Urinary calculi in a geriatric setting

The authors report a retrospective series of 174 patients with urolithiasis. They were all age between 65 and 88 years. This group represents one tenth of all patients treated for urinary stones in the Urology department of Sfax over the last decade. Neither the clinical symptoms nor radiological findings observed in this group differed from those other patients hospitalized for urolithiasis; on the other hand associated diseases related to aging appear to be well represented which alters the management, prognosis and outcome in this type of patients.     

Urinary incontinence in women in a geriatric ward

101 elderly female patients participated in a multidisciplinary programme for the diagnosis and management of urinary incontinence. Their median age was 81 years. 83 patients had been incontinent for more than 12 months. In only 23 patients was incontinence recognised as a problem prior to admission, and 69 patients claimed that they had never received any treatment for their disability. Urge and mixed incontinence were found to be the most prevalent forms, based on symptoms and simple measurements. After assessment, one to six measures were implemented for each patient in order to counteract internal and external causes of incontinence. The patients were reviewed after 6-8 weeks. 60 patients claimed there was an improvement, including 20 who described themselves as "much improved", and seven who had become continent. It is suggested that a hospital stay may provide a suitable opportunity to undertake primary assessment and treatment of incontinence in elderly women.     

Discussions about limiting treatment in a geriatric clinic

The ultrastructure of [leu]5-enkephalin-immunoreactive (ENK-IR) nerve fibres in the guinea-pig stellate ganglion was studied by means of pre-embedding immunohistochemistry. ENK-immunoreactivity was primarily contained within large dense core vesicles (91 +/- 21 nm in diameter; n = 259) but was absent from small clear vesicles (47 +/- 9 nm; n = 488) within the same nerve terminal that were concentrated at presynaptic regions. Thus, fast synaptic transmission mediated by ENK-IR terminals most probably does not involve [leu]5-enkephalin which may be released parasynaptically. Evaluating a total number of 123 synapses involving an ENK-IR presynaptic nerve ending, 47% terminated upon a spine, 46% upon a dendritic shaft, and 7% directly addressed a soma of a postganglionic neuron. In 30% of axo-dendritic synapses and 33% of axo-somatic synapses, non-immunoreactive dendrites or somata being postsynaptic to an ENK-IR terminal were in direct but non-synaptic contact to another dendrite/soma. Such arrangements are termed "triads". In view of the current hypotheses concerning the function of spines and triads, these findings indicate that ENK-IR terminals within the guinea-pig stellate ganglion may be involved in the generation of long-lasting synaptic events and modulation of non-synaptic intraganglionic communication.     

Psychosocial enhancement of immunocompetence in a geriatric population.

Assessed the enhancement of immunocompetence by relaxation and social contact in 45 60–88 yr old geriatric residents of independent-living facilities. Ss were randomly assigned to 1 of 3 protocols: (1) relaxation training, (2) social contact, or (3) no contact. Ss in the relaxation and social-contact conditions were seen individually 3 times/wk for 1 mo. Blood samples and self-report data were obtained at baseline, at the end of the intervention, and at a 1-mo follow-up. At the end of the intervention, Ss in the relaxation group, who had been taught progressive relaxation and guided imagery as an active coping skill, showed a significant increase in natural killer cell activity and significant decreases in antibody titers to Herpes simplex virus and self-rated distress. The other 2 groups showed nonsignificant changes. There was a general increase in the T-lymphocyte response to phytohemagglutinin stimulation at the end of the intervention, with greater change at lower mitogen concentrations. Data suggest that cellular immunocompetence may be enhanced by psychosocial interventions. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Malnutrition in geriatric patients: a neglected problem?

PURPOSE: The authors report their experience with the translumbar inferior vena cava (IVC) approach for central venous access during a 6-year period at three teaching hospital sites. PATIENTS AND METHODS: Twenty-nine percutaneous IVC central venous access catheters were inserted in 22 patients during a 6-year period in the radiology departments of three teaching hospital sites. All patients had undergone unsuccessful attempts at conventional central venous access. Information was gathered by retrospective radiologic and hospital chart review. RESULTS: All attempted placements were successful. Catheters were in place for a total of 3,510 catheter days. The average length of catheter placement was 121 days (range, 14-536 days). Life-table analysis predicted catheter function rates of 55% and 29% at 6 and 12 months, respectively. Three procedure-related complications occurred. A lower pole branch of the right renal artery was inadvertently entered with a 22-gauge needle during attempted IVC puncture in one patient without clinical sequelae. A second patient developed a small groin hematoma at the femoral venous puncture site, which resolved spontaneously. A third patient developed a moderate retroperitoneal hematoma, which resolved without specific intervention. The sepsis rate was 2.8 infections per 1,000 catheter days with an average time to infection of 127 days (range, 10-536 days). CONCLUSION: In the authors' experience of 29 translumbar central venous catheter insertions, all attempts were successful. Percutaneous central venous access via the IVC is a safe and effective option for patients in whom more conventional access is not possible.     

Evaluation of ear temperature measurements in a geriatric department

We evaluated an infrared tympanic thermometer (Genius 3000A) by comparing it with parallel measurements with an electronic rectal thermometer (Philips HP 5316) on 121 patients admitted to a geriatric department. Rectal temperature was on average 0.14 degree C +/- (ISD) above the ear temperature. 95% of the differences are within the interval from -1.18 degrees C to 1.46 degrees C. The coefficient of determination was only 0.30. The tympanic thermometer, Genius 3000A, cannot be recommended for daily use on a geriatric ward.     

Analysis of geriatric surgical experience in a veterans home

Surgical experience at the hospital of a State Veterans Home is reviewed over a period of two and half years (1973-1975). The average age of the patients was 74 years, and many had severe pulmonary or cardiac disease. Of the operations performed, 283 were major and 301 were minor. For the major operations (including emergencies) the mortality rate was 4.2 percent, for the minor procedures the rate was zero, and for all types of procedures the overall mortality rate was 2 percent. Emergency operations increased the expected mortality tenfold. Colonic and biliary-tract operations bore the highest mortality. The incidence of malignant lesions was high. In the elderly, indicated surgical procedures are justified, provided they are carried out by an organized, highly trained health team.     

Fluoxetine-induced SIADH: a geriatric occurrence?

After major depression was diagnosed in a 83-year-old woman, fluoxetine was prescribed. Six days later she became delirious and weak, necessitating hospitalization. She was found to have hyponatremia secondary to fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH). Recovery was complete after discontinuation of the medication.     

Disability in geriatric depression

OBJECTIVE: The authors' purpose was to identify the relationship of disability to clinical measures that are part of a comprehensive psychiatric examination of depressed elderly patients. METHOD: The disability of 75 elderly inpatients and outpatients with major depression whose cognitive function ranged from normality to mild dementia was assessed with the Philadelphia Multilevel Assessment Instrument. Age at onset of depression, chronicity of depression, severity of depression, cognitive impairment, medical burden, social support and living environment were assessed with standardized instruments. RESULTS: Impairment in instrumental activities of daily living was significantly associated with advanced age, severity of depression, and medical burden. The relationship of depressive symptoms to impairment in instrumental activities of daily living was not influenced by age or medical burden. Anxiety and depressive ideation as well as retardation and weight loss were significantly associated with impairment in instrumental activities of daily living. Interviewer-rated global disability was associated with advanced age at onset of depression, medical burden, and overall cognitive impairment. Specifically, a disturbance in initiation and perseveration was significantly related to global disability. CONCLUSIONS: Impairment in instrumental activities of daily living appears to be a relatively independent dimension of health status that is related to depressive symptoms, particularly anxiety and depressive ideation as well as retardation and weight loss. Global disability may be associated with impairment in initiation and perseveration and with late onset of depression. These findings provide a basis for studies investigating whether psychotherapy aimed at depressive ideation and rehabilitation efforts focused on instrumental activities of daily living can improve the outcome of geriatric depression.     

Hearing loss

Hearing loss may be caused by either a conductive problem, such that the sound waves do not reach the tympanic membrane, ossicles or inner ear, or a sensorineural problem, in which the cochlea and/or auditory nerve are somehow damaged. A combination of the above may also occur. The various causes of hearing loss and the options in treatment will be presented.     

Geographic isolation in the geriatric population of a rural town

OBJECTIVE: To estimate the prevalence and characteristics of geographic isolation in the elder people from Alora (Málaga). DESIGN: A transversal observational study. SETTING: Town of Alora. PATIENTS OR OTHER PARTICIPANTS: Elder people of both sexes, who lives habitually in Alora and born in 1927 or before. Home interview in a 153 individuals random sample proceeding from actual census during june to september 1992. MEASUREMENTS AND MAIN RESULTS: We found 25 individuals with the isolation conditions being the 16.34% (IC 95%: 10.48-22.20). In the 24% of them (IC 95%: 11.5-43.4) we found dependence of other person for two and more basic functions in the current life. Half of them this deficits are cover by the couple, the rest depends on their sons. We didn't found significative differences in none variables with the urban group. CONCLUSIONS: The geographic isolation affect to an important proportion of elder people in rural areas and must be used in the designs of care elderly programs.     

Body-mediated therapies in geriatric psychiatry

The use of body mediated therapies at the Clinical geriatric psychiatry became possible due to the convergence between multi, inter and transdisciplinary approaches and the clinical experience in this application of various therapeutic technics. This approach at the aged clinic must take into consideration the specificity of the correlation to the body of the aged person beside the advantages and the needs that resent this approaches to both the patient and his therapist.