摘要:

Objective:To evaluate the relationship between objectively measured memory functions and subjective complaints of memory disturbance and whether subjective complaints are affected by some personality traits or affective states.Design:Cross‐sectional two‐group comparison.Setting:The city of Kuopio in Eastern Finland, considered representative of the urban elderly population of Finland.Participants:Originally 403 subjects aged 67–78 years from the random sample and then two matched study groups initially including eighteen subjects but only ten in the final analysis.Measurements:Screening and follow‐up examinations of subjects with and without subjective memory complaints: (1) Memory functions: Benton's visual retention test and the paired‐associated learning subtest of Wechsler Memory Scale. (2) Memory complaints: Memory Complaint Questionnaire. (3) Personality traits and affective state: Two subscales from Minnesota Multiphasic Personality Inventory and Geriatric Depression Scale.Results:Complaints of memory loss did not correlate with the actual memory performance in the tests. However, those subjects who most emphatically complained of memory disturbance had greater tendencies toward somatic complaining, higher feelings of anxiety about their physical health, and more negative feelings of their own competence and capabilities than those who did not complain of memory deterioration associated with aging.Conclusions:The study suggests that subjective feelings of memory impairment are more closely associated with personality traits than with actual memory performance in normal elderly people.J Am Geriatr Soc 42

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06064.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To describe case managers' perceptions of the physician‐case manager relationship.Design:A qualitative field study using in‐depth open‐ended interviews was used to elicit case managers' experiences and practices. A muladisciplinary team analyzed transcripts using an adaptation of the “grounded theory” approach of Glaser and Strauss.Participants/Setting:Case managers were selected for interview using a maximum variation sampling strategy within an established state‐wide case management agency.Main Outcome Measures:Transcript analysis allowed for the organization of observations into themes, which were merged across interviews to generate theses.Results:Case managers report that: (1) The case manager role is poorly understood by physicians. (2) Physicians lack insight into the social and environmental aspects of home‐bound elderly people. (3) Access to physician services is often difficult to obtain. (4) Power struggles occasionally surface in care planning. (5) Decisions by physicians and case managers regarding the care of frail elderly are often made from different agenda.Conclusions:From the perspective of case managers, gaps in interprofessional communication may hinder the optimal care of frail elderly individuals.J Am Geriatr Soc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06065.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To determine if diagnostic classification is associated with different outcomes from treatment on a geriatric assessment unit (GAU) compared with usual care for elderly patients with acute illnesses.Study Design:Reanalysis after post‐hoc diagnostic classification of a randomized clinical trial with one year follow up.Setting:Community hospital with rehabilitation facility.Subjects:A total of 155 subjects, mean age 78 years and 78% female, of whom 58 subjects had a rehabilitation classification of their diagnoses and 97 had a medical or surgical classification.Outcome Measures:Mortality, nursing home use, activities of daily living, and charges for subsequent medical services.Results:Mortality was decreased in persons with a rehabilitation classification who had received the GAU intervention. The GAU increased point‐prevalence residence in the community for persons with a rehabilitation classification. For persons with a medical‐surgical classification, the GAU intervention was associated with decreased cumulative use of nursing homes. However, GAU intervention was also associated with trends for increased charges in both diagnostic classification groups, even when adjusted for differential survival.Conclusion:Greater benefit from the GAU intervention on mortality and maintenance of residence in the community was observed in a group with a rehabilitation classification when compared with a group with a medical‐surgical classification. These improved outcomes in the rehabilitation group were not accompanied by decreased charges for later medical services that could compensate for initial rehabilitation charges.J Am Geriatr Soc 42:11

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06066.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To compare prospectively the concordance between the diagnosis of dementia based on clinical criteria and using the DAT Inventory.Design, Setting, and Participants:A prospective study of 81 consecutive patients referred to a Memory Clinic. Only patients for whom a definitive diagnosis of dementia was established after 8 to 20 months follow‐up were retained in the study (n= 76).Measurements:The sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy of the DAT Inventory were calculated. Kappa values were also computed.Results:Based on all patients (n= 76), sensitivity and specificity were 71% and 95%, respectively, with 98% positive prediction, 56% negative prediction, 78% overall accuracy, and kappa of 0.54. Of 21 cases not meeting NINCDS/ADRDA criteria for DAT, one patient with multi‐infarct dementia was misclassified as DAT on the DAT Inventory. Of 55 DAT cases (NINCDS/ADRDA criteria), 16 patients, predominantly very mild or mixed cases, were classified as non‐DAT on the DAT Inventory. When mixed, very mild, and borderline cases were excluded (remainingn= 54), DAT Inventory sensitivity increased to 94%, and specificity remained unchanged at 95%, with 97% positive and 91% negative prediction, 94% overall accuracy, and kappa of 0.88.Conclusions:In general, scores above the designated cutoff point (>14/20) on the DAT Inventory are consistent with a clinical diagnosis of DAT (NINCDS/ADRDA criteria). Concordance is best in cases of mild to moderate dementia (Clinical Dementia Rating 1–2). The Inventory is less discriminating as a differential diagnostic instrument in cases of very mild dementia, atypical presentations of DAT, or in cases of mixed pathology.J Am Geriatr Soc 42:16

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06067.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To determine the usefulness of timed manual performance measurements (TMP) as predictors of health outcomes, hospitalization, and mortality in a large, heterogeneous sample of elderly people living in the community.Design:Prospective cohort study.Setting:Central North Carolina.Participants:1,286 community‐dwelling older people.Measurements:Demographic background, health problems, number of prescribed medications, perceived health, quality of life, and the TMP, a 27‐item test that has been shown to predict functional dependency and need of health‐care services in older people.Results:During the 2‐year follow‐up period, 127 people died and 200 were hospitalized. Scores for those who were able to complete the original TMP, as well as scores for two shorter versions of the TMP, predicted mortality and, to a lesser extent, hospitalization within 2 years. For both original and shorter versions of the TMP, relative risk of death was approximately 2.5 times greater for those in the poorest performance quartile, as compared with the best performing quartile, when adjusted for age, gender, race, and number of prescribed medications. TMP tests and an index of IADL were independent predictors of death.Conclusions:TMP scores may be useful in the clinical setting as a vital sign of functioning, providing a means of targeting those individuals at increased risk of mortality.J Am Geriatr Soc 42:2

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06068.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To evaluate the appropriateness of ciprofloxacin‐prescribing in the long‐term care setting.Design:Retrospective chart review.Setting:A large academically oriented long‐term care facility.Patients:Institutionalized elderly patients with a mean age of 88 years.Methods:One hundred orders were randomly selected for review from all ciprofloxacin orders initiated over a 3‐year period. Criteria for appropriateness of ciprofloxacin‐prescribing were developed based on a comprehensive review of the medical literature. Evaluation of appropriateness of prescribing was based on the indication for therapy and the availability of more effective and/or less expensive alternative antibiotic regimens. Only information available to the physician at the time of the order was used to judge appropriateness. Abstracted medical records were evaluated independently by a geriatrician and an infectious diseases specialist.Results:With respect to site of infection, the urinary tract accounted for 43% of all ciprofloxacin orders; the lower respiratory tract, 28%; and skin and soft‐tissue infections, 17%. Only 25% of orders were judged appropriate. Twenty‐three percent of orders were judged less than appropriate based on indication, and 49% due to the availability of a more effective and/or less expensive alternative antibiotic choice. There was insufficient information in the medical record to judge 3% of the orders.Conclusion:These results indicate less than optimal prescribing of oral fluoroquinolones in the long‐term care setting, with potential consequences including the development of resistant bacterial strains and increased health care costs.J Am Geriatr So

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06069.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To describe the adverse and unexpected events reported by staff over a 1‐year period in a large, long‐term care institution.Design:A retrospective review of resident incident reports.Setting:A 703‐bed, academically oriented, long‐term care facility.Patients:Residents of the facility have a mean age of 88.5 years, are 76% female, and have an average length of stay of 4.3 years.Measurements and Main Results:Of the 3,390 adverse and unexpected events reports over the 1‐year study period, falls (with and without associated injury) were the most frequently reported incidents, followed by non‐fall‐related injuries, medication‐related events, and wandering episodes. While a large proportion of falls occurred in ambulating residents (47%), the majority occurred under different circumstances including falls from bed, wheelchair, and commode/toilet. Bruises and skin tears were the most frequently reported fall‐and non‐fall‐related injuries. The annual incidence rates for falls, fall‐related injuries, and non‐fall‐related injuries varied according to resident care unit level, with semi‐dependent residents experiencing the highest rates of falls and dependent residents experiencing the highest rates of non‐fall‐related injuries. Circadian patterns in the incidence of these events varied according to resident care level.Conclusions:Information regarding adverse and unexpected events in the long‐term care setting can be organized into databases that allow analysis of patterns and trends. The results of these analyses may be helpful in targeting limited resources to areas of greatest need within an individual institution and for comparing quality of care across different long‐term care faci

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06070.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To examine and compare the inpatient stroke rehabilitation experience of older adults (≥75 years) with that of young adults (<65 years) and young‐old adults (65–74 years).Design:Cross‐sectional descriptive study.Setting:A large university‐affiliated free‐standing rehabilitation hospital.Participants:260 adults who were admitted to inpatient stroke rehabilitation with a primary diagnosis of recent (<120 days) stroke (ICD9 430–436).Variables:Demographic data, diagnosis, time between stroke onset and rehabilitation admission, discharge disposition, and functional status on admission and discharge were obtained from the patient's medical record. Treatment intensity and type, length of stay, and primary payment source data were obtained from the patient's billing record. Three‐month mortality data were available from the hospital's routine follow‐up survey.Main Results:Compared with the younger adults (<65 yrs and 65–75 years), the older adults (≥75 years) were admitted to rehabilitation earlier and with comparable cognitive but poorer motor function. Rehabilitation treatment intensity (per day) and type were similar across age groups, but the older adults (≥75 years) had significantly shorter rehabilitation stays. Three‐month survival was comparable across age groups, but the older adults (≥75 years) had poorer motor function at discharge and were more often discharged to a nursing home or required a paid caregiver.Conclusions:Age‐associated factors may influence inpatient stroke rehabilitation referral, treatment, and outcome, particularly for patients over age 75. The cumulative effects of frailty and co‐morbid disease upon stroke disability and treatment are possible explanations for the findings. The study provides evidence of a need for further investigation of stroke rehabilitation strategies for adults over 75 years old

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06071.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:This study was undertaken to analyze infection rate, risk for acquisition of infection, and spectrum of infectious disease in two distinct sub‐populations within a large, metropolitan, long‐term care skilled nursing facility (LTCSNF).Design:A retrospective chart review over an 18‐month period.Setting:A large, metropolitan LTCSNF.Patients:786 acute rehabilitative patients and 554 chronic patients.Measurements:The study compared infection rate, risk for acquisition of infection, and the microbiology of the most common infections in the two sub‐populations. Analyses comparing the infection rate in the rehabilitative population with the infection rate in the chronic population were performed by multiple regression. The dependent variable in these analyses was the number of infections. The length of time that the patient was at risk for infection was included as a covariate.Main Results:Approximately 75% of patients in both groups were women. The median age was 80 years in the rehabilitative group, 85 years in the chronic group. Urinary tract infection, pneumonia, skin/soft tissue infection were the most common infections in both groups. Five hundred forty‐seven patients in the rehabilitative group and 479 patients in the chronic group had three or more underlying diseases.Enterobacteriaceaeorganisms were the most common isolates in urinary tract infectious episodes in both groups; mixed flora were the most common isolates for pneumonia and skin/soft tissue episodes in both groups. The calculated rate of infection for the rehabilitative and chronic groups was not significantly different (P=>0.05).Conclusions:In concordance with other studies, urinary tract infection, respiratory infections, and skin and soft tissue infections were the most common in the long‐term care facility. Analyses of two distinct populations within a single, large, teaching nursing facility revealed, however, that the rate of infection was not significantly different between the groups and that length of stay or presence of underlying disease was not predictive of infection.J Am Geriatr Soc 42

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06072.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Objective:To study laxative use among older persons and the association of laxative intake with hypoalbuminemia.Design:Cross‐sectional study in a population‐based cohort.Setting:Community and institutions in the Iowa and Washington counties, Iowa site of the Established Populations for Epidemiologic Studies of the Elderly.Participants:Persons aged 71 years or older, who were interviewed at the 6th year of follow‐up and for whom drug intake information was obtained (n= 2,529).Main Outcome Measures:Laxative medication use and prevalence of hypoalbuminemia.Results:The prevalence rate of laxative use was 8.8% in the community and 74.6% in nursing homes. Increasing age was independently associated with laxative use (odds ratio [OR] = 1.66, 95% confidence interval [CI]= 1.33 to 2.07 for a 10‐year increase), after adjusting for gender, institutionalization, disability in activities of daily living, body mass index, and use of the following drugs: furosemide, benzodiazepines, antidepressants, codeine, and calcium antagonists. Laxative use was independently associated with hypoalbuminemia (OR = 3.17, 95% CI = 1.42 to 7.08) after adjusting for age, gender, anemia, number of comorbid conditions, disability in activities of daily living, body mass index, use of furosemide, and institutionalization status. Compared with those who never used laxatives, those who took laxatives only at the 6th year of follow‐up were at increased risk of hypoalbuminemia (OR = 2.65, 95% CI = 1.04 to 6.77), and those who used laxatives at both the 3rd and 6th years of follow‐up were at greatest risk (OR = 4.02, 95% CI = 1.53 to 10.06).Conclusion:Laxatives are used by large numbers of older persons, and the investigation on unknown adverse effects is important. Prospective studies are needed to confirm the association of laxative use with hypoalbuminemia found in this study and to assess the mechanisms of this association.J Am Geriatr Soc 42

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06073.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY