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Biomedical subjects

R W Besdine

Publications and source records attributed to R W Besdine.

At least 19 recordsLinked to original sources
PubMed1993

Stroke prevention in the elderly.

Stroke is a common, devastating and frightening event among older persons, often resulting in death or major loss of independence. Professional and lay attitudes of the past have assumed an inevitable and immutable course of stroke risk progression with age. Although stroke is strongly age-associated, recent data have accumulated demonstrating reduction in stroke rate by preventive interventions in older patients with risk factors. Statistically significant stroke reduction has been achieved by 1) antihypertensive treatment of patients with elevated systolic blood pressure, even beyond age 80; 2) anticoagulation with warfarin for patients with chronic or intermittent non-valvular atrial fibrillation; 3) use of low-dose aspirin in patients with TIA or nondisabling stroke; and 4) carotid endarterectomy for patients with symptoms and ipsilateral serve stenosis. Clinical strategies to prevent stroke in older adults are now tested and proven useful; they should be used as indicated in older persons at risk.

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PubMed1990

Prevalence of mammography use in a nursing home population.

A cross-sectional study was performed to estimate the utilization of screening mammography in a nursing home population. Included in the study were 139 women over 50 years of age who had been residing in a skilled nursing home in Connecticut for at least 1 year. Charts were reviewed to estimate screening mammography and chest x-ray examination use. Functional status of each subject was assessed by supervisory nurses using set criteria. One of the 139 subjects had received a mammogram, whereas 129 subjects (93%) had received chest x-ray examinations. Average length of stay in the nursing home was 6.5 years. No association was noted between functional status and use of mammography. It was concluded that in this clinical setting mammography appears to be underutilized as a screening test for breast cancer. The comparative data on chest x-ray examination use suggest strategies that may be useful in increasing compliance with current screening recommendations for mammography in the institutional setting.

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PubMed1989

Effects of age, education, and physician advice on utilization of screening mammography.

We investigated the utilization of mammography as a screening test for breast cancer in a middle-income Connecticut suburban community of 30,000 people. The sampling frame was community-dwelling women aged 30 years and over who had telephones. Random digit telephone survey methods were used to identify a sample of 470 eligible subjects. Of those eligible to be included, 350 or 74.4% completed the interview. Analysis of data from the 171 respondents aged 50 years or greater indicated that women aged 65-80 years had a significantly lower rate of screening mammography than did women aged 50-64 years (means 2 = 6.6, P = .01). When further analysis was done to take into account the effects of education and of income on these rates, the association of age with mammography utilization was no longer statistically significant. Among women who recalled their physician advising a mammogram, 88% had had one performed. Among women who could not recall their physician advising a mammogram, 7% had had one. The impact of physician advice was statistically significant (means 2 = 110.3, P less than .001). Physicians recommended screening mammography less for patients with low level of education (means 2 = 21.6, P less than .001), low income (X2 = 7.8, df = 2, P = .02) and greater age (means 2 = 14.2, P = .003). We conclude that utilization of screening mammography in the community studied is related more strongly to education and to income than to age. The bivariate association of mammography utilization with age may be attributable to a cohort effect, rather than an age effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1988

Illness behavior in the aged. Implications for clinicians.

A better understanding of the processes through which elderly individuals perceive, evaluate, and act on symptoms will enable physicians to respond more appropriately to the needs of older patients. This paper reviews existing evidence on how the experience of chronic disease and the atypical presentation of symptoms influence symptom recognition and reporting among elderly individuals. A discussion of research on health perceptions suggests that some elderly may inappropriately deny illness and delay seeking medical care, while others with overly negative health perceptions may make excessive physician visits. An overview is presented of the process by which elderly individuals come to seek care from their physicians, combining evidence from the diverse literatures on chronic illness, atypical presentation of disease, and health perceptions. We conclude by discussing the practical implications of this information for clinicians working with the elderly.

Activities of Daily Living↗
PubMed1983

The educational utility of comprehensive functional assessment in the elderly.

Comprehensive functional assessment in the elderly (CFAITE) is important in organizing and providing health care to elders in all health care settings, including the community, the nursing home and the acute-care hospital. The educational value of performing CFA coordinated with traditional discipline-specific diagnostic assessment resides in enhanced care for elders and more effective teaching of that care to their providers. The educational opportunities intrinsic to a system of health care using CFA are numerous and provide stimulation and enthusiasm for all involved professionals.

Activities of Daily Living↗
PubMed1983

Decisions to withhold treatment from nursing home residents.

Although the ethical issues in clinical care of severely impaired elderly nursing home residents may appear to be the same as those encountered in the acute hospital, they are not. In particular, "do not resuscitate" orders are not of central importance in the nursing home. For the individuals being considered, decisions about limiting routine treatments and whether treatment should include hospitalization are crucial. Establishing an ethical issues team is one means of increasing awareness of ethical issues in patient care and of dealing with these difficult issues more successfully.

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