摘要:

Objective:To compare the rate and magnitude of physiologic and psychologic adaptations to aerobic training between middle‐age and older men, to assess their interest in continued participation (>6 months) in a supervised high‐intensity training program, and to evaluate the safety of high‐intensity training for older people.Design: Before‐after intervention trial.Setting: Medical center in a Midwestern metropolitan city.Participants: Thirteen middle‐age (35–50 years) and 14 older (60–71 years) normal men.Intervention: Subjects trained on treadmills and leg cycle ergometers for 40 minutes 3 times per week. The intensity was increased to 85% of peak heart rate (HR) within the first 3 weeks of training.Measurement: Peak oxygen consumption, HR at submaximal work rates, three psychological tests, and election to continue in the supervised program.Results: At 6 months of training, peak oxygen consumption had increased by 12% and 11% in the middle‐aged and older groups, respectively, with 86% and 100% of this increase occurring within the first 3 months. Both groups showed comparable decreases in HR at submaximal work rates after 3 months of training with no further significant change from 3 to 6 months. None of the psychologic parameters evaluated changed significantly with 3 or 6 months of training in either group. More of the older (71%) than middle‐aged (45%) men elected to continue in the supervised program after 6 months.Conclusions: The results of this study involving small groups of carefully screened middle‐aged and older men suggest that the time course and magnitude of physiologic adaptations to aerobic training are similar between age groups when the training regimen is the same. Neither age group showed alterations in psychologic parameters nor experienced orthopedic injuries with training. The older group showed greater interest in continued participation in a supervis

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06172.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objectives:To describe the professional characteristics of doctors practicing in nursing homes and to determine whether those characteristics correlate with quality of prescribing.Design: A prospective, cohort study.Participants: 306 physicians practicing in 12 nursing homes in greater Los Angeles.Measurements: We surveyed doctors about their age, sex, education, credentials, and NH practice. We also determined medication orders for a 1‐month period and evaluated them using explicit criteria for appropriateness developed by an expert panel.Results: We obtained data from 72% of MDs. Respondents had a mean age of 53 years (29–78) and were 94% male. Fifty‐seven percent trained in internal medicine, 20% graduated outside the US or Canada, 67% were board certified in their declared specialty, and 5% had a certificate of added qualification in geriatrics (CAQ). Sixteen percent spent>10% of their professional time in NHs, and 46% had NH practices that were>20% Medicaid; most did not consult psychiatrists when prescribing psychoactive drugs. Forty percent of residents had at least one inappropriate prescription. The characteristics of doctors associated with the best prescribing quartile were female sex, CAQ, no board certification, and frequent consultation with psychiatrists. The characteristics of doctors in the most inappropriate quartile were older age, graduation from medical school before 1965, graduation from US medical school, small NH practice, and infrequent consultation with psychiatrists.Conclusions: Although the quality of prescribing in nursing homes is related to some physician characteristics, the relationships are not those most commonly s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06173.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To examine the disposition of intramuscular (IM) cefonicid in elderly patients with bacterial pneumonia.Design: Pharmacokinetic study.Setting: A 620‐bed university‐affiliated long‐term care institution with its own 39‐bed acute care unit.Patients: Nine consecutive elderly patients with bacterial pneumonia treated with IM cefonicid.Measurements: Blood samples were collected on the seventh day of therapy over a 24‐hour period and analyzed by high performance liquid chromatography. Pharmacokinetic parameters (volume of distribution, half‐life, and clearance) and protein binding were calculated. Clinical outcome of IM cefonicid therapy was also noted.Results: The estimated creatinine clearance (Clcr) ranged from 32 to 145 mL/min. Peak cefonicid serum concentrations occurred at 0.5–1.5 hours, with a mean value of 118 ± 41 μ/mL. Cefonicid concentrations declined monoexponentially to 57 ± 16 μg/mL at 12 hours and 28 ± 14 μg/mL at 24 hours. The mean apparent distribution volume was 0.2 ± 0.07 L/kg, and the mean apparent total clearance was 15 ± 12 mL/min. The half‐life ranged from 3.1 to 38 hours. A linear correlation was noted between Clcrand cefonicid clearance (r= 0.99).Conclusions: Cefonicid absorption was variable among these patients, and the serum half‐life was longer than previous values noted in younger patients with similar degree of renal dysfunction. Pharmacokinetic and clinical outcome data from our study group indicate the potential role of IM cefonicid in treating elderly patients

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06174.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To define a set of screening criteria that identifies elders who are at high risk for repeated hospital admission in the future.Design: Longitudinal cohort study. Logistic regression analysis of data from half of the subjects was used to identify risk factors for repeated hospital admission. The ability of these risk factors to identify elders who are at high risk for repeated hospitalization in the future was then tested using data from the other half of the subjects.Setting: United States.Participants: A subsample (n= 5876) of a multistage probability sample of all non‐institutionalized U.S. civilians who were 70 years or older in 1984.Measurements: At baseline (1984), elderly subjects were asked about their demographic, socioeconomic, medical, and functional characteristics and about their recent use of health services. Their subsequent hospital admissions and mortality were then monitored through the records of the Medicare program and the National Death Index (1985–88).Results: Among the subjects in the first half of the sample, eight factors emerged as risk factors for repeated admission: older age, male sex, poor self‐rated general health, availability of an informal caregiver, having ever had coronary artery disease, and having had, during the previous year, a hospital admission, more than six doctor visits, or diabetes. Based on the presence or absence of these factors in 1984, 7.2% of the subjects in the second half of the sample were estimated to have a high probability of repeated admission (Pra≥ 0.5) during 1985–1988. In comparison with subjects estimated to have a low risk (Pra<0.5), this high‐risk group's actual experiences during 1985–1988 included a higher cumulative incidence of repeated admission (41.8% vs 26.2%,P<0.0001), a higher cumulative rate of mortality (44.2% vs 19.0%,P<0.0001), more hospital days per person‐year survived (5.2 vs 2.6), and higher hospital charges per person‐year survived ($3731 vs $1841).Conclusion: Eight easily ascertained risk factors affect elders' probability of being hospitalized repeatedly within four years. In the future, brief surveys about the presence of these factors could be used to estimate elders' risk of future hospitalization and, thereby, to identify some of those who may derive the greatest benefit from interventions designed to avert the need fo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06175.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To determine the effects of long‐term use of the thiazide diuretic chlorthalidone on serum bone‐related biochemical variables in older persons.Design: Cross‐sectional comparison.Setting: Community‐dwelling subjects who had participated in the Systolic Hypertension in the Elderly (SHEP) program.Participants: Sixty‐six Caucasians (36 male and 30 female), age range 70 to 89 years, of whom 23 were taking a thiazide diuretic.Measurements: 25‐hydroxyvitamin D (25OHD), parathyroid hormone, osteocalcin, calcitonin, and serum bioavailable testosterone.Results: In both groups, there was a high prevalence of low 25 (OHD) levels (30%). Log 25OHD showed a significant inverse relationship to parathyroid hormone (r= .33,P<0.05). Thiazide users had lower levels of osteocalcin (P<0.05) and parathyroid hormone levels (P<0.05) compared with non‐thiazide users. Male thiazide users had decreased bioavailable testosterone levels compared with non‐thiazide users (P<0.05). Serum osteocalcin was significantly related to bioavailable testosterone in men not on thiazide (r= .43,P<0.05).Conclusions: Hypovitaminosis D is a common finding in older individuals with associated elevations in parathyroid hormone. Parathyroid hormone and testosterone concentration (in men) are correlated with serum osteocalcin, a measure of osteoblastic activity. Long‐term thiazide use alters these relationships and produces a biochemical profile suggestive of decreased bone formation. Reduced bioavailable testosterone may also play a role in these bi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06176.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To determine whether serum thyrotropin (TSH) levels are altered in euthyroid older persons compared with middle‐aged adults.Design: Serum TSH and thyroid hormone levels were measured in a large group of older persons (>70 years old,n= 216) and their middle‐aged offspring (40–60 years old,n= 211) after excluding those with clinical or historical evidence of thyroid disease or abnormal thyroid function.Measurements: Serum TSH, thyroxine (T4), free T4 index, estimated free T4, triiodothyronine (T3), estimated free T3, and ferritin levels were measured on the Abbott IMx instrument. Peroxidase and thyroglobulin antibodies were measured by radioimmunoassay using Kronus kits.Main Results: Overall, serum TSH showed a log‐normal distribution. The geometric mean TSH (mU/L) and 95% confidence limits in the older persons, 1.24 (0.29–5.4), did not differ significantly from that in the middle‐aged, 1.45 (0.54–3.9). The mean TSH in the 264 women, 1.37 (0.34–5.5), was similar to that of the 163 men, 1.30 (0.48–3.5). The mean TSH in older women, 1.21 (0.22–6.6), was slightly but significantly lower than that in middle‐aged women, 1.52 (0.55–4.2). However, when euthyroid women with positive antibodies were excluded, this difference was not significant. Four of the 123 older women had TSH1 U/mL), the prevalence was 32% of older women, 43.3% of middle‐aged women, 15% of older men, and 11.4% of middle‐aged men.Conclusions: Euthyroid older persons have about the same levels of serum TSH as younger ones, although older euthyroid women have a slightly lower serum TSH than middle‐aged women. We recommend that the normal range of serum TSH in the elderly be considered to be the s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06177.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.tb06178.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:Half of the population over 65 suffers from chronic sleep disturbance. As a consequence, almost 40% of hypnotic medications are prescribed to people over age 60. Yet, hypnotics are often of little benefit in this population. As such, an effective non‐drug alternative could prove important in the management of age‐related sleep maintenance insomnia. The current study sought to evaluate the efficacy of bright light exposure in the treatment of sleep maintenance insomnia.Design: Following baseline sleep and circadian rhythms assessment, subjects with sleep‐maintenance insomnia were treated with timed exposure to either bright white light or dim red light for 12 consecutive days. Sleep and circadian rhythms recordings were subsequently obtained and measures of sleep quality were compared to assess efficacy of the treatments.Setting: Baseline and post‐treatment sleep and circadian rhythms assessments took place in the Laboratory of Human Chronobiology, Department of Psychiatry, Cornell University Medical College. The treatment phase of the study was conducted in participants' homes.Participants: Sixteen men and women between the ages of 62 and 81 years were studied. All subjects were free of hypnotic medication, and all had experienced sleep disturbance for at least 1 year prior to entering the study.Results: Exposure to bright light resulted in substantial changes in sleep quality. Waking time within sleep was reduced by an hour, and sleep efficiency improved from 77.5% to 90%, without altering time spent in bed. Increased sleep time was in the form of Stage 2 sleep, REM sleep, and slow wave sleep. The effects were remarkably consistent across subjects.Conclusions: The findings demonstrate the effectiveness of timed exposure to bright light in the treatment of age‐related sleep maintenance insomnia. With further refinement of treatment regimens, this non‐drug intervention may prove useful in a large proportion of sleep distur

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06179.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To measure the influence of age on measures of nocturnal activity and immobility in 100 healthy subjects aged 50 to 98 years.Design: Cross‐sectional study.Setting: Urban population in Leiden. Recordings were performed at home while the subjects maintained their habitual 24‐hour pattern of activities.Participants: 100 subjects without a history of major medical disorders and a normal neurological examination and performance‐oriented assessment of gait (Tinetti).Measurements: Motor activity was recorded during six successive nights with a wrist‐worn activity monitor. The occurrence of supra‐threshold motor activity was recorded over 15‐second epochs. A questionnaire was used to evaluate sleep habits and the occurrence of sleep disturbances. Four mean measures reflecting activity or immobility during the nocturnal period were calculated for each subject.Results: Only one out of four measures, (ie, the nocturnal proportion of time with movement, increased with age for females. For males, no age effects emerged. The mean duration of nocturnal immobility periods was higher in females than in males. Also, for females, the use of hypnotics increased with successive decades. Sex and the use of hypnotics were significantly related to the mean duration of immobility periods.Conclusion: If care is taken not to confound aging with illness, measures of nocturnal activity and immobility reveal only marginal effec

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06180.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Objective:To determine the incidence of poison center calls involving the elderly, characterize these poisonings, and compare them with poisonings that occur in people younger than 60 years of age.Design: Concurrent, observational survey.Setting: The Virginia Poison Center in Richmond, Virginia.Participants: All persons 60 years of age and older who were involved in a poison exposure reported to the Virginia Poison Center from October 1, 1991 through March 31, 1992.Measurements: Incidence, type, route, location, management site, medical outcome of exposures and reasons for these exposures.Results: Exposures in persons 60 years of age and older accounted for 2.3% of all poison center calls during the 6‐month study period. These calls were most likely to involve women who unintentionally ingested extra doses of medications. The majority of these exposures occurred in the home and resulted in either no effect or minor effects. For those exposures that necessitated an emergency room visit, elderly persons were more likely to be admitted to the hospital than younger persons (P<0.05).Conclusions: The majority of poisonings that occur in persons 60 years of age and older are unintentional and may be amenable to poison prevention educatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb06181.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY