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At least 1,423 records · Page 79Linked to original sources
PubMed2001

Involuntary weight loss in elderly individuals: assessment and treatment.

CONTEXT: The loss of body weight and fat late in life is associated with premature death and increased risk of disability, even after excluding elderly subjects who have a preexisting disease. Although it is important to recognize that periods of substantially positive or negative energy balance and body weight fluctuation occur as a normal part of life, weight losses greater than 5% over 6 months should be investigated. We can divide the major causes of weight loss in the elderly into 4 categories: social, psychiatric, due to medical conditions, and age-related. The clinical evaluation should include a careful history and physical examination. If these fail to provide clues to the weight loss, simple diagnostic tests are indicated. A period of watchful waiting is preferable to blind pursuit of additional diagnostic testing that may yield few useful data, if the results of these initial tests are normal. The first step in managing patients with weight loss is to identify and treat any specific causative or contributing conditions and to provide nutritional support when indicated. Non-orexigenic drugs have found an established place in the management of protein-energy malnutrition. Early attention to nutrition and prevention of weight loss during periods of acute stress, particularly during hospitalization, may be extremely important, as efforts directed at re-feeding are often unsuccessful. DESIGN: Narrative review.

Age Factors↗
PubMed1989

[The influence of total parenteral nutrition on the circadian rhythm of the heart rate in elderly patients with wasting diseases].

The circadian rhythm of the heart rate was assessed using 24 hour electrocardiographic recordings in 18 hospitalized elderly patients with wasting diseases receiving total parenteral nutrition. The nutrient solutions were administered at doses ranging from 360 to 1640 kcal/day. To determine if the heart rate fluctuates rhythmically with a circadian period, the mean hourly heart rate on 24 hour electrocardiographic recordings was used to fit cosine curves by the statistical technique of least squares, and three parameters of the rhythm--designated the mesor, amplitude, and acrophase--were estimated. The cosine curves fitted with a P value of 0.01 or less in all patients before and after insertion of central venous catheters. The mesor represented the rhythm--adjusted mean of the heart rate. The mesor increased significantly with increase in the energy infusion rate (p less than 0.01). The amplitude values were derived from one half of the total diurnal variation of heart rate and the acrophase indicated the time when heart rates were at their peak above the mean. Neither amplitude nor acrophase changed significantly with increase in the energy infusion rate. Furthermore, neither norepinephrine nor epinephrine plasma levels changed with nutrient administration. There were no significant changes in thyroid hormone concentrations. There was a significant positive correlation between mesor changes and rectal temperature with increase in the energy infusion rate (r = 0.76, p less than 0.01). In severely malnourished subjects, changes in the level of feeding can profoundly affect cardiac functions and thermogenic response.

Aged↗
PubMed1992

Was disease involved in the decimation of Guam's avifauna?

Between 1982 and 1986, 402 (290 live, 112 dead) exotic, migrant or native resident birds on Guam were surveyed for disease-causing agents to determine the role of disease in the decline of native forest bird populations on Guam. Traumatic injury, primarily from collisions with motor vehicles and predation, was the most prevalent (46%) cause of death. Thirty-eight percent of the carcasses examined were in poor body condition largely as a result of inadequate nutrition in captive native birds and poultry and adipose exhaustion in errant migrants. A variety of commensal or opportunistic bacteria, including Salmonella spp., were cultured from 220 birds, and nothing remarkable was found in 15 fecal samples. Lastly, no haematozoans, the suspected cause for the decline of the Hawaiian avifauna, were observed in blood slides examined from 260 birds. Based on the results of the survey and other lines of evidence presented in the discussion, we concluded there were no data implicating disease in the decline of Guam's avifauna.

Accidents, Aviation↗
PubMed1998

[Evaluation on the clinical background on early death in patients with pulmonary tuberculosis during the past five years].

We evaluated the clinical background of early death (within 3 months after admission to our hospital) in patients with active pulmonary tuberculosis during the past five years (1992-1996). Among 65 active pulmonary tuberculosis patients who died during the past five years, 32 (49%) died directly of tuberculosis. Thirteen (41%) of those 32 patients died of acute respiratory failure and 9 patients (28%) died in emacitation state. Twenty two patients (69%) died within 3 months after admission to our hospital (the early death group) and 10 patients (31%) died after 3 months (the late death group). Thirteen patients (59%) in the early death group died of acute respiratory failure. On the other hand, none in the late death group died of acute respiratory failure but 4 patients died of chronic heart and/or respiratory failure and 4 patients died in emarciation state. Compared to the patients in the late death group, more patients in the early death group had long total delays (patient's and doctor's delays), had coexisiting diseases, had fallen into acute respiratory failure, and were under malnutrition. We evaluated the nutritional condition of patients using the Onodera's PNI (Prognostic Nutritional Index; 10 x serum almumin concentration + 0.005 x peripheral lymphocyte count) and the PNI value was lower among the patients in the early death group than among those in the late death group. To prevent death due to tuberculosis, we emphasize that it is important to start anti-tuberculosis therapy before patients fall into acute respiratory failure and/or malnutrition.

Acute Disease↗
PubMed1998

[Report of national survey on death due to tuberculosis in 1994 in national hospitals and the treatment and prognosis of tuberculous patients with mechanical ventilation].

1. National survey on died patients with active tuberculosis (tbc) or tbc sequelae had been held in national hospitals every five year from 1959 (3433 cases) to 1994 (688 cases). In 1994, 330 patients died due to pulmonary tbc. Recent study revealed the decreased rate of death due to operation, or far advanced cavitary cases, and the increased rate of nontuberculous death, aged people (> 60 yrs), and nontuberculous complications. Main causes of death in pulmonary tbc were lung insufficiency (about half) and general weakness (almost one fifth) in any survey. Rapid progression of pulmonary tbc had been increased cause of death (20.9% in 1994). Main attributable factors of death in 1994 in pulmonary tbc cases were severe condition on admission (38.4%), disturbed lung function (31.2%) and old age (33.2%). Delayed treatment (13.9%) and complications (12.1%) were increasing factors. Early death within 3 months from onset in 1994 was seen in patients < 60 yrs as well as in patients > 80 yrs. Severity due to delayed treatment and rapid progression were supposed to the causes of early death. 2. During 1994 to 1997, mechanical ventilation (MV; > 24 hours) was applied to 18 patients with active pulmonary tuberculosis; 10 acute respiratory failure (ARF), 5 chronic respiratory failure (CRF), 2 central nervous system tbc and 1 hemoptysis. Only one ARF case and three CRF ones survived. ARF cases had low PaO2/FIO2 (about 100), low albuminemia, short MV period (7 cases: < 7 days) and steroid therapy (9 cases). CRF cases had higher PaO2/FIO2 (294), longer MV period (4 cases: > 30 days) and all CO2 narcosis. 3. Noninvasive positive pressure ventilation (NIPPV) was applied to 23 patients with pulmonary tbc sequelae. In 13 patients with stable chronic respiratory failure (mean PaO2 91 mmHg, PaCO2 82 mmHg) 10 continued NIPPV and started home mechanical ventilation (HMV). In 10 patients with acute on chronic respiratory failure (mean PaO2 61 mmHg, PaCO2 92 mmHg) 2 patients fell into tracheal intermittent positive pressure ventilation (TIPPV). Eight patients recovered with NIPPV and 5 started HMV. NIPPV is supposed to be very effective to treat severe chronic hypercapmic respiratory failure.

Adult↗
PubMed1975

[Clinical study and course of 102 cases of chronic pancreatitis].

Symptomatology, signs and clinical course were studied in 102 cases of chronic pancreatics (CP), confirmed on the basis of strict criteria. Calcifications were present in 72 cases and chronic alcoholism in 81 cases. In seven patients acute pancreatitis, confirmed at surgery, appeared to have preceeded the development of CP. The only clinical difference between calcifying and non-calcifying forms was a higher incidence of steatorrhea in the first group. Cholelithiasis was present in 17 p.cent, alcoholic cirrhosis in 17 p.cent and a peptic ulcer in 24 p.cent of the whole series. Seventy two patients underwent surgery either for a complication in their course (attack of acute pancreatitis, pancreatic pseudo-cyst, cholestatic jaundice, segmental portal hypertension or antro-pyloroduodenal stenosis) or for cholelithiasis. Course assessed in 70 patients studied for more than 2 years was regressive in almost 60 p.cent of cases. There was no difference in the frequency of regression in those patients undergoing surgery and those treated medically only. In all cases, abstention from alcohol is an essential factor to a favourable result.

Adult↗