This study used secondary data analysis. Item response theory two-parameter model was used to analyse the data from the admission assessment of mental status by the Mini-Mental State Examination for patients. By using item response analysis, 16 items were selected from the original item Mini-Mental State Examination.
The 16 items included mainly the measures of orientation, recall and attention and calculation.
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The internal consistency of the item Mini-Mental State Examination was 0. The proposed new cut-off point for the item Mini-Mental State Examination was The correct classification rate was 0. This new cut-off point was determined for the purpose of over- identifying patients at risk so as to ensure early detection of and prevention from the onset of cognitive disturbance. Only a few items are needed to describe the subject's cognitive status.
Using item response theory analysis, the study found that the Mini-Mental State Examination could be simplified. Deleting the items with less variation makes this assessment tool not only shorter, easier to administer and less strenuous for respondents, but also enables one to maintain validity as a cognitive function test for clinical setting. CT examinations in older patients.
A total of 2, unselected subsequent CT examinations carried out in were analyzed retrospectively. All studies were performed in a university hospital with a centralized department of diagnostic radiology. Of the patients studied In all other age groups the relative distribution between emergency cases and regular studies revealed no significant differences. There was no statistically significant difference between the older age group patients older than 65 years and the total population of this study in almost all items investigated, i. Thus, the expected increase in patients in the older age group does not measurably prolong the CT examination time.
This statement applies to a major referral center with a high percentage of inpatients. Hippocampal Sclerosis in Older Patients. Cykowski, Matthew D. Hippocampal sclerosis may also be comorbid with frontotemporal lobar degeneration, Alzheimer disease, and Lewy body disease. Until recently, the terms hippocampal sclerosis of aging or hippocampal sclerosis dementia were applied in this context.
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Recent discoveries have prompted a conceptual expansion of hippocampal sclerosis of aging because 1 cellular inclusions of TAR DNA-binding protein 43 kDa TDP are frequent; 2 TDP pathology may be found outside hippocampus; and 3 brain arteriolosclerosis is a common, possibly pathogenic, component. Objective To aid pathologists with recent recommendations for diagnoses of common neuropathologies in older persons, particularly hippocampal sclerosis, and highlight the recent shift in diagnostic terminology from HS-aging to cerebral age-related TDP with sclerosis CARTS.
Conclusions In advanced old age, the substrates of cognitive impairment are often multifactorial. This article demonstrates common and frequently comorbid neuropathologic substrates of cognitive impairment in the older population, including CARTS, to aid those practicing in this area of pathology. This study comprises 81 thyrotoxic patients with onset after the age of Cardiovascular disorders cardiac failure, arrythmias etc. The other forms of appearance are both various and deceptive: depression, slight fever, asthenia or nausea.
Separate analysis of the three forms of hyperthyroidism did not reveal clinical, biological or therapeutic differences between them, except an inferior rate of captation for the toxic nodules. Isolated measurement of T3 or T4 is often insufficient to confirm the diagnosis because either of these hormones may appear at a normal rate. In three cases only the free thyroxin index was pathological on first determination. The authors have established that the autonomous nodules are larger and more active after, rather than before, 60 years of age, and have attempted to define their morphological identity.
The results of the treatment are analyzed and preference is expressed for radioactive iodine in every form of hyperthyroidism. Dysphagia in the Older Patient. Dysphagia in older adults is a challenging problem and necessitates a team approach. The key to effective management is recognition.
Patients tend to dismiss their symptoms as normal aging; therefore, early diagnosis depends on the diligence of the primary care doctors. No diagnostic technique can replace the benefits of a thorough history, with a detailed understanding of nutritional status and aspiration risk. Although one of the main goals in management is to ensure safe swallowing, the impact of a nonoral diet on the quality of life of patients should not be underestimated.
Constipation in the acutely hospitalized older patients.
The aim of this work was to establish the factors that determine the onset of constipation in acutely hospitalized older patients with a view to contributing towards an evidence-based identification of which patients warrant early, specific preventive measures. To evade the problem posed by the definition of constipation, we have considered parameters that are part of the daily routine in the hospital ward, such as the prescription of laxatives, also paying attention to how the co-operative older person subjectively interpret this condition.
One thirds of the hospitalized older patients needed a laxative at least once every 3 days. The use of laxatives at home and awareness that satisfaction with bowel movements drops in patients obliged to stay in bed for lengthy periods of time and in those who have suffered cerebrovascular damage, should provide the grounds for a screening program to establish rational guidelines on bowel movement therapy.
Copyright c Elsevier Ireland Ltd. Reconstructing nurses' relationships with older patients. This book will attempt to deconstruct communication patterns between registered nurses and older patients and propose methods for re-constructing the manner in which nurses and older patients relate to one another.
The number of Americans over the age of 65 grew from 3. Diagnostic challenges in the older patient. Full Text Available Abstract Older patients often present with a long, complex history and a clinical picture that frequently includes co-morbidities. It is essential that health professionals caring for older patients become familiar with common age-related changes, and the specific clinical factors that complicate the diagnostic process. A case-based approach is taken in this article to explore the diagnostic challenges in caring for older patients.
Three areas of focus are used: a polypharmacy, b cognitive issues such as delirium, dementia and depression, and c increased odds of pathologies and chronic illnesses. A prediction model to identify hospitalised, older adults with reduced physical performance. The principle aim of this study was to identify predictors for persisting, reduced physical performance in older adults following acute hospitalisation For example, such patients could receive targeted hospital interventions such as routine mobilisation.
Furthermore, at the time Barriers to dental attendance in older patients. Health professionals in Ireland are increasingly concerned about the quality of oral health in older patients. The aim of this study is to identify the obstacles that face this age-group when accessing dental care, so that we are in a better position to address them. A questionnaire was completed by patients attending a geriatric outpatient clinic.
The chief recommendation of this paper is thus to provide better education and access to older people on the importance of visiting the dentist. Identifying patient risks during hospitalization. Full Text Available Objective: To identify the risks reported at a public institution andto know the main patient risks from the nursing staff point of view.
Methods: A retrospective, descriptive and exploratory study. The study included all nurses working in care areas whoagreed to participate in the study. At the same time, sentinel eventsoccurring in the period from July to July were identified. Results: There were sentinel events reported, and the main risksincluded patient falls, medication errors and pressure ulcers. Sixty-fivenurses were interviewed. They also reported patient falls, medicationerrors and pressure ulcers as the main risks. Involvement of a multidisciplinaryteam is one of the steps for a successful process.
Education in appropiate pharmacotherapy in older patients. Appropriate pharmacotherapy in older patients is of increasing importance.
Advances in medicine and pharmacotherapy mean that people with health problems live longer. The longer life expectancy means that health professionals, but particularly physicians, pharmacists, and nurses, will have to meet. Perioperative care of the older patient. Blommers; M. Klimek Markus ; K. Hartholt Klaas ; T. Klein Jan ; P. Noordzij Peter.
Older patients are at increased risk of developing perioperative complications e. Preoperative risk.
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Sleep disturbance in older ICU patients. As a restorative process, sleep is important for supporting immune function and aiding the body in healing and recovery. Aging is associated with characteristic changes to sleep quantity and quality, which make it more difficult to adjust sleep—wake rhythms to changing environmental conditions. Sleep disturbance and abnormal sleep—wake cycles are commonly reported in seriously ill older patients in the intensive care unit ICU.
A combination of intrinsic and extrinsic factors appears to contribute to these disruptions. Further work is required to understand what impact sleep disturbance has on frailty levels and poor outcomes in older critically ill patients. Keywords: intensive care unit, sleep—wake rhythm, aging, frailty.
Full Text Available Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness.
However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes.
Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed. The older orthopaedic patient : general considerations. People older than 65 years are more likely to need elective and emergent orthopaedic surgery compared with younger persons. They also experience significant benefits.