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<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> > <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> > <a href="." class="crumb_link">April 1996</a> </span></p>
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<td><h1><a name="h1" id="h1"></a>Health Care for the Elderly </h1>
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<td><div id="centerContent"><div class="headnote">
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<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
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<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
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<a name="head1"></a>
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<h2>Serious complications rare in elderly patients undergoing hip
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arthroplasty</h2>
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<p>Elderly men and women frequently undergo hip arthroplasty and
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only rarely suffer serious complications, according to a study
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supported in part by the Agency for Health Care Policy and
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Research (HS06326). This procedure involves surgical
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reconstruction or replacement of a painful degenerated hip joint
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to restore mobility. The study of elderly Medicare patients shows
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that women had modestly higher total hip arthroplasty rates than
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men. For both men and women, rates increased with age up to about
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80 to 84 years, but declined thereafter. Blacks underwent this
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procedure at half the rate of whites, but it is unclear whether
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this was due to racial differences in osteoarthritis, barriers to
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care, or personal treatment preferences.</p><p>
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About 2.5 percent of patients died within 6 months of the
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operation, and 3.7 percent died within a year. Mortality was
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higher in male patients and patients older than 74 years of age.
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Additional hip surgery was performed in 1.8 percent of total hip
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arthroplasty cases within 1 year, in 3.2 percent within 2 years,
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and in 4.2 percent within 3 years. Serious complications were
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uncommon. Infections were identified in less than 1 percent of
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patients, even after 2 years. Pulmonary embolism occurred in
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about 2 percent of total hip arthroplasty patients within 6
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months but rarely occurred thereafter.</p>
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<p>These findings are based on analysis of a 5 percent sample of the
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U.S. Medicare population from July 1986 through July 1989. The
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group included 5,579 elderly patients with total hip arthroplasty
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performed in the absence of infection, fracture, or previous hip
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surgery. Most patients (83.3 percent) had osteoarthritis.</p><p>
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For more information, see "Total hip arthroplasty: Use and select
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complications in the U.S. Medicare population," by John A. Baron,
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M.D., M.S., M.Sc., Jane Barrett, M.Sc., Jeffrey N. Katz, M.D.,
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M.S., and Matthew H. Liang, M.D., M.P.H., in the January 1996
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<em>American Journal of Public Health</em> 86(1), pp. 70-72. </p>
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<a name="head2"></a>
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<h2>Unregulated use of psychotropic drugs poses danger to
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elderly residents of board and care facilities</h2>
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<p>Over one-third (35 percent) of elderly residents of board and
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care (B&C) facilities use at least one psychotropic
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(mind-altering) drug such as an antidepressant, antipsychotic, or
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sedative. And 30 percent of these patients take two to four
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different psychotropic medications. Moreover, many residents take
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psychotropic medication with drugs for diabetes, hypertension,
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Parkinson's disease, and other conditions, according to a study
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supported in part by the Agency for Health Care Policy and
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Research (National Research Service Award training grant T32
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HS00011). This potentially harmful polypharmacy sparked
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regulation of medications dispensed in nursing homes in 1987 and
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probably warrants similar regulation in B&C facilities,
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suggests Brown University researcher, Diana Spore, Ph.D., the
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study's principal investigator.</p><p>
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There are approximately 34,000 licensed B&C facilities, with
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more than 600,000 beds, in the United States, and there are
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thousands more unlicensed B&C facilities. B&C homes offer
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protective oversight and supportive services to their residents,
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most of whom (80 percent) are 65 years of age or older. Residents
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of B&C facilities typically suffer from dementia and other
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psychiatric disorders, have chronic physical disorders, and have
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limitations in their ability to perform activities of daily
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living. Dr. Spore points out that, although B&C facilities do
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not have medical directors and usually do not provide nursing
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care, most of them do store drugs and routinely use unskilled or
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poorly trained staff to administer them.</p>
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<p>The researchers examined 7-day drug use by a sample of 2,054
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residents aged 65 and older (most participants were white,
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female, and widowed) from 410 B&C facilities in 10 States.
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They
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found substantial drug duplications and inappropriate drug
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choices within therapeutic classes, use of multiple psychotropic
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drugs across classes, and concurrent nonpsychotropic use of such
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medications, all of which can create problems. For example, some
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residents (27.4 percent of benzodiazepine users) were taking
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long-acting benzodiazepines (minor tranquilizers), which have
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been associated with drug-induced memory impairment and falls.
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Also, concurrent use of antipsychotics and antidepressants may
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increase hypotension (abnormally low blood pressure), sedation,
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and anticholinergic effects (blocking the parasympathetic
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nerves).</p><p>
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According to the researchers, polypharmacy and suboptimal drug
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use in B&C facilities may result from inadequate physician
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and
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licensed pharmacist oversight, drug prescriptions from multiple
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physicians, and the absence of primary physicians and/or single
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pharmacies to review residents' drug use profiles. They recommend
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that attention be given to the need for systematic drug
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utilization review in B&C facilities, a program that is
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mandated
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in other settings.</p>
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<p>For more information, see "Psychotropic use among older residents
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of board and care facilities," by Dr. Spore, Vincent Mor, Ph.D.,
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Jeffrey Hiris, M.A., and others, in the December 1995 <em>Journal
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of
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the American Geriatrics Society</em> 43, pp. 1403-1409.</p>
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<a name="head3"></a>
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<h2>Alcohol problems in older patients often escape
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detection</h2>
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<p>About 1 percent of all hospitalizations for elderly persons in
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the United States are due to alcoholism, yet alcoholism remains
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an underrecognized problem among elderly primary care patients. A
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recent study shows that 1 in 10 primary care patients 60 years of
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age and older had current evidence of alcoholism, although fewer
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than half had alcohol abuse documented in their medical records.
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Older alcoholic patients were more likely than similar-aged
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nonalcoholic patients to be hospitalized and die, according to
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the researchers (supported in part by the Agency for Health Care
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Policy and Research, HS07632 and HS07763).</p><p>
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Christopher M. Callahan, M.D., and William M. Tierney, M.D., of
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the Indiana University School of Medicine, screened 4,100
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patients aged 60 and older for alcoholism, dementia, and
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depression during regularly scheduled visits at a
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university-affiliated primary care practice in 1991. They found
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that 10.5 percent of patients reported at least two symptoms of
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alcoholism as documented with the CAGE questionnaire. The CAGE
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consists of four questions about alcohol-related behavior: "Have
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you ever felt you should Cut down on your drinking? "Have people
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Annoyed you by criticizing your drinking? "Have you ever felt bad
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or Guilty about your drinking?" "Have you ever had a drink first
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thing in the morning to steady your nerves or get rid of a
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hang-over (Eye-opener)?"</p>
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<p>Patients with symptoms of alcoholism were more likely to die than
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nonalcoholic patients (10.6 percent vs. 6.3 percent).
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Nevertheless, older alcoholics did not stay in the hospital any
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longer or visit the emergency room or outpatient department any
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more often than their nonalcoholic peers in the year after the
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screening date. In addition, patients with evidence of alcoholism
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were just as likely to have completed preventive health measures,
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be smokers and malnourished, and have obstructive lung disease
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and injuries.</p><p>
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Details are in "Health services use and mortality among older
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primary care patients with alcoholism," by Drs. Callahan and
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Tierney, in the December 1995 <em>Journal of the American
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Geriatrics
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Society</em> 43 (12), pp. 1378-1383.</p>
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<p class="size2"><a href=".">Return to Contents</a><br />
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<a href="dept7.htm">Proceed to Next Article</a></p>
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<div class="footnote">
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<p> The information on this page is archived and provided for reference purposes only.</p></div>
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