摘要:

The increase in the number of persons age 65 and over—the Medicare‐age group—and the increasing cost of providing medical care to patients in this group have focused attention on enrollment of these persons in capitated plans as a means of containing costs. Although much is known about resources used for inpatient care for Medicare‐age patients, detailed information organized on a per‐patient, per‐year basis about ambulatory care of these patients is lacking. In order to address this problem and to investigate possible differences in resource use by age groups within the Medicare‐age population, a study was made of a primary care group practice in which 523 patients, including 174 patients in the Medicare‐age group, were followed for one year to determine their use of ambulatory care resources. A comparison of annual resource use by patients age 75 and over with patients age 65 through 74 showed that patients age 75 and over made more visits for primary care (8.15 vs. 6.46), made more visits to specialty and subspecialty clinics (3.41 vs. 2.33) and had higher total charges for ambulatory care ($749 vs. $623). The pattern of use of specialty and subspecialty clinics suggests that the primary care physicians functioned effectively as gatekeepers because most medical problems were handled without referrals to medical subspecialty clinics. The pattern also suggests that the projected rapid increase between now and the year 2000 in the number of persons age 75 and over may result in a greater than anticipated demand for services provided by ophthalmologists, podiatrists, and ot

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01393.x

年代:1987

数据来源: WILEY

摘要:

This study aims to learn whether the annual clinical and laboratory screening of nursing home residents provides significant information about their chance of dying during the following year.In August 1984, a comprehensive clinical data base was compiled for 176 male residents of this VA nursing home. During the next 14 months, 12 men were discharged to other locations and were dropped from the study; among the remaining 166, who comprised the study group of this report, 24 died. The most common immediate causes of death were infections (67%) and cardiac disorders (25%). Twenty of the deaths occurred after transfer to the acute hospital services.Among the 67 items in the clinical data base (including absence or presence of 17 diagnoses and 16 drugs), eight were significantly correlated with death rate. Age and functional impairment were directly related, and inversely related were the following: body weight as percent of ideal, triceps skin fold, hematocrit, hemoglobin, serum albumin, and serum cholesterol. Multivariate analysis showed cholesterol and hematocrit to be the most informative of the eight mortality predictors and to correlate with death independently of age and functional level.Subgroups defined on the basis of combinations of mortality‐related attributes differed many fold in their death rates. For example, men with cholesterol ≤ 256 mg/dl and hematocrit ≤ 41% died at a rate 42 times the rate of men with values above both thresholds.For each mortality‐related attribute, death rate varied with the level of the attribute. This relationship extended into the generally accepted “normal ranges” for cholesterol, hematocrit, hemoglobin,

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01394.x

年代:1987

数据来源: WILEY

摘要:

The association between falls, drugs, and diagnoses in elderly residents of a long‐term care facility was explored using case‐control methodology. The odds of being a faller rather than a control were significant (P<.01) for those taking antidepressants, sedatives/hypnotics, or vasodilators, and for those with osteoarthritis or depression.When drug/diagnosis subgroups were examined, these same drug classes and diagnoses had high‐odds ratios in the largest numbers of subgroups. In general, risk of falling appeared to be more strongly associated with drugs than with diag

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01395.x

年代:1987

数据来源: WILEY

摘要:

Pulmonary tuberculosis (TB) continues to pose a health threat to the elderly population. In order to delineate age‐related differences in disease presentation a comparison between young and old male veterans hospitalized over a five‐year period with culture proven Mycobacterium tuberculosis is reported. The study sample included 27 patients 60 years of age and older (range, 60 to 85; mean, 70) and 52 patients under 60 years of age (range, 22 to 59; mean, 51). The elderly were significantly less likely to demonstrate cavitary lesions on admission radiographs or present with hemoptysis but were more likely to present with right lower lobe infiltrates and complaints of dyspnea. Symptoms prior to admission occurring with equal frequency in both young and old subjects included fever, anorexia, weight loss, and cough. Although treatment was delayed in the elderly, there were no age‐related differences in mortality. Skin testing was underutilized in all patients regardless of age. The results support the notion that the clinical presentation of pulmonary TB is remarkably similar in young and old

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01396.x

年代:1987

数据来源: WILEY

摘要:

Electroconvulsive therapy (ECT) is often described as an effective and safe treatment of depression in the elderly. However, we have previously reported that there may be increased morbidity in this population, particularly in the very old. This paper extends this work to a second, larger sample of 136 subjects of whom 40 are over 60 years of age. We have again found that while ECT is efficacious, complications increase with age (r = .26; P ≤ .003), occurring in 35% of the elderly as opposed to 18% of the younger group. This increased rate of complications appears to be accounted for by problems in the very old; six of eight subjects over 75 years of age had some untoward event. Common complications in the elderly included severe confusion, falls, and cardiorespiratory problems. Complications in the whole sample were related to health status (r = .22; P ≤ .008) which in turn correlated with age (r = .50; P ≤ .0001). Those taking a greater total number of medications and a greater number of cardiovascular medications had significantly more complications during ECT. There was no relationship between either complications and outcome or complications and the number or laterality of treatments.These findings confirm the effectiveness of ECT in the elderly but suggest there may be unappreciated risks of ECT in this population. At particular risk are the very old, those in poor general health, and those taking multiple medications, particularly cardiovascular a

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01397.x

年代:1987

数据来源: WILEY

摘要:

Caregiver burden has been associated with patient dementia. In this study we tested the hypothesis that caregiver burden and depression are related to patient cognitive impairment. We analyzed records of 127 elderly male patients from a Veterans hospital geriatrics referral clinic. The patients and their informal caregivers had been referred to the clinic because the complexity and multiplicity of their problems were beyond the treatment capability of other clinics. There was a high prevalence of dementia (73%) and depression (69%) in these patients according to Diagnostic and Statistical Manual (DSM‐III) criteria.Quantitative measures of patient dementia and dependency in activities of daily living were not statistically associated with measures of caregiver depression or burden. In contrast, measures of patient depression were significantly correlated with measures of caregiver depression and burden.We hypothesize that caregivers of chronically ill, elderly men cope better with physical and cognitive incapacity than with affective symptoms. Because caregiver support is the most important factor in maintaining a disabled elder in the community, we suggest evaluating patients and caregivers for depression as part of standard practice in geriatric clinical setting

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01398.x

年代:1987

数据来源: WILEY

摘要:

Thyroid disorders are known to manifest occasionally as isolated psychiatric disorders. In order to determine whether thyroid dysfunctions could play a significant role in the pathogenesis of psychiatric disorders in the elderly, the prevalence of thyroid disorders was compared in a group of psychogeriatric patients and in a group of nonpsychiatric elderly patients.Thyroid function screening was performed in 157 patients consecutively admitted to a psychogeriatric unit, and the prevalence of hypothyroidism was determined in the different groups of psychiatric disorders (senile and multi‐infarct dementia, organic brain syndrome of other etiologies, psychotic depression, neurotic depression, chronic delusional state, acute confusional state, and personality disorder). Thyroid function screening was performed similarly in 104 unselected elderly patients admitted to the medico‐surgical admission unit of the University hospital to assess the prevalence of hypothyroidism in a general, nonpsychiatric, elderly population.Eight patients were diagnosed as hypothyroid based on an elevated basal thyrotropin (TSH) and on thyrotropin‐releasing hormone (TRH) test in the total number of patients, two in the nonpsychiatric and six in the psychiatric group. Three had clinical hypothyroidism, with decreased total and free T4and T3plasma levels in addition to increased basal TSH, five had biochemical hypothyroidism, with normal T4and T3levels and an excess TSH response to oral TRH. The prevalence of hypothyroidism in the two groups did not differ significantly (1.9% in the nonpsychiatric versus 3.8% in the psychiatric group).The prevalence of hypothyroidism in a subgroup of 88 patients with senile and multi‐infarct dementia was 2.3%. It was not statistically different from that of the general nonpsychiatric geriatric population. The prevalence of hypothyroidism in a subgroup of 27 patients with neurotic depression was 14.8%. It was significantly higher than the prevalence found both in the overall psychogeriatric group and in the general geriatric group.It is concluded that hypothyroidism is not involved in cognitive disorders, but may play a role in the pathogenesis of some depressive disorders in the

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01399.x

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01400.x

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01401.x

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb01402.x

年代:1987

数据来源: WILEY