The importance of diagnostic procedures to ensure quality of health care in geriatric medicine. Examples from recent studies.

Within the health care of the elderly with prevention, diagnosis, therapy, rehabilitation, nursing care and social service, diagnostic procedures are of great importance to avoid under- and over-diagnosis. Many diagnostic difficulties exist in elderly patients such as changed reference values, changed normal values and changed signs and symptoms. Well-known examples of conditions which are likely to be under-diagnosed include depression and urinary incontinence.

Neurological examination of elderly women under investigation for urinary incontinence.

A random sample of 6,000 women from the birth cohorts 1900-1920 were invited to participate in an investigation of urinary incontinence by completing and returning an enclosed questionnaire. Of the 4,206 women who returned the completed questionnaire, 677 (16.9%) complained of urinary incontinence and accepted an invitation to be examined and treated at our clinic.

Quantification of urinary incontinence in elderly women with the 48-hour pad test.

The ability of 34 elderly women (79 +/- 6 years, range 71-95 years) with urinary incontinence to perform the 48-h perineal pad test in their home environment was investigated. The mean involuntary urinary loss during the 48-h observation period was 80 +/- 88 g (range (2-411 g). Thirty patients successfully compared the two perineal pad systems commercially available in Sweden (LIC and Mölnlycke).

Pharmacokinetics and blood pressure effects of felodipine in elderly hypertensive patients. A comparison with young healthy subjects.

The pharmacokinetics and antihypertensive effects of felodipine, a new dihydropyridine calcium channel blocker, were studied in elderly hypertensive patients, 67 to 79 years of age and in young healthy subjects, 20 to 34 years of age following oral administration of 5 mg twice daily to steady-state. A single intravenous dose of 3H-felodipine (0.04mg) was given together with the oral dose on the study day.

Postural disturbances in a 75-year-old population: I. Prevalence and functional consequences.

In a representative population of 425 women and 333 men aged 75 years a survey of postural disturbances showed a prevalence of 40% among women and 30% among men. The most common forms were a feeling of unsteadiness when rising from lying to standing and when walking. Postural disturbances had been present for more than 6 months in 85%.

A double-blind evaluation of electroconvulsive therapy in Parkinson's disease with "on-off" phenomena.

Eleven patients with severe Parkinson's disease and on-off-phenomena were included in a controlled double-blind study on the effect of electroconvulsive therapy (ECT). Pharmacological treatment was optimally adjusted before the trial. The severity of extrapyramidal symptoms was measured before, during and after the treatment.

The analgesic effect of transcutaneous electrical nerve stimulation (TNS) in patients with rheumatoid arthritis. A comparative study of different pulse patterns.

Transcutaneous electrical nerve stimulation (TNS) was used on 20 patients with severe wrist pain due to rheumatoid arthritis. Three different stimulation frequencies were used: high 70 Hz stimulation (70 TNS), low frequency 3 Hz stimulation (3 TNS) and brief trains of stimuli with an internal frequency of 70 Hz and with a repetition rate of 3 Hz (3-70 TNS). The analgesic effect was evaluated on the patient's own estimate of pain relief and by means of a loading test in which the length of time the patient could hold a weight before and after TNS was used.