摘要:

Objective:To determine the relationship of age and the percentage of patients presenting to the emergency department with myocardial infarction who meet conventional electrocardiographic and time‐to‐presentation criteria for thrombolytic therapy.Design:Prospective cohort study.Setting:Emergency departments of three university hospitals and four community hospitals.Patients:Patients enrolled in the Multicenter Chest Pain Study, an investigation of patients aged 30 years or older presenting to the emergency department with the chief complaint of anterior, precordial, or left lateral chest pain unexplained by obvious local trauma or abnormalities on the chest radiograph.Interventions:None.Measurements:The frequency of patients who presented with conventional electrocardiographic and time‐to‐presentation criteria for thrombolysis.Main Results:Of a total of 12,140 patients who were enrolled in the Multicenter Chest Pain Study, 10,850 had information about their electrocardiogram and their time‐to‐presentation. Acute myocardial infarction occurred in 1,584 patients, 746 of whom were over age 65. Among patients presenting to the emergency department with acute myocardial infarction, the proportion who arrived within 6 hours of the onset of painandhad ST‐segment elevation or pathologic Q‐waves not known to be old decreased significantly with increasing age, from 34% in patients under 65 years to 18% for those 75 years and older. In addition, comorbidities that would have contraindicated thrombolytic therapy were present in an additional 12% of myocardial infarction patients who were older than 65 years.Conclusion:Although other analyses have shown that thrombolytic therapy is cost‐effective for eligible elderly patients with acute myocardial infarction, only a small percentage of very elderly patients who present to the emergency department with acute myocardial infarctions meet current eligibility criteria to receive it, so thrombolysis is unlikely to narrow the difference in mortality rates for young as compared with elderly patients with

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04938.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To determine whether there is a relationship between serum cobalamin levels, normal aging, and Alzheimer's Disease (AD).Design:Cross‐sectional survey.Setting:A district (Kungsholmen) in Stockholm, Sweden.Participants:Population‐based cohort of 545 subjects aged more than 74 years. The sample was selected on the basis of evidence of cognitive impairment from all inhabitants in an area of Stockholm (2368 individuals), both living at home or in institutions.Measurements:Serum cobalamin levels and diagnostic evaluation for a diagnosis of dementia and type of dementia.Results:The serum cobalamin levels in non‐demented individuals decreased 5.5 pmol/L with an increase of 1 year of age (regression coefficient = −5.53;P<0.0001). However, the regression coefficient was 0.21 (P= 0.91) in demented people and 2.57 (P= 0.32) in AD subjects. There was no difference between serum cobalamin levels in demented, AD, and non‐demented subjects, except for the oldest ages where demented people and AD sufferers showed higher values. AD patients still living in their own homes had significantly lower cobalamin concentrations compared with institutionalized AD sufferers. The prevalence rate of cobalamin deficiency was 15.5% (95% CI = 11.5–19.5) in normal aging and 18.1% (95% CI = 10.3–25.9) in AD.Conclusions:These data suggest that serum cobalamin levels decrease in normal aging, but not in dementia or AD. A lower cobalamin concentration observed in AD sufferers still living in their own homes compared with institutionalized persons with AD seemed to be related to but not fully explained by eating habits. Patients with AD living in their own homes are at risk of developing cobalamin deficiency, and monitoring of serum cobalamin concentrations might be useful

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04939.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To compare the clinical characteristics and survival of elderly and younger hospitalized patients who sustain cardiac arrest and receive cardiopulmonary resuscitation (CPR) in the 1990's and to assess predictors of survival.Design:Retrospective survey of cardiac arrest database and hospital charts, plus telephone follow‐up.Setting:450‐bed acute care teaching hospital.Study Population:Seventy‐eight hospitalized patients 70 years or older and 73 hospitalized patients under 70 years of age.Measurements:Survey of cardiac arrest data base, hospital charts, and telephonic follow‐up to allow (1) comparison of clinical characteristics, survival, and long‐term follow‐up between two age groups and (2) univariate and multivariate analysis of predictors of mortality.Main Results:Pre‐arrest clinical characteristics were not significantly different between the age groups. Prior to arrest the majority of patients were functionally active, and over one‐third were hospitalized for acute coronary artery syndromes. In approximately 85% of the patients, the arrest was witnessed, and 70% of the patients had their cardiac rhythm monitored at onset of the arrest. Survival was not significantly different between the age groups; 26% of the total 151 patients were discharged. No significant difference was noted in pre‐post arrest functional status of survivors. Survival at 1, 2, and 3 years in elderly and younger survivors was 86% versus 80%, 76% versus 67%, and 71% versus 61%, respectively. Multivariate analysis identified the presence of coronary artery disease, admission systolic blood pressure, and functional level to be independent pre‐arrest predictors of mortality. At the time of the arrest, the initial cardiac rhythm and duration of CPR were found to be independent predictors of mortality.Conclusions:Elderly patients hospitalized in the 1990's who receive CPR have outcomes similar to younger patients who receive CPR. The favorable outcome in the elderly patients may reflect patient selection: the majority of our patients were functionally active prior to hospitalization, without multiple serious illnesses; many were hospitalized for acute coronary artery syndromes; and, in most cases, the arrest was witnessed with the patient's cardiac rhythm monitored at

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04940.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To assess whether control of diabetes mellitus is as important in the elderly as in young and middle‐aged diabetic patients in terms of progression of retinopathy.Design:A 5‐year longitudinal cohort study.Setting:Outpatient diabetic clinic.Patients:One hundred fourteen non‐insulin‐dependent diabetic patients (30 males, 84 females) ≥ 60 years of age.Measurements:Retinopathy was checked at the beginning and end of the follow‐up period. During the 5‐year follow‐up period, demographic variables, body mass index, HbA***1c, blood pressure, and plasma lipids were monitored. Retinopathy was classified as follows: grade 0, no lesion; grade 1, non‐proliferative retinopathy; grade 2, pre‐proliferative retinopathy; grade 3, proliferative retinopathy. Progression of retinopathy during the 5‐year follow‐up was defined as an increase in its grade.Results:At the start of the study, 13% of the patients already had retinopathy, all of grade 1. The 5‐year follow‐up study showed that progression of retinopathy was 23.6% in all cases, 22.2% in those with grade 0 initially, and 33.3% in those with grade 1 initially. The progression rates of retinopathy as a function of the mean HbA***1c during the follow‐up were as follows: lower than 7%, 2%; 7–8%, 20%; 8–9%, 40%; more than 9%, 61%. Multiple logistic regression analysis showed that, of the parameters examined, only HbA***1c was a significant risk factor for progression of retinopathy.Conclusions:Control of diabetes mellitus is the most important factor associated with prevention of progression o

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04941.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objectives:To assess the prevalence of typical clinical features and need for treatment of small intestinal bacterial overgrowth (SIBO) in the elderly.Design:Random selection of patients, regardless of their nutritional status.Setting:Acute admissions ward in the Dept. of Medicine for the Elderly.Patients:Thirty elderly patients between 68 and 90 years of age.Measurements:Active clinical problems, including the presence of recent weight loss and diarrhea, were recorded. Routine blood tests, including serum vitamin B12, red cell folate, albumin and calcium, and qualitative small bowel bacteriology results, were analyzed. The effect of age on all variables was studied.Results:Twenty of the 30 small bowel aspirates had proven SIBO, and strict anaerobes were isolated in 15. The mean blood test values did not differ significantly between culture‐positive and culture‐negative patients. There was no significant correlation between those variables and the total bacterial counts. Of the 20 proven SIBO cases, eight had anemia, five had hypoalbuminemia, five had diarrhea, four complained of recent weight loss, and none had B12deficiency. Alternative causes other than SIBO were identified for many of these abnormalities. Advancing age correlated significantly with rising counts of small bowel strict anaerobes.Conclusions:These data suggest that age may be a predisposing factor in the development of anaerobic overgrowth but that SIBO is a benign entity in the elderly. Contrary to previous recommendations, treatment of this condition is not routinely indica

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04942.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To establish the tolerance of breast irradiation by women aged 65 and older.Design:Retrospective chart review.Patients and Setting:Women undergoing partial mastectomy and postoperative radiation therapy at the H. Lee Moffitt Cancer Center and Research Institute between 1986 and 1990. Of 163 women eligible for the study, 100 were under age 65, and 63 were aged 65–78.Measurements:Comparison of total treatment dose, treatment duration, number of treatment interruptions, incidence of cutaneous, mucosal, and hematological toxicity between women aged 65 and older and women younger than age 65.Main Results:All study measurements were comparable among younger and older women: total radiation dose (P= 0.5); treatment interruptions (P= 0.063); treatment duration (P= 0.78); cutaneous toxicity (P= 0.37); anemia (P= 0.83); leukopenia (P= 0.07), and thrombocytopenia (P= 0.94). There was no mucosal toxicity, nor higher than grade 2 hematological or cutaneous toxicity. The incidence and severity of toxicity was not higher for women aged 70 and older.Conclusions:Postoperative breast irradiation is well tolerated by older women. Age is not a contraindication to breast preservatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04943.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To examine the predictive power of self‐rated health, activities of daily living (ADL), and ambulatory activity for different causes of death in a representative sample of older persons.Design:Three‐year prospective cohort study.Setting:Sendai City, Japan.Participants:2,552 persons 65 years and older at baseline in 1988.Measurements:Independent variables (measured by self‐report of participants) were age, sex, self‐rated health, ADL, ambulatory activity level, and use of medical care. Dependent variables were mortalities from cancer, stroke, and heart disease.Main Results:Self‐rated health significantly predicted cancer mortality but not the other two causes of mortality. ADL disability was a significant predictor for stroke mortality, and limitation in ambulatory activity significantly increased the risk of heart disease mortality. The associations between ADL and stroke mortality as well as between ambulatory activity and heart disease mortality remained significant even after excluding those who reported having the index disease in 1988.Conclusion:The predictive powers of self‐rated health, ADL function, and ambulatory activity varied significantly with the underlying causes of death among

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04944.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To validate the use of knee‐height‐to‐stature formulas established on Caucasian subjects to estimate height of Japanese‐Americans, ages 60 to 90 years.Design:Survey by measurement of a convenience sample.Subjects:Japanese‐American men and women patients, aged 60 years or older, at The Queen's Medical Center during March and April 1992.Measurements:Each subject's height (without shoes) was measured in inches by standard height scale and then converted to centimeters. Each subject's knee height was measured using the tool and procedure described by Chumlea et al (Journal of the American Geriatrics Society 1985; 33:116–120).Results:Statures of Japanese‐American men and women predicted by the regression models developed on the Hawaii sample were significantly different (P<0.0001) from the heights predicted by the Caucasian regression model developed by Chumlea and associates (1985).Conclusions:The statistical models specific to elderly Japanese Americans predicted more precise height approximation than models developed

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04945.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To assess the satisfaction of surrogate decisionmakers with the decision to place feeding tubes in elderly patients with impaired decision‐making capacity.Design:Inception cohort followed for 5 weeks.Setting:Four hospitals in the greater Los Angeles area.Participants:Fifty‐eight surrogate decision‐makers for elderly patients (over 60) who recently received a first‐time percutaneous endoscopic gastrostomy. Participants were identified through the endoscopy departments at the four hospitals.Measurements:We surveyed surrogates by telephone within 5 days of placement for background data and after 5 weeks of use to assess satisfaction with the decision. The main outcome variables at follow‐up were: surrogate satisfaction; whether the surrogate would repeat the decision; whether the surrogate had considered removal of the tube; and surrogates' perception of patients preference for the tube.Results:After 5 weeks of use, 84% of surrogates stated that they would repeat the decision. Fifty‐nine percent of surrogates described themselves as satisfied with the decision, and 17% were dissatisfied. Only 10% had considered removing the tube. After 5 weeks of use, 36% of surrogates felt that the patient would prefer the tube, and 31% felt they would not.Conclusions:Most surrogates we studied would repeat the decision to have a feeding tube after experiencing its effects for 5 weeks. However, almost one‐third felt the patient would not want the tube. Physicians and surrogates may need to place greater emphasis on patients' wishes before placing feeding tubes and when reassessing their benefit to the patient after

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04946.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Purpose:To identify risk factors for the investigation of elder abuse, neglect, self‐neglect, exploitation, and abandonment in a population‐based observational cohort of community living elders.Study Population:Population‐based sample of 2,812 community‐living men and women in New Haven, Connecticut who were over age 65 in 1982.Methods:Matching process whereby cohort members who were investigated by Connecticut's State Ombudsman on Aging in 1985 or 1986 were identified.Analysis:Relative risks for ombudsman investigation in 1985 or 1986 were calculated based on risk factors status at baseline interview in 1982.Results:Sixty‐eight (2.4%) members of the cohort received investigation. Features at cohort entry significantly associated with investigation in multiple logistic regression included: requiring assistance with feeding (Adjusted OR 3.5, 95% CI 1.2, 11.7), being a minority elder (Adj. OR 2.3, 95% CI 1.4, 2.8), over age 75 at cohort inception (Adj. OR 1.9, 95% CI 1.1, 3.1), and having a poor social network as defined by a social network index (Adj. OR 1.7, 95% CI 1.0, 2.7). When stratified by race, requiring assistance with feeding was associated with ombudsman investigation in minority elders (Adj. OR 10.8, 95% CI 2.8, 40.5) but not non‐minority elders (Adj. OR 1.1, 95% CI 0.5, 7.5).Conclusion:Functional disability, minority status, older age, and poor social networks were associated with investigation for elder mistreatment in this prospective, community‐based population of men and women over

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb04947.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY