T. Nikolaus

Prospective value of self-report and performance-based tests of functional status for 18-month outcomes in elderly patients.

To determine predictors of death, nursing home placement and hospital admission, a prospective study was carried out in a university-affiliated geriatric hospital and a general practice. One hundred and thirty-five patients consecutively admitted from home to the geriatric hospital and discharged home again (site 1), and 144 patients, aged 70 years and over, of a general practice (site 2) were recruited for a comprehensive geriatric assessment program. At baseline, none was completely dependent on others, or severely demented. At follow-up after 18 months, 46 subjects (17%) had died, 20 subjects (7%) had been institutionalized, and 79 had been admitted to hospital (28 %) in the interim. Univariate analysis demonstrated a significant association between Barthel Activities of Daily Living (ADL), Lawton-Brody Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Balance and Gait Evaluation, Timed “Up and Go”, Timed Test of Money Counting, Grip-Strength and Williams Board Test, and death as well as nursing home placement. Barthel-ADL were significantly correlated with hospital admission. In a logistic regression analysis, Barthel-ADL were independent predictors for death; Barthel-ADL, Timed “Up and Go”, Timed Test of Money Counting, and Williams Board Test were independent predictors for nursing home placement. No independent predictor was found for hospital admission. It is concluded that self-report and performance-based measures of functional capabilities are useful instruments to identify patients at risk for nursing home placement and death. Factors contributing to hospital admissions are other than those measured by the applied tests.

Actual versus prescribed timing of lovastatin doses assessed by electronic compliance monitoring.

SummaryThe objective of the study was to compare compliance with and the hypocholesterolaemic effect of lovastatin given once daily as a morning or an evening dose. Twenty-four out-patients with familial hypercholesterolaemia were randomly assigned to receive placebo first, then lovastatin 20 mg, to be taken once daily for 4 weeks, either with the breakfast or evening meal, in a single-blind fashion.Drug compliance was assessed by pill counts and continuous electronic monitoring. Two compliance parameters were evaluated, consumption, defined as percentage of prescribed doses taken, and time compliance, the percentage of total dosing events recorded within defined intervals (6.00–10.00 h, and 17.00–21.00 h), for the morning and evening regimes.Both regimes satisfactorily reduced the total and LDL-cholesterol concentrations, and there was no significant difference in the extent of the reductions.Pill counts overestimated compliance, as revealed by the monitoring method. The times of actual consumption of doses by the patients often differed from that prescribed, predominantly in patients who were told to take the evening dose. Partial time compliance may have confounded the efficacy of the drugs. Electronic compliance monitoring appears to be particularly useful in chronopharmacological studies.

The Timed Test of Money Counting: A simple method of recognizing geriatric patients at risk for increased health care

The purpose of this prospective study was to measure patients’ ability to open a purse, take out money, and count it, in order to identify persons in need of increased health care. The study population consisted of 183 patients (mean age 78.9; range: 66-95) in two settings: 78 consecutively admitted geriatric hospital patients who could return home, and 105 community-dwelling patients aged 70 years or older. None was completely dependent on others, nor severely demented. Time for task performance was measured. Further assessment included the Mini-mental State Examination (MMSE), Barthel index of ADL, instrumental activities of daily living (IADL), socioeconomic status, grip strength, Williams board test, and medication profile. The Timed Test of Money Counting (TTMC) was reliable (interrater and intrarater), and showed construct and concurrent validity with other measures of physical function. There was a strong correlation (p<0.001) between the time required to count money, and to open and close the panel doors of the Williams board. The other functional measures were also significantly correlated with the TTMC. After 18 months, 26 of the patients had died, and 5 were lost to follow-up. The remainder were divided into those who had stable needs (group I), and those with increasing careneeds or nursing home placement (group II). Time required for money counting was significantly different (p<0.001) between groups (30.9±17.5 seconds for group I, and 122.6±94.4 seconds for group II). Using cut-off times of less than 45 seconds to identify persons with stable needs, and of more than 70 seconds to identify persons with increasing needs, the sensitivity and specificity were 83% and 75%, respectively, with 85% positive and 75% negative predictive accuracy. The TTMC seems helpful in identifying elderly persons in need of increased care. The test is performed quickly, requires no special equipment, and can be easily included in the routine geriatric examination. (Aging Clin. Exp. Res. 7: 179-183, 1995)

Anhang (zu Kap. 4): Pharmakokinetische Grundbegriffe

Die Clearance (Cl) ist ein Mas fur die Fahigkeit eines Organismus oder Organsystems, ein zugefuhrtes Arzneimittel oder eine Substanz zu eliminieren. Die Clearance kann als gesamte Korperclearance, Cltot, als renale Clearance, Clren oder nichtrenale Clearance, Clnonren beschrieben werden. In der Regel wird davon ausgegangen, das die totale Clearance die Summe aus Clren+ Clnonren ist.