Anemia in institutionalized elderly patients.

In a one-year period (1976--1977), 161 residents of a long-term facility were evaluated. There were 44 men and 117 women. According to criteria established by the World Health Organization, 64 residents (40 percent) were anemic. The incidence was greater for women than for men. The peak incidence occurred in the 71--80 age group for women, and in the 90+ age group for men. Iron deficiency secondary to surgical procedures, gastrointestinal bleeding or anticoagulant therapy was the most common cause of correctable anemia. Of the 64 anemic patients, 42 percent responded to therapy. Anemia among the elderly in institutions is often reversible, unlike the anemia of chronic disease. Evaluation should include a careful history and physical examination plus readily available laboratory findings. Invasive procedures are rarely indicated.

Falls in the institutionalized elderly.

The reports on 72 of 190 accidents occurring among 189 nursing home residents during a 3-month period were drawn at random and reviewed. The majority of the accidents were falls, either major or minor. Personal data on the residents included age, sex, mental status, number of diseases, and number of drugs administered. Data on environmental factors included the time of day and location of the accident, and the concomitant nursing staff patterns. Women of advanced age were more likely to be involved in a major fall, whereas younger men were more likely to be involved in a minor one. Alert, wheelchair-bound elderly patients were at the highest risk, whereas those who used assistive devices were at the lowest risk. Falls were directly related to the number of diseases present and the use of drugs. Most accidents occurred at the bedside during the evenings and nights, with the greatest frequency during the changes in nursing shifts or when the patient was either rising or retiring.

The role of geriatrics in a family practice residency program.

In an attempt to clarify the role of geriatrics in family practice, the program at St. Joseph's Hospital and Nursing Home of Yonkers is outlined. The objective of this Family Practice Program are: 1) to assist in identifying needs in a target population and in developing and providing services to meet these needs; 2) to train and educate the Family Practice resident in the multiple medical, social and psychiatric problems of late life; 3) to indoctrinate this resident in the unique and numerous needs of the institutional elderly and of the institution in which they reside; and 4) to develop new and comprehensive systems of health care that will permit the marginally ill elderly to remain in the community as long as possible.

Incidence of polypharmacy in a long-term care facility.

The incidence of polypharmacy was investigated in a 200-bed long-term care facility. One hundred residents were drawn at random for the study. The average number of drugs prescribed per patient was 3.33, and the average number of pills was 6.34 daily. The most frequently prescribed drugs were the analgesics, followed in order by antihypertensive agents, cardiotonic preparations and antimicrobials. The literature is reviewed with respect to the incidence, causes and end-results of polypharmacy. It is recommended that long-term care facilities develop enlightened and aggressive pharmacy committees to monitor and evaluate drug use routinely in an institutional setting.