The journals of gerontology. Series A, Biological sciences and medical sciences
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J. Gerontol. A Biol. Sci. Med. Sci. · Jun 2002
ReviewManagement of the older person with atrial fibrillation.
Atrial fibrillation (AF) is associated with a higher incidence of mortality, stroke, and coronary events than is sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Immediate direct-current (DC) cardioversion should be performed in patients with AF and acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. ⋯ Digoxin should not be used to treat patients with paroxysmal AF. Patients with chronic or paroxysmal AF at high risk for stroke should be treated with long-term warfarin to achieve an International Normalized Ratio of 2.0 to 3.0. Patients with AF at low risk for stroke or with contraindications to warfarin should receive 325 mg of aspirin daily.
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J. Gerontol. A Biol. Sci. Med. Sci. · Oct 2001
ReviewThe future history of home care and physician house calls in the United States.
Over the last 20 years, home care has experienced significant change. The home care industry developed into big business and a number of innovative models of home care were developed and evaluated. ⋯ However, the future history of home care will depend mostly on the ability of various stakeholders in the health care system to recognize the value of home care and develop and implement the appropriate incentives to encourage its proper place in the U. S. health care system.
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J. Gerontol. A Biol. Sci. Med. Sci. · Oct 2001
ReviewNutrition and quality of life in older adults.
Good nutrition promotes health-related quality of life (HRQOL) by averting malnutrition, preventing dietary deficiency disease and promoting optimal functioning. However, definitions of quality of life also encompass life satisfaction and both physical and mental well-being. Nutrition and diet have not been a part of mainstream research on quality of life and are not included among key quality of life domains. This article explores connections between diet and nutritional status in relation to HRQOL measures and overall well-being among older adults.
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J. Gerontol. A Biol. Sci. Med. Sci. · Jun 1999
ReviewNeural mechanisms of delirium: current hypotheses and evolving concepts.
The purpose of this article is to review current knowledge regarding potential neural mechanisms of delirium. A MEDLINE search for relevant English language articles was undertaken using various combinations of delirium (including cognitive disorders, encephalopathy, and confusion) with pathogenesis and pathophysiology. These articles were scanned for content related to hypotheses concerning the neurobiology of delirium. ⋯ Such mechanisms may differ in various clinical settings. There is probably no final common pathway to delirium, but rather, delirium is the final common symptom of multiple neurotransmitter abnormalities. Further situation-specific studies of delirium pathophysiology should lead to more effective prevention and treatment strategies.
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J. Gerontol. A Biol. Sci. Med. Sci. · May 1997
ReviewA systematic review of the evidence for hypodermoclysis to treat dehydration in older people.
The purpose of the study was to evaluate the evidence supporting the use of hypodermoclysis (i.e., subcutaneous infusion of fluids) to treat dehydrated elderly patients, and to discuss clinical applications of this mode of therapy in the long-term care setting. ⋯ Hypodermoclysis can be used to most safely provide fluids when electrolyte-containing fluids are administered. Hypodermoclysis may have fallen into disuse because of reports of severe adverse reactions related to infusions of electrolyte-free or hypertonic solutions that would likely be considered inappropriate today. Whether or not hyaluronidase is required to promote subcutaneous fluid absorption remains unresolved. Limited evidence suggests that potassium chloride may, with caution, be safely added to subcutaneous infusions. The majority of the available studies evaluating hypodermoclysis are of poor quality. Because of the tremendous potential benefits of administering fluid subcutaneously, there is a need for good quality studies to evaluate the efficacy of hypodermoclysis.