Elderly Medical Patients Research Articles

Short scales were as effective as long scales in screening for depression in older patients

(2001) Int J Geriatr Psychiatr 16, 321. Pomeroy IM, Clark CR, Philp I. . The effectiveness of very short scales for depression screening in elderly medical patients. . Mar; ....

Frequency of Ophthalmic Assessments among Elderly Whites and African Americans with Eye Disease and Impact on Visual Function

To study the difference in patterns of utilization of eye-care services among white and African American senior citizens with eye disease and its impact on visual function. This study involved cross-sectional assessments of visual function using the Activities of Daily Vision Scale (ADVS), as well as retrospective self-recall of history of eye disease and frequency of ophthalmic assessments. Participants included 99 consecutive elderly patients with history of eye disease who were attending the outpatient medical clinics at Nassau University Medical Center, a community teaching hospital in Long Island, New York. White Americans constituted 52% of the study sample and African Americans constituted the remaining 48%. African American subjects were less likely than whites to report visiting an eye specialist over the previous 5 years (69% versus 88%, P < 0.05). African American subjects who reported undergoing ophthalmic assessments over the past 5 years showed a trend of having higher ADVS scores (indicating better visual function) compared with those who did not report such history (86 +/- 12 versus 79 +/- 15, P = 0.098). On the other hand, reporting such history had no apparent relation to the ADVS scores in whites. African American elderly ambulatory medical patients with eye disease were less likely than their white counterparts to report use of eye-care services. The use of eye-care services in African American but not white subjects was linked to better visual function as assessed by the ADVS.

Endogenous anticholinergic substances may exist during acute illness in elderly medical patients.

The purpose of this study was to determine if serum anticholinergic activity (SACA) arises from endogenous substances produced during illness. Elderly medical inpatients (N = 612) were screened for anticholinergic medication use in the week prior to the study by interviews of subjects and proxies and review of emergency room, hospital, and nursing home medication administration records. Of 24 subjects without a recent anticholinergic medication history, 15 were recruited and 10 completed the study. Serum samples were obtained on Day 2 of hospital admission. SACA was measured using a radionuclide displacement assay. Medications taken by subjects were assayed for central muscarinic receptor binding at therapeutic concentrations. Results. Eight of the ten subjects had SACA detectable in the serum. No medication used by these subjects had anticholinergic activity at usual therapeutic concentrations. Endogenous anticholinergic substances may exist during acute illness. Characterization of such substances may increase the depth of our understanding of delirium and lead to useful intervention strategies.

A Randomized Controlled Trial of Low-Dose Recombinant Human Growth Hormone in the Treatment of Malnourished Elderly Medical Patients

A Randomized Controlled Trial of Low-Dose Recombinant Human Growth Hormone in the Treatment of Malnourished Elderly Medical Patients

The effectiveness of very short scales for depression screening in elderly medical patients

The effectiveness of very short scales for depression screening in elderly medical patients

HIV infection in elderly medical patients.

To determine the prevalence and presentation of HIV-infection among medical admissions aged 55 years and above. Prospective cross-sectional study. Dar es Salaam, Tanzania. Consecutive patients aged 55 years and above hospitalised in the medical wards of the Muhimbili Medical Centre in Dar es Salaam from February to May 1998. The overall HIV-1 seroprevalence was 15.0% (38/253); and by sex it was 18.5 % (28/ 151) among males compared to 9.8% (10/102) amongfemales (p=0.06). The HIV-1 prevalence among those aged 55 to 59 years was 29.7%. There was no association between HIV- 1 serostatus and whether one lived in a rural or urban area, marital status, level of education nor socio-economic status. The main presenting features in patients who were found to be HIV-1 seropositive were wasting 44.7%, fever 39.5%, pallor 34.2% and weight loss 31.6%. Only six (15.8%) of the 38 patients were initially suspected to have been HIV-infected before laboratory results were obtained. HIV-infection is a notable problem in the population of elderly medical admissions in Dar es Salaam. The possibility of HIV-infection should be considered among elderly patients with clinical features of immunodeficiency. HIV/AIDS prevention programmes directed towards the elderly should be established.

The effectiveness of very short scales for depression screening in elderly medical patients.

To compare very short scales for screening for depression with longer, widely used scales. Eighty-seven patients over the age of 60 who were admitted to rehabilitation wards or were attending a day rehabilitation facility at a British teaching hospital were screened for depression using the 1-item mental health inventory, and the 4-item, 15-item and 30-item geriatric depression scales. The sensitivity, specificity, and areas under receiver operating characteristic curves were compared, with the diagnostic criteria for research of ICD-10 providing the criterion diagnosis of depressive episode. All the scales had comparable sensitivity (82.4-100%), specificity (60.0-71.4%), and positive predictive values (33.3-42.9%). Comparison of receiver operating characteristic curves for each scale showed no statistically significant difference between them (range 0.80-0.88). The very short scales performed just as well as the widely used longer screening scales in this population. They are worthy of further examination in elderly populations at risk of depression, and may be particularly suitable for older adults due to their brevity and ease of use.

Pulmonary embolism in the elderly

The elderly are at increased risk for pulmonary embolism because of both the conditions common to this age group, and the immobility that often accompanies them. Whether aging alone represents a hypercoagulable state is unclear. The incidence of pulmonary embolism rises with age, however, as does pulmonary embolism mortality. The diagnosis of pulmonary embolism is difficult and frequently missed because elderly patients and their physicians may attribute nonspecific symptoms to underlying cardiopulmonary disease or to age itself. Routine laboratory examinations are also nonspecific. Lower extremity studies to diagnose DVT should always be pursued because a positive study results in identical treatment, without the need for further testing. D-dimer concentrations are useful when low, but are commonly elevated in the elderly because of other comorbid conditions. Lung scanning remains the most common initial study to diagnose pulmonary embolism, although spiral CT is as sensitive and specific. Pulmonary angiography should always be considered when the initial studies are nondiagnostic and clinical suspicion is high, and this test is well tolerated in the elderly. The role of newer diagnostic techniques, such as MR imaging, cannot be determined until well-designed outcomes trials are completed. Prophylaxis with appropriate pharmacologic agents or mechanical measures should be administered not only to patients undergoing hip or knee reconstruction surgery, but to all bed-ridden elderly medical and general surgery patients. Treatment for pulmonary embolism with anticoagulation reduces the mortality rate and should be administered in all elderly patients without contraindications. In addition, thrombolysis should be considered for all hemodynamically unstable patients with pulmonary embolism, regardless of age. Vena caval filters are warranted when anticoagulation is contraindicated, although evidence of the long-term benefit of these devices is lacking. At present, pulmonary embolism is underdiagnosed and undertreated in the elderly. By heightening awareness of this diagnosis and its appropriate management in this age group, considerable morbidity and mortality may be avoided.

Development and validation of a brief observer-rated screening scale for depression in elderly medical patients.

to develop a depression screening scale that does not rely on verbal communication. an acute geriatric unit in a teaching hospital. 96 patients (mean age 81 years, range 68-92, 59 women); 40% of the initial study group of 50 and 22% of the validation group of 46 were diagnosed as depressed. we devised a scale using nine items which could be rated by an observer; we determined inter-rater reliability, sensitivity, specificity and predictive values for each item compared with a Geriatric Mental State-AGECAT diagnosis of depression; we validated a final scale of six items. inter-rater reliability was poor for two items (irritability and sleep disturbance) while two items (sleep disturbance and night sedation) had poor sensitivity; we omitted these items in a revised scale. Re-analysis of data from the initial study showed that a cut-off of > or = 3 on the revised scale gave a sensitivity of 83%, a specificity of 95%, a positive predictive value of 0.89 and a negative predictive value of 0.90. Spearman's correlation coefficient between the six-item questionnaire and the Hamilton rating scale was 0.79. In the validation study, the cut-off score of > or = 3 on the revised six-item scale had a sensitivity of 90%, specificity of 72%, a positive predictive value of 0.69 and a negative predictive value of 0.96. this simple, short, observation-based screening scale completed by nurses is sensitive and specific in identifying depression in elderly medically ill patients, and may be a useful addition to clinical practice.

Discharge planning from hospital to home.

Discharge planning is the development of an individualised discharge plan for the patient prior to leaving hospital for home, with the aim of containing costs and improving patient outcomes. It has been suggested that discharge planning can reduce unplanned readmission to hospital. To assess the effects of discharge planning for patients moving from hospital to home. We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register, MEDLINE (1966 to 1996), EMBASE (1980 to 1996), Sigle (1980 to 1996), Bioethics (1985 to 1996), Health Plan (all available years), PsycLit (1974 to 1996), Cinahl (1982 to 1996), EconLit (1969 to 1996), Social Science Citation Index (1992 to 1996), and reference lists of articles. Randomised trials and controlled trials comparing discharge planning with routine discharge for hospital patients. The outcomes were mortality, clinical complications, hospital length of stay, readmissions, discharge destination, general and disease specific health status, functional status, psychological well-being, patient satisfaction, carer satisfaction, carer burden, cost to the health service, patient and family, general practice, and community services. Two reviewers independently extracted data and assessed study quality. Eight studies were included involving 4837 patients. Four studies recruited patients with a medical condition; four recruited patients with a mix of medical and surgical conditions, and one of these recruited medical and surgical patients as separate groups. There was a small reduction in hospital length of stay for elderly medical patients allocated to discharge planning (weighted mean difference -1.01, 95% CI -2.06 to 0.05). The effects of discharge planning on readmission rates were mixed. No statistically significant differences were detected for patient health outcomes. Patients with medical conditions allocated to discharge planning reported increased satisfaction compared with those receiving routine discharge. No statistically significant differences were reported for overall health care costs, although one study reported a significant reduction in readmission costs for medical patients allocated to discharge planning. The studies showed mixed results, which may reflect the different study populations and the different ways the intervention was implemented. There is some evidence that discharge planning may lead to reduced hospital length of stay, and in some cases reduced readmission to hospital. There is also some evidence that discharge planning increased patient satisfaction. There was no evidence that discharge planning reduced health care costs; however few studies conducted a formal economic analysis.

Expanded Normative Data for the Mattis Dementia Rating Scale for Use with Urban, Elderly Medical Patients

Normative data for the Mattis Dementia Rating Scale (MDRS), stratified by age and education, are provided for use with older adults (ages 61–94) in urban medical settings. Age and education accounted for the greatest amount of variance in MDRS performance. Gender and race were also associated with total MDRS scores, though to a lesser extent. The present normative data are more appropriate for use with older patients seen in urban medical settings than normative data obtained from samples of better-educated, relatively healthy, Caucasian adults. This study provides additional evidence of the significant influence of age and education on MDRS total score (MDRS-T) performance, and highlights the importance of matching an examinee's demographic background to the normative sample with which his or her test score is being compared. Careful consideration of this match is likely to lead to more accurate diagnostic conclusions and potentially improved patient care.

Commentary on "Large Neutral Amino Acid Changes and Delirium in Febrile Elderly Medical Patients": Do Amino Acids Play a Role in the Pathophysiology of Delirium?

Commentary on "Large Neutral Amino Acid Changes and Delirium in Febrile Elderly Medical Patients": Do Amino Acids Play a Role in the Pathophysiology of Delirium?

Therapeutic activity in elderly medical intensive care patients

Therapeutic activity in elderly medical intensive care patients

The Behavioral Dyscontrol Scale and Functional Status Among Elderly Medical and Surgical Rehabilitation Patients

This research was conducted in a sample of 150 older adults (mean age = 78.0) who were inpatients receiving rehabilitation services for a variety of medical and postsurgical conditions. The purpose of the study was to test the hypothesis that the Behavioral Dyscontrol Scale (BDS), a measure of the ability to use intentions to guide purposeful activity, would be strongly associated with concurrent functional status after controlling for age, sex, education, severity of pain, medical comorbidity, depression (Geriatric Depression Scale), and general mental status (Mini Mental State Exam [MMSE]). Functional status was assessed by rehabilitaion nurses' ratings of patients on 11 individual Activities of Daily Living (ADL) items and the Barthel Index. The hypothesis, tested by means of multiple regression analysis, was supported by the results. The BDS was the independent variable most strongly associated with all 11 ADL items and the Barthel Index. The MMSE contributed significantly to none of the models. Other covariates made minimal contributions to the variance shared with functional ability. Consistent with prior results in other samples, the ability to use intentions to guide purposeful behavior appears to be an important contributor to everyday functioning among older adults.

Performance and perseveration on Luria's reciprocal coordination tasks in elderly medical patients

Performance and perseveration on Luria's reciprocal coordination tasks in elderly medical patients

Performance and perseveration on Luria's reciprocal coordination tasks in elderly medical patients

Performance and perseveration on Luria's reciprocal coordination tasks in elderly medical patients

Risk Factors for Early Emergency Hospital Readmission in Elderly Medical Patients

Background: Early emergency readmissions is a common and important problem in the elderly patient. Identification of the risk factors for early emergency readmissions is needed to prevent this occurring. Objective: The aim of this study was to study the risk factors for early emergency readmission in the elderly medical patient. Methods: A case-control study (sex- and age-matched) was conducted from March to December 1996. 380 elderly (age 65 years or over) medical patients with emergency hospital readmission (within 28 days) and 380 matched controls were recruited from an acute university general hospital in Hong Kong. Potential risk factors which included demographic, socio-economic, principal medical diseases, comorbid diseases, dysphagia, physical functional status and mental status were studied. Results: In bivariate analyses for the risk factors of early emergency readmission, institutional carer, previous visiting nurse service, adverse drug reaction, chronic obstructive pulmonary disease, end-stage renal failure, mobility being chair- or bed-bound, dysphagia, use of a nasogastric tube feeding, urinary incontinence and bowel incontinence were significant. Readmission cases had higher mean number of comorbid diseases, lower mean Barthel Index, higher mean number of impairments in Activities of Daily Living (ADL) tasks and lower mean Abbreviated Mental Test score than controls. In multivariate logistic regression model, the number of ADL impairments (OR = 1.13, 95% CI = 1.08–1.19), no income (OR = 2.28, 95% CI = 1.19–4.37), adverse drug reaction (OR = 4.19, 95% CI = 1.56–11.2), advanced malignancy (OR = 2.45, 95% CI = 1.37–4.37), congestive heart failure (OR = 1.63, 95% CI = 1.05–2.53), chronic obstructive airways disease (OR = 2.1, 95% CI = 1.47–3.02), end-stage renal failure (OR = 5.48, 95% CI = 1.69–17.75), dysphagia (OR = 3.9, 95% CI = 1.5–10.11) and the number of comorbid diseases (OR = 1.3, 95% CI = 1.13–1.49) were significant risk factors for early emergency readmissions. Living in a private old aged home was associated with a lower risk of readmissions (OR = 0.53, 95% CI = 0.36–0.93). Conclusions: Definite medical, functional and socio-economic factors were found to be risk factors for early emergency readmissions in the elderly medical patient. A multiple risk factors intervention approach should be considered in designing future prevention strategies.

“Hospital at home” care was generally as effective as routine hospital care for older adults

Shepperd S, Harwood D, Jenkinson C , et al. Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. BMJ1998...

Detecting anxiety and depression in hospitalised elderly patients using a brief inventory

This study validated a French language version of an inventory designed to detect symptoms of depression and anxiety [Goldberg et al, 1987] in a sample of elderly French-speaking inpatients at risk for one of these disorders. Latent trait analysis was used to replicate the structure of the symptoms in the inventory, and receiver operating characteristic analysis was used to assess the performance of the inventory as a screening measure for Major Depressive Episode and Generalised Anxiety Disorder according to DSM-IV criteria. Reflecting the ascertainment of individuals in the sample as being at risk for a disorder, prevalence of individual symptoms was high although the general structure of the inventory was found to be comparable to that found in samples of both community elderly and younger medical patients. ROC analyses showed that the subscales of inventory performed satisfactorily as screening measures for anxiety or depression but lacked specificity for each disorder. In addition to providing further evidence for the utility of this inventory to detect general psychiatric distress in elderly persons, this study provides a valid means of detecting symptoms of depression and anxiety in French speaking groups.

Serum anticholinergic activity changes with acute illness in elderly medical patients.

Elevated serum anticholinergic activity levels have been associated with delirium in cross-sectional studies of ill older persons. This study used serial measures of serum anticholinergic activity levels to determine whether these levels change following illness resolution, and if such changes are specific to those with delirium. Twenty-two nursing home residents with a febrile illness had serum specimens drawn and were evaluated for the presence of delirium during the acute illness and at 1-month follow-up. Delirium was diagnosed using the Confusion Assessment Method. Serum anticholinergic activity was determined using a previously described radionuclide competitive-binding assay. Delirium was present during illness in 8 of 22 subjects (36%), and had resolved by 1-month follow-up in all but one resident. Serum anticholinergic activity levels were significantly higher during illness than at 1-month follow-up in both the delirious (0.69 +/- 0.85 nM atropine equivalents/200 microL sample versus 0.10 +/- 0.16; p = .06) and non-delirious (0.65 +/- 0.51 nM atropine equivalents/200 microL sample versus 0.08 +/- 0.12; p < .001) groups. Medication changes did not seem to be related to changes in serum anticholinergic activity. In older nursing home residents with a fever, serum anticholinergic activity appears to be elevated during illness, and declines following recovery from illness. This effect does not seem to be specific to those residents with delirium, nor does it seem related to medication changes.