摘要:

ObjectiveTo establish the concurrent validity of our new balance instrument, functional reach (FR = maximal safe standing forward reach), as a marker of physical frailty compared with other clinical measures of physical performance.Design, Setting, and Participants45 community‐dwelling persons age 66–104 were evaluated at one point in time using (1) FR (yardstick method), (2) Physical and Instrumental Activities of Daily Living (PADL, IADL), (3) Life Space, a 3‐point measure of social mobility, (4) 10‐item hierarchical mobility skills protocol, (5) 10‐foot walking speed, (6) one‐footed standing, and (7) tandem walking. Data analysis employed Spearman correlations. Partialr's were also calculated after controlling for age.ResultsThe FR performance range was broad (4.3–16.5 inches, mean 10.9, SD 3.1). Except for PADL, the association of FR with the other physical performance measures was strong, withr‘s ranging from 0.64–0.71; the association of FR with PADL was 0.48. After controlling for age in the regression analysis, partialr‘s ranged from 0.52–0.63. The association of FR with age was—0.50.ConclusionsBased on cross‐sectional data, FR is a practical instrument that correlates with physical frailt

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02068.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveThere are few data on the effect of walkers on gait and mobility or on comparisons of different walker types. We compared a commonly used 4‐legged, 2‐wheeled walker and a newer 3‐legged, 3‐wheeled walker in measures of gait, mobility, and patient satisfaction.DesignCross‐over controlled trial.SettingIn the Physical Therapy Department of a Veterans Affairs hospital.ParticipantsSubjects were 15 male and female frail elderly veterans (mean age, 82 years), both inpatients and outpatients, consecutively enrolled from a sample of 35 patients referred to the Physical Therapy Department for mobility problems. Subjects met the following criteria: age 65 or over, ambulatory, no prior use of a wheeled walker, stable medical condition, and informed consent.InterventionSubjects were evaluated without either walker and with each of the two walkers on a 15‐foot walkway and a 60‐foot obstacle course. Subjects were asked which walker they preferred.Outcome MeasureOutcome measures were stride length on the walkway, time on an obstacle course, and walker preference.ResultsStride length was 1.4 inches (3.6 cm) greater with the 3‐wheeled walker than with the 2‐wheeled walker (P= 0.016 by Wilcoxon signed‐rank test). Time on the obstacle course was 16.0 seconds less with the 3‐wheeled walker than the 2‐wheeled walker (P= 0.002). The 3‐wheeled walker was subjectively preferred.ConclusionsThe 3‐wheeled walker appears to have a greater positive impact on gait and mobilit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02069.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo study the prevalence and risk factors for colonization with MRSA at a long‐term‐care facility.DesignCross‐sectional surveillance culture survey.SettingA 233‐bed university‐affiliated long‐term‐care facility.MeasurementsSurveillance cultures for MRSA were performed on patients of two adjacent nursing units and on new admissions to the entire facility over a 4‐month period.ResultsOn the chronic medical unit, where patients known to be colonized had been cohorted, 20 of 38 (52.6%) were colonized vs 3 of 67 (4.5%) on the skilled/intermediate unit (P<0.001), suggesting that little intra‐facility spread of MRSA occurs. Twenty‐four of 55 (43.6%) chronic medical admissions were colonized vs 6 of 63 (9.5%) admitted to the other units (P<0.001). Thirteen of 30 (43.3%) admissions were not previously known to be colonized. By univariate analysis, colonized admissions were younger and more often male; had more listed diagnoses, including pressure sores, a previous positive MRSA culture, and urinary incontinence; were more often fed by feeding tube; and had longer durations of hospital stay prior to admission. Logistic regression analysis showed that the most powerful independent predictors of colonization at admission were: a prior positive culture for MRSA (OR 8.8, 95% CI 2.4, 32.4), male sex (OR 8.2, 95% CI 2.3, 29.7), urinary incontinence (OR 3.8, 95% CI 1.4, 10.4), and presence of pressure sores (OR 2.9, 95% CI 0.9, 9.2).ConclusionsUnrecognized colonization of nursing home residents with MRSA is common, and nursing homes are unwittingly repositories for patients colonized with MRSA following acute hospitalization. Gloving and careful attention to handwashing may limit spread of MRSA within nursing homes, and identification of colonized patients may be facilitated by targeted surveillance cultures of the most debilitated pa

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02070.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo determine the prevalence of hepatitis B antigen (HBsAg), antibody to hepatitis C virus (anti‐HCV), and antibody to human immunodeficiency virus (anti‐HIV) among residents of a long‐term care facility.DesignAnonymous unlinked serosurvey.SettingAccredited university‐affiliated long‐term‐care facility in Toronto with 300 chronic‐care hospital patients, 350 nursing home residents, and 200 residents of a senior citizens' apartment complex.InterventionsSera from left‐over blood samples obtained from residents in November 1990 were tested for HBsAg, anti‐HCV, and anti‐HIV using standard methods.ResultsA total of 508 sera were tested. The number (%) positive for HBsAg, anti‐HCV, and anti‐HIV, respectively were: 3(0.6%), 7(1.4%), and 0(0%).ConclusionsThis is the first report defining rates of infection with bloodborne infective agents among residents of a long‐term care facility. These results support the use of hepatitis B vaccine for medical and nursing staff and the implementation of universal precautions in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02071.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo assess the nursing home and hospital use of patients with Alzheimer's Type Dementia.DesignA prospective cohort study of 126 patients entered into an Alzheimer's disease registry after diagnosis at a university hospital clinic between 1980 and 1982. Only four patients were in nursing homes at enrollment.Measurements and Main ResultsData regarding nursing home use came from the registry and the individual nursing homes themselves. Hospital‐use data were obtained using Medicare claims files. Follow‐up was obtained on 123 patients (98%). Eighty‐five (69%) had died by July 1, 1989. Three‐quarters of the cohort (92) eventually resided in nursing homes. The median nursing home length of stay was 2.75 years (mean 2.95, 95% CI = 2.5, 3.4), over 10 times the national median length of stay for all diagnoses. Based on prevailing rates in the region, nursing home charges for the cohort were estimated to be between $4.3 and $6.4 million ($35,000–$52,000 per patient). During the 5‐year period 1983–1988, 69 patients filed Part A (hospital) claims to Medicare for 76 admissions and 616 inpatient days. Part A Medicare reimbursement for the cohort totaled $460,000 over 5 years ($3,700 per patient), an expenditure comparable to what a random Medicare cohort might incur.ConclusionsThe combination of a high rate of nursing home entry and lengthy stays makes long‐term care the largest determinant of the cost of care in Alzheimer's disease. While Alzheimer's Type Dementia undoubtedly has profound indirect costs, this study demonstrates that the direct institutional costs alone a

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02072.x

年代:1992

数据来源: WILEY

摘要:

Objective(1) To establish the range of cerebral atrophy across the adult age spectrum in optimally healthy, rigorously evaluated individuals. (2) To determine, across the age spectrum, the relation of gender and cerebral atrophy (as measured by ventricular enlargement) to cognitive function.DesignCross‐sectional comparison by age and gender.SettingAmbulatory research unit.ParticipantsSixty‐four healthy men (mean age ± SD = 49 ± 18 yr) and 43 healthy women (51 ± 18 yr) volunteers enrolled in a longitudinal study of healthy aging. The population was selected for optimal health; all were rigorously screened to exclude medical and psychiatric illness.Main Outcome MeasuresBrain atrophy by CT scan and cognitive function by standardized neuropsychological testing.ResultsAfter correction for inter‐subject variability in cranial volume, women had smaller lateral, but not third, ventricles. For both genders, there were significant differences with age in ventricular volume. After an approximately constant 20% increase in ventricular volume per decade in both genders, a precipitous increase in volume was found beginning in the fifth decade in men and in the sixth decade in women. In men and women, there was a significant negative correlation between ventricular volume and the sum of performance scale scores on the Wechsler Adult Intelligence Scale (WPSS) but not in the sum of the verbal scale scores (WVSS). However, after controlling for age, ventricular volume no longer significantly contributed to the relation between age and WPSS.ConclusionsIn unequivocally healthy individuals, gender plays an important role in age‐associated central cerebral atrophy as measured by progressive ventricular enlargement. Increase in ventricle volume independent of age, does not explain normal age‐related declines seen in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02073.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveThe purpose of this study was to identify the prevalence and predictors of commonly prescribed regularly scheduled medications.DesignData were collected on the first day following nursing home admission in this non‐experimental study.SettingA stratified, proportional probability sample of eight nursing homes in a large Mid‐South city participated in this study.ParticipantsA consecutive sample of 574 new and readmitted nursing home residents who did not refuse participation.InterventionsNone.Main Outcome Measure(s)Data were collected on regularly scheduled prescription medications and resident and nursing home characteristics.ResultsResidents without a diagnosis of dementia were more likely to receive cardiovascular medications (Odds Ratio = 2.34; 95% CI = 1.56–3.49), and white residents were more likely to receive cardiovascular medications (Odds Ratio = 1.74; 95% CI = 1.19–2.53) or central nervous system medications (Odds Ratio = 1.72; 95% CI = 1.18–2.51). Older residents were less likely to receive central nervous system medications (Odds Ratio = 0.97 per year; 95% CI = 0.96–0.99), and females were more likely to receive cardiovascular medications (Odds Ratio = 1.89; 95% CI = 1.30–2.75).ConclusionsResident characteristics were the most important predictors for cardiovascular and central nervous system medication prescriptions of new and readmitted nursing h

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02074.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo test the effect of pentoxifylline, a hemorheologic agent used to treat intermittent claudication, on the course of vascular dementia.DesignRandomized, double‐blind, placebo‐controlled, parallel group trial.SettingOutpatient tertiary care center.Patients64 patients meeting DSM‐III criteria for multi‐infarct dementia with modified Hachinski ischemic scores ≥6, 38 of whom completed the trial.InterventionPentoxifylline (Trental®) 400 milligram tablets three times daily vs placebo for 36 weeks.Main Outcome MeasureAlzheimer's Disease Assessment Scale (ADAS).ResultsBaseline demographic values and psychometric variables were similar in the placebo and control groups; endpoint statistical analysis was used to allow the use of data from all patients in this clinically high‐risk group. For the total group, the slowing of deterioration did not reach statistical significance (by 2‐tailedttest), as measured by scores on the total ADAS (P= 0.058) or on the cognitive (ADAS items 1–11;P= 0.064) or non‐cognitive subscales (ADAS items 12–21;P= 0.234), although it was significant on the cognitive subscales excluding memory (ADAS items 2–6, 8–10;P= 0.036). For the subgroup of 40 patients who had CT and/or MRI evidence of stroke as well as meeting the other inclusion criteria, treatment with pentoxifylline was associated with significantly slower deterioration, as measured by the total ADAS (P= 0.023) and cognitive subscores (P= 0.020) but not non‐cognitive subscores (P= 0.118). For the subgroup of 37 patients who had at least one discrete clinical stroke, treatment with pentoxifylline was associated with significantly less deterioration on the total ADAS (P= 0.002) and both the cognitive (P= 0.001) and non‐cognitive (P= 0.017) subscores.ConclusionTreatment with pentoxifylline may slow the progression of dementia in patients who meet DSM‐III criteria for “multi‐infarct dementia” and who also have clinical and neuroradiological

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02075.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo identify the sequence and significance of left ventricular filling abnormalities associated with progressive aging in humans.DesignCross‐sectional study comparing three age groups. Setting: Department of Geriatrics at University of Naples.ParticipantsSeventy‐five healthy subjects in three age groups: 25 subjects from 25 to 45 years (Group I), 25 subjects from 46 to 65 years (Group II), and 25 subjects from 66 to 85 years (Group III).InterventionNone.Main Outcome MeasuresAll underwent pulsed‐doppler echocardiography under color guide to measure the following parameters: peak velocity flow for early (E wave) and late (A wave) mitral flow; A/E wave ratio; deceleration time of mitral flow (MDt); isovolumic relaxation time (IRT); ratio of velocity time integrals of the A wave to the velocity time integrals of the entire mitral spectrum (VTIA/VTIM).ResultsPeak velocity of the E wave was slightly lower in Group II and III compared to Group I; in contrast, peak velocity of the A wave was greater (P<0.005) in aged individuals. Also A/E wave ratio, MDt, and IRT were significantly greater with advancing age (P<0.01;P<0.05 andP<0.001, respectively). Finally, VTIA/VTIM tended to be greater in the oldest group, but not significantly so.ConclusionsLeft ventricular relaxation is progressively impaired in late middle age and old age, presumably an early marker of cardiac aging. Increased left atrial pressure is compromised only in the oldest group, presumably representing a compensation for impaired left ventricular relax

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02076.x

年代:1992

数据来源: WILEY

摘要:

ObjectiveTo examine states' regulations governing infections and infection control in long‐term‐care institutions.DesignCollection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid.Main Outcome MeasuresRules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)‐infected patients, and (6) infection control were compared.ResultsThere were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge.ConclusionUniform federal standards for long‐term care would probably provide a better and more economical way to ensure quality of care in these insti

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1992.tb02077.x

年代:1992

数据来源: WILEY