摘要:

The medical charts of 188 Alzheimer patients and a comparison group of 80 nondemented patients matched for age and sex were retrospectively reviewed for history of psychiatric morbidity. The Alzheimer patients were more likely to have had a psychiatric illness earlier in life (χ2=8.5238, df =1, P<.001) with unipolar depression and paranoid disorder being the two most frequent psychiatric disorders. Possible explanations for these findings include underreporting, facility bias, functional psychiatric features as prodromal states of Alzheimer's disease, and vulnerability to psychiatric morbidity in those who go on to develop Alzheimer's disease. The likelihood of each of these explanations is discussed

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05759.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

On four acute medical wards 1292 patients were observed over 15 weeks to determine how frequently physical restraints were used. Patients were divided into age groups of less than 40 years, 40 to 55 years, 56 to 69 years, and 70 years and older. Ninety‐five patients were found to be restrained giving an overall incidence of 7.4%. As expected, patients 70 years of age and older were restrained more frequently (20.3%) than younger patients, with the lowest incidence (2.9%) occurring in those 40 to 55 years of age. In each age group the patients who were restrained had a length of stay more than twice as long as their unrestrained counterparts. Twelve percent of the restrained patients died, which was nearly one‐half of all the patients who died during the period of the study. The findings suggest a probable relationship between the severity of an illness and the use of physical restrai

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05760.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Ten healthy women in their tenth decade of life were compared with ten healthy women in their fourth decade of life regarding the response of plasma lipoproteins and platelet aggregation to one meal rich in saturated fats. In the elderly group, plasma cholesterol decreased in the postprandial state three hours after the meal in comparison to no significant changes in the younger group. This resulted from reduction in plasma lipoprotein cholesterol levels, except for the high‐density lipoprotein (HDL) cholesterol, which was enhanced. A similar pattern was found for plasma lipoprotein levels. The increase in plasma triglyceride concentration in the elderly women was less than in the younger women, as fewer changes in their plasma triglyceride‐rich lipoproteins (chylomicrons and very‐low‐density lipoprotein) were observed. Platelet aggregation in response to collagen was reduced in the elderly women, whereas in the younger group, increased platelet aggregation in the postprandial state was found. Our study thus demonstrates a clear advantage of the elderly women in comparison to the younger ones in reducing atherosclerosis and thrombotic risks. The elderly group responded to the saturated fat‐rich meal by minimal plasma triglyceride elevation, an increase in HDL cholesterol concentration, and reduced platelet ag

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05761.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

To evaluate the impact of the Medicare Prospective Payment System (PPS) on nursing homes, resident census and staffing data from 78 Portland, Oregon nursing homes were compiled from annual reports filed with the state. Between fiscal years (FYs) 1983 and 1984, (before and after initiation of the Medicare PPS), there was no significant change in the total number of patient‐days, but there was a 20.5% increase in the total number of deaths and a significant increase in average facility adjusted death rates (P =.004). Between the previous FYs 1982 and 1983, the total number of deaths had risen only 8.3%, and the average facility adjusted death rate had no significant change. Since initiation of diagnosis‐related groups (DRGs), these nursing homes also made sizeable increases in their adjusted full‐time registered nurse employment rate, and reported fewer patients reimbursed by Medicare.These same nursing homes were surveyed in spring, 1985 to determine the impact of Medicare DRGs in more qualitative terms. Of the 51 nursing homes (66%) responding, more than half reported increased severity of illness, shorter length of stay, increased prevalence of clinical problems, and increased use of medical supplies. In addition, more than half of the respondents reported increased frequency of requests for Friday and weekend admissions, admission of patients too sick for the facility, and physician phone consultation.These findings indicate that Portland, Oregon nursing homes experienced increased patient severity of illness, explained at least in part by earlier hospital discharge, following

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05762.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

All patients admitted to three medical services at the New York Hospital during a one‐month period were screened with Folstein's Mini‐Mental State Examination. The prevalence of cognitive impairment was 19.8% (23 of 116). Cognitively “impaired” patients, ie, those with a Folstein score less than 24, were older, sicker, and less physiologically stable than the cognitively “intact.” The in‐hospital mortality (17 versus 5%) and morbidity (39 versus 18%) rates were higher for the cognitively “impaired” patients; these differences could be explained by the greater severity of illness, instability, and comorbidity found in these patients. Cognitively “impaired” patients were particularly susceptible to respiratory complications. Cognitively “impaired” patients had longer lengths of hospital stay, spent more time in hospital awaiting placement, and were more likely to be discharged to a nursing home or require home assistance than their cognitively “intact” counterparts. Three‐month mortality rates were also higher for the cognitively “impaired” patients (30 versus 15%). These findings suggest that cognitive impairment on admission may be regarded as a marker

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05763.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05764.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05765.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Comprehension of informed consent materials from a study of psychological variables associated with chest pain was evaluated as a function of age (27 to 69 years), education (5 to 20 years), and readability of information [low (college level) versus high (7th grade)]. The potentially confounding effect of memory was eliminated by allowing patients to use the written information sheets to find answers to the multiple choice test. Feedback and a repeat test were provided if any answers were incorrect. The findings indicated that comprehension varied inversely with age and directly with education. It is suggested that while ensuring informed consent may be difficult for all volunteers, it may be a critical problem for elderly patients with low education. The effects of readability were not consistent, suggesting that simplifying informed consent materials by shortening words and sentences may not, by itself, be sufficient to improve comprehension.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05766.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

We studied attitudes of health professionals toward life‐sustaining treatment. A patient management questionnaire sent to staff physicians and nurses in 183 Oregon nursing homes consisted of eight patient sketches which varied age, mental status, and enjoyment of life. Respondents were asked whether they would favor tube‐feeding to correct malnutrition in each case.Nurses showed higher preferences for tube‐feeding than did physicians (P = .05). For both professions, patient happiness was the strongest and most significant (P<.0001) influence upon preferences for tube‐feeding. Both professions also showed a significant (P<.001) tendency to give younger patients higher preferences for tube‐feeding. Physicians showed a significant (P<.0001) influence of patient mental status upon preferences, while patient mental status did not affect nurses' preferences. Identifiable clinical factors appear to influence attitudes of physicians and nurses toward tube‐feedin

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05767.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

It is well known that the neurologic manifestations of vitamin B12deficiency can occur in the absence of anemia. The authors recently observed two elderly patients who presented to a chronic care institution with the diagnosis of dementia, and in both individuals low serum B12levels were found in conjunction with abnormal Schilling tests. In neither of these two patients was there anemia or macrocytosis. After receiving parenteral B12injections there was improvement noted in cognitive functions as well as in activities of daily living. The authors are reporting these patients to alert clinicians to the fact that pernicious anemia in the elderly can first present with low serum B12levels and neurologic abnormalities in the absence of anemia or macrocytosis.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb05768.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY