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Latest & greatest articles for geriatrics
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Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. In a randomized, double-blind five-year trial, we tested the efficacy of simultaneously elevating serum levels of high-density lipoprotein (HDL) cholesterol and lowering levels of non-HDL cholesterol with gemfibrozil in reducing the risk of coronary heart disease in 4081 asymptomatic middle-aged men (40 to 55 (...) years of age) with primary dyslipidemia (non-HDL cholesterol greater than or equal to 200 mg per deciliter [5.2 mmol per liter] in two consecutive pretreatment measurements). One group (2051 men) received 600 mg of gemfibrozil twice daily, and the other (2030 men) received placebo. Gemfibrozil caused a marked increase in HDL cholesterol and persistent reductions in serum levels of total, low-density lipoprotein (LDL), and non-HDL cholesterol and triglycerides. There were minimal changes in serum
A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations. As part of a prospective, randomized, controlled study of the effectiveness of a geriatric consultation team, we examined compliance by the house staff with recommendations made by the team. Recommendations were formulated for 185 patients, aged 75 years or older, who were randomized into intervention (n = 92) and control (n = 93) groups. In the control group, only 27.1% of the actions (...) that would have been recommended by the team were implemented independently by the house staff. Problems commonly neglected included polypharmacy, sensory impairment, confusion, and depression. In the intervention group, overall compliance was 71.7%. Highest compliance occurred for recommendations addressing instability and falls (95.0%) and discharge planning (94.3%). We conclude that a geriatric consultation team contributes substantial additional input into the care of older patients. Furthermore
Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years. Report from a double-blind international multicenter study. In a randomized double-blind study (N = 562), a traditional treatment schedule, starting antihypertensive treatment in elderly hypertensive patients (60 to 75 years old) with 25 mg of hydrochlorothiazide once daily and doubling the dose if a satisfactory response was not achieved, was compared with antihypertensive treatment of 100 mg (...) symptom score or single symptoms between the regimens, but significantly more patients had hypokalemia and hyperuricemia with the hydrochlorothiazide regimen. Thus, we conclude that beginning antihypertensive treatment with 100 mg of metoprolol once daily and adding a small dose of hydrochlorothiazide (12.5 mg) in patients whose response is not satisfactory with metoprolol alone appears to be effective and safe in elderly hypertensive patients.
Efficacy of antihypertensive drug treatment according to age, sex, blood pressure, and previous cardiovascular disease in patients over the age of 60. Results of the European Working Party on High Blood Pressure in the Elderly (EWPHE) trial have been analysed in relation to age, sex, blood pressure, and previous cardiovascular disease. Cardiovascular mortality and the cardiovascular study-terminating events were significantly and independently related to treatment, age, cardiovascular (...) complications at randomisation, and systolic but not diastolic blood pressure. The benefits of treatment observed in the trial seemed to be independent of entry blood pressure and the presence or absence of cardiovascular complications at entry. There was some evidence that treatment effect decreases with advancing age. Little or no benefit from treatment could be demonstrated in patients over the age of 80 years, the great majority of whom were women.
Multifactorial primary prevention of cardiovascular diseases in middle-aged men. Risk factor changes, incidence, and mortality. In a randomized five-year multifactorial primary prevention trial of vascular diseases, hyperlipidemias, hypertension, smoking, obesity, and abnormal glucose tolerance of the high-risk test group (n = 612 men) were treated with dietetic-hygienic measures and hypolipidemic (mainly probucol and clofibrate) and antihypertensive (mainly diuretics and beta-blockers) agents
Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. A double-blind randomised placebo-controlled trial of antihypertensive treatment was conducted in patients over the age of 60. Entry criteria included both a sitting diastolic blood pressure on placebo treatment in the range 90-119 mm Hg and a systolic pressure in the range 160-239 mm Hg. 840 patients were randomised either to active treatment (hydrochlorothiazide + triamterene
1985LancetControlled trial quality: predicted high
Effectiveness of a geriatric evaluation unit. A randomized clinical trial. We randomly assigned frail elderly inpatients with a high probability of nursing-home placement to an innovative geriatric evaluation unit intended to provide improved diagnostic assessment, therapy, rehabilitation, and placement. Patients randomly assigned to the experimental (n = 63) and control (n = 60) groups were equivalent at entry. At one year, patients who had been assigned to the geriatric unit had much lower (...) improvement in functional status and morale than controls (P less than 0.05). Direct costs for institutional care were lower for the experimental group, especially after adjustment for survival. We conclude that geriatric evaluation units can provide substantial benefits at minimal cost for appropriate groups of elderly patients, over and above the benefits of traditional hospital approaches.
Continuity of outpatient medical care in elderly men. A randomized trial. P6 an outpatient repeatedly sees the same practitioner, is his care influenced? This double-blind randomized trial examines the effects of outpatient health care provider continuity on the process and outcome of the medical care for 776 men aged 55 years and older. Participants were randomized to two different groups of provider care: provider discontinuity and provider continuity. The outcome of the continuity group (...) was significantly different from that of the discontinuity group. During an 18-month period, patients who had been randomized to the continuity group had fewer emergent admissions (20% v 39%) and a shorter average length of stay (15.5 v 25.5 days). These patients also perceived that the providers were more knowledgeable, thorough, and interested in patient education. We conclude that continuity of outpatient provider care for men aged 55 years and older results in more patient satisfaction, shorter
Screening for subclinical osteomalacia in the elderly: normal ranges or pragmatism? Although osteomalacia is known to be common in some sections of the elderly population, the disease is often subclinical and there is uncertainty about the point at which treatment is necessary. Identification and treatment of osteomalacia are inseparably bound; the response of varying degrees of subclinical disease to treatment with vitamin D or alfacalcidol is described here. The response is assessed (...) in relation to a simply derived reference range based on standard biochemical measurements together with a Jamshidi needle biopsy of the iliac crest. Although this technique does not define a truly normal range it identifies a treatable abnormality which could form the basis of further study of the problem of subclinical osteomalacia in the elderly.
Bacteriuria in elderly institutionalized men. Over a two-year period we obtained monthly urine samples from all noncatheterized male residents on two geriatric wards to determine the occurrence and optimal management of bacteriuria in this population. Among 88 men the prevalence of bacteriuria was 33 per cent, and the incidence was 45 infections per 100 patients per year. Outcomes after single-dose therapy for asymptomatic bacteriuria with 43 courses of trimethoprim/sulfamethoxazole and 23 (...) randomization were similar in the two groups. These data suggest that asymptomatic bacteriuria is common in elderly institutionalized men and that therapy is neither necessary nor effective.
Safety and immunogenicity of a new Haemophilus influenzae type b vaccine in infants under one year of age. 64 healthy infants 2-3 months old, were randomly assigned to one of three vaccination groups which received either diphtheria-pertussis-tetanus (DPT) vaccine, Haemophilus influenzae type b capsular polysaccharide polyribosyl-ribitol phosphate (PRP) vaccine, or PRP + P (with pertussis adjuvant) vaccine in three doses at intervals of 2 months. Local and systemic reactions occurred most
A double-blind trial to assess long-term oral anticoagulant therapy in elderly patients after myocardial infarction. Report of the Sixty Plus Reinfarction Study Research Group. In a randomised double-blind multicentre clinical trial the effect of continued oral anticoagulant therapy after a myocardial infarction was assessed in a group of patients over 60 years of age. Half of the 878 patients who had been on anticoagulants ever since their primary myocardial infarction received placebos (...) treated group (p = 0.0001). The incidence of intracranial events was 5.6% in the placebo group and 3.1% in the group on anticoagulants (p = 0.18). Major haemorrhagic episodes were reported by 3 placebo patients and by 27 patients treated with anticoagulants. No fatal extracranial haemorrhages were seen. In this selected group of elderly patients, continuation of intensive and stable oral anticoagulant therapy substantially reduced the risk of recurrent myocardial infarction and thereby of cardiac
1980LancetControlled trial quality: predicted high
Clinical effects of vitamin C in elderly inpatients with low blood-vitamin-C levels. The effect of oral vitamin C has been examined in elderly long-stay inpatients known to have low levels of vitamin C in their plasma and leucocytes. 1 g of vitamin C given daily for 28 days was shown to be associated with slight, but significant, clinical improvement and weight-gain when compared with placebo therapy.
Five-year findings of the hypertension detection and follow-up program. II. Mortality by race-sex and age. Hypertension Detection and Follow-up Program Cooperative Group. Data are reported for four race-sex and three age subgroups of the Hypertension Detection and Follow-up Program (HDFP). Throughout the HDFP trial, for black men, black women, white men, and white women and for persons aged 30 to 49, 50 to 59, and 60 to 69 years at entry, control of blood pressure was consistently better (...) for Stepped Care (SC) than Referred Care (RC) participants. This difference in degree of control was least for white women; it was less for whites than for blacks of the same sex. For white men, black men, and black women and for age subgroups 50 to 59 and 60 to 69 years, five-year all-cause death rates were substantially lower--by 15% to 28%--for the SC subgroups compared to the RC subgroups.
Glucose intolerance during diuretic therapy. Results of trial by the European Working Party on Hypertension in the Elderly. 119 elderly, hypertensive patients were followed-up for 1 year and 48 for 2 years in a double-blind, randomised, controlled trial in which they received either placebo or 25-50 mg hydrochlorothiazide and 50-100 mg of triamterene daily. Half of the active treatment group also received 250 mg to 2 g methyldopa daily. After 2 years the active treatment group had an average
Effect of coronary bypass surgery on longevity in high and low risk patients. Report from the V.A. Cooperative Coronary Surgery Study. There is considerable uncertainty about the effects of bypass surgery on the longevity of patients with coronary-artery disease and angina. The Cleveland Clinic has reported improved survival after surgical treatment; the Duke University study indicated improvement in a high-risk subgroup only. The Veterans Administration (V.A.) randomised study initially (...) . excluded) was 93% for those treated surgically and 96% for those treated medically. For all patients the rates were 85% and 86%, respectively. These findings indicate that in the evaluation of the effects of bypass surgery on longevity the characteristics of the coronary-artery disease are critical.
) For mild/no symptomology it is unknown whether any intervention is appropriate. Bibliographic details Neuhauser D. Elective inguinal herniorrhaphy versus truss in the elderly. In: Bunker J P, Barnes B A, Mosteller F (eds). Costs, risks and benefits of surgery. New York, NY, USA: Oxford University Press. 1977 Indexing Status Subject indexing assigned by CRD MeSH Adult; Aged; Costs and Cost Analysis; Hernia, Inguinal /economics /surgery; Trusses /economics /therapeutic use AccessionNumber 21995005220 (...) Elective inguinal herniorrhaphy versus truss in the elderly Elective inguinal herniorrhaphy versus truss in the elderly Elective inguinal herniorrhaphy versus truss in the elderly Neuhauser D Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn
Anticoagulant therapy after acute myocardial infarction. Relation of therapeutic benefit to patient's age, sex, and severity of infarction. 4117261 1973 01 05 2016 10 17 0098-7484 222 5 1972 Oct 30 JAMA JAMA Anticoagulant therapy after acute myocardial infarction. Relation of therapeutic benefit to patient's age, sex, and severity of infarction. 541-8 Drapkin A A Merskey C C eng Clinical Trial Journal Article Randomized Controlled Trial United States JAMA 7501160 0098-7484 0 Anticoagulants 0 (...) Placebos 5M7Y6274ZE Phenindione 5Q7ZVV76EI Warfarin 7QID3E7BG7 Dicumarol 9005-49-6 Heparin AIM IM Age Factors Aged Anticoagulants adverse effects therapeutic use Cerebrovascular Disorders mortality Clinical Trials as Topic Diabetes Complications Dicumarol therapeutic use Electrocardiography Female Heart Failure complications Hemorrhage chemically induced Heparin therapeutic use Humans Hypertension complications Male Middle Aged Myocardial Infarction complications drug therapy mortality Phenindione
Perceived age as clinically useful biomarker of ageing: cohort study. To determine whether perceived age correlates with survival and important age related phenotypes.Follow-up study, with survival of twins determined up to January 2008, by which time 675 (37%) had died.Population based twin cohort in Denmark.20 nurses, 10 young men, and 11 older women (assessors); 1826 twins aged >or=70.Assessors: perceived age of twins from photographs. Twins: physical and cognitive tests and molecular (...) biomarker of ageing (leucocyte telomere length).For all three groups of assessors, perceived age was significantly associated with survival, even after adjustment for chronological age, sex, and rearing environment. Perceived age was still significantly associated with survival after further adjustment for physical and cognitive functioning. The likelihood that the older looking twin of the pair died first increased with increasing discordance in perceived age within the twin pair-that is, the bigger