Statins and Selective Serotonin Reuptake Inhibitors are Associated with Longer Survival in Nursing Home Residents.

BACKGROUND: Statins and selective serotonin reuptake inhibitors (SSRIs) have beneficial effects on health outcomes in the general population. Their effect on survival in debilitated nursing home residents is unknown. OBJECTIVES: To assess the relationships between statins, SSRIs, and survival of nursing home residents. METHODS: Baseline patient characteristics, including chronic medications, were recorded. The association of 5-year survival with different variables was analyzed. A sub-group analysis of survival was performed according to baseline treatment with statins and/or SSRIs. RESULTS: The study comprised 993 residents from 6 nursing homes. Of them, 285 were males (29%), 750 (75%) were fully dependent, and 243 (25%) were mobile demented. Mean age was 85 ± 7.6 years (range 65-108). After 5 years follow-up, the mortality rate was 81%. Analysis by sub-groups showed longer survival among older adults treated with only statins (hazard ratio [HR] for death 0.68, 95% confidence intervals [95%CI] 0.49-0.94) or only SSRIs (HR 0.6, 95%CI 0.45-0.81), with the longest survival among those taking both statins and SSRIs (HR 0.41, 95%CI 0.25-0.67) and shortest among residents not taking statins or SSRIs (P < 0.001). The survival benefit remained significant after adjusting for age and after conducting a multivariate analysis adjusted for sex, functional status, body mass index, mini-mental state examination, feeding status, arrhythmia, diabetes mellitus, chronic kidney disease, and hemato-oncological diagnosis. CONCLUSIONS: Treatment with statins and/or SSRIs at baseline was associated with longer survival in debilitated nursing home residents and should not be deprived from these patients, if medically indicated.

Increased 1-year mortality rates among elderly hip fracture patients with atrial fibrillation.

BACKGROUND AND AIMS: Prediction of factors associated with survival following hip fracture is important. We studied crude and adjusted survival rates in elderly hip fracture patients with and without atrial fibrillation (AF) to assess possible risk of death associated with AF. METHODS: A historical prospective cohort study, comprising 1114 consecutive patients with hip fractures. Subjects were divided into three groups: patients with sinus rhythm (SR), paroxysmal atrial fibrillation (PAF) or chronic atrial fibrillation (CAF). The main outcome measures were crude and adjusted survival rates at 30, 90 and 365 days, and end of follow-up. RESULTS: AF patients differed from SR patients by gender (p=0.0018), age (p=0.008), heart failure (p<0.001), ischemic heart disease (p<0.001) and history of a stroke (p<0.001). The lowest death rates were observed among SR and PAF patients, whereas CAF patients had the highest rates at each follow-up time point. CAF (but not PAF or SR) patients were at a significantly higher risk of death at both 365 days and at the end of the study (HR 1.786, CI 1.011- 3.155 and HR 1.835, CI 1.302-2.585, respectively). Older age (HR 1.301, CI 1.135-1.491 and HR 1.321, CI 1.321-1.415) and male gender (HR 1.879, CI 1.271- 2.779 and HR 1.545, CI 1.251-1.909) also predicted higher risk of death at both 365 days and at the end of the study. CONCLUSIONS: Atrial fibrillation cannot be considered to adversely affect short-term survival of hip fracture patients. After 365 day, CAF was associated with a significantly higher risk of death.

Functional outcome of elderly survivors of ischemic stroke: a retrospective study comparing nonhypercholesterolemic and hypercholesterolemic patients.

BACKGROUND: Total cholesterol is significantly associated with increased risk of ischemic stroke. Patients with ischemic stroke and high cholesterol levels may show better functional outcome after rehabilitation. OBJECTIVES: To study the possible interrelations between hypercholesterolemia and functional outcome in elderly survivors of ischemic stroke. METHODS: We conducted a retrospective chart review study of consecutive patients (age > or = 60 years) with acute stroke admitted to a geriatric rehabilitation ward in a university-affiliated hospital. The presence or absence of hypercholesterolemia was based on registry data positive for hypercholesterolemia, defined as total cholesterol > or = 200 mg/dl (5.17 mmol/L). Functional outcome of patients with hypercholesterolemia (Hchol) and without (NHchol) was assessed by the Functional Independence Measurement scale (FIM) at admission and discharge. Data were analyzed by t-test and chi-square test, as well as linear regression analysis. RESULTS: The complete data for 551 patients (age range 60-96 years) were available for final analysis; 26.7% were diagnosed as having hypercholesterolemia. Admission total FIM scores were significantly higher in patients with Hchol (72.1 +/- 24.8) compared with NHchol patients (62.2 +/- 24.7) (P < 0.001). A similar difference was found at discharge (Hchol 90.8 +/- 27.9 vs. NHchol 79.7 +/- 29.2, P < 0.001). However, total FIM change upon discharge was similar in both groups (18.7 +/- 13.7 vs. 17.6 +/- 13.7, P = 0.4). Regression analyses showed that high Mini Mental State Examination scores (beta = 0.13, P = 0.01) and younger age (beta = -0.12, P = 0.02) were associated with higher total FIM change scores upon discharge. Total cholesterol was not associated with better total FIM change on discharge (beta = -0.012, P = 0.82). CONCLUSIONS: Elderly survivors of stroke with Hchol who were admitted for rehabilitation showed higher admission and discharge FIM scores but similar functional FIM gains as compared to NHchol patients. High cholesterol levels may be useful in identifying older individuals with a better rehabilitation potential.

The association between Norton scale gain and functional outcome among older hip fracture patients.

AIM: This study examines interrelations between gains of Norton Scale Score (NSS) and functional outcome measured by Functional Independence Measurement (FIM) among older hip fracture patients. DESIGN: Retrospective study. METHODS: We examined 227 patients consecutively hospitalized in a geriatric postacute rehabilitation ward. The data were collected during 2012-2017. Data were analysed using Student's t test, chi-square test, Pearson's correlation coefficient and linear regression. RESULTS: Patients with positive NSS gains demonstrated statistically significant higher total FIM, motor FIM and total FIM gain scores at hospital discharge, compared with patients showing no NSS gains or negative NSS. Multiple regression analysis indicated that positive NSS gains were independently predictive for higher total FIM and motor FIM scores at hospital discharge and higher motor FIM gains at discharge. CONCLUSION: Our results suggest that positive NSS gains are associated with higher FIM scores at hospital discharge and may assist in predicting the functional outcome of hospitalized older hip fracture patients.

[The bacteriological profile of bacteriuria in residents of a long-term geriatric facility].

BACKGROUND: Little is known on the bacteriological profile of consecutive urine samples in elderly patients institutionalized in nursing homes. AIM: This retrospective study aims to characterize urinary pathogens, rates of isolation of the same pathogen in subsequent urine samples and predicting factors associated with such repeated isolations. Data were retrospectively retrieved from medical charts of nursing home patients during a four-year period. The authors looked for changes in rates of positive cultures, changes in urine flora, in rates of repeated isolation of the same pathogens and the possible interrelations with the use of antibiotics. METHODS: A total number of 3229 urine cultures were studied, 1311 of which (43%) were positive and 493 out of these positive cultures (37.6%) were treated with antibiotics. The rates of positive cultures increased consistently during the study period (p=0.003). E. coli (68.1%), Klebsiella pneumoniae and Proteus mirabilis accounted for more than 90% of positive cultures. RESULTS: There was no difference with regard to pathogen types isolated from symptomatic or asymptomatic cases. The rates of recurrent bacteriuria, by the same pathogen isolated at baseline urine culture, were similar in treated and untreated cases. A regression analysis aiming to predict factors associated with subsequent positive cultures had negative results, except for cases of untreated bacteriuria with pseudomonas (CI 1.36-7.09, O.R. 3.11, p=0.006). CONCLUSION: Our data support earlier studies underscoring the need to carefully consider the role of antibiotics and for better clinical guidelines for the treatment of bacteriuria in this population.

Prerehabilitation alanine aminotransferase blood levels and one-year mortality rates in older adults following hip fracture.

Low alanine aminotransferase (ALT) blood levels prior to rehabilitation are associated with poor function in older adults following hip fracture. We hypothesized that low ALT blood levels prior to rehabilitation were also associated with one-year mortality in this population. Included were 456 older adults (age ≥ 60 years, 82.5% women) admitted for rehabilitation following hip fracture. ALT blood levels were documented between one and six months prior to rehabilitation. Excluded were patients with ALT blood levels over 40 IU/L possibly consistent with liver injury. The main outcome was all-cause mortality one year following rehabilitation admission. The study group included 142 (31.1%) patients with low (≤10 IU/L) ALT blood levels and the control group included 314 (68.9%) patients with high-normal (11-40 IU/L) ALT blood levels. Overall, 52 (11.4%) patients died within one year following rehabilitation admission. Compared with the control group, patients with low ALT blood levels had significantly higher 1-year mortality rates [17.6 vs. 8.6%, odds ratio 2.27, 95% confidence interval (CI) 1.27-4.08]. Cox regression analysis showed that low ALT blood levels prior to rehabilitation were associated with one-year mortality (hazard ratio 1.88, 95% CI 1.08-3.28) together with age (hazard ratio 1.06, 95% CI 1.02-1.11), independent of gender. However, this association was no longer significant following adjustment also for peripheral vascular disease, admission and discharge functional independence measure scores, albumin serum levels, and length of rehabilitation. In conclusion, low ALT blood levels prior to rehabilitation are associated with one-year mortality in older adults following hip fracture. They may be used when only age and gender are known.

Serum albumin levels predict cognitive impairment in elderly hip fracture patients.

The aim of this study was to investigate the possible interrelation of serum albumin levels and cognitive function of elderly hip fracture patients. The study involved 331 elderly patients with hip fractures, admitted for rehabilitation. Cognition was assessed by Mini-Mental State Examination (MMSE). MMSE scores less than 24 points were considered suggestive of cognitive impairment. Age, serum albumin levels, and previous stroke emerged as the only statistically significant parameters differing between those with MMSE score less than 24 or higher. After adjusting for confounding variables, the middle and lowest tertiles of serum albumin levels were associated with an increased risk of cognitive impairment (odds ratio 1.97, 95% confidence interval 1.15-3.38, P < .01 vs 3.06 and 1.79-5.23, P < .001, respectively). This study shows that lower serum albumin levels are independently associated with lower MMSE scores in hip fractured elderly patients, supporting the possible role of chronic low-grade inflammation in age-related cognitive decline.

Aortic stenosis in elderly hip fractured patients.

Aortic stenosis (AS) and hip fractures are unrarely seen in elderly patients. The decision whether to operate these patients or not remains difficult. The present study examined the characteristics of such patients and the possible interrelations with management and outcome. This retrospective chart review study was conducted in a tertiary hospital during a 10-year period. We looked for demographic, clinical and echocardiographic characteristics of the patients, as well as their in-hospital course, compared with 100 hip fracture patients without AS. We identified 71 patients with AS hospitalized for acute hip fractures, 62 out of whom were included in the final analysis. Mean age of AS patients was 85.9+/-7.4. Mean and peak AV gradient were 35.8+/-16.3 and 59.0+/-26.7 mmHg, respectively. Mean valve area was 0.97+/-0.64. Fifty-six AS patients (91%) were operated. Rate of major in-hospital complications was 8% compared with 3.6% in non-AS patients. In-hospital mortality was 6.5% compared with 3.3% in non-AS patients (p=0.01), respectively. One-year mortality was 17.7% (11/62) among AS patients and 16.1% in non-AS patients. Death of AS patients was not interrelated with age, gender, pre-fracture function or echocardiographic data (mean and peak AV gradients, ejection fraction and valve area). We conclude that surgery of hip fractured elderly with AS was associated with increased rate of major complications and in-hospital mortality rates, compared with controls; however, 1-year mortality rate was similar in both groups. It remains to be determined whether a more careful medical and surgical management of such patients will result in less eventful hospital course.

Functional Outcome of Elderly Hip Fracture Patients Is Not Affected By Prefracture Dementia.

OBJECTIVE: The aim of the study was to examine whether a diagnosis of prefracture dementia (PFD) affects functional outcome at discharge from a geriatric rehabilitation setting. DESIGN: A total of 211 consecutive elderly hip fracture patients were evaluated retrospectively. We used the Functional Independence Measure (FIM) and analyzed data by t test, χ(2) test, and multiple linear regression analysis. RESULTS: Patients with PFD were older (P = 0.001), presented with lower Mini-Mental State Examination scores (P < 0.001) and lower prefracture function (P < 0.001). Total-FIM and motor-FIM scores at admission and discharge, as well as FIM gain scores at discharge, were lower among patients with PFD, compared with nonprefracture dementia (NPFD) patients (P < 0.001). The FIM daily gains (efficiency) (P < 0.001) and Montebello relative functional scores (P < 0.001) were also lower in PFD, compared with patients with NPFD. However, linear regression analysis showed that PFD did not predict total, motor, or FIM gain at discharge (ß = -0.11, P = 0.115; ß = -0.06, P = 0.412; ß = -0.099, P = 0.329, respectively). Upon discharge, patients with PFD achieved lower FIM scores yet maintained similar motor-FIM gains compared with patients with NPFD. CONCLUSIONS: Our study results supports the inclusion of patients with PFD in postfracture rehabilitation programs.

Alanine aminotransferase blood levels and rehabilitation outcome in older adults following hip fracture surgery.

Low alanine aminotransferase (ALT) blood levels are associated with frailty and poor outcome in older adults. Therefore, we studied the association between ALT blood levels before rehabilitation and rehabilitation outcome in older adults following hip fracture surgery. A total of 490 older adults (age>60 years, mean age: 82.9±6.7 years, 82.0% women) admitted to rehabilitation following hip fracture surgery were included. The rehabilitation outcome was assessed by Functional Independence Measure (FIM) scores. ALT blood levels were documented between 1 and 6 months before rehabilitation. Patients with ALT blood levels over 40 IU/l possibly consistent with liver injury were excluded. The cohort was divided into two groups: patients with ALT more than 10 IU/l and patients with ALT less than or equal to 10 IU/l. Upon rehabilitation discharge, the FIM outcome measures (motor, cognitive, gain, efficiency) were significantly higher in patients with ALT more than 10 IU/l relative to patients with ALT less than or equal to 10 IU/l (P<0.05). A logistic regression analysis adjusted for age and sex showed that patients with ALT more than 10 IU/l were more likely to have higher (second to fourth upper quartiles) total FIM scores (>50), cognitive FIM scores (>16), and FIM efficiency (>0.228) upon rehabilitation discharge (odds ratio=1.56-1.78). However, this association was no longer significant following adjustment also for admission total FIM score, cognitive impairment, cancer, and albumin serum levels. High-normal ALT blood levels before rehabilitation are associated with a better rehabilitation outcome in older adults following hip fracture surgery. It may be used when data on admission FIM score, cognitive impairment, cancer, and albumin serum levels are not available.

Infection-related hypoglycemia in institutionalized demented patients: a comparative study of diabetic and nondiabetic patients.

Hypoglycemia is common in elderly community dwelling patients and may accompany episodes of acute infection. We analyzed the interrelations of clinical variables with infection-related hypoglycemia (IRH) and its outcome in institutionalized demented elderly patients, with and without diabetes mellitus (DM). This is a retrospective cohort study involving residents of a large long term-care facility. We measured demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. We identified 65 elderly patients with IRH and compared data of 33 diabetic patients with 32 nondiabetic patients. Mean age of patients was 77.7 years and mean Mini-Mental score of 1.8. Diabetic patients were younger, more cognitively impaired, had a lower functional score (nonsignificant differences), but presented with more comorbidities, compared with nondiabetics (p=0.004). Mean blood glucose levels in diabetics and nondiabetics were 53.2 and 54.3 mg/dl, respectively. Only 22% of the patients showed clinical signs indicating hypoglycemia. Multivariate analysis showed that, in groups, comorbidity and functional status, creatinine, albumin, C-reactive protein (CRP) and total cholesterol were all associated with IRH. During a 6 months period, 58% (38/65) of the patients died, out of whom 47% (18/38) died within one month following the documentation of IRH. There were no statistically significant differences in short and late mortality rates between patients with and without DM. we conclude that asymptomatic IRH in institutionalized demented elderly is frequently associated with common respiratory and urinary infections, in both diabetic and nondiabetic patients. IRH seems to indicate a poor general health status rather than being the cause of death. Blood glucose needs to be screened in this population during common infections, also in nondiabetics, to identify patients at high risk.

Functional outcome of ischemic stroke: a comparative study of diabetic and non-diabetic patients.

BACKGROUND AND PURPOSE: Diabetes is associated with more ischemic strokes and diabetic patients have up to a three-fold increased risk for suffering a stroke, compared with non-diabetics. The aim of this study is to evaluate whether diabetes mellitus may also affect the functional outcome of patients with acute ischemic stroke, undergoing post-acute care rehabilitation. METHODS: A retrospective charts analysis of consecutive older patients with acute ischemic stroke admitted for rehabilitation at a tertiary hospital with post-acute care geriatric rehabilitation wards. Functional outcome of diabetics and non-diabetics was assessed by the Functional Independence Measurement scale (FIM) at admission and discharge. Data were analysed by t-tests, Pearson correlation, and Chi-square test, as well as by linear regression analysis. RESULTS: A total number of 527 patients were admitted, of whom 39% were diabetics. Compared with non-diabetics, diabetic stroke patients were slightly younger (p = 0.0001) but had similar admission FIM scores. FIM gain parameters (total FIM gain, motor FIM gain, daily total and motor FIM gains) upon discharge were similar in both groups. A linear regression analysis showed that higher MMSE scores (beta = 0.08; p = 0.01) and higher admission total FIM scores (beta = 0.87; p < 0.001) predicted higher total FIM scores upon discharge. Diabetes mellitus was not interrelated, whatsoever, with better total FIM scores upon discharge (beta = -0.03; p = 0.27). CONCLUSIONS: The findings suggest that there is no difference in the functional outcome of diabetic and non-diabetic patients, presenting for rehabilitation after acute ischemic stroke. Diabetes should not be considered as adversely affecting rehabilitation of such patients.

Mini-Suffering State Examination: suffering and survival of end-of-life cancer patients in a hospice setting.

The objective of this study was to evaluate suffering of end-of-life cancer patients during their final hospice stay and the possible interrelations with survival. A cohort of consecutive patients hospitalized in an inpatient cancer hospice of a tertiary hospital was used for this study. Patients were evaluated upon admission and once weekly by the Mini-Suffering State Examination (MSSE). The distribution of patients for each MSSE score group, changes in MSSE scores (total and for each item of scale), and MSSE interrelation with clinical parameters associated with patients' condition during hospitalization were studied. In addition, the interrelation of MSSE score and survival was examined. Documentation of a high suffering level by the MSSE scale helps in identifying end-of-life cancer patients expected to benefit from enrollment in a hospice setting, provides quantitative information about various symptom dimensions, and may improve medical management and facilitate communication between these patients and caregivers.

Lumbar spine surgery in Israeli Arabs and Jews: a comparative study with emphasis on pain perception.

BACKGROUND: Surgery for spinal stenosis is a frequent procedure in elderly patients. Presentation, hospital course, and outcome of disease including pain perception may vary among patients of different ethnic origin. OBJECTIVES: To evaluate whether differences in various medical indicators can explain differences in pain perception between two ethnic groups. METHODS: We conducted a case-control study on the experience of two spinal units treating a mixed Arab and Jewish population, and compared the data on 85 Arab and 189 Jewish patients undergoing spinal lumbar surgery. RESULTS: Arab patients were younger (P = 0.027), less educated (P < 0.001), had a higher body mass index (P = 0.004) and included a higher proportion of diabetics (P = 0.013). Preoperative pain intensity (P = 0.023) and functional disability (P = 0.005) were more prominent, and factors associated with pre- or postoperative pain perception differed between the two ethnic groups. Despite these differences, results on follow-up were similar with respect to pain perception and level of disability. CONCLUSIONS: A better understanding of ethnic differences is crucial for predicting surgery outcomes.

Olfactory function in oncologic hospice patients.

INTRODUCTION: Normal sense of smell is important for well being. Although cancer is reported to be associated with impaired olfactory function, very few studies have directly evaluated this effect. PATIENTS AND METHODS: We performed a quantitative analysis of olfactory status in 42 hospice patients in a hospital-based hospice facility. Olfaction was assessed using the "Sniffin' Sticks" (Burghart Medical Technology, Tinsdaler, Germany) kit. RESULTS: Twenty-five patients (60%) were found to be hyposmic. CONCLUSION: Study results indicate the high incidence of decreased olfactory function among hospice patients.

High dose controlled-release oxycodone in hospice care.

Controlled-release oxycodone (OxyContin) is commonly used for pain relief in terminal cancer. This opioid may be considered as a treatment option for patients who prefer oral pain control, but who are unwilling to take oral morphine sulphate or cannot tolerate its side effects. However, little is documented about the use of high doses of this drug in terminal cancer patients. The purpose of this study was to investigate the clinical characteristics of terminally ill hospice inpatients treated with OxyContin for pain, and to compare those patients receiving high-dose OxyContin (150 mg/day) with patients taking low and more typical doses. This retrospective chart analysis with parallel groups included records of 97 consecutive terminal cancer patients. We recorded clinical and demographic data, as well as data regarding daily doses, rescue doses and parameters associated with quality of life. The mean daily OxyContin dose was 78.6 mg per day for all patients. Only 18 (18.55%) patients were treated with high doses (mean daily dose 231.1 mg). No statistically significant correlations were found between any of the deomographic parameters and dose ranges, with the exception of patients with painful bony metastases who consumed significantly higher doses (p = 0.008). No differences were observed in sleep quality or mood as a factor of OxyContin doses. However, compared with patients receiving low-dose (OR 1.0), patients treated with moderate and high doses maintained Karnofsky scores higher than 40 points most of the time (OR = 3.77, CI 1.1-13.0 and OR 4.95, CI 0.8-29.9, respectively). Survival was not related to OxyContin doses (Log Rank test, p = 0.12; Breslow test, p = 0.37). We conclude that the use of high dose OxyContin for terminal cancer pain management is safe, efficient, and unrelated to shorter survival times. The results suggest that health care professionals may use higher OxyContin doses, when indicated, to enable better pain relief and quality end-of-life care.

Pre-stroke dementia does not affect the post-acute care functional outcome of old patients with ischemic stroke.

AIM: The purpose of the present study was to evaluate whether a diagnosis of dementia before stroke onset (pre-stroke dementia [PSD]) affects the short-term functional outcome of elderly ischemic stroke patients. METHODS: This was a retrospective case-control study comprising of consecutive elderly ischemic stroke patients. Functional outcome was assessed by the Functional Independence Measure scale (FIM) at admission and discharge. Data was analyzed by t-test, χ(2) -test, multiple linear regression analysis and logistic regression. RESULTS: There were 919 patients with acute ischemic stroke, out of whom 11.5% were diagnosed with PSD on index day. Compared with non-PSD patients, those with pre-stroke dementia had a shorter length of stay (P < 0.001), higher rate of female patients (P < 0.001) and lower Mini-Mental State Examination scores (P < 0.001). Both total and motor FIM scores at admission and discharge, and their respective FIM gain scores at discharge were higher in non-PSD compared with PSD patients (P < 0.001). In logistic regression analysis to identify factors predicting successful outcome (defined as total FIM at discharge ≥80), PSD remained as significantly associated with increased risk for adverse outcome on discharge (OR 2.449, CI 1.207-4.970, P = 0.013). CONCLUSIONS: The present findings suggest that a diagnosis of pre-stroke dementia is associated with lower FIM scores at admission and discharge in patients with ischemic stroke. Yet, daily motor FIM gains were similar in PSD and non-PSD patients, suggesting that these patients should not be deprived of a post-acute rehabilitation, based on a diagnosis of dementia before stroke onset. Geriatr Gerontol Int 2016; 16: 928-933.

Does Polypharmacy in Nursing Homes Affect Long-Term Mortality?

OBJECTIVES: To investigate the association between polypharmacy and mortality in nursing home (NH) residents. DESIGN: Prospective observational cohort study. SETTINGS: Six NHs in central Israel. PARTICIPANTS: Mobile with dementia and fully dependent residents (N = 764; n = 558 (73%) fully dependent, n = 206 (27%) mobile residents with dementia requiring institutional care; mean age 82.2 ± 5.9). MEASUREMENTS: Two-year mortality and its association with number of drugs that individual residents were taking at baseline, controlled for multiple confounders. RESULTS: At baseline, 268 residents were taking five or fewer drugs per day, 202 were taking six or seven, and 294 were taking eight or more. In the multivariate analysis, the likelihood of dying within 2 years in the group taking six or seven drugs per day (odds ratio (OR = 0.95, 95% CI = 0.63-1.43) and in those taking eight or more (OR = 1.20, 95% CI = 0.78-1.84) was similar to that of those taking five or fewer. Variables at baseline independently associated with greater mortality were male sex (OR = 1.75, 95% CI = 1.24-2.46), older age (OR = 1.07, 95% CI = 1.04-1.10), higher Charlson Comorbidity Index (OR = 1.17, 95% CI = 1.04-1.30), and taking anticoagulant (OR = 1.78, 95% CI = 1.01-3.13) or antihyperglycemic medication (OR = 1.69, 95% CI = 1.12-2.53). Variables at baseline independently associated with lower mortality were higher body mass index (OR = 0.99, 95% CI = 0.93-0.99) and taking lipid-lowering medication (OR = 0.54, 95% CI = 0.36-0.80) and selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors (OR = 0.52, 95% CI = 0.37-0.75). CONCLUSION: Polypharmacy, defined quantitatively according to number of drugs, was not associated with mortality in these NH residents.

Endonasal geometry changes in elderly people: acoustic rhinometry measurements.

BACKGROUND: Skeletal nasal changes in elderly people have been extensively investigated, but data on variation of the endonasal architecture with age do not exist. We evaluated endonasal parameters in an elderly population as compared with those in a young group. METHODS: Acoustic rhinometry measurements were performed on 165 participants in the age range of 20-93 years. The rhinograms provided the endonasal volume from the nostril entrance to a 7.0 cm cephalic point (V0-7) and the minimal cross-sectional areas (MCA1 and MCA2). Statistical analysis was performed by Pearson correlation and one-way analysis of variance, using age as a continuous or categorical variable. RESULTS: There was no statistical difference in gender distribution within each age group. The results obtained for the left and right nostrils were similar. Endonasal volume V0-7 and the narrowing areas MCA1 and MCA2 significantly increase with age, except for men over 80 years in which a relative decrease was observed. CONCLUSION: Acoustic rhinometry examination of the endonasal architecture in a healthy young and elderly population demonstrated a gradual increase of endonasal volumes and minimal cross-sectional areas with age.

Antiepileptic drug use and the occurrence of pressure ulcers among bedridden institutionalized elderly patients: a retrospective chart review.

BACKGROUND: Phenytoin (PH) is indicated primarily for the control of grand mal and psychomotor seizures. However, topical PH has been used for the treatment of various types of ulcers, including pressure ulcers. OBJECTIVE: The aim of this study was to investigate the possibility of a relationship between the use of oral PH and the prevalence of pressure ulcers among bedridden institutionalized elderly patients. METHODS: This retrospective chart review was conducted in a state-run urban geriatric medical center in Israel and involved long-term bedridden institutionalized patients who were receiving chronic antiepileptic medication during the 7-year period between January 1996 and December 2003. The prevalence of pressure ulcers in patients who received treatment with PH alone or in combination with other antiepileptic drugs was compared with that in patients who received antiepileptic agents other than PH. RESULTS: The study analyzed data from the medical charts of 153 patients, 72 of whom received PH alone or in combination with other antiepileptic drugs, and 81 of whom received antiepileptic agents other than PH. Patients' mean (SD) age was 78.5 (7.2) years; 106 (69.3%) were women. All patients were totally dependent with respect to activities of daily living (mean Katz score, 2.0 [2.0]) and had severe cognitive decline (mean Mini-Mental State Examination score, 3.5 [3.3]). Pressure ulcers occurred in 9.7% of PH recipients and 27.2% of non-PH recipients (P = 0.006; chi2 = 7.55). In PH recipients, 85.7% of pressure ulcers were of mild to moderate severity (stage I or II), compared with 59.1% of ulcers in non-PH recipients; the difference between groups was not statistically significant. Four (18.2%) non-PH recipients and no PH recipients had stage IV pressure ulcers. In the PH group, 71.4% of patients had a pressure ulcer in only 1 anatomic location, compared with 22.7% of the non-PH group (P = 0.023; chi2 = 5.13); 28.6% of PH recipients and 63.6% of non-PH recipients had pressure ulcers in 2 or 3 anatomic locations; and 3 (13.6%) non-PH recipients and no PH recipients had pressure ulcers in > or = 4 areas. CONCLUSIONS: In the long-term bedridden institutionalized patients studied, those who received PH had lower rates of pressure ulcers, as well as less severe ulcers. PH may be a useful anticonvulsive agent in frail elderly patients, who are at risk for the development of pressure ulcers.