摘要:

ObjectiveTo find somatic, psychiatric, and social variables that predicted cessation of coital activity in elderly married men.DesignProspective, longitudinal, observational studySettingGeneral survey of a representative sample of 70‐year‐old urban men (born in 1901–02) in Göteborg, Sweden.ParticipantsForty‐one men who were married and had coital activity at age 70 and who, at the age of 75, were still married when the sample was reinterviewed.Main Outcome MeasuresPresence (c) or absence (nc) of coital activity at age 75.ResultsCessation of coital activity was associated with vasculogenic factors. At least one of the following disorders—systemic hypertension, ischemic heart disease, congestive heart failure, diabetes mellitus, or hypertriglyceridemia—was found in three of the C men and 14 of the NC men,P<0.005. Systemic hypertension was the most common disorder and was found in one C man and 10 NC men,P<0.01. Cessation of coital activity was associated with specified types of stress between 65 and 70 years of age in the subgroup of men who had stopped due to inability; six out of eight reported stress against five out of 20 in the C group,P<0.05. There was no association with any of the psychiatric or social factors studied.ConclusionsCessation of coital activity is predicted by somatic disorders which are associated with vascular damage and especially by hypertension. This observation does not allow the conclusion that antihypertensive treatment would be effective in postponing the cessation of coi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02007.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo compare the perceptions of the rehabilitation environment among staff, younger (65).DesignThe Ward Atmosphere Scale (WAS) was administered to 55 patients and 108 staff members in a rehabilitation hospital.SettingA large university‐associated free‐standing rehabilitation hospital.SubjectsPatients and staff primarily associated with one of three treatment teams, each on a separate floor. The teams were selected to reflect a diversity of treatment styles and patients' diagnoses.Main Outcome MeasureThe WAS is a 100 true/false questionnaire with 10 subscales which combine to form three dimensions: relationship, program orientation, and system maintenance. These dimensions represent the principal constructs of the instrument.Main ResultsMultivariate analysis of variance was performed on three groups completing the WAS—staff, patients less than 65 years old, and patients 65 years and older. This analysis revealed significant differences among the three groups on the Relationship (F= 14.3;P<0.01) and Program Dimensions (F= 36.5;P<0.01), and between staff and patients on the System Maintenance Dimension (F= 11.4;P<0.01). Compared to younger patients and staff, older patients had lower perceptions in the combined areas of involvement, support, spontaneity, autonomy, practical orientation, personal problem orientation, and anger and aggression. Likewise, older patients perceived more staff control than staff and younger patients. Younger patients scored between older patients and staff.ConclusionsThis study suggests that there may be a mismatch between current rehabilitation environments and the needs of elderly indivi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02008.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo develop a reliable and valid test of cognitive function suitable for patients with severe cognitive impairment.DesignAdministration of a test; test‐retest reliability; comparison to traditional test.SettingChronic long‐term‐care facility.Patients or Other ParticipantsThe participants were 40 elderly residents with severe cognitive impairment.Main Outcome MeasuresResults of the Test for Severe Impairment (TSI) and its subsections (language, memory, executive function, and motor performance); correlation of test and retest scores; correlation of TSI with Mini‐Mental State Exam.ResultsThe TSI was significantly correlated with the Mini‐Mental State Exam (r= 0.83,P≤ 0.0001). Test‐retest reliability was high (r= 0.96,P<0.0001). The internal reliability of the test was also good (alpha = 0.90). Preliminary result of a factor analysis suggests that factor scores may be derived that relate to memory, language production, and knowledge of body parts.ConclusionsThe TSI is a valid and reliable test of cognitive function in patients with severe cognitive impairment. It is appropriate to use it as a

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02009.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo evaluate the incidence, etiology and clinical course of rhabdomyolysis in hospitalized elderly patients.DesignRetrospective case series.SettingAcute geriatric department of a university‐affiliated teaching hospital.PatientsTwenty‐three patients who fulfilled our criteria of rhabdomyolysis. Criteria for inclusion were the finding of elevated serum creatine kinase of five‐fold or greater above the upper reference limit and greater than 97% MM isoenzyme.ResultsIn a 3‐year period 23 patients out of 2,870 admissions fulfilled the criteria for rhabdomyolysis, an incidence rate of 0.8%. Diseases or insults associated with rhabdomyolysis were, in order of frequency, acute immobilization, infectious disease, cerebrovascular accident, hyperosmolar state, hyponatremia, hypernatremia, hypothermia, and a fall. Twenty‐two patients recovered from the acute illness; one patient died from respiratory failure. Seventeen patients had renal failure (serum creatinine>180 μmol/L), none necessitating dialysis. Serum creatinine always declined following recovery.ConclusionElevation of CK with few other clinical features of rhabdomyolysis is common in admissions to a geriatric service. It is due to complete immobilization resulting from acute illness. Renal failure is mild and reversible, and the prognosis for recovery is

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02010.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine the accuracy of self‐reports of physical functioning by hospitalized elderly.DesignComparison of two measures.Patients and SettingTwo‐hundred forty‐seven medical inpatients (mean age 78.7 years) hospitalized at St. Marys Hospital Medical Center, Madison, WI.Main Outcome MeasuresMeasures of five activities of daily living by self‐report and by performance.ResultsThe rate of agreement between self‐report and performance ADL measures was the lowest in the areas of bathing and dressing where the agreement was 63% and 64%, respectively. When patients reported needing no help in these two tasks, they were measured lower 32% of the time for dressing and 42% for bathing. When patients reported needing help in an activity the agreement rate between patient and occupational therapist varied widely, from only 42% for toileting to 78% for bathing. The two factors which were statistically associated with poor agreement between the two ADL measurements were cognitive impairment (P<0.001) and a decline from the pre‐hospital level of ADL functioning which had occurred during hospitalization (P<0.001).ConclusionsThese data suggest that there may be significant differences between patient assessments and performance‐based measurements of ADL functioning in hospitalized elderly at time of discharge. These differences may have implications for the collection of functional measurements for discharge planning or for geriatric research in the hospita

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02011.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo evaluate the usefulness and reliability of the Caretaker Obstreperous‐Behavior Rating Assessment (COBRA), a new test instrument for caretaker assessment of types and severity of “obstreperous behaviors” (OBs) in demented patients.DesignCOBRA was completed by caretakers of 31 outpatients and 36 nursing home inpatients with dementia. Test‐retest reliability was determined when 25 of the outpatient caretakers re‐evaluated their demented relative 1 week later; inter‐rater reliability was determined on nursing home inpatients by comparing the reports of two nurse's aids with equivalent knowledge of seven of the patients.Setting(1) University medical center Alzheimer's Disease and Related Disorders Clinic; (2) community nursing home.PatientsThirty‐one sequentially‐seen outpatients with dementia; 36 nursing home patients with dementia.InterventionFollowing instruction in the use of the COBRA Scale, caretakers provided scores for their demented patient. The instrument has three unique features: (1) it divides OBs into four categories for ease of comprehension: Aggressive/Assaultive; Mechanical/Motor; Ideational/Personality; and Vegetative; (2) a companion videotape shown to caretakers in advance illustrates each behavior to improve reliability of reporting; (3) the significance of each OB is estimated with severity and frequency measures.Main Outcome MeasurementsFrequency and severity of OBs are epitomized in 12 summary scores. Test‐retest correlations (for outpatients) and inter‐rater correlations (for inpatients) were analyzed with Pearson Product Moment and Spearman Rank Order correlations.ResultsPrevalence of OBs and severity was reported for the experimental groups. Summary scores revealed test‐retest correlations of .95 to .73 for 11 of 12 scores (outpatients), and inter‐rater correlations of .99 to .73 for 8 of 12 scores (inpatients). Age, gender, and disease etiology were not significantly related to OBs; clinical severity correlated with type and severity of OBs.ConclusionsThe COBRA scale provides a convenient, comprehensive, and reliable means for caretakers to identify the types and measure the severity of OBs in demented outpatients and nursing home inpatients. If additional studies confirm these observations, COBRA will be a useful instrument for assessing the effects of interventions on OBs in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02012.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine the relative importance of factors influencing physicians to use tube feedings in patients lacking decision‐making capacity.DesignSurvey.Setting and ParticipantsFour hundred thirty‐nine members of the Missouri Academy of Family Physicians.MeasurementsUsing a mailed questionnaire, physicians were asked for a decision about feeding tube placement in an 89‐year‐old man who was unable to swallow or communicate after a stroke. Changing the conditions of the scenario, we then evaluated the influence of patient age, duration of disability, a living will, theCruzandecision, and family preferences on the physician's decision.ResultsAfter reading the initial case history, 47% of physicians opposed tube feedings. Physicians who were told that the patient signed a living will specifically excluding tube feedings were more likely to oppose tube feedings than those who were told that he signed only a standard living will (53% vs 42%;P= 0.02). Forty‐two percent of physicians who initially suggested a feeding tube changed their recommendation if the family opposed it. Sixty‐six percent of physicians who initially opposed a feeding tube changed their recommendation if the family “pushed” for it. Thirty‐three percent of physicians who initially opposed tube feedings under the living will scenario would favor tube feedings if the patient had not signed a living will. Twenty‐two percent of physicians who initially opposed tube feedings would change to favor them if the issue had arisen before theCruzandecision.ConclusionsAmong this group of physicians, there was no consensus on whether tube feedings should be initiated. However, it was found that the family's opinion was the most influential factor affecting the physician's recommendation about tube feedings. Most physicians endorsed family preferences for tube feedings even when this intervention was specifically opposed in the pa

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02013.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo investigate the accuracy of cranial computerized tomography (CT) scans in distinguishing patients with Alzheimer's disease from those with other dementing conditions.DesignRetrospective clinicopathological correlation with pre‐mortem CT scans.SettingUrban and rural hospitals and nursing homes in the Upper Midwest.PatientsAll 507 patients had clinical dementia diagnosed as Alzheimer's disease during life and the subsequent referral of their brains to a dementia brain bank. Of these, 375 patients had had CT scans as part of the diagnostic work‐up for dementia.Main Outcome MeasuresThe presence of neuropathological evidence of Alzheimer's disease and the specific findings on CT scans.ResultsOf the 375 patients evaluated with a CT, 28% were misdiagnosed (lacked neuropathological evidence of Alzheimer's disease); of the 132 patients evaluated without a CT scan, only 18% were misdiagnosed (P<0.05). The degree of atrophy and other CT findings were similar in the correctly diagnosed and misdiagnosed groups except for increased ventricular size in the correctly diagnosed patients (P<0.05).ConclusionAlthough CT scans do not usually contribute to the recognition of Alzheimer's disease, the presence of ventricular enlargement may help distinguish Alzheimer's disease from other dement

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02014.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo evaluate the extent to which mortality data, which is often used to track secular trends for specific diseases, underestimates the prevalence of dementia.DesignRetrospective analysis of existing data.SettingDepartment of Mental Health inpatient facilities in South Carolina.SubjectsInpatients at Department of Mental Health facilities who were listed in the South Carolina Statewide Alzheimer's Disease and Related Disorders Registry and who died between 1988 and 1990 (n= 450).Main Outcome MeasuresSensitivity and specificity of dementia diagnoses on death certificates compared to medical record diagnoses for inpatients with a pre‐mortem dementia diagnosis.ResultsTwenty‐three percent of death certificates contained any dementia diagnosis (104/450). The sensitivity of death certificates varied by type of dementia (28 percent for Alzheimer's disease; 8 percent for multi‐infarct dementia) as well as by race, sex, and age.ConclusionsMortality statistics substantially underestimate the prevalence of dementing illnesses and do not fully represent the public health burden of dem

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02015.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine the yield of standardized targeting criteria for identifying hospitalized HMO patients who are at high risk for mortality and nursing home placement and, therefore, may be appropriate for comprehensive geriatric assessment.DesignProspective cohort study.SettingFour HMO (Southern California Kaiser‐Permanente) hospitals.Subjects3,697 patients 65 years of age or older admitted to any inpatient service from July 1 through September 30, 1990.Main Outcome MeasuresScreening measures for standardized targeting criteria, administered 24–48 hours after admission.ResultsOverall, 35.1% of patients screened met at least one inclusionary criterion, which is considerably higher than other published reports. The most commonly met criteria were incontinence, impairment in performing activities of daily living, malnutrition, and immobility. The percentage of patients meeting at least one criterion and meeting each criterion varied considerably among hospitals. The vast majority of patients (83%) who were judged appropriate for assessment met at least three criteria.ConclusionsThe yield of standardized criteria differs when applied to patients in different health care systems and to patients at different hospitals within a health care system, which may reflect differences in the populations being served and the practice styles of physicians and the delivery system. Because no single criterion identified more than approximately half of patients who were judged appropriate for assessment, it is likely that a battery of criteria will be necessary to identify these patie

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02016.x

年代:1992

数据来源: WILEY