Asunto(s)
Traumatismos de la Rodilla/patología , Rodilla/patología , Neoplasias Pulmonares/patología , Neumonía/patología , Anciano , Antibacterianos/uso terapéutico , Antineoplásicos/uso terapéutico , Clorhidrato de Erlotinib , Resultado Fatal , Humanos , Rodilla/microbiología , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/microbiología , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/mortalidad , Masculino , Neumonía/tratamiento farmacológico , Neumonía/microbiología , Quinazolinas/uso terapéuticoAsunto(s)
Fascitis/diagnóstico por imagen , Gangrena de Fournier/diagnóstico por imagen , Enfermedades de los Genitales Femeninos/diagnóstico por imagen , Anciano , Fascitis/microbiología , Fascitis/cirugía , Femenino , Gangrena de Fournier/microbiología , Gangrena de Fournier/cirugía , Enfermedades de los Genitales Femeninos/microbiología , Enfermedades de los Genitales Femeninos/cirugía , Humanos , Perineo , Resultado del Tratamiento , UltrasonografíaRESUMEN
INTRODUCTION: At present, 7.2% of the population in Singapore is in the geriatric age group, which will increase to 18.4% in the year 2030. The frailest segment of the geriatric population live in nursing homes. They suffer from multiple co-morbidities requiring multiple medication use. Polypharmacy and inappropriate medication use have been considered as quality indicators for nursing home care. As no data of these indicators are available in Singapore, this study was planned to assess the prevalence of polypharmacy and inappropriate medication use in Singapore nursing homes. MATERIALS AND METHODS: A total of 454 residents in the geriatric age group residing in 3 randomly selected nursing homes were involved in the study. Case notes were reviewed for demographic information, clinical history and medication use. The data were analysed for polypharmacy (5 or more medication orders) and inappropriate medication use (based on established criteria). RESULTS: Residents were on an average of 5.32 medications. Polypharmacy and inappropriate medication use were seen in 266 (58.6%) and 318 (70.0%) residents, respectively. There was significant association between polypharmacy and inappropriate medication use [P < 0.001, chi2 = 82.56 at 95% confidence interval (CI)]. The most common medication-related problems were the use of medication without proper indication (n = 302), significant potential for adverse drug reactions (n = 281) and drug interactions (n = 141). CONCLUSION: The prevalence of polypharmacy and inappropriate medication use is high in Singapore nursing homes. Current practice of medication use in the nursing homes may lead to significant adverse drug reactions and drug interactions. A multidisciplinary approach involving geriatricians, nursing home physicians, nurses and pharmacists may potentially reduce polypharmacy and inappropriate medication use in Singapore nursing homes.
Asunto(s)
Utilización de Medicamentos/normas , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Casas de Salud/normas , Polifarmacia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Comorbilidad , Quimioterapia/normas , Quimioterapia/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Cuidados a Largo Plazo , Masculino , Casas de Salud/estadística & datos numéricos , Estudios Retrospectivos , SingapurRESUMEN
The aims of the study were to describe community-acquired and nosocomial bacteraemia in elderly patients and to determine the factors associated with increased mortality in these patients attending a tertiary hospital in Singapore. A consecutive series of 191 patients aged more than 60 years of age admitted in 1995 was studied retrospectively. All of them had positive blood culture results obtained from the Department of Pathology and the case notes were reviewed and entered into a standard clinical protocol. They were analysed for age, sex, place of origin, race, sites of infection, clinical parameters and bacteriology. The mean age of the study population was 75 years (SD = 8.9 years). Bacteraemia was acquired from the community in 57.5% of patients, 33% was nosocomial in origin and 9.5% acquired it in chronic long term care facilities. The common organisms cultured in community-acquired infections were Escherichia coli (26.1%), Klebsiella species (25.4%), Streptococcus species (11.1%), methicillin sensitive Staphylococcus aureus (7.6%) and Proteus mirabilis (4.8%). The common organisms cultured in nosocomial infections were Klebsiella species (19.8%), Enterobacter species (14.6%), E. coli (11.8%), Acinetobacter baumanii (9.2%), methicillin sensitive Staphylococcus aureus (7.9%) and methicillin-resistant Staphylococcus aureus (7.9%). Whilst most cases of bacteraemia were single organism cultures, 13.5% were polymicrobial. The common sources of bacteraemia were chest (27.5%), urinary tract (24.5%), skin (12.5), hepatic (8.8%), gut (4.3%), cardiovascular system (1%) and others (3.6%). In 12.5% of cases, the sources were multiple and in 5.3% of cases, the source could not be identified. Twenty-one per cent of patients with bacteraemia died. The following factors were associated with increased mortality rate: older age (median age of those that died was 78.5 years compared to survivors with a median age of 73 years, P = 0.011), patient's place of origin (patients in nursing home at higher risk of death, P = 0.04), patient's mobility status (immobile patients at higher risk, P = 0.00297), source of bacteraemia--respiratory infection at increased risk of death (P = 0.00009) but urinary tract infection had a better survival rate (P = 0.03935) and multiple sites of infection (patients with multiple sites of infection had higher risk, P = 0.00897). Methicillin-sensitive Staphylococcus aureus bacteraemia was associated with a mortality rate of 35.3%, followed by Klebsiella species 28.6%, Pseudomonas aeruginosa 28.6%, methicillin-resistant Staphylococcus aureus 25%, Proteus mirabilis 25% and E. coli 19.1%. Important clinical parameters which indicated a poor clinical outcome were: high pulse rate, hypotension, increased respiratory rate, low total white cell count, coagulopathy, hypoalbuminaemia and increased creatinine level.
Asunto(s)
Bacteriemia/epidemiología , Bacteriemia/microbiología , Anciano , Anciano de 80 o más Años , Bacteriemia/diagnóstico , Bacteriemia/mortalidad , Bacterias Anaerobias , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Femenino , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Hospitales Generales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Singapur/epidemiologíaRESUMEN
Parkinson's disease is characterised by a variable combination of tremor, rigidity, bradykinesia and impaired righting reflexes. The cumulative life-time risk is one in 40. Levodopa remains the single most effective treatment in older patients, and the minimum dose to achieve maximum functional benefit should be employed. When fluctuations occur, controlled release preparations and selegiline can improve function. Oral dopamine agonists have a role but the combined side effect profile with levodopa should be monitored. COMT inhibitors have recently become available. Subcutaneous apomorphine can be helpful when "on-off" phenomena are marked. The concept of neuroprotection continues to be debated. Surgery is an option for fitter older people but neurotransplantation remains essentially a research tool.