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PubMed1980

[Testing the effects of so-called geriatric agents].

The high average life expectation in the civilized and industrial countries can be attributed to a considerable extent to the achievements of the medical sciences. However, medical research also has the task of providing the physiological basis which will ensure that the extra years do not mean just an extension of the period of senility but instead form a period valuable for the individual and society. In accordance with the common definitions, one expects a "geriatric agent" (geriatricum) to slow down the aging process or to diminish its effects. Such influences are usually referred to as revitalization. However, a rejuvenation in the sense of a genuine reversal of the aging process is--according to our present knowledge--not possible. An objective assessment of revitalising effects can be reached by means of multivariate models of biological age, orientated on the aging process of a "normal population". However, research on human beings causes methodical difficulties and considerable expense because of the necessity for long-term studies and the importance of assessing psycho-social factors. Thus, it is necessary to test the effectiveness of "geriatric agents" primarily in the animal experiment. The laboratory rat seems well-suited for such studies. Using a multivariate model of the biological age of the rat, research into experimental influences on the aging process is demonstrated. The statistical testing and the analysis of the effects are carried out by means of discrimination analysis and factor analysis. With regard to the "geriatric agents" at present in use and the aims of experimental gerontology, it is established that such research has not yet been carried out to a satisfactory extent.

Aging↗
PubMed1994

Geriatric depression: brain imaging correlates and pharmacologic considerations.

The clinical approach to geriatric major depression involves a variety of special etiopathophysiologic, pharmacokinetic, and pharmacodynamic considerations. In regard to pathophysiology, modern brain imaging and postmortem assessments are elucidating neuropathologic changes in elderly depressives that challenge the notion that geriatric depression is simply a functional brain disorder. These data suggest (but do not yet establish) that many patients who experience depression onset at a late age may acquire affective disease on an arteriosclerotic basis. In contrast, elderly depressives who experience depression onset at an early age are more likely to have acquired depression due to genetic factors but may nevertheless develop degenerative neuropathologic changes over time. The presence of these neuropathologic changes appears to increase elderly patients' risk for developing the adverse central nervous system (CNS) effects of antidepressant treatments. They thereby add another level of complexity to the management of an age group in which pharmacokinetic and pharmacodynamic changes already contribute to the likelihood of adverse drug reactions. Fortunately, the last decade of antidepressant drug development has produced several new agents (including the serotonin selective reuptake inhibitors and more recently, venlafaxine and nefazodone) with substantially reduced CNS and cardiovascular toxicity that facilitate effective treatment of geriatric depression.

Age Factors↗
PubMed1994

[Functions of a geriatric facility].

A geriatric facility in a general hospital is a relatively new service, not clearly defined and varying in character from hospital to hospital. A geriatric rehabilitation department was opened at this hospital in 1973 and has treated more than 1,500 patients. It was originally set up to relieve pressure on the general and surgical wards. It admitted elderly patients who required additional treatment or who could not be discharged due to inability to function independently without a suitable support framework. The department has since focused increasingly on rehabilitation of elderly patients following CVA or fracture of the hip, with increasing emphasis on physiotherapy. At the same time, a geriatric facility system of work was consolidated, whose features are a multidisciplinary team, a thorough study of the patient from many aspects, and search for medical, nursing and rehabilitation solutions best suited to the patient's particular needs. Problems encountered in those admitted have recently changed, and patient turnover is now more rapid and duration of hospitalization has shortened. The department had been transformed from a long-stay ward treating chronic illness to one giving intensive treatment following an acute crisis.

Aged↗
PubMed1994

[The exhaustive geriatric evaluation in primary care: an assessment of its utility].

OBJECTIVE: To describe the preliminary results from evaluating the application of an exhaustive geriatric evaluation procedure within primary care. DESIGN: A descriptive crossover study of a non-random sample. SETTING: This was carried out in primary care at an out-station clinic serving a suburban population. PATIENTS AND OTHER PARTICIPANTS: Those people aged 70 and over who requested health-care at the clinic. All the 131 people who attended between February and December 1992 were included in the procedure. MEASUREMENTS AND MAIN RESULTS: The Exhaustive Geriatric Evaluation was applied as an instrument to diagnose hidden health problems. The instrument is composed of functional classification (Katz and Lawton-Brody scales), detection of risk factors which might lead to institutionalisation and an exhaustive clinical assessment (biomedical, psychological and socio-family). The diagnostic usefulness of the procedure is 2.4 +/- 0.21 new diagnoses per patient, for 98% of those to whom the complete new procedure was applied (62.6% of the patients included). Problems of hypoacusis (33.3%), senile memory lapses (41.6%) and urinary incontinence (26.2%) were found to a significant degree (p < 0.05) compared with the previously diagnosed morbidity. On the Katz and Lawton-Brody scales, 74% and 41.9% of patients, respectively, were independent. 55.7% of patients presented at least one risk factor leading to institutionalisation, with loneliness being the most common (35.8% of cases). CONCLUSIONS: The exhaustive geriatric evaluation is valid in primary care in looking after the elderly population, as it leads to the detection of functional and hidden bio-psychosocial problems.

Aged↗
PubMed1993

[Digoxin poisoning in patients of 2 geriatric departments in London: prevalence and mortality].

Digoxin is a toxic drug with a narrow therapeutic index that is mostly used by the elderly. Although it is accepted that toxicity of digoxin occurs more frequently in elderly than in younger patients, there is dispute about its prevalence and associated mortality. A study was therefore set up to, on the one hand, find the prevalence and associated mortality of digoxin toxicity in patients admitted onto two geriatric wards in London and, on the other hand, to study the relationship between serum digoxin level and age, serum urea, serum potassium and serum calcium in geriatric patients with digoxin toxicity. Over a period of three years 1438 patients (age 75-93) were admitted of whom 452 (31%) were on digoxin. Thirty-five patients (7.7%) were diagnosed as having digoxin toxicity. Eight patients (22.9%) with digoxin toxicity died during admission. Mortality was higher although not statistically significant for the patients with toxicity than for the patients who were on digoxin without toxicity. The fatal outcome was not predicted by age, serum urea, serum potassium or serum calcium. The serum digoxin level of the eight patients who died was lower than the level of those (n = 23) who survived. Four patients (11%) had a normal serum digoxin level and clinical features of digoxin toxicity that disappeared on stopping digoxin. A hypothesis is put foreward to explain the weak association between serum digoxin level and digoxin toxicity in geriatric patients.

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PubMed1996

Comparison of female geriatric lumbar-extension strength: asymptotic versus chronic low back pain patients and their response to active rehabilitation.

We compared lumbar-extension strength between healthy asymptomatic geriatric females (HEAL) and symptomatic geriatric females (INJ) seeking medical attention for chronic low back pain. The INJ group used the MedX lumbar-extension machine to perform isotonic exercises two times per week and were eventually reduced to one time per week. Range of motion (ROM) and strength were significantly different between groups before beginning the program. After the program, ROM and strength improved significantly and were not different from those of the HEAL group. The average length of treatment was 97 days and 20 visits. Subjective pain ratings were significantly reduced (60%) and exercise weights significantly increased (71%). This reconfirms the notion that many back pain sufferers have weaker lumbar-extension strength and that some symptomatic geriatric women can increase strength with progressive resistance exercise, which leads to a decrease in low back pain.

Aged↗
PubMed1996

[Diagnosis and discharge destination of patients admitted for mental dysfunctioning in a geriatric department].

OBJECTIVE: To determine the prevalence of psychiatric and somatic disorders and to evaluate functional status and discharge destinations of patients with impairment of mental functioning admitted to a geriatric unit of a general hospital. SETTING: Rijnstate Hospital Arnhem, the Netherlands. DESIGN: Descriptive prospective study. PATIENTS AND METHODS: In 1993, 43 patients with recent impairment in mental functioning were followed. Physical illness, course of physical and psychiatric problems and discharge destination were recorded. Psychiatric diagnoses were classified according to the DSM-III-R. The 'Barthel index' for activities of daily living (ADL), 'Mini-mental state examination', 'Hamilton depression scale' and 'delirium rating scale' were used in evaluation of functional status and mental functioning. RESULTS: All the patients had psychiatric problems (delirium 28, dementia 23, depression 6, several problems 21). Thirty-eight patients (88%) had recent physical illness, in 21 (49%) functional status was impaired (p < 0.001). In many patients improvement in mental functioning (70%), functional status (26%) and somatic condition (79%) was achieved. Improvement of the somatic condition (79%) was often (87%) accompanied by improvement of the psychiatric condition (other patients (21%): 50%, p < 0.05). Nursing home placement was needed in 53% (admitted geriatric patients in general: 13%, p < 0.001). CONCLUSION: Most patients suffered from delirium (65%). In 23 patients (53%) dementia was diagnosed, mostly for the first time. Improvement of the somatic condition was significantly related to improvement of the psychiatric condition. Patients admitted with recent impairment of mental functioning are at greater risk to be placed in a nursing home than admitted geriatric patients in general.

Activities of Daily Living↗
PubMed1997

Structural basis of geriatric voiding dysfunction. VI. Validation and update of diagnostic criteria in 71 detrusor biopsies.

PURPOSE: Refined criteria of distinctive patterns of detrusor ultrastructure in geriatric voiding dysfunctions have been developed as standard protocols for pathological evaluation of detrusor biopsies. This study was performed to test completeness and routine applicability of these protocols, corroborate our original ultrastructural/urodynamic correlations in larger material and identify subtle correlations that may have been elusive in our original study of 35 cases. MATERIALS AND METHODS: A total of 71 endoscopic detrusor biopsies was obtained from 44 elderly subjects grouped following comprehensive clinical and urodynamic evaluation into those with normal aging bladder, detrusor overactivity, impaired detrusor contractility, bladder outlet obstruction or a combination. Biopsies were evaluated ultrastructurally and randomly, and blinded to clinical information. Using standard protocols the primary ultrastructural pattern(s) was identified, additional auxiliary features were recorded and pathological diagnoses were made. Biopsies were grouped accordingly, still blindly, and correlated with urodynamic groups determined independently prior to biopsy. RESULTS: Our observations confirmed that the standard protocols are complete and readily applicable to routine ultrastructural evaluation of detrusor biopsies. They corroborated our previously reported ultrastructural/urodynamic matching of the biopsies in every case and revealed new constant features of the normally aging detrusor. We identified ultrastructural correlates distinguishing moderate and severe from mild or borderline (but not moderate from severe) impairment of detrusor contractility. CONCLUSIONS: The proposed protocols are consistently applicable to the routine pathological diagnosis of geriatric voiding dysfunction in detrusor biopsies. A diagnostic algorithm was developed to serve as a practical guide for making such diagnoses, and gaining insights into the pathophysiology of geriatric and possibly other voiding dysfunctions.

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PubMed1997

[Risk indices in geriatric surgery: ASA index versus Reiss index].

The use of the Risk Index in surgery is aimed to plan surgical strategy in order to achieve a better postoperative prognosis. This is especially true in geriatric surgery where the ASA Index and, more recently, the Reiss Index are widely employed. Since the mentioned Risk Indices are calculated on the basis of different factors, in this study we compared the two Risk Indices with the aim of verifying which index offers better prognostic indications. 210 patients, aged over 70 years, undergoing surgical treatment, were investigated. The patients were grouped according to the ASA and Reiss Indices. The ASA Index showed good correlation only with postoperative mortality. The three classes of Reiss Index showed a significant correlation with the incidence of post-operative morbidity and mortality (p.o. morbidity: 7.1%, 21.5%, 30.3%; p.o. mortality; 1.7%, 9.2%, 24.2% -Chi 2 = 20.7; p < 0.001). Our results support the hypothesis that Reiss index offers better prognostic evaluation of postoperative outcome, suggesting its use in assessing postoperative prognosis in geriatric patients. In addition, our observation confirms the criticism reported of the ASA Index, merely considered as an indicator of health status regardless of surgical treatment. In conclusion, routine preoperative evaluation of the Reiss Index should be advised in geriatric patients with the aim to forecasting surgical risk in the first place, and them modifying operative strategy in order to improve postoperative results.

Age Factors↗
PubMed1997

Hoarding symptoms in patients on a geriatric psychiatry inpatient unit.

BACKGROUND: While collecting may be a normal behaviour, hoarding is a symptom of various psychiatric disorders, including obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). Although anecdotal reports suggest that hoarding is not uncommon in geriatric psychiatry populations, its psychopathological correlates in such samples have not been well characterised. METHODS: The presence of clinically significant hoarding symptoms was screened for in 100 consecutive patients in a geriatric psychiatry inpatient unit. Both patient and collateral histories were obtained. When hoarding symptoms were present, a detailed history of their phenomenology was obtained by means of a structured questionnaire and the response of hoarding symptoms to treatment during hospitalisation was monitored. RESULTS: Clinically significant hoarding was found in 5/100 subjects. Four of these 5 patients met DSM-IV criteria for schizophrenia (paranoid subtype), with onset of symptoms coinciding with increased symptoms of dementia. The fifth patient met criteria for bipolar disorder (manic episode), also had symptoms of dementia, and had a lifelong history of hoarding. Hoarding behaviours responded to antipsychotic treatment in 3 of the 5 patients. CONCLUSIONS: A history of hoarding may be useful in many psychiatric patients, but psychopathological correlates of this symptom are likely to vary with age. In a geriatric psychiatry inpatient population hoarding was associated not with OCD or OCPD, but rather with paranoid schizophrenia and increasing symptoms of dementia. Dopamine blockers appeared useful in decreasing hoarding in some patients, raising interesting questions about the neurobiology of this symptom.

Aged↗
PubMed1997

Trace elements burden in geriatric hemodialysis patients: a prospective multicenter collaborative study.

INTRODUCTION: Hemodialysis therapy and the aging process have been reported to interfere with the trace element (TE) status in the body. This multicenter collaborative study on blood levels of TE in geriatric hemodialysis (HD) patients was carried out with an aim to clarify the impact of the aging process and HD therapy on the TE status in such patients. METHODS: One hundred and fifty-one HD patients (65 male, 86 female), all aged over 60 (68.2+/-3.86 y), and 112 elderly controls (58 male, 54 female) with a mean age of 67.5+/-3.03 were enrolled. All patients underwent standard HD for at least 6 months. The artificial kidneys used were hollow-fiber dialyzers of cellulose membranes. Water used for HD was prepared by reverse osmosis. Blood was collected in the morning prior to dialysis and after fasting. Atomic absorption spectrophotometry was applied to measure blood levels of Pb, Cd and Hg as well as plasma levels of Cu, Zn and Al. Data are presented as mean +/- SEM. Student's t-test and linear regression were applied for statistics. RESULTS: Our geriatric chronic HD patients showed a marked elevation of blood Al and decreased plasma Zn concentrations. The blood levels of Cu, Cd, Pb and Hg were within normal limits. The blood concentrations of Al, Cu and Pb were significantly higher in HD patients than in the normal elderly controls, whereas Cd and Hg were similar in both groups, and Zn were lower in HD patients. Plasma Zn value decreased as dialysis duration increased, however there was a reversely linear correlation between plasma Zn and age. CONCLUSIONS: This data reported can be regarded as a starting point and may serve as an insight to further studies on TE imbalances in geriatric and chronic HD populations.

Aged↗
PubMed1997

[Pediatric and geriatric small animal patients as risk groups in anesthesia management].

In the first 12 weeks of postnatal life puppies and kittens are defined by the term pediatric, because of their immature organ systems. In anaesthesiology they are considered as high risk patients. Dogs and cats can be defined by the term geriatric when they have completed 80% of their expected life spans. These patients show age-related decline in organ functions or in their mechanisms of compensation. Physiological and pathophysiological characteristics of pediatric and geriatric patients are discussed and principles of the perioperative anaesthetic management and of pediatric and geriatric anaesthetic techniques are given.

Age Factors↗
PubMedDate not supplied

[Surgical treatment of thyroid diseases in geriatric patients].

Thyroid diseases have a characteristic evolution in geriatric age, whether for the symptomatology frequently mingled with typical manifestations of again, or for glandular involution. Moreover, in the aged patient, the particular aspect of the epidemiology, physiopathology, clinic and therapy are to know and interpret. In most cases, the presence of a uni- or multi-nodular goiter does not cause compression problems or cancerization risk. In the presence of these problems and in multi-nodular goiter, we prefer total thyroidectomy because, at the present time, it is possible to put at zero the risks of this operation, neither we fear hypothyroidism which all the same also appears in less extensive operations. Between thyroid diseases, cancer has a typical biological behaviour and prognosis in geriatric patients. While most tumors have a better curability in geriatric age, these have a worse prognosis. So therapeutic indications very as a function of age. About this the authors present preliminary data of a prospective trial started in 1992.

Age Factors↗
PubMed1997

[Urinary and fecal incontinence in geriatric facilities in the Czech Republic].

BACKGROUND: Incontinence represents one of the common problems in long-term care geriatric facilities and nursing homes. However, in the Czech Republic data on prevalence, severity and incontinence-associated factors for nursing home residents are not available. The aim of the study was to report the prevalence of urinary (UI) and bowel incontinence (BI) in different geriatric facilities and to identify factors positively associated with incontinence. METHODS AND RESULTS: In a sample of 1162 residents of 18 long-term care facilities UI has been found in 684 residents (63.3%). Health and social care facilities did not differ significantly (60.7 vs 65.6%). Of the incontinent 294 residents (27.2%) suffered from permanent/daily incontinence, 390 (36.1%) from occasional transitory UI. Prevalence of BI reached 54.4%, as well as double incontinence (45.9%). Cognitive impairment, self-care ADL and/or mobility dependency and bed rest are factors significantly associated with UI (for all P < 0.001). However, age, gender and urinary tract infection did not reach the statistical significance (P = 0.280-0.069). Risk adjustment/stratification for UI revealed the prevalence of 33.0% in the low risk group. In the high risk group (high ADL dependency and severe cognitive impairment) the prevalence came up to 96.0%. CONCLUSIONS: Our study presents the first results focused on incontinence problem in long-term care geriatric institutions in the Czech Republic. High prevalence of this condition makes incontinence an important medical, nursing and economical yet neglected problem.

Aged↗
PubMed1976

[Chronic geriatric patient in the hospital].

The cost explosion in the health system, especially in the hospital field, and the prolongation of life, i.e. the increase of the proportion of old people in the total population, oblige us to ask the question as to the part of geriatric patients in the present and future hospital treatment. By means of statistically relevant material, i.e. 25,342 female and 20,189 male in-patients in the Municipal Hospitals Nuremberg during the year 1974, compared with investigations of the year 1964, the growing significance of the geriatric patients for the total health system is demonstrated. Particular interest is paid to the old chronically ill persons, as is shown in an estimate of the internal in-patients. 50% of the internal in-patients are chronically ill persons. The present structure of hospitals is by no means complying with this situation. As an improvement, a ward system with different aims instead of the one complex acute hospital is presented. Apart from the existing acute stations there should be provided geriatric rehabilitation wards, social stations and day-hospitals. Humanitarian and financial advantages to be expected of these new wards are outlined. Particular emphasis is given to the active rehabilitation in the sense of a comprising social-medical help.

Age Factors↗
PubMed1995

Description of a geriatric medical/psychiatry unit in a small community general hospital.

This article describes a geriatric medical/psychiatry inpatient unit (GMPU) in a small community general hospital. A program description and data from the second year of the unit's operation are presented. The GMPU provides comprehensive geriatric assessment and interdisciplinary treatment for frail, medically ill elderly patients with neuropsychiatric disorders. Many of the patients have dementia or other neurobehavioral disorders, and most reside in nursing homes. The GMPU provides a valuable clinical link in the continuum of care for the elderly. Moreover, it has proven to be an economically viable financial asset for the hospital.

Adult↗
PubMed1996

Factors related to length of stay in a geriatric evaluation and rehabilitation unit.

Factors related to length of stay were examined in 295 elderly patients (mean age = 79.0 +/- 7.3, range 65-94; males = 75, females = 220), consecutively admitted to a Geriatric Evaluation and Rehabilitation Unit (GERU, P. Richiedei Hospital, Gussago, Brescia, Italy) over a twelve-month period (November 1, 1993-October 31, 1994). Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), Tinetti Scale, Prognostic Nutritional Index (PNI), number of diseases and number of administered drugs were evaluated. An index of Disease Severity (IDS) was utilized to estimate the level of comorbidity severity. Three comorbidity classes were thus defined: I) patients with no disease of relevant severity; II) patients with only one disease of relevant severity accompanied by clinically significant comorbidity; and III) patients with two or more relevant diseases. The variables associated with the length of stay proved to be classes of comorbidity, MMSE, dependence in BADL and IADL, Tinetti scale, and PNI. The association of longer length of stay with greater comorbidity was enhanced by impairment in gait and balance (Tinetti < 18) and malnutrition (PNI > 45). These data suggest that the length of stay in hospital is related to comorbidity in patients with conditions of physical and biomedical frailty.

Aged↗
PubMed2001

Effectiveness of geriatric evaluation and care. One-year results of a multicenter randomized clinical trial.

The aim of this study was to demonstrate the effectiveness of outpatient elderly care based on Comprehensive Geriatric Assessment (CGA). Eleven hospital Geriatric Evaluation and Management units (GEMs) systematically screened 1386 inpatients over a 10-month period, using the same uniform selection plan which included 15 programmed exclusion-inclusion criteria and a standard CGA. At the end of this screening, 152 eligible frail elderly patients were randomized to either a comprehensive outpatient GEMs program (intervention group: N=79) or to usual care by their family doctors (control group: N=73). We did not find any statistically significant difference between the two groups at entry. During the one-year follow-up period, 6 GEMs patients (7.6%) and 12 controls (17.1%) died, without significant differences between the two survival curves. Only three patients (all controls) ultimately dropped out, and eight (3 unit patients and 5 controls) entered a nursing home. GEMs patients were significantly more likely to have individual improvement in mental status (p=0.006), morale (p=0.024) and functional level (p=0.023), compared to controls. Even though intervention participants spent fewer days in hospital and nursing home (p<0.05), they received much more home care and day-hospital assistance (p<0.001), which explains why total expenditure on health care was the same in the two groups. We conclude that: 1) a standardized selection plan may contribute to identify the older inpatients in need of CGA; and 2) CGA-based outpatient care may be clinical- and cost-effective if directly managed by GEMs, and may provide targeted older patients with more substantial benefits than standard care, without inflating health care expenses.

Aged↗