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Biomedical subjects

H M Hodkinson

Publications and source records attributed to H M Hodkinson.

At least 37 records · Page 2Linked to original sources
PubMed1981

Paraplegia and quadriplegia in the elderly due to spinal cord lesions: association with malignancy.

A retrospective study showed that paraplegia and quadriplegia due to spinal cord lesions occurred with a frequency of 1 in 500 admissions to a geriatric department. These cases predominantly were caused by malignant disease, particularly of the bronchus. However, elderly patients presenting to other hospital departments included a far higher proportion of cases with benign causes, particularly cervical spondylosis which affects patients of lower average age. Male patients predominated in both malignant and benign categories.

Age Factors↗
PubMed1981

The long-stay patient.

The characteristics of long-stay patients (defined as those staying more than 6 months) have been studied in a prospective series of 2,405 admissions. 5.6% become long-stay patients and they were more likely to be women, to be readmissions, to have been admitted from an old people's home, to have been non-emergency admissions, or to have been admitted by transfer. Further, they were more likely to have been physically inactive prior to admission, they had a lower average mental test score, and they were less likely to have had a constitutional upset at the time of admission. Subsequent outcome was studied by follow-up of 366 long-stay patients. Discharge rates were closely similar in the sexes, but mortality was significantly higher in men. During the first year of long stay, 14% were discharged to old people's homes and other institutions, 10% to their homes, while 33% of women and 48% of men died in hospital. After a further year only 20% of the original cohort remain in hospital.

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PubMed1980

Death and discharge from a geriatric department.

Discharge and death of in-patients has been studied by life-table analyses of outcome of over 2000 admissions to a department of geriatric medicine. Mortality risk is shown to be greater for men and in those who are older, had constitutional upset, dehydration or a low mental test score and who were admitted without a wait. Men who lived alone or were previously inactive and women who had had a previous admission to the department were found to have a lower risk of death. The prospects of discharge are equal in men and women but are less for those who are older, have low mental test scores, were previously inactive, waited for admission or were admitted from an institution. Women with dehydration or a previous admission to the department are also less likely to be discharged.

Age Factors↗
PubMed1980

The influence of route of admission on outcome in the geriatric patient.

Differences in the rates of discharge and death and length of stay are examined for 2433 elderly patients admitted to a geriatric department by different routes. Highly significant differences are found which persist even when full allowance is made for variations in age, sex, mental test score, domicile, number of admissions, wait for admission, dehydration and constitutional upset. However, if an estimate of length of stay are no longer significant. This suggests that the residual effects of route of admission even when the other factors were allowed for may be due to diagnostic differences.

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PubMed1979

Fractured neck of femur in the elderly: an attempt to identify patients at risk.

1. During a 15-month period, 110 elderly patients admitted with fractured neck of femur were studied in comparison with 72 elderly control patients undergoing elective surgery admitted over the same period to the same orthopaedic wards. 2. A striking finding was the marked similarity of all variables measured in the fracture and control groups. The principal differences between the two populations were that the fracture patients had a lower mean forearm bone mineral content, and that their serum concentrations of albumin, globulin and phosphate were reduced. 3. Neither measurements of radioisotopic calcium absorption, nor those of the serum concentrations of calcium, 25-hydroxy-vitamin D3 nor alkaline phosphatase provided satisfactory discrimination between the groups. 4. Several indices were devised, based on linear combinations of the test results obtained, in an attempt to predict the liability to future fractures of patients being considered for prophylactic therapy with oestrogens or other drugs. However, further work is required to define an index of improved predictive power and to evaluate it prospectively.

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PubMed1979

Beta-thromboglobulin and the diagnosis of thrombosis in elderly patients.

The plasma concentration of beta-thromboglobulin was estimated in elderly in-patients using a radio-immuno-assay technique. There were highly significance differences between the mean values of patients with arterial or venous thrombosis, as compared with controls. The ability of the test to detect thrombosis above the inguinal ligament means that it is a useful addition to the existing battery of tests for detecting thrombosis.

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PubMed1979

Prediction of outcome of patients admitted to a geriatric department.

The reliability of a clinical prognosis of outcome at six weeks has been investigated in a series of 1092 consecutive admissions to a geriatric department. The prognosis was made within a day of admission and made use only of the history and clinical findings. The results for discharge were good but categorization of patients who died or who stayed longer than six weeks was less reliable. Unpredicted deaths were often sudden or related to disease with developed after assessment. Other errors were due to over-optimism in forecasting response to medical treatment or rehabilitation. In other cases progressive deterioration had not been clearly recognized at our assessment based on a single point in time.

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PubMed1979

The clinical pathology of heart failure and atrial fibrillation in old age.

The factors associated with the development of heart failure and of atrial fibrillation in elderly patients were studied in a prospective clinico-pathological series of 171 cases. Multiple logistic analyses allowed the contributions of multiple factors to be assessed simultaneously. Senile cardiac amyloidosis, ischaemic heart disease and atrial fibrillation were significantly associated with heart failure and had additive effects. Senile cardiac amyloidosis, ischaemic heart disease, mitral valve ballooning and higher age were significantly associated with atrial fibrillation but their additive effects were modified by significant interactions between ischaemic heart disease and mitral valve ballooning (whose effects were multiplicative) and senile cardiac amyloidosis and age (the age effect being confined to those without amyloidosis).

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PubMed1978

Capillary fragility in elderly in-patients.

Capillary fragility has been examined in 110 elderly patients, excluding those patients who might have been expected to have abnormal fragility. Nonetheless, fragility appeared to be greater in elderly patients than in younger subjects. It was much increased in the non-paralysed arm of hemiplegic patients but not in the paralysed arm--perhaps because petechiae were obscured by trophic changes. Capillary fragility was significantly correlated with systolic blood pressure but not with age. This suggests that higher values in elderly patients may be related to the high prevalence of arteriosclerosis rather than to age itself.

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PubMed1978

Valvular calcification in the elderly: possible pathogenic factors.

Calcification of the mitral ring and of the aortic valve cusps was studied in an unselected autopsy series of 219 patients over 60, dying in a department of geriatric medicine. Possible correlations with age, sex, heart size, systolic and diastolic blood pressures, bone density and serum calcium, phosphate and alkaline phosphatase were examined. There were no significant findings for aortic valve calcification though there was a weak association with advanced age. Mitral ring calcification was significantly associated with higher age, female sex and with increased heart weight after correction for body size. These findings suggest that mechanical factors, rather than changes in mineral metabolism, are implicated in the development of mitral ring calcification.

Age Factors↗
PubMed1977

Hypercalcaemia in elderly hospital in-patients: value of discriminant analysis in differential diagnosis.

Plasma calcium was measured routinely as a part of profile screening of patients admitted to a geriatric department. Pathological hypercalcaemia was found in 1.33% of those screened, the cause being bone metastases (29%), hyperparathyroidism (21%), bronchial carcinoma without bone metastasis (18.5%), lymphosarcoma without bone metastasis (8%) and multiple myeloma (2.5%). There remained a further group of patients with hypercalcaemia and renal failure (21%) in whom diagnosis was often obscure. Where renal function was normal, discriminant analysis showed that the four main diagnostic groups were biochemically distinguishable. Discriminant analysis thus seems likely to be of practical value in the differential diagnosis of hypercalcaemia in elderly patients with normal renal function, but requires prospective validation.

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PubMed1977

Thyroid function tests in the elderly in the community.

A study of the well elderly living at home has demonstrated that the ranges for serum thyroxine (T4), triiodothyronine (T3) uptake and free-thyroxine index (FTI) are much narrower than those for the sick elderly in-patient. The prevalence of thyroid disease appears similar in both types of elderly population.

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PubMed1977

Pathological validation of auscultation of the elderly heart.

Systolic murmurs present in 129 geriatric patients followed to post-mortem were assessed as mitral or aortic in origin by simple clinical assessment alone. Post-mortem examination contradicted clinical findings in only 2% of cases. Mitral valve pathology, mostly post-inflammatory scarring or mucoid degeneration, was present in 50% of the cases with murmurs. There was a significant correlation between the presence of murmurs, particularly mitral murmurs, and congestive cardiac failure, and there was also a significant correlation with age. A tendency for aortic systolic murmurs to be associated with a higher mean systolic blood pressure was not significant and there was no significant association between systolic murmurs and ischaemic heart disease.

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PubMed1977

The clinical significance of senile cardiac amyloidosis: a prospective clinico-pathological study.

The heart was screened for amyloid deposits in an unselected post-mortem series of 244 patients over 60 who had been admitted to a geriatric department. Cardiac amyloidosis was found in 121 cases (49-6 per cent) but was limited to minor atrial involvement in 55 (22-5 per cent). The prevalence and severity of cardiac amyloidosis were significantly related to age and sex, females having the higher prevalence (56 per cent compared with 37 1/2 per cent). Cardiac amyloidosis was also significantly correlated with the occurrence of atrial fibrillation and of cardiac failure during the period of admission to hospital. Cardiac amyloidosis showed no significant correlations with other factors studied which included ECG evidence of left ventricular hypertrophy, ischaemia and bundle branch block, pathological evidence of cardiac enlargement or ischaemia, diagnosis of malignant disease, generalized wasting and the occurrence of digitalis toxicity.

Age Factors↗
PubMed1976

Factors predicting mortality in the elderly in the community.

Factors which best predict mortality within five years have been examined in a random community sample of 852 people over 65. Apart from sex, multiple-regression analysis shows the best predictive factors to be higher age and the occurrence of proteinuria in both sexes. In men, low vitamin c intake and an unfavourable clinician's assessment of the subject's health were also significant predictors. In women, whether the subject was housebound, the diagnoses of stroke and of diabetes and a low serum pyridoxine were additional adverse factors. The findings regarding low vitamin C intake in men and low serum pyridoxine levels in women should be regarded with caution. The former appears unlikely to represent a true vitamin deficiency effect and whilst the latter might, the evidence is no more than suggestive and further confirmatory studies are required.

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