摘要:

Blood pressure in the elderly may decrease after a meal or after oral glucose loading. It has been suggested that eating may affect blood pressure homeostasis through an insulin‐induced blunting of baroreflex sensitivity. We investigated the effects of oral glucose loading on baroreflex sensitivity in young normotensives and in elderly normo‐ and hypertensive subjects. Blood pressure was measured by a new noninvasive device, Finapres, which measures blood pressure continuously in the finger. Baroreflex sensitivity was estimated with the phenylephrine and nitroglycerin method. In both elderly groups mean arterial pressure fell significantly after the glucose load (11 ±1 mm Hg, P<.001 in the hypertensives, and 8±2 mm Hg, P<.01 in the normotensive subjects), whereas no change in blood pressure was found in the young group. Baroreflex sensitivity was lower in both elderly groups than in young normotensives. Glucose loading had no influence on baroreflex sensitivity in the three groups. Therefore, we conclude that other factors are involved in the phenomenon of postprandial hypotension in the elderly. J Am Geriatr Soc 37:1017–10

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb06914.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Improvements in diabetes knowledge, psychosocial functioning, and metabolic control were assessed following a six‐week diabetes education program for older male patients (aged 65 to 82 years) and their spouses. Before and after the program, scored questionnaires were administered to patients and their wives regarding knowledge, quality of life, stress, family involvement in diabetes care, and patient involvement in social activities. The patients were again assessed six months later. Results were compared to those of younger adult male patients (aged 28 to 64 years). The older patients significantly increased their knowledge of diabetes (P<.05), and to an extent equal to that of younger individuals. Reduction in stress correlated with their increase in knowledge (r =0.9;P<.05) and their improved diet‐related quality of life (r =0.7;P<.02). A decrease in stress was still evident six months after the program (P<.01). Perceived quality of life for areas requiring greater life‐style modification (diet and exercise) increased (P<.01), and was maintained at six months. In contrast, younger patients reported decreases in perceived quality of life (P<.05). Older patients with participating spouses, compared to those without, showed greater improvement in knowledge (P<.02), increase in family involvement (P<.05), less stress (P<.02), and improvement in metabolic control of diabetes (P<.001). The program increased spouses' knowledge and perceived involvement in the care of their diabetic partners (P<.01). This study suggests that diabetes education is an effective intervention for elderly patients and their spouses. A theoretical model of compliance and control specific to diabetes in the elderly is pro

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb06915.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Among the 116 consecutive patients aged 70 and older who were evaluated for dizziness in the UCLA neurotology clinic, the mean duration of symptoms was 36.2 months. One or more specific diagnoses were identified in 100 patients (86.2%), with the most common diagnoses being benign positional vertigo (25.9% of patients) and cerebrovascular disorders (21.6%). Benign positional vertigo was characterized by brief episodes of positional vertigo, a positive Hallpike maneuver, and lack of focal signs on neurologic examination and electronystagmography. Cerebrovascular disease presented as two entities, infarction and transient ischemic attacks, each of which had a distinct clinical picture. Patients who could not be definitively diagnosed frequently described presyncopal lightheadedness provoked by upright posture, and usually had normal physical examinations and electronystagmography. The clinical history, particularly the description and temporal nature of the patient's symptoms, provided the key diagnostic data in 69.0% of cases.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb06916.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Some studies have shown a negative association between age and serum albumin. Several of these studies included older people with known disease. Disease may reduce albumin in any age group. Other studies have shown no association between age and albumin. To investigate the association of age and albumin, albumin levels were determined in 241 apparently healthy subjects aged 55 to 101. A small but consistent negative regression slope of about 4% per decade was found for those aged over 70. Because the relationship to age was small, the finding of hypoalbuminemia in an elderly patient generally should be attributed to disease rather than age alone.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb06917.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The purpose of this study was to identify prospectively risk factors for pressure sores and to compare these results with a cross‐sectional analysis in the same population. Medical records on all admissions to a chronic care hospital over a 13‐month period were reviewed. Data on potential risk factors were abstracted from the initial history, physical examination, nursing assessment, and laboratory studies. Pressure sore status on admission and at three weeks was determined from a standardized form completed on all patients with a sore. The cross‐sectional analysis was performed by comparing patients with and without a pressure sore at the time of admission. The cohort analysis used patients initially without a pressure sore and monitored for a new sore at three weeks. Factors associated with pressure sores on univariate testing were entered into a stepwise logistic regression model. One hundred of the 301 admissions presented with a pressure sore. Factors significantly associated with the presence of a sore were altered level of consciousness (OR = 4.1), bed‐ or chair‐bound (OR = 2.4), impaired nutritional intake (OR = 1.9), and hypoalbuminemia (OR = 1.8 for 10 mg/mL decrease). Of the 185 patients without a pressure sore, 20 (10.8%) developed a sore. Factors significantly associated with the development of a new pressure sore were a history of cerebrovascular accident (OR = 5.0), bed‐ or chair‐bound (OR = 3.8), and impaired nutritional intake (OR = 2.8). Neither urinary nor fecal incontinence, nor the presence of hypoalbuminemia, was associated with sore development. We have prospectively identified risk factors for pressure sores. Although cross‐sectional studies may identify several of these risk factors, important differences exist. Cohort studies should be used in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb06918.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

This study evaluated a treatment procedure in which 126 incontinent nursing home patients were checked on an hourly basis, asked if they needed toileting assistance (prompted), and socially reinforced for appropriate toileting. Urodynamic analysis (including cystometrogram), provocative stress test, and behavioral assessment revealed that the nursing home patients were severely debilitated, with 65% demonstrating bladder abnormalities, 87% incapable of independent toileting, and 25% failing to score on the Mini‐Mental Status Exam (average score, 8.0). The treatment procedures were evaluated with a multiple baseline design in which subjects were randomly divided into immediate or delayed treatment groups after a baseline observation period. During treatment, the frequency of incontinence per 12 hours changed from a baseline average of 3.85 to a treatment average of 1.91. Three behavioral measures that can be easily collected by nursing staff significantly predicted continence levels during treatment (multiple R, 0.79) and change in incontinence during treatment (multiple R, 0.64). These prognostic criteria offer nursing staff a cost‐effective method for selecting the most responsive patients for prompted‐voiding trea

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb06919.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.tb06920.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.tb06921.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.tb06922.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

In a statement published in this issue, the Public Policy Committee of the American Geriatrics Society endorses the view that chronological age should not be a criterion for exclusion of individuals from medical care. This article aims to amplify the Committee's position by placing it within a broader context and identifying its justification in ethical argument. The paper is divided into three parts. The first part clarifies the difference between allocation (the distribution of funds between categories) and rationing (the distribution of funds within a single category). It is argued that given the current allocation of funds to medical care, some form of rationing is unavoidable. As others have noted, rationing is already occurring in an informal and piecemeal fashion. However, ethically sound rationing requires publicly debated and defensible policies. The second section of the paper reviews a number of arguments advanced in favor of rationing medical care on the basis of age. Objections to these arguments are carefully set out. The final part of the paper details and defends a series of positive arguments establishing special duties to the elderly. The paper concludes that to the extent that scarcity forces rationing, older persons should not be excluded because they are old.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb06923.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY