摘要:

In an examination of Navajo elderly inpatients and outpatients, high rates of protein undernutrition (despite normal caloric stores) were found to be prevalent. The protein malnutrition was present in each of several measures used, covering structural as well as visceral protein. It was more common in males, inpatients, and the aged elderly, but excess rates of undernutrition were found in all groups examined. These rates were higher than those in any comparable group reported to date. With multiple regression analysis, length of stay in the hospital is shown to be related to this undernutrition among inpatients studied.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02634.x

年代:1989

数据来源: WILEY

摘要:

An explosive outbreak of influenza A/H3N2 began in a nursing home in the Denver area early in November, 1987. Residents had not been vaccinated at that time. Vaccine was administered on November 11th. Two weeks after the vaccine was given, the attack rate differed between the vaccinated and unvaccinated individuals. There were 40 cases of influenza among the 98 elderly residents, 12 cases of pneumonia, and seven deaths. Vaccine efficacy two weeks after it was given was estimated to be 65.4% in preventing clinical illness. There were no cases of pneumonia and no deaths among people who were vaccinated more than two weeks before. The virus was identified as influenza A by complement fixation tests with convalescent sera from 16 individuals who had been ill. Many also had hemagglutination inhibition titers for A/Colorado/1/87, which were as high as titers for A/Leningrad/87. A/Colorado/1/87 closely resembled A/Sichuan/87.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02635.x

年代:1989

数据来源: WILEY

摘要:

Thirty‐five elderly patients receiving intermittent urethral catheterization in a Veterans Administration Hospital and attached nursing home care unit were prospectively studied for development of bacteriuria and/or urinary tract infection. Thirty‐one of the 35 patients (88.6%) developed urinary tract colonization. The mean time from initiation of catheterization to development of colonization was 5.7±1.3 days. Persistent bacteriuria with one or several different microorganisms developed in 17 patients. The most common colonizing organisms were coagulase negative staphylococci, Klebsiella pneumoniae,and enterococcus. Four patients (11%) developed symptomatic urinary tract infection. Although urinary tract colonization was common in patients receiving intermittent urethral catheterization, especially in those with poor functional status, infection was uncommon. Based on these results, intermittent urethral catheterization appears to be a safe and effective method of bladder drainage in elderly male patients when performed with sterile techniques over short periods of time in the nursing home or hospital set

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02636.x

年代:1989

数据来源: WILEY

摘要:

Participants in a therapeutic program for osteoporosis were studied to determine if program participation improved psychological outcomes. The 4‐day program included intensive education about the disease and its prognosis, physical therapy education, nutritional counseling, and medical evaluation and treatment. All therapeutic patients enrolled in the program over a one‐year period (N = 38) were interviewed individually pre‐ and post‐participation. Knowledge of osteoporosis, level of social support, coping styles, and perceptions of the impact of pain and chronicity were assessed. Patients reported improved future outlook despite continued concern about pain and chronicity. Mention of depression was reduced, and knowledge of osteoporosis increased significantly. In addition, there were meaningful changes in patients' understanding of disease management. These included knowing when to make specific changes and avoid harmful actions. The findings suggest that an educational program can have a positive impact on patients' coping. Educational efforts may be an important component in the management of chronic

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02637.x

年代:1989

数据来源: WILEY

摘要:

The prevalence of self‐reported constipation and the factors which contribute to it were investigated in a door‐to‐door survey of 209 people aged 65 to 93. Thirty percent of men and 29% of women described themselves as constipated at least once a month. However, elderly people define constipation differently than do their physicians: only 3% of men and 2% of women in the community sample reported that their average stool frequency was less than three per week, the customary medical criterion for constipation. The primary symptom which elderly people used to define constipation was having to strain in order to defecate. Multiple factors were found to influence self‐reports of constipation. The amount of liquids consumed was significantly related to longest period without a bowel movement in men, but fiber and liquids were not related to self‐reported constipation in either sex. The number of chronic illnesses and the number of nonlaxative medications were significantly related to constipation in women but not men, and the number of psychological symptoms correlated significantly with self‐reports of constipation in both men and women. Age was not significantly related to self‐reported constipation in men or women over

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02638.x

年代:1989

数据来源: WILEY

摘要:

Ambulatory cardiac (Holter) monitoring is often recommended in the routine evaluation of patients who fall; however, the prevalence of arrhythmias in old people is high, and the usefulness of such monitoring is unproven. As part of a large study of institutionalized elderly fallers, we compared Holter findings of fallers (N = 51) with a group of nonfallers (N = 27) having similar medical and demographic characteristics. Prevalence of ventricular arrhythmias was 82% in each group, and all patients had supraventricular arrhythmias. The mean number of ventricular and supraventricular couplets and runs did not differ between groups. There was no difference in severity of arrhythmias between fallers and nonfallers; in fact, fallers had slightly fewer Lown 4B arrhythmias than nonfallers (10% vs 18%, NS). Prevalence of heart disease was 78% in both groups and was associated with increased ventricular ectopy in the form of runs and couplets (P<.05). No symptoms were reported during the Holter monitoring. We conclude that Holter monitoring should not be a routine part of the work‐up of the patient who fall

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02639.x

年代:1989

数据来源: WILEY

摘要:

Cutaneous‐delayed hypersensitivity was studied by one and two‐step Mantoux‐type skin tests to four standard antigens in 33 elderly nursing home residents, 34 geriatric clinic patients, and 20 healthy young adult controls. Demographic and anthropometric data were collected to determine the effects of nutrition and other variables on cutaneous‐delayed hypersensitivity. Anergy (a lack of response greater than 5 mm of induration when read at 48 hours) to any of the four antigens occurred in 34% of nursing home residents, 17% of geriatric clinic patients, and none of the healthy young adults. Mean and maximal responses were less in the nursing home residents than the clinic patients or controls, even if anergic individuals were excluded from analysis, suggesting both a qualitative and quantitative decline in cell‐mediated immune function in this elderly population. Repeat testing with each antigen for which there was a negative initial response revealed a “booster” affect of 7 to 19% and occurred as commonly in the healthy young adults as in the nursing home residents or geriatric clinic patients. The mumps antigen elicited strong responses in the healthy young adults, but weak reactions in the nursing home residents. An unexpectedly high prevalence of positive tuberculin (PPD) responses occurred in the nursing home residents, suggesting recent exposure. Analysis of anthropometric and demographic characteristics show that neither nutritional status nor age alone can account for differences in cutaneous‐delayed hypersensitivity observed between populations. Cutaneous‐delayed hypersensitivity may vary widely between elderly populations and have important practical implications for th

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02640.x

年代:1989

数据来源: WILEY

摘要:

We hypothesized that the blood pressure response to standing may depend on the method of establishing baseline blood pressure. Three hundred elderly subjects previously completed a postural blood pressure protocol with three supine baseline blood pressure readings obtained two minutes apart prior to standing. Comparison of the readings showed a significant drop between the first and the second(P<.001)but not between the second and third supine systolic blood pressures. The difference between the first supine systolic blood pressure and the one minute standing blood pressure was significantly greater than that between the third supine systolic blood pressure and the one minute standing blood pressure(P<.001).A second group was prospectively studied to determine whether the change in blood pressure after standing was greater if only a single baseline reading was taken rather than multiple readings, and whether the decline in blood pressure over three readings was related to duration supine or to the number of blood pressures taken. This group also demonstrated a decline in systolic blood pressure with three serial readings. We conclude that supine blood pressure declines significantly between the first and second readings taken two minutes apart and is secondary to the repetition of readings and not the duration supine. However, this change in supine blood pressure does not significantly alter the blood pressure response to standing. Thus, it appears that a single baseline supine blood pressure measurement is adequate for determining the postural blood pressure response, and that pooling of multiple baseline readings may not be appropriate.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02641.x

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02642.x

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb02643.x

年代:1989

数据来源: WILEY