ABSTRACT
BACKGROUND: Referring patients from nursing homes to general hospitals exposes them to nosocomial diseases, and may result in the development of a broad spectrum of physical, mental and social damages. Therefore, minimizing the referring of nursing home patients to hospitals is an important factor for keeping the elderly healthy and minimizing health expenditures. In this study we examined the variables related to the referral rates from nursing homes to general hospitals and the relationship between the referral and the mortality rates among the elderly who live in nursing homes in the Haifa Sub-district. METHODS: Thirty-two nursing homes were included in a cross-sectional study. All medical directors and head nurses were interviewed using a structured questionnaire between November 2006 and October 2007. Statistical analysis, including the ANOVA and the nonparametric Spearman tests, were employed to determine the factors that influence referral rates and the correlation between referral rates and mortality rates. RESULTS: The referral rate ranged between 18 and 222 per 100 financed elderly in a single year. In the multivariate analysis, the absence of a physician from the nursing home at the time of the referral to general hospitals was the only significant variable related to referral rates. No significant relationships were found between referral rates and mortality rates. CONCLUSIONS: Absence of a significant relationship between referral rates and mortality rates may indicate that high referral rates do not necessarily protect the elderly from death. Therefore, any recommendations issued by the Ministry of Health (MOH) should emphasize in-house treatment rather than hospitalization. Clear instructions on referral from nursing homes to general hospitals need to be constructed by the MOH. The MOH should increase the presence of physicians in the nursing homes, especially, when the need to refer a patient arises. Further quantitative and epidemiologic studies should be conducted in order to, more fully and reliably, create guidelines for policy recommendations.
ABSTRACT
BACKGROUND: Alteration of innate and acquired immunity can play a role in the mechanism involved in the development of dementia. Epidemiologic studies indicate that the use of non-steroidal anti-inflammatory drugs can delay the onset or slow progression of Alzheimer disease. OBJECTIVES: To determine whether the use of NSAIDs is associated with natural killer activity alteration in AD and multi-infarct vascular dementia patients, as compared with non-demented elderly and healthy young people. METHODS: In this prospective open study four groups of subjects (AD, VD, non-demented elderly, and healthy young people) were treated with an NSAID drug (rofecoxib 12.5 mg/day or ibuprofen 400 mg twice daily) for 7 days. Natural killer cell cytotoxicity was measured after flow cytometry analysis before and after treatment. RESULTS: Of the 49 subjects studied, 15 had a diagnosis of AD (3 men, 12 women; mean age 83.5 +/- 8.1 years), 15 had a diagnosis of multi-infarct VD (7 men, 8 women; mean age 75.5 +/- 8.4), 13 were non-demented elderly (1 man, 12 women; mean age 80.2 +/- 7.2), and 6 were healthy young volunteers (3 men, 3 women; mean age 36.8 +/- 4.4). While all examined subjects showed decreased NK cell cytotoxicity after treatment, this decrease was most prominent and statistically significant in elderly patients suffering from vascular dementia--from an average of 30.5 +/- 11.8% before treatment to 22.5 +/- 16% after treatment (P = 0.04). The decrease in NK cell cytotoxicity was only moderate and not statistically significant in all other elderly and young subjects. Young healthy volunteers exhibited a significantly higher total NK cytotoxicity before and after treatment compared to all age groups (P < 0.001). CONCLUSION: These findings suggest that NSAIDs decrease NK activity in vascular dementia patients. Our findings also suggest that natural killer activity alteration cannot explain the ability of anti-inflammatory drugs to delay the onset or slow the progression of AD.