The aim of this study was to identify differences in the medical management and clinical outcome in a group of elderly patients admitted to a designated geriatric assessment unit (GAU) or to two general medical units (GMUs). A prospective randomised controlled trial was undertaken in 267 patients aged 70 years and over (mean age = 78.3 years). Following discharge from hospital, patients were followed up at three monthly intervals for a total of 12 months. At the time of discharge, no significant differences were found in inpatient management, length of stay, mortality rates, discharge rates to institutional care or utilisation of community services in patients admitted to the GAU and the GMUs. Similarly, no significant differences were found at three, six, nine, and 12 month follow up in case fatality, activities of daily living indices, mental health status, rates of institutional referral and the level of community service support in patients admitted to the GAU and the GMUs studied. These findings do not show any advantage for the unselected 70+ acutely ill elderly patient who is admitted to a designated geriatric assessment unit rather than to a general medical unit. Therefore, an admission policy to GAU, based solely on age 70+ is medically inappropriate and cost-inefficient. Evidence from other sources suggests that an age cohort of acutely admitted patients beyond 80 years may well have returned more optimistic findings for the GAU. In future, GAUs will require a more selective admission policy to maximise the benefits of their rehabilitative and interdisciplinary approach.
A prospective study was undertaken to investigate the incidence and aetiology of acute confusional states in physically ill old people. The subjects were 71 patients aged 70 years or over who were admitted as emergencies to a general medical unit. Mental testing revealed that: (a) one in six patients had an acute confusional state on admission; and (b) one in four patients had evidence of dementia. The presence of dehydration/volume depletion at the time of admission was estimated by various parameters which were brought together to form a new index called the 'dehydration score'. There was a definite statistical association between high degrees of dehydration/volume depletion and poor mental function. Advanced age, on the other hand, appeared to increase the risk of dehydration/volume depletion only slightly. It was also found that a patient's mental score was a much better guide to prognosis than age. The implications of these findings are discussed.
Problems were identified in accuracy of diagnosis and appropriate intervention. Awareness of the risk factor profile is needed among health workers, to ensure early preventative strategies. Populations to target for future prevention include elderly people (including those in institutional care), patients with cognitive impairment and patients taking diuretics, multiple medication and/or with other severe co-existing illnesses. Treatment could be more standardised.
Incubation of the pentachlorophenol (PCP) metabolites, tetrachloro-p-benzoquinone (chloranil, TCpBQ), tetrachloro-p-hydroquinone (TCpHQ) and tetrachloro-p-benzoquinone (TCoBQ) with V79 Chinese hamster cells led to a significant enhancement of the amount of 8-hydroxydeoxyguanosine (8-OH-dG) in DNA. With PCP itself and the metabolite tetrachloro-o-hydroquinone (TCoHQ) no distinct induction of this lesion could be observed. The average yields of 8-OH-dG were about 2-2.5 times above background levels. In addition, TCpBQ and TCpHQ were able to generate DNA single-strand breaks, while PCP, TCoHQ and TCoBQ failed to induce this lesion. All incubations were performed for 1 h without exogenous metabolic activation and concentrations were 25 microM of the respective agent. It is concluded that these metabolites may contribute to the carcinogenicity of PCP observed in mice, by generating reactive oxygen species (ROS) through their redox cycling properties.
A mailed survey of 28 residential facilities for ambulant people with dementia questioning the types of labelling of residents' toilets yielded 24 replies: 42% (10) had no labelling, “Toilet” was used in 50% and “Male” or “Female” was used in 8%. The survey was followed by asking elderly people in an acute medical hospital ward and in an aged care residential complex their preferences for toilet word and symbol labelling There were 21 elderly people with normal cognition, 11 people with mild dementia and 16 people with moderate dementia. The international symbol was preferred by people with normal cognition or mild dementia but a symbol more representative of a toilet was preferred by people with moderate dementia (p < 0.05). “Ladies” or “Gents” was the word most preferred by people with normal cognition. “Toilet” was the word preferred by people with moderate dementia (p < 0.05). We recommend the use of the word “Toilet” accompanied by a picture of a toilet for labelling toilet doors for people with dementia.
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