ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06296.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Twelve hundred twenty‐six (1,226) persons representative of the noninstitutionalized United States population aged 65–74 years were interviewed and examined as part of the 1971—1975 Health and Nutrition Examination Survey (HANES). Using information available in the HANES data base, standards for what could be considered minimally acceptable care were developed for five tracer conditions. Rates of “deficient” care were: angina, 46 percent; dyspnea on exertion, 78 per cent; hypertension, 26 per cent; hearing impariment, 61 per cent; depression, 80 per cent. Deficient care was analyzed by gender, race, income, locale, and self‐rated health status. Only low income emerged as a consistent risk factor for deficient care, with the relative odds for deficient care for poor patients as compared with non‐poor patients ranging from 2.7 to 5.6 (P<0.05) for four of five conditions. A subgroup analysis attempted to determine whether deficiencies were caused by limited access to physicians, underreporting of symptoms, or barriers that occurred after presenting complaints to a physician. The analysis revealed that for three of four symptomatic conditions, the poor and non‐poor patients were equally likely to report their symptoms, whereas the poor were more likely to receive “deficient” care after presenting complaints to physicians. The ramifications of these findings as they pertain to the present situ

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06297.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Herpes zoster is common in the elderly. Persons over the age of 50 years have an attack rate double that of patients less than 50 years old. In the very aged, this rate nearly doubles again. The loss of cell‐mediated immunity for the VZ virus appears to be the primary factor in the disruption of the dynamic containment process responsible for VZ virus latency within the sensory ganglion. Humoral immunity may play a role in the maintenance of latency, but the degree is unproven, except in the case of dissemination where loss of detectable antibodies seems to correlate with extradermatomal dissemination. Severe forms of the disease and its complications, e.g., postherpetic neuralgia, are likely among the elderly. Direct im‐munofluorescent staining or cytologic examination is useful for early diagnosis, and serologic changes can document the confusing clinical entity of zoster sine herp

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06298.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Growing numbers of aged patients are being cared for in both acute care and chronic care settings. It is often necessary to relocate elderly patients within the institution. Relocations are generally considered to increase mortality and morbidity among the elderly and to be detrimental to activities of daily living. Effects of relocation on long‐term patients in an acute care institution are examined. Thirty‐six (36) patients were assigned to experimental and control groups. The experimental group (n= 20) was relocated for nine weeks, while members of the control group (n= 16) remained in their original units. The two groups were evaluated for differences in mortality, morbidity, activities of daily living, and drug management. The experimental group was managed by a geriatrics team during the nine‐week relocation period, while the control group remained under the supervision of a general medical surgical team. No statistically significant (P<0.05) differences were found with respect to mortality and morbidity, activities of daily living, or drug management. Some clinical improvements were noticed in the experimental group under the geriatrics team's supervision. The authors conclude that if careful consideration is given to the relocation of long‐term patients in an acute care setting, detrimental outcomes can be

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06299.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

In the course of evaluating and following more than 600 geriatric outpatients referred to a subspecialty clinic because of cognitive impairment, standardized computer‐compatible evaluation and follow‐up forms were developed, as well as a computerized data base. The forms cover medical, neurologic, psychiatric, psychometric, and clinical laboratory examinations; they help health professionals to perform thorough, standardized, and efficient examinations focused on those characteristics relevant to dementias. The computerized data base facilitates follow‐up and other clinical studies. This article presents both the forms and their translation into query‐language term

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06300.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

The development of the Medicare Prospective Payment System based on diagnosis‐relating groupings is reviewed. Special emphasis is placed on analysis of the provisions that have a potential impact on geriatric medicine and on the care of the frail elderly. The authors conclude that in its present form, the DRG system may systematically undercompensate hospitals for treating the frail elderly and, therefore, result in attempts by some hospitals to reduce or avoid altogether programs in geriatric medicine and admissions of frail elderly persons. These effects, together with federal and state efforts to limit nursing home and home care costs, may result in a major under‐provision of care for the frail elderly and exclusion of clinical geriatric medicine from the medical care sys

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06301.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06302.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

Clinical investigators face formidable methodologic and ethical challenges in the study of eldery people. To define problems specific to geriatric research the fundamental elements of clinical research are outlined and considerations important to a geriatric study population are identified. Because of the underestimated biologic variation of elderly people, the evaluation of new interventions in one older population may be difficult to generalize to all older people. Inasmuch as older people represent a study population with a lifetime of cumulative exposures for various diseases such as cancer, historical cohort studies are particularly suitable research designs. Despite these advantages, the retrospective study of certain interventions in older people, for example cardiopulmonary resuscitation, requires thoughtful attention to avoid strong and often subtle selection biases. Issues of informed consent and the presence of multiple, comorbid illnesses, especially relevant to clinical trials, are problematic in studying geriatric conditions. Recently, instruments measuring function and disability have been used extensively by investigators in geriatric research, but the precise way to quantify these observations remains controversial. Testing artifacts may be considerably greater in older persons than in many of the populations in which the instruments have been validated. Finally, certain statistical assumptions and inferences may be inappropriate in the study of older people.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06303.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06304.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1984.tb06305.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY