Beverly J. Volicer

Predicting short-term survival for patients with advanced Alzheimer's disease

The purpose of this study was to develop a statistical model for predicting short term survival in patients with dementia of the Alzheimer type (DAT).

Medical-Surgical Differences in Hospital Stress Factors

Psychosocial stress due to the experience of hospitalization was ascertained for 535 medical and surgical patients in a community hospital, using a Hospital Stress Rating Scale, Medical-surgical differences along nine dimensions of stress as measured by this scale were examined, using analysis of covariance to control for the effects of patient characteristics known to be associated with scores on the Hospital Stress Rating Scale. The controlled variables were age, education, number of previous hospitalizations, number of years since last hospitalization, and seriousness of illness (Seriousness of Illness Rating Scale). The analysis of covariance results indicated higher perceived stress for surgical patients on the dimensions of unfamiliarity of surroundings, loss of independence, and threat of severe illness. Medical patients scored higher on the dimensions of stress due to financial problems and lack of information. The authors discuss how these findings might be incorporated in experimental studies designed to reduce stress among hospital patients.

Hospital stress and patient reports of pain and physical status.

The Hospital Stress Rating Scale was used to measure stress due to the experience of hospitalization for 535 medical and surgical patients in a community hospital. Patients were also asked to rate the pain they experienced on a pain thermometer, and a recovery inventory was used to score patient self-reports of their physical status, both during hospitalization and subsequent to discharge. With statistical control for patient characteristics correlated with self-reports of pain and physical status, associations between hospital stress and these variables were observed. Patients scoring high in hospital stress tended to report more pain, lower physical status during hospitalization, and less improvement after discharge than patients scoring low in hospital stress.

Palliative fever management in Alzheimer patients. quality plus fiscal responsibility.

Aggressive medical treatment of infections does not affect the progressive course of dementia of the Alzheimer type (DAT) and has limited effect on the mortality rate. Utilization of health care resources and discomfort during a fever episode were compared in three differing treatment conditions: in 18 patients in a dementia special care unit (DSCU) who received palliative management, 26 patients in a DSCU who were treated aggressively, and 17 DAT patients in traditional long-term care units who were treated aggressively. Both groups of patients in the DSCU had lower discomfort scores, lower utilization of high-cost health care resources, and higher utilization of analgesics and narcotics. A nursing model of care incorporating hospice concepts into the DSCU is suggested.

Variation in length of time to development of alcoholism by family history of problem drinking

Patients hospitalized for treatment of alcoholism were asked to provide information on family history of drinking problems, age at onset of drinking, and timing of the occurrence of problems due to use of alcohol in their lives, using a time scale. Analysis of data from 256 male patients indicated a strong association between a family history of problem drinking and development of alcoholism at a young age. Mean age at the time the patients could be defined as alcoholic, based on the chronological history of the time of occurrence of symptoms, ranged from 27.2 years for bilineal family history positive patients to 38.5 years for those with negative family history, and the difference could not be explained by differences in age at onset of drinking. The results indicate that the increased risk of alcoholism among individuals with family history of problem drinking, which has been postulated on the basis of many cross-sectional studies, is likely to be overestimated.

Effect of fever-management strategy on the progression of dementia of the Alzheimer type.

Summary:This study was undertaken to determine if the progression of dementia of the Alzheimer type (DAT) is accelerated by an intercurrent infection and if management strategy (aggressive or palliative care) would modify this effect. A prospective cohort study compared the progression of DAT in patients in three 25-bed dementia special care units that provide a hospice option for care. There were three groups of patients, as follows: (a) developed a fever and received aggressive care (FAC, n=30), (b) developed a fever and received palliative care (FPC, n=19), and (c) did not develop a fever (NF, n=46). The presence of a fever episode did not have an effect of its own on DAT progression. Over a 3-month period, DAT severity increased in most patients, but more so in FAC patients. Thus aggressive medical treatment of infections did not affect the underlying disease process and was associated with an acceleration of the progression of severity of DAT. Providing palliative care is recommended because it prevents patients from undergoing invasive diagnostic workups and treatments, does not accelerate the progression of DAT, and conserves scarce health care resources

Relationship of family history of alcoholism to patterns of drinking and physical dependence in male alcoholics

The occurrence of physical dependence, morning drinking and binge drinking was assessed in alcoholic men in relation to family history of problem drinking. The incidence of physical dependence, binge drinking and morning drinking was higher in men with a family history of problem drinking than in men without such a history. Physical dependence also developed earlier in family history positive subjects than in family history negative ones. The incidence of physical dependence was higher in subjects who reported binge drinking or morning drinking than in others. These results indicate that family history of problem drinking is associated with severe alcohol abuse resulting in early development of physical dependence.

Sex differences in correlates of problem drinking among employed males and females

Drinking patterns and problems were analyzed in relation to demographic and occupational characteristics, using data from a survey of a random sample of 3000 employed men and women. Results indicated an association between problem drinking and youth, low education, low job seniority, single or divorced or separated marital status, and low income, for males only. Among females, problem use of alcohol was found to be positively associated with the number of children and the number of children at home, and this relationship persisted when age, education, marital status, and income were statistically controlled.

Preexisting correlates of hospital stress.

More than 450 general medical and surgical patients were surveyed as part of an ongoing study of psychosocial factors in illness. Patients completed the Social Readjustment Rating Scale (Holmes and Rahe, 1967) as a measure of life stress prior to hospitalization and a hospital stress rating scale as a measure of hospital stress. Additional data included demographic variables, information about prior hospitalizations, and diagnosis, coded according to the Seriousness of Illness Rating Scale (Wyler et al., 1968). Analysis using multiple regression procedures indicated age (negatively) and life stress (positively) as predictors of hospital stress, for both medical and surgical patients. In addition, for medical patients, recency of previous hospitalization was a significant predictor of hospital stress, those with recent hospitalization reporting more stress than others. For surgical patients, those with serious illnesses reported more stress than others, and women reported more stress than men. Results revealed several preexisting correlates of hospital stress that can be easily identified at the time of hospital admission.

Cardiovascular changes associated with stress during hospitalization

Abstract Psychosocial stress due to the experience of hospitalization can be quantified using the Hospital Stress Rating Scale. Each patient is asked to identify, from a list of 49 events often experienced by hospitalized persons, those events which he/she personally has experienced since coming to the hospital. Each event has a stress score attached to it, which indicates the amount of stress generally caused by that event relative to the other events on the scale, as judged by a large number of hospital patients. A stress score can therefore be calculated for each patient by summing the scores for those events he/she has identified. In addition, the items on the scale are clustered into nine different hospital stress factors, representing specific dimensions of psychosocial stress associated with hospitalization. Therefore, nine-factor stress scores can be calculated for each patient by summing the stress scores for all items within each factor separately. The purpose of this paper is to examine the effects of the nine hospital stress factors on changes in blood pressure, heart rate and stroke volume during the course of hospitalization. Data were analyzed separately for different groups classified by type of patient (medical or surgical) and seriousness of illness. Our results indicated positive correlation between hospital stress and changes in heart rate for patients with minor illnesses, both medical and surgical. For medical patients with serious illnesses, both systolic and diastolic blood pressure changes correlated positively with hospital stress. Finally, among surgical patients with serious illnesses, we found negative correlation between hospital stress and changes in stroke volume.