Biomedical subjects
T J Wilkinson
Publications and source records attributed to T J Wilkinson.
A census-based comparison of centenarians in New Zealand with those in the United States.
OBJECTIVE: To describe the characteristics of New Zealand's centenarians, as given in the 1991 census, and to compare these characteristics with those of centenarians from the United States. DESIGN: A census-based descriptive study. SETTING: The complete national population as defined by the 1991 New Zealand census. RESULTS: In 1991, there were 246 female and 51 male centenarians in New Zealand. Fifty-one percent of the men and 29% of the women lived at home; 16% lived at home with someone else (55% with children). People who were widowed were more likely to be living in a residential institution (69%) than people who were married (40%). Forty-three percent of men and 39% of women earned less than NZ$10,000 per year. Most had no formal educational qualification. Fourteen percent of men and 35% of women living at home did housework in the previous week. Compared with the United States, there are fewer New Zealand centenarians per number of population. People of European race were overrepresented in the New Zealand centenarian population, whereas African Americans were overrepresented in the United States centenarian population. CONCLUSIONS: Our data have shown the heterogeneity associated with extreme ageing and can be used as a basis for comparison with other countries.
The association between mortality, morbidity and age in New Zealand's oldest old.
People aged eighty-five years and over (the oldest old) will form an increasing proportion of the population of New Zealand and many other countries. Because of their smaller numbers and relative inaccessibility, their health status has sometimes been extrapolated from populations of people aged sixty-five to eighty-four years. For people aged sixty-five to eighty-four years an exponential relationship is seen between age and morbidity and mortality. We explore if this exponential relationship extends to people aged ninety years and over. We analyzed data from the New Zealand 1991 Census and 1992 hospital discharge records and, for people aged sixty to eighty-nine years, confirmed an exponential relationship between age and mortality, inactivity, hospital utilization, and occupation of residential institutions. This exponential trend did not continue for people aged ninety years and over for whom mortality rates and indicators of morbidity were considerably lower than expected, and conclude that the actual health status of people aged ninety years and over is better than the status extrapolated from that of people aged sixty to eighty-nine years.
Implementation of guidelines for no-CPR orders.
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The effect of hospital admission on the opinions and knowledge of elderly patients regarding cardiopulmonary resuscitation.
OBJECTIVE: to determine (i) if the opinions of elderly people, regarding their wish for cardiopulmonary resuscitation (CPR), change after staying in hospital, (ii) how much elderly people wish to be involved in making decisions about CPR and (iii) the degree of knowledge they use to make their decisions. DESIGN: consecutive sample survey. SETTING: assessment, treatment and rehabilitation unit. PATIENTS: 95 elderly inpatients (63% of all admissions) without a terminal illness who could give informed consent, interviewed after hospital admission. Sixty-seven were interviewed again at hospital discharge and three were interviewed 16-35 days after admission. INTERVENTION: patient education and semi-structured questionnaire. OUTCOME MEASURES: patients' knowledge and opinions on basic knowledge of CPR, preference for CPR, who should decide and how this should be documented. RESULTS: knowledge improved after intervention, although patients persistently overestimated the success rate of CPR. Eighty percent on admission and 69% following a hospital stay wished to have CPR if necessary. Men were more likely to want CPR. On admission, 74% stated the patient should make the decision regarding CPR. This rose to 84% after a hospital stay. Only 57% wished to have their preference recorded in the hospital record and only 43% wanted their general practitioner notified of their wishes. Ninety-four percent felt comfortable with the interview. CONCLUSIONS: elderly people wish to be consulted about CPR but many do not wish their preference to be committed to paper. Most older patients want CPR but these wishes may change with time. It is important that any recorded directive from a patient is updated frequently.
The response to treatment of subclinical thiamine deficiency in the elderly.
The significance of subclinical thiamine deficiency in the elderly was determined by assessing response to thiamine supplementation in a randomized double-blind, placebo-controlled trial. Thirty-five of 222 people aged > or = 65 y had two concentrations of erythrocyte thiamine pyrophosphate (TPP) < 140 nmol/L 3 mo apart and 41 other people had the first, but not the second, TPP concentration below this value. Both groups were randomly assigned in a double-blind trial to oral thiamine (10 mg/d) or a placebo. All subjects randomly assigned to receive thiamine showed increases in TPP concentrations compared with control subjects. Only the subjects with persistently low TPP concentrations showed subjective benefits from treatment with improvements in quality of life (measured on a visual analogue scale; P = 0.02) and decreases in systolic blood pressure (P = 0.05) and weight (P < 0.01) when compared with subjects given placebo. There was a trend toward benefits in sleep and energy (P = 0.07). We conclude that a low TPP concentration on two occasions is a better predictor of response to treatment than an isolated measurement. Quality of life was enhanced by providing thiamine supplements. Blood pressure and weight were lower after thiamine supplementation.
Assessing and restoring function in elderly people--more than rehabilitation.
OBJECTIVE: To quantify the medical component of assessing and restoring function in the elderly and to determine if a subset who did not require medical input could be identified. DESIGN: Prospective consecutive sample. SETTING: Inpatient assessment, treatment and rehabilitation unit for the elderly in New Zealand. PATIENTS: Two hundred patients aged 60-98 years. MAIN OUTCOME MEASURES: (1) Proportion of elderly people receiving rehabilitation who also required treatment of medical problems. (2) Characteristics of those not requiring medical input. RESULTS: One hundred and seventy-two (86%) of people required some medical input during their hospital stay for rehabilitation. Forty-nine per cent had medical conditions which had a direct impact on their rehabilitation. Rehabilitation was delayed for a mean 16.8 (13.0-20.6)% of hospital stay when significant medical problems required treatment. People with previously undiagnosed conditions affecting rehabilitation tended to be older. The referral diagnoses most likely to result in an uncomplicated inpatient stay (i.e. rehabilitation only or rehabilitation with treatment of minor medical problems) were postsurgical treatment (55% uncomplicated), stroke (47% uncomplicated) or amputation (55% uncomplicated). However, 45-53% of people with these problems had a major medical component to their stay. People with other referral diagnoses or those admitted from institutions for the elderly were more likely to have a medical component to their stay. CONCLUSION: Restoration of function in the elderly requires a combination of both medical and rehabilitation skills. Reliable predictors of those not requiring medical input could not be found.
The added effectiveness of early geriatrician involvement on acute orthopaedic wards to orthogeriatric rehabilitation.
AIMS: To evaluate the effect of regular input by a geriatrician to an orthopaedic ward. METHOD: A geriatrician saw all patients aged over 65 years admitted to an acute orthopaedic ward-this was compared to an adjacent orthopaedic ward which had consultation only service, and also to both wards in the preceding year. All subjects over the age of 65 years with fractured neck of femur admitted over a 4 month period were enroled. Main outcome measures were length of stay, cost, discharge destination. RESULTS: In the year prior to study, patients in both wards had a mean total stay of 28 days. On the intervention ward the mean stay was reduced to 20.7 days, and on the control ward to 27 days. The cost per case on the intervention ward was NZ$9400, and on the control ward was NZ$11 500. Eleven percent went to a higher care level on the intervention ward, compared with 23% on the control ward. CONCLUSION: Geriatrician input on a twice weekly basis to all patients over 65 years of age on an orthopaedic ward, saves bed days, reduces costs and produces an improved outcome.
Collaboration with orthopaedic surgeons.
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Collaboration with orthopaedic surgeons.
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Stroke units.
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Diagnosis related groups based funding and medical care of the elderly: a form of elder abuse?
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The effete in the heat: heat-related hospital presentations during a ten day heat wave.
BACKGROUND: Severe heat-related illness can result in hospitalisation and possibly death. These illnesses are potentially preventable; in Australia high environmental temperatures are common. AIMS: To identify (i) possible risk factors for hospital attendance with heat-related illness during a heat wave, (ii) problems with diagnosis and therapy, (iii) issues in prevention, and (iv) areas for further study. METHODS: A retrospective descriptive survey from four major teaching hospitals in Adelaide, South Australia (SA), was conducted during a ten day period of exceptional heat in February 1993, in order to review all emergency department presentations (i.e. deaths, casualty treatment or hospital admissions) with a heat-related illness as determined by attending doctors' documentation. Demographic, clinical, management and outcome data were collected. RESULTS: Ninety-four patients were classified as having a heat-related illness of whom 78% had heat exhaustion. Eighty-five per cent were age 60 years or over; 20% came from institutional care; 48% lived alone; 30% had poor mobility. Peak presentation followed high daily temperatures for four consecutive days. Severity was related to pre-existing cognitive impairment, diuretic use and presenting temperature, heart rate, blood pressure, plasma sodium and plasma creatinine. Treatment tended to be non-standardised. Mortality was 12%. Seventeen per cent required a more dependent level of residential care upon discharge. CONCLUSION: Problems were identified in accuracy of diagnosis and appropriate intervention. Awareness of the risk factor profile is needed among health workers, to ensure early preventative strategies. Populations to target for future prevention include elderly people (including those in institutional care), patients with cognitive impairment and patients taking diuretics, multiple medication and/or with other severe co-existing illnesses. Treatment could be more standardised.
Testicular cancer and age at puberty.
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Testicular cancer in blacks: a multicenter experience.
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Do the clinical years change medical students' attitudes to old people?
Students at the Christchurch School of Medicine have previously been shown to demonstrate a significant improvement in attitudes and knowledge about old people after a 5-week attachment in their first clinical year (fourth year of their medical course). The original cohort were retested between 1 and 3 years after graduation. A modified version of the Rosencranz-McNevin Semantic Differential Scale was used to measure general attitudes to old age and a Likert scale to measure attitudes to medical care and knowledge. Attitudes measured by the Rosencranz-McNevin Scale showed no change between the completion of the fourth-year attachment and graduation. The Likert scale showed no change in knowledge but the attitude score showed a worsening (P < 0.001). Knowledge and attitudes of graduates who had completed a house office attachment in health care of the elderly were better than those who had not (knowledge P < 0.01, attitude P < 0.06).
Asymptomatic low bone mineral density in otherwise healthy people: four year follow up.
AIM: To determine the effect of screening a normal population for low bone density on lifestyle, subsequent bone density and fracture risk. METHOD: A cross sectional study of 726 subjects screened for low bone density identified 60 with bone density greater than one standard deviation below an age and sex matched mean. Those who accepted further assessment were followed clinically and with repeat bone densitometry for up to four years. Those declining assessment were contacted four years later and questioned about lifestyle changes and fractures. They were offered repeat bone densitometry. RESULTS: Twenty five subjects accepted intervention and were advised on lifestyle modification and treated with calcium supplements (18) calcitriol (5) or oestrogen (1). 22 of the 35 subjects who initially declined intervention volunteered to have their bone density repeated. Bone density increased in the group accepting intervention compared to the 22 subjects in the group who initially declined assessment (p < 0.05). Several laboratory investigations had a low yield. Lifestyle modification in the group declining assessment did not significantly affect subsequent bone density. Fractures occurred infrequently in both groups. CONCLUSION: After screening the normal population for low bone density, significant improvements in bone density can be achieved in patients accepting further intervention.
Initial warfarin treatment in hospital--room for less caution? A twelve month prospective audit.
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