Risk factors for coronary artery disease in persons older than 62 years in a long-term health care facility

A history of smoking 5 to 60 cigarettes per day, hypercholesterolemia (fasting total serum cholesterol 200 mg/dl or more), history of systolic (160 mm Hg or more) or diastolic (90 mm Hg or more) hypertension, diabetes mellitus (fasting venous plasma glucose 140 mg/dl or more) and obesity (at least 20% above ideal body weight) were correlated with coronary artery disease (CAD) in 138 men (mean age 82 +/- 8 years) and 380 women (mean age 82 +/- 8 years) in a long-term health care facility. CAD occurred in 43 of 138 men (31%) and in 103 of 380 women (27%), difference not significant. A history of smoking 5 to 60 cigarettes per day significantly correlated with CAD in men (p less than 0.001) but not in women. Hypercholesterolemia significantly correlated with CAD in both men (p less than 0.001) and women (p less than 0.005). A history of systemic hypertension significantly correlated with CAD in women (p less than 0.001) but not in men. Diabetes mellitus did not significantly correlate with CAD in men or women but weakly correlated with CAD in men plus women (p less than 0.05). Obesity did not significantly correlate with CAD in men or women. Hypercholesterolemia, a history of smoking 5 to 60 cigarettes per day, and a history of systemic hypertension were considered major risk factors. Having 2 or 3 major risk factors correlated with CAD significantly better than having no or 1 major risk factor in both elderly men (p less than 0.001, p less than 0.01) and women (p less than 0.001).     

Risk factors for new atherothrombotic brain infarction in older African-American men and women

Independent risk factors for new atherothrombotic brain infarction (ABI) in older African-American men were hypertension (risk ratio 4.381), diabetes mellitus (risk ratio 2.872), and previous ABI (risk ratio 1.904). Independent risk factors for new coronary events in older African-American women were cigarette smoking (risk ratio 2.754), hypertension (risk ratio 5.914), diabetes mellitus (risk ratio 3.464), serum total cholesterol (risk ratio 1.008), serum high-density lipoprotein cholesterol (inverse association) (risk ratio 0.958), age (risk ratio 1.026), and previous ABI (risk ratio 2.601).     

Risk factors for new atherothrombotic brain infarction in older Hispanic men and women.

BACKGROUND: We report the prevalence and incidence of atherothrombotic brain infarction (ABI) in older Hispanic men and women in a long-term health care facility. METHODS: The prevalence and incidence of ABI and the association of risk factors with new ABI were investigated in 201 Hispanic men, mean age 79 +/- 8 years, and in 302 Hispanic women, mean age 80 +/- 9 years, in a long-term health care facility. Mean follow-up was 42 +/- 20 months in men and 47 +/- 26 months in women. RESULTS: The prevalence of prior ABI was 33% in Hispanic men and 30% in Hispanic women. The incidence of new ABI was 24% in Hispanic men and 23% in Hispanic women. Significant independent risk factors for new ABI were age (risk ratio = 1.09 in men and 1.08 in women for each increase of 1 year of age), current cigarette smoking (risk ratio = 2.8 in men and 2.7 in women), hypertension (risk ratio = 2.8 in men), diabetes mellitus (risk ratio = 3.5 in men and 5.0 in women), prior ABI (risk ratio = 5.6 in men and 5.5 in women), serum total cholesterol (risk ratio = 1.03 in men and 1.01 in women for each 1 mg/dl increase), and serum high-density lipoprotein (HDL) cholesterol (risk ratio = 1.06 in men and 1.06 in women for each 1 mg/dl decrease). CONCLUSIONS: Significant independent risk factors for new ABI were age, current cigarette smoking, diabetes mellitus, prior ABI, serum total cholesterol, and serum HDL cholesterol (inverse association) in older Hispanic men and women and hypertension in older Hispanic men.     

Two years of infection surveillance in a geriatric long-term care facility

Prospective infection surveillance was carried out for 2 years on two selected units of an 800-bed geriatric long-term care facility. Information was obtained by discussion with attending medical and nursing staff members, chart review, and review of laboratory data. Unit A houses 47 ambulatory Home for the Aged (nursing home) residents (70% female) with a mean age of 89 years. Unit B, for patients requiring chronic hospitalization, houses 32 residents (60% female) with a mean age of 77 years. The infection rates per 1000 patient-days on units A and B were 1.77 and 9.45, respectively. The higher infection rate on unit B was probably due to the presence of a more debilitated patient population. The most common sites of infection on both units were respiratory tract, urinary tract, skin, and soft tissue. The major goals of surveillance in long-term care facilities should be to aid in early detection of outbreaks and to identify preventable endemic infections. Definitions of infection and methods of surveillance that take into account the unique characteristics of elderly subjects residing in long-term care facilities with relatively limited resources need to be developed.     

Increased plasma homocysteine is an independent predictor of new atherothrombotic brain infarction in older persons

A prospective study investigated the association of plasma homocysteine and other risk factors with the incidence of atherothrombotic brain infarction (ABI) at 31 +/- 9 month follow-up in 153 men and 347 women (mean age 81 +/- 9 years, median age 82). The stepwise Cox regression model showed that significant independent predictors of new ABI in older persons were age (risk ratio 1.060 for each 1-year increase of age), plasma homocysteine (risk ratio 1.079 for each 1 micromol/L increase), prior ABI infarction (risk ratio 3.282), current cigarette smoking (risk ratio 2.687), hypertension (risk ratio 2.965), and diabetes mellitus (risk ratio 2.015).     

Tuberculosis surveillance in a long-term care facility

The prevalence of tuberculous infection in residents of a large nursing facility in New York City was assessed. The population was predominantly female (80%) and white (86%), with almost one-half (49%) being foreign born. The mean age of the group was 86.1 years. Four hundred and fifty-five residents were given tuberculin skin tests using the two-step Mantoux test procedure. The prevalence of tuberculous infection was 27.5% with only slight differences being noted between the native-born (28.8%) and foreign-born (26.1%) residents. A 10% booster effect was noted. Tuberculous infection rates were higher in non-white than white residents. A progressive decline in the prevalence of tuberculous infection was noted with increasing age. No cases of tuberculosis were detected. Our study provides a model for collecting and evaluating epidemiologic data to assess infection prevalence and tuberculosis transmission in a long-term care facility.     

Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors

OBJECTIVES: To quantify the prevalence, risk factors, and mode of transmission associated with colonization by multidrug-resistant gram-negative bacteria (MDRGN) in the long-term care (LTC) setting.
DESIGN: Cross-sectional.
SETTING: Four nursing units in a 648-bed LTC facility in Boston, Massachusetts.
PARTICIPANTS: Eighty-four long-term care residents.
MEASUREMENTS: Nasal and rectal swabs were obtained to determine colonization with MDRGN; if present, molecular typing was performed. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) was also determined. Demographic and clinical characteristics were obtained from the medical record. Multivariable analysis was used to identify factors independently associated with MDRGN colonization.
RESULTS: A total of 51%, 28%, and 4% subjects were colonized with MDRGN, MRSA, and VRE, respectively. After multivariable adjustment, advanced dementia (adjusted odds ratio (AOR)=2.9, 95% confidence interval (CI)=1.2–7.35, P =.02) and nonambulatory status (AOR=5.7, 95% CI=1.1–28.9, P =.04) were the only independent risk factors for harboring MDRGN. Molecular typing indicated person-to-person transmission.
CONCLUSION: Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.     

Risk factors for pancreatic stone formation in autoimmune pancreatitis over a long-term course

Background

Autoimmune pancreatitis (AIP) has the potential to progress to a chronic state that forms pancreatic stones. The aim of this study was to clarify the risk factors underlying pancreatic stone formation in AIP.

Methods

Sixty-nine patients with AIP who had been followed for at least 3?years were enrolled for evaluation of clinical and laboratory factors as well as computed tomography and endoscopic retrograde cholangiopancreatography findings.

Results

During the course of this study, increased or de novo stone formation was seen in 28 patients, who were defined as the stone-forming group. No stones were observed in 32 patients, who were defined as the non-stone-forming group. Nine patients who had stones at diagnosis but showed no change during the course of this study were excluded from our cohort. Univariate analysis revealed no significant differences in clinical or laboratory factors associated with AIP-specific inflammation between the two groups. However, pancreatic head swelling (P?=?0.006) and narrowing of both Wirsung’s and Santorini’s ducts in the pancreatic head region (P?=?0.010) were significantly more frequent in the stone-forming group. Furthermore, multivariate analysis identified Wirsung and Santorini duct narrowing at diagnosis as a significant independent risk factor for pancreatic stone formation (OR 4.4, P?=?0.019).

Conclusions

A primary risk factor for pancreatic stone formation in AIP was narrowing of both Wirsung’s and Santorini’s ducts, which most presumably led to pancreatic juice stasis and stone development.