Acupressure in insomnia and other sleep disorders in elderly institutionalized patients suffering from Alzheimer's disease.

BACKGROUND: Sleep disorders are very common in elderly institutionalized people with dementia and acupressure recently has been associated with conventional medicine in their treatment. AIMS: Exploring the effectiveness of acupressure for the treatment of insomnia and other sleep disturbances and we want to show that the acupressure treatment is feasible also in elderly resident patients. METHODS: We enrolled institutionalized patients suffering from Alzheimer's disease with mild cognitive impairment and insomnia. A daily acupressure on HT7 point (H7 Insomnia Control(®)) was performed for a 8-week period. We administered the following scales: the mini mental state examination, the global deterioration scale, the neuropsychiatric inventory, the state-trait-anxiety inventory, the activity daily living and the instrumental activity daily living, the global health quality of life, and the Pittsburgh sleep quality index. RESULTS: After receiving the acupressure treatment, patients saw a significant decrease of sleep disorders. The number of hours of effective sleep was perceived as increased. Furthermore, the time necessary to fall asleep decreased significantly and also the quality of sleep increased. Additionally, also the quality of life was bettered. Sedative drugs have been reduced in all patients involved in the study. CONCLUSIONS: Acupressure can be recommended as a complementary, effective, and non-intrusive method to reduce sleep disturbances in old resident patients affected by cognitive disorders. A limitation of the study is the small sample size. More studies are needed to further validate the results of our study.

Efficacy of oxycodone/acetaminophen and codeine/acetaminophen vs. conventional therapy in elderly women with persistent, moderate to severe osteoarthritis-related pain.

We aimed to evaluate the efficacy and safety of oxycodone/acetaminophen (O/A) and codeine/acetaminophen (C/A) vs. conventional therapy (CT) without opioids in older women suffering from osteoarthritis (OA)-related pain, sub-optimally responsive to prior conventional treatments. We performed a 6 week, randomized, single blind, controlled study in three nursing homes. We enrolled 154 women with painful OA. They were assigned to treatment with O/A (n=52) and C/A (n=52) vs. CT (n=50). We evaluated at baseline and at week 6: average pain in the last week (mean pain, MeP), pain at rest (RP), pain in movement (MP) (numeric rating scale, NRS); depressive symptoms (Beck Depression Inventory-II, BDI-II); functional status (activities of daily living, ADL) and cognitive status (mini mental state evaluation, MMSE). We considered the adverse events (AEs) in the study period. At week 6, MeP, RP and MP were significantly reduced in all three groups (p<0.001); compared to CT, O/A and C/A were associated with greater reductions in MeP (p<0.001 and p=0.004, respectively), in RP (p=0.028 and p=0.032, respectively) in MP (p<0.001 and p=0.002, respectively) and with significant improvement in BDI-II score (p=0.05 and p=0.04, respectively) and ADL value (p=0.04 and p=0.05, respectively). AE rates did not differ between groups.

Risk factors of functional decline during hospitalization in the oldest old.

BACKGROUND AND AIMS: The number of hospital admissions of the elderly is increasing and hospitalization often leads to functional decline. The aim of this study was to identify major risk factors for functional decline in the hospitalized oldest old. METHODS: Prospective, observational, non-randomized study of patients aged >/=80 years, admitted for at least two days to the University Department of Geriatric Medicine of Torino, Italy, between November 2003 and November 2004. For detection of functional decline, the ADL scale was used, referring to the number of dependent ADL. RESULTS: At discharge, ADL mean scores were significantly higher than on admission (2.5+/-2 vs 2.3+/-1.9, p<0.001). 23.9% of the sample lost at least one ADL function during hospitalization, and 19.2% were transferred to long-term care, compared with 5.4% of those with no functional decline. Length of hospitalization, neoplasm, low level of albumin and high number of drugs prescribed were associated with functional decline. At multivariate analysis, only in-hospital stay was an independent risk factor for functional decline (RR 1.1 per day of hospitalization, CI 1.03-1.14). CONCLUSIONS: Hospitalization of the oldest old increases the risk of functional decline, especially if prolonged. It is important to identify patients at high risk for functional decline after hospital admission.