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Biomedical subjects

S R Gambert

Publications and source records attributed to S R Gambert.

At least 19 recordsLinked to original sources
PubMed1990

Atypical presentation of diabetes mellitus in the elderly.

Diabetes mellitus is a common problem affecting the elderly. Unfortunately, many people learn they have a problem only after late sequelae of the disease are present. Classic symptoms of hyperglycemia may be lacking or confused with other age-prevalent problems or the aging process itself. Any change in condition, whether medical or psychological, deserves a glucose control assessment. Because of problems in diagnosis, glucose screening has been advocated. Only by diagnosing diabetes mellitus early can late complications be prevented and a high quality of life assured.

Aged↗
PubMed1989

Implementing a "Do-Not-Resuscitate" (DNR) policy in a nursing home.

During implementation of a new Do-Not-Resuscitate (DNR) policy in New York State, decisions by 233 nursing home patients of their surrogates were evaluated. Eighteen patients with capacity (mean age +/- SD = 76.4 +/- 12.1 years) chose DNR; 30 patients with capacity (mean age +/- SD = 76.2 +/- 10.7 years) chose to be resuscitated (CODE); 54 patients without capacity, (mean age +/- SD = 86.1 +/- 9.1 years) had surrogates who chose DNR; and 131 patients without capacity and with surrogates (mean age +/- SD = 81.9 +/- 9.8 years) remained CODE. Most patients with capacity who chose DNR had multiple sclerosis, while most choosing CODE had strokes. Most patients who lacked capacity had dementia. Forty-five percent of surrogates did not respond regarding CODE status during the three-month study interval, and 10% wanted additional time to decide. Patient age appeared to be a factor in surrogate choice for DNR but not in patients with capacity making their own decision. Reasons for patients with capacity choosing DNR are discussed; perceived quality of life and premorbid feelings by patients help in the decision-making process.

Adult↗
PubMed1989

Typical geriatric accidents and how to prevent them.

Certain accidents tend to be more common in elderly patients. Others are common among the general population and include the elderly in their numbers. These include accidents involving fire, carbon monoxide, food and medications, water, restraints, motor vehicles, and those in the workplace. This article reviews such accidents and discusses basic measures of prevention in which the attentive and comprehensive clinician may play a pivotal role.

Accident Prevention↗
PubMed1989

Preventive care: what it's worth in geriatrics.

Though aging is a lifelong process, many persons think of their aging only late in their lives. By this time many have in fact accelerated their aging or developed diseases that may otherwise never have occurred. This article focuses on measures that, if followed throughout one's lifetime, may improve functional status during one's later years. Environmental factors and diet are a few of the areas discussed.

Aged↗
PubMed1988

Common nutritional disorders in the elderly: atypical manifestations.

Nutritional problems are commonly seen in elderly persons living in both community and institutional settings. Multiple interacting medical problems, age-related physiological changes, and low socio-economic status are just some of the factors placing the older person at greater risk for nutritional problems. Nutritional inadequacies often have a slow and insidious onset; many of the presenting features mimic changes of normal aging. Absence of clear-cut signs and symptoms may easily lead to a delay in the diagnosis of these potentially serious yet easily reversible conditions. Practicing physicians need to keep in mind the atypical presentation nutritional deficiencies may have in old age.

Aged↗
PubMed1988

Dementia secondary to metabolic and nutritional abnormalities.

It is clear that dementia may result from nutritional and metabolic causes. Prior to labeling the demented person as having Alzheimer's disease or multi-infarct dementia, a thorough physical, historic, and laboratory evaluation is essential. Not only must other causes for the dementia be ruled out, but co-existing abnormalities that may confuse therapeutic intervention must be considered. Elderly persons notoriously under-report symptoms, in this case further complicated by the dementia. In addition, normal age-related changes, age-prevalent illness, and the atypical way in which diseases often present late in life may make the situation more confusing. Being aware of the wide variety of causes of dementia, however, will improve diagnostic abilities.

Aged↗
PubMed1988

Atypical presentation of endocrine disorders in the elderly.

Endocrine disorders affecting the elderly present a continuing challenge to the clinician. Often confused with normal age-related changes or age-prevalent disease, disorders such as thyrotoxicosis, hyperglycemia, and hypercalcemia often go undetected until late in their course, if at all. Non-specific and atypical presentations make the diagnosis even more difficult and a low threshold for obtaining laboratory testing is advised. Thyrotoxicosis may present with only anorexia, weight loss, and cardiac dysfunction. Hyperglycemia often remains undetected; long-term sequelae, however, may impair function and result in problems such as neuropathy, postural instability, and nephropathy--conditions often dismissed as consequences of old age. Hypercalcemia may not present with the classic findings of renal colic, GI pathology, and skeletal disease. An acute confusional state with or without volume depletion appears to be a more frequent presentation during later life.

Aged↗
PubMed1987

Establishment and impact of a dementia unit within the nursing home.

Thirty-two demented, elderly residents of a nursing home were admitted to a specially designed dementia unit. Each patient was assessed three times: prior to admission, and at four and 12 months after admission to the unit. Patients were evaluated using a modified version of a previously published assessment scale as well as with a standardized New York State numerical rating system. There was an increased level of functioning in both mental and emotional status and basic functions of daily living at both four (P less than or equal to 0.001) and 12 months (P less than or equal to 0.005). The improvement in scores was maintained over a prolonged time period, despite the expectation of progression of the dementing process. There was no change noted on the New York State assessment. Our data suggest that a select group of demented elderly can benefit from being placed on a specialized dementia unit.

Aged↗
PubMed1985

Age-related differences in knee muscle strength in normal women.

This study provides normal baselines of knee muscle strength for women up to 86 years of age. Knee muscle strength (torque) was measured during maximum isometric and dynamic (isokinetic) contractions in 72 normal healthy women in three age groups between 20 and 86 years. Strength of the oldest group ranged from 56 to 78% of that in the youngest group, depending on knee joint position. Strength values were greater for isometric contractions than for isokinetic contractions (performed at 36 degrees per second) and were approximately twice as great for the extensor as for the flexor muscles. For both muscle groups, the torque generated with the knee in 30 degrees of flexion was usually lower than that generated with the knee at the 45- or 60-degree position. Despite the significant deficit found in the strength of the oldest group, it is likely that this relative weakness would not be detected on routine clinical examination using manual muscle testing.

Adult↗
PubMed1985

Atypical presentation of thyroid disease in the elderly.

In general, because of the higher prevalence of hypothyroidism in the elderly and the paucity of signs and symptoms in many thyrotoxic elderly persons, thyroid disorders must be included in the differential diagnosis of every elderly patient's problems. Although not a substitute for close clinical observation, periodic screening for thyroid hormone abnormalities should be a routine part of periodic medical evaluation of elderly patients. Early diagnosis and treatment of abnormal thyroid function is the best way to avoid major complications that may result from this otherwise easily treatable problem.

Aged↗
PubMed1984

Periodic oral examinations and panoramic radiographs in edentulous elderly men.

Oral and panoramic radiographic examinations were performed on eight-six edentulous elderly men residing in a government-sponsored skilled nursing facility. Clinical examinations revealed eleven findings in eleven subjects, 12.8% of the total number examined. Panoramic radiographs were taken compared with those available from previous years. Of the 173 radiographs available for review, twenty-two films of seven subjects yielded significant findings. In no case did there appear to be progression of the radiographic findings over time, and no findings required intervention. Data suggest that the availability of ongoing dental care through consultations may reduce the prevalence of findings on periodic oral examination.

Aged↗
PubMed1984

Reminiscence and life review in the elderly.

Reminiscence in skilled hands may be a useful adjunct when caring for older individuals. The individual may benefit psychologically from a feeling of increased self-esteem and control. Staff must clearly establish a modality in which to utilize reminiscence; goals must be set. Problems that may result from uncovering certain memories must be carefully dealt with and may even require the assistance of a skilled psychotherapist. Additional research is necessary to improve our understanding of this potentially useful interactional tool.

Aged↗