Wandering in a dementia special care unit: behavioral aspects and the risk of falling.

BACKGROUND: Wandering is a common phenomenon among patients with dementia. While traditionally considered to be a behavioral problem, it also includes fundamental aspects of motor performance (e.g., gait and falls). OBJECTIVES: To examine the difference in motor function and behavioral symptoms between patients with severe dementia who wander and those who do not. METHODS: We conducted a retrospective study reviewing the medical records of 72 patients with severe dementia, all residents of a dementia special care unit. Motor and behavioral aspects were compared between "wanderers" and "non-wanderers." RESULTS: No difference was found in motor performance including the occurrence of falls between the wanderers and non-wanderers. A significant difference was found in aggressiveness and sleep disturbances, which were more frequent among the wanderers. There was no preference to wandering at a certain period of the day among the patients with sleep disturbances who wander. CONCLUSIONS: In a protected environment wandering is not a risk factor for falls. Sleep disturbances and wandering co-occur, but there is no circumstantial association between the two symptoms.

Management and 1 year outcome of oldest-old hospitalized heart failure patients: a subacute geriatric hospital survey.

BACKGROUND: Guidelines are frequently under-implement in older patients with heart failure. Octogenerians are often excluded from clinical trials. OBJECTIVES: To characterize the clinical profile of the oldest-old (age > or =80 years) heart failure patients hospitalized in a subacute geriatric hospital and to evaluate their management and 1 year outcome. METHODS: Patient characteristics and in-hospital course were retrospectively collected. Diagnosis of heart failure was based mainly on clinical evaluation in addition to chest x-ray results and echocardiographic findings when available. RESULTS: The study population comprised 96 consecutive unselected heart failure patients hospitalized from January to June 2003. The patients were predominantly women (67%), aged 85 +/- 5 years, fully dependent or frail with a high rate of comorbidities. Adherence to guidelines and useof recommended heart failure medications were poor. Their 1 year mortality was 57%. According to logistic regression analysis the predictor of lower 1 year mortality was higher body mass index (odds ratio 0.86, 95% confidence interval 0.78-0.96), and the predictor of higher 1 year mortality was high urea levels (OR 1.04, 95% CI 1.02-1.06). CONCLUSIONS: Our study confirms that the managementof oldest-old heart failure patients hospitalized in a subactute geriatric hospital was suboptimal and their mortality was exceptionally high.

[Inflammatory Bowel diseases in the elderly].

Although often regarded as a disease of young adults, Inflammatory Bowel Disease occurs with greater frequency in the elderly than is generally anticipated. Due to the comorbidity in the elderly, the precise diagnosis of Inflammatory Bowel Disease is overlooked. There is a tendency for both Crohn's disease and ulcerative colitis to involve the distal colon in older patients. As a consequence, the disease is often milder and less complicated than in younger patients. The first wave of the disease in an older age group is characterized by a higher complication rate. The treatment modalities are the same as in the younger age groups. The disease is often overlooked and misdiagnosed. However, since it is a treatable condition, the clinician has to be more suspicious about it in the cases of prolonged diarrhea or other gastrointestinal symptoms in the elderly.