bluuebunny/crossref_metadata_2025 huggingface dataset:
Overestimation of Diastolic Blood Pressure in the Elderly
Authors: Hla Khin Mae , Vokaty Kathryn A. , Feussner John R.
Published: April 2015

Indirect sphygmomanometric blood pressure measurement is the established method of diagnosing and monitoring hypertension, but it may overestimate the true blood pressure in certain elderly patients leading to unnecessary or excessive treatment. The authors studied 36 elderly (aged 60 years or older) hypertensive men and compared direct intraarterial diastolic blood pressure (DBP) measurements with indirect DBP measurements obtained concurrently by a standard mercury sphygmomanometer and also by an automatic blood pressure recorder to: 1) assess the presence and degree of overestimation of DBP by indirect cuff measurement, and 2) evaluate an alternative noninvasive method. The difference between sphygmomanometric and intraarterial DBP was 10 mmHg or greater in 14 of 36 patients, whereas that between the automatic recorder and intraarterial DBP was 10 mmHg or greater in only three of 36 patients (P < .05). Fourteen patients (39%) had a DBP of greater than or equal to 90 mmHg by the mercury sphygmomanometer compared with five patients (14%) by intraarterial measurement (P < .05); only seven patients (19%) had a DBP of greater than or equal to 90 mmHg by the automatic recorder (P = .7). Thus, in the authors' patient population: 1) indirect sphygmomanometer overestimated the frequency of elevated DBP by nearly threefold compared with intraarterial measurements, and 2) the automatic recorder closely approximated intraarterial values offering a more accurate, noninvasive measure of DBP in the elderly.
Decreasing the Burden in Families Caring for a Relative With a Dementing Illness
Authors: Kahan Jason , Kemp Bryan , Staples Fred R. , Brummel‐Smith Kenneth
Published: April 2015

The purpose of this study was to investigate the efficacy of a specifically designed group support program for relatives of patients with Alzheimer's disease and related disorders. The group program included educational/supportive activities and used basic principles of the cognitive‐behavioral approach. Twenty‐two subjects participated in an eight‐session program. Eighteen control subjects received no treatment. Measures of family burden, levels of depression, and knowledge of dementia were obtained. Experimental subjects showed a significant decrease in total family burden, whereas control subjects actually showed a significant increase, experimental subjects also showed reduction in their levels of depression. Experimental subjects showed a significantly greater improvement than did control subjects on knowledge of dementia. The acquisition of new knowledge was an important ingredient in reducing perception of burden and levels of depression, but other facets of the intervention also accounted for the improvement. Results indicated that a relatively short but intensive support experience can have a positive effect in reducing some of the burden and depression associated with the care of a demented relative.
Community‐Acquired Pneumonia Requiring Hospitalization
Authors: Marrie Thomas J. , Haldane E. Vanora , Faulkner Ruth S. , Durant Heather , Kwan Carol
Published: April 2015

The authors studied 138 patients, 57 of whom were younger than 65 years of age and 81 who were 65 years of age and older, with community‐acquired pneumonia to determine whether or not such pneumonia is different in the elderly and to define how such patients are investigated and treated. Pneumonia in the elderly was characterized by a higher mortality, 30 v 10%; more likely to be of unknown etiology, 54 v 30%; and more likely to show radiographic progression after the patient had been admitted to the hospital, 48 v 11%. In addition, elderly patients were more likely to be afebrile when admitted, 57 v 26%. Twenty‐seven etiologic categories were present in the 77 patients in whom a cause for the pneumonia was established. Streptococcus pneumoniae accounted for 9.4% of the pneumonia overall and for 27% of the pneumonia among patients who had sputum cultures performed before antibiotic therapy. The diagnostic yield was 11.6% for blood cultures, 38.2% for sputum cultures, 2.3% for throat washing, and 22.1% for serological studies. Twenty‐seven percent of patients were receiving antibiotics of the time of admission to the hospital. Most (79%) received more than one antibiotic after admission. This study indicates that community‐acquired pneumonia is a serious illness and that an algorithm approach to diagnosis and treatment of such pneumonia is necessary.
Screening the Elderly
Authors: Fillenbaum Gerda G.
Published: April 2015

Although multidimensional functional assessment may be the route of choice in determining the personal status of the elderly and the services they need, the majority of the elderly are well and competent, making it hard to justify routine extensive assessment with its attendant costs. Described herein is a brief, valid, and reliable five‐item screener based on instrumental activities of daily living which can rapidly identify elderly community residents with impaired functional capacity, and which, because of its substantial correlation with physical health (r = .54 to .55), mental health (r = .54 to .60), and predictability of death can identify those for whom more extensive assessment is warranted. Use of such a brief screener should result in better targeting of elderly in need of service, facilitate coordinated and efficient health care delivery, and maintain the functional independence of the elderly.
Beneficial Effect of Moderate Weight Loss in Older Patients with Non‐Insulin‐dependent Diabetes Mellitus Poorly Controlled with Insulin
Authors: Reaven Gerald M.
Published: April 2015

Fifteen patients with non‐insulin‐dependent diabetes mellitus, poorly controlled on insulin, were enrolled in a weight loss program. Criteria included a fasting plasma glucose concentration greater than 200 mg/dl, age in excess of 65 years, and the presence of obesity. Twelve of the 15 patients were able to complete the program, and the average weight loss of the group was 9 kg. Prior to initiation of the weight loss program the 12 patients were receiving (mean ± SEM) 52 ± 5 units of insulin per day and had a mean (±SEM) fasting plasma glucose concentration of 258 ± 10 mg/dl. Insulin treatment was discontinued in all subjects during the weight loss period, and did not need to be resumed when weight stabilization had occurred. On the other hand, reasonable diabetic control could not be maintained without medication, and all patients were started on chlorpropamide during the period of weight stabilization. With this approach, a mean (±SEM) fasting glucose concentration of 137 ± 4 mg/dl was achieved with a daily chlorpropamide dose of 354 ± 30 mg. This dramatic clinical change took place despite the fact that no patient achieved ideal body weight. These results document the ability of a moderate amount of weight loss to transform patients with non‐insulin‐dependent diabetes mellitus, who are overweight and older than 65 years of age, from treatment failures to treatment successes. J Am Geriatr Soc 33:93, 1985
Estimating Stature from Knee Height for Persons 60 to 90 Years of Age
Authors: Chumlea William Cameron , Roche Alex F. , Steinbaugh Maria L
Published: April 2015

Stature is an important variable in several indices of nutritional status that are applicable to elderly persons. However, stature is difficult or impossible to measure in the nonambulatory elderly person, or its value may be spurious if measured in those elderly persons with excessive spinal curvature. Simple equations are presented for estimating the stature of elderly men from a recumbent measure of knee height and for elderly women from a recumbent measure of knee height and age. The 90 per cent error bounds for these equations for an individual are about plus or minus 6.0 cm. Knee height Is highly correlated with stature. J Am Geriatr Soc 33:116, 1985
An Analysis of T Lymphocyte Subpopulations in Patients with Alzheimer's Disease
Authors: Leffell Mary S. , Lumsden Lo , Steiger William A.
Published: April 2015

The relative proportions of regulatory T lymphocyte subpopulations and T lymphocyte proliferative responses to the mitogen phytohemagglutinin (PHA) were studied in 30 patients with clinically apparent Alzheimer's disease (mean age = 71.5). Comparisons were made with 30 age‐matched, nondemented healthy controls (mean age = 68.8) and with 20 younger, normal adult controls (mean age = 27.5). The relative percentages of total peripheral T lymphocytes, T helper/inducer lymphocytes (Th), and T suppressor/cytotoxic lymphocytes (Ts) were similar between the Alzheimer patient group and the age‐matched controls. However, when the two older groups were compared with the young adult controls, a significant decrease was seen in the percentage of Ts cells, with a concomitant increase in the ratio of Th:Ts. Lymphocyte proliferative responses to PHA were similar in the Alzheimer patients and their age‐matched controls; however, when compared with the young adult controls, a significant decrease in responsiveness for both older groups was observed. These results confirm decreases in certain immune indices with aging, but suggest that there are no changes in T lymphocyte subsets or in lymphocyte proliferation, which are unique to Alzheimer's disease. J Am Geriatr Soc 33:4, 1985
Prevalence and Functional Correlates of Low Back Pain in the Elderly: The Iowa 65+ Rural Health Study
Authors: Lavsky‐Shulan Mollie , Wallace Robert B. , Kohout Frank J. , Lemke John H. , Morris Martha Clare , Smith Ian MacLean
Published: April 2015

As part of an interview survey of a defined population of 3,097 rural persons 65 years and older (the Iowa 65+ Rural Health Study), the prevalence and functional correlates of specifically defined low back pain were studied. Low back pain was reported by 23.6 per cent of the women and 18.4 per cent of the men in the year prior to the survey, with prevalence rates declining with age. Forty per cent of those with low back pain noted its presence at the time of the interview. Over half had used analgesics. Use of medical and chiropractic services for this symptom was nearly 75 per cent; 25 per cent had at least one hospitalization directly related to low back pain and over 5 per cent had low back surgery. Limitation of walking, sitting, bending over, and performing household chores was reported by 15 to 40 per cent, and 21 per cent attributed sleep disturbance to the low back pain. Nearly 75 per cent of subjects with low back pain reported first onset of the problem prior to age 65, which has important implications for pathogenesis and prevention. The functional and clinical burdens of low back pain in this population of rural elderly were substantial and require further evaluation of risk factors and impact on health status. J Am Geriatr Soc 33:23, 1985
Survey of the Age Structure of “Age‐Relevant” Articles in Four General Medical Journals
Authors: Clarfield Avram Mark , Friedman Ruby
Published: April 2015

The authors analyzed clinical research articles (1980 to 1982) in four general medical journals: New England Journal of Medicine, Annals of Internal Medicine, Journal of the American Medical Association, and British Medical Journal. Of the 1943 articles surveyed, 38.2% were judged to be clinically “relevant” to the elderly. “Relevant” articles were further analyzed to determine whether they contained enough older subjects to enable the reader to draw any inferences about the particular disease or diagnostic or treatment modality studied. Criteria for “age sufficiency” included: mean age of study group () greater than or equal to 60 years; if was less than 60 years, two SD or the range included at least one patient aged 70 years; and greater than or equal to 20% of the study group was older than 60 years. Overall, slightly more than 50% of clinically relevant articles had too few older subjects by the authors' quite liberal age criteria. No statistically significant differences were found among the four journals. Of the age‐relevant articles, 25.5% had a mean age of sample studied of greater than or equal to 60 years, 10.9% of greater than or equal to 65 years, 5.6% of greater than or equal to 70 years, and 2.3% of greater than or equal to 75 years. The average age of all subjects studied for three conditions commonly found among the elderly was calculated: coronary artery disease (51.7 years); hypertension (49.8 years); and cancer (52.9 years). The authors concluded that many of the original articles of these four journals did not include (for 1980 to 1982) enough older subjects in their study samples to enable readers to draw any valid inferences about the older population itself.
When Patients Resist Feeding
Authors: Dresser Rebecca
Published: April 2015

In the recent past, public and professional attention has focused on the question of whether and when it is appropriate to discontinue nutritional support from patients unable or unwilling to ingest food orally. This article addresses the special problems raised by patients who resist medical feeding. It discusses the following issues relevant to this patient group: competency to make treatment choices, decision making on behalf of incompetent patients, the competent patient's right of self‐determination, and procedures for reviewing treatment decisions. Legal decisions bearing on the nourishment question are analyzed as well. Although the author concludes that cessation of nourishment is morally and legally permissible in a few cases, she also cautions that the option should be carefully and narrowly applied.
Comparison of Admission and Discharge Medications in Two Geriatric Populations
Authors: Alexander Neil , Goodwin James S. , Currie Colin
Published: April 2015

Drug usage patterns were determined from a chart review of two groups of the elderly upon admission to and discharge from the hospital. A comparision was made between a United States group (N = 60) and a Scotland group (N = 60). The most common drugs noted in both groups were cardiovascular drugs (primarily diuretics) and vitamins and minerals. The mean number of drugs per patient in both groups was approximately four, with minimal change in number between admission and discharge. The number of drugs decreased with male sex and increasing age in the United States group and increased with male sex and increasing age in the Scotland group. The Scotland group was on more short‐acting benzodiazepines, more bowel medications, more antidepressants, more antiparkinson agents, and fewer respiratory drugs than the United States group. Although both groups tended to have certain drugs deleted, Scotland patients were more likely to have narcotics discontinued and bowel medications added before discharge. These drug usage patterns demonstrate substantial polypharmacy in the elderly and the importance of selecting appropriate drugs in the elderly. J Am Geriatr Soc 33:827, 1985
Digitalis Withdrawal in Elderly Nursing Home Patients
Authors: Wilkins Charles E. , Khurana Manbir S.
Published: April 2015

Nursing home patients were studied to determine the usefulness of a maintenance dose of digoxin in elderly patients with normal sinus rhythm. Of 64 patients, 26 were identified to be on digoxin. Thorough history and physical examination were done on all the patients. Baseline electrocardiogram showed normal sinus rhythm in 19 patients, who were observed very closely for the period of four months after withdrawal of digoxin. Eighteen of 19 patients did well without digoxin, which suggests that most of the elderly nursing home patients with normal sinus rhythm do not need a maintenance dose of digoxin. J Am Geriatr Soc 33:850, 1985
Factors Affecting the Use of Influenza Vaccine in the Institutionalized Elderly
Authors: Setia Usha , Serventi Isabel , Lorenz Patricia
Published: April 2015

Annual influenza vaccination has been recommended for the past four years for all the patients residing on the extended‐care facility of this large county hospital. During the fall of 1983, baseline data was collected regarding compliance with these recommendations. It was found that only 33% of the high‐risk individuals had been vaccinated. A study was planned to investigate the factors for poor compliance rate and explore alternate methods of delivery of the vaccine. Despite the physician's strong belief in the vaccine, all methods of reminders to the physicians failed to have significant impact on increased use of the influenza vaccine. Finally an institutional policy pertaining to a standing order for the influenza vaccine was approved by the Infection Control Committee and the hospital Medical Staff Comittee and 95% of the patients on the extended‐care facility of this hospital were immunized. J Am Geriatr Soc 33:856, 1985
Use of Influenza Vaccine in Nursing Homes
Authors: Patriarca Peter A. , Weber Judith A. , Meissner Morgan K. , Stricof Rachel L. , Dateno Bernadine , Braun Jane E. , Arden Nancy H. , Kendal Alan P.
Published: April 2015

The organization and outcome of influenza immunization programs were studied in 67 randomly or systematically selected nursing homes (8354 residents) in six states during the autumn of 1982 and/or 1983. In each home, influenza vaccine was usually offered to all residents on a voluntary basis, independent of their age, level of required nursing care, or underlying medical conditions. However, the proportion of residents who were vaccinated ranged from 8 to 98% (mean, 62% overall), with significantly lower rates in homes that also required consent from relatives (usually by return mail) than in homes that did not (P < .00001; median, 57 versus 90%, respectively). These observations suggest that distribution of educational materials about the risks and benefits of influenza vaccine and systematic follow‐up of relatives who fail to return the consent form may be useful strategies to further increase the number of nursing home residents who are immunized.
Univariate and Multivariate Analyses of the Mental Status Examination
Authors: Klein Lawrence E. , Roca Robert P. , McArthur Justin , Vogelsang Georgia , Klein Gayle B. , Kirby Susan M. , Folstein Marshal
Published: April 2015

Investigators have reported poor recognition of dementia by primary physicians. For this reason, mental status examinations were performed on 72 demented and 144 nondemented medical inpatients to assess the sensitivity, specificity, and predictive value of components of this examination in the diagnosis of dementia. Sensitivity of individual level‐of‐orientation items was low (15.3 to 56.9%), though specificity was high (91.7 to 100%). Sensitivity of several nonorientation items was high (80.6 to 100%), though specificity was low. A multivariate discriminant equation using both orientation and nonorientation items achieved high sensitivity (89.6% test cases, 87.5% validation cases) and specificity (78.1% test cases, 87.5% validation cases). Adding the easily obtained patient characteristic of age to the equation further increased sensitivity (95.8%, 91.3%), while maintaining specificity (82.3%, 85.4%). From these results, it is concluded that the level‐of‐orientation screening examination used by clinicians to detect dementia is unacceptably insensitive. In contrast, a composite decision rule including nonorientation items achieves high sensitivity with relatively high specificity.
A 12‐Month Fever Surveillance Study in a Veterans' Long‐Stay Institution
Authors: Finnegan Terence P. , Austin Thomas W. , Cape Ronald D. T.
Published: April 2015

This report describes a 12‐month fever surveillance survey in a 258‐bed veterans long‐term care institution. There were 128 episodes of fever (one episode per 24 patient‐months); 114 were studied. Lower respiratory tract infections were most frequent, 36 (32%), with 26 (23%) urinary tract infections. Streptococcus pneumoniae was the most common pathogen in the chest infections and Proteus mirabilis the most common of the urinary tract infections. In 40 (35%) there was no evidence of a lower respiratory tract, urinary tract, or other bacterial infection. Most recovered rapidly, many with no specific treatment. There was a 16% mortality associated with the febrile episodes.
Hospital Readmissions Among the Elderly
Authors: Gooding Judith , Jette Alan M.
Published: April 2015

This paper investigates the six‐month hospital readmission rates among 444 patients 65 years of age or older admitted to a large metropolitan teaching hospital who had a primary discharge diagnosis of cerebrovascular disease, hip fracture, or congestive heart failure. Twenty‐four percent were readmitted to the same institution one or more times during the six‐month follow‐up. Striking variability was observed in use of hospitals across these diagnostic groups. Patients with a primary diagnosis of congestive heart failure were at highest risk of hospital readmission (36%). Multiple readmissions among the congestive heart failure group were prevalent. These preliminary data suggest that hospital readmission among the aged is a complex multifaceted phenomena.
The Meaning of Cognitive Impairment in the Elderly
Authors: Folstein Marshal , Anthony James C. , Parhad Irma , Duffy Bonnie , Gruenberg Ernest M.
Published: April 2015

In order to determine the meaning of cognitive impairment in community dwelling elderly, 3,481 adults were interviewed in their homes using the Mini‐Mental State Examination. Ninety‐six per cent of the population aged 18–64 scored 23 or higher, whereas 80 per cent of the population 65 and over scored 23 or higher. Individuals with low scores were suffering from a variety of psychiatric disorders including dementia. Thirty‐three per cent of the elderly population scoring in the range of 0–23 had no diagnosable DSM‐III condition. Prevalence of dementia from all causes was 6.1 per cent of the population over age 65. Two per cent of the population over age 65 were diagnosed as having Alzheimer's disease
Patterns of Mental Disorders among the Elderly Residents of Eastern Baltimore
Authors: Kramer Morton , German Pearl S. , Anthony James C. , Von Korff Michael , Skinner Elizabeth A.
Published: April 2015

An extensive analysis of prevalence rates of cognitive impairment and other mental morbidities was carried out as part of a five‐site national study on the health and mental health of an ambulatory population. This study reports on prevalence rates contrasted by age across the 18 and over population for cognitive impairment and other diagnoses in the Baltimore, Maryland, site of this study. Differences in prevalence rates by age are striking. Eight conditions have rates above 1 per cent among those 64 and younger: phobia (13.8 per cent), alcohol use disorder (6.5 per cent), obsessive compulsive disorder (2.2 per cent), schizophrenia (1.4 per cent), and panic disorder (1.2 per cent). For the older group, 65 to 74 years, five conditions have such prevalence rates: phobic disorder (12.1 per cent), severe cognitive impairment (3.0 per cent), alcohol use disorder (2.1 per cent), obsessive compulsive disorder (2.2 per cent), and dysthymia (1.0 per cent). For the oldest group, those 75 and over, only four conditions have rates of 1 per cent or more. These are: phobic disorders (10.1 per cent), severe cognitive impairment (9.3 per cent), major depression (1.3 per cent), and dysthymia (1.1 per cent). Rates of cognitive impairment increase markedly with age and high rates of this disorder were found among those never married, separated, divorced, or widowed. Implications of these findings for understanding mental morbidity among the elderly and issues for future planning are discussed.
Age‐related Change in Volumes of the Ventricles, Cisternae, and Sulci: A Quantitative Study Using Computed Tomography
Authors: Takeda Shumpei , Matsuzawa Taiju
Published: April 2015

Using computed tomography, the authors studied enlargement of the ventricles and the free spaces (cisternae and sulci) above the level of the tentorium cerebelli during aging in 97 men and 55 women with no neurologic disturbances, ranging in age from 17 to 86 years, and calculated a ventricular volume index (100% × ventricular volume/cranial cavity volume) and a free space volume index (100% × free space volume/cranial cavity volume). Both the ventricular volume and the ventricular volume index started to increase significantly in the forties in men and in the fifties in women. Both the free space volume and the free space volume index were found not to increase until the sixties in both men and women. Both the ventricular volume index and the free space volume index were smaller in hypertensives than in normotensives in men over age 65.
Factors Associated with Early Demise in Nursing Home Residents: A Case Control Study
Authors: Lichtenstein Michael J. , Federspiel Charles F. , Schaffner William
Published: April 2015

A case‐control study was performed to identify factors differentiating nursing home residents who die within 12 months of admission (decedents) and those who survive for at least four years (survivors). Using Tennessee Medicaid data, 49 decedent/survival pairs admitted during the same year were matched for age, race, sex, nursing home, and diagnosis. There were no significant differences between the decedent and survivor groups in demographic factors, sensory impairments, physical handicaps, or number of drugs prescribed. Assessments of the ability to perform activities of daily living were found to be strongly associated with survival, providing a valuable prognostic tool. The authors suggest that personnel providing care for patients of advanced age would benefit from instruction in making such assessments
Gastric Emptying and Small‐bowel Transit Rate in the Elderly
Authors: Kupfer R. M. , Heppell M. , Haggith J. W. , Bateman D. N.
Published: April 2015

Gastric emptying of liquid and small bowel transit in a group of elderly patients (mean age 79 years) was studied, with the elderly subjects compared to two groups of young controls. In 14 elderly patients, the initial rate of gastric emptying was significantly higher than in 14 young controls: the five‐minute volume was 159 ± 30 ml (mean ± SEM) in the elderly patients and 294 ± 22 ml in the young controls (p < 0.005). The two groups' gastric emptying rates after five minutes were not significantly different. Small‐bowel transit in 15 elderly patients was not significantly different from that found in 15 younger volunteers. These results suggest that gastric homeostatic mechanisms are impaired in the elderly.
Medical Paternalism and Patient Self‐determination
Authors: Perry Clifton B. , Applegate William B.
Published: April 2015

In response to the common belief that paternalism directed toward a competent patient necessarily transgresses the patient's right of self‐determination and is therefore morally suspect, the authors argue that such a general view fails to appreciate the complexity of the patient/physician relationship as it is manifested in various clinical settings. It is the authors' contention that some strongly paternalistic acts may fail to violate the patient's right of autonomy, that other such acts may actually be a function of respect for patient autonomy, and that others may only suspend or momentarily infringe upon patient autonomy. They conclude that if these instances of paternalism differ from the classical examples of strong paternalism, then so also should the moral appraisal
Geriatric Consultation Teams in Acute Hospitals: Impact on Back‐up of Elderly Patients
Authors: Barker William H. , Williams T. Franklin , Zimmer James G. , Van Buren Carol , Vincent Sharon J. , Pickrel Susan G.
Published: April 2015

Back‐up of elderly patients in hospital awaiting long‐term placement has become a major problem in some areas of the United States and elsewhere. In 1982, geriatric consultation teams (physician, nurse, and social worker) were introduced into six acute hospitals in Monroe County, New York, to help alleviate the problem through more attention to restoration of patient function and comprehensive discharge planning. Over a six‐month period, 4,328 newly hospitalized patients aged 70 or older were screened, and geriatric consultations were provided for 366 (8.5 per cent) who were judged to be at risk of requiring prolonged hospital stays. During this period, the mean monthly census of elderly patients backed up in hospital declined 21 per cent, a reversal of previous rises that could not be explained by any other identifiable factors. The impact was on length of stay on back‐up status rather than rate of entry to that status. A variety of medical, rehabilitative, and social interventions accounted for this outcome. A number of health care system barriers to expeditious rehabilitation and discharge of hospitalized elderly patients were identified. Geriatric consultation was deemed useful for implementation in acute hospitals in other settings.
The Psychosocial Impact of Cancer on the Elderly: A Comparison with Younger Patients
Authors: Ganz Patricia A. , Schag Cyndie Coscarelli , Heinrich Richard L
Published: April 2015

This report examines the psychosocial impact of cancer in 240 men according to age using a recently developed cancer‐specific survey instrument. Overall, younger patients experienced more frequent or severe psychosocial and treatment‐related problems than the older patients, especially in relation to work and chemotherapy. In addition, younger patients experienced more difficulty dealing with the health care setting. The authors conclude that the elderly cancer patient experiences less psychosocial disruption from cancer than do younger individuals. J Am Geriatr Soc 33:429, 1985
Effective Low Dose Tricyclic Antidepressant Treatment for Depressed Geriatric Rehabilitation Patients: A Double‐Blind Study
Authors: Lakshmanan Mark , Mion Lorraine C. , Frengley J. Dermot
Published: April 2015

The efficacy of low doses (10 to 20 mg daily) of doxepin in the treatment of depressive disorders in elderly inpatients was assessed by a double‐blind study in 24 patients. The patients were treated for a three‐week period to test for an early response. The Hamilton Depression Scale and the Geriatric Depression Scale were used to quantify symptoms of depression. The patients treated with doxepin had a significantly greater reduction in depressive symptoms than did those who received a placebo. No side effects were found and there were no major differences in the degree of physical dependency between the doxepin and placebo groups. A depressive disorder is a common occurrence among elderly inpatients and the effectiveness of low dose doxepin therapy without demonstrable side effects argues for the active treatment for this condition. J Am Geriatr Soc 34:421–426, 1986
Correlation of Pressure Sores and Nutritional Status
Authors: Pinchcofsky‐Devin Gayle D. , Kaminski Mitchell V.
Published: April 2015

As life expectancy increases, so do the problems of the elderly population. One major problem is that of protein calorie malnutrition; another is the susceptibility of this population to pressure sores. The purpose of this study was to determine if a correlation exists between deteriorating nutritional status and the development of pressure sores. The nutritional status of 232 nursing home patients (mean age 72.9 ± 12 years) was determined using biochemical and anthropometric measurements. Overall, the incidence of some degree of malnutrition was 59%. Seventeen of the patients were found to have pressure sores and were all malnourished. When classified as mild, moderate, or severe malnutrition, the patients with pressure sores were in the severe group. There was a significant difference (P < .002) between the nutritional status of pressure sore patients and the malnourished patients. It appears that the development of pressure sores correlates with nutritional deficiencies. The authors' findings suggest a need for more aggressive nutritional support in the elderly, especially those with pressure sores. J Am Geriatr Soc 34:435–440, 1986
Rehabilitation Home Visits
Authors: Rosenblatt D. E. , Campion Edward W. , Mason Mary
Published: April 2015

This chart review study describes 40 geriatric hip fracture patients focusing on the in‐home functional and environmental assessment done before discharge from a rehabilitation hospital. Patients were aged 65 to 96 years. Before hospitalization all ambulated independently and three‐quarters required limited or no social support. On discharge, none ambulated independently and all required support. Discharge plans for three patients were changed by the home visit, resulting in two nursing home placements. The role and structure of the rehabilitation home visit are outlined together with the common safety recommendations and equipment needs. The home visit assessment form is presented. The rehabilitation home visit is a practical tool to help achieve successful home discharge for elderly hip fracture patients. It is particularly useful in discharge planning for elderly patients with hip fracture, amputation, or stroke. J Am Geriatr Soc 34:441–447, 1986
Age and the Hematopoietic System
Authors: MD David A. Lipschitz , Udupa K. B.
Published: April 2015

The aging process is characterized by a decline in the function of many organ systems. Changes that occur in cardiovascular, endocrine, and immune function with aging have been described extensively. The bone marrow clearly plays an important role in normal physiology, being responsible for oxygen delivery to tissues as well as participating in normal hemostasis and host defense. There is evidence that anemia is common in older persons and that the increased morbidity and susceptibility to infection that occurs in the elderly is in part related to altered granulocyte function. This review will discuss normal bone marrow function and describe the most recent evidence implicating alterations in hematopoiesis with age.
Aging and Exocrine Pancreatic Function
Authors: Gullo Lucio , Ventrucci Maurizio , Naldoni Paola , Pezzilli Raffaele
Published: April 2015

In view of the limited information concerning the influence of aging on exocrine pancreatic function, the authors undertook the present study. To examine a large number of elderly persons, including people of very advanced age (80 years and over), pancreatic function was studied by using the fluorescein dilaurate test (pancreolauryl test), one of the most recent tubeless, noninvasive pancreatic function tests. Sixty healthy noninstitutionalized elderly individuals (35 women and 25 men, aged 66 to 88 years, mean 78) participated in the study. Thirty‐six healthy younger subjects (16 women and 20 men, aged 21 to 57 years, mean 36) were also studied as controls. All elderly subjects showed a strictly normal fluorescein dilaurate test. No significant differences in the pancreatic function test results were observed between the elderly under 80 years old and those over 80 years old. The authors conclude that the aging process per se does not significantly affect exocrine pancreatic function and, more particularly, does not impair the digestive capacity of the elderly person.
Informing the Elderly: A Comparison of Four Methods
Authors: Tymchuk Alexander J. , Ouslander Joseph G. , Rader Nancy
Published: April 2015

Providing elderly persons with understandable information with which they can make informed health care decisions is a difficult, yet critical, task. Four methods of enhancing understanding of the Resident's Bill of Rights were evaluated in residents of the board and care section of a long‐term care facility. The methods included the use of large print and simplified language, a storybook, and a videotape. There was no significant improvement for performance on the comprehension test after any of the methods of presentation of the Bill of Rights. A number of subjects were found to be very deficient in short‐term memory or in verbal knowledge. When these subjects were eliminated from the analyses, significant improvement was demonstrated with the simplified version of the Bill of Rights yielding the most improvement. These findings indicate that many elderly people can benefit from an informed consent procedure that provides information clearly and simply. Furthermore, with relatively simple cognitive screening procedures, it should be possible to identify those unable to process the information necessary to participate in common health care decisions.
Folate Deficiency Among Institutionalized Elderly: Public Health Impact
Authors: Infante‐Rivard Claire , Krieger Monique , Gascon‐Barré Marielle , Rivard Georges‐Etienne
Published: April 2015

All patients 65 years and older who had been living in an institution for at least six months had a measurement of red blood cell folate (RBCF), serum folate (SF), vitamin B12, hemoglobin, and mean corpuscular volume. Twenty‐two percent of the 97 studied subjects were found deficient in RBCF, although only 6% had anemia. Length of stay at the institution was significantly associated with deficiency in RBCF and this association was uncon‐founded by age. The proportion of RBCF deficiency among the studied subjects attributable to length of stay is 80%. The prophylactic administration of folate among long‐term nursing home type of patients should be considered.
Nutrition, Cancer, and Aging: An Annotated Review
Authors: Hardy Cheryl , Wallace Clinton , Khansur Tawfiq , Vance Ralph B. , Thigpen J. Tate , Balducci Lodovico
Published: April 2015

The interactions of cancer and malnutrition are discussed with the focus on aging. To establish whether the elderly are more likely to develop cancer cachexia and its complications, this review encompasses the pathogenesis of malnutrition in cancer; the age‐related alterations of appetite, gastrointestinal function, energy expenditure, and protein turnover; the diagnosis of malnutrition; and the effectiveness of nutritional support in the elderly. Although metabolic and physiologic changes induced by cancer and age appear synergistic in causing cachexia, more frequent complications of malnutrition have not been observed in the geriatric cancer patients. This may be due to only a small proportion of the elderly with cancer being enrolled in clinical studies or to a reduced cachexia‐inducing ability of tumors in these patients. A limited number of studies indicate nutritional replenishment is obtainable in malnourished elderly by hyperalimentation. As restoration of the lean body mass may be slower in older patients, early institution of nutritional support is recommended in malnourished elderly or elderly at risk for malnutrition during neoplastic treatment.
Postprandial Blood Pressure Reduction in Healthy Elderly
Authors: Lipsitz Lewis A. , Fullerton Karen J.
Published: April 2015

Previous studies have identified postprandial systolic blood pressure reductions in old, frail institutionalized subjects, which do not occur in healthy, young subjects, after a morning meal. To evaluate the relative contributions of state of health and time of day to this potentially dangerous abnormality in cardiovascular homeostasis, we measured sitting systolic blood pressure and heart rate before and at intervals after a noon meal, and in identical fashion without a meal, in 21 healthy, community‐dwelling elderly subjects (73 ± 6 years of age) attending a nutrition program. Systolic blood pressure changed a maximum of −11 ± 9 (SD) mmHg CP = .006, analysis of variance) by 60 minutes after the meal, in contrast to 1 ± 7 mmHg (NS) by 60 minutes, when no meal was given (P < .0001, meal versus control studies). There was a highly significant inverse correlation between postprandial and basal sitting systolic blood pressure changes (R = −0.60, P = .004). Healthy community‐dwelling elderly demonstrate postprandial reductions in systolic blood pressure which correlate with basal sitting systolic blood pressure. This is consistent with age‐ and hypertension‐related impairment in baroreflex compensation for the hypotensive stress of eating.
Oral Assessment of the Dentulous Elderly Patient
Authors: Gordon Steven R. , Jahnigen Dennis W.
Published: April 2015

The percentage of elderly persons retaining natural teeth is increasing. Although many of these individuals cannot be convinced to see a dentist regularly, they are generally seen by a physician or nurse relatively frequently. The physician or nurse can provide a vital service for these patients by performing oral screening examinations. A technique is described for accomplishing this.
Herpes Zoster Ophthalmicus and Granulomatous Angiitis: An Ill‐Appreciated Cause of Stroke
Authors: Verghese Abraham , Sugar Alan M.
Published: April 2015

The syndrome of granulomatous angiitis related to varicella zoster virus infection often manifests as herpes zoster ophthalmicus followed by contralateral hemiplegia. Forty‐five cases have been reported to date, and the authors' experience with two additional cases seen in a one‐year period is described. Given the frequency of both stroke and herpes zoster ophthalmicus in an aging population, the authors postulate that granulomatous angiitis is underdiagnosed. There is need for increased awareness of this disease by the non‐neurologist. Diagnostic and therapeutic considerations are reviewed.
Suicide in Late Life: Review and Commentary
Authors: Blazer Dan G. , Bachar James R. , Manton Kenneth G.
Published: April 2015

Increasing attention has been directed to recent increases in suicide rates for children, adolescents, and young adults. Nevertheless, persons 65 years and older continue to commit suicide at a higher rate than any other age group in the United States. In this paper various aspects of suicide are examined by analyzing recent trends among young and elderly populations, cohort suicide rates, and future projection of the number of suicides in late life. Data are derived from US death certificates. Consideration of the epidemiologic data and projections may be helpful both to those interested in public policy and to clinicians serving the elderly. J Am Geriatr Soc 34:519–525, 1986
Symptomatic Depression in Elderly Medical Outpatients
Authors: Borson Soo , Barnes Robert A. , Kukull Walter A. , Okimoto Joseph T. , Veith Richard C. , Inui Thomas S. , Carter William , Raskind Murray A.
Published: April 2015

The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty‐four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1 % reported receiving mental health treatment by a specialist. Self‐reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic disease.
Families of Alzheimer's Victims
Authors: Scott Jean Pearson , Roberto Karen A. , Hutton J. Thomas
Published: April 2015

This study examined the instrumental and social‐emotional support provided by families to the primary caregivers of Alzheimer's patients. It was anticipated that the more adequate the support provided by the family, the less sense of burden and the better the coping effectiveness of the caregiver. Ratings of instrumental assistance, social‐emotional support, adequacy of support, and coping effectiveness were made by trained raters from transcribed interviews with 23 primary caregivers. Also, a second family member who was usually next closest of kin to the caregiver was interviewed in order to provide another perspective of the support the family provided.
Families of Elderly Stroke Patients
Authors: Silliman Rebecca A. , Fletcher Robert H. , Earp JoAnne L. , Wagner Edward H.
Published: April 2015

Elderly stroke patients and their families were studied to determine 1) the health effects of providing home care on family caregivers, 2) whether or not caregivers actually providing care in the home experience different effects than caregivers whose family members live in nursing homes, and 3) factors associated with any observed deleterious effects of caregiving. One hundred forty‐seven stroke patients were eligible for study. Of these, 101 were available for follow‐up; 89 family caregivers were interviewed (88%). Caregivers reported both positive and negative effects of providing home care. When actual home caregivers were compared with potential caregivers (those with family members in institutions), no differences in effects were seen. The relationship between each of three health effects (general, social, and emotional) and patient and caregiver attributes was explored. No factors were found to be related to poorer perceived general health. Dependent patient functional status and additional life stress were both associated with diminished social activity and emotional ill‐health. In the latter instance, insufficient social activity and help from family were additional risk factors. If policy is going to advocate home care, its consequences for family caregivers must be known.
Development and Testing of an Incontinence Monitoring Record
Authors: Ouslander Joseph G. , Urman Harold N. , Uman Gwen C.
Published: April 2015

Bladder records can play an important role in the assessment and treatment of incontinence. Many records currently used in long‐term care settings are difficult to read and interpret, and they do not provide for the recording of information that can be of value in the assessment and treatment process. Two versions of an incontinence monitoring record OMR), one using black and white symbols and the other using colored circles, were developed and tested in a quasiexperimental design in three proprietary nonacademically affiliated nursing homes. The IMRs were well accepted by the nursing staff in these homes. Recordings were made more frequently and interrater reliability was highest with the color version of the IMR. Results of this initial study are promising and suggest that the IMR, or a similarly designed record, will be helpful in nursing homes to assess the bladder and bowel status of new admissions, determine patterns of and factors associated with incontinence, design individualized bladder training programs, and monitor the results of these programs and other treatment modalities. In addition, the IMR can provide an opportunity for nurses' aides to meaningfully participate in the assessment and treatment of a condition they manage on a daily basis.
Informed Consent for Research
Authors: Taub Harvey A. , Baker Marilyn T. , Sturr Joseph F.
Published: April 2015

Comprehension of informed consent materials from a study of psychological variables associated with chest pain was evaluated as a function of age (27 to 69 years), education (5 to 20 years), and readability of information [low (college level) versus high (7th grade)]. The potentially confounding effect of memory was eliminated by allowing patients to use the written information sheets to find answers to the multiple choice test. Feedback and a repeat test were provided if any answers were incorrect. The findings indicated that comprehension varied inversely with age and directly with education. It is suggested that while ensuring informed consent may be difficult for all volunteers, it may be a critical problem for elderly patients with low education. The effects of readability were not consistent, suggesting that simplifying informed consent materials by shortening words and sentences may not, by itself, be sufficient to improve comprehension.