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Serious complications rare in elderly patients undergoing hip
Elderly men and women frequently undergo hip arthroplasty and
only rarely suffer serious complications, according to a study
supported in part by the Agency for Health Care Policy and
Research (HS06326). This procedure involves surgical
reconstruction or replacement of a painful degenerated hip joint
to restore mobility. The study of elderly Medicare patients shows
that women had modestly higher total hip arthroplasty rates than
men. For both men and women, rates increased with age up to about
80 to 84 years, but declined thereafter. Blacks underwent this
procedure at half the rate of whites, but it is unclear whether
this was due to racial differences in osteoarthritis, barriers to
care, or personal treatment preferences.
About 2.5 percent of patients died within 6 months of the
operation, and 3.7 percent died within a year. Mortality was
higher in male patients and patients older than 74 years of age.
Additional hip surgery was performed in 1.8 percent of total hip
arthroplasty cases within 1 year, in 3.2 percent within 2 years,
and in 4.2 percent within 3 years. Serious complications were
uncommon. Infections were identified in less than 1 percent of
patients, even after 2 years. Pulmonary embolism occurred in
about 2 percent of total hip arthroplasty patients within 6
months but rarely occurred thereafter.
These findings are based on analysis of a 5 percent sample of the
U.S. Medicare population from July 1986 through July 1989. The
group included 5,579 elderly patients with total hip arthroplasty
performed in the absence of infection, fracture, or previous hip
surgery. Most patients (83.3 percent) had osteoarthritis.
For more information, see "Total hip arthroplasty: Use and select
complications in the U.S. Medicare population," by John A. Baron,
M.D., M.S., M.Sc., Jane Barrett, M.Sc., Jeffrey N. Katz, M.D.,
M.S., and Matthew H. Liang, M.D., M.P.H., in the January 1996
American Journal of Public Health 86(1), pp. 70-72.
Unregulated use of psychotropic drugs poses danger to
elderly residents of board and care facilities
Over one-third (35 percent) of elderly residents of board and
care (B&C) facilities use at least one psychotropic
(mind-altering) drug such as an antidepressant, antipsychotic, or
sedative. And 30 percent of these patients take two to four
different psychotropic medications. Moreover, many residents take
psychotropic medication with drugs for diabetes, hypertension,
Parkinson's disease, and other conditions, according to a study
supported in part by the Agency for Health Care Policy and
Research (National Research Service Award training grant T32
HS00011). This potentially harmful polypharmacy sparked
regulation of medications dispensed in nursing homes in 1987 and
probably warrants similar regulation in B&C facilities,
suggests Brown University researcher, Diana Spore, Ph.D., the
study's principal investigator.
There are approximately 34,000 licensed B&C facilities, with
more than 600,000 beds, in the United States, and there are
thousands more unlicensed B&C facilities. B&C homes offer
protective oversight and supportive services to their residents,
most of whom (80 percent) are 65 years of age or older. Residents
of B&C facilities typically suffer from dementia and other
psychiatric disorders, have chronic physical disorders, and have
limitations in their ability to perform activities of daily
living. Dr. Spore points out that, although B&C facilities do
not have medical directors and usually do not provide nursing
care, most of them do store drugs and routinely use unskilled or
poorly trained staff to administer them.
The researchers examined 7-day drug use by a sample of 2,054
residents aged 65 and older (most participants were white,
female, and widowed) from 410 B&C facilities in 10 States.
found substantial drug duplications and inappropriate drug
choices within therapeutic classes, use of multiple psychotropic
drugs across classes, and concurrent nonpsychotropic use of such
medications, all of which can create problems. For example, some
residents (27.4 percent of benzodiazepine users) were taking
long-acting benzodiazepines (minor tranquilizers), which have
been associated with drug-induced memory impairment and falls.
Also, concurrent use of antipsychotics and antidepressants may
increase hypotension (abnormally low blood pressure), sedation,
and anticholinergic effects (blocking the parasympathetic
According to the researchers, polypharmacy and suboptimal drug
use in B&C facilities may result from inadequate physician
licensed pharmacist oversight, drug prescriptions from multiple
physicians, and the absence of primary physicians and/or single
pharmacies to review residents' drug use profiles. They recommend
that attention be given to the need for systematic drug
utilization review in B&C facilities, a program that is
in other settings.
For more information, see "Psychotropic use among older residents
of board and care facilities," by Dr. Spore, Vincent Mor, Ph.D.,
Jeffrey Hiris, M.A., and others, in the December 1995 Journal
the American Geriatrics Society 43, pp. 1403-1409.
Alcohol problems in older patients often escape
About 1 percent of all hospitalizations for elderly persons in
the United States are due to alcoholism, yet alcoholism remains
an underrecognized problem among elderly primary care patients. A
recent study shows that 1 in 10 primary care patients 60 years of
age and older had current evidence of alcoholism, although fewer
than half had alcohol abuse documented in their medical records.
Older alcoholic patients were more likely than similar-aged
nonalcoholic patients to be hospitalized and die, according to
the researchers (supported in part by the Agency for Health Care
Policy and Research, HS07632 and HS07763).
Christopher M. Callahan, M.D., and William M. Tierney, M.D., of
the Indiana University School of Medicine, screened 4,100
patients aged 60 and older for alcoholism, dementia, and
depression during regularly scheduled visits at a
university-affiliated primary care practice in 1991. They found
that 10.5 percent of patients reported at least two symptoms of
alcoholism as documented with the CAGE questionnaire. The CAGE
consists of four questions about alcohol-related behavior: "Have
you ever felt you should Cut down on your drinking? "Have people
Annoyed you by criticizing your drinking? "Have you ever felt bad
or Guilty about your drinking?" "Have you ever had a drink first
thing in the morning to steady your nerves or get rid of a
Patients with symptoms of alcoholism were more likely to die than
nonalcoholic patients (10.6 percent vs. 6.3 percent).
Nevertheless, older alcoholics did not stay in the hospital any
longer or visit the emergency room or outpatient department any
more often than their nonalcoholic peers in the year after the
screening date. In addition, patients with evidence of alcoholism
were just as likely to have completed preventive health measures,
be smokers and malnourished, and have obstructive lung disease
Details are in "Health services use and mortality among older
primary care patients with alcoholism," by Drs. Callahan and
Tierney, in the December 1995 Journal of the American
Society 43 (12), pp. 1378-1383.
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