Archives of gerontology and geriatrics
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The mechanisms and outcome of trauma in hospitalized elderly patients were studied. The data of Al-Ain Hospital Trauma Registry were prospectively collected over a period of 3 years (2003-2006). All elderly trauma-patients above 60 years who were admitted to surgical ward or who died on arrival were studied. ⋯ Overall mortality was 6% (7 patients), of whom 5 were pedestrians hit by cars. We concluded that low-energy trauma from falls was the most common cause of injury in the elderly. Mortality was high mainly from pedestrian injuries.
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Arch Gerontol Geriatr · May 2008
Japanese physicians' practice of withholding and withdrawing mechanical ventilation and artificial nutrition and hydration from older adults with very severe stroke.
Amid the lack of legislation or guidelines regarding withholding and withdrawing care in Japan, some physicians who have withdrawn mechanical ventilation from dying patients have recently been subjected to police investigations on suspicion of murder. Under the circumstances, we examined Japanese physicians' attitudes towards mechanical ventilation and artificial nutrition and hydration (ANH) as life-sustaining treatments (LST) to find out if they withhold or withdraw the LST when treating older adults with stroke-caused profound impairment with no hope for recovery. Face-to-face, in-depth interviews were conducted with 27 physicians ranging in age from 26 to 70 in 2004 mainly in the Tokyo metropolitan area. ⋯ The introduction of the practice of a trial treatment period may be more cogent, considering the inherent uncertainty of diagnoses. The findings of the study also indicated that the physician informants tended to view the value of maintaining the lives of non-communicative patients in terms of the relationships of such patients with others. The vulnerability of patients without strong relationships with others needs to be taken into consideration when compiling guidelines regarding withholding and withdrawing care in Japan.
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Arch Gerontol Geriatr · Mar 2008
Multicenter Study Comparative Study Clinical TrialA propensity-matched study of the association of physical function and outcomes in geriatric heart failure.
Most heart failure (HF) patients are older adults. However, the association of functional status and outcomes in ambulatory older adults with chronic HF has not been well studied. Of the 7788 Digitalis Investigation Group (DIG) trial participants, 4036 were > or =65 years. ⋯ NYHA III-IV class was associated with increased cardiovascular (HR, 1.25; 95% CI, 1.04-1.49; p=0.016) and HF mortality (HR, 1.51; 95% CI, 1.16-1.97; p=0.002). NYHA III-IV class was not significantly associated with hospitalizations due to all causes (HR, 1.10; 95% CI, 0.96-1.25; p=0.165), cardiovascular causes (HR, 1.11; 95% CI, 0.96-1.29; p=0.150), or worsening HF (HR, 1.09, 95% CI, 0.92-1.30; p=0.330). Baseline NYHA functional class was associated with mortality but not with hospitalization in ambulatory older adults with chronic HF.
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Arch Gerontol Geriatr · Nov 2007
The effect of co-morbidity on the rehabilitation process in elderly patients after hip fracture.
We conducted a prospective observational study involving patients older than 65 years admitted for rehabilitation to the Geriatric Department of a university hospital after surgical treatment of hip fracture. We assessed functional status before, during and at the end of rehabilitation and as a measure of success of rehabilitation we calculated the Montebello Rating Factor Score (MRFS). In an attempt to make this index more reflective of changes in rehabilitative status we revised it accordingly. ⋯ In the uinvariant analysis, cognitive status, length of stay in Geriatric Department and co-morbidity were found as significant predictors of rehabilitation success. In the linear regression only Severity Index (SI) of Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was found as a statistically significant predictor of rehabilitation outcome. In our context, we found that only co-morbidity (as measured by CIRS) is the best predictor of rehabilitation outcome of elderly patients after surgical repair of hip fracture.
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Arch Gerontol Geriatr · Nov 2007
Prognostic implications of hyponatremia in elderly hospitalized patients.
Hyponatremia is the most common electrolyte imbalance in elderly in-patients. We hypothesized that hyponatremia was independently associated with increased length of stay and loss of independence or death as measured by failure to return to previous residence. This cohort study measured the prognostic impact of hyponatremia in all patients admitted to two acute geriatric wards. ⋯ Only a larger drop in serum sodium was significantly associated with failure to return to previous residence (p<0.001). We conclude that hyponatremia in elderly in-patients is common. Drop in serum sodium during admission was strongly associated with increased length of stay and loss of independence.