The effect of hospital admission on the opinions and knowledge of elderly patients regarding cardiopulmonary resuscitation.

OBJECTIVE: to determine (i) if the opinions of elderly people, regarding their wish for cardiopulmonary resuscitation (CPR), change after staying in hospital, (ii) how much elderly people wish to be involved in making decisions about CPR and (iii) the degree of knowledge they use to make their decisions. DESIGN: consecutive sample survey. SETTING: assessment, treatment and rehabilitation unit. PATIENTS: 95 elderly inpatients (63% of all admissions) without a terminal illness who could give informed consent, interviewed after hospital admission. Sixty-seven were interviewed again at hospital discharge and three were interviewed 16-35 days after admission. INTERVENTION: patient education and semi-structured questionnaire. OUTCOME MEASURES: patients' knowledge and opinions on basic knowledge of CPR, preference for CPR, who should decide and how this should be documented. RESULTS: knowledge improved after intervention, although patients persistently overestimated the success rate of CPR. Eighty percent on admission and 69% following a hospital stay wished to have CPR if necessary. Men were more likely to want CPR. On admission, 74% stated the patient should make the decision regarding CPR. This rose to 84% after a hospital stay. Only 57% wished to have their preference recorded in the hospital record and only 43% wanted their general practitioner notified of their wishes. Ninety-four percent felt comfortable with the interview. CONCLUSIONS: elderly people wish to be consulted about CPR but many do not wish their preference to be committed to paper. Most older patients want CPR but these wishes may change with time. It is important that any recorded directive from a patient is updated frequently.

Variability in the elimination of mianserin in elderly patients.

1. Two studies of the elimination of mianserin are reported. 2. In the first study, the oral clearance of mianserin was measured in 15 elderly patients at steady state. In a sub-group of eight patients who completed studies at two different doses there was evidence of enhanced oral clearance at the higher dose. 3. In the second study, the elimination half-life was estimated in 12 patients who were observed to have disproportionately high mianserin concentrations with respect to dose. All had half-lives greater than or equal to 2.5 days with a mean of 6 +/- 2.8 (s.d.) days. In six of the patients the profile of elimination was suggestive of saturable elimination. 4. The sparteine oxidation status was measured in seven of the patients showing slow mianserin elimination. Only one was a 'poor oxidiser' of sparteine, suggesting no concordance with this phenotype. 5. It is concluded that there is marked variability in the elimination of mianserin in elderly patients.

Effect of opiate, general anaesthesia and surgery on plasma atrial natriuretic peptide levels in man.

1. Animal data suggest that opiates, halothane anaesthesia and activation of the sympathetic system stimulates release of atrial natriuretic peptide (ANP). To examine whether this is so in man, venous ANP levels were measured in five patients undergoing elective cholecystectomy. 2. Plasma levels of cortisol, aldosterone, norepinephrine and epinephrine increased 3-6 fold during the study. Cortisol-aldosterone relationships were close in all patients (r = 0.73-0.97), whereas plasma renin activity and aldosterone correlations were strong in only two subjects. 3. Baseline plasma ANP concentrations were within the normal range and were not altered by opiate injection, anaesthesia, or surgery. 4. Unlike experimental animals, man exhibits little or no ANP response to opiates, halothane, or surgical stimulation of the sympathetic nervous system.