摘要:

ObjectiveThe study was designed to investigate sleep‐wake patterns in healthy elderly men and women (>88 years) using ambulatory recording techniques.DesignCross‐sectional observations on 2 consecutive days.MethodsTwo consecutive 24‐hour recordings were made. Each 30‐second period of the recording was scored as characteristic of wakefulness, REM, and non‐REM sleep (stages 1–4).SettingInterviews and recordings were done in the home of the elderly, not interfering with the habitual routine.ParticipantsAmong eligible members of the “Senieur” protocol, screened for wellness, seven females (88–102 years) and seven males (88–98 years) volunteered to participate.Main Outcome MeasuresOrganization of sleep, sleep structure, and daytime napping.ResultsThere was no difference between the first and second night recording. Important gender differences were observed: males had significantly less total sleep, shorter REM latency, more transitions to wake from REM, less NREM 3 sleep, and virtually no NREM 4. Daytime napping, REM amount, and distribution did not show sex differences. Although the variability in the amount of napping was considerable, it occupied less than 10 percent of the total sleep time in both women and men. Daytime napping was unrelated to sleep characteristics.ConclusionsAmbulatory sleep‐wake recordings allow an objective and critical evaluation of sleep function in normal aging. Interesting findings include a shift of REM sleep to the first part of the sleep period an increased cycle variability, and non‐correlation of night‐time sleep with daytime napping. In contrast to earlier findings in elderly persons, a polygraphic and subjective first

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01928.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo prospectively evaluate the incidence and impact of viral respiratory infection in the institutionalized elderly during a winter season.DesignProspective descriptive study, without intervention.MethodPatients with respiratory illnesses were evaluated by a directed history and physical examination. Nasopharyngeal secretions for viral culture were obtained, and acute and convalescent serum samples were obtained for analysis. Serologic evidence of infection with respiratory syncytial virus (RSV) and parainfluenza were determined by enzyme immunoassay (EIA), and influenza by hemagglutination‐inhibition assay and EIA.SettingA 591‐bed nursing home.ParticipantsResidents with signs or symptoms of acute respiratory illness (nasal congestion, pharyngitis, cough, wheezing, or respiratory difficulty) were eligible for study.ResultsA viral etiology was documented in 62 out of 149 illnesses (42%). RSV was the most common virus associated with illness; it was documented in 27% of respiratory illnesses, followed by rhinovirus (9%), parainfluenza (6%), and influenza (1%). RSV was associated with significantly more severe disease when compared with rhinovirus. Clustering of specific viral infections occurred, suggesting nosocomial transmission.ConclusionsViruses are an important cause of acute respiratory infections in the institutionalized elderly during the winter mon

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01929.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveLocal cerebral metabolic rates for glucose were compared between patients with familial Alzheimer's disease (FAD), sporadic Alzheimer's Disease (SAD), and normal controls (NC) to determine if FAD is associated with a unique pattern of brain metabolism.DesignCase‐control study matched to convenience sample of FAD.MethodsSubjects in the three diagnostic groups were scanned using fluorodeoxyglucose and the Positron Emission Tomographic (PET) technique. The criterion standard of a detailed clinical history and examination were compared to scan results.SettingPatients in a university hospital.SubjectsAmbulatory controls and Alzheimer's patients, both sporadic (n= 8) and familial (n= 7). The two groups were similar in severity of cognitive dysfunction.ResultsFAD and SAD patients did not significantly differ in terms of local cerebral metabolic rates for glucos

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01930.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo compare risk factors for ischemic and hemorrhagic strokes in subjects aged 70 years and above with those in younger subjects.DesignCase control study, with controls matched for age and sex in 5‐year age groups.SettingA general district hospital in Hong Kong with a catchment population of over 1 million.PatientsAll patients admitted consecutively over a 6‐month period. Classification of stroke was by neurological examination and CT scan, or autopsy if death occurred before CT scanning could be performed. Exclusion criteria: onset of ictus>48 hours before admission, those with previous stroke, subarachnoid hemorrhage, or embolic stroke from rheumatic heart disease, and those with liver, renal, biliary, or thyroid diseases. For ischemic strokes, 78 pairs<70 years and 121 pairs ≥70 years were recruited. For hemorrhagic strokes, the numbers were 40 and 39, respectively.ResultsFor ischemic strokes, atrial fibrillation and the presence of ischemic heart disease were risk factors only for those aged 70 years and above, while smoking and left ventricular hypertrophy were risk factors only for those below 70 years. Hypertension and glucose intolerance were risk factors for both age groups, although the effect of glucose intolerance was less marked in the older group. No marked difference in serum lipids and lipoproteins as risk factors was observed between the two age groups. Hypertension was the only demonstrable risk factor for hemorrhagic stroke in the younger, but not in the older, group.ConclusionRisk factors for ischemic and hemorrhagic strokes are different in elderly compared with younger subjects, with the possibility that certain risk factors for ischemic strokes, in contrast to those for hemorrhagic strokes, may be modifiable even in subjects aged 70 years or

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01931.x

年代:1992

数据来源: WILEY

摘要:

ObjectivesTo determine the prevalence and management of hearing loss and hearing handicap among non‐demented nursing home residents.DesignDescriptive study of total population of two nursing homes.ParticipantsAll 121 eligible residents.SettingsTwo nursing homes.Mini Outcome MeasuresAudiometry, questionnaires of nurses and subjects regarding perceived hearing handicap, and documentation in medical records of hearing loss.Results77% had at least a mild (≥26 dB Hearing Level) hearing loss in the better ear, and 51% had a moderate to severe loss (≥41 dB HL). Self‐assessments of hearing handicap by residents, together with audiometric findings and expressed interest in a hearing aid, were more useful guides for aural rehabilitation needs than were nurses' assessments of residents' handicaps. Medical records failed to identify 48% of residents with moderate to severe hearing losses. Fifty‐eight percent of residents with severe hearing loss currently had hearing aids, and 38% more would like to have an aid.ConclusionResidents should have hearing evaluations with documentation of results on admission and periodically under the direction of a nurse trained as a hearing specialist. Environmental modifications of the NH plus use of hearing aids can improv

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01932.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo test an individualized form of habit training for urinary incontinence (UI) among long‐stay cognitively and/or physically impaired elderly nursing home residents over time.DesignRandomization of subjects occurred by nursing home unit. Baseline wet checks were done hourly for one 24‐hour period at 3‐week intervals over 12 weeks followed by 72 hours of continuous electronic monitoring to establish precise voiding patterns for each subject. The 12‐week intervention period was administered by indigenous staff after they attended a 4‐hour UI educational program. Subjects were followed an additional 12 weeks to determine the extent of maintenance of the intervention among staff and subjects.SettingFour non‐profit nursing homes; west, mid‐west, east coast.PatientsConsent was obtained from 154 (71%) who met primary inclusion criteria. Forty‐one failed the secondary inclusion criteria leaving 113 who entered the 37‐week study. Eighty‐eight completed the study (experimental = 51, control = 37); all were physically and/or mentally impaired, averaged age 85, and had either urge or urge/stress UI.ResultsUI was significantly decreased during the 3‐month period (P<0.001). Eighty‐six per cent showed improvement over baseline while one‐third improved 25% or more over their baseline UI rate. The control group's UI increased during the same period of time. The volume of UI among the experimental group also decreased (P<0.005) while the control group's UI volume increased.ConclusionsThe training program was effective in reducing UI though compliance among nursing staff averaged only 70% of the prescribed toileting times. The success of this approach is similar to other recently described behavioral programs but achieved the reduction using only regular nursing staff. This individualized approach supports the recent regulatory thrust to individualize care to promote and maintain function

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01933.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo describe and quantify the impact of pacemaker implantation on cognitive functioning in the elderly.DesignProspective case‐control, non‐randomized trial. Data were collected from clinical and family interviews and from a psychological test battery.SettingPacemaker clinic in a tertiary care hospital.ParticipantsNineteen elderly (65+ years) patients undergoing new or replacement pacemaker implantation for dysrhythmias and volunteer controls matched for age, sex, and short Mental Status Questionnaire test results, without dysrhythmia or intervention.Main Outcome MeasuresSubjective and clinical impressions based on family interviews; results of psychological test battery before and 6–12 months after pacemaker implantation.ResultsPrior to pacemaker implantation, three patients met DSM‐III criteria for dementia and two for delirium. Paced patients demonstrated deficiency in immediate memory, language, memory for less structured information, and learning of abstract materials. These deficits were due primarily to the poor performance of patients with complete heart block. Despite clinical and subjective impressions of improvement, there was no change in psychologic test performance subsequent to pacemaker implantation.ConclusionsImpaired cognitive functioning is not always clinically apparent but appears common in patients with cardiac dysrhythmias; it is not altered 6–12 months after pacemaker imp

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01934.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo assess whether knowledge or psychosocial and glycemic benefits of a diabetes education program are enhanced by a support group for older patients.DesignA partially randomized controlled trial involving two groups of patients: Group A, subjects who received an education program followed by 18 months of support group sessions; Group B, only the diabetes education program. A third convenience sample, Group C, received neither intervention. Groups A and B were assessed before and immediately after the education program, and all groups were assessed 2 years after the education program.SettingDiabetes clinic at a Veterans Affairs Medical Center. Patients: All subjects were male (mean age = 68 ± 1.3 years, range = 57–82 years; duration of diabetes = 10 ± 2 years, range 3–16). Sample sizes were 11 in Group A, 13 in Group B, and 8 in Group C.InterventionThe education program consisted of six weekly sessions covering aspects of diabetes self‐care. The support group consisted of 18 monthly sessions for continuing education, discussion, and structured social activities.Outcome MeasuresDiabetes knowledge, psychosocial factors (self‐care‐related quality of life, stress, family involvement in care, and social involvement), depression, and glycemic control.ResultsGroup A scored better (at leastP<0.05) on knowledge, quality of life, and depression than the other groups. Groups A and B showed less stress, greater family involvement, better glycemic control, but less involvement in social activities than Group C.ConclusionDiabetes education programs can have long term benefits on knowledge, psychosocial functioning, and glycemic control for older diabetic patients. The addition of support groups enhances diabetes knowledge and psychosocial

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01935.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo study the effectiveness of hemopoietic growth factors in older patients.DesignLiterature review. All articles published in English language between 1987 and 1990 were reviewed. Those reporting studies without age limits as entry criteria and describing the effects of growth factors in individual patients were suitable for analysis. Bone marrow transplantation related articles were excluded.Main Outcome MeasuresThe meanfold increase of granulocytes for Granulocyte‐Colony Stimulating Factor, Granulocyte Macrophage‐Colony Stimulating Factor, and Interleukin 3 and of hemoglobin for erythropoietin were compared in subjects younger and older than 65, by Mann‐Whitney U test.ResultsOf 68 studies, 23 were suitable for analysis. These included patients with myelodysplastic syndromes, aplastic anemia, chemotherapy‐induced myelosuppression, chronic granulocytopenia, anemia, and myelosuppression of malignancies and of chronic disease. Of 204 patients, 67 were 65 years of age or older and 42 were over 70. No difference was seen in meanfold increase of granulocyte and hemoglobin in time of response to growth factors or in response in presence of an absolute neutrophil count lower than 1000/μL between younger and older patients.ConclusionEarly response to hemopoietic growth factors appears well maintained with advanced age. Prospective studies of the prolonged effects of these factors in older and younger patients ar

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01936.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo assess how dietary change affects gain in strength and muscle mass during heavy resistance training of elderly men.DesignRandomized controlled trial.InterventionDuring 12 weeks of resistance training of knee extensors and flexors, a daily supplement of 560 ° 16 kcal/day (17% energy from protein, 43% from carbohydrate, 40% from fat) was randomly assigned to six men (S) while five men (U) received no supplement. Food intake, strength, whole body composition, and midthigh composition by CT scan were assessed before training and at 6 and 12 weeks.SettingThe men were outpatients but lived in a Metabolic Research Unit during the three assessments.ParticipantsEleven healthy men aged 61 to 72 years.ResultsDensitometry showed no change over time in fat or fat‐free mass. However, the S men increased (P<0.05) weight, skinfold thickness at six sites, subcutaneous midthigh fat, and creatinine excretion; in all men, changes in these values and in midthigh muscle were proportional to changes in reported energy intake (P<0.05). There was midthigh muscle hypertrophy in both groups, but it was greater in S than U (P<0.01). Both groups gained strength (P<0.001) with no effect of diet.ConclusionsDuring physical rehabilitation of the elderly, dietary intake may influence the increase in lean as well as adipose tissue without altering strength gain. These preliminary findings should be confirmed by a larger study with sedentary contro

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01937.x

年代:1992

数据来源: WILEY