摘要:

Knowledge about blood lipids in older individuals is limited. In the Lipoprotein Study of the Honolulu Heart Program, plasma cholesterol, triglyceride, and high‐density lipoprotein (HDL) were measured during 1980 and 1981 in Japanese‐American men over 60 years of age. In addition, low‐density lipoprotein cholesterol (LDL‐C) was estimated via a regression model. Age‐related differences in mean lipid levels between the youngest (60 to 64 years) and the oldest (75 years and older) groups included a decrease in total cholesterol from 214 to 207 mg/dL and plasma triglyceride from 188 to 144 mg/dL. High density lipoprotein cholesterol rose from 47 to 49 mg/dL and LDL was relatively stable (137 and 135 mg/dL, respectively). Age‐adjusted total cholesterol tended to significantly increase with increasing body mass index and hematocrit but was not significantly related with systolic blood pressure, physical activity index, cigarettes per day, or alcohol intake. Among those variables HDL‐C decreased significantly with increasing body mass index and hematocrit and increased significantly with increasing alcohol intake. Compared with elderly white men in the Lipid Research Clinic Program, total cholesterol values tended to be slightly higher and triglyceride values were substantially higher, whereas HDL and LDL values were appreciably lower. Both cholesterol and triglyceride values were substantially higher than values reported from Japan from men in the

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03980.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Nutritional assessment parameters were studied in a sample of 132 community‐living well elderly. Results are presented for biochemical parameters of serum albumin, hemoglobin, and total lymphocyte count and anthropometric parameters of height, weight, mid‐arm circumference, and triceps skinfold. The data show that, although there are some differences between age groups (young‐old and old‐old), all values remain well within normal limits established for younger indi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03981.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The Federated Council for Internal Medicine recommended in 1981 “increased emphasis on geriatric medicine in the medical school curriculum, the medical residency, and continuing medical education.”1In the same year the first examination for a Certificate of Special Competence in Geriatric Medicine was held in Canada. This was the culmination of a process begun in 1974 to establish the subject as a subspecialty within Internal Medicine. The Royal College of Physicians and Surgeons of Canada set up a Specialty Committee which developed criteria for the accreditation of training programs. Candidates have to be eligible to sit for the certification examination in Internal Medicine before they can sit for the Certificate of Special Competence in Geriatric Medicine which is awarded only after passing both examinations. Thirty‐nine individuals sat for the examination in its first five years of whom 26 were successful. These now form a nucleus of well‐qualified internist‐geriatricians who are developing academic programs in geriatric medicine in Canadian Medica

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03982.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

In view of the limited information concerning the influence of aging on exocrine pancreatic function, the authors undertook the present study. To examine a large number of elderly persons, including people of very advanced age (80 years and over), pancreatic function was studied by using the fluorescein dilaurate test (pancreolauryl test), one of the most recent tubeless, noninvasive pancreatic function tests. Sixty healthy noninstitutionalized elderly individuals (35 women and 25 men, aged 66 to 88 years, mean 78) participated in the study. Thirty‐six healthy younger subjects (16 women and 20 men, aged 21 to 57 years, mean 36) were also studied as controls. All elderly subjects showed a strictly normal fluorescein dilaurate test. No significant differences in the pancreatic function test results were observed between the elderly under 80 years old and those over 80 years old. The authors conclude that the aging process per se does not significantly affect exocrine pancreatic function and, more particularly, does not impair the digestive capacity of the elderly perso

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03983.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

In a two‐year follow‐up of 16 patients with mixed symptoms of depression and dementia, eight showed clinical improvement and eight showed deterioration. Improvement at two‐year follow‐up was associated with several baseline measures: a Folstein Mini‐Mental State score of 21 or greater, a Hamilton Depression score of 21 or greater, and a sleep efficiency of less than 75%. These findings suggest that in the elderly with mixed symptoms of depression and dementia, a more favorable outcome is associated with initially greater depressive symptomatology, higher cognitive function, and moderate sleep continuity disturbance (“early morning

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03984.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The ratio of pepsinogen I to pepsinogen II in the circulation decreases progressively with increasing severity of atrophic gastritis of the fundic gland mucosa. Fasting blood was obtained from 359 free‐living and institutionalized elderly people (age range, 60 to 99 years). A pepsinogen ***I/pepsinogen II ratio less than 2.9, indicating atrophic gastritis, was found in 113 (31.5%) subjects. The prevalence of atrophic gastritis increased significantly with advancing age (P<.05). Within the atrophic gastritis group, 84 had a pepsinogen I level greater than or equal to 20 μg/L, indicating mild to moderate atrophic gastritis, and 29 had a pepsinogen I level less than 20 μg/L, indicating severe atrophic gastritis or gastric atrophy. A significant increase in the prevalences of elevated serum gastrin levels (P<.005), low serum vitamin B12levels (P<.005), circulating intrinsic factor antibody (P<.005), and anemia (P<.025) was observed with stepwise increases in severity of atrophic gastritis. Subjects with atrophic gastritis exhibited a lower mean serum vitamin B12level (P<.05) and a higher mean folate level (P<.05), but no difference was detected in mean hemoglobin levels or serum levels of iron, ferritin, retinal or α‐tocopherol. It is concluded that serum pepsinogen I and pepsinogen II levels can be used to determine the prevalence and severity of atrophic gastritis, that atrophic gastritis is common in an elderly population, and that atrophic gastritis is associated with vitamin B12deficiency and anemia. Further, higher folate levels in atrophic gastritis may be related to an accumulation of 5‐methyl tetrahydrofolate in serum due to vitamin B12deficiency and/or greater folate synthesis by the intestinal flora resulting from bacterial overgrowth secondary to hypo‐ or ac

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03985.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

We studied the use of the do not resuscitate (DNR) order among general medical patients. During the six‐month study period, of 2431 admissions there were 95 patients (3.9%) declared DNR. Of 105 deaths, 69 (66%) occurred among DNR patients. Twenty‐seven percent of the DNR patients left the hospital alive. In 90% of the cases the medical intern initiated the DNR discussion, and in 60% of the cases a decision was reached in less than 24 hours. Two‐thirds of the DNR orders were consented to by family members, and one‐third of all DNR orders had a discernible impact on nonresuscitative care. Less aggressive therapy accounted for 60% of these restrictions, whereas the remainder involved limitations in diagnostic evaluations. When compared with age‐ and sex‐matched general adult inpatient control subjects, DNR patients were found to have longer hospitalizations (P= .01), be more likely to reside in a nursing home (RR= 4.2), have a metastatic neoplasm (RR= 3.6), and be admitted with an abnormal mental status (RR= 6.1) or urinary incontinence (RR= 2.9). These differences remained significant when we controlled for the presence of a metastatic neoplasm. Despite a high in‐hospital mortality rate (73%), DNR patients were not admitted more frequently than controls to the intensive care unit. We conclude that the DNR decision is based on clinical prognostic indexes and that once established, this order serves to modify the allocation of medi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03986.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.tb03987.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

There are differing opinions on whether or not to use isoniazid (INH) preventive treatment in older people with significantly reactive (“positive”) tuberculin skin tests and fibrotic changes on chest roentgenogram. To assist the clinician facing this decision, a Decision Analysis was completed. Using available data, it is seen that using INH will not have much impact on five‐year survivorship, but will reduce the number of tuberculosis disease cases, thus having an overall beneficial impact. Where tuberculosis incidence is higher, the benefit of INH preventive treatment is correspondingly higher.J Am Geriatr Soc 34:814–8

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03988.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Providing elderly persons with understandable information with which they can make informed health care decisions is a difficult, yet critical, task. Four methods of enhancing understanding of the Resident's Bill of Rights were evaluated in residents of the board and care section of a long‐term care facility. The methods included the use of large print and simplified language, a storybook, and a videotape. There was no significant improvement for performance on the comprehension test after any of the methods of presentation of the Bill of Rights. A number of subjects were found to be very deficient in short‐term memory or in verbal knowledge. When these subjects were eliminated from the analyses, significant improvement was demonstrated with the simplified version of the Bill of Rights yielding the most improvement. These findings indicate that many elderly people can benefit from an informed consent procedure that provides information clearly and simply. Furthermore, with relatively simple cognitive screening procedures, it should be possible to identify those unable to process the information necessary to participate in common health care decisi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1986.tb03989.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY