A prospective study of chronic subdural haematomas in elderly patients.

OBJECTIVE: to study clinical features and prognosis of older people with chronic subdural haematoma who present to an elderly medicine department rather than a neurosurgical unit. DESIGN: prospective descriptive study with immediate and 6-month follow-up. SUBJECTS: patients aged 75 and over with chronic subdural haematoma presenting to an elderly medicine service, selected on the basis of age alone. METHODS: information was taken from inpatient notes and computerized tomographs and, for 6-month follow-up, from outpatient clinics, inpatient notes or via the general practitioner. RESULTS: the most common presenting features were falls and progressive neurological deficit. 42% of patients were known to be confused before their chronic subdural haematoma. Only 37% of the patients were treated by neurosurgeons. The others were managed conservatively either because they were unfit for surgery or the haematoma was small. There was only one death related to surgery but 31% of patients died within 6 months of diagnosis. CONCLUSION: Elderly patients in neurosurgical series are a selected subgroup of older patients with subdural haematoma.

Appendix abscess: a surgical giant presenting as a geriatric giant.

CASE REPORT: A women aged 102 years presented with falls and was found to have an atypical presentation of appendicitis. CONCLUSION: This illustrates the non-specific presentation of disease in old age and the importance of a careful medical assessment of people who have fallen.

Age-related geriatric medicine: relevance of special skills of geriatric medicine to elderly people admitted to hospital as medical emergencies.

This study was carried out to find out how many patients aged 75 and over admitted to hospital as medical emergencies had features appropriate to care by physicians in geriatric medicine and to examine the extent of use of specialist facilities by these patients. The purpose was to examine criticisms of age-related admission policies which have focused on misplacement of patients with single diagnoses and lack of access to specialist care. An analysis was made of admission, process and discharge characteristics relevant to the special skills of geriatric medicine, multiple pathology and use of specialist services by 554 patients aged 75 and over. These were collected prospectively, consecutively admitted as medical emergencies via the accident and emergency department of a large district general hospital with an age-related (75 and over) medical admissions policy. 84 patients (15%) had single pathology and no characteristics suggesting the need for specialist geriatric care. 177 (32%) had single pathology and one or more specialized characteristics. 66 (12%) had multiple pathology alone. 227 (41%) had multiple pathology and specialized characteristics. There were 142 specialist referrals in 121 patients (22% of the whole sample). We concluded that the special skills of general physicians specializing in the medical and associated community problems of elderly people are highly relevant to patients aged 75 and over presenting as medical emergencies. There was no evidence of lack of involvement of specialists in their care.

Safe use of streptokinase in myocardial infarction in patients aged 75 and over.

We have given streptokinase to 73 patients aged 75 and over admitted to medical admission wards for elderly people using strict exclusion criteria. This was safe and free from significant adverse events by comparison with other studies. The average age of the patients was 78.2 years so they formed a relatively young group compared with all patients over 75. There was a relatively long delay between presentation at the hospital and receipt of treatment.

Causes and mortality in patients aged over 75 years with gastrointestinal haemorrhage.

One hundred and fifty-five patients aged 75 years and over with gastrointestinal haemorrhage were studied and compared with a series of patients aged under 75 years. The mortality in patients with gastric ulcer or gastric carcinoma was not affected by age. However, the mortality in patients with duodenal ulcer was greater in the over-75s (8/31 deaths in the over-75s, 4/77 deaths in the under-75s, P = 0.01). There was no reluctance to operate on the over-75s. These results can be used to help construct future trials to improve treatment.

Dementia, depression and physical disability in a London borough: a survey of elderly people in and out of residential care and implications for future developments.

We studied 1303 of the 1471 elderly people resident in Local Authority homes, NHS long-stay wards (medical and psychiatric), private and voluntary homes and Local Authority sheltered housing or in receipt of augmented domiciliary services in the London Borough of Waltham Forest. Depression and dementia were assessed using the Brief Assessment Schedule and physical functioning by a modified Barthel index. Residents with high levels of dependency were spread throughout the different forms of residential accommodation. There was little disability outside residential care. There was a high prevalence of depression in the study population. These findings are relevant to future plans for services for elderly people.

Elderly people taking non-steroidal anti-inflammatory drugs are unlikely to have excess renal impairment.

The importance of possible adverse effects on renal function of non-steroidal anti-inflammatory drugs has been widely discussed. Elderly people have been thought to be particularly at risk. We therefore studied simple indices of renal function and plasma potassium in 54 patients with a mean age of 85 years, 27 taking these drugs and 27 controls. Twenty five of our 54 patients were also taking diuretics. Non-steroidal anti-inflammatory drugs did not affect renal function or plasma potassium in these patients.

Gastrointestinal haemorrhage in elderly people.

The management of elderly patients with gastrointestinal haemorrhage is controversial. This review argues that early surgery may be appropriate for patients over the age of 60 but as they reach 75 and over it may be preferable for surgery to be delayed.

Medical problems of elderly patients admitted to a mental illness hospital--incidence, nature and importance for service provision.

The study deals with 147 elderly patients admitted to acute psychiatric beds in a Health District where access to medical rather than to psychiatric beds for elderly people was easier. Fifteen of these patients were transferred from medical wards and 53 had 56 problems which needed treatment from a physician. Collaboration between physicians and psychiatrists in the management of elderly psychiatric patients requires more extensive facilities than those available in joint assessment units.

Benefits of effective hospital services for elderly people.

An age related hospital service for elderly people was set up in Waltham Forest Health Authority to provide acute medical care when needed. Despite a reduction in the allocation of funds over the years 1982-4 the health authority increased the number of district general hospital beds available for elderly patients and improved home nursing services. The outcomes of the changes made were assessed against the aims of the service by using data from the Hospital Activity Analysis, SH3 returns, government population estimates, and yearly figures collected in our department. It is concluded that introducing an age related service in our health authority has benefited people aged over 65.

Immunoglobulin deficiency responding to vitamin B12 in two elderly patients with megaloblastic anaemia.

Two elderly patients with vitamin B12 deficiency were found to have low immunoglobulin levels. These returned to normal on treatment with vitamin B12.

Late infection of joint prostheses.

Late infection of an orthopaedic prosthesis can cause serious illness in elderly patients. Four cases are described to show the importance of recognizing this condition.