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。     

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。     

作业疗法对脑卒中恢复期患者上肢功能与ADL相关性研究

目的 探讨作业治疗对脑卒中恢复期患者上肢运动功能康复效果与日常生活动作(ADL)之间的相关性.方法 61例患者接受作业治疗,采用Brunnstrom评定患者上肢的功能状况,用巴塞尔指数(BI)评定患者的ADL,应用Spearman相关性检验分析脑卒中恢复期患者上肢运动功能与ADL之间的关系.结果 训练前、后上肢及手的功能及手的实用性判定的功能显著改善(P＜0.001),上肢、手指功能、手的实用性判定与ADL存在中度的相关性(r=0.583～0.716),并呈正相关.Brunnstom分级太粗可能是影响上肢功能与ADL相关性的原因之一.结论 作业疗法对卒中恢复期患者上肢功能与ADL存在着正相关关系,可促进患瘫侧受损功能的恢复与健侧功能的代偿.     

综合康复治疗外伤性截瘫32例

目的观察外伤性截瘫的综合康复治疗的临床疗效。方法对32例外伤性截瘫患者在不同病期分别采用药物治疗、运动疗法、二便功能训练、中频电疗、电针等综合康复治疗,治疗前后采用Barthel指数法对患者的日常生活活动(ADL)能力进行评定。结果治疗后32例患者的Barthel指数评分均明显高于康复治疗前(P<0.05)。结论综合康复治疗外伤性截瘫疗效显著。     

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.     

IADL Ability Measured with the AMPS: Relation to two Classification Systems of Mental Retardation

The purpose of this study was to examine the relationship between the Assessment of Motor and Process Skills (AMPS) and two types of assessment of level of mental retardation. The subjects were 22 adults from the United States and 39 adults from Sweden, all diagnosed with mental retardation. The subjects in each group were divided into three subgroups according to their level of mental retardation. The level of mental retardation was determined according to established criteria used in each country. They were then assessed using the AMPS to evaluate motor and process (organizational and adaptive) skills necessary for competent IADL task performance. The results showed that different methods of determining the level of mental retardation showed patterns similar to motor and process skills. The correlations were strongest between the Swedish method of assessing level of mental retardation and the AMPS. The correlations were stronger between level of mental retardation and process skills in both the Swedish and US groups. The results indicate a relationship between level of mental retardation and IADL ability, despite differences in assessments of level of mental retardation. The study recommends the use of the AMPS as a valid and sensitive instrument of IADL ability in the development of intervention strategies in occupational therapy for persons with mental retardation. Further studies with the AMPS are suggested in order to evaluate IADL skills in this population.     

Significant junctures on the way towards becoming a user of assistive technology in Alzheimer's disease

Abstract

Objective: The aim of this study was to describe how persons in the early stages of Alzheimer's disease (AD) became users of assistive technology (AT), and what the use of AT came to mean to these users and, when relevant, their significant others. Methods: Persons with AD were provided with individually chosen AT during a six-month period. Semi-structured interviews were conducted during the intervention period. The data were analysed with a constant comparative approach. Results: On the way towards becoming a user of AT, four junctures were identified, at which significant decisions were made by the participants. These decisions influenced whether to become a user or not and related to how the initial decision was made, how the routines to incorporate the AT were adjusted, whether the participant trusted the AT, and whether the participants felt an increased sense of capacity when using the AT. As users, the participants perceived how time and effort was saved, how worries and stress decreased, and how their sense of safety increased, which enabled them to perform valued activities, e.g. health-promoting and social activities, to a greater extent and in a more relaxed way than before. Conclusions: The findings support the view that AT can positively affect the activity performance of people with AD when the potential user can identify difficulties and needs and is motivated and able to make changes to overcome them, given that appropriate human support is available.