摘要:

ObjectiveTo determine if dietary intake, nutritional status, and other physical markers are risk factors for the development of pressure sores in the elderly.DesignCohort study.Setting250‐bed skilled nursing facility with 90 extended care beds in which the average length of stay is 28 days.PatientsTwo hundred newly admitted residents (70% female, 95% Caucasian) who were over age 65, estimated to stay>10 days, at risk for pressure sore development (Braden Scale score ≤17) but free of existing pressure sores were studied for 12 weeks or until discharge.MeasuresSkin assessment, Braden Scale score, blood pressure, body temperature, anthropometrics, and dietary intake were studied weekly. CBC, serum albumin, serum total protein, serum iron, iron binding capacity, serum zinc and copper, and serum vitamin C were studied weekly for 4 weeks and biweekly for 8 weeks.Main Outcome MeasuresPresence/absence and stage of pressure sores.Main ResultsStage I pressure sores developed in 70 (35%) and Stage 2 or worse in 77 (38.5%) residents. Subjects who developed pressure sores were older (P<0.001) and had lower systolic and diastolic blood pressure (P<0.001) and higher body temperature (P<0.001) than those without pressure sores. Dietary intake of all nutrients was lower among subjects who developed pressure sores. Using logistic regression, the best predictors or pressure sore development were the Braden Scale score, diastolic blood pressure, temperature, dietary protein intake, and age.ConclusionsRisk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein int

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01845.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo compare the effect of post‐operative analgesia using epidural versus intravenous infusions on the incidence of delirium after bilateral knee replacement surgery in elderly patients. Additional risk factors and impact on post‐operative recovery were also assessed.DesignProspective randomized controlled trial.SettingUrban referral hospital specializing in elective orthopedic surgery.Patients60 consecutive patients undergoing bilateral knee replacement surgery with epidural anesthesia were approached; 51 patients were eligible and consented. The mean age was 68, 55% were women, and there was a high prevalence of comorbid medical disease. No patient was demented pre‐operatively.InterventionRandom allocation to either continuous epidural infusion of bupivicaine and fentanyl or continuous intravenous infusion of fentanyl. Infusions were initiated at the first complaint of pain and continued through the 36‐ to 48‐hour stay in the recovery room.Main Outcome MeasureAcute post‐operative delirium defined using an algorithm based on DSM III criteria.ResultsThe overall incidence of acute delirium was 41%, with no difference between types of post‐operative analgesia. Predictors of delirium were age, gender, and pre‐operative alcohol use. All cases resolved within 1 week, and length of stay and achievement of physical therapy goals were the same for delirious and non‐delirious patients.ConclusionsThere is a high incidence of post‐operative delirium in elderly non‐demented patients following bilateral knee replacement, regardless of whether post‐operative analgesia is administered by the epidur

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01846.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo compare cognitive function and the prevalence of selected behavioral problems in delusional and non‐delusional dementia patients.DesignRetrospective medical record review.SettingAn outpatient geriatric assessment center.Participants114 consecutive patients with dementia.Main Outcome MeasuresDelusions as recorded in a consultation report.ResultsDelusions were described in 25.5% of patients. A variety of behavioral disturbances were more common in delusional than non‐delusional patients, including agitation, angry or hostile outbursts, urinary incontinence, wandering or pacing, and insomnia. While cognitive function as measured by the MMSE was similar in delusional and non‐delusional patients (18.9 ± 3.8 and 19.2 ± 5.9, respectively), there was a statistically borderline tendency for delusions to occur more often in patients in the mid‐range of cognitive impairment (17 ≤ MMSE ≤ 23) compared with patients with greater or lesser degrees of cognitive impairment (32% vs 17% respectively).ConclusionDelusions in dementia are associated with a variety of behavioral problems. Further studies are needed to clarify the role of delusions in the development of disruptive behaviors in deme

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01847.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo study the association of two well known risk factors for breast cancer and the association of knowledge of those risk factors with mammography utilization.DesignCross sectional: two independent random telephone surveys.SettingTwo Northeastern metropolitan communities surveyed in 1987 and in 1989.ParticipantsWomen without breast cancer who spoke English and who were between 45 and 75 years of age.Main Outcome MeasuresThe two risk factors measured were a family history of breast cancer and being 65 or older. Participants were surveyed about their knowledge of risk factors, presence of risk factors, selected beliefs, attitudes, reinforcing factors and mammography use. Results were analyzed for women 50–75.ResultsThere was a substantial increase in mammography use over the 2‐year period. Having a positive family history or being older is not associated with increased mammography utilization. Knowledge that family history and/or age are risks is associated with increased utilization. However, knowledge of risk factors is not associated with having those risks. Older women have lower utilization than younger women regardless of their knowledge of age as a risk. Increased physician recommendation is associated with increased utilization.ConclusionSince knowing that a factor is a risk and having a physician recommend mammography are each associated with increased use, we conclude that the primary care physicians' role in increasing mammography utilization is criti

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01848.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo examine differences between healthy elderly and young adults in daytime napping, nocturnal sleep, and 24‐hour sleep/wake patterns. A second objective was to determine whether elderly subjects with more and less frequent naps differed in their clinical features or nocturnal sleep.DesignSurvey by sleep/wake logs and polysomnography. Comparison by age.SettingSleep/wake logs were completed in the subjects' homes. Polysomnographic studies were conducted on an outpatient basis in a sleep and chronobiology research laboratory.SubjectsConvenience samples of forty‐five healthy subjects over 78 years of age (21M, 24F) and 33 healthy adults between 20 and 30 years of age (20M, 13F).Main Outcome MeasuresUsing self‐reports, we estimated the frequency and timing of daytime naps; timing, duration, and quality of nocturnal sleep; and 24‐hour patterns of sleep and wakefulness. Also Polysomnographic sleep measures.ResultsCompared to young adults, elderly subjects reported a greater mean number of daytime naps (P= .004), shorter nocturnal sleep with more wakefulness and earlier sleep hours (P<.003 for each), and a trend for a shorter 24‐hour sleep fraction. Among the elderly, more‐frequent and less‐frequent nappers did not differ in clinical ratings, self‐report sleep measures, or polysomnographic measures. There was a trend for more sleep‐disordered breathing and periodic limb movements in more frequent nappers.ConclusionsThese findings are consistent with an age‐related decrease in amplitude of the circadian sleep propensity rhythm, or with the expression of a semi‐circadian (12‐hour) sleepiness rhythm. However, we cannot exclude the additional possibility that napping results from lifestyle factors and nocturnal sleep pathologies in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01849.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo re‐assess relationships between mortality, hypnotic use, subjective insomnia, and sleep duration.DesignA prospective study examining 5‐year mortality among hypnotic drug users and respondents with subjective insomnia identified in a longitudinal study of health, activity, and lifestyle (Nottingham Longitudinal Study of Activity and Ageing).SettingGeneral community.Participants1042 survey respondents, aged over 65 years, randomly selected from the community and stratified at age 75 years.Main Outcome MeasureRecorded mortality.ResultsDuring the 5‐year period, 352 respondents died. The mortality rate was significantly greater among those taking some form of medication for sleep (n= 208) than for those not taking sleep medication (n= 812; chi‐square = 4.91,df= 1,P= 0.027). When sleep medication users were categorized as either “hypnotic users” (ie, users of medication with recognized hypnotic or sedative actions) or “other users” (including analgesics and other over‐the‐counter medicines), only “other users” showed significant excess mortality (chi‐square = 7.27,df= 1,P= 0.007). Logistic regression showed that “other users” were 2.5 times more likely to die than “non‐users” even when gender, health risk, and usual sleep duration were controlled. There were no significant relationships between mortality and subjective insomnia or reported duration of sleep.ConclusionsEarlier reported relationships between excess mortality and use of medication for sleep are replicated in this study. Among elderly people, however, this relationship does not derive from the pharmacological characteristics of prescription hypnotics. Rather, it appears that reported self‐medication to promote sleep, using a variety of non‐sedative products, provides an epidemiological “marker” for a group within which levels of morbidity and mortality are particularly high. Excess mortality associated with very short or long sleep duration was not replicated in this study. Overall, these findings provide little epidemiological support for a widespread interaction between benzodiazepine hypnotic us

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01850.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo test the strength of the evidence in favor of the hypothesis that protein‐energy undernutrition is an independent risk factor for non‐elective hospital readmission within 3 months of discharge in a population of elderly hospitalized patients.DesignRetrospective analysis of data from prospective observational study.MethodsAll 110 elderly patients admitted to a geriatric recuperative care and rehabilitation unit during a 6‐month period completed a comprehensive in‐patient evaluation. Ninety‐eight of these patients were subsequently discharged alive and followed prospectively for 3 months. All hospital readmissions during the observation period were identified by patient interview and, within the VA hospital system, computer tracking of admissions. Based on the discharge assessment, the strongest predictors of non‐elective readmission were identified using univariate and multivariate statistical procedures.ResultsTwenty‐eight of the 98 patients discharged alive and completing the 3‐month follow‐up (29%) had at least one non‐elective readmission. The patients discharged home were non‐electively readmitted more frequently than were the patients discharged to a nursing home (32% vs 11%,P= 0.05). Of the 109 discharge assessment variables analyzed, the best predictor of which patients would have at least one non‐elective hospital readmission was the discharge serum albumin, followed by a diagnosis of dementia, discharge gamma globulin, the subscapular skinfold thickness, home ownership, and the discharge Katz Index of ADL score. Discharge serum albumin concentration, subscapular skinfold thickness, and discharge serum gamma globulin concentration were all negatively correlated with risk of non‐elective readmission. The presence of functional debilitation or dementia was associated with a lower likelihood of non‐elective readmission compared with the absence of these conditions.ConclusionsProtein‐energy undernutrition appears to be a strong independent risk factor for non‐elective hospital readmission especially among the highest risk patients, those who are functionally ind

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01851.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo examine changes in functional status over time by age, gender, and ethnicity in a representative sample of older persons.DesignSix‐year prospective cohort study.SettingAlameda County, California.Participants508 persons 65 years old and older at baseline in 1984.Main Outcome MeasuresActivities of daily living (ADL) dependence, mobility impairment, and functioning on an 18‐item scale.ResultsThe prevalence of ADL dependence and mobility impairment at baseline increased with age, while function decreased. Particularly striking differences occurred for those 80 and older. Changes in function over the 6‐year follow‐up showed a similar pattern. While death rates for males were higher, females had poorer initial functioning, and surviving females declined more than surviving males. The incidence of ADL dependence and mobility impairment during follow‐up was similar for males and females, although females survived longer with incident disability than did males. Blacks had poorer baseline functioning, more ADL dependence and mobility impairment, and declined more than non‐Blacks during follow‐up. Some of the baseline difference in function between Blacks and non‐Blacks was due to higher rates of chronic illness and co‐morbidity. In spite of the general downward trend in functioning over the 6 years, 13% of the males and 20% of the females improved.ConclusionAge‐related changes in function for older persons are complex and result in much heterogeneity. Clarifying the reasons for such heterogeneity is an important and challengi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01852.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo investigate the relations among the initial perceived stress of Alzheimer patients' caregivers, the rate of change of perceived stress, patients' sundowning behaviors, and patients' rate of cognitive decline.DesignA longitudinal cohort study in which Alzheimer patients and their caregivers were assessed at 6‐month intervals.SettingHospital out‐patient clinic. Patients and caregivers lived at home.SubjectsSubjects were 35 patients (50–79 years) with Alzheimer's disease and their primary caregivers (24 males and 11 females); all caregivers were spouses.MethodsAt time of entry into the study, caregivers indicated which of seven behaviors indicative of sundowning were exhibited by the patient. Patients were evaluated successively using the Mini‐Mental State Examination, whereas caregivers completed the Perceived Stress Scale, provided an index of social support utilization, and completed the Beck Depression Inventory.Main Outcome MeasuresCaregivers' initial perceived stress and the rate of change of perceived stress, patients' sundowning behavior, and rate of cognitive decline.ResultsThe pattern of correlations indicated that both rate of cognitive decline and initial sundowning behavior were significantly correlated with initial perceived caregiver stress. The average rate of increase of caregivers' perceived stress was positively correlated with the initial incidence of sundowning behaviors, even when controlling for the effects of caregiver depression and social support utilization.ConclusionSundowning behavior of Alzheimer patients is associated with an increased rate of change of caregivers' perceived stress. This association may be specific to sundowning behavior because there was no relation between the rate of change of perceived stress and morning agitation. The findings suggest that future caregiver intervention programs could profitably focus on sundowning behavior rather than general ag

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01853.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveThis study investigated the association between physical restraint use and decline in cognition.DesignCohort analytic study describing changes in resident characteristics.SettingEight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area.Participants437 nursing home admissions, with 201 remaining at 1 year.Main Outcome MeasuresCognitive status was measured by geropsychiatrists, using the Folstein Mini‐Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year.ResultsRestraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non‐ambulatory but without dementia and having strong social support.ConclusionsThese findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decl

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01854.x

年代:1992

数据来源: WILEY