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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pressure ulcers are a common and serious problem predominately among elderly persons who are confined to bed or chair. Additional factors associated with pressure ulcer development include cerebrovascular accident, impaired nutritional intake, urinary or fecal incontinence, hypoalbuminemia, and previous fracture. Implementation of preventive measures, such as an in-depth assessment for mobility, a pressure-relieving device combined with adequate repositioning, and thorough evaluation for nutritional status and urinary incontinence, significantly reduce pressure ulcer incidence. If the pressure ulcer is a partial thickness (stage II) wound, the causative factors are probably friction or moisture. If the ulcer is full thickness (stage III and IV), it is secondary to pressure or shearing forces. The development of wound infection is the most common complication in the management approach. Osteomyelitis is not an uncommon occurrence and must be initially ruled out in all full thickness pressure ulcers. Surgical debridement of necrotic tissue is necessary prior to further treatment and assessments. Antibiotic therapy is indicated only upon evidence of infection (cellulitis, osteomyelitis, leukocytosis, bandemia, or fever). Topical pharmacologic agents may be used to prevent or treat infection but must be carefully controlled to avoid such adverse effects as toxicity to the wound, allergic reaction, and development of resistant pathogens. Proper use of occlusive dressings increase patient comfort, enhance healing, decrease the possibility of infection, save time, and reduce costs. A patient presenting an ulcer that fails to improve or, because of its size, will take a great deal of time to heal should be evaluated for surgical closure.
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PMID:Pressure ulcers. Physical, supportive, and local aspects of management. 193 37

The purpose of this study was to identify prospectively risk factors for pressure sores and to compare these results with a cross-sectional analysis in the same population. Medical records on all admissions to a chronic care hospital over a 13-month period were reviewed. Data on potential risk factors were abstracted from the initial history, physical examination, nursing assessment, and laboratory studies. Pressure sore status on admission and at three weeks was determined from a standardized from completed on all patients with a score. The cross-sectional analysis was performed by comparing patients with and without a pressure sore at the time of admission. The cohort analysis used patients initially without a pressure sore and monitored for a new sore at three weeks. Factors associated with pressure sores on univariate testing were entered into a stepwise logistic regression model. One hundred of the 301 admissions presented with a pressure sore. Factors significantly associated with the presence of a sore were altered level of consciousness (OR = 4.1), bed- or chair-bound (OR = 2.4), impaired nutritional intake (OR = 1.9), and hypoalbuminemia (OR = 1.8 for 10 mg/mL decrease). Of the 185 patients without a pressure sore, 20 (10.8%) developed a sore. Factors significantly associated with the development of a new pressure sore were a history of cerebrovascular accident (OR = 5.0), bed- or chair-bound (OR = 3.8), and impaired nutritional intake (OR = 2.8). Neither urinary nor fecal incontinence, nor the presence of hypoalbuminemia, was associated with sore development. We have prospectively identified risk factors for pressure sores.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Risk factors for pressure sores. A comparison of cross-sectional and cohort-derived data. 280 51

A review of 33 studies identifies the factors of prior stroke, older age, urinary and bowel incontinence, and visuo-spatial deficits as adverse prognostic indicators of function. No relationship is shown between sex, hemisphere of stroke, and functional outcome. Functional admission score is a strong predictor of discharge functional status, but its relationship with improvement in function is unclear. Findings regarding the prognostic value of severity of paralysis and onset-admission delay are ambiguous. Comparison among studies is hindered by differences in patient samples, timing of assessments, criteria by which outcome is measured and measuring instrument used. Future studies should measure function at set times post-stroke, use functional scales whose reliability and validity is well established, and be conducted in several treatment centres to ensure that the sample is representative of the population to which the predictor measure is to be applied.
Stroke
PMID:Prediction of function after stroke: a critical review. 352 49

The incidence of incontinence in a series of 135 consecutive stroke patients was 51% (urine) and 23% (feces) within one year. In 75% the urinary incontinence started within the first two weeks, and in 41% it had cleared during that time. Incontinence at onset is associated with measures of severity of stroke (and of immobility for fecal incontinence). Among 92 survivors at one year, 15% were incontinent of urine, a proportion that rose in two- and three-year survivors to 23 to 24%, but by four years was again 14%, a level similar to that of the general elderly population. It is concluded that incontinence is more commonly a by-product of immobility and dependency than of involvement of the neurologic pathways, and most of it is transient.
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PMID:Incidence and correlates of incontinence in stroke patients. 401 99

Eight hundred and seven elderly persons aged 65-84 years who were randomly selected from the community were interviewed about falls. The rate of falls in the preceding year was 12.8% in men and 21.5% in women. The difference in the rate between the sexes was statistically significant. The rate in the older group was significantly higher than that in the younger group in both sexes, when they were divided into two major age categories. Multivariate logistic regression analysis showed that contact with a doctor within a month preceding the survey in both sexes, age, history of stroke, visual deficit in men, and urinary or bowel incontinence in women were significantly associated with increased risk of falling. The study reveals that falls tend to occur in physically frail elderly people in the community.
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PMID:Rate of falls and the correlates among elderly people living in an urban community in Japan. 797 82

To estimate the prevalence and risk factors of urinary and fecal incontinence and examine its prognosis among a community-residing elderly population, a randomly selected sample of 1473 elderly people, aged 65 years and over, living in the City of Settsu, Osaka, was investigated in October 1992. Data was obtained from 1405 for a response rate of 95.4%. The cohort of 1405 was followed for 38 months and follow-up was completed for 1325 (94.3%). The main results were as follows: 1) The prevalence of urinary incontinence of any degree was 9.8% in both sexes, and 8.7% men and 6.6% women admitted to some degree of fecal incontinence. 3.4% and 2.0% of the elderly were daily incontinent in urine and feces, respectively. There was an increasing prevalence of urinary and fecal incontinence with age in both sexes. 2) By univariate analyses, age older than 75 years, low activities of daily living (ADL), stroke, dementia, no participation in social activities, and lack of a perception of having a life worth living were significantly associated with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years and low ADL were significantly associated with any type of incontinence. Stroke was associated with incontinence less than once a day, while dementia was associated with incontinence more than once a day. 3) From analysis by Kaplan-Meier method and log-rank test, the estimated survival rates were higher among the elderly without incontinence than among those with incontinence, and tended to become low with the increased frequency of incontinence in both urine and feces. 4) From Cox proportional hazards model analysis, less than once daily fecal incontinence and once or more fecal and urinary incontinence daily remained as statistically significant factors associated with survival, controlling for other factors.
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PMID:[Urinary and fecal incontinence in a community-residing elderly population: prevalence, correlates and prognosis]. 917 10

Pressure ulcer development is a serious problem occurring predominately among elderly persons, who are confined to bed or chair. Factors associated with pressure ulcer development include: cerebrovascular accident, impaired nutritional intake, fecal incontinence, lymphocytopenia and a high comorbidity score. Implementation of preventative measures, such as: in-depth assessment for mobility, a pressure relieving device combined with adequate repositioning, thorough evaluation for nutritional status and urinary incontinence, significantly reduce pressure ulcer incidence. If the pressure ulcer is a partial thickness (Stage II) wound, the causative factors are probably friction and/or moisture. If the ulcer is full thickness (Stage III, IV) it is secondary to pressure and/or shearing forces. The development of wound infection is the most common complication. Osteomyelitis is not an uncommon occurrence and must be initially ruled out in all full thickness pressure ulcers. Surgical debridement of necrotic tissue is necessary prior to further treatment and /or assessments. Cultures and antibiotic therapy are indicated only upon evidence of infection (erythema, edema, cellulitis, osteomyelitis, leukocytosis, bandemia or fever). Topical pharmacologic agents may be used to prevent or treat infection but must be carefully controlled to avoid such adverse effects as toxicity to the wound, allergic reaction and development of resistant pathogens. Proper use of occlusive dressings increase patient comfort, enhance healing, decrease the possibility of infection, save time and reduce costs. A patient presenting an ulcer which fails to improve, or due to its size will take a great deal of time to heal, should be evaluated for surgical closure.
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PMID:Pressure ulcers: critical considerations in prevention and management. 1014 70

"Fecal incontinence" is defined as the involuntary loss of stool at any time of life after toilet training. It is a socially and psychologically devastating condition for patients and their families, and a topic which both patients and physicians are reluctant to approach. Although the true prevalence of fecal incontinence is unknown, studies have reported it to be as high as 2. 2% in the general population, with significantly higher rates among nursing home residents and hospitalized elderly. Risk factors include advancing age, female gender and multiparity. An understanding of pelvic floor anatomy and physiology is required to appreciate how diverse medical conditions can affect mechanisms involved in normal continence. The rectum serves as a storage reservoir until elimination can take place at a socially acceptable time and place. The pelvic floor muscles help to regulate the defecatory process and maintain continence. These muscles include the internal anal sphincter, the external anal sphincter and the puborectalis muscle. Each muscle contributes to normal continence, although the relative importance of each is controversial. Neurologic integrity and sensation are also key factors. Conditions associated with fecal incontinence include diarrheal states, fecal impaction, idiopathic neurologic injury, surgical and obstetric injury, pelvic trauma, collagen vascular disease, and neurologic impairment related to stroke, diabetes, or multiple sclerosis. Evaluation of the patient with fecal incontinence includes a directed history and physical examination, with particular attention paid to integrity of the perineum and rectum, and a complete neurologic evaluation. Diagnostic tools such as stool studies, anorectal manometry, defecography, electromyography, pudendal nerve conduction, and endoanal ultrasound may be employed in an outpatient setting. Fecal incontinence may be treated conservatively by employing such methods as dietary restriction, stool bulking agents, and biofeedback. Surgery may be the best option for cases refractory to medical treatment, or for those patients with rectocele or obstetrical injury. In this article, we review the presentation, epidemiology, pathophysiology, and etiology of fecal incontinence. Evaluation, including key components of directed history and physical examination, and the appropriate use of diagnostic studies and indications for treatment options are also addressed.
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PMID:Fecal incontinence: a clinical approach. 1074 64

Several neurological diseases cause constipation or faecal incontinence restricting social activities and influencing quality of life. As several new treatment modalities have become available within the last few years, doctors treating patients with neurological diseases should be aware of the symptoms and have a basic knowledge of relevant treatment options. Constipation and faecal incontinence are common symptoms in patients with traumatic spinal cord injuries, spina bifida, multiple sclerosis, diabetic polyneuropathy, Parkinson's disease, stroke, and cerebral palsy. New treatment modalities are: prokinetic agents, enemas administered through the enema continence catheter or through an appendicostomy, and biofeed-back. Sacral nerve stimulation is still mostly at an experimental level and colostomy should be restricted to the few patients with most severe problems resistant to other therapy.
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PMID:Colorectal symptoms in patients with neurological diseases. 1142 45

Ageing of the Hong Kong population is associated with an increased prevalence of physical and mental disability. For persons with severe disability, infirmary care is needed. In the present study, the morbidity pattern of persons waiting for infirmary service in Hong Kong was studied. Two hundred and four consecutive Central Infirmary Waiting List persons were included in the study. Clinical assessment was based on history review and physical examination. The commonest diagnoses giving rise to severe disability in this population, 89.2% of whom were elderly (aged greater-than-or-equal65 years), in descending order of prevalence were stroke (40.2%), dementia (27.0%), proximal femoral fracture (7.4%), and parkinsonism (5.9%); 67.5% of subjects were dependent physically. For cognitive function, 87.3% had a subnormal Abbreviated Mental Test score of less-than-or-equal5. Approximately 80% had urinary incontinence and/or bowel incontinence. For the outcome of assessment, 93.6% needed infirmary care, while 6.4% did not. More adequate provision of infirmary beds, innovative medical, nursing, and social home-support programmes, and effective prevention and rehabilitation programmes for patients with these disabling diseases are urgently needed in Hong Kong.
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PMID:Morbidity patterns of persons waiting for infirmary care in Hong Kong. 1184 86


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