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Biomedical subjects

F A Silverstone

Publications and source records attributed to F A Silverstone.

At least 19 recordsLinked to original sources
PubMed1998

The effect of nutritional status on length of stay in elderly hip fracture patients.

BACKGROUND: In this period of cost constraints, any indicator, such as nutritional status, which may predict the outcome of rehabilitation for a common problem, such as hip fractures, merits evaluation. METHODS: Nutritional indices--serum albumin, cholesterol, and body mass index--were assessed in 114 subacute rehabilitation hip fracture patients. RESULTS: Hypoalbuminemia was very common, occurring in 101 of 114 patients (88.6%). Using a forward stepwise regression model which considered age, total protein count, albumin, cholesterol, weight, height, and body mass index, serum albumin was the only variable that was significantly correlated with the length of stay (b=-0.23; p<.015). A scatterplot showed that almost all the albumin values in this elderly group fell between 2.4 mg/dl and 3.2 mg/dl, relatively low values, with a significant negative linear relationship between serum albumin and length of stay in this range. The average length of stay at 3.2 mg/dl was 44 days and at 2.4 mg/dl was 56 days. CONCLUSION: Hypoalbuminemia remains an important indicator of poor health outcome. Early biomedical monitoring of elderly subacute patients may lead to a reduction in length of stay and consequently reduce the costs of rehabilitation.

Aged↗
PubMed1995

Determination of normal ear temperature with an infrared emission detection thermometer.

STUDY OBJECTIVE: To determine normal body temperature with an infrared emission detection ear thermometer. DESIGN: Cross-sectional convenience sample. SETTING: Four acute and long-term health care facilities. PARTICIPANTS: Subjects who denied recent potentially febrile illness and ingestion of medications affecting normal body temperature. RESULTS: Two thousand four hundred forty-seven subjects aged 12 hours to 103 years were enrolled. Ear temperatures were normally distributed for each of eight age groups. There were differences in mean temperature among different age groups (P < .001, by ANOVA) and a striking cutoff at adolescence; the mean temperature for children aged 3 days to 10 years was 36.78 +/- 0.47 degrees C, as compared to 36.51 +/- 0.46 degrees C for subjects 11 years and older (P < .001, by t test). Temperatures were higher in female subjects and showed the characteristic diurnal variation of normal body temperature in five subjects studied longitudinally. The reproducibility of the ear thermometer was better than that of a commonly used electronic thermometer at the oral and axillary sites. CONCLUSION: The infrared emission detection ear thermometer is an accurate means of assessing normal body temperature without using corrective offsets to estimate temperature at other body sites. On the basis of these data, the 95th percentile for infrared emission detection temperature in children younger than 11 years old was 37.6 degrees C. The 99th percentile was 37.9 degrees C for children younger than 11 years old and 37.6 degrees C for people 11 years or older. Because only 1% of normal people have an infrared emission detection temperature higher than these values, these may represent appropriate cutoffs for fever screening using this device.

Adolescent↗
PubMed1994

Weight loss in Alzheimer's disease: an international review of the literature.

Alzheimer's disease affects an estimated 2 million elderly in the U.S. and challenges primary care physicians to assist caregivers in dealing with the daily management of these patients. To support the clinical observation of weight loss in Alzheimer patients despite adequate food intake, we reviewed the existing literature. To date, eight international studies have focused on nutrition in Alzheimer's disease and all have found weight loss. It is not clear whether this weight loss is a component of or a consequence of the disease. These findings suggest systemic, metabolic alterations in Alzheimer's disease. They require further investigation as to their nature and as to their appropriate recognition and management to retard the deteriorating effects of chronic weight loss and malnutrition. Finally, some reports lead to speculation that nutritional strategies may improve cognitive function.

Aged↗
PubMed1992

Nutritional patterns and weight change in Alzheimer patients.

A nutritional study of 100 patients enrolled in an active geriatric outpatient teaching program was conducted to document the clinical impression of weight loss in Alzheimer's disease. All new patients were asked to complete a questionnaire on nutrition. Patients were evaluated by a geriatrician, then categorized using DSM-III and NINCDS-ADRDA criteria. There were 34 Alzheimer patients and 60 nondemented patients with an average weight of 56.2 kgs and 66.1 kgs, respectively (p less than .002). Of the Alzheimer group, 44% reported weight loss in the past five years compared with 37% of the nondemented group, despite a concomitant increase in food intake in 35% versus 7%, respectively. On a one-year follow-up, 92% of Alzheimer patients lost weight, whereas 57% of the nondemented patients actually gained weight. The increase in reported food intake, with a significant concomitant weight loss, raises some challenging questions as to the existence of a hypermetabolic state in Alzheimer's disease.

Aged↗
PubMed1992

The do-not-resuscitate order in a nursing home: patient's choice or staff's decision.

An 86-year-old woman in a residential health care facility suffered a massive stroke; immediate intubation was performed, she was transferred to a nearby hospital where she died two months later. Within 48 hours of this event, three mentally competent residents and one family member on the unit requested a do-not-resuscitate order. They, along with the seven other mentally competent and non-terminal residents on the unit, participated in a questionnaire survey, the purpose of which was to elicit information on DNR attitudes. Only one respondent requested cardiopulmonary resuscitation. All insisted that do-not-resuscitate decisions were theirs alone to make. A staff questionnaire was given to 81 employees having many years of health care experience. Most had witnessed death and cardiopulmonary resuscitation and knew of its poor outcome. However, 51% were very willing to participate in cardiopulmonary resuscitation, and 65% thought cardiopulmonary resuscitation was worthwhile in residential health care facilities. Furthermore, 56.8% thought that families should participate in the decision. The dichotomy between residents' wishes and staff perceptions merits recognition and further study.

Aged↗
PubMed1990

Demographic changes and their financial implications.

The impressive rise in the number of elderly persons (65 years and over) will continue in the next two to three decades. Urinary incontinence is a common problem in the elderly, adversely affecting medical, social, and "quality of life" aspects. The cost of urinary incontinence is substantial and is expected to escalate enormously (e.g., by 160% from 1980 to 2040). An aggressive approach toward the diagnosis and management of urinary incontinence can result in an impressive reduction in health care costs and improvement in the quality of life.

Aged↗
PubMed1989

Psychiatric profile of the noncompliant geriatric patient in the community.

A pharmacist collected data in an active geriatric outpatient program on 140 patients admitted consecutively over a 1-year period. Compliance was monitored by patient statement, pill counting, and daily written record-keeping of all medications with the help of a pocket diary provided in the program. Weekly pharmacist counseling sessions were then initiated for all patients. After four compliance sessions, two subgroups of patients were identified: 120 compliant patients and 20 patients showing persistent 50% noncompliance. Patients were interviewed by a psychiatrist to develop a profile of the noncompliant patient. This profile may be useful in identifying other noncompliant geriatric patients. Early recognition of this special group of patients in need of directed counseling may help reduce medical misjudgment in prescribing for the frail elderly population.

Aged↗
PubMed1989

Screening for Alzheimer's disease by clock drawing.

The fear of Alzheimer's disease for both patients and families is growing along with the increasing evidence of the disease itself. This study (N = 312) of the validity of the clock drawing test in screening patients with probable Alzheimer's disease was conducted in an active outpatient geriatric clinic. Clock drawings by patients with normal mental status or depression were essentially normal. Alzheimer's patients were unable to complete a normal clock and demonstrated five characteristically abnormal patterns. As a test for Alzheimer's disease, clock drawing had a sensitivity of 86.7% and a specificity of 92.7%. There was correct identification in 97.2% of normals. These findings indicate that the clock drawing test, an easily administered, low cost screening tool, can be useful to health care professionals in characterizing cognitive loss in a general geriatric clinic population.

Aged↗
PubMed1988

Tube feedings in elderly patients. Indications, benefits, and complications.

During an 11-month period, 70 tube-fed patients aged 65 to 95 years were studied prospectively to determine the indications, benefits, and complications of enteral alimentation. Indications for alimentation were refusal to swallow (35 patients [50%], dysphagia without obstruction (33 [47%]), and esophageal obstruction (two [3%]). Nasogastric tubes (NGTs) were used initially in 69 patients; 15 of these subsequently required a gastrostomy tube (GT). One patient was treated initially with a gastrostomy. Indicators of nutritional status included weight, hemoglobin level, hematocrit, and serum albumin level. During the first two weeks the most common problems in the NGT group were agitation and self-extubation (36 patients [67%]) and aspiration pneumonia (23 [43%]). In GT patients the most common early problems were aspiration pneumonia (nine patients [56%]), tube dysfunction (eight [50%]), and agitation and extubation (seven [44%]). The common late problems were aspiration pneumonia (24 patients [44%] in the NGT group and nine [56%] in the GT group), and feeding tube dysfunction in six (38%) of the GT group. Self-extubation as a late problem was limited to the NGT group (21 patients [39%]). Twenty-eight (40%) of the 70 patients died during the study period.

Aged↗
PubMed1988

Prevention of falls in the elderly population.

In response to the challenge posed by falls in the elderly, the Jewish Institute for Geriatric Care established a Falls Clinic. The coordinated expertise of a geriatrician, neurologist, cardiologist, and physiatrist were combined with resources in audiology, ophthalmology, and podiatry. Thirty-six patients enrolled in the study had sustained a total of 36 falls, which resulted in 13 fractures and seven soft-tissue injuries. Falls were a daily occurrence for three patients, weekly for five patients, monthly for ten, semiannually for 14, and yearly for four patients. After a one-year follow-up, 77% of the patients experienced no further falls. We suggest that falls are a multidisciplinary issue and recommend a team approach for successful management.

Accident Prevention↗
PubMed1986

Autopsy proven pulmonary embolism among the institutionalized elderly.

The presentation of pulmonary embolism is variable in the elderly as in any age group. Common symptoms such as chest pain, dyspnea, and hemoptysis may be absent. Furthermore, precursors such as phlebitis, malignancy, and recent surgery often may be absent as well. Our intent was to examine the occurrence in a long-term care institution of pulmonary embolism at autopsy and the extent of missed antemortem diagnosis of this condition, and to compare patients with and without pulmonary embolism by chart and autopsy review. The incidence of pulmonary embolism in our study of elderly patients during a six-year period in a teaching nursing home was 12.8%. Although our series is small, consisting of 47 autopsies, our results are in accord with reports from other patient sites. Few autopsies are performed on nursing home patients and even fewer have been studied with regard to the occurrence and characteristics of pulmonary embolism in this population. The diagnosis remains difficult and uncertain, especially so in the elderly, because of the variability of presentation and association, the lesser pursuit of aggressive or invasive diagnostic methods, and the paucity of postmortem documentation.

Aged↗
PubMed1985

Efficacy of routine annual studies in the care of elderly patients.

The authors reviewed the results of annual laboratory screening (SMA 20, T3, T4, UA, EKG, chest x-ray) performed on a population of 500 institutionalized and ambulatory patients retrospectively followed from 1 to 19 years. With 30 laboratory values recorded for each annual exam, there were an average of 1.56 new abnormal laboratory findings per year per patient. A sample of 100 patients was further reviewed to determine the incidence of new diagnoses and treatment initiated by the appearance of new abnormal laboratory findings; 756 new abnormalities were recorded out of a possible 15,000, and 66 medical work-ups were initiated, which lead to new diagnoses in 21 cases and a treatment plan in 12 cases. The authors suggest that, in view of the rapid increase in the number of elderly persons and the consequent need to conserve limited health care resources, "standard" laboratory screening may not be warranted on a yearly basis in the elderly population.

Aged↗