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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fall related hip fractures in elderly persons may substantially deteriorate a previously worthwhile life. Anxiety, isolation, depression and the immediate need for help jeopardize surgery and successful rehabilitation. It was therefore of interest to evaluate the impact of a comprehensive case management guided by a discharge assessment which included medical and social criteria. In a prospective, open study, conducted by a community hospital in Vienna and the Research Department of the Red Cross, 124 carefully selected patients (117 female, 7 male, mean age 81.8 +/- 7.0 years) over a period of six months were assessed one week before hospital discharge by a multiprofessional team. Patients were excluded for mental illness, dementia, disabling neurological diseases and noteworthy surgical complications. Thirty-four patients (mean age 83.7 +/- 7.6 years) were considered as intervention group. Ninety essentially independent patients (mean age 81.1 +/- 6.6 years) were considered as control group. A specialised nurse from the Community of Vienna was responsible for the link between the patients of the intervention group, the rehabilitation unit and the Social Services, for the discharge check lists and the feed back questionnaires (2, 6 and 12 weeks after discharge). All patients were asked for a check up 12 weeks after discharge in order to investigate needs and substantial changes in the ADL or required care. In the control group, nearly all patients reached the pre-traumatic level, whereas in the intervention group a drop out rate of 1/5th and a higher over all need of Social Services care was observed. However, in respect of the higher age, the more compromised health and activities, even this group of patients obviously profits by this case management strategy. In conclusion, surgery and rehabilitation need a thoroughly performed discharge assessment followed by a network of comprehensive Social Services measures to treat successfully high risk elderly patients after fall related hip fractures.
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PMID:[Improvement of rehabilitation outcomes of hip fractures: discharge assessment by patient care team, case management and wound healing]. 1084 53

Poor medication compliance is a major issue in the health care of older patients. To identify risk factors for medication noncompliance in the elderly, inpatients aged 65 years and older at Nagoya University Hospital and at Chubu National Hospital underwent a comprehensive geriatric assessment and tests for the assessment of medication compliance. The dependency of medication assistance by a caregiver is associated with low physical function activity, cognitive impairment, depression and communication inability. Medication noncompliance was not associated with the score of any component of comprehensive geriatric assessment. There was a good relationship between patient's knowledge of medications and the frequency of dosage interval, both of which were associated with the score of instrumental ADL, cognitive function and communication ability. The knowledge was also associated with the medication compliance at Nagoya University Hospital but not at Chubu National Hospital. These results may suggest that the elderly patient's understanding of a medication regimen is important but that other factors are also required to maintain their treatment regimen.
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PMID:[Factors influencing noncompliance with medication regimens in the elderly]. 1093 25

The objectives of this prospective cohort study were to 1) determine the prevalence of depressed mood, 2) identify the characteristics associated with it, and 3) evaluate the recognition rate of depressed mood by clinicians. The study population was a cohort of 401 elderly patients, aged 75 years and older, admitted to the internal medicine service of a tertiary care academic medical center in Western Switzerland over six months. We excluded patients with severe cognitive impairment, terminal disease or those living in a nursing home. Data on demographics, medical, physical, social and mental status were collected upon admission. Presence of depressed mood was defined as a score > or = 6 on the Geriatric Depression Scale (GDS), short form (15-item). An independent reviewer performed a discharge summary abstraction to assess recognition rate. Subjects' mean age was 82.4 years, 60.9% were women. Overall, 90 patients (22.40%) had an abnormal GDS score (> or =6). Compared to those without a depressed mood, these subjects were (all p<0.05) older (83.5 vs 82.0 years), more frequently living alone (66.7 vs 55.0%), dependent in both basic activities of daily living (BADL) and instrumental ADL (48.9 vs 36.0%, and 91.1 vs 84.9%, respectively), and cognitively impaired (47.8 vs 27.7% with MMSE score<24). In addition, they had more comorbidities (Charlson index 1.6 vs 1.2). In multivariate analysis, an independent association remains for subjects living alone (OR 1.8, 95%CI 1.1-3.0), with cognitive impairment (OR 1.9, 95%CI 1.1-3.2), and comorbidities (OR 1.3 per point, 95%CI 1.1-1.5). Detection rate during the index hospitalization was only 16.7% (15/90). In conclusion, depressed mood was frequent but rarely detected in this population. These findings emphasize the need to improve screening efforts, and to develop additional strategies such as using a pre-screening question to enhance clinical recognition.
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PMID:Depressed mood in a cohort of elderly medical inpatients: prevalence, clinical correlates and recognition rate. 1107 50

Subjective memory complaint is common in later life. Its relationship to future risk of dementia is unclear, although many reports have found a positive association. We designed the present cross-sectional survey to investigate the clinical features associated with subjective memory impairment. One hundred and eight volunteers and 38 non-complainers acting as age-matched controls were recruited. Eleven subjects with memory complaints were excluded because of prior stroke or low MMSE score. The CAMCOG was used to measure cognition; complainers had significantly lower scores (p<0.001). Univariate analysis showed that complainers had greater prevalence of depression, anxiety, insomnia, psychotic phenomenon, difficulties with ADL and word-finding difficulties. The frequency distribution of the apolipoprotein E epsilon4 allele was similar for both groups (p=0.469). Logistic regression analysis indicated that CAMCOG scores (p=0.002) and word-finding difficulty (p=0.002) were independently associated with memory complaints. These results show that memory complainers have worse cognitive performance than non-complainers and support the findings of other studies that suggest that subjective memory loss may be a reliable indicator of cognitive decline.
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PMID:Clinical characteristics of individuals with subjective memory loss in Western Australia: results from a cross-sectional survey. 1124 22

Many patients with Parkinson's disease (PD) have clinically significant anxiety, depression, fatigue, sleep disturbance, or sensory symptoms. The comorbidity of these nonmotor symptoms and their relationship to PD severity has not been extensively evaluated. Ninety- nine nondemented PD patients were evaluated with the following battery of tests: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), a sensory symptom questionnaire, Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr (H/Y) Stage, and the Schwab & England ADL scale (S/E). The comorbidity of the nonmotor symptoms and their relationship to PD severity was analyzed. Thirty-six percent of the study population had depression (BDI > or =10), 33% had anxiety (BAI > or =10), 40% had fatigue (FSS > 4), 47% had sleep disturbance (PSQI > 5), and 63% reported sensory symptoms. Only 12% of the sample had no nonmotor symptoms. Fifty-nine percent of the patients had two or more nonmotor symptoms, and nearly 25% had four or more. Increased comorbidity was associated with greater PD severity (P < 001). This study reveals that the nonmotor symptoms of PD frequently occur together in the same patients. Increased comorbidity of the five nonmotor symptoms was associated with greater PD severity. These results suggest that recognition of these diverse nonmotor symptoms may be enhanced by looking for others when one nonmotor symptom has been identified.
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PMID:Comorbidity of the nonmotor symptoms of Parkinson's disease. 1139 46

Comprehensive geriatric assessment was developed in the Anglo-American countries as a diagnostic process to better understand the effects of diseases and interactions of multiple chronic conditions. To standardize the use of assessment instruments, a working group of the two German geriatric societies has elaborated recommendations. As the first step, an expanded version of the screening according to Lachs should be used, followed by performing the Barthel-ADL, the Mini-Mental State Examination, the Geriatric Depression Scale, the 'Timed Up and Go' and the (Semi-) Tandem Stance. The expanded version of the screening of Lachs is helpful for targeting patients and for placement; the others are not useful for that purpose. No instrument satisfactorily fulfills all test criteria, which include validity, reliability, sensitivity, practicability and repeatability, and, in part, these dimensions are not investigated at all. All test instruments are diagnostic tools for functional status and capabilities but do not give information about resource needs. No instrument covers the new concept of ICIDH completely.
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PMID:[Geriatric assessment. The status of current knowledge with reference to suitability criteria (discrimination, prediction, evaluation, practical aspects)]. 1142 68

The aim of the present study was to assess the efficacy and safety of chronic subthalamic nucleus deep-brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). 18 consecutive severely affected PD patients were included (mean age, SD: 56.9+/-6 years; mean disease duration: 13.5+/-4.4 years). All the patients were evaluated clinically before and 6 months after the surgical procedure using the Unified Parkinson's Disease Rating Scale (UPDRS). Additionally, a 12 months follow-up was available in 14 patients. The target coordinates were determined by ventriculography under stereotactic conditions, followed by electrophysiology and intraoperative stimulation. After surgery, continuous monopolar stimulation was applied bilaterally in 17 patients at 2.9+/-0.4 V through 1 (n = 31) or 2 contacts (n = 3). One patient had bilateral bipolar stimulation. The mean frequency of stimulation was 140+/-16 Hz and pulse width 68+/-13 micros. Off medication, the UPDRS part III score (max = 108) was reduced by 55 % during on stimulation (score before surgery: 44.9+/-13.4 vs at 6 months: 20.2+/-10; p < 0.001). In the on medication state, no difference was noted between the preoperative and the postoperative off stimulation conditions (scores were respectively: 17.9+/-9.2 and 23+/-12.6). The severity of motor fluctuations and dyskinesias assessed by UPDRS IV was reduced by 76 % at 6 months (scores were respectively: 10.3+/-3 and 2.5+/-3; p < 0.001). Off medication, the UPDRS II or ADL score was reduced by 52.8 % during on stimulation (26.9+/-6.5 preop versus 12.7+/-7 at 6 months). The daily dose of antiparkinsonian treatment was diminished by 65.5 % (levodopa equivalent dose -- mg/D -- was 1045 +/- 435 before surgery and 360 +/- 377 at 6 months; p < 0.01). These results remained stable at 12 months for the 14 patients studied. Side effects comprised lower limb phlebitis (n = 2), pulmonary embolism (n = 1), depression (n = 6), dysarthria and freezing (n = 1), sialorrhea and drooling (n = 1), postural imbalance (n = 1), transient paresthesias and dyskinesias. This study confirms the great value of subthalamic nucleus stimulation in the treatment of intractable PD. Some adverse events such as depression may be taken into account in the inclusion criteria and also in the post-operative outcome.
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PMID:Subthalamic nucleus stimulation in Parkinson's disease: clinical evaluation of 18 patients. 1202 40

A strong association between functional disability and depressive symptoms in older people has frequently been reported. Some studies attribute this association to the disabling effects of depression, others to the depressogenic effects of physical health-related disability. The authors examined the reciprocal effects between depressive symptoms and functional disability and their temporal character in a community-based cohort of 753 older people with physical limitations who were assessed at yearly intervals. They compared structural equation models that differed in terms of direction and speed of effects between patient-reported disability in instrumental and basic activities of daily living (IADL/ADLs) and depressive symptoms. The association between disability and depression could be separated into three components: (a) a strong contemporaneous effect of change in disability on depressive symptoms, (b) a weaker 1-year lagged effect of change in depressive symptoms on disability (probably indirect through physical health), and (c) a weak correlation between the trait (or stable) components of depression and disability. IADL/ADL disability and depressive symptoms are thus mutually reinforcing over time. Compensatory forces like effective treatment and age-related adaptation may protect elders against this potential downward trend. To improve quality of life in elderly adults, treatment should target disability when it is new and depression when it is persistent.
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PMID:Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life. 1208 84

The development of civilization and progress in medicine made the prolongation of the life span and increased share of the advanced old age people in the population. The consequence of this process is growth in frequency of diseases related to age including dementia. However diagnosis of cognitive impairment is still difficult and it makes some problems in an everyday medical practice. The aim of this report is to define main and significant determinants of dementia basing on the MMSE scale. This could make it easier to suspect the cognitive disorders to make indepth diagnosis and to start earlier therapy. The sample consisted of 124 community dwelling persons 75-year old and over. 64 of them were mildly, moderately or severely demented according to Katzman scale administered previously and 60 were intellectually intact. The both groups of persons were tested with MMSE. Geriatric Depression Scale, ADL scale (EASY-Care questionnaire) and short internal and neurological examination. The multiple regression model were used, where dependent variable was the MMSE score and independent variables social-demographic data, ADL and GSD scales and data from interview and medical examination. 72 variables were included to the model and 39 of them were significantly connected with cognitive impairment. The valid factors explained dementia in 78.7% (adjusted R2 = 0.787). The strongest connection was found with (1) an ignorance of own date of birth, (2) low education level, (3) behaviour disorders and (4) an advanced old age. These determinants, including difficulties with handling own money, have explained dementia in 57%. The presence such symptoms could make easier to suspect the cognitive disorders, to make in-depth diagnosis, and to start earlier therapy.
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PMID:[Determinants of dementia in the advanced old age elderly]. 1218 87

Forty-five stroke patients and their 45 proxies were interviewed after the patients' hospital admission and before discharge. The topics of the interviews were disease knowledge, expectations in and judgement about therapy, estimation of functional health status (CCOP/WONCA Charts), and prognosis. The patients and proxies were also asked to name the patient's actual three most important health problems. The depressive symptomatology in the patients (geriatric depression scale) and their ADL status (Barthel Index) were evaluated on admission and before hospital discharge. The proxies' general knowledge of disease was superior compared to that of the patients. There were knowledge deficits regarding individual risk factors and secondary prevention, in particular. Information was predominantly obtained from physicians. However, an additional need for information on prognosis and prevention, in particular, was expressed by patients and proxies before hospital discharge. There was a high agreement between the patients and their proxies in mentioning the patients' actual three most important health problems, apart from psychological problems. These were mentioned only by the proxies but not by the patients themselves. Depressive symptomatology in the patients increased significantly. There were associations of depression with the level of the Barthel Index score and the patients' self-estimation of functional health status before and after the stroke. Full recovery was expected by one half of the patients, on admission. The patients' primary therapeutic goal was the ability to walk again. Their ADL status improved significantly, as measured by a mean increase in the Barthel Index score by 22 points. The patients and their proxies, as well, judged the result of treatment equally high. The proxies' total satisfaction with patient care was significantly related to their ratings of separate parts of patient care regarding nurses, therapists, and physicians, to their expectations in therapy, and the satisfaction of their own personal needs. The results of the study revealed a particular need for information on prognosis and secondary prevention of stroke. Furthermore, depression and coping with consequences of the disease should be important issues in counselling of stroke patients and their proxies. The results regarding patient and proxy satisfaction with care were of importance for internal discussion in the clinic.
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PMID:[Knowledge concerning illness, expectations and perceptions of treatment of elderly stroke patients and family caregivers--a prospective study during inpatient treatment]. 1221 9


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