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Latest & greatest articles for elderly
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Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. To assess the ability of antihypertensive drug treatment to reduce the risk of nonfatal and fatal (total) stroke in isolated systolic hypertension.Multicenter, randomized, double-blind, placebo-controlled.Community-based ambulatory population in tertiary care centers.4736 persons (...) (1.06%) from 447,921 screenees aged 60 years and above were randomized (2365 to active treatment, 2371 to placebo). Systolic blood pressure ranged from 160 to 219 mm Hg and diastolic blood pressure was less than 90 mm Hg. Of the participants, 3161 were not receiving antihypertensive medication at initial contact, and 1575 were. The average systolic blood pressure was 170 mm Hg; average diastolic blood pressure, 77 mm Hg. The mean age was 72 years, 57% were women, and 14% were black.--Participants
Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial. --To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy, sedentary older adults.--Year-long randomized, controlled trial comparing (1) higher-intensity group-based exercise training; (2) higher-intensity home-based exercise training; (3) lower-intensity home-based exercise training; or (4) assessment-only control.--General (...) community located in northern California.--One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease. One out of nine persons contacted through a community random-digit-dial telephone survey and citywide promotion were randomized.--For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise training, five 30-minute endurance
Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men. To investigate the long-term effects of multifactorial primary prevention of cardiovascular diseases (CVD).The 5-year randomized, controlled trial was performed between 1974 and 1980. The subjects and their risk factors were reevaluated in 1985. Posttrial mortality follow-up was continued up to December 31, 1989.Institute of Occupational Health, Helsinki, Finland, and Second
Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) Although the benefits of antihypertensive treatment in "young" elderly (under 70 years) hypertensive patients are well established, the value of treatment in older patients (70-84 years) is less clear. The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomised, double-blind, intervention study set up to compare the effects of active antihypertensive (...) therapy (three beta-blockers and one diuretic) and placebo on the frequency of fatal and non-fatal stroke and myocardial infarction and other cardiovascular death in hypertensive Swedish men and women aged 70-84 years. We recruited 1627 patients at 116 health centres throughout Sweden, who were willing to participate, and who met the entry criteria of three separate recordings during a 1-month placebo run-in period of systolic blood pressure between 180 and 230 mm Hg with a diastolic pressure
as 11,672. No other costs were given. Synthesis of costs and benefits The cost per QALY for elderly patients treated within 3 hours was given as 500. This was produced by dividing the total cost by total benefit of 21.2 extra QALYs. Other QALY results were presented graphically. Costs per QALY were given for ages: under 45,45-54, 55-64 and 65 and over. They were further broken down by hours from onset of symptoms before treatment into 3 categories: 0-3 hours, 4-6 hours and 7-24 hours. Lowest costs per (...) QALY are 500 for patient aged over 65 years treated within 3 hours to approximately 3,200 for patients aged 45-54 years treated between 7 and 24 hours after the onset of symptoms. Costs per QALY were higher for younger age groups in each category and higher for each age group the longer therapy was delayed. Authors' conclusions Age is a highly significant prognostic factor for MI. Cost utility analysis showed that the cost of thrombolytic therapy with streptokinase in the elderly was lower per
there was large variance in the CQLI scores. Bibliographic details Drummond M F, Mohide E A, Tew M, Streiner D L, Pringle D M, Gilbert J R. Economic evaluation of a support program for caregivers of demented elderly. International Journal of Technology Assessment in Health Care 1991; 7(2): 209-219 PubMedID Indexing Status Subject indexing assigned by NLM MeSH Aged; Community Health Nursing /economics; Cost-Benefit Analysis; Dementia /economics /nursing /psychology; Female; Home Nursing /economics /psychology (...) Economic evaluation of a support program for caregivers of demented elderly Economic evaluation of a support program for caregivers of demented elderly Economic evaluation of a support program for caregivers of demented elderly Drummond M F, Mohide E A, Tew M, Streiner D L, Pringle D M, Gilbert J R Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results
The effects of antihypertensive therapy on left ventricular mass in elderly patients. Left ventricular mass sometimes decreases during treatment of hypertension, but this response is inconsistent and its effects on left ventricular function are unknown. In a six-month randomized trial, we studied the ability of verapamil and atenolol to reduce left ventricular mass in 42 elderly patients with hypertension and the effects of this reduction in mass on cardiac function. The mean blood pressure (...) ejection rate, were significantly higher than before treatment (2.42 +/- 0.2 vs. 3.31 +/- 0.4 [P less than 0.05] and 0.61 +/- 0.03 to 0.85 +/- 0.05 [P less than 0.05], respectively). Diastolic filling was unchanged in the group that had no reduction in left ventricular mass. Cardiac output and the ejection fraction at rest and during mild exercise were unchanged in both groups as compared with baseline values. We conclude that left ventricular mass can be reduced in elderly patients with hypertension
Screening the elderly in the community: controlled trial of dependency surveillance using a questionnaire administered by volunteers. To test the benefits of regular surveillance of the elderly at home using an activities of daily living questionnaire administered by volunteers.Randomised controlled study.539 Subjects aged 75 and over from two general practices.All subjects were visited at the beginning and end of the study by volunteers, who completed a scored activity of daily living (...) of daily living score.Regular visiting of oldpeople at home by non-professional volunteers using a simple activity of daily living questionnaire is a practical way of identifying problems and initiating action for this group.
A randomized, controlled trial of a geriatric assessment unit in a community rehabilitation hospital. We conducted a randomized trial in a community rehabilitation hospital to determine the effect of treatment in a geriatric assessment unit on the physical function, institutionalization rate, and mortality of elderly patients. Functionally impaired elderly patients (mean age, 78.8 years) who were recovering from acute medical or surgical illnesses and were considered at risk for nursing home (...) hospital, nursing home, or rehabilitation hospital). Survival analysis showed a trend toward fewer deaths among the patients treated in the geriatric assessment unit, and mortality was significantly reduced in the patients considered to be at lower risk of immediate nursing home placement (P less than 0.05). We conclude that the treatment of selected elderly patients in a specialized geriatric rehabilitation unit improves function, decreases the risk of nursing home placement, and may reduce mortality
Immunization of six-month-old infants with different doses of Edmonston-Zagreb and Schwarz measles vaccines. Because measles causes an estimated 2 million deaths per year among children in developing countries, including a substantial proportion of infants less than nine months old--the age at which vaccination is recommended--there has been interest in using different strains of vaccine and higher doses to achieve immunization of younger infants. We conducted a randomized trial of three (...) different doses of Edmonston-Zagreb and of Schwarz measles vaccines in infants to evaluate the effect of the strain and dose of vaccine on the serologic response and acute adverse reactions to vaccination. Six-month-old infants received a standard, medium, or high dose of one of the vaccines, and nine-month-old infants received a standard dose. Antibody levels were measured before and after vaccination, by means of a plaque-reduction neutralization assay, in 1061 six-month-olds and 299 nine-month-olds
Dietary supplementation in elderly patients with fractured neck of the femur. 59 elderly patients (mean age 82) with femoral neck fractures were randomised into two groups. 27 patients received daily an oral nutrition supplement (250 ml, 20 g protein, 254 kcal) for a mean of 32 days; 32 patients acted as controls. On admission most patients had nutritional deficiencies. Despite being offered adequate quantities, nutritional requirements were not met during the hospital stay. Clinical outcome (...) of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation.
Locomotor disability in very elderlypeople: value of a programme for screening and provision of aids for daily living. To assess the prevalence of potentially reversible locomotor disabilities in elderly subjects and the cost effectiveness of providing aids for daily living.Population based randomised controlled trial of subjects aged greater than or equal to 85 living independently in an inner London borough.21 Electoral wards of the London Borough of Hackney.1255 Subjects aged greater than (...) intervention group v control group: raised toilet seat, 71 v 13 teapot tipper 100 v 33; tap turner 100 v 0; saucepan 88 v 0; shoe horn 50 v 13) and time taken to complete the tasks. A cost benefit analysis of this screening-intervention programme suggested a total cost of 32 pounds per individual benefit.Appreciable degrees of unrecognised locomotor disability are detected on screening of very elderlypeople living independently. Providing aids offers a feasible and cost effective means of improving
Cognitive and functional competence after anaesthesia in patients aged over 60: controlled trial of general and regional anaesthesia for elective hip or knee replacement. To determine the influence of general or regional anaesthesia on long term mental function in elderly patients.Prospective study of patients randomly allocated to receive general or regional anaesthesia.The patients' homes and a large teaching hospital in Cardiff.146 Patients aged 60 and over scheduled for elective hip or knee (...) and functional competence in elderly patients was not detectably impaired after either general or regional anaesthesia when attention was paid to the known perioperative influences on mental function.
Measuring blood pressure in the elderly: does atrial fibrillation increase observer variability? To compare the interobserver and intraobserver variability of blood pressure measurements in geriatric patients in atrial fibrillation and in sinus rhythm.Prospective assessment of blood pressure measurements carried out in random order in two groups of elderly patients by five doctors unaware of the aims of the study.Acute assessment wards for geriatric medicine, Cardiff Royal Infirmary.50 Elderly (...) was not significant for systolic pressures. These differences were not related to pulse rate, age, or level of blood pressure.The findings suggest that in the presence of atrial fibrillation physicians' interpretations of Korotkoff sounds are less uniform, which may have important clinical implications. Possibly a standardised methodology may overcome this problem.
Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization. Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation (...) in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.
Frequency of adverse reactions to influenza vaccine in the elderly. A randomized, placebo-controlled trial. Concern about side effects constitutes a major deterrent to patient compliance with influenza vaccination, yet there is a paucity of data about the occurrence of adverse reactions in the population targeted for immunization. We conducted a randomized, double-blind, crossover trial to compare the frequency of adverse reactions following administration of 1988-1989 trivalent split-antigen (...) influenza vaccine and saline placebo. Outpatient veterans 65 years of age or over (n = 336) were recruited by mail and were randomly assigned to receive vaccine followed 2 weeks later by placebo injection or placebo followed 2 weeks later by vaccine. There was no significant difference between influenza vaccine and placebo with respect ot the proportion of subjects reporting disability or systemic symptoms.
Relation between mortality and treated blood pressure in elderly patients with hypertension: report of the European Working Party on High Blood Pressure in the Elderly. To investigate the relation between mortality and treated systolic and diastolic blood pressures.Randomised double blind placebo controlled trial. Mortality in the two treatment groups was examined in thirds of treated systolic and diastolic blood pressures.339 And 352 patients allocated to placebo and active treatment (...) , respectively. The groups were similar at randomisation in sex ratio (70% women), mean age (71.5 years), blood pressure (182/101 mm Hg), and proportion of patients with cardiovascular complications (35%).In the placebo group total mortality rose with increasing systolic pressure whereas it had a U shaped relation with diastolic pressure, the total lowest mortality being in patients in the middle third of the distribution of diastolic pressure. In the group given active treatment total mortality showed a U
Serological effects of Edmonston-Zagreb, Schwarz, and AIK-C measles vaccine strains given at ages 4-5 or 8-10 months. To examine the value of vaccinating children against measles at age 4-5 months three groups of children in Togo were randomly assigned to receive high-dose Edmonston-Zagreb, high-dose Schwarz, or AIK-C vaccines at that age. Two other groups were vaccinated at age 8-10 months, with either the standard Schwarz vaccine or the same batch of AIK-C as for early immunisation (...) . For the 55% of children who were seronegative before vaccination at age 4-5 months seroconversion rates were 96% with the AIK-C, 94% with the Edmonston-Zagreb, and 50% with the high-dose Schwarz. The immune response rates for children who were seropositive before vaccination were estimated to be around 50% with the high-dose Edmonston-Zagreb and AIK-C strains and 10% with the Schwarz strain. Seroconversion rates for vaccination at 8-10 months were 87% for the AIK-C and 68% for the Schwarz strains. Thus
Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial. To compare a community support scheme using care attendants with standard aftercare for their effects on independence and morale of elderly patients discharged from hospital and on their use of health and social services.Randomised controlled study of cohort of patients over 75 discharged to their own homes.District general hospital and community.Total of 903 (...) patients (mean age 82, 25% over 85).Total of 464 patients received support from care attendants on first day at home and for up to 12 hours a week for two weeks. Support comprised practical care, help with rehabilitation, and organising social help. The remaining 439 patients received standard aftercare.Difference between two groups of 7% in hospital readmission rates or one point on activities of daily living scale (power 80%, significance level 5%).Three months after the initial discharge 763
Comparison of mastectomy with tamoxifen for treating elderly patients with operable breast cancer. Comparison of tamoxifen and mastectomy in treatment of breast cancer in elderly patients.Randomised trial of treatment of operable breast cancer by wedge mastectomy or tamoxifen, with median follow up 24 and 25 months respectively (range 1-63).University hospital; most patients from primary catchment area.135 consecutive patients with breast cancer aged over 70 with operable tumours (less than 5 (...) and free of local recurrence at 24 months; in tamoxifen group only 47% remained alive and free of local progression. In mastectomy group locoregional recurrence occurred in 16 patients and metastatic disease in 13; in tamoxifen group locoregional progression occurred in 29 patients and metastatic disease in seven.As a high proportion of patients treated with tamoxifen eventually required surgery treatment of elderly patients with breast cancer should include mastectomy. Optimum treatment may include