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PubMed2003

Demographic and clinical characteristics of geriatric horses: 467 cases (1989-1999).

OBJECTIVE: To describe the demographic and clinical characteristics of a population of geriatric horses. DESIGN: Retrospective study. ANIMALS: 467 horses that were > or = 20 years of age. PROCEDURE: Medical records of 539 geriatric horses that were evaluated at a university large animal hospital between 1989 and 1999 were reviewed. Data collected included signalment, reason for evaluation, specific diagnoses, surgical procedures, inpatient or outpatient care, duration of hospitalization, and outcome. RESULTS: 467 horses met the criteria for inclusion in the study. Horses that were > or = 20 years of age comprised 2.2 and 12.5% of horses evaluated during 1989 and 1999, respectively. Pony breeds were significantly overrepresented in the > or = 30-years-of-age group. Gastrointestinal tract, musculoskeletal, and respiratory tract problems were most frequently reported. Colic was the most common clinical sign, followed by lameness. Diagnoses made most frequently included pituitary dysfunction, strangulating lipoma of the small intestine, laminitis, heaves, large colon impaction, and gastric ulcers. Pituitary dysfunction was significantly more prevalent in horses that were > 30 years of age. Laminitis was significantly associated with the presence of pituitary dysfunction. CONCLUSIONS AND CLINICAL RELEVANCE: It was difficult to assess association of age with illnesses identified in these horses. Demographic data and information regarding common diseases of horses that are > or = 20 years of age are limited but will become increasingly important as this geriatric population increases.

Aging↗
PubMed1990

Ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. A prospective study.

The purpose of this study was to investigate the prevalence and type of lesions in the upper gastrointestinal tract and to identify characteristics associated with ulcer disease among geriatric inpatients with positive faecal occult blood test and/or iron deficiency anaemia. Two thousand five hundred and four patients aged 60-98 (mean, 82) years admitted to a geriatric clinic for rehabilitation were screened by faecal occult blood test, for B-haemoglobin, and, in a case of anaemia, analyses of serum levels of mean corpuscular volume, mean corpuscular haemoglobin concentration, iron, and total iron-binding capacity. One hundred and seventy patients were included in the study. A high prevalence of ulcer disease (22%) was found. Significantly higher proportions of non-steroidal anti-inflammatory drugs and steroid users and of patients with rheumatoid arthritis and osteoarthrosis were found among ulcer patients than among patients without ulcerative upper gastrointestinal lesions. The clinical picture of ulcer disease differed from the classic presentation: abdominal pain occurred in only 7 of 38 patients (18%), whereas appetite and weight loss and nausea/vomiting were common. It is important to be aware of the high prevalence and the clinical picture of ulcer disease among geriatric inpatients with iron deficiency anaemia and/or occult gastrointestinal bleeding.

Aged↗
PubMed1993

[The significance of repeated users of geriatric health care facility].

Our geriatric health care facility was established 3 years ago. The real number of users since April 1989 to March 1991 amounts to 519, of which 62 have been admitted 3 times or more (defined as repeated here). At the same time, this facility has a day care activity 6 times a week. The utilization rate of day care activity was 14.8% for total users, while it was 59.7% for repeaters. These results indicate that repeaters actively utilize day care activity as well as geriatric health care facility. In other words, repeaters usually reside at home and their home cares are greatly supported by both repeated admissions to the facility and daily utilization of day care activity which are effective in improving ADL of the disabled elderly. It is concluded that geriatric health care facility plays an important part in supporting home care of the disabled elderly as well as transitional step from hospital to their own home.

Aged↗
PubMed2004

[The long-term care insurance system and geriatric psychiatry].

The long-term care insurance system targets people who require support because of mental or physical disturbances due to aging. This overlaps in many areas with the field of geriatric psychiatry, which is expected to play a significant role in diagnosis and hospitalization in the long-term care insurance system. Representative of the former is the forgetfulness clinic, and representative of the latter is the "senile dementia disorder center". When a person at home or in a nursing facility becomes seriously demented or suffers serious physical illness, he is generally hospitalized. However, there is an ongoing project which allows group homes to care for the seriously demented or physically damaged elderly. Under the long-term care insurance system, there are many problems that should be dealt with by geriatric psychiatry. One essential issue is the lack of basic research on judgment abilities and mental competency, even though users are expected to select services and make their own decisions under this system. Once there is a social support system for the care-requiring elderly, it is necessary to assess the decision-making ability of individual elderly. If this ability is sufficiently maintained it should be respected to the utmost. If it is impaired, we must have a viewpoint on how to provide care through a social system. A consensus has yet to be reached on informed consent for the demented elderly, and this issue should be considered with a focus on geriatric psychiatry.

Aged↗
PubMed2005

Colorectal cancer in geriatric patients: endoscopic diagnosis and surgical treatment.

AIM: To investigate the prevalence of colorectal cancer in geriatric patients undergoing endoscopy and to analyze their outcome. METHODS: All consecutive patients older than 80 years who underwent lower gastrointestinal endoscopy between January 1995 and December 2002 at our institution were included. Patients with endoscopic diagnosis of colorectal cancer were evaluated with respect to indication, localization and stage of cancer, therapeutic consequences, and survival. RESULTS: Colorectal cancer was diagnosed in 88 patients (6% of all endoscopies, 55 women and 33 men, mean age 85.2 years). Frequent indications were lower gastrointestinal bleeding (25%), anemia (24%) or sonographic suspicion of tumor (10%). Localization of cancer was predominantly the sigmoid colon (27%), the rectum (26%), and the ascending colon (20%). Stage Dukes A was rare (1%), but Dukes D was diagnosed in 22% of cases. Curative surgery was performed in 54 patients (61.4%), in the remaining 34 patients (38.6%) surgical treatment was not feasible due to malnutrition and asthenia or cardiopulmonary comorbidity (15 patients), distant metastases (11 patients) or refusal of operation (8 patients). Patients undergoing surgery had a very low in-hospital mortality rate (2%). Operated patients had a one-year and three-year survival rate of 88% and 49%, and the survival rates for non-operated patients amounted to 46% and 13% respectively. CONCLUSION: Nearly two-thirds of 88 geriatric patients with endoscopic diagnosis of colorectal cancer underwent successful surgery at a very low perioperative mortality rate, resulting in significantly higher survival rates. Hence, the clinical relevance of lower gastrointestinal endoscopy and oncologic surgery in geriatric patients is demonstrated.

Aged↗
PubMed1990

Nursing attitudes toward geriatric alcoholism.

Nurses play a critical role in public education regarding the assessment of medical problems related to alcoholism or alcohol abuse. Nurses must assess their personal attitudes toward the disease concept of alcoholism before they can effectively provide services to geriatric patients who are alcoholics or who abuse alcohol. Among the geriatric population, there is a constellation of medical problems related to alcoholism and alcohol abuse. Potentially dysfunctional attitudes exist among nurses and other health-care professionals who are involved in the provision of medical care to geriatric patients who have alcoholism or who abuse alcohol.

Aged↗
PubMed2004

Pharmacists and their effectiveness in ensuring the appropriateness of the chronic medication regimens of geriatric inpatients.

OBJECTIVE: Geriatric patients are prescribed multiple medications by multiple physicians, leaving them at an increased risk for adverse events. The Beers criteria for determining inappropriately prescribed medications have been applied to elderly patients in various geriatric settings. Using the 1997 Beers criteria, we planned to determine if the Acute Care for Elders (ACE) team pharmacist improved the medication regimens of geriatric inpatients. DESIGN: This study was a retrospective, case series design. SETTING: The setting for this study was a large teaching hospital. PATIENTS: There were 99 patients who met the inclusion criteria. MAIN OUTCOME MEASURES: Age, gender, race, and medication data were collected for all eligible patients. The prevalence of inappropriately prescribed medications and the number of medications were determined both upon admission and at discharge. Statistical analyses were conducted where appropriate. RESULTS: Upon admission to the hospital, 10.1% of the patients were prescribed inappropriate medications. At discharge, 2.02% of patients consulted by the ACE team were prescribed an inappropriate medication. This was a statistically significant difference (P < 0.02). The number of medications at admission compared with discharge showed no statistical difference (P = 0.15). CONCLUSION: Based on the Beers criteria, the ACE team pharmacist was able to make a statistically significant difference in the number of elderly patients being prescribed inappropriate medications upon discharge when compared with admission medication regimens. The number of medications a patient was prescribed did not decrease.

Journal Article↗
PubMed2000

Dizziness among older adults: a possible geriatric syndrome.

BACKGROUND: In previous studies of dizziness, the prevalence of specific causes has varied widely and either no or multiple causes have been identified. Dizziness might be better considered a geriatric syndrome that results from impairment or disease in multiple systems. OBJECTIVE: To determine the predisposing characteristics and situational factors associated with dizziness. DESIGN: Population-based, cross-sectional study. SETTING: Community. PARTICIPANTS: Probability sample of 1087 community-living persons in New Haven, Connecticut, who were at least 72 years of age. MEASUREMENTS: Episodes of dizziness that occurred for at least 1 month; manifestations of dizziness; and predisposing demographic, medical, neurologic, sensory, and psychological characteristics. RESULTS: 261 participants (24%) reported dizziness; 56% of dizzy persons described several sensations and 74% reported several triggering activities. The adjusted relative risks for characteristics associated with dizziness were 1.69 (95% CI, 1.24 to 2.30) for anxiety, 1.36 (CI, 1.02 to 1.80) for depressive symptoms, 1.27 (CI, 0.99 to 1.63) for impaired hearing, 1.30 (CI, 1.01 to 1.68) for five or more medications, 1.31 (CI, 0.92 to 1.87) for postural hypotension, 1.34 (CI, 0.95 to 1.90) for impaired balance, and 1.31 (CI, 1.00 to 1.71) for past myocardial infarction. The adjusted relative risk for dizziness was 1.38 (CI, 1.27 to 1.49) for each additional characteristic. CONCLUSIONS: The association among characteristics in multiple domains (cardiovascular, neurologic, sensory, psychological, and medication-related) and dizziness, coupled with the multiplicity of sensations and triggering activities, suggests that dizziness may be a geriatric syndrome, similar to delirium and falling. If so, an impairment reduction strategy, proven effective for other geriatric syndromes, may be effective in reducing the symptoms and disabilities associated with dizziness.

Aged↗
PubMed1976

[Effect of volume substitution with dextran on the haemodynamics under enflurane anaesthesia in geriatric patients (author's transl)].

The haemodynamic effect of enflurane has been examined in two groups of geriatric patients, one with and the other without preanaesthetic administration of 15 mg/kg of 1,8% dextran in lactated Ringer's solution. All the patients have been immobilized for 2 to 3 days before they were operated for an orthopaedic procedure. The administration of the colloidal solution led only to minor cardiovascular alterations: a rise of central venous pressure by 6 +/- 1 (+/- S.E.M.) cm H2O, an increase of mean arterial pressure by 6 +/- 2%, an increase of cardiac output by 10 +/- 4%. Heart rate decreased by 5 +/- 4% and total peripheral resistance by 12 +/- 5%. The cardiovascular depressant effect of enflurance was markedly attenuated by the preanaesthetic volume administration. Mean arterial pressure decreased during anaesthesia by only 16 +/- 3%, as compared with a decrease of 25 +/- 7% in the control group, cardiac output remained virtually unchanged (-3 +/- 9% vs. -37 +/- 5% in the controls) and total peripheral resistance decreased not significantly by 10 +/- 12%, while it rose in the controls by 20 +/- 8%. These findings support the hypothesis that the particular sensitivity of geriatric patients towards the depressant effects of anaesthetics is at least partially due to a compensated hypovolaemia which occurs as a physiological adaptation to immbolization. Enflurane appears as a suitable anaesthetic for geriatric patients, if proper measures for preanaesthetic volume substitution are taken.

Age Factors↗
PubMed1999

Modeling geriatric depression in animals: biochemical and behavioral effects of olfactory bulbectomy in young versus aged rats.

Geriatric depression exhibits biological and therapeutic differences relative to early-onset depression. We studied olfactory bulbectomy (OBX), a paradigm that shares major features of human depression, in young versus aged rats to determine mechanisms underlying these differences. Young OBX rats showed locomotor hyperactivity and a loss of passive avoidance and tactile startle. In contrast, aged OBX animals maintained avoidance and startle responses but showed greater locomotor stimulation; the aged group also exhibited decreased grooming and suppressed feeding with novel presentation of chocolate milk, effects which were not seen in young OBX. These behavioral contrasts were accompanied by greater atrophy of the frontal/parietal cortex and midbrain in aged OBX. Serotonin transporter sites were increased in the cortex and hippocampus of young OBX rats, but were decreased in the aged OBX group. Cell signaling cascades also showed age-dependent effects, with increased adenylyl cyclase responses to monoaminergic stimulation in young OBX but no change or a decrease in aged OBX. These data indicate that there are biological distinctions in effects of OBX in young and aged animals, which, if present in geriatric depression, provide a mechanistic basis for differences in biological markers and drug responses. OBX may provide a useful animal model with which to test therapeutic interventions for geriatric depression.

Adenylyl Cyclases↗
PubMed1992

Integrating care for the geriatric patient. Examples from the Social HMO (SHMO).

Managing the care of geriatric patients with chronic disease focuses attention on the functional impairments that place these patients at risk in the home environment. Maintaining patients in their preferred home settings requires physicians to coordinate effective discharge planning and long-term community care resources. A service coordinator or case manager can play a key role in coordinating the broad array of services needed, as well as linking the providers involved. A coordinated acute and long-term care service delivery system is described, with examples from the Social HMO (SHMO). Data are presented on SHMO enrollee demographic characteristics, chronic disease conditions and functional levels, as well as data on care plans, utilization and costs. A case example illustrates how ongoing medical and long-term care are integrated. Implications for geriatric care and HMO practice are discussed, with recommendations for improving geriatric care in the next generation of SHMO sites.

Aged↗
PubMedDate not supplied

Can a house call by a public health nurse improve the quality of the discharge process for geriatric patients?

OBJECTIVE: To determine whether there was any benefit from a single house call by a health visitor (a public health nurse) to an elderly person after discharge home from a geriatric hospital. METHODS: A randomized controlled trial with blind assessments at 28 days was conducted. Subjects included residents of Bath, England, with an average age of 83 years, who were discharged consecutively from a geriatric hospital to their homes. Intervention was a single visit by a health visitor 72 hours after discharge, to ensure the patient was settled at home, or normal post-discharge care. Outcome measures taken at 28 days by a research nurse included survival, hospital readmissions, nursing home admissions, cognitive and physical function, services requested and supplied, and drug therapy. RESULTS: There were no important differences between the intervention and control groups at 28 days on any of the outcome measurements. The control subjects did better than the study subjects on many of the outcome measures. CONCLUSION: A house call by a health visitor to elderly patients after discharge from geriatric wards does not measurably improve the quality of the discharge.

Activities of Daily Living↗
PubMed1983

A hospital planning response to the "geriatric imperative".

The emerging geriatric patient population, a situation for which few hospitals are adequately prepared, is examined within the context of the "geriatric imperative." Reductions in morbidity and increases in the elderly population and the chronic diseases and disabilities associated with aging are causing hospitals to reexamine their orientation to short-term episodic care to adapt to the needs of a more elderly patient population. A geriatric care planning framework is presented to assist hospitals with this process.

Aged↗
PubMed1998

[Use of digitalis in elderly patients admitted to a geriatric unit at a general hospital].

PURPOSE: To determine the prevalence of digoxin use as well as its indications in elderly patients at the time of admission to a geriatric unit of a general hospital. METHODS: One hundred and thirty elderly patients aged 65 and over (mean age = 80 +/- 9 years), 100 women and 30 men were consecutively investigated. Each patient was submitted to a thorough clinical investigation, laboratory work-up, chest X-ray, electrocardiogram and doppler echocardiogram. The use of digoxin was considered appropriate, questionable or inappropriate. RESULTS: At the time of admission to the geriatric unit 27.6% of the patients were receiving digoxin. The indication was considered appropriate in 36.1%, questionable in 11.1% and inappropriate in 52.7%. CONCLUSION: We found a high prevalence of digoxin use in elderly patients admitted to a geriatric unit of a general hospital. In most cases its indications were considered inappropriate or questionable. Due to the increased risk of digitalis intoxication in this age group the drug should be prescribed under more strict indications.

Age Factors↗
PubMed1999

Psychosocial problems in elderly subjects from geriatric home revitalization approach.

The psychosocial aspects of aging and senility appear a major problem for the marked senescence of the Bulgarian nation--25% of the population is over the age of 60 years. The present study attempts to make a medico-ethic and social evaluation of life quality in old age and illness and outline possibilities for appropriate revitalization of elderly subjects dwelling geriatric homes. The governing body of the geriatric home does not refer to scientific methods of management for planning and organization of everyday living activities. No coping strategy is applied to reduce stress and illness offence. Current scientific revitalization approach should be realized in the policy of the geriatric home to prevent a long-term disabled existence and induce a worthier lifestyle.

Aged↗
PubMed1999

Factors related to the length of in-hospital stay of geriatric patients.

The aim of this study was to evaluate factors predicting length of stay in hospital of geriatric patients. Study participants were 402 patients (183 males and 219 females) consecutively admitted to four geriatric wards located in Chieti, Perugia, Pescara and Prato, Italy. Information on potential predictors of length of stay was collected; in particular, we assessed the presence and severity of specific chronic medical conditions, level of physical function, cognitive status, and depressive symptoms. Moreover, information on family and social support was obtained. In general, participants were old, often cognitively impaired and physically disabled. Average length of stay ranged from 9.4 +/- 3.3 days (Perugia) to 14.1 +/- 7.2 days (Chieti), and was statistically different across centers (p < 0.001). None of the specific medical diagnoses was associated with different length of stay. However, higher comorbidity score (p < 0.001), living alone (p < 0.01), lower MMSE score (p = 0.03), and poor functional status (p = 0.05) were all associated with longer length of stay. When these variables were included in a multivariate model predicting length of stay, differences between centers were no longer statistically significant. Findings of this study show that specific medical diagnoses are not adequate instruments to estimate length of stay in geriatric units. Other assessment systems based on extension of the social network, comorbidity, and the cognitive as well as the functional level need to be developed.

Age Distribution↗
PubMed1999

[Pharmacokinetic aspects of geriatric therapy].

Some pharmacokinetic aspects of geriatric therapy were showed. Influence of alterations of physiological processes (changes of protein and lipid metabolism, failure of blood circulation and of renal function) in old age, on pharmacokinetics of drugs applied in geriatric pharmacotherapy (antibiotics, antiarrhythmic drugs, hypotensive drugs) were discussed. In this context, principles of rational pharmacotherapy of geriatric patients were proposed.

Aged↗
PubMed1999

Treatment guidelines for geriatric mood disorders.

The authors reviewed the literature on the pharmacotherapy of geriatric mood disorders. Based on the evidence available, we have proposed: (i) that although any antidepressant is assumedly equal in antidepressive efficacy, ones with weak anticholinergic and antialpha1 effects are preferable in geriatric patients; (ii) that augmentation therapy with lithium and methylphenidate has modest evidence of efficacy in this population; (iii) that modified electroconvulsive therapy is safe and effective for severe and psychotic depression in the elderly; and (iv) that lithium remains the first choice for geriatric bipolar disorder, although its optimal serum level may be lower than in younger adults.

Adult↗