ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06232.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:This research addresses the most frequently cited methodological criticism of the Epidemiologic Catchment Area (ECA) surveys ‐ which might lead to significantly lower estimates of true prevalence rates for late‐life depression ‐ the inability of the Diagnostic Interview Schedule (DIS) to distinguish between somatic symptoms of depression that result from physical causes and those that result from psychiatric causes.DESIGN:The data for this study come from the ECA Wave Two surveys sponsored by the National Institute of Mental Health. In this analysis, symptoms of depression the respondent always attributed to physical causes are recoded to be equivalent to those having a psychiatric cause. The third edition of the Diagnostic and Statistical Manual (DSM‐III) scoring algorithm for depression (i.e., dysphoria plus four of the eight Criterion B symptoms) was then applied to the recoded data set.RESULTS:Recoding somatic symptoms of depression, originally attributed to physical or medical explanations, to psychiatric symptoms does not result in a disproportionate rise in diagnosable depression in the older age groups.CONCLUSIONS:This analysis provides additional support for the ECA survey's prevalence estimate of late‐life depression. This research failed to find evidence that the highly structured nature of the DIS makes it unsuitable for ascertaining symptoms of depression in th

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06233.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To describe the epidemiology of human immunodeficiency virus (HIV) infection diagnosed in persons aged 60 years and older at a large urban county hospital.DESIGN:Retrospective chart review of patients, aged 60 years and older, diagnosed with HIV infection, among 6,493 patients identified with positive EIA‐HIV tests performed at Grady Memorial Hospital between January 1, 1985 and July 1, 1992.RESULTS:A total of 32 HIV‐infected elderly patients, including 27 men and five women, with a mean age of 64.8 years (range, 60–83 years) were identified. Among the 27 men, HIV risk factors included: homosexual/bisexual (10 patients); injection drug users (IDU) (5); transfusion‐associated (2); heterosexual (2); eight patients had no HIV risk factor identified. Among the five women, only one had an identified risk factor (blood transfusion). HIV testing of 47% (15/32) elderly patients was performed after a diagnosis of an AIDS‐defining opportunistic infection. Among 24 elderly patients who presented to a physician with signs or symptoms of HIV infection, testing for HIV was often delayed (median 3.1 months, range: 1–10 months). Eleven patients underwent work‐ups to rule out a malignancy, and three patients were initially diagnosed with organic brain syndrome. Ten of the 32 patients (31%) had a history of syphilis, and 90% (19/21) of patients tested were found to be immune to hepatitis B.CONCLUSION:The majority of HIV‐infected patients 60 years or older acquired their infection through sexual intercourse or IDU. The diagnosis of HIV infection in the elderly was usually not considered by clinicians until late in the course of infection, despite a high prevalence of prior sexually transmitted diseases (STDs). Our data indicate that clinicians who take care of elderly patients should do a complete sexual history and offer sexual education. HIV testing and counseling should be considered for all individuals with a history of recent STDs or reporting behaviors putting them at risk fo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06234.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES:To study caregivers' decisions to end home care for relatives with dementia; to study the changes in caregiver functioning over time.DESIGN:A prospective longitudinal follow‐up study.SETTING:Individual homes and chronic care facilities in Montreal.PARTICIPANTS:157 caregiver‐dependent dyads, followed up 2 years later; dependents had been diagnosed as having progressive dementia.MEASUREMENTS:A standard interview and a series of standardized psychological questionnaires were given to caregivers, assessing their functioning and their appraisals of the dependent person in their care. Dependents received the Mini‐Mental State Examination.MAIN RESULTS:Caregivers cited patient deterioration as the most common reason for ending home care. Most caregivers did not prepare their relative before institutionalization. Most caregivers were satisfied with having ended home care and believed the decision was positive for themselves and their dependent, but a sizable minority of caregivers and dependents had difficulty adjusting to the end of home care. Repeated measures multivariate analyses indicated that caregivers who had discontinued home care because of placement or death of the dependent had improved functioning and quality of life and better health than caregivers still providing home care.CONCLUSIONS:Caregivers most frequently cite deteriorating patient conditions as the main causes of ending home care. Caregiver exhaustion is the single most frequently given reason. Caregivers who were still providing home care at the end of the study were functioning less well than caregivers who had ended home care, despite having initially functioned at better l

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06235.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

PURPOSE:To compare two self‐administered, one interviewer‐administered, and one performance‐based measure of physical function in community‐based older persons.METHODS:Eighty‐three subjects were recruited from meal sites, senior recreation centers, and senior housing units for a comprehensive geriatric assessment program. At the time of screening, study participants self‐administered the Functional Status Questionnaire (FSQ) and were administered the Katz Activities of Daily Living (ADL) and the Older Americans Resources and Services Instrumental Activities of Daily Living (OARS‐IADL) instruments by interview. Participants also completed the Physical Performance Test (PPT) and were given the Medical Outcomes Study SF‐36 to self‐administer on site or at home and return by mail.RESULTS:All 83 subjects completed FSQ, Katz ADL, OARS‐IADL, and PPT; 72 returned SF‐36 forms. Correlations between the two self‐administered physical function measures (FSQ and SF‐36) were higher than between self‐administered and interviewer‐assessed (ADL and OARS‐IADL) or performance‐based (PPT) measures. When assessed for construct validity, the self‐administered, OARS, and PPT measures had comparable correlations with role limitations as a result of physical health problems, but relationships between physical functional status measures and other SF‐36 measures of health were inconsistent.CONCLUSION:The relationships between commonly used self‐administered, interviewer‐administered, and performance‐based measures of physical function were inconsistent and weak, suggesting that these instr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06236.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To describe the 3‐year incidence of acute respiratory illness in a population of noninstitutionalized elderly persons.DESIGN:Cohort analytic study with an observation period of 3 years.SETTING:Large midwestern urban community.SUBJECTS:574 noninstitutionalized persons aged 65 years and older, of whom 349 were living independently, 110 were in congregate settings, and 115 were living independently and regularly caring for small children.METHODS:Subjects were interviewed and examined by nurse practitioners at intake and every 4 months. Acute illness and convalescent visits were made when illnesses were reported by participants.MAIN OUTCOME MEASURES:The incidence of acute respiratory illness was used to test the hypothesis that elderly persons taking care of children have the highest incidence, congregate‐dwellers intermediate incidence, and those living independently the lowest incidence.RESULTS:The average incidence of acute respiratory illness was 2.5 per 100 person months, comparable to rates reported in the National Health Survey. The incidence of respiratory illness was significantly greater in subjects living in congregate settings or regularly caring for young children. Similarly, greater proportions of persons in the congregate and child‐care groups reported at least one episode of illness (P<.05). A more detailed analysis of exposure shows that acute respiratory illness was significantly more common in subjects who had contact with children (P<.05). This risk was definitely present during the months November through February, and probably also during July through October, but was not observed for March through June.CONCLUSIONS:Elderly persons living in the community experience low rates of acute upper respiratory illness. Contact with children increases their risk of developing such illnesses during certain seasons of the

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06237.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To evaluate the rate of specific pathogens and clinical syndromes associated with acute respiratory tract infections (ARTI) in frail older persons attending daycare.DESIGN:Prospective descriptive study, without intervention.SETTING:Two sites of a senior daycare program providing all‐inclusive care for the older persons in Rochester, New York.PARTICIPANTS:Staff members and participants of the daycare.MEASUREMENTS:Demographic, medical, and physical findings were collected from older subjects at baseline and while ill with respiratory illnesses. Nasopharyngeal specimens for viral and Chlamydia culture and sputum for bacterial culture were obtained from subjects when ill. Acute and convalescent sera were also collected with each illness and examined for viral, chlamydial, and mycoplasma infection.MAIN RESULTS:One hundred sixty‐five illnesses were documented in 165 older daycare participants as well as 113 illnesses among 67 staff members during the 15‐month study. The rate of ARTI in the elderly group was 10.8 per 100 person months. The most common etiologies in both the staff and elderly participants were respiratory syncytial virus (RSV), Influenza A, and coronavirus. The etiologies of illnesses in the staff compared with those in elderly group were similar except that bacterial infections were significantly more common among the elderly (7% vs. 0,P= 0.05). Multiple pathogens were found to cocirculate within centers, and no clear outbreak of a predominant organism was noted. Cough and nasal congestion characterized most illnesses. The elderly experienced significantly more cough, dyspnea, and sputum production than did the staff. There were 10 hospitalizations related to respiratory infections and four deaths during the acute illness among the elderly group and none in staff.CONCLUSIONS:Acute respiratory infections are a common occurrence in both the staff and participants of a senior daycare center and are the cause of substantial morbidity in frail older pe

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06238.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To describe a new observational scale, the Sessing scale, for measuring the progression of pressure ulcers.CRITERION STANDARDS:Changes in Shea stage and the diameter of healing pressure ulcers.SUBJECTS:A cohort of 84 nursing home residents with pressure ulcers.RESULTS:There were strong relationships between changes in healing as measured by the Sessing Scale and those measured by the Shea Scale (Spearman'sr= 0.90;P<.0001), and between changes in the Sessing scale compared with changes in ulcer diameter (Spearman'sr= 0.64;P<.001). Test‐retest reliability was good (Kappa = 0.84) in a sample of 50 subjects.CONCLUSION:The Sessing scale is a simple, easy to use, observational instrument with validity and reliability for the assessment of progression of pressure ulcers in a clinical or research setting. Findings indicate that the Sessing scale, with its description of granulation tissue, infection, drainage, necrosis, and eschar, measures an important domain of wound healing that is independent and perhaps as important to clinicians and researchers as either Shea stage or ulcer siz

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06239.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06240.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb06241.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY