2024-03-29T15:06:52Zhttp://open-archive.highwire.org/handler
oai:open-archive.highwire.org:ageing:26/2/1072015-05-19HighWireOUPageing:26:2
Activities of daily living: changes in functional ability in three samples of elderly and very elderly people
BOWLING, ANN
GRUNDY, EMILY
Research papers
<sec><st>Objectives:</st> to investigate changes in functional ability and physical health, psychiatric morbidity, life satisfaction, service use and social support. </sec><sec><st>Design:</st> a structured interview survey of three samples of elderly people living at home at two points in time. The three samples comprised one census of people aged 85 and over [City (of London) and Hackney], and two random samples of people aged 65–84 (City and Hackney and Braintree). The follow-up interviews took place 2.5–3 years after the baseline interviews. </sec><sec><st>Setting:</st> City and Hackney (East London) and Braintree (Essex). Respondents were interviewed at home by one of 12 trained interviewers. </sec><sec><st>Subjects:</st> 630 people aged 85+ at baseline (70% response rate), and 78% of survivors re-interviewed at follow-up; 464 people aged 65–84 in Hackney at baseline (67% response rate), and 83% of survivors re-interviewed; 276 people aged 65–84 in Braintree at baseline (82% response rate), and 78% of survivors re-interviewed. </sec><sec><st>Main outcome measures:</st> scores on scales of functional ability, psychiatric morbidity, life satisfaction and social support, and items measuring number and type of health symptoms and services used. </sec><sec><st>Conclusions:</st> decreasing levels of physical functioning were associated with poor mental health, trouble with feet and problems with muscles and joints. There were no associations with level of physical functioning and use of rehabilitative or general medical services, use of social worker or carer relief. Few respondents used preventive or rehabilitation services. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/107
http://dx.doi.org/10.1093/ageing/26.2.107
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/1152015-05-19HighWireOUPageing:26:2
Morbidity and disability in elderly Zimbabweans
ALLAIN, THERESA J.
WILSON, ADRIAN O.
GOMO, Z. ALFRED R.
MUSHANGI, EBBA
SENZANJE, BEULAH
ADAMCHAK, DONALD J.
MATENGA, JONATHON A.
Research papers
<sec><st>Background:</st> the population aged over 60 years in Zimbabwe is expanding. Despite the likely increased demand on medical services that this will bring, little is known about the health needs of this elderly population. </sec><sec><st>Objective:</st> to record the prevalence of disability (impairment of activities of daily living), subjective morbidity (symptoms), the social circumstances and the utilization of healdi services in a group of elderly Zimbabweans. </sec><sec><st>Design:</st> cross-sectional community survey </sec><sec><st>Setting:</st> a remote rural area in North Eastern Zimbabwe and two urban townships located approximately 80 km from Harare. </sec><sec><st>Subjects:</st> 278 subjects (154 women, 174 rural), aged > 60 years (range 60–92) living at home. </sec><sec><st>Method:</st> subjects were selected by random cluster sampling. They were assessed in a structured interview and underwent physical examination including visual acuity, inspection for cataracts and assessment of mobility. </sec><sec><st>Results:</st> less than 4% experienced difficulty with self-maintenance activities of daily living, but 30% had difficulty with instrumental activities. The former were all visually impaired and both visual and mobility problems contributed to the latter. Elderly people experienced many symptoms but had inadequate access to health services and used medication infrequently. Subjects were mainly self-sufficient for financial income and 60% still worked. They had declining resources with age and received little help from the social welfare department. Their health and functional abilities deteriorated with age but it was older subjects who had most difficulty getting to the clinic. Simple measures such as cataract surgery and analgesics were available only to the minority or not at all. </sec><sec><st>Conclusions:</st> this study highlights problem areas where simple, low-cost measures could make a difference to the morbidity and disability of elderly Zimbabweans. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/115
http://dx.doi.org/10.1093/ageing/26.2.115
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/1232015-05-19HighWireOUPageing:26:2
Casemix for inpatient care of elderly people: rehabilitation and post-acute care
CARPENTER, G. IAIN
TURNER, GILLIAN F.
FOWLER, R. W.
FOR THE CASEMIX FOR THE ELDERLY INPATIENT WORKING GROUP,
Research papers
<sec><st>Background:</st> defining contracts for the care of elderly people on the basis of the number of episodes is inappropriate as it fails to take account of the wide variation in their physical disability and rehabilitation needs. Resource use on a day-to-day basis can be estimated for patients using the Resource Utilization Groups version III (RUG-III) casemix system. For practical use, RUG-III assessments cannot be made daily and so assessments at different time intervals were evaluated in order to give an indication of resource use for an inpatient stay. This study describes how RUG-III assessments can be used to give an indication of resource use for an inpatient episode. </sec><sec><st>Method and results:</st> RUG-III assessments were completed for all admissions to elderly care rehabilitation wards in two Health Districts over a 10 week period. There were 336 patients and 965 RUG-III assessments. The average time required to make RUG-III assessments fell from 10 to 4min by the end of the study period. Fortnightly assessment intervals including a discharge assessment correlated well with the average of weekly assessments (<it>R</it>2 = 0.88=0.91, <it>P</it> < 0.0001). </sec><sec><st>Conclusion:</st> using the results from these assessments we propose a model for use of the RUG-III system in contracts for rehabilitation and post-acute care of elderly people which addresses the difficulty of combining clinical characteristics, rehabilitation, resource use and length of stay into a single useful meaningful casemix system. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/123
http://dx.doi.org/10.1093/ageing/26.2.123
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/1332015-05-19HighWireOUPageing:26:2
What degree of medical treatment do nursing home residents want in case of life-threatening disease?
MOE, CLAUS
SCHROLL, MARIANNE
Research papers
<sec><st>Aim:</st> to examine the degree of medical treatment wanted by nursing home residents, their relatives and staff members should the resident develop a serious and life-threatening disease and to analyse the degree of agreement between the wishes of these parties. </sec><sec><st>Design:</st> an epidemiological, descriptive cross-sectional study. </sec><sec><st>Material and methods:</st> the study population consisted of 101 competent and 106 incompetent residents from 16 nursing homes; 142 relatives and 207 staff members were also interviewed. A hypothetical disease story was presented to residents, relatives and staff members and their choices classified into four groups according to degree of treatment. </sec><sec><st>Results:</st> direct comparisons for the individual resident showed the greatest degree of disagreement whether to accept or refuse referral to hospital between relatives of incompetent residents and staff members, in that the preference for curative treatment was significantly more frequent among the relatives. </sec><sec><st>Conclusions:</st> nursing home staff should try to discuss with relatives of incompetent residents their preferences for treatment in case the resident develops a serious disease before an acute situation arises. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/26/2/133
http://dx.doi.org/10.1093/ageing/26.2.133
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/1392015-05-19HighWireOUPageing:26:2
Determinants of age-associated changes in os calcis ultrasonic indices in elderly women: potential involvement of geriatric hyposomatotropism in bone fragility
BOONEN, STEVEN
NICHOLSON, PATRICK H. F.
LOWET, GEERT
CHENG, XIAO GUANG
VERBEKE, GEERT
LESAFFRE, EMMANUEL
AERSSENS, JEROEN
DEQUEKER, JAN
Research papers
<sec><st>Objective:</st> ultrasound measures a clinically relevant property of bone strength in addition to and distinct from bone mass. The aim of the present study was to examine the effects of healthy ageing on ultrasound measurements of the calcaneus. </sec><sec><st>Design:</st> cross-sectional study. </sec><sec><st>Study participants:</st> a sample of 177 community-dwelling healthy women aged 70–87 years. Exclusion criteria were diseases or medications known to affect the musculoskeletal system or the somatotrophic axis. </sec><sec><st>Measurements:</st> serum levels of 1,25-dihydroxyvitamin D3 and insulin-like growth factor-I (IGF-I) were measured by radioimmunoassay, serum 25-hydroxyvitamin D<inf>3</inf> (25(OH)D<inf>3</inf>) was determined by competitive binding assay and serum parathyroid hormone was assessed immunochemically. Isometric and isokinetic quadriceps strength were evaluated using a Cybex II system. Calcaneal ultrasound indices-broadband ultrasound attenuation (BUA) and speed of sound (SOS)-were measured with an Achilles system. </sec><sec><st>Results:</st> we found a significant decrease with ageing in BUA and SOS (−0.5 and −1.3% per year, respectively), suggesting a continuing loss of bone quality. Quadriceps strength, serum IGF-I and 25(OH)D<inf>3</inf> constituted the best predictors of BUA, while IGF-I was the only parameter found to be independently associated with SOS. </sec><sec><st>Conclusion:</st> these findings suggest that, among other factors, the activity of the growth hormone-IGF-I axis is of importance for skeletal integrity. Age-related bone fragility may, in part, be related to geriatric hyposomatotropism. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/139
http://dx.doi.org/10.1093/ageing/26.2.139
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/1472015-05-19HighWireOUPageing:26:2
CYP2D6, NAT2 and CYP2EI genetic polymorphisms in nonagenarians
AGÚNDEZ, JOSÉ A. G.
RODRÍGUEZ, INMACULADA
OLIVERA, MANUELA
LADERO, JOSÉ MARIA
GARCIA, MARÍA. A.
RIBERA, JOSÉ M.
BENÍTEZ, JULIO
Research papers
<sec><st>Background:</st> enzymatic polymorphisms affecting the metabolic disposition of xenobiotics may modulate the rate of activation or deactivation of carcinogens and other toxic environmental chemicals. Hence, these polymorphisms may influence the risk of suffering some types of cancer and other degenerative diseases that are incompatible with extreme longevity. </sec><sec><st>Aims:</st> to establish the distribution of three well known enzymatic polymorphisms that affect the <it>CYP2D6, NAT-2</it> and <it>CYP2E1</it> genes and the activity of their enzymatic gene products, involved in the disposition of many xenobiotics, in a group of nonagenarians and in much younger controls. </sec><sec><st>Patients:</st> the three genotypes were determined in 41 nonagenarians (10 males, mean age 92.2 years, range 90–98) free of known malignancies or neurodegenerative diseases. The control groups comprised 217 healthy volunteers (128 males, mean age 36.3 years; SD, 12.7) for the <it>CYP2D6</it> and <it>NAT2</it> genotypes and 137 (116 males, mean age 32 years; SD, 18.8) for the <it>CYP2E1</it> genotype. </sec><sec><st>Methods:</st> after extraction of DNA from white blood cells, polymerase chain reaction and restriction fragment polymorphism methods were used to identify the allelic variants of the three genotypes. </sec><sec><st>Results:</st> we found no qualitative or quantitative difference in the mutations underlying the three genetic polymorphisms studied, nor in the expected enzymatic phenotypes. Instead, a close parallelism exists between advanced age and younger groups. </sec><sec><st>Conclusion:</st> longevity does not seem to be related to any special configuration of these three polymorphic traits. Comparisons with younger controls may be adequate when studying the distribution of these polymorphisms in diseases affecting old people. No genetically determined differences in the activation of drugs metabolized by these enzymes are to be expected in very old people. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/147
http://dx.doi.org/10.1093/ageing/26.2.147
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/1532015-05-19HighWireOUPageing:26:2
Acute phase proteins, C-reactive protein and serum amyloid A protein, as prognostic markers in the elderly inpatient
HOGARTH, MAXINE B.
GALLIMORE, J. RUTH
SAVAGE, PHILIP
PALMER, ALISON J.
STARR, JOHN M.
BULPITT, CHRISTOPHER J.
PEPYS, MARK B.
Research papers
<sec><st>Aim:</st> to study the clinical significance and potential utility of measuring serum amyloid A protein (SAA) compared with the classical acute phase protein, C-reactive protein (CRP). </sec><sec><st>Method:</st> a 3 month prospective study on 66 women, mean age 83 years (range 69–106) and 33 men, mean age 84 years (range 69–95), admitted to the geriatric medicine unit at Hammersmith Hospital. CRP and SAA were determined on admission and at intervals throughout hospital stay; outcome end-points were death during the study, detection of infection, duration of admission and early re-admission to hospital after discharge. </sec><sec><st>Results:</st> CRP and SAA responses were highly correlated (<it>r</it> = 0.75, <it>P</it> =0.0001). However, the SAA response was greater than that of CRP in most individuals, with a median ratio of initial SAA to CRP of 2.2 in patients with infective pathology and 1.6 in those with inflammatory pathology. Median (range) SAA on admission was 98 (0.1–940) mg/ml in patients with infection and was twice that observed in patients with other causes of inflammation, median value 50 (0.6–699) mg/l. There was no difference between median CRP on admission in patients with infection or inflammation, median value 53 (0.1 –235) and 51.5 (5 –246) mg/l respectively. Initial and peak levels of CRP, but not of SAA, were significantly greater in patients who subsequently died, whereas high levels of both proteins predicted length of admission and early re-admission. </sec><sec><st>Conclusion:</st> major elevations of the serum concentrations of CRP and SAA indicated serious disease and predicted poor outcome. Measurement of SAA as well as CRP enhanced the clinical utility of monitoring the acute phase response in 7% of patients with a diagnosis of infection. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/153
http://dx.doi.org/10.1093/ageing/26.2.153
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/1592015-05-19HighWireOUPageing:26:2
Loss of vision in the ageing eye: Research into Ageing Workshop, London, 10 May 1995
BRON, A. J.
CAIRD, F. I.
Conference report
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/159
http://dx.doi.org/10.1093/ageing/26.2.159
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/163-a2015-05-19HighWireOUPageing:26:2
Does it make sense to speak of senile dementia?
TRULLEN, J. M. Pérez
Pardo, P. J. Modrego
Letter to the Editor
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/163-a
http://dx.doi.org/10.1093/ageing/26.2.163-a
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/1632015-05-19HighWireOUPageing:26:2
Instructions to authors
Instructions to authors
Oxford University Press
1997-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/26/2/163
http://dx.doi.org/10.1093/ageing/26.2.163
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/632015-05-19HighWireOUPageing:26:2
Glaucoma therapy may take your breath away
DIGGORY, PAUL
FRANKS, WENDY A.
Review
Chronic simple glaucoma is a common disease in old age and lowering intraocular pressure is the treatment strategy. Although this can be achieved surgically, medical treatment with eye drops is more often prescribed. β-antagonists are the class of drug most often chosen, although other medical therapies are available. Systemic absorption of β-antagonist eye drops can cause unsuspected respiratory impairment. Physicians should be alert to the possibility of respiratory side-effects of topical therapy with β-antagonists and whenever such side-effects occur should use alternative treatments.
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/63
http://dx.doi.org/10.1093/ageing/26.2.63
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/692015-05-19HighWireOUPageing:26:2
Community-acquired pneumonia in old age: a prospective study of 91 patients admitted from home
LIEBERMAN, DAVID
LIEBERMAN, DEVORA
SCHLAEFFER, FRANSISC
PORATH, AVI
Research papers
<sec><st>Objective:</st> to characterize the background, aetiology, clinical course and outcome of community-acquired pneumonia (CAP) in elderly compared with younger patients. </sec><sec><st>Design:</st> a 1 year prospective study. </sec><sec><st>Setting:</st> a university hospital in southern Israel. </sec><sec><st>Participants:</st> ninety-one patients over 65 years who were hospitalized from their homes with CAP. These patients were compared with a reference group of 54 CAP patients, aged 55–64 years. </sec><sec><st>Measurements:</st> an intensive work-up (primarily serological) to identify the aetiological causes of CAP. The age groups were compared in terms of variables related to CAP. </sec><sec><st>Results:</st> the proportion with pneumococcal infection, the most common aetiology for CAP, increased from 29.6% in the 55–64-year group through 45.6% in the 65–74-year group; up to 57.8% in the 75+ group (P = 0.019). <it>Chlamydia pneumoniae</it> was identified as the aetiological agent in 26.4% of elderly patients. Mortality in patients ≥75 years was 20% and was significantly higher than in the two younger age groups (P = 0.019). The leucocyte count was significantly higher among the elderly group (P = 0.013) and the serum urea concentration was higher in patients 75 years and older (<it>P</it> = 0.025). The proportion of patients treated with antibiotics before admission decreased with increasing age (<it>p</it> = 0.026). </sec><sec><st>Conclusions:</st> CAP has more serious clinical and abnormal laboratory features in the elderly than younger patients, particularly in those over 75. In independent elderly people, the pneumococcus is the most common causative agent for CAP but other agents, particularly <it>C. pneumoniae</it>, are common. Initial antibiotic treatment for these patients should therefore include a macrolide. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/26/2/69
http://dx.doi.org/10.1093/ageing/26.2.69
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/772015-05-19HighWireOUPageing:26:2
Complications of laparoscopic cholecystectomy in the ageing patient
MAYOL, JULIO
MARTINEZ-SARMIENTO, JAVIER
TAMAYO, FRANCISCO J.
ALVAREZ FERNÁNDEZ-REPRESA, JESUS
Research papers
<sec><st>Aim:</st> to determine the safety of simple laparoscopic cholecystectomy in ageing patients. </sec><sec><st>Method:</st> the outcome of patients between 60 and 70 years of age and patients over 70 who underwent laparoscopic cholecystectomy for symptomatic non-malignant gallbladder disease was comparatively analysed. All patients over 60 years of age with symptomatic gallbladder disease and without cholecholithiasis, septic shock, diffuse peritonitis, gallbladder malignancy, portal hypertension or contraindication for general anaesthesia were selected for simple laparoscopic cholecystectomy (<it>n</it> + 158). This group represents over 80% of all elderly patients undergoing biliary surgery at our department over this period. Group A (<it>n</it> + 97) included patients from 60 to 69 years of age. Group B (<it>n</it> + 61) comprised patients over 70 years. </sec><sec><st>Results:</st> there was no difference in sex distribution between groups. Operative time and conversion rates were similar in both groups. The overall morbidity rate was 14.5%, with no statistically significant increase in group B (11% for group A <it>vs</it> 20% for group B). No perioperative mortality occurred. Recurrent biliary surgery was required in two patients from group B (3%). Postoperative endoscopic retrograde cholangiography and sphincterotomy was done in four patients from group A (4%). The mean postoperative stay was longer for older patients (group A, 3.1 (2.5) days; group B, 4.2 (4.3) days; i+0.05). </sec><sec><st>Conclusion:</st> simple laparoscopic cholecystectomy is safe in the aged, even for patients over 70. This procedure is associated with a short hospital stay and low rates of re-admission and recurrent biliary surgery </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/77
http://dx.doi.org/10.1093/ageing/26.2.77
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/832015-05-19HighWireOUPageing:26:2
Competence thresholds for the use of inhalers in people with dementia
ALLEN, STEPHEN C.
Research papers
<sec><st>Methods:</st> the ability to learn three inhaler techniques of increasing levels of complexity was studied in 50 normal and demented inhaler-naive elderly people (mean age 81 years) with stable 10-point mini-mental test scores (MTS). There were 10 subjects in each of the following groups: MTS 8–10 (non-demented), MTS 7 (borderline), MTS 6 (mild dementia), MTS 5 and MTS 4 (2 moderate dementia groups). The techniques were taught on one day and reassessed on the following day on consecutive days in ascending order of complexity. </sec><sec><st>Results:</st> those with an MTS of 4 were unable to learn any of the techniques, while all the non-demented people could learn all three techniques. For the five-stage technique (standard metered dose inhaler) the 0% threshold (i.e. when none of the subjects was able to learn) was MTS 6, the 50% threshold (at least half but not all could learn) MTS 7 and the 100% threshold (all could learn) MTS 8. For the four-stage technique (inhaler with large spacer) the 0% threshold was MTS 5, the 50% threshold MTS 6 and the 100% threshold MTS 8. For the three-stage technique (inspiration-triggered inhaler) the 0% threshold was MTS 4, the 50% threshold MTS 5 and the 100% threshold MTS 7. </sec><sec><st>Conclusions:</st> MTS can be used to determine the likelihood of a mild or moderately demented patient being able to learn a multiple-stage inhaler technique. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/83
http://dx.doi.org/10.1093/ageing/26.2.83
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/872015-05-19HighWireOUPageing:26:2
The effect of long-term omeprazole on the glucose-hydrogen breath test in elderly patients
HUTCHINSON, STUART
LOGAN, ROBERT
Research papers
<sec><st>Objective:</st> to test whether omeprazole taken for longer than 1 month causes an increase in the rate of small bowel bacterial overgrowth in elderly subjects. </sec><sec><st>Subjects:</st> 44 elderly people, 22 taking omeprazole, 22 not taking omeprazole or H2 receptor antagonists. </sec><sec><st>Main outcome measures:</st> rate of positive glucose-hydrogen breath tests; anthropometric measures and blood tests reflecting malabsorption. </sec><sec><st>Results:</st> there was no difference in the rate of positive tests between those taking omeprazole (45%) and those not taking it (59%). The omeprazole group had significantly lower serum albumin concentrations. There was no difference in body mass index, mid-arm circumference, arm fold thickness, adjusted calcium concentration or haemoglobin levels. </sec><sec><st>Conclusions:</st> omeprazole does not cause increased bacterial small bowel overgrowth in elderly subjects. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/26/2/87
http://dx.doi.org/10.1093/ageing/26.2.87
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/912015-05-19HighWireOUPageing:26:2
Blood pressure and intellectual function in elderly subjects
PALOMBO, VINCENZO
SCURTI, ROSA
MUSCARI, ANTONIO
PUDDU, GIOVANNI MARIA
IORIO, ANGELO DI
ZITO, MICHELE
ABATE, GIUSEPPE
Research papers
<sec><st>Objective:</st> to assess the relationship between hypertension and cognitive function in elderly subjects. </sec><sec><st>Methods:</st> 17 subjects with uncomplicated hypertension (nine male, eight female) and 27 control subjects with similar educational level and age (18 male, nine female) were studied. These individuals were recruited, according to strict selection criteria, from a random sample of 120 elderly subjects living in the community, who had a normal Mini Mental State score. An extensive neuropsychological test battery, sensitive to mild cognitive impairment, was administered in standard conditions to measure attention, concentration and judgement, psychomotor speed, memory and learning. Affective disorders were also evaluated. In all patients a computed tomography scan was performed. </sec><sec><st>Results:</st> subjects with high blood pressure had lower mean levels of performance in attentional measures: tapping test (inhibition of incorrect answers), three words-three shapes test (attempts; incidental memory) and reaction time to multiple stimuli. They also scored worse in clusters 1 and 2 of the Hamilton rating scale for depression. Confluent white matter lesions were found in nine hypertensive subjects (52.9%) and five controls (18.5%; <it>P</it> = 0.0170). Lacunes were demonstrated in 11 hypertensive (64.7%) and four normotensive people (14.8% <it>P</it> – 0.0007). In a multivariate analysis (logistic regression), three cognitive variables (tapping, Hamilton cluster 2 and Hamilton total score) remained significantly associated with hypertension, independently of the presence of cerebral lesions. </sec><sec><st>Conclusions:</st> in elderly otherwise normal hypertensive subjects, an attentional impairment may occur, which appears to be functional and possibly reversible rather than structural and progressive. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
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http://ageing.oxfordjournals.org/cgi/content/short/26/2/91
http://dx.doi.org/10.1093/ageing/26.2.91
en
Copyright (C) 1997, British Geriatrics Society
oai:open-archive.highwire.org:ageing:26/2/992015-05-19HighWireOUPageing:26:2
Reported activities of daily living: agreement between elderly subjects with and without dementia and their caregivers
ØSTBYE, TRULS
TYAS, SUZANNE
MCDOWELL, IAN
KOVAL, JOHN
Research papers
<sec><st>Objective:</st> to determine how accurately information on disability provided by a caregiver (proxy respondent) reflected the opinion of subjects themselves, and if this agreement varied by severity of dementia or relationship of the caregiver to the subject. </sec><sec><st>Setting and participants:</st> the study was based on data from the Canadian Study of Health and Aging, a multicentre study of dementia and health of Canadians age 65 and over. Eight hundred study subjects and their caregivers were independently interviewed regarding the subjects' activities of daily living (ADL). </sec><sec><st>Measurements:</st> the percentage of subjects who were independent for individual ADL items and the agreement in these reports between subjects and caregivers were investigated using three-level <it>k</it> statistics. </sec><sec><st>Results:</st> index subjects with caregivers other than spouses or offspring required more assistance with ADL. The reported percentage of independence decreased with increasing severity of dementia. There was more agreement between self- and proxy-reported level of independence for physical ADL than for instrumental ADL items. Agreement decreased with increasing severity of dementia. Few statistically significant differences were noted between level of agreement and caregiver relationship. </sec><sec><st>Conclusion:</st> satisfactory levels of agreement on ADL between cognitively normal subjects and their caregivers indicate that proxy respondents are a reasonable source of information on ADL when data collection from the subjects themselves is not feasible. Since agreement decreases as the severity of dementia increases, caregiver reports may be preferred for elderly patients even with mild dementia in order to facilitate longitudinal assessment of ADL ratings as the dementia progresses. </sec>
Oxford University Press
1997-03-01 00:00:00.0
TEXT
text/html
http://ageing.oxfordjournals.org/cgi/content/short/26/2/99
http://dx.doi.org/10.1093/ageing/26.2.99
en
Copyright (C) 1997, British Geriatrics Society