摘要:

Passive, agitated, and self‐centered behavioral changes were noted on initial evaluation in two‐thirds, one‐third, and one‐third, respectively, of subjects with mild senile dementia of the Alzheimer's type (SDAT). Over a 50‐month follow‐up period, the percentage of patients who exhibited agitated and self‐centered behaviors doubled. The percentage of subjects who demonstrated all three behavioral changes increased from 11% at entry to the study (mild SDAT) to over 50% when the dementia had reached a severe stage. The presence of personality changes at a mild stage of dementia did not predispose subjects to more rapid progression to a more advanced sta

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06349.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A controlled trial was conducted to examine the effects of superimposing an interdisciplinary geriatric consultation team upon the conventional patterns of care in medical wards of an acute care hospital. Two hundred and twenty‐two patients, aged 69 years of age or older, admitted from the emergency room to two trial wards and 182 similar patients admitted to two control wards where the team did not work, were followed. Evaluations at admission, two and four weeks, and three and six months postadmission by independent evaluators allowed comparisons between the care groups with reference to survival, length of stay, disposition, physical, mental, and social functional levels, and use of services after discharge. Data from charts and treatment logs allowed the care processes to be compared. Findings determined that patients in the two groups were alike on socio‐demographic and clinical characteristics at entry. Results demonstrated that patients in the trial and control groups fared similarly on the outcome measures at each evaluation point, although a trend toward better survival among team patients was noted. It was concluded that the addition of a consultative geriatric team to the medical wards failed to show a significant impact on patient outco

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06350.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

To evaluate the current outcome of patients hospitalized with diabetic hyperosmolar state (DHS), we retrospectively studied 135 patients admitted to two general hospitals over an 11‐year period. Mortality was 17%. Patients who died had a mean age of 77 years, compared to 68 years for the survivors (P = 0.008). They were also more likely to be nursing home residents (48 versus 23%, P = 0.01). Additionally, mean serum osmolality was significantly higher among those who died (383 versus 358 mosm/L, P<0.0001) as was blood urea nitrogen (81.3 versus 62.3 mg/dl, P = 0.006) and sodium (148 versus 137.4 mEq/L, P<0.001). However, mean glucose level and anion gap were similar among patients who died and patients who survived (1068 versus 1092 mg%; 23 versus 24 mEq/L, respectively). The presence of a chronic disease or an acute comorbid illness was not associated with mortality. Diminished physiologic reserve, attendant comorbidity, or functional disability may explain the effect of age and nursing home residence. High osmolality may indicate a greater water deficit and a more advanced stage of DHS at the time of diagnosi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06351.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

An explosive outbreak of Influenza A (H3N2) occurred during early February 1985 among the 55 residents of a nursing home in Douglas, Wyoming. Thirty of the 55 (55%) had febrile respiratory illnesses. Thirty‐six (65%) had received influenza vaccine. The attack rate was 84% in unvaccinated and 39% in vaccinated persons. Vaccine efficacy was estimated to be 54%. There were eight cases of pneumonia in unvaccinated and four in vaccinated persons, three deaths in unvaccinated and one death in vaccinated persons. Complement fixation and hemagglutination inhibition tests on sera from 47 residents confirmed the diagnosis of Influenza A in the great majority of individuals, and furthermore showed very low levels of anti‐body for the Influenza A H1N1 and Influenza B components of the vacc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06352.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Eighty‐nine episodes of pneumococcal bacteremia were reviewed over a 66‐month period at a Veterans Administration Medical Center. Forty‐one percent of these episodes were nosocomial in origin, and 59% of the patients were elderly (60 years of age or older). Nosocomial infection occurred more often in the elderly (55%) compared to those less than 60 years of age (32%; P<0.05). Within the elderly group, those older than 75 years of age had a higher rate of nosocomial bacteremia than those 60 to 75 years of age (76 versus 44%; P<0.05). The clinical presentation of the elderly and younger groups was not significantly different. All but one patient had serious underlying diseases. Eighty‐three percent of the episodes were due to pneumonia, and penicillin alone was prescribed for only 21% of all cases. The mortality rate directly due to the bacteremia was 22%, while the overall mortality during the hospitalization was 47%. In the elderly, the percentage of deaths due to infection was similar to the younger group, but overall mortality during the hospitalization was significantly higher in the elderly (74 versus 26%; P<0.01). Physicians showed poor recognition of the significance of pneumococcal disease, as demonstrated by inclusion of the diagnosis of pneumococcal infection or bacteremia in only 27% of the discharge summaries and by predischarge vaccination of only 7% (6 of 82) of those without previous pneumococcal vaccination. In conclusion, the rate of nosocomial pneumococcal bacteremia was high in a predominately elderly male population; it may be appropriate to consider a hospital‐based vaccine program in similar po

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06353.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Available strategies to increase influenza vaccination rates in the elderly have not been tested in the private sector where most elderly receive care. We performed a randomized controlled trial of a postcard reminder in three private general internal medicine practices. The observed vaccination rates of 55% in experimental patients (N = 262) and 54% in control patients (N = 278) were similar, though much higher than estimated national rates of 20%. The data indicated that the baseline (control group) vaccination rate was high probably because study participants were exposed to many community vaccination cues, separate from the study cue. That vaccination rates were not higher after additional exposure to the study cue suggests that a “ceiling effect” occurred. Including 70 patients not randomized into the trial because they received flu shots prior to randomization, the vaccination rate in patients who had a clinic visit during autumn months was 75% compared to a rate of 52% in patients not visiting the clinic (P<.0001).Our results suggest that vaccination rates can be considerably higher in the private sector than those reported in the past, and that both vaccination cues and direct patient contact appear important to promote vaccination. This and other studies suggest that traditional cues may have a ceiling effect, yielding vaccination rates no higher than 55 to 65%; further increases in rates will require other approac

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06354.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The purpose of this study is to determine the accuracy of predictions in identifying older persons who subsequently require long‐term care such as home services or institutionalization. Eighty‐six individuals undergoing geriatric evaluation between May 1983 and April 1984 were evaluated using a series of commonplace tasks such as opening doors, stacking checkers, and copying a simple sentence. Predictions of an individual's use of long‐term care services were made during the initial evaluation and were based on whether the person could complete all the manual tasks and on the amount of time required to do so. Outcomes were determined by telephone interviews by a trained social worker in Dec 1984.A statistically significant association (P<0.005) was observed between the predictions and actual outcomes. Analysis of variance confirmed that the mean times for each outcome were different (F = 2.6, P<0.05).The results suggest that timing manual performance offers a useful way to prospectively identify older persons at risk of requiring additional long‐term care s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06355.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The sleep/wake patterns of 16 institutionalized demented women were visually monitored hourly for 14 consecutive days. Individual mean total sleep time varied markedly from 5.0 to 12.1 hours per 24 hours. Unexpectedly, amounts of day sleep and night sleep correlated positively, suggesting a general sleep tendency manifested throughout the 24‐hour day. Consistent individual sleep patterns and high inter‐day correlations were found. A high degree of individuality in the sleep/wake patterns was also found, contrary to expectations that elderly obtain less sleep than others. Night sleep in the institutionalized elderly was not lessened by daytime sleep. Visual monitoring of sleep/wake patterns generated reliable d

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06356.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen from their special competencies and with regard for appropriate balance.This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06357.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb06358.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY