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PubMed2003

Comparison of subcutaneous and intravenous rehydration in geriatric patients: a randomized trial.

OBJECTIVES: To compare the acceptance, feasibility, and adverse effects of subcutaneous (SC) and intravenous (IV) rehydration in dehydrated geriatric patients and clinical changes exhibited by the patients. DESIGN: A prospective, randomized, open clinical trial. SETTING: Hospital geriatric wards during a period of 20 months. PARTICIPANTS: Ninety-six patients with a mean age +/- standard deviation of 85.3 +/- 6.7 with signs of mild to moderate dehydration needing parenteral fluids. INTERVENTION: Geriatric patients were randomly allocated to receive SC or IV infusions of half-normal saline-glucose solutions as long as clinically necessary. MEASUREMENTS: A standardized patient record form was used to document the observed adverse effects. Using a Likert-like scale based on the German school marks system with scores ranging from 1 = very good to 6 = very bad, patients were asked to score their discomfort; nurses and doctors scored the feasibility of the intervention. Changes in laboratory and clinical findings (including patients' orientation and activities of daily living using the Barthel Index) and adverse effects were recorded. RESULTS: Forty-eight patients were randomized into each group. Median duration of fluid administration was 6 days (SC and IV, P =.33). Median volume was 750 mL/day (SC) and 1,000 mL/day (IV, P =.002). In 13 patients, the therapy had to be changed from SC to IV (SC/IV subgroup): 11 times because of the exigency of an IV drug application and twice because of poor resorption. In 17 patients, there was a change from IV to SC (IV/SC subgroup), mainly because of impossibility of further peripheral IV punctures (8 times) and permanent removal of the IV cannula (5 times). The patients of the IV/SC subgroup scored their discomfort significantly worse (median 5.5 vs all other groups median 2, P =.017). This corresponded with the scoring of feasibility by the nurses (IV/SC: median 4.25 vs all other groups median 2, P =.009) and by the doctors (IV/SC: median 4 vs all other groups: median 2, P =.001). Both methods of rehydration caused only few systemic adverse reactions; acute cardiac failure occurred twice in the SC group versus four times in the IV group (P =.68) and hyponatremia once in the SC group versus twice in the IV group (P = 1.0). Some patients experienced local side effects (SC, n = 29 vs IV, n = 24; P =.41), mainly to a mild extent (SC, n = 25 vs IV, n = 24; P = 1.0). Major local side effects (large edema, phlebitis, cellulitis, erythema and strong pain) occurred in nine SC and eight IV (P = 1.0) patients. The clinical and laboratory changes during therapy were similar in both trial arms. CONCLUSIONS: Rehydration by hypodermoclysis is equally well accepted by geriatric patients as the IV therapy and offers a similarly easy feasibility. Additionally, in confused patients and in those in whom IV punctures are difficult to achieve, it represents the far superior method. Both techniques are comparably safe and effective.

Aged↗
PubMed2000

Cognitive status and ambulation in geriatric rehabilitation: walking without thinking?

OBJECTIVE: To assess the relation between cognitive and ambulatory abilities in geriatric rehabilitation inpatients. STUDY DESIGN: Survey study of geriatric cohorts. SETTING: Inpatient university hospital rehabilitation unit. PATIENTS: One hundred fifty urban geriatric rehabilitation patients with orthopedic, neurologic, or medical diagnoses. MAIN OUTCOME MEASURES: Functional Independence Measure (FIM), Mattis Dementia Rating Scale, Neurobehavioral Cognitive Status Examination. RESULTS: Both cognitive measures predicted admission and discharge total FIM scores, continence status, and activities of daily living (ADL) scores. Neither measure could predict admission or discharge FIM ambulation scores better than demographic variables. CONCLUSION: While cognitive status affects the overall rehabilitation course and ultimate functional status of the geriatric patient, it does not predict walking or stair climbing ability.

Activities of Daily Living↗
PubMed1990

Screening of geriatric patients for thyroid dysfunction with thyrotropin-releasing-hormone test, sensitive thyrotropin and free thyroxine estimation.

Hospitalized geriatric patients (N = 354) from an iodine-deficient area were screened with sensitive thyrotropin (TSH), free and total thyroxine (FT4, T4) and total triiodothyronine (T3) to determine the occurrence rate of clinical and subclinical thyroid dysfunction. The diagnostic value of the tests was compared to each other and to that of the thyrotropin-releasing-hormone test (TRH-test) in order to find the optimal first line screening test in geriatric patients. Clinical hyperthyroidism was found in 13, subclinical hyperthyroidism in 10, overt hypothyroidism in 6 and subclinical hypothyroidism in 8 cases. 20.6% of the patients were euthyroid but had subnormal TSH response to TRH, as a sign of possible thyroid autonomy. The low occurrence rate of clinical thyroid disorders (4.8%) does not justify the screening of geriatric patients in general, but the high probability of thyroid autonomy makes reasonable the investigation of every geriatric patient before iodine administration. Suppressed basal TSH and high FT4 were found to be both sensitive and specific in diagnosing clinical hyperthyroidism, but the predictive value was insufficient; elevated T4 and T3 are specific, but not sensitive. Basal TSH is sensitive, specific and has a good predictive value in diagnosing euthyroidism, whereas normal T4, FT4 or T3 are not specific enough for euthyroidism. Basal TSH is better as a first line test of thyroid function than FT4. A normal basal TSH confirms euthyroidism by itself. Other tests (TRH test, T4, FT4, T3) are necessary to elucidate the clinical importance of a subnormal or suppressed basal TSH.

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PubMed1998

[Desflurane versus isoflurane in geriatric patients. A comparison of psychomotor and postoperative well-being following abdominal surgical procedures].

PURPOSE: The new volatile anaesthetic agent desflurane has a significantly lower blood-gas partition coefficient (0.42) than isoflurane (1.4), suggesting excellent intraoperative control of anaesthesia and rapid emergence and recovery from anaesthesia. However, only limited experience is available in geriatric patients undergoing major abdominal surgery. METHODS: After approval by the local ethics committee and with written informed consent, 52 patients (> or = 65 years old, ASA class II or III) scheduled for major abdominal surgery were randomised to receive either desflurane (DES) or isoflurane (ISO) for maintenance of anaesthesia. After oral premedication with midazolam 3.75-7.5 mg, anaesthesia was induced with etomidate 0.2-0.3 mg/kg and fentanyl 3 micrograms/kg. Vecuronium 0.1 mg/kg provided muscle relaxation for endotracheal intubation. All patients were mechanically ventilated to maintain normocapnia. For maintenance of anaesthesia, DES or ISO was administered in 60% N2O and additional boluses of fentanyl and vecuronium were given as required. At the end of surgery, the neuromuscular blockade was reversed with neostigmine 0.02 mg/kg and DES or ISO was discontinued at the end of skin closure. Episodes of bradycardia and tachycardia and hypo- and hypertension, the time from the end of anaesthesia to extubation, opening eyes, squeezing hand, stating name and birthdate and to discharge from the recovery room were recorded. Until 360 minutes after the end of anaesthesia, the recovery of psychomotor functions was measured by means of simple reaction time tests, critical flicker fusion test, labyrinth test, ball bearing test, short and long-term memory test and digit symbol substitution test. The patient's well-being was documented with scores for pain, sedation and postoperative nausea and vomiting. RESULTS: Demographic data in both groups was similar (Tab. 1). Anaesthesia was significantly prolonged in the ISO group. No significant differences between groups were found for MAC hours and the total dose of fentanyl and vecuronium administered (Tab. 3). Intraoperative haemodynamics were comparable between both groups (Tab. 4). No episodes of increases in heart rate or blood pressure associated with rapid increases in DES concentration were seen. Early emergence parameters were faster in the DES group (Tab. 5). When compared to ISO, the overall test performance and testing ability was superior following DES. Psychomotor tests showed significantly better results up to 240 minutes after the end of DES anaesthesia (Tab. 7, Fig. 4). Comparing the postoperative well-being, there were mild advantages for DES (Tab. 6, Fig. 1, 2, 3). However, time to discharge of geriatric patients from the recovery room was significantly shorter in the DES group (median 171 vs. 215 min., p < 0.05). CONCLUSION: Using a balanced anaesthesia technique, we found desflurane as suitable as isoflurane for geriatric patients. Additionally, due to the fast emergence from anaesthesia, an improved cooperativity was found. In the DES group overall better postoperative psychomotor performance resulted in a shortening of discharge times from the recovery room. Hence, desflurane anaesthesia may be advantageous in geriatric patients.

Abdomen↗
PubMed1984

Effectiveness of a geriatric evaluation unit. A randomized clinical trial.

We randomly assigned frail elderly inpatients with a high probability of nursing-home placement to an innovative geriatric evaluation unit intended to provide improved diagnostic assessment, therapy, rehabilitation, and placement. Patients randomly assigned to the experimental (n = 63) and control (n = 60) groups were equivalent at entry. At one year, patients who had been assigned to the geriatric unit had much lower mortality than controls (23.8 vs. 48.3 per cent, P less than 0.005) and were less likely to have initially been discharged to a nursing home (12.7 vs. 30.0 per cent, P less than 0.05) or to have spent any time in nursing home during the follow-up period (26.9 vs. 46.7 per cent, P less than 0.05). The control-group patients had substantially more acute-care hospital days, nursing-home days, and acute-care hospital readmissions. Patients in the geriatric unit were significantly more likely to have improvement in functional status and morale than controls (P less than 0.05). Direct costs for institutional care were lower for the experimental group, especially after adjustment for survival. We conclude that geriatric evaluation units can provide substantial benefits at minimal cost for appropriate groups of elderly patients, over and above the benefits of traditional hospital approaches.

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PubMed2000

Fibroblasts in geriatric vocal fold mucosa.

Fifty fibroblasts in the macula flava (MF) and 50 fibroblasts in the Reinke's space (RS) of geriatric vocal folds were studied by transmission electron microscopy. Five larynges from autopsy cases in the age range 74-83 years were included in the study. The results were compared with those obtained previously from younger adults. The majority of fibroblasts in RS were spindle-shaped and those in MF were stellate. This was the case with younger adults. The nucleus/cytoplasm (N/C) ratio was 0.5-2.0 in most fibroblasts in RS and MF. Again, this was in common with the findings in younger adults. The development of rough endoplasmic reticulum (rER) and Golgi apparatus (GA) in MF was less marked in the geriatric group than in adults. Glycogen particles were observed in 28 fibroblasts in MF. Lipofuscin granules were found in 12 fibroblasts of RS and 9 cells of MF. The findings suggest a decrease in activities and the presence of ageing processes in fibroblasts of geriatric vocal fold mucosa, to which geriatric changes in the vocal ligament can be attributed.

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PubMed2006

Homocysteine measurements in geriatric patients.

OBJECTIVE: Homocysteine measurements may be relevant in geriatric medicine as homocysteine has been identified as an independent risk factor for prevalent disorders such as occlusive arterial vascular disease, cognitive impairment and dementia. The aim of the present study was to study diagnostic correlates of plasma total homocysteine (tHcy) in geriatric in-patients. MATERIAL AND METHODS: Blood samples for the analysis of tHcy and related factors like serum vitamin B12, serum folate, red blood cell folate and clinical data were collected from geriatric patients (n=114) in stable clinical condition. RESULTS: Almost 40% of the patients had tHcy values above 20 micromol/L. tHcy correlated significantly with serum folate, serum vitamin B12, serum creatinine and congestive heart failure, but not with red blood cell folate, cerebrovascular disease, coronary heart disease or cognitive impairment. CONCLUSIONS: Hyperhomocysteinaemia seems to be frequent in geriatric patients and might primarily be an indicator of low folate and high creatinine values.

Aged↗
PubMed2006

Comparison of medical treatments for the dying in a hospice and a geriatric hospital in Japan.

CONTEXT: Most older adults who die in Japan do so in the hospital without receiving hospice or palliative care. While there are some hospices in Japan, little is known about the care they provide to the elderly. OBJECTIVE: To clarify how the care of dying patients differs in a hospice and a geriatric hospital in Japan. DESIGN: Cohort study. SETTING: A hospice and a geriatric hospital in Japan. PARTICIPANTS: One hundred ninety-one inpatients aged 65 or older. MAIN OUTCOME: Areas of our interest: (1) gender and age; (2) primary disease(s) and cause of death; (3) observed symptoms/conditions and medical treatment or care conducted within 48 hours prior to death; (4) the actual topics leading to disclosure; and (5) whether or not advance directives had been given. RESULTS: The X2 test determined that there were statistically significant differences between a geriatric hospital and a hospice, with respect to mean age, diagnoses on admission, primary cause of death, symptoms/conditions, and the practice of medical interventions. However, controlling for patient characteristics and assuming a bivariate distribution between the probabilities of choosing a facility and of undergoing a medical procedure, we found that patients at the hospice were more likely to undergo treatment with opioids, urethral catheter, and oral medicine; such patients were less likely to undergo oxygen inhalation, total parenteral nutrition, and other intravenous drips. CONCLUSION: The hospice examined in this study was similar to the approach regarding medical treatments observed at the geriatric hospital.

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PubMed1984

The dynamics of a geriatric day hospital.

This report describes a prospective study of a geriatric day hospital. All 334 patients who attended during a six-month period were included with follow-up for a minimum of six months for each patient. One third were patients who had been discharged from the acute geriatric ward and most of the remainder were direct referrals from general practitioners. Transport was provided in 92% of cases by the Ambulance Service using a single-person crew in two-thirds and a driver plus attendant in the remainder. Only 8% came by private transport (family car). Patients were classified as 'once-only' attenders (22%), other new patients (37%), re-referrals (11%), current attenders (19%) and 11.1% were patients for whom a positive decision had been made to continue their day hospital attendance until death or admission to an institution (so-called 'chronic attenders'). This day hospital is an integral part of a comprehensive geriatric service which relies upon early referral and immediate response to avoid waiting lists both for in-patient and day hospital care. The services used by day patients are given with the proportion of patients receiving each service. The ecology of the day hospital was demonstrated to be more or less in balance. It is especially notable that the largest proportion of patients were discharged (from 41% to 63% of different patient categories) and there was no accumulation of chronic attenders. Of the 260 patients (excluding only the 74 once-only patients), only 25 were in geriatric accommodation and 12 in residential homes after a minimum of six months' follow-up. Forty-four patients had died.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

High prevalence of postprandial and orthostatic hypotension among geriatric patients admitted to Dutch hospitals.

BACKGROUND: Previous studies have indicated that postprandial hypotension (PPH) and orthostatic hypotension (OH) occur infrequently together. As data on geriatric patients in hospitals are scarce, we investigated the prevalence of PPH and OH and their combined occurrence. Our study sample included patients admitted to two geriatric departments in Dutch hospitals. METHODS: During 9 months, hemodynamic changes were measured with Spacelab 90207 after standing and after meals in all eligible patients. PPH is defined as a meal-related decline in systolic blood pressure (SBP) > or =20 mmHg, OH after standing up. RESULTS: Eighty-five patients (44 men), mean age 80 +/- 7 years (range 60-98 years), with 4 +/- 2 diseases and 6 +/- 3 prescriptions, were included. PPH was present in 57 patients (67%) with a significant postmeal SBP decrease of 34 +/- 4 mmHg. OH was present in 44 patients (52%) with a mean SBP decline of 44 +/- 4 mmHg after standing. Thirty-two patients (37%) had OH and PPH. Only 16 patients (19%) had neither OH nor PPH. Symptoms of PPH were present in 65% of patients, with syncope (in five patients) and sleepiness as the most common symptoms. OH was symptomatic in 61% of patients, with dizziness and risk for falls as the most common symptoms. CONCLUSIONS: PPH and OH are more common in geriatric patients than was previously appreciated, with a high statistical probability that OH and PPH occur simultaneously. There is little overlap in symptoms of OH (dizziness, fall risk) versus PPH (sleepiness, syncope), which can play an important role in diagnosis. Because of the high prevalence of symptomatic PPH and OH, blood pressure measurements for diagnosing hypotensive syndromes should be part of a comprehensive geriatric assessment.

Aged↗
PubMed1987

Survival after trauma in geriatric patients.

In contrast to other studies, a recent report from the authors' institution has shown a good prognosis for functional recovery in geriatric patients that survive trauma. Because most survivors regained their pre-injury function, the authors examined factors related to nonsurvival in this population of 82 consecutive blunt trauma victims older than the age of 65. Seventeen patients died (21%). Compared with survivors, nonsurvivors were older, had more severe overall injury, and had more severe head and neck trauma but did not differ in severity of trauma that did not involve the head and neck, number of body regions injured, mechanism of injury, or incidence of surgery after injury. Nonsurvivors experienced more frequent complications (82% vs. 33%, p less than 0.05), including a higher incidence of cardiac complications (53% vs. 15%, p less than 0.05) and ventilator dependence for 5 or more days (41% vs. 14%, p less than 0.05). Mortality rates were increased in patients who were 80 years of age or older compared with those ages 65-79 (46% vs. 10%, p less than 0.01), despite injury of similar severity. More frequent complications may contribute to an increased mortality rate in the older group, including an increased incidence of prolonged mechanical ventilation (36% vs. 12%, p less than 0.025), cardiac complications (54% vs. 10%, p less than 0.01), and pneumonia (36% vs. 16%, p less than 0.06). Severely injured patients (Injury Severity Score [ISS] greater than or equal to 25) older than 80 years old had a mortality rate of 80%, and the survivors required permanent nursing home care. Discriminant analysis yielded a reliable method of differentiating survivors from nonsurvivors based on age, ISS, and the presence of cardiac and septic complications. To assess the accuracy of the discriminant function, 61 consecutive patients admitted during 1985 were reviewed prospectively. Discriminant scoring predicted outcome correctly in 92% of these patients. A Geriatric Trauma Survival Score (GTSS) based on the discriminant function was calculated for each of the 143 patients studied and was highly correlated with mortality rate (r = 0.99, p less than 0.001). Thus, the GTSS may serve as a valuable tool for evaluating death in geriatric trauma victims. Furthermore, because complications are potentially avoidable and contribute to increased mortality rates, routine aggressive care for geriatric patients with moderate overall injury is indicated.

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PubMed2001

A population-based study of geriatric trauma in a rural state.

BACKGROUND: Urban geriatric trauma patients are known to die more often than their younger counterparts. Little is known of the fate of geriatric trauma patients in a rural environment where delays to definitive treatment are frequent. We hypothesized that rural trauma patients would do worse than their urban counterparts because of prolonged delays to definitive care. METHODS: Five-year retrospective analysis of all trauma deaths occurring within a rural state and retrospective outcome analysis of trauma patients admitted to a tertiary care facility who were less than 55 years old (defined as young) and 55 or more years old (defined as old). Outcome analysis was performed comparing old and young rural hospitalized patients to the Major Trauma Outcome Study data set collected in major urban trauma centers. RESULTS: Of the total trauma deaths in the state, 32.5% were old. Old patients were less likely to die at the scene of the injury than were their younger counterparts (R2 = 0.84, p < 0.001). Hospitalized old patients had a significantly higher mean Revised Trauma Score and a significantly lower Injury Severity Score, a higher complication rate, and a higher mortality rate than did hospitalized young patients. The young group had a significantly better survival (W = 0.59, Z = -3.49, p = 0.0001) than the MTOS data set, but the old group had a significantly worse survival (W = -1.8, Z = -3.49, p = 0.001). CONCLUSION: In a rural environment, old trauma patients die more commonly in the hospital than their younger counterparts, who die more commonly at the scene. Old trauma patients who die in the hospital were less severely injured than their younger counterparts who died in the hospital. Old patients admitted to this rural trauma center have a significantly worse survival than their urban counterparts despite the fact that young rural trauma patients do significantly better than their urban counterparts. Understanding the demographics of rural geriatric trauma may be useful in allocating resources in rural trauma system design. It must be understood that despite relatively low injury severity and physiologic stability, there is a significant potential for rural geriatric trauma patients to do poorly.

Adolescent↗
PubMed1997

Improving health care outcomes through geriatric rehabilitation. Conference summary.

The Boston Working Group on Improving Health Care Outcomes Through Geriatric Rehabilitation was structured around four major themes: (1) defining disability or disablement; (2) the patient's experience of the processes and outcomes of care; (3) the role and value of clinical practice guidelines; and (4) the need for casemix and severity or risk adjustment procedures and measures. These discussions produced opening statements of policy or empiric issues and recommendations about the best means of demonstrating the benefits of geriatric rehabilitation and, in particular, how to measure, ensure, and improve the quality of rehabilitation services, especially for the elderly. This article summarizes the reports from the work groups and identifies some common themes. Critical points include: (1) the need to define and describe geriatric rehabilitation better for nonexperts in the health field and for patients and consumers in general; (2) the need for more research to link rehabilitation processes with measurable and clinically important outcomes; (3) the breadth and depth of domains of processes and outcomes of care that ideally could and should be measured; and (4) the need to reach many audiences with a clear message about the importance of geriatric rehabilitation in ensuring high quality of care and good health status and functional outcomes for all elderly patients.

Aged↗
PubMed1998

Compliance of frail elderly with health services prescribed at discharge from an acute-care geriatric ward.

OBJECTIVES: A model of compliance by frail elderly with prescribed healthcare services was developed and tested. The discrepancy between primary care, geriatric and community health center (CLSC) services prescribed at discharge after comprehensive geriatric evaluation and treatment was measured, as were those services actually used during a 6-week interval (compliance). In this model, compliance was directly related to elders' intention to adhere to prescribed services, but this relationship was modified by organizational factors, reinforcing factors, and changes in health status during the observation period. Intention to adhere resulted from individual and reinforcing factors existing before discharge. METHODS: This model was tested on 211 patients discharged to community settings from an acute-care hospital geriatrics ward. Information was obtained through interviews with the patients or care givers and from hospital, outpatient, and local community health center charts. RESULTS: On average, patients used 56.9% of services prescribed; 13% of patients did not use any of the services prescribed for them, whereas 22% used all the services prescribed. Intention to adhere was influenced by patients' perception of the benefits of prescribed services and by their perception of the ease of access to transportation. Intention itself was not found to be an important determinant of overall compliance. Among organizational factors, having the ward staff make a follow-up appointment with the patients' family doctor and with the geriatric clinic before discharge and communication with the local community health center increased overall compliance. Moreover, patients who perceived they had access to transportation and to an accompanying person were more likely to comply. CONCLUSIONS: The results suggest that when discharging patients to the community, steps taken for them by the discharging healthcare providers will improve compliance.

Aged↗
PubMed1999

Mania in the geriatric patient population: a review of the literature.

The diagnosis of mania in the geriatric population is uncommon. However, it comprises significant healthcare utilization and cost requirements, which are expected to increase in the near future with the projected increase in the geriatric population. The authors review literature pertaining to geriatric mania and discuss epidemiology, psychopathology, neuropathology, differential diagnosis, evaluation, treatment, and outcomes. Literature searches were performed by GratefulMed for the years 1960-1997, with secondary- and tertiary-source follow-up. It is clear from this review that geriatric mania is a complex illness with many possible etiologies and treatments. Much more research needs to be conducted in all of the areas reviewed.

Age of Onset↗
PubMed2006

The prevalence of skin diseases in the elderly: analysis of 4099 geriatric patients.

BACKGROUND: The geriatric population is composed of persons over 65 years of age, and few studies are available on the dermatologic diseases in this group. METHODS: Data on a total of 4099 geriatric patients admitted between the years 1999-2003 were analyzed. Hospital-based patient registry records were used for data collection. The data were analyzed according to age, sex, and time of admittance. RESULTS: The five most frequently encountered diseases in elderly patients were eczematous dermatitis, fungal infections, pruritus, and bacterial and viral infections. The most common disorders in males were fungal, bacterial, and viral infections, disorders of the feet, cutaneous ulcers, and vesiculo-bullous diseases, whereas, in females, they were immune-rheumatologic diseases and disorders of the mucous membranes. The five most frequently encountered diseases were significantly different in geriatric age subgroups. In the younger age group, pruritus, disorders due to sun exposure, and precancerous lesions and skin carcinomas were less common, whereas eczematous dermatitis was more common. The frequencies of some diseases showed significant seasonal variations. Infestations were more common in spring and summer, fungal infections were more common in summer but less so in winter, pruritus was more common in autumn but less so in spring, disorders due to sun exposure were more common in spring, and benign neoplasia were more common in autumn. In 2003, benign neoplasia, precancerous lesions and skin carcinomas, and immune-rheumatic disorders were more common, but vesicular and bullous diseases, fungal infections, and cutaneous lymphomas were less common when compared with the year 1999. CONCLUSIONS: This study provides important data on the frequency of dermatologic diseases in elderly patients, and shows variations in the frequency depending on age, gender, and season. We believe that this study will create awareness about the extent and patterns of dermatologic problems in geriatric patients.

Aged↗
PubMed1979

A new geriatric application of electrocardiographic treadmill testing in an office setting.

An accepted method of measuring exercise tolerance was applied exclusively to geriatric practice for the purpose of exercise prescription. This stress testing was performed to minimize the risks of introducing exercise in an elderly population, and to restore or maintain elderly persons at their own optimal level of function, for life. As no geriatric testing protocol was available, two standardized protocols were chiefly used to start the trial program in March, 1978. A geriatric modification devised by the author is described. During the first month of the study, in a physician's office, ECG-monitored treadmill testing was conducted without mishap in 175 patients (age range, 60--89 years). All but 4 of the subjects (98 percent) led habitually sedentary lives, and documented coronary heart disease was present in about one-fourth of the series. The initial test data in this proposed continuing study are summarized. The methods for candidate selection, the safety precautions, and the test procedure are outlined. The distinction is made between testing by functional grades and testing to maximal levels. Information obtained from this stress test is an integral part of the individualized exercise prescription for each geriatric subject.

Aged↗
PubMed1981

Urinary dysfunction in a geriatric long-term care population: prevalence and patterns.

More complete data on th prevalence and types of urinary dysfunction in geriatric institutional patients are essential for the management of their urologic problems. Over a 13-month period, a prospective study was conducted of all new admissions to a hospital for long-term care. Eighty percent (277/347) of the newly admitted patients were geriatric (65 or older). Urinary dysfunction was identified in 69.3 percent of the geriatric group; 38.3 percent were incontinent, 20.2 percent bore a urinary diversion device, and 10.8 percent were symptomatic without incontinence. Obtaining reliable information about urologic status posed a significant problem, particularly as 27 percent of the subjects had a mental disorder, including organic brain syndrome or confusion. Thirty percent of all patients questioned were unable to give any history of their own health status. Questioning of both staff and patient to determine reliability of the data revealed that the given information was correct in 77 percent of patients who acknowledged genitourinary dysfunction, and in 83 percent of those who denied it. The study failed to elicit useful data concerning the specificity of symptoms, urologic history, diagnosis and management of urinary dysfunction in this series of geriatric patients under long-term institutional care.

Aged↗