ABSTRACT
BACKGROUND: Systematic study results of geriatric inpatient treatment assessing the impact of psychiatric disorders on treatment outcome are so far missing. This exploratory study investigated the impact of dementia, depression and delirium on treatment outcome in a geriatric department, compared to those individuals without psychiatric symptoms at the beginning of treatment. METHOD: From January to June 2018 treatment data from geriatric inpatient records were retrospectively evaluated. Functional measurements (Barthel index, timed up and go test, Tinetti test and the De Morton mobility index) were assessed at the start of geriatric treatment and at discharge. A multivariate variance analysis (MANOVA) was used to calculate the possible impact of psychiatric disorders on functional improvement during treatment and to find out if there were significant differences between the four defined groups (dementia, depression, delirium and mentally sound). RESULTS: A total of 280 geriatric inpatients with an average age of 84 years, were included in this study and showed a noticeable prevalence of psychiatric disorders: dementia 29%, depression 27%, and delirium 15%. As expected, the patients in the sample showed a high level of multimorbidity and polypharmacy. Functional improvement was present in each of the defined groups and significant differences between all groups were found. The results of MANOVA showed that none of the possible confounding variables, e.g. age, mini mental status examination (MMSE), degree of care, cognitive impairment, social status, gender and comorbid illness, had an important influence on the group results. CONCLUSION: This study of an acute geriatric department demonstrated that psychiatric disorders in these multimorbid, aged patients did not prevent functional improvement by treatment, showed significant differences during the course of treatment and outcome and compared to inpatients without psychiatric symptoms.
Subject(s)
Delirium , Geriatric Assessment , Inpatients , Aged , Aged, 80 and over , Delirium/diagnosis , Delirium/epidemiology , Humans , Postural Balance , Retrospective Studies , Time and Motion Studies , Treatment OutcomeABSTRACT
During endarterectomy of the internal carotid artery (ICA) blood flow velocity of the ipsilateral medial cerebral artery (MCA) was continuously monitored in twelve patients with the help of a new transcranial pulsed Doppler system. Additionally, the basal cerebral arteries where examined pre- und postoperatively in order to evaluate criteria for selective intraoperative shunting and to document flow improvement following ICA reconstruction. All patients had symptoms, either of TIA or of minor stroke. Five of them had in addition a contralateral ICA occlusion. During intraoperative carotid cross-clamping on the patients with unilateral ICA lesions, MCA blood flow dropped to zero in only one of them. In the other cases, a 20 to 60% flow reduction occurred indicating cross-filling or/and collateral blood supply via the posterior circulation. More severe MCA flow reductions were found in patients with contralateral ICA occlusion, with the occurrence of a no-flow state in two of them. All patients were operated on with an indwelling shunt. Its effect on MCA blood flow varied considerably. Apparently, the shunt was necessary in some patients but was superfluous in the majority of them. Transcranial Doppler meets the basic criteria of an examination technique to be recommended for monitoring. The method is noninvasive. The parameter, i.e. MCA flow velocity, can be evaluated on-line. It is representative and highly sensitive for cerebral circulatory disturbances and impending ischemia in the carotid territory. Transcranial MCA flow monitoring does not affect the course of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
