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Biomedical subjects

A Wettstein

Publications and source records attributed to A Wettstein.

At least 19 recordsLinked to original sources
PubMed2006

Caregivers' adaptation to change: the impact of increasing impairment of persons suffering from dementia on their caregivers' subjective well-being.

As progressive dementia involves changes in patients' behaviour and cognitive and functional abilities, dementia caregiving can be considered as a process that demands continuous adaptation to change. The current intervention study investigated associations between the course of dementia patients' impairment and their caregivers' well-being over two years. One hundred and twenty-eight care recipient-caregiver dyads participated in a controlled randomised intervention study (psycho-educational group intervention), 99 dyads in which the care recipients still lived at home participated in the second assessment, and 75 dyads in the third assessment. Caregivers were interviewed about their subjective well-being (emotional well-being and life satisfaction) as well as care recipients' behavioural problems and functional disability. Care recipients completed various neuropsychological tests. The assessments were repeated one and two years later. The psycho-educational intervention had a positive impact on caregivers' well-being. Level and increase in behavioural problems and increases in cognitive and functional impairment negatively affected caregiver well-being over time. For participants from the control condition the negative association between increase in impairment and decrease in caregiver well-being over time was stronger than for the caregivers in the intervention group. Our results suggest that it is not only the severity of current problems and stress, but also the rate of change, that is important for caregivers' well-being. Psycho-educational group intervention may help caregivers to adapt to the increasing impairment of care recipients with dementia.

Adaptation, Psychological↗
PubMed2004

[Does a reduction of drugs yield a higher quality of life in geriatric patients?].

Considering the constant increase of medication costs in medical institutions we analysed in a Swiss municipal nursing home whether medication in geriatric long term patients can be reduced without compromising quality of life. To document these effects we applied two established questionnaires on different issues of quality of life; the interviews with the patients and with the nursing staff were performed as a pre-post-comparison of the 3-month intervention. The new geriatric medication concept allowed a decreased daily medication as well as a 23% reduction of the medication costs at an average. In comparison to a previous group of control this study showed no reduction in quality of life for nursing home residents but even a stabilisation yielding to an actual improvement of quality of life.

Age Factors↗
PubMed2004

[Can falls in nursing homes be avoided?].

Fall-related injuries in nursing homes for the aged are frequent and cost-intensive. Their iatrogenic causes are well known and avoided in modern geriatric institutions. We examined all falls in an institution during the period of 19 months. Patients who carry out daily tasks on a semi-independent level were most at risk. The main risk-factor was dementia. Medication did not prove a major risk-factor. At 37% p. a. the risk of falling was lower than in previous studies. This was due to a restriction on benzodiazepines with short term effects, minimising of neuroleptics, diuretics and other types of antihypertensives as well as avoidance of polypharmacy. Unavoidable risks need to be identified and should result in use of a hip protector.

Accidental Falls↗
PubMed2003

[Can empowerment of elderly with chronic disease be achieved in Switzerland? First results of the ALLFIT program in Zurich].

Self management courses can efficiently empower elderly with chronic disease. ALLFIT, a Swiss self management and fitness programme for seniors with chronic heart, lung, musculoskeletal or diabetic disease, consists of individual contracting and coaching by a Nurse, a weekly Fitness Training and 8 self management courses for 2 hours a week. Of the first 100 Participants, 99 defined contracts of goals and 80 achieved at least partially, 21% improved their physical fitness in walking and 25% in climbing stairs. Empowerment of elderly with chronic diseases can be achieved in Switzerland by a combination of fitness, self management training and individual coaching.

Activities of Daily Living↗
PubMed2003

[How stable is the attitude of aged people towards life-extending measures? Results of a 3-year follow-up in nursing home residents].

OBJECTIVE: To explore the stability of attitude towards life-extending measures in aged people. METHOD: Face-to-face interviews of nursing home residents at an interval of 3 years (prospective longitudinal survey). RESULTS: During the first interview period in 1997 (n=50), 19 nursing home residents (38%) had advocated treatment with antibiotics in a hypothetical scenario of acute life-threatening pneumonia. 15 individuals (30%) had refused such treatment, while statements from a further 16 (32%) had been ambivalent. Three years later, 19 individuals could be re-interviewed (28 had died in the meantime, 3 suffered from advanced dementia). 16 of these expressed the same or a similar attitude towards the above scenario as they did three years earlier (correspondence 84.2%, p<0.01). CONCLUSION: The results indicate a high stability of attitude towards life-extending measures in aged people. This finding may have implications for the meaning of advance directives in geriatric long-term care.

Advance Directives↗
PubMed2002

[Effects of social support on well-being of demented nursing home residents. The Käferberg Visitation Study].

BACKGROUND: Relatives and caregivers of patients with dementia are often insecure about the impact of their efforts. This study examines whether and to what extent social support in the form of regular visits is increasing the well-being of demented aged. PROCEDURE: A field experiment with slightly to seriously demented institutionalized aged persons (MMS 5-25) was carried out to assess the effect of increased social support upon their well-being. Voluntary helpers, who were willing to visit their patients on a regular basis, were recruited by appeals at the senior university and by advertisements. The volunteers were trained to deal with the demented and were looked after regularly. The test subjects were randomly assigned to one of two test groups. The first group was visited regularly for ten weeks, whereas the second group served as a control group. The participants of the experimental group received a visiting card with a photo of the volunteer and the next appointment date to remember their visitors and to increase the effect of predictability. RESULTS: The effect of visits on the well-being of the institutionalized aged persons was significantly positive (F(1,39) = 11.16, p < 0.002). The psychological, physiological and social well-being of the participants was improved. Additionally, visits moderated the pain resulting from physical illness and seemed to decrease the effects of mental decline on their performance. Furthermore, it was most impressive to find that the demented aged really took notice of the visits and seemed to remember them in one way or an other. The study pointed out that demented aged persons are still very sensitive in an emotional respect and that they are still able to give astonishing good and differentiated information about their feelings even in an advanced state of dementia. Even the volunteers gained from their visits, which was shown by their higher well-being after their visits.

Adaptation, Psychological↗
PubMed2001

[Dementia: what the primary care physician must know about it].

Therapy of dementia is most successful in its early stages. Therefore the diagnosis of dementia has to be made early. Helpful are semiquantitative history of forgetfullness and screening exams of cognition. Laboratory and imaging examinations determine curable causes. The therapy of dementia has to combine pharmacotherapy of cholinesteraseinhibitors with symptomatic treatment of behavioural disturbances and should always be accompanied by counselling and educating the caregivers. For mild cognitive impairment not (yet) dementia Ginkgoextracts are the only approved therapy and should be combined with stroke preventary measures and training of fitness and memory.

Aged↗
PubMed2001

Acceptance of hip protectors for hip fracture prevention in nursing homes.

In order to prevent hip fractures 548 fall-prone senior citizens living in 20 nursing homes participated in a randomized controlled trial of hip protectors. One hundred and sixty-four were randomly selected into the control group and 384 into the intervention group. Of the patients in the intervention group 138 (35.9%) wore the protector throughout the whole 10 months of the study's duration, 124 (32.3%) quit wearing the protectors after an initial wearing period and 122 (31.8%) refused to wear them at all. The regular wearers had the protector on during an average of roughly 12 hours a day, so they were protected for 50% of their exposure time (including at night). Fifty-nine percent of the drop-outs stopped wearing the protectors in the first two study months, mostly for non-medical reasons. Calculation by a forecasting model showed that those senior citizens who were initially prepared to wear the protector tended to be those who were physically restricted.

Accidental Falls↗
PubMed2001

Fish oil (Eicosapen) is less effective than metronidazole, in combination with pantoprazole and clarithromycin, for Helicobacter pylori eradication.

BACKGROUND: In vitro omega-3-fatty acids (Eicosapen) are bacteriostatic to Helicobacter pylori and have a variety of immuno-modulating effects. AIM: To investigate the efficacy and tolerability of eicosapen (E) as an antibiotic-sparing component of a triple H. pylori eradication regimen in non-ulcer dyspepsia patients in a randomized, double-blind trial. METHODS: Non-ulcer dyspepsia patients (n=199), with a normal upper endoscopy and a positive (13)C-urea breath test (UBT) were randomly assigned to either pantoprazole, clarithromycin and metronidazole (PCM) or pantoprazole, clarithromycin and eicosapen (PCE) for 7 days. Four weeks after treatment, H. pylori eradication was determined by UBT. Symptoms were followed up to 16 months. RESULTS: In the intention-to-treat population, PCM eradicated infection in 78% but PCE was successful in only 34% (P < 0.001). Symptomatic improvement occurred in both groups, and was not related to H. pylori eradication. CONCLUSION: Eicosapen is unlikely to be useful in H. pylori eradication regimens.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

[Diagnosis and therapy of behavior disorders in dementia].

Alzheimer's disease is one of the most common brain disorder in the elderly. In most patients who develop dementia the core syndrome of cognitive dysfunction is superimposed over the course of the disease by behavioral disorders that manifest at least temporarily to varying degrees. These include depression, anxiety, agitation, restlessness, aggression, disturbances of the sleep-wake cycle, delusions and hallucinations. Classical psychiatric exploration can be complemented by the use of the Neuropsychiatric Inventory (NPI) which allows structured diagnosis and comparative documentation of the clinical course. The majority of psychotropic drugs used in psychogeriatics have not been specifically developed for or tested in elderly, often multimorbid patients. Substances used in psychogeriatrics are subject to special requirements due to the pharmacokinetic and pharmacodynamic changes specific to very old persons. They must show clinical efficacy and a low rate of cardiovascular, peripheral and central anticholinergic effects, a low delirogenic potential and favorable pharmacokinetic and pharmacodynamic properties. Most of the newer atypical neuroleptics (e.g. risperidone) and the newer antidepressants (e.g. from the class of selective serotonin reuptake inhibitors, SSRIs, or selective serotonin and noradrenaline reuptake inhibitors, SNRIs) tend to fulfill these criteria better than the high-potency neuroleptics of the butyrophene type (e.g. haloperidol) or the tricyclic antidepressants. For that reason, these newer products should usually be preferred over the conventional agents.

Aged↗