Assistive devices used by home-based elderly persons with arthritis

OBJECTIVE: This article examines assistive device use by home-based elderly persons with arthritis. METHOD: Sixty-six persons were interviewed for the State University of New York at Buffalo (University at Buffalo) Rehabilitation Engineering Research Center Consumer Assessment Study, which sought information on need for and current use of assistive devices. Subjects were assigned to a moderate or a severe arthritis group according to the impact of arthritis on their activities. RESULTS: Subjects in the severe arthritis group had more chronic diseases, a higher level of pain, and a lower level of independence in self-care activities than subjects in the moderate arthritis group. Similarities between the groups included relatively poor health, high rate of medication use, depression, use of a high number of assistive devices (about 10 per person), and an expressed need for additional devices, such as reachers, magnifiers, grab bars, jar openers, and hearing aids. Generally, there was a high rate of satisfaction with the assistive devices used. Most subjects missed being able to participate in at least one activity; most of these activities were active and many related to leisure time. CONCLUSION: Findings also revealed that subjects had inadequate information on assistive devices, which suggests the importance of more occupational therapy involvement with elderly persons in selecting devices.     

A nutritional assessment of homebound elderly in a physician-monitored population

Nutritional information and support for the elderly are available from many sources. Yet many older adults still remain at risk for malnutrition. This study examined the nutritional status of homebound elderly in a physician-monitored population, with access to health and social services. Older adult patients from the Home Visit Program of the Department of Family Medicine were visited, and an assessment was administered. All patients had primary care physicians who visited patients in their homes, on average, every 3 months. For this survey, the Nutritional Risk Index, the Nutritional Screening Initiative Checklist, an ADL (Activities of Daily Living) assessment, and general history questions were asked. In order to evaluate content of diet, food frequency and a 24-hour diet history were used. Questions on basic nutritional knowledge were asked, and a kitchen survey was used to examine purchasing behavior. Most patients were found to be at high nutritional risk with an average Nutritional Screening Initiative Risk score of 7, but for reasons that varied among patients. Most patients claimed to have a good appetite and enough money for food. The 24-hour diet analysis showed that many individuals did not meet 70% of RDA for major energy sources and fiber. Patient knowledge of the four basic food groups was poor. Since none of the patients shopped for themselves and many did not cook, the nutritional knowledge and food preparation behaviors of caregivers may be important for the nutritional well-being of the patient. An educational program for this population should include the caregiver as well as the patient.     

The use of microwave ovens by elderly persons with disabilities

OBJECTIVE: This study examined the effectiveness of microwave ovens in assisting elderly persons with disabilities with cooking food. METHOD: The participants were five elderly persons who had gross motor, fine motor, or vision impairments but no cognitive impairments. Before the study, none of the participants owned or operated a microwave oven. In this single-subject design of four phases (ABAB), training in microwave oven use was provided between the first A (baseline) and first B (intervention) phases. Participants had access so the microwave oven in their homes only during the B phases. Each phase lasted for 3 weeks, for a total of 12 weeks. The frequency of using cooking appliances, the number of food items prepared, and the time spent preparing meals were recorded through daily self-reports. RESULTS: All participants showed an increase in the frequency of using cooking appliances for at least one of the two B phases, although they showed different patterns. The number of food items prepared increased in the B phases, except for two participants who were ill. With the introduction of the microwave oven, time spent preparing meals decreased for all five participants, and their participation in meal preparation increased. Although not measured as a study variable, results suggest that the quality of diet also improved with microwave oven use. CONCLUSION: Occupational therapy practitioners who serve elderly clients might consider recommending microwave ovens for those who do not have cognitive impairments but who are having difficulty with cooking because of vision impairments or physical disabilities.     

Mental slowing in elderly persons: A cognitive psychophysiological analysis.

In recent attempts to formulate an integrative model of mental slowing in elderly persons, regression analyses have been done in which reaction-time (RT) data from a large number of studies spanning a broad range of speeded decision-making tasks were combined. The results of these meta-analyses were then used to support the conclusion that there is a generalized, proportional decline in mental processing speed among elderly adults that affects all elements of mentation equally. We present a series of similar regression analyses in which both RT and the latency of the P300 component of the event-related brain potential are included. The results of these analyses indicate that there are elements of mental processing that may be slowed additively, not proportionately, in older persons. Furthermore, the results raise some questions about the logic underlying the interpretation of the meta-regression analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Root caries in a sample of elderly persons

With the anticipated increase in the aged adult population and the associated gingival recession, the prevalence of root caries is expected to increase. The purpose of this study was to determine the experience and distribution of root caries in a group of aged adults living in Kayelitsha. All non-institutionalized elderly black adults participating in a community geriatric programme were examined. Root caries was recorded using visual and tactile criteria and expressed as the root caries index (RCI) rate. The mean age of the subjects was 65.2 years, the mean number of teeth present was 17.3 and the mean RCI rate was 2.2 per cent. All subjects had gingival recession while only 23.8 per cent had root caries. No surfaces with restored root caries lesions were found. In the maxilla the highest RCI rate was observed on the interproximal surfaces of the posterior teeth (4.4 per cent) but in the mandible the buccal surfaces of the posterior teeth had the highest RCI rate (4.2 per cent). In both the maxilla and the mandible the lingual surfaces of the anterior teeth showed no root caries. Maxillary teeth did not have a significantly higher root caries attack rate than mandibular teeth. Root caries does not appear to be a public health problem in the sampled population.     

Therapy of congestive heart failure in elderly persons

LVEF should be measured in all elderly persons with CHF Underlying causes and precipitating causes of CHF should be treated. Persons with CHF associated with abnormal LVEF should be treated with a low sodium diet, diuretics, and ACE inhibitors. If CHF persists, digoxin should be added. If CHF still persists, isosorbide dinitrate plus hydralazine should be added. If CHF still persists, a beta blocker should also be added. However, calcium channel blockers should not be used. Persons with CHF associated with normal LVEF should be treated with a low sodium diet, diuretics, and ACE inhibitors. If CHF persists, a beta blocker, isosorbide dinitrate plus hydralazine, or a calcium channel blocker should be added to the therapeutic regimen. If sinus rhythm is present, digoxin should not be used. Persons with CHF and abnormal or normal LVEF unable to tolerate ACE inhibitors should be treated with losartan.     

Cardiovascular survey of 40-year old persons in Hordaland. A critical evaluation

The results of a heart screening programme in the county of Hordaland showed a high average heart infarction risk score in the two small municipalities, Fedje and Masfjorden where respectively ten and 24 men were screened. A closer look at the results revealed that in Masfjorden the results were affected by two men having very high heart infarction score. Median infarction risk score is a better measure than average infarction risk score, particularly in small municipalities. It does not seem to be a good policy to use the mass media for a preventive and health promotion strategy on the basis of the average infarction risk score.     

Reversible malabsorption of folic acid in the elderly with nutritional folate deficiency

The question of the point of impact of the electric current in the galvanic vestibular test is not solved. An important feature is that, after destruction of both the vestibular end organs, a galvanic nystagmus can still be provoked. The effect of a direct current on the spontaneous nystagmus following partial or total destruction of the vestibular end organs was investigated. The frequency of the spontaneous nystagmus diminishes when the electric stimulus causes an eye movement in the same direction as the fast phase of the nystagmus, the frequency increases when the polarity of the electric stimulation is reversed. Simultaneous application of torsion-swing and electric stimulation causes a summation of the separate effects. Our findings confirm the conculsions drawn by Ledoux (4, 5) from his findings in frogs.     

Progressive and imaginal relaxation training for elderly persons with subjective anxiety.

Elders exposed to either progressive or imaginal relaxation procedures reported significant relaxation effects and showed improvement on measures of personal functioning. The results of the Physical Assessment Scale of the Relaxation Inventory indicated that relaxation responses were acquired within and across sessions. Large, consistent changes in relaxation occurred in all 4 sessions. The Symptom Checklist-90—Revised, which measures self-reported personal adjustment, showed significant positive changes following relaxation training and at 1-mo follow-up. Elders who imagined muscle tension release profited as much as those engaged in actual muscle tension-release activities. This finding is of importance for older adults who may experience physical limitations that contraindicate muscle-tension-release procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of nutritional status in persons with spinal cord injury: a prerequisite for successful rehabilitation

A minority of patients with acute pulmonary embolism (PE) show failure of resolution when assessed by serial ventilation/perfusion (V/Q) radionuclide lung imaging. The fibrinolytic systems were studied in six such patients (group I), and in 11 patients in whom PE had resolved (group II), together with 17 healthy control subjects. Assays of the fibrinolytic system included euglobulin clot lysis times (ECLT), tissue plasminogen activator (tPA), and plasminogen activator inhibitor-1 (PAI-1). Euglobulin clot lysis times were not prolonged in the unresolved PE group, but were significantly longer in patients in group II when compared to control subjects (P < 0.03). This could not be explained either on the basis of tPA levels, which were higher in group II when compared to group I (P < 0.05) and control subjects (P < 0.02), or on the basis of PAI-1 levels which did not differ significantly between the three groups. Our inability to demonstrate derangements of fibrinolysis in the patients with unresolved PE makes defective fibrinolysis an unlikely aetiological factor in the persistence of thrombosis in these patients.     

Variants of progressive dementias in middle-aged and elderly persons

Today, dental assistants are becoming more aware that a professional image is necessary for putting dental professionals in the best light in the changing health care society. Not only must dental assistants know how to work in the system and how to effectively care for dental patients, but attention to matters such as personal grooming, dress, and body language is necessary if dental assistants are to be a powerful and proud profession in today's society. How you look and act will make a difference in how others treat you. When you act like a professional, others will react to you as one.     

Human milk: nutritional aspects of a dynamic food

Questions as to the fundamentals of "consciousness" are envisaged, first of all, from the viewpoint of quantifying experiments on visual perception in humans, focussed on "internal censorship", the role of intrapsychic mechanisms processing and correcting perception, and secondly based on recent theories on "mimesis" in the sense of R. Girard's concept of psychosocial transfer of aims and values between humans. The paper demonstrates a convergence between these two strategies of understanding, pointing to the view that "consciousness" may be interpreted as the performance of the intrapsychic "translation" between "cognitive" and "assessing" (or "valuating") emotional processes.     

A single center's experience with 308 free flaps for repair of head and neck cancer defects

Since its inception at our institution in 1988, microvascular reconstructive surgery has become an integral part of the treatment of head and neck cancer patients. This review of 308 free flaps performed over the last 4 years was done to evaluate the complication and flap loss rates and to investigate which factors may contribute to these rates. The overall complication rate was 36.1 percent, the vessel thrombosis rate was 6.8 percent, the flap loss rate was 5.5 percent, and the flap salvage rate was 19.0 percent. Multifactorial analysis of delayed reconstruction, tobacco use, alcohol consumption, previous radiation therapy, previous surgery, and use of vein grafts showed that only previous surgery and the use of vein grafts led to significantly higher rates of flap loss (p < 0.01 for both).     

End of life and termination of life: opinions of elderly persons with health problems

OBJECTIVE: To determine the views of elderly persons with physical limitations about a number of aspects of the end stage of life and termination of life. DESIGN: Enquiry. SETTING: University of Groningen, the Netherlands. METHOD: An enquiry was conducted in 1995 among 575 elderly (429 females, 146 males; age 57-99 years; 281 living alone) with physical restrictions (mostly heart disease, hypertension, rheumatism or other articular diseases). The group had been selected from the 'Groningen longitudinal aging study'. The respondents were asked (a) what they thought about euthanasia, (b) whether they worried about the end stage of life, (c) whether they were afraid of death and how much they were 'preoccupied with death'. For the last-mentioned two questions a visual analogue scale was used. RESULTS: Almost one-third of the elderly were not preoccupied with death and over half were not afraid of death. Very few scored high on these scales. Respondents' views about the acceptability of active termination of life varied greatly: almost half were of the opinion that their life had to be terminated once they themselves had developed complete dementia. Regarding the end stage of life, respondents mostly worried about being a burden to others, being completely dependent on others, having to say goodbye to their loved ones and having to suffer greatly. Elderly persons with poorer health were more preoccupied with death and worried more about the problems of the end stage of life. CONCLUSION: Most of those interviewed were not greatly preoccupied with or afraid of death. They did worry, however, about the problems that might be associated with the end stage of life.