Biomedical subjects
H A Nygaard
Publications and source records attributed to H A Nygaard.
[Legal rights of demented patients in somatic nursing homes].
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Dosing of neuroleptics in elderly demented patients with aggressive and agitated behaviour: a double-blind study with zuclopenthixol.
A double-blind controlled trial was carried out in 73 hospitalized elderly patients to evaluate the effect of different low doses of the neuroleptic, zuclopenthixol, on behavioural disorders associated with dementia. Patients were randomized into four groups and received treatment for 4 weeks with fixed daily doses of 2 mg, 4 mg or 6 mg zuclopenthixol, or with a dose which could be increased from 4 mg to 20 mg daily. The dose could also be reduced if necessary. Fifty-four of the patients remained on the same daily dose throughout the study. The results of symptom assessments showed that there was a significant improvement from baseline scores in all of the dose groups and, with the exception of patients on 2 mg daily, this was evident after only 1 week of treatment. Although improvement was noted in all the symptoms evaluated, the best effect was achieved on aggressive behaviour, restlessness/agitation, sleep disorders, and shouts/torments others. Only a few, relatively mild side-effects were recorded and there was no increase in frequency with increasing doses. There was significant correlation between the serum concentration and the dose of zuclopenthixol used but not in connection to age and clinical efficacy.
[Use of hypnotics by elderly patients admitted for rehabilitation].
60 persons (13 men, 47 women, median age 80 years) who were admitted to a nursing home for rehabilitation were studied with respect to sleep-related problems and consumption of hypnotic drugs. 25 patients (42%) used hypnotics regularly. The median time of drug use was 72 months. More users than non-users reported difficulty in falling asleep (OR 3.1) and were less likely to feel rested in the morning (OR 4.4). There was no difference between users and non-users with respect to sex, age, living condition, use of analgesics or drugs that can influence sleep. In general, drug consumption was significantly higher among users of hypnotics than among non-users, and more of the users drank coffee or tea in the afternoon or evening. Ten of the users did not want to discontinue their drug consumption.
[Functional level among patients living permanently in nursing homes. Changes between 1984-1991].
Measurements of nursing load score, which imply weighting the performance of everyday activities, were performed once a year between 1984 and 1991 for all permanent residents at Fyllingsdalen nursing home. The nursing load score was higher for women than for men and for demented than non-demented residents. Dementia was significantly associated with impaired ability to perform most everyday activities. During the observation period the number of patients needing help in dressing, for personal hygiene and to go to the toilet increased, as did the number of residents with faecal incontinence. The number of patients who were independently mobile increased; an increase explained by the rising number of demented residents. Improved municipal services at home have enabled frail elderly to remain longer in their own homes. As a consequence, patients admitted permanently to a nursing home will be more impaired than has been the case before. In particular, the number of demented patients, with their special needs, has increased. Sheltered units for demented persons will partly meet the needs of this group of patients, but better staffing is a necessity if a safe care is to be provided.
[Rehabilitation in nursing homes. Experiences from a 3-year period].
Patients who were admitted to a rehabilitation unit in a somatic nursing home between 1.9.1987 and 31.12.1988 were interviewed approximately 19 months (mean) after discharge with respect to how they functioned at home and their quality of life. Demographic data, diagnoses and level of functioning at admission and upon discharge were collected from the medical records. 134 patients were admitted, 99 of whom were discharged to their home, 20 transferred to long-term care in an institution, 12 died and three were transferred to hospital. The study comprises 86 patients who were available for an interview at follow up. In 20% of these patients new diagnoses were made, which were of clinical importance. The level of functioning improved during period of treatment, but at follow up had declined, particularly in the case of stroke patients. Demented patients were more liable to be placed in an institution, as were unmarried or widowed persons and people unable to prepare their own meals. Family contact and the ability to eat without help were significant for quality of life.
Inappropriate placement of residents in psychiatric nursing homes in Bergen, Norway.
The mental and physical capacities of all residents in psychiatric nursing homes in Bergen were studied. It was found that 95% were moderately or severely mentally impaired and 53% received antipsychotic medication regularly. By objective criteria, 47.9% were considered improperly placed. These patients typically had had a long stay in the institution, were immobile, and were given antipsychotic drugs infrequently.
Zuclopenthixol, melperone and haloperidol/levomepromazine in the elderly. Meta-analysis of two double-blind trials at 15 nursing homes in Norway.
A meta-analysis was carried out of the data from two double-blind, multi-centre studies with identical methodology which compared the effectiveness of treatment of elderly patients with zuclopenthixol and with other antipsychotic drugs. In one study, patients were treated for 4 weeks with either zuclopenthixol or melperone; in the other, with either zuclopenthixol or a combination of haloperidol and levomepromazine. The meta-analysis evaluated the results of 96 patients, 49 in the zuclopenthixol group and 47 in the comparison group. Doses, which were adjusted to individual patient's needs, were low as shown by the percentages of defined daily doses for each of the study drugs. The results indicated that all three treatment alternatives were effective in the treatment of elderly patients with symptoms of agitation and hostility/aggressiveness. There was a trend, however, for zuclopenthixol to have a more rapid onset of effect. Zuclopenthixol also has the advantage for both patients and nursing staff that dosage is once daily. Only few and mild side-effects were reported with the three drug regimens.
Risk factors for admission to a nursing home. A study of elderly people receiving home nursing.
Risk factors for permanent admission to a nursing home were studied in a prospective study of persons 70 years and over who received home nursing. Demographic data and use of psychotropic drugs were registered, and mental capacity, behaviour, and performance of activities of daily living (ADL-function) estimated. 214 patients received home nursing. 166 patients were available for the follow-up study after 16 months, of whom 31 had been admitted to a nursing home. Senile dementia and stroke were the most frequent diagnoses of admitted patients. Mental impairment, age, and amount of home nursing were associated with permanent admission to a nursing home. The odds for being admitted were 10.2 (C.I. 2.3-44.4) times higher in moderately and severely mentally impaired persons than in not mentally impaired persons. The odds for admittance for those 85 years and over, compared with those younger than 80, were 5.0 higher (C.I. 1.6-15.6); and those receiving home nursing three times weekly or more had 3.8 (C.I. 1.4-9.8) times higher odds than those with less help.
[Permanent admissions to nursing homes. Admission pattern changes between 1979-1989].
Patients admitted permanently to a somatic nursing home between 1979 and 1989 were retrospectively studied to find out the mode of, and reasons for, admission. A total of 589 patients were admitted. The percentage of demented patients increased from 38 to 66%. The proportion of patients admitted from their own homes or from a hospital decreased, whereas the proportion transferred from a short admission to a permanent stay increased. It is concluded that, in many cases, the public services for elderly people living in their own homes are unable to cope with the problems that arise, especially in demented persons. The problem of "bed blockers" is no longer restricted to hospitals, but also affects nursing home beds allocated for short time purposes. It is necessary to develop a holistic approach to the tasks of caring for the elderly population, across existing administrative levels.
Who cares for the caregiver? Factors exerting influence on nursing home admissions of demented elderly.
Forty-six demented elderly and their caregivers previously studied with respect to strain on caregivers; were studied one year after the initial assessment with respect to institutionalization. Patients admitted to a nursing home, showed more pronounced mental and behavioural disturbances. Cognitive functions, gender, marital status and living conditions did not differ between the two groups. The caregivers of institutionalized demented were older, they expressed more feelings of anger and despair and more often requested the care receiver transferred to a nursing home.
Lower mortality of demented nursing home residents. A two-year survival study.
The mortality of 318 patients residing permanently in a nursing home was analyzed over two years in a retrospective study. Survival analysis showed that age was significantly associated with increased mortality, and dementia with decreased mortality. The results may to some extent explain the large percentage of demented patients in nursing homes, and provide some support for the hypothesis that demented patients accumulate in the nursing homes, partly due to inappropriate community services for these patients, leading to a relatively early institutionalization.
[Injuries in nursing homes].
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Mental and physical capacity and consumption of neuroleptic drugs in residents of homes for aged people.
The mental and physical capacity of all residents in homes for aged people were estimated, and their neuroleptic drug consumption and duration of stay were registered. One third was moderately to severely mentally impaired and 38% demanded more extensive nursing care. Physical dependence was significantly associated with mental decline, and less with age. One quarter of severely mentally impaired people had stayed for less than one year; 23% of the residents received neuroleptic drugs. Treatment was more common in physically incapacitated people together with wandering and aggressive ones. Lack of psychogeriatric services may enhance the use of neuroleptic drugs in homes for aged people.
[Use of resources in open health care].
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Strain on caregivers of demented elderly people living at home.
Forty-six patients with senile dementia and their primary caregivers were studied. The strain score of the caregiver and the mental and behavioural deviation of the patients were estimated. Memory problems, listlessness, apathetic, critical and demanding behaviour and urinary incontinence were the most disturbing features of the patients. Eighty-five percent of the caregivers felt despair and anger and 75% complained of chronic fatigue. There was a statistical significant correlation between caregivers strain on one hand, and duration of symptoms, degree of dementia and deviation of behaviour on the other hand. Elderly women caring for their husbands and daughters caring for their parents were especially at risk. Future services must concentrate on maintaining the ability of caregivers to proceed the caring task.
[Who wants to live in a nursing home?].
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[Cisordinol and Buronil in the elderly. A controlled multi-center double-blind comparison].
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