| 41. |
- Lundström, Maria
(författare)
-
Delirium in old patients with femoral neck fracture : risk factors, outcome, prevention and treatment
- 2004
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Delirium is probably the most common presenting symptom of disease in old age. Delirium, as defined in DSM-IV, is a neuropsychiatric syndrome characterized by disturbance in attention and consciousness, which develops over a short period of time and where the symptoms tend to fluctuate during the course of the day. The overall aim was to increase knowledge about the risk factors and outcome of delirium in old patients with femoral neck fracture and to develop and evaluate a multi-factorial intervention program for prevention and treatment of delirium in these patients.In a prospective study of 101 consecutive patients with a femoral neck fracture, 29.7% were delirious before surgery and another 18.8% developed delirium postoperatively. Of those who were delirious preoperatively all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and seemed to have more postoperative complications, such as infections. Patients with preoperative delirium had a poorer walking ability on discharge compared to patients with postoperative delirium only.In a five-year prospective follow up study 30 out of 78 (38.5%) non-demented patients with a femoral neck fracture developed dementia. Twenty out of 29 (69%) who were delirious postoperatively developed dementia compared to 10 out of 49 (20%) who were not delirious during hospitalization (p<0.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years compared to 17/49 (34.7%) of those who remained lucid postoperatively (p=0.001).A non-randomized multi-factorial intervention study with the aim of preventing and treating delirium among patients with femoral neck fracture (n=49) showed that the incidence of delirium was significantly lower than reported in previously published studies. The incidence of other postoperative complications was also lower and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge.A similar multi-factorial intervention program evaluated as a randomized controlled trial including 199 femoral neck fracture patients showed that fewer intervention patients than controls suffered postoperative delirium (56/102, 55% vs. 73/97, 75%, p=0.003). For intervention patients the postoperative delirium was also of shorter duration (5.0±7.1 days vs. 10.2±13.3 days, p=0.009). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from significantly fewer in-hospital complications, such as decubital ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0±17.9 days vs. 38.0±40.6 days, p=0.028).In conclusion, pre- and postoperative delirium is common and seems to be associated with various risk factors, which require different strategies for prevention and treatment. Delirium is also associated with the development of dementia and a higher mortality rate. Multifactorial intervention programs can successfully be implemented and result in the reduction of delirium, fewer complications and shorter hospitalization.
|
|
| 42. |
- Lundström, Maria, et al.
(författare)
-
Dementia after delirium in patients with femoral neck fractures.
- 2003
-
Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 51:7, s. 1002-1006
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate whether delirium in older patients with femoral neck fractures is associated with an increased risk of developing dementia and a higher mortality rate.DESIGN: A 5-year prospective follow-up study.SETTING: Department of Orthopedic Surgery at the University Hospital in Umeå, Sweden.PARTICIPANTS: Seventy-eight nondemented patients aged 65 and older operated on for femoral neck fractures were followed for 5 years.MEASUREMENTS: The patients were assessed using the Organic Brain Syndrome (OBS) Scale pre- and postoperatively. Medical and social data were collected from the patients, their caregivers, and medical records, and the survivors were visited and assessed with the OBS Scale and the Mini-Mental State Examination in their homes 5 years after the fracture.RESULTS: Thirty of 78 (38.5%) nondemented patients with a femoral neck fracture developed dementia within a 5-year period. Twenty of 29 (69%) who were delirious postoperatively developed dementia, compared with 10 of 49 (20%) who were not delirious during their hospital stay (P <.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years, compared with 17 of 49 (34.7%) of those who remained lucid postoperatively (P =.001).CONCLUSION: Delirium in nondemented femoral neck fracture patients is associated with the development of dementia and a higher mortality rate. Patients with preoperative or postoperative delirium should therefore be assessed not only for the etiology of the delirium but also for any underlying organic brain disorder. Questions that remain unanswered are whether postoperative delirium is a marker of undetected dementia and whether postoperative delirium contributes to the development of dementia.
|
|
| 43. |
- Wilhelmson, Katarina, 1958
(författare)
-
Longer life - better life? Studies on mortality, morbidity and quality of life among elderly people
- 2003
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Life expectancy has been increasing, but whether or not the added years are years with good health and quality of life have been vividly debated. Knowledge of the health conditions among elderly is of increasing importance.Aim:- To analyse differences in mortality and morbidity in three cohorts of 70-year olds with special regard to the impact of social factors. - To compare health information from interviews and medical records. - To investigate what elderly people consider being important for their quality of life. - To determine predictors for suicide among the old elderly (75+).Methods: Paper I and II: Random samples of 70-year old people born in 1901/02 (n=973), 1906/07 (n=1036) and 1911/12 (n=619). They were examined and interviewed regarding social background, social network and health. Death records were obtained up to and including 1998. Paper III-V: 85 elderly suicide cases (65 years of age and above) and 153 randomly selected control persons were interviewed in persons or by proxy, and their medical records were reviewed.Results: The later born cohorts had lower mortality compared to the first-born cohort. Participants not living in an institution, non-smokers and those with one or more diseases were among those who had lower mortality in the later born cohorts. There were fewer 70-year olds not feeling healthy, fewer having many symptoms and there were indications of better physical functioning in the later born cohorts. Medical records gave better information concerning specific diseases, while interview data provided better measures of impairments. Elderly persons consider health, social relations, functional ability and activities to be important to the quality of life. Family discord, severe physical illness, loneliness and depression were risk factors for suicide in the old elderly. Conclusions: Good years seem to have been added - although we live longer with diseases. More good years can be gained with improvements in life style behavior and with continued improvements in health services and medical treatment. It is important to recognize and treat depressions among elderly people, especially in the context of severe illness and impairment.
|
|
| 44. |
- Steen, Bertil, 1938, et al.
(författare)
-
Anthropometry and body composition
- 2004
-
Ingår i: To become old: The Gerontological and Geriatric Population Studies in Göteborg, Sweden 1971-2002 Editor: Bertil Steen. - Göteborg : Göteborg University. - 9163171821 ; , s. 33-40
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 45. |
- Andersson, Edith, et al.
(författare)
-
Acute confusional state in elderly orthopaedic patients: factors of importance for detection in nursing care
- 2001
-
Ingår i: International Journal of Geriatric Psychiatry. - 1099-1166. ; 16:1, s. 7-17
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aims of this study were to identify factors of significance in the development of acute confusional state (ACS) and the differences between patients who developed ACS and those who did not. METHOD AND RESULTS: Assessment, observations and interviews with 505 patients admitted to an orthopaedic clinic revealed that 51 patients developed ACS during their in-hospital stay. Patients admitted for hip fracture had a higher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthros or gonarthros (3.6%). The highest hazard ratio for ACS was several other physical diseases 15.94 (CI: 4.60-55.31 and p-value <0.00001) and the lowest was age 1.10 (CI: 1.04-1.15 and p-value <0.0002). The ACS lasted from 1 to 9 days, and patients had one (N=42), two (N=8) or three episodes (N=1) of confusion during their stay on the ward. More patients who developed ACS before surgery had two or more confusional episodes and emergency patients developed ACS more rapidly. The ACS lasted longer in patients with a higher score on the OBS scale at admittance and with rapid development of ACS. CONCLUSIONS: Acuteness in the situation seems an important risk indication for ACS in the elderly. Awareness of factors associated with the development of ACS makes it possible to more systematically identify those at risk, for instance by systematic assessment in the first interview with the patient on admission to hospital.
|
|
| 46. |
- Bergman, Birgitta, 1941
(författare)
-
On vision in old age. A longitudinal study of subjects 70 to 97 years old
- 2003
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims. The main purpose of this study was to investigate different aspects of vision and visual function in old people, like change in vision and visual ability, to study the natural course of eye diseases, assess needs of visual intervention, investigate risk factors for ocular disorders late in life, and also to investigate coexistence between visual and hearing impairments. Materials and Methods. Within the framework of the Gerontological and Geriatric Population Studies, the H70 Study , launched 1971 in Göteborg, Sweden, a cohort comprising 958 subjects at the start of the study was eye-examined longitudinally at ages 70, 82, 88, 95, and 97 years. At ages 95 and 97, cross-sectional groups were added to extend the sample. Audiological and laboratory data were analysed in connection with the ophthalmological examinations.Results. At age 70, best-corrected normal vision (VA ³0.8) was found in 86%, at age 82 in 48%, at age 88 in 24%, and at age 95 in 8% of subjects. At age 97, severe visual impairment (VA £0.1) was found in every third subject. The deterioration rate (i.e., logMAR change per year) was faster in the highest age interval. At age 82, the visual ability score correlated with distance VA (r = 0.62). In subjects with no pathological findings, median VA was 0.9 at age 82 and 0.8 at age 88. Geographic atrophy was more common than exudative late ARM. At 97 years 30% had undergone cataract surgery. The benefit of regular eye examinations, improvement of glasses, and early cataract surgery was assessed. At age 70, blood folate levels, and physical activity earlier, correlated positively, and body mass index (BMI) correlated negatively, to VA ³0.8 at ages 82 and 88. Higher BMI at 70 correlated to cataract disease at age 88, and smoking at age 70 correlated to early ARM at age 82. Mild impairments of vision and hearing increased from 2% at age 70 to 22% at age 82.Conclusions. In old age, gradual deterioration of vision is encountered. Regular eye screening, with improvement of glasses, and/or cost-effective cataract surgery, should be performed early to increase the time of improved vision. Lifestyle variables may prospectively correlate to future eye health and vision. Combined visual and hearing impairment can result in pronounced problems in everyday activities.
|
|
| 47. |
- Elfgren, Christina, et al.
(författare)
-
Subjective experience of memory deficits related to clinical and neuroimaging findings.
- 2003
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 16:2, s. 84-92
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate cognitive impairment, psychiatric symptoms and cerebral blood flow (CBF) patterns in middle-aged (35–64 years) and younger old patients (65–74 years) with subjective experience of memory deficits. The study group was heterogeneous with patients fulfilling criteria for dementia, as well as patients with mild cognitive impairment (MCI) and with non-verified cognitive impairment (non-MCI). Seventy per cent of the non-MCI patients reported long-lasting experiences of psychosocial stress tentatively causing the memory problems. The MCI patients were subdivided into two groups: MCI type 1 included patients with isolated memory impairment, while MCI type 2 included patients with memory impairment together with slight verbal and/or visuospatial impairments. CBF measurements comparing the two MCI groups with the non-MCI group were performed. The MCI type 2 showed reduced CBF in the left anterior medial temporal lobe as well as in parts of the posterior cingulate gyrus. The CBF pattern in MCI type 2 concurs with the pathophysiological process of Alzheimer’s disease. The results indicate that it is important to make a subdivision of MCI patients regarding the presence of isolated memory impairments or memory impairments together with other slight cognitive deficits.
|
|
| 48. |
|
|
| 49. |
|
|
| 50. |
- Gustafson, Lars, et al.
(författare)
-
Frontotemporal dementia – Differentiation from Alzheimer's disease
- 2004
-
Ingår i: Psychogeriatria Polska. - 1732-2642. ; 1:4, s. 279-292
-
Forskningsöversikt (refereegranskat)abstract
- Organic dementia is dominated by primary degenerative disorders such as Alzheimer’s disease (AD) and frontotemporal dementia (FTD). FTD is a distinct clinical syndrome with behavioural, personality, emotional and language disturbances preceding the cognitive decline. This clinical presentation is distinctly different from that of AD which is characterized by early cognitive changes, such as memory impairment, aphasia and apraxia, and a relatively preserved personality and behaviour. The differences between these two conditions reflect the predominant topographic distribution of brain pathology. The differences in clinical profiles and treatment strategies will be highlighted. In both disorders loss of functional ability, development of behavioural disturbances and dependency impose heavy demands on family and other caregivers. This presentation will concentrate on early recognition and diagnosis, using systematic clinical evaluation, neuropsychological testing and different brain imaging methods. This is important for a successful development of therapeutic strategies for both cognitive and behavioural symptoms in FTD and AD.
|
|
