Journal of the American Geriatrics Society
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Comparative Study
Geriatric psychiatry in the emergency department, II: Evaluation and treatment of geriatric and nongeriatric admissions.
The records of a hospital psychiatric emergency department were reviewed for elderly and middle-aged patients who were diagnosed with organic brain syndrome (OBS) or psychiatric disorder. These records were then compared with those of elderly patients from the medical emergency department. ⋯ When tests were administered to psychiatric patients, many abnormal results were apparent, indicating the possible presence of physical disease. It is recommended that all elderly patients with psychiatric symptoms undergo adequate medical evaluations to screen for physical causes of the psychiatric symptoms.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of a physician-led home care team on terminal care.
Inconsistent results in studies of cost-effectiveness of home health care have led to the need for identification of target populations for whom cost-savings can be anticipated if expanded home care programs are introduced. This analysis of results of a randomized controlled study of efficacy of a physician/geriatric nurse practitioner/social worker home care team identifies such a potential target population. The team provides round-the-clock on-call medical services in the home when needed, in addition to usual nursing and other home care services, to home-bound chronically or terminally ill elderly patients. ⋯ Of 21 team and 12 control patients who died but had at least two weeks of utilization experience in the study, team patients had about half the number of hospital days compared with controls during the terminal two weeks, and although they had more home care services, had only 69 per cent of the estimated total health care costs of the controls. Satisfaction with care received was significantly greater among the total group of team patients, and especially among their family caretakers, than among controls. This model is effective in providing appropriate medical care for seriously ill and terminal patients, and in enabling them to die at home if they so wish, while at the same time reducing costs of care during the terminal period.
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Six hundred fifty-one psychiatric consultations performed during a one-year period were reviewed retrospectively. Cognitive impairment was present in 54 per cent and depression in 27 per cent of the elderly patients in the population studied. ⋯ Twenty-one per cent of consultations were done on patients over the age of 60, although elderly patients occupied 28.5 per cent of hospital beds. Thus, elderly patients were less often referred for psychiatric consultation than younger patients, although the incidence of psychiatric disorders increases with age.
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Case Reports Comparative Study
Where do elderly patients prefer to die? Place of death and patient characteristics of 100 elderly patients under the care of a home health care team.
This report describes the places of death of 100 elderly home-bound patients served by a home health care team. It compares some medical and psychosocial characteristics of the patients who died at home and the patients who died in an institution, and examines the factors that lead to death in an institutional setting for patients who had planned to die at home. All patients at the time of admission to team care had wished to receive care at home. ⋯ Sociodemographic variables such as age, sexual gender, Medicaid status, living arrangements, diagnosis, and pain level did not appear to be related to place of death. The patient's expressed wish for one or the other option seemed the key factor. Failure to provide death at home to 19 patients was mostly due to a prolonged terminal phase leading to emotional and physical exhaustion in the patient or the family.
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Comparative Study
Earlobe type, race, and age: effects on earlobe creasing.
There has been much discussion of the utility and validity of the earlobe crease as a warning sign of cardiovascular disease. The authors postulated that the mixed findings were due to the neglect of three variables: age, race, and earlobe shape. ⋯ It was found that creases develop with age in healthy adults, that creasing is related to earlobe shape, that the age of onset of creasing varies according to race, and that the frequencies of occurrence of different earlobe shapes differ by race. Future studies of earlobe creases should therefore include the variables of age, race, and earlobe shape.