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Measurement and evaluation of body temperature: Implications for clinical practice
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim was to explore factors influencing the normal variation and measurement of body temperature. Additional aims were to study morbidity, mortality and the clinical presentation of pneumonia and predictors for survival in elderly nursing-home residents. Two hundred and thirty seven non-febrile nursing home residents (aged 66-99 years) and 87 healthy adults (aged 19-59 years) were included. In elderly individuals, the morning ear and rectal body temperature was measured at baseline and pneumonia and survival was observed at one- two and three-year. In healthy adults the rectal, ear, oral and axillary temperature were measured simultaneously on one morning and repeated measurements were performed in three subjects.

Overall, the range of normal body temperature was wider then traditionally stated. In elderly nursinghome residents, functional and cognitive impairment and BMI < 20 were related to a lower body temperature and medication with analgesics to a higher. Compared to adults < 60 years elderly persons had a higher average ear and a lower rectal temperature. Men and postmenopausal women < 60 years had lower body temperature than premenopausal women. The repeated measurements showed a wide individual variability irrespective of the site of measurement, and that replicated measurements do not improve accuracy. When comparing the rectal temperature with oral, ear and axillary readings the average difference was > 0.5°C with a wide individual variation.

The yearly incidence of nursing-home acquired pneumonia varied between 6.9% and 13.7%. Functional impairment, chronic obstructive pulmonary disease (COPD) and male sex were related to a higher risk of acquiring pneumonia and presenting non-specific symptoms were common. Age and functional impairment predicted mortality, irrespective of gender, while cerebral vascular insult, a lower body mass index and malnutrition in women and heart disease, COPD, medication with sedatives and mortality rate index in men were gender specific predictors. Surviving women had a higher baseline body temperature than non-surviving, while no such difference was found in men.

When assessing body temperature, it is important to consider the site of measurement, technical design, operator technique, age and gender and, in elderly nursing-home residents, physical and cognitive impairment, body constitution and medication with analgesics. The best approach is to use an unadjusted mode, without adjusting to another site. To prevent a delayed diagnosis of pneumonia, one should be aware of a low baseline body temperature and lack of specific clinical symptoms in elderly nursing-home residents. Preserving and/or improving functional, cognitive, nutritional status and preventing agitation and confusion would improve survival in nursing-home residents.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. , 54 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 872
Keyword [en]
Assessment, body temperature measurement, elderly, evaluation, infection, nursing home, pneumonia, survival
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-5200ISBN: 91-7373-848-4 (print)OAI: oai:DiVA.org:liu-5200DiVA: diva2:21132
Public defence
2004-12-02, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2012-01-25Bibliographically approved
List of papers
1. The impact of ADL-status, dementia and body mass index on normal body temperature in elderly nursing home residents
Open this publication in new window or tab >>The impact of ADL-status, dementia and body mass index on normal body temperature in elderly nursing home residents
2002 (English)In: Archives of gerontology and geriatrics, ISSN 0167-4943, Vol. 35, no 2, 161-169 p.Article in journal (Refereed) Published
Abstract [en]

A subset of seniors might demonstrate a lower body temperature compared with younger subjects. However, data on normal body temperature in seniors are sparse. The aim of the study was to study normal body temperature with a view of predicting factors of low body temperature in non-febrile seniors. Elderly women (n=159) and 78 men, aged ≥65 years, living in community resident homes were included in the study. Data on chronic diseases and medication were collected from medical records. Tympanic and rectal temperature was measured twice daily; once at 7–9 AM and then at 6–8 PM. In addition, body mass index (BMI), activities of daily living (ADL) status, as well as details regarding dementia and malnutrition were recorded. The variation in tympanic and rectal temperatures ranged from 33.8 to 38.4 °C and 35.6 to 38.0 °C, respectively. ADL status, dementia and BMI were significantly related to lower and analgesic to higher tympanic temperature. Dementia was significantly related to lower rectal temperature. Therefore, dementia, BMI, ADL status and analgesic shall not be overlooked when assessing temperature in seniors. More research is needed to further clarify the influence of these predictive factors, as well as the impact of BMI and malnutrition.

Keyword
Dementia, Activities of daily living status, Body mass index, Normal body temperature in elderly
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13663 (URN)10.1016/S0167-4943(02)00019-5 (DOI)
Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2009-06-04
2. Errors in body temperature assessment related to individual variation, measuring technique and equipment
Open this publication in new window or tab >>Errors in body temperature assessment related to individual variation, measuring technique and equipment
2005 (English)In: International journal of nursing practice, ISSN 1322-7114, Vol. 10, no 5, 216-223 p.Article in journal (Refereed) Published
Abstract [en]

Errors in body temperature measurement might seriously influence the evaluation of an individual's health condition. We studied individual variation, measurement technique and the equipment used when assessing body temperature. In the first part of the study, three volunteers performed repeated measurements for five mornings. In the second part, the morning rectal, oral, ear and axillary temperatures were measured once in 84 men and women (19–59 years). The repeated measurements showed a daily temperature difference of 0.1–0.4°C in rectal and oral temperatures, 0.2°C−1.7°C in the ear and 0.1–0.9°C in the axillary temperatures. In the sample of 84 subjects, men and postmenopausal women had a lower mean body temperature compared to premenopausal women. The mean deviation between rectal temperature, and oral, ear and axillary temperatures, respectively, was > 0.5°C, with a large individual variation. In conclusion, in order to improve the evaluation of body temperature, the assessment should be based on the individual variation, the same site of measurement and no adjustment of oral, ear or axillary temperatures to the rectal site.

Keyword
body temperature, gender, individual variation, repeated measurements, standardized
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13664 (URN)10.1111/j.1440-172X.2004.00483.x (DOI)
Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2009-06-04
3. Morbidity, mortality and clinical presentation of nursing homeacquired pneumonia in a Swedish population
Open this publication in new window or tab >>Morbidity, mortality and clinical presentation of nursing homeacquired pneumonia in a Swedish population
Show others...
2003 (English)In: Scandinavian journal of infectious diseases, ISSN 0036-5548, Vol. 35, no 5, 306-310 p.Article in journal (Refereed) Published
Abstract [en]

Pneumonia has been estimated to be the second most common infection in nursing-home residents. However, to the authors' knowledge, no such Swedish data are available. Therefore, this study investigated the incidence, risk factors, and 30 d case-fatality rate and clinical presentation of nursing home-acquired pneumonia (NHAP) in 234 nursing-home residents aged 66-99 y. Activities of daily living (ADL status), malnutrition and body mass index were measured at baseline. The residents were then followed prospectively during 1 y for symptoms and signs of pneumonia. Pneumonia was verified clinically and/or radiologically in 32 residents, corresponding to a yearly incidence of 13.7%. The 30 d case-fatality rate was 28%. Cough and sputum production were the most specific, and fever ≥38.0°C rectally and cognitive decline were the most common non-specific presenting symptoms. Chronic obstructive pulmonary disease, ADL status >5 and male gender were risk factors for acquiring pneumonia. In conclusion, NHAP is associated with high morbidity and mortality in Sweden. In order not to delay treatment, it is necessary to be aware that specific symptoms of pneumonia may be lacking in the clinical presentation in the nursing-home setting.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13665 (URN)10.1080/00365540310008456 (DOI)
Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2009-08-21
4. Gender differences in predictors for survival in elderly nursing-home residents: A 3-year follow-up
Open this publication in new window or tab >>Gender differences in predictors for survival in elderly nursing-home residents: A 3-year follow-up
2007 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 21, no 1, 18-24 p.Article in journal (Refereed) Published
Abstract [en]

This study focus on predicting factors of survival possible to modify by nursing care, and the incidence and mortality rate of nursing-home-acquired pneumonia, allocated to 1, 2 and 3 years of follow ups. The residents consisted of 156 women and 78 men living in special housing for the elderly. Data on chronic disease and medication were obtained at baseline, and activities of daily living (ADL) status, nutritional status and body temperature were assessed. The incidence of pneumonia was noted prospectively for 1 year and retrospectively for the following 2 years. Predictive factors for survival were explored by Cox hazard regression analysis. The results showed that age, functional and cognitive impairment were predictors of mortality irrespective of gender, while poor nutritional status in women and chronic obstructive pulmonary disease, heart disease and medication with sedatives in men were gender-specific predictors. ADL correlated positively with dementia and negatively with S-albumin irrespective of gender, while malnutrition correlated positively with ADL in women and positively with chronic obstructive pulmonary disease in men. To promote the quality of daily living in elderly individuals, it is of importance to improve the capabilities in daily functions and nutritional status, especially in women with functional impairment, and to prevent anxiety particularly in men. The findings also clarify that pneumonia is as common as cerebral vascular insult and heart failure as cause of death in this population.

Keyword
activities of daily living, gender, malnutrition, nursing care, pneumonia, survival
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13666 (URN)10.1111/j.1471-6712.2007.00431.x (DOI)
Available from: 2004-12-19 Created: 2004-12-19 Last updated: 2017-12-13

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