摘要:

ABSTRACT:This lecture presents an outline of early historical observations on pulmonary disorders in relation to age, as well as current studies on respiratory‐tract defense mechanisms, with particular reference to pneumonia. Special attention is paid to the prevention of pneumococcal pneumonia by means of vaccines. Although much remains to be learned about this vaccine and its efficacy in some segments of the population at high risk from pneumococcal infection, current knowledge regarding its safety and efficacy warrants its more extensive use. Included are interesting notes on Osier's ambivalent attitude toward pneumonia in old age and his stimulating ideas on retirement, patterned after Trollope's writings, which contain an early cost‐benefit analysis for events set in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03349.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:A rational approach to the diagnosis of osteoporosis by the primary care physician is outlined, with emphasis on the patient who presents with chronic back pain and a vertebral compression fracture. The basic information includes data from the patient's history and physical examination, laboratory, x‐ray and bone biopsy studies, and determination of bone mineral content (BMC) by photon absorptiometry. Characteristic radiologic features associated with bone loss, BMC changes, and bone biopsy findings are illustrated. This diagnostic approach, summarized in a flow diagram, poses a series of questions; the answer to each question leads either to a diagnostic conclusion or to further questions which must be answered. This permits decision as to whether a compression fracture is due to trauma, local osteoporosis, osteomalacia, secondary osteoporosis or primary osteoporosis. In the study population (150 subjects), 80 percent of patients presenting with vertebral compression fractures had primary osteoporosi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03350.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:A common clinical entity in the elderly population is the systolic murmur detected during cardiac auscultation. Although it can occur in patients of any age group, the approach to diagnosis differs in the elderly. Two cases are presented which illustrate different pathologic processes that can result in the development of a systolic murmur. The prevalence of this entity in the elderly is highlighted, and a strategy for diagnosis is outlined.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03351.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:A schema for future research and efforts to remediate abuse of the elderly is presented. In the community at large, increased exposure of and education pertaining to the elderly are needed in order to intensify the public/community presence and reduce prejudices. In the medical community, improvements are needed in the extent of geriatric training, the ethics of pronouncement of death, the reliability of clinical documents, and the reporting of suspected cases of abuse. In the legal community, there is need for laws prohibiting abuse and neglect, and providing opportunity for recovery of minimum damages, with covering of attorney's fees and court costs. It is proposed that the administrative process be altered so as to provide either a financial penalty for abuse and neglect, or a reward for providing superior care.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03352.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:Scant attention has been paid to the objective evaluation of insomnia as a function of age, particularly with reference to increased drug sensitivity and resulting loss in balance performance. Therefore, the electroencephalographic sleep and the balance‐board performance of 10 young and 12 geriatric insomniacs were studied under baseline and hypnotic drug (ketazolam) conditions. In terms of objectively measured sleep, the geriatric insomniacs had worse sleep on every dimension except sleep latency and percentage of stage‐2 sleep. These differences between aged and young insomniacs, however, were no greater than might be expected as a function of normal aging. Drug‐age interactions indicated that ketazolam differentially increased sleep efficiency, decreased the percentage of REM sleep, and eliminated any learning improvement on the balance board in geriatric versus young insomniacs. The findings indicate that the geriatric subjects were more sensitive to the hypnotic drug, in that their sleep improved to a greater extent. However, an important loss in balance performance was also obs

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03353.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:The relative importance of dementia, gender, age and functional status (FS) was examined for relationships to mortality within five years after admission of the subjects to a New York City nursing home for the aged. Using a random sample of 212 of the nursing home's patients, a statistical model was developed to estimate the relative risk of mortality. When this model was cross‐validated on an independent sample of 118 residents, it failed to show significant lack of fit. Given these results, an international model was developed by combining the New York City samples (N = 330) and comparing them to a sample (N = 363) from a nursing home in Tokyo, Japan. In the New York model, gender was the most important predictor, with age and dementia next in importance; FS was not a significant predictor. Despite the apparent differences in the types of dementia in the New York and Tokyo nursing homes, the mortality patterns were simila

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03354.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:In a skilled nursing facility, 36 patients (chiefly elderly) with persistent urinary incontinence were the subjects of this study. In their management, the usual disposable pads were compared with a new launderable bed sheet (Kylie) which absorbs urine in the second layer while maintaining a dry surface next to the patient's skin. There was a 42 percent reduction in the frequency of bedding changes with the new bed sheets. The patients experienced increased comfort due to decreased skin wetness and decreased creasing of the sheets. The reduced frequency of bed linen changes permitted longer undisturbed periods for the patient. Management costs were reduced by 40 percent with the launderable bed sheets. There were no adverse effects on the condition of the patients or in the quality of care.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03355.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:The elderly are widely believed to be predisposed to adverse drug reactions, chiefly because of the large quantities of drugs they consume, combined with the effects of aging on distribution, metabolism, and the patterns of drug usage. These beliefs affect the physician's prescribing behavior. To study the validity of these concepts, the supporting medical literature was reviewed. Existing studies of the rates of adverse drug reactions have several methodologic limitations, including inadequate control for disease severity, the use of calculation denominators which overestimate incidence, and dependence upon definitions of medication error rates which do not adequately reflect the potential for adverse outcome. Further studies are needed for clarification of drug‐use patterns and problems among the elderl

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03356.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:An analysis is presented of a geriatric evaluation unit (GEU) established at the Sepulveda VA Medical Center in 1979 to provide comprehensive interdisciplinary assessment and treatment of geriatric inpatients. The data on 74 patients admitted during the first year show that major improvements can occur in several outcome areas. Placement location was improved over expectations in 48.4 percent of patients, thus permitting a higher level of independence with a lower level of care requirements. Functional status (Katz ADL scale) improved in two‐thirds of the patients who could have shown improvement. An average of almost four new treatable disorders not noted by previous physicians were diagnosed per patient. The mean daily number of prescribed drugs was reduced by 32 percent per patient, and the total number of drug doses by 43 percent. Though limited by the unique aspects of the VA situation and by lack of a control group, the findings lend support to the efficacy and value of the GEU concept. (A randomized controlled study is in progress

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03357.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT:Self‐ratings of memory were studied in 69 institutionalized women. The patients also were evaluated by means of three screening tests for organic brain syndrome (OBS) and a hypochondriasis scale. A negative correlation existed between self‐rating of memory and actual memory as measured by the screening tests for OBS, but it was significant (p<.05) for only one of the tests. There was also a negative correlation (p<.01) between memory rating and scores on the hypochondriasis scale. Therefore, clinicians should not take patients' memory complaints as valid indicators of OBS, but as possible indicators of hypochondria

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1981.tb03358.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY