Serum proteins as mortality index in elderly patients.
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Biomedical subjects
Publications and source records attributed to C H Rapin.
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This one-day prevalence survey of 1919 patients (74% females and 44% aged greater than or equal to 85 years) in nine geriatric hospitals, six of them located in France and three in Switzerland, indicated a high prevalence of infections in elderly institutionalized patients (infection rate: 18.7% in males and 15.4% in females). The risk factors for infection were identified and the relative risks assessed. Prevention of infections in geriatric wards should be one of the goals of every care-giver. A low rate of infection in elderly inpatients is thus likely to be associated with care of good quality.
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59 elderly patients (mean age 82) with femoral neck fractures were randomised into two groups. 27 patients received daily an oral nutrition supplement (250 ml, 20 g protein, 254 kcal) for a mean of 32 days; 32 patients acted as controls. On admission most patients had nutritional deficiencies. Despite being offered adequate quantities, nutritional requirements were not met during the hospital stay. Clinical outcome was significantly better in the supplemented group (56% favourable course vs 13% in controls) during the stay in the convalescent hospital. The rates of complications and deaths were also significantly lower in supplemented patients (44% vs 87%). 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients (40% vs 74%). The median duration of hospital stay was significantly shorter in the supplemented group (24 vs 40 days). Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation.
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Protein-energetic malnutrition is frequent in geriatric practice and particularly among hospitalized patients. It has many different causes and its consequences frequently hinder medical and surgical treatments. It is difficult to diagnose and the measures to take belong to the field of social medicine, nutrition, biological research and education. A multidisciplinary approach is therefore essential in this field which needs to be developed.
These reports concern 117 elderly patients suffering from cancerous pain and demonstrate the efficacy of oral morphine treatment, more often associated with adjuvants. The score relief is good. The frequent side effects have been in the most cases rapidly controlled by appropriate measures. Being old is not an obstacle for a safe and efficient analgesic treatment. The useful dosage of morphine, the scores of relief, and the frequency of side effects are comparable to those observed in non-geriatric groups.
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The zinc status of 53 healthy elderly subjects was evaluated. The dietary Zn intake estimated by 24-h recall was 9.2 mg/d and 65% of subjects had intakes less than two-thirds of the RDA. Mean serum Zn concentration (13.0 mumol/L) and urinary Zn excretion (7.0 mumol/d) were normal. The Zn content of platelets, mononuclear cells, and polymorphonuclear cells was 5.8, 147, and 135 nmol/10(9) cells, respectively. Seventeen subjects were supplemented for 28 d with 30 mg Zn/d. The mean concentration of Zn in serum and urine increased 24% and 2.5-fold, respectively. Zn content of platelets and leukocytes did not change with Zn supplementation. The concentration of visceral proteins (ie, albumin, prealbumin, transferrin, and retinol-binding protein) and immunoglobulins (ie, IgG, IgA, and IgM) did not change with Zn supplementation. The data indicate that aging per se does not necessarily imply poor Zn status.
Twelve blood parameters were studied in five groups of women totalling 120 subjects--group I: 26 blood donors (average age 45.2 years, range 23-66); group II: 18 patients with various cerebral, cardiovascular, or infectious illnesses (average age 79.9 years, range 66-92); group III: 28 patients with femoral neck fractures (average age 79.4 years, range 56-95); group IV: 12 patients with hip osteoarthrosis (average age 71.7 years, range 60-87); group V: 36 patients with vertebral crush fractures associated with postmenopausal and involutional osteoporosis (average age 63.0 years, range 51-75). The parameters measured were total proteins, albumin, total, alpha 1, alpha 2, beta, and gamma globulins, total calcium, phosphates, alkaline phosphatase, bilirubin, and haemoglobin. Statistical analysis showed that each group differed from the others even with adjustment for age. Among the discriminant parameters, serum albumin had a distinctive position. Significantly high concentrations of serum albumin in the group with osteoarthrosis raise the question of the possible existence of a population prone to osteoarthrosis in whom the serum albumin level may reflect a special nutritional state associated with the well known bone density in subjects with hip osteoarthrosis. Albumin values in patients with femoral neck fractures are lower than normal but non-significantly. The difference between the group with vertebral crush fractures and that with femoral neck fractures seems to be due to age.
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