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Biomedical subjects

H G Koenig

Publications and source records attributed to H G Koenig.

At least 109 records · Page 6Linked to original sources
PubMed1988

Religious activities and attitudes of older adults in a geriatric assessment clinic.

Few studies have examined the prevalence, salience, and impact of religious beliefs, activities, and commitment among medical patients in later life. Surveys of the U.S. population aged 65 years and over reveal a high frequency of such beliefs and activities, which are reported to play a significant role in their lives. In this study, the religious beliefs, activities, and motivations of 106 consecutive patients (mean age 74.4 years) attending a geriatric outpatient clinic were examined. A high prevalence of orthodox Christian beliefs, religious community activity, private devotional activity, and intrinsic religious orientation was found. Levels of religious activity and intrinsic orientation were lower among patients with cancer, chronic anxiety, depressive symptoms, and those who smoked cigarettes or consumed moderate to large amounts of alcohol. Intrinsic religiosity was lower among men with hypertension. Patients with mild to moderate dementia tended to have higher levels of intrinsic religious orientation. The results of this study suggest that religion is a powerful cultural force in the lives of older medical patients and is integrally related to both mental and physical health.

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PubMed1988

Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness.

Until now, no self-rated depression scale had been validated as a screening measure for major depression in the older patient hospitalized with medical illness. The present report establishes the validity of two brief, easily administered depression screening tests, the Geriatric Depression Scale (GDS) and the Brief Carroll Depression Rating Scale (BCDRS), in this population. Structured psychiatric interviews were performed and self-rated depression measures administered to 128 men, aged 70 and over, consecutively admitted to medical and neurological services of a VA hospital. The GDS and BCDRS were both shown to have high sensitivity and specificity for detecting major depression in this setting. Optimal cut-off scores determined by the receiver operating curve characteristics of these tests were 11 for the GDS and 6 for the BCDRS. At a cutoff score of 11, the GDS had a sensitivity of 92%, a specificity of 89%, and a negative predictive value of 99%; lowering the break point to 8 did not increase sensitivity. At a cutoff score of 6, the BCDRS achieved a 100% sensitivity, 93% specificity, and 100% negative predictive value. Whether clinicians decide to implement either of these depression screens in their practice will depend to a large degree on the importance ascribed to the detection of these disorders and on attitudes toward the benefits of treatment.

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PubMed1988

Detection and treatment of major depression in older medically ill hospitalized patients.

While major depression is common among medically ill older inpatients, little is known about the frequency of detection or appropriate treatment in this population. In the present study, 171 consecutive men age seventy and over admitted to the medical and neurological services of a VA medical center were screened for major depression. The medical records of all patients identified with this disorder were reviewed for documentation of depression by housestaff 1) prior to our evaluation and 2) throughout the rest of the hospital stay. Relative and absolute contraindications to antidepressant therapy were also sought. Of patients identified with major depression, 20 percent (3/15) had depressive symptoms documented in their charts by housestaff prior to our evaluation. After housestaff were informed of the possibility of major depression, 27 percent (4/15) of these patients eventually received psychiatric consultations, and 13 percent (2/15) had antidepressants initiated. At the time of discharge only 13 percent (2/15) had followup plans documented in their medical record to provide ongoing therapy or any therapy for depression after discharge. While this low detection rate and less than adequate treatment may indicate a lack of sensitivity on the part of clinicians to depression in this population, the reluctance to use antidepressants may be partly explained by the observation that 87 percent (13/15) of depressed patients had relative or absolute contraindications to antidepressants.

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PubMed1988

Depression in elderly hospitalized patients with medical illness.

Depressive symptoms and disorders were identified by structured psychiatric interview in 130 consecutively admitted male inpatients aged 70 years and over. Major depression was found in 11.5% and other depressive syndromes in 23%. While depressive symptoms and syndromes are common among the medically ill, this study demonstrated the need for careful diagnostic assessment of older patients with depressive symptoms before initiating treatment that may itself convey significant risk. Sociodemographic and health characteristics of older men at higher risk for depression were also identified. Patients more likely to be depressed were over age 75 years, had less formal education, experienced cognitive dysfunction, suffered from more severe medical illness (particularly recent myocardial infarction), and had a history of psychiatric illness. Depressive symptoms were also common among patients with renal or neurologic diseases, those having a family history of psychiatric illness, the unmarried, and the more severely disabled. Given the impact of depression on recovery from medical illness, compliance with medical therapy, and costs of extended hospital stays, detection and treatment of this disorder are imperative.

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PubMed1986

Rational theophylline use in older asthmatics.

In the sick adult, the variability of clearance from patient to patient may be greater than 50%. A given dose of theophylline that is predicted to result in a serum concentration of 15 micrograms/ml may result in an actual range of serum concentrations from 6.6 to 33 micrograms/ml. Respiratory infections, both acute and chronic, seem to have an adverse effect on theophylline clearance. Studies in adults with acute viral upper respiratory infections, pneumonia, and chronic obstructive pulmonary disease show a significant decrease in clearance.

Absorption↗
PubMedDate not supplied

Religious commitment and health status: a review of the research and implications for family medicine.

The empirical literature from epidemiological and clinical studies regarding the relationship between religious factors (eg, frequency of religious attendance, private religious involvement, and relying on one's religious beliefs as a source of strength and coping) and physical and mental health status in the areas of prevention, coping, and recovery was reviewed. Empirical studies from the published literature that contained at least 1 measure of subjects' religious commitment and at least 1 measure of their physical or mental health status were used. In particular, studies that examined the role of religious commitment or religious involvement in the prevention of illness, coping with illnesses that have already arisen, and recovery from illness were highlighted. A large proportion of published empirical data suggest that religious commitment may play a beneficial role in preventing mental and physical illness, improving how people cope with mental and physical illness, and facilitating recovery from illness. However, much still remains to be investigated with improved studies that are specially designed to investigate the connection between religious involvement and health status. Nevertheless, the available data suggest that practitioners who make several small changes in how patients' religious commitments are broached in clinical practice may enhance health care outcomes.

Adaptation, Psychological↗
PubMedDate not supplied

Religious beliefs and practices in family medicine.

OBJECTIVES: To determine whether the religious beliefs and behaviors of family medicine outpatients differed from those of their physicians and whether patients' religiousness affects their expectations of their physicians regarding religious matters. DESIGN: A survey study was performed on a consecutive sample of 380 family medicine clinic outpatients and 31 family medicine faculty and residents in 2 family medicine residency programs. SETTING AND SUBJECTS: Outpatients were recruited from an outpatient clinic of a family medicine residency program in North Carolina. Family medicine physicians and residents were recruited from this program and another in Texas. MAIN OUTCOME MEASURES: Scores were obtained from the Springfield Religiosity Scale, the Hoge Intrinsic Religiosity Scale, and a religious beliefs questionnaire designed for this study. RESULTS: Absence of religious affiliation was more common for physicians than patients. Physicians were less likely than patients to pray privately and less likely to hold intrinsic religious attitudes. Patients were more likely than physicians to be interested in their own physician's religious beliefs, more likely to feel that they should know their physician's religious beliefs, and more likely to want their physician to pray with them under certain circumstances. When sex and age were controlled, some of these differences disappeared. When compared with patients, physicians tended to be younger and male--characteristics inversely associated with religious belief and practice. Regardless of sex or age, however, the more religious the patients, the more likely the desire to know their physician's religious beliefs and share their own religious beliefs. CONCLUSIONS: Patients are more involved in religious beliefs and practices than physicians, a finding partially explained by age and sex. The more religious the patients, the more important it is for them to know their physician's beliefs, share their beliefs with their physician, and want their physicians to pray with them.

Adult↗
PubMedDate not supplied

Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study.

BACKGROUND: Although church attendance has been associated with a reduced risk of mortality, no study has examined the impact of religious struggle with an illness on mortality. OBJECTIVE: To investigate longitudinally the relationship between religious struggle with an illness and mortality. METHODS: A longitudinal cohort study from 1996 to 1997 was conducted to assess positive religious coping and religious struggle, and demographic, physical health, and mental health measures at baseline as control variables. Mortality during the 2-year period was the main outcome measure. Participants were 596 patients aged 55 years or older on the medical inpatient services of Duke University Medical Center or the Durham Veterans Affairs Medical Center, Durham, NC. RESULTS: After controlling for the demographic, physical health, and mental health variables, higher religious struggle scores at baseline were predictive of greater risk of mortality (risk ratio [RR] for death, 1.06; 95% confidence interval [CI], 1.01-1.11; chi(2) = 5.89; P =.02). Two spiritual discontent items and 1 demonic reappraisal item from the religious coping measure were predictive of increased risk for mortality: "Wondered whether God had abandoned me" (RR for death, 1.28; 95% CI, 1.07-1.50; chi(2) = 5.22; P =.02), "Questioned God's love for me" (RR for death, 1.22; 95% CI, 1.02-1.43; chi(2) = 3.69; P =.05), and "Decided the devil made this happen" (RR for death, 1.19; 95% CI, 1.05-1.33; chi(2) = 5.84; P =.02). CONCLUSIONS: Certain forms of religiousness may increase the risk of death. Elderly ill men and women who experience a religious struggle with their illness appear to be at increased risk of death, even after controlling for baseline health, mental health status, and demographic factors.

Adaptation, Psychological↗
PubMedDate not supplied

Antidepressant use in elderly medical inpatients: lessons from an attempted clinical trial.

The authors conducted a clinical trial to examine the efficacy and safety of nortriptyline in the treatment of major depression in elderly medical inpatients. The diagnosis of major depression was made by a psychiatrist in 41 of 680 patients 65 years of age or older. The study was balted at the midpoint because of inadequate patient recruitment, primarily a consequence of medical illnesses that prevented more than 80% of eligible patients from participating in or completing the clinical trial. Major or minor medical contraindications to the use of antidepressants were present in over 90% of depressed patients. Short-term follow-up was conducted on untreated depressed patients, those receiving antidepressants at the time of assessment, and those in whom antidepressant treatment was initiated after assessment. Non-randomized exposure to antidepressants did not predict remission of depression at follow-up due to spontaneous remission in the untreated group. Given the prevalence of medical contraindications to antidepressant use among depressed elderly patients and the problems with side effects in treated patients, there were few depressed, elderly hospitalized patients who were candidates for antidepressant therapy.

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PubMedDate not supplied

Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals.

The 35-item Duke Social Support Index (DSSI) measures multiple dimensions of social support and has been used extensively in cross-sectional and longitudinal studies of aging. Epidemiological studies of chronically ill, frail elderly individuals often wish to include a measure of social support. However, most multidimensional measures (including the DSSI) are long and may exhaust the patient, especially when included in an often already congested interview schedule. The authors have developed two abbreviated versions of the DSSI (23-item and 11-item) that capture the essential components of social support related to mental health outcomes and use of health services in treating elderly individuals with nonpsychiatric medical illness.

Adaptation, Psychological↗