Biomedical subjects
J L Dall
Publications and source records attributed to J L Dall.
Training in geriatric medicine in United Kingdom.
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The roles of general and geriatric medicine in the provision of acute medical care for elderly patients.
To determine whether there are differences between elderly patients admitted acutely to general medicine and those admitted to geriatric medical wards, and whether the patients are appropriately referred, a prospective survey of 426 consecutive patients aged 65 years or over admitted acutely to general medical and geriatric wards over a three month period was performed. A total of 286 patients were admitted to general medicine (GM) and 140 to the geriatric unit (GER). GER patients were older (81.0 v. 75.8 years) and had greater pre-morbid functional impairment and incontinence. Fewer GER patients presented with readily apparent organ specific diagnoses (56% v. 94%). Median length of stay was longer in GER patients (23 days v. 9 days). Variables independently predictive of GER admission were increasing age, increasing duration of illness, poor pre-morbid functional status and prior reliance on a carer. Length of stay was not associated with unit of admission allowing for the variables described above. GER patients are a different population. They have more chronic illness and functional impairment, and are more likely to require multidisciplinary assessment and rehabilitation in addition to treatment of presenting illness. Elderly patients are appropriately referred by General Practitioners (GPs) without a formal admissions policy.
Key factors in the treatment of the elderly hypertensive.
Cardiovascular diseases are of fundamental importance in the cause of death and morbidity in the elderly as a group. If the successful management of blood pressure can effect a reduction in morbid events as well as death, as has been indicated by recent trials, the elderly have more to gain than any other group within the population by adequate treatment of blood pressure. The physiologic response to aging in the cardiovascular system has characteristics similar to a beta-adrenergic blocking effect. Some similar changes are seen in older hypertensives. Hypertension may represent premature aging in the cardiovascular system. Blood pressure can be reduced in elderly people, and it is now relevant to determine whether one particular method of reducing blood pressure has advantages over others. Education of the elderly as to the advantages of treatment is important, but education of professionals who prescribe is, perhaps, more important. A clear understanding of the gains to be made and the side effects of different groups of drugs is necessary to allow the doctor to prescribe confidently for the elderly patient.
Hypertension in the elderly.
The relation between hypertension, cerebrovascular disease, and heart failure in the elderly is well established. The concept that this was entirely due to hardening of the arteries and, therefore, an essential feature of aging has been revised in the last 15 years to show that there are groups of elderly people in whom hypertension is not a problem, and in this group stroke disease and heart failure are relatively uncommon. The treatment of hypertension in the elderly attracts increasing attention. The successful lowering of blood pressure in the elderly has now been reported by many authors with a variety of therapeutic agents. The case for treatment has been demonstrated in those up to 80 years of age by the European Working Party in Hypertension in the Elderly, and relevant data on compliance are also available in the older age group in the Sub-Group Analysis of the Hypertension Detection and Follow-up Programme. A similar reduction of blood pressure, both systolic and diastolic, can be safely achieved with thiazides, beta-blockade, calcium channel blockade, angiotensin-converting enzyme inhibitors, and centrally acting drugs. The differentiation between these groups is largely a matter of the side effects that occur and any concurrent existing illness from which the patient suffers, e.g., diabetes, bronchitis, heart failure, and so on. From the information available to date, the problem of choice of the most suitable drug remains a clinical decision for the prescribing doctor.
Outcome after episodes of hypothermia.
A retrospective study was made of all patients aged over 65 years with hypothermia discharged from or dying in the Victoria Infirmary, Glasgow in the years 1977-81. Full follow-up data were obtained on 81 of the 91 patients identified. Patients were divided into cases of primary and secondary hypothermia. There were no significant differences between the two groups in initial mortality mean age on admission or mean temperature on admission, but there was a highly significant (P less than 0.001) difference in long-term outcome: the 3-year mortality in patients who survived the index admission was 100% in the primary group and 24% in the secondary group.
Guidelines for rational diuretic use in the elderly.
The elderly not only have lower body stores of potassium, but also tend to eat a diet relatively low in potassium content. Loss of muscle strength, constipation and mental apathy are all features of potassium deficiency. In addition, serious arrhythmias have been attributed to hypokalaemia and must therefore be prevented. While potassium supplements may replete body potassium stores, they often require large amounts and may still be ineffective in preventing diuretic-induced hypokalaemia. Thus, several guidelines for the rational and safe use of diuretics in the elderly have been proposed including in addition to potassium supplementation, the determination of dietary and total body potassium sources, dosage of the diuretic and intensity of the diuresis, and the relationship between potassium and calcium and magnesium.
Chlormethiazole and electro-encephalogram changes.
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Hypertension--a case for treatment.
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Management of confusional states.
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Helping old people to continue living at home. The contribution of the day hospital.
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Hypertension: don't wait for a stroke before you treat.
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Who needs speech therapy?
Assessment of communication by a patient with a speech disorder by clinicians is often dependent on whether the patient makes an appropriate response to an instruction. The speech therapist concerned with language usage and the over-all ability to communicate has developed skills and investigational techniques to identify subgroups within the broad categories of speech pathology appreciated by the clinicians. This prospective study of 100 patients with neurological disease referred for speech therapy, examined in detail in good working conditions and with ample therapy time, is intended to clarify for the clinician a method of assessment, and to illustrate the value of therapy, and establish a prognosis for the variety of speech and language disorders encountered.
Potassium intake of elderly patients in hospital.
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Dietary intake of potassium by geriatric patients.
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