摘要:

Inadequate nutrition is a major problem facing the elderly today. Despite seemingly appropriate meal standards and dietary supervision, patients in long‐term care facilities remain at risk for developing malnutrition. Various nutritional parameters including weight loss, percentage average body weight, serum albumin levels, anthropometrics, and skin testing were examined in 130 patients in an academic nursing home, two thirds of whom were over the age of 65 years. Functional status including type of feeding and associated diseases was also determined. The data show that nutritional risk factors are similar among different age‐groups in nursing home patients. A significant proportion of our patients lost weight while maintaining their serum albumin levels. Despite this, there appears to be less evidence of malnutrition among patients in the academic nursing home compared with other nursing home settings stud

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04017.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The recent focus on the young homeless mentally ill has diverted attention from other subgroups of the homeless, particularly the aging, who compose one fourth of the homeless population. A total of 86 street‐dwelling and 195 non‐street‐dwelling (177 flophouse‐, 18 apartment‐dwelling) men aged 50 and older on the Bowery in New York City were studied. Although 23% evidenced psychosis or had prior psychiatric hospitalization (PPH group), depression was more prevalent with one third of all men categorized as clinically depressed. Only 5% evidenced gross organic mental disease. Several groups were identified for intervention because of their increased susceptibility to depression: alcoholics, relatively younger men, those with organic mental symptoms, street men. With respect to the PPH men, they did not appear to be distinct from the other homeless men on various social and health indices, although they differed substantially from age‐matched community men. Thus these men must be viewed as homeless first, and in addition, as having the handicap of mental illness. Contrary to the popular stereotype, there was no evidence of widespread isolation among the PPH men, and despite their disturbances, most showed an adequate capacity f

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04018.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The elderly have a high incidence of sleep complaints. A high incidence of sleep apnea (SA) and sleep‐related periodic leg movements (PLMs) is also suspected. The relationship between the incidence and severity of SA and PLMs and sleep complaints has not, however, been determined in terms of symptomatology and physiologic abnormality. In a group of 46 community resident seniors (60 to 95 years old), the incidence of SA and PLMs was correlated with subjective sleep‐wake complaints. Sixty‐one percent of subjects had SA and/or PLMs. Apneas/hypopneas were associated with an average oxygen desaturation of less than 5% and an average change in heart rate of less than 10 beats per minute. While subjects with SA or PLMs had clear evidence of objective sleep disturbance, only one quarter of them admitted to any subjective sleep complaints or daytime sleepiness. Furthermore, severity of SA or PLMs failed to predict sleep‐wake complaints, and vice versa. This study confirms that typically mild SA and PLMs are widespread in the elderly but tend not to be manifested in sleep‐wake complaints and probably go untreated as a result. Further research is needed to determine any long‐term medical s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04019.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The Mini‐Mental State Examination and the WAIS‐R were administered to 105 patients in the early stages of Alzheimer's disease. MMSE scores correlated 0.83 with full scale 1Q, which indicates that the MMSE may be a reasonable alternative measure of overall intellectual functioning in Alzheimer patients, for whom more extensive testing is impractical or clinically inappropriate. The prediction formula is presented, along with a prediction table. Folstein and McHugh6report that, as the WAIS Performance IQ falls below 100 in demented patients, that there is a concomitant decline in the MMSE below 24 points. Data from our laboratory further support what some clinicians have long suggested, ie, that in those cases where only the mental status examination can be given, this short test can provide a reasonably valid and reliable prediction of the patient's IQ sc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04020.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

A cross‐sectional study of 216 impotent men aged 40 to 79 years (mean age 60.9 years) was conducted to determine if there are age‐related changes in clinical and hormonal parameters in an impotent population. There was a slight increase in the degree of sexual dysfunction with age, with complete erectile failure occurring in a larger percent of the 60‐ and 70‐year‐olds than in the younger patients (41% vs 27% for the 40 year olds, P<.05). No patient above the age of 70 years reported any full erections, even of short duration. In contrast, reported levels of libido did not vary significantly with age. Abnormal penile Doppler studies diagnostic of vasculogenic impotence were found in 17.8% of the patients tested, and an additional 17.8% were found to have evidence suggestive of a vascular etiology. These abnormal vascular findings were associated with an extremely high prevalence of clinically apparent atherosclerosis in this population. In 22.9% of the subjects, an abnormal vascular response was found only on exercise, ie, a “pelvic steal”, which only occurred above the age of 50 years. There was a marked age‐related alteration in the concentration of testosterone CD and bioavailable testosterone (BT), but no statistically significant change in the levels of gonadotropins with age. An increase in the prevalence of eugonadotropic hypogonadism with age was found, which suggested an increasing prevalence of hypothalamic pituitary dysfunction in this patient group. For both vascular and hormonal changes (such as low T and BT), the greatest changes appear to occur after the age of 50.These data strongly support the multifactorial nature of impotence in the elderly with prominent vascular and hormonal factors, and stress the need for careful assessment and evaluation. They provide strong support for the importance of organic components of impotence in males over

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04021.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Sexual dysfunction is so highly prevalent in elderly males that it is often considered an inevitable consequence of “normal aging.” To determine if other factors are related to an age‐associated decline in sexual function, we surveyed two groups of elderly male veterans in a geriatric ambulatory care clinic: aged 65 to 75 years (“young‐old”) and aged over 75 (”old‐old”). We compared their survey responses with responses from a general medical clinic for unstable medical patients, aged under 65 (“old‐young”). Of 347 subjects surveyed, 225 completed a health and sexual function questionnaire (response rate = 65%). Absent libido was reported by 30% of old‐young, 31% of young‐old, and 47% of old‐old. Erectile dysfunction was reported in 26% of old‐young, 27% of young‐old, and 50% of old‐old (P<.01). We used ordinal logistic regression and found overall sexual dysfunction to be significantly related to subjective poor health, diabetes mellitus, and incontinence (P<.05), while controlling for age. These data suggest that, although sexual dysfunction is more common in the aged, it is often related more t

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04022.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The aims of this study were to estimate the incidence of acute confusional state (ACS), its predisposing factors and consequences in 111 consecutive patients operated for fractured neck of the femur. The incidence of ACS was 61 percent and the predicting factors were old age and dementia. Drugs with anticholinergic effect, depression, and previous stroke were factors that seemed to be associated with the development of ACS. Ninety‐two percent of the patients who had severe perioperative blood pressure drops developed ACS. The consequences of ACS were prolonged ward‐stay at the orthopedic department, a greater need for long‐term care after discharge, and poor walking ability at discharge and six months after surgery. The confused patients also had more complications, such as urinary problems, feeding problems and decubital ulcers, as compared with the nonconfused pat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04023.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The Wisconsin Drug Utilization Review Project used Medicaid claims data to examine the use of long‐term, full doses histamine‐2 receptor antagonists (H2RAs) among long‐term care facility (LTCF) residents, ie, doses exceeding 800 mg per day of cimetidine or 150 mg per day of ranitidine for 12 weeks or more. Additional information about a small but representative sample of patients was obtained from consultant pharmacists by mail questionnaire.Of approximately 35,000 residents, there were 1,046 receiving long‐term, full‐dose H2RAs during 1984 at a cost of 405$,848. No differences were noted between treated patients and the overall LTCF population by gender, age, level of care, or geographic locality. Among 387 patients receiving therapy for the last 3 months of 1984, over one half received antacids and over 20% received nonsteroidal anti‐inflammatory drugs concurrently. According to survey respondents, almost one half of the patients had no diagnosis amenable to treatment by H2RAs. Diagnostic procedures conducted within 30 days prior to the initiation of H2RAs were hemoglobin/ hematocrit assessment (performed on 53% of patients), stool testing (34%), radiological exam (23%) and endoscopy (8%).The results suggest that there is widespread use of long‐term full‐dose H2RAs in LTCFs for undocumented, inappropriate, and poorly supported diagnoses. Such findings are of concern to all persons charged with monitoring drug use in nursing homes because of the implications for both quality and cost of care. Information from this study will be used in designing a program to reduce inappropriate utilization of H2RAs, and Medicaid claims data will be used to monitor trends

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04024.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Plasma levels of immunoreactive atrial natriuretic peptide (ANP) were estimated in 69 elderly patients over 60 years of age (mean 76.4 years) with or without heart diseases and in ten young, healthy volunteers (mean 33.0 years) to evaluate the clinical significance of ANP in the elderly. Plasma ANP levels in nine patients without heart diseases were significantly (P<.01) higher than in the ten young, healthy subjects (mean ± SD, 46.0 ± 22.0 vs 22.1 ± 6.3 pg/mL) and a significant positive correlation was observed between ANP level and age in these subjects (r = 0.60, P<0.01). Plasma ANP levels in 60 patients with heart diseases (158.4 ± 158.5 pg/mL) were significantly (P<0.05) greater than in nine patients without heart diseases. Plasma ANP levels in patients with congestive heart failure or atrial fibrillation were 285.8 ± 185.2 or 223.0 ± 185.9 pg/mL, respectively; each of these values was significantly (P<0.01) higher than in patients without heart diseases. In three patients with paroxysmal atrial fibrillation, plasma ANP levels during atrial fibrillation were three times greater than when atrial fibrillation returned to normal sinus rhythm (377.3 ± 78.5 vs 101.1 ± 68.5 pg/mL).These results indicate that plasma ANP levels increase with advancing age, and that increased ANP levels are associated with various heart diseases in elderly subjects, possibly through stretch of the atri

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04025.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb04026.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY