Gerontology
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The aim of our study was to test whether the supine position or the sitting position worsens static, forced expiratory flows and measurements of lung mechanics in a group of aged subjects living in a nursing home who were clinically stable and without clinical evidence of cardiorespiratory diseases. Seventeen subjects (mean age 80 +/- 7 years; 16 f) were studied under baseline conditions. Spirometric, breathing pattern and mechanics data by means of an esophageal balloon were measured in sitting and supine positions. ⋯ Moreover, mechanics and breathing pattern data showed a significant decrease in tidal volume (Vt) and dynamic lung compliance (Cld) (p < 0.05) and an increase in respiratory rate/Vt ratio (p < 0.05). Our data confirm the results of previous reports about Cld decrease in supine posture in young normal people. Although our aged subjects showed a significant decrease in forced expiratory volumes and Vt when the supine position was adopted, static mechanics data did not appear modified by the gravitational effect of this posture.
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Adhesion molecules, such as leukocyte-function-associated antigen (LFA-1 or CD11a/CD18), intercellular adhesion molecule 1 (ICAM-1 or CD54) and Hermes antigen (HCAM or CD44), have important roles in many adhesive interactions involving cells of the immune system. Since it has been shown that many immunological alterations were present in aged subjects, we studied the expression and density of these molecules on peripheral blood lymphocytes and monocytes from healthy old subjects. A decrease in monocyte subpopulations bearing CD11a/CD18 and an increase in CD11a/CD18 and and CD44 antigen density on lymphocytes and on monocytes, respectively, were observed. These changes might be an event in the mechanism leading to the decreased lymphocyte proliferative response in vitro and to other immunological dysfunctions reported in old subjects.
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Necropsy studies suggest that thiamine deficiency is underdiagnosed in life, in part because the classical clinical presentations are uncommon. Anecdotal reports suggest that thiamine deficiency may contribute to the development of delirium, heart failure and peripheral neuropathy in elderly patients, but little systematic research has been reported. We examined thiamine levels in 36 consecutive non-demented, community-dwelling patients admitted to an acute geriatric unit. ⋯ Absent ankle jerks were noted in 2/19 (10%) patients with normal thiamine status and 7/17 (41%) patients with thiamine deficiency (p = 0.06). There was no difference in anthropometric indices or in the prevalence of other nutrient deficiencies between the two groups. Thiamine deficiency is common in elderly patients admitted to hospital and may contribute to the development of delirium.
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The measurement of the transcutaneous PO2 (tc PO2) demonstrates that localized pressure on skin sites under bony prominences (e.g., the sacral and trochanteric areas) decreases the tc PO2 at these skin positions to zero when subjects are lying motionless on a normal hospital mattress. This explains the high risk of pressure sore formation in elderly patients, who have a greatly reduced frequency of involuntary movements. ⋯ With healthy adults, placed in this position, both the skin areas over the trochanteric and sacral bony prominences remain almost free from pressure and thus normally oxygenated. In addition, the tc PO2 measurement allows an immediate assessment of the efficacy of a procedure for sore prevention.
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The degree of multiple pathology in 184 consecutive patients admitted to a geriatric unit was recorded using the 13 commonest conditions present at the time of admission to provide a standard group of disorders for comparison. All of the conditions were chronic in nature, and 35% of the patients had a combination of four or more of these present. ⋯ Families, including those who were elderly, continued to support most of the frail elderly people even in the presence of multiple pathology. This emphasizes the social implications of multiple pathology and the need for support and information in the management of long-term disability.