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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A prospective study of 419 patients aged 70 and over admitted to acute medical wards was carried out by medical staff from a geriatric unit. Data, including presenting problem, housing, social support, mental state, continence, and degree of independence before and after admission, were recorded. Of the 419 patients, 143 remained in hospital after 14 days and 65 after 28 days. The major factors associated with prolonged stay in hospital included advanced age, stroke, confusion and falls as reasons for admission to hospital, incontinence, and loss of independence for everyday activities. Social circumstances did not predict length of stay. Although these factors are interrelated, the most important influence on length of stay was the medical reason for admission. Early contact with the geriatric medical unit in these patients may speed up the recovery or result in more appropriate placement.
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PMID:Elderly patients in acute medical wards: factors predicting length of stay in hospital. 308 1

Infection is a common problem in elderly patients, the most common infections being those in the urinary tract and the respiratory tract. In geriatric practice, infection is most frequently seen in combination with many other problems. The geriatric presentation is described in which patients may present with an increased dependency upon care providers due to the development of fresh problems like falls, immobility, confusion, incontinence of urine, and fecal impaction with incontinence. It is important to recognize this presentation and not to miss the diagnosis. It is well recognized that pneumonia is the most frequently missed diagnosis in the elderly. An increase in dependency should not be ignored and attributed to old age. The presence of pathophysiological changes and organ involvement, together with fever, raised white count, or elevated ESR, are strongly supportive of a diagnosis of infection. Once identified, the infection can usually be appropriately treated, resulting in significant improvement in multiple geriatric problems which these patients suffer from.
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PMID:Atypical presentation of geriatric infections. 336 Mar 29

Immobility, falls, incontinence, mental confusion and homeostatic disturbances are the major problems encountered in elderly patients. These occur with increasing frequency in the very old (age greater than 85) but studies have shown that the level of disability for those aged 65-84 remains no more than 15-20%. As at all ages, a small proportion of elderly experience most of the clinical problems. To improve our performance in managing these requires education of medical trainees, cooperation between acute and long-term care institutions and a concentrated program of biomedical research. Therapy designed to light up fading receptors or increase neurotransmitter function to maintain cerebral control mechanisms for posture, excretion and appetite control will achieve more than psychosocial or administrative attempts to solve such clinical problems.
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PMID:A clinical perspective on aging. 374 12

Two elderly patients, who were chronically receiving aspirin, developed lethargy, incontinence, and confusion after dosing with acetazolamide. Unbound plasma acetazolamide concentrations were elevated and plasma protein binding was reduced, suggesting an interaction with aspirin. In vitro studies demonstrated a concentration-dependent effect of salicylate on acetazolamide binding to serum proteins. At a therapeutic serum acetazolamide level of 8.0 micrograms/ml, the unbound percentage of acetazolamide in serum was 3.3% and increased to 11.0% and 30.0%, with serum salicylate levels of 200 and 386 micrograms/ml, respectively. Furthermore, the apparent association constant of acetazolamide for binding to serum proteins was decreased by 58% and 86% of its control value at these respective salicylate concentrations. The maximal binding capacity of serum for acetazolamide was not affected by salicylate. Pharmacokinetic studies in four volunteers showed that the plasma protein binding and renal clearance of acetazolamide were significantly reduced during chronic salicylate dosing. Salicylate appears to competitively inhibit the plasma protein binding of acetazolamide and simultaneously to inhibit acetazolamide renal tubular secretion. Caution is advised when acetazolamide and salicylate are used concurrently.
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PMID:Toxic interaction between acetazolamide and salicylate: case reports and a pharmacokinetic explanation. 376 83

Eight percent of the elderly patients discharged from a geriatric unit in one year were readmitted within three months. Forty-six percent had been living alone and nearly all of these had received full community support at the time of discharge. Recurrent problems were the reason for readmission in 59% of cases, mainly due to falls, incontinence, and confusion. Only 54% of the readmitted patients were discharged home again--those with new additional problems tended to die in hospital, whereas those with recurrent problems often required institutional long-term care. It is concluded that even with careful discharge planning, a proportion of patients will require readmission, some of which will also require long-term institutional care. This number is quite small in terms of the total number of patients discharged from a geriatric unit and should not be a reason for seeking nursing home care at an early stage.
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PMID:Relevance of readmission of elderly patients discharged from a geriatric unit. 394 Dec 44

In a randomly selected sample of 559 subjects 65 years and over living in the community and in institutions the prevalence of urinary incontinence was found to be 11.6%. In those 80 years and over the prevalence rose to 21.7%. Those with dementia were more likely to be incontinent than those with normal mental function. In the majority of those over 80 who were incontinent, the incontinence was associated with either confusion or a combination of factors. The estimated population prevalence of faecal incontinence for those 65 years and over was 3.1%. Urinary incontinence was associated with an increased risk of death. In a review of subjects after three years 73.5% of the incontinent group had died while only 34.9% of those originally continent had died. Because incontinent elderly people are commonly frail, with a number of conditions contributing to the disorder, the extent of investigation of the disorder needs to be carefully assessed for each patient.
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PMID:Incontinence in the elderly: prevalence and prognosis. 400 85

Within 1 year six elderly patients (aged 80-89 years) were admitted because of non-specific deterioration in mental or physical well-being. In no instance was hepatobiliary disease suspected at the time of hospital admission. One patient presented with intermittent confusion only. The other five were referred with "falls" or having "gone off legs", with malaise, confusion, or incontinence. All had raised alkaline phosphatase levels of 159-1230 IU/l, which led to investigation of the biliary tree. At endoscopic retrograde cholangiopancreatography all were shown to have biliary disease (three common duct stones, one gallbladder calculus, one an abscess, and one a widely dilated common bileduct ). With appropriate treatment (endoscopic sphincterotomy for two, surgery for two, and antibiotics alone for two), all showed a gratifying return of mobility and mental function. Biliary disease is a treatable cause of chronic ill health in the elderly and should be excluded, even in the absence of "classical" symptoms, when there is abnormal liver function.
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PMID:Gallstones presenting as mental and physical debility in the elderly. 614 85

This study examined a geriatric rehabilitation pilot project on an acute-care medical unit. Over a 6-week period, using a 35-item geriatric rating scale and a mental assessment tool, changes in behaviours of 23 patients admitted to the geriatric rehabilitation module were compared to changes in behaviours of 10 elderly patients on a regular medical unit. The patients' demographic characteristics, their nursing and medical diagnoses, and discharge patterns were reviewed. Significant changes in behaviours of patients on the rehabilitation model included: increased ability to care for themselves, to maintain balance, and to communicate with others; decreased restlessness at night; decreased confusion; decreased incidence of incontinence; and improved social skills. The paper describes the geriatric rehabilitation programme and discusses implications for nursing of elderly patients in acute-care hospitals.
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PMID:Geriatric rehabilitation on an acute-care medical unit. 656 47

More complete data on th prevalence and types of urinary dysfunction in geriatric institutional patients are essential for the management of their urologic problems. Over a 13-month period, a prospective study was conducted of all new admissions to a hospital for long-term care. Eighty percent (277/347) of the newly admitted patients were geriatric (65 or older). Urinary dysfunction was identified in 69.3 percent of the geriatric group; 38.3 percent were incontinent, 20.2 percent bore a urinary diversion device, and 10.8 percent were symptomatic without incontinence. Obtaining reliable information about urologic status posed a significant problem, particularly as 27 percent of the subjects had a mental disorder, including organic brain syndrome or confusion. Thirty percent of all patients questioned were unable to give any history of their own health status. Questioning of both staff and patient to determine reliability of the data revealed that the given information was correct in 77 percent of patients who acknowledged genitourinary dysfunction, and in 83 percent of those who denied it. The study failed to elicit useful data concerning the specificity of symptoms, urologic history, diagnosis and management of urinary dysfunction in this series of geriatric patients under long-term institutional care.
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PMID:Urinary dysfunction in a geriatric long-term care population: prevalence and patterns. 678 37

This study prospectively examines 502 general medical patients for evidence of side-effect of hospitalization unrelated to diagnosis or therapy of acute illness. Symptoms of depressed psychophysiologic functioning (confusion, falling, not eating, and incontinence) unrelated to acute medical diagnoses were found in 8.8% of the patients under 70 and in 40.5% of the elderly population (P less than 0.0001). The rate of medical intervention secondary to these symptoms (psychotropic medications, restraints, nasogastric tubes, and foley catheters) was 37.9% among the young patients and 47.1% in the elderly group (P = 0.4). The sample was too small to permit adequate empirical determination of the complication rate from medical intervention (thrombophlebitis, pulmonary embolus, aspiration pneumonia, urinary tract infection, septic shock) but estimates from the literature indicate that each of the interventions studied entails a complication rate of 25-30%. Combining the observed rate of functional symptoms development and intervention, and the literature rates of complications, yields a risk of complications of 1.0% for the young and 5.7% for the elderly (P less than 0.0001). These data indicate that hospitalized elderly patients are at high risk of developing symptoms of depressed psychophysiology functioning and of sustaining medical intervention as a result of these symptoms, with attendant medical complications. We suggest that in incidence of depressed psychophysiologic function needs to be assessed in patients treated outside the hospital, along with efficacy of treatment outside the hospital, to determine whether there are patients for whom hospitalization is not optimal therapy.
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PMID:Adverse consequences of hospitalization in the elderly. 695 65


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