulations governing driving licensure, few offer specific guidelines regarding older persons. Accordingly, much of the responsibility for determining medical competence to drive and counseling patients in this regard is left to physicians.Normal physiologic changes may limit sensory information, particularly visual, available to the driver. In addition, chronic diseases in older persons including coronary artery disease, dementia and other neurologic disorders, diabetes mellitus, and drug use may increase the risk of crashes while driving. Once the question of competence to operate an automobile has been raised, ethical dilemmas must be addressed regarding the benefit of continued driving for the individual versus the risk to that person and society as a whole.In this article, we review the medical grounds for determining competence to drive, discuss ethical implications, and report current legal regulations for physicians and aging drivers. Future directions and possible areas for further research are outlined.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04403.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY