摘要:

BACKGROUND: Approximately 10% of nondisabled, community‐dwelling adults aged 75 years and older lose independence in basic activities of daily living (ADLs) each year. The purpose of this study was to evaluate whether simple tests of physical performance could identify older adults, independent in their basic ADLs, who were at increased risk for the onset of functional dependence.METHODS: Among a representative cohort of 1103 community‐dwelling adults aged 72 years and older, we evaluated the 664 subjects who were cognitively intact and independent in their basic ADLs at the baseline interview. All cohort members had undergone a comprehensive assessment, including a battery of qualitative and timed performance tests. The main outcome event was the onset of functional dependence, defined as a new disability in one or more of the seven basic ADLs at the 1‐year follow‐up.RESULTS: Functional dependence developed in 53 (9%) of the 563 subjects who had complete data at the 1‐year follow‐up. Eight of the 12 qualitative tests and all six of the timed tests were significantly associated (P<.05) with the onset of functional dependence. Both qualitative and timed performance tests demarcated subjects into groups at low and high risk for functional dependence. Four timed tests—chair stands, rapid gait, 360° turn, and bending over—showed a threshold phenomenon, where the rate of new dependence increased slowly with worsening performance until a critical point (or threshold) was reached, and the rate of dependence increased substantially. For timed chair stands, for example, the rates of functional dependence within quarters of worsening performance were 5.3%, 6.3%, 6.7%, and 16%. The risk of functional dependence was markedly elevated (30%‐50%) for subjects who were unable to perform the timed tests.CONCLUSIONS: Several simple tests of physical performance were strongly associated with the onset of functional dependence. These results support the potential use of physical performance tests to develop a risk assessment strategy that could identify subgroups of older persons, independent in all ADLs, who are at increased risk for fun

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07192.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To determine if oxybutynin, a bladder relaxant medication, adds to the effectiveness of prompted voiding (PV) in the management of urinary incontinence among nursing home residents.DESIGN: Randomized, placebo‐controlled, double‐blinded, dose‐adjusted, crossover trial of oxybutynin added along with PV.SETTING: Seven nursing homes in Los Angeles County, California.PARTICIPANTS: Seventy‐five nursing home residents with predominantly urge incontinence, whose incontinence did not respond well to a trial of PV.MAIN OUTCOME MEASURES: The frequency of incontinence, measured as the percentage of hourly (7 AM to 7 PM) physical checks over a 3‐day period at which the resident was found wet.RESULTS: Sixty‐three (84%) of the residents completed the study. Among those completing the trial, the percent of checks wet went from 26.5% to 23.7% on placebo to 20.2% on active drug. These changes were statistically significant but not clinically meaningful. A clinically significant decrease in the frequency of incontinence, which we defined as a relative reduction in the percent of checks wet of>33%, occurred in 20 subjects (32%) while on active drug and in 12 subjects (19%) while on placebo (P= .48 by chi‐square). Twenty‐five subjects (40%) met our “continence criteria” of an average of one or less wet per day while on active drug, and 11 subjects (18%) achieved this goal on placebo (P= .005 by chi‐square).CONCLUSION: Oxybutynin does not add to the clinical effectiveness of PV in the majority of nursing home residents with urge type urinary incontinence. Selected residents may, however, become more responsive to PV while on oxybutynin. Our data are consistent with other studies of bladder relaxant medications in functionally impaired populations. New drugs and/or other interventions are needed for the large number of incontinent nursing home residents who do n

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07193.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To examine month‐by‐month variability of bacteriuria in a cohort of older women and to evaluate the performance of rapid diagnostic tests commonly used to indicate the presence of significant bacteriuria.DESIGN: Prospective, observational study.SETTING: Community housing sites and a long‐term care institution.PARTICIPANTS: Sixty‐one women, mean age 77.6, took part in the study.MEASUREMENTS: Midstream clean‐catch urine samples and medical information on subjects were collected at baseline, and then monthly for 6 months.RESULTS: Bacteriuria alone (≥105organisms per mL) occurred in 17% of all urine samples (28% of patients), bacteriuria with pyuria in 15% (26% of patients), and bacteriuria with symptoms in 3% (10% of patients). Spontaneous clearance of bacteriuria with pyuria was common (P= .30), as were new occurrences (P= .12) over 6 months of follow‐up. For the outcome of bacteriuria with symptoms, sensitivity of urinary diagnostic tests such as bacteria and pyuria on microscopic analysis, and leukocyte esterase on dipstick testing, ranged from 79 to 93%. Negative predictive values of these tests approached 100%.CONCLUSIONS: Bacteriuria was a very common event, occurring in almost one‐fifth of all urine samples and one‐third of all subjects during 6 months of follow‐up. Month‐by‐month follow‐up indicates that the natural history of bacteriuria is marked by frequent spontaneous alternation between positive and negative events. The high negative predictive value of many simple diagnostic tests commonly used for urinary tract disease suggests that they can quickly and cost‐effectively rule out bacteriuria

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07194.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES: To determine the factors that influence users' destinations on discharge from Geriatric Intermediate Care Facilities (GICFs), which were established in Japan in 1987 to help hospitalized older people return home.DESIGN: Retrospective chart review.SETTING: A 94‐bed GICF attached to Saku Central Hospital in Japan.SUBJECTS: Charts of all users (N = 437) aged 65 years and older, discharged from the GICF between July 1987 and February 1991, were reviewed.MEASUREMENTS: The independent variables, obtained from users' admission records, were age, sex, place of residence before admission, length of stay, intellectual impairment (assessed by Karasawa's diagnostic criteria for senile dementia), ability to perform activities of daily living (ADLs), and living arrangement of users in the GICF. The dependent variable was destination after discharge from the GICF.MAIN RESULTS: Multiple logistic regression analyses revealed that, compared with users who were able to successfully return home, users with little ability to perform ADLs, male users, and those admitted from other institutions were more likely to be hospitalized. Such analyses also revealed that users who came from institutions, had low ability to perform ADLs, and lived alone were more likely to be institutionalized in nursing homes.CONCLUSIONS: Evaluating a user's physical, mental, and socioeconomic conditions at an early stage of admission to a GICF may allow us to predict whether the user can be successfully discharged to his or her home or will have to remain at the GICF for an extended perio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07195.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To describe the effect of age on the care of patients hospitalized with acute myocardial infarction (MI).DESIGN: Retrospective chart review of all cases with a primary or secondary discharge diagnosis of acute MI.SETTING: Two large community hospitals in Milwaukee, Wisconsin, from July 1, 1990 to June 30, 1991.PATIENTS: There were 771 charts reviewed, of which, 149 cases were aged 54 years or younger, 203 were 55 to 64 years, 224 were 65 to 74 years, and 195 were aged 75 years or older.MEASUREMENTS: Hospital charts were examined for use of diagnostic and therapeutic interventions, including medications and procedures, as well as length of stay and inhospital mortality.RESULTS: Older patients were more likely to be female (18%, 20%, 38%, and 56% for the four age groups, respectively,P<.001 chi‐square for linear trend), more likely to present with congestive heart failure (31%, 39%, 51%, and 72%,P<.001), and had a higher in‐hospital mortality rate (5%, 7%, 10%, and 18%,P<.001). Older patients had a longer length of stay in the hospital. The use of cardiac catheterization in these post‐MI patients was high and did not decrease until after age 75 (85%, 88%, 88%, and 47%,P<.001). The percentage of patients receiving balloon angioplasty decreased with age (51%, 51%, 43%, and 20%,P<.001), whereas the percentage of patients receiving myocardial revascularization did not significantly differ with age (15%, 22%, 25%, and 19%,P= .46). Aspirin was less likely to be prescribed to older patients at discharge (79%, 82%, 70%, and 62%,P<.001).CONCLUSION: A surprisingly high percentage of those older than age 65 received invasive tests and interventions. This high utilization rate coexists with our continued ignorance about the efficacy of these tests and interventions in older a

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07196.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To determine whether age is associated with the outcome of cardiopulmonary resuscitation (CPR) in the coronary care unit (CCU).DESIGN: Retrospective chart review.SETTING: The coronary care units of two Canadian tertiary care teaching hospitals.PATIENTS: Two hundred sixty‐four coronary care unit patients undergoing cardiopulmonary resuscitation between January 1, 1985 and June 30, 1992.RESULTS: There was no significant difference in survival to discharge after CPR between patients less than 70 years of age (17.0%) and patients 70 years of age and older (17.2%) (odds ratio = 0.99; 95% confidence interval = 0.46, 1.80). Patients 70 years of age and older who survived to discharge after CPR had significantly greater lengths of stay (28.1 vs 19.3 days,P= .008).CONCLUSIONS: Age was not associated with a difference in survival to discharge after CPR in the CCU, although a clinically significant difference could not be excluded because of limited powe

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07197.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To determine which measurements and test conditions on posturography are most useful for identifying balance problems in older people.SUBJECTS: Two samples of 70 community‐dwelling older subjects (>75 years). One group (controls) considered their balance normal for their age, and the other (patients) complained of imbalance.MEASUREMENTS: Velocity of sway on static (with and without foam) and dynamic posturography, Tinetti gait and balance score, self‐reported fear of falling, and number and circumstances of falls.RESULTS: Mean sway velocity was significantly increased in patients compared with controls. The greatest difference between patients and controls occurred with measures of anterior‐posterior sway velocity during angular tilt of the platform. Sway velocity was not significantly increased in patients or controls who reported falls compared with those who did not report falls. Even when comparing those who fell as a result of loss of balance with those who fell because of trips or slips, there was no significant difference in sway velocity. By contrast, those who reported fear of falling (patients and controls) had significantly increased sway velocity compared with those who did not report fear of falling.CONCLUSION: On average, velocity of sway (particularly in the anterior‐posterior direction) is higher in older subjects who complain of imbalance compared with age‐matched controls, and the difference is greater with dynamic posturography than with static posturography. However, the posturography data provided little information about the cause of the imbalance and did not correlate with the frequency of repor

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07198.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To describe the attitudes toward and practice of health prevention and advance planning measures by a group of community‐dwelling older adults and to examine the effect of age on these practices.DESIGN: A descriptive study performed by mail survey.PARTICIPANTS: Members of a research registry who were 65 years of age or older.MEASUREMENTS: By means of a written questionnaire, we asked about knowledge of various health prevention and advance planning topics, including exercise, cholesterol screening, rectal examination, influenza vaccination, sigmoidoscopy, mammography, prostate cancer screening, organ donation, autopsy, health care proxy, and advance directives. Of those who knew about the topic, we asked if the respondent had discussed it with a physician, who initiated the conversation, and if the respondent participated in the activity. We also asked how important the topic was to the respondent.RESULTS: We received 598 completed surveys, a response rate of 83%. Respondents had a mean age of 74 years, were predominately white (96%), and were well educated, with 44% having completed college. The respondents were all knowledgeable about the topics, and, with the exception of sigmoidoscopy, organ donation, and autopsy, more than 70% thought these topics were important. In the case of health screening and prevention activities, a large percentage of respondents reported having discussed the topic with a physician, and a slightly smaller percentage reported regular participation. In the case of health care proxies and advance directives, however, only about one‐half of those who had made these arrangements said they had discussed them with a physician. When discussion did occur, it was much more likely to have been initiated by the respondent. Controlling for level of education, age was inversely associated with the likelihood of a woman reporting she had undergone mammography (P<.05). Age, however, was not associated with decreased frequency of undergoing other screening tests.CONCLUSIONS: Among a group of well educated older adults, reported interest in and compliance with health screening, health promotion, and advance planning activities were high. However, sigmoidoscopy, a relatively more invasive procedure that is generally recommended as a screening tool, is reported less likely to be practiced than prostate cancer screening, a less invasive procedure without such recommendation. Older adults state they are pursuing health care proxies and advance directives, often without the involvement of their physicians. Of the screening tests about which we asked, age was associated only with less frequent practice of mammogra

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07199.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To investigate the prevalence of contractures in patients with Alzheimer's disease and to assess possible associations between contractures and cognitive and functional decline in Alzheimer's disease.DESIGN: Case series.SETTING: Subjects from an outpatient, university‐based, dementia research center, followed, when necessary, into residential home and nursing home settings.PATIENTS: A consecutive sample of 161 patients (48 men, 113 women; mean age 75.3 ± 8.6 years) with a clinical diagnosis of probable Alzheimer's disease and with deficits in basic activities of daily living or more severe functional impairment.MAIN OUTCOME MEASURES: For cognition, the Mini‐Mental State Examination (MMSE); for functioning, the Functional Assessment Staging Scale (FAST); contracture is defined as a decrease of 50% or more of the normal passive range of motion of the joint.RESULTS: Prevalence of contractures was correlated highly with degree of functional impairment (r= .70,P<.001). More than three quarters of patients who had lost the ability to walk manifested contractures; however, contractures were found in fewer than 11% of all ambulatory patients examined. When present, contractures involved more than one extremity in 97% of cases and involved all four extremities in more than two‐thirds of patients.CONCLUSION: Joint contractures are very common in the severe stages of Alzheimer's disease. More than a quarter of a million institutionalized residents in US nursing homes are likely to be afflicted by this potentially painful and disfiguring condition. Possible pathophysiology and contributing factors and possible means of intervention for this major source of disability are dis

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07200.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES: To study whether a low, “normal” sumscore (i.e., 24 or higher) on the Mini‐Mental Status Examination (MMSE) near the cutpoint usually employed for identifying persons with cognitive impairment predicts later development of dementia.DESIGN: A prospective study of a random sample of nondemented persons aged 75 years and older, according to DSM‐III criteria, with follow‐ups after 3 and 6 years.PARTICIPANTS: The subjects were 215 persons living at home, mean age 81 years, 81% women. Their mean MMSE sumscore at the start of the study (T0) was 27.9 (range 24–30).MAIN RESULTS: A low MMSE sumscore at T0was identified as a statistically strongly significant predictor of dementia after 3 years (P<.001), when more than 40% of those with a sumscore of 24 or 25 at T0had become demented. A similar, although weaker and statistically nonsignificant, trend was observed for the risk after 6 years in relation to MMSE scoring at baseline.CONCLUSION: Persons with a sumscore of 24 or 25 and classified as not suffering from dementia according to the DSM‐III criteria are at high risk of developing dementia w

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07201.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY