摘要:

Bladder records can play an important role in the assessment and treatment of incontinence. Many records currently used in long‐term care settings are difficult to read and interpret, and they do not provide for the recording of information that can be of value in the assessment and treatment process. Two versions of an incontinence monitoring record OMR), one using black and white symbols and the other using colored circles, were developed and tested in a quasiexperimental design in three proprietary nonacademically affiliated nursing homes. The IMRs were well accepted by the nursing staff in these homes. Recordings were made more frequently and interrater reliability was highest with the color version of the IMR. Results of this initial study are promising and suggest that the IMR, or a similarly designed record, will be helpful in nursing homes to assess the bladder and bowel status of new admissions, determine patterns of and factors associated with incontinence, design individualized bladder training programs, and monitor the results of these programs and other treatment modalities. In addition, the IMR can provide an opportunity for nurses' aides to meaningfully participate in the assessment and treatment of a condition they manage on a daily basi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05473.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The authors compared the demographic and clinical characteristics and treatment recommendations for elderly (greater than or equal to 60 years) and younger patients (17 to 59 years) seen for an emergency psychiatric consultation in a teaching general hospital. Findings revealed 11 distinctive characteristics that differentiated elderly from younger patients. Most notably, the elderly experienced their chief complaint for a longer time before referral to the emergency room by their primary care physician and had higher prevalence of affective disorders and psychologic factors affecting physical condition. Some of the implications of these results are discussed with the view to planning psychiatric services for the elderly and education programs.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05474.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

A prevalence survey was performed at a Veterans Administration nursing home care unit to detect the frequency, demographics, features, and potential risk factors associated with infections, compare different methods for calculating infection rates, and compare prevalence data with routine physician reporting of infections during a one‐month period. In 176 evaluable residents, 22 nursing home‐acquired infections were detected, with rates of 12.5% by infections per residents at risk, and 4.6% by infections per 1000 resident‐days. Fifty percent of these infections (11 of 22) involved the urinary tract, seven of which were associated with indwelling catheters. Factors potentially associated with increased overall infection rates included immobility(P<.02),acute‐care hospitalization in the 28 days preceding the study(P<.01),and antibiotics given preceding the infection(P<.001).An indwelling urinary catheter(P<.01)potentially was associated with an increased urinary tract infection rate. During the concurrent period, routine physician reporting of infection detected four of the 22 infections (18%) that were identified by the survey. These findings suggest that physician reporting of infection underestimates infection risk as compared with conventional surveillance practices, and that hospital‐based care units may have infection problems more similar to acute‐care hospitals than to community nursing homes. Identification of potential risk factors is critical in planning preventive practices based on institution‐s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05475.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05476.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Now that the benefits of treating diastolic hypertension in the elderly have been convincingly proved, attention is turning to the need for, and the choice of, treatment of isolated systolic hypertension in this age group. The hemodynamic mechanism differs in the elderly, whose isolated systolic hypertension is likely to be accompanied by reduced cardiac output, high peripheral resistance, and reduced plasma volume, whereas young people with similar blood pressure may have high cardiac output, normal peripheral resistance, and normal plasma volume. Increased risk of cardiovascular morbidity and mortality and the importance of reducing cardiac workload in older persons, are significant factors in the need for reduction of systolic pressure. After a good history and physical examination, and a careful check to ascertain that the elevated pressure is measured accurately, elderly patients can begin stepped‐care therapy with a diuretic such as hydrochlorothiazide or chlorthalidone. The considerable dangers of a sudden drop in blood pressure can be avoided by giving small initial doses. Methyldopa or clonidine is recommended for step two; the third step can be hydralazine. Side effects, especially in the elderly, should be monitored carefull

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05477.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Understanding the problem of hypertension in the elderly calls not only for an understanding of the physiologic phenomenon involved, but of the statistics currently available pertaining to this widespread disorder. In the age group 60 to 69 years, more than 25% of the population screened by the Hypertension Detection and Follow‐Up Program (HDFP) had isolated systolic hypertension; ie, a systolic blood pressure greater than or equal to 140 mmHg with a diastolic blood pressure less than 90 mmHg. Setting the criterion for definition at a systolic blood pressure greater than or equal to 160 mmHg, the prevalence in this age group was almost 10%. Prevalence of diastolic hypertension, ie, diastolic blood pressure greater than or equal to 90 mmHg in this age group was more than 40%. Data from that same study show also that elevated systolic blood pressure in the face of a normal diastolic blood pressure was associated significantly with increased mortality. In the HDFP, stepped‐care treatment reduced the five‐year incidence of fatal and nonfatal stroke in these individuals by more than 50%. These results were achieved with minimum side effects. Reports of this kind surely will overcome the popular tendency to consider elevated blood pressure in the elderly as a natural phenomenon of aging and, hence, acceptable. There is nothing natural about hypertension in the elderly, nor should it be acceptable. Because it is important to control hypertension before it can cause end‐organ damage, physicians are urged not to postpone treatment of hypertension in the elderly, but to initiate it promptly, keeping in mind the whole physiologic and psychosocial state of the elderly patient with hyper

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05478.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05479.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05480.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The interrelationships of diet and carcinogenesis are discussed with the focus on aging. To establish whether the elderly are more susceptible to dietary carcinogens and whether dietary prevention of cancer is a reasonable goal for this population, the mechanisms of chemical carcinogenesis, the age‐related metabolic and physiologic changes, and the current cancer preventive dietary strategies are reviewed. Vulnerability to dietary carcinogens results from a combination of factors that may increase or decrease the occurrence of cancer in the elderly, and it is, therefore, a very individualized feature, unpredictable when based solely on a subject's age. Dietary prevention of cancer may be effective in advanced age, and the dietary guidelines of the National Academy of Sciences should be implemented in this populatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05481.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Volvulus of the gallbladder is an extremely rare condition presenting often in elderly patients commonly mimicking acute cholecystitis. Two cases of gallbladder volvulus in two octogenarian patients are presented from our institution. Clinical presentation is reviewed and some characteristic clinical and radiographic findings are described. The etiology of this rare entity is discussed with particular emphasis on visceroptosis, a common finding in elderly patients. The importance of early recognition and rapid treatment of this potentially fatal disease is emphasized. It is possible with increasing longevity, with its accompanying tendency to visceroptosis, that this entity may occur more frequently in the future. Its recognition and proper treatment is essential to good results in this elderly group of patients.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05482.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY