Non-geriatric Group Research Articles

Poster 49: Acute rehabilitation of the geriatric patient: sociocultural, clinical, and functional characteristics with implications

Objectives: To define the sociodemographics, clinical, and functional characteristics of the Singapore population and to discuss the implications. Design: A database review of patients defined as geriatric (age >64y) compared with the nongeriatric patients. Setting: Rehabilitation unit. Participants: 172 (46%) of 374 consecutively admitted patients. Interventions: Not applicable. Main Outcome Measure: FIM™ instrument. Results: 87 (51%) of the geriatric group were men and stroke (64.5%) was the most common primary diagnosis. 39 patients (22.6%) had depression, and urinary tract infection (UTI) was the most common (n=36, 20.1%) medical complication. Comparing the geriatric and nongeriatric groups, no significant differences were found in the rehabilitation length of stay ( P=.41). In the geriatric group, the mean admission FIM score was 65 while the final FIM score was 84.1 and these were lower than the corresponding scores for the nongeriatric group (admission FIM=70.2, P=.03; discharge FIM=90.4, P=.008). However, there were no differences in the quantum of improvement of the FIM scores ( P=.45) between the 2 groups. 24 geriatric patients (14%) had no ready caregiver. Most geriatric patients (90.1%) were discharged home and outpatient therapies were arranged for most (80%). Conclusions: About half of our patients were geriatric, and good functional gains were achieved compared with the nongeriatric patients. Depression and UTI are common and vigilance should be maintained in detecting and treating these. A home disposition is an achievable goal and discharge planning should consider options if no caregiver is available. Outpatient therapies should remain affordable and accessible.

Geriatric psychiatric morbidity in rural northern India: implications for the future.

This was an epidemiological study funded by the Indian Council of Medical Research and conducted in a representative rural geographical area in northern India. The study aimed to determine the pattern of psychiatric morbidity in those aged 60 years or above and to ascertain the causative/contributory role of biosociodemographic factors, if any. Three groups of subjects formed the sample: the geriatric psychiatrically ill and non-ill and the nongeriatric psychiatrically ill. The prevalence of psychiatric morbidity was found to be much higher in the geriatric group (43.32%) than in the nongeriatric group (4.66%). The psychiatric morbidity pattern consisted of neurotic depression, manic-depressive psychosis depression, and anxiety state in descending order of frequency. Socially, economically, and educationally disadvantaged subjects were found to be more psychiatrically ill. The data indicate that by the year 2000, there will be about 28 million psychiatrically ill geriatric persons in the country requiring the attention of health policy planners. The implications of these findings in light of the available services for psychiatrically ill geriatric persons have been discussed and future directions identified.

Carotid endarterectomy in the elderly

Increasing life expectancy has resulted in an increasing number of elderly. As the elderly population grows, the incidence of stroke will increase. Many such strokes result from carotid stenosis (CS). In view of the benefits of carotid endarterectomy (CEA) shown in recent clinical trials, it would seem prudent that surgery for CS be considered for prevention of stroke in this population. Traditionally, members of the geriatric population have often been viewed, perhaps arbitrarily, as inappropriate candidates for CEA because of perceived greater operative risks. The purpose of this study was to assess the safety of performing CEA in geriatric patients. A total of 175 patients who underwent CEA between January 1994 and June 1996 were evaluated retrospectively. The patients were divided into the nongeriatric group (NGG <75 years of age) and the geriatric group (GG >75 years of age). There were 90 (51%) patients in the NGG and 85 (49%) in the GG. The two groups were compared for the following: rationale for surgery (symptomatic vs. asymptomatic), risk factor profile, preoperative imaging studies (noninvasive vs. invasive), and complications of surgery. Both groups were generally comparable in terms of their risk factors, rationale for surgery, and preoperative cardiac risk. Noninvasive imaging alone was used in 56% of NGG and 60% of GG patients, whereas 44% of NGG and 40% of GG underwent invasive cerebral angiography in addition to other noninvasive studies. There were 4(4.4%) postoperative neurological complications, including two strokes and two transient ischemic attacks (TIAs), in the NGG and 1(1%) stroke in the GG. One patient died in the NGG from a stroke. Although one patient in the GG experienced a postoperative myocardial infarction, there was no mortality in this group. CEA can be safely performed for both symptomatic and asymptomatic CS in appropriately selected patients irrespective of age.