Components of a geriatric medical service: view from the UK.
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Biomedical subjects
Publications and source records attributed to I R Hastie.
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Resuscitation of patients in hospital following cardiopulmonary arrest is a standard procedure. Such intervention is not always appropriate, and this article examines some of the issues involved in making the decision not to resuscitate, with particular reference to elderly patients. The effectiveness and possible adverse effects of cardiopulmonary resuscitation (CPR) in the elderly are considered, along with ethical aspects of the problem such as how to discuss the pros and cons with the patient and relatives.
To find out whether the diagnosis of dementia agreed with findings at necropsy a detailed assessment of 27 elderly patients (mean age 82 (range 70-94] presenting with dementia was conducted at a combined department of geriatric medicine and psychiatry for the elderly. On the basis of the results the cause of the dementia was diagnosed clinically. Neuropathological examinations were performed after death. The clinical diagnosis made during life was not supported by the findings at necropsy in 11 cases. Alzheimer's disease was overdiagnosed in life (13 cases, of which only six were confirmed at necropsy). Although the clinical investigation was limited by availability of resources, neither cranial computed tomography nor the Hachinski score helped to distinguish between multi-infarct dementia and Alzheimer's disease in this age group. This study confirms the value of neuropathological studies in the precise diagnosis of dementia.
A new method for quantifying the transparency of skin using an adapted pair of Harpenden's Calipers is described. A constant for each skinfold's ability to transmit light, the H factor, is calculated and this shows a steady decline with age.
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