Aging (Milan, Italy)
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Aging (Milan, Italy) · Dec 2001
Emergency hospitalization in the elderly in a French university hospital: medical and social conditions and crisis factors precipitating admissions and outcome at discharge.
Emergency admissions of elderly patients constitute a major management issue due to the complexity of their problems. The aim of this retrospective observational study was to identify medical and social characteristics and crisis factors for emergency department (ED) hospitalization in elderly patients, and to evaluate the influence of these factors on the length of stay and outcome at discharge. During a 4-month period, 396 patients aged 70 years and older were referred to the ED of a University Hospital (Hĵpital Edouard Herriot) in Lyon, France. ⋯ For many elderly, the ED remains a critical point of access to more complete managed care. This elderly population is comprised of polypathological, frail persons whose morbid state requires multidisciplinary management in geriatric units. The findings of this study suggest that interventions of multidisciplinary networks, such as home health care programs aimed at detecting crisis factors and establishing early prevention of crisis states, may improve unfavorable medical and social conditions and reduce hospitalization in geriatric patients.
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Aging (Milan, Italy) · Oct 2001
Comparative StudyAssessing pain and pain relief in geriatric patients with non-pathological fractures with different rating scales.
Although pain is a frequent problem among elderly patients, they are often omitted in clinical trials and few studies have focused on assessing pain relief in this population. The aim of this study was to compare geriatric patients' verbally reported effect of analgesics with changes in pain experience rated with four different rating scales: the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS), the Numeric Rating Scale (NRS), and the Pain Relief Scale (PRS). Altogether 53 geriatric patients (mean=82 yrs) with non-pathological fractures in 4 geriatric units at a large university hospital were selected. ⋯ The correlations between the ratings of the VAS, GRS and NRS were strong and significant (r=0.80-0.95; p<0.001) both at the initial assessments and at the re-assessments. However, the verbally reported effects of the analgesics were often directly opposite to the changes in rated pain. Therefore, application of the VAS, NRS, GRS and PRS for the purpose of assessing pain relief must be combined with supplementary questions that allow the patient to verbally describe possible experience of pain relief.
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Aging (Milan, Italy) · Jun 2001
ReviewStructural neuroimaging of Alzheimer's disease and other dementias.
This paper reviews the use of imaging techniques to aid in the clinical diagnosis of dementia. Two approaches are distinguished. One is the exclusionary approach in which imaging is used to rule out diseases that would mimic or cause dementia; based on the literature, this approach yields very little, if any, information that was not identified clinically. ⋯ For a diagnosis of vascular dementia imaging is necessary, although not all vascular changes fulfill requirements of being relevant to dementia. Potentially of more importance, given the higher prevalence of AD, is the identification of concomitant vascular changes in AD that may be amenable to therapy, and may be used to identify subgroups. Structural and functional MRI techniques have great potential in identifying patients at risk for AD, which will allow for a very early treatment with drugs that slow or even halt progression.
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Aging (Milan, Italy) · Apr 2001
Outcome of medically unstable elderly patients admitted to a geriatric ward after hip fracture.
Outcome of surgical treatment is superior to that of conservative treatment for hip fractures. Nevertheless, for a number of patients, the operation is either delayed or unfit due to their unstable medical conditions. We retrospectively reviewed patients admitted to a geriatric ward after hip fracture, and investigated complications, functional outcome and survival in different cognitive, pre-fracture functional and treatment groups. ⋯ Functional outcome was similar in the surgical vs the conservative group, and intracapsular vs extracapsular fractures. ASA I + II patients had a higher survival rate compared to ASA III + IV patients (p=0. 02). We conclude that after stabilization of acute medical conditions, the most important preoperative consideration is the anesthetic risk, and surgical and conservative approaches may be equally considered in selected groups of elderly, frail patients with hip fracture who are medically unstable for more than a few days.
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Aging (Milan, Italy) · Feb 2001
Case ReportsNon-invasive ventilation for frail elderly patients with acute respiratory failure.
We describe 3 elderly patients with acute respiratory failure who received respiratory assistance with nasal bi-level positive airway pressure (BiPAP) on the ward. In these patients with poor prognostic factors, non-invasive positive pressure ventilation was preferred as a reasonable alternative to invasive ventilation; indeed, their admission to the intensive care unit for mechanical support was considered inappropriate. ⋯ Two questions nevertheless need further evaluation in this setting, and are also addressed. The first is technical: can transient non-invasive breathing assistance be delivered on the ward? The second is ethical: is BiPAP a possible alternative when invasive ventilation is considered inappropriate?