Michael Mulvihill

LONG-TERM ENTERAL FEEDING OF AGED DEMENTED NURSING HOME PATIENTS

The terminal phase of dementia is initiated by the inability to swallow. New techniques of enteral alimentation permit more effective, longer intubation. To assess the application of these new techniques to late‐stage demented aged patients, all current intubations in a teaching nursing home were reviewed. Of 52 feeding intubations, 26 had been in situ for more than 1 year. A randomly selected comparison group of nonintubated patients was also studied.

Work organization and Low back pain in nursing personnel

Nursing personnel are at a high risk from occupational low back injury. Work organization has been suggested as one factor playing a part in the aetiology of occupational low back pain. Baseline data for a prospective epidemiology study were gathered by means of a questionnaire. One part of the questionnaire elicited characteristics of work organization, perceived autonomy, the relationship with head nurse and satisfaction in the relationship with co-workers. Information on history of musculoskeletal problems, reported frequency of lifting and personal characteristics was also gathered. Of 787 nursing staff at two acute care hospitals, 154 (19-6%) reported troublesome low back pain occurring within the previous 6 months. From univariate analyses, such characteristics of work organization as shift, type of schedule and primary versus functional nursing were not associated with low back pain. The relationship with head nurse and perceived autonomy of the job also were not related to recent back pain. Recent...

Survival of Elderly Patients with Transfusion-Related Acquired Immunodeficiency Syndrome

Objective: To determine the influences of age and risk group on the survival of AIDS patients. We concentrated on transfusion because it is the commonest risk factor for AIDS in patients over 70 years of age.

Role of transurethral resection in dissemination of cancer of prostate.

Recent studies have suggested an adverse impact on disease progression and survival in patients with prostatic cancer who undergo transurethral resection (TURP). Four hundred fifteen patients with prostatic carcinoma were reported to a Tumor Registry from 1965 to 1971. Of these, 184 charts had sufficient follow-up data to assess the impact of TURP in each stage of prostatic cancer. In Stage A the five-year survival difference between the TURP group (87.5%) and the open prostatectomy group (88%) was not significant (P = 0.54). In Stage B the five-year survival difference between the TURP group (38.7%) and the needle biopsy group (68%) was significant (P = 0.02). In Stages C and D there was no significant difference in survival between the TURP group and the needle biopsy group (P = 0.44 and P = 0.2, respectively). Our data reinforce the importance of diagnosing Stage B prostatic cancer preoperatively when curative treatment modalities may be utilized and TURP avoided. Finally, in advanced stages TURP may be efficacious in relieving prostatic obstruction while not adversely influencing survival.

Alarm Devices Instead of Restraints

with high resistance training. This is in agreement with a recent study in men on the lower limbs, using similar training and testing methods.6 The increase in strength appears to vary according to the measuring technique used. Previous studies have reported similar variability, with strength gains ranging from 10% to 72%.3 This is not surprising considering the number of parameters that are likely to influence the results. In future studies, the experimental design, the specificity of training and testing, psychological and motivational factors etc. must be controlled and standardized as far as possible in order to make studies interpretable. The underlying mechanisms accounting for a traininginduced increase in muscle strength in the elderly are not known. In principle, it can be due to adaptation in the nervous system, hypertrophy of the muscle, or both. To provide a definite answer, future studies need to combine strength measurements with assessments of muscle structure and function in the same elderly subject. Furthermore, to distinguish the effects of the training regimen from that of the placebo effect, future investigations will have to use a much more controlled trial design, one in which subjects are randomly allocated to a training and control group. If an objective evaluation eventually can show that this type of uncomplicated training protocol can improve an elderly person’s muscular strength, any general rehabilitation or exercise program for the elderly is thereby likely to benefit from the inclusion of such a training regimen.

Orthostatic change in blood pressure in non-demented, ambulatory nursing home patients.

While postural hypotension was present in almost 20% of ambulatory patients of this long-term institution, associated symptoms were infrequent. A comparison of the groups with and without a history of falls in the prior year revealed no relationship to the presence of postural hypotension and no relationship to a number of medications which have been reported to be associated with orthostatic hypotension. Blood pressure readings should be obtained at 1,3 and 5 min after assuming the erect position as significant falls in blood pressure were found at each interval.

Tuberculosis surveillance in a long-term care facility

The prevalence of tuberculous infection in residents of a large nursing facility in New York City was assessed. The population was predominantly female (80%) and white (86%), with almost one-half (49%) being foreign born. The mean age of the group was 86.1 years. Four hundred and fifty-five residents were given tuberculin skin tests using the two-step Mantoux test procedure. The prevalence of tuberculous infection was 27.5% with only slight differences being noted between the native-born (28.8%) and foreign-born (26.1%) residents. A 10% booster effect was noted. Tuberculous infection rates were higher in non-white than white residents. A progressive decline in the prevalence of tuberculous infection was noted with increasing age. No cases of tuberculosis were detected. Our study provides a model for collecting and evaluating epidemiologic data to assess infection prevalence and tuberculosis transmission in a long-term care facility.

MENTAL STATUS GUIDE: FROMAJE for Use With Frail Elders

1. There is no single pathognomonic sign, symptom, or clinical or laboratory test for making the diagnosis of dementia. A key element of the examination must be the inclusion of a mental status evaluation. 2. The FROMAJE--an acronym for Function, Reasoning, Orientation, Memory, Arithmetic, Judgment, and Emotion--Mental Status Guide (FMSG) has the advantage of a clear relationship between the acronym and the characteristics being measured. 3. The FMSG is meant to serve as a guide for the primary care clinician, who may have little experience in formal mental status testing. It is a convenient cognitive screening instrument to detect dementia in the elderly.

Refusal of Tube Feeding as Seen from a Patient Advocacy Organization: A Comparison with Landmark Court Cases

Objective: To determine how closely high court decisions regarding tube feeding are a reflection of the situations that occur in the general population.

Utilization of Cardiovascular Drugs in the Aged in a Long-Term-Care Institution for the Aged over a 5-Year Period 1987--1992.

A comparative study was made of the utilization of cardiovascular drugs in a long-term-care facility for the aged for 1987 and 1992 during which the age and sex distributions and incidence of usage were similar.There were statistically significant declines in the usage of diuretics and potassium supplementation, digoxin, antihypertensives, antiarrhythmics, and beta blockers and a rise in the use of calcium-channel blockers. There was a slight fall in the use of antianginal drugs. The ACE inhibitors introduced after 1987 were taken by 6.1%.The dosages of digoxin and diuretics decreased as management was adequate and toxicity avoided and usage of digoxin reduced in accordance with the concept that digoxin is useful in failure only when left ventricular output is impaired.