Occurrence of adverse effects and high amantadine concentrations with influenza prophylaxis in the nursing home.

Amantadine, in a dose of 100 mg/day, is recommended for influenza prevention in older nursing home residents. We studied an influenza prevention protocol in a 98-bed community nursing home (96% female; mean age = 87.4 years). Fifty-five residents received amantadine when influenza A was confirmed. Although no further influenza cases were diagnosed, 22% experienced adverse events. Dose in mg/kg/day was significantly higher in the group experiencing adverse events (2.24 +/- 0.98 vs 1.76 +/- 0.35; P less than .01). Amantadine concentrations in 32 residents ranged from 128-5,810 ng/mL. Six residents had amantadine concentrations greater than 1,000 ng/mL. Seventy-eight percent would have qualified for further dose reduction on the basis of estimated creatinine clearance. The results suggest that adverse events may be an important problem with the 100 mg/day dose, and this dose may be excessive for influenza prophylaxis in many nursing home residents.

Circadian endocrine time structure in humans above 80 years of age.

The circadian rhythms in blood hormone concentrations of 17 pituitary, adrenal, pancreatic, testicular, and thyroid hormones were determined in 9 women and 5 men 81 to 91 years of age. Six samples over a 24-hr span were studied for each hormone. Even with the small sample available, 9 of the 17 hormones determined showed a statistically significant circadian rhythm as a group phenomenon (prolactin, estradiol, 17-hydroxyprogesterone, insulin, C-peptide, thyroid stimulating hormone, aldosterone, cortisol, dehydroepiandrosterone sulfate). No rhythm detection by population mean cosinor analysis at the .05 level was obtained in this relatively small group of subjects for adrenocorticotropic hormone, follicle stimulating hormone, growth hormone, luteinizing hormone, triiodothyronine, thyroxine, progesterone (determined in women only) and testosterone (determined in men only).

The value of annual medical examinations in the nursing home.

Although annual medical examinations are required in many nursing homes for all residents, little is known about the value of these examinations. To investigate this, 732 annual examinations were evaluated for frequency of positive findings and clinical importance of the findings. Although 51 per cent of examinations yielded a finding that was new or related to a known chronic disease process, only 3 per cent of findings were judged by primary care physicians to be of major importance. Approximately a fourth of findings were considered to be of intermediate importance. These results provide only modest support for endorsing annual medical examinations for nursing home residents.

Causes for hospitalization of nursing home residents: the role of infection.

Little is known about specific clinical conditions that lead to hospitalization of nursing home patients. To explore this, the authors examined the hospitalizations of 128 nursing home residents and compared them with hospitalizations of 320 patients from the outpatient clinic. Hospitalized nursing home patients were older, were admitted to medical services more frequently, and had more nonspecific complaints on admission. Nursing home patients were hospitalized most frequently for diseases of the circulatory system (16 per cent), respiratory system (14 per cent), and genitourinary system (12 per cent); clinic patients, for diseases of the circulatory system (25 per cent) and nervous system (10 per cent), neoplasms (10 per cent), and signs and symptoms of ill-defined conditions (10 per cent). The most frequent causes of hospitalization for all patients were diseases of the circulatory system (23 per cent), nervous system (10 per cent), and neoplasms (10 per cent). Among patients from the nursing home, infections caused substantially more admissions (27 per cent) than among patients originating from clinic (12 per cent; P less than 0.001). These findings disclose an important opportunity to reduce health care costs and enhance quality of life in the nursing home, particularly through the treatment and control of infections.