Archives of gerontology and geriatrics
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Arch Gerontol Geriatr · Sep 2005
The problem with advance directives: maybe it is the medium, not the message.
Some of today's most significant bioethical challenges center around decisions to initiate or withhold medical treatment for incapacitated patients. In order to ascertain what treatment the patient would have desired, physicians often rely on written advance directives and designated surrogate decision-makers. Unfortunately, both approaches suffer from numerous shortcomings that ultimately limit their usefulness. ⋯ VADs may thus enhance the physician's understanding of the patient's wishes. VADs may also ease family conflict and save physician's considerable time by helping family members reach a stronger consensus on the patient's wishes, and do so in a timelier manner. This article reviews the limitations of written advance directives and surrogate decision-makers and describes why VADs may be helpful in overcoming these limitations.
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Arch Gerontol Geriatr · Sep 2005
Determinants of the subjective functional outcome of total joint arthroplasty.
The aim of the study is three-fold: (i) to analyze association between early subjective functional outcome of total joint arthroplasty (TJA) and patient-related risk factors; (ii) to evaluate the six-month subjective functional outcome of TJA as compared with subjective functional status of non-operated outpatients; (iii) to evaluate TJA self-perceived amelioration rates compared to the status of an age-matched sample from a general medical practice. A prospective consecutive study was performed upon 100 elderly inpatients with recent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) for osteoarthritis. Interviews on preoperative status and short-term outcome were performed at admission and six months after surgical intervention with Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC). ⋯ Objective functional outcome of post-operative rehabilitation has not revealed predictive value for the six-month outcome of TJA in terms of self-perceived functional status. Logistic regression analysis indicated that preoperative status was the only significant predictor of higher WOMAC scores six months after TJA. The survey confirms the early benefit of THA or TKA for osteoarthritis, but a less favorable subjective functional outcome is expected at six months when preoperative subjective functional status is severely compromised.
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Arch Gerontol Geriatr · May 2005
Functional recovery after hip fracture in old-old elderly patients.
Hip fracture is epidemic and prevalence increased with advanced age. Impact of comorbid and cognitive status, gender, type of fracture, operative delay and pre-fracture ambulatory levels on functional outcome was shown in previous studies. We studied functional outcome after rehabilitation for hip fracture in old-old elderly (85 years and older) and compared it to young elderly (65-74 years) community-dwelling patients. ⋯ The mean duration of rehabilitation stay was significantly longer in old-old elderly patients. On discharge old-old elderly patients more suffer from pain and difference between the groups according to the laboratory and to the cognitive data increased. Age per se is indicator of frailty and determinate functional recovery after hip fracture.
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Arch Gerontol Geriatr · Mar 2005
Disability and its effects on quality of life among older people living in Antalya city center, Turkey.
The problems of older people become more prevalent with aging of the population. Occurrence of disability and its effects on living conditions are two of the major factors that determine the quality of life of elderly people. The aim of this study is to find out the frequency and severity level of disability for people aged 65 and older living in Antalya city center. ⋯ Disability affects the fields of lives of elderly people with rates of 90.4% for "self care", 88.6% for "getting around" and 85.2% for "life activities". For the elderly population participating in our study, disability is most frequently seen in "participation in society", the most severe disability is seen in "life activities" and the most effected field is found to be "self care". These findings must to be incorporated into planning procedures as expenditure is allocated in order to decrease disability.
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Arch Gerontol Geriatr · Mar 2003
Comparative StudyAge-related changes in sensory and secretomotor nerve endings in the larynx of F344/N rat.
The aim of the present study was to define the age-related changes in sensory and secretomotor nerve endings in the larynx of F344/N rats. For this purpose, laryngeal tissue sections obtained from 12-, 24- and 35-month-old F344/N rats were compared with respect to the density, distribution and morphology of various types of sensory and secretomotor nerve endings immunoreactive for protein gene product 9.5 (PGP 9.5), calcitonin gene-related peptide (CGRP) and substance P (SP). Two distinct forms of PGP 9.5-immunoreactive motor end-plates were noted; the large sized motor end-plates localized in thyroarytenoid and cricoarytenoid muscles were degenerated in aged rats, while the small sized motor end-plates, localized predominantly in vocal muscles, did not show any age-related changes. ⋯ CGRP- and SP-immunostained taste bud-nerve endings were noted in 12- and 24-month-old rats, but only rarely in 35-month-old rats. The laryngeal epithelium contained PGP 9.5-, CGRP- and SP-immunoreactive thin free nerve endings with many varicosities; their number and distribution were similar between 12- and 24-month-old rats, while only a few endings were observed in 35-month-old rats. Our results indicated that ageing is associated with the reduction of laryngeal sensory and secretomotor nerve endings.