The symptomatic post-surgical stomach--an endoscopic review.

100 consecutive endoscopies in elderly patients referred with symptoms after previous gastric surgery are reviewed. 57% showed positive findings, and the procedure was found particularly useful in making definitive diagnoses in patients presenting with dyspepsia and upper gastro-intestinal bleeding. The incidence of gastric carcinoma was low, and the findings did not support routine repeated endoscopies in elderly patients.

Routine chest radiography in the elderly.

Routine chest radiography is common practice in geriatric admission units. The cumulative cost of this unproven procedure is very high, and the authors challenge the need to carry out the investigation in all cases. A prospective survey of 1000 consecutive admissions to an acute geriatric ward showed that 35-50% had little or no clinical indication for chest X-ray examination, and that omitting the investigation in these patients would not have resulted in 'missed' significant chest conditions. Considerable savings to the service would accrue if radiology was restricted to those patients with a positive indication for the investigation.

Clinical budgeting and drug management on long-stay geriatric wards.

Over-prescribing on long-stay wards for the elderly is a common problem. A scheme of senior doctor surveillance of prescribing on long-stay wards in a district general hospital is described, which involved stopping all drugs except those considered essential. A reduction of over 50% in the number of drugs taken per patient, and a saving of 34% in drug costs was achieved, without detriment to patients' well-being. Increased drug utilization on some wards is considered to occur because of the ward sister's demand for patients to be given drugs such as sedatives and tranquilizers. Regular re-education of nursing and junior medical staff to reduce over-prescribing is recommended.

Endoscopy in the elderly.

The endoscopic experience involving the study of 114 patients in the geriatric age group (65-89 years) in a district general hospital is described. The cases examined were mainly patients with dyspepsia, gastrointestinal blood loss, suspected upper alimentary tract carcinoma or those who had undergone gastric surgery. The procedure was well tolerated and safe. Useful information was obtained in the majority of patients (93 per cent). When the endoscopic and radiological findings were compared the endoscopist and radiologist were in agreement in 55 per cent of the cases examined by both techniques. In the others endoscopy played an essential role in establishing the presence of radiologically undetected or undetectable disease, and in confirming or excluding radiologically doubtful disease.

Endoscopic evaluation of dysphagia in the elderly.

A survey of 100 consecutive endoscopies on elderly patients with suspected obstructive dysphagia is reported. Seventy-eight patients had positive findings and one to three lesions were reported in these cases. Benign stricture of the oesophagus was the commonest finding, and led to active treatment (dilation) in most cases either with Hurst bougies or Eder dilators. Fifteen patients had upper gastro-intestinal malignancy (12 oesophagus, three stomach). All of those with oesophageal carcinoma received some form of active treatment, either in the form of radiotherapy, surgery, dilation or Celestin tube insertion. Six patients with negative endoscopies had diagnoses established by other means and in 14 no cause was identified, but in four of these symptoms settled after endoscopy. The duration of dysphagia was not particularly helpful clinically. Two thirds of 'endoscopically normal' patients had short histories with dysphagia for less than 1 year, as did half of the patients with benign stricture. Most patients who were found to be malignant had experienced dysphagia for only a short time although one patient had a 4-year history! Upper gastro-intestinal endoscopy is a safe and valuable procedure in elderly patients with dysphagia and often leads to positive therapeutic intervention even in quite frail subjects.

Augmented home nursing as an alternative to hospital care for chronic elderly invalids.

A scheme of augmented home care for disabled elderly invalids is compared with long-stay hospital care. Initial results suggest that selected patients may be suitable for home care if they can be left unsupervised at night or if a relative is available to provide supervision. The cost of such care is in most cases cheaper than keeping the patient in hospital, and schemes such as this might reduce the need for additional long-stay geriatric beds to meet the necessary demands of our growing elderly population.