The Australian general practice morbidity and prescribing survey, 1969 to 1974. 4. Patients: geriatric patients.
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Dermatoses in geriatric patients.
Geriatric patients, though they may present many of the dermatological problems occurring throughout adult life, show a greater incidence of the degenerative skin changes consequent on sun exposure in the form of collagen degeneration, solar keratoses, keratoacanthoma and skin cancer. The benign, precancerous and malignant skin tumours, the various types of eczema, senile pruritus and certain other conditions will be discussed.
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Estimation of serum digoxin levels in geriatric patients.
The correlation in geriatric patients between estimated serum digoxin levels based on pharmacokinetic calculations and serum digoxin levels measured by radioimmunoassay was studied. Serum digoxin levels were estimated for 17 geriatric patients recieving digoxin using the "total body stores" concept. A statistically significant correlation between calculated and measured digoxin levels was shown (p less than 0.05, r = 0.51); however, 95% confidence limits were so large (+/- 1.75 ng/ml) that the results were clinically unacceptable. Until data describing specific causes of variance are available and calculations modified to account for specific variations, pharmacokinetic models should not be relied upon for accurate estimates of digoxin levels in geriatric patients.
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Molecular determinants of antimicrobial resistance in Klebsiella pneumoniae isolates among geriatric patients in Chattogram, Bangladesh: a cross-sectional study.
Klebsiella pneumoniae (KPN) infections pose heightened risks in the geriatric population due to weakened immunity, prevalent comorbidities, potential exposure in long-term care settings, and increased likelihood of antibiotic resistance (ABR). The study focused on the prevalence and antibiotic resistance of KPN infections, the presence of ABR genes in KPN, and the genomic characterization of KPN obtained from geriatric patients in Chattogram. A total of 543 specimens were collected from four hospitals in Chattogram, along with demographic data from hospital records. Genomic DNA was extracted from multi-drug-resistant (MDR) KPN, and the presence of ABR genes, blaTEM-1, sul-1, aadB, blaNDM-1, blaSHV-11, and phoE was identified. To characterize the KPN genomes, two MDR KPN isolates were subjected to whole-genome sequencing (WGS), and the data were analyzed using bioinformatics tools to identify genomic determinants of ABR. KPN exhibited high resistance to ceftazidime (96%), cefuroxime (92%), and cefixime (83%), but sensitivity to colistin (79%) and amikacin (75%). MDR KPN was mostly detected in sputum (36%) and urine (27%) specimens, where the prevalence of ABR genes, blaTEM-1, sul1, aadB, blaNDM-1, and blaSHV-11 were 28.2%, 17%, 6.17%, 56%, and 48% of these strains, respectively. These genomes exhibited distinct profiles for sequence types, ST420 and ST277 in Kpn007 and Kpn016, respectively, and ABR genes (qnrS1, blaCTX-M-15, and blaSHV-27), virulence factors (ybt, iuc1, iro1), and contained both K (K20, K46) and O antigens (O1, O3b). MDR KPN in the geriatric population poses a serious health concern due to their increased vulnerability to infections and limited treatment options, requiring careful management.IMPORTANCEMultidrug resistance (MDR) and the hypervirulence nature of Klebsiella pneumoniae (KPN) in geriatric patients pose a critical health concern in nosocomial infections worldwide and result in high clinical complexity and mortality. The study investigated the factors for KPN infections and analyzed antimicrobial resistance profiles. More than 60% of Klebsiella pneumoniae isolates from geriatric patients were resistant to third- and fourth-generation cephalosporins, and most isolates carried blaNDM-1 and blaSHV-11 genes. Analyzing whole genomes of two KPNs, Kpn007 (ST277) was identified as a hypervirulent strain with aerobactin and yersinia siderophores, contributing to virulence, and Kpn016 (ST420) carried fluoroquinolone (qnrS1), ESBL (blaCTX-M-15 and blaSHV-27) resistance. Both genomes contained K antigens (K20 and K46) and O antigens (O1 and O3b).
Humans↗
[Effect of volume substitution with dextran on the haemodynamics under enflurane anaesthesia in geriatric patients (author's transl)].
The haemodynamic effect of enflurane has been examined in two groups of geriatric patients, one with and the other without preanaesthetic administration of 15 mg/kg of 1,8% dextran in lactated Ringer's solution. All the patients have been immobilized for 2 to 3 days before they were operated for an orthopaedic procedure. The administration of the colloidal solution led only to minor cardiovascular alterations: a rise of central venous pressure by 6 +/- 1 (+/- S.E.M.) cm H2O, an increase of mean arterial pressure by 6 +/- 2%, an increase of cardiac output by 10 +/- 4%. Heart rate decreased by 5 +/- 4% and total peripheral resistance by 12 +/- 5%. The cardiovascular depressant effect of enflurance was markedly attenuated by the preanaesthetic volume administration. Mean arterial pressure decreased during anaesthesia by only 16 +/- 3%, as compared with a decrease of 25 +/- 7% in the control group, cardiac output remained virtually unchanged (-3 +/- 9% vs. -37 +/- 5% in the controls) and total peripheral resistance decreased not significantly by 10 +/- 12%, while it rose in the controls by 20 +/- 8%. These findings support the hypothesis that the particular sensitivity of geriatric patients towards the depressant effects of anaesthetics is at least partially due to a compensated hypovolaemia which occurs as a physiological adaptation to immbolization. Enflurane appears as a suitable anaesthetic for geriatric patients, if proper measures for preanaesthetic volume substitution are taken.
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Double-blind study of thioridazine and haloperidol in geriatric patients with a psychosis associated with organic brain syndrome.
Forty geriatric patients from the psychiatric ward of a state hospital were enrolled in a 12 week double-blind comparative study of the concentrate forms of thioridazine and haloperidol. The objective of the study was to assess the efficacy and safety of these drugs in the treatment of psychosis associated with organic brain syndrome in the elderly. Two types of patients comprised the population, those who had been hospitalized most of their adult lives and those who had not entered the hospital until late in life. Although both drugs produced significant improvement in these patients' symptoms, the improvement with thioridazine tended to be greater than that with haloperidol in most ratings. A plateau effect was seen with haloperidol in contrast to a steady improvement seen with thioridazine. The safety of both drugs was confirmed. Geriatric patients who display both psychotic and OBS symptomatology were found to respond quite well to both drugs, regardless of their previous psychiatric history, but a somewhat more dramatic response was seen with thioridazine.
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[Diagnostic standards for geriatric patients in orthopedics (author's transl)].
Geriatric patients in orthopedics frequently fail ill of some typical diseases. For clearing up of diagnosis in the clinical investigation the application of Neutral-O-transitional method and of some supplementary investigation (who lead likewise to numerical findings) are recommendable. Selected roentgenograms and laboratory methods are necessary additional for clearing of diagnosis. The application of this "diagnostic standard" is an effective guide for diagnosis and an improvement in the exchange of findings between medical specialists.
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Diastematomyelia in a geriatric patient.
The discovery of diastematomyelia in a geriatric patient is a rare occurrence. A 76-year-old woman with this entity was not diagnosed until she developed superimposed motor neuron disease.
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[The geriatric patient and his nutrition].
The nutrition of geriatric patients should observe the following characteristics of advanced age: diminished calorie requirement, impaired glucose tolerance, tendency to elevated serum cholesterin and triglyceride levels, increased requirements for protein of high biological value, absence of thirst and reduced total body water. Considering these metabolic changes recommendations for an adequate nutrition of senescent people are discussed.
Adult↗
A double-blind comparison of two bulk laxatives on geriatric patients.
Bulk laxatives have been said to have a good effect in normalizing both hard and loose stools in geriatric patients as concluded from some open studies. In a double-blind study Vi-Siblin, Lunelax and placebo were compared in the six weeks treatment of 29 patients (8 patients on Vi-Siblin, 8 patients on Lunelax, 13 patients on placebo). Two weeks prior to the study and the two last weeks of the study defecation frequency, consistency of stools and the use of additional laxatives were registered by the personnel. Results showed no significant differences between groups or between substances. From this controlled double-blind study it is not possible to draw any definite conclusions regarding the efficacy of bulk laxatives on geriatric patients.
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[Imbecile children visit geriatric patients. A possibility for clinical sociotherapy].
130 observation minutes of organized visits of imbecile girls in school age to geriatric patients accommodated for a long time (17 chronic schizophreniacs and 8 cerebro-organic patients) were analysed. Singing, ball and party games for children and dancing two by two to recorded music proved as suitable means of communication. This kind of contacts led to a social activation especially by schizophreniacs who had a lack of drive and seemed to be regressive, also caused an increase of drive and self-reliance by formerly timid, reserved girls. The staff was even relieved by the presence of the children, because these activated the geriatric patients. The arrangement can be realized without great effort in big psychiatric hospitals.
Adolescent↗
Thiothixene in the treatment of geriatric patients with chronic organic brain syndrome.
Thiothixene was used in a four-week double-blind placebo-controlled study of 42 geriatric patients with chronic organic brain syndrome (psychotic or nonpsychotic). The results, according to several rating measures, showed no significant difference between placebo and thiothixene. Side effects were mild and few. These data support the safety of thiothixene therapy for geriatric patients; however, there is no conclusive evidence of its efficacy in the treatment of chronic organic brain syndrome.
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Metabolism of methaqualone in geriatric patients.
The urinary excretion of five C-monohydroxy metabolites and the N-oxide of methaqualone has been measured in a group of eleven geriatric patients aged 71--90 years. The total excretion of the six metabolites in 24 h after the oral administration of a single dose was approximately one-half of that in a group of young healthy adults. The relative importance of the six metabolites was 4'-hydroxy greater than N-oxide greater than 2'-hydroxymethyl = 3'-hydroxy greater than 6-hydroxy = 2-hydroxymethyl which was the same order as that in young adults. The ratio of C-to N-oxidation was also the same in the two groups. There was no impairment of conjugation of the C-hydroxy metabolites with glucuronic acid in the geriatric group but there was greater interindividual variation in metabolite excretion. There was also evidence for delayed metabolism in the geriatric patients.
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[Treatment of behavioral and affective disorder in alcoholic and geriatric patients (author's transl)].
Tiapride, a new drug of the anisamides' family, offers not only a major effectiveness on physical disease in alcoholism, but also on behavioral or affective disorder such agitation, hostility, impulsivity in alcoholic or in geriatric patients; this particular effectiveness is presented through the study of a sample of 15 alcoholic and geriatric patients.
Adult↗
Plasma levels and effect on heart rate and blood pressure of metoprolol after acute oral administration in 12 geriatric patients.
Metoprolol, a cardioselective beta-blocking agent, has been given orally to 12 geriatric patients with moderate hypertension. Drug levels of metoprolol as well as the effect of the drug on resting heart rate and BP were studied. Metoprolol was given in a dose of 20 mg, and 8 of the 12 patients also received a 50 mg dose. After the 20 mg dose the peak drug plasma concentration varied between 5 and 80 ng/ml (mean 33), and after the 50 mg dose between 14 and 212 ng/ml (mean 111). This variation is much greater than that seen in earlier studies on healthy volunteers and on a group of non-geriatric hypertensive patients. Plasma half-life of metoprolol averaged about 3.5 hours after both the 20 mg and the 50 mg dose; this does not differe from the plasma half-life in earlier studies in younger age groups. The variability observed in the study might be explained multifactorially, e.g. by different body weight, absorption and/or first-pass effect of the drug.
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[Chronic geriatric patient in the hospital].
The cost explosion in the health system, especially in the hospital field, and the prolongation of life, i.e. the increase of the proportion of old people in the total population, oblige us to ask the question as to the part of geriatric patients in the present and future hospital treatment. By means of statistically relevant material, i.e. 25,342 female and 20,189 male in-patients in the Municipal Hospitals Nuremberg during the year 1974, compared with investigations of the year 1964, the growing significance of the geriatric patients for the total health system is demonstrated. Particular interest is paid to the old chronically ill persons, as is shown in an estimate of the internal in-patients. 50% of the internal in-patients are chronically ill persons. The present structure of hospitals is by no means complying with this situation. As an improvement, a ward system with different aims instead of the one complex acute hospital is presented. Apart from the existing acute stations there should be provided geriatric rehabilitation wards, social stations and day-hospitals. Humanitarian and financial advantages to be expected of these new wards are outlined. Particular emphasis is given to the active rehabilitation in the sense of a comprising social-medical help.
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[Haemodynamic effects after rapid infusion of dextrane in geriatric patients (author's transl)].
In 85 geriatric premedicated patients haemodynamic effects were investigated following rapid infusion of 500 ml dextrane. The data measured one day preoperative revealed typical age-related changes of the cardiovascular system: decrease of cardiac output, stroke volume and heart rate; increase of peripheral vascular resistance and mean arterial pressure. After infusion of dextran central venous pressure rose by 4.9 mm Hg (mean), mean arterial pressure by 7.5 mm Hg (8.5%) and cardiac output by 1.04 1/min (24.3%). Heart rate alterations were insignificant, but total peripheral resistance decreased significantly by 12.5%. Pulmonary capillary pressure rose to 15.4 +/- 3.4 mm Hg. We conclude that it is possible to increase cardiopulmonary efficiency by extracardiac measures preoperatively even in aged patients. In no case critical left- or right ventricular filling pressure exceeded, so we cannot accept the often expressed warnings against induced hypervolaemia in patients with no cardiac failure except old age.
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Effects of a protected hospital ward area on wandering and nonwandering geriatric patients.
The differential effect of a protected ward area on wandering and nonwandering geriatric patients was evaluated in terms of their physical, cognitive, and psychosocial functioning. Thirty wanderers and 18 nonwanderers were assessed prior to their transfer between the experimental and other wards and again after 6 and 12 weeks. A group (wanderers vs. nonwanderers) x ward (on vs. off the experimental ward) multivariate analysis of covariance, with the pretransfer measurements as the covariates, was used to analyze the data. Analysis revealed the following multivariate effects at both 6 and 12 weeks. The multivariant group x ward interaction for the physical range of motion) variables was significant, with wanderers showing greater range of motion on the experimental ward and nonwanderers showing greater range of motion off the ward. The multivariate group effect for the psychosical variables was also significant, with wanderers showing less improvement than nonwanderers.
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