摘要:

OBJECTIVE: To determine the effects of stopping and restarting two types of exercise programs in older adults.DESIGN: A controlled, longitudinal study that utilized random assignment of volunteers. Treatments were exercise programs designed to improve cardiovascular or neuromuscular fitness.MEASUREMENTS: Dependent variables measured before and after implementation of treatments were: maximum oxygen consumption, oxygen pulse, treadmill and cycle training workloads, quadriceps isokinetic peak torque, quadriceps isokinetic total work, and quadriceps training workload.MAIN RESULTS: Exercise training was highly effective in improving cardiovascular endurance or muscular strength. Ten weeks of exercise detraining resulted in small losses in newly gained cardiovascular capacity but more noticeable losses in muscular strength. Exercise retraining was accomplished easily using cardiovascular or resistive exercises. The functional benefits of restarting a cardiovascular exercise program appeared additive despite a 10‐week intervening period of exercise detraining. In this age group, cardiovascular exercise produced limited improvements in muscular strength, and resistive exercise training positively influenced cardiovascular exercise performance.CONCLUSIONS: Older adults are fairly resilient to 10 weeks of cardiovascular detraining and retain newly gained muscular strength for at least 5 weeks, despite an interruption of formal exercise. An occasional missed exercise session or temporary cessation of habitual exercise should not be a cause for distress in exercising older adults. Instead, they should realize the ease with which they may restart their exercise program and also appreciate the generalizable fitness benefits that can be ascribed to becoming more active.J Am Geriatr Soc 43: 209–215, 1

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07324.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To determine whether older age is associated with a decrease in self‐reported depressive symptoms, independent of examiner‐rated symptoms, in inpatients with major depression.DESIGN: Survey study.SETTING: Inpatient psychiatric units at a university medical center.PATIENTS: Eligible subjects were those over 20 years of age with a primary diagnosis of DSM‐III‐R major depression. Participation was sought from all subjects over 60 years of age and from every second or every third younger subject, depending on rater availability. Of 137 eligible subjects, 97 completed all study measures.MEASUREMENTS: The Beck Depression Inventory (BDI), as a measure of self‐reported depressive symptoms, was the dependent variable. The Hamilton Rating Scale for Depression (Ham‐D) was used to assess examiner‐rated symptoms.MAIN RESULTS: Older age (P= .03) was associated negatively and examiner‐rated depressive symptoms (P= .0001) were associated positively with BDI score. Other variables, including gender, education, age of depression onset, and medical illness burden, were not independently associated with BDI. Examination of depressive symptom subtotals (psychologic/affective vs. somatic/neurovegetative) revealed that only the self‐reported psychologic/affective subtotal was significantly associated with age (P= .0018).CONCLUSIONS: Some older patients with clinically significant depression underreport their symptoms. When asking older patients about depressive symptoms, clinicians should view negative responses only within larger clinical contexts and should obtain information from other sources as needed. Similar concerns must temper interpretation of research that relies on subject self‐report to study depression in late life.J Am Geriatr So

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07325.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES: To compare hospital utilization, health status, and sociodemographic characteristics of older persons with and without hypertension and to examine the nature of the association of hypertension with medical care utilization.DESIGN: A retrospective, nonexperimental study.SETTING: A large health maintenance organization (HMO), located in the Portland, Oregon and Vancouver, Washington areas, that provides comprehensive, prepaid benefits to its members.PARTICIPANTS: Approximately 4200 older (≥65 years) members enrolled in the Social HMO Demonstration Project.MEASUREMENTS: The dependent variables were (1) whether a member was hospitalized (0 = no; 1 = yes) and (2) the number of hospitalizations during the 12‐month period before the return of the Health Status Form, a mail questionnaire. The predictor variables were high blood pressure and other medical conditions, health status, and sociodemographic characteristics. Patients classified as hypertensive were those who self‐reported high blood pressure and who received two or more dispensings for antihypertensive medications.RESULTS: Older hypertensives were more likely than older nonhypertensives to have been hospitalized (odds ratio (OR) = 1.14 (95% CI 1.01,1.27)), self‐report their health as only good or fair (P<.001), self‐report IADL functional limitations (P<.001), and to be younger than nonhypertensives (P<.001). Utilization differences were similar after controlling for patients' age and gender. Factors independently associated with an increased likelihood of hospitalization were: male gender (OR = 1.14 (1.00,1.31)), age (OR = 1.35 (1.00,1.81)), poor (OR = 1.32 (1.02,1.72)) or fair (OR = 1.20 (1.01,1.44)) self‐rated health status, functional limitations in activities of daily living (OR = 1.74 (1.48,2.03), and self‐reported heart trouble (OR = 1.50 (1.34,1.68)), stroke (OR = 1.37 (1.15,1.64)), or cancer (OR = 2.89 (1.72,4.84)). Factors independently associated with a decreased likelihood of hospitalization were excellent self‐reported health (OR = 0.65 (0.47,0.90)), no physical impairments (OR = 0.59 (0.48,0.72)), and no circulation problems (OR = 0.85 (0.74,0.98)).CONCLUSIONS: Older hypertensive patients had poorer self‐reported health, more functional limitations, used more hospital services, and were not as old as nonhypertensive older patients. To the extent that general health is improved by treatment of hypertension, appropriate treatment of high blood pressure may not only improve health, it may also reduce medical care utilization. Our findings offer further support for hypertension prevention, detection, and treatment programs designed to reduce or minimize hypertension's later medical complications and to reduce future utilization.J Am Geriatr Soc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07326.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Predicting Bacteremia in Older PatientsOBJECTIVE: To evaluate potential clinical predictors of bacteremia in hospitalized geriatric patients and to propose an individual risk score as an alternative to “subjective” clinical judgment for a more efficient approach in early recognition and treatment of bacteremia.DESIGN: A 16‐month prospective study.SETTING: The University Geriatric Hospital of Geneva, Switzerland.PATIENTS: Four hundred thirty‐eight patients aged 62 years or older in whom 558 episodes of bacteremia were suspected.MEASUREMENTS: The unit of evaluation was the blood culture episode, which was defined as a 48‐hour period beginning with the drawing of the first blood for culture. An extensive precoded protocol, including clinical and biological data, was completed by the resident who requested the blood cultures. For each episode, the resident also provided a subjective assessment of the probability of bacteremia. Odds ratios and their variances were used to estimate the relative risks of potential predictors of bacteremia. The performance of a predictive clinical model based on risk score threshold was evaluated by means of a receiver‐operating characteristic analysis.RESULTS: Of the 558 potentially bacteremic episodes investigated, 46 (8.2%) yielded positive blood cultures. The bacteremia rate was strongly associated with the type of episode: it reached 15.6% among the community‐acquired (CA) episodes (those occurring within 48 hours of hospital admission) and 6.0% only among the hospital‐acquired (HA) episodes (those occurring after the first two days of hospitalization). Predictors of bacteremia with highest relative risks included: bladder catheter removal, fever (≥38.5°C), rigors, shock, total band count ≥ 1500/mm3, and lymphocyte count ≤ 1000/mm3. When assessed by episode type, it appeared that bladder catheter removal and rigors were good predictors of bacteremia in HA episodes only, whereas fever (≥38.5°C) had a good predictive value in CA episodes only. The performance of the clinical model was two times better than the physician's subjective ability to predict bacteremia when the threshold of the risk score was fixed at two or more predictors per episode.CONCLUSIONS: These findings provide means to identify older hospitalized patients at high risk of bacteremia. Although the proposed predictive model will need further validation and more precise evaluation of the potential benefits, it may nevertheless be of some help in early recognition and treatment of bacteremia.J Am Geri

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07327.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Elevated Plasma Levels of Interleukin‐6 in Postmenopausal Women Do Not Correlate with Bone DensityOBJECTIVE: To determine if plasma levels of Interleukin‐6 (IL‐6) across the lifespan correlate with bone density or plasma osteocalcin.DESIGN: Cross‐sectional study.PARTICIPANTS: Forty‐five healthy community‐dwelling volunteers aged 25–74 years. Exclusion criteria were smoking, use of medications known to affect bone metabolism (corticosteroids, heparin, thyroxine, thiazides, and anticonvulsants), and presence of chronic inflammatory disease.MEASUREMENTS: Bone density was measured by dual‐energy X‐ray absorptiometry at the femoral neck and lumbar spine. Plasma levels of IL‐6 and osteocalcin were determined by ELISA and RIA, respectively.RESULTS: Plasma levels of IL‐6 increased with advancing age (P<.0001) and correlated with postmenopausal status (P<.0001). No correlation was observed between plasma IL‐6 level and bone mineral density at either the lumbar spine or femoral neck, and none was observed with plasma osteocalcin.CONCLUSIONS: The elevation of plasma IL‐6 observed following menopause is consistent with the proposed importance of estrogen in the regulation of IL‐6. These findings do not provide support for a role of IL‐6 in determination of peak bone density or subsequent development of osteoporosis. However, it is possible that plasma levels of IL‐6 differ from those in the bone microenvironment.J A

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07328.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Predictors of Hospital Mortality in Older Patients with Subdural HematomaOBJECTIVE: To identify presenting characteristics of older patients with subdural hematoma who are unlikely to survive hospitalization.DESIGN: A retrospective cohort.PATIENTS: All patients ≥ 65 years of age hospitalized at a tertiary care center from 1985–1990 with the primary diagnosis of subdural hematoma.MEASUREMENTS: Chart review was performed to characterize presenting clinical characteristics, hospital course, and outcome at the time of hospital discharge.MAIN RESULTS: Of the 157 eligible patients, 42% (66/157) were ≥80 years of age. Although 30% of patients had no recorded trauma, 54% experienced a fall before hospitalization. Twenty‐six percent (47/157) of patients had been on antithrombotic therapy (14 on coumadin, two on heparin, 31 on antiplatelet agents, one on both coumadin and an antiplatelet agent). Sixty percent of patients had no focal neurologic findings, and the mean Glasgow Coma Score was 12.3 (±3.6). The hematoma was considered chronic in 49% (77/157) of cases, based on time from antecedent trauma or on neuroimaging criteria. Midline shift by neuroimaging was present in 69%.Overall hospital mortality was 31% (48/157). Using logistic regression to control for other factors, level of consciousness (Glasgow Coma Score ≤7) (OR = 10.4), age ≥ 80 (OR = 3.7), duration of hematoma considered acute (OR = 2.7), and craniotomy (OR = 2.6) were significantly associated with hospital mortality. Presence of focal symptoms, previous antithrombotic medication use, nature of trauma, comorbidity score, and presence of midline shift were not associated with hospital mortality.CONCLUSIONS: Among older patients with subdural hematoma, level of consciousness, extreme old age, duration of the hematoma, and nature of the intervention were significantly associated with hospital mortality. These factors should help physicians in clinical decision making and formulation of advance directives for geriatric patients with subdural hematoma.J Am Geriatr Soc 43: 2

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07329.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Effectiveness of Oral Antibiotic Treatment in Nursing Home‐Acquired PneumoniaOBJECTIVE: To determine factors associated with success or failure of oral antibiotic treatment for nursing home‐acquired pneumonia (NHAP).DESIGN: Retrospective study of outcomes for all identifiable NHAP cases in 1991.SETTING: The Nursing Home Services Program of St. Paul Ramsey Medical Center and 31 metropolitan St. Paul, Minnesota, community nursing homes.PARTICIPANTS: Nursing home (NH) cohort: 124 patients (mean age 85.2 years) with a new respiratory symptom and new infiltrate on portable chest X‐ray for whom oral antibiotics were prescribed. Hospital cohort: 74 NH patients (mean age 84.3 years) admitted to hospital with new X‐ray infiltrate and pneumonia diagnosis. Supportive care status patients were excluded. Forty‐three physician/nurse practitioner (MD/NP) teams were represented.MEASUREMENTS: Nursing home cohort: Outcomes of hospitalization within 14 days or 30‐day mortality. A discriminant model was applied to predict outcome and discriminant rule performance was analyzed. Hospital cohort: 30‐day mortality.RESULTS: Of 198 episodes of NH pneumonia, 63% were treated in the facility; 30.6% (38) failed NH treatment. Thirty‐day mortality was 13%. There was no examination by the MD or NP for 59% of NH‐treated episodes. The hospital cohort had a higher mean pulse (P30/min, feeding dependence, and mechanically altered diets. A discriminant model using these factors was significant (P= .002). The NH treatment failure rate was 11% for no factors present, 23% for two or fewer factors, and 59.5% for three or more (likelihood ratio 3.1). Thirty‐two percent of the hospital cohort had zero or one factor present and were alive at 30 days.CONCLUSION: The majority of NHAP episodes were treated successfully with oral antibiotics, but 31% failed treatment in the NH. Patients with a mechanically altered diet or requiring feeding assistance by staff had significantly higher failure rates. Feeding dependence and need for a mechanically altered diet as well as abnormal vital signs are associated with oral antibiotic treatment failure. These factors should be considered in treatment decisions for NHAP.J Am Geriatr S

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07330.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Life Satisfaction and Associated Factors in Older Hong Kong ChineseOBJECTIVE: To determine life satisfaction and its association with physical, functional, socioeconomic, psychological, and social support characteristics in Hong Kong Chinese aged 70 years and older.DESIGN: Cross‐sectional study.SETTING: Territory‐wide random sample of persons aged 70 years and older.SUBJECTS: A total of 843 men and 714 women were selected by random sampling, stratified by age and sex, from the Old age and Disability Allowance Register, after exclusion of subjects with cognitive impairment.MEASUREMENTS: Life satisfaction was assessed by the subjects' response to the question “Are you satisfied with life”, using a 0 to 10‐point linear scale. They were also asked to name the most important factor contributing to life satisfaction. Information was also obtained regarding physical health, functional ability, depressive symptoms, and socioeconomic factors.RESULTS: There was a weak association between score and age. Health, adequate income to meet living expenses, and caring relatives were rated the most important factors (>65%). Some of these factors were also those associated with a high life satisfaction score. Factors associated with a life satisfaction score greater than 6 points were higher social class and educational attainment, adequate income to meet living expenses, satisfactory living arrangement, Christianity, good social support, participation in social activities, functional independence, good self‐perceived health, good hearing and vision, daily exercise, absence of recurrent falls, and low depressive symptom score. Multiple logistic regression identified having two or more relatives and tertiary education as positive associated factors, whereas inadequate income to meet expenses, dissatisfaction with living arrangement, non‐participation in religious group activities, and a high depressive symptom score were negative associated factors.CONCLUSION: In older Chinese, social factors such as the support provided by family members, as well as adequate income to meet living expenses, play a role equal to that of physical factors in contributing to life satisfaction.J Am Geriatr Soc 43:

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07331.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Clinical Spectrum of Tuberculosis in Older PatientsOBJECTIVE: To investigate the clinical differences between old and young patients infected withMycobacterium tuberculosisin a developing country.DESIGN: Retrospective chart and chest radiograph review.SETTING: A university‐affiliated teaching hospital.PATIENTS: The medical records of patients with documented tuberculosis (TB) from January 1990 through December 1991 were analyzed. Clinical assessment included sex, age, diagnosis at first visit, past history, symptoms and signs, laboratory data, X‐ray findings, bacteriological examinations, outcome, time elapsed from first visit to initiation of anti‐TB therapy and the major determinants for starting anti‐TB therapy. Statistical significances were analyzed by Student'sttest and χ2tests.RESULTS: Among 205 patients with culture‐proven TB, 57 were 65 years of age and older (range, 65 to 91; mean, 73) and 148 under 65 years of age (range, 16 to 64; mean, 41). There was a higher incidence of previous TB (26.3% vs. 16.2%) and diabetes mellitus (24.5% vs. 14.3%) in the elderly patients. Initial diagnosis of TB at first visit was less frequent in the elderly than in the young group (38.6% vs. 47.3%), although symptoms and signs at first visit were similar in each of the age groups. Radiographic presentation with mass lesions was more frequently encountered in elderly patients (10.5% vs. 2.1%,P<.05). Elapsed time from the first visit to suspicion of TB and the initiation of anti‐TB therapy was frequently delayed in elderly patients (22 ± 23 vs. 13 ± 20 days,P<.05). The incidence of drug‐resistance (39% vs. 16%,P<.05) and unfavorable response to anti‐TB therapy (17.5% vs. 3.4%,P<.05) were significantly higher in the older patients.CONCLUSIONS: Although clinical presentation of TB in the elderly did not differ significantly from that in younger patients, this study showed that diagnosis and treatment were more often delayed in the elderly, and there was a higher incidence of treatment failure.J Am Geriatr Soc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07332.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Effect of Psyllium on Absorption of Co‐ingested CalciumOBJECTIVE: To determine whether psyllium fiber (in the form of Metamucil®) interferes with absorption of calcium ingested at the same meal.DESIGN: Three‐way, randomized, cross‐over study in 15 healthy postmenopausal women, with calcium‐fortified orange juice as the calcium source in all three meals. The test load of calcium was 219 mg (∼5.5 mmol). One test meal contained Metamucil, providing 3.4 g psyllium fiber; one had an equivalent amount of neutral cellulose; the third had no added fiber.METHODS: The calcium‐fortified orange juice was extrinsically labeled with45Ca; calcium absorption fraction was calculated from the specific radioactivity of serum calcium at 5 hours after tracer ingestion.RESULTS: Fractional absorption of calcium from orange juice without added fiber averaged 0.341 ± 0.059; in the presence of psyllium fiber, 0.317 ± 0.067; and in the presence of neutral fiber, 0.354 ± 0.083. While the absorption with cellulose was slightly higher than in the absence of fiber, and the absorption with psyllium was slightly lower, neither difference was statistically significant. However, the difference between added psyllium and cellulose was statistically significant (P<.05).CONCLUSION: Psyllium in the form of Metamucil makes little practical difference to availability of co‐ingested calcium when ingested at typical therapeutic doses.J Am Geriatr Soc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07333.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY