摘要:

Accurate measurement of stature is important for the determination of several nutritional indices as well as body surface area (BSA) for the normalization of creatinine clearances. Direct standing measurement of stature of bedridden elderly nursing home patients is impossible, and stature as recorded in the chart may not be valid. An accurate stature obtained by summing five segmental measurements was compared to the stature recorded in the patient's chart and calculated estimates of stature from measurement of a long bone (humerus, tibia, knee height). Estimation of stature from measurement of knee height was highly correlated (r = 0.93) to the segmental measurement of stature while estimates from other long‐bone measurements were less highly correlated (r = 0.71 to 0.81). Recorded chart stature was poorly correlated (r = 0.37). Measurement of knee height provides a simple, quick, and accurate means of estimating stature for bedridden females in nursing home

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04632.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Little information exists on the use of mechanical restraints among nonpsychiatric inpatients. This prospective study evaluates their use among consecutive medical and surgical admissions to an acute care hospital. Daily direct observation of patients and hospital record review provided data on potential predictors of restraint, reasons for their application, complications, and outcome. Cox regression analysis was used to calculate relative risk of restraint while adjusting for duration of hospitalization as well as other variables.Restraints were applied to 37 (17%) of the 222 study patients. Restrained patients were eight times more likely to die during hospitalization (24% v 3%; P<0.01). Abnormal mental status exam, diagnosis of dementia, surgery, and presence of monitoring and support devices (eg, intravenous lines) were statistically significant independent predictors of restraint. Mechanical restraint is a common occurrence among nonpsychiatric inpatients particularly those with impaired mentation, requirement for surgery, or intensive medical intervention. Identification of medical and surgical patients at risk for restraint may reduce the use of these devices by concentrating surveillance and prevention on this group.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04633.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The psychiatric in‐patient records of 90 patients ≥65 years of age were reviewed retrospectively to determine the prevalence of chemical dependence and if lack of recognition and treatment of chemical dependence resulted in serious complications. Nineteen of the 90 patients were characterized as drug dependent and ten of these patients were neither recognized nor detoxified. Seven of the ten nondetoxified patients, but only one of the nine detoxified patients, experienced serious medical complications typically requiring transfer to a medical floor or medical intensive care unit. Unrecognized chemically‐dependent patients were significantly more likely to he female benzodiazepine abusers, while recognized chemically dependent patients were significantly more likely to be male alcohol ab

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04634.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Despite the many questions being raised about multivitamin use by the elderly, it has not been proven that consuming an oral multivitamin alters vitamin blood levels in the aged. To address this question, we performed a randomized, prospective, placebo‐controlled study of daily multivitamin supplementation in 101 noninstitutionalized ambulatory elderly persons (median age, 64 years). Vitamin levels were assayed at baseline, and at two and four months of supplementation. At four months, those taking multivitamins had statistically significant increased levels of water soluble vitamins (C, B2, B12, plasma, and erythrocyte folate) that were greater than changes noted for the placebo group. This was not true for fat soluble vitamins A and E. Greater storage pools of fat soluble vitamins help explain this discrepancy. We conclude that in the ambulatory elderly, oral multivitamins can raise levels of water soluble vitamins but the effect on fat soluble vitamins remains uncertai

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04635.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

A two‐year study of 159 community dwelling Alzheimer's disease (AD) patients evaluated in a geriatric clinic is reported. Patients were not as disabled as commonly supposed, having only a moderate reduction in cognitive function (Folstein mean Mini‐Mental Status [MMS], 15.3) and physical activities of daily living (PADL), mean, 3.3, but were more dependent in their instrumental activities of daily living (IADL), mean, 1.9. Associated medical problems averaged 3.4 per patient. Forty‐seven percent lived alone and 39% had not been out of the home in the previous week, making isolation a major concern. During the study, 34% went into nursing homes. Initial mean MMS of these patients was 12.4 compared to 16.6 for patients who remained at home, but activities of daily living (ADD mean scores were not significantly different. Based on this assessment, the management of AD patients, including medication use, daycare, education and support for family caregivers, and nursing home placement, is disc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04636.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Survival, quality of life, and need for continuing medical care were evaluated for 134 elderly patients admitted to the intensive care units (ICU) at Stanford University Hospital and for a control group. Of the patient group, 57.5% were admitted to the ICU following elective surgery; 42.5% were emergency surgical and medical patients. Hospital mortality was 3.9% for elective and 22.8% for nonelective patients; 18‐month mortality was 13.0% and 47.4%, respectively. Fifty‐nine patients (60.8% of survivors) completed follow‐up questionnaires. Subjective and objective quality of life was good. Quality of life was slightly worse for ICU survivors than for controls; elective and nonelective patients did not differ significantly. Although the cost of ICU hospitalization was high, additional medical care was not excessive. Nonelective patients required more continuing care than elective patients, and both groups required more than con

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04637.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Thirty‐two demented, elderly residents of a nursing home were admitted to a specially designed dementia unit. Each patient was assessed three times: prior to admission, and at four and 12 months after admission to the unit. Patients were evaluated using a modified version of a previously published assessment scale as well as with a standardized New York State numerical rating system. There was an increased level of functioning in both mental and emotional status and basic functions of daily living at both four (P ≤ 0.001) and 12 months (P ≤ 0.005). The improvement in scores was maintained over a prolonged time period, despite the expectation of progression of the dementing process. There was no change noted on the New York State assessment. Our data suggest that a select group of demented elderly can benefit from being placed on a specialized dementia

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04638.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

This study was undertaken to examine the association of specific medical and genitourinary conditions, medications, and functional disabilities with urinary incontinence (UI) in a nursing home (NH) population. Seventy‐six incontinent and 38 continent patients in a Veterans Administration NH were studied. Incontinence was highly associated with each of the physical and mental functional disabilities we examined. However, with the exception of recurrent urinary tract infections and dementia, no specific clinical factors were significantly more common among incontinent than continent patients. Although precise causes for the UI were not determined, these data highlight the potential role of impairments of physical and/or mental function in the pathogenesis of UI among NH patients, and emphasize the need to address these impairments in future research on the assessment and treatment of UI in this populatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04639.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Sexuality is considered to be among the more disturbing sexual problems in skilled nursing facilities. Staff attitudes and beliefs often lead to discomfort in dealing with the continued sexual interests of patients. It is clear that if sexuality has been an important part of self‐image and of coping, then it remains important. Staff reaction to two cases is used to illustrate the need for programmatic interventions with staff, residents, and familie

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04640.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

The nonpathological age‐related changes in the dopamine‐and serotonin‐containing neurotransmitter systems in human and rodent brain are reviewed. The dopamine system exhibits age‐related declines both presynaptically and postsynaptically. Presynaptically, both the levels of dopamine and the number of midbrain dopamine‐containing neurons decline by up to 50% at advanced ages in the absence of neurological disease. Postsynaptically, the density of D‐2 dopamine receptors decreases by 40%, while D‐1 dopamine receptors either increase (man) or remain stable (rodents). Additional reductions of dopamine levels and D‐2 receptors have been reported in Alzheimer's disease (AD), but these changes are relatively small, and not consistently observed.The levels of serotonin appear stable during normal aging, and presynaptic markers such as (3H)imipramine binding may actually increase. In human brain, the two major classes of serotonin receptor (S‐1 and S‐2) decrease by 30 to 50% over the lifespan. In AD, both presynaptic and postsynaptic markers of the serotonin system are reduced, including a loss of the serotonin‐containing raphe neurons. The additional loss of serotonin receptors in AD approaches 80% when compared with young normals.A hypothesis is presented to explain the typically young age at onset of schizophrenia (usually before 30 years of age) and the older age at onset of parkinsonism (rarely before 50 years of age) within the context of normal age‐related declines in the dopamine system occurring in the absence of neurological disorders. The possibility that chronic cocaine abuse might accelerate the development of pa

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1987.tb04641.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY