摘要:

ABSTRACT:Both pure systolic, and systolic plus diastolic hypertension are risk factors for cerebrovascular and cardiovascular disease in patients over 65 years old, but the efficacy of antihypertensive therapy in preventing the complications of hypertension in the elderly has been questioned. The risks associated with such therapy seem to have been overemphasized. Although the evidence is incomplete, elderly patients should be treated when the systolic blood pressure exceeds 160 mm Hg or the diastolic pressure exceeds 95 mm Hg, or both. A revised stepped‐care approach, with use of vasodilating agents as the Step‐2 drugs, is propo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01765.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:The effect of the aging process on gastric emptying was studied in 11 elderly subjects (mean age, 77) and in 7 young healthy volunteers (mean age, 26). Gastric emptying rates were assessed by a modified sequential scintiscanning technique after administration of the nonabsorbable chelated radiopharmaceutical99mTc‐DTPA. The rate of emptying, expressed as half‐time (T1/2e) in minutes, was significantly longer (p<0.001) in the elderly subjects (mean apparent T1/2e= 123.23 min) compared to the young healthy volunteers (mean apparent T1/2e= 49.69 min). Clinical implications of these findings are discussed, particularly with respect to the rate and extent of drug absorption in elderly pers

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01766.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:In a series of 934 elderly patients admitted to the geriatric department of a general hospital, several admission laboratory tests were found to provide prognostic information. When tests were combined as a discriminant function, the matter of death or survival at six weeks after admission was predicted with 84 percent accuracy in women and 77 percent in men. Values for serum sodium, blood urea, triiodothyronine uptake, and hemoglobin contributed significantly to the prediction in both sexes, whereas the values for serum albumin and blood glucose contributed only in women.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01767.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:More complete data on the prevalence and types of urinary dysfunction in geriatric institutional patients are essential for the management of their urologic problems. Over a 13‐month period, a prospective study was conducted of all new admissions to a hospital for long‐term care. Eighty percent (277/347) of the newly admitted patients were geriatric (65 or older). Urinary dysfunction was identified in 69.3 percent of the geriatric group; 38.3 percent were incontinent, 20.2 percent bore a urinary diversion device, and 10.8 percent were symptomatic without incontinence. Obtaining reliable information about urologic status posed a significant problem, particularly as 27 percent of the subjects had a mental disorder, including organic brain syndrome or confusion. Thirty percent of all patients questioned were unable to give any history of their own health status. Questioning of both staff and patient to determine reliability of the data revealed that the given information was correct in 77 percent of patients who acknowledged genitourinary dysfunction, and in 83 percent of those who denied it. The study failed to elicit useful data concerning the specificity of symptoms, urologic history, diagnosis and management of urinary dysfunction in this series of geriatric patients under long‐term institutional

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01768.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:Of 2,586 consecutive patients admitted to a private general teaching hospital, 370 (14 percent) received digoxin therapy. Serum digoxin assays were performed on 261 of these 370 subjects. In a representative sample of 97 patients, 61 attending physicians were responsible for their care. The mean and median age of the patients was 70 years (range, 39–96 years), and one‐quarter of them had a significant degree of renal impairment. Sixty‐one percent of the patients were being treated for congestive heart failure (CHF), and the remainder for atrial fibrillation with or without CHF. Overall, 67 percent of the serum digoxin assays were judged to be appropriate, particularly those requested for evaluation of possible digitalis toxicity or the dosage in renal impairment, but only 43 percent of the assays used to assess maintenance therapy or the patient's compliance were deemed appropriate. A significant difference was found in the percentage of appropriate assays rated useful by the physicians, as compared to the percentage of inappropriate assays. Inappropriate serum digoxin assays cost about $30,000 annually in this 680‐bed hospital. Stricter criteria for admission assays would eliminate much of this excessiv

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01769.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:Among 27 ambulatory aged patients receiving thyroxine therapy for hypothyroidism, 4 had the “failing thyroid syndrome” (FTS) and 23 had frank clinical hypothyroidism. Patients with FTS are asymptomatic and the subnormal thyroid function is recognized only by a high level of serum thyrotropin (TSH) with a normal level of thyroid hormone (thyroxine or triiodothyronine). They require a smaller dosage of thyroid hormone for replacement initially. Identification of these cases through routine blood analyses for TSH in patients at risk (those with a history of Graves' disease or Hashimoto's thyroiditis) may permit early treatment of incipient hypothyroidism and the prevention of clinical hypothyroidism. Since there is a reduction in the thyroxine dosage required for complete thyroid replacement with age, the expected final replacement dosage when the thyroid fails completely is less than that reported for younger adults. This is true for patients with FTS, for patients with newly diagnosed clinical hypothyroidism, and for patients with long‐established hypothyroidism receiving replacement therapy. The thyroid replacement dosage should be adjusted both for age and for body weight to avoid overdosage and thyroid toxicity, to which the elderly are particularly sens

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01770.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:From 1973 through 1979, 32 patients over 60 years of age were admitted to the Beth Israel Medical Center, New York, because of a perforated gastric or duodenal ulcer. In many of them, the symptoms and physical findings were minimal. In abdominal roentgenograms (subject erect or supine), only 17 (60 percent) of these patients showed free intraperitoneal air. Among the 29 surgically treated patients, plication of the ulcer was performed in 28 and hemigastrectomy‐vagotomy in one. The postoperative morbidity rate was 62 percent, and the mortality rate 17 percent. In 3 of the 32 patients, the diagnosis of perforated ulcer was established only at autopsy. Thus, failure to diagnose this condition accurately may be the principal cause of death in elderly patients with a perforated peptic ulcer. The increased use is recommended of contrast roentgenograms of the stomach and duodenum and of endoscopy, in an effort to improve diagnostic accuracy in dealing with perforated peptic ulcer

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01771.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:Transtracheal aspiration was performed in 32 elderly hypoxic patients with bacterial pneumonia. No morbidity or mortality was associated with the procedure. Gram stains of the transtracheal aspirate provided rapid, accurate delineation of the etiologic pneumonic agent, and were particularly valuable in indicating mixed bacterial infections. These included 5 cases of Streptococcus pneumoniae plus Gram‐negative bacillary pneumonia. The safety and value of transtracheal aspiration in the severely ill elderly patient are discusse

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01772.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:The presence of bacteria and local infection is an important factor in the local management of chronic pressure ulcers. For successful closure of the ulcer, the bacterial count should be 105or less per gram of tissue in the granulating wound. In a prospective randomized study of 45 (eventually 40) hospitalized patients, silver sulfadiazine (Silvadene) cream and povidone‐iodine (Betadine) solution were compared to physiologic saline for effectiveness in preparing pressure ulcers for closure. Quantitative bacteriologic techniques on tissue biopsy specimens were used for objective evaluation. In 100 percent of the ulcers treated with silver sulfadiazine cream (15 patients) the bacterial counts were reduced to 105or less per gram of tissue within the three‐week test period, compared to 78.6 percent in those treated with saline (14 patients) and 63.6 percent in those treated with povidone‐iodine solution (11 patients). Moreover, the ulcers treated with silver sulfadiazine cream responded more rapidly, with one‐third showing bacterial levels of<105within three days, and half within

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01773.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:This study involved 27 geriatric patients with asymptomatic chronic bacteriuria; all had indwelling Foley catheters. The treatment regimens (daily oral dosage) were: methenamine mandelate (MM) granules, 4 gm; MM, 4 gm, plus ascorbic acid, 4 gm; and MM, 4 gm, plus ascorbic acid, 4 gm, plus cranberry cocktail, 1 liter—administered according to a cross‐over design. Proteus vulgaris, Pseudomonas aeruginosa and E. coli were the most common urinary organisms. Proteus organisms were more often found in alkaline than in acidic urines, but the type of pathogen had no influence on urinary pH. Urinary formaldehyde concentration [HCHO] was lower in patients with Proteus infection (17.7 μg/ml) than in those with Pseudomonas (21.9 μg/ml) or E. coli infection (21.8 μg/ml). However, for Proteus infection, [HCHO]was higher in patients receiving MM plus ascorbic acid than in those receiving MM alone. Addition of cranberry cocktail to ascorbic acid did not enhance urinary pH, [HCHO] or methenamine efficacy. Our data suggest that in Foley catheter patients with chronic asymptomatic bacteriuria secondary to Proteus, Pseudomonas or E. coli infection, the type of urinary pathogen or the urinary pH cannot be used to predict the efficacy of methenamine therapy either with or without urinary acidifying

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb01774.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY