摘要:

To study the effect of dietary salt restriction and supplementation on blood pressure of elderly subjects, we performed a randomized, placebo‐controlled, double‐blind, crossover trial. Seven healthy subjects living in a long‐term care facility, with a mean age of 85 and normal to borderline‐hypertensive blood pressures, completed a 16‐week protocol. During the double‐blind cycles, subjects consumed either a low sodium (43 mmol/day) or a high sodium diet (175 mmol/day) for four weeks supplemented with placebo or salt capsules, with crossover to the other diet. Sitting diastolic blood pressure was significantly lower during the low sodium diet (69.86 mmHg ± 3.80 vs 78.71 mmHg ± 3.99, P<.01), with all subjects showing decreases. Supine plasma renin activity and plasma aldosterone were significantly lower during the high sodium diet. Both low and high sodium diets were well‐tolerated by subjects. Symptomatic postural hypotension and hyponatremia were not observed. We conclude that old‐old subjects with borderline hypertension demonstrate salt‐dependent increases in blood pressure. Without additional supportive studies, however, these results should not be generalized to any specific cohort of

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07277.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

To determine the short‐term functional and medical outcomes and predictors of outcome following discharge from an acute hospital emergency department, 100 elderly (≥65 yr) and 100 nonelderly (<65 yr) patients were studied prospectively. Patients were interviewed at three days and again at three weeks following emergency department discharge. The number of new prescriptions given to both groups in the emergency department was similar (elderly 41%; nonelderly, 31%). The elderly were as likely as the nonelderly to know the correct name (elderly, 88%; nonelderly, 87%), dosage schedule (elderly, 90%; nonelderly, 90%) and purpose (elderly, 85%; nonelderly, 94%) of their new medications. There was no difference in patients' understanding of the diagnosis (elderly, 72%; nonelderly, 72%) or in medication compliance (elderly, 81%; nonelderly, 74%). Elderly patients were more likely to keep scheduled follow‐up appointments (87%vs65%;P<.05). Despite these similarities the elderly had worse medical outcomes at three weeks; 67% of the elderly were better and 20% were worse, including seven patients who required interim hospitalization, four of whom died. In contrast, 82% of the nonelderly were better and only 4% were worse (P<.01). None of the nonelderly required hospitalization or had died. Functional impairments were more common in the elderly both at baseline (elderly, 26%; nonelderly, 6%;P<.01) and at three weeks (elderly, 27%; nonelderly, 5%;P<.001). Independent predictors of poor medical outcome included age ≥65 (P<.009) and functional impairment at baseline (P<.022). Older patients with impaired functional status who are discharged from an emergency department should be targeted for close medical surveillance and ready access to health s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07278.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

In order to clarify the reasons why hyperthyroidism due to Graves' disease is mild in aged patients compared to young patients, we examined the degree of hyperthyroidism and immune abnormalities in 371 untreated patients. The patients were divided into nine groups based on their age; groups A to I consisted of patients aged 0–9, 10–19, 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years, respectively. Serum thyroxine (T4), triiodothyronine (T3), and thyroglobulin levels were highest in group B (patients aged 10–19 years) and decreased progressively with advancing age. T3/T4ratio was also highest in group B and decreased progressively with age. These data reconfirmed that the degree of hyperthyroidism is milder in older patients. The prevalence of positive microsomal and thyroglobulin antibodies was highest in group B (patients aged 10–19 years) and progressively lower in older groups, suggesting that an association with Hashimoto's thyroiditis is less prevalent in aged patients. We suggest that hyperthyroidism due to Graves' disease is mild in aged patients because responsiveness of the thyrocyte to the abnormal stimulator, thyrotropin‐receptor antibody, may be reduced. Such reduced responsiveness may not be due to Hashimoto's thyroiditis, since the prevalence of antithyroid antibodies is lower in aged than in younger patients with hyperthyroidism

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07279.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Four hundred twenty‐one consecutive patients admitted to an acute general medical ward and two acute rehabilitation medical wards were studied to compare the characteristics and outcomes of physically restrained patients and unrestrained patients. Restraints were used in 35 (13%) of the general medical patients and in 49 (34%) of the rehabilitation patients. The restrained general medical patients had higher mortality and morbidity rates than their unrestrained counterparts. Restrained patients had a higher prevalence of a psychiatric diagnosis, and major tranquilizers were used more than in their unrestrained counterparts in both settings. The general medical patients tended to have more than one type of restraint at a time, whereas the rehabilitation patients were restrained for longer proportions of their hospital stay. Thirty‐three percent of the restrained patients whom we were able to interview expressed negative perceptions about the presence of the physical restraints. Moreover, it was found that the presence of cognitive and physical impairments were highly predictive of restraint use in both populati

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07280.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

We investigated the utilization of mammography as a screening test for breast cancer in a middle‐income Connecticut suburban community of 30,000 people. The sampling frame was community‐dwelling women aged 30 years and over who had telephones. Random digit telephone survey methods were used to identify a sample of 470 eligible subjects. Of those eligible to be included, 350 or 74.4% completed the interview. Analysis of data from the 171 respondents aged 50 years or greater indicated that women aged 65–80 years had a significantly lower rate of screening mammography than did women aged 50–64 years (χ2= 6.6, P = .01). When further analysis was done to take into account the effects of education and of income on these rates, the association of age with mammography utilization was no longer statistically significant. Among women who recalled their physician advising a mammogram, 88% had had one performed. Among women who could not recall their physician advising a mammogram, 7% had had one. The impact of physician advice was statistically significant (χ2= 110.3, P<.001). Physicians recommended screening mammography less often for patients with low level of education (χ2= 21.6, P<.001), low income (χ2= 7.8, df = 2, P = .02) and greater age (χ2= 14.2, P = .003). We conclude that utilization of screening mammography in the community studied is related more strongly to education and to income than to age. The bivariate association of mammography utilization with age may be attributable to a cohort effect, rather than an age effect. Physician advice appears to be an important factor influencing the decision to have t

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07281.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Physical and mental correlates of dependent living were determined in 128 Catholic sisters (nuns), aged 75 to 94 years, who had similar social support systems and lifestyles. The primary a priori hypothesis was that poor manual dexterity would correlate strongly with living in the nursing home. Stepwise discriminant analysis indicated that manual dexterity explained 51% of the variance in the sisters' residential living site (ie, nursing home, retirement home, or living in community). The discriminant analysis equation using manual dexterity predicted living site correctly for 63% of the sisters in the nursing home with a specificity of 99%, a positive predictive value of 96% and a negative predictive value of 84%. The addition of age and mental status to the equation improved the prediction only slightly.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07282.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Head trauma has been found with greater frequency in the histories of Alzheimer patients than age‐matched controls in some studies, but not in others. We hypothesized that events that accelerate neuron loss, such as significant head trauma, hasten the onset of symptoms of Alzheimer's disease in persons vulnerable to the disorder. Retrospective data on 148 probable Alzheimer patients and 33 demented controls were examined. Alzheimer patients with severe head injury before the age of 65 showed onset of symptoms at an earlier age than Alzheimer patients without head traum

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07283.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07284.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07285.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Epidural methadone analgesia was initiated soon after admission to emergency room in elderly patients who sustained osteoporotic proximal femoral fracture and who were considered to be high surgical risks. The severe pain was significantly reduced, enabling early mobilization of the patients. The analgesia was discontinued only when nonnarcotic analgesia sufficed. The treatment lasted for about 3.5 weeks. One minor complication was observed during the treatment period. We concluded that patients who have femoral neck fracture who are at high risk for operation and have to be observed and stabilized before operation can be managed by continuous epidural methadone analgesia.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb07286.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY