Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · May 2010
Randomized Controlled TrialLoss of autonomy among elderly patients after a stay in a medical intensive care unit (ICU): a randomized study of the benefit of transfer to a geriatric ward.
In order to evaluate changes in the functional autonomy of elderly patients after a stay in a medical intensive care unit (ICU), and the impact of post-ICU management in geriatric ward, we included in a randomized controlled trial 45 patients aged>or=75 years. They were assessed for functional autonomy before ICU stay, just after ICU discharge, just after hospital discharge, and 6 months later. The patients were randomly divided into two post-ICU management groups: "geriatric ward" and "standard care". ⋯ These results underline the rapid loss of autonomy after a stay in a medical ICU. Early specific intervention to improve the autonomy of elderly patients seems an attractive solution that could be assessed by randomized controlled trial. Above all, our results should also serve as a basis for further controlled randomized studies in this setting.
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Arch Gerontol Geriatr · May 2010
Older people's use of pre-hospital emergency medical services in Izmir, Turkey.
The aim of this study is to determine the use of pre-hospital emergency medical services (EMS) in elderly people aged 65 years and over in Izmir, Turkey. In this descriptive study, older patients admitted to pre-hospital EMS of Izmir Province Health Directorate between 2004 and 2005 years was evaluated through the review of Emergency Call Registry Forms. The study data included socioeconomic characteristics, reasons of calling, distribution of calling times in the day, distribution of ambulance callers and preclinical diagnosis. ⋯ The most frequent pre-hospital EMS caller were persons in family (70.7%), and utilization of ambulance services was the highest in winter. Medically related incidents accounted for 89.1% of all emergency ambulance calls and cardiovascular diseases accounted for most common cause (32.6%) of calls. The utilization rate of pre-hospital EMS among older persons was approximately four times higher than that of the younger age groups.
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Arch Gerontol Geriatr · May 2010
Multicenter Study Comparative StudyNutritional and hydration status in elderly subjects: clinical rating versus bioimpedance analysis.
Malnutrition and dehydration are common in elderly. A simple, reliable instrument to assess nutritional and hydration status would be very helpful. Bioelectrical impedance analysis (BIA) has been promising in this context, but data of elderly persons and geriatric in-hospital patients are rare. ⋯ We then compared BIA measurements with clinical judgement of hydration status in 103 acute geriatric hospital in-patients. Concordance between the results of clinical judgement and BIA measurements was only 43.7%. In assessing geriatric in-patients, there is little concordance between the clinical and the bioelectrical evaluation of the hydration status.
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Arch Gerontol Geriatr · May 2010
Validation of the Chinese-Canadian study of health and aging clinical frailty scale (CSHA-CFS) telephone version.
This was a cross-sectional validation study of the Chinese-Canadian study of health and aging clinical frailty scale telephone version (CSHA-CFS TV). The study pool consisted of 67 patients of outpatient clinics at a tertiary medical center in Taipei, Taiwan. They were enrolled in the program comprehensive geriatric assessment and the frailty study of elderly patients (CGAFSEP). ⋯ Criterion validity was achieved with weighted kappa of 0.689 (p<0.0001) and Kendal's tau of 0.612 (p<0.0001) between the TV and the PV scores. Divergent validity was demonstrated with significant correlation but only fair agreements comparing both TV and PV scores with the cardiovascular health survey (CHS) phenotypic definition of frailty. One could conclude that the CSHA-CFS TV appears to be a quick, reliable, and valid frailty screening instrument for community-dwelling elderly.
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Arch Gerontol Geriatr · May 2010
Comparative StudyDeveloping a self-reported comorbidity index to predict mortality of community-dwelling older adults.
Current common comorbidity measures have poor to moderate predictive validity of mortality of community-dwelling older adults. Hence, our aim is to develop a simpler resource-efficient self-reported comorbidity index in the prediction of survival. 113 older adults in Greater Manchester, United Kingdom attended a routine medical examination whereby information gathered was used to construct Charlson Comorbidity Index (CCI). They completed the Cornell Medical Index (CMI) questionnaire and reported the number of medication prescribed to them. ⋯ Remarkably, by means of forward step-wise Cox-regression, two variables emerged significant: (i) number of medicine (beta coefficient=0.229, SE=0.090 and p=0.011) and (ii) age (beta coefficient=0.106, SE=0.051 and p=0.037). We demonstrated that simple count of medication predicted mortality of community-dwelling older adults over the next 7 years more accurately than CMI or CCI. Further works involving a larger scale of subjects is needed for use in epidemiological study of survival where cost and resources are concerned.