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Biomedical subjects

D Clinch

Publications and source records attributed to D Clinch.

16 recordsLinked to original sources
PubMed2001

Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study.

OBJECTIVE: In a retrospective study we reported absence of abdominal pain in 35% of elderly patients with peptic ulcer disease. We now report a prospective study on this question. METHODS: Patients undergoing upper GI endoscopy were systematically questioned before endoscopy. A reproducible method for identifying the location of symptoms was used. Among patients referred for upper endoscopy, there was no selection of patients for study purposes as all had strong indications, such as pain, dyspepsia, GI bleeding, weight loss, or anemia. Patients were divided into two groups according to age: A younger group consisting of patients <50 yr (mean, 33.6 yr) and an older group >60 yr (mean, 70.9 yr). RESULTS: A total of 277 patients were included in the study. There was no significant difference in reported use of medications, alcohol, or cigarette use between the groups. Of the 106 patients with peptic ulcer, 15 (14.2%) had not experienced pain. Abdominal pain was absent in 5 (6.9%) of the younger patients and 10 (29.4%) of the older patients. The difference was significant using the chi2 method (p = 0.004). A trend toward an even higher proportion of pain-free peptic ulcer disease was noted in the elderly female group (37.5%), but it did not reach statistical significance. CONCLUSIONS: Absence of abdominal pain is confirmed in approximately 30% of elderly patients with peptic ulcer disease.

Abdominal Pain↗
PubMed1997

Prevalence of cognitive impairment in the hospitalized elderly.

Surveys of older populations reveal rates of senile dementia varying from 5.2% to 25%. The specialist branch of psychiatry dealing with the elderly advocates that services for these patients and their carers should predominantly be based outside hospital. The following study was conducted in Limerick, Ireland before the arrival of a consultant in old age psychiatry and associated services. Its aim was to assess the extent to which the patients with dementing disorders were using hospital facilities other than those in psychiatric wards. The study assessed 371 patients aged 65 years and over in various medical and surgical units. The Mini Mental State Examination was performed on all patients. Patients with scores of 23/31 or less were considered to have significant cognitive impairment and those with 16 or less to have severe impairment. As mental performance can be impaired by acute illness, methods were used to avoid such patients being wrongly labelled as suffering from dementia. In the acute hospital 112 patients with an average age of 74.7 years were examined and 22.3% of these had significant cognitive impairment. These patients were predominantly sited on medical wards. On acute medical wards 31% of older patients had significant impairment compared to only 7.3% on the surgical wards. In the orthopaedic unit 15.8% of the elderly had evidence of cognitive impairment. In hospitals specializing in continuing care of the elderly the proportion was 70.6% and of these 46% were severely impaired. We conclude that in the absence of specialized dementia services for the elderly, medical beds both in the acute and long-stay sector will be used for these patients more than their medical needs might otherwise require.

Aged↗
PubMed1994

Acute pneumothorax: a comparison of elderly with younger patients.

This report compares the presentations and outcome of pneumothorax in 11 patients aged over 65 with 15 patients aged 20-35 years. Information was retrospectively collected from the charts regarding modes of presentation and the course of the illness. A questionnaire was sent to the general practitioners of the older group asking about the long-term outcome relating to functional status. Older patients were more likely than younger to present primarily with dyspnoea. The classical symptom of acute onset of pleuritic chest pain was present in ten of the 15 younger patients but in only two of the older patients. There were also statistically significant associations of the elderly patients with the following: radiological evidence of pre-existing lung disease; absence of pleuritic chest pain on admission; atypical or absent pain; a major delay from symptom onset to presentation; the diagnosis being clinically missed prior to chest radiography; and prolonged hospitalization. Nine of the 11 elderly patients were eventually independent at home.

Acute Disease↗
PubMed1989

Maximising safety when prescribing non-steroidal anti-inflammatory drugs.

Current knowledge on side-effects of non-steroidal anti-inflammatory drugs (NSAIDs) is reviewed. These occur most commonly in the gastro intestinal tract and include peptic ulceration and haemorrhage as well as effects on the small and large bowel. Renal effects with many manifestations are also increasingly described. Photosensitivity is the most common adverse dermatological effect. The role of various NSAIDs in causing asthma is now well recognised. Many less common side-effects occur, the most significant of which is marrow aplasia. Phenylbutazone and indomethacin are rarely but definitely associated with this, but other NSAIDs including ibuprofen are also suspected, but unproven, causes. A strategy for minimising side-effects is outlined. Where there is not a strong indication for use of an NSAID, local physical measures or a pure analgesic can be substituted. If an NSAID is really necessary, it is best to commence with a drug of lesser potency in the first instance, unless the patient is suffering from a severe inflammatory disorder. Indomethacin and piroxicam should be reserved for when other NSAIDs have not been effective. Patients who have a past or present history of peptic ulceration but still need to continue their NSAID therapy, should combine it with an anti-ulcer drug. In the case of younger patients a H2 receptor antagonist is the drug of first choice, whereas in the older patient a mucosal protective agent such as sucralfate is preferred. In the event of ulcer relapse, combination with a prostaglandin analogue is the next step. The growing awareness of side-effects with NSAIDs suggests that monitoring of patients commencing NSAIDs and on long-term treatment, should be increasingly practiced.

Anemia, Aplastic↗
PubMed1984

Absence of abdominal pain in elderly patients with peptic ulcer.

The presentation of peptic ulcer in 132 elderly patients is compared with that in 67 younger patients. Abdominal pain was not present in one third of the elderly group. Absence of pain was associated with the older age group to a highly significant degree (P less than 0.001).

Abdomen↗
PubMedDate not supplied

Peptic ulcer disease in the elderly--is there bias against endoscopy in the elderly?

A questionnaire study was circulated to all 109 General Practitioners in the Mid-West region. It was designed to determine whether older age is a factor in referral of patients for endoscopic evaluation of possible peptic ulcer symptoms. Approximately 80% of doctors responded and indicated that proportionately far more older patients were referred for endoscopy. We conclude that in our area at least, current recommendations such as those in the Maastricht Consensus Report are being implemented.

Age Factors↗
PubMedDate not supplied

Use of an age related admission policy in establishing a new department of medicine for the elderly.

Possible admission policies when initiating new Departments of Medicine for the Elderly are discussed. We report the results of a new acute unit where an age related policy was used in an area with no prior contact with the speciality. Six hundred and fifty-one acute medical admissions aged 80 years and over were treated in the unit's first year. Average age was 84.6 years with an average stay of 8.6 days. 54% were discharged directly home with a further 17% going home after rehabilitation. Only 12% eventually needed continuing nursing care. 9.4% of the patients died. We conclude that Medicine for the Elderly is highly effective if allowed access to patients from the point of admission rather than on a take-over basis. It is suggested that an age-related policy is appropriate when setting up new departments unless there is a clear indication for an alternative policy.

Aged↗
PubMedDate not supplied

General practitioner views of a new specialist Department of Medicine for the Elderly.

The reactions of General Practitioners (GPs) in an area served by a new Department of Medicine for the Elderly (Geriatric Medicine) are described. 89% of GPs thought the new service had brought significant benefits to their patients, The department operated an over 80 admission policy for acute medical admissions. After two years in operation 59% of doctors felt this should be lowered with 4% suggesting it should be raised. Rehabilitation and respite admissions were other features of the new service that had approval ratings of over 70% by the doctors surveyed. It is suggested that a Department of Medicine for the Elderly with a policy of rapid assessment and high turnover is appreciated by GPs. While local circumstances will often dictate policy it is suggested that an age-related admission procedure will minimise difficulty for patient and referring practitioner alike.

Aged↗