Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · Nov 2009
Randomized Controlled TrialEfficacy of oxycodone/acetaminophen and codeine/acetaminophen vs. conventional therapy in elderly women with persistent, moderate to severe osteoarthritis-related pain.
We aimed to evaluate the efficacy and safety of oxycodone/acetaminophen (O/A) and codeine/acetaminophen (C/A) vs. conventional therapy (CT) without opioids in older women suffering from osteoarthritis (OA)-related pain, sub-optimally responsive to prior conventional treatments. We performed a 6 week, randomized, single blind, controlled study in three nursing homes. We enrolled 154 women with painful OA. ⋯ We considered the adverse events (AEs) in the study period. At week 6, MeP, RP and MP were significantly reduced in all three groups (p<0.001); compared to CT, O/A and C/A were associated with greater reductions in MeP (p<0.001 and p=0.004, respectively), in RP (p=0.028 and p=0.032, respectively) in MP (p<0.001 and p=0.002, respectively) and with significant improvement in BDI-II score (p=0.05 and p=0.04, respectively) and ADL value (p=0.04 and p=0.05, respectively). AE rates did not differ between groups.
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Arch Gerontol Geriatr · Sep 2009
Exaggerated morning blood pressure surge and cardiovascular events. A 5-year longitudinal study in normotensive and well-controlled hypertensive elderly.
Cardiovascular events (CE) occur most frequently in the morning hours in hypertensive subjects. We studied the association between the morning blood pressure (BP) surge and CE in prognosis of 10 normotensive and 32 well-controlled hypertensive elderly, in whom ambulatory BP monitoring was performed and who were followed prospectively for 5 years. The morning surge (MS) of BP was calculated as mean systolic BP during 2h after awakening--mean systolic BP during 1h that included the lowest sleep BP. ⋯ The logistic regression analysis showed the MS sleep-trough surge as predictive variable of CE (odds ratio, OR=0.794, p=0.022). In conclusion, in older normotensives and well-controlled hypertensives, a higher BP MS is associated with vascular risk independently of clinical and ambulatory BP. Reduction of the MS could thus be a therapeutic target for preventing vascular events also in non-hypertensive patients.
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Arch Gerontol Geriatr · Mar 2009
The diagnosis of delirium among elderly patients presenting to the emergency department of an acute hospital.
Delirium is prevalent among elderly people presenting to an emergency department (ED). However, despite the fact that delirium is associated with longer hospital stays, an increased rate of institutionalization and higher mortality (especially in the case of undiagnosed delirium), this condition often goes undiagnosed by ED doctors. We examined the rate of mental status assessment and the prevalence of delirium in the ED among patients older than 65 years in a large teaching hospital in Southern Israel via a retrospective chart review. ⋯ Furthermore, only 12.5% of people received either an adequate or even a partially adequate mental status assessment by the ED doctors. We attribute these negative findings not to a low incidence of delirium but probably to a combination of a heavy workload along with a lack of adequate training of ED physicians. We suggest that part of the solution involves providing appropriate education to ED physicians as well as adding a geriatric consultant to the ED roster.
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Arch Gerontol Geriatr · Mar 2009
Emergency department (ED) utilization of oldest old men in a veterans care home in Taiwan.
ED is a common channel for older people to seek for medical services. However, unlike most care homes in the world, veterans care home in Taiwan has a constantly operating outpatient and inpatient services. Therefore, utilization of ED services among veterans care home may be different from most care home residents. ⋯ Nearly a half of Banciao Veterans Home residents had visited ED for at least once in 2006 and the medical expenditure was four times higher than other ED visitors. In average, 52.3% of ED visitors would be hospitalized and the most common diagnosis was infectious conditions. Onsite primary care geriatricians may play an important role in such settings.
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Arch Gerontol Geriatr · Jan 2009
Randomized Controlled Trial Comparative StudyFrailty is associated with postoperative complications in older adults with medical problems.
We sought to test whether frailty may be predictive of operative risk in older adults with medical problems. One hundred and twenty-five patients at least 70 years of age had a previously developed frailty screen, the Edmonton Frail Scale (EFS), administered at a pre-surgical clinic, prior to elective non-cardiac surgery. A blinded chart audit assessed for postoperative medical complications, length of stay and inability to be discharged home. ⋯ EFS scores of 3 or less were associated with a lower risk of having a complication (age-adjusted OR 0.27, 95% CI 0.09-0.80, likelihood ratio of 0.33) and a higher chance (80%) of being discharged home (p<0.02). EFS scores exceeding 7 were associated with increased complications (OR 5.02, 95% CI 1.55-16.25, likelihood ratio of 3.9) and a lower chance of being discharged home (40%, p<0.02). This study suggests that a frailty screen can refine risk estimates of postoperative complications in older adults undergoing elective non-cardiac surgery.