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

The ability to identify physical waypoints along the continuum of illness may give end-stage patients and their families opportunities for goal reframing and risk reduction. That period which exists between active participation in the activities of daily living and a bedbound status, herein described as the transitional phase, is characterized by the four precursive, or seminal, behaviors of anorexia, increased sleep, weakness, and confusion, and the two cardinal behaviors of incontinence and falls. It is a time of heightened anxiety for families and risk of injury for patients. The ability to identify these behaviors as part of a definable phase, with a beginning and an end, allows the health care clinician or hospice worker to educate the family, assisting with goal reassignment, risk reduction, and diminishment of anxiety. Family understanding of the finite nature of the transitional phase may also reduce the need for placement outside the home for those wishing their loved one to die at home, and provide the caregiver with meaningful participation in end-of-life problem solving.
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PMID:The transitional phase: the closing journey for patients and family caregivers. 1188 61

Potential geriatric patients are frail old persons characterized by the presence of one or several geriatric conditions: polypharmacy, socio-economic problems, vision/hearing impairment, confusion, impaired mobility, incontinence, weight loss, depression, falls, dementia, and prolonged bedrest. Admission of these frail old patients to a geriatric unit may reduce mortality, improve function, and decrease the risk of nursing home placement. These frail old patients may not all be able to profit from geriatric rehabilitation. The published randomized trials showing substantial effect of geriatric rehabilitation exclude patients with severe dementia, terminal disease or those with a single medical disease for which there is no further treatment. Careful selection of patients is necessary in order to achieve superior, clear-cut effect when compared to conventional treatment in general medical wards.
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PMID:[Who should be admitted to a geriatric unit?]. 1288 61

Gerontological nursing is a unique area of nursing. The cornerstone of the gerontological nursing process is assessment. In some traditional education models, nurses are taught assessments in general areas, such as cardiology, neurology, urology, and orthopedics. Little emphasis is placed on integrating these systems. A one-day workshop was developed with the objective to further develop the assessment skills of the registered nurse (RN) in continuing care by demonstrating a holistic approach to assessment and care planning. For this workshop, the "giants of geriatric medicine," namely falls, incontinence, confusion, iatrogenic illness, and impaired homeostasis (Cape, 1978) were further developed into a geriatric nursing model to include the psychosocial issues. This model demonstrates a way of assessing and integrating the information known about the resident. To ensure the workshop content was practical for the nurse, existing resident care documentation within the sponsoring organization, The Capital Care Group, was used. Through the education provided in the workshop, the RNs recognized that individualized care is based on full assessment of the resident, integration of the information gathered, and complete documentation.
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PMID:Geriatric nursing assessment. 1367 54

The patient discussed in this care study is a 91-year-old woman admitted to hospital from her own home. She presented with reduced mobility, constipation, increased confusion and reduced oral intake. Her history included small vessel disease and a stroke. On admissions she also had a number of grade two pressure ulcers on her buttocks. The surrounding skin appeared macerated and the patient complained of pain when the skin was cleaned after she was incontinent of both urine and faeces. It was expected that the wound would be fast healing, as it was superficial, but the healing rate proved otherwise. This article will focus on incontinence management as well as ways of aiding in healing a pressure ulcer where skin is macerated and the patient has many risk factors.
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PMID:Managing and caring for a patient with a complicated wound. 1556 99

November 2004. A 63-year-old woman presented with slowly aggravating lower back pain and recent urinary urge incontinence. MRI revealed a sharply-delineated, partly cystic intradural mass with inhomogenous contrast-enhancement and ectatic vessels at the upper pole. An ependymoma was suspected, and the tumor was resected in toto. Histologically, at first glance, the tumor strongly resembled an ependymoma, showing a monomorphic cellular pattern, perivascular pseudorosettes and ependymal canal-like structures. However, the finding of a delicate collagen capsule, compartmentation of tumor cells into zellballen and the presence of ganglionic cells were untypical. These features were indicative of a paraganglioma with a gangliocytic component. Immunoreactivity of the tumor cells for neuroendocrine antigens, the detection of GFAP-positive sustentacular cells and the ultrastructural confirmation of neurosecretory granules substantiated this diagnosis. The clinical, radiological and morphological similarity between ependymomas, which are far more common in the cauda equina region than paragangliomas, has led to substantial diagnostic confusion in the past.
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PMID:November 2004: intradural mass of the cauda equina in a woman in her early 60s. 1591 90

This paper describes the first part of a two-stage research project designed to investigate the clinical and service outcomes of a comprehensive intermediate care service. It is a baseline study of patients presenting to two elderly care departments as emergencies with the clinical syndromes of falls, incontinence, confusion or poor mobility before the introduction of a city-wide intermediate care service. The outcome measures were: mortality; disability (Barthel Index, BI); social activities (Nottingham Extended Activities of Daily Living); service use; and carer distress (General Health Questionnaire -28). These were measured at 3, 6 and 12 months after recruitment. Eight hundred and twenty-three patients were recruited (median age = 84 years; proportion of women = 70%; proportion with cognitive impairment = 45%; median BI score = 15). There was a high mortality rate (36%), evidence for incomplete recovery, a gradual decline in independence over 12 months and a high degree of carer stress. There was little use of rehabilitation services (< 5%), about 25% required readmission to hospital by each assessment point and there was a gradual increase in institutional care admissions. These findings support a needs-based argument for a more comprehensive community service for frail older people.
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PMID:A prospective baseline study of frail older people before the introduction of an intermediate care service. 1596 1

The psychopathology of stroke encompasses several psychiatric and behavioral disorders that have high prevalence in the geriatric population, reduce the patient autonomy and increase the caregiver's burden. These disorders are usually associated with other cognitive and neurological deficits, and are labelled as neuropsychiatric when the whole clinical picture is consistent with the specific dysfunction of a neural system or brain region. Thus the neuropsychiatry of stroke comprises disorders of the perception/identification of the self and the environment (anosognosia of hemiplegia, misidentification syndromes, confabulations, visual hallucinations, delirium and acute confusional state), amotivational syndromes (apathy and athymhormia), disorders of emotional reactivity (blunted affect, emotional incontinence, irritability, catastrophic reactions), poor impulse or ideation control (mania) and personality changes. The clinical profile of the subcortical vascular dementia also points to specific brain dysfunction (frontal-subcortical pathways) that manifests with behavioral (depression, emotionalism, irritability) and cognitive symptoms (psychomotor retardation, attention, executive and memory deficits). However, post-stroke depression and anxiety, which have a more variable clinical presentation and might be assimilated, for several aspects, to post-traumatic or adaptive disorders, are disorders less characterized in their neural correlates.
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PMID:[Psychopathology of stroke]. 1631 15

Acute cholangitis is more common in older people, and increasing age is a determinant of morbidity and mortality, as is early biliary decompression by ERCP. This study aims to identify factors that may contribute to delays in the diagnosis and treatment of older people with acute cholangitis. Case notes of 122 patients (45 aged < 75 years, 77 > 75 years) with a final diagnosis of acute cholangitis who underwent ERCP were reviewed for presenting clinical features (pain, jaundice, rigors, fever, falls, incontinence, confusion), liver function tests, blood count, and the interval from admission to diagnosis, ultrasonography, and ERCP. The most common symptom at presentation was abdominal pain (81%), followed by jaundice (55%). These symptoms were no less common in older patients. Charcot's triad was present in only 15.6% of young and 18.8% of older patients. Jaundice was not detected in 16% of significantly hyperbilirubinemic older patients, but only the presence of functional symptoms was associated with significant diagnostic delay (median, 1 day [range: 0-11] vs. 9.5 days [3-25]; P< 0.001) and delay in performing ERCP (median: 4 days [0-24] vs. 16.5 days [2-29], P< 0.001). Overall mortality was 10%, and the incidence of septic shock was similar in both groups. Charcot's classical triad is infrequent in patients suffering from acute cholangitis. Given the greater difficulty assessing jaundice in older people and the confounding effect of falls, incontinence, and confusion, a routine policy of liver function tests, with further investigation of abnormal results in such presentations, may reduce delays in diagnosing and treating acute cholangitis.
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PMID:Clinical presentation and delayed treatment of cholangitis in older people. 1641 62

Falls among inpatients are the most frequently reported critical incidents in hospitals and can have tragic consequences that affect morbidity and mortality. The present study aimed to determine whether certain nursing units of care identified on patient care plans can be used to predict falls among hospitalized inpatients. A retrospective analysis of 7167 inpatient admissions in the 2002 calendar year was conducted. Faller status was ascertained from the hospital's accident and incident monitoring system, and nursing units of care activated in the hospital's nursing information system were identified. Twelve nursing units of care predicted falls. Logistic regression analyses showed that nursing units of care related to patient safety, confusion, incontinence, medication, mobility, and sleep were significant risk factors for falls among inpatients. The number of nursing units of care activated also predicted falls. Data collected from nursing information systems can be used to identify patients at high risk of falls.
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PMID:Falls in hospitalized patients: can nursing information systems data predict falls? 1670 48

A 33-year-old woman, with a 7-year clinical history of invasive thymoma treated at ages 26 and 30 years by thymectomy and radiation, presented with a generalized convulsion and loss of consciousness. Following the seizure there was no neurological deficit and normal tendon reflexes. Magnetic resonance imaging (MRI) of the brain without gadolinium enhancement revealed multiple small lesions of high signal intensity on T2 and diffusion weighted images located in the cortical area beyond the temporal lobes. Brain biopsy demonstrated encephalitis with activated microglias and activated T-cell infiltration. Within 4 months of treatment with nothing other than anticonvulsant therapy, the lesions visible on the original MRI had completely disappeared and the patient was discharged with no neurological symptoms. The patient subsequently had two more episodes with a variety of symptoms such as incontinence, confusion, aphasia, apallial syndrome, and motor paresis. MRI following these episodes again revealed multiple lesions of similar appearance to those of the first episode, although in different locations, and much larger and more numerous. The patient had steroid pulse therapy after both episodes and the lesions noted on brain MRI disappeared within a few months with minimal neurological complications.
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PMID:Recurrent limbic and extralimbic encephalitis associated with thymoma. 1709 50


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