bluuebunny/crossref_metadata_2025 huggingface dataset:
Senile Dementia: Treatment with Deanol†
Authors: Ferris Steven H. , Sathananthan Gregory , Gershon Samuel , Clark Cathy
Published: April 2015

Recent research indicates a possible cholinergic involvement in memory processes and thus the possibility that acetylcholine deficiency may underlie memory impairment in senile dementia. Deanol (2‐dimethylaminoethanol), which is assumed to increase brain acetylcholine, was given openly for 4 weeks to 14 senile outpatients, to determine the safety of the drug and whether or not it reduces cognitive impairment. The dosage was gradually increased to 600 mg three times daily during the first two weeks, with no adverse effects. Ten patients improved globally and 4 were unchanged (p < .01). The total score on the Sandoz Clinical Assessment‐Geriatric (SCAG) was lowered by the third week (p < .01), primarily as a result of reduced depression, irritability and anxiety, and increased motivation‐initiative. However, neither the clinical ratings nor an extensive pre‐ versus post‐treatment series of cognitive tests revealed changes in memory or other cognitive functions. Since a similar separate study with a different compound produced no behavioral changes, it is unlikely that the improvement with deanol was due entirely to placebo effects. The results thus suggest that although deanol may not improve memory, it may produce positive behavioral changes in some senile patients.
Calcium Metabolism in Aging Inhabitants of Mountain versus Seacoast Communities in the Kii Peninsula
Authors: Fujita Takuo , Okamoto Yukiharu , Tomita Tateo , Sakagami Yoshiyuki , Ota Kiichiro , Ohata Masahiro
Published: April 2015

A survey was conducted on age‐related changes in various measures of calcium metabolism in 609 men and women over the age of 30 (more than half were over the age of 60) in two communities of the Kii Peninsula at the central southern tip of the Japanese mainland. One community was on Oshima Island, with adequate nutritional intake; the other community was in the mountainous Shichikawa district, with a low intake of calcium and protein. The subjects of the Shichikawa study showed shorter stature, higher prevalence of lumbago, thinner clavicular cortex, lower serum levels of phosphorus, total protein and cholesterol, and a higher level of alkaline phosphatase than did the subjects of the Oshima study. There was no difference in the serum calcium levels.
Differentiation of the Dementias of Old Age by Ultrasonic Doppler Flowmetry: A Pilot Study
Authors: Cole M. , Kraehenbuhl B. , Richard J.
Published: April 2015

At the Bel‐Air Psychiatric Clinic, Geneva, Switzerland, the technique of ultrasonic Doppler flowmetry was used to examine the internal carotid arteries of 30 aged patients — 10 with cerebral degenerative dementia, 10 with cerebrovascular dementia, and 10 without dementia. An index of cerebrovascular resistance was calculated. Apparently this index can distinguish a group of vascular dementias from a group of degenerative dementias.
Sideroblastic Anemia in an Elderly Patient
Authors: Strauss Z. , Sirkis I. , Himmelstein N.
Published: April 2015

A 91‐year‐old man had been treated for iron‐deficiency anemia for four years before admission to the Geriatric Unit of the Hasharon Hospital because of cardiac insufficiency and epigastric pain. In the Unit, laboratory studies revealed, in addition to hypochromic anemia, a high level of plasma iron and a reduced iron‐binding capacity. The low reticulocyte count in the peripheral blood despite hyperplasia in the bone‐marrow erythrocyte series, the rapid disappearance of radioactive iron from the plasma, and the impaired erythrocytic uptake of iron were all indicative of ineffective erythropoiesis. The findings suggested the possibility of sideroblastic anemia, and examination of bone‐marrow aspirates stained for iron confirmed this diagnosis.
Aging and Insulin Resistance in a Group of Nonobese Male Volunteers†
Authors: Kimmerling George , Javorski W. Curtis , Reaven Gerald M.
Published: April 2015

The relationship of age to insulin resistance was determined in 100 nonobese men whose ages ranged from 22 to 69 years. Seventy of the 100 subjects had normal glucose tolerance, and 30 had chemical diabetes. Insulin resistance was estimated by measuring the steady‐state plasma glucose response to a continuous infusion of insulin, glucose, epinephrine, and propranolol. This approach permitted inhibition of endogenous insulin release, achievement of a comparable steady‐state plasma level of exogenous insulin, and use of the height of the steady‐state plasma glucose response as a direct estimate of insulin resistance. With this experimental method, no correlation was found between age and insulin resistance over the age span of the experimental population. Furthermore, there was no correlation between age and the height of the plasma glucose response to an oral glucose challenge in this population of nonobese, healthy ambulatory men.
Lymphocyte Reactivity in the Aged
Authors: Halbrecht Isac , Komlos Luise , Strauss Zoltan
Published: April 2015

Lymphocyte reactivity in cultures toward the nonspecific T and B cell mitogens, phytohemagglutinin (PHA) and pokeweed (PWM), was studied in 46 subjects in three groups: a) young healthy persons, b) elderly healthy persons, and c) hospitalized elderly patients with atherosclerotic cardiovascular disease. No statistically significant differences in the lymphocyte reactivity of young and old healthy persons toward PHA could be observed with different incubation times, mitogen concentrations, or serum sources. A significantly decreased lymphocyte response was found in elderly hospitalized patients compared to young and elderly healthy subjects. In contrast, no differences in the lymphocyte reactivity toward PWM could be found among the three groups, including a comparison between elderly healthy and elderly hospitalized persons. The results suggest that the B lymphocyte‐dependent response to a B lymphocyte stimulator is more stable than is the T cell response in aged subjects.
Psychic Reactions to Long‐Term Hemodialysis: Evaluation in the Elderly by Means of the Draw‐A‐Person Test†
Authors: Lowenhaupt Elizabeth
Published: April 2015

Twelve patients who attended a daytime session in a hemodialysis unit were studied. Most were older than patients whose adaptation has been the subject of previous reports. Problems of life satisfaction for these elderly patients often are different from those for younger persons. Most of the group showed maladaptive reactions which interfered with their activities when away from the unit. The Draw‐A‐Person test was a useful tool in pinpointing these reactions, which can lead to feelings of helplessness and depression. Factors which encourage good adaptation to long‐term hemodialysis are discussed.
Pigmentation and Musculoskeletal Abnormalities in an Aged State Hospital Population
Authors: Campbell Katherine M. , Wade David , Ross Luther W. , Meyer George G.
Published: April 2015

In a State hospital population, 686 patients (mean age, 65 years) were examined for patterned pigmentation on unexposed areas of the body. Of these patients, 285 (41.5 percent) met the criteria for pigmentation. There were no sex or age differences. Psychosis had been diagnosed in 96 percent of the pigmented group. All of the 239 patients examined orthopedically had vertebral malalignment greater than 15 degrees and often had other bony deformities. Nearly all of the pigmented group displayed dyskinetic activity. A possible mechanism for the production of the pigmentation‐psychosis‐skeletal deformity triad could be an alteration in the concentration of available melatonin. Continued research along these lines may lead to an effective means of pharmacologic treatment as well as better psychologic and physical care.
Temporal Arteritis
Authors: Murray T. J.
Published: April 2015

Temporal arteritis (granulomatous inflammation) usually involves the temporal and and ophthalmic arteries, but may be part of a more widespread inflammation of the medium and large vessels. The patient usually presents with an associated group of constitutional symptoms (fever, malaise, anorexia, weight loss, anemia) and rheumatic complaints (polymyalgia rheumatica). The diagnosis should be considered in any patient over 55 years old in whom these symptoms develop or in whom there is evidence of recent onset of headache, visual loss or localized arterial involvement. The diagnosis is also to be considered when the erythrocyte sedimentation rate is over 50 mm/hr, and the presence of arteritis is confirmed by temporal‐artery biopsy findings. Visual loss may occur in 50 percent of affected patients; other serious complications are less common. A strong clinical suspicion of temporal arteritis will permit diagnosis of the more uncommon and atypical presentations of the syndrome. Although cases of temporal arteritis may be self‐limited, treatment is imperative because of the threat of blindness. Patients respond well to steroid (prednisone) therapy, which should be maintained for a prolonged period.
Effects of Chronic Papaverine Administration on Mild Senile Organic Brain Syndrome
Authors: Branconnier Roland J. , Cole Jonathan O.
Published: April 2015

Two groups of geriatric patients were treated with either 300 mg/day of papaverine hydrochloride (Pavabid) or placebo in a double‐blind study of two months’ duration. All patients (25 in each group initially) had mild to moderate senile organic brain syndrome but were ambulatory and treated on an outpatient basis. Neuropsychologic evaluations were made by means of the following six tests: Electroencephalographic Analysis (EEG), Profile of Mood States (POMS), Subject Paced Digit Symbol Substitution Test (SPDT), Continuous Performance Test (CPT), Peterson and Peterson Test (P & P) for Short‐Term Memory, and Clinical Global Impression (CGI). The tests were comparative with a baseline period and between treatment groups. There were positive responses from baseline to active‐drug treatment in four of the six evaluations—EEG, POMS, SPDT and CPT. Some side effects were noted in both drug and placebo groups, but these were not disabling and did not interrupt therapy. Positive responses were also observed between treatment groups. By the EEG criterion, the papaverine patients responded positively. By the P & P test for short‐term memory, the placebo group responded better than did the papaverine group. It is suggested that the pharmacodynamic action of papaverine in ameliorating the symptoms of senile organic brain syndrome may not be due to vasodilation but to dopamine receptor blockade.
The Changing Attitudes of Physicians Toward Prolonging Life
Authors: Noyes Russell , Jochimsen Peter R. , Travis Terry A.
Published: April 2015

This follow‐up survey of physicians’ attitudes and practices reveals a changing approach toward the care of terminal patients. It shows that: 1) communication with dying patients is becoming more open, 2) support for the omission of life‐prolonging treatments is increasing, and 3) opposition to the use of death‐hastening measures remains strong. It indicates that the physician's experience with terminal patients and the setting of his practice influence his attitude towards these patients and the approach to treatment.
Agnogenic Venous Mesenteric Thrombosis†
Authors: Mitty William F. , Purisima Clementino O.
Published: April 2015

One of the most difficult diagnoses to establish is that of agnogenic venous mesenteric thrombosis (AVMT). This disorder occurs chiefly in elderly patients and, unless diagnosed promptly, leads to death in most instances. AVMT may follow surgical operations or occur during a prolonged illness. In the past five years at St. Clare's Hospital and Health Center in New York City, this diagnosis was established in five patients. In reviewing these cases, it was noted that some of the signs and symptoms such as those due to hypotension and shock with marked leukocytosis, were out of proportion to those usually observed when the preoperative diagnosis is being considered. The pathologic and radiologic characteristics of this disorder are outlined, and the recommended operative procedure for treatment is discussed. The importance is stressed of prompt, vigorous and prolonged anticoagulation therapy in order to minimize the chance of recurrence in the early postoperative period. Anticoagulant therapy is also effective preoperatively, if the disease is diagnosed sufficiently early. As greater numbers of elderly patients are being treated in hospitals, this dire complication should be uppermost in the minds of physicians and surgeons if a fatal outcome is to be avoided following a successful operative procedure.
Ivan Basilevich: A Gerontologist in Transit
Authors: FREEMAN JOSEPH T.
Published: April 2015

Chance often determines the names that are recorded in history. Among an earlier generation's gerontologists, Ivan Basilevich was distinguished by the promise of his career and recognition in the USSR by his peers. The military invasion of his nation changed the pattern of his life. From a professional level in his native land, at the age of 50, he became a resident in psychiatry in Rhode Island where he continued his work on aging. He became a citizen in 1954 and by 1962 was the senior psychiatrist of his hospital's staff. His contributions to gerontology included his participation in the Kiev Congress of Aging in 1938 and a monograph in English (unpublished) on the medical aspects of natural old age. He wrote some 70 articles. In his papers on the subject of aging he heralded the transition of gerontology to its modern stage.
The Estrogen‐Cancer Controversy*
Authors: GREENBLATT ROBERT B. , STODDARD LELAND D.
Published: April 2015

Postmenopausal women should not be denied estrogen therapy because of the controversy about the alleged causal relationship of estrogens to endometrial cancer. A prestigious team of biostatisticians reviewed three publications that claimed this relationship and concluded that no such association could be confirmed. Although the incidence of endometrial cancer has doubled in the past 25 years, there is no valid basis for the assumption that the widespread use of estrogens is the cause. The incidence also has increased in Norway and Czechoslovakia where estrogens are rarely used. Moreover, the histologic pattern of endometrial dysplasias is such that many pathologists will make a diagnosis of endometrial cancer as a safeguard for the patient. Thus the statistics for the incidence of endometrial cancer may be inflated. As a test, the administration of 200 mg of an oral progestogen over 5–10 days will convert a histologic pattern of pseudomalignancy, but not of adenocarcinoma, into one of secretory endometrium. Unopposed endogenous or exogenous estrogens may induce hyperplasia, atypical adenomatous hyperplasia or adenocarcinoma in women who are genetically predisposed. To minimize such a possibility, it is advisable to give a 5–7 day course of an oral progestogen so that the endometrium will be shed at monthly intervals. The benefits of hormone replacement therapy for the postmenopausal woman far outweigh the putative risk of endometrial cancer
Clinical Research and the Noninstitutional Elderly: A Model for Subject Recruitment
Authors: LEADER MARCIA A. , NEUWIRTH ELIZABETH
Published: April 2015

Two approaches (normative and symptomatic) are presented for recruiting volunteers for a study of the effects of a vasodilator on the psychophysiologic functioning of elderly patients with mild to moderate cerebroarteriosclerosis. The subjects had to be at least 60 years old, in good physical and emotional health, of at least average intelligence, manifesting cognitive impairment by at least one of several test measures, maintaining themselves in the community, and active in a senior citizens program. Results of both approaches were compared for rates of volunteer response, study eligibility, and admission to the study. The normative approach emphasized data on the normal cognitive changes associated with the aging process. The symptomatic approach focused on the early diagnosis and treatment of an existing cognitive impairment. A combined total of 1,030 potential volunteers, nearly equally divided according to the two techniques, were addressed in group meetings. With the normative approach, 33 percent volunteered; of this group, 27 percent were found eligible for the study, and of these, 10 percent entered the study. With the symptomatic approach, 36 percent volunteered; of this group, 54 percent were found eligible for the study, and of these, 51 percent entered the study. Thus the symptomatic approach was five times more effective than the normative approach.
Echocardiographic Evaluation of Cardiac Function and Drug Effects in Acute Myocardial Infarction
Authors: PRAKASH RAVI
Published: April 2015

The hemodynamic evaluation of patients with acute myocardial infarction (AMI) usually is performed by invasive methods. A prospective echocardiographic study was conducted on 23 AMI patients to determine the feasibility of this technique in evaluating hemodynamics and in measuring the effect of drugs on left ventricular performance. The results showed that: 1) reproducible measurements of left ventricular end‐diastolic and end‐systolic dimensions can be obtained by echocardiography, and 2) echocardiography can be used in the assessment of the effect of drugs in AMI. As echocardiography is a simple noninvasive procedure, it is well suited for conducting longitudinal studies in patients outside the coronary care unit and in ambulatory AMI patients.
Severe Impairment of Dietary Folate Utilization in the Elderly
Authors: BAKER HERMAN , JASLOW SEYMOUR P. , FRANK OSCAR
Published: April 2015

Absorption of folates, vitamin B(i, pantothenate, and riboflavin from a natural food source (yeast) and from synthetic folylmonoglutamate was studied in 24 elderly subjects (age range, 73 to 101 years) and in 12 healthy younger subjects (age range, 24 to 42 years). All subjects absorbed riboflavin, vitamin B6, and pantothenate from yeast. Ingested folylpolyglutamates (the preponderant folates in yeast) proved to be a very poor source of folates for the elderly subjects, whereas synthetic folylmonoglutamate served as a good source. In the younger subjects, yeast was a significant folate source. It is suggested that the folate deficits so common in the elderly are caused by impaired ability to obtain folate from ingested foods. The resultant folate deficit may induce changes in the epithelial structure and enzyme secretion of the small bowel, which may further exacerbate folate malabsorption.
Serum Uric Acid and the Renin‐Angiotensin System in Hypertension
Authors: Saito I. , Saruta T. , Kondo K. , Nakamura R. , Oguro T. , Yamagami K. , Ozawa Y. , Kato E.
Published: April 2015

To study whether the renin‐angiotensin system is related to hyperuricemia in hypertension, the serum concentration of uric acid was determined in 96 patients with various types of hypertension and various degrees of plasma renin activity (PRA). In malignant hypertension, both PRA and the serum uric acid level were higher than in essential hypertension; but in primary aldosteronism or desoxycorticosterone‐excess hypertension, they were lower than in the essential type. In renovascular hypertension, PRA was higher than in essential hypertension, but the serum uric acid levels were similar. There were no differences in PRA and serum uric acid concentration between Cushing's syndrome and essential hypertension. The serum uric acid level in high‐renin essential hypertension was higher than in either the normal‐renin or the low‐renin type. There was a significant correlation between serum uric acid concentration and PRA in the basal state, and between the change in PRA and the change in serum uric acid induced by administration of furosemide. Apparently the close correlation between the renin‐angiotensin system and the concentration of serum uric acid is related to changes in extracellular fluid volume, although an intrarenal effect of angiotensin II cannot be excluded.
Loxapine Succinate as a Neuroleptic Agent: Evaluation in Two Populations of Elderly Psychiatric Patients
Authors: Branchey Marc H. , Lee J. Hillary , Simpson George M. , Elgart Beltran , Vicencio Alfin
Published: April 2015

Loxapine succinate, a newly developed neuroleptic drug, was administered to two groups of geropsychiatric patients: (a) 12 with psychosis and organic brain syndrome, and (b) 14 with chronic schizophrenia. After a two‐week baseline period, loxapine was given for 12 weeks. The moderate therapeutic effect of loxapine in the “responders” was similar to that of other neuroleptic drugs. The therapeutic dosage range was found to be from 10 to 80 mg daily—about half that used for younger patients. The chief side effects were drowsiness, mild extrapyramidal symptoms, and a slight increase in blood pressure.
Psychologic Problems of the Aged
Authors: Mooney Craig M.
Published: April 2015

Some serious psychologic problems associated with the biologic processes of growing old and the sociologic states of being old are discussed in the light of a recent (1974) inquiry into the sufficiency of gerontologic resources in Canada and the adequacy of provisions for the well‐being of elderly Canadians. Many inadequacies in old‐age provisions are attributable to insufficient understanding on the part of program planners, service directors and the general public, of the personal, social and cultural needs of old people. This indicates a requirement for substantial investment in basic and applied gerontology. At present, many of the psychologic problems of old age seem to be a consequence of the demoralizing effects of personal poverty, social alienation, and cultural deprivation. Significant improvements in the conditions of life in old age will depend upon wide public understanding of the vital importance and enduring nature of the human needs of old people.
Cardiovascular Changes in/of Old Age*
Authors: Neurath Otto
Published: April 2015

Although the causes of aging are still unknown, the effects of decrements in anatomic structure and physiologic function have led to wrong concepts and resulting discriminatory policies against old people. Cardiovascular changes are common among the aged but are not necessarily symptomatic; they may be the result of past illnesses or signs of diminished cardiac reserve. In many cases, a cardiac abnormality detected by our modern diagnostic hardware does not in itself constitute the necessity for treatment. Illustrative cases are cited. A rise in blood pressure with advanced age often is a sign of adaptation to the increased rigidity of the arterial system. Certain heart murmurs mimicking mitral insufficiency may indicate slight papillary muscle dysfunction or a clinically insignificant degree of mitral valve prolapse. On the other hand, the changing clinical status in old age may involve a diminution of symptoms. Therefore, in geriatric medicine, the physician should be on the alert for aberrant manifestations, e.g., painless myocardial infarction or atypical pulmonary embolism. Psychologic evaluation is important. There is no cardiac disorder which is typical for the older age group, but also there is none from which older people are exempt.
Electroencephalographic Sleep Recordings and Depression in the Elderly*
Authors: Kupfer David J. , Spiker Duane G. , Coble Patricia A. , Shaw David H.
Published: April 2015

Eighteen patients over the age of 60 who were experiencing a major depressive episode were studied on a Clinical Research Unit after they had been drug‐free for at least two weeks. All‐night electroencephalographic (EEG) recordings revealed considerable fragmentation of sleep, a mean sleep efficiency of 58 percent, and very little delta sleep. The findings of reduced sleep time, shortened REM latency, and high REM density were similar to those in depressed patients under the age of 60. These preliminary findings support the application of EEG sleep recordings as a tool for the differential diagnosis of depression in the elderly.
The Social Behavior of Elderly Aphasic versus Nonaphasic Long‐Term Patients
Authors: Derie Fern , Pablo Renato Y.
Published: April 2015

A study was made of the social consequences of communicative disorders among 51 elderly hospitalized long‐term patients. Independent variables used to account for variations in social behavior were: 1) the presence or absence of aphasia, an impairment resulting in varying degrees of loss of verbal recognition, comprehension and language production; 2) sex; and 3) the level of nursing‐care needs as an indicator of overall physical independence. A rating scale for measuring “Social Involvement” was constructed. It involved four analytically‐derived factors — Interpersonal Behavior, Familial and Social Contacts, Group Participation, and Extent of Social Contacts. Since a comparison of the 15 aphasic and 36 nonaphasic subjects on the basis of these four factors revealed no substantial main effect, it would seem that social isolation was not attributable to aphasia per se. Rather, a number of significant interactions indicated that differences in the levels of social involvement were attributable to the combined influences of sex, presence or absence of aphasia, and varying levels of physical independence. The relationship between social involvement and social isolation has implications for the overall management and rehabilitation of long‐term patients.
Major Gynecologic Surgical Procedures in the Aged
Authors: PANAYIOTIS GEORGHIOU , ELLENBOGEN ADRIAN , GRUNSTEIN STEPHAN
Published: April 2015

ABSTRACT: The results of major gynecologic operations in 160 women over the age of 65 were reviewed and compared with the results in 120 younger women 40–55 years old. Most of the complaints of the elderly group were related to genital prolapse. These conditions caused daily discomfort and anxiety. Contrary to the practice in the younger group, most of the operations in the elderly were vaginal. Vaginal hysterectomy was the preferred procedure in most cases of uterine prolapse. Spinal anesthesia was used, as it is rarely contraindicated in the elderly. Postoperative complications were few and did not cause prolongation of hospital stay. There was only one postoperative death, a mortality rate of 0.6 percent. When care is exercised in medical evaluation, choice of anesthesia, and performance of the operation, the elderly patient usually can tolerate major gynecologic surgical procedures well, and should not be lightly disqualified from receiving the benefits.
Contribution of the Consultant Pharmacist to Rational Drug Usage in the Long‐Term Care Facility*
Authors: COOPER JAMES W. , BAGWELL C. GREG
Published: April 2015

ABSTRACT: In a rural 116‐bed skilled nursing facility, a study was made of the influence of a Consultant Pharmacist on drug usage over a one‐year period. Lines of communication were established with the six attending physicians by means of work rounds, telephone calls, and both official and unofficial memoranda. Daily pharmacy rounds were conducted with health‐care students and the nursing supervisor, who facilitated physician‐pharmacist communication. The physician‐nurse‐pharmacist team studied each patient's problems, the status of the therapeutic endpoint, and the need of and usage of each regularly scheduled or pro re nata (PRN) drug. Stop‐order and standing‐order protocols were developed. During the one‐year period, the number of regularly scheduled drugs per patient was reduced from 3.30 to 2.66 (19.4 percent decrease), and of PRN drugs from 3.92 to 2.12 (45.9 percent decrease). The overall reduction was from 7.22 to 4.78 drugs per patient (33.8 percent decrease). The most significant reduction was associated with the protocol and stop‐order discontinuances of routinely scheduled drugs, and with the duplicated orders for drugs to relieve pain, nausea, vomiting, diarrhea, colds and cough. Implications for optimal care of the patients, and for the economics of this federally‐mandated system of consultant pharmacists are discussed.
Multiple Primary Malignancy in the Elderly
Authors: RAO DODDA B. , BATINA RADHA R. , RAY MANJULA
Published: April 2015

ABSTRACT: The longer a patient lives, the more predisposed he is to become host to primary malignant neoplasms at various sites. Hence the importance of follow‐up clinics in long‐term care facilities. Data on multiple malignancies at Oak Forest Hospital are presented. Among 34 such patients (average age, 72 years), 28 had malignant lesions at two primary sites, and 6 at three primary sites.
The Nursing Home and Training in Geropsychiatry
Authors: JACOBSON SEYMOUR B. , JUTHANI NALINI
Published: April 2015

ABSTRACT: Athough the elderly have a higher incidence of mental illness than other groups, their need for psychiatric services is not being met adequately. This situation could be improved by providing psychiatrists with a broader education in aging and more extensive supervised experience in treating mentally ill old people at an early stage of their training. The Bronx‐Lebanon Hospital established a program for this purpose in cooperation with the Daughters of Jacob Geriatric Center. Second‐year residents in psychiatry are given regular assignments, under supervision, in this multiservice nursing home. They become knowledgeable about the aging process, gain a better understanding of the effect of physical, emotional and social factors on mental health in late life, and acquire a special competence and greater interest in treating the mentally ill aging. The success of the program suggests its value as a means of encouraging psychiatrists to take a more active and responsible role toward the aging.
Falls in the Institutionalized Elderly*
Authors: KALCHTHALER THOMAS , BASCON R. A. , QUINTOS V.
Published: April 2015

ABSTRACT: The reports on 72 of 190 accidents occurring among 189 nursing home residents during a 3‐month period were drawn at random and reviewed. The majority of the accidents were falls, either major or minor. Personal data on the residents included age, sex, mental status, number of diseases, and number of drugs administered. Data on environmental factors included the time of day and location of the accident, and the concomitant nursing staff patterns. Women of advanced age were more likely to be involved in a major fall, whereas younger men were more likely to be involved in a minor one. Alert, wheelchair‐bound elderly patients were at the highest risk, whereas those who used assistive devices were at the lowest risk. Falls were directly related to the number of diseases present and the use of drugs. Most accidents occurred at the bedside during the evenings and nights, with the greatest frequency during the changes in nursing shifts or when the patient was either rising or retiring.
Vitamin Profiles in Elderly Persons Living at Home or in Nursing Homes, versus Profile in Healthy Young Subjects
Authors: BAKER HERMAN , FRANK OSCAR , THIND INDERJIT S. , JASLOW SEYMOUR P. , LOURIA DONALD B.
Published: April 2015

ABSTRACT: The vitamin profile of 473 elderly persons was compared with that of 204 healthy volunteers (controls). Of the 473 elderly, 327 (mean age 87) lived in nursing homes, and 146 (mean age 77) lived at home. The 204 controls were in the 20–50 year age group. The circulating levels of biotin, pantothenate, riboflavin, vitamins A, B6, B12, C, E, folate, thiamine, nicotinate, and carotenes were determined in all groups. Hypovitaminemia was not obvious for biotin, pantothenate, riboflavin, vitamins A, E, and carotenes in either the institutional or non‐institutional elderly. Thiamine, vitamin C and vitamin B12 levels were strikingly depressed in the non‐institutional elderly as compared with the institutional population or the controls. Over 30 percent of the institutional elderly had vitamin B6 and nicotinate hypovitaminemia compared to the controls. Both the institutional and the non‐institutional elderly showed depressed levels of folate and vitamin B12. Vitamin supplementation reduced the percentage of folate and B12 deficits. The marked vitamin deficits in the institutional population, in descending order of incidence were: vitamin B6, nicotinate, vitamin B12, folate, thiamine, and ascorbate, whereas the pattern for the non‐institutional elderly was: vitamin B12, thiamine, ascorbate, vitamin B6, nicotinate, and folate. In the 473 elderly studied, vitamin B6, nicotinate, and vitamin B12, in that order, were the most common deficits; folate, thiamine and ascorbate deficits comprised a lesser percentage. The role of vitamin deficits and the effects upon the aging population are discussed.
Medical Views of Depression in the Elderly: Historical Notes
Authors: WILLMUTH LEWIS R.
Published: April 2015

ABSTRACT: Ancient Greek and Roman physicians recognized the high prevalence of depressive illness in old age and began to differentiate the major mental syndromes of the elderly. Greek humoral theory connected black bile, melancholia and old age, and this formulation dominated medical thinking until the seventeenth century. Beginning with the Enlightenment and continuing throughout most of the nineteenth century, physicians spurned the idea that old age and depression were linked, or tended to view depression as evidence of brain decay. Although twentieth century studies have confirmed that depression in the elderly is a common illness, usually self‐limiting and rarely coexisting with dementia, these views have been incompletely incorporated into modern medical practice.
A Social Policy Directed Toward the Health and Welfare of the Aged in the Soviet Union*
Authors: CHEBOTAREV DMITRI F. , SACHUK NINA N.
Published: April 2015

ABSTRACT: Dealt with in detail are the factors which have determined the characteristics and peculiarities of medical and social care for the aged in the USSR. The forms of geriatric care, personnel training and delivery of social and domestic services to the aged are also presented. Facts are given about the state policy directed at improvement of well‐being of the aged as well as at drawing these people into public life and preventing their “disadaptation.” The importance of the UN‐ and WHO‐sponsored international programs in this field is emphasized.
Drug Usage and Health Characteristics in Noninstitutional Retired Persons*
Authors: VENER ARTHUR M. , KRUPKA LAWRENCE R. , CLIMO JACOB J.
Published: April 2015

ABSTRACT: A study was made of total drug usage (prescription, over‐the‐counter, social), health characteristics, and life satisfaction in 55 noninstitutional retired men and women whose average age was 70 years. The sample was purposively selected on the basis of involvement in peer group interaction networks. Among those using drugs, the average number taken per person was 2.0 prescription, 1.8 over‐the‐counter, and 1.8 social (alcohol, caffeine, nicotine), for a total of 5.6 drugs. For men the average was 7.5, and for women 4.7 drugs. Although drug interaction hazards from prescription drugs alone appeared to be minimal, examination of total drug usage indicated potential interactive hazards. Despite the number of chronic illnesses and physical impairments (5 and 1 per person respectively) and the number of drugs ingested, the respondents usually expressed overall satisfaction with their life condition. A commonly expressed dissatisfaction (males 75 percent, females 35 percent) was with government officials. Respondents had confidence in both their physicians' diagnoses and the effectiveness of the drugs prescribed. The findings that women reported more chronic diseases and physical impairments, and were relatively more dissatisfied with their life condition than were men, may be associated with their greater acquiescence with self‐disclosure.
Reasonable Expectations in Geriatric Rehabilitation*
Authors: GRYFE C. I.
Published: April 2015

ABSTRACT: Rehabilitation and traditional medical treatment have different primary orientations within philosophic, operational and time frameworks. As a result, traditionally trained physicians often do not understand the possible benefits of energetic rehabilitation efforts in the elderly. Accurate assessment includes differentiating the irreversible handicaps of normal aging from the disabilities of remediable disease. Such assessment is the essential prerequisite of effective rehabilitation; together with positive attitudes and continuous re‐evaluation, the likelihood of a successful outcome is greatly enhanced.
Validity Study of the Short Portable Mental Status Questionnaire for the Elderly*
Authors: SMYER MICHAEL A. , HOFLAND BRIAN F. , JONAS EDWARD A.
Published: April 2015

ABSTRACT: The short, portable mental status questionnaire (SPMSQ) developed by Pfeiffer has several advantages over previous short instruments designed to assess the intellectual functioning of older adults. It is based upon data from both institutionalized and community‐dwelling elderly. Although Pfeiffer outlined a four‐group classification, he used two groups in his initial validation study: (a) intact/mildly impaired, and (b) moderately/severely impaired. The present study compared clinicians' ratings with those based upon the SPMSQ scores, and examined the validity of the four‐group classification. The sample included 181 subjects from seven intermediate care facilities and nine home‐care agencies. All were assessed by the OARS questionnaire, which includes the SPSMQ. Three discriminant analyses were performed with three different criteria, for two‐group, three‐group, and four‐group models. Results indicated that the two‐group model (intact/mildly impaired and moderately/ severely impaired) permitted significant discrimination. The four‐group model, however, gave less distinct results. In particular, patients who were mildly intellectually impaired could not be clearly distinguished from those who were intact and from those who were moderately impaired. The three‐group model (minimally, moderately, severely impaired) seemed to offer the best compromise between the gross dichotomy of the original two‐model system and the less accurate four‐category system.
d‐Amphetamine in Elderly Patients Refractory to Rehabilitation Procedures
Authors: CLARK A. N. G. , MANKIKAR G. D.
Published: April 2015

ABSTRACT: This report concerns the use of d‐amphetamine in 88 elderly in‐patients who initially failed to respond to rehabilitation procedures. These patients exhibited characteristics of the Poor Motivation Syndrome (PMS), not associated with depression or dementia. The syndrome was seen five times more frequently in women. d‐Amphetamine was given for three weeks in increasing dosage (2.5–10.0 mg twice daily). The responses were scored according to mobility, self‐care and motivation. Of the & 8 patients, 48 improved and another 28 were discharged who would otherwise have remained dependent nursing cases. An unexpected finding was that 17 patients showed an age‐related resistance to the effects of the drug (P < 0.05). The likelihood of a beneficial response also diminished with increasing age (P < 0.01). Side effects were in the psychiatric sphere; they occurred in 23 patients early in treatment and were not age‐related; the drug was withdrawn. Thus treatment with d‐amphetamine should be restricted to selected patients who satisfy the diagnostic criteria of PMS, and administration should be carefully supervised. With these safeguards, a substantial proportion of patients previously refractory to rehabilitation will show improvement, become more independent and may be discharged from the hospital in a much more active, less dependent state of mind and body.
Rheumatoid Arthritis in the Elderly, Presenting as Polymyalgia Rheumatica
Authors: DIMANT JACOB
Published: April 2015

ABSTRACT: Two elderly patients presented with generalized aches and pains (particularly in the shoulders and the pelvic girdle), stiffness, fatigue, anemia, and an elevated erythrocyte sedimentation rate, but there were no signs or symptoms directly referable to the joints. Two and five months later respectively, pain, swelling, and signs of synovitis appeared in several joints in a symmetrical pattern, and a diagnosis of rheumatoid arthritis was made. Rheumatoid arthritis in the elderly may resemble polymyalgia rheumatica. On the other hand, synovitis in many patients with polymyalgia rheumatica may resemble rheumatoid arthritis. In the elderly, the differentiation of these two entities may be difficult. Moreover, patients initially presenting with the signs and symptoms of polymyalgia may eventually manifest typical rheumatoid arthritis.
Hospital Treatment of Elderly Neuropsychiatric Patients. II. Statistical Profile of the First 122 Patients in a New Teaching Ward
Authors: Spar James E. , Ford Charles V. , Liston Edward H.
Published: April 2015

Data are presented on the first 122 patients admitted to a geropsychiatric teaching ward in a university hospital. A high incidence of medical problems as reflected by abnormal laboratory findings complicated the management of these patients, most of whom had dementia or depression. In all diagnostic categories, the patients appeared to benefit from the intensive inpatient treatment. Difficulties in the areas of diagnosis, treatment, length of hospital stay, discharge placement and program evaluation are discussed.
Demographic Characteristics of Elderly Drug Overdose Patients Admitted to a Hospital Emergency Department
Authors: Schernitski Paul , Bootman J. Lyle , Byers James , Likes Keith , Hughes John H.
Published: April 2015

This study was undertaken to identify the demographic characteristics of patients aged 55 or older in a drug‐overdose group admitted to the Emergency Department of Arizona Health Sciences Center during the 3‐year period, August 1975‐July 1978. Of the 646 overdose patients observed, 60 (9.5 percent) were aged 55 or older; of these, 77 percent were women—a significantly higher proportion than in the rest of the overdose group. The majority of the overdose incidents were unintentional, and most patients required hospitalization. For the elderly, the drugs involved in the overdoses did not differ significantly from those ingested by others in the overdose group. Concurrent traumatic injury occurred more often in the older age group, necessitating a longer hospital stay and higher health care costs. Drug overdosage is a significant problem in the elderly population. Since many overdoses are unintentional, elderly persons in particular require the counsel of physicians and pharmacists in the medication process.
Split‐Course Radiation Therapy: Effects on Pulmonary Function in Patients with Bronchogenic Carcinoma
Authors: Shankar Patil S.
Published: April 2015

Pulmonary function studies were made in 15 patients with unresectable bronchogenic carcinoma treated by split‐course megavoltage radiation. Forced vital capacity and forced respiratory volume per second were measured before starting each of the first and second phases of the split‐course therapy, and at 2 weeks and 12 weeks after completion of treatment. Improvement in ventilatory functions was noted in more than half of the patients. Adverse effects on lung function appeared to be minimal.
Serum Digoxin Concentration and Age*
Authors: Guggenheim Ralph , Reidenberg Marcus M.
Published: April 2015

A review was conducted of the charts of 79 consecutive inpatients (age range, 17–93 years) who were in a steady state with respect to digoxin dosage, and had serum creatinine levels below 1.6 mg/dl or urea nitrogen levels below 26 mg/ dl. In these patients whose renal function was not impaired, there was no correlation between age and the serum digoxin level normalized for dosage. Concurrent administration of quinidine significantly elevated digoxin concentration. Patients with congestive heart failure showed a higher serum digoxin level than did those without heart failure. Thus, age appeared to have little, if any effect on the relationship between the dose of digoxin and the steady‐state serum level when the factor of impaired renal function (often associated with aging) was eliminated.
Temporal Arteritis: Cerebrospinal Fluid and Brain Scan Abnormalities (Case Report)
Authors: Gordon Michael , Gordon Elaine P.
Published: April 2015

A 61‐year‐old man presented with a syndrome suggesting temporal arteritis. Abnormal radioisotope brain scan and cerebrospinal fluid (CSF) findings were consistent with a diagnosis of intracranial vasculitis. Although the clinical response to steroids was dramatic, improvement in the CSF abnormalities lagged. Nevertheless, persistent use of steroids in high dosage resulted in normalization of both CSF and brain scan abnormalities.
New Ideas for Old Eyes†
Authors: Kornzweig Abraham L.
Published: April 2015

The most significant recent advance in ophthalmology has been implantation of an intraocular plastic lens to replace the cataractous lens. The success rate is 75–85 percent. Complications are discussed, and the importance of this operation for the aged is stressed. Vitrectomy is now being used for stopping vitreous hemorrhages and for other therapy not previously attempted. New diagnostic methods involving ultrasound have been of special help when the eye tissue is opaque. Brain tumors compressing the optic nerve have been diagnosed by computerized axial tomography. The laser beam is now being applied for treatment of diabetic retinopathy, for obliteration of retinal holes, and for the creation of holes in the iris in the treatment of narrow‐angle glaucoma. Electronic instruments can estimate the refractive error. The new devices for measuring intraocular pressure do not require the use of local anesthetics. Soft contact lenses for continuous wear have been perfected. The binocular operating microscope has been an outstanding innovation in intraocular and corneal surgery. Timolol, a new drug for the treatment of glaucoma, reduces intraocular pressure without contracting the pupil.
Psychiatric Findings in the Population of a Geriatric Evaluation Unit: Implications†
Authors: Cheah Keong Chye , Beard Owen W.
Published: April 2015

Psychiatric evaluation was performed routinely in 262 patients newly admitted to a Medical Geriatric Evaluation Unit (GEU). The study was conducted in a medical facility that provides excellent medical and surgical care for acute illnesses. The psychiatric disorders found far exceeded those one might expect in a comparable general population, and most were not recognized prior to the patient's transfer. For example, in the GEU, the incidence of organic brain syndrome was 65.3 percent, and of dysphoria‐depression 31.3 percent. The data indicate a need to recognize psychiatric problems in order to ensure appropriate care, and suggest that medical care of the elderly with acute illness will be inadequate if it is based upon the approach used for younger populations. This situation apparently exists in most hospitals, including leading medical centers. The needs of the elderly with acute illnesses are quite different from those of younger patients. Recognition of factors that potentially influence outcomes and overall future health will meet public health's primary and secondary prevention goals.