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The effect of admission to a geriatric ward on medication use: 2002 versus 1985.

PURPOSE: To investigate the changes in pharmacotherapy of patients during and after admission to a geriatric ward in 2002 and to investigate if this goes along with reduction of drugs. To describe the differences of the admitted patients and their medication in 2002 compared to 1985. METHODS: Included patients were admitted to the geriatric ward of a general hospital in the Netherlands during 2002 (n = 258, mean age 84.2 years). Medication at admission, during admission and at discharge were described after retrospective reviewing of medical charts. A comparable study was performed at the same ward in 1985. RESULTS: In 2002, most frequently used medication at admission was acetylsalicylic acid (30.2%). Pantoprazole was during admission used in 38.8% of patients and at discharge in 31.8%. Folic acid that was at admission used by 11.6% of patients was at discharge increased to 23.4%. At discharge, vitamin D was used in 21.5% of patients, whereas lisinopril was used in 17.8% of patients. Both in 1985 and 2002 vitamins were added and use of antibiotics was increased during admission. A mean addition of 1.0 drug in 1985 and of 0.7 drugs in 2002 was observed. CONCLUSIONS: Geriatric hospital admission resulted both in 1985 and 2002 in addition of medication. In both periods reductions in medication were nullified by addition of medication for reason of therapy optimisation. Compared to 1985 admitted patients receive more medication resulting from new insights into pharmacotherapy and more use of preventive medicine.

Aged↗

Metabolism of methaqualone in geriatric patients.

The urinary excretion of five C-monohydroxy metabolites and the N-oxide of methaqualone has been measured in a group of eleven geriatric patients aged 71--90 years. The total excretion of the six metabolites in 24 h after the oral administration of a single dose was approximately one-half of that in a group of young healthy adults. The relative importance of the six metabolites was 4'-hydroxy greater than N-oxide greater than 2'-hydroxymethyl = 3'-hydroxy greater than 6-hydroxy = 2-hydroxymethyl which was the same order as that in young adults. The ratio of C-to N-oxidation was also the same in the two groups. There was no impairment of conjugation of the C-hydroxy metabolites with glucuronic acid in the geriatric group but there was greater interindividual variation in metabolite excretion. There was also evidence for delayed metabolism in the geriatric patients.

Aged↗

[Elimination of desacetyl cefotaxime in geriatric patients with multiple diseases].

Plasma concentrations of cefotaxime and desacetyl cefotaxime were determined by HPLC in geriatric patients with multiple diseases. Comparison with a younger control group of healthy volunteers showed a prolongation of half-life of CTX and dCTX in the older patients. A significant correlation between pharmacokinetic parameters of dCTX and other clinical and chemical parameters was found. Half-life of dCTX was positively correlated with age of the geriatric patients (P less than 0.05). There was also a significant relationship between CHE in serum and plasma peak concentrations of dCTX. Time until reaching plasma peak concentrations correlated closely with total bilirubin (P less than 0.01), CHE (P less than 0.001), cholesterol (P less than 0.01), and urea (P less than 0.01). Accumulation of the pharmacologically active metabolite dCTX could not be excluded in one patient with kidney disease. In accordance with other investigators it is recommended to reduce the dose of cefotaxime in geriatric patients with kidney diseases.

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Orthopedic or geriatric rehabilitation of hip fracture patients: a prospective, randomized, clinically controlled study in Malmö, Sweden.

From November 1988 to December 1989, all hip fracture patients in the municipality of Malmö, excluding nursing-home patients and patients who were already hospitalized at the time of the fracture, were postoperatively randomized to rehabilitation at either the orthopedic or the geriatric department in Malmö. The study, which comprised 371 patients, compared the following end points: primary mortality; destination at discharge; total first-year mortality; and the number of hip protheses during the first postoperative year. No significant differences were found between the two regimens. One year after the fracture, patients discharged to their previous living arrangements were invited to a control visit conducted by a physiotherapist; no significant differences between the two groups were found in walking ability, use of walking aids, "walking speed", or absence or presence of pain in the operated hip. Patients in the orthopedic group spent fewer days in the hospital, but had significantly more re-admissions, primarily due to orthopedic-related diagnoses (p = 0.003). The men in the geriatric arm of the trial were on the average 5.5 years older. The types of fracture were not evenly distributed between the two regimens. More patients treated at the geriatric department received technical aids, and more had adjustments made in their homes.

Aged↗

Drugs and falls in older people in geriatric care settings.

BACKGROUND AND AIMS: Falls and their consequences constitute serious health problems in the older population. The aim was to study predisposing factors for falls among older people in geriatric care settings, focusing on drugs. METHODS: This population-based study, with a cross-sectional design, analysed all geriatric care settings, comprising 68 residential care facilities, 31 nursing homes, 66 group dwellings for people with dementia, seven rehabilitation/short-stay units, two somatic geriatric and two psychogeriatric clinics, in the county of Västerbotten; 3604 residents with a mean age of 83.3+/-7.0 (65-103) years (68% women) were included. The residents were assessed by means of the Multi-Dimensional Dementia Assessment Scale (MDDAS) that measures, for example, mobility, paresis, vision, hearing, functions of activities of daily living (ADL), and behavioural and psychiatric symptoms. Drug consumption and falls during the previous week were recorded. RESULTS: Three hundred and one residents (8.4%) had sustained a fall at least once during the preceding week. Multivariate analyses showed that a history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, and use of neuroleptics or antidepressants were all associated with being a faller. Among the antidepressants, selective serotonin reuptake inhibitors (SSRIs) but not serotonin and noradrenalin reuptake inhibitors (SNRIs) were associated with falls. Cholinesterase inhibitors were not associated with falls. CONCLUSIONS: Like functional and cognitive impairment, treatments with antidepressants and neuroleptics are predisposing factors for falls in older people in residential care. However, there seem to be differences between subgroups among these drugs and, from the perspective of fall prevention, SNRIs rather than SSRIs should perhaps be preferred in the treatment of depression in older people.

Accidental Falls↗

Reporting adverse drug reactions on a geriatric ward: a pilot project.

OBJECTIVE: To test a method for registration of adverse drug reactions (ADRs) resulting in hospital admission and of ADRs occurring during hospital stay. Spontaneous reporting was compared with data from patient interview. METHODS: Spontaneous reporting of ADRs by nurses and physicians, as well as patient interviews by pharmacists. This pilot project was carried out in the geriatric ward of the Ghent University Hospital over a period of 8 months in order to develop suitable registration forms and to test feasibility. Causality, severity, type and level of intervention of the reported ADRs were analysed. Reports from physicians and nurses were compared with the data obtained by patient interviews. RESULTS: During the 8 months, for 168 patients, 12 spontaneous reports were received from physicians and nurses. Fifty-six of these patients were interviewed and 32 ADRs were reported. Only 2 ADRs detected by patient interview were also reported spontaneously. The interviews of the 56 geriatric patients indicated that 20% of them were admitted to the hospital because of an ADR. ADRs occurred during hospital stay in another 20% of those patients. CONCLUSION: Spontaneous reporting by physicians and nurses revealed considerably fewer ADRs than patient interview by pharmacists. Physicians and nurses reported the more serious ADRs that occurred during hospital stay, whereas the interviews revealed more ADRs that caused hospital admission. Our data confirm that ADRs are an important cause of hospital admission of geriatric patients and occur frequently during their hospital stay.

Adverse Drug Reaction Reporting Systems↗

[Social work in geriatric clinics--between autonomy and functional organization].

Geriatric therapy is defined through interdisciplinarity, teamwork, and multiprofessionality. Besides questions of medical therapy, psychosocial dimensions of elderly are highly relevant. Social work is mostly described as an important profession in the process of geriatric therapy. This work refers to the presentation and discussion of the results of an interdisciplinary study to the role of social work in German geriatric hospitals. It shows that the role of social work is determined by the various perceptions of the professions. Another influence on it is by the structures of the hospital. Social workers defines their activities through the relationship to the client; the other professions recognize the tasks of social work in a very diffusely way, mostly reduced in connection with the management of dismission of the patient from hospital. The professional education of social workers is not well known by the nurses and doctors. The fact that social workers are mostly acting under the responsibility of doctors, leads to a definition of problems and aims from a medical point of view. In many of the hospitals there are distinct problems of communication and cooperation between the professions. If the profession of social workers wants to contribute to the reduction of these impediments of communication and cooperation, they must actively and constructively communicate with the other professions and become more clear about their own professional way of acting.

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[Geriatric health system, economic profit and the debate on euthanasia].

Three characteristic developments in modern western societies usually are considered to be independent variables in the ethical discussion:1. An explosion-like increase in medical and social expenditures following a rapid multiplication of old and multiply disabled people in this century. 2. the increasing economic importance of the "health industry", and 3. the "new" debate of euthanasia. All these developments are discussed controversially. The volume of geriatric support is mostly considered to be insufficient, but usually it is restricted by both, scarcity of resources as well as increasing demands to focus on "evidence-based medicine" (which might exclude a lot of medical procedures in old age). The mutation of health systems from - originally - social activities to business branches more and more gives priority to economical based decisions in medicine, but otherwise has advanced an increasing number of new health professions. The origin of the actual debate on euthanasia is the development and judicial certification of individual's self-determination in modern societies. However, euthanasia is still refused world-wide because it is considered to be linked with a process of weakening basic ethical principles. The 3 seemingly independent developments certainly are facts in modern societies. They hardly can be influenced by the medical profession, being forced to conform to them. However, there are significant connections between them.A geriatric health system, primarily denying individual demands and basic convictions of old people, contributes to an attitude of non-acceptance towards daily practice medicine. The same effect may result from the economic transformation of medicine when creating a system of self-perpetuating demand (being characteristic for an "ideal" business branch) by "unlimited" prolongation of life of the very old and highly disabled patients. The result from this development undoubtedly will be an increasing demand for self-determination at the end of life, including medical assistance in suicide and euthanasia, which cannot successfully be confronted with moral appeals.Alternatively, a basic correction of the geriatric health system must be introduced mainly including psychodynamic factors in medical decision making, or euthanasia will be accepted by the majority, as already has happened in the Netherlands.

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[Development of geriatrics in Germany].

After an inquiry of the Bundesministerium für Arbeit und Sozialordnung by the responsible Landesministers, the number of inpatient geriatric institutions rose by about 34% from 1997 to 2000 and the number of partly inpatient geriatric institutions rose by 106% in the same timeframe. Outpatient geriatric rehabilitation institutions are, on the other hand, still basically nonexistent, whose number has risen from 9 to 12 since 1997. The situation is similar for mobile outpatient services, whose number doubled from 5 to 10.

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[Satisfaction of geriatric patients with their pain therapy. Wish and reality].

AIM: The goal of this study was to determine the level of satisfaction of geriatric patients with their pain therapy, their wishes for improved treatment, and possible influencing factors. METHODS: From April to November 2002, all patients able to communicate ( n=1432) were included in the study if they had reported pain in the previous 7 days or were taking regular analgesic medication without specifying pain. RESULTS: Of the geriatric patients reporting from home, 36.4% were not satisfied with their pain therapy up to that time, and 25.4% of surgical patients were dissatisfied as were 28.5% of patients treated in other departments. A total of 93.3% desired better pain treatment. Independent predictors for dissatisfaction with their therapy or wish for improvement were increasing pain intensity, frequent concomitant complaints in addition to pain, and the objectively perceived everyday competence. CONCLUSION: This study supports the observation that competent pain therapy is necessary and that there is room for improvement in geriatric facilities. Measuring pain intensity, posing questions pertaining to satisfaction with pain therapy, and determining whether patients desire better pain treatment are all indispensable for optimal care. Pain therapy should equally address reduction of pain intensity and management of other complaints.

Aged↗

Geriatric polytrauma.

BACKGROUND: compared to a younger population, the treatment of geriatric trauma victims is known to be associated with a higher mortality and morbidity. The objectives of this study are to assess the clinical course and outcome of multitrauma patients aged 65 years and over. In addition, a direct comparison between the geriatric trauma patients and the younger collective is performed. METHOD: our study includes all multitrauma patients treated between 1992 and 2001 at a major urban trauma center. The major issues of this analysis are: injury severity, injury pattern, preclinical hemodynamics and intubation rate, operative treatment, ventilation time, outcome as well as incidence of multiorgan failure (MOF) and adult respiratory distress syndrome (ARDS). Out of these results, adults over 65 years of age (group B, n = 45) are compared to the younger group, ranging from 16 to 64 years of age (group A, n = 369). RESULTS: The preclinical intubation rate was comparable in both groups (A: 73.2%, B: 68.9%). Significantly more cases of group B were primarily shocked (A: 29.0%, B: 48.9%). The mean ISS was comparable in both groups (A: 34.0; B: 32.1). The younger group showed a significantly higher incidence of spine injuries (A: 21.1%; B: 6.7%). The number of emergency procedures (A: 24.2%; B: 24.4%) and operations during the first 24 hours (A: 70.2%; B: 60.0%) was comparable in both groups. The older group showed a lower number of reconstructive operations (A: 57.6%; B: 35.6%). Geriatric trauma patients had a longer ventilation time compared to their younger counterparts (A: 13.0 days, B: 20.0 days). During ICU-therapy, the ARDS rate was comparable (A: 16.0%, B: 15.6%). In contrast, the incidence of MOF was significantly higher in group B (A: 7.1%; B: 17.8%). The older group showed a significantly higher mortality rate (A: 26.8%; B: 53.3%) as well as early mortality during the first 24 hours after admission (A: 16.3%, B: 31.11%). CONCLUSION: Despite similarity in injury severity and a comparable injury pattern, elderly multitrauma patients initially presented a higher rate of hemodynamic instability, had to be ventilated longer and had a higher mortality.

Adolescent↗

Brain computed tomography findings in geriatric depression and primary degenerative dementia.

Brain computed tomography (CT) scans were performed in hospitalized geriatric patients with major depression (n = 45) or primary degenerative dementia (n = 21). Depressed patients with onset of illness at age 60 years or older (n = 32) had greater ventricular size than geriatric depressives with earlier age of illness onset (n = 13). CT parameters of late-onset depressives were comparable to those of patients with primary degenerative dementia. However, early-onset geriatric depressives had significantly smaller ventricles and less sulcal widening than demented patients. The findings suggest that late-onset depression may have a stronger association with neurological dementing disorders than early-onset depression.

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Symptom stability in geriatric chronic schizophrenic inpatients: a one-year follow-up study.

The results of previous studies of symptom stability in schizophrenia suggest that negative symptoms manifest traitlike characteristics while positive symptoms fluctuate over time. Various prospective studies of chronic schizophrenic patients have found consistent results, regardless of the follow-up period, yet there is little research addressing symptomatology in geriatric schizophrenic patients. Since these patients have a very poor outcome and more severe negative symptoms, their symptoms might differ from younger patients. This study examined the course of symptomatology in 178 geriatric schizophrenic inpatients who were assessed twice at a 1-year interval with the Positive and Negative Syndrome Scale (PANSS). Intraclass correlations revealed that the distribution of negative symptoms was considerably more stable than that of positive symptoms over the interval, and subtypes based on negative symptoms were the only ones that manifested consistent stability over time. There was also a significant increase in negative symptom severity for the sample, with a slight decrease in positive symptom severity. Thus, even in chronic inpatients, with a very extended illness, positive symptom severity is not particularly stable within patients. These data indicate that the characteristics of negative and positive schizophrenic symptoms are similar in younger and geriatric schizophrenic patients, suggesting a continuity of the illness process. Tentative evidence for increasing severity of negative symptoms over a brief follow-up period suggests the possibility of a steady worsening of clinical state in very elderly patients who remained hospitalized.

Age Factors↗

A return to time, cells, systems, and aging: V. Further thoughts on Gompertzian survival dynamics--the geriatric years.

In this paper, I attempt to address the problem of how to model the survival curve in the later lifespan years; the geriatric years. I present a new general model for a three group population in which the first group represents early life failure (neonatal failure), the second group represents the classical "Gompertzian failure", and the third group represents the later life failure or geriatric failure. Theoretical results are compared to the known biological data. It is demonstrated that this three group model embeds, within itself, a greater variety of the known biological survival dynamics. In particular, this new model resolves some of these issues concerning the failure of the pure Gompertzian to model the later life (geriatric) survival distribution.

Adolescent↗

Geriatric and nongeriatric psychiatry consultation. A comparison study.

Data from geriatric and nongeriatric psychiatry consultations done on medical and surgical inpatients at a Veterans Administration Medical Center over a 1-year period were analyzed. A total of 750 consultations were conducted. Patients age 60 and over were referred significantly more often for agitation and competency assessment, and significantly less often for suicidal ideation. More than half the older patients had evidence of an organic brain syndrome. Notably fewer geriatric than nongeriatric patients were diagnosed as having personality disorders. Psychotropic medications were prescribed and further medical workups were recommended more often for the elderly. The results have important implications for mental health professionals working with older patients. The need for more training of both psychiatric and nonpsychiatric residents in the management of geriatric patients is discussed.

Aged↗

Psychological distress in geriatric and adult medical in-patients.

Psychological distress was evaluated in two groups of medical in-patients, one composed of geriatric subjects (178), the other of adults (201). The instrument used for this purpose was the SCL-90. The predominant pattern of emotional response among the geriatric patients was depression; although this pattern was also present among the adult patients, reactions of an anxious type were more common in these subjects. Women of both groups of patients scored significantly higher than men on many of the subscales of the SCL-90. No significant differences emerged in relation to the type of organic disease among the adult patients, while among the geriatric patients, subjects with disorders of the CNS, muscular-skeletal system and blood scored significantly higher than those with other diseases.

Adult↗

Pharmacokinetics of diuretics in geriatric patients.

Pharmacokinetics of three diuretics (furosemide, spironolactone, and triamterene) were investigated in 70 geriatric patients. Comparing the data with the corresponding values of young healthy volunteers, mean plasma concentrations of furosemide and spironolactone (and peak concentrations of triamterene) were markedly higher in the geriatric patients. Different concomitant diuretic therapy (hydrochlorothiazide vs. piretanide) seems to influence the kinetic parameters of triamterene and its active metabolite in the geriatric patients. In elderly patients reduction or correction of the dosage seems to be necessary for all three diuretics investigated in our studies.

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Pharmacokinetics of tiaprofenic acid in geriatric patients with ischemic heart disease.

The serum levels of tiaprofenic acid were determined by HPLC in 20 geriatric patients with ischemic heart disease, and the pharmacokinetic parameters were calculated. The results indicate that in geriatric patients the drug does not accumulate when given at a dose of 300 mg twice a day. Sufficient plasma levels are reached and the short terminal phase half-life prevents accumulation. The electrolyte balance was examined during the 7 days of treatment, and no change in sodium and potassium levels in the serum or in urine were observed. Weight as well as blood pressure of the patients remained constant, so that an increased development of edema, especially with regard to the existing ischemic heart disease of the patients, could be excluded. The results of our study indicate that tiaprofenic acid at the employed dosage is suitable for the therapy of arthritis in geriatric patients suffering from ischemic heart disease, without accumulation of the drug or the development of edema.

Aged↗