Abnormal behavior of elderly people residing in institutions of medical and social welfare systems

Abstract We investigated factors correlated with abnormal behavior in the elderly residing in a special nursing home (group A) and a psychiatric hospital (group B) using the dementia behavior disturbance scale, the mini mental state examination, the Japanese version of the Philadelphia Geriatric Center morale scale, and the ADL assessment scale. The cognitive function of group B was decreased compared with that of group A, but most activities of daily living (ADL) in the latter group were disrupted compared with those in the former. Only a few categories of ADL correlated with abnormal behavior in group A, whereas cognitive function, quality of life, and most categories of ADL correlated with abnormal behavior in group B. These results suggest that factors correlated with abnormal behavior in the elderly differ within institutions of medical and social welfare systems.     

上海市某社区老年慢性病人对日常生活功能综合影响分析

目的 研究上海市某社区老年人慢性病对日常生活功能（ＡＤＬ和ＩＡＤＬ）的影响。方法 问卷询问和体格检查相结合,对上海市某社区９６６名≥６０岁的老年人进行慢性病和日常生活功能调查。运用非条件Ｌｏｇｉｓｔｉｃ回归分析慢性病对老年人日常生活功能损害作用的大小。结果 慢性病患病率为５７．８％,ＡＤＬ损害率为９．４％,ＩＡＤＬ损害率为２３．２％。对ＡＤＬ损害影响显著的疾病依次为脑血管疾病、白内障和慢性阻塞性肺部疾患;对ＩＡＤＬ损害影响显著的疾病依次为脑血管疾病、冠心病和慢性阻塞性肺部疾患。结论 慢性病患病率高低与老年人日常生活功能损害率无对应关系,而受疾病性质、严重程度和躯体活动能力影响较大;对老年人日常生活功能损害作用显著的疾病的分布有一定地区性。     

Problem solving,sense of coherence and instrumental ADL of elderly people with depression and normal control group

The purpose of this study was first, to explore the separate contribution and interaction between verbal and performance based problem solving and sense of coherence; and second, to examine the association of these variables with Instrumental Activities of Daily Living (IADL) function among elderly people with depression living in the commuinity and a normal control group. The participants included elders receiving ambulatory care for depression (n=31; mean age=73, SD=9.3); and normal elders (n=30; mean age=78, SD=5.8). Screening for general cognitive ability and level of depression was done using the Mini Mental Status Examination (MMSE) and the Geriatric Depression Scale (GDS). All participants underwent evaluation using the Large Allen Cognitive Level Test (LACL) (a measure of performance based problem solving); the Problem Solving Verbal Reaction to everyday problematic situations (PSVR); the Sense of Coherence questionnaire (SOC) and the Routine Task Inventory (RTI) (a measure of IADL from the cognitive perspective). Wilcoxon statistical analysis indicated highly significant differences between the two groups for all of the study variables. In the depressive group, significant correlations were found between the components of problem solving (LACL and PSVR) and IADL (r=0.70 and r=0.53), while the SOC did not correlate with IADL in either group. Results of ANCOVA controlling for LACL showed that it has a significant effect (F=13.63, p=0.001); however, beyond it verbal problem solving still has a significant effect on IADL (F=4.77, p=0.02), and SOC in interaction with verbal problem solving was significant (F=3.97, p=0.035). The findings suggest that depression in elderly people is associated with lower functioning in problem solving and IADL function, and lower sense of coherence; hence, attention to these factors should be integral to intervention with elderly people. However, it is recommended that further study be made of the relationships of variables found in this study with the current instruments, and also with additional tools because of confounding effects, in order to further support and validate the findings. As the sample size was small compared with the number of measures, it is important to replicate the study with larger groups to have more power. Copyright © 1999 Whurr Publishers Ltd.     

前列地尔治疗急性中重型脑梗死的疗效观察

目的观察前列地尔注射液对超过治疗时间窗的急性中重型脑梗死的疗效和安全性。方法采用随机对照方法,将发病2～7d的30例大脑中动脉区中重型脑梗死按1∶2比例分配,对照组10例应用对症治疗的中性疗法,治疗组20例则加用前列地尔注射液治疗。均治疗14d。结果治疗组神经功能缺损减分率、ADL评分、治疗有效率均优于对照组,有显著性差异(P<0.025,P<0.0005,P<0.005);在治疗中未发现明显不良反应。结论前列地尔注射液对急性中重型脑梗死有明显疗效,药物安全性能良好,有一定临床推广应用价值。     

血抗栓汤内服联合西医治疗急性脑梗死疗效分析

目的观察活血抗栓汤联合奥扎格雷钠治疗急性脑梗死疗效。方法将80患者按抽签法分为观察组和对照组各40例。对照组奥扎格雷钠氯化钠注射液,500 mL/次,2次/d,静滴,治疗2周。治疗组在对照组基础上加用活血抗栓汤,水煎200 mL,1剂/d,2次/d,治疗2周。观测临床症状、神经功能、日常生活能力、凝血功能。结果治疗后,观察组红细胞聚集指数、血细胞容积、纤维蛋白原、全血高切黏度、血浆比黏度改善程度高于对照组(P<0.05)。治疗前,两组ADL评分、NIHSS评分比较,无显著差异(P>0.05),治疗后,观察组NIHSS评分低于对照组,ADL评分高于对照组(P<0.05)。结论血抗栓汤内服联合西医治疗急性脑梗死,可改善凝血功,值得推广。     

注射用丹参多酚酸治疗急性脑梗死的疗效观察

目的 观察注射用丹参多酚酸治疗急性脑梗死的临床疗效。方法 选取2017年6月—2018年6月安阳市第六人民医院治疗的急性脑梗死患者200例作为研究对象,将患者分为对照组和观察组,每组各100例。对照组给予抗血小板聚集、清除及抗自由基等治疗脑梗死的常规药物治疗,观察组在对照组治疗的基础上静脉滴入注射用丹参多酚酸,130 mg稀释于0.9%氯化钠溶液250 mL,1次/d。两组均治疗2周。比较两组患者治疗前后的美国国立卫生研究院卒中量表（NIHSS）和日常生活活动能力（ADL）评分,并观察两组患者的临床疗效。结果 治疗后,两组NIHSS评分明显下降,ADL评分明显提升,同组治疗前后比较差异具有统计学意义（P<0.05）;治疗后,观察组NIHSS评分明显低于对照组,ADL评分明显高于对照组,两组比较差异具有统计学意义（P<0.05）。治疗后,观察组总有效率为95%,明显高于对照组的71%（P<0.05）。结论 注射用丹参多酚酸应用于急性脑梗死患者的治疗疗效确定,可在很大程度上改善患者肢体运动功能和神经功能,提高日常生活质量,值得临床广泛推广使用。     

并用脑蛋白水解物治疗小儿脑瘫的疗效

目的 :观察并用脑蛋白水解物注射液 (丽珠赛乐 )治疗小儿脑性瘫痪 (CP)的疗效。方法 :在全国 19个医疗单位应用统一诊断标准 ,对观察组 10 5 0例及对照组 2 80例CP患儿予以物理疗法、针灸、按摩、高压氧等治疗 ,观察组患儿同时静脉滴注丽珠赛乐。用统一标准测评治疗前后 2组发育商和ADL评分 ,对比有效率及疗程长短间的差异。结果 :观察组疗效明显高于对照组 (P <0 .0 0 5 ) ;7个疗程治疗有效率高于 3个疗程 (P <0 .0 5 ) ;轻、中度患儿疗效最佳 (P <0 .0 0 5 )。结论 :并用丽珠赛乐注射液可增加CP的治疗效果。     

影响脑卒中患者日常生活活动能力社区康复效果的相关因素

目的探讨影响脑卒中患者日常生活活动能力（ADL）社区康复效果的相关因素。方法202例脑卒中患者随机分为社区康复组103例和对照组99例，社区康复组进行康复治疗和随访，包括对高危因素的药物控制、康复治疗、卫生宣教、心理疏导等，对照组只进行随访。于入组时和治疗5个月后，应用巴氏指数（BI）、神经功能缺损量表及综合功能评定（FCA）中的认知项，对两组患者进行评定。将所有患者最后一次ADL评分作为因变量，分组情况、病程、高血压、高血脂、糖尿病、吸烟、发病部位、文化程度、性别、年龄、饮酒、睡眠质量、FCA认知功能（入组时）、FCA运动功能（入组时）、BI（入组时）、神经功能缺损程度评分（入组时）做为自变量，进行多元回归分析。结果分组情况、发病前是否饮酒、病程（入组时间早晚）、神经功能缺损评分及综合功能评分（运动功能和认知功能）与患者日后的ADL恢复存在相关性。结论早期社区康复治疗对提高脑卒中患者的ADL作用显著；认知障碍对患者的ADL有显著影响。     

影响脑卒中患者躯干控制能力的相关因素分析

目的探讨脑卒中不同病变性质和损伤半球对躯体控制能力的影响及躯干控制能力与认知功能、日常生活能力的相关性。方法75例住院脑卒中患者分为A组（右脑出血）15例、B组（右脑梗死）25例、C组（左脑出血）14例和D组（左脑梗死）21例，于康复治疗前及治疗1个月后进行简明认知功能评定（MMSE）、躯干控制能力评定（Sheikh）和改良Brathel指数（MBI）评定。结果治疗前，A组、C组患者的Sheikh、MBI评分低于B组、D组（P〈0．05～0．001）；治疗后．4组患者的MMSE、Sheikh、MBI评分均有提高，但A组、C组患者的提高幅度更大。Sheikh评分左、右半球病变患者间差异无显著性意义。Sheikh评分与MBI在治疗前后均高度相关，与MMSE评分在治疗前无相关，但治疗后部分相关。结论脑出血患者较脑梗死患者躯体控制能力受损大，但康复治疗后恢复也较快；左右半球卒中对躯体控制能力损害无差异；躯体控制能力与日常生活活动能力在康复治疗前后高度相关，与认知功能在康复治疗前无相关性，但治疗后有相关性。     

Secondary Prevention of Cardiovascular Disease in Older Adults

Atherosclerotic cardiovascular disease is extremely common in older adults and the potential benefits of secondary prevention are perhaps greater in this population than in younger patients. While there is good evidence that secondary prevention efforts are justified in patients up to 80 years of age, limited data are available on secondary prevention in octogenarians and there is no evidence to guide treatment in patients ≥ 90 years of age. Further, the value of secondary prevention may be confounded by prevalent comorbidities, polypharmacy, and limited life expectancy. It is therefore essential that all management decisions be made in relation to individual preferences and goals of care, with understanding by patients that benefits as well as risks may increase with age. Furthermore, research is needed to refine markers to better delineate which older adults are most likely to benefit from preventive therapies.