摘要:

ObjectiveTo assess the validity of the Neurobehavioral Rating Scale (NRS) in patients with Alzheimer's disease (AD) or multi‐infarct dementia (MID) and to characterize the cognitive, psychiatric, and behavioral disturbances that occur in these patients.DesignCross‐sectional evaluation.SettingWest Los Angeles VAMC Geropsychiatry Inpatient Unit, Neurobehavior Inpatient Unit, and Dementia Clinic; UCLA Alzheimer's Disease Clinic.PatientsConvenience sample of 61 patients with AD and 22 patients with MID.Main Outcome MeasureThe NRS, a 27‐item observer‐rated instrument that measures cognitive, psychiatric, and behavioral disturbances.ResultsThe NRS demonstrated content and convergent validity in this patient group. Principal components analysis of the NRS ratings identified a six‐factor solution, and each factor contained clinically related symptoms. The factors were Cognition/Insight, Agitation/Disinhibition, Behavioral Retardation, Anxiety/Depression, Verbal Output Disturbance, and Psychosis. Among the patients with AD, agitation, disinhibition, hostility, poor insight, poor motivation, suspiciousness, and delusions were more severe in patients with more advanced dementia. Depressive symptoms occurred with equal severity in patients with mild and advanced dementia, but depressed mood was more severe in patients with earlier age of onset of AD.ConclusionThe NRS is a useful instrument for structured assessment of a broad range of cognitive, psychiatric, and behavioral disturbances in patients with

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02101.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo compare the effects of the opioid antagonist, naloxone, on fluid ingestion in young and older males, in order to estimate the role of the opioid system in hypodipsia of older men.DesignSingle‐blinded, randomized, cross‐over, placebo‐controlled study.SettingOutpatient Department of Veterans Affairs.Study ParticipantsSixteen young subjects (aged 23 to 39) and eight older subjects (aged 69 to 75). All subjects were healthy, community‐dwelling, non‐smoking men, on no medications.InterventionSubjects were randomized to receive either placebo or naloxone on day one. Whichever substance the subject did not receive was given on day two with days one and two separated by at least a 2‐week washout period.Main Outcome MeasuresFluid intake after overnight food and fluid deprivation, with placebo or naloxone injected in the morning.ResultsAfter overnight fluid deprivation, older individuals consumed 29% less fluid in 2 hours compared with younger individuals (ns). After overnight fluid deprivation and injection with naloxone 100 μg/kg, fluid intake was diminished by 42% (P<0.05) in young subjects compared with placebo, but only by 7% (ns) in older subjects. Subjective ratings did not differ significantly between young and old subjects.ConclusionsThese preliminary data suggest that the opioid system plays a role in the drinking response in young subjects while failing to alter fluid intake in older subjects. Hypodipsia in older individuals may be due to a deficit in the opioid dr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02102.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo compare the prevalence of specific psychiatric disorders in the homebound elderly to other elders, controlling for demographic, physical health, and socio‐economic factors.DesignSurvey.SettingEpidemiologic Catchment Area (ECA) project in New Haven, CT.Participants2,553 non‐institutionalized elders representing the total elderly population of the greater New Haven area.InterventionNoneMain MeasuresHomebound status determined by self‐report; psychiatric status according to DSM III by the Diagnostic Interview Schedule (DIS); cognitive status by Mini‐Mental Status Examination.ResultsCognitive impairment (21.8% vs 11.0%,P<0.001), depression (2.3% vs 0.7%,P<0.01), dysthymia (3.9% vs 1.7%,P<0.01), and anxiety disorders (2.2% vs 0.4%,P<0.001) were each at least twice as prevalent among elders confined to a bed or chair as among non‐homebound elders. Most of this increase was consistent with the poorer physical health status of the homebound; after controlling for health status, only dysthymia (Odds ratio = 2.1,P<0.01) was significantly more prevalent among elders confined to a bed or chair.ConclusionsThe higher prevalence of disorders among the homebound support recommendations that psychiatric assessments become routine in primary care examinations of homebound elders and that the availability of preventive and therapeutic psychiatric services to the homebound

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02103.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo assess the effect of age on driving skills independent of the limitations related to disease or dementia.DesignProspective comparison of driving skills across three age groups.SettingA university‐based research study of student and university‐affiliated volunteers.ParticipantsHealthy elderly (age 65+), teen‐age (age 18–19), and young adult drivers (age 25–35). Twenty subjects in each age group were recruited after meeting entry criteria for the study.Main Outcome MeasuresTotal error count and score on the Miller Road Test, a standardized road test developed by the Division of Bus and Traffic Safety in North Carolina.ResultsThe elderly were found to have fewer errors than either of the two younger groups of drivers (P= 0.0013). Specific driving skills were judged to be either superior or unchanged in the elderly subjects in comparison to their younger counterparts.ConclusionsRoad test skills appear to be well preserved in the healthy elderly population. More road test studies are needed on elderly individuals with mental and physical impairments to determine if road tests can play a role in identifying the driver at high risk fo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02104.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveGoal attainment scaling (GAS) is a measurement approach used extensively in mental health. It accommodates multiple individual patient goals, yet retains mathematical properties allowing comparisons between patients. This study was carried out to investigate the feasibility and measurement properties of GAS in a geriatric care setting.DesignProspective descriptive study.SettingThe geriatric restorative care service and geriatric assessment unit at Camp Hill Hospital, a 350‐bed tertiary care facility in Halifax, Canada.PatientsFifteen patients aged 65 to 94 who were consecutively admitted to the two geriatric services (mean age 79 years, mean length of stay 37 days, 9 females).InterventionGoal Attainment follow‐up guides were developed independently for each patient by two geriatricians after a comprehensive assessment of the patient. These guides were later compared to assess level of agreement in goal setting and scale development. A single goal attainment follow‐up guide was then developed for each patient by consensus of the two geriatricians. At the end of the follow‐up, the guides were scored independently for each patient by one of the geriatricians and by the patient's primary care nurse.Main Outcome MeasuresGAS scores were determined on admission and discharge. Each patient also received admission and discharge ratings on the Barthel Index as well as a global rating of outcome (on a subjective 10‐point scale) by a geriatrician who was blinded to the Goal Attainment follow‐up score.ResultsGAS proved feasible, requiring 15–20 minutes to scale an average of six goals per patient. GAS also appears reliable. Of 87 goals, 71 (82%) were identified independently by two geriatricians, and the remainder were determined by consensus. This is also a measure of content validity. The physician‐nurse inter‐rater reliability was 0.87 (intraclass correlation). Concurrent validity was assessed by correlation with the Barthel Index (r= 0.86) and the global clinical outcome rating (r= 0.82). Content validity was also assessed by comparing our goal areas with those identified in recent consensus reports on geriatric assessment. Of these 13 assessment areas, 12 appeared to be reasonably well covered while one assessment area (sexual problems) was not identified for any of the 15 patients.ConclusionsGAS appears to be a feasible method of goal setting and outcome evaluation in geriatric care settings, with promising reliabi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02105.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo examine the clinical utility of the Clock Test for identifying dementia.DesignGroup comparisons.SettingA hospital‐based out‐patient diagnostic clinic.PatientsVolunteer sample of elderly individuals (normal elderly, NE,n= 62) and a referred sample of probable Alzheimer Disease (AD,n= 58) patients meeting NINCDS‐ADRDA criteria.Main Outcome MeasureThe Clock Test is composed of three components: Clock Drawing, Clock Setting, and Clock Reading. A detailed scoring system for qualitative as well as quantitative evaluation of Clock Drawing errors was used. Five time settings, varying in level of complexity, were used to evaluate Clock Setting and Clock Reading.ResultsThe groups differed significantly on Clock Drawing, Clock Setting, and Clock Reading (P<0.001). On Clock Drawing, the AD group made significantly more errors of omission and misplacement of numbers than the NE group (P<0.001). Using cut‐off scores derived to maximize separation between the groups to define deficits in performance, the sensitivity and specificity for the diagnosis of AD of Clock Drawing, Clock Setting, and Clock Reading were 92% and 86%, 87% and 97%, 92% and 85%, respectively. Using a criterion of deficits on two or more of the three components, sensitivity and specificity increased to 94% and 93%, respectively.ConclusionsDeficits on clock drawing in AD may be reflective of a generalized disturbance in the conceptualization of time rather than constructional apraxia, per se. The functionally relevant components of Clock Setting and Clock Reading combined with Clock Drawing make the Clock Test particularly useful as a screening and research tool

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02106.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo compare ratings of patients referred for geriatric evaluation and their proxies with respect to patients' ability to perform activities of daily living.DesignRetrospective chart audit.SettingUniversity‐based Outpatient Geriatric Clinic.PatientsElderly medicine patients referred to a university‐based outpatient geriatrics clinic for the first time.Main Outcome MeasuresModified Katz Physical Activities of Daily Living (PADL) and Instrumental Activities of Daily Living (IADL).ResultsWith regard to PADLs, patients were generally rated as independent by both patients (91%) and proxies (87%); for IADLs, ratings of independence by both patients (68%) and proxies (51%) were significantly lower. Concordance between patient and proxy ratings was significantly (P<0.001) greater for PADLs (92%) than for IADLs (82%). When disagreement occurred, patients consistently rated themselves as more independent than their proxies, especially for IADLs. Moreover, concordance between patients and proxies regarding IADLs was significantly (P<0.001) worse for patients who had scores below 24 on the Folstein Mini‐Mental State Examination (72%) compared with those scoring 24 or higher (95%).ConclusionsPatient and proxy ratings were concordant when rating patients' ability to perform PADLs. Moreover, concordance was extremely high on IADLs when patients' Folstein scores were 24 or higher. Concordance with respect to IADLs was relatively poor only among patients with Folstein scores below 24. In that case, patients had a more optimistic view of their independence, compared with their pr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02107.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo describe the epidemiologic features of an outbreak of influenza A that occurred in a skilled nursing home although over 90 percent of the resident population had previously received influenza vaccine.DesignRetrospective cohort study.SettingSkilled nursing home facility in western New York State.PatientsNursing home residents and patient‐care staff.Main Outcome MeasureIncidence of influenza‐like illness among vaccinated versus unvaccinated nursing home residents and staff.ResultsThirty‐seven of 124 residents (attack rate = 30%) and 18 of 146 staff (attack rate = 12%) had an influenza‐like illness. Staff illness began 16 days prior to onset among residents. Six cases of pneumonia and three influenza‐related deaths occurred, all among the vaccinated residents. Ninety percent of the nursing home residents and 10% of the staff received the influenza vaccine prior to the outbreak. The calculated vaccine efficacies were minus 21% and plus 45% for residents and staff, respectively.ConclusionWhile antigenic drift of the circulating influenza virus was the major factor in the apparent vaccine failure, the observed poor staff immunization rate (10%) and absence of surveillance which precluded the use of amantadine chemoprophylaxis suggest that the use of these strategies may be of importance in controlling influenza outbreaks in nurs

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02108.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo assess whether cardiopulmonary resuscitation performed by in‐house physicians is effective for long‐term‐care residents.DesignRetrospective chart review.SettingLong‐term‐care facility with an intermediate care unit, “skilled” care unit, and a convalescent and assessment unit at a retirement community for veterans.ParticipantsAll residents resuscitated from April 1987 to August 1990. All participants were male. The mean age was 75 years ± 7.3 (range 42–93 years).Main Outcome MeasurementsCharts were abstracted for demographics, advanced directives information, information about the arrest, and post‐resuscitation course.ResultsForty‐five elderly residents underwent resuscitation during this period. Nine residents (20%) were successfully resuscitated, with seven dying within 24 hours of hospitalization. No residents survived to return to long‐term care (95% CI, 0–7%). The diagnoses were consistent with age‐related chronic disease. Seventeen (38%) arrests were witnessed. The predominant rhythm at onset of resuscitation was asystole.ConclusionWe conclude that cardiopulmonary resuscitation, even when performed by a trained and experienced physician and team, has limited benefit for elderly

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02109.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo examine the characteristics of all individuals assessed as requiring nursing home care arising from a population living within a defined geographical region and to study the manner in which they presented for assessment.DesignClinical assessment by a physician in geriatric medicine with the assistance of other disciplines.SettingRegional Geriatric Assessment Service.SubjectsAll persons recommended for nursing home care within the study period.ResultsThe major diseases contributing to the need for nursing home care were organic brain disorders (60%) and stroke (32%). Dementia was present in 64% of cases; significant behavioral disturbance in 18%; severe communication disorders were frequent. The majority (86%) had been ill for greater than 1 year.The mode of presentation was acute in 9%, acute‐on‐chronic in 46%, and chronic in 45%. It was associated with significant differences in case characteristics including the location at the time of assessment, diagnoses, duration of illness, physical dependency, communication disorders, behavioral disturbance, and skilled nursing care requirements.ConclusionsThese observations suggest that progression to nursing home care varies considerably. Strategies directed toward the prevention of institutionalization should be organized in recognition of these variati

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02110.x

年代:1992

数据来源: WILEY