摘要:

Objective: To assess the attitude and factors affecting decision‐making by offspring for life‐sustaining measures toward their elderly terminally ill parents.Design: SurveySetting: Acute geriatric department of a university‐affiliated teaching hospital.Patients and Participants: 108 offspring of 48 terminally ill elderly patients were interviewed.Measurements: The attitude of offspring regarding life‐sustaining measures based on a comprehensive questionnaire, administered by face‐to‐face interview, that included clinical, social, and religious information for each patient and social, religious, demographic, and educational information for each family member.Results: A significant majority requested the continuation of fluid, nutrition, and medication (78%, 66%, 73%, respectively). A minority of 25%–29% requested the initiation of resuscitation, mechanical ventilation, and dialysis. Active euthanasia was requested by seven offspring. Factors that significantly affected offspring's decisions were the degree of religious observance and close relationship. Approximately 50% of offspring believed they knew their parents' wishes, but most of them did not comply with the parents' wishes. The offspring's preferences for themselves differed in important aspects from the requests for their parents. The great majority stated that a family member and/or the responsible physician should be involved in the decision‐making process (76% and 79%, respectively). Only 2.0% suggested the participation of an ethics committee, and the court was rejected by all.Conclusions: Basic life‐sustaining measures are requested for the terminally ill parents by most of the offspring. A significant minority even requested aggressive life‐sustaining measures. The degree of religiosity and closeness of relationship influenced offspring's re

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06729.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective: To determine the prevalence of electroencephalogram (EEG) abnormalities at different levels of cognitive impairment and to assess the possible diagnostic usefulness of the test.Design: Combined prospective assessment of subjects receiving EEGs and retrospective chart review of symptoms and medications.Setting: Academic geriatric psychiatry service.Patients: 350 adults age 50 and above; 312 were patients being evaluated for possible organic mental syndrome and 38 were normal controls.Measurements: All subjects had EEGs and Mini‐Mental State Examinations (MMSE) performed at the time of the EEG. EEGs were rated for the presence and type of abnormality, and subjects were stratified according to the severity of impairment. Charts were reviewed by a person blinded to EEG results to determine clinical diagnosis and medications received.Main Results: Abnormal EEGs were significantly more common among all patients (67%) in the study than among controls (11%), and the prevalence of abnormality increased with increasing impairment. Many demented patients with equivocal impairment (42%), and most with mild‐to‐moderate impairment (65%) had abnormal EEGs. An abnormal EEG was not indicative of dementia even when clear cognitive impairment was present, since patients with depression frequently also had abnormal EEG results.Conclusions: These findings suggest that the EEG is a moderately sensitive but non‐specific indicator of brain dysfunction in the elderly. The significance of abnormalities among patients with equivocal impairment should be more fully assessed by longitudinal follow‐up to determine if greater cognitive impairment

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06730.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective: To determine normal serum bone‐related biochemical variables in older African‐Americans.Design: A convenience sample of older African‐Americans who had a health screening and blood testing for calciotropic hormones was compared with white Americans who were recruited at the end of the Systolic Hypertension in the Elderly Program (SHEP) study and were not on a thiazide diuretic.Setting: Community‐dwelling African‐Americans who participated in SHEP or who attended one of two mass health screenings.Participants: Thirty‐two African‐Americans aged 68–93 years and 43 white Americans aged 70–89 years.Measurements: Twenty‐five hydroxyvitamin D (250HD), parathyroid hormone, osteocalcin, and calcitonin.Results: Serum 250HD levels in 38% of the African‐American men and 38% of African‐American women were less than 8 ng/mL compared with 22% of Caucasian men and 40% of Caucasian women. Serum parathyroid hormone (PTH) was above the normal range in 25% of men and 33% of women of African‐American descent and 14% of Caucasian men and 30% of Caucasian women. Serum 25OHD was lower (P<0.05) in individuals with a previous history of fracture. Serum albumin (P<0.05), calcitonin (P<0.05), and osteocalcin (P<0.05), but not 25OHD, were lower in African‐Americans (men and women) when compared with Caucasians (P<0.05). Serum calcium corrected for albumin was higher in the African‐Americans than in the Caucasians (P<0.05). As previously reported in Caucasians, PTH was inversely related to log 25OHD in African‐Americans. Serum osteocalcin was positively correlated to PTH in African‐Americans, as previously reported in Caucasians. Log 25OHD correlated inversely with osteocalcin in African‐Americans, but this was not seen in Caucasians.Conclusions: In this limited sample, hypovitaminosis D (as assessed by 25OHD level) with secondary hyperparathyroidism occurred frequently in elderly African‐Americans. Osteocalcin, a measure of osteoblast activity, correlated with 25OHD and parathyroid hormone. Osteocalcin serum levels were lower in African‐Americans than Caucasians, but serum calcium corrected for albumin was high

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06731.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective: To determine if family caregivers are aware of the severely underweight elder's risk of malnutrition and accordingly increase nutritional care efforts.Design: Case‐control study.Participants: Familial caregivers to community‐dwelling elders.Measurements: Risk of malnutrition as defined by body mass index ≤ 5th percentile of the national average for elders aged 65–90.Results: Compared with caregivers of elders without risk for malnutrition, caregivers to undernourished elders are significantly more likely to give elders protein supplements, to make foods accessible to elders, and to encourage and pressure the elder to eat.Conclusions: Caregivers recognize gross signs of malnutrition in elders, increase nutritional care in response, and deserve some measure of support for their claims of health ex

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06732.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06733.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective: To present a new model for analyzing longitudinal data. The trilinear model is superior to the commonly used linear model that includes the flawed assumption that decline is uniform throughout the course of disease—an assumption that does not correspond to clinical observations.Design: A longitudinal cohort sample was used to compare the linear and trilinear models. Simulated longitudinal data were generated to assess classification errors with the trilinear model.Subjects and Setting: The subjects were 80 patients with Alzheimer's disease tested in a hospital out‐patient clinic.Methods: The trilinear model describes Alzheimer's disease as proceeding through three periods: An initial period of stability before detectable decline, a period of decline, and a final period of stability during which there is no further detectable decline. A program for the Apple Macintosh computer is available at no charge to apply the model to data.Findings: The analyses indicated that the trilinear model provides a better reflection of decline in Alzheimer's disease than does the linear model. This advantage is present whether the periods of stability reflect a “true” lack of decline or insensitivity of a measurement instrument.Conclusions: The trilinear model provides not only a more accurate estimate of the average rate of change, but also (when possible) estimates of the point at which decline begins and ends. Also, more detailed comparisons of tests could be made by using the trilinear parameters. The trilinear model would benefit researchers engaged in longitudinal research of progressive di

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06734.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective: This study intends to determine what role fiberoptic bronchoscopy (FOB) plays in the diagnosis of tuberculosis (TB), particularly in a geriatric population.Design: Cases of tuberculosis reported to the Tennessee Department of Health during the years 1989 and 1990 were divided into two age groups: Group A (<65 years) and Group B (≥65 years). Natural sputum smears and cultures positive forM, tuberculosis(M.TB) in each group were compared with FOB specimens, acid‐fast bacilli (AFB) smears and cultures. Data were analyzed by chi‐square tests of independence for each year, then compared to determine statistical significance.Setting and Patients: Of the 601 TB cases reported to the State of Tennessee in 1989, 285 patients were in Group A and 316 in Group B. For 1990, 525 cases were reported, 269 in Group A and 256 in Group B. All cases met CDC‐approved criteria for diagnosis of tuberculosis.Measurements: The number of positive AFB smears and M. TB cultures were compared in each group. In cases with sputum negative but FOB specimens positive for TB, identification was made by FOB only.Main Results: In Group A, 26 (9.1%) were diagnosed by FOB; only eight of these had positive sputum cultures. In Group B, 77 (24.4%) were diagnosed by FOB. Of these, 23 had positive sputum cultures; the remaining 54 patients (17.1%) had diagnoses based on FOB alone. In 1990, 269 cases of TB were reported in Group A. Of these, 38 (14.1%) were diagnosed by FOB. There were 256 TB cases reported among Group B, 83 (32.4%) of which were diagnosed by FOB. Of these 83 cases, 60 (23.4%) were diagnosed by FOB only. While no statistically significant difference was seen between the 1989 and 1990 rates of TB diagnosis by FOB for those in Group A (age<65), the difference in rates for those in Group B (age ≥65) was statistically significant (P<0.05).Conclusions: A steady increase in the use of FOB as a diagnostic tool was noted, suggesting that a significant number (19.9%) of geriatric TB cases might have been missed without the aid of FOB. While the exact reason for its increased utilization is not known, this study indicates that FOB has become a more important source of diagnosis in pulmonary TB, particularly among th

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06735.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective: To estimate the prevalence of incomplete bladder emptying by the elderly and to determine its significance and its relationship to overflow incontinence.Design: Survey comparing groups with and without incomplete bladder emptying.Setting: A geriatric hospital ward.Patients: One hundred patients who were consecutively admitted, with an average age of 82.6 years.Measurements: A physical examination, perineal examination, micturition assessment, and evaluation of the postvoiding residual urine volume (PRUV) by ultrasonography at day 1 and day 8 following admission. One‐channel cystometry and urine cultures were also done. Between‐group comparison was performed between groups R (ie, PRUV greater than 50 mL) and C (ie, PRUV less than 50 mL).Main Results: The prevalence of PRUV greater than 50 mL was 34%. Group R patients presented with greater dependency; death was the final outcome of hospitalization in 36% of these cases (vs only 9% in group C). A high PRUV was not correlated with urinary tract infection or renal failure, but there was a strong, almost significant trend toward incontinence being more prevalent in R (57%) than in C (38%) (P= 0.06). Group R presented a hypotonic bladder in 45% of cases, evidenced by cystometry, versus 6% in group C.Conclusions: In cases with a high PRUV, the utmost caution is necessary both in the diagnosis of overflow incontinence and in establishing a therapeutic approach. Incomplete bladder emptying is associated with a poor progno

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06736.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06737.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective: To establish population‐based data, with special emphasis on the effects of age, gender, and education, for eight, widely used neuropsychological tests in a community‐dwelling cohort of normal and cognitively impaired older adults.Design: A population‐based observational study.Setting: Examinations were performed in a research clinic by specially trained staff during a 1988–1992 evaluation for osteoporosis.Participants: 1,692 community‐dwelling subjects, aged 55 to 94 years, who were members of the Rancho Bernardo Heart and Chronic Disease Study initiated in 1972. The mean age for men was 73.9 years (SD 9.3) and for women, 73.5 (SD 9.1).Outcome measures: Eight neuropsychological tests were used to measure cognitive functions. Analysis of variance and post hoc contrasts were performed to determine the effects of age, gender, education, and their interactions on performance on these tests.Results: Performance on all tests decreased progressively, without leveling off, from the youngest, age 55, to the oldest, age 94. Women performed better on verbal tasks and men on tests of visuospatial, visuoconceptual, and mental control functions. Performances of men on several tests declined more rapidly with advancing age than those of women. Both men and women with some college education performed better on most tests than men and women with high school educations, and the rate of decline with age was sometimes slower in the college‐educated group. Only the savings score from the Visual Reproduction Test, which is a measure of rate of forgetting, and the scores of short‐term recall derived from the Selective Reminding Test (Buschke‐Fuld) were unaffected by educational attainment.Conclusions: In a community‐dwelling cohort, including normal and cognitively impaired elderly men and women, advancing age is accompanied by decline in cognitive functions as measured by neuropsychological tests. This decline is slower in women and in college‐educated subjects. Two cognitive indices were unaffected by education, and these may be especially useful in cro

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06738.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY