RESUMO
UNLABELLED: In a population-based case-control study, we demonstrate that middle-aged women who were active with walking or in different physical spare time activities were at lower risk of later sustaining a hip fracture compared to more sedentary women. INTRODUCTION: In middle-aged women participating in the Umeå Fracture and Osteoporosis (UFO) study, we investigated whether physical activity is associated with a subsequent decreased risk of sustaining a hip fracture. METHODS: The UFO study is a nested case-control study investigating associations between bone markers, lifestyle, and osteoporotic fractures. We identified 81 female hip fracture cases that had reported lifestyle data before they sustained their fracture. Each case was compared with two female controls who were identified from the same cohort and matched for age and week of reporting data, yielding a total cohort of 237 subjects. Mean age at baseline was 57.2 ± 5.0 years, and mean age at fracture was 65.4 ± 6.4 years. RESULTS: Conditional logistic regression analysis with adjustments for height, weight, smoking, and menopausal status showed that subjects who were regularly active with walking or had a moderate or high frequency of physical spare time activities (i.e. berry/mushroom picking and snow shovelling) were at reduced risk of sustaining a hip fracture (OR 0.14; 95% CI; 0.05-0.53 for walking and OR 0.19; 95% CI; 0.08-0.46, OR 0.17, 95% CI; 0.05-0.64 for moderate and high frequency of spare time activities, respectively) compared to more sedentary women. CONCLUSION: An active lifestyle in middle age seems to reduce the risk of future hip fracture. Possible mechanisms may include improved muscle strength, coordination, and balance resulting in a decreased risk of falling and perhaps also direct skeletal benefits.
Assuntos
Fraturas do Quadril/epidemiologia , Atividade Motora , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Suécia/epidemiologia , CaminhadaRESUMO
BACKGROUND: There is a need for improved screening methods for spatial neglect. AIM: To construct a VR-test battery and evaluate its accuracy and usability in patients with acute stroke. METHOD: VR-DiSTRO consists of a standard desktop computer, a CRT monitor and eye shutter stereoscopic glasses, a force feedback interface, and software, developed to create an interactive and immersive 3D experience. VR-tests were developed and validated to the conventional Star Cancellation test, Line bisection, Baking Tray Task (BTT), and Visual Extinction test. A construct validation to The Rivermead Behavioral Inattention Test, used as criterion of visuospatial neglect, was made. Usability was assessed according to ISO 9241-11. RESULTS: Thirty-one patients with stroke were included, 9/31 patients had neglect. The sensitivity was 100% and the specificity 82% for the VR-DiSTRO to correctly identify neglect. VR-BTT and VR-Extinction had the highest correlation (r² = 0.64 and 0.78), as well as high sensitivity and specificity. The kappa values describing the agreement between traditional neglect tests and the corresponding virtual reality test were between 0.47-0.85. Usability was assessed by a questionnaire; 77% reported that the VR-DiSTRO was 'easy' to use. Eighty-eight percent reported that they felt 'focused', 'pleased' or 'alert'. No patient had adverse symptoms. The test session took 15 min. CONCLUSIONS: The VR-DiSTRO quickly and with a high accuracy identified visuospatial neglect in patients with stroke in this construct validation. The usability among elderly patients with stroke was high. This VR-test battery has the potential to become an important screening instrument for neglect and a valuable adjunct to the neuropsychological assessment.
Assuntos
Testes Neuropsicológicos/normas , Transtornos da Percepção/diagnóstico , Interface Usuário-Computador , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Percepção/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Inquéritos e Questionários/normas , Análise e Desempenho de Tarefas , Testes de Campo Visual/métodosRESUMO
This study investigates whether the positive effects on bone mineral density (BMD, g/cm(2)) and neuromuscular function following a combined weight-bearing program are sustained in older women, a longer period after cessation of training. Thirty-four women (18 exercisers and 16 controls) aged 73-88 years, who completed a 12-month randomized-controlled trial, were invited to a 5-year follow-up assessment of BMD and neuromuscular function. Both groups sustained significant losses in BMD of the femoral neck, trochanter, and Ward's triangle during the follow-up period. Significant losses were also seen in all neuromuscular function tests. The inter-group change was, however, significant only for maximal walking speed where the exercise group had a significantly greater loss. In conclusion, this study suggests that gains in bone density and neuromuscular functions achieved by training are lost after cessation of training. Continuous high-intensity weight-loading physical activity is probably necessary to preserve bone density and neuromuscular function in older women.
Assuntos
Densidade Óssea/fisiologia , Exercício Físico/fisiologia , Pós-Menopausa , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , SuéciaRESUMO
Acetylcholinesterase from Torpedo californica (TcAChE) can be found as a glycosyl phosphatidylinositol (GPI)-anchored, membrane associated form. The C-terminal amino-acid sequence of the precursor protein resembles the signal peptide sequence found in proteins and enzymes destined for GPI-modification. Characteristics of such a signal peptide are a relatively polar stretch of amino acids, separating a cleavage- and modification-site (omega-site) residue from a hydrophobic C-terminus. We have introduced mutations, both at putative omega-sites and in the hydrophobic region, and analysed their effects on GPI-anchoring of TcAChE. Our results show that substitution of all three Ser residues in the region Ser542-Ser544 prevents GPI-modification and membrane anchoring. Individual substitution of each of these residues resulted in no or only a minor effect on the modification. We therefore conclude that more than one residue within this sequence can be utilised as the omega-site. Our analyses of double substitutions indicated that Ser543 and Ser544 are the preferred residues for GPI-modification. Moreover, the hydrophobic region is shown to be essential for GPI-anchoring of TcAChE.
Assuntos
Acetilcolinesterase/química , Acetilcolinesterase/metabolismo , Glicosilfosfatidilinositóis/metabolismo , Acetilcolinesterase/biossíntese , Sequência de Aminoácidos , Animais , Linhagem Celular , Membrana Celular/enzimologia , Chlorocebus aethiops , Clonagem Molecular , Cisteína , Eletroforese em Gel de Poliacrilamida , Cinética , Substâncias Macromoleculares , Dados de Sequência Molecular , Peso Molecular , Mutagênese Sítio-Dirigida , Fragmentos de Peptídeos/química , Fosfatidilinositol Diacilglicerol-Liase , Diester Fosfórico Hidrolases/metabolismo , Sinais Direcionadores de Proteínas , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/química , Proteínas Recombinantes/metabolismo , Torpedo , TransfecçãoRESUMO
Glycosyl phosphatidylinositol (GPI)-modified proteins have a C-terminal signal peptide (GPIsp) that mediates the addition of a GPI-anchor to an amino acid residue at the cleavage and modification site (omega-site). Within the GPIsp, a stretch of hydrophilic amino acid residues are found which constitutes the spacer region that separates the omega-site residue from a hydrophobic C-terminus. Deletions and insertions into the spacer region of human acetylcholinesterase (AChE) show that the length of this spacer region is very important for efficient GPI-modification. Surprisingly, the natural length of the spacer region in human AChE was not optimal for the highest degree of GPI modification. The importance of the two adjacent residues downstream of the omega-site, the omega+1 and omega+2 residues, was investigated by peptide-quantitative structure-activity relationships (Peptide-QSAR). A model was made that predicts the efficiency of the GPI modification when these residues are substituted with others, and suggests important features for these residues. The most preferred omega+1 and omega+2 residues, predicted by the model, in combination with an ideal spacer length resulted in an optimised GPIsp. This mutant protein is more efficiently GPI-modified than any mutant AChE tested thus far.
Assuntos
Acetilcolinesterase/química , Glicosilfosfatidilinositóis/química , Sinais Direcionadores de Proteínas/genética , Acetilcolinesterase/genética , Acetilcolinesterase/metabolismo , Sequência de Aminoácidos , Animais , Células COS , Membrana Celular/enzimologia , Humanos , Mutação , Mapeamento de Peptídeos , Relação Estrutura-Atividade , TransfecçãoRESUMO
The three-dimensional crystal structure of the glycosyl phosphatidylinositol (GPI)-modified form of Torpedo acetylcholinesterase reveals the participation of Arg-44 and Glu-92 in a salt bridge and a hydrogen bond between Asp-93 and Tyr-96. To investigate the biological significance of these interactions, we have made amino acid replacements in this form of AChE: R44E, R44K, E92Q, E92L, D93N, and D93V. None of the introduced mutations affected the production of the acetylcholinesterase polypeptide significantly. However, the mutations introduced at position 92, as well as the D93V and R44E mutations, resulted in a total loss of surface located, active acetylcholinesterase. Replacement of Asp-93 with Asn resulted in a reduced amount of active enzyme. This mutant enzyme was indistinguishable from the wild-type enzyme regarding catalytic constants, but was more sensitive to thermal inactivation. The results show that the salt bridge and hydrogen bond involving residues Arg-44, Glu-92, and Asp-93 have important structural roles and are needed for correct folding, required for transport to the cell surface of TcAChE. The GPI-modified form of acetylcholinesterase is a disulfide bonded dimer. Cys-537 is shown to be required for the formation of the intersubunit disulfide bond in the dimer. Replacement with Ser resulted in the production of an enzyme, that migrates as a monomer upon non-reducing SDS-PAGE and has a lower stability compared to the dimeric wild-type enzyme.
Assuntos
Acetilcolinesterase/química , Torpedo/metabolismo , Acetilcolinesterase/genética , Acetilcolinesterase/isolamento & purificação , Animais , Dissulfetos , Estabilidade Enzimática , Estrutura Molecular , Mutagênese Sítio-Dirigida , Dobramento de Proteína , Proteínas RecombinantesRESUMO
Circulating levels of dehydroepiandrosterone sulfate (DHEAS) and cortisol were studied in 86 patients with dementia; 45 with Alzheimer's disease and 41 with multi-infarct dementia. Compared to an elderly control group, after adjustment for age and sex, patients with Alzheimer's disease were found to have lower serum levels of DHEAS. We found a covariation between serum albumin and DHEAS levels, which may be of importance regarding peripheral hormone concentration in patients with dementia. These findings may provide evidence for a role of DHEAS in amnestic disorder in humans, either reflecting or contributing to the course of dementing diseases.
Assuntos
Doença de Alzheimer/sangue , Doença de Alzheimer/diagnóstico , Desidroepiandrosterona/análogos & derivados , Demência por Múltiplos Infartos/sangue , Demência por Múltiplos Infartos/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Barreira Hematoencefálica/fisiologia , Desidroepiandrosterona/sangue , Sulfato de Desidroepiandrosterona , Feminino , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Degeneração Neural/fisiologia , Testes Neuropsicológicos , Radioimunoensaio , Albumina Sérica/metabolismoRESUMO
A simple and rapid method to study aging of soman-inhibited cholinesterases was developed. The method was applied to study the aging characteristics of soman-inhibited cholinesterase from the muscles of the plaice (Pleuronectes platessa). The orientation of the soman molecule in the active site is decisive both for the rate of aging and the degree of reactivation of unaged enzyme, a conclusion reached by using soman stereoisomers. Fluoride ions were found to affect reactivatability as well as aging rate.
Assuntos
Colinesterases/metabolismo , Músculos/enzimologia , Compostos Organofosforados/farmacologia , Soman/farmacologia , Animais , Estabilidade de Medicamentos , Peixes , Concentração de Íons de Hidrogênio , Concentração Osmolar , Ligação Proteica , Fluoreto de Sódio/farmacologia , Estereoisomerismo , Relação Estrutura-AtividadeRESUMO
Acetylcholinesterase was purified from human caudate nucleus and skeletal muscle. The enzyme preparations were used to study aging and reactivation by HI-6 and obidoxime after inhibition by soman and its isomers. HI-6 was found to be the most potent reactivator. For both enzyme preparations a higher reactivatability and a higher rate of aging were observed after inhibition by C+-soman than after inhibition by C(-)-soman. Aging was retarded by propidium diiodide. Reactivation by the two oximes was also studied after inhibition by tabun, sarin and VX. Tissue homogenates were used for this part of the work. Our conclusion is that HI-6 is superior to obidoxime for human acetylcholinesterases inhibited by soman and sarin, while obidoxime is better towards tabun-inhibited enzyme.
Assuntos
Reativadores da Colinesterase/farmacologia , Cloreto de Obidoxima/farmacologia , Oximas/farmacologia , Compostos de Piridínio/farmacologia , Acetilcolinesterase/análise , Acetilcolinesterase/isolamento & purificação , Núcleo Caudado/enzimologia , Edrofônio/farmacologia , Humanos , Músculos/enzimologia , Organofosfatos/toxicidade , Compostos Organotiofosforados/toxicidade , Sarina/toxicidade , Soman/toxicidade , EstereoisomerismoRESUMO
In an attempt to evaluate possible adrenal abnormalities in Alzheimer's disease (AD), prestimulus levels and ACTH-stimulated serum levels of steroid hormones, corticosteroid-binding globulin (CBG), and insulin-like growth factor I (IGF-I) were measured in 18 patients with early AD (8 men, 10 women; 74.6 +/- 6.5 years, mean +/- SD) and 19 healthy controls (10 men, 9 women; 74.2 +/- 7.6 years, mean +/- SD). Steroid hormone levels were measured before and after an intravenous bolus injection of 250 micrograms ACTH. AD per se had an independent influence on hormone levels when evaluated in MANOVA models. AD patients had significantly higher prestimulus levels of dehydroepiandrosterone and androstenedione (p = .04 and p = .003, respectively) with accentuated differences after ACTH (p = .02 and p < .001 for peak responses, respectively). Serum levels of cortisol, CBG, free cortisol, 17 alpha-hydroxyprogesterone (17 alpha-OHP), and IGF-I did not differ between groups. These abnormalities may have implications for neuronal degeneration as well as for behavioural symptoms in AD.
Assuntos
Glândulas Suprarrenais/fisiopatologia , Doença de Alzheimer/sangue , Androgênios/sangue , Glucocorticoides/sangue , Hormônio Adrenocorticotrópico , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Feminino , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valores de Referência , Transcortina/metabolismoRESUMO
Patients who had Alzheimer's disease-senile dementia of the Alzheimer type (AD/SDAT) or multi-infarct dementia (MID) were compared with a group of controls. Demented patients had approximately the same degree of dementia and the same duration of illness. The MID group had a significantly higher mean age than the AD/SDAT group. Sixty-three per cent of the AD/SDAT patients were free of other diseases, while 65 per cent of the MID patients had cardiovascular disease. Thirty per cent of the MID patients had a history of previous depression, while only 5 per cent of the AD/SDAT patients had had depression. At the time of the investigation, however, AD/SDAT patients showed significantly more signs of depression than the MID patients. Focal neurologic signs were found in 70 per cent of the MID patients and only 6 per cent of the AD/SDAT patients. The electrocardiogram was normal for every AD/SDAT patient, while 75 per cent of the MID patients had abnormal ECGs. Electroencephalography showed generalized slow frequencies in 79 per cent of the AD/SDAT patients and localized slow frequencies and abnormalities in 65 per cent of the MID patients. Computed tomography of the brain showed that MID patients had significantly greater dilation of the ventricular system, while cortical atrophy did not differ significantly among the three groups. Homovanillic acid in the cerebrospinal fluid was significantly lower in the AD/SDAT group as compared with controls.
Assuntos
Doença de Alzheimer/diagnóstico , Demência/diagnóstico , Idoso , Doença de Alzheimer/fisiopatologia , Análise Química do Sangue , Doenças Cardiovasculares/complicações , Demência/complicações , Demência/fisiopatologia , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Ácido Homovanílico/líquido cefalorraquidiano , Humanos , Ácido Hidroxi-Indolacético/líquido cefalorraquidiano , Masculino , Pessoa de Meia-Idade , Escalas de Graduação PsiquiátricaRESUMO
OBJECTIVE: To examine the prevalence, psychiatric and behavior symptoms, differing symptom profiles, and diurnal variations of delirium in older patients. DESIGN: A descriptive, point prevalence study with a cross-sectional design. SETTING: One ordinary county hospital (n = 148), three nursing homes (n = 202), five old people's homes (n = 196), and home medical care patients (n = 171) in parts of a hospital catchment area in Mid-Sweden. PARTICIPANTS: A total of 717 patients 75 years of age and older were observed and assessed for the prevalence of delirium. Women accounted for 66.4% of the studied population, and the mean age for both sexes was 83.7 years. MEASUREMENTS: All patients were examined using the OBS (Organic Brain Syndrome) scale, and delirium was diagnosed according to DSM-III-R. RESULTS: Delirium was diagnosed in 315 of 717 (43.9%) patients, and 135 of 315 (42.9%) of the delirious patients had dementia. Thirty-seven percent of the patients with delirium were delirious in the afternoon, evening, or at night, and 47% of the delirious patients had morning delirium. The delirious patients presented a wide variety of psychiatric symptoms. More than half the patients exhibiting anxiety, psychomotor slowing, depressed mood, and irritability. Nearly 26% were classified as having hypoactive, 22% as having hyperactive, and 42% as having mixed delirium, whereas 11% had neither hypo- nor hyperactive delirium. Seventy-seven percent were classified as having delirium with pronounced emotional and 43% with pronounced psychotic symptoms. CONCLUSIONS: This study shows that patients with delirium have very different clinical profiles. This might indicate a need for different treatment strategies for patients with different types of delirium.
Assuntos
Delírio/psicologia , Sintomas Afetivos/psicologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Ritmo Circadiano , Estudos Transversais , Delírio/diagnóstico , Delírio/fisiopatologia , Demência/psicologia , Depressão/psicologia , Feminino , Humanos , Humor Irritável/fisiologia , Masculino , Prevalência , Transtornos Psicomotores/psicologia , Transtornos Psicóticos/psicologiaRESUMO
STUDY OBJECTIVE: To determine the accuracy of diagnosis and documentation of acute confusional states (ACS) in the medical records of patients with hip fracture. DESIGN: The diagnosis of ACS in two prospective clinical studies was compared to its diagnosis in the medical records of the same patients on the same hospitalization. In order to determine if the simultaneous prospective study influences the diagnostic and documentary practices evidenced in the medical records, a further comparison was done by reviewing medical records of two series of patients seen some years prior to the prospective studies. SETTING: Patients with femoral neck fractures treated at a department of orthopedic surgery in a university hospital and one retrospective control sample from a department of general surgery in a county hospital. SUBJECTS: Two prospective samples of patients 65 years and older treated for femoral neck fractures (n = 111 and n = 57, respectively) and two earlier retrospective samples (n = 66 and n = 68, respectively). MEASUREMENTS AND MAIN RESULTS: All comparisons showed that both physicians and nurses diagnosed ACS unsatisfactorily and documented the patients' mental status poorly. The analysis of the two retrospective medical record control samples gave the same results. Neither the physicians nor the nurses used any kind of diagnostic instrument to detect cognitive disorders in the patients. CONCLUSIONS: ACS is a common and severe complication in elderly people treated for femoral neck fractures. Acute confusional states have, by definition, one or more causes that can often be identified and treated. Poor assessment and documentation is a threat to the patients as a correct diagnosis of ACS is a prerequisite for further assessment of its underlying causes and the consequent necessary medical and nursing care.
Assuntos
Confusão/diagnóstico , Fraturas do Colo Femoral/complicações , Prontuários Médicos/normas , Registros de Enfermagem/normas , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Confusão/complicações , Confusão/epidemiologia , Demência/complicações , Demência/diagnóstico , Diagnóstico Diferencial , Feminino , Fraturas do Colo Femoral/enfermagem , Fraturas do Colo Femoral/cirurgia , Hospitais de Condado , Hospitais Universitários , Humanos , Incidência , Masculino , Auditoria Médica , Auditoria de Enfermagem , Diagnóstico de Enfermagem/normas , Estudos Prospectivos , Estudos Retrospectivos , Suécia/epidemiologiaRESUMO
OBJECTIVES: The aim of this study was to investigate the differences between preoperative and postoperative delirium regarding predisposing, precipitating factors and outcome in older patients admitted to hospital with femoral neck fractures. DESIGN: A prospective clinical assessment of patients treated for femoral neck fractures. SETTING: Department of orthopedic surgery at Umeå University Hospital, Sweden. PARTICIPANTS: One hundred one patients, age 65 and older admitted to the hospital for treatment of femoral neck fractures. MEASUREMENTS: The Organic Brain Syndrome (OBS) Scale. RESULTS: Thirty patients (29.7%) were delirious before surgery and another 19 (18.8%) developed delirium postoperatively. Of those who were delirious preoperatively, all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, had been treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium, and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and had more postoperative complications such as infections. Male patients were more often delirious both preoperatively and postoperatively. Patients with preoperative delirium were more often discharged to institutional care and had poorer walking ability both on discharge and after 6 months than did patients with postoperative delirium only. CONCLUSIONS: Because preoperative and postoperative delirium are associated with different risk factors it is necessary to devise different strategies for their prevention.
Assuntos
Delírio/etiologia , Fraturas do Colo Femoral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Delírio/epidemiologia , Delírio/psicologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Estudos Prospectivos , Fatores de RiscoRESUMO
Physical restraints are commonly used on older persons living in geriatric care settings. The aim of this study was to investigate the influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence. In this cross-sectional study of 33 nursing home wards and 12 group living units for old persons with dementia in two municipalities in northern Sweden, 540 residents (mean age 82) and 529 staff members were evaluated for resident and staff characteristics and organizational and environmental variables. The proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff's attitudes towards use of restraints were the strongest discriminators between restraint-free wards and wards that used restraints. A classification function analysis showed that these three variables could correctly classify the wards as restraint-free, low-use, and high-use wards in 63.6% of the cases, with the highest figures for restraint-free wards (91%). This study has shown that the use of physical restraints is strongly connected with residents' functional status and nursing staffs' attitudes toward their use.
Assuntos
Ambiente de Instituições de Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Transtornos Mentais/enfermagem , Transtornos dos Movimentos/enfermagem , Recursos Humanos de Enfermagem/organização & administração , Características de Residência , Restrição Física , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Lares para Grupos/organização & administração , Humanos , Masculino , Casas de Saúde/organização & administraçãoRESUMO
OBJECTIVE: Physical restraints are used frequently in geriatric care to promote the safety of frail older patients. This study investigated the prevalence of the use of physical restraints in geriatric care and the way in which patient characteristics are related to the use of physical restraints. DESIGN: A point prevalence study of patients cared for in various types of geriatric settings. SETTING: Eight nursing homes, 15 old people's homes, a somatic geriatric clinic, and a psychogeriatric clinic in a health care district in northern Sweden. PARTICIPANTS: A total of 1325 patients, mean age 82 years, 64% of whom were women. MEASUREMENTS: The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to measure motor function, vision, hearing, speech, ADLs, behavioral symptoms, psychiatric symptoms, use of psychoactive drugs, and the physical and psychological workload of the staff. In addition, questions concerning the use of physical restraints were added to the instrument. RESULTS: Twenty-four percent of the patients were physically restrained. The highest prevalence was found in nursing homes and psychogeriatric care. Physical restraints were found to relate most strongly to cognitive impairment, impaired ADLs, and speech and walking ability. Ninety-four percent of the restrained patients were cognitively impaired. Other variables relating to the use of physical restraints were psychiatric symptoms and behavioral disturbances. CONCLUSIONS: This study has shown that physical restraints are used frequently in geriatric care in Sweden and that cognitive and physical impairments relate very closely to the use of physical restraints.
Assuntos
Controle Comportamental , Transtornos Cognitivos/enfermagem , Idoso Fragilizado , Enfermagem Geriátrica , Restrição Física , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Feminino , Avaliação Geriátrica , Enfermagem Geriátrica/métodos , Enfermagem Geriátrica/estatística & dados numéricos , Psiquiatria Geriátrica , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Casas de Saúde , Prevalência , Restrição Física/métodos , SuéciaRESUMO
OBJECTIVE: To analyze the mechanisms of falls that result in femoral neck fractures among lucid older people. DESIGN: A cross-sectional study. SETTING: An orthopedic university hospital department. PARTICIPANTS: A consecutive series of 123 lucid patients, 65 years of age or more, who were admitted for femoral neck fractures. MEASUREMENTS: On admission, the subjects were interviewed about fracture accident characteristics, and falling mechanisms were classified. An arterial blood gas sample was taken from each patient soon after admission. Based on data regarding drug consumption and social and medical characteristics, a fall-risk index was calculated for each subject. RESULTS: It was ascertained that 95% of the fractures were caused by falls and < 2% were spontaneous. Most accidents (68%) took place indoors, 47% of the falls were classified as extrinsic, 24% as intrinsic, 7% as nonbipedal, and 22% remained unclassified. Almost all outdoor falls were extrinsic; however, intrinsic falls were as common as extrinsic falls indoors (P < .001). Extrinsic fallers presented a significantly lower fall-risk index score than subjects with fractures caused by intrinsic, nonbipedal, and unclassifiable falls. A large proportion of subjects (24%) wre hypoxemic (pO2 < 8 kPa) on admission, and patients who sustained fractures at night had lower oxygen tension than that of daytime fallers (P = .006). CONCLUSIONS: Accidental falls are the primary cause of femoral neck fractures. Preventive actions should be directed toward intrinsic, as well as extrinsic, risk factors for falls. Hypoxemia might be a risk factor for falls, especially those falls that occur at night.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Fraturas do Colo Femoral/etiologia , Competência Mental , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Gasometria , Estudos Transversais , Feminino , Humanos , Hipóxia/sangue , Hipóxia/complicações , Masculino , Fatores de RiscoRESUMO
OBJECTIVES: The incidence of sleep apnea and stroke increases with age. The aim of this study was to investigate the presence of sleep apnea after stroke and its relationship to delirium, depressed mood, cognitive functioning, ability to perform activities of daily living (ADLs), and psychiatric and behavior symptoms. DESIGN: Cross-sectional study. SETTING: Geriatric stroke rehabilitation unit. PARTICIPANTS: 133 patients (78 women and 55 men, mean age 77.1 +/- 7.7 years) consecutively admitted to a geriatric stroke rehabilitation unit. MEASUREMENTS: All patients underwent overnight respiratory sleep recordings at 23 +/- 7 days (range 11 to 41 days) after suffering a stroke. The patients were assessed using the Organic Brain Syndrome Scale, Montgomery-Asberg-Depression-Rating Scale, Mini-Mental State Examination (MMSE), and Barthel-ADL Index. Sleep apnea was defined as an apnea-hypopnea index (AHI) of 10 or more. RESULTS: The median of the AHI for the studied sample (N = 133) was 13 (range 0-79; interquartile range 6-28). Fifty-nine percent fulfilled the criteria for sleep apnea; 52% with first-ever stroke had sleep apnea. More patients with sleep apnea than without were delirious, depressed, or more ADL-dependent. Sleep apnea patients also had a higher frequency of ischemic heart disease and had more often suffered from an earlier cerebral infarction. Multivariate analysis showed that obesity, low ADL scores, ischemic heart disease, and depressed mood were independently associated with sleep apnea. Low ADL scores, apnea-related hypoxemia, body mass index < or = 27, and impaired vision were independently associated with delirium. The presence of sleep apnea was not associated with any specific type of stroke or location of the brain lesion. CONCLUSIONS: Sleep apnea is common in stroke patients and is associated with delirium, depressed mood, latency in reaction and in response to verbal stimuli, and impaired ADL ability. We suggest a trial investigating whether delirium, depressed mood, and ADL ability improve with nasal continuous positive airway pressure treatment of sleep apnea in stroke patients.
Assuntos
Atividades Cotidianas , Cognição , Delírio/etiologia , Depressão/etiologia , Síndromes da Apneia do Sono/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Idoso , Estudos Transversais , Feminino , Humanos , MasculinoRESUMO
The aims of this study were to estimate the incidence of acute confusional state (ACS), its predisposing factors and consequences in 111 consecutive patients operated for fractured neck of the femur. The incidence of ACS was 61 percent and the predicting factors were old age and dementia. Drugs with anticholinergic effect, depression, and previous stroke were factors that seemed to be associated with the development of ACS. Ninety-two percent of the patients who had severe perioperative blood pressure drops developed ACS. The consequences of ACS were prolonged ward-stay at the orthopedic department, a greater need for long-term care after discharge, and poor walking ability at discharge and six months after surgery. The confused patients also had more complications, such as urinary problems, feeding problems and decubital ulcers, as compared with the nonconfused patients.
Assuntos
Transtornos Cognitivos/epidemiologia , Confusão/epidemiologia , Fraturas do Colo Femoral/psicologia , Idoso , Idoso de 80 Anos ou mais , Anestesia/métodos , Ansiolíticos/efeitos adversos , Benzodiazepinas , Pressão Sanguínea , Confusão/etiologia , Demência/complicações , Feminino , Fraturas do Colo Femoral/reabilitação , Fraturas do Colo Femoral/cirurgia , Humanos , Masculino , Complicações Pós-OperatóriasRESUMO
The aim of this study was to evaluate the effect of a geriatric-anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre- and post-operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri-operative blood pressure falls and treatment of post-operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P less than 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post-operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P less than 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay.