RESUMO
OBJECTIVES: The increasing number of older cardiac patients combined with the tendency to reduce hospital stays created the need for a Convalescence Cardiac Unit (Con.CU). It functions as a transitional facility for elderly patients discharged from hospitals after cardiac events, and was established within a geriatric medical center using existing infrastructure and staff. METHODS: Patients from 5 neighboring general hospitals (including 23 internal medicine wards and 3 departments of cardiac surgery) were offered the option of one week stay in the Con.CU after discharge. During the stay in the unit they received medical supervision as well as counsel on matters of nutrition and physical activity. RESULTS: 78 patients were admitted during the first 14 months. Forty patients were after coronary artery bypass grafts (CABG) (51%)30 after acute myocardial infarction (MI) (38%). The average age was 75 +/- 2.5 (SD). Medical complications developed in 57%. Most of these patients were treated by the local staff. Five cases had to be readmitted to the hospital they came from. Elderly cardiac patients that chose the option of Con.CU and their families expressed high appreciation regarding this experience and its contribution in facilitating return home. CONCLUSION: This innovative model is aimed to improve continuity of care for elderly cardiac patients and provide them with a new service in this era of "early discharge" from hospitalization. Geriatric settings striving to diversify their services, and medical directors required to contribute to policy development may learn from this experience.
RESUMO
The objective of this study was to evaluate the accuracy of the social worker estimation (SWE) of the length of survival of patients who were seen at the end stage of their terminal illness, in home-based palliative care treatment. Estimates were filled out on a form every 2 weeks during the time of the visits until the patient's discharge or death. The wording used by the social worker was the 'average survival period'. Survival was measured from the time of each survival prognostication until death from any cause. Both SWE and actual survival were categorized into
RESUMO
We compared the demographic and clinical characteristics of 37 subjects under and 41 subjects over 75 years of age who were consecutive new referrals to an out-patient psychogeriatric service in order to examine if an age-related dichotomy emerges in this population. Even though the groups were similar in most demographic (gender, education, years in Israel, family status) and some clinical aspects (number of physical diagnoses, medications taken) they differed significantly in some other clinical variables. "Functional" disorders, independence in performing household activities and Activities of Daily Living (ADL) and more recommendations for ambulatory follow-up were more prominent in the younger group. This profile has much in common with elderly patients newly referred to the general mental health services. The older group had more "organic" disorders, significant need for assistance in household activities and ADL, and more recommendations for follow-up in day-care centers, a profile more characteristic of patients who are treated in memory/dementia clinics. Thus, from a services organizational point of view, it is possible to subdivide out-patient elderly individuals with cognitive and emotional disturbances into separate groups, each with its own characteristics and needs.
Assuntos
Serviços de Saúde para Idosos/provisão & distribuição , Transtornos Mentais/reabilitação , Encaminhamento e Consulta , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
During the Gulf War in 1991 a telephone-based support system was established for elderly patients living at home in Israel. The study population involved 93 elderly patients (mean age 74), who had recently been discharged from hospital and were chosen for supervision by the Home-Care Unit of the Tel Aviv Sourasky Medical Center, Israel. Two different teams were involved with the telephone support calls: secretarial staff (nonprofessional team) and social workers (professional team). The research examined the characteristics of the study population and also included a comparison between the two groups of patients receiving the psycho-social support. The latter indicated that better results of outcome indices were achieved by the professional team. Further, this study demonstrated the feasibility of telephone-support outreach as an interventional strategy for psycho-social support for elderly patients at a time of crisis.
Assuntos
Idoso Fragilizado , Serviços de Saúde para Idosos/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Serviços de Saúde Mental/organização & administração , Apoio Social , Serviço Social/métodos , Telemedicina/organização & administração , Idoso , Idoso de 80 Anos ou mais , Ansiedade/prevenção & controle , Distribuição de Qui-Quadrado , Intervenção em Crise/organização & administração , Feminino , Humanos , Israel , Masculino , Oriente Médio , Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente/normas , Satisfação do Paciente , Serviço Social/normas , GuerraRESUMO
Presented here are two case reports of elderly persons with Diogenes syndrome (variously known as senile breakdown, social breakdown and senile squalor syndrome). Diogenes syndrome is often (but not always) characterized by a tendency to hoard excessively (syllogomania). The first patient was diagnosed as having both a schizotypal personality disorder and obessive-compulsive disorders (OCD) while the second was diagnosed as having a schizoid personality disorder. Only the former demonstrated the tendency to hoard rubbish. The Diogenes syndrome in both cases can be hypothesized to be a reaction to stress in elderly people with certain personality characteristics or as the end stage of a personality disorder. The hoarding behavior that was manifested only in the first case can probably be the result of the presence of an OCD. The authors raise the possibility that OCD may be the cause of hoarding rubbish in those cases of Diogenes syndrome in which hoarding exists and cannot be explained by psychotic disorders, dementia or any other mental disorders due to a general medical condition (GMC) or substance-related disorders.
Assuntos
Comportamento Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/complicações , Transtornos da Personalidade/complicações , Transtornos da Personalidade/diagnóstico , Ajustamento Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Serviços de Cuidados Domésticos/provisão & distribuição , Humanos , Israel , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , SíndromeRESUMO
During the Gulf War, 93 elderly patients (mean age 74 years) received telephone-based support calls from a hospital-based home care facility. Accuracy of memory recall of these telephone support calls was assessed 6 weeks after the termination of the war by means of a postal questionnaire. The relative accuracy of the recall memory of these patients or their caregivers to the telephone calls received exhibited a sensitivity of 75%, a specificity of 78%, a positive predictive value of 60% and a negative predictive value of 88%. Patients who had received four calls demonstrated better memory recall than those receiving less than four. Thus, relying upon patient's memory alone may be insufficient for evaluating survey data in the elderly. In addition, we found that only patients who correctly remembered receiving four individual telephone support calls tended to exhibit a decrease in the anxiety level. This study emphasizes the importance of repeated interventional telephone calls as a method of increasing recall accuracy and decreasing anxiety in aged patients.
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Transtornos Cognitivos/terapia , Serviços Comunitários de Saúde Mental/organização & administração , Serviços de Saúde para Idosos/organização & administração , Transtornos Mentais/terapia , Idoso , Serviços Comunitários de Saúde Mental/tendências , Serviços de Saúde para Idosos/tendências , Humanos , IsraelAssuntos
Infecções por Escherichia coli/complicações , Hipoglicemia/etiologia , Idoso , Glicemia , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/urina , Feminino , Gentamicinas/uso terapêutico , Glucose/uso terapêutico , Humanos , Hipoglicemia/tratamento farmacológicoAssuntos
Hemólise , Temperatura Alta , Diálise Renal/efeitos adversos , Adulto , Humanos , MasculinoRESUMO
Serendipitously occasioned, interim findings from an exploratory study "which-as Whitehead once said of William James's pragmatism-'chiefly starts a log of hares for people to chase.'"3 The data, collected in a 1965 community survey of health, show that no indulgence in the sick role apparently entails greater mortality risk than does a modicum of such indulgence.