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Y Gustafson

Publications and source records attributed to Y Gustafson.

At least 37 records · Page 2Linked to original sources
PubMed1998

In-patient rehabilitation after stroke: outcome and factors associated with improvement.

A study aimed at examining the outcome of activities of daily living (ADL) of patients undergoing geriatric stroke rehabilitation was performed. Background and admission data of 99 patients surviving the acute phase and needing further hospital rehabilitation were registered. Forty per cent of the patients improved their ADL ability. The logistic regression modelling with the dichotomous dependent variable improvement versus no improvement showed the following factors associated with improvement: a diagnosis of intracerebral haemorrhage, male sex, high postural stability score at the admission and cohabitation. In conclusion, the most severely affected stroke patients, especially patients with intracerebral haemorrhage, have a great potential for improving their ADL. The results of the logistic regression model can serve as a useful guide when it comes to identifying patients that stand a fair chance of improving during their rehabilitation stay. Equally important, patients with a poor rehabilitation prognosis who may need intensified rehabilitation efforts to achieve optimum improvement can now be identified.

Activities of Daily Living↗
PubMed1997

Fall prediction index for patients in stroke rehabilitation.

BACKGROUND AND PURPOSE: The identification of stroke patients who are prone to falls is essential to the development of prevention strategies. This study aimed at developing an easily administered fall risk index for patients in stroke rehabilitation. METHODS: A consecutive series of 135 patients in geriatric stroke rehabilitation was studied. Patient characteristics viewed as potential fall predictor variables were assessed at admission. Univariate and multiple Cox regression analyses of these variables were used in the development of a fall prediction index. RESULTS: The final index included the following items: male sex, poor performance of activities of daily living, urinary incontinence, impaired postural stability, bilateral motor impairment, presence of bilateral cortical or white matter lesions, visuospatial hemineglect, and use of diuretics, antidepressants, or sedatives. The index score correlated significantly with the fall risk (odds ratio, 1.46; 95% confidence interval, 1.26 to 1.69). The score was also used to classify individuals into low-, intermediate-, and high-risk groups, among which the fall rates differed significantly (log rank statistics, 29.86; P < .001). CONCLUSIONS: An easily administered fall risk index is suggested, which might serve as a basis for prevention strategies among patients in stroke rehabilitation.

Accidental Falls↗
PubMed1997

Incidence of falls in three different types of geriatric care. A Swedish prospective study.

The incidence and consequences of falls were investigated in three different types of Swedish geriatric care clinics: a geriatric rehabilitation clinic, a psychogeriatric clinic and a nursing home. Falls were prospectively registered by the nursing staff. The incidence rate (and 95% confidence interval) of falls per 10,000 patient days of the psychogeriatric clinic was 171 (146-196), compared with 92 (72-112) at the geriatric rehabilitation clinic, and 31 (22-41) at the nursing home. Most falls (62%) did not result in injury, while major injuries occurred in 5%. We conclude that accidental falls are a major problem in geriatric care in Sweden, but there is a considerable difference in incidence rates between different types of institutions.

Accidental Falls↗
PubMed1996

Falls leading to femoral neck fractures in lucid older people.

OBJECTIVE: To analyze the mechanisms of falls that result in femoral neck fractures among lucid older people. DESIGN: A cross-sectional study. SETTING: An orthopedic university hospital department. PARTICIPANTS: A consecutive series of 123 lucid patients, 65 years of age or more, who were admitted for femoral neck fractures. MEASUREMENTS: On admission, the subjects were interviewed about fracture accident characteristics, and falling mechanisms were classified. An arterial blood gas sample was taken from each patient soon after admission. Based on data regarding drug consumption and social and medical characteristics, a fall-risk index was calculated for each subject. RESULTS: It was ascertained that 95% of the fractures were caused by falls and < 2% were spontaneous. Most accidents (68%) took place indoors, 47% of the falls were classified as extrinsic, 24% as intrinsic, 7% as nonbipedal, and 22% remained unclassified. Almost all outdoor falls were extrinsic; however, intrinsic falls were as common as extrinsic falls indoors (P < .001). Extrinsic fallers presented a significantly lower fall-risk index score than subjects with fractures caused by intrinsic, nonbipedal, and unclassifiable falls. A large proportion of subjects (24%) wre hypoxemic (pO2 < 8 kPa) on admission, and patients who sustained fractures at night had lower oxygen tension than that of daytime fallers (P = .006). CONCLUSIONS: Accidental falls are the primary cause of femoral neck fractures. Preventive actions should be directed toward intrinsic, as well as extrinsic, risk factors for falls. Hypoxemia might be a risk factor for falls, especially those falls that occur at night.

Accidental Falls↗
PubMed1996

Using the Downton index to predict those prone to falls in stroke rehabilitation.

BACKGROUND AND PURPOSE: Falls are a major complication in inpatient stroke rehabilitation. An important issue in preventive strategies is the early identification of those at risk. This study aimed at assessing the fall-prediction accuracy of an easily administered fall risk index in stroke rehabilitation. METHODS: A consecutive series of 135 patients admitted to a geriatric stroke rehabilitation unit was studied. A score on the Downton fall risk index was obtained from the admission assessment data and used as a predictive indicator of the risk of falls. The patients' falls were prospectively recorded during their rehabilitation stay. The correlation between falls and the predicted risk was assessed by means of survival analysis and a multiple regression analysis, adjusting for the time of observation. RESULTS: The risk of falls as a function of the time observed was significantly greater among those predicted to be at high risk (index score > or = 3) than among the others (P = .009, log-rank test; odds ratio, 2.9). Furthermore, the number of falls during rehabilitation stay was moderately correlated (R = .57) with the fall risk index sum when adjusted as for the time of observation. The sensitivity of the fall prediction as to outcome was 91%, whereas the specificity was limited to 27%. CONCLUSIONS: A moderately high correlation was found between the predicted and the observed risk of falls in stroke rehabilitation when the Downton fall risk index was used. However, a low specificity rate limits the accuracy of the prediction.

Accident Proneness↗
PubMed1996

Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment.

A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help for the clinician concerned with hospital based geriatric medicine. It may also be useful for quality control and teaching. Not least, it may be useful for health professionals other than geriatricians. To some extent, the position of geriatric medicine in the Nordic countries varies between the countries. However, the background for developing a Nordic version of geriatric work-up is shared attitudes and principally the same organization of the health care system, and collaboration within geriatrics for many years. Several trials on comprehensive geriatric assessment and management performed in different settings have shown favourable outcomes. Results from controlled Nordic trials are compiled and summaries of meta-analyses are presented. The concept of Nordic geriatric work-up is based on a model defining health and disease in old age as dimensions of pathology, impairments, functional limitations, and disability, all being modified by extra- and intraindividual factors. Handicap is defined as the disability gap. Different health professionals have varying responsibilities in the geriatric team-work, but all should be dedicated to establish common goals. The geriatric work-up is presented with success factors and barriers, stating important differences between multidisciplinary and interdisciplinary processes. Checklists and assessment scales may be very useful when performing a geriatric work-up, but they should be used with caution. Specific scales covering different functional areas of the geriatric patient are recommended for clinical practice. Such scales must be valid, reliable, acceptable to the patient, responsive to change, and should be in an appropriate format, as well as easy to administer. Prior to the use among geriatric teams in the Nordic countries the scales should be translated into all the Nordic languages, and the translated versions should ideally have been subjected to validity and reliability testing. However, so far no scale meets these demands regarding all the five Nordic languages.

Aged↗
PubMed1995

Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies.

BACKGROUND AND PURPOSE: The risk of falls is very high among stroke patients, and falling is a major complication in stroke rehabilitation. This study aimed to investigate the incidence, characteristics, and consequences of falls in an inpatient stroke rehabilitation setting. METHODS: One hundred sixty-one patients consecutively admitted to a geriatric stroke rehabilitation unit were studied. Falls that occurred during their rehabilitation stay were prospectively registered and analyzed. RESULTS: Sixty-two of the patients (39%) suffered falls. The total number of falls was 153, which corresponds to an incidence rate of 159 falls per 10,000 patient-days. Most falls occurred during transfers or from sitting in a wheelchair or on some other kind of furniture. Seventeen falls (11%) were classified as the result of extrinsic mechanisms, 49 (32%) were intrinsic falls, 39 (25%) occurred in a nonbipedal position (while sitting or lying), and 48 falls (31%) remained unclassified. No injury was observed in 109 of 153 incidents (71%), whereas 6 falls (4%) involved fractures or other serious injury. CONCLUSIONS: Since falls are so frequent, they must be considered a significant problem in stroke rehabilitation. Fall prevention strategies should therefore be developed and included in rehabilitation programs.

Accidental Falls↗
PubMed1995

Epidemiology and treatment of post-stroke depression.

Depression is a common and serious complication after stroke. According to epidemiological studies, at least 30% of stroke patients experience depression, both early and late after stroke. However, in clinical practice only a minority of the patients are diagnosed and even fewer are treated. There are several studies confirming the magnitude of the problem but the main conclusion which can be drawn from the few treatment studies published is that tricyclic antidepressants cannot be recommended for the treatment of post-stroke depression, mainly because of the high frequency of contraindications and adverse effects. Until now there has only been 1 double-blind, placebo-controlled treatment study from which some general conclusions can be drawn. The study evaluated a selective serotonin reuptake inhibitor (citalopram) and concluded that the drug was well tolerated and effective for the treatment of post-stroke depression. However, when treatment was initiated very early, both the treatment group and the placebo group improved equally during the first 7 weeks after stroke. This finding could indicate diagnosis difficulties during the first few weeks after stroke. A recent study, although small, comparing the combination of drugs with either noradrenergic (desipramine plus mianserin) or noradrenergic and serotonergic effects (imipramine plus mianserin) for post-stroke depression, indicated that drugs with the dual effect may be more effective. Many more double-blind placebo-controlled treatment studies and studies comparing the efficacy and adverse effects of various antidepressants in patients with post-stroke depression need to be conducted. According to 3 small studies, electroconvulsive therapy (ECT) seems to be quite well tolerated and therefore ECT may also be considered in the treatment of post-stroke depression. Future studies should also address the long term efficacy of treatment for post-stroke depression.

Aged↗
PubMed1994

[Acute confusional states in patients with hip fractures can be prevented and treated].

Acute confusional states among the elderly constitute a manifest problem in most medical specialties. All too often the disoriented patient is deemed to be suffering from dementia, and no investigation is made of the background factors. Intervention studies have clearly shown that confusional states are both reversible and preventable.

Adrenocortical Hyperfunction↗
PubMed1992

Abnormalities at different levels of the hypothalamic-pituitary-adrenocortical axis early after stroke.

BACKGROUND AND PURPOSE: Hypercortisolism is common in stroke patients. The aim of this study was to investigate possible disturbances at different sites within the hypothalamic-pituitary-adrenal axis. We also studied possible associations between hypercortisolism and clinical manifestations of brain dysfunction. METHODS: Patients with an acute ischemic stroke (n = 16; mean +/- SD age, 71 +/- 11 years) were compared with healthy elderly subjects (n = 9). We performed a short adrenocorticotropic hormone (ACTH) test with 0.25 mg 1-24 ACTH injected intravenously and an overnight dexamethasone suppression test with 1 mg dexamethasone given orally at 11 PM. RESULTS: Serum cortisol levels after dexamethasone at 8 AM were significantly higher in stroke patients (p = 0.003). The area under the curve for the cortisol response to ACTH was elevated in seven (47%) of stroke patients, and the centered cumulative cortisol response was elevated in three (20%) patients. The area under the curve response correlated significantly to the presence of an acute confusional state and male sex in stroke patients (rs = 0.63 and rs = 0.62, respectively; p < 0.05), whereas the centered cumulative cortisol response diminished with increasing age (rs = -0.62; p < 0.05). Postdexamethasone cortisol levels were significantly correlated to the presence of an acute confusional state and to extensive limb paresis (rs = 0.66 and rs = 0.62, respectively; p < 0.05). CONCLUSIONS: There are abnormalities in the cortisol axis both at the central level and at the adrenal level early after stroke. Hypercortisolism is closely associated with cognitive disturbances and extensive motor impairment.

Adrenal Cortex↗
PubMed1991

Catecholamine excretion in old age.

Catecholamine excretion was studied in two groups of nonhospitalized subjects, 60 and 80 years of age, N = 35 and 29, respectively. Urinary 24h dopamine excretion exhibited an age-related decline (p = 0.001). There was a sex difference for dopamine excretion; men had higher excretion levels (p = 0.04). Twenty-four-hour excretion of epinephrine and norepinephrine was slightly higher in 60- than in 80-year-old individuals (NS). Smoking was associated with a considerable increase in epinephrine (p = 0.001) and norepinephrine (p = 0.04) excretion. Body mass index was negatively correlated to epinephrine excretion (r = -0.27; p less than 0.05). When analyzed with a multi-way analysis of variance with analysis of covariance, significant influences of age on dopamine excretion, of creatinine clearance on dopamine and norepinephrine excretion, and of smoking on epinephrine excretion were seen. Thus, factors such as age, gender, body mass, kidney function and smoking habits considerably influence catecholamine excretion in elderly people.

Aged↗
PubMed1991

ADL performance and dependency on nursing care in patients with hip fractures and acute confusion in a task allocation care system.

In a prospective study 35 patients operated on for cervical hip-fractures were followed with respect to Acute Confusional State (ACS), problems of basic nursing care and dependency on care-givers. Fifteen patients became acutely confused after the fracture. They turned out to be more dependent on help from others than the non-confused patients were even before the fracture. They rapidly reached a significantly higher level of dependence than the non-confused patients and remained on that level throughout the study month. Six months after the fracture the post-operatively confused patients were still highly dependent on care-givers, significantly more than they were before the fracture. Only three of them were not hospitalised. All the non-confused patients lived in their own homes six months after the fracture and had regained the same level of independence as before it. These findings will be discussed in relation to the organisation of the nursing care. Task allocation nursing care was applied in the wards. A model for the development of dependency in acutely confused hip-fracture patients will be presented and suggestions for how to reduce nurse/patient dependency induced by nursing care will be made.

Activities of Daily Living↗
PubMed1991

Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients.

STUDY OBJECTIVE: To determine the accuracy of diagnosis and documentation of acute confusional states (ACS) in the medical records of patients with hip fracture. DESIGN: The diagnosis of ACS in two prospective clinical studies was compared to its diagnosis in the medical records of the same patients on the same hospitalization. In order to determine if the simultaneous prospective study influences the diagnostic and documentary practices evidenced in the medical records, a further comparison was done by reviewing medical records of two series of patients seen some years prior to the prospective studies. SETTING: Patients with femoral neck fractures treated at a department of orthopedic surgery in a university hospital and one retrospective control sample from a department of general surgery in a county hospital. SUBJECTS: Two prospective samples of patients 65 years and older treated for femoral neck fractures (n = 111 and n = 57, respectively) and two earlier retrospective samples (n = 66 and n = 68, respectively). MEASUREMENTS AND MAIN RESULTS: All comparisons showed that both physicians and nurses diagnosed ACS unsatisfactorily and documented the patients' mental status poorly. The analysis of the two retrospective medical record control samples gave the same results. Neither the physicians nor the nurses used any kind of diagnostic instrument to detect cognitive disorders in the patients. CONCLUSIONS: ACS is a common and severe complication in elderly people treated for femoral neck fractures. Acute confusional states have, by definition, one or more causes that can often be identified and treated. Poor assessment and documentation is a threat to the patients as a correct diagnosis of ACS is a prerequisite for further assessment of its underlying causes and the consequent necessary medical and nursing care.

Acute Disease↗
PubMed1991

A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures.

The aim of this study was to evaluate the effect of a geriatric-anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre- and post-operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri-operative blood pressure falls and treatment of post-operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P less than 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post-operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P less than 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay.

Aged↗
PubMed1989

Problems of basic nursing care in acutely confused and non-confused hip-fracture patients.

Thirty-five patients operated on for femoral neck fracture were studied. Fifteen (42.9%) became acutely confused after surgery. Problems in the 14 components of basic nursing care (Henderson 1964), were identified by means of interviews with the patients and their caregivers. The quantitative analysis of the results showed that significantly more of the acutely confused patients had problems in nine out of 14 components of basic nursing care as compared with the non-confused patients. The qualitative analysis showed that the problems of the non-confused patients were mostly caused by the fracture and by hospitalisation. The same problems were also present among the acutely confused patients who, in addition, had problems which arose from the acute confusional state.

Activities of Daily Living↗
PubMed1989

Hormones in 'young' and 'old' elderly: pituitary-thyroid and pituitary-adrenal axes.

Changes of the pituitary-thyroid and pituitary-adrenal hormone axes with age and possible differences between the sexes in the elderly were studied in 60-year-old (n = 39) and 80-year-old (n = 34) non-hospitalized subjects. The 80-year-old age group had a significantly lower response of thyrotropin (TSH) to thyrotropin-releasing hormone (TRH; p less than 0.05). Otherwise, there were no significant differences between the two age groups. Sex differences were found for plasma arginine vasopressin and cortisol excretion (higher values in men), and free thyroxine index, TSH and prolactin response to TRH (higher values in women). Cortisol levels after dexamethasone were negatively correlated to body mass index. There were no differences in hormone levels between smokers and non-smokers. In obtaining reference values for hormones in old age it is important to consider possible changes after the age of 60 years and to adjust for gender and body mass.

Aged↗