RESUMEN
BACKGROUND: As serum creatinine is relatively inaccurate for estimating renal function, prediction formulae are commonly used for more precise renal function estimation. However, these equations have not been studied in acutely hospitalized octogenarian patients. AIM: To compare three commonly used formulae for estimating GFR to measured creatinine clearance (CCR) in patients aged >/=80 years admitted to an acute geriatric department. DESIGN: Prospective, observational study. METHODS: Consecutive patients aged >/=80 years with urinary catheters, admitted over a 12-month period to the acute geriatric ward of a 600-bed university hospital, were enrolled in the study. All had an accurate 24-h urinary collection, as well as serum and urinary urea and creatinine determinations. CCR was calculated and compared with GFRs derived from the three formulae. RESULTS: Of the 154 patients enrolled in the study, 107 (69.5%) had normal serum creatinine (
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Anciano de 80 o más Años/fisiología , Creatinina/orina , Modelos Biológicos , Insuficiencia Renal/diagnóstico , Enfermedad Aguda , Anciano , Envejecimiento/orina , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Hospitalización , Humanos , Masculino , Estudios Prospectivos , Reproducibilidad de los Resultados , Cateterismo UrinarioRESUMEN
OBJECTIVES: The objectives of this study were to (1) estimate rates of difficulty, need for assistance, and receipt of assistance with activities of daily living (ADLs) among the old-old in Israel; (2) describe the living arrangements of the dependent old-old; and (3) gain insight into the caregiving provided to the disabled members of this population. DESIGN: A random stratified sample of 1,820 subjects age 75 to 94 selected from the National Population Register (NPR), a complete listing of the Israeli population maintained by the Ministry of the Interior. The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5-year age groups: 75-79, 80-84, 85-89, 90-94), sex, and place of birth (Europe-America, Middle East/North Africa, Israel). SETTING: National sample of old-old Jewish Israelis. PARTICIPANTS: One thousand eight hundred twenty Israelis age 75 to 94 who were living in the community or in institutions at the time of the baseline interview. MEASUREMENTS: Participants' disability status was classified in terms of difficulty with, needing help with, and receiving help with any of five ADLs (washing/bathing, dressing, transferring, toileting, and eating). Only those receiving assistance from a person (as opposed to a device) were considered to be receiving help. The independent variables used included sociodemographic, health, and social network characteristics of the participants. RESULTS: Twenty-one percent of those age 75 to 94 were found to be receiving personal assistance with at least one ADL. The most dependent were those age 90 to 94, women, those born in the Middle East or North Africa, and those living in an institution. Among those dependent in one or more ADLs, the overall community:institutionalized ratio was 2.4:1. Those who were dependent in three to five ADLs were about twice as likely to live in an institution as were those who were dependent in one or two ADLs. The Middle Eastern/North African born were more likely to be dependent, and at any given level of disability were more likely to be living in the community with a child and receiving the majority of their caretaking from the informal sector, primarily their family. CONCLUSION: We conclude that the families of disabled older people, particularly the Middle Eastern/North African born, provide a great deal of care for their older relatives despite the availability of a full range of services, providing no evidence of withdrawal of family care when state home and institutional care are available. This finding may imply underutilization of services, which should be investigated further to determine if it is caused by barriers to utilization or by the free choice of the disabled old-old and their families.
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Actividades Cotidianas/clasificación , Anciano Frágil/estadística & datos numéricos , Servicios de Salud para Ancianos/estadística & datos numéricos , Evaluación de Necesidades , Anciano , Anciano de 80 o más Años , Cuidadores , Estudios Transversales , Etnicidad , Femenino , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Servicios Domésticos/estadística & datos numéricos , Viviendas para Ancianos , Humanos , Israel/epidemiología , Modelos Logísticos , Masculino , Casas de Salud/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
OBJECTIVES: The objective of this paper is to assess the risk factors for physician contact in the month before the interview (PM) and emergency room utilization (ERU) and overnight hospitalization (OH) in the year before the interview, through the use of the behavioral model as a conceptual framework. DESIGN: A random stratified sample of subjects age 75 to 94 was selected from the National Population Register (a complete listing of the Israeli population maintained by the Ministry of the Interior). The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5-year age groups: 75-79, 80-84, 85-89, and 90-94), sex, and place of birth (Europe/America, Asia/Africa, and Israel). SETTING: Community-dwelling old-old Jewish Israelis. PARTICIPANTS: 1,487 people living in the community at the time of the baseline interview. MEASUREMENTS: The dependent variables were PM in the month before the interview and ERU and OH in the previous year. The independent variables were: predisposing variables (age, sex, place of birth, and education); enabling variables (income and the social network variables of marital status, living arrangements, and number of in-person contacts per week with any child); and need variables (number of self-reported chronic medical conditions, subjective health, depressive symptoms, number of difficulties with activities of daily living and instrumental activities of daily living, measures of physical robustness, and engaging in regular physical sportive activities). RESULTS: The predisposing and enabling factors were only minimally associated with utilization rates in the old old in Israel, with the exception of lower rates of ERU by those who were living alone. Age was not significantly associated with healthcare utilization in the old-old population studied. Healthcare utilization was found to be associated primarily with health and functional status. CONCLUSION: In a system of free and equal access to healthcare services, the demand for health services by a population with high levels of chronic disease and disability is driven primarily by health needs, rather than by extraneous factors such as income and education. The study indicates that equity in the provision of health services is attainable. Policy makers should provide for actual need, remove artificial barriers, and prepare accurate estimates of future needs.
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Anciano de 80 o más Años/psicología , Anciano de 80 o más Años/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicios de Salud para Ancianos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Médicos/estadística & datos numéricos , Actividades Cotidianas , Anciano , Causalidad , Comorbilidad , Estudios Transversales , Femenino , Evaluación Geriátrica , Conductas Relacionadas con la Salud , Encuestas de Atención de la Salud , Estado de Salud , Humanos , Israel/epidemiología , Judíos/psicología , Judíos/estadística & datos numéricos , Modelos Logísticos , Estudios Longitudinales , Masculino , Modelos Psicológicos , Evaluación de Necesidades , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
The structure and function of social networks and the perceived instrumental and emotional support associated with these networks were studied longitudinally among a random sample of 687 Jewish Israelis aged seventy-five to ninety-four, stratified by five-year age groups, place of birth (Europe-America, Asia-Africa, or Israel), and gender, interviewed in 1989-92 and 1993-94. Perceived instrumental support at follow-up was predicted by baseline measures of proximity of at least one child and by four or more weekly contacts with intimate friends or family, whereas perceived emotional support was more broadly based and was predicted by more frequent contacts with children, neighborliness, and having more intimate friends. Changes occurring during the follow-up interval, such as entering long-term care or losing a confidant, were associated with a decrease in perceived emotional support but not with a loss of instrumental support. Emotional support was less replaceable over time than was instrumental support.
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Envejecimiento/psicología , Emociones , Apoyo Social , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Israel , Estudios Longitudinales , MasculinoRESUMEN
We assessed the prevalence of self-reported medical complaints among the community-dwelling elderly receiving regular medication, and determined associations between health and sociodemographic variables, and the prevalence of complaints. The study included 170 patients, 60-90 years of age, living at home. Participants were recruited from the 3 main primary care clinics in Rishon LeZion. All were receiving chronic medication and were followed-up utilizing a long-term medication card. Data were gathered in interviews held in patients' homes using a structured questionnaire which included sociodemographics, diseases and medication, mental state assessment by Katzman's score, and a list of 15 medical complaints common among the aged. Relations to age, gender, education, living arrangements, number of diseases and number of medications per patient were determined. Mean age of participants was 73.2 +/- 6.0 years and they suffered an average of 4.07 +/- 2.16 diseases and took 5.10 +/- 2.83 types of drugs. The most prevalent complaints were: weakness and fatigue (65.0%), agitation and restlessness (56.4%), dry mouth (45.6%), constipation (43.6%) and dizziness (43.2%). The number of diseases, gender, education and age had the strongest associations with the prevalence of specific complaints, as well as their total number. The association between number of medications and mean number of complaints was of borderline significance.
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Enfermedad Crónica/tratamiento farmacológico , Enfermedad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Prevalencia , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
BACKGROUND: The impact of chronic conditions on the development of disability has not yet been comprehensively studied among the elderly population living in Israel. This study evaluates the prevalence of disability and morbidity among the community-dwelling oldest-old population and examines the association between medical conditions, comorbidity, and disability in basic and instrumental activities of daily living (ADLs, IADLs). METHOD: The data are based on a national random stratified sample of 1,820 Israeli Jewish individuals 75-94 years old, of whom 1,487 lived in the community. RESULTS: Nineteen percent of the population was disabled in ADLs and 36% in IADLs. Disability rose with age and was higher for women and among individuals of Middle Eastern and North African origin. Stepwise logistic regression indicates that the variables associated with disability in ADLs and IADLs were older age, Middle Eastern or North African origin, living with others, and the following conditions: stroke, hip fracture, diabetes, osteoporosis, anemia, and heart attack. In addition, lower education and suffering from urinary or kidney diseases, respiratory disease, and/or Parkinson's disease were related to disability in ADLs; being a woman and suffering from heart diseases other than heart attack were related to disability in IADLs. Comorbidity was related to increased disability only for individuals with three or more conditions. CONCLUSIONS: The identification of medical conditions and sociodemographic variables related to limitations in functioning may serve as a basis for health promotion and disease prevention in elders by attempting to reduce the incidence and disabling consequences of known disabling conditions.
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Envejecimiento/fisiología , Comorbilidad , Personas con Discapacidad , Morbilidad , Actividades Cotidianas , África del Norte/etnología , Anciano , Anciano de 80 o más Años , Etnicidad , Femenino , Humanos , Israel/etnología , Masculino , Medio Oriente/etnología , Análisis de Regresión , Caracteres SexualesRESUMEN
A case of fatal torsade de pointes in a 53 year old patient treated with disopyramide is described. The arrhythmia followed the development of acute hepatocellular dysfunction and may have been due to failure of the liver to efficiently degrade the drug to its metabolites.
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Disopiramida/efectos adversos , Ictericia/inducido químicamente , Taquicardia/inducido químicamente , Femenino , Humanos , Hígado/efectos de los fármacos , Persona de Mediana EdadRESUMEN
A patient with several weeks of diarrhea developed for the first time severe urinary frequency and urgency and was admitted with acute urinary retention. Imaging techniques showed a large mass compressing the posterior wall of the bladder adjacent to the rectosigmoid colon, leading to a bilateral dilatation of the ureters. Cystoscopy and biopsy of the affected part of the bladder showed no tumor but a nonspecific acute inflammation. After identification of trophozoites of Entamoeba histolytica in the stool and confirmation by colonoscopy, barium enema, and serology of acute amebic colitis, the patient was treated with metronidazole. Urinary symptoms immediately resolved with a complete disappearance of the mass and a later cure of the colitis. This is a first report of severe urinary symptomatology dominating the clinical picture in amebic colitis, due to compression of the urinary bladder by an ameboma.