摘要:

In view of some controversies still existing about the real efficacy of ergot derivatives in the management of dementia, a double‐blind, randomized, parallel group trial extending up to 6 months was carried out to compare the effects of nicergoline, 60 mg daily, and placebo in 315 patients suffering from mild to moderate dementia. Clinical evaluation was performed by the SCAG scale. The trial, which included a 1‐month placebo run‐in period, showed that both placebo and nicergoline were associated with some degree of improvement. The effect of nicergoline, however, was significantly greater and more sustained, steadily increasing with time. In particular, the difference between nicergoline and placebo in mean total SCAG score was 5.5 at 3 months (95% confidence interval: 3.6–7.4) and increased to 9.8 at 6 months (95% confidence interval: 7.8–11.8). A comparison of nicergoline versus placebo in the frequencies of changes in each item of the SCAG showed also a significant difference at 6 months, the percent of patients displaying an improvement by at least 2 points ranging from 13.5 (bothersome) to 30.2 (disorientation) in nicergoline group, against 4.1 (self‐care) to 14.3 (fatigue) in placebo group. The safety of nicergoline, as judged by hemodynamic changes and drug‐related adverse reactions, was quite

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05494.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Degenerative central nervous system diseases such as Alzheimer's disease and lymphoreticular malignancies such as multiple myeloma occur with increased frequency with advancing age. Relatives of early‐onset Alzheimer's disease patients may have an increased risk of lymphoreticular malignancies. This led us to evaluate the family history of central nervous system diseases in a case‐control study of multiple myeloma. Thirteen of 439 multiple myeloma cases had one or more first‐degree relatives with degenerative or demyelinating central nervous system disease. In comparison, there were nine “positive” family histories in 1,317 matched hospital controls (relative risk = 4.4, 95% confidence interval = 1.9–10.3). Relative risks for the component categories of Parkinson's disease, multiple sclerosis, and miscellaneous degenerative central nervous system diseases were 3.0, 4.0 and 11.9, respectively. Our findings suggest that the degenerative and demyelinating central nervous system diseases and the lymphoreticular malignancies may comprise an etiologically related group of “protean diseases.” These diseases may have a shared genetic susceptibility, possibly an immunologic abnormality. The varied disease manifestation in family members suggests a second necessary etiologic step of a variable and possibly envir

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05495.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The purpose of this study is to examine the ability of physicians to diagnose alcoholism in the elderly patient and to define characteristics specific to the elderly patient with alcoholism. During a 3‐month period, all new admissions to the medical service of The Johns Hopkins Hospital were screened for alcoholism with two screening tests (the CAGE questionnaire and Short Michigan Alcohol Screening Test). The prevalence of screen‐positive alcoholism was 27% in patients under 60 years of age and 21% in patients 60 years and older. Elderly patients with alcoholism were more likely to be black (P<.01), but did not differ significantly in any other way from elderly patients who did not have alcoholism. Although 60% of screen‐positive young patients with alcoholism were identified by their houseofficers, only 37% of elderly patients with screenpositive alcoholism were so identified (P<.05). The elderly patients with alcoholism were significantly less likely to be diagnosed by their houseofficer if they were white, female, or had completed high school (P<.01). Even when diagnosed, elderly patients with alcoholism were less likely than younger patients with alcoholism to have treatment recommended by their houseofficers (P<.05) and, if treatment were recommended, it was less likely to be initiated (P<.05). These data suggest that current medical education is deficient in providing physicians with the skills to detect and treat elderly patients with alcoh

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05496.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The use of a screening test for thyroid functional disorder by sensitive thyroid stimulating hormone assay in the elderly was investigated. The basal thyroid stimulating hormone levels predicted the response of thyroid stimulating hormone to thyrotropin releasing hormone; it was suppressed in 99 (99.0%) of 100 hyperthyroid patients. Therefore, not only primary hypothyroidism but also hyperthyroidism can be excluded when the serum thyroid stimulating hormone levels are normal.An epidemiological study was then performed on 2,421 (76.7%) of the Japanese general population aged 40 or over recruited from the residents in Hisayama town and also in 122 residents between 20 and 40 years of age. Additional free T4measurement was necessary in about 10% of the residents with abnormal TSH levels to confirm the diagnosis of hyperthyroidism or distinguish latent from overt hypothyroidism. There was a significant correlation between age and serum thyroid stimulating hormone levels after logarithmic conversion (r =0.1533, P<.001). The prevalence of thyroid dysfunction found in 1,026 males and in 1,395 females aged 40 or over was, respectively: hyperthyroidism,<0.1% and 0.2%, latent (subclinical) hypothyroidism, 3.2% and 5.5%, and overt hypothyroidism, 0.4% and 0.7%.We conclude that the screening with this sensitive thyroid stimulating hormone assay and additional free T4measurement is useful for detection of patients with thyroid functional disorder.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05497.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

To assess the rate of occurrence of drug‐induced illness as a cause for admission to the general medicine service of a community hospital, charts were reviewed retrospectively of all patients admitted to the service over two randomly selected one‐month periods. Statistical analysis was performed on patients over and under the age of 65, and on iatrogenic and noniatrogenic admissions. Twenty‐three of 244 patients (9.4%) were admitted with drug‐induced illness. Patients with drug‐induced illness had 5.7 medications as compared to 3.2 medications per patient admitted for other reasons (P<.05). A single drug was responsible for 61% of all drug‐induced illness admissions. Aspirin and other nonsteroidal anti‐inflammatory agents were most often implicated. Eighteen of 155 elderly patients (11.7%) were admitted with drug‐induced illness. These patients were on an average of 6.3 medications as compared with 3.8 medications per elderly patient admitted for other causes (P<.005). Polypharmacy and a preponderantly elderly population may explain the substantial number of admissions caused by adverse drug reactions. Further research to assess the role of patient age and the number and type of medications involved in the event of drug‐induced illness requires standardization of definition and di

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05498.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one‐fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one‐fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effe

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05499.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Deaths from fires are the fifth leading cause of injury death among people aged 65 years or older. To describe the epidemiology of deaths from residential fires among older people, we analyzed mortality data for 1984 collected by the National Center for Health Statistics. Although older people represented only 12% of the U.S. population in 1984, they accounted for 29% (1,278) of that year's 4,466 residential fire deaths. Conflagrations accounted for 78% of older people's deaths from residential fires; clothing ignitions and other fires accounted for 11% each. Residential fire death rates increased with advancing age. Older black people had death rates 4.6 times the death rates of older white people. Older males had higher death rates than older females. Host, environmental, and behavioral risk factors for residential fire deaths among older people and potential strategies for intervention are discussed. Unless intervention strategies are focused on older people, the residential fire death toll in the U.S. may actually grow as the population of older people increases from 12% of the population in 1984 to about 21% of the population in 2030.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05500.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

We studied the effect of patient age on treatment decisions related to radiation therapy using data obtained through the Patterns of Care Study. Definitive treatment given for breast cancer (191 patients) and palliative therapy given for a variety of symptoms (784 patients) were investigated using data collected from 49 facilities selected on a random basis to reflect fairly the national practice of radiotherapy. Elderly (aged 70 or older) patients accounted for23.6%of the palliatively treated patients and 19.5% of the definitively treated breast patients. No correlation was found between patient age and the dose or number of days used in palliative therapy. Older patients were more likely to have the “boost” dose of radiation to the tumor bed delivered through external rather than implant techniques. While statistically significant, this difference is not felt to be clinically important. We conclude that once a patient is selected for a course of radiation therapy, age per se, is not a basis for prejudicial treatm

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05501.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

This paper addresses the ways that noninstitutionalized older adults deal with involuntary urine loss. The data come from a 1983–1984 sample survey of Washtenaw County, Michigan residents aged 60 and over. Five hundred twelve self‐reported incontinent respondents are included in the analyses. About a quarter of the incontinent respondents had discussed their condition with a doctor in the previous year, while 66% used one or more methods to control urine loss. Respondents preferred using absorbent products (47% of those who used some method) and locating a toilet upon reaching a destination (42%). Fewer respondents manipulated their voiding patterns (29%) or diet and fluid intake (17%), or did pelvic muscle exercises (10%). Only 7% were taking medication for their incontinence. Logistic regression analyses were performed to identify factors associated with the choice of actions. Predictors were taken from theoretical models of health service utilization and health behavior, and included predisposing characteristics, health beliefs, enabling factors, and illness variables. Illness variables, particularly severity and type of incontinence, were the best predictors of consultation with a doctor and use of any urine control method. The predictors were less useful for understanding the choice of a specific met

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05502.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Most studies that assess the effects of exercise in the elderly involve subjects who are in good health. The objective of this prospective longitudinal study was to examine the impact of exercise on cardiovascular fitness, flexibility, and strength in an elderly population that included chronically ill individuals. Patients were recruited initially from a population of veterans over 64 years of age who use a VA outpatient clinic as their regular source of care. The exercise intervention consisted of 90 minutes of exercise 3 days per week at 70% of the patient's maximal capacity. Activities included stationary cycling, stretching, weight training, and walking. Of 69 patients who began the program, 49 (71%) reached 4‐month follow‐up. Most patients completing follow‐up (76%) had at least one chronic disease, such as arthritis, hypertension, or heart disease. Patients who dropped out were more likely to have multiple chronic illnesses than those who remained in the program. Average weekly attendance was 65% and was stable over time. Improvements in cardiovascular fitness at 4‐month follow‐up were significant: Metabolic equivalents increased from 7.1 ± 2.3 to 8.3 ± 1.6 (P<.001), treadmill time increased from 8.5 ± 3.8 to 11.2 ± 4.1 minutes (P<.001), submaximal heart rate decreased from 123.7±18.8 to 118.8 ± 19.4 beats per minute (P<.001) and resting heart rate decreased from 68.1 ± 10.6 to 63.3 ± 11.6 beats per minute (P =.005). Hip flexibility also increased significantly from 58.5±13.8 to 67.7±9.9 degrees (P<.001), and abdominal strength increased significantly from 88.8 ± 32.4 to 104 ± 28.4 foot‐pounds (P<.001). No major complications resulted from exercise. This study demonstrates that elderly individuals, including those with chronic diseases, will participate in an exercise program and experience improvements in cardiovascular fitness, strength, and flexibility. Whether these improvements will enable elderly individuals to live independently for a longer period of time and avoid or postpone the need for long‐term care requires addit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05503.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY