摘要:

Two different balance testing methods were compared: (1) measurement of spontaneous postural sway during quiet standing, and (2) measurement of induced postural sway in response to an applied postural perturbation. Eyes‐open tests were performed in 64 healthy young and elderly adults and in five elderly subjects with a history of falling. In both balance tests, the sway was defined in terms of the displacement of the center of pressure on the feet. Spontaneous sway was quantified using a number of different amplitude‐ and frequency‐based parameters. Induced sway was measured in response to anterior‐posterior acceleration of a platform on which the subject stood. The induced‐sway test was specially designed to be safe and nonthreatening for elderly subjects; thus, the platform perturbation was confined to small accelerations and a gentle pseudorandom motion was used. To derive a measure of postural stability, the data from this test were fitted with a model that was then used to predict the response to sudden (transient) perturbations, thereby simulating the response in actual falls. Although both induced‐ and spontaneous‐sway measures demonstrated significant aging‐related decreases in stability, the differences were more pronounced for the induced‐sway data. Conversely, some of the spontaneous‐sway measures were much more successful in distinguishing the fallers from the nonfallers. There was a significant correlation between induced‐sway and certain spontaneous‐sway measures in the normal young adults; however, in the elderly normals and fallers, the data from the two types of balance tests either showed no correlation or, for certain spontaneous‐sway measures, tended to sho

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01588.x

年代:1990

数据来源: WILEY

摘要:

Epidemiological evidence suggests that elevated serum cholesterol, especially the low density lipoprotein (LDL) fraction, the total/high density lipoprotein (HDL)–cholesterol ratio, and the LDL/HDL–cholesterol ratio, remains a risk factor for atheromatous disease up to the age of 79 years. We studied the efficacy and tolerability of simvastatin, an HMG CoA reductase inhibitor, in 20 patients aged 65 to 75 years with clinical evidence of atheromatous disease. After four weeks of treatment, there was a 29% fall in LDL‐cholesterol levels (P<.01 vs placebo) with low dose simvastatin and a 38% fall with high dose simvastatin (P<.001 vs placebo). Similar falls were seen in total cholesterol levels and the LDL/HDL–cholesterol and total/HDL–cholesterol ratios. Apoprotein B levels decreased by approximately 20% with both doses (P<.05 vs placebo). In an open extension of the study, the decreases in lipid parameters were sustained for a further 48 weeks of treatment with doses of simvastatin ranging from 10 to 40 mg. Two patients required the addition of cholestyramine. Although a small study like this cannot establish safety and tolerance, side effects were minor and did not require stopping therapy in any patient. Simvastatin is an effective cholesterol lowering agent in older

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01589.x

年代:1990

数据来源: WILEY

摘要:

The effect of probucol in lowering serum lipoprotein in young and middle‐aged (YM) and elderly (E) patients with familial hypercholesterolemia were compared. Probucol at 1000 mg/day was administered orally to 37 YM patients and 14 E patients for an average of 10 months. Probucol treatment for this period caused significant reductions in the serum levels of total cholesterol, low density lipoprotein cholesterol (LDL‐C), high density lipoprotein cholesterol, and apoprotein AI, AII, B, and CIII in both groups. The decreases in the levels of total cholesterol, LDL‐C, and apoprotein B were greater in the E group than in the YM group (total cholesterol: YM, −19.3%, E, −31.3% [P<.001]; LDL‐C: YM −17.0%, E, −35.4% [P<.001]; apoprotein B: YM, −12.3%, E, −28.1% [P<.01]). The decreases in other parameters in the two groups were not significantly different. The serum probucol concentrations in the YM and E groups were not significantly different. No significant side effects were observed in any patient. Thus probucol reduced the serum level of LDL more in the E group than in the YM group, and did so without any increase in the serum concentration of the drug or in side effects, suggesting that probucol is safe and beneficial for use

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01590.x

年代:1990

数据来源: WILEY

摘要:

Cerebrospinal fluid (CSF) somatostatin concentrations were measured in 35 aged patients with Parkinson's disease (mean age, 79.5 years) and 11 control subjects (mean age, 82.3 years). In patients with Parkinson's disease the levels of somatostatin‐like immunoreactivity were lower than in controls (P<.02); these values were lowest in the untreated group. Somatostatin‐like immunoreactivity levels in the CSF tended to increase with treatment but not significantly (P = .11). Somatostatin values were not correlated to age, sex, or duration of the disease. Somatostatin concentrations tended to be lower in more severely affected patients with higher scores on the Hoehn and Yahr (P = .13) and Webster staging scales (P = .13) and lower scores on Mini‐Mental State (P = .10), but without statistical significance for these correla

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01591.x

年代:1990

数据来源: WILEY

摘要:

Few studies have assessed the prevalence and outcome of acute renal failure (ARF) in the elderly. Among 437 ARF cases prospectively studied during a nine‐year period in a nephrology department, 152 (35%) occurred in patients over 70 years of age (Group 1). Patients over 70 account for only 10.5% of all hospital admissions in our country, and prevalence of ARF was 3.5 times higher in these patients than in younger people. Acute tubular necrosis (ATN) was diagnosed in 40% of Group 1 and 52% of the younger patients (Group 2) (P<.05), whereas prerenal ARF was found in 47% and 32%, respectively (P<.001). Dehydration was the most frequent cause of prerenal ARF in the elderly (51%). The etiological distribution of ATN was similar in both groups, being of multifactorial origin in most cases. Oliguria was present in 49% of ATN in Group 1 and in 66% of Group 2 (P<.05). There were no significant differences in dialysis needs.Mortality was higher in the elderly in all types of ARF, although differences did not reach statistical significance. Need for dialysis, mechanical respiration, decreased level of consciousness, and hypotension were associated with poor prognosis in both groups. Total recovery from ARF in older persons was less frequent and slower than in younger patients.It may be concluded that patients over 70 years of age are at high risk for developing ARF; nevertheless, age should not be used as a discriminating factor in therapeutic decisions concerning AR

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01592.x

年代:1990

数据来源: WILEY

摘要:

A prospective, controlled trial to reduce polypharmacy in patients 65 years or older was carried out in the residents' clinic of a teaching hospital. Of 272 elderly patients surveyed, 89 (33%) were taking five or more prescription drugs. Recommendations to discontinue medications or to simplify regimens were formulated for 79 polypharmacy patients. Compared to 41 controls, the 38 patients whose physicians were informed of the recommended changes demonstrated a small but significant reduction in the mean number of drugs, the complexity, and the cost of their regimens. Physicians complied with eight (100%) of eight recommendations to simplify a dosage schedule, eight (62%) of 13 recommendations to substitute a new drug for the old one, and only eight (40%) of 20 recommendations to stop a medication (P = .04). Noncompliance usually resulted from patient refusal or from medications being prescribed by another provider. Whereas feedback to the primary physician is beneficial, more substantial reductions in outpatient polypharmacy may require overcoming patient barriers and limiting the number of prescribing physicians.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01593.x

年代:1990

数据来源: WILEY

摘要:

This paper presents the results of four studies that evaluated the use of neuroleptics in an aging population both in nursing homes and in a psychiatric teaching hospital. The purpose was to determine the degree to which prescribing practices were in compliance with recent court rulings respecting the right of patients to informed consent to “exceptional” medication. The results indicate that physicians in nursing homes do not inform their patients of the risks of neuroleptics, do not seek consent, and do not consider competency to be even an issue. Elderly patients in the acute academic setting were informed of risks and benefits. However, both consent to medication and the competency to give this consent were presumed until or unless the patient failed to acquiesce. The degree to which these practices might be in potential conflict with state law, ignore the benefits of a negotiated doctor/patient partnership, and demonstrate one aspect of poor quality of care are discussed, and policy recommendations are m

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01594.x

年代:1990

数据来源: WILEY

摘要:

Hearing impairment is one of the most common chronic health problems of elderly Americans. Although adverse effects on quality of life are thought to be considerable, they have not been rigorously evaluated. This study was designed to identify the types and extent of dysfunction experienced by elderly individuals with hearing loss, and to define the most appropriate measures for assessing this dysfunction. Elderly male veterans attending a primary care clinic were screened for hearing loss and had their quality of life assessed with a comprehensive battery of disease‐specific and generic measures. Of 472 people who had their hearing tested, 106 had hearing loss. Hearing loss was associated with significant emotional (P = .0001), social (P = .0001), and communication (P = .02) dysfunction. Most individuals (66%) perceived these dysfunctions as severe handicaps even though audiologic loss revealed only mild to moderate impairment (pure tone average loss, 27–55 dB). Adverse effects were best detected with disease‐specific rather than generic functional status measures. We conclude that hearing impairment is associated with important adverse effects on the quality of life of elderly individuals, and that these effects are perceived as severe handicaps even by individuals with only mild to moderate degrees of hearing

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01595.x

年代:1990

数据来源: WILEY

摘要:

The case reports describe three elderly amputees with coexisting severe COPD. All three successfully mastered their prostheses and were discharged home able to walk functional distances. This demonstrates that these patients deserve a trial period of rehabilitation in a situation where close medical supervision and optimal medical management are available. Two of our cases died within 5 years, indicating the fragility and poor long‐term prognosis of these patients; the third was lost to follow

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01596.x

年代:1990

数据来源: WILEY

摘要:

Definitive treatment of the Dieulafoy erosion—once recognized—has generally been surgery. Numerous surgical approaches have been suggested, including: simple oversewing of the lesion,11wedge restriction,12and gastrectomy with and without vagotomy and pyloroplasty.8,12Attempts at endoscopic electrocoagulation and angiographic embolization have generally been disappointing; however, Pointer el al have recently reported satisfactory control of hemorrhage from Dieulafoy lesions with bipolar electrocoagulation and endoscopic injection sclerotherapy, either independently or in combination.13These case reports describe two elderly patients with massive upper gastrointestinal tract bleeding from Dieulafoy's gastric erosion; it is hoped the geriatrician will be alerted to an often unrecognized source of hemorrh

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1990.tb01597.x

年代:1990

数据来源: WILEY