Aging (Milan, Italy)最新文献

Patients ratings of care serve as an indicator of quality of care, as well as a predictor of patient behavior. In spite of the heterogeneity of the older population and their disproportionate consumption of health care resources, relatively little attention has been paid to assessing the elderly's satisfaction with medical care. Using data from the 1991 Medicare Current Beneficiary Survey, we compare ratings of medical care and quality of physician care between the young-old (65-79 years) and old-old (80+ years) living in the community. Multivariate logistic regression analyses are performed to assess the independent effect of age on patients' ratings of care. Results show a significant negative association between age and highly positive ratings of care in the elderly; the old-old are less likely than the young-old to give very favorable opinions (e.g., very satisfied vs other) of the care they received. The relationship remains even after controlling for measures of health status and experience and use of health care. However, variations were observed when more negative ratings (e.g., satisfied/very satisfied vs dissatisfied/very dissatisfied) were considered. Although elderly people as a group usually are found to rate their care more positively than younger adults, this study indicates there is heterogeneity in the older population regarding views of medical care.

We investigated the use of hypnotics in nursing homes and old age homes in the county of Sogn og Fjordane, Norway. Data on administration of hypnotics on 3 separate days within a week in August 1995 was obtained from the drug administration records in 31 institutions. Twenty-five percent of the 1062 patients in the institutions used hypnotics, with no difference between patients from nursing homes and old age homes. The number of patients treated with hypnotics, the doses administered, and the time of administration were similar for weekends and workdays. About 100% of the hypnotics were used as scheduled, and 29% of the doses administered were higher than the recommended lowest dose for elderly patients. Furthermore, about 50% of the hypnotics administered were long-acting benzodiazepines. The results indicate a need for a review of the prescribing of hypnotics in geriatric institutions.

We analyzed cancer mortality trends in 3282 elderly subjects from two general Italian populations with different life-style patterns taking part in the Cardiovascular Study in the Elderly (CASTEL). The aim of the study was to evaluate which predictors were able to influence cancer mortality. Age, gender, tobacco smoking, the presence of respiratory symptoms, increased serum levels of ALT and ALP, and the town of residence were powerful predictors. Subjects living in Chioggia (low income, rural) had significantly greater lung and liver cancer mortality, compared with those living in Castelfranco (industrial). The findings suggest that an incongruous life-style (smoking, alcohol consumption, poor hygienic conditions) may increase cancer mortality despite the favorable environmental conditions typical of rural Mediterranean areas.

Osteoporosis is a major risk factor for fractures in the elderly. Osteoporotic (hip, forearm, and vertebral) fractures today strike hard on Western populations, with a lifetime risk in women similar to the risk for cardiovascular disease. The risk of dying from hip fracture equals breast cancer mortality. Osteoporotic fractures are associated with pain, crippling and social dependency; annual costs in the United States are between $7 to $20 billion, and the contribution from hip fractures is above 60%. Of all hospital beds in Europe, 1 to 1.5% are occupied by osteoporotic patients, a figure expected to more than double during the next fifty years. Whereas vertebral fractures mainly seem to be caused by osteoporosis alone, hip fractures are heavily affected by an age-dependent contributory risk factor, frailty. Frailty might act as an involutionary phenomenon or as comorbidity, particularly neurological; it affects fracture risk along several causal paths, but the increasing frequency and severity of falls are essential. Results of attempts to prevent falls are discouragingly poor. Nevertheless, identification of risk possessors, particularly demented elderly living in institutions, is substantial for directing preventive and treatment programs, mainly acting on general health and on osteoporosis. Frailty of populations increases with longevity. Consequently, projections of fracture occurrence are too conservative. The annual hip fracture incidence in Asia in 2050 might pass 10 million, rather than the hitherto forecasted 3.2 million, thus shifting tomorrow's burden of age-related fractures from the wealthier to the poorer countries. There is an immediate call for vigorous global actions to reallocate resources, to reorganize health care, and to institute high-risk prevention programs.