摘要:

Serum 25‐hydroxyvitamin D (25‐OHD) levels were measured in 338 elderly patients admitted to the Geriatric Medicine Departments of a general hospital in Israel in the course of one year. The mean (±SD) serum 25‐OHD levels were significantly lower (P<.01) in the elderly patients (13.5 ± 8.9 ng/mL) than in healthy young controls (24.7 ± 6.1 ng/mL). One hundred ten patients (35.5%) were either vitamin D deficient (25‐OHD<5 ng/mL) or had borderline serum levels of 25‐OHD (5–9 ng/mL). The mean (±SD) serum 25‐OHD concentration of patients who were completely mobile before hospitalization was 15.5 ± 8.8 ng/mL (n = 239). In patients mainly immobilized but able to leave the house occasionally, it was 10.2 ± 6.3 ng/mL (n = 84) and of bed‐ridden patients, it was 5.2 ± 3.2 ng/mL (n = 15). No correlation was found between serum 25‐OHD levels and the patients' age or serum calcium, phosphorus, alkaline phosphatase, and albumin values. Thus, in order to detect vitamin D deficiency in the elderly, it is necessary to measure serum 25‐OHD concentration. The results demonstrate that vitamin D deficiency is common among elderly patients even in sunny climates and indicate the need for development of effective programs o

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01247.x

年代:1989

数据来源: WILEY

摘要:

This study investigates whether a brief educational program, provided to spouses of patients with Alzheimer's disease, improved the caregivers' coping skills; it also questions whether the gender of the spouse had an effect on coping ability. The sample consisted of 40 spouses who were caring for the Alzheimer patient at home, 20 who participated in the educational program, and 20 controls. The instrument used for the study was the Health Specific Family Coping Index (HSFCI). This instrument provided a quantitative assessment of overall family coping with both potential and actual health problems in the psychosocial and physical domains of health. It is rated in nine domains: physical independence, therapeutic competence, knowledge of the condition, application of principles of personal hygiene, attitude toward health care, emotional competence, family living patterns, physical environment, and use of community resources. A home visit was made by a registered nurse prior to the educational intervention and at the end of the four‐week intervention period. The HSFCI was completed at each visit. There were no pretreatment differences between the intervention and control groups in coping ability. Findings indicate that the educational program was beneficial in assisting spouses to feel greater competence in the face of the disease process and to function with greater independence. In the treatment group, the greatest significant increase was in the knowledge domain, followed by therapeutic competence and emotional competence. There was no overall relationship between gender of the spouse and coping abilit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01248.x

年代:1989

数据来源: WILEY

摘要:

Forty‐one elderly medical inpatients with active major depression were matched with nondepressed controls from the same population. Survival and health care utilization were examined during a mean follow‐up period of five months. Cases and controls were matched by age, functional status, severity and type of medical illness, and extent of disease. In‐hospital mortality was significantly higher among depressed compared with nondepressed controls (6 vs 0 deaths, P=.03). For patients discharged from the hospital alive, however, depression did not have a substantial impact on mortality (31.4% cases, 31.7% controls). Health care utilization—in terms of days of inpatient care—was significantly higher both during the index admission (25 vs 14 days, P<.005) and during the follow‐up period (16 vs 7 days, P<.05) for depressed patients compared with controls. Hence, older medically ill patients with major depression consume more healthcare resources and experience greater mortality during their initial hospital stay. After discharge, while survival is little affected, excess resource utilization persists among those with

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01249.x

年代:1989

数据来源: WILEY

摘要:

Although anthropometrics have traditionally been utilized in the assessment of protein‐energy malnutrition, little is known of the reliability of these measurements in elderly patient populations. In this study, the reliability of an anthropometric measurement protocol, designed for ease in measurement of both independent and functionally debilitated elderly patients, is evaluated. An analysis of variance technique was used to calculate the test‐retest variance for each of three observers. Although the experience of the three observers was equivalent, the precision of their measurements varied considerably. After repeat practice sessions, improved measurement reliability was demonstrated. For all the observers, the test‐retest variance was found to be proportional to the size of the measurement and to be influenced by the accuracy in which the site for each measurement was located. Based on this study, we conclude that when using anthropometrics it is important to know the reliability of each observers' measurements. Because of the correlation between the test‐retest variance and the measurement value, we suggest that the variance be expressed as a percentile. A method for transforming the variances is pr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01250.x

年代:1989

数据来源: WILEY

摘要:

We performed a prospective study of 250 men undergoing transurethral resection of the prostate to determine the incidence of perioperative myocardial infarction. The prevalence of coronary artery disease in the study group was 27%. Patients had measurement of total creatine kinase and its MB isoenzyme and electrocardiography preoperatively and on the first three postoperative days. Only one myocardial infarction was diagnosed, an incidence rate of 0.4%. The overall rate of serious postoperative complications was 3.6%. No deaths occurred during the operative hospitalization. We conclude that with transurethral resection perioperative myocardial infarction is a rare event despite the high prevalence of coronary artery disease in this surgical population. Routine postoperative surveillance with electrocardiograms and creatine kinase determinations in asymptomatic patients is not warranted.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01251.x

年代:1989

数据来源: WILEY

摘要:

A random sample of 46 general practitioners of the Unitá Sanitaria Locale in Torino recruited 802 elderly outpatients and collected information about complaints and current drug treatment. Within a week each patient received a home interview and details were collected on drug compliance and use of drugs other than those reported by the general practitioners. On average, each patient was taking 3.6 drugs, of which 2.9 were correctly reported by the general practitioners and 0.7 were unreported. Among the most prescribed therapeutic groups there were drugs with a narrow therapeutic index (cardiovascular drugs, diuretics, psychotropic agents) and substances whose efficacy has never been fully documented (“cerebroactive‐vasoactive” agents). Age and number of complaints were positively and significantly correlated with number of prescribed drugs. Nearly half of the sample (44.4%)—more frequently women and people with higher education—were taking one or more drugs not detected by the general practitioners, often benzodiazepines taken over a long period for anxiety or insomnia. Full compliance occurred for 81.5% of the prescriptions and 59.9% of patients were correctly taking all prescribed drugs. Compliance was lower for prescriptions of the general practitioners compared with other doctors' prescriptions (eg, hospital doctor, private doctor) and probability of taking correctly all the prescribed drugs decreased with the number of medicines concurrently taken. The most common reason for noncompliance was fear of si

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01252.x

年代:1989

数据来源: WILEY

摘要:

The costs of inpatient hospital care for treating head trauma were examined in 125 patients over the age of 50. Regression analysis indicated that injury severity, as measured by the admitting Glasgow Coma Scale, was a good predictor of hospital cost, while patient age was unrelated to cost. The regression relationship, however, was quadratic (not linear), indicating that least injured and severely injured patients cost less than moderately injured patients. These findings are in direct contrast with the commonly held belief that the elderly consume more hospital resources than younger patients. They suggest the need for a reexamination of the use of age in setting prospective reimbursement amounts in certain diagnoses, and in making resource allocation decisions relative to geriatric programming at the hospital level. Head trauma patients are costly because they are sick, not because they are old.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01253.x

年代:1989

数据来源: WILEY

摘要:

The financing of long‐term care is one of the largest and most vexing health care problems facing our society. The problem will be further exacerbated when the rate of growth in the number of persons needing long‐term care is further accelerated by the graying of those in the “baby boom” generation. The current financing mechanism, which relies almost entirely on concurrent funding through either a means tested welfare program (Medicaid) or self‐pay, is inequitable and inadequate even for our present needs. Despite the magnitude of the problem, only recently has sufficient attention been focused on finding alternatives to the current means of financing long‐term care. The search for a solution has been hampered by multiple, and sometimes conflicting, policy and political considerations. After reviewing the demographic and social roots of our current dilemma and listing the major alternatives for financing long‐term care, a series of basic principles and definitions are reviewed. These elements are meant to serve as guidelines to compare and evaluate the growing number of proposals which seek to create a more effective and equitable system for financing long‐term care. Future articles in this section will detail some of the more promising approaches to the dilemma of financing

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01254.x

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01255.x

年代:1989

数据来源: WILEY

摘要:

The Medicare program provides the largest single source of funding for the clinical portion of housestaff training programs. Despite the fact that the clinical training in geriatric fellowship programs focuses heavily on the care of Medicare recipients, the proportion of funds supporting geriatric fellowships that is derived from Medicare is actually smaller than that of most other fellowship programs. Legislation passed by Congress in 1986, and just recently implemented, creates an opportunity to increase Medicare funding for geriatrics. Those concerned with geriatric fellowship training must have a clear understanding of how Medicare funding for graduate medical education will occur under the new legislation if the opportunity is to be used effectively. Finally, other barriers created by general pressures on housestaff budgets that may interfere with capitalizing on the opportunity are discussed.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01256.x

年代:1989

数据来源: WILEY