摘要:

Influenza remains a major cause of illness and death in elderly people despite current vaccination programs. One factor is an immunization failure rate in the elderly that may be as high as 50%. To test whether administration of thymosin α 1 would result in greater antibody production, we administered it (900 μg/m2subcutaneously twice weekly for eight doses) in conjunction with the 1986 trivalent influenza vaccine. Ninety men (65—99 years old, mean age 77.3 years) were randomized double‐blind to receive thymosin α1, or placebo by the same schedule; the sera from 85 of these men were acceptable for analysis. The two groups were similar with respect to underlying disease, medications, and age. No toxicity was observed in either group. Antibody response rate was defined as a four‐fold rise in antibody titer over 3—6 weeks following vaccination and was measured by an enzyme‐linked immunosorbent assay (ELISA). Analysis was performed on treatment groups and subgroups divided by the mean age: the older group consisted of subjects aged 77 years and older, and the younger group those aged from 65—76 years. Baseline and change in absolute antibody levels were compared by t test and using age as a continuous variable by multiple regression analysis. The response was greater in the thymosin α1treatment group at 6 weeks compared to the placebo group (P = .023), and this difference in absolute amount of antibody produced could be attributed to the greater response to vaccine in the older thymosin α1treated subjects (P = .039) as no difference was observed between the younger treatment groups, or between the older thymosin α1treated subjects and the younger subjects. The ability of elderly men receiving thymosin α1treatment to produce antibody to vaccine similar to their younger counterparts may be of c

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01561.x

年代:1989

数据来源: WILEY

摘要:

A cohort of 3,595 white women aged 40–77 years was followed for an average of 10 years during which 84 new cases of hip fracture were identified. Triceps skinfold thickness and arm muscle area measured at baseline were examined as possible risk factors for hip fracture controlling for physical activity, height, menopausal status, calcium consumption, and smoking. Of these variables only arm muscle area, triceps skinfold thickness, and activity in recreation were independent predictors of hip fracture incidence using the Cox proportional hazards model. After adjustment, the estimated relative risk of hip fracture was approximately two for an increment of each anthropometric indicator (adjusted for the other) equivalent to comparing those at the 25th percentile to those at the 75th percentile (maximum width of 95% confidence intervals, 1.2–2.9). Risk of hip fracture was approximately two‐fold for persons who reported little recreational exercise compared to persons who reported much recreational exercise (95% confidence interval, 1.2–3.2).Our findings are the first evidence from a prospective study that anthropometric indicators besides body mass index may have an independent relationship to risk of hip f

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01562.x

年代:1989

数据来源: WILEY

摘要:

Elderly patients often have problems not easily detected during an office visit. We investigated the yield of a home visit by a geriatric nurse specialist as part of an interdisciplinary assessment process. Compared with the findings of an office‐based assessment by a general internist, the home visit resulted in up to four new problems (median = 2, mean = 1.7, 95% confidence interval = 1.5–1.8) and one to eight new recommendations (median = 4, mean = 3.6, 95% confidence interval = 3.4–3.9.) Twenty‐three percent of the problems could have resulted in death or significant morbidity. The most frequent problems related to psychobehavioral difficulties (23.1% of problems involving 38.3% of patients), safety (21.6% of problems involving 35.7% of patients), and caregiver related problems (20.4% of problems involving 33.8% of patients). The most common recommendations related to safety (30.7% of recommendations involving 81.8% of patients), caregiver well‐being (19.8% of recommendations involving 52.6% of patients), and social issues (12.7% involving 33.8% of patients). Baseline clinical information did not predict the yield of the home visit in this sample. We conclude that an in‐home assessment contributes unique and meaningful information to the geriatric assessm

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01563.x

年代:1989

数据来源: WILEY

摘要:

To determine differences in perception of benefit from a patient's admission to a geriatric Assessment and Rehabilitation Unit, we asked both medical and nursing staff (health team) and the patient and carer (clients) for their evaluation after discharge. The areas studied were functional ability, relief of the principal symptom, education about the principal problem, and development of coping skills. Of 94 patients studied, 58 patients were discharged to the community (52 to carers, 6 to live alone) and 36 to institutions. In the former group, the health team had a consistently higher perception of benefit than the clients (P<.001). Factors positively predicting health team perception of benefit were a higher carer happiness, improvement in patient independence, and internalization of the patient's locus of control. A negative predictor was an increase in patients' responsibilities. Client perception of benefit was positively predicted by fewer problems with companionship and communication with others. The health team's perception rated the adequacy of patient education and development of coping skills more highly than did the clients. In the patients discharged to the community, their perception of benefit at 1 week was a good predictor of survival in the community to 6 weeks. The possible reasons for these differences in perception of benefit and their implications are discussed.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01564.x

年代:1989

数据来源: WILEY

摘要:

The high prevalence of mental disorders such as depression and dementia in institutionalized elderly patients warrants screening for psychiatric diagnosis in patients newly admitted to long‐term care facilities. The diagnostic accuracy of the Mini‐Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) was evaluated against a standardized psychiatric interview. The MMSE was found to be 81% sensitive and 83% specific in screening for dementia using a previously established cutpoint of less than 24/30 points. Adjusting MMSE scores for physical disabilities precluding completion of specific tasks on the MMSE did not significantly change the diagnostic accuracy of the test. The GDS was 47% sensitive and 75% specific in screening for depression using the suggested cutpoint of greater than 13/30 points. The MMSE was significantly correlated with functional status (r = 0.48, P = .0001), but not with the scores on the GDS or the clinical diagnosis of depression. The GDS did not correlate with functional status. In summary, the MMSE is a good screening test for dementia in institutionalized elderly, but the GDS is not sensitive for depression in this populat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01565.x

年代:1989

数据来源: WILEY

摘要:

Elderly psychiatric patients who are cared for in general hospital psychiatric settings have not been clearly characterized in the literature in terms of demographics, primary diagnoses, hospital course, and outcome. The authors reviewed charts of 168 patients over the age of 60 years admitted to a general hospital inpatient psychiatry unit over a 5‐year period in order to develop a demographic and clinical profile of this patient population. Results indicated that the large majority of patients had affective syndromes; dementia was the second most common diagnosis. Length of stay correlated with severity of depressive illness, while a diagnosis of dementia was associated with a shorter hospitalization. Outcome measures showed favorable response to treatment in three‐fourths of this population of elderly psychiatric patients. These data suggest that the general hospital acute inpatient setting is well suited to care for the combined medical and mental illnesses of elderly psychiatric patie

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01566.x

年代:1989

数据来源: WILEY

摘要:

Sixteen patients with early Alzheimer's disease (AD) completed a 3‐month outpatient double‐blind parallel trial of oral physostigmine versus placebo. Ten subjects received drug; six received placebo. After a dose‐titration phase, each patient was placed on his or her best dose of drug or placebo. Subjects were evaluated with both memory and nonmemory tasks. Seven of the ten drug‐treated patients, but none of the six placebo‐treated patients, demonstrated improvement on a selective reminding task, a test of verbal memory. Family members reported improvement in six of ten drug‐treated patients and none of six placebo‐treated individuals. There was a trend toward greater improvement with increasing drug dose. There was no improvement on the nonmemory tests administered. The data indicate that oral physostigmine improves memory but not other areas

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01567.x

年代:1989

数据来源: WILEY

摘要:

An elderly female who had suffered a stroke was admitted to the Jewish Institute for Geriatric Care (JIGC) for rehabilitation. Three years previously she was found to have a pituitary macroadenoma (prolactinoma) that was treated with radiation therapy. She had been on thyroid replacement for secondary hypothyroidism. Upon admission she was found to have severe cognitive impairment in association with a low plasma Cortisol level. After treatment with prednisone there was a dramatic improvement in cognitive function and the patient was able to participate in a rehabilitation program.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01568.x

年代:1989

数据来源: WILEY

摘要:

Discussion of code status of a patient is usually raised in the inpatient setting, when patients are unable to participate because of their critical condition. In order to increase patient participation, code status was discussed in the homes of 37 chronically ill patients enrolled in a hospital‐based home care program. Twenty patients or conservators did not want resuscitation performed in case of cardiac arrest. In this small, select group, outpatient code discussions benefited the patients, families, and health care provider

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01569.x

年代:1989

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1989.tb01570.x

年代:1989

数据来源: WILEY