Taste acuity in institutionalized and noninstitutionalized elderly men

Taste detection thresholds were determined in young men (18 to 25 years of age, n = 15), noninstitutionalized elderly men (63 to 88 years of age, n = 17), and institutionalized elderly men (61 to 92 years of age, n = 15). The technical procedure utilized a single blind format. The tastants were presented to the subjects in a multiple forced-choice sample presentation with an ascending series. Additional testing conditions included adequate oral hygiene, 10 ml of tastant, timed intervals, and deionized water rinses. The major findings were that sour, salt, and bitter thresholds increased with age. Sweet threshold did not change with age. The institutionalized elderly men had significantly higher sour detection thresholds when compared with the noninstitutionalized elderly men. The use of salt and tobacco had no apparent effect on detection thresholds for sweet, salt and bitter, but medication ingestion elevated the sour thresholds. Elderly subjects on antihypertensive medications had significantly higher salt detection thresholds.     

Latitude of choice and well-being in institutionalized and noninstitutionalized elderly

While important positive effects on the psychological and physical well-being of the elderly often result from increased perceived and actual personal control, the literature also reflects many inconsistent findings. The lack of consensus on aging and the psychology of control has been variously attributed to differences in methodology, measurement devices, theoretical assumptions and the impact of moderator variables. To help bring order to this area the present study evaluated the Latitude of Choice model to determine whether Latitude of Choice scores differ across living arrangements, gender or age. Analysis of covariance tests, controlling for measures of education, perceived health and economic satisfaction, yielded significant main effects but no significant interactions. Partial correlations between Latitude of Choice and measures of psychological well-being, for the total sample and each of the main effect samples, were all significant. These findings provide substantive support for the theoretical approach that underlies Latitude of Choice as a measure of personal control of everyday activities and the potential value of personal control as a moderator of well-being in different environments.     

Cognitive and mnemonic information processing in institutionalized and noninstitutionalized elderly patients

Older subjects (institutionalized in a home for the aged and non-institutionalized) were compared in a test battery according to the recommendations of the NINCDS-ADRA. The institutionalized subjects were not distinguishable from the controls when only a small amount of information was to be processed or when the information had to be recalled with no distraction. Possible reasons for the observed differences are discussed.     

Dental status and mortality in institutionalized elderly people

Background:   Inadequate dentition for mastication is one of the major issues associated with systemic health for institutionalized elderly people, but its prognostic value and related deaths have not been fully examined.
Methods:   Four hundred and three patients aged 65 and older were recruited from nine nursing homes and were prospectively followed up for morbidity and mortality for 5 years in Japan. These patients were classified into three groups according to dental status: patients who had adequate dentition with natural teeth only or natural teeth with partial dentures (Group A); those who were edentulous but wearing full dentures (Group B); and those who had inadequate dentition without dentures (Group C).
Results:   Dental status was strongly related to age, cognitive function and activities of daily living. After allowing for confounding effects, the 2-year risk of mortality among those in Group C was 1.84 times that of Group A (95% confidence interval 1.01–3.36, P  = 0.047). Furthermore, the 5-year mortality rate in Group C was higher than that in Group A, whereas that was not significant with a hazard ratio of 1.30 (0.90–1.88, P  = 0.168). The main causes of death were respiratory infections, which explained 14.1% of all causes of death in Group A, 14.3% in Group B and 18.3% in Group C. Any associations between a specific cause of death and the different dental status did not reach a significant level.
Conclusion:   Inadequate dental status is associated with high overall mortality. Our findings suggest that systemic attention to dental status should be recommended in institutionalized elderly people.     

Oral mucosal disorders in institutionalized elderly people

The aim of the study was to investigate the type and incidence of oral mucosal disorders in the elderly, any relationship between these disorders and the wearing of dentures, and the associated subjective symptoms of pain. The subjects were 480 residents of 24 municipal old people's homes in different parts of Finland: 153 males and 327 females, age range 65-100 years. The methods used were clinical examination and interview. Clinical examination showed about 60% of the elderly to have one or more oral mucosal disorders. Altogether, 431 pathological conditions were recorded, with changes of the surface of the tongue the most frequent. Hyperplasia and/or denture-related ulcerations and press-points were found in 43% of denture wearers. The interviews revealed that only 17% of those with oral mucosal disorders had symptoms of pain, most frequently caused by press-points and ulcerations. The absence of subjective symptoms emphasizes the importance of frequent oral examinations, especially of the oral mucosa.     

Frequency of mandibular dysfunction symptoms in institutionalized elderly people.

Mandibular dysfunction symptoms were found in 74% of 375 elderly persons, aged 65 or over, 79% of the women and 59% of the men (p less than 0.001). 36% had one symptom, 26% two symptoms, 8.5% three symptoms, and 3% 4--5 symptoms. The most frequent were the temporomandibular joint (TMJ) sounds (48%). Deviation of mandible on opening and/or closing movement was found in 44%, in women more often than men (p less than 0.05). The frequency of limited opening was 14%, higher among women than men (p less than 0.05). Tenderness to palpation laterally over the TMJ was observed in 14%. 7% reported pain on opening movement, women more often than men (p less than 0.01).     

Relationship between eating dysfunction and life span and mortality in institutionalized elderly people

AIM: The aim of this study was to evaluate the relationship between eating disorders and anticipated life span stage and mortality in institutionalized elderly people. METHODS: Ninety-eight elderly residents (mean 86.3 +/- 5.9 years) at a nursing home were selected for investigation of the date and cause of death. Inclusion was limited to those who died within one week from admission to the institution/hospital. Data on 11 potential prognostic factors were analyzed: underlying disease, activity of daily living (ADL), disorder of anticipatory stage, swallowing function, need for feeding assistance, weight decrease rate in the part 6 months, body mass index (BMI), minimum nutritional assessment (MNA), occlusal status, age and sex. These 11 factors were analyzed by Kaplan-Meier survival curve, and either the log-rank or Wilcoxon test was used to analyze significant differences in survival days in subjects with and without the factors listed above. Moreover, the regression analysis was made using Cox proportional-hazards model, a nonlinear multivariate analysis, to extract factors contributing greatly to short survival days. RESULTS: The survival days showed significant differences in six factors; ADL, disorder of anticipatory stage, swallowing function, need for feeding assistance, BMI and MNA. Three factors were shown to be related to a significantly shorter mortality by the Cox proportional-hazards model: disorder of anticipatory stage (hazard rate = 2.85, 95% CI = 1.04-7.83), swallowing function (hazard rate = 2.90, 95% CI = 1.06-7.91) and BMI (hazard rate = 2.54, 95% CI = 1.00-6.44) were involved in. CONCLUSION: This study speculated that an appropriate response with a focus on feeding training may possibly contribute to prolong the mortality of elderly people.     

Caregiver and environmental variables related to difficult behaviors in institutionalized, demented elderly persons.

This study describes the relationship between caregiver and elder behavior in institutionalized, cognitively impaired, elderly persons. A repeated-measures design was used to observe interactive behaviors between caregivers and demented elders within three caregiving situations (dressing, toileting, and bathing) and an interpersonal contact in two long-term care facilities. During observations, the caregiver's behaviors were rated using the Interaction Behavior Measure and Health Professional's-Geriatric Patient Behavior Rating scale, whereas the elder's behaviors were rated using a modified version of the Interaction Behavior Measure. The study included 116 subjects (58 elders and 58 caregivers), with each unique caregiver/elder pair being observed in the four situations. All elder behaviors varied according to situation type, with the most difficult elder behaviors occurring during bathing. Ten of the 12 caregiver behaviors included in the analysis varied by situation type. Significant relationships were systematically found between the caregiver's relaxed and smiling behavior and the elder's calm/functional behaviors, r = .42 (dressing) to r = .46 (toileting) for caregiver relaxed behavior and r = .34 (bathing) to r = .58 (dressing) for smiling. The elder's behavior did not vary by type of nursing unit (special dementia unit or general nursing unit), or interruptions to the interaction.     

Physical training in institutionalized elderly people with multiple diagnoses--a controlled pilot study

Reduction in muscle mass and physical function depends on a variety of interacting factors: age, physical activity level, nutritional state and the type and impact of disease. The aim of this study was to investigate the effect of an individualized moderate intensity physical training program on muscle strength, balance, mobility, ambulation and activities of daily living (ADL) in institutionalized elderly people aged 65 and over with multiple diagnoses. Baseline assessments consisted of strength, balance, mobility/ambulation, and ADL. Twenty-one subjects were included in the intervention program. A control group (21 subjects) was first matched in pairs according to gender, age, ADL and mobility, and then by balance, ambulation and strength. The intervention program was individualized and included strength, mobility, balance and endurance training. Follow-up measures were conducted directly after the intervention and 10 weeks later. After drop-out, 20 subjects in the intervention group and 15 subjects in the control group remained for analyses. Balance and mobility improved significantly in the intervention group while declining in the control group. This pilot study indicates that a physical training program may improve functional capacity for institutionalized elderly persons with multiple diagnoses.     

Are elderly people less responsive to intensive care?

Older patients may be excluded from intensive care units because of the perception that they will benefit less than younger patients. To determine if advanced age is associated with increased mortality independent of severity of illness, we compared older and middle-aged patients admitted to a medical intensive care unit. We reviewed the charts of 130 patients age 75 years or older and 135 patients age 55 to 65 admitted over a 30-month period. We controlled for severity of illness using the Acute Physiology Assessment and Chronic Health Evaluation (APACHE II) system without including points for age (APACHE IIM). The groups were similar with regard to gender, whether or not they had a private attending physician, mean APACHE IIM score, and diagnoses, except that older patients had more chronic obstructive pulmonary disease. Hospital stay was slightly longer in the older group (37 vs. 39 days, rank sum, P less than .02). Hospital mortality was significantly greater in the older group (39% vs. 51%, Chi-square P less than .05) with a crude relative risk of 1.32 (95% confidence interval [CI]: 1.01, 1.73). However, the relation of age group to mortality differed for patients with different diagnoses. When we used logistic regression to adjust for APACHE IIM, whether the patient had a private attending physician, primary admitting diagnosis, or presence of cancer, older patients did not have a significantly greater risk of dying (adjusted relative risk, 1.05; 95% CI: 0.97, 1.12). When pulmonary artery catheterization was added to the model, it independently predicted mortality adjusted relative risk, 1.47; 95% CI: 1.05, 2.06.(ABSTRACT TRUNCATED AT 250 WORDS)     

Social and psychologic factors related to falls among the elderly

Studies on falls are reviewed. Little information exists on which social or psychologic factors predispose an older person to fall or to sustain a fall-related injury. Risk of falling appears to be greater among females, the cognitively impaired, and those who use hypnotics, tranquilizers, and diuretics. The potential significance of depression and senile dementia of the Alzheimer's type on the risk of falling is explored. It is suggested that because of the associated impaired judgment, distraction, and psychomotor retardation, the presence of either clinical condition may increase an individual's risk of falling. In the final section of the article, directions for future research are discussed. Development of a systematic research program is suggested including epidemiologic studies of all falls and of medically treated falls. Such studies should be multidisciplinary and include assessment of social and psychologic factors as well as physical and functional health status, ambulatory function, perceptual acuity, and the circumstances surrounding the fall. The psychologic consequences of falling, particularly in the absence of a serious fall-related injury, is identified as an important research area.     

Sexuality and the institutionalized elderly

Sexuality is considered to be among the more disturbing sexual problems in skilled nursing facilities. Staff attitudes and beliefs often lead to discomfort in dealing with the continued sexual interests of patients. It is clear that if sexuality has been an important part of self-image and of coping, then it remains important. Staff reaction to two cases is used to illustrate the need for programmatic interventions with staff, residents, and families.     

Prevalence of peripheral arterial disease and related risk factors in elderly institutionalized subjects.

Blood pressure was measured at the posterior tibial artery by Doppler ultrasonography in 124 elderly subjects (37 men and 87 women) living in two retirement homes in Naples (Italy). Ankle-to-arm systolic pressure ratios below 0.97 and 0.90 was considered as a probable and definite pathological sign of peripheral arterial disease, respectively. Half of the subjects (48% of men and 51% of women) gave a value below 0.97, while a third (35% of men and 33% of women) had a value below 0.90. By multiple regression analysis, mean blood pressure, plasma cholesterol levels and cigarette smoking were all negatively correlated with ankle systolic pressure values with a progressively lower significance. Most of the patients with pathological Doppler examination were asymptomatic at a questionnaire for intermittent claudication.     

The reclassification of elderly people following admission to residential aged care

Objectives: To determine the incidence of, and factors associated with, the reclassification of level of care needs of older people following admission to a residential aged care facility (RACF) in Tasmania. Method: Focus group discussions with 11 Directors of Nursing of RACFs were conducted to inform the development of a questionnaire, which was administered to all residential aged care providers in the State. Results: More than 10% of elderly people admitted to a RACF in Tasmania are subject to a reclassification from high to low care or vice versa within 60 days of admission. The study also revealed a number of variables associated with reclassification. Conclusions: Reclassification of residents is often considered to be a ‘significant problem’. To reduce the incidence of reclassification many RACFs conduct their own assessments. Dementia, admission of hospital inpatients and greater than 6 months since an ACAT assessment represent the key predictors of reclassification.     

老年医学与衰弱老年人的医疗服务

目的 随着年龄的增长.人们发生多种健康问题的可能性增大.这些问题可被称作健康缺陷.健康缺陷越多.越容易引发健康方面的不良后果,例如健康状况恶化,甚至死亡.所渭衰弱,是指能够增加不良健康后果的危险的身体状态.健康缺陷度越高,身体衰弱度就越大.在临床上,通过临床衰弱量表-09的使用,可以对衰弱度进行逐级描述(此量表是加拿大健康与衰老研究课题所设计使用的临床衰弱量表的修订版).衰弱导致了健康问题的复杂化.由于老年人的健康问题较为复杂,而临床服务一般只侧重于诊治单一的问题,造成对老年患者的服务不够全面.老年专科医生应该是能够综合处理复杂问题的专家,应擅长诊治并存多种健康问题的老年患者.充分了解和认真研究健康需求的复杂性问题,老年专科医生才能最有效地帮助那些身体衰弱的老年患者.模式识别就是对付老年疾病复杂性的一种重要手段,它借助于老年综合性评估和对实际发病的衰弱老年人所表现出的症状特征的识别而加以实现.