摘要:

OBJECTIVE:To examine the association of self‐reported physical activity with performance‐based and self‐reported physical functioning measured 3 to 5 years later.DESIGN:A population‐based, longitudinal study.SETTING:The island of Oahu, Hawaii.PARTICIPANTS:Subjects were 3640 Japanese‐American men older than 70 years of age.MEASUREMENTS:Estimated daily energy expenditure evaluated from self‐reported engagement in a variety of activities determined from a mail survey in 1988; physical functioning status determined from both self‐report and performance‐based measures 3 to 5 years later. The effect of physical activity on physical functioning scores was determined through multiple logistic regression and analysis of covariance techniques for subjects who had chronic diseases as well as those in a healthy subsample.RESULTS:For the healthy subsample, those who were highly active in 1988 were more likely to have optimal function for the basic activities of daily living score (odds ratio 2.3; confidence interval (CI) 1.1 to 4.9), home management skills score (odds ratio 1.5; CI 1.1 to 2.1), and physical endurance‐type tasks score (odds ratio 1.7; CI 1.2 to 2.4) than subjects classified as low active. A significant linear trend was found additionally across physical activity level for time to walk 10 feet and grip strength (Pvalues<.001). Similar results were found for subjects with chronic diseases; however, most of the benefit of physical activity for this subsample occurred for subjects who were at least physically active at a moderate level.CONCLUSION:Engaging in physical activity is predictive of a high level of physical functioning in older men with and without chronic diseases. Participation in at least moderate physical activity may be suff

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05525.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To define reference hematologic and biochemical lab values in older individuals.DESIGN:Randomly selected, age‐ and gender‐stratified participants.SETTING:Visits by participants to four research clinics.PATIENTS:A total of 5201 participants in the Cardiovascular Health Study, an observational study of older Medicare‐eligible individuals living at home.MEASUREMENT:Information about health status, previous illness, and medication use was obtained from participants and/or their MDs. This information was used to define a healthy subset of the population. Blood samples were obtained for Cholesterol, HDL and LDL cholesterol, fasting and 2‐hour postload glucose and insulin, fibrinogen, factors VII and VIII, potassium, creatinine, albumin, uric acid, white blood count, hematocrit, hemoglobin, and platelet count.RESULTS:Significant differences were found for age group and/or gender for all mean values. Many tests were significantly different from the generally accepted reference ranges used in clinical laboratories.CONCLUSIONS:In some situations accepted laboratory norms for the general population can not be extrapolated to older adults. There are implications for both research and clinical practice.J Am Geriatr Soc 43:855–

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05526.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To evaluate the impact of caffeine in medication on sleep complaints in a community population of persons aged 67 or older.DESIGN:Cross‐sectional analysis.SETTING:Iowa 65+ Rural Health StudyPARTICIPANTS:Those who completed their own interview, including a section on the use of medications, during the third annual in‐person follow‐up in 1984–1985.MEASUREMENTS:Main outcomes: trouble falling asleep or other sleep complaints. Covariates: use of caffeine‐containing medication, spasmolytic, or sympathomimetic drug; number of drugs used; depressive symptoms; self‐perceived health; comorbidity, hip fracture, arthritis, ulcer of stomach or intestines; and consumption of caffeinated beverages.RESULTS:The prevalence of caffeinated medication use by participants was 5.4%. Those reporting the use of any caffeine‐containing medication were at an increased risk of having trouble falling asleep (Odds Ratio [OR] = 1.79, 95% confidence interval [CI]= 1.19–2.68). There was no significant risk of other reported nighttime or daytime sleep problems associated with use of caffeine‐containing drugs. Even after adjusting for other factors that could interfere with initiation of sleep, such as painful disease, depressive symptoms, polypharmacy, use of specific medications known to interfere with sleep, and coffee consumption, the use of caffeine‐ containing medication still presented a significantly increased risk of having trouble falling asleep (OR = 1.60, CI = 1.04–2.46). Although those participants using over‐the‐counter analgesic medication containing caffeine had an increased risk of trouble falling asleep (OR = 1.88, CI = 1.22–2.90), there was no significant risk of trouble falling asleep for those who took similar noncaffeinated OTC analgesic drugs (OR = 1.26, CI = 0.87–1.83).CONCLUSIONS:The use of caffeine‐containing medication is associated with slee

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05527.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES:To compare the safety and cost of clean versus sterile intermittent bladder catheterization in male nursing home residents. To provide evidence to support the hypothesis that intermittent catheterization is a valid, alternative method of bladder management in male residents of long‐term care in whom urinary retention is a documented problem.DESIGN:Randomized clinical trial.SETTING:Three long‐term care sites having predominantly male populations.PARTICIPANTS:Eighty male veterans, residents of three long‐term care facilities, ranging in age from 36 to 96 years with a mean age of 72.INTERVENTIONS:Standardized procedures for clean and sterile intermittent catheterization (IC) were implemented by staff nurses at each site. Patients were randomized into clean and sterile IC groups. Nursing time and catheterization equipment usage were recorded using bar code readers. Clinical data were collected from the medical chart. Treatment of urinary tract infection was prescribed by the medical personnel responsible for each individual resident.MEASUREMENTS:We compared the number of treatment episodes for symptomatic bacteriuria between groups randomized to receive either clean or sterile intermittent catheterization. Laboratory analysis of blood and urine was done on predetermined days. Control variables were research site and patient history of urinary tract infection within the last 6 months. A cost comparison of nursing time and equipment usage for the two catheterization techniques was also performed.RESULTS:No significant differences were found between clean and sterile groups with regard to number of treatment episodes, time to first infection, type of organism cultured, or cost of antibiotic treatment. The cost of sterile technique was considerably higher both in terms of nursing time and supplies.CONCLUSIONS:Findings from this study demonstrate that clean technique intermittent catheterization is a safe and cost‐effective bladder management technique with male, nursing home residents, despite the frailty of this high risk population. An annual savings of approximately $1460 per patient in nursing time and catheterization supplies could be anticipated if a patient were catheterized an average of four times per day substituting clean IC technique for sterile IC technique.J Am Geriatr Soc 43:865–

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05528.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To describe the incidence and associated factors of injury‐causing falls by place of residence.DESIGN:A prospective population‐based study.SETTING:Five municipalities in northern Finland.PARTICIPANTS:All persons in the five communities aged 70 years or older living at home (n = 1016) and in long‐term institutionalized care (n = 143).MEASUREMENTS:We recorded all fall incidents during a 2‐year period by occurrence and severity of injury, using diary reporting and regular calls and by examining the medical and nursing records of all participants. The times, places, circumstances, and medical treatment needed were recorded as well.RESULTS:Men living at home experienced 71 minor injuries/1000 person years (PY), 42 major soft tissue injuries/1000PY, and 12 fractures/1000PY; women at home experienced 175 minor injuries/1000PY, 65 major soft tissue injuries/1000PY, and 33 fractures/1000PY. Institutionalized older men had 272 minor injuries/1000PY, 122 major soft tissue injuries/1000PY, and 41 fractures/1000PY; institutionalized women had 292 minor injuries/1000PY, 131 major soft tissue injuries/1000PY, and 58 fractures/1000PY. Falls causing injury to older adults in long‐term institutionalized care were more evenly distributed by time of day than those that occurred at home. The majority of the injuries sustained in long‐term institutionalized care were injuries to the head. The incidence rate of fall injuries requiring medical attention in women, 113/1000PY, was twice that in men, 57/1000PY.CONCLUSIONS:Injury‐causing falls are more frequent in older people living in long‐term institutionalized care, and the time‐distribution and some circumstances differ from those of injury‐causing falls in home‐dwelling older people.J Am Geriatr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05529.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

BACKGROUND:Most ADL summary measures add up the number of dependencies. They assume an equal weighting among items and require an arbitrary definition of dependency.METHODS:A panel of experts in geriatrics was asked to rate a set of ADL and IADL components in terms of the contribution of each to overall dependency using a magnitude estimation (ME) technique. The ratings were done for both domains and for levels of function within each domain. The resultant scores were compared with the usual dependency count approach.RESULTS:The distribution of weighted items appears to have face validity. The pattern of dependency traced by the ME model was intermediate between those created by simple counts with two different definitions of dependency. The ME approach has stronger statistical properties than the ordinal scoring approach.CONCLUSIONS:The ME approach appears to be a reasonable and workable method for creating a measure that permits meaningful statements about the mean value of functional dependencies. This result can be used for any comparison of means, such as across individuals, across aggregates of individuals, or across time.J Am Geriatr Soc 43:877–884, 199

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05530.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To determine whether the introduction of coordinated geriatric and discharge planning services at teaching and community hospitals in Toronto has changed the number of beds occupied by patients awaiting transfer to long‐term care institutions.DESIGN:Retrospective review of social work records for the period 1985–1992.SETTING:Two tertiary and four primary acute care hospitals in Metropolitan Toronto.PARTICIPANTS:Hospitals were matched for location, acuity, and teaching affiliation.MAIN OUTCOME MEASURES:The numbers of beds occupied by patients awaiting transfer to nursing homes or chronic care hospitals were noted.RESULTS:In those teaching and community hospitals that had introduced coordinated geriatric and discharge planning services, there was a reduction in the percentage of beds occupied by patients awaiting long‐term care placement (average −51%), whereas in hospitals without geriatric services, the percentage of beds occupied by patients awaiting long‐term care placement increased (average +25%) (P= .05 by Fisher's exact method, 95% confidence limit odds ratio 0, .9999).CONCLUSION:The introduction of coordinated geriatric and discharge planning services was associated with a decrease in the percentage of beds occupied by patients awaiting long‐term care in both teaching and community hospitals.J Am Geriatr Soc 43:88

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05531.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05532.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05533.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05534.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY