摘要:

Using a series of graded destabilizing forces, we have developed a simple quantitative test of the postural response: the Postural Stress Test (PST). Suitable for widespread testing of elderly subjects, the test evaluates the subject's ability to avoid a fall as well as the appropriateness of the response. We have determined that by comparison with young subjects, the elderly controls have compromised although functionally effective balance. On the other hand, the balance response was severely compromised in half of the individuals with a history of falls. Experience with the Postural Stress Test suggests it will predict those elderly individuals with a tendency to fall as well as provide a simple mechanism for studying the balance response in the elderly.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07256.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Systematic multidimensional assessment techniques such as the Functional Assessment Inventory (FAI) are increasingly used with the elderly for outcome measurement, prediction of service needs, and accurate description for comparative purposes. The FAI is a structured interview followed by a rating process which compares patient status against standard descriptive phrases. Patients are assessed in five areas: mental health, physical health, social resources, economic resources, and activities of daily living (ADD. The validity of the FAI was tested by comparing ratings of patient health obtained by a single investigator using only the instrument with ratings obtained by consensus from an interdisciplinary home care team providing long‐term care for the patients studied. An excellent level of agreement (weighted kappas from .583 to .780) was found in all areas studied. A single significant difference in ADL rating with a high correlation coefficient (r= .85) was interpreted as due to a difference between the single rater and the team in the definition of ADL. The ease of obtaining summary ratings from clinical personnel suggests that further exploration of this rapid quantification of patient health is warrante

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07257.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

This retrospective review of medical records was designed to address three questions: 1) Can the depression seen in some patients with Dementia of the Alzheimer's Type (DAT) be successfully treated? 2) Does this treatment lead to any long‐term improvement in the patient's cognitive status? and 3) Do patients with coexisting DAT and depression have a different long‐term clinical course than nondepressed DAT patients? In the authors' sample of 131 DAT subjects, 41 (31%) also met DMS‐III criteria for a major affective disorder. Of those DAT plus depression patients whose records reflected treatment (usually with a tricyclic antidepressant), 85% (17 of 20) showed clear evidence of improvement in mood, vegetative signs, or activities of daily living (ADLs) based on review of the medical record. An analysis of change in cognitive function (measured by the Folstein Mini‐Mental State) and five global measures failed to reveal any differences between the depressed and nondepressed groups after a mean interval of 17 months. The depression that occurs in approximately one‐quarter to one‐third of DAT patients appears to respond to appropriate therapy. These patients often show improvement in their mood and ADLs but rema

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07258.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

In a survey of wheelchair use in two nursing homes, the authors found a substantial number of cognitively intact nursing home residents who walked, but who also used a wheelchair. Using chart review and interviews with the residents, it was found that multiple physical factors, including pain, strength, endurance, vision and balance, and multiple social and environmental factors, including the fear of falling, were related to the resident's decision to use a wheelchair as an alternative means of mobility. A physical examination focused on aspects of mobility was completed on each resident and was intended to characterize the physical limitations in groups studied. In the nursing home environment, use of the wheelchair is viewed by the residents as a self‐initiated choice which the residents believed significantly enhanced their sense of well‐being. Finally, there was minimal recognition of mobility as a problem on the part of the medical and nursing staff. The study raises a number of important issues concerning walking versus wheelchair use in the nursing h

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07259.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

To better understand declining autopsy rates, data have been gathered prospectively on 1080 consecutive deaths over six years among patients admitted to a medical intensive care/coronary care unit. Overall autopsy rate was 36%. Autopsy rates declined sharply with age from 60% for those aged 16 to 34 years to 23% for those 85 and over (P<.001). The highest rates by diagnosis were aortic aneurysm (70%), hepatic failure (52%), heart rhythm disturbance (48%), pulmonary embolism (45%), and sepsis (41%). Patients receiving major procedures had a significantly higher autopsy rate (38 versus 29%,P<.05) but rates bore little relation to prognoses given at admission by house officers, suddenness of death, sex, marital status or year of admission. Even among intensively treated patients, autopsy rates decline strikingly with age, demanding honest re‐appraisal to restore the place of autopsy in medical education, clinical research, and quality of care assessment for an increasingly elderly populatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07260.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The pharmacologic treatment of depression in the elderly is often complicated by cardiovascular disease and other medical illnesses. Both the tricyclic antidepressants and the monoamine oxidase (MAO) inhibitors have adverse effects that are potentially dangerous in this age group. Second generation antidepressants may have fewer cardiovascular and anticholinergic side effects, but many do not offer any real advantage over the older drugs. In practical terms, the choice of antidepressants for use in elderly patients will be based largely on their degree of tolerance for unwanted effects.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07261.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

This study examined the effects of Supporter Endurance Training (SET) on family supporters of elderly demented patients. Single case methodology was used in evaluating the outcome of providing eight supporters with eight weekly training sessions in meditative relaxation and assertiveness. Four such supporters received no special training. A videotape dramatizing typical problem situations encountered with a demented family member was used to elicit information about supporters' coping styles. Post‐training and six‐month follow‐up evaluation indicated improvements among trained individuals on measures related to assertiveness, problem solving, and stress reduction. Trained subjects' estimates of the length of time they would be able to cope with problems involved in caring for their relatives also increased. Few such improvements occurred among untrained subjects. These results suggest the usefulness of brief structured skills training programs in helping supporters to improve their coping abil

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07262.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

An analysis was completed of 34 patients with dementia who attended a mixed medical day care program over a five‐year period. The parameters reviewed included age, home situation, diagnosis, incidence of co‐existent medical disorders, management by the social worker, nurses and neuropsychiatrist, the extent of social and program participation, length of stay, and disposition. There was a high incidence of medical problems which were managed effectively because of close nursing observation, availability of ancillary services, specialty clinics, and frequent communication with the community physicians. The social worker assisted families with the management of long‐term planning for the dementia patients and the entire social‐nursing‐recreational therapy team devised programs which encouraged the patients to function at an optimum level. Neuropsychiatrie management, including drug therapy, was an integral part of th

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07263.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

“I fear that our profession as a whole is not even now sufficiently alive to the presence in their clientele of many patients suffering from thyrotoxicosis, camouflaged as heart disease.”1Hyperthyroidism in the elderly is a great masquerader. We will present a summary of a remarkable patient to serve as a background for an analysis of present knowledge about the diagnosis and treatment of this condit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07264.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

At this time of increasing uncertainty regarding future health care delivery, certain medical issues present an urgent challenge to society. Among these issues are the care of the growing mass of elderly and the training of physicians who can meet their needs.1

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb07265.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY