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At least 1,027 records · Page 57Linked to original sources
PubMed1991

Detectable serum levels of tumor necrosis factor alpha may predict early mortality in elderly institutionalized patients.

OBJECTIVE: To determine if detectable serum tumor necrosis factor alpha (TNF) levels are associated with higher mortality in nursing home residents. SUBJECTS AND METHODS: The basal serum concentrations of TNF and interleukin-1 alpha (IL-1) were measured in 129 elderly nursing home patients (mean age of 89 years), and survival in the cohort was monitored over a 13-month period. RESULTS: At 4 months follow-up, seven out of 33 patients with detectable serum TNF levels had died (21.2%), and only three out of 96 patients with undetectable serum TNF levels had died (3.1%) (P less than 0.001). The difference in mortality remained significant up to 13 months of follow-up (P less than 0.05). Those with detectable serum TNF levels and those with undetectable levels were comparable in age, body mass index, hematocrit, lymphocyte counts, and serum level of albumin, prealbumin, and retinol-binding protein. When patients with detectable serum IL-1 levels were compared to those with undetectable levels, there were no significant differences in mortality over a 13-month period. CONCLUSION: Detectable serum TNF levels in elderly nursing home patients may be a predictor of early mortality.

Aged↗
PubMed1994

Constipation: assessment and management in an institutionalized elderly population.

OBJECTIVES: To examine prescribing and utilization patterns of laxatives, stool softeners, and enemas in a large, long-term care facility, to compare self-reports of constipation with specific, bowel-related symptoms in residents of this facility, and to examine concordance between bowel symptoms reported by residents and the assessments of the nursing staff. DESIGN: Cross-sectional study. SETTING AND SUBJECTS: All individuals residing in an academically oriented long-term care facility in the United States for at least 1 month (n = 694). MEASUREMENTS: Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews regarding bowel-related symptoms were conducted with all able participants (n = 456 (66%)) and their respective primary nurses, and concordance was determined. The study definition of symptom-specific constipation was no more than 2 bowel movements per week and/or straining on more than 1 in 4 bowel movements. RESULTS: Fifty percent (n = 367) of all residents used at least 1 daily laxative, stool softener or enema during a 1-month study period. Over half of all laxative users (n = 200) took more than 60 doses per month. Stool softeners were most commonly prescribed, followed by saline laxatives, stimulant laxatives, hyperosmolar laxatives, and bulk laxatives. Forty-seven percent (n = 213) of the 456 interview responders reported constipation ("self-reporters"), but only 62% of self-reporters met the study criteria for symptom-specific constipation. Concordance between resident's and nurse's report regarding specific bowel symptoms was only fair to slight (kappa 0.12-0.38). Self-reporters of constipation took almost twice as many laxatives, stool softeners, and enemas as residents who did not report constipation.

Aged↗
PubMed1995

An epidemiologic study of fall-related fractures among institutionalized older people.

OBJECTIVES: The purpose of this study was to assess the incidence of fall-related fractures, and the circumstances surrounding these events, during a 5-year period among all residents of a long-term care facility. PARTICIPANTS: The study group was composed of residents with radiologically confirmed fractures that were the direct result of a fall occurring between the years 1988 and 1992. This group was 82% female and had a mean age of 89 +/- 6 years. DESIGN: The study was designed as a 5-year retrospective cohort study in a long-term care institution where annual incidence rates of fracture were assessed. RESULTS: There were 296 fall-related fractures during the 5-year period. Annual incidence rates remained fairly constant (72, 86, 84, 70, and 94 per 1000 person-years, respectively) despite a 54% decline in the use of physical restraints during the 5-year period. Hip fractures comprised almost 50% of all fractures. Based on incident reports of these fractures, 42% occurred during the day, 55% took place in the bedroom or adjoining bathroom. 67% occurred while the resident was ambulating, and a wet floor was in evidence in 16% of the incidents. CONCLUSION: Fracture incidence in this long-term care facility has remained stable despite reduced restraint use. The incident reporting system may contribute valuable information to the identification of factors that should receive further attention in studies of risk factors for fracture in the long-term care setting.

Accidental Falls↗
PubMed2004

A placebo-controlled trial of a proprietary extract of North American ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults.

OBJECTIVES: To compare a proprietary extract of American ginseng, CVT-E002, with placebo in preventing acute respiratory illness (ARI) in an institutional setting during the influenza season. DESIGN: Two randomized, double-blind, placebo-controlled trials conducted late in the 2000 (8 week) and 2000-2001 (12 week) influenza seasons. SETTING: Long-term care setting that included nursing home and assisted living at three sites. PARTICIPANTS: Eighty-nine (2000) and 109 (2000-2001) enrolled subjects, average age 81 and 83.5, respectively; 74% women. Approximately 90% had received influenza vaccine in each of the 2 years. INTERVENTION: Oral twice-daily administration of a proprietary ginseng extract, CVT-E002, 200 mg or placebo. MEASUREMENTS: ARI was defined as two new respiratory symptoms or one with a constitutional symptom. Confirmation of viral ARI was by culture (influenza or respiratory syncytial virus (RSV)) or serology for influenza. Laboratory safety monitoring was done at 0, 4, and 8 or 12 weeks. RESULTS: An intent-to-treat analysis of pooled data corrected for drug exposure time showed that the incidence of laboratory-confirmed influenza illness (LCII) was greater in placebo- (7 cases/101 subjects) than CVT-E002-treated (1/97) groups (odds ratio (OR)=7.73, P=.033). Combined data for LCII and RSV illness were also greater in placebo- (9/101) than CVT-E002-treated (1/97) groups (OR=10.50, P=.009), for an overall 89% relative risk reduction of ARI in the CVT-E002 group. CONCLUSION: CVT-E002 was shown to be safe, well tolerated, and potentially effective for preventing ARI due to influenza and RSV.

Acute Disease↗
PubMed1980

Prevalence of root surface caries among institutionalized older persons.

Fifty-nine residents of a chronic hospital (average age 67.9 years) were examined visually for root surface caries. Root lesions were found to be present in 44 of the residents and were located most frequently on the proximal surfaces of anterior teeth. The number of coronal DF surfaces, age and number of retained teeth were the factors found to be helpful in discriminating between persons with and without root surface caries.

Adult↗
PubMed1984

Survey of the dental health and denture status of institutionalized elderly patients in Ireland.

An investigation was conducted to establish the dental status of 368 elderly patients in two geriatric hospitals in Limerick, Ireland, in terms of denture status and the number of teeth present. Seventy eight percent of those examined were edentulous, but only 27% of edentulous patients were wearing maxillary and mandibular dentures. A further 18% wore a maxillary denture only, 21% had dentures made but no longer wore them, and 33% had never had dentures. Forty-four patients had some maxillary and mandibular teeth present and 20 of these had sufficient teeth for masticatory purposes. Very few patients, edentulous or dentate, complained of any problems, although 27 were felt to require extraction of one or more teeth.

Aged↗
PubMed1988

General diseases and dental treatability of the institutionalized elderly Finnish population.

The purpose of the present study was to investigate the relationship between such general diseases and dental treatability of the elderly living in municipal old people's homes in Finland. The sampling methods used were PPS sampling (probabilities proportionate to size), and non-randomized and randomized sampling. The subjects were 480 residents of 24 municipal old people's homes in different parts of Finland. Of the subjects 153 were men and 327 women, and their ages ranged from 65 to 100 yr. Data on the general diseases was obtained from the subjects' medical histories. The assessment of dental treatability was based on the subjects' communicative ability and cooperation during interview, on a clinical oral examination, and on the subjects' ability to cope with the stress of an interview and examination. Eleven percent of the subjects had no diagnosed diseases, whereas 28% had three or more. The most common diseases in both men and women were cardiovascular diseases followed by respiratory disorders in men and endocrine disorders in women. The dental treatability was considered very poor or poor in 29% and good in 26% of cases. No clear statistical correlation was found between dental treatability and the number of diseases suffered by the subject. However, cardiovascular diseases and neurologic and mental disorders were found to reduce dental treatability more than other disorders.

Aged↗
PubMed1989

Dental state and subjective chewing ability of institutionalized elderly people.

The purpose of the present study was to investigate the dental state of the elderly, to provide a subjective appraisal of their chewing ability and their inability to eat certain foods because of their poor dental state. The subjects were 480 residents of 24 municipal old people's homes in different parts of Finland. Of the subjects, 153 were men and 327 women, and their ages ranged from 65 to 100 years. The methods used were clinical examination and interview. The clinical examination revealed that 68% of the subjects had no natural teeth, and 22% had neither natural nor artificial teeth. The number of teeth in dentate subjects was small (average 7.6), and the condition mostly poor. Only 2% had any serviceable counterparts. 51% of the subjects wore dentures: 57 subjects in the maxilla alone, three in the mandible alone and 186 in both maxilla and mandible. 41% said that because of their teeth they were unable to eat some foods they would have liked to eat, crisp bread being mentioned most often as such a food (85% of those with chewing difficulties). Edentulous subjects and dentate subjects wearing both maxillary and mandibular dentures said more often than those without dentures that they could eat everything; those without any teeth had most often (59%) to avoid some foods. More attention should be given to the dental condition and the masticatory function of the elderly, especially of those living in institutions, to ensure that they are comfortable physically, psychologically, and socially for the rest of their lives.

Aged↗
PubMed1991

Oral mucosal health and disease in institutionalized elderly in Brazil.

During the last decade, many studies in Europe and North America have evaluated oral conditions and dental needs in the elderly. Similar information does not exist in Brazil. The aim of this study was to determine the prevalence of oral health and disease in elderly persons living in an institution in the city of Piracicaba, State of São Paulo, Brazil. Of 350 elderly persons, 134 males and 136 females were interviewed and clinically examined. Less than one half had healthy mouths. 58.9% of the examined individuals showed one or more lesions in the oral mucosa, the most frequent being denture-induced stomatitis (20.0%). Fibrous hyperplasias (11.8%) and angular cheilitis (9.3%) were fairly common. Gender, use and degree of hygiene of the denture were factors statistically significantly contributing to prevalence of denture stomatitis. Precancerous lesions such as leukoplakia (3.0%), actinic cheilitis (2.6%) were uncommon but three cases of squamous carcinoma (1.1%) were revealed. This study emphasizes the need for regular oral examinations of the elderly by personnel trained in oral diagnosis.

Aged↗
PubMed2004

Caries management for institutionalized elders using fluoride and chlorhexidine mouthrinses.

OBJECTIVES: The effectiveness of either a 0.2% neutral sodium fluoride (NaF) solution or a 0.12% chlorhexidine (CHX) solution as a daily mouthrinse for controlling caries was tested against a placebo rinse in this 2-year randomized clinical trial among elders in long-term care (LTC) facilities. METHODS: At baseline, 369 recruits were examined clinically for caries and allocated randomly to one of the mouthrinse groups. RESULTS: After 2 years, 116 participants remained in the trial. The prevalence of caries and the dental status of the groups were similar at baseline and after 2 years. On average, each group lost less than one tooth per person, but the fluoride group compared with the others had significantly less caries and significantly more reversals from carious to sound dental surfaces at the end of the trial. CONCLUSIONS: We conclude that 0.2% neutral NaF mouthrinse every day does reduce the incidence of caries among elders in LTC facilities.

Aged↗
PubMed1997

Dental erosions and gastro-oesophageal reflux disease in institutionalized intellectually disabled individuals.

OBJECTIVE: Both exogenous acids, from the diet, and endogenous acids, from stomach juice, can dissolve the enamel mineral, resulting in dental erosions. Gastric acid may reach the mouth by gastro-oesophageal reflux disease (GERD), recurrent vomiting, rumination and regurgitation. These conditions are frequently found in the intellectually disabled population. Therefore, we investigated the presence of dental erosions in combination with GERD among intellectually disabled inhabitants, with an IQ < 50, taken from three Dutch institutes. MATERIALS AND METHODS: At random 63 individuals underwent an oesophageal pH test and dental screening and possible predisposing and attributable factors were determined. An abnormal pH level was defined as a pH < 4, > 4.5% of the measured time. Subjects with dental erosions were compared to those without dental erosions. RESULTS: In 29 out of 63 (46.0%) cases evidence of dental erosions was found. In 19 of these 29 subjects with erosions (65.5%) GERD was diagnosed, compared to nine (26.5%) out of 34 subjects without erosions (P = 0.04). In the subjects with erosions mean duration of pH < 4 was 15.6% (range: 0.5-90.5) compared to 6.3% (range 0-40.4) in subjects without erosions (P = 0.02). An IQ < 35 was found to be predisposing (P < 0.001). CONCLUSION: In this population of 63 institutionalised intellectually disabled persons dental erosions were diagnosed in 46%. Sixty-five per cent of them had GERD. Individuals with longer duration of pH < 4 than 6.3% of the measured time and with an IQ < 35 were at higher risk to develop dental erosions. This study shows that dental erosions in the intellectually disabled population might be an oral manifestation of GERD.

Adolescent↗
PubMed1991

Mono- or polypharmacotherapy in institutionalized epileptic children with severe mental retardation? A team approach for optimizing antiepileptic therapy.

Nine severely mentally retarded patients with severe epilepsy who were living in an institution were studied during a three-year period by a multi-disciplinary team. A seizure rate serum level chart was made for each patient. It served as the basis for monthly discussions in the team about medication changes. Drug plasma concentrations were monitored monthly. Statistical comparisons between seizure frequency on different drug regimens were made by chi 2 test. Withdrawal of all medication was possible in one case and reduction to monotherapy in two cases. In the remainder of the patients a combination of two or three anticonvulsants gave the best clinical effect. We thus found polypharmacotherapy necessary for some severely retarded patients with epilepsy. Our multidisciplinary approach and chart monitoring system has many advantages and is valuable for the medical care and drug treatment of this patient category.

Adolescent↗
PubMedDate not supplied

A group for "wandering" institutionalized clients with primary degenerative dementia.

The authors implemented a group in a state psychiatric institution for women with primary degeneration dementia. The group provided scheduled opportunity in a nonrestrictive environment for structured movement and sensory stimulation. Over a period of nine sessions, small but significant changes were noted in the members' behavior. This type of therapy can benefit such limited clients by enhancing the quality of their life in the institution.

Dementia↗