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Elderly Patients (elderly + patient)
Kinds of Elderly Patients Selected AbstractsPOSTTRAUMATIC SUBGALEAL HEMATOMA WITH ORBITAL EXTENSION ASSOCIATED WITH CLOPIDOGREL USAGE IN AN ELDERLY PATIENT: CASE REPORTJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2007Sanjay H. Chotirmall MBBCh No abstract is available for this article. [source] COMBINATION THERAPY FOR POSTPRANDIAL AND ORTHOSTATIC HYPOTENSION IN AN ELDERLY PATIENT WITH TYPE 2 DIABETES MELLITUSJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2006Naomune Yamamoto MD No abstract is available for this article. [source] SEPTIC SHOCK IN AN ELDERLY PATIENT ON DIALYSIS: ENEMA-INDUCED RECTAL INJURY CONFUSING THE CLINICAL PICTUREJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2004Ravi K. Bobba MD No abstract is available for this article. [source] DONEPEZIL AND ATHETOSIS IN AN ELDERLY PATIENT WITH ALZHEIMER'S DISEASEJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2003Makoto Tanaka MD No abstract is available for this article. [source] MANAGEMENT AND HOSPITAL OUTCOME OF THE SEVERELY HEAD INJURED ELDERLY PATIENTANZ JOURNAL OF SURGERY, Issue 7 2008Biswadev Mitra Introduction: Severe traumatic head injury in the elderly has been associated with poor outcomes. However, there is currently no consensus to direct management in these patients. This study outlines the demographics, injury characteristics, management and outcome of the elderly trauma patients with severe head injury across a defined population. Materials and Methods: A retrospective review of all elderly patients (age >64 years) with a Glasgow Coma Scale (GCS) score of 8 or less, and confirmed intracranial pathology or fractured skull, was undertaken over a period of 40 months from July 2001 to September 2005. Data on patient demographics, injury cause, presenting clinical features and interventions were collected. In-hospital mortality was used as the primary outcome. Results: There were 96 patients who met the inclusion criteria. One-third of the patients were managed palliatively, one-third supportively without surgery and another third underwent surgery. Overall mortality was 70.8% (n = 68). Older age and brainstem injuries were identified as independent predictors of mortality. Mortality was reported in all patients aged 85 years or older. Conclusions: Although overall outcomes were poor, careful consideration should be given to active treatment as favourable outcomes were possible even in the presence of extremely low GCS scores. Prediction of outcome on the basis of age and anatomical diagnoses may help in this decision-making. [source] POSTPRANDIAL HYPERGLYCEMIA IS AN INDEPENDENT RISK FOR RETINOPATHY IN ELDERLY PATIENTS WITH TYPE 2 DIABETES MELLITUS, ESPECIALLY IN THOSE WITH NEAR-NORMAL GLYCOSYLATED HEMOGLOBINJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2010Toru Aizawa PhD No abstract is available for this article. [source] BILATERAL FOOT DROP AFTER INTESTINAL SURGERY: PERONEAL NEUROPATHY UNABATED IN ELDERLY PATIENTSJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007Erkan K No abstract is available for this article. [source] IS AGE A RISK FACTOR FOR WARFARIN-RELATED MAJOR BLEEDS IN ELDERLY PATIENTS WITH ATRIAL FIBRILLATION?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2006Huai Yong Cheng MD No abstract is available for this article. [source] FACTORS ASSOCIATED WITH COGNITIVE IMPAIRMENT IN ELDERLY PATIENTS WITH DIABETES MELLITUSJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2006Mari Suzuki MD No abstract is available for this article. [source] ASSOCIATION BETWEEN RISPERIDONE TREATMENT AND CEREBROVASCULAR ADVERSE EVENTS IN ELDERLY PATIENTS WITH DEMENTIAJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2005Francesc Formiga MD No abstract is available for this article. [source] ALL PATIENT REFINED DIAGNOSIS RELATED GROUPS: A NEW ADMINISTRATIVE TOOL FOR IDENTIFYING ELDERLY PATIENTS AT RISK OF HIGH RESOURCE CONSUMPTIONJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2005Alberto Pilotto PhD No abstract is available for this article. [source] EFFECT OF TEMPERATURE ON SWALLOWING REFLEX IN ELDERLY PATIENTS WITH ASPIRATION PNEUMONIAJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2004Aya Watando MD No abstract is available for this article. [source] PLASMA LEVELS OF INFLAMMATORY C-REACTIVE PROTEIN AND INTERLEUKIN-6 PREDICT OUTCOME IN ELDERLY PATIENTS WITH STROKEJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004Antonello Silvestri MD No abstract is available for this article. [source] RISK FACTORS IN SURGICAL MANAGEMENT OF THORACIC EMPYEMA IN ELDERLY PATIENTSANZ JOURNAL OF SURGERY, Issue 6 2008Ming-Ju Hsieh Background: Although elderly patients with thoracic disease were considered to be poor candidates for thoracotomy before, recent advances in preoperative and postoperative care as well as surgical techniques have improved outcomes of thoracotomies in this patient group. The aim of this study was to investigate surgical risk factors and results in elderly patients (aged ,70 years) with thoracic empyema. Methods: Seventy-one elderly patients with empyema thoracis were enrolled and evaluated from July 2000 to April 2003. The following characteristics and clinical data were analysed: age, sex, aetiology of empyema, comorbid diseases, preoperative conditions, postoperative days of intubation, length of hospital stay after surgery, complications and mortality. Results: Surgical intervention, including total pneumonolysis and evacuation of the pleura empyema cavity, was carried out in all patients. Possible influent risk factors on the outcome were analysed. The sample group included 54 men and 17 women with an average age of 76.8 years. The causes of empyema included parapneumonic effusion (n = 43), lung abscess (n = 8), necrotizing pneumonitis (n = 8), malignancy (n = 5), cirrhosis (n = 2), oesophageal perforation (n = 2), post-traumatic empyema (n = 2) and post-thoracotomy complication (n = 1). The 30-day mortality rate was 11.3% and the in-hospital mortality rate was 18.3% (13 of 71). Mean follow up was 9.4 months and mean duration of postoperative hospitalization was 35.8 days. Analysis of risk factors showed that patients with necrotizing pneumonitis or abscess had the highest mortality rate (10 of 18, 62.6%). The second highest risk factor was preoperative intubation or ventilator-dependency (8 of 18, 44.4%). Conclusion: This study presents the clinical features and outcomes of 71 elderly patients with empyema thoracis who underwent surgical treatment. The 30-day surgical mortality rate was 11.3%. Significant risk factors in elderly patients with empyema thoracis were necrotizing pneumonitis, abscess and preoperative intubation/ventilation. This study also suggested that surgical treatment of empyema thoracic in elderly patients is recommended after failed conservative treatment because of the acceptably postoperative complication and mortality rate. [source] High Response to Intravenous Immunoglobulin in the Treatment of Acquired Hemophilia in an Elderly PatientJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2004Marc Paccalin MD No abstract is available for this article. [source] Paresthesias Developing in an Elderly Patient after Chronic Usage of Nitrofurantoin and Vitamin B6JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2003Rhodora A. Lacerna MD No abstract is available for this article. [source] Routine Transesophageal Echocardiography for the Evaluation of Cerebral Emboli in Elderly PatientsECHOCARDIOGRAPHY, Issue 9 2005Sergey Vitebskiy M.D. Background: Approximately 20% of cerebral infarctions are cardioembolic in nature. Transesophageal echocardiography (TEE) is widely regarded as the initial study of choice for evaluating cardiac source of embolism. Although the majority of cerebrovascular accidents occur in elderly patients, the value of TEE in this population is poorly defined. Methods: We compared 491 patients older than 65 years with suspected embolic stroke or transient ischemic attack (TIA) who had undergone TEE evaluation between April 2000 and February 2004 to an age-, sex-, and time-matched control group that consisted of 252 patients. Studies were reviewed for abnormalities associated with thromboembolic disease. Results: The overall incidence of stroke risk factors was significantly higher in the study than in the control group. However, the four patients with left atrial thrombi had a history of atrial fibrillation. Although ascending and aortic arch sessile atheromata were observed more frequently in the study than control group, there were no significant differences in the incidence of either complex or mobile aortic atheromata. The incidence of atrial septal aneurysm was higher in the stroke/TIA group, but not in association with patent foramen ovale. Finally, there were also no differences in the incidence of spontaneous echocontrast, and/or patent foramen ovale between study and control groups. Conclusions: We conclude: (1) There is a higher incidence of abnormalities implicated as sources of thromboembolic disease on TEE in elderly patients with cerebral infarctions, but (2) this incidence is driven by the presence of sessile aortic atheroma and atrial septal aneurysm. Until the benefits of specific therapies for these conditions are known, routine TEE in elderly patients with suspected embolic neurological events appears to be unwarranted. [source] The Combined Effects of Participatory Styles of Elderly Patients and Their Physicians on SatisfactionHEALTH SERVICES RESEARCH, Issue 2 2004K. Tom Xu Objectives. To test whether concordance or discordance of patient participation between patients and physicians is associated with higher satisfaction, and to examine the effects of patients' and physicians' participatory styles on patients' satisfaction with their physicians. Data. Data collected in the Texas Tech 5000 Survey of elderly patients in West Texas were used. Patient satisfaction with their physicians was measured by a single item from the Consumer Assessment of Health Plans (CAHPS), representing patients' ratings of their physicians. Patient participation was measured by an index derived from a three-item instrument and physicians' participatory decision-making (PDM) style was measured by a three-item instrument developed by the Medical Outcomes Study. Methods. An ordered logit multivariate regression was used to investigate the effects of patients' and physicians' participatory styles on satisfaction with physicians. The interaction between patients' participation and physicians' participatory styles was also included to examine the dependency of the two variables. Results. Controlling for confounding factors, a higher PDM score was associated with a higher rating of patient satisfaction with physicians. A higher patient participation score was related to a lower physician satisfaction rating. The combined effect of patients' and physicians' participation styles indicated that for a low patient participation score, a high PDM score was not needed to produce high satisfaction. The greater the discordance in this direction, the higher the satisfaction. However, with a high patient participation score, only an extremely high PDM score would produce relatively high satisfaction. Conclusions. The current study supports the discordance hypothesis. Participatory physicians and patient,physician communications concerning patient participation can promote higher satisfaction. [source] Fatigued Elderly Patients With Chronic Heart FailureINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Anna Ehrenberg PURPOSE To compare descriptions of fatigue based on the NANDA characteristics from interviews with elderly people with congestive heart failure (CHF) and data recorded by nurses at a Swedish outpatient heart failure clinic. METHODS Patients were screened for moderate to severe CHF. A total of 158 patients were interviewed using a revised form of the Fatigue Interview Schedule (FIS) based on the NANDA characteristics. Of these patients, half (n= 79) were offered visits at a nurse-monitored heart failure clinic. Nursing documentation of fatigue at the heart failure clinic was reviewed based on the NANDA characteristics and compared with the content in the patient interviews. FINDINGS Tiredness was documented in 43 (75%) records and indicated in 36 patients based on patient scores on the FIS (X,= 5.5; range 1,9). The most frequently recorded observation related to fatigue was the symptom emotionally labile or irritable, followed by notes on lack of energy and decreased performance. Patients' descriptions of their fatigue were expressed as a decreased ability to perform and a perceived need for additional energy. Results indicated poor concordance in patients' descriptions and record content concerning fatigue. Whereas patients emphasized the physical characteristics of fatigue, nurses emphasised the emotional features. Decreased libido was linked to fatigue according to the patients but not according to the nurses' records. Whereas cognitive characteristics of fatigue occurred rarely in the records, they were more frequent in the patient interviews. DISCUSSION Symptoms such as irritability and accident-proneness may be seen as manifestations of the patients' experiencing the need for more energy or a feeling of decreased performance. These consequences of being fatigued, rather than the different dimensions of fatigue, seemed to have been easy for the nurses to observe and document. Earlier studies indicate that poor observation, medication, and diet in patients with heart failure might partly be explained by cognitive impairment. CONCLUSIONS Findings of this study highlight the need for nurses to pay attention to the experience of fatigue in patients who suffer from CHF, and to validate their observations with the patients own expressions. Using the patients' words and expressions and the diagnostic characteristics of fatigue in recording can support the nurses in developing both understanding of patients living with CHF and strategies to help patients cope with their restricted ability in daily life. [source] Predicting Hospital Admission and Returns to the Emergency Department for Elderly PatientsACADEMIC EMERGENCY MEDICINE, Issue 3 2010Michael A. LaMantia MD Abstract Objectives:, Methods to accurately identify elderly patients with a high likelihood of hospital admission or subsequent return to the emergency department (ED) might facilitate the development of interventions to expedite the admission process, improve patient care, and reduce overcrowding. This study sought to identify variables found among elderly ED patients that could predict either hospital admission or return to the ED. Methods:, All visits by patients 75 years of age or older during 2007 at an academic ED serving a large community of elderly were reviewed. Clinical and demographic data were used to construct regression models to predict admission or ED return. These models were then validated in a second group of patients 75 and older who presented during two 1-month periods in 2008. Results:, Of 4,873 visits, 3,188 resulted in admission (65.4%). Regression modeling identified five variables statistically related to the probability of admission: age, triage score, heart rate, diastolic blood pressure, and chief complaint. Upon validation, the c-statistic of the receiver operating characteristic (ROC) curve was 0.73, moderately predictive of admission. We were unable to produce models that predicted ED return for these elderly patients. Conclusions:, A derived and validated triage-based model is presented that provides a moderately accurate probability of hospital admission of elderly patients. If validated experimentally, this model might expedite the admission process for elderly ED patients. Our models failed, as have others, to accurately predict ED return among elderly patients, underscoring the challenge of identifying those individuals at risk for early ED returns. ACADEMIC EMERGENCY MEDICINE 2010; 17:252,259 © 2010 by the Society for Academic Emergency Medicine [source] Family Support of Elderly Patients Hospitalized in a Public Tertiary Hospital in Greece: A Prospective StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2009George Samonis MD No abstract is available for this article. [source] Pressure Ulcers in Elderly Patients with Hip Fracture Across the Continuum of CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2009Mona Baumgarten PhD OBJECTIVES: To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period. DESIGN: Prospective cohort study. SETTING: Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged. PARTICIPANTS: Hip fracture patients aged 65 and older who underwent surgery for hip fracture. MEASUREMENTS: A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission. RESULTS: In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3,3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1,4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8,2.3) and 1.3 (95% CI=0.8,2.1), respectively. CONCLUSION: Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals. [source] Hyperglycemia as a Predictor of In-Hospital Mortality in Elderly Patients without Diabetes Mellitus Admitted to a Sub-Intensive Care UnitJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2008Intissar Sleiman MD OBJECTIVES: To investigate the association between hyperglycemia and in-hospital and 45-day mortality in acutely ill elderly patients. DESIGN: Retrospective cohort. SETTING: Hospital medical patients admitted to a sub-intensive care unit (sub-ICU) for elderly patients, which is a level of care between ordinary wards and intensive care. PARTICIPANTS: One thousand two hundred twenty-nine patients (mean age 79.6±8.4) admitted to the sub-ICU from January 2003 to January 2006. Forty patients with acute myocardial infarction and 34 patients with extreme fasting glucose values (<60 or >500 mg/dL) were excluded. Eight hundred twenty-two patients without a history of diabetes mellitus (DM) and 333 patients with a diagnosis of DM were selected and subdivided into three categories according to serum fasting blood glucose: 60 to 126 mg/dL (Group A), 127 to 180 mg/dL (Group B), and 181 to 500 mg/dL (Group C). MEASUREMENTS: Age, sex, mental and functional status, Acute Physiology Score, comorbid conditions, serum albumin, serum cholesterol, fasting serum glucose, and length of stay. In-hospital mortality was the primary outcome, and 45-day mortality was the secondary outcome. RESULTS: Total in-hospital mortality was 14.5%. In patients with and without DM, mortality was 8.8% and 11.3%, respectively, in Group A; 13.6% and 17.3% in Group B, and 12.6% and 34.3% in Group C. After controlling for confounders, newly recognized hyperglycemia (>181 mg/dL) was independently associated with in-hospital mortality (adjusted odds ratio=2.7, 95% confidence interval=1.6,4.8). Forty-five-day mortality in newly recognized hyperglycemic patients was 17.5%, 25.7%, and 42% in Groups A, B, and C, respectively, whereas it was 21.2% in patients with DM. CONCLUSION: In elderly patients, newly recognized hyperglycemia was associated with a higher mortality rate than in those with a prior history of DM. These data suggest that further randomized clinical trials are needed to assess the efficacy and the risk of a target glucose of greater than 180 mg/dL. [source] Two-Minute Mental Health Care for Elderly Patients: Inside Primary Care VisitsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007(See editorial comments by Drs. Charles Reynolds, Bruce L. Rollman), Carrie Farmer Teh, Mario Cruz OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients. DESIGN: Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health. SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners. PARTICIPANTS: Thirty-five primary care physicians and 366 of their elderly patients. MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk. RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients. CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits "during which a mental health problem is discussed" may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed. [source] Randomized Trial to Improve Prescribing Safety in Ambulatory Elderly PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007Marsha A. Raebel PharmD OBJECTIVES: To determine whether a computerized tool that alerted pharmacists when patients aged 65 and older were newly prescribed potentially inappropriate medications was effective in decreasing the proportion of patients dispensed these medications. DESIGN: Prospective, randomized trial. SETTING: U.S. health maintenance organization. PARTICIPANTS: All 59,680 health plan members aged 65 and older were randomized to intervention (n=29,840) or usual care (n=29,840). Pharmacists received alerts on all patients randomized to intervention who were newly prescribed a targeted medication. INTERVENTION: Prescription and age information were linked to alert pharmacists when a patient aged 65 and older was newly prescribed one of 11 medications that are potentially inappropriate in older people. MEASUREMENTS: Physicians and pharmacists collaborated to develop the targeted medication list, indications for medication use for which an intervention should occur, intervention guidelines and scripts, and to implement the intervention. RESULTS: Over the 1-year study, 543 (1.8%) intervention group patients aged 65 and older were newly dispensed prescriptions for targeted medications, compared with 644 (2.2%) usual care group patients (P=.002). For medication use indications in which an intervention should occur, dispensings of amitriptyline (P<.001) and diazepam (P=.02) were reduced. CONCLUSIONS: This study demonstrated the effectiveness of a computerized pharmacy alert system plus collaboration between healthcare professionals in decreasing potentially inappropriate medication dispensings in elderly patients. Coupling data available from information systems with the knowledge and skills of physicians and pharmacists can improve prescribing safety in patients aged 65 and older. [source] Postprandial Hypotension in Long-Term Care Elderly Patients on Enteral FeedingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2006Emily Lubart MD OBJECTIVES: To examine the prevalence and nature of postprandial hypotension (PPH) in orally fed (OF), nasogastric tube (NGT)-fed, and percutaneous endoscopic gastrostomy (PEG)-fed older people. DESIGN: Prospective comparative study. SETTING: Nursing and skilled nursing wards of three geriatrics hospitals. PARTICIPANTS: Three groups (OF, PEG, NGT) of long-term care patients (50 in each cohort) were enrolled. MEASUREMENTS: Blood pressure (BP) and heart rate measurements were obtained just before lunch and at 15-minute intervals for 90 minutes after the completion of the meal. The meals were similar in caloric content and composition. RESULTS: PPH was evidenced in 64 (43%) patients. No significant intergroup (OF, PEG, NGT) differences were present. In 68% of PPH patients, the systolic BP (SBP) drop appeared within 30 minutes, and 70% reached their systolic nadir at 60 minutes. In 31%, the SBP drop was registered on only one measurement, whereas in 25%, the drop was detected on five to six measurements. All parameters were without notable intergroup differences. CONCLUSION: In enterally fed elderly patients (NGT or PEG), the rate and pattern of PPH are similar and not significantly different from that observed in OF patients. [source] Use of Antibiotics in Elderly Patients with Exacerbated COPD: The OLD-Chronic Obstructive Pulmonary Disease StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2006Raffaele Antonelli Incalzi MD OBJECTIVES: To verify how frequently geriatric patients hospitalized for exacerbated chronic obstructive pulmonary disorder (COPD) had not been given antibiotics at home and to identify the relationship between the patient's condition and the prescribing practice. DESIGN: Observational study. SETTING: General medicine acute care wards. PARTICIPANTS: Four hundred fifty-nine elderly patients admitted to the hospital because of exacerbated COPD. MEASUREMENTS: Indices of severity of COPD exacerbation, such as age, St. George Respiratory Questionnaire (SGRQ) score, number of exacerbations in the previous year, and Cumulative Illness Rating Scale score were considered in the analyses. RESULTS: Ninety (19.6%) patients had an antibiotic prescribed before admission. The prescription was not associated with older age and was weakly associated with greater comorbidity. Having more than four exacerbations (odds ratio (OR)=2.16, 95% confidence interval (CI)=1.27,3.66) and a SGRQ symptoms subscore greater than 70 (OR=1.61, 95% CI=1.0,2.68) were independent correlates of the use of antibiotics before admission, although 67% of patients reporting more than four exacerbations in the previous year and 73.1% of patients with a SGRQ symptoms subscore greater than 70 had not been given any antibiotic prescription at home. CONCLUSION: The majority of older patients hospitalized for exacerbated COPD had not been given antibiotics at home, although they had at least one index of exacerbation severity. [source] Outcome Predictors of Pneumonia in Elderly Patients: Importance of Functional AssessmentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Olga H. Torres MD Objectives: To evaluate the outcome of elderly patients with community-acquired pneumonia (CAP) seen at an acute-care hospital, analyzing the importance of CAP severity, functional status, comorbidity, and frailty. Design: Prospective observational study. Setting: Emergency department and geriatric medical day hospital of a university teaching hospital. Participants: Ninety-nine patients aged 65 and older seen for CAP over a 6-month recruitment period. Measurements: Clinical data were used to calculate Pneumonia Severity Index (PSI), Barthel Index (BI), Charlson Comorbidity Index, and Hospital Admission Risk Profile (HARP). Patients were then assessed 15 days later to determine functional decline and 30 days and 18 months later for mortality and readmission. Multiple logistic regression was used to analyze outcomes. Results: Functional decline was observed in 23% of the 93 survivors. Within the 30-day period, case-fatality rate was 6% and readmission rate 11%; 18-month rates were 24% and 59%, respectively. Higher BI was a protective factor for 30-day and 18-month mortality (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94,0.98 and OR=0.97, 95% CI=0.95,0.99, respectively; P<.01), and PSI was the only predictor for functional decline (OR=1.03, 95% CI=1.01,1.05; P=.01). Indices did not predict readmission. Analyses were repeated for the 74 inpatients and indicated similar results except for 18-month mortality, which HARP predicted (OR=1.73; 95% CI=1.16,2.57; P<.01). Conclusion: Functional status was an independent predictor for short- and long-term mortality in hospitalized patients whereas CAP severity predicted functional decline. Severity indices for CAP should possibly thus be adjusted in the elderly population, taking functional status assessment into account. [source] Cholesterol and Mortality in Elderly PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2004Renzo Rozzini MD No abstract is available for this article. [source] The Vulnerability of Middle-Aged and Elderly Patients to Hepatitis C Virus Infection in a High-Prevalence Hospital-Based Hemodialysis SettingJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004Anil K. Saxena MD Objectives: To determine the relationship between advancing age and the risk of acquiring hepatitis C virus (HCV) infection, through evaluation and statistical comparison of seroprevalence and seroconversion rates in different age groups of patients on long-term hemodialysis (HD). Design: Retrospective cohort study. Setting: Hemodialysis facility of King Fahad Hospital and Tertiary Care Center, Al-Hasa region of the eastern province of Saudi Arabia. Participants: One hundred ninety-eight patients with end-stage renal disease enrolled for long-term HD therapy from September 1995 to September 2000. Measurements: HCV seroprevalence and seroconversion rates. Results: The overall HCV seroprevalence of 43.4% (86/198) and seroconversion rate of 8.6% per year were recorded. Patients aged 55 to 64 had the highest anti-HCV prevalence (55.3% (26/47)) and annual seroconversion rates (11.0%). Those aged 65 to 74 had the next-highest prevalence (48.9% (24/49)) and seroconversion rate (9.7%), and patients aged 15 to 24 had the lowest prevalence (12.5% (1/8)) and seroconversion rate (2.5%) (reference group). Conclusion: Significantly higher annual seroconversion rates in those aged 55 to 64 and 65 to 74 during a shorter dialysis period (35.6 and 32.7 vs 58.0 months), suggest the greater susceptibility of the middle-aged and elderly patients to acquisition of HCV infection than the younger (15,24 years) group. This could be attributed to the combined effect of immunosuppression associated with advancing age, uremia, and undernutrition, but multicenter molecular follow-up studies with larger sample sizes would be needed to corroborate these findings and plan appropriate strategies for these high-risk groups. [source] | |||||||||||||||||||||||||||||||||||||||||||