摘要:

In order to determine whether acute hospitalization leads to changes in the medications used by the elderly after discharge, we studied the medications used at admission and discharge for 197 elderly subjects admitted to one hospital. We found that 40% of all admission medications were discontinued by discharge and 45% of all discharge medications were newly started during the hospitalization. Although the number of drugs used did not increase significantly from admission to discharge (4.50 to 4.80, P =.128), the number of narcotics, laxatives, and antibiotics increased significantly. For those elderly subjects admitted to the hospital taking less than the average number of medications, the overall use of medication increased from admission to discharge (2.89 to 3.75, P<.0001). These “low users” were discharged on more benzodiazepines, narcotics, laxatives, antibiotics, and cardiac medications. Our data suggest that during hospitalization admission medications are discontinued and new medications are started in large numbers and that these changes are accompanied by a tendency towards the increased use of certain categories of medications. These changes may place the elderly patient at increased risk of polypharmacy and its complicati

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02227.x

年代:1989

数据来源: WILEY

摘要:

This study examines how plans about cardiopulmonary resuscitation (CPR) were made, what relevant orders were written, and what actual events occurred at the time of death in a nursing home. A chart review of 119 residents who died in a 233‐bed nursing home in 1987 found one who underwent (unsuccessful) CPR. Nine records were unusable. The remaining 109 cases, none of which involved CPR, were studied. Documentation of discussions about CPR between physicians and residents or their surrogates was present in 90 charts. Of 85 residents with cognitive impairment, four were included in the CPR discussion and surrogates were consulted for 66. In 15, no discussion was documented. Of 24 residents without documented cognitive impairment, 11 were consulted. For nine others, surrogates were asked, and in four no discussion was recorded. One resident and three surrogates requested CPR. All others who were asked accepted a do‐not‐resuscitate (DNR) order. For 67 residents DNR orders were written. In six of these cases, physicians wrote the order without documenting consultation with resident or surrogate. For five residents orders to resuscitate (full code orders) were written. For 37 residents no order about CPR was recorded. Of the 42 residents who died without a DNR order, 37 were found dead by nursing staff, but in only one case was a physician contacted urgently. In this nursing home advance planning about CPR was frequently undertaken. Regardless of planning or the orders in the chart, CPR was a rare

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02228.x

年代:1989

数据来源: WILEY

摘要:

The prevalence of dietary supplementation and its relationship to health and dietary habits was investigated in a random mail survey of 2,195 people aged 65 years and over in Adelaide, South Australia. Subjects were selected from the electoral rolls in an urban area, and 77% returned completed survey instruments. Thirty‐five percent of men and 46% of women reported taking some form of supplement at least once a week regularly throughout the year (these are defined as “regular” supplementers). The most popular supplements (in descending order of popularity for the total group) were: unprocessed bran, wheatgerm, vitamin C, and multivitamins or minerals. Thirteen percent of men and 15% of women reported the use of supplements on an occasional basis (once every few months or “now and then”)—these are defined as “irregular” or “occasional” supplementers. Supplement users did not differ from non‐supplementers in their use of medical facilities or in the number of bouts of minor illness they had experienced in the preceding year. Regular supplement users had more favorable dietary habits and higher intakes of several vitamins, minerals, trace elements and fiber than either non‐supplementers or o

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02229.x

年代:1989

数据来源: WILEY

摘要:

The self‐reported physical and mental health of 315 persons caring for a spouse who had been diagnosed with Alzheimer's disease or a related disorder was compared with general population norms for existing data bases controlling for age and gender. Results suggest that across all indicators of mental health, spouse caregivers are more depressed, express higher levels of negative affect, are more likely to use psychotropic drugs, and have more symptoms of psychological distress than the general population. In terms of physical health, caregivers report higher than expected rates of diabetes, arthritis, ulcers, and anemia, yet they use medical services at rates which are similar or lower than those reported by the general population. Since no simultaneous control group was studied, these results suggest, but do not prove, the presence of differences between caregivers and non‐caregiv

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02230.x

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02231.x

年代:1989

数据来源: WILEY

摘要:

The objectives of this study were to design and prospectively evaluate a strategy to assess geriatric urinary incontinence in primary care settings. A management plan for urinary incontinence was determined for 264 elderly incontinent patients (205 females and 59 males) based on a clinical evaluation, simple tests of lower urinary tract function, and several criteria for referral for further evaluation derived from the literature on incontinence. Of the 264 patients, 168 (64%) also consented to undergo a urologic and formal urodynamic evaluation. Half of these 168 patients met at least one criterion for referral for further evaluation. At least one‐quarter of the patients who met one or more of the criteria were found not to require surgical intervention, and probably did not benefit from the urologic and urodynamic evaluation. Among 84 patients who did not meet any of the criteria for referral, the urologic and urodynamic evaluation changed the initial treatment plan in only 10 (12%). The risks associated with the treatment plan based on the clinical assessment in these patients were, however, relatively small. While further refinement and testing in larger numbers of incontinent patients are needed, the data presented document that a substantial proportion of elderly patients with a treatable and often ignored problem can be appropriately managed based on a relatively simple and inexpensive assessment, which can easily be carried out in primary care setting

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02232.x

年代:1989

数据来源: WILEY

摘要:

We have tested a simple and reliable measure of visuospatial ability in Alzheimer patients — the Clock Drawing Test. To determine the usefulness of this measure, we asked 67 Alzheimer patients and 83 normal controls to draw the face of a clock reading the time of 2:45. Six independent observers blindly evaluated the results with ratings from 10 (best) to 1 (worst). The mean performance score of Alzheimer subjects was 4.9 ± 2.7 compared to 8.7 ± 1.1 for normal controls(P<.001). Inter‐rater reliability for the clocks drawn by Alzheimer patients was highly significant(r =0.86;P<.001), and there was relatively little overlap between ratings for Alzheimer patients and normal controls. Furthermore, correlations were highly significant(P<.001) between the mean score of clock drawings and three independent global measures of dementia severity. Although the Clock Drawing Test is certainly not a definitive indicator of Alzheimer's disease, the test is easy to administer and provides a useful measure of dementia severity for both research and office settings where sophisticated neuropsychological testing is not avai

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02233.x

年代:1989

数据来源: WILEY

摘要:

The fear of Alzheimer's disease for both patients and families is growing along with the increasing evidence of the disease itself. This study (N = 312) of the validity of the clock drawing test in screening patients with probable Alzheimer's disease was conducted in an active outpatient geriatric clinic. Clock drawings by patients with normal mental status or depression were essentially normal. Alzheimer's patients were unable to complete a normal clock and demonstrated five characteristically abnormal patterns. As a test for Alzheimer's disease, clock drawing had a sensitivity of 86.7% and a specificity of 92.7%. There was correct identification in 97.2% of normals. These findings indicate that the clock drawing test, an easily administered, low cost screening tool, can be useful to health care professionals in characterizing cognitive loss in a general geriatric clinic population.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02234.x

年代:1989

数据来源: WILEY

摘要:

Plasma glucose and insulin responses and basal and insulin‐stimulated glucose uptake were determined in 24 non‐obese, healthy, physically active individuals, divided into two groups on the basis of age. The mean (± SEM) age of the younger group was 33 ± 3 years, in contrast to an age of 64 ± 2 years for the older group. Plasma glucose concentrations were significantly higher (two‐way ANOVA, P<.001) for three hours after a 75 g oral glucose challenge in the older group, as was the plasma insulin response (two‐way ANOVA, P<.001). Furthermore, there was a significant correlation between age and total plasma glucose(r =0.63, P<.001) and insulin(r =0.44, P<.01) during the glucose tolerance test. However, the magnitude of the decrease in glucose tolerance with age was relatively modest. For example, total plasma glucose response was only 11% higher in the older group, and the plasma glucose concentration 120 minutes after the oral glucose load only increased approximately 2 mg/dL per decade. Glucose uptake during euglycemic clamp studies was also reduced in the older group, and this was true if the clamps were performed at plasma insulin concentration of approximately 10 μU/mL(P<.05) or 60 μU/mL(P<.10). However the differences were relatively modest in magnitude, ie, 10–25%. The fact that the increase in glucose uptake when plasma insulin was raised six‐fold was similar in both groups suggests that insulin sensitivity does not decline with age. These data confirm previous observations that glucose tolerance deteriorates with age, but emphasize that this age‐related decline is modest in magnitude in healthy, non‐obese individuals. Since plasma insulin concentrations also were higher in the older group, the decline in glucose tolerance must be due to an age‐related impair

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02235.x

年代:1989

数据来源: WILEY

摘要:

Seventy‐five patients with probable Alzheimer's disease were screened for binding of alpha2receptors (A2R) to their platelet membranes; the results were compared with 51 age‐ and sex‐matched controls. Receptor binding assays were performed using [3H] Yohimbine as the radioligand. The results showed a higher binding capacity in the demented population as compared to the control group (2.18 ± 0.15 fmol/mg protein, as compared to 1.73 ± 0.13, P<0.03). This increased binding to platelets in the demented patients was more prominent in demented females: 34% higher binding as compared with female controls (2.06 ± 0.5vs1.54 ± 0.04). The difference between demented and normal males was less (2.34 ± 0.05vs1.88 ± 0.05). The results indicate an involvement of the A2R system, either primarily or secondarily, in the disease process. Since there is an overlap between results from the patients with Alzheimer's disease and the normal subjects, A2R may serve as only a supportive marker for Alzheime

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02236.x

年代:1989

数据来源: WILEY