Gerontology
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Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatremia in elderly hospitalized patients; however in many patients the etiology remains unclear even after routine investigations. ⋯ Potentially, urinary retention by itself may cause hyponatremia. The possible mechanism for this is SIADH, triggered by bladder distention or pain due to bladder distention. Urinary catheterization may be the key to treatment in these cases of hyponatremia.
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Bereavement is often associated with increased levels of depression, anxiety, and stress. The question of whether grief is associated with cognitive deficits in older adults remains largely unanswered. Although Xavier and coworkers (see text) found preliminary evidence that grief, in the absence of depression, impacted on memory in a sample of the oldest-old in Brazil, the impact of bereavement on cognitive functioning, independent of the effects of mood, has not been adequately examined. ⋯ The evidence suggests that grief associated with death of a spouse has limited associations with cognition beyond those that would be expected to occur as a result of depression, anxiety, and stress.
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It has been suggested that regular moderate physical activity (PA) promotes resistance to upper respiratory tract infections (URTI). In an older population, this relationship should be examined in a wider concept of multiple factors potentially able to influence infection rate and reported symptomatology. Especially, the impact of depression should be taken into consideration. ⋯ These results indicate that in elderly subjects the symptomatology of URTI is interrelated with their habitual PA and depressive symptomatology. Less active and more depressed subjects develop more URTI symptoms during 1-year follow-up. This URTI symptomatology, together with the baseline PA and the depressive status, contributes to the follow-up PA and depression scores.
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Long-term care (LTC) residents, especially the orally fed with dysphagia, are prone to dehydration. The clinical consequences of dehydration are critical. The validity of the common laboratory parameters of hydration status is far from being absolute, especially so in the elderly. However, combinations of these indices are more reliable. ⋯ Dehydration was found to be common among orally fed FOSS-2 LTC patients. Surprisingly, probable dehydration, although of a mild degree, was not a rarity among NGT-fed patients either. The combination of 4 parameters, BUN, BUN/S(Cr ), U/S(Osm) and U(Osm), offers reasonable reliability to be used as an indication of dehydration status in daily clinical practice.
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Percutaneous endoscopic gastrostomy (PEG) is generally used for long-term enteral nutrition. Patients who require PEG placement are often very sick, and postoperative complications, especially aspiration pneumonia, can be fatal. ⋯ S-SPT is particularly useful in PEG patients. The scores provided by S-SPT and endoscopic examination can be very useful for aspiration pneumonia after PEG. The patients with scores < or =2 appear to be at very low risk for aspiration pneumonia, and patients with the scores > or =3 should be carefully followed up.