Self-reported benefits of t'ai chi practice by older women.

Self-rated health is a powerful and consistent predictor of self-care capability and health outcomes including mobility, morbidity, and mortality. Exercise is important for health and functioning of older adults. Although daily physical activity is advocated for reducing many health risks and maintaining mobility, older women are generally not heeding the message. Exercise interventions for older women should be age appropriate. T'ai chi, an ancient Chinese martial art, involves an integration of the mind and body in slow, circular movements and changes in the center of gravity. Although there is a growing body of literature on the health benefits of t'ai chi exercises, few studies focus on the self-assessment of health benefits of t'ai chi for older women. This within-participants, single-factor study of women aged 72 to 96 years resulted in statistically significant improvement in self-assessed health as well as numerous self-reported benefits after 3 months of t'ai chi exercise participation.

Rehabilitation after a hip fracture. Special needs of the elderly.

Hip fractures are one of the most common and potentially devastating injuries in the geriatric population. The incidence, morbidity, and health care costs associated with hip fracture among older persons are well recognized. Because of the complex health care needs of the elderly, rehabilitation after a hip fracture can present a challenge at a time when the nursing workforce and health care funding are declining. Aggressive rehabilitation focusing on continuity of care and attention to the cognitive as well as physiologic status results in effective and cost-effective rehabilitation.

Creating an effective poster presentation.

One way to build knowledge in nursing is to share research findings or clinical program outcomes. The dissemination of these findings is often a difficult final step in a project that has taken months or years to complete. One method of sharing findings in a relaxed and informal setting is a poster presentation. This method is an effective form for presenting findings using an interactive approach. The milieu of a poster presentation enables the presenters to interact and dialogue with colleagues. Guidelines for size and format require that the poster is clear and informative. Application of design helps to create visually appealing posters. This article summarizes elements of designing and conducting a poster presentation.

Case management model for a community-based multiple sclerosis clinic.

This article describes the process from inception to successful operation of a case management model of a community-based multiple sclerosis clinic. The article includes information regarding the pathophysiology, diagnosis, and clinical manifestations of multiple sclerosis. The assessment, planning, and intervention stages of the process are explained, and a case study of one clinic patient is provided.

Multiple sclerosis update.

Multiple sclerosis (MS) is the most common central nervous system disease among young adults and the third leading cause of disability in the United States. It is estimated that 400,000 Americans have this disorder of the brain and spinal cord, which causes disruption in the smooth flow of electrical messages from the brain to nerves throughout the body. The clinical manifestations vary more in MS than any other neurologic disease. Because of the complexity of MS, a collaborative approach to care of these clients and their family is ideal. This article provides an update on the diagnosis, pharmacologic management, and collaborative care for patients and families.

The relation of exercise habits to health beliefs and knowledge about osteoporosis.

The relation of exercise habits of 113 female college students to their knowledge about osteoporosis and their health beliefs was investigated, using the health belief model to determine why some people participate in self-care preventive actions but others do not. Age was positively correlated with the level of osteoporosis knowledge, awareness of personal susceptibility, and motivation for general health behaviors. Older participants, however, perceived more barriers to exercise as an osteoporosis-prevention measure than did the younger respondents. The authors' conclusions support the importance of early osteoporosis education and lifetime physical activities to prevent osteoporosis.

Temazepam withdrawal in elderly hospitalized patients: a double blind randomised trial comparing abrupt versus gradual withdrawal.

31 of 36 elderly mainly confused hospitalized patients (69-98 years) taking temazepam 10 mgs nocte for more than one month completed a double blind randomised placebo controlled trial comparing abrupt versus gradual withdrawal of temazepam. Hours of sleep were recorded for all patients during a 7 day baseline period while taking temazepam 10 mg nocte. Then the abrupt withdrawal (AW) group (n = 15) received placebo for 10 nights and the gradual withdrawal (GW) group (n = 16) received temazepam 5 mg for the first 4 nights, 2 mg for the next 4 nights and placebo for the last 2 nights. There was no significant difference in mean hours of nightly sleep during the baseline period between the AW group (5.9 +/- 1.1 SD) and GW group (5.8 +/- 1.1 SD) and between the baseline and withdrawal periods in each group (withdrawal periods, AW 5.6 +/- 1.2, GW 5.6 +/- 1.0). There was no rebound insomnia when temazepam was withdrawn either abruptly or gradually in long-term hospitalised elderly patients and may not be effective as a long-term hypnotic.

A study of drug compliance, including the effect of a treatment card, in elderly patients following discharge home from hospital.

Compliance with prescribed medication was assessed in 104 mentally alert elderly patients one and two months after discharge from a geriatric medical unit. Of the 82 patients (58 females, 24 males) who completed the study, 72% were compliant by average tablet count after one month and 69% after two months. Using urinary riboflavin excretion as a marker of compliance, 69% were compliant after one month and 59% after two months. These differences were not significant, nor was any significant difference shown when a crossover design was used to study the effect of a treatment card on compliance. No differences in age, sex, social support or number of tablets taken were found between compliant and non-compliant patients. The value of a careful explanation of drug therapy by both a hospital pharmacist prior to discharge, and a research nurse, one and two months after discharge, has been highlighted. A considerable number of patients benefited from the assistance of a relative or home helper in administering their own treatment. It is recommended that a suitable helper be identified and counselled to assist at risk elderly patients with their medication. Thus, elderly mentally alert patients can achieve a satisfactory level of compliance equivalent to younger patients if appropriate counselling is undertaken.

Do drugs affect the risk of hip fracture in elderly women?

The drugs prescribed for 280 women with hip fractures (mean age 83 years) were compared with those prescribed for 145 women controls (mean age 81 years) as recorded in a family practice age-sex register. Thirty-three percent of the fracture patients were taking diuretics compared with 24% of the controls (.10 greater than P greater than .05). Forty-six percent of these diuretics taken by the fracture group (compared with 40% taken by the controls) were either loop or potassium sparing diuretics in combination with another diuretic. Twenty-five percent of the controls (compared with 9% of the fracture patients) were taking nonsteroidal anti-inflammatory drugs (NSAIDs) (P less than .001). The greater use of NSAIDs by control subjects may be due to the small overlap between osteoporosis and osteoarthritis. No significant differences were found for digoxin, anti-hypertensive drugs, and those taking no drugs. Thirty percent of fracture patients were taking sedatives and hypnotics compared with 28% of controls. Within this category, 54% of the fracture patients and 80% controls were receiving drugs (mainly benzodiazepines) with half-lives longer than 24 hours. Thus, this population did not confirm a previously identified association between long-acting sedatives and the risk of fracture. As only 3.5% of fracture patients and 2.1% controls were receiving phenothiazines, a role for these drugs in hip fracture cannot be ruled out. In summary, hip fracture patients were slightly more likely to be taking diuretics and somewhat less likely to be taking NSAIDs than controls but there were no differences with respect to other drugs.

Narcolepsy in the elderly: a forgotten diagnosis.

Two cases of narcolepsy presenting in elderly patients are reported. Delay in diagnosis prior to presentation resulted in considerable psychosocial problems for both patients. Satisfactory responses to therapy were achieved with patients regaining independence. Difficulties associated with this diagnosis in the elderly are discussed.

Absence of evidence for a role of calcitonin in the etiology of femoral neck fracture.

Twenty elderly women with fracture of the femoral neck were compared with 10 age-matched women undergoing elective hip surgery. In spite of an equivalent calcium response to intravenous calcium, neither basal nor stimulated calcitonin levels were significantly different between the groups. Parathormone, 25OHD, and 1,25(OHD)2 showed no significant differences between the femoral neck fracture group and control subjects. It is thus unlikely that calcitonin has an important role in the etiology of postmenopausal osteoporosis associated with femoral neck fracture.

Effect of calcium and stanozolol on calcitonin secretion in patients with femoral neck fracture.

The role of calcitonin in the aetiology of postmenopausal osteoporosis remains uncertain. Oestrogen, an established therapy for postmenopausal osteoporosis, has been shown to enhance calcitonin secretion. In order to assess whether two other osteoporotic drug treatments, oral calcium and stanozolol (an anabolic steroid), may also affect calcitonin secretion, 20 elderly women with femoral neck fracture were randomly selected to receive either 880 mg calcium or 5 mg stanozolol daily for 12 weeks. Basal calcitonin and serum calcium were not altered significantly by either treatment. The calcitonin response to a 10 min infusion of calcium was enhanced following treatment with oral calcium but not stanozolol. This suggests one possible mechanism of action whereby calcium may exert its antiresorptive effect on bone and supports the use of oral calcium in the treatment of postmenopausal osteoporosis.

A microcomputer based audit of fracture of the proximal femur in the elderly.

A microcomputer was used for patient record management and statistical analysis to study prospectively an elderly female population with femoral neck fracture. Of 150 patients studied, 58% presented with a cervical fracture and 42% with a trochanteric fracture. The patients with trochanteric fracture were significantly older than the patients with cervical fracture (P less than 0.001), required a longer stay in hospital (P less than 0.01) and returned to their previous environment less frequently. The proportion of trochanteric fractures increased with age. In view of the ageing population and the rising incidence of femoral neck fracture, these findings have important implications for the future allocation of hospital resources.

Reduction of lecithin-cholesterol acyltransferase, apolipoprotein D and the Lp(a) lipoprotein with the anabolic steroid stanozolol.

The effects of the anabolic steroid stanozolol (17-methyl-2H-5 alpha-androst-2-eno-(3,2-c)pyrazol-17 beta-ol) on lecithin-cholesterol acyltransferase, apolipoproteins B and D and the Lp(a) lipoprotein were determined in a prospective study of ten normolipidemic women with postmenopausal osteoporosis. Lecithin-cholesterol acyltransferase was reduced approx. 30% by 6 weeks of treatment with stanozolol (off treatment 5.1 +/- 1.2, on treatment 3.4 +/- 0.8 muml; P less than 0.02). The Lp(a) lipoprotein was reduced 65 +/- 23% by the steroid treatment (off treatment 5.5 +/- 5.5, on treatment 1.4 +/- 0.7 mg/dl; P less than 0.02). Apolipoprotein D was reduced 23 +/- 9% by the treatment (off treatment 5.9 +/- 0.9, on treatment 4.5 +/- 0.7 mg/dl; P less than 0.02). In contrast, apolipoprotein B increased slightly but insignificantly on steroid therapy (off treatment 90 +/- 21, on treatment 112 +/- 24 mg/dl). By 5 weeks after the drug was discontinued, all four of these proteins were near pretreatment levels. These significant changes in lipoprotein metabolism, combined with our previous report of reductions of HDL and particularly HDL2, suggest the need for caution in the long-term use of anabolic steroids.

Reduction in high density lipoproteins by anabolic steroid (stanozolol) therapy for postmenopausal osteoporosis.

The effects of stanozolol, 17-methyl-2H-5 alpha-androst-2-eno [3,2-c] pyrazol-17 beta-ol, on lipoprotein levels were assessed in a short-term (6 wk) prospective study of 10 normolipidemic, postmenopausal, osteoporotic women. While total cholesterol and triglyceride levels remained constant, equal and offsetting responses were seen in low density lipoprotein (LDL) cholesterol (+30.9 +/- 28.1 mg/dl [mean +/- S.D.], p less than 0.01, a 21% increase) and high density lipoprotein (HDL) cholesterol (-32.5 +/- 11.9 mg/dl [mean +/- S.D.], p less than 0.001, a 53% decline). Hence the LDL/HDL ratio increased dramatically, from 2.5 +/- 0.7 to 6.8 +/- 2.5. Within HDL, stanozolol was associated with a greater decline in HDL2 (from 26.0 +/- 7.4 mg/dl to 3.8 +/- 1.9 mg/dl, p less than 0.001, an 85% decrease) than HDL3 (which diminished from 35.7 +/- 3.2 to 24.1 +/- 5.8 mg/dl. p less than 0.001, a 35% decrease). The major HLD apolipoproteins also declined (A-I by a mean of 41% and A-II by 24%, both p less than 0.001). Postheparin hepatic triglyceride lipase increased (off treatment 74 +/- 42 nmole free fatty acid min-1 mole-1, on treatment 242 +/- 110, n = 6, p = 0.06). All changes were reversed by 5 wk following termination of the drug. These lipoprotein changes suggest caution in the long term prescription of stanozolol, particularly in those without overriding clinical indications for its use.

Deficient calcitonin response to calcium stimulation in postmenopausal osteoporosis?

To test whether mobilisation of immunoreactive calcitonin in response to calcium challenge is reduced in postmenopausal osteoporosis, seventeen postmenopausal osteoporotic women with compression fractures and ten normal age-matched women were given intravenous infusions of 3 mg/kg elemental calcium over a 10 min period. Blood samples were obtained 5 min before and at 0, 10, 20, and 60 min after start of infusion for the measurement of serum calcium and plasma immunoreactive calcitonin. Serum calcium increased significantly from baseline in both normal and osteoporotic groups; immunoreactive calcitonin increased significantly in the controls 10 min and 20 min after the start of infusion, but in the women with osteoporosis calcitonin levels did not change significantly at any time. 20 min after the start of infusion the change in immunoreactive calcitonin from baseline was significantly less in osteoporotic women than in the controls. These data are consistent with a decreased immunoreactive calcitonin response to calcium infusion in postmenopausal osteoporotic women, and suggest that calcitonin deficiency may be involved in the development of postmenopausal osteoporosis.