To assess the documentation of a do-not-attempt-resuscitation (DNAR) or do-not-hospitalize (DNH) orders in the medical record and to determine factors related to these orders.
Five thousand six hundred and fifty four subjects from three different levels of institutional long-term care (LTC), chronic care hospitals (n = 1989), nursing homes (n = 3310), and assisted living (n = 335) in 67 LTC facilities in 19 municipalities were assessed.
Out of these patients, 751 (13%) had a DNAR order and only 36 (0.6%) had a DNH order. The variation in DNAR orders between individual LTC institutions was enormous, ranging from 0 to 92%. In logistic regression analysis, individual institutions and their local caring cultures had the strongest explanatory value (R(2) = 0.49) for advance orders to limit therapy. Impaired activity in daily living (ADL) function (R(2) = 0.11), impaired cognition (R(2) = 0.07), level of LTC (R(2) = 0.05), and diagnoses (R(2) = 0.04) did not provide adequate explanations. Terminal prognosis was not significantly associated with advance orders.
We found marked differences in the use of DNAR and DNH orders between caring units. Diseases and ADL status were only weakly significant as background factors. Open discussions, general guidelines, and research about the adequacy of DNAR decisions are needed to improve equality and self-empowerment among the elderly residing in institutions.
The association of apathy with Alzheimer disease and other dementias and caregiver burden has been examined in a number of studies; however, less is known about its relationship with delirium and mortality. We aimed to investigate the prevalence, relationship with delirium and dementia, and prognostic value of apathy in an elderly and frail inpatient population.
The cohort included 425 patients in acute geriatric wards and in 7 nursing homes in Helsinki (1999-2000). Demographic factors, physical functioning, diagnoses, and drugs were assessed with special reference for dementia, delirium, and apathy. Mortality was registered from central registers.
Of the patients, 98 (23.1%) suffered from apathy, and it was more frequent among men (32% versus 21% women, P = .037 ). There was no difference in mean age, number of comorbidities, or in the mean number of medications between those with and without apathy; however, those with apathy had lower mean MMSE points (9.2 versus 14.0 without apathy, P
There are scarce data of alcohol consumption and telomere length, an indicator of biological age. In 1974, detailed alcohol consumption was available for a socioeconomically homogenous cohort of middle-aged men (The Helsinki Businessmen Study). Their alcohol use, divided into 5 groups (zero, 1-98, 99-196, 197-490, >490 g/week) has been repeatedly assessed until old age. In 2002/2003, leukocyte telomere length (LTL) and the proportion of short telomeres (less than 5 kilobases) were measured in a random subcohort of 499 men (mean age 76 years) using the Southern blot. Age-adjusted mean LTL in the 5 midlife alcohol consumption groups were 8.33, 8.24, 8.12, 8.13, and 7.87 kilobases, respectively (P
Many potentially inappropriate drugs prescribed to older people have anticholinergic properties as adverse effects and are therefore potentially harmful. These effects typically include constipation, dry mouth, blurred vision, dizziness and slowing of urination. It has been shown that drugs with anticholinergic properties (DAPs) are associated with cognitive decline and dementia, may contribute to events such as falls, delirium and impulsive behaviour, are associated with self-reported adverse effects and physical impairment, and may even be associated with mortality. However, studies of the prognostic implications of DAPs remain scarce.
To evaluate the impact of DAPs on hospitalization and mortality in older patients with stable cardiovascular disease (CVD).
This was a prospective study with a mean follow-up of 3.3 years involving two study groups: users (n?=?295) and non-users (n?=?105) of DAPs. The participants were 400 community-dwelling older people (aged 75-90 years) with stable CVD participating in a secondary prevention study of CVD (DEBATE) in Helsinki, Finland. The use of DAPs was estimated using definitions from the previous scientific literature. The Charlson Comorbidity Index (CCI) was used to estimate the burden of co-morbidity and the Mini-Mental State Examination test was used to assess cognitive function. The risks in the two study groups for hospital visits, number of days spent in hospital care and mortality were measured from 2000 to the end of 2003.
The unadjusted follow-up mortality was 20.7% and 9.5% among the users and non-users of DAPs, respectively (p?=?0.010). However, the use of DAPs was not a significant predictor of mortality in multivariate analysis after adjustment for age, sex and CCI score (hazard ratio 1.57; 95% CI 0.78, 3.15). The mean?±?SD number of hospital days per person-year was higher in the DAP user group (14.9?±?32.5) than in the non-user group (5.2?±?12.3) [p?
The aim was to investigate the relationship between self-rated health (SRH) in healthy midlife, mortality, and frailty in old age.
In 1974, male volunteers for a primary prevention trial in the Helsinki Businessmen Study (mean age 47 years, n = 1,753) reported SRH using a five-step scale (1 = "very good," n = 124; 2 = "fairly good," n = 862; 3 = "average," n = 706; 4 = "fairly poor," or 5 = "very poor"; in the analyses, 4 and 5 were combined as "poor", n = 61). In 2000 (mean age 73 years), the survivors were assessed using a questionnaire including the RAND-36/SF-36 health-related quality of life instrument. Simplified self-reported criteria were used to define phenotypic prefrailty and frailty. Mortality was retrieved from national registers.
During the 26-year follow-up, 410 men had died. Frailty status was assessed in 81.0% (n = 1,088) of survivors: 434 (39.9%), 552 (50.7%), and 102 (9.4%) were classified as not frail, prefrail, and frail, respectively. With fairly good SRH as reference, and adjusted for cardiovascular risk in midlife and comorbidity in old age, midlife SRH was related to mortality in a J-shaped fashion: significant increase with both very good and poor SRH. In similar analyses, average SRH in midlife (n = 425) was related to prefrailty (odds ratio: 1.52, 95% confidence interval: 1.14-2.04) and poor SRH (n = 31) both to prefrailty (odds ratio: 3.56, 95% confidence interval: 1.16-10.9) and frailty (odds ratio: 8.38, 95% confidence interval: 2.32-30.3) in old age.
SRH in clinically healthy midlife among volunteers of a primary prevention trial was related to the development of both prefrailty and frailty in old age, independent of baseline cardiovascular risk and later comorbidity.
Leukocyte telomere length has been taken as a measure of biological age but several inconsistencies exist.
We investigated associations between leukocyte telomere length in old age, midlife risk factors, and mortality. The Helsinki Businessmen Study (a cohort of mainly business executives, born 1919-1934) had baseline assessments of cardiovascular risk factors including body mass index between 1964 and 1973 at a mean age of 40. Leukocyte telomere length and proportion of short telomeres were measured from DNA samples collected in 2002-2003 (n = 622, mean age 78 years). Body mass index and smoking in old age were assessed from questionnaires. Total mortality was verified from registers through January 2010. Main outcome measures were relationships between telomeres, body mass index, smoking, and mortality.
Leukocyte telomere length and notably proportion of short telomeres (
To investigate clinical and laboratory variables associated with good subjective and objective health ("active and healthy aging", AHA) in a cohort of octogenarian men.
Cross-sectional analyses of a longitudinal study.
The Helsinki Businessmen Study in Finland.
A socioeconomically homogenous cohort of men (baseline n = 3293), born in 1919-1934, has been followed up from the 1960s. From 2000, the men have been regularly sent mailed questionnaires and mortality has been retrieved from national registers.
In 2010 survey, AHA was defined as independently responding to the mailed survey, feeling happy without cognitive or functional impairments and without major diseases. In 2010/11, a random subgroup men was clinically investigated and survivors with healthy and nonhealthy aging were compared.
By 2010, 1788 men of the baseline cohort had died, and 894 men responded to the mailed survey. 154 (17.2 %) of those fulfilled the present AHA criteria. Increasing number of criteria were negatively (P
Early identification of those at risk of developing type 2 diabetes (T2DM) is essential. We examined how normoglycemic levels of fasting blood glucose (FBG) and 1-hour glucose predict the development of diabetes among men initially at low risk.
In the Helsinki Businessmen Study (men born in 1919- 1934), 1,145 men had normal FBG (
Different diagnostic criteria differ in their capacity to identify subjects as delirious. It is not known how DSM-IV classification, compared with the DSM-III, DSM-III-R, and ICD-10, identifies delirium among individuals with and without dementia and whether the symptom profiles differ between these two subgroups.
A cross-sectional study was performed on patients (age > or = 70 years) in seven acute geriatric wards (n = 230) and in seven nursing-homes (n = 195) in Helsinki, Finland. Delirium was diagnosed according to the operationalized criteria according to the DSM-III, DSM-III-R, DSM-IV, and clinical criteria of ICD-10. Dementia was defined according to consensus judgment among three geriatricians with concise information including: prior dementia diagnoses, Clinical Dementia Rating Scale, operationalized criteria according to the DSM-IV, nurses and/or caregivers interviews, and the results of the brain CT/MRI and prior Mini-Mental State Examination scores, when available.
According to the DSM-III, DSM-IIIR, DSM-IV and ICD-10 criteria of delirium 22.7, 23.5, 25.9 and 14.9% of the demented, and 12.9, 13.5, 23.5 and 2.9% of the non-demented, respectively, were diagnosed as delirious. In stepwise logistic regression analysis clouding of consciousness, perceptual disturbances, and disorganized thinking were the most significant contributors to delirium diagnosis according to the DSM-IV among individuals with dementia, whereas perceptual disturbances, motor disturbances, and disorientation were the most significant contributors among those without dementia.
DSM-IV criteria of delirium identify new, often non-demented, subjects as being delirious, while ICD-10 is overly restrictive. The symptom profile of delirium was slightly different among individuals with and without dementia.