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Biomedical subjects

L Z Rubenstein

Publications and source records attributed to L Z Rubenstein.

122 records · Page 7Linked to original sources
PubMed1983

Plasma norepinephrine responses to posture and isometric exercise increase with age in the absence of obesity.

This study examines the effects of age on plasma norepinephrine (NE) responses to upright posture and isometric handgrip exercise in nonobese men. Increasing age was associated with increased basal levels of plasma NE as well as increased NE responses to upright posture. These results suggest that aging affects sympathetic system activity by mechanisms largely independent of the increasing adiposity generally associated with aging.

Adult↗
PubMed1983

Falls in the elderly: a clinical approach.

"Topics in the Primary Care Medicine" Presents articles on common diagnostic or therapeutic problems (such as dizziness, pruritus, insomnia, shoulder pain and urinary tract infections) encountered in primary care practice that generally do not fall into well-defined sub-specialty areas and are rarely discussed thoroughly in medical school, house staff training, textbooks and journals. Often the pathophysiology is poorly understood and clinical trials to assess the effectiveness of diagnostic tests or therapies may be lacking. Nevertheless, these problems confront practitioners with practical management questions. The articles in this series discuss new tests and therapies and suggest reasonable approaches even when definitive studies are not available. Each article has several general references for suggested further reading. We hope this series is of interest and we welcome comments, criticisms and suggestions.

Accident Prevention↗
PubMed1982

The role of geriatric assessment units in caring for the elderly: an analytic review.

Specialized geriatric assessment units (GAUs) have been established across North America in response to the growing recognition of the many unmet needs of the frail elderly and the conviction that GAUs can have major beneficial impacts. Although their structures and objectives vary considerably, GAUs are generally designed to comprehensively assess elderly patients' medical and psychosocial problems, to determine optimal placement, and often to provide therapy and rehabilitation. We offer a framework for examining structural and outcome studies indicates that GAUs can provide important positive impacts on health care for the elderly, including more thorough diagnoses, improved levels of physical and psychological functioning, and better placement decisions.

Aged↗
PubMed1982

Dementia in the elderly: the silent epidemic.

The graying of America will be accompanied by an epidemic of major proportions--dementia or intellectual impairment--that will have an impact on all aspects of the helath care system, particularly on the institutional component of the long-term care system. Health professionals; federal, state, and local health planners; families; and others must recognize that many ameliorable or curable physical and emotional diseases in the elderly are associated with intellectual impairment that may be difficult to distinguish from irreversible brain disease of the Alzheimer type. We present information on the cause, physiopathologic mechanism, clinical presentation, appropriate laboratory studies, and anticipated outcomes in the various forms of intellectual impairment found in the elderly. Important new developments will occur in the next decade that will address the cause, pathogenesis, further refinement of laboratory investigation, and specific therapeutic intervention in dementia.

Aged↗
PubMed1981

Utilization review in nursing homes: making implicit level-of-care judgments explicit.

Comprehensive data on 3,579 patients in Baltimore nursing homes were collected by trained teams of reliable observers. The data included an implicit judgment about the level of care (LOC) deemed most appropriate for each patient. Two different approaches were used to fit the patient data to the LOC judgments: Several versions of an algorithm adapted from a utilization review scheme based on simple clinical criteria and a series of mathematical equations based on logistic regression were each tested. In the case of the latter, each equation was derived from a random half of the data and tested on the remaining half. Both approaches yielded comparable results. The best variation of the algorithm correctly identified 71 per cent of patients needing skilled care and 69 per cent of those needing unskilled care. The equations based on the logistic regressions could correctly classify 86 per cent of those needing skilled care and 63 per cent of those not needing such care. Further improvements in accuracy of prediction on one group came at the cost of less accurate identification of the other. In general, the simplest models proved the most useful. These techniques are recommended as useful for preliminary screening of nursing home patients for appropriate LOC but should not be used as a basis for final judgments. The advantages offered by this approach are the reduction of workload demands for skilled professional judgment and the availability of a very reliable preliminary screening judgment in a highly politicized atmosphere.

Activities of Daily Living↗
PubMed1981

Improved care for patients on a new geriatric evaluation unit.

An analysis is presented of a geriatric evaluation unit (GEU) established at the Sepulveda VA Medical Center in 1979 to provide comprehensive interdisciplinary assessment and treatment of geriatric inpatients. The data on 74 patients admitted during the first year show that major improvements can occur in several outcome areas. Placement location was improved over expectations in 48.4 percent of patients, thus permitting a higher level of independence with a lower level of care requirements. Functional status (Katz ADL scale) improved in two-thirds of the patients who could have shown improvement. An average of almost four new treatable disorders not noted by previous physicians were diagnosed per patient. The mean daily number of prescribed drugs was reduced by 32 percent per patient, and the total number of drug doses by 43 percent. Though limited by the unique aspects of the vA situation and by lack of a control group, the findings lend support to the efficacy and value of the GEU concept. (A randomized controlled study is in progress.)

Activities of Daily Living↗
PubMed1981

Specialized geriatric assessment units and their clinical implications.

Geriatric assessment units are among the several innovative responses by members of the US health care system to the many unmet needs facing elderly people who are frail and ill. Based on British models, these units are designed to improve the assessment of medical and psychosocial problems, to provide therapy and rehabilitation, and to determine optimal posttherapy placement at as high a level of independent functioning as possible. While generally similar, the structures and functions of various North American units vary considerably in such areas as type of patients accepted, amount of rehabilitation carried out and type of institutional setting (such as chronic-care hospital, acute-care hospital or outpatient facility). These differences have a bearing on outcomes. Though few experimental studies exist, impacts from the units appear to be substantial, and include more thorough diagnosis, higher levels of patient functioning and improved placement. Physicians can apply several of the lessons from these units to improve their care of elderly patients.

Geriatric Nursing↗
PubMed1980

The baseline ECG in the evaluation of acute cardiac complaints.

One reason for performing the ECG routinely on asymptomatic persons is to assist the physician in determining the need for hospitalization should acute cardiac symptoms later develop. To establish how often baseline ECGs are actually useful in this situation, we reviewed the records of 236 patients presenting to two emergency departments with the complaint of chest pain. Of these patients, 195 (82.7%) had clinical or ECG findings sufficiently diagnostic that the baseline ECG could not have affected the decision to hospitalize or discharge. For 11 patients (4.7%) with equivocal clinical and ECG findings, a baseline ECG (if it was available) might have been useful in avoiding an unnecessary hospitalization. There was no patient for whom a baseline ECG would have aided in avoiding an inappropriate discharge. The routine ECG has little value as a baseline for emergency comparison when patients later experience acute cardiac symptoms. Routine ECGs as baselines for future comparison should be reconsidered.

Acute Disease↗
PubMed1975

Determinants of the choice of rural practice: a study of Yugoslav general practitioners.

A questionnaire study of Yugoslav general practitioners was undertaken to document reasons for the unpopularity of rural practice and to characterize better the GPs who do choose rural practice. Responses indicated that rural GPs were significantly more overworked, had less opportunity for continuing education, had poorer medical facilities, and had less adequate schools for their children than urban GPs. On the other hand, rural work was felt to be more interesting and to provide closer contact with patients. GPs who were happy in rural practice were more likely to have urban backgrounds, to have planned to be rural physicians before entering medical school, and to have undergone GP specialization training than were other GPs in the sample. Relative importances attributed to the various practice location determinants are noted. Possible applications of the study in alleviating rural doctor shortages are discussed.

Attitude of Health Personnel↗
PubMedDate not supplied

One-leg standing balance and functional status in a population of 512 community-living elderly persons.

The objective of this cross-sectional study (whose baseline data were drawn from a longitudinal population study) was to determine if one-leg standing balance might be a useful marker of functional status in elderly persons independently living in an urban community (N = 512, mean age 73 +/- 7.0, 71.4% women). One-leg standing balance (ascertained by the Tinetti test) and functional status were obtained from a baseline gerontological assessment and follow-up questionnaires. Correlations were tested between one-leg balance and physical health and functional measurements. One-leg standing balance (OLSB) was abnormal in 24.7% of the population. At least one incapacity in instrumental activities of daily living (IADL) was found in 60.6% of those with OLSB abnormality, vs 45.5% in those with OLSB "adaptive" (borderline abnormal), and 33.3% in those with normal one-leg standing balance (p < 0.0001). Multivariate analysis showed 3 independent factors related to one-leg balance abnormality: age > 71 years (OR = 5.11, CI = 1.99-13.10); IADL deficit requiring help with transportation (OR = 3.61; CI = 1.15-11.40); and "poor" health status on the Iowa Self-Assessment Inventory (OR = 2.67, CI = 1.35-5.27). We conclude that one-leg standing balance may be a simple, predictive and inexpensive marker helpful in screening for low functional level and frailty in clinical practice.

Activities of Daily Living↗
PubMedDate not supplied

The reliability and validity of an obstacle course as a measure of gait and balance in older adults.

The use of an obstacle course to quantify gait, balance and functional mobility in elderly persons, particularly to assess objectively changes following exercise and rehabilitation interventions, has not been extensively developed or tested. In this study, we describe an 18-item obstacle course developed as an outcome measure for an exercise intervention among fall-prone elderly men. Reliability and validity of the obstacle course was tested in a group of 58 community-living elderly men (mean age = 75 years). Each subject's performance was videotaped and timed. The videotapes were scored by a physical therapist and a physician. Inter-rater reliability between the raters was high (Kappa = 0.96, p < 0.0001). Both the obstacle course score and time correlated significantly with gait velocity, a 6-minute walk test, and a performance-oriented instrument of gait and balance. Obstacle course scores showed significant improvement among the most impaired subjects, but not among higher functioning subjects following a 3-month exercise intervention. These results suggest that an obstacle course may be a useful and valid method for measuring outcomes related to mobility tasks in selected elderly populations. Further work is needed to determine in which populations, and for which outcomes, an obstacle course is better than simpler performance-based measures.

Aged↗
PubMedDate not supplied

Overview of the MNA--Its history and challenges.

The Mini Nutritional Assessment (MNA) is a simple tool, useful in clinical practice to measure nutritional status in elderly persons. From its validation in 1994, the MNA has been used in hundreds of studies and translated into more then 20 languages. It is a well-validated tool, with high sensitivity, specificity, and reliability. An MNA score > or = 24 identifies patients with a good nutritional status. Scores between 17 and 23.5 identify patients at risk for malnutrition. These patients have not yet started to lose weight and do not show low plasma albumin levels but have lower protein-calorie intakes than recommended. For them, a multidisciplinary geriatric intervention is needed, which takes into account all aspects that might interfere with proper alimentation and, when necessary, proposes therapeutic interventions for diet or supplementation. If the MNA score is less than 17, the patient has protein-calorie malnutrition. It is important at this stage to quantify the severity of the malnutrition (by measuring biochemical parameters like plasma albumin or prealbumin levels, establishing a 3- day record of food intake, and measuring anthropometric features like weight, BMI, arm circumference and skin folds). Nutritional intervention is clearly needed and should be based on achievable objectives established after a detailed comprehensive geriatric assessment. The MNA has been shown to be useful for nutritional intervention follow-up as well. The MNA can help clinicians design an intervention by noting where the patient loses points when performing the MNA. Moreover, when a nutritional intervention is successful, the MNA score increases. The MNA is recommended by many national and international clinical and scientific organizations. It can be used by a variety of professionals, including physicians, dietitians, nurses or research assistants. A short screening version (MNA-SF) has been developed, which, if positive, indicates the need to complete the full MNA. It takes less than 4 minutes to administer the MNA-SF and between 10 and 15 minutes for the full MNA.

Aged↗