摘要:

Automatic postural responses and effector factors were examined in 10 persons with unexplained falls after clinical examination and 24 older controls. Fallers were more unstable than controls on clinical tests of balance (20% of fallers vs 79.2% of controls were able to stand on one foot (P<.005), 40% of fallers and 100% of controls were stable while turning in place (P<.001), postural stress test median score was 12 for fallers and 20 for controls (P<0.001). We found prolonged tibialis anterior latency (fallers 158.8 ± 23.7, controls 143.2±15.7 milliseconds, P=0.03), marked losses in ankle strength (dorsiflexion: fallers 3.2±2.9, controls 8.9 ± 4.2 foot‐pounds, P<0.001; plantarflexion: fallers 7.9 ± 5.3, controls 21.4 ± 11.1 foot‐pounds, P<0.001), and decreases in range of motion (ankle plantarflexion: fallers 29.2 ± 7.0, controls 37.8 ± 12.4 degrees, P=0.02). Gastrocnemius latency and electromyographic (EMG) measures of sequence showed no differences between fallers and controls. Sequence measures were not symmetric between the lower extremities in either fallers or controls. In this population of persons with unexplained falls who demonstrated substantial impairments in functional balance, effector factors appear more impaired than automatic postural responses. Alternatively, contemporary analysis of automatic postural responses may require further development before it can be useful to study balance problems in ol

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01642.x

年代:1991

数据来源: WILEY

摘要:

Malnutrition in the elderly is often unrecognized and untreated. Reduced secretion of growth hormone (GH) has been suggested as a cause of decreased muscle and bone mass with aging. This pilot study characterized the nutritional response of elderly malnourished subjects to recombinant human GH (rhGH). Subjects were included if they were over 60 years of age, if weight was more than 20% below average body weight (ABW), and if serum albumin concentration was less than 3.8 g/dL. Subjects were divided into two groups: one received 100 Hg/kg rhGH (Protropin®, Genentech) intramuscularly (IM) daily for 21 days; the other received a daily control injection of normal saline (Controls ‐ C) (0.1 mL/kg IM) for the same period of time.During the 3‐week period, mid‐arm muscle circumference (MAMC) increased an average of 0.6 cm in GH patients but fell in C subjects. There was a non‐significant trend to a decreased caloric intake in the control group. Weight increased an average of 4.95 lbs (2.2 kg) in the GH treated group, and decreased an average of 4.9 lbs (2.2 kg) in C subjects (P<0.05). Urinary nitrogen retention occurred only in the growth hormone treated subjects (P<0.05). Somatomedin C (IGF‐1) rose significantly in those treated with GH (P<0.05), while there was no change in the control group. There was a significant assocition between weight change and IGF 1 concentration (r = 0.837, P<0.05). Neither clinical edema nor hyperglycemia was noted. These findings suggest that GH may be an effective way of maintaining and enhancing weight in malnourished older i

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01643.x

年代:1991

数据来源: WILEY

摘要:

To determine if diabetes in the elderly is associated with increased prevalence of podiatric problems, a random sample of diabetic patients (n = 74) was compared to a group of elderly non‐diabetic patients (n = 79). The two groups were comparable in age (range 70–90 years), smoking habits, and consumption of alcohol. The mean duration of diabetes was 14.5 ± 11.7 years (± SD), and mean serum fructosamine level was 3.3 ± 0.66 mmol/L. The number of medical diagnoses and medications used was significantly higher in the diabetic group. Diabetic patients had modestly higher prevalence of neuropathy, vascular disease, kidney disease, and eye complications. The most common podiatric problem in both groups was elongated toenails. The prevalence of podiatric problems such as cellulitis, amputation, tinea pedia, onychomycosis, calluses, bunions, and hammer toe deformity were not increased in diabetic patients. Active foot ulcers were more common in diabetic patients (13/74 vs 5/79, P<0.05). It is concluded that diabetes in the elderly, unlike in young patients, increases the risk of foot problems only marg

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01644.x

年代:1991

数据来源: WILEY

摘要:

Thirty‐one subjects aged 75 years and over who were identified as suffering from mild, idiopathic dementia in a large community survey were reviewed at annual intervals for 2 years. Diagnoses and severity ratings were based on defined criteria following a mental state examination, a medical and psychiatric history, detailed cognitive testing, and an interview with relatives or other key informants. Fourteen subjects became more severely demented within 2 years. The initial cognitive test battery failed to reveal any differences between respondents whose dementia advanced and those whose condition remained unchanged, but, in the former group, subjects' symptoms had been present for longer, and a greater proportion had been recognised as demented, or possibly demented, by their general practitioners. We suggest that subjects whose dementia progressed had actually been more severely disabled at the time of identificatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01645.x

年代:1991

数据来源: WILEY

摘要:

This study compared the B complex vitamin status at time of admission of 20 geriatric and 16 young adult non‐alcoholic inpatients with major depression. Twenty‐eight percent of all subjects were deficient in B2 (riboflavin), B6 (pyridoxine), and/or B12 (cobalamin), but none in B1 (thiamine) or folate. The geriatric sample had significantly higher serum folate levels. Psychotic depressives had lower B12 than did non‐psychotic depressives. Poorer blood vitamin status was not associated with higher scores on the Hamilton Depression Rating Scale or lower scores on the Mini‐Mental State Examination in either age group. The data support the hypothesis that poorer status in certain B vitamins is present in major depression, but blood measures may not reflect central nervous system vitamin function or severity of affective syndromes as measured by the assays and scales in the presen

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01646.x

年代:1991

数据来源: WILEY

摘要:

Sleep apnea is characterized by transient hypoxemias which are thought to affect mental functioning. Accordingly, speculation and research have focussed on relationships between sleep apnea and dementia. We studied 235 nursing home (ie institutionalized) patients (152 women with a median age of 83.5; 83 men with a median age of 79.7) with portable sleep recording equipment. The Mattis Dementia Rating Scale and the Geriatric Depression Scale were given to each. Seventy percent of the patients had five or more respiratory disturbances per hour of sleep and 96 percent showed some dementia. Sleep apnea was significantly correlated with all sub‐scales on the dementia rating scale. There were trivial differences in dementia ratings between those with mild‐moderate apnea and those with no apnea. There were significant differences, however, between the latter two groups and those with severe apnea. In particular, items reflecting attention, initiation and perseveration, conceptualization, and memory tasks on the DRS distinguished between those with and without severe sleep apnea. Among those patients with no depression, all patients with severe sleep apnea were also severely demented. Our data suggest that there is a strong relationship between dementia and sleep apnea when the sleep apnea and dementia are severe. Although causality cannot be inferred from associations, our hypothesis for study is that sleep apnea causes deficits in brain function, possibly due to global effects rather than any particular cortical or subcortical struct

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01647.x

年代:1991

数据来源: WILEY

摘要:

The course of untreated mild hypothyroidism was followed in 67 nursing home residents (mean age 78 years). The diagnosis was based on a normal free thyroxine index (FTI) and elevated thyrotropin concentration (TSH 4.6 to 15.0 μIU/mL, nl ≤ 4.5 μIU/mL). FTI and TSH were measured in follow‐up>42–378 (mean 161) days after the diagnosis of mild hypothyroidism had been made. In 45 patients initial TSH was6.8 μIU/mL, TSH remained elevated at follow‐up. In 4 subjects whose initial TSH concentrations ranged from 5.0 to 9.6 μIU/ml, FTI fell below normal 91–141 days after the diagnosis of mild hypothyroidism was made. Clinical progression of the signs or symptoms of hypothyroidism was not detected in the 4 patients who developed hypothyroxinemia. Three demonstrated positive thyroid antibody titers, and 1 had myasthenia gravis. These observations suggest a need for replacement therapy in debilitated patients with mild hypothyroidism and evidence of thyroi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01648.x

年代:1991

数据来源: WILEY

摘要:

A review of 431 outpatient geriatric assessments conducted over 2 years examined the associations of referral problems, assessment diagnoses, and therapeutic recommendations with the source of patient referral, as well as that referral source's diagnostic accuracy in identifying the referral problems. Families referred 52% of patients, primarily for problems of memory and behavior, whereas social service agencies made 32.9% of all referrals, primarily for bladder control problems or safety‐related concerns. Physicians made only 6% of referrals in this setting. Referral source was found not to be associated with any of the seven categories of medical diagnoses resulting from the assessment process and was associated with only two of the functional diagnostic categories. Therapeutic recommendations were also broadly distributed among referral sources, though social service agencies did refer more patients who required urgent nursing home placement, financial representation, or adult protective service involvement. The performance of family referral sources in accurately referring patients with dementia and psychiatric impairment was comparable to that of physicians, though all referral sources frequently missed patients with incontinence. Non‐physician referral sources appear to serve as important and quite valid case‐finders for outpatient geriatric asses

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01649.x

年代:1991

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01650.x

年代:1991

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1991.tb01651.x

年代:1991

数据来源: WILEY