Journal of the American Geriatrics Society
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Comparative Study
Ventricular ectopy during prolonged ambulatory electrocardiographic monitoring in elderly hypertensive subjects.
To examine whether ventricular ectopy in hypertensive older people is associated with age, the hypertensive process, or treatment, a 24-hour ambulatory electrocardiogram recording was obtained in 94 noninstitutionalized subjects aged 60-90 years with isolated hypertension and 136 noninstitutionalized normotensive subjects aged 60-82 years. A significantly higher prevalence of frequent ventricular ectopic beats (VEB greater than 100 per recording) was found in hypertensive and normotensive groups age greater than or equal to 70 years compared to age 60-69 years (44% vs 15%, P less than .01, and 28% vs 9%, P less than 01, respectively). Complex ventricular ectopy was found to be significantly increased only in the hypertensive group greater than or equal to 70 years compared to 60-69 years (53% vs 28%, P less than .05). ⋯ For complex ventricular ectopy, analysis of variance showed a significant effect of hypertension (P less than .001) and age (P less than .05). Multivariate regression analysis confirmed that complex ventricular ectopy was significantly associated with hypertension (P less than .01) and age (P less than .05). In elderly subjects aging alone is associated with increased frequency of ventricular ectopy, whereas complex ventricular ectopy is more significantly related to the hypertensive process than to age.
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In a statement published in this issue, the Public Policy Committee of the American Geriatrics Society endorses the view that chronological age should not be a criterion for exclusion of individuals from medical care. This article aims to amplify the Committee's position by placing it within a broader context and identifying its justification in ethical argument. The paper is divided into three parts. ⋯ Objections to these arguments are carefully set out. The final part of the paper details and defends a series of positive arguments establishing special duties to the elderly. The paper concludes that to the extent that scarcity forces rationing, older persons should not be excluded because they are old.
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To determine the short-term functional and medical outcomes and predictors of outcome following discharge from an acute hospital emergency department, 100 elderly (greater than or equal to 65 yr) and 100 nonelderly (less than 65 yr) patients were studied prospectively. Patients were interviewed at three days and again at three weeks following emergency department discharge. The number of new prescriptions given to both groups in the emergency department was similar (elderly 41%; nonelderly, 31%). ⋯ None of the nonelderly required hospitalization or had died. Functional impairments were more common in the elderly both at baseline (elderly, 26%; nonelderly, 6%; P less than .01) and at three weeks (elderly, 27%; nonelderly, 5%; P less than .001). Independent predictors of poor medical outcome included age greater than or equal to 65 (P less than .009) and functional impairment at baseline (P less than .022).(ABSTRACT TRUNCATED AT 250 WORDS)
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During implementation of a new Do-Not-Resuscitate (DNR) policy in New York State, decisions by 233 nursing home patients of their surrogates were evaluated. Eighteen patients with capacity (mean age +/- SD = 76.4 +/- 12.1 years) chose DNR; 30 patients with capacity (mean age +/- SD = 76.2 +/- 10.7 years) chose to be resuscitated (CODE); 54 patients without capacity, (mean age +/- SD = 86.1 +/- 9.1 years) had surrogates who chose DNR; and 131 patients without capacity and with surrogates (mean age +/- SD = 81.9 +/- 9.8 years) remained CODE. Most patients with capacity who chose DNR had multiple sclerosis, while most choosing CODE had strokes. ⋯ Forty-five percent of surrogates did not respond regarding CODE status during the three-month study interval, and 10% wanted additional time to decide. Patient age appeared to be a factor in surrogate choice for DNR but not in patients with capacity making their own decision. Reasons for patients with capacity choosing DNR are discussed; perceived quality of life and premorbid feelings by patients help in the decision-making process.