ABSTRACT
Thirty-four consecutive patients with unrecognized intra-abdominal perforation were identified from post-mortem records and retrospective analysis was undertaken. The common factors that appeared to contribute to the missed diagnoses included obesity (50%), communication difficulty (33%) and previous abdominal surgery (38%). In addition, symptoms and signs may have been obscured in those patients receiving analgesics (26%), steroids (21%) or non-steroidal anti-inflammatory drug therapy (44%). Cardiopulmonary presentation (79%) and the absence of free intraperitoneal gas on conventional radiology also may have diverted clinical attention. Elderly obese women appeared to be at particular risk and the diagnosis should be considered especially in the presence of associated, unexplained tachycardia (38%), hypotension (59%) or pyrexia (29%) as gastro-intestinal perforation remains a potentially curable condition.
Subject(s)
Intestinal Perforation/diagnosis , Aged , Aged, 80 and over , Autopsy , Diagnostic Errors , Female , Humans , Intestinal Perforation/etiology , Male , Retrospective StudiesABSTRACT
One hundred community-dwelling psychiatric outpatients, 60 years and older, were evaluated for factors associated with symptoms of dizziness, falling, and orthostatic hypotension. Thirty-nine percent complained of dizziness or falling, and 34% had systolic orthostatic hypotension. Together, systolic and diastolic blood pressure drop, type of somatic illness, type and number of drugs, and psychiatric diagnosis accounted for 50% of the variance in dizziness and falling. Type of illness, drug category, and psychiatric diagnosis accounted for only 19% of the variance in orthostatic hypotension. Statistical analysis showed that systolic orthostatic hypotension, disease classification, and type and number of drugs taken contribute independently to dizziness and falling. In geriatric psychiatric patients, careful attention to orthostatic hypotension, concurrent somatic illness, and number and type of medication is essential to the prevention of dizziness, falling, and their consequences.
Subject(s)
Dizziness/etiology , Hypotension, Orthostatic/complications , Accident Prevention , Aged , Dizziness/chemically induced , Dizziness/classification , Dizziness/psychology , Female , Humans , Hypotension, Orthostatic/chemically induced , Male , Mental Disorders/complications , Middle Aged , Models, Psychological , RiskABSTRACT
The authors examined 100 psychiatric patients who were 60 years old and older for orthostatic hypotension and symptoms of dizziness and falling. Almost 40% of the patients complained of dizziness and falling, although only 27% had systolic orthostatic hypotension. Drug treatment, particularly the combination of tricyclics with other orthostatic hypotension-inducing drugs, was the most important factor accounting for the dizziness and falling. Underlying medical illness, particularly heart disease, also correlated significantly with the patients' symptoms.
Subject(s)
Dizziness/etiology , Postural Balance , Aged , Ambulatory Care , Blood Pressure/drug effects , Coronary Disease/complications , Dizziness/chemically induced , Drug Therapy, Combination , Female , Hospitals, Psychiatric , Humans , Hypotension, Orthostatic/chemically induced , Hypotension, Orthostatic/complications , Male , Mental Disorders/drug therapy , Middle Aged , Postural Balance/drug effects , Psychotropic Drugs/adverse effects , Psychotropic Drugs/therapeutic useABSTRACT
Psychiatric problems are rampant among the aged, yet the psychiatric profession has not developed sufficient resources for training the necessary number of practitioners able and willing to treat elderly psychiatric patients. The management of psychiatric problems in old age differs substantially from that in younger age groups. The elderly patient is likely to have multiple needs and to require diverse services. Fundamental goals in training geriatric psychiatrists should focus on differential diagnosis and treatment, pharmacologic issues, consultation, community resources, and psychiatric, medical, and psychosocial aspects of care. The authors describe a curriculum tailored to meet these goals.
Subject(s)
Curriculum , Education, Continuing , Geriatric Psychiatry/education , Psychiatry/education , Aged , Chronic Disease , Humans , Mental Health , Psychology, Social/education , Psychopharmacology/education , Psychophysiology/education , United StatesABSTRACT
Three instruction schemes for self-medication in older patients were designed and compared to see whether they improved drug compliance. Forty-six patients in two rehabilitation units were divided into three different groups. Each group was instructed verbally on the nature and amount of their medication. One group was also given a tear-off calendar and a second group a tablet identification card as a memory aid. Patients were then responsible for taking their own medicine for 14 days. Those with calendars made fewer errors than those with cards, and those with either a card or a calendar made significantly fewer errors than those given only standard instructions.
