Showing papers in "Age and Ageing in 1988"
TL;DR: Discriminant analysis of selected medical and anthropometric variables indicated that handgrip strength in the dominant hand and reported symptoms of arthritis, giddiness and foot difficulties were most influential in predicting reports of recent falls.
Abstract: Of 1042 individuals aged 65 years and over who were successfully interviewed in a community survey of health and physical activity, 35% (n = 356) reported one or more falls in the preceding year. Although the overall ratio of female fallers to male fallers was 2.7:1, this ratio approached unity with advancing age. Mobility was significantly impaired in those reporting falls. Asked to provide a reason for their falls, 53% reported tripping, 8% dizziness and 6% reported blackouts. A further 19% were unable to give a reason. There was no association between falls and the use of diuretics, antihypertensives or tranquilizers, but a significant association between falls and the use of hypnotics and antidepressants was found. Discriminant analysis of selected medical and anthropometric variables indicated that handgrip strength in the dominant hand and reported symptoms of arthritis, giddiness and foot difficulties were most influential in predicting reports of recent falls.
1,219 citations
TL;DR: A study of concurrent validity has shown a strong correlation between the disability index obtained by the SMAF and the amount of required nursing-care time.
Abstract: The Functional Autonomy Measurement System (SMAF) is an instrument developed for the measurement of the needs of the elderly and the handicapped. Its elaboration was based on the World Health Organization's classification of impairments, disabilities and handicaps. A functional autonomy rating scale, using a four-level measurement scale, quantifies a subject's performance on 29 functions in five sectors of activity: activities of daily living, mobility, communication, mental functions and instrumental activities of daily living. For each function, the evaluator must also estimate available resources to compensate for any identified disability in order to estimate the handicap. The disability and handicap profile obtained is the basis for the prescription of home care or the allocation of chronic care beds. An inter-observer study concluded that the scale is reliable for evaluators from different professions in the community as well as in institutional settings. The instrument is rapid to administer (on average 42 min) and the reliability is not influenced by training. A study of concurrent validity has shown a strong correlation between the disability index obtained by the SMAF and the amount of required nursing-care time. This instrument can be used for clinical purposes and in epidemiological and evaluative research.
418 citations
TL;DR: Free-field voice testing appears a simple, reliable and reproducible test for detecting hearing impairment in elderly patients.
Abstract: This study investigated the reliability of simple bedside free-field voice testing in the detection of hearing impairment in patients admitted to a geriatric unit. Sixty-two consecutive admissions were assessed at four graduated levels of loudness by geriatrician and otolaryngologist independently. Pure tone audiometry was then performed blind. Voice testing by both observers was concordant in 88% of all ears and in 100% of ears able to hear a whispered voice (WV) at 2 ft (approximately 0.6 m). The WV at 2 ft was the most discriminant test with a sensitivity of 100%, a specificity of 84% and a predictive value of 92% for hearing impairment likely to benefit from provision of a hearing aid. Free-field voice testing appears a simple, reliable and reproducible test for detecting hearing impairment in elderly patients.
202 citations
TL;DR: A serial record showing improvement in walking speed proved useful in predicting eventual independent mobility of poorly mobile subjects and is an objective yet inexpensive method of monitoring gait rehabilitation.
Abstract: Walking speed was measured on admission and then weekly during treatment of 125 subjects admitted to a geriatric rehabilitation ward. Walking speed was strongly related to the ability to stand up from a chair without help. Placement decisions at discharge were made without knowledge of gait speed data so that they could be used as a standard against which to compare walking speed as a valid and practical measure of mobility. It was found that a discharge walking speed of 0.15 m/s best separated immobile subjects who required long-term hospital care from those sufficiently mobile to be discharged home alone or to a rest home (54% versus 0% below cut-off, respectively). Relative walking speed (speed/height) was no better at predicting placement or mortality than walking speed. Uncorrected walking speed therefore remains the preferred clinical measure of velocity. A serial record showing improvement in walking speed proved useful in predicting eventual independent mobility of poorly mobile subjects. Thus walking speed is an objective yet inexpensive method of monitoring gait rehabilitation.
151 citations
TL;DR: Alz patients lose weight and on average weigh 21% less than ND patients and 14% less Than MID patients, and this weight loss is not accounted for by any obvious deficit in food intake, or by mal absorption.
Abstract: Nutritional assessments were performed in three groups of hospitalized elderly women comparable in age and mobility: a group with Alzheimer's disease (ALZ), a multi-infarct dementia group (MID) and a nondemented group (ND). We have shown that: ALZ patients lose weight and on average weigh 21% less than ND patients and 14% less than MID patients. This weight loss is not accounted for by any obvious deficit in food intake, or by malabsorption. Biochemical indices of nutrition are little different in the three groups. The reason for weight loss in ALZ remains uncertain.
132 citations
TL;DR: The results emphasize that, in addition to apparently 'normal' age-related changes in the structure of sleep, subjective insomnia in old age may often be mediated by the physical and psychological disorders which can accompany ageing.
Abstract: Profiles of sleeping habits, subjective sleep quality, and mental and physical well-being were obtained from 1023 elderly individuals randomly sampled from the Nottinghamshire Family Practitioner Committee's records. Subjective insomnia at least 'sometimes' was reported by 37.9% of the sample. Discriminant analysis of selected health and demographic variables indicated that symptoms of anxiety, sex and self-ratings of health were the factors most influential in predicting reports of problem sleep. Thus, respondents classified as subjective insomniacs tended to have significantly higher anxiety scores, to be women, and to rate their health as below average. Relative to the non-insomniac respondents, those complaining of sleep problems also perceived their sleep latency as longer, and their total sleep as shorter. These results emphasize that, in addition to apparently 'normal' age-related changes in the structure of sleep, subjective insomnia in old age may often be mediated by the physical and psychological disorders which can accompany ageing.
84 citations
TL;DR: This study may not have shown any significant improvement in neuropsychological function because the exercise programme was too light to improve aerobic fitness, or because neuroPsychological tests were repeated 3-7 days after exercise was completed and any acute effects of exercise may have disappeared by that time.
Abstract: This randomized controlled trial examined the effect of a 3-month exercise programme on neuropsychological function in a population of very elderly institutionalized women. Baseline neuropsychological testing was performed, and following 3 months of exercise or control intervention, subjects were retested 3-7 days after the completion of the study period. Apart from the Word Fluency Test, there was no significant improvement in any of the neuropsychological test scores. This study may not have shown any significant improvement in neuropsychological function because our exercise programme was too light to improve aerobic fitness, or because neuropsychological tests were repeated 3-7 days after exercise was completed and any acute effects of exercise may have disappeared by that time.
76 citations
TL;DR: The psychiatric morbidity among 390 residents of the 12 Part III homes managed by the London Borough of Camden has been assessed using a standard interview, for comparison with data obtained from residents in a previous survey, suggesting that Part II homes are continuing to amass a large number of residents suffering from dementia and depression.
Abstract: The psychiatric morbidity among 390 (89%) residents of the 12 Part III homes managed by the London Borough of Camden has been assessed using a standard interview, for comparison with data obtained from residents in a previous survey. Fewer residents were now assessed as having no evidence of dementia or depression, the proportion with some degree of dementia having risen in the 3.6-years follow-up period. Of the original residents, 64% were no longer present by the time of the second survey; the great majority were likely to have died. Residents who had previously been assessed as severely demented or depressed were over-represented in this group. Of the residents who remained, only 17% of those previously depressed had recovered. This evidence suggests that Part III homes are continuing to amass a large number of residents suffering from dementia and depression. The need for adequate psychogeriatric services to Part III homes remains pressing.
61 citations
TL;DR: The most significant finding is that elderly patients with pneumonia who are found to be acutely confused at the time of presentation or who gave a previous history of chronic brain failure are much more likely to die than others.
Abstract: Acute pneumonia in the elderly is a common and serious condition. The importance of key clinical features and physical signs presenting to the junior hospital doctor was prospectively assessed in 100 consecutive patients admitted acutely to two hospitals. The most significant finding is that elderly patients with pneumonia who are found to be acutely confused at the time of presentation or who gave a previous history of chronic brain failure are much more likely to die than others. Thus such patients should be assessed with particular attention to the early diagnosis and vigorous treatment of pneumonia.
58 citations
TL;DR: Postmortem findings showed a decreasing frequency of pulmonary emboli in the elderly which may indicate a reduction in predisposing factors.
Abstract: A retrospective study was made of a consecutive series of patients over 65 years of age diagnosed as having a pulmonary embolus by either ventilation-perfusion lung scan or at necropsy No clinical features were particularly helpful in making the diagnosis though signs of deep-vein thrombosis were present in 35% Anticoagulants were well tolerated by all patients to whom they were prescribed Postmortem findings showed a decreasing frequency of pulmonary emboli in the elderly which may indicate a reduction in predisposing factors
TL;DR: Poor anticoagulant control was observed particularly in those receiving drugs known to potentiate warfarin effect and in whom more changes were made to their concomitant drug therapy.
Abstract: Forty-nine patients aged 65-89 years, treated for 6 months-6 years (mean 3.9 years) over a total of 195 patient years, were studied. The efficacy of anticoagulant control or the occurrence of complications or treatment failures did not vary with the age, sex, social status, mobility, visual acuity, domiciliary supervision of medication or the indication for anticoagulation. A significant correlation was observed between the concomitant drug therapy and anticoagulant control (P less than 0.001) but not with the occurrence of complications and treatment failures. Poor anticoagulant control was observed particularly in those receiving drugs known to potentiate warfarin effect and in whom more changes were made to their concomitant drug therapy. Five patients who experienced six non-fatal haemorrhages (two major and four minor) showed poor overall anticoagulant control from the outset (P less than 0.01). The treatment failure rate was 4%.
TL;DR: It is concluded that, with the exception of geriatric medicine, discharge planning for the elderly remains a very neglected aspect of patient care.
Abstract: People aged 65 years and over are the largest consumer group of hospital care, and an important element of their treatment is the transfer back into the community. Preparation and planning for discharge is, therefore, an integral aspect of the care of older people in hospital. This study used a random sample of people aged 65 and over discharged from hospitals throughout Wales to investigate, by the use of a postal questionnaire, the preparation they had received for their discharge whilst in hospital. Preparation for discharge was defined as length of notice of impending discharge and discussions with staff about their return home. A response rate of over 80% was obtained to the questionnaire. Thirty-nine per cent of the sample were given less than 24 h notice of discharge and less than 50% reported that a member of the hospital staff discussed their discharge/return home with them whilst in hospital. Discharge planning/preparation was very much better amongst patients seen in geriatric medicine compared with those seen in other specialties. It is concluded that, with the exception of geriatric medicine, discharge planning for the elderly remains a very neglected aspect of patient care.
TL;DR: Since microsomal mono-oxygenase activities and affinities appear not to change in human liver, other factors such as a fall in liver volume or blood flow must be responsible for the decline in clearance of many oxidized drugs which occurs with ageing.
Abstract: Although the clearance of many oxidized drugs falls with age, a corresponding fall in the maximal activities of drug metabolizing enzymes has not been noted. The possibility of a fall in enzyme affinity for substrate with age, which could account for the observed changes, has not previously been investigated in human liver. We have studied the kinetics of the microsomal mono-oxygenase 7-ethoxycoumarin-O-de-ethylase in 17 human liver biopsy specimens. No correlation was observed between age and microsomal protein recovery, maximal enzyme activity or apparent enzyme affinity. Since microsomal mono-oxygenase activities and affinities appear not to change in human liver, other factors such as a fall in liver volume or blood flow must be responsible for the decline in clearance of many oxidized drugs which occurs with ageing.
TL;DR: It is suggested that the progressive decrease during the present century in the amount of physical activity associated with everyday life has resulted in increased numbers of elderly people being at risk of femoral fracture and may be the cause of the rises in age-specific incidence rates now being observed.
Abstract: Physical inactivity is associated with low bone mass in adults, and might therefore be a risk factor for proximal femoral fracture in old age. This hypothesis was tested in a case-control study of 139 selected patients with confirmed proximal femoral fracture and 139 age- and sex-matched community controls, using an interviewer-administered questionnaire. Patients had been significantly less physically active in middle age than had controls, a difference that was greater in the younger subjects. It is suggested that the progressive decrease during the present century in the amount of physical activity associated with everyday life has resulted in increased numbers of elderly people being at risk of femoral fracture and may be the cause of the rises in age-specific incidence rates now being observed. If this explanation is correct, a planned increase in leisure-time physical activity in middle age and beyond may be the most effective method of preventing these fractures.
TL;DR: Information from a geriatric health screening programme was used to study the prevalence and risk factors predisposing to intermittent claudication in 1704 ambulatory elderly subjects, finding a positive relationship between IC and the number of other diseases and symptoms reported.
Abstract: Information from a geriatric health screening programme (Dunedin Program) was used to study the prevalence and risk factors predisposing to intermittent claudication (IC) in 1704 ambulatory elderly subjects. Risk factors studied included reported symptoms and diseases, mediation use, haematological and biochemical findings. The prevalence of IC reported by Dunedin participants was 14.1% for women and 14.4% for men. There was a positive relationship between IC and the number of other diseases and symptoms reported (P less than 0.0001). Serum glucose, cholesterol, and triglycerides were significantly higher in subjects reporting IC. Systolic blood pressure was higher in men and women reporting IC, but no significant relationship was observed with diastolic blood pressure.
TL;DR: It is concluded that measurement of bronchial responsiveness is feasible and clinically valuable in elderly subjects and both predicted bronchodilatation following a 6-week course of inhaled corticosteroid and beta agonist.
Abstract: We have assessed the feasibility and value of measuring nonspecific bronchial responsiveness to methacholine in investigation of asthma in the elderly. Results from duplicated tests in 20 subjects aged 65-82 years were expressed as dose provoking a 20% decrement in 1 second forced expiratory volume (PD20.FEV1) or peak expiratory flow (PD20.PEF). Repeatability for PD20.FEV1 was satisfactory but less good than in younger subjects, 95% confidence limits being 0.39-2.57 and 0.52-1.91, respectively, x initial PD20. For PD20.PEF, confidence limits were wider (0.26-3.91 x initial PD20) but multiple PEF measurements were better tolerated than those of FEV1, which commonly caused fatigue and dizziness. PD20.FEV1 and PD20.PEF correlated closely (r = 0.95, P less than 0.0001) and both predicted bronchodilatation following a 6-week course of inhaled corticosteroid and beta agonist. This was not predicted by the response to a single dose of beta agonist. We conclude that measurement of bronchial responsiveness is feasible and clinically valuable in elderly subjects.
TL;DR: The relationship between bone mass and dementia in elderly hip fracture patients from areas with different aluminium concentrations in water supplies has been investigated to determine whether a high concentration of aluminium in the drinking water and the negative calcium balance of age-related osteoporosis together predispose to senile dementia.
Abstract: The relationship between bone mass and dementia in elderly hip fracture patients from areas with different aluminium concentrations in water supplies has been investigated, to determine whether a high concentration of aluminium in the drinking water and the negative calcium balance of age-related osteoporosis together predispose to senile dementia. Mental test scores were recorded on admission to hospital, and Singh indices of radiographs taken at that time assessed blind by a single trained observer. No significant difference in either mental test score (chi 2 = 1.253, df = 2, P = 0.53) or Singh index (chi 2 = 1.039, df = 5, P = 0.96) was found between patients resident in high versus low water aluminum areas. No correlation was detectable between mental test score and Singh index (chi 2 = 0.95, df = 1, P = 0.33).
TL;DR: A survey of all identifiable consultants providing specialized psychiatric services for old people was conducted in 1985/6, finding major variations were recorded between health regions in the proportion of the elderly population served by respondents and in the personnel and facilities provided.
Abstract: A survey of all identifiable consultants providing specialized psychiatric services for old people was conducted in 1985/6. Respondents, mostly working more than four sessions per week in old age psychiatry covered 64% of the elderly population of the UK. Major variations were recorded between health regions in the proportion of the elderly population served by our respondents and in the personnel and facilities provided. The national average provision of key facilities and groups of staff is reported and regional variations highlighted.
TL;DR: The results suggest that the hyperglycaemia related to decreased survival is a stress response rather than an indication of preexisting diabetes mellitus but do not support the view that a high blood glucose level is itself harmful to the brain.
Abstract: To study the relation of blood glucose soon after the onset of stroke and outcome in terms of fatality and functional recovery 6 months later, two prospective studies were performed. Fasting blood glucose measured within 48 hours of onset was significantly higher in those who died than in those who survived. However, random blood glucose, mean daily blood glucose and HbA1 were not related to fatality or functional recovery. Fasting blood glucose levels soon after the stroke were significantly higher than those in the same patients measured 1 month later. These results suggest that the hyperglycaemia related to decreased survival is a stress response rather than an indication of preexisting diabetes mellitus but do not support the view that a high blood glucose level is itself harmful to the brain.
TL;DR: The clinical course of all new patients with ulcerative colitis or indeterminate colitis aged 65 years or older diagnosed in one health district between 1 January 1975 and 31 December 1984 has been compared with that of allnew patients 55 years or younger diagnosed in the same period.
Abstract: The clinical course of all new patients with ulcerative colitis or indeterminate colitis aged 65 years or older diagnosed in one health district (population 274,000) between 1 January 1975 and 31 December 1984 has been compared with that of all new patients 55 years or younger diagnosed in the same period. Elderly patients were admitted more often in a first attack and were more likely to receive systemic steroids. No elderly patient required urgent surgery and no patient in either group died of ulcerative colitis or its complications. The mortality amongst elderly patients with ulcerative colitis was no greater than expected in a population of the same age. The prognosis for ulcerative colitis in elderly patients is the same as for younger patients.
TL;DR: The results of this study provide further evidence that congestive heart failure due to nonsteroidal anti-inflammatory drug treatment is a probable adverse drug reaction in elderly individuals with or without a history of impaired cardiac performance.
Abstract: Congestive heart failure in the elderly which might be due to treatment with nonsteroidal anti-inflammatory drugs was studied by means of a questionnaire sent to the participants of a postgraduate course on locomotor disease in the elderly, and also by analysis of the hospital records of 600 elderly subjects diagnosed with congestive heart failure. The questionnaire revealed 22 possible cases, reported by 20 physicians (84 physicians out of 243 responded). In the hospital population five probable cases were detected. Details of these patients are presented. In contrast with findings in the literature, solute retention was in no case the result of kidney function impairment. The specific problems regarding the attribution of this adverse effect are discussed. The results of our study provide further evidence that congestive heart failure due to nonsteroidal anti-inflammatory drug treatment is a probable adverse drug reaction in elderly individuals with or without a history of impaired cardiac performance. It may result from drug toxicity following (relative) overdosing in this age group, from reduced effectiveness of concomitant diuretic treatment or from effects on cardiovascular homoeostasis.
TL;DR: There was a statistically significant relationship between leg power, visual acuity, posture sense and mental function and sway, and a weaker positive association between a variety of other factors and sway.
Abstract: The relationship of a range of clinical variables to balance was investigated in a group of 121 elderly patients giving a history of falls. Information collected included a clinical history and physical examination, and an evaluation of position sense, vibration sense and vestibular function. Postural changes in blood pressure were measured on a tilt-table, and sway was quantified on an ataxiameter. There was a statistically significant relationship between leg power, visual acuity, posture sense and mental function and sway, and a weaker positive association between a variety of other factors and sway. When factors showing a positive association with sway were used to construct a 'pathology' scene for each patient, it emerged that there was a statistically significant correlation between scores and ataxiameter readings. This suggests that, in the elderly, ataxia is usually the result of multiple factors. Language: en
TL;DR: Recurrent infection, including both relapse and reinfection is the usual short-term outcome following therapy for asymptomatic bacteriuria in this population of institutionalized women, and differences in patient characteristics may prove useful in predicting which individuals may respond to minimal therapy.
Abstract: Twenty-six elderly (mean age 83.3 +/- 8.7 years) institutionalized women with asymptomatic bacteriuria were treated with antibiotic therapy, including initial single-dose and subsequent 2 weeks' therapy, then 6 weeks' therapy if relapse occurred. Forty-seven courses of single-dose, 30 of 2 weeks', and 10 of 6 weeks' therapy were given during a 1-year period. At 8 weeks of follow-up, 57% of single-dose courses, 52% of 2-week, and 29% of 6-week had been followed by relapse, and 32%, 24%, and 29%, respectively, by reinfection. Outcome with single-dose therapy did not correlate with infecting organism, antimicrobial therapy, or presence of pyuria with the infection. However, residents who persistently relapsed following single-dose therapy appeared to be a less-well population, as evidenced by a significantly greater age, number of chronic disease diagnoses and medications, as compared to those who were cured by single-dose therapy. Thus, recurrent infection, including both relapse and reinfection is the usual short-term outcome following therapy for asymptomatic bacteriuria in this population. Differences in patient characteristics may prove useful in predicting which individuals may respond to minimal therapy.
TL;DR: Findings suggest that Cl. difficile is not part of the normal faecal flora in elderly in-patients, and is not detected in the stools of any patient.
Abstract: A recent report suggested that Clostridium difficile (Cl. difficile) was endemic in chronic-care facilities. We have examined the prevalence of Cl. difficile carriage in 67 patients in a large geriatric hospital. Cl. difficile was sought by both toxin and culture methods, but was not detected in the stools of any patient. These findings suggest that Cl. difficile is not part of the normal faecal flora in elderly in-patients.
TL;DR: Irregularity between gait cycles was noted, a finding previously described in Parkinson's disease, dementia and normal old men at a fast walking speed, and may prove to be a major risk factor for falls.
Abstract: The potential value of objective assessment of gait in geriatric medicine cannot be explored fully whilst gait analysis remains a laboratory research tool, imposing special conditions which often preclude its use in the elderly. We describe a method of gait analysis suitable for the geriatric clinic and illustrate its use in documenting the response to interventions in three patients presenting with falls due to parkinsonism. Irregularity between gait cycles was noted, a finding previously described in Parkinson's disease, dementia and normal old men at a fast walking speed. Such irregularity may prove to be a major risk factor for falls. Where multiple pathologies which disturb gait coexist, measurement of changes in gait in response to treatment may provide a much needed means of audit. Language: en
TL;DR: Hypothyroidism appeared to be more common and photosensitivity less common than in previously reported series in younger adults, and it is the policy to continue to prescribe amiodarone to elderly patients, regulate monitoring for adverse effects is however mandatory.
Abstract: Amiodarone is a powerful anti-arrhythmic drug. However, its use is somewhat limited by side-effects. No study examining side-effects specifically in elderly patients exists. We have reviewed noncardiac side-effects in 61 elderly patients on long-term oral amiodarone treatment (follow-up 3-66 months). The most troublesome side-effect was hypothyroidism (nine patients, 15%). No cases of frank hyperthyroidism were seen. Elevation of aspartate transaminase (AST) was common (16 patients, 26%), but generally mild and transient. Photosensitivity occurred in six patients (10%). Corneal deposits were common but gave rise to symptoms in only one patient. Two patients reported tremor. Hypothyroidism appeared to be more common and photosensitivity less common than in previously reported series in younger adults. Possible reasons for this are discussed. It is our policy to continue to prescribe amiodarone to elderly patients, regulate monitoring for adverse effects is however mandatory.
TL;DR: It is shown that the attributes of disability and distress, on which QALYs are presently based in the UK, are insensitive to changes in the health status of elderly people in long-term care when compared to other measures of quality of life which are frequently used in studies of older people.
Abstract: QALYs have developed in the UK as a tool for comparing the outcome of health care procedures in a single index over time. This tool can then be used, along with information on costs of procedures, in decision-making about health service resource allocation. It is shown that the attributes of disability and distress, on which QALYs are presently based in the UK, are insensitive to changes in the health status of elderly people in long-term care when compared to other measures of quality of life which are frequently used in studies of older people. Thus, if the use of QALYs increases, they should be based on attributes appropriate to the groups studied, otherwise certain groups may be discriminated against in health service resource allocation owing to the use of an insensitive measure of outcome.
TL;DR: The liaison service provided excellent medical training in acute and rehabilitative aspects of geriatric medicine, enhanced the role of other disciplines in the care of the elderly orthopaedic patient and facilitated communication between departments.
Abstract: The use of orthopaedic beds by large numbers of elderly patients with multiple pathology will increase and already exceeds the provision of orthopaedic-geriatric rehabilitation units. A cross-specialty multidisciplinary ward round improved the quality of care of orthopaedic patients without requiring expenditure on equipment, facilities or staff, and abolished the need to transfer patients to geriatric beds for rehabilitation, this being achieved on the orthopaedic unit. The liaison service provided excellent medical training in acute and rehabilitative aspects of geriatric medicine, enhanced the role of other disciplines in the care of the elderly orthopaedic patient and facilitated communication between departments.