摘要:

PURPOSE: The present study was conducted to assess the policies and practices of nursing homes in regard to immunizations for residents and employees.METHODS: A 20‐item, cross‐sectional survey was mailed to all 445 Minnesota nursing homes from May through July 1993. Questions asked were about facility characteristics and their policies, practices, and attitudes regarding immunizations for residents and employees. Second and third mailings were sent to nonresponding institutions.RESULTS: The median size of the 399 (90%) responding institutions was 88 beds and 110 employees. The median number of residents on December 1, 1992, was 84. Although 99% of the facilities had an influenza vaccination program, only 69.3% had written policies. The mean influenza vaccination rate for residents was 84%, with higher rates in institutions having written policies, facility‐wide standing orders for vaccine administration, and in institutions that did not require written consent for vaccination. One‐third of the facilities had written policies for pneumococcal vaccination, and 16.3% had policies for tetanus/diphtheria. Twelvemonth immunization rates for these vaccines were 11.9% and 2.9%, respectively. Most facilities had an influenza vaccination program for employees with a mean vaccination rate of 33%. These rates were higher if the facility offered vaccine onsite, free of charge, and provided special inservice education to employees. Employee 12‐month vaccination rates for hepatitis B and tetanus/diphtheria were 23.2% and 1.7%, respectively. Few of the institutions included evaluation of immunization activities in their quality assurance programs.CONCLUSION: Many long‐term care facilities have inadequate policies and practices for ensuring their residents and employees immunity to important vaccine preventable diseases. These institutions, as caretakers for a vulnerable population, should develop and implement organized programs to immunize their residents and employees. By doing so, they will be able to take advantage of important opportunities to prevent illness and protect the health of their residents and employees.J Am Geriatr Soc 44:34

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06401.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine how modifications of key chair design aspects, such as seat height, posterior seat tilt, backrest recline, seat compressibility, and armrest placement, affect how older adults rise from a chair and the seating comfort they experience.DESIGN: Cross‐sectional comparisonSETTING: Congregate housing facility and university laboratorySUBJECTS: Two groups of volunteers, Old (n = 29, mean age 84) and Young (n = 21, mean age 23).MEASUREMENTS: Analysis of time to rise, body motion (determined by use of digitized videotaping), and self‐reported difficulty when subjects rose from a variety of controlled chair settings thought to represent important chair design specifications encountered by older adults. Subjects also reported their comfort while being seated in these settings.RESULTS: Lowered seat height, increased posterior seat tilt and backrest recline, and perhaps increased seat compressibility cause increased time to rise, increased body motion, and increased self‐reported ratings of rise difficulty in both Young and Old groups. Under the most challenging conditions, the effect appears to be stronger in the Old than in the Young: a few Old were unable to rise, and the Old took disproportionately longer to rise and used disproportionately greater neck motion (Pgenerally<0.001) compared with the Young. Arm rest placement did not alter rise performance or ratings significantly. The conditions in which rise difficulty increases or decreases do not correspond exactly to conditions in which comfort increases or decreases. Some aspects that increase rise difficulty, such as tilt/recline and seat compressibility, may also increase comfort.CONCLUSIONS: Aspects of chair design such as lowered seat height, increased posterior seat tilt, increased back recline, and increased compressibility interfere with chair egress in older adults. While decreasing ease of egress, however, these same factors may increase seating comfort. Furniture designers and manufacturers must find a balance between degree of sitting comfort, ease of egress, and the degree to which the seating device facilitates functional independence, particularly to meet the needs of disabled older adults.J Am Geriatr Soc 44:356–36

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06402.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine the frequency and characteristics of homebound older adults in a rural community.DESIGN: An epidemiological survey of an age‐stratified random community sample.SETTING: The rural mid‐Monongahela Valley in Southwestern Pennsylvania.PARTICIPANTS: A total of 878 noninstitutionalized persons aged 68 years and older, fluent in English, and with at least grade 6 education.MEASUREMENTS: The frequency with which subjects left their homes, the Mini‐Mental State Examination (MMSE) score, and additional information on demographics, self‐reported health problems, health services utilization, IADLs, depression, and social support were measured.RESULTS: 10.3% of the sample was classified as home‐bound. In univariate analyses, being homebound was found to be associated significantly (P<.001) with being older, female, and widowed and with MMSE and IADL impairment, with more depressive symptoms and worse social supports, fair to poor self‐rated general health, weight loss, and histories of stroke, angina, arthritis of the spine, and falls. In a multiple regression model, variables associated independently with homebound status were gender (odds ratio = 9.4, 95% confidence interval = 3.6 − 24.9), weight loss (OR = 3.7, CI = 1.7 − 8.2), IADL impairment (OR = 2.6, CI = 2.1 − 3.1), and depressive symptoms (OR = 2.1, CI = 1.3 − 3.2). Being homebound was also associated with recent acute hospitalization and use of home health and social services.CONCLUSIONS: These data provide evidence that homebound older adults have a disproportionate share of morbidity and disability and suggest a sociodemographic and clinical profile to help identify those older people at risk of being or becoming homebound. They also point to the need for home‐based health services for the older adults, particularly in medically underserved communities such as rural areas.J Am Geriatr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06403.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: To determine whether there is a group of recent hip fracture patients who exhibit the signs of failure to thrive and to identify potential precursors to their decline in physical functioning.DESIGN: Prospective (nonintervention) study of hip fracture recovery; patients were assessed in the hospital and at 2, 6, 12, 18, and 24 months post‐fracture.SETTING: Hip fracture patients admitted to one of eight Baltimore area hospitals from the community with a new fracture of the proximal femur between January 1, 1990, and June 15, 1991.PARTICIPANTS: Patients were 65 years of age and older and lived in the community before the fracture. A total of 804 patients were eligible for the study; the present study analyses were restricted to the 252 patients who survived 1 year and had a self‐report assessment at 6 and 12 months post‐fracture.MEASUREMENTS: A questionnaire administered during hospitalization assessed pre‐fracture functional and health status and current affective and cognitive status. In‐home interviews post‐fracture ascertained dependence and difficulty with physical and instrumental activities of daily living. Abstraction of the medical records provided information about comorbidities, surgical procedure, and hospital length of stay.RESULTS: Patients who declined in ability to walk from 6 to 12 months post‐fracture had greater use of health resources (more hospitalizations) and poorer physical functioning up to 2 years post‐fracture. Impaired function in physical activities of daily living at 6 months, high glucose, calcium, and CO2at admission, and low BUN and creatinine at admission were more prevalent among decliners than among non‐decliners.CONCLUSIONS: Findings indicate that certain older hip fracture patients begin to exhibit signs and symptoms of failure to thrive. About 10% of patients who survived at least 1 year after fracture could not retain their recovery level of functioning after 6 months and began to decline further. High glucose and CO2and low BUN and creatinine on hospital admission were associated with later functional decline among hip fracture patients, but their clinical significance is uncertain.J Am Geriatr Soc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06404.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine demographic, functional, and health‐related factors that may have influenced the selection of older adults for a randomized trial of balance enhancement.DESIGN: Comparison of participants with nonparticipants at various stages of the recruiting process.SETTING: Northeastern suburban community.PARTICIPANTS: Registered voters aged 75 and older (n = 7191).MEASUREMENTS: Demographic, health‐related, functional, balance, gait, and falling characteristics.RESULTS: The overall participation rate in the randomized trial was 1.5%. Compared with nonparticipants, participants were significantly more likely to be male, married, living with others, living in a house, highly educated, healthy, and physically active.CONCLUSION: Recruiting older subjects by mail to studies of rigorous interventions can produce significant selection biases that may limit the population to which results can be generalized.J Am Geriatr Soc 44:377–382,

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06405.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: Although postprandial and orthostatic hypotension are commonly observed in nursing home residents, their reproducibility, relationship to each other, and association with chronic use of cardiovascular medications are poorly understood.DESIGN: We examined blood pressure (BP) and heart rate (HR) before and after postural change, and before and after a 419‐kcal meal in 22 nursing home residents (mean age 89 ± 5 (SD) years), each on two occasions, to determine reproducibility of changes. These studies were repeated in 17 residents, with and without previous administration of cardiovascular medications, in random order.SETTING: Hebrew Rehabilitation Center for the Aged, an academic long‐term care facility.RESULTS: Systolic BP declined an average (± SE) of 16 ± 4 mm Hg and 12 ± 4 mm Hg during the first and second meal studies, respectively. Mean intra‐class correlation of postprandial systolic BP values during the two studies was 0.88 (95% CI 0.85–0.97). Systolic BP increased significantly during the first posture test to a maximum of 8 ± 6 mm Hg at 6 minutes. There was no significant difference over time in postural systolic BP between the two tests. Repeated postural studies showed a mean intra‐class correlation of 0.72 (95% CI 0.62–0.92) for changes in systolic BP. Cardiovascular medications had no additional effect on mean postprandial or orthostatic BP and HR changes. During the first studies, 10 subjects had postprandial hypotension, and three subjects had orthostatic hypotension, but only two of 22 subjects had both.CONCLUSIONS: Patterns of systolic BP response to meals or postural change are reproducible. BP responses to meals and postural change seem to be unaffected by potentially hypotensive medications in chronic users. Postprandial hypotension is distinct from orthostatic hypotension, occurring more commonly than orthostatic hypotension and infrequently together in the same patients.J Am Geriatr Soc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06406.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: To investigate the impact of age as a prognostic factor in older patients with breast cancer and to discuss the role of surgery in this category of patients.DESIGN: A retrospective study.SETTING: A tertiary care university teaching hospital.PARTICIPANTS: One hundred ninety patients aged 70 years or older (mean age: 75 years) were treated for breast cancer from 1967 through 1991. These patients were compared with 190 younger patients (mean age: 52 years) and matched on the basis of T and N categories (TNM staging system) and surgical procedures.MEASUREMENTS: Disease‐free survival, breast cancer‐specific survival.RESULTS: The 10‐year actuarial breast cancer‐specific survival was 66% for older patients and 56% for younger patients (P= .224). The 10‐year actuarial disease‐free survival was 54% for older patients and 45% for younger patients (P= .136). Univariate and multivariate survival analysis revealed that tumor size and nodal stage were significant prognostic factors for both older and younger patients.CONCLUSION: Treatment with curative intent, similar to that adopted in younger patients, is appropriate for women over the age of 70 with breast cancer.J Am Geriatr Soc 44:39

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06407.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine the epidemiology, clinical characteristics and natural history of nursing home residents with a diagnosis of Parkinson's disease (PD).DESIGN: A cohort study with 18‐month follow‐up utilizing resident assessments from the National HealthCorp 1991–1992 dataset.SETTING: Seventy‐one National HealthCorp nursing homes.PARTICIPANTS: A total of 5020 nursing home residents older than age 55 were studied. Residents with primary and secondary diagnoses of PD were identified from the population using theInternational Classification of Diseases, Ninth Revision, Clinical Modification code 332.0.MEASUREMENTS: Baseline demographic and clinical characteristics were compared for residents with and those without Parkinson's disease. Outcome measures over the course of 18 months included death and functional status.RESULTS: The prevalence of a diagnosis of PD was 6.8%. Significant factors associated independently with PD included: younger age (79 ± 7 vs 81 ± 9 years;P<.001), male sex (32% vs 23%;P<.001), severe dependence in activities of daily living (OR = 1.26; 95% CI 1.08–1.46), impaired body control (OR = 1.38; 95% CI 1.03–1.68), symptoms of depression (OR = 1.29; 95% CI 1.02–1.64), and the number of daily medications (OR = 1.23; 95% CI 1.08–1.44). Residents with a diagnosis of PD had a faster rate of functional decline over 18 months (P<.001) but did not have a higher mortality rate than residents without PD.CONCLUSIONS: Parkinson's disease is a relatively common diagnosis among nursing home residents and is associated with increased functional disability. There are several potentially modifiable conditions associated with PD that may offer an opportunity to design specific interventions and health services to improve the quality of life and slow functional decline in this frail population.J Am Geriatr Soc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06408.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: Controversy exists as to whether Alzheimer's disease (AD) patients should be told their diagnosis, yet no research has been done examining older patients' attitudes on this topic. This study examines patient's attitudes toward this topic.DESIGN: A prospective, community‐based study. Participants read vignettes of two patients, one with AD and one with terminal cancer, and then answered questions regarding their attitudes toward these illnesses.SETTING: A community‐based retirement community in Charlottesville, Virginia.PARTICIPANTS: One hundred fifty‐six community‐dwelling older persons (mean age 79.7 ± 6.9 years).MEASUREMENTS: A structured questionnaire disclosed demographic data (age, sex, race, religion, marital status), personal experience with cancer and AD, and opinions about being told the diagnosis of these diseases.RESULTS: Most participants (n = 124, 79.5%) responded that they would prefer to know if they had AD, but the number was significantly fewer (Fisher exact test,P<.001) than those who would want to know if they had terminal cancer (n = 143, 91.7%) Interestingly, significantly fewer married subjects would want their spouse to know if the spouse had either illness. Only 65.7% (n = 69) of subjects would want their spouse to know if the spouse had AD (Fisher exact test,P= .008), whereas for cancer, 80.2% (n = 77) would want their spouse to know if the spouse had cancer (Fisher exact testP<.001). No demographic variables distinguished subjects who did from those who did not want to know the diagnosis for themselves or their spouses for either AD or cancer. Among the reasons some subjects gave for wanting to know of the diagnosis of AD was being able to consider suicide.CONCLUSION: Although these results may support disclosure of diagnosis for most patients with AD, clinical and ethical issues remain in individual cases.J Am Geriatr Soc 44:400

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06409.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: The purpose of this descriptive analysis is to demonstrate that among older patients with hyponatremia, there is a subset with apparent hyponatremia of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) type, which appears associated with the aging process. A retrospective chart review was done to identify patients with hyponatremia and to classify them into non‐SIADH, SIADH, and idiopathic categories.DESIGN: The participants were the ambulatory population of The Mount Sinai Hospital's outpatient geriatric clinic. Pertinent data generated during the antecedent 24 months were collected from outpatient charts and included sets of laboratory values (consisting of one sodium, glucose, BUN and creatinine level), age, sex, race, clinical history, present diagnosis, medications, and prescribed diets for each patient in the total population.RESULTS: Patients demonstrating hyponatremia with serum sodium levels of less than 135 mEq/L were identified from the total population and were further divided into SIADH and non‐SIADH etiologies. The SIADH patients were then subdivided into known etiology SIADH and apparent idiopathic SIADH. In an ambulatory geriatric population of 405 subjects, 46 had hyponatremia, with SIADH the apparent cause in 27. Of the SIADH population, seven patients were considered to have idiopathic SIADH. An apparent predilection for development of this syndrome was observed among non‐black patients and the old old.CONCLUSIONS: The results support the hypothesis that aging is a risk factor for the development of SIADH‐like hyponatremia in a subset of older patients who do not have an apparent underlying etiology. Thus, aging may be an independent etiology for the development of hyponatremia.J Am Geriatr Soc 44:404–

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb06410.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY