Frequency of ophthalmic assessments among elderly whites and African Americans with eye disease and impact on visual function.

OBJECTIVES: To study the difference in patterns of utilization of eye-care services among white and African American senior citizens with eye disease and its impact on visual function. METHODS: This study involved cross-sectional assessments of visual function using the Activities of Daily Vision Scale (ADVS), as well as retrospective self-recall of history of eye disease and frequency of ophthalmic assessments. Participants included 99 consecutive elderly patients with history of eye disease who were attending the outpatient medical clinics at Nassau University Medical Center, a community teaching hospital in Long Island, New York. RESULTS: White Americans constituted 52% of the study sample and African Americans constituted the remaining 48%. African American subjects were less likely than whites to report visiting an eye specialist over the previous 5 years (69% versus 88%, P < 0.05). African American subjects who reported undergoing ophthalmic assessments over the past 5 years showed a trend of having higher ADVS scores (indicating better visual function) compared with those who did not report such history (86 +/- 12 versus 79 +/- 15, P = 0.098). On the other hand, reporting such history had no apparent relation to the ADVS scores in whites. CONCLUSIONS: African American elderly ambulatory medical patients with eye disease were less likely than their white counterparts to report use of eye-care services. The use of eye-care services in African American but not white subjects was linked to better visual function as assessed by the ADVS.

Utilizing pain assessment scales increases the frequency of diagnosing pain among elderly nursing home residents.

To study the effect of utilizing a combination of three easily-administered pain assessment instruments on the frequency of diagnosing pain among elderly nursing home residents, a cross-sectional study was conducted at two academic skilled nursing facilities: an 899-bed facility in Long Island, New York, and a 201-bed facility in Maryland Heights, Missouri. A total of 305 randomly selected elderly (>or= 60 years) subjects were enrolled in this study. The study involved medical records abstracting and patient interviews. Pain was assessed in 150 (49%) subjects using the question "Do you have pain?" (Group 1). In the remaining 155 (51%) subjects (Group 2), pain was assessed using three pain assessment instruments: the visual analog scale, the behavior (faces) scale, and the pain descriptive scale. The overall frequency of diagnosing pain was greater in the subjects in Group 2 compared to the subjects in Group 1 (30% vs. 15%, P < 0.01). Using the three pain assessment scales greatly increased the frequency of diagnosing pain among the old-old (>or= 85 years) residents (32% Group 2 vs. 6% Group 1, P < 0.001). The frequency of diagnosing pain among cognitively impaired residents showed a similar trend (16% Group 2 vs. 10% Group 1, P = 0.2). These data indicate that using three easily-administered pain assessment scales increased the frequency of diagnosing pain among nursing home residents.

Hormone replacement therapy and fractures in older adults.

Estrogen deficiency in women is associated with accelerated bone loss, and estrogen replacement therapy has been proven to be effective in preventing osteoporosis and fractures in postmenopausal women. The introduction of selective estrogen receptor modulators that have an estrogen-like effect on the skeleton but have a different pattern of effects on other tissues may have an important role in the management of osteoporosis in women in the near future. In men, androgen deficiency has been shown to be associated with osteoporosis. Although androgen replacement in hypogonadal men may decrease bone resorption and increase bone mass, long-term placebo-controlled trials are needed to better define the benefits and risks of such therapy before it can be recommended. Sex hormone deficiency is linked to the development of osteoporosis in both women and men. In women, hormonal replacement by estrogen or the newly developed selective estrogen receptor modulators may prevent the development of osteoporosis and its related fractures. In men, there is early evidence that testosterone replacement therapy may enhance bone mass in hypogonadal men.

The activities of daily vision scale: a useful tool to assess fall risk in older adults with vision impairment.

OBJECTIVE: To evaluate the validity of the Activities of Daily Vision Scale (ADVS) as a tool to assess fall risk in older adults with vision impairment. DESIGN: Cross-sectional assessments of visual function and retrospective collection of fall data. SETTING: The outpatient medical clinics of an academic tertiary care community hospital. PARTICIPANTS: Randomly selected sample (n = 143) of older (> or = 65 years) patients seen at the outpatient medical clinics at Nassau County Medical Center in Long Island, New York. These patients had one or more of five ocular conditions: refractive errors (n = 90), cataracts (n = 77), glaucoma (n = 29), diabetic retinopathy (n = 19), and/or macular degeneration (n = 6). MEASUREMENTS: Visual function, assessed using the ADVS, demonstrated scores ranging from 0 (marked visual disability) to 100 (no visual difficulty). Fall history and the presence of eye disease were based on the self-recall of patients. Fall history was assessed retrospectively over a 1-year period from the time of the interview. RESULTS: Thirteen percent of the subjects reported having one or more falls during the 1-year period before the time of the interview. These subjects scored significantly lower on the ADVS compared with the scores of the group that did not report falls (74 +/- 22 vs 85 +/- 14, P < .01). Using a cutoff score of 90 points (10% loss of visual function on the ADVS), the ADVS had a 67% sensitivity in identifying those patients who had falls. Among the patients with glaucoma and those with diabetic retinopathy, the ADVS had a 100% sensitivity in identifying those patients who reported a history of falls. In patients with cataracts and refractive errors, the ADVS had a sensitivity of 82% and 64%, respectively, in identifying patients with a history of falls. The number of falls reported by the subjects showed no relationship with the ADVS scores. CONCLUSION: The results from this study suggest that the ADVS may prove to be a useful tool to assess fall risk in older adults with vision impairment, especially in those persons with glaucoma, diabetic retinopathy, and/or cataracts.

Wound management in postacute care.

Decreasing hospital length of stay has dictated that postacute and long-term care facilities bear the brunt of treating acute and chronic wounds. Two types of chronic wounds are discussed: (1) pressure ulcers and (2) diabetic ulcers. The differential diagnosis of these ulcers is imperative because the management of both types of wound differs substantially. Wound therapy includes relieving pain, correcting nutritional deficiencies, maintaining an optimal wound environment, shielding the wound from further damage, removing necrotic debris, promoting granulation tissue formation, protecting against bacterial contamination, choosing an appropriate dressing, and surgical treatment. The application of these principles is discussed, and the differences among wound types are highlighted.

Diabetes mellitus among ethnic seniors: contrasts with diabetes in whites.

Diabetes mellitus is one of the most common chronic diseases affecting older persons in the United States. It occurs in 18% of persons between 65 and 75 years of age and in as many as 40% of persons over 80 years of age. The prevalence of diabetes mellitus varies considerably by ethnic group and is higher among most minority groups in the United States than among non-Hispanic white persons. Published data also show increased complications and mortality rate from diabetes in the minority groups. In this article, we review the current literature on the prevalence, complications, and mortality-rate effects of diabetes mellitus and the results of interventions in three major minority groups in the United States, namely African Americans, Hispanic Americans, and Native Americans. Recent studies of diabetes mellitus in Mexican seniors also are described. Our review focuses primarily on patients with non-insulin-dependent diabetes mellitus, because by far this is the most prevalent type in older persons.