摘要:

The clinical features of 47 frail nursing home diabetic patients with a mean age of 81 ± 1.6 years were compared to those of 61 nondiabetic nursing home residents with a mean age of 80.2 ± 1.2 years. Diabetic patients had a higher prevalence of renal failure, proteinuria, retinopathy, neuropathy, and infections than did other nursing home residents. Macroangiopathic disease tended to be equally common in both age groups. Diabetic nursing home residents had higher body weights compared to nondiabetic nursing home residents. Surprisingly, however, 21% of nursing home diabetics were greater than 20% below average body weight (compared to 24.5% of other nursing home residents), suggesting that undernutrition is a major problem in diabetic patients in a nursing home setting. Overall, the diabetic nursing home patients had better blood glucose control than younger ambulatory diabetic patients (mean age 66.2 ± 4.7 years). The glycosylated heomglobin (HbA1) level in those on oral agents was 8.9% ± 0.7% for nursing home patients compared to 11.8% ± 0.7% in ambulatory patients (P<0.01). The HbA1in insulin‐treated patients was similarly lower in nursing home diabetics (9.6% ± 0.4%vs11.8% ± 0.7, P<0.05). There were only two mild hypoglycemic episodes in nursing home patients over 6‐month observation period, whereas 12 ambulatory patients reported hypoglycemic episodes during the same period of time. We conclude that although the diabetic nursing home patients are sicker than the ambulatory diabetics, it is possible to achieve a fair blood glucose control in nursing home patients without a significant risk of recurrent hy

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02376.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

This survey study of 1,798 Swedish health care workers in 31 acute and chronic institutional settings found considerable disagreement between staff concerning euthanasia. For example, attitudes of aides and LPNs, were significantly (χ2= 42.0, P<.0001) more favorable toward active euthanasia (38.9% of aides and 28.8% of LPNs were neutral or approved) than were RNs and physicians (20% and 14.9%). This disagreement was most apparent among those staff in institutions with many demented patients. Favorable attitudes were also more frequent among aides experiencing job dissatisfaction and “burnout,” younger staff, and those without a relative in long‐term care. Possible reasons for favorable attitudes toward active euthanasia and staff attitude polarization are discussed along with implications for patien

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02377.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The Cambridge Mental Disorders of the Elderly Examination (CAMDEX) was developed by Roth, et al (1986) to assist in the early diagnosis and measurement of dementia in the elderly. In this study the CAMDEX was administered to a mixed group of independently diagnosed elderly psychiatric patients and control subjects in the United States. The CAMDEX was found to have a high interrater reliability with a mixed group of clinicians of varying backgrounds. The diagnostic scales and the cognitive section of the CAMDEX demonstrated considerable promise in distinguishing between independently diagnosed populations of depressed, demented, and normal subjects. The results suggest comparability between samples of subjects in England and the US, and that the CAMDEX is a promising instrument for use in both research and clinical settings.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02378.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

This study examined the administration of psychotropic medication to Medicaid recipients who resided continuously in an Illinois nursing home during 1984. Of these residents, 20,037 (60%) received at least one such medication during the year, with administration most likely for those from the ages of 45 to 74 years. Haloperidol, thioridazine, and flurazepam were the most frequently prescribed drugs of those examined.The study also investigated the relationship of demographic and institutional variables to the probability of drug administration and the amount administered. These variables were most strongly related to the probability of antipsychotic, antiparkinson, and antimanic (lithium) administration. The association of these variables with the amount of drug administered was strongest for antimanic and antipsychotic medications, particularly the latter. In all analyses, the addition of institutional variables increased goodness of fit minimally over that produced by demographic variables alone. This finding supports the conclusion that the prescription of psychotropic medication is more influenced by individual patient characteristics than by the nature of the institutional setting in which the patient resides.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02379.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

To identify important factors in the refusal of hospitalization by elderly patients, a study was conducted of 35 such “refusers” on the Home Medical Service (HMS) of University Hospital and a comparison group of 70 patients who accepted hospitalization. Data were collected from health care providers and patient records at entry and six weeks later. The two groups were compared on the basis of demographic factors, health care factors, medical condition, and outcomes. Reasons for refusal were most commonly related to a negative perception of the health care system or a passive acceptance of death. Refusers were significantly less ill than acceptors and did not change in health or functional status at follow‐up. The results suggest that refusal of hospitalization is most often related to interaction with the health care system and that less ill patients may have reasonable outcomes when treated at

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02380.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Exercise treatment has become generally accepted as therapy for some types of vertigo. Benign paroxysmal positional vertigo (BPPV) has been very successfully treated by vestibular habituation training (VHT). This is an exercise treatment whereby the patient is repeatedly exposed to the maneuvers eliciting vertigo. Elderly patients treated by VHT also showed very satisfying results, albeit the therapeutic effect developed somewhat slower than in the younger patients. In the scope of the problem of “falling in the elderly,” the therapeutic effect for BPPV is worth emphasiz

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02381.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The current analysis was designed to examine further the association between total serum carotenoids and a series of preselected variables (dietary intakes, anthropometric parameters, serum cholesterol, vitamin A, transport proteins, and others) using 85 elderly patients.Simple correlation between serum carotene and carotene intake, as estimated by a three‐day weighed method, was 0.19 (P = 0.08), which was substantially increased (r = 0.29, P = 0.01) after adjustments for a selected set of variables. Standardized coefficients of multivariate regression indicated that the most important predictors of serum carotene were serum cholesterol (β = 0.38), total serum proteins (β = —0.35), and sex (β = 0.34), followed by carotene intake (β = 0.28) and midarm circumference (β= 0.20). These variables accounted for 46% of the variance. Results suggest that serum carotene may be related to protein‐energy status in hospitalized elderly, but further investigation should be directed to serum carotene in undernourished elderly. Nevertheless, total serum proteins could be an important factor in any attempt to correlate carotene intake and blood con

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02382.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

We evaluated the Jelliffe and the Cockcroft and Gault methods of estimating creatinine clearance in elderly nursing home patients (65 years) with chronic indwelling urethral catheters. Although these relationships have been prospectively validated in hospitalized and ambulatory populations previously, we found that they produced poor estimates of creatinine clearance in this patient group. For the Jelliffe method, 11 of 19 estimates were 20% or greater from the measured value; 10 of 11 poor estimates were high. The Cockcroft‐Gault method had 10 of 19 estimates 20% or greater from the measured value with 8 of 10 of the poor estimates being high. An altered relationship between body weight, muscle mass, and daily creatinine production is the most likely explanation for the bias in these creatinine‐clearance estimations. New estimates of the relationships between age, weight, serum creatinine, and creatinine clearance need to be developed for this populat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02383.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02384.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb02385.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY