摘要:

Falls affect a large proportion of the elderly and can result in a variety of injuries, including hip fractures. Several studies have suggested that visual impairment contributes to falls, but studies have not used standardized definitions of visual impairment and have not examined injurious falls or fractures. We looked at the risk of hip fracture associated with visual impairment in those members of the Framingham Study Cohort who took part in the Framingham Eye Study in 1973–75. Of 2,633 subjects followed for 10 years after the eye exam, 110 sustained hip fractures. The fracture rates in those with moderately impaired (20/30 to 20/80) vision (8.5%) and poor (20/100 or worse) vision (11.3%) were higher than in those with good (20/25 or better) vision (3.0%). After adjustment for age, sex, weight, alcohol consumption, and (in women) estrogen use, the relative risk of fracture in those with moderate impairment was 1.54 (95% CI = 0.95–2.49), while for those with poor vision, the relative risk was 2.17 (95% CI = 1.24–3.80). Of note, those with moderately impaired vision in one eye and good vision in the other had a higher risk of fracture (relative risk = 1.94) than those with a similar degree of binocular impairment (relative risk = 2.11). Poor vision in one or both eyes was linked to an elevated fracture risk. This suggests that good stereoscopic vision may be necessary to prevent falls. The risk of fracture with poor and moderately impaired vision combined was increased in women (relative risk = 1.96, 95% CI = 1.23–3.11) but not in men (relative risk = 0.79, 95% CI = 0.23–2.72). 17.5% (17/97) of women with poor vision in at least one eye sustained a hip fracture during the 10 years of the study. Cataracts were the most common cause of fracture‐related visual impairment, but neither cataracts nor other common eye diseases had an independent effect on fracture risk after adjustment for visual acuity. In sum, visual impairment is an important risk factor for hip fracture, especially among el

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05678.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A prospective study correlated coronary risk factors with new coronary events in 192 elderly men and 516 elderly women, mean age 82 ± 8 years. Follow‐up was 41 ± 6 months (range 24–44). Coronary events (myocardial infarction, primary ventricular fibrillation, and sudden cardiac death) occurred in 64 of 192 men (33%) and in 149 of 516 women (29%), P not significant. Using univariate analysis, significant risk factors for coronary events were antecedent coronary artery disease, cigarette smoking, hypertension, diabetes mellitus, serum total cholesterol (TC) ≥ 200 mg/dL and ≥ 250 mg/dL, serum high‐density lipoprotein cholesterol (HDL‐C)<35 mg/dL, and serum TC/HDL‐C ≥ 6.5 in men and women, and obesity in women. Using multivariate analysis, significant risk factors for coronary events were age, antecedent coronary artery disease, cigarette smoking, hypertension, diabetes mellitus, and serum TC in men and women and serum HDL‐C and serum triglycerides in women. Using univariate analysis, significant risk factors for coronary events in men and women with antecedent coronary artery disease were cigarette smoking, diabetes mellitus, serum TC ≥ 250 mg/dL, and serum TC/HDL‐C ≥ 6.5. Using multivariate analysis, significant risk factors for coronary events in men and women with antecedent coronary artery disease were age, cigarette smoking, diabetes mellitus, serum TC, serum HDL‐C, and serum triglycerides. Using univariate analysis, significant risk factors for coronary events in men and women without antecedent coronary artery disease were cigarette smoking, hypertension, diabetes mellitus, serum, TC ≥ 200 mg/dL and ≥ 250 mg/dL, serum HDL‐C<35 mg/dL, serum TC/HDL‐C ≥ 6.5, and hypertriglyceridemia. Using multivariate analysis, significant risk factors for coronary events in men and women without antecedent coronary artery disease were age, cigarette smoking, hypertension, diabetes mellitus, serum TC,

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05679.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The significance of hypochondriacal complaints in elderly depressives was explored. Sixty percent of patients had such symptoms on admission. Twelve percent were delusional. At discharge, hypochondriasis was present in 40% of the sample, with 0% delusional. Hypochondriasis was associated with anxiety (P<.05) and somatic concerns (P<.001), but not with complaints of depressed mood, suicidality, or short‐term outcome. In dependent physical illness ratings did not correlate with hypochondriasis, however nonpsychotropic medication use did (P<.01). Improvement in hypochondriacal complaints with treatment, yet persistence of less intense hypochondriacal concerns after remission suggests that these features may represent an admixture of state and trait phenomena in elderly depressive

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05680.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

We determined rate of cognitive decline in 54 patients with a clinical diagnosis of Alzheimer's disease. Cognitive ability was assessed by score on the Blessed test of orientation, memory, and concentration. Rate of progression was defined as the change in score on the Blessed test per year and was computed using a linear regression analysis. Only patients who had been followed for at least one year and who had at least three separate evaluations were included in the study. The overall rate of progression was 4.1 Blessed points per year. Age of onset, duration of illness, and family history of dementia had no significant influence on rate of progression.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05681.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Fifteen Alzheimer patients were treated with increasing doses of vinpocetine (30, 45, and 60 mg per day) in an open‐label pilot trial during a one‐year period. Patients were assessed seven times both on and off drug with: the Buschke Selective Reminding Task, a letter fluency test, a category fluency test, the Boston Naming Test, a cognitive capacity screening examination, and a clinical global impression. Vinpocetine failed to improve cognition on psychometric testing or overall functioning, as measured by the clinical global impression, at any dose tested. Patients showed significant decline in most measures during the course of the study, at the same rate as a matched control group, consistent with progressive dementia. There were no significant side effects from drug therapy. We conclude that vinpocetine is ineffective in improving cognitive deficits and does not slow the rate of decline in individuals with Alzheimer's dise

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05682.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Epidemiologic study of Alzheimer's disease by family history requires that Alzheimer's be distinguished from other dementias. Identification of demented family members is usually based on recall by relatives. This study examines the validity of the classification of Alzheimer's disease and other dementias based on relatives' reports. Close relatives of autopsy‐confirmed dementia cases were asked to complete a questionnaire describing the patient's symptoms. These informants were familiar with the patient's disease and involved in his/her care prior to death. The questionnaire included the DSM‐III criteria for Primary Degenerative Dementia and the Hachinski Ischemic Scale. A diagnosis derived from the close relatives' responses was compared to the neuropathologic diagnosis for thirty‐six cases: 20 Alzheimer's disease, 9 mixed Alzheimer's disease, and 7 non‐Alzheimer's disease dementias. The diagnosis of Primary Degenerative Dementia derived from questionnaire responses had a sensitivity of 0.93 and specificity of 0.43 for pathologic Alzheimer's disease. Few vascular dementias were included in the series, thereby precluding the study of so‐called multi‐infarct dementia. Hachinski scores based on relatives' responses classified 40% of pathologically pure Alzheimer's disease cases as multi‐infarct dementia (HIS>7). Thus, using these elevated Hachinski scores to rule out Alzheimer's disease would cause substantial misclassification. Diagnosis based on questionnaire Primary Degenerative Dementia criteria was quite sensitive but relatively nonspecific. When attempting to obtain a complete family history or pedigree that describes the occurrence of Alzheimer's disease and other dementias in all family members, the questionnaire approach should be supplemented with additional information from medical records, physicians, and ot

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05683.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

It has been reported that postural hypotension in the elderly is common. However, these studies included institutionalized and more or less disabled persons. Furthermore, postural hypotension may be related to baseline blood pressure. In this study, the influence of age and blood pressure on the hemodynamic and plasma catecholamine responses to orthostatic stress was investigated in young and old normotensive and hypertensive healthy subjects. In normotensive and hypertensive elderly persons, the percentage blood pressure responses during tilt were not significantly different from that seen in young normotensives. We measured a slight decrease of systolic blood pressure and a slight increase of diastolic blood pressure. The hypertensive young patients showed an enhanced diastolic blood pressure response with no fall in systolic blood pressure, in contrast to the normotensive young subjects. Both elderly groups had a lower increase of heart rate than the young subjects. The percentage increase in norepinephrine after tilting was significantly lower in elderly hypertensives than in elderly normotensives and young hypertensives. The presence of hypertension was associated with a decrease in blood pressure, but age had no influence on the change in blood pressure during tilt. In this group of healthy elderly subjects, there was no significant orthostatic hypotension when the blood pressure course of the entire tilt test was taken into account.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05684.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Thyrotropin releasing hormone (TRH) tests were conducted in 99 healthy elderly men and women between the ages of 65 and 89. The TRH test identified elderly patients with subclinical thyroid dysfunction not recognized by basal TSH values alone. Men revealed significantly diminished TSH responses to TRH injection relative to women. Mean ΔmaxTSH was 9.0 ± 8.3 μIU/mL in men vs 15.7 ± 14.8 μIU/mL in women (P<.01) reflecting the need to consider gender effect in the interpretation of TRH test respo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05685.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

A total of 221 elderly patients between the ages of 70 to 99 years who presented to a community‐based teaching hospital emergency room were prospectively evaluated by assessing for fever (≥ 37.5°C), leukocytosis (≥ 14,000/ mm3) and bandemia (>6%) as a screening method for predicting the presence of bacterial infection. Thirty‐three patients had documented bacterial infections. Although with increasing body temperature the percent of patients who were infected increased, 48% of the infected elderly patients had no fever. In patients with fever, 39% had a bacterial infection compared to only 9% in the afebrile group. In patients with fever, leukocytosis, and bandemia, all patients were infected. Conversely, in the absence of fever, leukocytosis, and bandemia, only 6% had bacterial infection.All elderly patients who present with an acute or subacute change in health status or functional capabilities associated with fever, leukocytosis, or bandemia should be carefully assessed for the high probability of a bacterial i

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05686.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

During implementation of a new Do‐Not‐Resuscitate (DNR) policy in New York State, decisions by 233 nursing home patients of their surrogates were evaluated. Eighteen patients with capacity (mean age ± SD = 76.4 ± 12.1 years) chose DNR; 30 patients with capacity (mean age ± SD = 76.2 ± 10.7 years) chose to be resuscitated (CODE); 54 patients without capacity, (mean age ± SD = 86.1 ± 9.1 years) had surrogates who chose DNR; and 131 patients without capacity and with surrogates (mean age ± SD = 81.9 ± 9.8 years) remained CODE. Most patients with capacity who chose DNR had multiple sclerosis, while most choosing CODE had strokes. Most patients who lacked capacity had dementia. Forty‐five percent of surrogates did not respond regarding CODE status during the three‐month study interval, and 10% wanted additional time to decide. Patient age appeared to be a factor in surrogate choice for DNR but not in patients with capacity making their own decision. Reasons for patients with capacity choosing DNR are discussed; perceived quality of life and premorbid feelings by patients help in the decision

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb05687.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY