Biomedical subjects
R D Cape
Publications and source records attributed to R D Cape.
The influence of clinical problems, age and social support on outcomes for elderly persons referred to regional aged care assessment teams.
BACKGROUND: Aged Care Assessment Teams (ACATs) have been established throughout Australia during the past seven years. Early studies of their effect have concentrated on their impact on the rate of institutionalisation of disabled elderly, the clinical characteristics of referred cases and the relationship between disability and recommended care plan. AIMS: The aim of this study was to explore the relationship between age, clinical features and social characteristics of ACAT subjects with outcomes at 12 months after assessment. METHODS: The examination of an arbitrary sample of persons referred to ACATs over a year by one generalist geriatrician with follow-up of all cases by the three ACATs associated with the study was carried out. All analyses were performed on raw data presented as categorical variables in the form of contingency tables. RESULTS: The sample included 324 subjects who suffered from 2030 clinical problems with a mean of 6.5 per person aged 75 or over and 5.5 for those under 75. Cardiovascular and neurological disease were the commonest source of problems. Study of accommodation outcome at 12 months, for those subjects who survived this period revealed that, in the older group, over 60% of subjects with neurological disease were resident in nursing homes while the majority of all other groups remained in the community, as did two-thirds of those aged under 75. Admission to a nursing home was independent of social support for older subjects with neurological disease, but it played a significant role in those with cardiopulmonary or musculoskeletal disease. CONCLUSIONS: The study demonstrates that for one-year survivors there is an increased likelihood of admission to a nursing home of people aged 75 or over with neurological disease, while those under 75 were more likely to remain at home. The association was independent of whether spouse, family or friends were living with the subject.
Atrial and ventricular arrhythmias in asymptomatic active elderly subjects: correlation with left atrial size and left ventricular mass.
Elderly normal subjects have an increased prevalence of cardiac arrhythmias compared with young and middle-aged subjects. The objective of this study was to test the hypothesis that the incidence and complexity of atrial and ventricular arrhythmias may be related to either left atrial enlargement or to increased left ventricular mass, respectively. From 146 asymptomatic volunteers older than 60 years, 86 subjects were considered to be free of cardiovascular abnormalities and had adequate M-mode echocardiograms and 24-hour ambulatory electrocardiograms. The mean age was 72 +/- 7 years, with a range of 60 to 96 years. There were 37 men and 49 women. During 1415 +/- 73 minutes of ambulatory electrocardiography, the average heart rate was 72 +/- 8 beats/min in men and 76 +/- 6 beats/min in women (p less than 0.05). Atrial arrhythmias were present in 64 subjects (74%); the frequency and complexity of these arrhythmias correlated with left atrial size (p less than 0.01). Ventricular arrhythmias were present in 55 subjects (64%); the frequency and complexity of ventricular arrhythmias did not correlate with left ventricular mass index. These results suggest that left atrial dilatation, a normal development in healthy elderly subjects, plays a significant role in the pathophysiology of the increased incidence of atrial arrhythmias. Increased left ventricular mass, which also occurs normally in the aging heart, is not, on the other hand, associated with an increased frequency and/or complexity of ventricular arrhythmias.
Acute effects of exercise on neuropsychological function in elderly subjects.
Fit elderly score higher on tests of fluid intelligence than aged-matched sedentary controls. Elderly patients who have taken part in exercise programs have shown improvement in mental function. We compared the effects of 45 minutes of exercise on memory, mood, and cognitive function in elderly subjects to a control intervention using a randomized control study design. Neuropsychological tests employed where the color slide test, digit symbol test, digit span test, logical memory test, word fluency test, and the Mini-Mental State Examination. We measured mood using a mood test and geriatric depression scale. Each subject was tested before, and immediately after, control and exercise sessions. Fifteen elderly subjects [ten men and five women; mean age, 66 years, (range, 60 to 85 years)] completed the study. There was a greater improvement in six of the eight scores of cognitive function following exercise, compared to control. These differences were significantly greater following exercise for the logical memory test score (P less than or equal to 0.02) and Mini-Mental State Examination (P less than or equal to 0.025) compared with the control intervention.
Falls in the elderly.
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Special facilities for patients with Alzheimer's disease.
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Integrated university training program in geriatric medicine accredited and evaluated by the Royal College of Physicians and Surgeons of Canada.
The Federated Council for Internal Medicine recommended in 1981 "increased emphasis on geriatric medicine in the medical school curriculum, the medical residency, and continuing medical education." In the same year the first examination for a Certificate of Special Competence in Geriatric Medicine was held in Canada. This was the culmination of a process begun in 1974 to establish the subject as a subspecialty within Internal Medicine. The Royal College of Physicians and Surgeons of Canada set up a Specialty Committee which developed criteria for the accreditation of training programs. Candidates have to be eligible to sit for the certification examination in Internal Medicine before they can sit for the Certificate of Special Competence in Geriatric Medicine which is awarded only after passing both examinations. Thirty-nine individuals sat for the examination in its first five years of whom 26 were successful. These now form a nucleus of well-qualified internist-geriatricians who are developing academic programs in geriatric medicine in Canadian Medical Schools.
A clinical perspective on aging.
Immobility, falls, incontinence, mental confusion and homeostatic disturbances are the major problems encountered in elderly patients. These occur with increasing frequency in the very old (age greater than 85) but studies have shown that the level of disability for those aged 65-84 remains no more than 15-20%. As at all ages, a small proportion of elderly experience most of the clinical problems. To improve our performance in managing these requires education of medical trainees, cooperation between acute and long-term care institutions and a concentrated program of biomedical research. Therapy designed to light up fading receptors or increase neurotransmitter function to maintain cerebral control mechanisms for posture, excretion and appetite control will achieve more than psychosocial or administrative attempts to solve such clinical problems.
A 12-month fever surveillance study in a veterans' long-stay institution.
This report describes a 12-month fever surveillance survey in a 258-bed veterans long-term care institution. There were 128 episodes of fever (one episode per 24 patient-months); 114 were studied. Lower respiratory tract infections were most frequent, 36 (32%), with 26 (23%) urinary tract infections. Streptococcus pneumoniae was the most common pathogen in the chest infections and Proteus mirabilis the most common of the urinary tract infections. In 40 (35%) there was no evidence of a lower respiratory tract, urinary tract, or other bacterial infection. Most recovered rapidly, many with no specific treatment. There was a 16% mortality associated with the febrile episodes.
Preliminary observations of a form of coherence therapy for osteoporosis.
Five patients suffering from osteoporosis were subjected to from three to eight cycles of a form of Coherence Therapy for Osteoporosis (1) used at this center. Assessment of the patients' trabecular bone remodeling activity as measured by histomorphometric analyses of trans-iliac crest bone biopsies showed a marked improvement.
A history of urinary incontinence: or, 400 years of incontinence--are we any drier?
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Marathoners over sixty years of age: results of a survey.
A survey of 32 marathon runners over the age of 60 years was undertaken. The group was predominantly male, well educated, and health conscious. While the injury rate was high, it was comparable to the expected rate in younger runners. Six of the 32 claimed to have an addiction to running.
Potassium-sparing diuretics: interaction with digoxin in elderly men.
The effects of two potassium-sparing diuretic combination drugs, triamterene-hydrochlorothiazide and spironolactone-hydrochlorothiazide, were compared with those of two kaliuretic diuretics, hydrochlorothiazide and furosemide, in order to ascertain the effects of those diuretics on concentrations of serum digoxin, serum potassium, and erythrocyte potassium, and to determine whether any of these diuretics should be preferred for patients taking digoxin. It was concluded that in patients for whom potassium depletion may lead to digoxin toxicity, a potassium-sparing diuretic may safely be used in order to reduce potassium excretion and thereby reduce the risk of arrhythmias.
A personal history of experience with a geriatric day care hospital: its initiation, development, function, and effectiveness.
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Impaired enzyme induction by rifampicin in the elderly.
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Myxedema megacolon after external neck irradiation.
Myxedema megacolon is a rare manifestation of hypothyroidism. It may respond to appropriate treatment but is sometimes irreversible, resulting in fatal complications. Two possible mechanisms to explain the colonic atony include (1) myxomatous infiltration of the submucosa with separation of the muscular fibers from the ganglia of Auerbach's plexus, and (2) severe autonomic neuropathy affecting the extrinsic nerves to the colon and the myenteric plexus. Histology from our case supports the first proposed mechanism. Urecholine challenge and manometric measure response may help predict reversibility of colonic atony. Treatment should be individualized and should include factors such as age, duration of symptoms, and other medical illness. Low-dose oral or intravenous triiodothyronine is effective. Hypothyroidism following external radiation of the neck for lymphoma is not uncommon, and the risk increases following one or more lymphangiograms. Such patients should be followed up with regular TSH estimations for at least three years.
Diuretics and the institutional elderly: a case against routine potassium prescribing.
In 14 elderly male residents of a veterans' care complex who were receiving diuretic therapy for cardiac failure, oral potassium (K) supplements were withdrawn. Plasma and erythrocyte K levels were measured immediately before and six weeks after withdrawal of the supplements (38 mEq K daily). The controls comprised 19 elderly residents without disease and not taking drugs likely to influence K status. Study subjects and controls were receiving the same diet (average daily K content 100 mEq). After withdrawal of K supplements, the mean plasma K level fell significantly but the mean erythrocyte K level remained unchanged and did not differ from the control values. For a further six weeks after the withdrawal period, 7 subjects were treated with Aldactazide (diuretic hydrochlorothiazide plus K-sparing spironolactone). The plasma K level increased significantly but the erythrocyte K level remained unchanged. It was concluded that, in this setting, diuretic-induced hypokalemia is not necessarily accompanied by intracellular K depletion and that routine prophylaxis with K supplements or K-sparing agents is unnecessary and not without risk. Such therapy should be reserved for patients considered at special risk of K depletion because of known poor dietary intake, advanced liver disease, secondary hyperaldosteronism with renovascular hypertension, gastrointestinal losses, or nondiuretic medication known to affect K status adversely.
Computerised tomographic changes and behavioural deficits in senile dementia.
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