摘要:

OBJECTIVES: The primary purpose of this study was to determine the prevalence of current and past estrogen use among older, community‐dwelling, postmenopausal women. The secondary purpose was to describe factors associated with estrogen use in this population.DESIGN: A survey.SETTING: The Piedmont region of North Carolina.PARTICIPANTS: The sample included 2602 community‐dwelling women over the age of 65 who were interviewed for the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE).MEASUREMENTS: Current and past use of estrogen.RESULTS: Of the women surveyed, 6.1% reported current estrogen use, and 18.5% reported past use. Approximately half of the participants reported using estrogen for more than 2 years. Multivariate analysis demonstrated that current estrogen users were younger, more affluent, had smaller families, and were more likely to be white and to live in an urban area than were never users. Current users were also more likely to drink alcohol and to take calcium supplements; and compared with past estrogen users, they were more likely to be white, have smaller families, and to drink alcohol.CONCLUSION: Estrogen replacement therapy is used by a small minority of older women, especially blacks. Moreover, although women with some risk factors for osteoporosis are more likely to use estrogen, the chief determinants of estrogen utilization are socioeconomic.J Am Geriatr Soc 44:1–6,

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05630.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia.DESIGN: Randomized controlled clinical trial with 6‐month follow‐up.SETTING: A 250‐bed community nursing home.PATIENTS: The nursing home was screened to identify patients with dementia and behavior disorders. A total of 118 patients were eligible for randomization. Of these, 89 (75.4%) were randomized, and 81 of these (91.0%) completed the trial.INTERVENTION: The A.G.E. dementia care program consisted of Activities, Guidelines for psychotropic medications, and Educational rounds. The control treatment was usual nursing home care.MEASUREMENTS: Behavior disorders, antipsychotic drug and physical restraint use, patient activity levels, and cognitive and functional status.RESULTS: After 6 months, 12 of 42 (28.6%) intervention patients exhibited behavior disorders compared with 20 of 39 (51.3%) controls (OR = 0.38; 95% CI [0.15, 0.95];P= .037). Controls were more than twice as likely to receive antipsychotics (OR = 2.55, 95% CI [0.96,6.76];P<.056), to be restrained during activity times (OR = 2.98, 95% CI [1.10, 8.04];P<.028), and to be restrained on nursing units (OR = 2.14, 95% CI [0.9,5.3];P<.10). Intervention patients were much more likely to participate in activities (OR = 13.71; 95% CI [4.51,41.73];P= .001).CONCLUSIONS: The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints. It is practical, feasible, and appears to improve the lives of patients with dementia in nursing homes.J Am Geriatr Soc 44:7–1

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05631.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: The objective of this study is to determine if exercise increases joint symptoms in older adults with a history of arthritis or produces symptoms in older adults without such history. In addition, we examine whether joint symptoms explain the large observed variation in strength gain in older adults undergoing vigorous strength training exercise, and report the incidence of musculoskeletal injuries upon initiation of an exercise program.DESIGN: A population‐based, single blinded, randomized controlled trial with three exercise groups and one control group.SETTING: A large urban health maintenance organization.PARTICIPANTS: Older men and women (N = 105) aged 68 to 85, with leg strength below the 50th percentile for their age, sex, height, and weight and without neuromuscular disease or active cardiovascular disease.INTERVENTIONS: Supervised exercise in 1‐hour sessions, three times each week, for 24 to 26 weeks. One exercise group did strength training (ST) using weight machines (n = 25); another group did endurance training (ET) using stationary cycles (n = 25); and the third group did combined strength training and endurance training (ST+ET) (n = 25). The control group (n = 30) received no intervention.MEASUREMENTS: Strength was measured at the ankle, knee, hip, and elbow using an isokinetic dynamometer. Joint symptoms were rated on a 6‐point scale (0 = none, 5 = severe). Arthritis severity was based on self‐reported use of arthritis medication. Health status was measured with sub‐scales of the SF‐36 and Sickness Impact Profile (SIP).RESULTS: Joint symptoms fluctuated over time in all exercise groups, but they did not improve or worsen significantly in any group. The physical dimension of the SIP and SF‐36 subscale scores, including Bodily Pain Scores, did not change over time in any group. Subjects with arthritis and joint symptoms gained as much strength with strength training as did subjects without joint symptoms. Adjustment for age, gender, baseline strength, adherence, and exercise group did not affect this finding. The rate of minor musculoskeletal injuries was 2.2 injuries per 1000 exercise hours.CONCLUSIONS: Moderate intensity stationary cycle exercise and vigorous intensity strength training do not appear to produce or exacerbate joint symptoms in older adults. Joint symptoms did not explain the large variation in gains in strength in older adults participating in a standardized strength training exercise program. Musculoskeletal injuries occurred relatively infrequently, and no major injuries occurred. In evaluating joint pain that occurs in older adults in well regulated exercise programs, clinicians should consider other etiologies before attributing pain to exercise per se.J Am Geriatr Soc 4

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05632.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine the incidence of pressure ulcers in varied populations, and whether demographic characteristics (age, gender, race) and primary diagnosis are factors in pressure ulcer development when the level of risk for developing ulcers is considered. To determine if there is a difference in the type of preventive services prescribed for persons who do or do not develop pressure ulcers when risk is controlled and whether differences can be related to demographic characteristics.DESIGN: Cohort study.SETTING: Two skilled nursing homes, two university operated tertiary care hospitals, and two Veteran's Administration Medical Centers (VAMCs) in Omaha, NE, Durham, NC, and Chicago, IL.PATIENTS: A total of 843 randomly selected patients more than 19 years of age who did not have pressure ulcers on admission to their place of care. Subjects were 63% male, 79% white, and had a mean age of 63 (± 16) years.MEASURES: A head‐to‐toe skin assessment for pressure ulcers recording site and stage of ulcers, scores for the Braden Scale for Predicting Pressure Sore Risk, demographic characteristics (age, sex, race), and primary diagnosis and preventive interventions (turning or repositioning orders and pressure reduction surface) were documented on the patient record. Observations were made every 48 to 72 hours for a minimum of 1 to a maximum of 4 weeks.MAIN OUTCOME MEASURES: Presence/absence and stage of pressure ulcers.MAIN RESULTS: One hundred eight of 843 (12.8%) subjects developed pressure ulcers. The incidence was 8.5%, 7.4%, and 23.9% in tertiary care, VAMCs, and nursing homes, respectively. Logistic regression demonstrated that lower Braden Scale scores, older age and white race predicted pressure ulcers; gender was not predictive. Primary diagnoses were not significant predictors of pressure ulcer risk when the Braden Scale score was entered into the regression. Prescription of turning was predicted by Braden Scale scores and by white race, whereas prescription of pressure reduction was predicted by Braden Scale scores, white race, and female sex.CONCLUSIONS: Risk assessment, rather than diagnoses or demographic characteristics, is recommended as the basis for prescriptive decisions. Risk assessment should cue health care providers to make more judicious use of turning and support surfaces to prevent pressure ulcers. Persons who are at risk for pressure ulcers should have turning and pressure reduction surfaces consistently prescribed and implemented. The costs and goals of preventive prescription for those not at risk for pressure ulcers should be considered.J Am Gcriatr Soc 44:22–30

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05633.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To examine the association between declining serum cholesterol and mortality in a sample of older nursing home residents.DESIGN: A retrospective cohort study.SETTING: A 203‐bed nursing home.PARTICIPANTS: Persons aged 65 and older, resident in the nursing home on January 1, 1988, or admitted through December 31, 1989, were eligible (n = 185) for the study. Follow‐up for mortality was conducted until June 30, 1991. Fifty‐five survivors with two or more cholesterol levels recorded before January 1, 1990, and the 76 decedents with two or more recorded cholesterol levels constituted the analytic sample (71% of eligible subjects).OUTCOME MEASURE: Mortality of the nursing home residents.RESULTS: Cholesterol declined 31.1 mg/dL/yr (95% confidence interval [CI], 19.7 to 42.6) among decedents, versus 4.2 mg/dL/yr (95% CI, −4.9 to 13.2) among survivors. The association between cholesterol decline (absolute or relative rates) and mortality was examined using logistic regression controlling for age, sex, and tube feeding. Compared with a referrent group with no change or increase, declining cholesterol greater than 45 mg/dL/yr was accompanied by an adjusted relative odds for death of 6.2 (95% CI, 2.1 to 18.4); declining cholesterol greater than 20% per year was accompanied by an adjusted relative odds for death of 7.3 (95% CI, 2.4 to 22.2). Extreme declines greater than 20% per year occurred in 47% of decedents but in only 15% of survivors.CONCLUSION: Precipitously declining cholesterol appeared to be a marker for mortality in the sample and may help explain the low cholesterol‐mortality association in older nursing home residents.J Am Geriatr Soc 44:31

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05634.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine the effectiveness of physician‐initiated counselling on the rate of health care proxy appointment.DESIGN: Observational study of an intervention in a convenience sample.SETTING: A geriatric outpatient clinic in a tertiary care teaching hospital, New York, New YorkPARTICIPANTS: A total of 687 patients enrolled in the geriatric clinic during the study period March 1991 through June 1993.INTERVENTION: Physician counselling about the New York State Health Care Proxy Law, distribution of educational materials and healthcare proxy forms, and reminders in 331 of 466 eligible patients.MEASUREMENTS: Rate of healthcare proxy appointment in eligible and counselled groups; predictors of appointment and non‐appointment; time elapsed from counselling to appointment; reasons for non‐appointment; characteristics of the proxy appointment process.RESULTS: A healthcare proxy was appointed for 31.5% of patients eligible for counselling and for 44% of patients who actually received the intervention, compared with a 2.3% proxy appointment rate at baseline. Eighty‐one percent of the patients completing the proxy appointment process did so at or before their third clinic return visit after the counselling intervention. Of the counselled patients who did not appoint a proxy, 25% explicitly declined, and 75% had not come to a decision by the end of the study period. Proxy completion was associated with ethnicity, education, and more frequent clinic visits. Of those who appointed a proxy, 97% had good or fair comprehension of the procedure, 92% discussed the appointment with their designees, 63% appointed a daughter or son, and 80% discussed their wishes for care at the end of life with their proxy.CONCLUSIONS: Physician counselling of older outpatients is an effective means of increasing healthcare proxy appointments.J Am Geriatr Soc 44:37

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05635.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To examine whether subjective memory complaints, measured with a series of four questions, are associated with performance on cognitive tests.DESIGN: Cross‐sectional study of individuals, 65 to 85 years of age, who lived in the community of Amsterdam.PARTICIPANTS: Individuals were selected randomly within 5‐year age strata from the patient lists of 30 general practitioners. Of the 4051 participants, 2537 nondepressed and nondemented respondents were included in the analysis.MEASURES: Four categories of subjective memory complaints were developed on the basis of answers to questions about the presence or absence of memory complaints and memory‐related problems in daily functioning. Tests of cognitive function were derived from the subscales of the CAMCOG.MAIN RESULTS: Individuals with complaints and memory‐related problems performed more poorly on tests of memory and memory‐related functions. This relationship was strengthened after adjusting for age, sex, and premorbid verbal intelligence, all of which were related to complaint status and to performance on cognitive tests.CONCLUSION: Simple questions about memory function are related to memory performance in nondepressed, nondemented community‐dwelling older people. Subjective memory complaints may be a promising indicator of memory impairment that signals the need for follow‐up.J Am Geriatr Soc 4

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05636.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: To determine if aging modifies the clinical presentation of hyperthyroidism and the signs of thyrotoxicosis in older people.DESIGN: Prospective cohort study.SETTING: A French university hospital.SUBJECTS: Eighty‐four new patients with overt hyperthyroidism confirmed chemically between January 1992 and January 1993. Controls were 68 older euthyroid patients matched to the older hyperthyroid patients.MEASUREMENTS: Comparison of 19 classical signs of hyperthyroidism between 34 older patients (≥70 years; mean age 80.2) and 50 younger patients (≤50 years; mean age 37.4). Older patients were also compared with controls (mean age 81.3).RESULTS: Three signs were found in more than 50% of older patients: tachycardia, fatigue, and weight loss. Seven signs were found significantly less frequently in older patients (P<.001): hyperactive reflexes, increased sweating, heat intolerance, tremor, nervousness, polydipsia, and increased appetite. Only anorexia (32% vs 4%) and atrial fibrillation (35% vs 2%) were more found frequently in older people (P<.001). A goiter was present in 94% of the younger and in 50% of the older patients (P<.001). The mean number of clinical signs found in the older subjects was significantly smaller than the number found in younger patients (6 vs 10.8;P<.001). Comparison with older controls showed three signs that were highly associated with thyrotoxicosis in older people: apathy (Odd ratio (OR): 14.8), tachycardia (OR: 11.2), and weight loss (OR: 8.7).CONCLUSION: This study confirms the paucity of clinical signs of hyperthyroidism in older adults. These results suggest the necessity of routine screening for thyroid disease in this age group.J Am Geriatr Soc 44:50–5

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05637.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To describe the use of cardiovascular drugs in an older population with respect to age, sex, housing type, and creatinine clearance.DESIGN: A cross‐sectional survey.PARTICIPANTS: All residents of a district of Stockholm (Kungsholmen), Sweden, aged 75 and older, living in institutions or at home.MEASUREMENTS: Cardiovascular drug use, serum creatinine, electrolytes, height, weight, and symptoms.RESULTS: A total of 43 cardiovascular (CV) drugs were used. The most common drugs were digoxin (used by 18.2%), furosemide (16.4%), and glyceryl trinitrate (12.4%). Drugs with an antihypertensive effect accounted for 61% of all CV drugs. CV drug use increased with age for cardiac glycosides and diuretics, but decreased with age for calcium antagonists and β‐blockers. Drug doses tended to be less than the recommended daily dose except for a few drugs, e.g., furosemide. There was a trend toward decreasing dose with increasing age, but this was not significant. Diuretics were the only CV drugs used more often in women. People living in institutional care used the least amount of CV drugs. The dose of drugs taken did not appear to be related to estimated creatinine clearance. Comparisons between drug use and complaint of symptoms showed a strong correlation between the use of cardiac glycosides and anorexia, calcium antagonists and constipation, and nitrates and vertigo. There were weaker correlations with cardiac glycosides and visual disturbances and with potassium sparing diuretics and a high potassium.CONCLUSIONS: CV drugs are used commonly in older people. We suggest that the symptoms correlating with cardiac glycoside use may be signs of unrecognized toxicity, and this may relate to our finding that drug use is often not tailored to renal function as measured by creatinine clearance.J Am Geriatr Soc 44:54–60

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05638.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To examine the occurrence of breast fibroadenomas in postmenopausal patients referred for breast biopsy.DESIGN: A retrospective review of breast biopsy outcome and of patient demographics, including menstrual and hormonal status.SETTING: The Tucson Breast Center, a large outpatient breast cancer detection clinic affiliated with the University of Arizona Health Sciences Center in Tucson, Arizona.PARTICIPANTS: All women seen at the Tucson Breast Center between 1985 and 1990 who were referred for breast biopsy.RESULTS: A total of 100 fibroadenomas were found in 709 breast biopsies whose results were known. Fifty‐two of these were in premenopausal women and 44 in postmenopausal women; the menopausal status of four women was unknown. In postmenopausal women, 11 of the 44 patients reported hormone use. Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women. Fibroadenomas constituted 10% (44 of 447) of all biopsies in postmenopausal women, including those with breast masses, abnormal calcifications, or other lesions.CONCLUSION: Noncalcified fibroadenomas of the breast are not confined to young women and may constitute a small but noteworthy proportion of lesions coming to breast biopsy in postmenopausal women.J Am Geriatr Soc 44:61–64, 1

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb05639.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY