摘要:

Falls among elderly residents are a major concern of facilities caring for the aged. A group of institutionalized women with senile dementia of the Alzheimer type (N= 60; mean age 83) were studied longitudinally and evaluated annually on 21 variables of physical, social, emotional, self‐care, and cognitive functioning. A substudy of falls they experienced used data from two such annual evaluations. Clinical ratings by the interdisciplinary team estimated 1) the women's changes in function during the preceding year and 2) the current levels of the women's functioning. Separate regressions for each of the two years returned identical significant patterns indicating that ratings of physical vigor were significantly related to number of falls. Those women who had been among the most vigorous in the group but who had shown significant declines in the preceding year were the most vulnerable to falls; women who had been rated as the least vigorous but whose levels of vigor had been stable during the year tended to have fewer falls. Falling therefore appears to be related to the process of decline in vigor among those in the group whose levels of vigor were higher initially. There were corresponding significant declines in emotional and cognitive scale

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00886.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

A day care program for patients with dementia was developed by the Burke Rehabilitation Center in 1979. Sixty‐nine patients have taken part in the program, some for as long as three years. The majority of patients stay in the program for one to two years. This pilot program was designed to provide a structured series of daily activities for the patient with dementia and to give those responsible for their care at home a period of freedom each week from the responsibilities of care. The program has been well received by the patients and appreciated by their families. It has not altered the steady progression of intellectual decline. It has made it possible for families to continue to keep patients at home and delay nursing placement or the hiring of additional help at home. It is cost effective when compared with the general alternative of nursing home placement. Similar programs could be conducted outside health care facilities at lower cost to patients and their families. Family support group discussions have eased the burden for the caregiver and have been useful in discovering new ideas for better patient managemen

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00887.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Motility in the sigmoid, rectosigmoid, and rectum was studied before, during, and after a 900‐kcal meal in 18 healthy elderly and 18 healthy young adults. Three intraluminal pressure transducers spaced 5 cm apart were used for the recording. No differences existed in the percentage activities and the surface areas under the contraction curves (SA) for the corresponding measurements during fasting, during eating, and after consumption of a meal in the elderly and young adults (P>0.1). A 900‐kcal meal significantly increased percentage activity and SA in all three recording areas in both the elderly and young adults (P<0.02). Percentage activity and SA returned to fasting levels immediately after consumption of the meal. Percentage activity and SA were highest 15 cm above the anal verge in both elderly and young adults. These findings suggest that age and gender do not affect sigmoidal, rectosigmoidal, and rectal motil

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00888.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Several research groups have reported alterations in mineral concentrations in patients with Alzheimer's disease (AD). A study of serum copper, zinc, magnesium, calcium, and albumin concentrations in outpatients with Alzheimer's disease (in the early‐to‐middle stages) and in these patients' healthy spouses is reported. Hair concentrations of copper, zinc, magnesium, calcium, and manganese were also measured in these AD patients and controls. No differences in serum or hair concentrations were found, and determinations of these hair and serum mineral concentrations do not appear to be of use in the diagnosis of AD. Significant positive correlations were found between age and hair manganese (Mn) in the control spouses, and a similar (but statistically nonsignificant) trend in the AD patie

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00889.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Twenty‐one elderly patients with essential hypertension, all over 65 years of age, were subjected to automated noninvasive 24‐hour blood pressure measurement. Readings were obtained every 7.5 minutes throughout the day. The data were analyzed with respect to: correlation between office and ambulatory pressure measurements; possible differences in the circadian blood pressure pattern; and the existence of hypertensive or atherosclerotic cardiovascular complications. In all patients, the office systolic pressures were significantly higher than the ambulatory daytime pressures; diastolic pressures were similar. At night, two patterns of blood pressure emerged. In one there was a further fall in both systolic and diastolic pressures to normotensive levels, whereas the other pattern revealed no change in diastolic pressure, although systolic pressure increased significantly to similar levels as measured in the office. The prevalence of hypertensive or atherosclerotic cardiovascular complications in the patients with the first pattern was significantly less than in the group of patients with the second pattern (chi square,P<0.025). The data reported herein indicate that ambulatory blood pressure monitoring may help in the overall clinical evaluation of elderly patients with hypertens

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00890.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Multidisciplinary geriatric evaluation units are being established in hospitals and, to a lesser extent, as outpatient clinics. This paper presents results of a chart audit of 332 patients seen from 1978 to 1982 at a university based geriatric outpatient evaluation unit. The relationships of clinic staffing to types of referrals and other aspects of clinic operation are investigated. During the time under study, the proportion of patients whose problems were medical rather than psychiatric or social increased. Presenting problems varied by referral source. Family and self referrals were most likely to identify a medical presenting problem, while physician and community agency referrals were most likely to identify a psychiatric problem. Patients frequently received diagnoses in areas of function other than those identified as the presenting problems. For example, medical clinicians made at least one psychiatric diagnoses for 86 per cent of patients they evaluated. Important questions about the potential contribution of such geriatrics clinics to health care of the elderly remain to be answered.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00891.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Difficulties exist in making treatment decisions for the very old and dependent patient. In the years to come, these difficulties will increase. It is argued that such persons should not be abandoned to their “rights” as autonomous persons; yet quality of life judgments should also be avoided except in limited circumstances. Since aging is a process of becoming more dependent, the author proposes a dependency rule, by which greater responsibility for treatment decisions falls on care‐givers as a person's dependency increases. In place of quality of life judgments he suggests a medical indications policy, if the latter includes restoration of some affective function. Five kinds of freedom are proposed, of which only some are lost in chronic illness and old age. Finally, it is suggested that life itself involves greater interdependence than the autonomy criterion itself can allow. The author focuses on the problem of dependency in the aged and the role an increase in this dependency plays, with corresponding loss of personal autonomy, in quality of life judgments. These, in turn, form the basis for treatment deci

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00892.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

In February 1984, the following “friend of the court” (amicus curiae)brief was submitted to the New Jersey Supreme Court by the American Geriatrics Society to assist in the Court's deliberation in the case known asIn reClaire C. Conroy. The Board of Directors of the AGS had decided to undertake this endeaver because the reasoning adopted by the Appellate Division in this case would, if affirmed by the Supreme Court, greatly diminish the capacity of physicians to serve their patients, especially their older patients. The brief was prepared by AGS member Joanne Lynn, MD, and was critiqued, revised, and finally approved by all of the members of the Executive Committee of the Board of Directors. A New Jersey attorney, Mr. Charles Deubel, III, filed the brief and the necessary associated papers on behalf of the AGS and without charge. Expenditures by the AGS in this endeavor totalled less than £300. The Editors of theJournaland the Board of Directors of the AGS would welcome comments from the membership and other concerned persons concerning the content of the brief and the process of developing and submittin

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00893.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

A conceptual framework that is based on the biopsychosocial model and focuses on functional status is proposed for the understanding and teaching of the functional approach to health care. Functional status can be viewed as the composition of various biologic, psychologic, and social capabilities that are integrated in order to perform the activities necessary to ensure an individual's well‐being. When functional status is threatened by aging or by disease‐related deficits, a compensatory response is generated by mobilizing reserve resources/capabilities in an effort to maintain functional status. Since the aging process is characterized by the acquisition of multiple age‐ and disease‐related deficits, primary care providers need to appropriately detect functional impairments through multidimensional assessment and orchestrate compensatory responses in an effort to restore, maximize, and maintain functional status and independence for as long as p

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00894.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Cardiopulmonary resuscitation (CPR) has been practiced since 1960. In mixed‐age populations there is about a 10 per cent survival rate. Most CPR studies state that “age alone” is not a critical factor in survival. Studies that focus specifically on the elderly suggest that although “age alone” is not a critical survival factor, previous level of function and severity of underlying disease have major effects on CPR outcome. In most medical institutions CPR is undertaken unless a specific “do not resuscitate” order is written. Many impaired and chronically ill elderly therefore undergo unnecessary and unsuccessful CPR. The available data suggest that CPR is suitable for the independent and relatively well elderly to whom CPR measures can be quickly applied. For the chronically dependent and ill elderly, CPR in most instances should not be undertaken. Such an eventuality, however, should be anticipated and whenever possible discussed with patients and family members, thus allowing decisions to be made consciously rather than leaving the

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb00895.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY