摘要:

ObjectiveTo determine whether an activity‐based test of balance and gait is predictive of the risk of: (1) falling in situations that are related to specific tasks evaluated as part of the test, (2) experiencing falls precipitated by different classes of biomechanical events, or (3) falling in general; and to compare the predictive ability of the activity‐based test for the falls described in (2) and (3) to that of a posturography test that has been found previously to be predictive of falling risk.DesignCohort study.SettingBaseline tests performed in balance laboratory; subsequent history of falling monitored prospectively for 1 year in two residential‐care facilities.ParticipantsSeventeen male and 83 female consecutive volunteers (mean age = 83, SD = 6) who were independent in activities of daily living and able to stand unaided.MeasurementsIndependent variables were derived from an activity‐based balance‐and‐gait test and a posturography test. Dependent variables were the numbers of subjects with one or more: (1) falls in specific situations related to activity‐based test items, (2) falls related to general classes of biomechanical precipitant, and (3) falls in general.Main ResultsSubjects who were rated as “abnormal” in activity‐based test items related to transfers, turning or reaching were more likely to experience one or more falls in related situations in everyday life. Activity‐based scores were predictive of risk of experiencing falls with no obvious biomechanical precipitant and falls precipitated by center‐of‐mass perturbation, but not falls precipitated by base‐of‐support perturbation. In comparison, a posturographic measure of spontaneous medial‐lateral postural sway (blindfolded conditions) failed to predict falls having no biomechanical precipitant, but provided the best predictions of both center‐of‐mass and base‐of‐support falls, as well as risk of falling in general.ConclusionsActivity‐based testing of certain tasks (transfer, turning, reaching) may be useful in indicating a specific need for intervention to reduce the risk of falling during related everyday activities. In terms of predicting falling risk, a static posturography test may provide better prediction overall of the different classes of falls and may be useful as a quick and simple screening to

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01881.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo audit the outcome of temporary endocardial pacing in an elderly population.DesignRetrospective case‐series analysis.SettingThe Department of Medicine for the Elderly at the Wrexham Maelor Hospital, a District General Hospital with 612 beds serving a catchment population of 220,000.SubjectsA sample of 50 consecutive elderly patients, with an age range of 65 to 99 years, undergoing transvenous cardiac pacing.Main Outcome MeasuresLength of stay in hospital, complications of the pacing procedure, whether a permanent pacemaker was installed, and whether the patient died within 1 month of admission.ResultsThere was no difference in length of stay between those with a myocardial infarction and those without. Minor complications occurred in three patients (one local infection and two “failures to pace”). Major complications occurred in two patients (septicemia and pneumonia). More patients without a myocardial infarction (86.9%) went on to implantation of a permanent pacemaker than those with an infarction (11.1%,P= 0.001), and fewer of them died (8.7% compared with 48.1%,P= 0.0025). In those patients with a myocardial infarction who died, there was no difference between the proportions who had inferior (7/18) and anterior (5/9) infarctions.ConclusionCardiac pacing seems to be a safe and reliable procedure in the elderly, although long term morbidity and mortality may be dependent on the presence or absence of myocardial ischaemic disease. Myocardial infarction in the elderly is an event of major significance, carrying with it a high mortality rate, particularly if accompanied by cardiogenic shock and the need for cardiac p

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01882.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine medical, ophthalmologic, and demographic predictors of cognitive function scores as measured by the Telephone Interview for Cognitive Status (TICS), an adaptation of the Folstein Mini‐Mental Status Exam. A secondary objective was to perform an item‐by‐item analysis of the TICS scores to determine which items correlated most highly with the overall scores.DesignCross‐sectional cohort study.SettingThe Glaucoma Consultation Service of the Massachusetts Eye and Ear Infirmary.Subjects472 of 565 consecutive patients age 65 and older who were seen at the Glaucoma Consultation Service between November 1, 1987 and October 31, 1988.MeasurementsEach subject had a standard visual examination and review of medical history at entry, followed by a telephone interview that collected information on demographic characteristics, cognitive status, health status, accidents, falls, symptoms of depression, and alcohol intake.ResultsA multivariate linear regression model of correlates of TICS score found the strongest correlates to be education, age, occupation, and the presence of depressive symptoms. The only significant ocular condition that correlated with lower TICS score was the presence of surgical aphakia (modelR2= .46). Forty‐six percent (216/472) of patients fell below the established definition of normal on the mental status scale. In a logistic regression analysis, the strongest correlates of an abnormal cognitive function score were age, diabetes, educational status, and occupational status. An item analysis using step‐wise linear regression showed that 85 percent of the variance in the TICS score was explained by the ability to perform serial sevens and to repeat 10 items immediately after hearing them. Educational status correlated most highly with both of these items (Kendall TauR= .43 and Kendall TauR= .30, respectively).ConclusionEducation, occupation, depression, and age were the strongest correlates of the score on this new screening test for assessing cognitive status. These factors were stronger correlates of the TICS score than chronic medical conditions, visual loss, or medications. The Telephone Interview for Cognitive Status is a useful instrument, but it may overestimate the prevalence of dementia in studies with a high prevalence of persons with less than a high schoo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01883.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo study the efficacy of quinine in the prevention of nocturnal leg muscle cramps.DesignDouble‐blind, randomized, crossover trial with four periods of observation, each lasting 2 weeks.SettingGeneral internal medicine outpatient clinic.ParticipantsAmbulatory outpatients who experienced an estimated two or more typical nocturnal leg cramps per week.Intervention200 mg of quinine taken at bedtime.Main Outcome MeasuresSelf‐reported ratings of leg cramp frequency, duration, and intensity.ResultsSixteen patients completed the trial. During the 2 weeks patients used quinine, there was no statistically significant reduction in mean leg cramp number (quinine 3.5 vs placebo 4.2, P = 0.48), mean leg cramp duration (quinine 152 seconds vs placebo 163 seconds,P= 0.89), or patient ratings of severity using a 1 (low) to 10 (high) scale (quinine = 4.2 vs placebo = 4.0,P= 0.83).ConclusionNo significant reduction in nocturnal leg cramp frequency, intensity, or duration could be found using nightly quinine in this study. Since quinine is not without the potential for side effects and drug interactions, clinicians need to carefully consider the likelihood of modest benefit associated with quinine against the potential for side effects and drug‐drug interac

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01884.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo study tubular urate transport in Alzheimer's disease (AD) and measure sodium and lithium transport rates in rats exposed to AD plasma.DesignCross‐sectional study in three comparison groups.SettingReferral private institution involving outpatient and hospitalized patients.PatientsAD, multi‐infarct dementia (MID) and non‐demented controls (C) were selected and evaluated by a geriatrician and a psychiatrist according to availability and willingness to participate in the study. Demented patients had brain imaging, categorized according to NINCDS‐DSM III criteria, and had Mini‐mental status examination (MMSE) scores determined.InterventionsInjection of 0.5 mL of plasma I.P. followed 120 minutes later by an IV plasma injection of 0.2 mL priming dose and infusion of 1.8 mL of plasma at 0.01 mL/min in Sprague Dawley rats.MeasurementsRenal clearance studies were performed in subjects and in rats exposed to the plasma of study subjects. We measured serum urate concentration and fractional excretion (FE) of urate in subjects and FE sodium and FE lithium in rats.ResultsSerum urate was lower and FE urate higher in 18 AD patients compared with six patients with MID,P<0.05 andP<0.005, and 11 C,P<0.02 andP<0.005, respectively. Higher FE sodium and FE lithium were noted in rats given plasma from 19 AD patients compared with 12 with MID,P<0.005 andP<0.0025, and 14 C,P<0.0025 andP<0.0005, respectively. FE sodium and FE lithium decreased progressively after serial dilutions of three AD plasmas and FE lithium was negatively correlated with MMSE scores only in AD,r= ‐0.71 andP<0.0005.ConclusionsIn AD there is defective tubular urate transport and a plasma natriuretic factor(s). FE sodium and/or FE lithium in rats exposed to plasma of demented patients may differentiate AD from MID and estimate the sev

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01885.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo examine the behavioral and functional problems of the cognitively impaired.DesignA survey of a cohort of residents from six nursing homes.ParticipantsSubjects were randomly selected based on a minimum age of 70 years and a Resource Utilization Group (RUG) classification of the Physical or Behavioral type. Of those eligible, 44% (n= 366) agreed to participate. The participants and non‐participants had similar demographics except for a higher incidence of mental illness in the non‐participant group, which did not have a significant impact on agitation.SettingSix nursing homes in New York City, three voluntary non‐profit and three proprietary.MeasurementThe study used chart review, assessment of residents' cognitive and functional abilities, nursing assistants' ratings of residents' functional abilities, behavioral problems, and the amount of effort required in care, and time‐motion observations of staff‐resident interactions.ResultsResidents' level of cognitive impairment had a significant impact on problem behaviors during ADL tasks, along with supervision required in patient care (P<0.05). These results were validated by time‐motion analysis. Regression analysis revealed that for non‐demented subjects, the best indicator of care needs was health status, while for demented residents the best indicator was cognitive status (P<0.0003).ConclusionsThe care needs of residents with dementia are better estimated by a mental status test for cognitive impairment then by ADL assessment alone. Greater agitation is associated with increasing cognitive impairment. Further, agitation and behavioral problems associated with care result in a need for increased staf

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01886.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo evaluate the effects of short‐term administration of chlorothiazide on fasting urinary hydroxyproline, an index of bone resorption, and other bone‐related biochemical parameters in normal post‐menopausal women.DesignSubjects served as their own control before and after chlorothiazide treatment.SettingSubjects were recruited by advertisement.ParticipantsThirteen healthy post‐menopausal women with a mean age of 65 years.InterventionEach subject was given chlorothiazide 500 mg bd po for 7 days. Fasting blood and urine samples were obtained immediately before the commencement of chlorothiazide (day 1) and 2 and 7 days after starting chlorothiazide.ResultsChlorothiazide decreased the urinary calcium/creatinine (mean value day 1, 0.267; day 2, 0.143; day 7, 0.135; P<0.001) and hydroxyproline/creatinine (day 1, 0.0192; day 2, 0.0145; day 7, 0.0139;P<0.02) molar ratios.ConclusionChlorothiazide decreases fasting urinary hydroxyproline, a marker of bone resorption in post‐menopausal women. This observation supports a potential role for thiazide diuretics in the prevention of osteoporosis. The observed fall in urinary hydroxyproline is of the same order as that seen after treatment with estrogen or calcium su

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01887.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo examine the association between self‐reported pain and cognitive impairment among frail elderly institution residents.DesignA cross‐sectional correlational study.SettingA large urban nursing home and congregate apartment complex housing predominantly Jewish elderly.ParticipantsSeven hundred fifty‐eight elderly institution residents (30% in the nursing home, 70% in congregate apartments). The sample was 70% female and averaged 83.3 years of age.MeasurementsRespondent self‐reports tapped pain intensity, number of localized pain complaints, cognitive status, and disability in performance of activities of daily living. Attending physicians or physician assistants rated respondents health status.Main ResultsPain intensity and number of localized pain complaints bore small but significant negative relationships to cognitive impairment. Pain was positively associated with physician‐rated ill health and functional disability. The association between pain and cognitive status remained significant even when controlled statistically for effects of physical health and functional disability. Item‐by‐item examination of localized pain complaints indicated that markedly cognitively impaired individuals were less likely to report pain in the back and joints. However, examination of possible physical causes of reported pain revealed no differences between pain reports of cognitively impaired versus intact individuals in either the presence or the absence of a likely physical cause.ConclusionsThese data provide no evidence for the “masking” of pain complaints by cognitive impairment. They suggest instead that, although cognitively impaired elderly may slightly underreport experienced pain, their self‐reports are generally no less valid that those of cognitively intact individuals. Limitations of the research are acknowledged and implications for treatment of cognitively impaired institution resi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01888.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo determine whether the ankle‐arm blood pressure index is a useful predictor of mortality in a large group of patients aged 50 or older.DesignCohort study over a 13‐year period.SettingPeripheral vascular laboratory in a hospital affiliated with an academic health center.Participants1,027 male and 903 female patients referred for arterial evaluation.Outcome MeasuresAll‐cause and cause‐specific mortality.ResultsA decrease in ankle‐arm index was a strong independent predictor of all‐cause mortality [relative risk (RR) for men = 1.8(95% CI 1.5, 1.9); for women = 1.5, (1.2, 2.0)] and atherosclerotic heart disease mortality [RR for men = 2.0 (1.4, 2.9); for women = 2.1 (1.4, 3.1)]. The risk of mortality was inversely proportional to the ankle‐arm index. No relationship was found between the index and mortality due to stroke or cancer.ConclusionsThese results suggest that a decreased ankle‐arm index has important prognostic significance for mortality due to atherosclerotic heart disease in older men and women. Measurement of this index may be useful in identifying those at high risk who may benefit from aggressive therapeut

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01889.x

年代:1993

数据来源: WILEY

摘要:

ObjectiveTo study the acute effects of non‐strenuous physical exercise on memory retrieval and visuo‐motor performance in old‐old nursing home residents.DesignA randomized control trial.SettingA nursing home.ParticipantsAmbulatory volunteers from the nursing home, with all 20 shown to be normal on mental status. Three were male and 17 female, with a means of 84.5 years for age and 9.3 years for education. They were divided at random into an exercise and a control group.InterventionA single 15‐minute standardized bout of non‐strenuous exercise administered independently to each participant in the exercise group. Control group participants watched a video of similar exercises for 15 minutes.MeasurementsTwo measures requiring the retrieval of category instances with semantic or initial consonant cues. Retrieval time was 60 seconds for each of four categories per measure. Visuo‐motor performance was measured by Symbol Digit coding. Testing sessions were held before exercise, immediately post‐exercise and 30 minutes post‐exercise.ResultsThe group‐by‐time interaction was significant only for semantically cued memory (P<0.01), with higher retrieval at post‐testing only in the exercised group. The higher retrieval was mainly attributable to more new items retrieved by the exercise group at the immediate post‐test (P<0.05).ConclusionsThis study provides preliminary support for the hypothesis that non‐strenuous physical exercise has positive acute effects on

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1993.tb01890.x

年代:1993

数据来源: WILEY