Biomedical subjects
Publications and source records attributed to B Habot.
After her daughter died, depression developed in a 93-year-old woman with congestive heart failure receiving digoxin therapy. After treatment with fluoxetine hydrochloride she became anorexic and her serum digoxin level increased. A possible interaction, which has not been reported in the literature, may have occurred between fluoxetine and digoxin.
BACKGROUND: We evaluated psychiatrically 100 subjects, who were referred to a sleep laboratory in a general hospital because of sleep complaints. METHODS: All subjects were interviewed using a Structured Clinical Interview for DSM-III-R and underwent one night of standard polysomnography (PSG) examination. RESULTS: Forty three percent of the population had at least one Axis I DSM-III-R disorder. High rate of depressive mood disorder (24%) was observed in our sample, in contrast to low prevalence of alcohol and drug abuse (4%). Our results of a Israeli population are different from the United States studies in respect to alcohol and drug abuse. Furthermore, 11% of patients with PSG diagnosis exhibited comorbid psychiatric disorder. CONCLUSION: it appears that individuals with sleep complaints have high rate of psychiatric morbidity, especially mood disorders. LIMITATION: The rapid eye movement (REM) latency, a biological marker for depression, was not investigated. CLINICAL RELEVANCE: it seems that both PSG and psychiatric evaluation of sleep disturbance are of importance for appropriate therapeutic strategy for individuals with sleep complaints, especially in those with features of suspected depressive mood disorders.
BACKGROUND: The impact of chronic conditions on the development of disability has not yet been comprehensively studied among the elderly population living in Israel. This study evaluates the prevalence of disability and morbidity among the community-dwelling oldest-old population and examines the association between medical conditions, comorbidity, and disability in basic and instrumental activities of daily living (ADLs, IADLs). METHOD: The data are based on a national random stratified sample of 1,820 Israeli Jewish individuals 75-94 years old, of whom 1,487 lived in the community. RESULTS: Nineteen percent of the population was disabled in ADLs and 36% in IADLs. Disability rose with age and was higher for women and among individuals of Middle Eastern and North African origin. Stepwise logistic regression indicates that the variables associated with disability in ADLs and IADLs were older age, Middle Eastern or North African origin, living with others, and the following conditions: stroke, hip fracture, diabetes, osteoporosis, anemia, and heart attack. In addition, lower education and suffering from urinary or kidney diseases, respiratory disease, and/or Parkinson's disease were related to disability in ADLs; being a woman and suffering from heart diseases other than heart attack were related to disability in IADLs. Comorbidity was related to increased disability only for individuals with three or more conditions. CONCLUSIONS: The identification of medical conditions and sociodemographic variables related to limitations in functioning may serve as a basis for health promotion and disease prevention in elders by attempting to reduce the incidence and disabling consequences of known disabling conditions.
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For the past several years, the hospitalization and care of complex nursing care patients (CNCP) has caused concern among organizers, funders and care-givers of the geriatric hospitalization system (GHS). To assist in improving efficiency of the GHS and to address the lack of comprehensive, empirical and up-to-date information on these patients, we conducted a survey to characterize CNCP, to assess their medical problems and to determine their prevalence among the patients in GHS. The survey was conducted in 1994 using a day census. Data were collected on the 2,319 patients in geriatric beds in all the general hospitals and geriatric hospitals in Israel on the day of the survey. 28% of the patients in the GHS were CNCP and a quarter of them (7% of all patients) suffered from more than 1 medical condition. Tube feeding was the most prevalent condition (13% of all patients), followed by terminal illness (9%), deep pressure sores (7%) and intravenous transfusion for more than 3 days (6%). The 80% of the CNCP were hospitalized in geriatric hospitals, primarily in geriatric rehabilitation wards. Their average length of stay was over a year. Internal medicine wards of general hospitals were the most frequent source of patient referral. The survey's findings raise issues related to the organization of care of CNCP. They may serve as a basis for the reorganization of the geriatric hospitalization system in order to improve efficiency and quality of care for the benefit of patients, their families and services providers.
We describe an elderly patient with primary hyperparathyroidism and dementia who was admitted to a psychogeriatric department because of delusions of new onset. While hospitalized he had three episodes of delusions that coincided with mild hypercalcemia. Treatment for the hypercalcemia resulted in rapid remission of the delusional state, but did not induce any change in his cognitive abilities or in the severity of dementia. We review the relevant literature and offer recommendations for treatment and follow-up of elderly patients with hyperparathyroidism associated with a delusional state.
The increasing numbers of the elderly admitted to general hospitals, and the complexity of their problems, has increased the need for geriatric consultations. We evaluated geriatric consultations given at the Wolfson Medical Center by the geriatricians of Shmuel Harofeh Hospital. Data on 6-months of consultations in medical, surgical, urologic, neurologic, orthopedic and intensive care departments were evaluated. 7,910 elderly (65 years and over) were admitted during this period, representing 58% of all admissions; 742 (9.4%) were targeted for geriatric consultation. The largest number of consultations (525) were in the medical wards, but the highest rate of consultations was in the orthopedic ward for rehabilitation after operations for hip fractures. The selection of patients for geriatric consultation at Wolfson Hospital was done by the staff of each ward. This method differs from that in most general hospitals abroad, where selection is by geriatric teams. Despite this difference, our data show that the rates of consultations were similar. Also, the multidisciplinary teams consisted of members of the staff of each ward and the geriatric consultant. The method of geriatric consultations presented is easy to set up, simple to operate, efficient and appreciated by the medical staff of the departments.
Thirty patients > or = 80 years of age (mean 86) underwent diagnostic and/or therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The low mortality (6.6%) and complication (6.6%) rates lead us to believe that ERCP in octogenarians provides an acceptable route for diagnosis and treatment of biliary and pancreatic disorders.
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Cancer is an age-associated disease, and 55% of newly diagnosed cases and 67% of cancer deaths are in those above 65 years. There has recently been increasing interest in geriatric oncology, and more of the elderly are being screened for early cancer detection. Elderly cancer patients present problems not only because of their primary disease, but also because of comorbidity, reduced functional reserve, and diminished social support. Because of this combination of factors many of them need the specially skilled nursing care available in special units. 304 elderly cancer patients were admitted to our "skilled nursing division" of 156 beds during the 6 years 1987-1992. They represented 16% of all admissions and their average age was 78 +/- 0.4 (SD). Mean survival after admission was 4.1 +/- 0.4 months. In the 143 men it was 3.1 +/- 0.4 months and in the 161 women, significantly longer, 4.9 +/- 0.5. The most common location in men was colorectal (22.6%), followed by prostate (16%), while in women it was breast (25.4%), followed by colorectal (16.0%). The longest survival was for women with breast cancer (9.1 +/- 1.3 months) and the shortest for women with gastric cancer (1.9 +/- 0.6). On admission 81% had more than 1 comorbid condition: 91% had restricted mobility, 215 urinary incontinence and 12% various kinds of stomas. Serious conditions were urinary tract infections in 40%, sepsis 20%, pneumonia 12%, gastrointestinal bleeding 10% and bedsores in 7%. 77% needed intravenous fluids and/or drugs for infections, 50% narcotics for analgesia, 27% nasogastric tubes, 20% blood transfusions, 6% debridement, and 5% paracentesis. The elderly with cancer are the most difficult long term patients to treat, since their conditions are dynamic, continuously deteriorating, and they require intensive medical, nursing and psychological care.
The nasogastric tube (NGT) not only provides nutritional support, but is also an effective diagnostic and therapeutic aid. We present the profile of the geriatric patient who needs the NGT, the reasons for its use, and mortality in these patients. 25 women (aged 83.9 +/- 5.5) and 25 men (aged 79 +/- 7.7) required the NGT, 15 of them only temporarily (TNGT) and 35 permanently (PNGT). The percentage of those with chronic neurologic disorders and/or incontinence (fecal or urinary), was highest in the PNGT group, as was the number of drugs used per patient (4.2 +/- 1.8 vs. 2.9 +/- 1.4). Laboratory studies showed no differences between the groups. PNGT was used in those whose conditions were chronic and progressive (inability to swallow or not sufficiently alert for oral nutrition). TNGT was used commonly as a diagnostic or therapeutic aid. During the study 20 patients died (40%), all in the PNGT group. Pneumonia was the main cause of death (18%), followed by decubitus ulcer (14%) and urinary tract infections (8%).
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The authors present a case of gastric angiodysplasia with upper gastrointestinal bleeding, associated with severe ischemic congestive cardiomyopathy.
A fifty-four-year-old woman from a high socioeconomic class developed acute isolated tuberculous pericarditis, three years after her sister had recovered from such disease. She was treated successfully by a triple drug regimen including isoniazid, rifampin, and ethambutol.
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A 70-year-old man was treated with oral mexiletene because of ventricular premature beats due to ischemic heart disease. He developed a severe maculopapular rash which did not respond to antiallergic treatment, but disappeared after discontinuation of the drug. Adverse effects on the central nervous, cardiovascular and gastrointestinal systems have been described. A rash is rare, and in our case was of unusual severity.