Biomedical subjects
M Gosney
Publications and source records attributed to M Gosney.
Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems.
Influenza is a major problem both in the community and hospital and elderly people who are at particular risk should be included in vaccination programmes. In August 1998 the Chief Medical Officer for England extended the current influenza immunization policy to include all those aged 75 years or over. However, prior to this date only those patients with co-existing cardiac or respiratory diseases at increased risk of influenza were vaccinated routinely. In order to determine whether such patients had been immunized, we approached all patients admitted to Care of the Elderly wards during an 8-week period in January and February. The study additionally identified factors that may have influenced patients' participation in this immunization programme. Six hundred and forty-nine patients on Care of the Elderly wards with acute medical illness were questioned with regard to vaccination against influenza during the previous year. Of the 649 patients 279 were suitable for entry into the study. Of these 39% had been vaccinated against influenza. When considering the 171 who were not vaccinated, 25% (44 patients) had actually been offered and declined vaccination, in 46% of these cases due to previous side-effects, or fear of anticipated side-effects. In those unvaccinated three-quarters considered that the influenza vaccine was not efficacious. Unfortunately, patients with co-existing cardiac, respiratory or endocrine diseases were no more likely to have been vaccinated than were those without these diseases. Many older patients admitted with acute medical problems had not been vaccinated against influenza and the reasons for this included not being offered vaccination, a belief that influenza vaccination was not efficacious and concerns about possible side-effects. The role of community doctors and nurses in facilitating the vaccination of such an at-risk group is evident and should be incorporated into resource planning.
Investigation and treatment of cancer in old age.
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Gait disturbance in Alzheimer's disease: a clinical study.
Gait disturbance is common in patients with Alzheimer's disease (AD). The aim of this study was to analyse the clinical gait syndromes of patients with AD using Nutt's classification. Fifty-five patients who satisfied the NINCDS-ADRDA criteria for probable AD and 55 controls were recruited from a geriatric and a psychogeriatric unit. Patients with classical musculoskeletal or neurological syndromes causing gait disturbance were excluded. A standardized neurological examination was carried out in all subjects. Twenty-two (40%) patients and ten (18%) controls had a higher level gait disorder (p < 0.01). The pattern of gait disturbance in AD patients varied according to the stage of the disease. Cautious gait was the commonest gait disorder in AD patients with mild dementia, while frontal gait disorder was the commonest disturbance in patients with severe dementia. The prevalence of frontal release signs (gegenhalten or any primitive reflex) was highest among patients with frontal gait disorder.
Prescription of contraindicated and interacting drugs in elderly patients admitted to hospital.
573 elderly patients admitted to the general medical and geriatric beds of a teaching hospital in January, 1983, were receiving an average of 2.14 drugs on admission, 5.48 during inpatient stay, and 3.47 on discharge. Contraindicated or adversely interacting drugs were identified in 200 (3.2%) of 6160 prescriptions. 136 (23.7%) patients were affected. 7 patients received drugs to which they had had adverse reactions. There were a further 60 contraindicated and 133 adversely interacting drugs. 117 prescriptions were potentially hazardous and another 27 interactions may have led to suboptimal treatment. 131 (65.6%) undesirable prescriptions were deemed avoidable and a further 36 (18%) were probably so. The frequency of errors was higher in admission medication (5.3%) than in hospital prescriptions (2.9%). The importance, origin, and prevention of prescribing errors in drug-induced morbidity in the elderly are discussed.
Smoking cessation.
Smoking cessation has been shown to be cost effective, even in older individuals. It is therefore important that this health promotion is not missed in this vulnerable group.
Side effects of influenza vaccination in healthy older people: a randomised single-blind placebo-controlled trial.
OBJECTIVES: To investigate the frequency of side effects following influenza vaccination in healthy participants aged 65-74 years. MATERIALS AND METHODS: A single-blind randomised placebo-controlled trial was performed in general practices in central Liverpool on 729 healthy individuals (341 females and 388 males) aged 65-74 (median age 68.9) years, of whom 552 received influenza vaccine and 177 received placebo. The main outcome measures were analysed from adverse reactions reported by the subjects on a postal questionnaire 3 days after vaccination. RESULTS: 724 (99.3%) questionnaires were returned. 62 (11.3%) participants who received influenza vaccination complained of local symptoms compared with 9 (5.1%) participants who received placebo (difference 6.2%; 95% CI 1.3 to 10.0%; p = 0.02). 192 (35.1%) individuals who received influenza vaccine complained of one or more systemic side effects compared with 75 (42.4%) who received placebo (difference -7.3%; 95% CI -15.6 to 0.9%; p = 0.10). CONCLUSION: Healthy people belonging to this age group can be reassured that, when compared with placebo, influenza vaccination causes few, if any, systemic side effects and only a low incidence of local side effects.
Acute stroke predisposes to oral gram-negative bacilli -- a cause of aspiration pneumonia?
OBJECTIVES: To assess any change in the oral flora in the mouths of stroke patients during the acute and rehabilitation phases and to determine whether this is related to episodes of aspiration pneumonia and clinical outcome. MATERIALS AND METHODS: This observational study was carried out in hospital wards in a University teaching hospital. The subjects were patients immediately post-stroke and during the rehabilitation period, acute admissions and a group of healthy volunteers. An assessment of dentition and swallow in the presence or absence of oral aerobic gram-negative bacilli (AGNB) was correlated. RESULTS: Of the acute stroke patients 52% had an unsafe swallow. AGNB carriage was documented in 34% of the acute stroke group. Of the 11 patients who died 55% had AGNB, 73% had an unsafe swallow and 36% had a combination of both. CONCLUSION: AGNB is a common finding in acute stroke patients. It is not a consequence of age or acute hospitalisation and is associated with an unsafe swallow and a higher mortality.
The burden of chronic illness in local authority residential homes for the elderly.
A survey of all Part III residential homes in the Central and Southern area of Liverpool Health District examined the diagnoses and medication of 331 residents. A heavy burden of chronic illness was observed with cardio-vascular, psychiatric and orthopaedic problems being the most prevalent. Of the top 10 diagnoses, accounting for over half of all conditions, all disease instances required monitoring of their response to treatment. At least two thirds of these diseases were likely to progress, and the usual treatment of three quarters of the sample was associated with possible side-effects. This heavy burden of chronic illness in Part III residential homes implies a major need for both anticipatory and event-related medical care. These needs are unlikely to be met, given that the subtle, but significant, deterioration in the health of residents has been shown to go undetected.