ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05454.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05455.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The organization and outcome of influenza immunization programs were studied in 67 randomly or systematically selected nursing homes (8354 residents) in six states during the autumn of 1982 and/or 1983. In each home, influenza vaccine was usually offered to all residents on a voluntary basis, independent of their age, level of required nursing care, or underlying medical conditions. However, the proportion of residents who were vaccinated ranged from 8 to 98% (mean, 62% overall), with significantly lower rates in homes that also required consent from relatives (usually by return mail) than in homes that did not (P<.00001; median, 57 versus 90%, respectively). These observations suggest that distribution of educational materials about the risks and benefits of influenza vaccine and systematic follow‐up of relatives who fail to return the consent form may be useful strategies to further increase the number of nursing home residents who are immunize

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05456.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

A crucial factor in promoting a vigorous quality of life in the aging population is assessment and treatment of cognitive deficits. A very high percentage of delirium and at least 20% of dementia is eminently treatable. This study of patients over 65 years of age admitted to a university general hospital reveals that 79% of cognitive deficits were missed by the examining physicians. Furthermore, in 394 examinations of 165 patients, only four mental status examinations were recorded. A clear‐cut cognitive deficit on admission was predictive of later acute episodes of confusion. The global techniques of evaluation deserve remediable action by medical schools and hospital training programs if the medical care of the elderly is to be improve

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05457.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

In a prospective study, 46 patients discharged from a teaching hospital to a “teaching unit” nursing home, where primary medical care was provided by faculty geriatricians, medical students, and medical housestaff, were compared with 78 similar patients discharged to one of five community nursing homes without a teaching affiliation. At the time of hospital discharge, patients were determined to have a terminal, rehabilitative, or long stay prognosis based on a review of hospital discharge summaries using specific criteria. Among 34 study and 55 control patients with a long stay prognosis, ten of the study group compared with seven of the control group returned home (P= .03). Seven of 34 long stay patients in the study group were rehospitalized, while 15 of a matched control group of 34 required hospitalization (P= .04). There was no increase in mortality or emergency service use in the study population. Patients considered to be terminal or rehabilitative showed no difference in ultimate outcome or hospital use. In the study group patients experienced an average reduction in total medications prescribed from 6.2 to 5.3, while patients in the control group had an increase from 5.4 medications prescribed to 7.6 (P<.001). Of 16 study patients discharged from the teaching unit nursing home, all remained home at least three months after discharge; only 12 of 18 control group patients discharged from the nursing home remained at home at three months (P<.01). Long‐term care by geriatric faculty, students, and housestaff appeared to have favorably influenced patient out

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05458.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The medical records of 412 residents of three southeastern Massachusetts nursing homes were reviewed to examine the frequency and medical management of urinary incontinence and the indications for chronic urinary catheterization. The mean age of the patients was 84.1 years. In this study 9.7% of the patients were managed with a urinary catheter, while an indication for catheterization was recorded in the medical records of only 27.5% of these patients. Half of the noncatheterized nursing home patients were transiently or permanently incontinent of urine, but were not catheterized. Incontinent patients without catheters were more likely to require assistance in toileting (75.5v26.1%) or to have bacteriuria (60.1v26.1%) than continent patients. Despite the frequency of urinary incontinence, this problem was included in the medical problem list of less than 5% of the incontinent nursing home patients. The authors conclude that urinary incontinence is a frequent medical problem in the nursing home population, but it is rarely recorded and evaluated as a medical problem. Furthermore, indications for urinary catheterization frequently are also not recorded. An explanation for this practice was not determined, but possibilities include a lack of physician knowledge of the evaluation and management of incontinence and a nonaggressive approach to such patients, given their other medical problems.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05459.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Investigators have reported poor recognition of dementia by primary physicians. For this reason, mental status examinations were performed on 72 demented and 144 nondemented medical inpatients to assess the sensitivity, specificity, and predictive value of components of this examination in the diagnosis of dementia. Sensitivity of individual level‐of‐orientation items was low (15.3 to 56.9%), though specificity was high (91.7 to 100%). Sensitivity of several nonorientation items was high (80.6 to 100%), though specificity was low. A multivariate discriminant equation using both orientation and nonorientation items achieved high sensitivity (89.6% test cases, 87.5% validation cases) and specificity (78.1% test cases, 87.5% validation cases). Adding the easily obtained patient characteristic of age to the equation further increased sensitivity (95.8%, 91.3%), while maintaining specificity (82.3%, 85.4%). From these results, it is concluded that the level‐of‐orientation screening examination used by clinicians to detect dementia is unacceptably insensitive. In contrast, a composite decision rule including nonorientation items achieves high sensitivity with relatively high spec

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05460.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05461.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05462.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb05463.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY