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PubMed2005

Geriatric autopsy findings in the last 10 years: an Urban Teaching Hospital experience.

In this study, we reviewed autopsy records for clinical data and autopsy findings from patients aged 70 or more, over a 10-year period (1993 to 2002) in an urban university hospital. For that period, there were a total of 772 autopsy cases of which 180 (23%) patients were aged 70 years or older. We found that despite a marked decrease in total autopsy rates, there has been a perceptible rise in geriatric cases. Cardiovascular and infectious diseases in this age group are the leading causes of death as reported nationally. We found that women died more of acute myocardial infarctions than men, even though hypertensive and atherosclerotic cardiovascular diseases not otherwise specified were more prevalent in men. It is our conclusion that at our institution: 1) despite a marked decrease in the total autopsy rate, the geriatric autopsy rate is rising; 2) infectious and cardiovascular diseases are the leading causes of death in elderly patients; 3) Myocardial infarcts as a cause of death are more often seen in women for this age group. It is also our impression that better autopsy reporting is needed for maximal utilization of autopsy findings in medical auditing and teaching and for improvements in the quality of patient care in general and the geriatric patient in particular.

Aged↗
PubMed1992

[Drug administration schedules in geriatric patients].

BACKGROUND: In this study the prescription of drugs in an outpatients geriatric population was evaluated in terms of age and body weight. METHODS: From a wide survey carried out on 500 geriatric outpatients, all the prescriptions corresponding to H-2 antagonists, digoxin, theophylline, bromazepam, diazepam, lorazepam and triazolam were analyzed. The patients studied were of 60 or more years of age. For each drug patients were stratified into groups according to intervals of body weight with mean age of the patient being determined in each of the intervals as well as the doses received in mg/kg. RESULTS: Two hundred eighty prescriptions were analyzed with 12% corresponding to the H-2 antagonists, 29% to digoxin, 23% to theophylline and 35% to benzodiazepines. There was no significant correlation between age and the doses received. In general, the lowest body weight corresponded with a higher mean age and a marked increase in the mean dose of cimetidine, ranitidine, theophylline, bromazepam, lorazepam, and triazolam administered. There was a tendency to an adjustment in the doses of digoxin in the most elderly patients. CONCLUSIONS: The data found concerning the prescription of drugs to a geriatric outpatients population indicate that in elderly patients adjustments are not made in the doses of drugs administered according to the age and body weight of the patient. Low body weight of the elderly is a overdosage risk factor.

Age Factors↗
PubMedDate not supplied

Prevalence of disability and handicaps in geriatric population in rural south India.

Proportion of aged persons in India is increasing and is expected to be around 70 million by the end of the year 2000. The epidemiological consequences would be increase in the geriatric problems, particularly, impairments, disabilities and handicaps There are not many community-based studies using the International Classification of Impairments, Disabilities and Handicaps (ICIDH). The main objective of this study was to estimate the prevalence of disabled in the elderly population (aged above 60 years) in a district of south India using ICIDH classification. Thirty villages were selected using probability proportional to size linear systematic sampling (PPSLSS) from Villupuram health unit district in Tamilnadu in south India. One hundred and five households were selected from each selected village by using linear systematic sampling. A structured proforma was administered to 974 subjects to obtain information on disability as perceived by rural geriatric population. Visual disability was found to be the most important single preventable disability (56%). Only 33% of persons with visual disability wore spectacles. A decline in social interaction was reported. There was an urgent need to strengthen health care activities related to geriatric health care to improve the quality of life of the elderly population, including care of vision in particular.

Activities of Daily Living↗
PubMed2005

[Structured educational programs for geriatric patients with diabetes mellitus].

Two-thirds of all diabetics are older than 60 years. Owing to the presence of multimorbidity and functional impairments, one-half of these diabetics must be considered "geriatric patients". This category of patients in particular requires a special educational program aimed at improving their situation and quality of life on the basis of good diabetic control. Currently, two educational concepts aimed in particular at elderly patients with type II diabetics and cognitive deficits are available and are described in the present paper. Education for diabetics with impairment of cognitive performance is available to such diabetics irrespective of age. The educational program: "Structured Education for Persons with Type II Diabetes in Old Age", newly developed by the Working Group Diabetes and Geriatrics of the German Diabetes Society teaches self-help skills, offers opportunities for empowerment, and has proved successful also in geriatric patients with mild cognitive deficits.

Aged↗
PubMed2005

Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital.

OBJECTIVES: To investigate the prevalence and risk factors of malnutrition in geriatric patients admitted to a convalescent and rehabilitation hospital. DESIGN: Cross-sectional study. SETTING: Regional hospital, Hong Kong. PATIENTS: A total of 120 patients (aged 60 years or older) referred to Tung Wah Eastern Hospital. MAIN OUTCOME MEASURES: Anthropometric, biochemical, and haematological parameters were measured for nutritional assessment. Malnutrition was defined as a body mass index of lower than 18.5 kg/m(2) and serum albumin level of lower than 35 g/L. The clinical outcomes of patients were also recorded. The predictive value of the Chinese Mini Nutritional Assessment as a nutritional screening tool was assessed. Potential risk factors associated with malnutrition were evaluated according to established protocols. RESULTS: The mean age of patients was 80.3 years (standard deviation, 7.4 years), and the mean body mass index was 21.9 kg/m(2) (standard deviation, 4.4 kg/m(2)). The prevalence of malnutrition was 16.7%. The age distribution of malnourished patients (mean, 86.2 years; standard deviation, 7.0 years; n=20) was significantly different to those nourished (mean, 79.1 years; standard deviation, 6.9 years; n=100) [P=0.0001]. Mortality was also higher in malnourished patients (25%) than nourished patients (4%) [P=0.001]. Based on the Chinese Mini Nutritional Assessment, 16.9% of patients were classified as malnourished (cut-off value, 18.5). The Chinese Mini Nutritional Assessment was useful as a screening tool to exclude patients who were not malnourished, ie it had a high negative predictive value (95%). Being totally dependent for the performance of activities of daily living, living in a home for the elderly, and being chair- or bed-bound posed a significantly increased risk of malnutrition. The presence of mental depression (geriatric depression scale score of 8 or higher), moderately or severely impaired cognitive function (abbreviated mental test score of lower than 7), or polypharmacy (five medications or more) did not significantly affect risk of malnutrition. CONCLUSIONS: Malnutrition was common in the geriatric patients studied and was associated with an increased mortality. The Chinese Mini Nutritional Assessment was a useful screening tool to exclude malnutrition. Significant risk factors of malnutrition were total dependence, living in a home for the elderly, and being chair- or bed-bound.

Age Factors↗
PubMed1992

[Intensive care of geriatric patients in surgery].

BASIC REMARKS: Concomitant cardiovascular and pulmonary diseases in particular represent a considerable risk to the postoperative course in the geriatric patient. MAIN DISCUSSION POINTS: The main aim of intensive care consists in the avoidance and treatment of systemic complications. In contrast, local surgical complications as the reason for intensive care are of secondary importance in the geriatric patient. In the postoperative phase, the main problems encountered by the geriatric patient affect the cardiovascular system and pulmonary function. Age-specific pathophysiological changes affecting the lungs and heart require prophylactic measures aimed at preventing atelectasis, bronchial pneumonia and edema. As a rule, patients of advanced age require such intensive care for one to three days. CONCLUSIONS: The perioperative care of the elderly patient comprises, where possible, preoperative preparation and, postoperatively, a specific prophylactic intensive care regimen.

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PubMed1992

Geriatric rehabilitation: perspectives from the United Kingdom.

Although rehabilitation professionals acknowledge the need for more services for the aging American society, only recently has there been large-scale discussion on the state of geriatric rehabilitation in the United States. In contrast, geriatric rehabilitation has been a central component of British health planning since the beginning of the National Health Service in 1948. In the hope of stimulating discussion, this article examines geriatric rehabilitation services in the United Kingdom. Contrasts between the UK and US are drawn to highlight the relative strengths and weaknesses of each system of care. The importance of cultural determinants to health care services is emphasized.

Comprehensive Health Care↗
PubMed2006

[Friendship relationship in the geriatric institution].

This article aims at understanding what the friend and friendship represent for the elderly in the context of the geriatric home. One utilized the qualitative approach while the techniques for data collection were: thematic interview and indirect participant observation. The collection period was from April to June 2003, in a geriatric home located in the city of Salvador, Bahia. 15 elderly subjects were interviewed. The used analysis was of thematic contents. We understood that the definition of friend and friendship for the institutionalized elderly is associated with his shortages in the life of the geriatric home. One comes to the conclusion that the friendship relations established transcend ages, cultures and physical conditions.

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PubMed2006

Rapid onset of Parkinsonian-like symptoms in a geriatric dental patient: a case report.

This article reviews the clinical issues regarding adverse drug reactions in geriatric dental patients. Accurate clinical observations and diagnosis are complicated in geriatric patients because they are predisposed to chronic illnesses, various prescribing physicians, and a decreased ability to metabolize and detoxify multiple medications. The authors have further reviewed neurological motor reactions with a detailed review of the physical presentations of Parkinson's disease. As such, the dental professional has a unique opportunity to provide observational feedback to other healthcare providers concerning the health status of their geriatric patients. In this case report, the changes in the patient's physical status and mental well-being were not a result or associated with a catastrophic event (eg, stroke, cardiovascular event, or head injury). The patient's rapid degeneration was anecdotally associated with a recently prescribed group of medications, which shows the need for healthcare professionals to be aware of changes in medications when assessing patients' health.

Aged, 80 and over↗
PubMed1992

Hip fractures in geriatric patients. Results of an interdisciplinary hospital care program.

The care of geriatric patients who sustain hip fractures is difficult because of associated medical comorbidities, the risk of medical and surgical complications, and the functional limitations that are often present before the fracture. The authors developed and used a comprehensive, interdisciplinary care program that has so far treated 431 geriatric hip fracture patients. The results of the program group were compared to a matched nonprogram group of patients (n = 60) cared for before the initiation of the program (and before the initiation of diagnosis-related groups). The program patients had fewer postoperative complications, significantly fewer (p less than .05) intensive care unit transfers (10.2% versus 20%), significantly improved (p less than .001) ambulatory ability at discharge (56.3% independent with assistive devices versus 18.2%), and proportionately fewer discharges to nursing homes (8.1% versus 19.3%). These results support the use of an interdisciplinary approach as a means of improving the inhospital care of geriatric hip fracture patients.

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PubMed1991

Severely injured geriatric patients return to independent living: a study of factors influencing function and independence.

Our previous work demonstrated that geriatric trauma patients (age greater than 65 years) consume disproportionate amounts of health care resources. In the past we hypothesized that late mortality is high, long-term outcome is poor, and return to independence is low in a severely injured geriatric population. Of 6,480 trauma admissions over 5 years, geriatric patients (n = 495) with blunt trauma injury (n = 421) and an ISS greater than 16 (n = 105) who survived until discharge (n = 61) underwent long-term follow-up (mean = 2.82 years). We surveyed 20 measures of functional ability; 10 measures of independence; availability and use of rehabilitation resources; employment history; alcohol use; support systems; and nursing home requirements. Of the 105 patients, 7 were subsequently lost to follow-up. Among the remaining 98, 44 (44.9%) died in hospital and 54 (55.1%) were discharged and interviewed. The mean age of the contacted patients was 72.6; their mean ISS was 23.3. Forty eight of 54 (88.9%) were alive at the time of interview, while 6/54 (11.1%) had died. Although only 8/48 patients regained their preinjury level of function, 32/48 (67%) returned to independent living. The 32 independent patients, those with "acceptable" outcome, were compared with an "unacceptable" outcome group composed of the 44 in-hospital deaths, the 6 late deaths, and the 16 dependent patients. Factors associated with poor outcome include a GCS score less than or equal to (p = 0.001), age greater than or equal to 75 (p = 0.004), shock upon admission (p = 0.014), presence of head injury (p = 0.03), and sepsis (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMedDate not supplied

Financing geriatric programs in community health centers.

There are approximately 600 Community and Migrant Health Centers (C/MHCs) providing preventive and primary health care services principally to medically underserved rural and urban areas across the United States. The need to develop geriatric programs within C/MHCs is clear. Less clear is how and under what circumstances a comprehensive geriatric program can be adequately financed. The Health Resources and Services Administration of the Public Health Service contracted with La Jolla Management Corporation and Duke University Center on Aging to identify successful techniques for obtaining funding by examining 10 "good practice" C/MHC geriatric programs. The results from this study indicated that effective techniques included using a variety of funding sources, maintaining accurate cost-per-user information, developing a marketing strategy and user incentives, collaborating with the area agency on aging and other community organizations, and developing special services for the elderly. Developing cost-per-user information allowed for identifying appropriate "drawing card" services, negotiating sound reimbursement rates and contracts with other providers, and assessing the financial impact of changing service mixes. A marketing strategy was used to enhance the ability of the centers to provide a comprehensive package of services. Collaboration with the area agency on aging and other community organizations and volunteers in the aging network was found to help establish referral networks and subsequently increase the number of elderly patients served. Finally, development of special services for the elderly, such as adult day care, case management, and health education, was found to increase program visibility, opportunities to work with the network of services for the aging, and clinical utilization.

Community Health Centers↗
PubMed1991

Urinary incontinence in the geriatric population.

Urinary incontinence in the geriatric population is prevalent, morbid, and costly. Despite the high prevalence and adverse effects, many incontinent geriatric patients do not undergo any type of diagnostic evaluation. Assessment of incontinence in this patient population should focus on identifying reversible factors that may contribute to the incontinence, determining whether the patient should be referred for further evaluation before initiating treatment, and pinpointing the cause(s) of the incontinence so that appropriate treatment can be instituted. Many different therapeutic modalities can be helpful for geriatric urinary incontinence, including behavioral, pharmacologic, and surgical approaches. Chronic catheters and diapers should generally not be used as the initial treatment, and be reserved for patients who fail more specific treatment approaches. Although it may not be possible to cure the incontinence, it is almost always possible to ameliorate the problem, and prevent discomfort, complications, and excessive costs.

Aged↗
PubMed1990

Utility and tolerance of stress testing in geriatric patients.

OBJECTIVES: To determine the sensitivity and specificity of stress testing in geriatric patients and to estimate the tolerance of these patients to exercise. DESIGN: A prospective study done in two populations with different ages. SETTING: Cardiologists and a stress testing laboratory. PATIENTS: Persons with ages above and under 65 years who were admitted in our center and submitted to stress testing and coronary angiography for suspicion of ischemic heart disease. PROCEDURES: All stress tests were performed on a Siemens Elama cicloergometer model 380-B adapted to a Hewlett Packard 1517 A ECG recorder. Our protocol started with an initial work load of 30 Watts with increments of other 30 Watts every three minutes. A 12 lead ECG was registered at rest, at maximum effort and in the recovery phase (approx. eight minutes after maximum effort). Three leads ECG's (V2, aVF, V5) were registered every three minutes. Stress finishing criteria were: symptom's limited, fatigue and maximum heart rate (220-age). Blood pressure was also controlled every three minutes during exercise and every two minutes during the recovery phase. Coronary angiographies were performed on a Siemens Cardoskop U (cine) using the Judkins technique. Left anterior oblique, right anterior oblique and postero anterior projections were used in all the procedures. RESULTS: Stress testing presents high sensitivity and low specificity in geriatric patients. A good tolerance to exercise was observed in this group of patients. CONCLUSIONS: A similar sensitivity was observed in the stress tests performed by patients with ages above and under 65 years. Sensitivity seems to be related to the severity of the coronary lesion. On the other hand stress testing presented a lower specificity in the geriatric patient. Finally, good tolerance to exercise was observed in patients older than 65 years.

Aged↗
PubMed1990

Orthopaedic geriatric care--is it effective? A prospective population-based comparison of outcome in fractured neck of femur.

Orthopaedic geriatric care has become widely accepted despite relatively little formal evaluation. In the East Dorset health authority all patients with fractured neck of femur initially share common orthopaedic facilities but only those from one geographical sector have subsequent access to an orthopaedic geriatric unit, patients from the other sector receiving standard care. We have carried out a prospective population-based comparison of the outcome of 155 consecutive incident cases of fractured neck of femur aged over 65 years. On admission to hospital the two populations were similar in respect of age, sex, fracture type, social status, medical and orthopaedic problems, mental status and dependency (Clifton assessment procedure for the elderly). Multiple regression analysis showed that the mean length of stay was 9.5 days shorter in patients from the sector with access to orthopaedic geriatric care (p less than 0.05, 95% confidence interval 0.6 to 18.4 days). This reduction was not due to any difference between the two groups as regards dependency or the level of support provided on discharge. There was no difference in outcome at 6 months post-operatively in terms of mortality, functional outcome (pain and mobility), change in dependency or social status. We conclude that in the East Dorset health authority this combined approach has resulted in a significant reduction in the length of inpatient stay without any other apparent effect on patient outcome.

Age Factors↗
PubMed1990

[Polypharmacy in patients of a geriatric department of a general hospital].

At three somato-geriatric and one psychogeriatric units in the Amsterdam 'Slotervaartziekenhuis', retrospective research into the use of drugs by all patients admitted in 1985 (n = 724) was conducted. The main aim was to answer the question whether geriatric treatment can reduce the hitherto frequently described polypharmacy of the elderly. For that purpose the medication of all patients is registered as from their admission into hospital until the time of discharge from hospital. The average number of drugs used in the hospital appeared to have increased from 2.8 on admission to 3.8 on discharge. Geriatricians in Amsterdam were unable to reduce polypharmacy, probably because of the multiple pathology of their patients (4.4 diagnoses on discharge per patient). Yet, they prescribed only 0.86 drug per diagnosis on average. The most frequently prescribed drugs were vitamins, laxatives, diuretics, analgetics, sedatives/hypnotics and cardiovascular drugs. Antibiotics were used by a large percentage (46%) of the patients. On admission clearly fewer drugs (2.4) were used by patients who lived independently than by patients from residential and nursing homes (respectively 4.1 and 3.6). Eight percent of the patients was admitted because of adverse drug reactions or intoxications. On admission they used an average number of 4.1 drugs daily, which is considerably more than the number (2.7) used by other patients. Their drug use of course was reconsidered during their stay at the geriatric department.

Aged↗
PubMed1990

Violence by geriatric patients who need psychiatric hospitalization.

The authors examine issues related to violent behavior exhibited by elderly patients during episodes of mental illness that are severe enough to warrant psychiatric hospitalization. The medical records of 195 geriatric patients admitted to a psychiatric hospital over a 9-year period were reviewed. During the 2 weeks before admission, 20% of the geriatric patients physically assaulted others, 20% engaged in fear-inducing behavior, and 60% were not violent. Patients with senile organic psychotic conditions were significantly more likely to attack others than were patients with other diagnoses. The most common victims of the patients' violent behavior were family members. The authors discuss the implications of these findings for treatment of geriatric psychiatric patients and their families.

Age Factors↗
PubMed1989

Septic arthritis in the geriatric population.

Septic arthritis has emerged as an important infection in geriatric patients. Between 25% and 50% of all cases of nongonococcal bacterial arthritis in nonprosthetic joints occur in patients over the age of sixty years. Thirty-three percent of nongonococcal septic arthritis occurs in the geriatric population. In this retrospective study of geriatric septic arthritis, 22 patients were reviewed. The major predisposing factor was prior history of arthritis, with the knee being the most commonly affected joint. Staphylococcus aureus was the major pathogen, with gram-negative organisms accounting for a significant number of infections. We think that empiric antibiotic coverage for gram-negative organisms should be initiated at the time of treatment only in patients with multiple predisposing factors for septic arthritis. The disease also may be more indolent than previously reported, leading to delayed diagnosis, treatment, and increased morbidity and mortality.

Aged↗