摘要:

OBJECTIVETo determine whether medical conditions that can impair sensory, cognitive, or motor function increase the risk of injury due to motor vehicle collision in older drivers.DESIGNCase‐control study.SETTINGGroup Health Cooperative of Puget Sound, a large prepaid health plan.PARTICIPANTSGroup Health members age 65 or older who were licensed drivers in 5 counties. Cases were injured while driving during 1987 or 1988. Controls were matched to cases on age, gender, and county of residence but experienced no such injury during the study years.MEASUREMENTSThe outcome was injury requiring medical care due to a police‐investigated motor vehicle collision. Risk factors evaluated included selected medical conditions active within the previous 3 years, as determined from the medical record.MAIN RESULTSInjury risk was 2.6‐fold higher in older diabetic drivers (95% CI: 1.4–4.7), especially those treated with insulin (odds ratio [OR] = 5.8, 95% CI: 1.2–28.7) or oral hypoglycemic agents (OR = 3.1, 95% CI: 0.9–11.0), those with diabetes for over 5 years (OR = 3.9, 95% CI: 1.7–8.7), and those with both diabetes and coronary heart disease (OR = 8.0, 95% CI: 1.7–37.7). Increases were also found for older drivers with coronary artery disease (OR = 1.4), depression (OR = 1.7), alcohol abuse (OR = 2.1), or falls (OR = 1.4), but these associations could easily have arisen by chance.CONCLUSIONSCounseling about driving risks may be warranted for certain elderly diabetic drivers. Further research is needed to determine whether transient hypoglycemia or long‐term complications expl

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06526.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To identify dietary, psychological, and physiological characteristics of older individuals with chronic constipation, compared with a control group of individuals without constipation, and identify correlates of colonic transit time.DESIGN: Cohort study.SETTING: University hospital and affiliated clinics.PARTICIPANTS: Eighteen constipated and 18 control subjects who were nondemented, ambulatory, community‐dwelling outpatients over the age of 60 years.MEASURES: Measures included a 1‐week food diary, diet questionnaire, bowel diary, the Hopkins Symptom Checklist (SCL‐90R), colonic transit study, and medical history, including queries about activity, medications, medical illnesses, and bowel symptoms.MAIN RESULTS: Constipated subjects reported consuming fewer meals per day compared with control subjects (P<0.01) and a tendency to consume fewer calories (P= 0.07). There were no differences between groups on fiber or fluid intake or any of the other dietary parameters. However, slow colonic transit was significantly related to low caloric intake (P<0.0001), higher percent of protein in the diet (P<0.05), low fluid intake (P<0.05), and to psychological symptoms of somatization, obsessive‐compulsiveness, depression, anxiety, and the global severity index (P<0.05). Transit times were unrelated to crude or dietary fiber intake, activity level, or age.CONCLUSIONS: The data suggest that constipation in this older population is related to caloric intake rather than fiber consumption or other dietary qualities. Psychological distress is associated with slowed colonic transit and should be investigated further as a possible etiologic factor in const

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06527.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To determine the test‐retest reliability of a questionnaire designed to measure elderly persons' probability of repeated admission (Pra) to a hospital within 4 years.DESIGN: Participants received the test questionnaire by mail; respondents to the test questionnaire received the retest questionnaire 3 weeks later.PARTICIPANTS: Elderly (65+) community‐dwelling enrollees in the Medical Assistance (Medicaid) program of Ramsey County, MN (n= 192).MAIN OUTCOME MEASURE: The correlation (r) between the Pravalues computed from the test‐retest correlations (k) of the questionnaire's individual items were also measured.RESULTS: The response rate was 63% (121/192) for the test questionnaire and 69% (84/121) for the retest questionnaire. The test and retest values of Pracomputed from responses to the questionnaires were highly correlated (r= 0.78,P<0.0001). For the individual questionnaire items, the range ofkvalues was 0.50–1.00 (P<0.0001 for all items). Slightly higher values ofrandkwere obtained when the respondents were women and when the same person (either proxy or self) completed both questionnaires. Age was not consistently related to reliability.CONCLUSION: the test‐retest reliability of individual items and of the computed Prawas high, suggesting that responses by elderly persons to mailed questionnaires pertaining to health status are stable over brief periods of time. The resulting Pravalues may be useful in identifying elders at high risk for hospital

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06528.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: This study describes the course and risk factors of psychological distress following bereavement, controlling for factors often omitted from studies of grief: psychiatric history, social support, and coping choices of the bereaved.PARTICIPANTS: Spouses of patients hospitalized for serious illness or elective surgery were systematically screened and followed longitudinally through the recovery or death of the hospitalized patient. Of 440 respondents, 154 were bereaved within 2 months.DESIGN AND SETTING: Spouses were interviewed in their homes by trained interviewers at intake and 2, 6, 13, and 25 months postintake.MEASUREMENTS: Dependent variables were measured with the CES‐D (depressive symptoms) and the PERI (general anxiety and hopelessness/helplessness) scales. Independent variables were measured with the SADS‐L (past personal history of dysphoria) and the Lazarus' Ways of Coping scale as well as sociodemographic measures.MAIN RESULTS: Lifetime prevalence of a brief period of dysphoric mood among spouses before the patient's illness was 22%; past personal history of dysphoric mood was related to female sex, smaller networks, and more depression and anxiety during the hospitalization of their spouses. Newly widowed persons with a past history of dysphoria perceived their networks to be relatively nonsupportive, but devoted similar amounts of coping effort to seeking social support and reported similar amounts of social interaction compared with persons with no history of dysphoria. Persons with a past history of dysphoria reported elevated levels of depressive symptoms, general anxiety, and hopelessness/helplessness through 25 months postbereavement, yet their recovery trajectory was similar to those without a past history of dysphoria.CONCLUSIONS: It was concluded that a past history of subsyndromal symptomatology in conjunction with a stressful life event such as bereavement increases one's vulnerability to excess psychological distr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06529.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To describe site of death and patterns of predeath service use (hospital, nursing home, and in‐home services) among persons with dementia who have a family caregiver.DESIGN: Family caregivers who experienced the death of their relative while participating in a 5‐year longitudinal study were surveyed retrospectively about service use patterns in the 90 days before the death of their relative.SETTING: Community.SUBJECTS: Eighty‐two family caregivers of a person with dementia who experienced the death of their relative while participating in a longitudinal study (n= 326) were included in this analysis. All participants were providing care to a relative with dementia in the home at entry into the study.MAIN OUTCOME MEASURES: Survey items were used to identify site of death and measure use of the following services in the 90 days before death: hospital, nursing home, skilled nursing services, home health aides, and physician home visits.RESULTS: Sixty‐nine percent of the caregivers were spouses, and 28% were adult children. Family caregivers had been providing care for an average of 6 years (SD = 3.9) before the death of their relative. The most frequent setting for patient death was home (42%), followed by nursing home (32%) and hospital (26%). The average number of days spent at home in the 90 days before death by the sample was more than 60 days. Thirty‐four percent of the dementia patients were cared for exclusively in the home in the 90 days before death, and 34% spent more than half of the 90 days before death at home. Hospital stays were brief, and less than one‐fourth of the sample spent all of the 90 days before death in an institutional setting. Twenty‐one percent of the sample used no in‐home services in the 90 days before death, 48% of the sample did not use skilled nursing services, and only 27% received a physician home visit.CONCLUSIONS: The results of this study suggest that dementia patients who have a family caregiver receive a significant proportion of their care at home in the 90 days before death. A hospice approach may help address the needs for assistance of families who provide terminal care in the home for a relativ

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06530.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To describe causes of death for patients with Alzheimer disease (AD) and other dementing illnesses enrolled in a population‐based Alzheimer disease patient registry (ADPR) and to describe the variation in causes by the level of cognitive impairment before death in probable AD cases.SETTING: The ADPR enrolls and diagnoses newly recognized potential dementia cases occurring in a large, stable health maintenance organization. To date, 654 cases have been enrolled and followed annually to monitor cognitive decline and verify initial diagnosis.DESIGN: Longitudinal descriptive study.PATIENTS: ADPR enrollees who have died.MEASUREMENTS: Death certificates were obtained for all who died (totaln= 104, probable AD = 55); reported causes of death were reviewed by a physician to determine the underlying cause. AD patients were categorized according to their Mini‐Mental State Exam score (cognitive impairment) within 12 months of death as (a) mildly (21+), (b) moderately (15–20), or (c) severely (0–14) impaired, and underlying cause and all reported causes of death for each group were tabulated.MAIN RESULTS: Among probable AD patients, pneumonia and AD were most often recorded on death certificates when cognitive impairment within the year prior to death had reached the severe level; heart disease, stroke, and other common causes of death predominated in AD patients who were less cognitively impaired.CONCLUSIONS: When AD cases were followed from first diagnosis to death, the causes of death varied by level of cognitive impairment. Illnesses potentially amenable to treatment caused death at all levels of disease, but more so early in the course of AD. Cognitive impairment may make patients less able to recognize and report symptoms of medical problems, thereby complicating efforts to in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06531.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To compare the lifetime personality dysfunction of geriatric patients having late and early onset of major depression.DESIGN: Group comparisons.SETTING: Inpatient geriatric psychiatry unit and hospital‐based geriatric psychiatry outpatient clinic.PATIENTS: Volunteer sample of recovered elderly depressives with history of early onset of major depression (age60) (n= 14).MAJOR OUTCOME MEASURE: Personality Disorder Examination, containing diagnostic and dimensional scores for DSM‐III‐R personality disorders.RESULTS: The two groups had similar demographic profiles and levels of depression after treatment. Early onset subjects had significantly higher mean dimensional scores in the avoidant, dependent, and not otherwise specified NOS personality disorders, and higher dimensional scores with a trend toward significance in 6 additional personality disorders.CONCLUSIONS: Early onset geriatric depressives may have more lifetime personality dysfunction than late onset subjects. Greater personality dysfunction in early onset subjects may reflect postdepressive changes, predisposition, or a low grade depressive su

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06532.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To assess the perception of angina in the elderly and its relationship to autonomic function.DESIGN: Prospective cohort study of patients with exertional ischemia.SETTING: Medical, geriatric and cardiac outpatient clinics in two centers.PARTICIPANTS: All subjects had ischemic heart disease as evidenced by positive treadmill stress tests and, in some, diagnostic angiography and/or documented Q wave infarction. In the first study (I), 37 older patients (range 70–82 years) and 39 younger patients (range 42–59 years) were studied. In a subsequent study (II), a further 49 patients were divided into 2 groups: those with good perception of angina (Anginal Perception Threshold<15 seconds, group A, 26 patients) and those with no angina despite ischemia (group B, 23 patients).MEASUREMENTS: Anginal perceptual threshold (APT), age, cardiovascular autonomic function, and blood pressure were measured. APT was defined as the time between onset of 1 mm ST depression to the onset of angina during treadmill stress testing. Autonomic function was studied using heart rate ratios before and after the valsalva maneuver, heart rate responses to deep breathing, and heart rate and blood pressure responses to standing.RESULTS: In study I, APT in the older patients was delayed by a median value of 49 seconds [79 (range 15–188) versus 30 (–99 to 97) seconds in the younger patients,P30 seconds) was analyzed separately, there was a significant correlation between APT prolongation and impaired valsalva response (r= −0.4;P<0.005).In study II, 21 of 23 patients (91.3%) with positive exercise test but with no angina (group B) had at least one abnormal autonomic function test compared with 5 of 26 (19%) patients with good anginal perception (group A). Of note, group A was significantly younger than group B [60 (53–63) years vs 66 (62–70 years,P<0.001].CONCLUSION: Elevation of APT in the elderly suggests that warning of critical myocardial ischemia is delayed. Autonomic dysfunction may be one of the underlyi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06533.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To measure markers of inflammation in a cohort of young and old subjects and relate these findings to the functional level of the individuals.DESIGN: For the pilot study, blood samples were obtained from 18 young (age 20–35 years) and 18 old (age 68–83 years) subjects. The main study population included community‐dwelling subjects between the ages of 70 and 79. The group consisted of 282 subjects with minimal physical limitations, 17 subjects from the middle third, and 16 from the lower third of physical function rankings.METHODS: Plasma markers were measured by ELISA techniques, and certain biochemical values were obtained through routine clinical tests performed by a commercial laboratory.RESULTS: D‐Dimers were higher for physically impaired subjects in all groups, but most prominently among black females, who also had significantly higher D‐Dimer levels in every functional group. To inquire whether higher D‐Dimers were associated with markers of inflammation, we also examined the macrophage metabolite, neopterin, the neutrophil product, elastase complexed to antitrypsin (E/a), and the albumin globulin ratio (A/G ratio). No differences were found in neopterin or E/a levels on the basis of gender, race, or functional status. The A/G ratio was significantly lower in functionally impaired subjects.CONCLUSION: These preliminary findings demonstrate racial/ethnic and gender differences in D‐Dimers in a population of community‐dwelling elderly, and suggest that factors influencing hemostasis may be particularly relevant to physical functional status in black women. A sample containing more subjects with lower physical function will be needed to establish the relationship between inflammation, altered hemostasis, and physical f

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06534.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To develop and validate the Physical Performance and Mobility Examination (PPME), an observer‐administered, performance‐based instrument assessing 6 domains of physical functioning and mobility for hospitalized elderly.DESIGN: Development of a pass‐fail and 3‐level scoring system and training manuals for the PPME instrument for use in both clinical and research settings. Two patient samples were used to assess construct validity and interrater reliability of the PPME. A third sample was selected to assess the test‐retest reliability of the instrument.SETTING/PATIENTS: (1) 146 subjects ≥65 years of age with impaired mobility admitted to Medical Units of Stanford University Hospital. (2) 352 subjects ≥65 admitted to acute Medical and Surgical Services of the Palo Alto VA Medical Center. Patient samples were obtained during hospitalization and followed until 3 months post‐discharge. To study test‐retest reliability, 50 additional patients, whose clinical condition was stable, were selected from both settings.METHODS: An expert panel selected 6 mobility tasks integral to daily life: bed mobility, transfer skills, multiple stands from chair, standing balance, step‐up, and ambulation. Tasks were piloted with frail hospitalized subjects for appropriateness and safety. Test‐retest and interrater reliability and construct validity were evaluated. Construct validity was tested using the Folstein Mini‐Mental State Examination, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Geriatric Depression Scale, and modified Medical Outcomes Study Measure of Physical Functioning (MOS‐PFR). Two scoring schema were developed for each task: (1) dichotomous pass‐fail and (2) 3‐level high pass, low pass, and fail. A summary scale was developed for each method of scoring.MAIN RESULTS: High interrater reliability and intrarater reliability were demonstrated for individual tasks. The mean percent agreement (interrater) for each pass/fail task ranged from 96 to 100% and from 90 to 100% for the 3 pairs of raters for each task using the 3‐level scoring. Kappas for individual pairs of raters ranged from .80 to 1.0 for pass‐fail scoring and from .75 to 1.0 for 3‐level scoring (allP<0.01). Intraclass correlation coefficients for 3‐level scoring by pairs of raters ranged from .66 to 1.0. For summary scales, the mean intraclass correlation was .99 for both scoring schema. Test‐retest reliability for summary scales using kappa coefficients was .99 for both pass‐fail and 3‐level scoring, and .99 and .98, respectively, using Pearson Product Moment Correlation. Correlations of PPME with other instruments (construct validity) suggest that the PPME adds a unique dimension of mobility beyond that measured by self‐reported ADLs and physical functioning, and it is not greatly influenced by mood or mental status (r= 0.70 (ADL),r= 0.43 (IADL),r= 0.36 (MMSE),r= 0.71 (MOS‐PFR),r= 0.23 (GDS)). The 3‐level summary scale was sensitive to the variability in the patient population and exhibited neither ceiling nor floor effects.CONCLUSIONS: The PPME is a reliable and valid performance‐based instrument measuring physical functio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06535.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY