Thesis (Ed.D.)--Teachers College, Columbia University, 1964. / Typescript; issued also on microfilm. Includes tables. Sponsor: Mildred Montag. Dissertation Committee: Paul Essert. Includes bibliographical references (leaves 156-159).

The aging process is associated with disease states that may be painful, disabling and life-threatening. Elderly patients frequently have more than one disorder and appropriate pharmacotherapy may result in polypharmacy (treatment with multiple drugs). This situation, combined with age-related alterations in the handling of and sensitivity to drugs, predisposes older patients to adverse drug reactions (ADR's). This study was undertaken to assess the actual risks and potential benefits of long-term polypharmacy in the management of elderly hospital out-patients. A particular aim was to get some indication of whether or not polypharmacy was justifiable in the study population. Accordingly, the medical records of 132 ambulatory patients, 70 years of age and over, who had been attending the general out-patient department of a large teaching hospital for a period of twelve months or longer, were retrospectively examined. The patient's age, diagnoses, prescribed medication, ADR's and clinical therapeutic benefit were assessed, recorded and analyzed. The average patient age in the sample studied was 77,6 years. 71% of the sample were females. 419 disorders were identified, giving an average of 3,17 per patient. 603 drugs were prescribed in total, giving an average of 4, 57 per patient. There was no statistically significant association between increasing age and the number of diagnoses per patient or the number of drugs prescribed. Medication was felt to be therapeutically effective in 63% of the patients, whilst an ADR was noted in 14% of the sample. There was no statistically significant difference in the age, number of diseases or number of drugs prescribed between the total group, the ADR group and the non-ADR group. These parameters were therefore not useful in identifying those patients more likely to experience an ADR. The apparent effectiveness of the medication prescribed and the relatively low incidence of ADR' s in the group studied suggests that appropriate and judicious multiple drug therapy can benefit many elderly ambulatory patients and therefore polypharmacy could be regarded as permissible in this context. Apart from these observations, this dissertation also includes recommendations on ways to minimize the incidence of ADRs in the elderly, and areas for ongoing research in this field are identified.

Elderly people living in long-term care (LTC) are at risk for malnutrition. Those who consume a pureed diet may be particularly at risk because of the food restrictions required on a pureed diet. Fortification of pureed foods with micronutrients may be an effective technique to treat malnutrition. The purpose of this study was to develop fortified pureed foods to incorporate into a menu at a LTC facility to assess if nutrient intakes and serum vitamin levels increased. <p>Fortification levels were determined using a combination of two techniques: the Dietary Reference Intakes report on planning formula, Estimated Average Requirement plus two standard deviations of intake; and Health Canadas method of using a defined nutrient contribution to the total daily intake. Fortification levels for 11 vitamins and 9 minerals were determined, which allowed for formulation of a vitamin/mineral mix and a vitamin-only mix. Seven pureed foods were fortified and triangle sensory tests were performed to determine whether fortification changed the flavour of the foods. Panelists were able to discriminate between the unfortified and vitamin/mineral fortified mix samples (P > 0.05). When the vitamin-only fortified foods were subjected to the triangle test, the panelists were unable to detect a difference (P < 0.05).<p>Four vitamin-fortified foods per day were incorporated into the pureed menu at a LTC facility. Nutrient intakes (n = 10) and serum vitamin B12, folate, and 25-hydroxyvitamin D levels (n = 11) were analyzed at baseline and 8 weeks after the intervention. Nutrient intakes increased after the intervention for all vitamins assessed (P < 0.01). Serum 25-hydroxyvitamin D and folate levels increased from 41 ± 21 nmol/L and 10.7 ± 4.9 nmol/L at baseline to 66 ± 11 nmol/L and 25.2 ± 6.4 nmol/L after the intervention (P < 0.01). Serum vitamin B12 levels did not change (P > 0.05).<p>The development of acceptable vitamin-fortified pureed foods is feasible and fortified pureed foods are an effective way to increase the nutritional status of LTC residents.

Elderly people living in long-term care (LTC) are at risk for malnutrition. Those who consume a pureed diet may be particularly at risk because of the food restrictions required on a pureed diet. Fortification of pureed foods with micronutrients may be an effective technique to treat malnutrition. The purpose of this study was to develop fortified pureed foods to incorporate into a menu at a LTC facility to assess if nutrient intakes and serum vitamin levels increased. <p>Fortification levels were determined using a combination of two techniques: the Dietary Reference Intakes report on planning formula, Estimated Average Requirement plus two standard deviations of intake; and Health Canadas method of using a defined nutrient contribution to the total daily intake. Fortification levels for 11 vitamins and 9 minerals were determined, which allowed for formulation of a vitamin/mineral mix and a vitamin-only mix. Seven pureed foods were fortified and triangle sensory tests were performed to determine whether fortification changed the flavour of the foods. Panelists were able to discriminate between the unfortified and vitamin/mineral fortified mix samples (P > 0.05). When the vitamin-only fortified foods were subjected to the triangle test, the panelists were unable to detect a difference (P < 0.05).<p>Four vitamin-fortified foods per day were incorporated into the pureed menu at a LTC facility. Nutrient intakes (n = 10) and serum vitamin B12, folate, and 25-hydroxyvitamin D levels (n = 11) were analyzed at baseline and 8 weeks after the intervention. Nutrient intakes increased after the intervention for all vitamins assessed (P < 0.01). Serum 25-hydroxyvitamin D and folate levels increased from 41 ± 21 nmol/L and 10.7 ± 4.9 nmol/L at baseline to 66 ± 11 nmol/L and 25.2 ± 6.4 nmol/L after the intervention (P < 0.01). Serum vitamin B12 levels did not change (P > 0.05).<p>The development of acceptable vitamin-fortified pureed foods is feasible and fortified pureed foods are an effective way to increase the nutritional status of LTC residents.

Thesis--University of Washington. / Includes bibliographical references (leaves 222-226).

No description available.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2007. / Title from title screen (site viewed Nov. 9, 2007). PDF text: 195 p. : ill. ; 9 Mb. UMI publication number: AAT 3266775. Includes bibliographical references. Also available in microfilm and microfiche formats.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis (Ph. D., Adult Education)--University of Idaho, March 20, 2008. / Major professor: Karen Wilson Scott. Includes bibliographical references (leaves 128-137). Also available online (PDF file) by subscription or by purchasing the individual file.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1980. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 211-222).