Disablement process and the utilization of home care among non-institutionalized elderly people: contrasting results between cross-sectional and panel data.

PURPOSE: In this article we studied the role of disablement process variables in home care utilization in a cross-sectional and in a panel approach among low-functioning community dwelling elderly people. METHODS: We analysed data from a prospective follow-up study in The Netherlands (n = 555) and used three outcome variables: professional home care (yes or no) measured in the same year as the process variables (cross-sectional approach), professional home care (yes or no) also after 2 years (panel-approach: no change) and the new users of professional home care 2 years later (panel-approach: change). Process variables were categorized as pathology, functional limitations, disability, risk factors and psychosocial attributes. RESULTS: Trajectories of home care utilization can be divided into an unchanging part and a changing part. Both parts are not predicted by the same process variables. For instance disability did not predict the new users of professional home care 2 years later, but correlated strongly with the stable users. The changing part was predicted by the beginning of the process of disablement (i.c. pathology). In addition, far most predictors could be considered as additive in stead of interactive. CONCLUSIONS: It is important to take into consideration the design of the investigation in studying the disablement process: cross-sectional data and panel data provide different results.

Quantification of the atrial contribution to diastolic filling during radionuclide angiography.

To define exactly the onset of late diastolic filling with respect to atrial contraction, the atrial contribution (AC) to left ventricular filling was quantified in 34 patients with a variety of diseases using radionuclide angiography. From the time-activity curve and its first derivative, a flow-volume loop was constructed. Using the flow-volume loop, the period between minimal flow and the moment of maximal end-diastolic counts was defined as the AC-interval and correlated with the PQ-interval on the electrocardiogram. The relative filling volumes within these time periods were closely related in all patients (r = 0.99, P < 0.0001). The correlation between the PQ-interval and AC-interval was also statistically significant (r = 0.82, P < 0.0001). In a subset of patients, the PQ-interval and AC-interval were not exactly the same. In these patients, the AC-interval was always longer than the PQ-interval, indicating the existence of passive diastasis flow before the onset of atrial contraction. This was more apparent in patients with low heart rates than in those with high heart rates. Despite the close correlation between the PQ-interval on the electrocardiogram and the AC-interval of the flow-volume loop, they may represent different entities. We conclude that the PQ-interval is better than the AC-interval for determining the moment of onset of atrial activity during radionuclide angiography.

Normal values and reproducibility of left ventricular filling parameters by radionuclide angiography.

BACKGROUND: In physiologic situations age, heart rate (HR) and left ventricular ejection fraction (EF) may influence left ventricular filling rate. In this study, we determined normal values for radionuclide angiography (RNA) derived diastolic filling parameters, the correlations with age, HR and EF and their reproducibility. METHODS: The study was performed in 20 patients, 40-76 years old (mean 57), with normal findings at coronary angiography and left ventriculography. The first RNA was performed at rest (RNA1). Then, five minutes bicycle ergometry was performed and the patients were allowed five minutes rest before RNA was repeated (RNA2). From the left ventricular time activity curve we determined peak filling rate (PFR), time to peak filling rate (TPFR) and atrial contribution (AC) to ventricular filling. RESULTS: Values for PFR1 were 2.2 +/- 0.6 EDV/sec (PFR2 2.4 +/- 0.7 EDV/sec, r = 0.82), for TPFR1 198 +/- 22 msec (TPFR2 203 +/- 24 msec, r = 0.45) and for AC1 31 +/- 11% (AC2 31 +/- 10%, r = 0.72). The correlations of PFR and TPFR with age were statistically significant (respectively r = -0.68 and r = 0.48, P < 0.05). PFR was also influenced by HR and EF (resp. r = 0.51 and r = 0.50, P < 0.05). TPFR however was not influenced by HR and EF, whereas AC was positively correlated with HR (r = 0.79, P < 0.01). CONCLUSIONS: Radionuclide angiography is a reliable and reproducible method to assess parameters of diastolic left ventricular filling in individual patients. It may therefore be used to serially follow diastolic function. When used for interindividual comparison the dependency of RNA derived left ventricular filling parameters on age, HR and EF should however be considered.

Effect of mibefradil on left ventricular diastolic function in patients with congestive heart failure.

Calcium antagonists have antihypertensive and antianginal properties. In heart failure, however, their use can be hazardous, as systolic function can deteriorate. This may not be true of the new calcium antagonist mibefradil, which has a new chemical structure. Calcium antagonists may also be beneficial for diastolic left ventricular function in coronary artery disease. To investigate the possible effects of mibefradil on diastolic left ventricular function, we performed the present study as a multicenter, double-blind,placebo-controlled, multiple-dose safety trial. Fifteen patients with New York Heart Association (NYHA) class II or III for dyspnea and depressed ejection fraction (<40%) due to a previous myocardial infarction were investigated. The measured nuclear angiographic parameters included ejection fraction (EF), peak ejection rate (PER), and peak filling rate (PFR). Systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were also obtained. Group I (5 patients) received placebo medication; group IIA (6 patients) received mibefradil 6.25, 12.5, or 25 mg/day; and group IIB (4 patients) received mibefradil 50 or 100 mg/day. Measurements were made before and after the first dose and after 1 week of treatment before and after the final dose. Mibefradil clearly decreased HR (repeated-measures analysis of variance p < 0.05). No statistically significant effects of mibefradil were noted on SBP or DBP or on systolic and diastolic left ventricular function. In our study conditions, mibefradil caused no worsening of systolic function and preserved diastolic function in short-term treatment of patients with decreased EF and heart failure.

[Substitutes in care of the elderly? The artifact of a null correlation]. / Substituten in zorg aan ouderen? Het artefact van een nulsamenhang.

On theoretical grounds or as a consequence of social policy measures (substitution), a negative correlation between formal and informal help is expected. A remarkable finding in most of the cross-sectional research is however a zero-correlation. Some researchers are tempted to conclude that substitution in care is not possible. In this article the composition of the population under investigation is suggested as an explanation for the absence of the correlation. If the population contains many young and healthy elderly, neither formal nor informal help is mostly necessary. The existing substitution in care for the needy elderly is consequently obscured and a zero-correlation between formal and informal help is found. This zero-correlation suggests that no substitution has taken place, but results from the composition of the population. In this article data on a life situation survey among 304 elderly people in a rural area are presented to illustrate this assumption.

[Local backgrounds of demand and supply of nursing homes]. / Lokale achtergronden van vraag en aanbod van verzorgingstehuizen.

This report deals with the question, why municipalities differ so much in the number of elderly who are staying in a home for the aged. Official statistics, the national survey in 1982 and a local survey among the elderly in a municipality with a low capacity have been analysed. Some interesting results of the report are: if there isn't a home for the elderly in the domicile -- and the elderly have to move to another village for the care they need -- many prefer to stay on their own. In the past alternatives (such as special dwellings, more home help, etc.) have been created. In municipalities with many small villages also a relatively low capacity of homes for the elderly has been realised in the past. An other determinant of the capacity is the political and religious structure of a municipality.