Changes in drug treatment after discharge from hospital in geriatric patients.

OBJECTIVES: To ascertain changes in drug treatment of elderly patients after discharge from hospital and to identify areas of communication which may require improvement. DESIGN: Follow up of patients six to 14 days after discharge, when the drugs supplied by the hospital should have run out and a further supply obtained from the general practitioner. Patients were also asked about information supplied to them by health care professionals during their hospital stay. SUBJECTS: 50 elderly patients discharged from five geriatric wards (mean age 76.9 years). SETTING: Sunderland District Health Authority. MAIN OUTCOME MEASURE: Drugs taken after discharge from hospital. RESULTS: After returning home the drug regimen of 45 patients differed from that prescribed on discharge from hospital, with 11 patients taking a different dose, 10 having stopped drugs, and 20 taking new drugs. Possible influencing factors included an incomplete drug history, the continuation of drugs taken before hospital admission, and changes in the prescription not attributable to a conscious clinical decision. Lack of information also contributed; 46 patients could not recall being told when to take drugs before discharge. CONCLUSION: Closer communication is needed between hospital and community health care professionals to ensure that patients are informed about their discharge prescription and continuation of treatment.

Hypothermia in the elderly: management in a purpose-built chamber.

Results of treatment of 86 hypothermic elderly patients in a purpose-built chamber are presented. They were barrier-nursed, continuously monitored and treated by slow active rewarming by warm air. The early 24-hour mortality did not significantly differ from other published reports. The complications of 'rewarming shock' and 'after drop' were prevented. It is concluded that a specially built hypothermia room facilitates management of hypothermic elderly patients and is recommended in all geriatric departments.

Folate status and its relation to vitamin C in healthy elderly men and women.

Plasma and red-cell folate levels and dietary folate intake were monitored for about six months, including two months during which supplementary vitamin C was given, in 21 healthy elderly men and women living at home in the north of England. Although biochemical values were consistently low in some subjects, no clinical folate deficiency was detected. Dietary folate intake was significantly correlated with red-cell folate, but not with plasma folate. Before vitamin C supplementation, folate intake was significantly correlated with vitamin C intake, and plasma, but not red-cell, folate was significantly related to plasma and buffy-coat vitamin C levels. During the period of vitamin C supplementation, no significant changes in plasma or red-cell folate levels were detected, even in subjects who had low initial levels of circulating vitamin C.

Relative contributions of diet and sunlight to vitamin D state in the elderly.

In winter the vitamin D state of elderly people may reach levels associated with osteomalacia, although the disease may not be clinically apparent. A statistical correlation was observed in a group of elderly subjects during the winter between dietary vitamin D intake and vitamin D state, but the intake was generally too low to make a biologically important contribution to maintaining vitamin D concentrations. Ultraviolet light (UVL) is the primary determinant of vitamin D state in summer and winter, in winter owing to the pools of vitamin D built up during the previous summer. Plasma concentrations of 25-hydroxy vitamin D (25-OHD) in winter of 15.0-22.5 nmol/l (6-9 ng/ml) require that the concentration in the previous summer was over 40 nmol/l (16 ng/ml). To maintain plasma concentrations in the elderly above those associated with osteomalacia a mean dietary vitamin D intake of over 5 microgram/day is required. A more physiological approach, however, would be to increase exposure to UVL.

Long-term vitamin status and dietary intake of healthy elderly subjects. 1. Riboflavin.

1. Long-term clinical and biochemical riboflavin status and dietary intake of riboflavin were monitored for 18 months in a group of twenty-three relatively-healthy elderly subjects living at home in the north of England. 2. Both dietary intake and biochemical status, as measured by the activation coefficient (stimulated:basal activity) of NAD(P)H2:glutathione oxidoreductase (EC 1.6.4.2), remained fairly constant for each individual and for most subjects the usual intake and biochemical status were characterized quite accurately by a single week's intake dietary record and a single measurement of the activation coefficient. 3. The expected relationship between biochemical status and dietary intake was present, but not strongly evident. There was a significant within-subject correlation between alpha values and the immediately preceding dietary intake; however the between-subject correlation between alpha values and dietary intake approached zero if the two subjects receiving long-term riboflavin supplements were omitted. Over the limited range of intakes observed in unsupplemented subjects, non-dietary factors evidently obscure the relationship. 4. Although eight subjects had average values above 1.2 for the activation coefficient, no excessively high values were observed, and no subject showed any clear-cut clinical deficiency symptoms.

Effect of drugs on vitamin B 12 levels obtained using the Lactobacillus leichmanii method.

In 750 consecutive assays of serum vitamin B(12) levels using Lactobacillus leichmanii, 25 (3.3%) showed inhibition. A satisfactory history of drug therapy was obtained in 23 cases. Seventeen of these were receiving ampicillin at the time. Two patients showed inhibition while receiving phenoxmethyl penicillin or phenethicillin. A prospective study of 11 patients detected inhibition in seven at varying intervals during ampicillin therapy. It was shown that the vitamin B(12) as measured by the radioisotope and Euglena gracilis methods was not affected. Inhibition of L. leichmanii was reproduced in vitro with concentrations of ampicillin corresponding to those obtained in therapy. Benzylpenicillin, streptomycin, and chloramphenicol had no such effect.A prospective study of patients receiving chlorpromazine yielded negative results.Inhibition may occasionally be seen in the absence of any known intake of drugs. Measurement by other methods may be required to distinguish this from vitamin B(12) depletion.