Subject(s)
Heparin, Low-Molecular-Weight/administration & dosage , Thromboembolism/drug therapy , Thromboembolism/prevention & control , Aged , Aged, 80 and over , Data Collection , Drug Administration Schedule , Female , France , Geriatrics/methods , Humans , Long-Term Care , Male , Primary Prevention , Prognosis , Risk Assessment , Surveys and Questionnaires , Treatment OutcomeABSTRACT
OBJECTIVES: Nursing home residents and geriatric ward patients have a high risk of venous thromboembolism. Prevention is a major challenge. We conducted a one-day audit to ascertain heparin use patterns in a large sample of geriatric facilities in France. METHODS: This one-day audit was made with a questionnaire mailed to 150 geriatric centers in France. Items were the number of subjects receiving heparin on the day of the survey, and for each of these subjects, the reason for the prescription, risk factors for venous thromboembolism and date of treatment onset. RESULTS: Ninety-six centers (63%) participated. These centers had 14,208 beds the day of the survey (short-term hospitalization, day-care hospitalization, nursing homes, retirement homes). These centers reported 1,312 subjects (9.2%) receiving heparin on the day of the survey. Their mean age was 83.4 days. Among the hospital centers, heparin had been prescribed in 33.4% of the short-term hospitalization patients, 27.3% of the day-care patients, and 5.6% of the nursing home patients. Heparin was prescribed for prophylaxis in 1,143 patients (87%)--basically low-molecular-weight heparin. These patients had on the average 3.33 risk factors. The duration of preventive treatment was more than 30 days in 481 subjects (50%) and 161 (17%) had received heparin for 6 months or more. CONCLUSION: Prevention of venous thromboembolism is a major concern in geriatric centers in France. Although the preventive efficacy has not been clearly demonstrated in geriatric medical patients, low-molecular weight heparin is widely used for this purpose with, in a large number of cases, very long treatment durations.
Subject(s)
Fibrinolytic Agents/therapeutic use , Geriatrics , Heparin/therapeutic use , Aged , Aged, 80 and over , Data Collection , Drug Utilization , Female , France , Humans , Male , Risk FactorsSubject(s)
Pruritus , Skin Diseases/complications , Skin/injuries , Aged , Humans , Pruritus/diagnosis , Pruritus/etiology , Pruritus/therapyABSTRACT
BACKGROUND: Orthostatic hypotension (OH) is a major problem in the elderly population. Its diagnosis is based on measurement of the blood pressure (BP) response to orthostatism (BPRO). This study investigates the within-day and day-to-day variability of the BPRO and the reproducibility of the diagnosis of OH in this population. METHODS: BP was measured in the supine position and after 1 and 2 minutes of orthostatism in 53 consecutive elderly patients (43 women and 10 men aged 83.7 +/- 9.5 years) of an intermediate care geriatric ward. BPRO was assessed 4 times on the same day (8-9 AM, 10-11 AM, 1-2 PM, and 5-6 PM) and twice more on another day of the same week (8-9 AM and 1-2 PM). RESULTS: There were significant within-day differences between the four orthostatic changes in systolic BP (OCs, supine minus standing systolic BP) after 1 minute or 2 minutes (p < .05). Day-to-day differences between the OCs measured at the same times were not significant. OH defined as an OCs of 20 mm Hg or more at 1 or 2 minutes of orthostatism, was found in ten cases (19%) in the initial set of measurements on the first day. A cumulative diagnosis of OH after the six BPRO tests was found in 23 cases (43%). The reproducibility of the diagnosis of OH was mild or poor (all kappa values were below 0.47). CONCLUSIONS: BPRO exhibits significant within-day variability in elderly patients. Within-day and day-to-day reproducibility of the diagnosis of OH, based on conventional criteria, were found to be poor.
Subject(s)
Hypotension, Orthostatic/diagnosis , Aged , Aged, 80 and over , Blood Pressure , Female , Humans , Male , Reproducibility of Results , Supine PositionABSTRACT
OBJECTIVES: The medical record (MR) is a key document for hospitalized patients. Several audits have however demonstrated that much important information is often missing in hospital MR. We conducted this survey with the aim of improving the quality of MR in a geriatric unit. PATIENTS AND METHODS: A structured MR was elaborated and implemented in order to guide and record the assessment of patients admitted in our geriatric ward. MR of 54 consecutive patients admitted after implementation of the structured MR were studied and compared to those of 108 consecutive patients admitted on the preceeding year (classical MR). Quality of data collected at admission was assessed using a 33-item guide, proposed by 3 experts in geriatric medicine unaware of the structured MR studies. For each item, a binary score (present/absent) and a precision score were used. A validation study was conducted using the same methods in another geriatric ward which has not participated to development of the structured charts MR studied. RESULTS: For most items studied, information was present in a significantly higher proportion in structured MR than in classical MR. Likewise, the precision score was significantly higher in structured MR. The validation survey found analogous results. CONCLUSION: Use of a structured MR significantly improves the quality of data collection at admission in geriatric units. This improvement appears to be related more to the use of the structured MR than the effect of developing a new tool.
