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Biomedical subjects

M S Pathy

Publications and source records attributed to M S Pathy.

At least 19 recordsLinked to original sources
PubMed1992

Randomised trial of case finding and surveillance of elderly people at home.

Health screening for old people who live at home has been the subject of debate for 30 years or so. It has come to the fore again in the UK with the new emphasis on annual assessments by general practitioners (GPs) of those aged 75 or more. Screening in the elderly has implications for manpower. How can it best be done? We describe here a randomised, controlled study of case finding and surveillance in patients aged 65 and over in a general practice in South Wales. Problem identification was by a postal questionnaire, focusing on function, that was sent at random to 369 eligible patients with subsequent verification and intervention by a specially appointed nurse. The 356 controls had no questionnaires and no contact with that nurse. The study lasted 3 years, and end-points included mortality, self-ratings of quality of life, and health status, and use of all services (GP contacts, hospital admission, home help, and so on). Mortality was significantly lower in the intervention group (18%) than in the controls (24%) (difference 6.0% [95% CI 0.1-11.9%], p less than 0.05). Total number of hospital admissions did not differ between intervention and control groups, but duration of hospital stay of patients aged 65 to 74 years was significantly shorter in the intervention group (difference 4.6 days [95% CI 1.6-7.6], p less than 0.01). An increase in visits to a GP was largely offset by a lower number of home visits by a GP. Quality-of-life measures revealed no between-group differences, but self-rated health status was superior in the intervention group. We conclude that the use of a postal screening questionnaire with selective follow-up and intervention can favourably influence outcome and use of health care resources by elderly people living at home.

Aged↗
PubMed1992

Glycosylated haemoglobin in the diagnosis of diabetes mellitus in elderly people.

An oral glucose tolerance test (OGTT, 75 g WHO criteria) was applied to healthy elderly subjects (mean age 76 years) within a week of measurement of random blood glucose and glycosylated haemoglobin (HbA1). The 'Corning' method was used to assay HbA1 (established normal range for our laboratory 5-8%). Sixty-five subjects (38 women) of whom 54 were not diabetic on WHO criteria for OGTT participated in the study. Five of the 54 patients with non-diabetic OGTT results had abnormal HbA1 (greater than 8%). These five subjects had no evidence of impaired glucose tolerance. Eleven subjects had diabetic OGTT results of whom only four had raised HbA1 assay results. Seven subjects had normal HbA1 in spite of diabetic OGTT. The mean HbA1 in the group of subjects with normal OGTT (n = 52) was 6.7% (SD 1.05, range 4.6-8.7%). It appears from our study that the normal range of HbA1 in elderly subjects is not markedly different from established normal values. The poor sensitivity (36%) and predictive value (44%) of abnormal HbA1 in detecting diabetes, as shown in our study, would not permit its use for screening purposes nor as a confirmatory test for diabetes in elderly subjects.

Aged↗
PubMed1991

Thyrotropin response to thyrotropin-releasing hormone in elderly patients with and without acute illness.

The response of thyrotropin (TSH) to thyrotropin-releasing hormone (TRH) was measured in 70 clinically euthyroid elderly patients who were acutely ill and in 70 age- and sex-matched euthyroid controls who were free of acute disease. The incremental TSH response (delta TSH) was often blunted (less than 2 mU/l) in both groups, though more often in those with acute illness (30%) than in those without (19%). However, in patients from both groups who had a blunted delta TSH, there was often a substantial proportional rise in TSH. A substantial proportional TSH rise may be useful in differentiating between genuine thyroid disease and euthyroid sick syndrome in elderly patients with a blunted delta TSH.

Acute Disease↗
PubMed1991

Hypernatraemia in an adult in-patient population.

We report a retrospective study of hypernatraemia (serum sodium concentration greater than 150 mmol/l) in an adult in-patient population of a health district during one year. The incidence was 0.3% with at least 60% of cases developing after hospital admission, mainly in elderly patients. Dehydration appeared to be the major cause, with the use of diuretics, depressed conscious level or febrile illness implicated in a majority. Most patients had more than one contributory factor and iatrogenic causes were common. Associated illnesses were often severe and the in-hospital mortality was high (54%) regardless of age. Hypernatraemia in hospitalized patients should be largely avoidable and there is a need for greater awareness of the importance of active maintenance of hydration in susceptible patients.

Adult↗
PubMed1990

Measurement of height in the elderly.

Height is an essential variable when assessing renal clearance, nutritional status, and absorption. Standard methods of estimating height are impractical in the nonambulant. One hundred sixty-five elderly inpatients were studied. Total standing height, knee-to-floor height, and tibial length were measured. Total arm, upper arm, and forearm measurements were obtained in both erect and supine positions. Measured height correlated best with supine total arm length (R2 = .69), knee-to-floor height (R2 = .63), and erect forearm length (R2 = .61). A nomogram relating both supine total arm length and knee-to-floor height with the patient's measured height has been prepared.

Aged↗
PubMed1989

Thyroid function tests in elderly patients with and without an acute illness.

Thyroid function was assessed by measurement of free thyroid hormones and thyrotrophin (TSH) in 78 acutely ill elderly patients and in a control group without acute illness. Abnormal results with any test were more frequently found in the acutely ill group than in controls. In particular, abnormal TSH values were found in 40% of the acutely ill group and in only 8% of controls (p less than 0.001). Seven acutely ill subjects had very low TSH levels (less than 0.04 mU/l) and a blunted response to thyroid-releasing hormone (TRH). With few exceptions these abnormalities could not be attributed to thyroid disease. This suggests that pituitary TSH secretion can be impaired in euthyroid sick old people. High sensitivity TSH assays may therefore be inappropriate as first-line tests of thyroid function, at least in this select group.

Acute Disease↗
PubMed1989

A comparative study of conventional and controlled-release formulations of trazodone in elderly depressed patients.

One hundred sixty-six elderly depressed patients were recruited from six hospital centers and entered in a double-blind, randomized, parallel group comparative study of conventional and controlled-release formulations of trazodone. Patients received a single nighttime dose of 100 mg for 1 week, followed by 3 weeks of 200 mg or less, depending upon tolerance. Efficacy was measured using the modified Hamilton depression rating scale and global assessments of the severity of depression and improvement relative to baseline. Both treatments were equally effective with 39 (68%) patients completing 4 weeks of treatment with the conventional formulation and 41 (77%) patients completing 4 weeks treatment with the controlled-release formulation rated as very much improved. Sleep improved shortly after initiation of treatment in most patients and there were no significant differences between groups. There was a tendency for fewer side effects to be recorded during the first week of treatment in patients receiving the controlled-release formulation but no difference reached statistical significance.

Aged↗
PubMed1989

Acute mesenteric infarction in elderly patients.

The clinical features, the treatment given, the factors governing treatment selection, and the result of such treatment were analyzed in all patients aged 65 years and over in whom a tissue diagnosis of acute mesenteric infarction was made at a major teaching hospital. Thirty-two such patients, of mean age 78.5 years, were identified during the 8-year study period. Expected clinical features of bowel infarction were commonly absent; for example, there was no abdominal pain and no abdominal tenderness in 29% and 26% of patients, respectively. A sizeable minority of patients (29%) were acutely confused at presentation. All patients not undergoing surgery died shortly after admission to hospital. For those 20 patients (63%) who underwent abdominal surgery, half were discharged alive from hospital. Whether or not the patient survived was associated with the ward to which they were originally admitted. Those admitted to a surgical ward tended to be younger and had a more typical clinical presentation than their counterparts admitted to a medical ward. In particular they were more likely to have abdominal pain and distention and less likely to be confused. Surgical intervention was undertaken more often and earlier in those admitted to surgical wards and this may have accounted for the better outcome. It should be emphasized that acute mesenteric ischemia is a potentially correctable surgical condition even in very elderly people. A realization that the presentation is often atypical should increase the likelihood of early recognition and lead to improved patient survival.

Aged↗
PubMed1989

Attitudes of hospital doctors in Wales to use of intravenous fluids and antibiotics in the terminally ill.

Decisions concerning the use of intravenous fluids and antibiotics in terminally ill patients are regularly made by hospital doctors, but there is little record of staff attitudes and current practice in Britain. A questionnaire was therefore distributed to 833 Welsh hospital doctors, citing the case of a hypothetical terminally ill patient and asking questions about medical management. Of the 448 (54%) doctors who replied, 346 (77%) had managed a similar patient recently. Intravenous fluids would be administered by 238 (53%), with 206 of these (87%) resiting the cannula as required and 62 (26%) resorting to a central venous line if there was no alternative. With increasing age and seniority doctors become conservative in their approach. Nearly all claimed that 'ensuring the patient's comfort' was the reason for their decision. Only 72 (16%) would use antibiotics if the patient became pyrexial. The results suggest that British doctors are divided in their approach to the medical management of terminally ill patients and there is a need for greater discussion and training so that all the issues involved are fully appreciated.

Anti-Bacterial Agents↗
PubMed1988

Thiamine status, vitamin supplements and postoperative confusion.

In a prospective, randomized, controlled study an intravenous vitamin B complex and vitamin C preparation was administered pre- and post-operatively to 28 elderly patients with a fractured proximal femur and compared with 32 nonsupplemented postoperative controls. Vitamin supplementation significantly, though only transiently, improved postoperative thiamine status (P less than 0.001), but had no influence on mental state or outcome during the postsurgical period. Therefore, the use of parenteral vitamins for postoperative confusion cannot be justified on a routine basis.

Aged↗
PubMed1988

Bioavailability and acceptability of a dispersible formulation of levodopa-benserazide in parkinsonian patients with and without dysphagia.

The bioavailability of levodopa-benserazide in a standard capsule and a new dispersible tablet was compared in Parkinsonian patients, with (n = 8) and without (n = 8) swallowing difficulties. There was considerable variation within and between subjects, but no significant differences between formulations for any pharmacokinetic parameters, other than an earlier time-peak concentration following the dispersible tablets (P less than 0.01) in non-dysphagic patients. The acceptability of the dispersible tablets in the dysphagic patients was also determined following 7 days regular use. It was felt there were advantages in four of the patients because it was easier to administer or to swallow. The dispersible formulation may offer practical benefits to a minority of Parkinsonian patients without any anticipated loss of therapeutic efficacy.

Aged↗
PubMed1988

Myocardial infarction in old people. The influence of diabetes mellitus.

The clinical features and outcome were determined for 100 consecutive patients aged 65 years or older with a history of diabetes mellitus who presented to hospital with acute myocardial infarction. Each case was compared with an age- and sex-matched nondiabetic control also admitted to hospital with acute myocardial infarction. Chest pain was equally common in both groups and was the main presenting symptom. Cardiac failure was a more frequent accompaniment in the diabetics, despite the lack of evidence for greater infarct size in this group. The outcome was worst for female diabetics, of whom 46% died. Contrary to popular teaching, painless myocardial infarction is not a specific feature of elderly diabetics.

Acute Disease↗
PubMed1988

Can old people on oral anticoagulants be safely managed as out-patients?

Of 62 patients (mean age 75, range 65-92 years) referred to an out-patient anticoagulant clinic specifically for those aged 65 years or more, treatment was considered unsafe in only one patient and was discontinued. Minor bleeding which did not require a significant change in management was recorded on 25 (7%) of 381 clinic visits and one major haemorrhage occurred requiring emergency hospital admission. Anticoagulation was maintained within the therapeutic range on 284 (75%) visits. The results confirm that with appropriate out-patient care and supervision, the risks of oral anticoagulant therapy in the elderly need be no greater than in younger patients.

Administration, Oral↗
PubMed1988

Markers of the nutritional status in acutely ill elderly patients.

We recorded anthropometric and laboratory data in 98 sick old people on admission to a high-dependency unit. The measurement of triceps skinfold thickness and arm muscle area was feasible even in very ill people, while measurement of the body mass index was difficult and sometimes unreliable. Anthropometric measurements indicated that our study group was better nourished than a local population, with just 3 subjects (3%) being fat depleted and a further 4 (5%) being protein depleted. Serum albumin was the laboratory variable that correlated best with anthropometric parameters. However, it was low in 47% of the subjects, indicating that its lower reference value needs to be redefined in this select group.

Acute Disease↗
PubMed1988

A geriatric high dependency unit--an innovation in the care of the acutely ill elderly patient?

A geriatric High Dependency Unit has been in operation at Cardiff Royal Infirmary for the past 7 years to provide "special-care" for acutely ill elderly people requiring careful bedside monitoring and intensive nursing and medical treatment. The background to the unit, its present functioning and the results of a prospective study of 432 consecutive admissions are described. The unit offers more appropriate and better continuity of hospital care for many very ill geriatric patients and may be a satisfactory alternative to admission to coronary or intensive care units where resources are not freely available.

Acute Disease↗