Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · Mar 2011
Differential effects of delirium on fluid and crystallized cognitive abilities.
Patients with delirium (acute confusional state) show extensive cognitive deficits. These deficits have typically been measured using tests of fluid cognition, which involve the active processing of mental representations. However, the effects of delirium on stored, crystallized dimensions of cognition, such as well-learnt word pronunciation knowledge, are not known. ⋯ Patients with delirium showed significant post-operative deficits on most tests of fluid cognition, but no change in the NART measure of crystallized cognition (p=0.95). These results parallel recent findings in Alzheimer's dementia and suggest that, despite showing extensive deficits of fluid cognitive processing, crystallized cognition is preserved in delirium. The results also suggest that the NART may be a useful tool for assessing premorbid ability in patients with delirium.
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Arch Gerontol Geriatr · Jan 2011
Management and outcomes of delirious patients with hyperactive symptoms in a secured behavioral unit jointly used by geriatricians and pyschogeriatricians.
To compare the clinical outcomes and length of stay (LOS) between delirious patients with hyperactive symptoms admitted directly and those admitted indirectly from Emergency Department into a secured, behavioral unit jointly used by geriatricians and pyschogeriatricians (the Unit). A retrospective study analyzing data from the medical records of 122 patients with an admission diagnosis of delirium with hyperactive symptoms and subsequently discharged from the Unit, including restraint, one-to-one nursing care, falls, absconding, duration of delirium, recovery from delirium, destination and LOS. Significantly fewer patients with direct admission (n=68) required physical restraint or chemical restraint compared with those transferred (n=54). ⋯ The falls rate reduced from 14.2 to 6.7 falls/1000 patient delirium days after transfer. Delirious patients with hyperactive symptoms admitted directly to the Unit fared better in clinical outcomes and LOS. They also required less restraint, less intensive nursing and were unlikely to abscond compared to those transferred.
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Arch Gerontol Geriatr · Nov 2010
Assessment of pain, fatigue, sleep and quality of life (QoL) in elderly hospitalized cancer patients.
As the proportion of older adults in the population continues to grow, the number of patients with cancer is expected to increase proportionally. In the previously conducted studies, data on elderly cancer patients were generally compared with the QoL scores of elderly patient group and with the data of non-cancer individuals. The purpose of this study was to examine differences in reported pain, fatigue, sleep problems and QoL between middle-aged and elderly hospitalized patients with cancer. ⋯ A significant relationship was observed in both age groups between the scores of pain, fatigue and sleep problems, and QoL (p<0.05). Elderly hospitalized cancer patients did not demonstrate a distinctive difference in terms of pain, sleep and QoL compared to the younger group. The relationship between pain, fatigue, sleep and QoL should be definitely kept in mind in clinical practice.
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Arch Gerontol Geriatr · Nov 2010
Analysis of the expectations of elderly patients before undergoing total knee replacement.
The opinion of patients expressed in terms of satisfaction is extremely important in any evaluation of total knee arthroplasty (TKA) results. The primary endpoint of this study was to determine the quantitative and qualitative expectations of elderly patients before undergoing TKA. Cross-sectional study of 497 patients over 65 years was performed before TKA. ⋯ There were statistically significant correlations with age (r=-0.321), pain before operation (r=-0.206), expected pain at 6 months (r=-0.206), depressive symptoms (r=-0.180) and the Barthel index (BI) (r=0.154). One can conclude, that the expectations of improvement among patients before TKA are high and may be classified as expectations of improvement of pain, basic functional activities and general well being. Age, pain intensity and presence of depression correlate inversely with the amount of expectations.
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Arch Gerontol Geriatr · Sep 2010
Acute medical management of the non-ST-segment elevation acute coronary syndromes (NSTE-ACS) in older patients.
Older patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) represent many clinical challenges. For example diagnosis can be difficult, and comorbidities are common. Furthermore, NSTE-ACS is particularly common in older patients (>60% of acute myocardial infarctions occurring in patients aged 65 years or older) and the mortality associated with NSTE-ACS is particularly high. ⋯ Furthermore, the lack of clear clinical evidence in this population means that the current treatment guidelines do not fully address the needs of elderly patients. Several recent clinical trials have highlighted some of the main considerations we should make when treating elderly patients with NSTE-ACS. Different therapy options in the pharmacological management of NSTE-ACS in this age group are also discussed.