Janet L. Vittone

Cardiovascular Disease in Elderly Patients

OBJECTIVE To provide an overview of the cardiovascular consequences of the normal aging process in humans and to review unique aspects of the diagnosis and management of heart disease in the elderly population. DESIGN We reviewed relevant published articles and summarized the diagnostic approaches and treatment recommendations for congestive heart failure, coronary artery disease, cardiac valvular disease, and arrhythmias in elderly patients. RESULTS The aging process is associated with predictable anatomic and physiologic alterations in the cardiovascular system. consequently, the manifestations of heart disease in the geriatric population differ from those found in younger patients. Additionally, outcomes of cardiac diseases and therapeutic options change with advancing age because of such factors as alterations in drug metabolism. CONCLUSION Age-related changes in the cardiovascular system result from intrinsic cardiac aspects of human senescence, primary cardiac disease, and influence of comorbid conditions on the heart. The natural history of heart disease is generally adversely affected by age. Although many treatment strategies with demonstrated efficacy in younger patients are relevant in the elderly age-group, careful attention to the influence of concomitant illness, the unique physiologic and pharmacologic changes, and the assessment of the potential effect of therapy on survival and quality of life is essential in treating elderly patients.

Medical Care of Nursing Home Residents

OBJECTIVE To present an overview of the special challenges of providing medical care for nursing home residents. DESIGN After researching the current medical literature, we summarized information on nursing home demographics, government regulations, and specific care issues for medical practice in nursing homes. RESULTS Almost 2 million Americans currently live in more than 20,000 nursing homes nationwide, and these nursing home residents are increasingly older and more frail than in the past. Most nursing home residents receive multiple prescription medications, and many are cognitively and functionally impaired. Nursing home-acquired infections are a frequent occurrence, as are falls and fall-related injuries. Recent federal laws have had a major effect on medical care in the nursing home and have made physicians more accountable for the care provided. The use of physical restraints and psychotropic drugs has been severely restricted. CONCLUSION The medical care of nursing home residents presents many challenges to primary-care physicians. Nevertheless, nursing home residents are among those patients in greatest need of competent, compassionate care. Despite numerous disincentives, provision of medical care for nursing home residents can be gratifying.

Application of the LaGrange Polynomial in Skeletal Muscle Fatigue Analysis

Abstract The percentage of decrement in torque and the number of serial contractions are mutually exclusive methodological controls in the study of muscular fatigue. This paper examines the feasibility of using the LaGrange polynomial in the analysis of voluntary muscular fatigue patterns. Twenty-one men (ages 20–60 years) reported to the orthopedic biomechanics laboratory on 2 days separated by 4 months. During both sessions, participants completed three maximal isokinetic (180 deg·s−1) contractions of the knee extensors to serve as baseline, before starting the fatigue protocol. The fatigue protocol consisted of serial contractions until a 50% strength decrement was reached. The LaGrange polynomial was first used to interpolate the individual fatigue pattern for each participant into 15 data points (trials). Data analysis was then conducted on these 15 data points. Intraclass correlation analysis of variance showed that the reliability of baseline torque was very good (.93). Baseline torque, the average of three trials, exhibited a 5.4 Nm (6%) increase from the first to second test session (p < .05). The mean level of torque, average of the 15-point fatigue pattern, also increased 7.5 Nm (15%) on the second test session (p < .05). The classic torque deficit for the first trial of a fatigue series was preserved by the interpolation method. Serial contractions resulted in an average decrease in torque of 29.5 Nm (50%) from the first to last trial (p < .05). The interpolation method also retained the linear and quadratic trend components commonly observed for isometric and isokinetic fatigue patterns. The two trend components accounted for 94.7% of the total trial variance. It was concluded that the LaGrange polynomial used to interpolate fatigue patterns to fewer data points was successful.