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PubMed1997

Recurrence and relapse in geriatric depression: a review of risk factors and prophylactic treatment strategies.

An emerging body of epidemiologic data has substantiated that in younger and middle-aged populations, major depression may be characterized by early relapse, recurrence, and chronicity. Information regarding the prognosis of geriatric depression is less extensive. This article reviews the literature on the longitudinal outcome of major depression in older adults, with particular emphasis on the limited data on strategies for the pharmacologic and electroconvulsive prophylaxis of recurrent unipolar geriatric depression. Possible biological markers for relapse risk, derived from sleep electroencephalography, neuroendocrine tests, and neuroradiographic findings, are also discussed. Recommendations for the treatment and long-term follow-up of geriatric depression are presented.

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PubMed1988

Overlapping symptoms of geriatric depression and Alzheimer-type dementia.

The occurrence of geriatric depression and dementia of the Alzheimer type, two of the most common diseases of late life, is certain to increase as the proportion and absolute number of Americans over the age of 65 grow larger. Overlapping symptomatology can sometimes make it difficult to determine whether a patient suffers from geriatric depression with cognitive abnormalities, Alzheimer-type dementia with depressive symptoms, or coexisting depression and dementia. In this review of the course, symptomatology, and pathophysiology of Alzheimer-type dementia and geriatric depression, the authors describe the symptoms often shared by these diseases as well as the characteristics usually associated with one or the other. Factors that complicate diagnosis, such as the presence of other medical illnesses and pharmacokinetic and pharmacodynamic changes associated with aging, are also discussed.

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PubMed1990

Quantifying undiagnosed organic mental disorder in geriatric inpatients.

Organic mental disorder often goes undetected in geriatric patients who have coexisting psychiatric symptoms. To determine the prevalence of organic mental disorders in geriatric patients admitted to a large metropolitan psychiatric inpatient service, charts for 95 patients over the age of 60 were reviewed, and diagnoses at admission and discharge were compared. Despite the facility's admission policy of excluding patients with only organic mental disorder, 32 patients required evaluation for organic mental disorder during hospitalization, and on reevaluation 15 patients received a primary diagnosis of organic mental disorder. The author discusses the mental health care and fiscal considerations of accurately assessing geriatric patients, especially in the context of the new federal regulations prohibiting most nursing home admissions for mentally ill patients.

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PubMed1991

Geriatric patients and services in state hospitals: data from a national survey.

Notwithstanding the large-scale deinstitutionalization of the elderly, psychogeriatric patients continue to make up a significant portion of patients in U.S. state hospitals. This paper reports pilot data from a national survey assessing the current status of geriatric populations in state hospitals. Elderly patients still account for one-fifth of state hospital patients, and two-thirds of state hospitals still have separate geriatric units. The data suggest that, while deinstitutionalization of the elderly may be continuing in many state hospitals, in more than one-third of state hospitals the geriatric census is on the rise. Tentative hypotheses suggesting further research are discussed.

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PubMed1989

Efficacy and safety of pentoxifylline in geriatric patients with intermittent claudication.

The effects of pentoxifylline on intermittent claudication were evaluated at a dose of 1200 mg/day in an open-label twelve-week study on geriatric patients with chronic occlusive arterial disease (COAD). Standardized treadmill testing and clinical signs and symptoms of COAD were followed up before and during drug administration. Twenty-four subjects with a mean age of 73.5 years, capable of walking between 20 and 200 meters on the treadmill, were entered into the trial; 22 participated for eight weeks and 19 completed the study in terms of treadmill walking distance measurements at 12 weeks. The mean walking distance for all patients was increased 111% over baseline at week 12. Thirteen subjects were considered drug responders (greater than or equal to 50% increase in treadmill walking distance) and 9 were considered nonresponders (less than 50% increase). Improvements in clinical signs and symptoms of COAD were noted. Decreases in elevated systemic systolic pressures (but not diastolic) were unexpectedly observed in many drug responders. Seven of 19 males reported sexual function improvements while receiving pentoxifylline. Fourteen (58%) of the 24 subjects reported mild side effects of dyspepsia, nausea, vomiting, dizziness, headache, or insomnia; no subjects were withdrawn from the study because of side effects. In summary, pentoxifylline improved function and symptoms in 13 of 22 geriatric patients with intermittent claudication; the drug was safe and well tolerated at the usual dosage in this geriatric patient population.

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PubMed2004

Single-dose pharmacokinetics of daptomycin in young and geriatric volunteers.

Daptomycin is a novel lipoprotein antibiotic that was recently approved for the treatment of complicated skin and skin structure infections caused by aerobic gram-positive bacteria. The pharmacokinetics of daptomycin was evaluated after a single 0.5-hour intravenous infusion of 4 mg/kg to groups of young adult (18-30 years) and geriatric (>or= 75 years) volunteers. Daptomycin was safe and well tolerated. No adverse events related to the infusion were reported. With increased age, there were increases in the area under the plasma concentration-time curve extrapolated to infinity (AUC( infinity )) and the terminal elimination half-life. Systemic (CL) and renal clearance (CL(R)) both decreased with increasing age. The observed changes seen in CL between the two cohorts were most likely a result of changes in renal function, as estimated by creatinine clearance. No statistically significant differences were observed between the two groups in the maximum plasma concentration (C(max)) and volume of distribution at steady state (Vd(ss)). The confidence intervals for the arithmetic mean ratios of the fraction of the dose excreted in the urine as daptomycin (%Fe) (geriatric subjects over younger subjects) were 60% to 101%, indicating that %Fe(dose) was lower in geriatric subjects. These results demonstrate that changes in the pharmacokinetics of daptomycin in the elderly are attributable to changes in renal function, whereas age per se is not a significant factor.

Adolescent↗
PubMed1996

Polypharmacy among nursing home geriatric Medicaid recipients.

OBJECTIVE: To determine the factors that influence the number of different drugs prescribed to geriatric Medicaid recipients residing in Louisiana's intermediate care facilities I (ICFs I). DESIGN: Observational and cross-sectional with descriptive and analytic components. PARTICIPANTS: All geriatric Medicaid recipients in Louisiana ICFs I during 1994 (n = 19932). METHODS: Relevant data on sex, age, race, geographic region of a recipient, number of prescribing physicians, number of pharmacies used, and the number of drugs prescribed to a recipient were extracted from the state Medicaid files. Frequencies for the seven study variables were calculated. Regression analysis was used to evaluate the influence of the six predictor variables on the number of drugs prescribed. RESULTS: The study population was 73.63% women, 60.07% 81 years of age and older, 70.65% white, 23.21% African-American, 6.14% other races, and 29.83% from predominantly rural north Louisiana. A total of 44.60% of the residents received prescriptions from one physician, 8.41% of the residents were single pharmacy users, and 45.65% were prescribed more than 10 drugs during the year. The regression model accounted for 20.53% of the total variation in the number of drugs prescribed to a recipient. Race, geographic region, number of prescribing physicians, and number of pharmacies used by a recipient influenced the number of drugs prescribed. CONCLUSIONS: To reduce the number of drugs prescribed and polypharmacy among geriatric Medicaid recipients, Louisiana's ICFs I should minimize the number of physicians and pharmacies used in this population.

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PubMedDate not supplied

Prevalence of sedative drug use in geriatric in-patients: a multi-centre study.

OBJECTIVE: This cross-sectional study registered the prevalence of sedative drug use and withdrawal strategies in geriatric in-patients from 30 centres in nine European countries. METHODS: We conducted a survey among young geriatricians using a standardised questionnaire on sedative drug use for more than three weeks. The study population consisted of 1972 in-patients aged 75 years or older. Acute care (620), intermediate care/rehabilitation (359), long-term care (261), terminal care (47) and nursing home (685) settings were represented. The pre-specified outcomes included the prevalence of sedative drug use; the identification of main prescribers and main reasons for prescribing and, the assessment of withdrawal policy, including psychological counselling and involvement of general practitioners. RESULTS: Prevalence of sedative use was highest in long-term care (72%), followed by nursing homes (70%) and terminal care (59%). Geriatricians started prescribing sedatives after admission on 52% of all occasions. The main reasons for prescribing were continuation of medication taken at home (37%), sleep problems emerging after admission (26%) and post-admission worsening of existing sleep problems (20%). Most prescribers (70%) applied an active withdrawal policy. Short-term withdrawal programmes were mostly applied (57%). Most patients (60%) were psychologically counselled during withdrawal from sedatives. General practitioners were often (60%) involved in withdrawal policy. CONCLUSION: The prevalence of prescription of sedative drugs in geriatric in-patients is high. Appropriate setting specific guidelines are needed to control use of sedatives in geriatric in-patients and to ensure withdrawal from these drugs whenever possible.

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PubMed2002

Food intakes and preferences of hospitalised geriatric patients.

BACKGROUND: A cross sectional survey was carried out on 120 hospitalised geriatric patients aged 60 and above in Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur to investigate their nutrient intakes and food preferences. METHODS: Food intakes were recorded using a one day weighed method and diet recall. Food preferences were determined using a five point hedonic score. Food wastages and factors affecting dietary adequacy were also investigated. RESULTS: The findings indicated that the mean intakes of energy and all nutrients investigated except for vitamin C and fluid were below the individual requirement for energy, protein and fluid, and the Malaysian Recommendation of Dietary Allowances (RDA) for calcium, iron, vitamin A, thiamin, riboflavin, niacin and acid ascorbic. In general, subjects preferred vegetables, fruits and beans to red meat, milk and dairy products. There was a trend of women to have a higher percentage for food wastage. Females, diabetic patients, subjects who did not take snacks and subjects who were taking hospital food only, were more likely to consume an inadequate diet (p < 0.05 for all values). CONCLUSIONS: Food service system in hospital should consider the food preferences among geriatric patients in order to improve the nutrient intake. In addition, the preparation of food most likely to be rejected such as meat, milk and dairy products need some improvements to increase the acceptance of these foods among geriatric patients. This is important because these foods are good sources of energy, protein and micronutrients that can promote recovery from disease or illness.

Journal Article↗
PubMed2006

End of life content in geriatric textbooks: what is the current situation?

BACKGROUND: Physicians caring for elderly people encounter death and dying more frequently than their colleagues in most other disciplines. Therefore we sought to examine the end-of-life content in popular geriatric textbooks and determine their usefulness in helping geriatricians manage patients at the end of their lives. METHODS: Five popular geriatric textbooks were chosen. Chapters on Alzheimer's disease, stroke, chronic heart failure, chronic obstructive pulmonary disease and lung cancer were examined because of their high mortality rates among the elderly patients. Text relevant to end-of-life care was highlighted. Two reviewers independently coded text into 10 pre specified domains and rated them for the presence of end-of-life information. Content was rated as absent, minimally helpful, or helpful. The proportion of helpful information was calculated. RESULTS: The textbook with the best end-of-life coverage contained 38% helpful information, the worst had only 15% helpful information. Minimally helpful information ranged from 24% to 50%. As much as 61% of the content in one textbook contained no helpful information at all. Of the ten domains, epidemiology, disease progression and prognostic factors were fairly well covered. Information on advance care planning, ethical issues, decision making and effects of death and dying on patient's family were generally lacking under the individual diseases though they were covered as general topics in other parts of the textbooks. All except one textbook dedicated a chapter to the care of the dying. CONCLUSION: This study showed that end-of-life content in geriatric textbooks differed significantly. Most of the textbooks lack good coverage on end-of-life care and more can be done to improve on this.

Journal Article↗
PubMed1995

The longitudinal stability of cognitive impairment in schizophrenia. Mini-mental state scores at one- and two-year follow-ups in geriatric in-patients.

BACKGROUND: Severe cognitive impairment affects many patients with schizophrenia, especially geriatric in-patients. Little is known about the course of this impairment, however. METHOD: Two hundred and twenty-four geriatric schizophrenic in-patients were examined for changes in cognitive functioning over a one-year follow-up period, and 45 of them were assessed over a two-year period. In addition, the subset of 45 patients participated in a one-week and one-month test-retest reliability study of the instrument used to assess cognitive impairment, the Mini-Mental State Examination (MMSE). RESULTS: The average MMSE scores did not change over a one- or two-year follow-up period. The test-retest reliability of the scale was extremely good at both retest intervals. CONCLUSION: Among the implications of these data are that cognitive changes in geriatric schizophrenic patients are very slow and are more consistent with a neurodevelopmental process than a neurodegenerative course.

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PubMed2004

Acute coronary syndrome, comorbidity, and mortality in geriatric patients.

Morbidity and mortality rates from heart diseases are highly represented in geriatric-aged patients, but these patients also have supporting diseases. Acute coronary syndrome includes unstable angina and acute myocardial infarction with and without ST elevation. The aim of this study was to make a retrospective morbidity analysis of patients admitted to the emergency department. The study is made for a period of three years (from 1998 to 2000). It includes 588 patients divided by age (395 were 65-75 years old; 193 were older than 75 years) and sex (there were 326 men and 262 women). Comorbidity and mortality were investigated. Patients with one, two, three, and more than three supporting diseases were 6.29%, 23.13%, 68.53%, and 2.04%, respectively, of the total number. The most frequent geriatric patients had heart failure, followed by endocrinological diseases (type 2 diabetes, obesity, struma), neurological diseases (insultus, paresis), and chronic kidney diseases (pielonephritis, nephrolithiasis). The combination of hypertension, heart failure, and type 2 diabetes had the highest comorbidity frequency. The mortality rate for 1998 was 8.81%, for 1999 7.74%, and for 2000 13.41%. The mortality rate at the first 12 hours at the beginning of the acute coronary syndrome was 66.6%. Geriatric patients suffer from many diseases, and at the beginning of the onset of acute coronary syndrome they have multiorganal failure. Elderly patients are a high-risk contingent in intensive coronary care units.

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PubMedDate not supplied

Religion, spirituality, and health status in geriatric outpatients.

BACKGROUND: Religion and spirituality remain important social and psychological factors in the lives of older adults, and there is continued interest in examining the effects of religion and spirituality on health status. The purpose of this study was to examine the interaction of religion and spirituality with self-reported health status in a community-dwelling geriatric population. METHODS: We performed a cross-sectional analysis of 277 geriatric outpatients participating in a cohort study in the Kansas City area. Patients underwent a home assessment of multiple health status and functional indicators by trained research assistants. A previously validated 5-item measure of religiosity and 12-item spirituality instrument were embedded during the final data collection. Univariate and multivariate analyses were performed to determine the relationship between each factor and self-reported health status. RESULTS: In univariate analyses, physical functioning (P < .01), quality of life (P < .01), race (P < .01), depression (P < .01), age (P = .01), and spirituality (P < .01) were all associated with self-reported health status, but religiosity was not (P = .12). In a model adjusted for all covariates, however, spirituality remained independently associated with self-appraised good health (P = .01). CONCLUSIONS: Geriatric outpatients who report greater spirituality, but not greater religiosity, are more likely to appraise their health as good. Spirituality may be an important explanatory factor of subjective health status in older adults.

Activities of Daily Living↗
PubMed1993

Thymic abscess with bacteremia and manubriosternal pyarthrosis in a geriatric patient.

We describe a geriatric patient with acute substernal chest pain thought to be due to coronary heart disease, who was subsequently found to have Staphylococcus aureus bacteremia associated with infection of the thymus and manubriosternal joint. To our knowledge, this is the first report of (1) a thymic abscess in a geriatric patient, (2) a thymic abscess associated with bacteremia, (3) extra-articular extension of manubriosternal pyarthrosis, and (4) manubriosternal pyarthrosis in the geriatric age group.

Abscess↗
PubMed2002

[Telereha--special challenges for telemedicine in geriatric rehabilitation].

Modern telecommunication technology has the potential to improve the quality of life for elders with physical and mental impairments as well as for their caregiving relatives. This can be viewed as an opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Results of a tele-rehabilitation project ("TeleReha", conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients caregiving relatives and geriatric professionals, showed that participants regard telecommunicational and communicational needs.

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PubMed2005

Is suicide ideation a surrogate endpoint for geriatric suicide?

The present study explored the validity of treating suicide ideation as a surrogate endpoint that can serve as a proxy for suicide in clinical intervention research with suicidal seniors. Two criteria; that suicide ideation is modulated by the proposed intervention and that modulation of suicide ideation leads to a quantitative reduction in suicide rates, were the focus of this review. A series of literature searches of the PsychINFO and Medline databases were conducted on the terms geriatric, elderly, seniors, suicide, self-destruction, clinical, randomized, trial, treatment, intervention , and ideation . Articles were analyzed if they provided sufficient information to examine whether an intervention effectively led to a reduction in suicide ideation among seniors. Two hundred and eight articles were considered for potential inclusion in this study, with 19 articles meeting final inclusion criteria. The articles reviewed were divided into three broad categories: articles supporting suicide ideation as a surrogate endpoint for geriatric suicide ( n = 6); those not supporting this hypothesis ( n = 1); and those providing insufficient information to test the hypothesis ( n = 12). The present analysis provided modest evidence for suicide ideation as a surrogate endpoint for geriatric suicide, due, in part, to a paucity of randomized controlled trials of treatment interventions for suicidal seniors, thus demonstrating a clear need for research in this area. Implications of utilizing surrogate endpoints in suicide research are discussed.

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PubMed2005

Cytochrome p450 polymorphisms in geriatric patients: impact on adverse drug reactions--a pilot study.

BACKGROUND AND OBJECTIVE: Up to 23% of the population, depending on their ethnic background, has genetically determined differences in the metabolism of drugs by the cytochrome P450 (CYP) enzymes CYP2C9, CYP2C19 and CYP2D6. The aim of this survey was to determine the relationship between genetical polymorphisms in these CYP enzymes and adverse drug reactions (ADRs) in geriatric patients. STUDY DESIGN: In a prospective 6-month cohort study of 243 patients in a geriatric rehabilitation ward, mean age 80.2 +/- 7.7 years, ADRs were identified by intensive monitoring by a pharmacoepidemiological team, consisting of pharmacists and physicians. 125 out of these 243 patients were genotyped cross-sectionally for polymorphisms of CYP2C9, CYP2C19 and CYP2D6 by the TaqMan-polymerase chain reaction. The main outcome measures were the prevalence of genetical polymorphisms and the patients' risk for developing an ADR as related to the genotype. RESULTS: Patients received an average of 14.2 drugs during hospitalisation which led to 251 ADRs in the whole cohort and 149 ADRs in the cross-sectional genotyping study. Genotype frequencies of CYP2C9 enzyme were 25.9% (n = 29) intermediate metabolisers (IMs) and 2.7% (n = 3) poor metabolisers (PMs). For the enzyme CYP2C19, 26.8% (n = 33) IMs and 0.8% (n = 1) PMs were detected. For the enzyme CYP2D6, 24.1% (n = 26) IMs and 3.7% (n = 4) PMs were found in the analysed patient population. In total, 61.6% (n = 77) of genotyped patients experienced mutations in at least one of the three cytochrome enzymes. The ADR rate did not differ significantly between patients with genetic mutations and wild-type genotype patients. Moreover, only eight out of 40 ADRs which were associated with drugs metabolised by CYP2C9, CYP2C19 or CYP2D6 were detected in patients with IM genotype and none in patients with PM genotype. CONCLUSION: In this investigation geriatric patients showed a high rate of ADRs. However, no association between the ADR rate and the patients' genotype could be detected, which most likely was a result of the small number of patient samples analysed. Although prophylactic genotyping would have not prevented ADRs in this pilot study, physicians nevertheless have to be aware of potential genetic mutations in patients with polypharmacy.

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PubMed2001

Significant reduction of methicillin-resistant Staphylococcus aureus bacteremia in geriatric wards after introduction of infection control measures against nosocomial infections.

OBJECTIVES: (1) To investigate the efficacy of infection control measures against methicillin-resistant Staphylococcus aureus (MRSA) bacteremias in geriatric wards. (2) To identify predisposing risk factors for MRSA bacteremia. METHODS: Cases with nosocomial bacteremias were retrospectively analyzed between January 1991 and March 1995. The study period was divided into four annual periods and the period 1, January to December 1991, was applied as the control. MATERIALS: We investigated patients with nosocomial bacteremias in geriatric wards (190 beds) of AINO Memorial Hospital, affiliated with Nagasaki University. RESULTS: A significant reduction in cases with MRSA-induced nosocomial bacteremia was observed after the introduction of a stringent infection control and prevention program (period 1 vs. periods 2, 3, and 4: p<0.00833, p<0.00167, and p<0.00167, respectively). The major source of bacteremia included urinary tract infections, intravenous catheter-related infections, and infected decubitus ulcers. Improvement of decubitus ulcer was associated with a significant reduction in MRSA bacteremia (period 1 vs. periods 2 and 3: p<0.00017 and p<0.00833). CONCLUSION: Stringent infection control programs, including prevention and treatment of decubitus ulcers, are necessary in geriatric wards to reduce and prevent MRSA bacteremia.

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