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PubMed2003

Institutionalizing the option of dam removal: the New Hampshire initiative.

For two years, the State of New Hampshire has worked to institutionalize the option of dam removal. The high gradient streams that flow through the granite hills and mountains of this small northeastern state provided ideal conditions for dam construction, particularly during America's Industrial Revolution of the 1800s when mills were constructed throughout the area. With more than 4,800 dams in the state's database, there are many opportunities for the removal of dams that no longer serve a useful purpose, have become a public safety hazard and impact the river environment. Efforts to facilitate removal of dams in New Hampshire include the formation of a River Restoration Task Force and the creation of a dam removal program within the state agency responsible for regulating dams. This has led to the removal of two dams in the past year, with approximately ten additional projects in various stages of planning. A history of this agency-led initiative, as well as a discussion of the program's strengths, challenges and goals for the future are presented.

Conservation of Natural Resources↗
PubMed1978

MA changes in institutionalized Down's syndrome persons: a semi-longitudinal approach.

A semi-longitudinal approach was employed in this partial replication of a larger study of MA changes in institutionalized retarded persons (Fisher & Zeaman, 1970). Curves were fitted to MA data for a Down's syndrome group and a group of retarded subjects matched on the basis of initial Ma and CA. The findings generally replicated those of the earlier study. Specifically, the results of a multiple regression/correlation analysis indicated that the two curves were similar in shape, but differed with respect to height.

Adolescent↗
PubMed1978

The antibody response of institutionalized Down's syndrome patients to seven microbial antigens.

An earlier cross-sectional study had revealed that institutionalized Down's syndrome (DS) patients possessed much lower titres of hepatitis B surface antibodies (anti-HBs) than did their non-Down's (ND) counterparts. In an attempt to determine whether DS patients were generally deficient in humoral antibody response, the inmates of an institution for the mentally retarded (110 DS, seventy-eight ND) were immunized with tetanus, diphtheria (toxoids), influenza A, influenza B (inactivated vaccines), measles, mumps and rubella (attenuated vaccines), and tested for their antibody responses. The DS and ND groups did not respond differently to any of the seven antigens. Furthermore, there was no general relationship between the anti-HBs titres of inmates and their capacity to respond to the defined antigenic stimulus of any of the seven antigens. From these results it is apparent that a general humoral deficit in the DS group cannot explain their tendency to possess much lower anti-HBs titres than their ND counterparts upon becoming infected with the hepatitis B virus. When the antibody status and responses to immunization of the inmates who possessed anti-HBs were compared with those who had chronic HBsAg antigenaemia, there was no significant difference between the groups.

Antibody Formation↗
PubMed1978

Speaking fundamental frequency characteristics of institutionalized adults with Down's syndrome.

Mean speaking fundamental frequency was obtained from 16 institutionalized adults with Down's syndrome (8 males, 8 females) and from 16 nonretarded adults of similar age and sex. Both male and female adults with Down's syndrome exhibited a higher mean speaking fundamental frequency than did the nonretarded adults of the same sex. This finding does not support early reports of a characteristically low-pitched voice among Down's syndrome individuals.

Adult↗
PubMedDate not supplied

[Evaluation of palatability of two special oral diets for institutionalized elderly diabetics, Glucerna SR vs Resource Diabet].

OBJECTIVES: To evaluate the organoleptic characteristics of two specific nutritional supplements for diabetes (Glucerna SR and Resource Suport) and compare them. SETTING: An evaluation was made of 456 patients with Type 2 diabetes (most of them receiving OADs or insulin) from 34 centers. They were non-smoking elderly patients (mean age 73 to (71-78) admitted to nursing homes or homes for the aged distributed all over the Spanish territory. INTERVENTIONS: Palatability was studied using a modified wine tasting scale assessing 6 parameters (appearance, smell, body, sweetness, aftertaste and taste) that were scored individually, with a total score ranging from 0 (most unfavorable) to 20 (most favorable). Each brand was evaluated in two flavors (vanilla and strawberry) according to a crossover, double-blind design. RESULTS: A total of 906 evaluable observations were made, and highly statistically significant differences favorable to Glucerna RS were found in all parameters considered both absolutely and relatively, exception for sweetness, for which statistical significance was not reached because it was relatively evaluated. No statistical differences were found between the two flavors (vanilla and strawberry). The only significant confusing factor found was age; the older the age, the more the differences were noted between the two brands. CONCLUSIONS: Glucerna SR has a better flavor than Resource Suport for institutionalized elderly diabetic patients.

Aged↗
PubMed2005

[Psychotropic drug use in the Belgian non-institutionalized population].

OBJECTIVE: To assess psychotropic drug utilization in the general population of Belgium, and the pattern of use in individuals with mental disorders. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium aged 18 or older (n = 2419) were interviewed between April 2001 and June 2002. Individuals were asked about any psychotropic drug use in the past 12 months, even if they used the drug(s) just once. The interview took place by means of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Slightly more than 19% reported that they had used any psychotropic drug in the past 12 months; 11% had a 12-month mental disorder. The extent of psychotropic drug utilization varied according to the nature of the disorders: 60% in mood disorders, 53% in alcohol disorders, and 39% in anxiety disorders. Thirty nine percent of the respondents with a mood disorder consumed an antidepressant drug in the past year; 23% of the respondents with an anxiety disorder consumed an anxiolytic drug in the past 12 months. Among those who reported that they used antidepressants, selective serotonin reuptake inhibitors were most commonly consumed (SSRI). CONCLUSION: These data do not provide evidence for any over-consumption of psychopharmacological agents in Belgium. By contrast, they question the appropriateness of pharmacological treatments, in which under-treatment seems to be coupled with a high use of non-specific medications.

Adolescent↗
PubMed2005

Racial differences in institutionalization after hip fractures: California hospital discharge data.

OBJECTIVE: Hip fractures related to osteoporosis are a major cause of illness leading to institutionalization of elderly patients. Our objective was to determine the ethnic differences and the factors influencing the placement of hip fracture patients in extended-care facilities (ECFs). DESIGN: Secondary data analyses of California Hospital Discharge Data Program (CHDDP). PARTICIPANTS: 78,576 men and 246,177 women > or = 65 years of age with hip fractures related to osteoporosis were included for the analyses. METHODS: The main outcome variable was placement in ECFs as opposed to home. Other variables studied were age, gender, ethnicity, cormobid conditions, insurance, and length of stay in the hospital. RESULTS: Whites and African-American patients with hip fractures were more likely to be placed in ECFs compared to Hispanics. Older age, male gender, presence of two or more comorbid conditions, Medicare insurance, and shorter length of stay in the hospital were also significantly associated with placement in ECFs. CONCLUSION: Future studies should explore sociocultural and other factors that influence ethnic differences in the disposition of hip fracture patients.

Aged↗
PubMed2006

[Sexual expression among the institutionalized elderly with dementia, and strategies for sexual care].

Despite the general reduction in sexual needs with aging, human beings have sexual needs which are life long. This study looks at the overall lack of privacy, as well as at the biological, psychological and social changes that occur among the institutionalized elderly with dementia, and addresses the appropriateness of sexual expression. Conflicts involving social values, a lack of policies regarding sexual issues, and a lack of in-service training in institutions result in caregivers experiencing difficulty with the sexual issues faced by patients. It is essential to develop strategies which are consistent with culture and institutional philosophy. Through the understanding of sexual expression and its influencing factors among residents with dementia, caregivers can develop a care plan that allows residents to express appropriate sexual behavior.

Aged↗
PubMedDate not supplied

[Benzodiazepines consumption and risk of dependence in institutionalized geriatric patients].

The use of psychoactive drugs in geriatric nursing homes has to be considered within the peculiar frame work of the elderly condition. The present study was aimed at verifying the prevalence and characteristics of prolonged benzodiazepine use (greater than 1 month) in the entire elderly institutionalized population of an Italian region (Molise). In the 31 benzodiazepine consumers identified, psychosocial and clinical data were recorded by means of a specific scale and of a semistructured interview for the assessment of drug effects. The dependence potential was evaluated in a smaller sample of 18 patients, recording with a scale the onset of withdrawal and/or rebound symptoms following discontinuation of drug treatment. The characteristics of prescription appeared to be generally correct and no appreciable tendency toward abuse was evidenced. In only one patient, discontinuation of benzodiazepines precipitated a confusional state. In other 5 patients significant but not severe withdrawal symptoms were recorded. Duration of treatment was the only variable moderately correlated with the onset of withdrawal/rebound symptomatology (p less than 0.1). In conclusion, the results of our study are reassuring but they should not induce to disregard important clinical aspects of psychopharmacotherapy in the elderly, such as: psychopathological diagnosis, drug associations and interactions, duration of treatment and dosage of prescribed benzodiazepines.

Aged↗
PubMed2005

Use of neuroleptics: study of institutionalized elderly people in Montreal, Que.

OBJECTIVE: To determine the prevalence of neuroleptic use in long-term care institutions in the greater Montreal, Que, area and to estimate the extent of use of atypical neuroleptics. DESIGN: Cross-sectional study in which single-day chart reviews were conducted to evaluate the prevalence of use of conventional and atypical neuroleptics. SETTING: Ten long-term care institutions in the greater Montreal area. PARTICIPANTS: Two thousand, four hundred sixty residents aged 65 years or older living in 10 long-term care institutions in and around Montreal. MAIN OUTCOME MEASURES: Single-day medication profiles compiled by institutions' pharmacists. RESULTS: Among patients in the 10 participating institutions, use of neuroleptics ranged from 15% to 37% with a mean of 25.2% (620/2460). Atypical neuroleptics were prescribed to 15.6%, conventional neuroleptics to 7.6%, and a combination of both to 2.0% of the 2460 patients. CONCLUSION: Use of neuroleptics was relatively prevalent, and there was wide use of atypical neuroleptics in Montreal-area long-term care institutions. There is little information on the safety and efficacy of these medications for institutionalized elderly people.

Aged↗
PubMed1990

Effect of antibiotic treatment on outcome of fevers in institutionalized Alzheimer patients.

Fever episodes in 104 institutionalized patients with Alzheimer's disease were prospectively evaluated to determine the impact of antibiotic treatment on fever outcomes. During the 34-month observation period, 75 patients developed 172 episodes of fever and 29 patients had no fevers. Patients who developed fevers had more advanced disease than patients who did not. Patients who received diagnostic workup of all fevers and treatment with antibiotics (Antibiotic Group) were compared with patients who received comfort measures only (Palliative Group). The incidence of fever was similar in the Antibiotic and Palliative groups. Survival analysis revealed that, for the more severely affected patients, there was no difference in survival between the groups. Among less severely affected patients, survival was higher for the Antibiotic than the Palliative Group. These results suggest that treatment of fever with antibiotics does not alter the outcome of fever in patients with advanced Alzheimer's disease.

Age Factors↗
PubMed2006

[Vitamin B12 and folate in non-institutionalized urban older people].

Vitamin B12 and folate deficiencies are the main nutritional determinants of hyperhomocysteinemia, which is an independent risk factor for cardiovascular diseases. There is scarce information about nutritional status on vitamin B12 and serum levels of folate in Mexican older people. The objective was to evaluate the nutritional status of vitamin B12 and folic acid concentration in non-institutionalized, urban elderly men and women subjects. One hundred volunteers over 60 years were included in this cross-sectional study. Serum levels of vitamin B12 and folate were measured. In addition some biochemical and anthropometric indicators were also evaluated. Considering serum values of vitamin, 30% had vitamin B12 deficiency, 52% normal status and 18% with high levels. None subjects had folic acid deficiency, by the contrary, a high proportion (62%) showed elevated levels in serum. There was an effect of sex on vitamin B12 status. Elderly men showed significantly lower levels of vitamin B12, and it was according with significant higher prevalence of vitamin B12 deficiency in this group as compared with the women group. The high proportion of vitamin B12 deficiency found in this study underline a possible public health problem and guarantee further survey-studies about vitamin B12 status and to explore causes and consequences of the deficiency. Finally, due the sample size and the design of the study, the results must be seen with caution and not try to generalize.

Aged↗
PubMedDate not supplied

Psychological status and immunological parameters of institutionalized aged.

In the elderly, an impairment of the immune system could lead to increased incidence of infectious, neoplastic and autoimmune diseases; on the other hand, depression, which is the most common psychiatric problem in aged people, seems to be linked with alterations in immunological function. Thirteen institutionalized elderly subjects were studied to investigate the relationship between depression and immunological parameters. These subjects were selected as "healthy" according to the SENIEUR-EURAGE protocol and they belonged to a population already evaluated by our group--one year before--for psychological, endocrinological and immunological parameters. The lymphocyte mitotic response to PHA was greatly diminished in aged subjects, when compared to the adult controls. Depressed elderly showed impaired immunological function as compared with nondepressed ones, either "in vitro" or "in vivo". Lymphocyte stimulation with phytohemagglutinin (PHA), T cell growth factor (TCGF) production (induced by stimulation with PHA) and cutaneous delayed hypersensitivity (CDH) were reduced in depressed aged subjects. As far as lymphocyte proliferation with PHA in the whole group were concerned, no differences were found comparing the present results with those obtained in a former study. Although it is difficult to understand the significance of the immune imbalance associated with depression in the elderly, our results suggest that psychological status could influence the immunological functions in old people.

Aged↗
PubMed1990

[Vitamin D supplementation in institutionalized elderly. Effects of vitamin D3 (100,000 IU) orally administered every 3 months on serum levels of 25-hydroxyvitamin D].

A clinical trial carried out during the autumn/winter season in 46 institutionalized elderly subjects (35 women, 11 men) (group mean age = 83 +/- 2 years) revealed a severe deficiency in vitamin D in these subjects (25-hydroxyvitamin D level less than or equal to 3 ng/ml). After oral administration of 100,000 IU of vitamin D3, an increase in 25-hydroxyvitamin D levels above the 10 ng/ml threshold was observed and maintained for three months. A second dose, administered after 3 months, made it possible to sustain this level. No sign of toxicity was detected, notably no trace of hypercalcemia. In contrast, no change in the deficit (25-hydroxyvitamin D level less than or equal to 3 ng/ml) was seen in the placebo population. Three-monthly administration of the moderate dosage of 100,000 IU of vitamin D3 all year round would offer a simple, effective and risk-free system to counteract vitamin D deficiency in the elderly and of preventing the risk of osteomalacia, thus reducing the incidence of fractures.

Administration, Oral↗
PubMed1991

The prevalence of gallstone disease in very old institutionalized persons.

We present the results of a study that was undertaken at a large geriatric nursing home to assess the prevalence of gallstone disease in very old institutionalized persons. One hundred seventeen residents underwent ultrasound examination of the gallbladder. Two thirds of 82 women and half of 35 men had gallstone disease. When stratified for age, 80% of women and men over the age of 90 years were positive for the disease. In summary, the prevalence of gallstone disease in our very old nursing home population was found to be unexpectedly high.

Aged↗
PubMed1990

Abnormal diurnal weight gain among institutionalized patients with manic-depressive spectrum disorders.

We found diurnal weight gain to be abnormal among 41 institutionalized patients with manic-depressive spectrum disorders. They were weighed at 7 AM and 4 PM weekly for three weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 AM weight from the 4 PM weight, multiplying the difference by 100, and then dividing the result by the 7 AM weight. NDWG was 2.216 +/- 1.513 percent for the study population, .631 +/- .405 percent for 16 young, newly admitted controls, and .511 +/- .351 percent for 29 normals. Abnormal NDWG may be an additional feature of manic-depressive spectrum disorders.

Adult↗
PubMed1990

Retrospective study of lithium use for institutionalized mentally retarded individuals with behavior disorders.

Severely and profoundly mentally retarded institutionalized residents (N = 74) who received lithium carbonate for various behavior disorders were followed in a 10-year retrospective study. Their disorders had not been responsive to other medications or treatments. Behavioral data had been recorded regularly and coordinated with medication use. Subjects who demonstrated a sustained major reduction or elimination of behavioral symptoms were classified as lithium responders (n = 31). Characteristics that indicated greater likelihood of response included older age and presenting symptoms of psychosis, although all characteristics studied were seen in both the responder and nonresponder group.

Adult↗