| 1. |
- Brännström, Benny, et al.
(författare)
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ADL performance and dependency on nursing care in patients with hip fractures and acute confusion in a task allocation care system
- 1991
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 5:1, s. 3-12
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Tidskriftsartikel (refereegranskat)abstract
- In a prospective study 35 patients operated on for cervical hip-fractures were followed with respect to Acute Confusional State (ACS), problems of basic nursing care and dependency on care-givers. Fifteen patients became acutely confused after the fracture. They turned out to be more dependent on help from others than the non-confused patients were even before the fracture. They rapidly reached a significantly higher level of dependence than the non-confused patients and remained on that level throughout the study month. Six months after the fracture the post-operatively confused patients were still highly dependent on care-givers, significantly more than they were before the fracture. Only three of them were not hospitalised. All the non-confused patients lived in their own homes six months after the fracture and had regained the same level of independence as before it. These findings will be discussed in relation to the organisation of the nursing care. Task allocation nursing care was applied in the wards. A model for the development of dependency in acutely confused hip-fracture patients will be presented and suggestions for how to reduce nurse/patient dependency induced by nursing care will be made
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| 2. |
- Ericsson, Kjerstin, et al.
(författare)
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The short human figure drawing scale for evaluation of suspect cognitive dysfunction in old age
- 1994
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 19:3, s. 243-51
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Tidskriftsartikel (refereegranskat)abstract
- Human figure drawings have been widely used to assess cognitive development in children. In the present study, free-hand human figure drawings were examined for 62 demented patients, and 60 normal elderly subjects. The drawings were scored for 53 body details using a method derived from work with children. A short scale of 15 details was developed by selecting body details with high item-total correlations which are simple to score even for untrained staff. This short scale had excellent interscorer and test-retest reliability and excellent concurrent validity as well. It correlated highly with the Mini-Mental State Examination, a commonly used screening test for dementia. The short scale discriminated demented and non-demented subjects and different levels of dementia severity as graded by the Clinical Dementia Rating Scale. However, no differences were observed between Alzheimer patients and patients with vascular dementia concerning presence of details in human figure drawings.
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| 3. |
- Gustafson, Yngve, et al.
(författare)
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A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures
- 1991
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 39:7, s. 655-662
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the effect of a geriatric-anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre- and post-operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri-operative blood pressure falls and treatment of post-operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P less than 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post-operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P less than 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay
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| 4. |
- Gustafson, Yngve, 1949-
(författare)
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Acute confusional state (delirium) : clinical studies in hip-fracture and stroke patients
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Acute confusional state (ACS) or delirium according to DSM-III-R holds a central position in the medicine of old age. ACS is a common and sometimes the only symptom of diseases and medical complications in the elderly patient.The aim of this study was to elucidate ACS in patients with femoral neck fractures and patients with acute stroke with regard to frequency, predictors, possible pathogenetic mechanisms, associated complications, assessment and documentary routines and the clinical outcome for the patients. An intervention program to prevent postoperative ACS based on our results was developed and evaluated.The main findings of the study were high frequencies of ACS in elderly patients with femoral neck fractures (61 %) and in patients with acute stroke (48 %). The main risk factors for ACS in patients with femoral neck fractures were old age, diseases and drug treatment interfering with cerebral cholinergic metabolism. There was no link between anaesthetic technique and ACS but the connection between peroperative hypotension, early postoperative hypoxia and ACS was close.In stroke patients the degree of extremity paresis and old age were independent ACS risk factors. ACS was commonly associated with post stroke complications such as myocardial infarction, pneumonia, urinary infection and urinary retention. In stroke patients there was a close connection between high hypothalamic-pituitary-adrenal axis (HPA-axis) activity and ACS. High HPA-axis activity and disturbances in the cerebral cholinergic system may be two important ACS mechanisms.A correct diagnosis is a prerequisite for proper treatment of ACS and its underlying causes. In the orthopaedic wards both physicians and nurses diagnosed and documented ACS poorly and therefore associated complications were insufficiently treated.The intervention program for postoperative ACS, aimed mainly at protecting the cerebral oxidative metabolism and thereby the cerebral cholinergic metabolism which is especially sensitive to hypoxia. Postoperative complications associated with ACS were also treated. The intervention resulted in reduced frequency, duration and severity of postoperative ACS and in shorter orthopedic ward stay for patients with femoral neck fractures.Key words: Acute confusional state, delirium, elderly
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| 5. |
- Gustafson, Yngve, et al.
(författare)
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Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients
- 1991
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 39:8, s. 760-765
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: To determine the accuracy of diagnosis and documentation of acute confusional states (ACS) in the medical records of patients with hip fracture. DESIGN: The diagnosis of ACS in two prospective clinical studies was compared to its diagnosis in the medical records of the same patients on the same hospitalization. In order to determine if the simultaneous prospective study influences the diagnostic and documentary practices evidenced in the medical records, a further comparison was done by reviewing medical records of two series of patients seen some years prior to the prospective studies. SETTING: Patients with femoral neck fractures treated at a department of orthopedic surgery in a university hospital and one retrospective control sample from a department of general surgery in a county hospital. SUBJECTS: Two prospective samples of patients 65 years and older treated for femoral neck fractures (n = 111 and n = 57, respectively) and two earlier retrospective samples (n = 66 and n = 68, respectively). MEASUREMENTS AND MAIN RESULTS: All comparisons showed that both physicians and nurses diagnosed ACS unsatisfactorily and documented the patients' mental status poorly. The analysis of the two retrospective medical record control samples gave the same results. Neither the physicians nor the nurses used any kind of diagnostic instrument to detect cognitive disorders in the patients. CONCLUSIONS: ACS is a common and severe complication in elderly people treated for femoral neck fractures. Acute confusional states have, by definition, one or more causes that can often be identified and treated. Poor assessment and documentation is a threat to the patients as a correct diagnosis of ACS is a prerequisite for further assessment of its underlying causes and the consequent necessary medical and nursing care.
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