摘要:

ObjectiveTo test the hypothesis that shoes with thick, soft midsoles, such as modern running shoes, provide better stability in older individuals than those with thin‐hard midsoles. In addition, we examined the relation between footwear comfort and stability and stability when barefoot.DesignRandomized‐order, cross‐over, controlled comparison.SettingSubjects were drawn from an internal medicine practice.ParticipantsA random sample of 25 healthy men, minimum age 60 years. Additional selection criteria were absence of disabilities influencing ability to walk and lack of history of frequent falls.MeasurementsBalance failure frequency, which was defined as falls from the beam per 100 meters of beam walking when 10 passes were made down a 9 M long balance beam. Comfort rating was based on an ordinal scale.ResultsContrary to the hypothesis: (1) midsole softness was associated with poor stability (F(2,48) = 17.9,P<0.0001); (2) thick midsoles also provided poor stability (F(1,24) = 7.36,P<0.01). When barefoot, subjects showed 19% higher balance failure frequency than with the poorest shoe and 171% greater than the best shoe (t= 5.33,P<0.0001). Higher comfort was generally found in shoe types associated with higher balance failure frequency.ConclusionsFor optimal stability, shoes with thin, hard soles are preferable for older individuals. Health professionals should exercise caution when recommending shoes with thick, yielding midsoles, such as running shoes, to unstable elderly individuals. Older men and women with a history of falls or who are obviously unstable, should avoid barefoot locom

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01795.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo investigate the reliability and validity of freehand clock drawings, a frequently used measure of constructional apraxia, in patients with Alzheimer's disease.DesignSurvey for the purpose of testing reliability and validity of a new scale.SettingMemory Disorder Clinic at a university‐affiliated hospital in the Upper Midwest.PatientsForty‐six patients were diagnosed with clinically probable dementia of the Alzheimer type after a dementia evaluation, and 26 normal elderly controls were research volunteers without a history of cognitive dysfunction.MeasurementsNeuropsychological tests, dementia‐related scales, and clock drawings rated by a new 20‐item Clock Drawing Interpretation Scale. Reliability measures, correlations, and clustering of items in the CDIS.ResultsThe CDIS had inter‐rater reliability (r= .94), internal consistence (rtt= .95), and reproducibility over a 6‐month interval. CDIS scores were significantly correlated with two dementia‐related scales and all neuropsychological tests and had the highest correlations with other measures of constructional apraxia. All but four Alzheimer patients (91%) and none of the controls had CDIS scores of 18 or less.ConclusionClinicians may reliably screen patients with Alzheimer's disease with the clock‐drawing task, a measure sensitive to deficits in constru

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01796.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo describe how diabetic ketoacidosis in those aged 65 or over differs from that in younger adults.DesignRetrospective chart review of all adult patients with a primary or secondary discharge diagnosis of diabetic ketoacidosis (n= 338).SettingThree urban teaching hospitals in Milwaukee, WI from January 1, 1987 to May 31, 1990.PatientsTwo hundred twenty cases in 150 patients met our criteria for severity of illness to be included in the study. Twenty‐seven cases were in patients ≥ age 65; 193 cases were in patients

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01797.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine the safety and efficacy of the anabolic steroid nandrolone in elderly patients with hip fractures. Design: A randomized double‐blind placebo‐controlled trial. Setting: The orthopedic ward of a university teaching hospital.Participants29 frail elderly females with hip fractures. Intervention: Subjects received nandrolone 2 mg/kg (n= 15) or placebo (n= 14) by weekly injection for 4 weeks or until discharge.MeasuresBaseline functional status was assessed by the Lawton‐Brody ADL and IADL. Hemoglobin, transferrin, thyroid‐binding prealbumin, albumin, liver function tests, creatinine, weight, MAMC, bioelectric impedance, standard anthropometrics and grip strength were measured at baseline and weekly intervals. Rehabilitation parameters and length of stay were recorded.ResultsThe placebo and nandrolone groups were similar in age, although the control group had slightly higher baseline ADL scores. There was no difference between groups in biochemical parameters, anthropometrics, body composition, grip strength, rehabilitation end points or length of stay. One subject in the nandrolone group had a doubling of AST and was withdrawn from the study.ConclusionsNandrolone can be given safely to frail elderly subjects with hip fractures but is likely to be of minimal benefit at the doses we e

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01798.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine if the impaired mental skills in Alzheimer's Disease (AD) may adversely affect driving ability.DesignRetrospective survey.SettingThe Alzheimer's Clinic of the University of Kansas Medical Center.PatientsWe interviewed 67 AD patients and their families and compared them with 100 elderly, non‐spousal controls.MeasuresThe questionnaire was designed to obtain information on their driving habits, with emphasis placed on whether they were still driving, and the number of accidents per year for the past 10 years.ResultsForty‐six of the AD subjects had stopped driving because of safety concerns expressed by the subjects, their families, or health care providers, and two had stopped for other reasons. Only two of the normal controls had stopped driving (P<0.0001, Chi‐square test). Over the past 3 years, the 19 AD subjects who were still driving had 263.2 motor vehicle accidents per million vehicle miles of travel compared with 14.3 for the controls (P<0.002, Mann‐Whitney U test) and 5.7 for the general driving population age ≥ 55 years (P<0.05, Students one group, two‐tailedttest).ConclusionThis study suggests that a significant traffic safety problem exists in subjects with AD who continue to drive. Efforts should be directed to detect patients with AD whose driving presents a traffic saf

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01799.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine the prevalence of antidepressant drug treatment among nursing home elderly with major depression.DesignSurvey early and late in nursing home stay.SettingSixty Medicaid/Medicare‐certified skilled nursing homes.ParticipantsAdmission cohort of 5,752 residents age 65 or older in 1976 through 1983.MeasuresChart review by nurse‐abstractors of physicians' diagnoses, drug used, and alertness rating. Diagnosis of depression equivalent to DSM‐III‐R major depression.ResultsOf 868 persons with a diagnosis of depression in the medical record, only 10% were treated with antidepressant drugs. More received neuroleptics and benzodiazepines than received antidepressants, but most (52%) received no psychoactive drug at all. A subset of 258 depressed persons had positive notations in their records supporting a mental status rating of “alert and oriented.” Of that subset, only 15% received antidepressants. When followed from admission to discharge or end of study the prevalence rate of antidepressant drug treatment increased by 4%.ConclusionsIn the late 1970's and early 1980's, even when the primary care physician made and recorded a diagnosis of depression, most such nursing home residents remained untreated, incorrectly treated, or inadequat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01800.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo investigate the usefulness of head‐upright tilt table testing for vasovagal episodes in the evaluation and management of elderly patients with recurrent idiopathic syncope.DesignProspective survey.SettingElectrophysiology laboratory of a university hospital.PatientsTwenty‐five patients (11 male, 14 female; mean age 73 ± 6 years) with recurrent unexplained syncope and seven control subjects with other causes of syncope (4 male, 3 female; mean age 70 ± 4 years).MethodsEach patient underwent head‐upright tilt table testing for 30 minutes with or without an infusion of isoproterenol (1–3 μg/min given intravenously) in an attempt to provoke bradycardia, hypotension, or both.Main ResultsSyncope occurred in nine patients (36%) during the baseline tilt and in seven patients (28%) during isoproterenol infusion (total positives 64%). None of the controls had syncope during the test. All of the patients who had positive test results eventually became tilt table negative with therapy, and over a mean follow‐up period of 24 months, no further syncopal episodes have occurred.ConclusionsHead‐upright tilt table testing combined with isoproterenol infusion may be a useful tool in the diagnosis of vasovagal syncope in the elderly and in the evaluation of prev

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01801.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo identify which Instrumental Activities of Daily Living (IADL) are related to cognitive impairment, independent of age, sex, and education; to assess the performance of an IADL score using these items in screening for cognitive impairment and dementia in elderly community dwellers.DesignSurvey based on the baseline interview of the PAQUID study on functional and cerebral aging.SettingCommunity survey in 37 randomly selected parishes in Gironde, France.SubjectsRandom sample of 2,792 community dwellers aged 65 and over (participation rate: 69%).MeasurementsTwo‐phase screening: (1) functional assessment, Mini‐Mental State Examination (MMSE) and DSM‐III criteria for dementia; (2) in DSM‐III‐positive patients, NINCDS‐ADRDA criteria applied by a neurologist. Functional assessment: IADL scale of Lawton and Brody. Criterion standards: cognitive impairment: MMSE score lower than 24; dementia: DSM‐III and NINCDS‐ADRDA criteria.ResultsFour IADL items are correlated with cognitive impairment independent of age, sex, and education: telephone use, use of means of transportation, responsibility for medication intake, and handling finances. A score adding the number of IADL dependencies has a sensitivity of 0.62 and a specificity of 0.80 at the lowest cut‐off point (score>0) for the diagnosis of cognitive impairment. The same score at the same cut‐off has a sensitivity of 0.94 and a specificity of 0.71 for the diagnosis of dementia. The prevalence of dementia (2.4%) is reduced by a factor of 12 in subjects independent for the four IADL.ConclusionThe four IADL score could be incorporated into the screening procedure for dementia in elderly

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01802.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine whether age‐related bone loss is negatively associated with serum intact parathyroid hormone (PTH).DesignSurvey.SettingUniversity hospital outpatient department.Participants100 community‐dwelling women, age 18 to 80, recruited as a convenience sample.MeasurementsDependent variables—bone density at the spine and femoral neck by dual‐energy X‐ray absorptiometry. Independent variables—age, menopausal status (binary) and intact serum PTH by Allegro immunometric assay.ResultsPost‐menopausal women had higher serum PTH and lower bone density of spine and femoral neck than pre‐menopausal women. Bone density at the spine decreased with age, but this effect was accounted for by menopausal state. Bone density at the femoral neck decreased with age even after adjusting for menopause. Log PTH was negatively associated with bone density at the femoral neck but not significantly at the spine. Multiple regression analysis adjusting for age and menopause showed no significant association between intact PTH and bone density at the spine or the femoral neck.ConclusionAlthough this study confirmed the rise in intact PTH with age, there is no evidence that this is the mediator of age‐

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01803.x

年代:1992

数据来源: WILEY

摘要:

ObjectivesTo study how well the scoring on each item of the MMSE relates to the sum‐score when the purpose is to identify persons with cognitive impairment, and to identify an equally effective subset of MMSE items for predicting cognitive impairment.DesignRetrospective survey of MMSE data for 850 elderly. Setting: A variety of clinical settings.ParticipantsMean age 82 years (range 54 to 99), 74% women. The subjects were of three different categories: geriatric in‐patients, patients living under supervision, and elderly people living independently at home.ResultsFive of the binomial (“State,” “Town,” “Name a pencil,” “Name a watch,” “Read and obey”) and one of the polychotomous MMSE variables (“Learn three words and repeat immediately”) had low sensitivity and gave high percentages of misclassifications versus the sumscore dichotomized at the cut‐point 23/24. Univariate logistic regression indicated that the three remaining polychotomous variables (“Spell backwards,” “Recall three words,” and “Three‐stage command”) can be scored binomially. Two factors were identified on factor analysis. Logistic regression analysis showed that 12 of the original 20 items predicted the sumscore dichotomized at 23/24 with only 3% misclassifications. Validation against the psychogeriatrician's diagnosis showed that this 12‐item MMSE derivative performs as well as the full MMSE.ConclusionsSix of the 20 MMSE variables perform poorly regarding sensitivity and misclassifications versus the sum‐score at cut‐point 23/24. Two additional items did not contribute to the prediction of a low/high sumscore. The remaining 12 MMSE items can all be scored binomially and produce a sumscore which is equally as effective as the sumscore of the full MMSE when the purpose is to id

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb01804.x

年代:1992

数据来源: WILEY