RESUMEN
OBJECTIVES: To familiarize physicians with this relatively rare syndrome; to review the signs and symptoms, with special emphasis on its nature and the terminology used; and to help physicians choose an appropriate course of action. DATA SOURCES: MEDLINE (1966 to 1997) and Psychlit (1990 to 1996), references from articles, reference texts on geriatrics and psychiatry. STUDY SELECTION: All of the articles reviewed involved case studies. SYNTHESIS: Descriptive articles enabled us to define this syndrome more clearly. The dissimilarity of the case studies indicates that the condition is not clearly defined, and the reference to the Greek philosopher Diogenes is misleading. CONCLUSION: The various features described to make up a geriatric syndrome characterized by extreme self-neglect, squalid living conditions, and social withdrawal. This complex geriatric problem poses clinical, social and ethical challenges.
Asunto(s)
Actividades Cotidianas , Demencia/diagnóstico , Autocuidado , Aislamiento Social , Anciano , Anciano de 80 o más Años , Demencia/etiología , Demencia/prevención & control , Evaluación Geriátrica , Humanos , Aceptación de la Atención de Salud , Pronóstico , Síndrome , Terminología como AsuntoRESUMEN
Treating agitation in elderly people is a complex process. Faced with a paucity of empirical information, clinicians tend to adopt a therapeutic approach based on their clinical evaluation. This article offers a rational approach that will help physicians to better understand, evaluate, and treat agitation.
Asunto(s)
Agitación Psicomotora/diagnóstico , Agitación Psicomotora/terapia , Distribución por Edad , Factores de Edad , Anciano , Antipsicóticos/uso terapéutico , Terapia Conductista , Humanos , Prevalencia , Agitación Psicomotora/clasificación , Agitación Psicomotora/etiologíaRESUMEN
OBJECTIVE: To evaluate the incidence of benzodiazepine overprescription as a cause of benzodiazepine overuse in nursing homes. DESIGN AND SETTING: Physicians were asked to complete a multiple-choice questionnaire for patients receiving at least one benzodiazepine and to indicate the reason for the prescription. To control for social desirability bias, two fictitious cases were submitted to each physician. Overprescription was defined as a prescription for benzodiazepine that differed from the indications given in the product monograph. PARTICIPANTS: Family physicians of patients living in three nursing homes in the Quebec City area were solicited by mail to take part in the survey. RESULTS: Fifteen physicians treating 152 patients, whose average age was 82.1 years (range 50 to 100 years), agreed to take part in the study. It was found that 77.1% of the patients had been taking a benzodiazepine for more than a year. For 14.5% of the prescriptions, there was no official indication. The reasons most frequently cited for these prescriptions were that the physician was renewing a prescription given before he took charge of the patient, the patient's refusal to discontinue use of the medication, pressure from the nursing staff, and the fact that the patient was causing a disturbance. In 4% of the cases (6 answers), the physician acknowledged that there was no indication for prescribing a benzodiazepine. CONCLUSION: This study shows that, in 14.5% of cases, overprescription could be a cause of benzodiazepine overuse in nursing homes.