摘要:

Prevalence of reported symptoms was studied in 1927 women and 1140 men over 65 years of age in an ambulatory health screening program. Reports of 28 common symptoms were obtained from a standardized questionnaire completed by participants at the time of their fourth annual visit to the program. A comparison was made of the prevalence of specific symptoms by sex, age, disease states, and drug use patterns. The most common symptoms reported by women were nocturia (80.4%), swollen feet or ankles (30.5%), cold feet and/or legs (28.6%), and irregular heartbeat (23.2%), whereas men complained most often of nocturia (79.8%), irregular heartbeat (24.8%), cold feet and/or legs (23.6%), and tinnitus (23.1%). Women reported a mean of 3.99 symptoms compared with 3.22 reported by men (P<.0001). In women there was a statistically significant association for most symptoms in subjects reporting the use of medication compared with a group who did not use medication. In men the use of medication was less highly correlated with reports of symptoms. Nearly 100% of participants reported having at least one disease state. The number of symptoms reported was strongly related to the number of disease states, and after adjusting for diseases, women reported more symptoms than men. The best predictor of symptom prevalence was the number of disease states followed by the number of drugs used and then age.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04315.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty‐four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1 % reported receiving mental health treatment by a specialist. Self‐reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic dise

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04316.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

This study examined the instrumental and social‐emotional support provided by families to the primary caregivers of Alzheimer's patients. It was anticipated that the more adequate the support provided by the family, the less sense of burden and the better the coping effectiveness of the caregiver. Ratings of instrumental assistance, social‐emotional support, adequacy of support, and coping effectiveness were made by trained raters from transcribed interviews with 23 primary caregivers. Also, a second family member who was usually next closest of kin to the caregiver was interviewed in order to provide another perspective of the support the family provi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04317.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Cerebral blood flow (CBF) was measured by the133Xe inhalation method in patients with multi‐infarct dementia (MID,N= 26), Alzheimer's dementia (AD,N= 19), and among age‐matched, neurologically normal, healthy volunteers (N= 26). Cognitive performance was assessed in all subjects using the Cognitive Capacity Screening Examination (CCSE). Cerebral vasomotor responses were calculated from differences in values of mean hemispheric gray matter blood flow (ΔCBF) measured during inhalation of 100% oxygen (hyperoxia) compared with CBF measured while breathing room air. Significant correlations were found between CCSE performance and vasomotor responsiveness in patients with MID (P<.01), but not in patients with AD or in neurologically normal volunteers. Loss of vasomotor responsiveness is an indicator of cerebrovascular disease with rigidity and/or loss of reactivity of cerebral vessels, which impairs cerebrovascular responses to situational demands and predisposes to cerebral ischemia. Loss of cerebral vasomotor responsiveness among MID patients, which is a biologic marker of cerebrovascular disease, provides confirmatory evidence of the vascular etiology of MID and assists in separating MID from AD pati

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04318.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

America's population is aging, and there is a direct relationship between advancing age and sensitivity to adverse drug reactions (ADRs). The number of the old old, those 85 years and older, will increase by 114% by the year 2000, and by another 44% in the subsequent 20 years.1The largest absolute and relative increases are seen and will continue to be seen for unmarried women older than 85 years (women are more sensitive to ADRs than are men). Importantly, the population 95 years of age and older has increased by about twice the rate of the aggregate population 85 years and older. Activity limitations among community‐living elderly rise precipitously with age, afflicting about 12% of those 65 to 74 years old but almost 46% of those 85 years and older.2It has been estimated that approximately 4.6 million community‐living elderly are limited in activities of daily living (ADLs) or instrumental activities of daily living (IADLs, cognitive impairment),3and that number may double, triple, or even quadruple in the next 50 ye

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04319.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo‐controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long‐term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial. J Am Geriatr Soc 34:368–376

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04320.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The elderly constitute the fastest growing segment of the population and, as such, pose significant and unique health care problems. Aging is characterized by a decline in the organism's ability to respond or to adapt to a variety of environmental stresses. An example of this reduced “adaptive responsiveness” can be found in the immune system which undergoes a marked and well‐documented decline during aging.1Perhaps as a result of this deficiency, the incidence of infectious diseases and the associated morbidity and mortality increase significantly in the elderly.2–4Furthermore, the greater frequency of chronic diseases in the elderly predisposes them to complications resulting from inf

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04321.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Zinc deficiency during long‐term total parenteral nutrition has been well reported in the literature. However, there is limited information available on zinc deficiency occurring during total enteral nutrition. Two cases of clinical zinc deficiency in patients on long‐term enteral feedings are presented. Nutritional assessment of these two patients on admission revealed hypoalbuminemic malnutrition. Nutritional support in the form of nasogastric tube feedings were initiated in both patients due to altered mental status. The formula used was Ensure (Ross Labs, Columbus, OH), which provided greater than 150% of the RDA for zinc. However, four months and seven months after initiation of adequate nutritional support, both patients developed skin rashes around the groin and under the breasts and axilla. Serum zinc levels were depressed in both patients, to 42 and 54 mg/dL, respectively (normal for the authors' laboratory, 66 to 120 mg/dL). Supplementation with zinc sulfate 220 mg per day via nasogastric tube resulted in disappearance of the rash with return of serum zinc to normal levels. The authors suggest close observation of patients on long‐term enteral nutrition for clinical manifestation of zinc deficiency, especially an unexplained skin rash. Further studies are needed to establish minimum daily zinc requirements in patients on long‐term enteral feedings. J Am Geriatr Soc 34:385

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04322.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The in‐hospital mortality associated with acute myocardial infarction rises markedly with advancing age. It is not established whether the elderly may benefit from early surgical repair of postinfarction cardiogenic shock due to ventricular septal defect (VSD), acute severe mitral regurgitation (MR), or left ventricular power failure. Eighteen consecutive patients between the ages of 66 and 79 (mean, 72 years) and in cardiogenic shock underwent surgical repair, most with counterpulsation support, within one week of developing VSD, MR, or left ventricular power failure. Of ten patients with VSD, five (50%) survived. Three of seven patients with MR (43%) and the only patient with power failure survived for an overall survival of 50%. The nine long‐term survivors were followed up for six months to five years (mean 31 months) by personal interviews with the patient or referring physician. There was one late death, due to congestive heart failure, ten months after the operation. Of the remaining eight patients, seven are categorized as New York Heart Association class 1, and one as class II. These patients have all been able to live and function independently after cardiac operation. The authors conclude that older patients with postinfarction cardiogenic shock may benefit from early operation and that advanced age does not preclude successful surgical outcome. Furthermore, operation may result in excellent long‐term quality of life. J. Am Geriatr Soc 34:389–3

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04323.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Recent studies on laboratory rodents demonstrate that steroid hormones can cause irreversible damage and dysfunction on select target cells in the adult brain. During the past 20 years, a careful distinction was proposed between the short‐ and long‐term effects of hormones on the rodent brain. The permanent (organizing) actions of sex steroids on the brain were considered restricted to development and completed by puberty. Thereafter, sex steroids continue to have crucial roles in reproductive physiology and behavior, but the effects were widely considered to be short‐term, lasting weeks or a few months at most. However, a number of researchers have clearly shown that sustained high physiologic levels of steroids have long lasting effects on the adult rodent brain. A portentious example is that prolonged stress with elevated corticosteroids kills specific neurons in the hippocampus if maintained for three months in young rats.1These same neurons are also commonly lost during aging in rodents and humans. Similar steroid‐dependent mechanisms may be involved in the neuroendocrine changes in aging female rodents that include lactotrophic pituitary tumors and impaired control of prolactin and luteinizing hormone. These same changes are greatly reduced during aging by ovariectomy of rodents when young and, moreover, can be prematurely induced in the young by extended treatments with estrogens.2The concept that endogenous steroids interact with aging processes is also supported by considerable data showing that hypophysectomy retards many aspects of aging in peripheral cells of r

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb04324.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY