bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypercalcemia and Malignant Disease in the Elderly: Magnesium Sulphate Therapy
Authors: RAY ASWINI K. , RAO DODDA B.
Published: April 2015

ABSTRACT: Twenty‐three cases of metastatic malignant disease in the elderly were investigated for possible hypercalcemia. Regular biweekly estimation revealed that 7 (about 30 per cent) of these patients had hypercalcemia with many severe symptoms. The commonest symptom was generalized weakness. Though care of the malignant disease usually is not possible, these terminal patients can be made much more comfortable by reducing the concentration of serum calcium. Low dosages of magnesium sulphate were used for this purpose, with excellent results. It is concluded that serial estimation of serum calcium concentration in cases of malignant disease, particularly when distant metastases are present, is a useful adjunct in management. Magnesium sulphate is a simple and effective agent for reducing the serum calcium level.
Management of Popliteal Aneurysms in the Elderly*
Authors: TAHERI S. A. , OSWAKS ROY M.
Published: April 2015

ABSTRACT: Popliteal aneurysms are more common than generally believed and they give rise to more complications than do aneurysms in other locations. Even when these aneurysms are asymptomatic there is danger of limb loss; when symptomatic they can be a threat to life. Too many limbs and lives are still being lost by conservative treatment or emergency operations for this lesion. When surgical treatment is elective, before complications develop, the mortality is low. The preferred technique is the bypass procedure accomplished by means of an autogenous saphenous‐vein graft. Old people tolerate this operation well despite the frequency of associated cardiovascular disease. An important point in management is early diagnosis by routine aortography whether or not the aneurysm is palpable. If the aortogram reveals a good outflow tract, an excellent result can be anticipated. The authors present data on their series of cases and review the data of other surgeons.
Effects of Levodopa Therapy in Patients with Parkinson's Disease: Statistical Evidence for Reduced Tolerance to Levodopa in the Elderly
Authors: GRAD BERNARD , WENER JOSEPH , ROSENBERG GILBERT , WENER STEPHEN W.
Published: April 2015

ABSTRACT: The systolic and diastolic blood pressure (BP), with the patient in the standing, sitting and recumbent positions, and the pulse rate were determined at various time intervals in 51 parkinsonian patients during prolonged levodopa therapy. Hypotension was observed in 10 patients (19.6 per cent). In 5 of these cases it was clinically significant and associated with syncope, so the drug had to be discontinued after two to sixteen weeks of therapy. In the other 5 cases the hypotension was transitory and not clinically significant, so the drug did not have to be discontinued. These 5 cases were included with the 46 cases subjected to statistical analysis. In the 46 cases, both the analysis of variance and the correlation coefficients showed that the dosages of levodopa had no significant effect either on the BP or the pulse. In attempting to produce a clinically significant therapeutic effect with a minimum of toxic effects it was found that a statistically significant lower dosage of levodopa was necessary for the “older” subjects (those over age 70) as compared to the “younger” subjects (those aged 70 or younger). Furthermore, such dosage differences appeared to be more marked in women than in men. In both the normotensive and the hypotensive responses to levodopa, no orthostatic effect was observed nor was there a dose‐related response of the BP within the dosage range used in this study (a maximal level between 2.0 and 4.0 gm daily).
Gastroesophageal Asthma*
Authors: STERNLIEB CHERYL M. , KASHAN FAIZ
Published: April 2015

ABSTRACT: The case is presented of an elderly woman with severe recurrent attacks of asthma refractory to vigorous medical treatment. A careful history revealed that the attacks chiefly occurred at night and awakened the patient. An x‐ray (barium) examination showed only a small hiatal hernia, but an additional water siphonage test demonstrated a large amount of gastroesophageal reflux which could cause aspiration when the patient was in the horizontal position. After repair of the hernia, the reflux stopped and all respiratory symptoms disappeared. For cases such as this, the term “gastroesophageal asthma” is suggested. Early identification is important as it is a potentially curable form of respiratory disease. It should always be considered in the differential diagnosis, particularly in elderly patients.
Personality Patterns in Chronic Alcoholism (Korsakoff's Syndrome), Chronic Schizophrenia, and Geriatric Patients with Chronic Brain Syndrome
Authors: PLUTCHIK ROBERT , DiSCIPIO WILLIAM J.
Published: April 2015

ABSTRACT: The personality profiles of three groups of long‐term hospital patients were obtained by means of the Emotions Profile Index, a personality test designed to measure 8 basic traits. The study groups were as follows: 1) patients with severe chronic alcoholism who showed definite evidence of Korsakoff's syndrome, 2) patients with chronic schizophrenia, and 3) geriatric patients with chronic brain syndrome. All these groups were in state hospitals. The Korsakoff‐alcoholic patients appeared to be gregarious, obedient, timid, and poorly self‐controlled. Then‐profile was different from those of normal subjects and of patients with schizophrenia. However, their profile was similar to that of geriatric patients with chronic brain syndrome who were not alcoholic. The basic similarity between Korsakoff‐alcoholic patients and geriatric‐CBS patients suggests that there is not a unique alcoholic personality.
Comprehensive Outpatient Respiratory Care: A Program Conducted in a Suburban Private Practice*
Authors: OBLEY FRED A. , PREISER FRANKLIN M.
Published: April 2015

ABSTRACT: ABSTRACT: Fifty‐nine patients (ages, 51–58) with chronic obstructive pulmonary disease took part for nine months in a comprehensive outpatient respiratory program that involved training in various factors of daily living but stressed retraining in breathing, airway hygiene and respiratory efficiency. The patients were followed closely by means of pulmonary function and other tests. Subjectively, 55 patients noted functional improvement and an increased feeling of well‐being. Objectively, 49 patients showed increased endurance and physical capacity. In 7 cases, pulmonary function tests showed an improvement of 30 per cent or more. In general, there was a significant increase in walking distance, chest expansion and body hydration, and a reduction in the use of corticosteroids and the rate of hospital admissions. These results indicate the desirability of having such a program available in every community to patients with chronic obstructive pulmonary disease.
Serum Cholesterol Concentration and Atherosclerotic Cardiovascular Disease in the Aged
Authors: VAVRIK M. , PRIDDLE W. W. , LIU S. F.
Published: April 2015

ABSTRACT: The subjects of this investigation were 509 residents of a Home for the Aged — 195 men and 314 women whose ages ranged from 60 to 90 years. The cross‐sectional study included the distribution and prevalence of various serum cholesterol levels in the different old‐age groups and the association between serum cholesterol concentration, blood pressure, diabetes, and the prevalence of atherosclerotic cardiovascular and cerebrovascular diseases (such as ischemic heart disease and stroke). No association was found between serum cholesterol concentration and the level of systolic or diastolic blood pressure. Serum cholesterol concentrations above 250 mg/100 ml were more common in diabetic than in non‐diabetic females (p < 0.01) but no such relationship was found in the males. A positive correlation was demonstrated between serum cholesterol concentration and the prevalence of atherosclerotic cardiovascular diseases (p < 0.01). In patients with clinically evident coronary and/or cerebral atherosclerosis, the greater prevalence of high serum cholesterol concentrations (above 250 mg/100 ml) was statistically significant in both sexes (p < 0.01).

The results of this study support the view that there is a relationship between serum cholesterol concentration and the prevalence of atherosclerotic cardiovascular diseases even in the older age groups. In the individual patient, however, the serum cholesterol concentration has only limited diagnostic and prognostic value.
Urinary Calcium Excretion in Relation to Kidney Function in the Adult
Authors: Goldschmied A. , Modan B. , Greenberg R. A. , Zurkowski S. , Modan M.
Published: April 2015

A study based on 55 hospital patients (age groups 40–59, 60–69, 70–79) demonstrated a significant correlation between the glomerular filtration rate (as expressed by endogenous creatinine clearance) and the mean urinary calcium concentration. Excluded were patients with thyroidal or hypophyseal disorders, osteoporosis, renal stones, immobilizing conditions, or those treated with corticosteroids. The study patients had a normal fluid intake and did not receive any diuretics. The urinary calcium concentration test is less laborious and less liable to laboratory errors than the creatinine clearance test, which requires a 24‐hour urine collection. Because of the gradual decrease in the glomerular filtration rate in the elderly, this test should be of value in geriatric practice.
The Longevity of Gerontologists†
Authors: Freeman Joseph T.
Published: April 2015

The forces of mortality are the prime determinants of longevity. Longevity is a basic consideration of gerontology and includes the life expectancy of the species, the average expectancy of survival at birth, and the average lifespan. In the history of the study of old age, for which the modern period began about 1930, there are no reports of the average lifespan for the students of aging. A survey revealed that the average lifespan of 28 special groups (15,000 individuals) was 68 years; this included an average of 68.01 years for 394 gerontologists during the same eras. These figures are comparable because the attainment of a particular status in a profession or vocation is evidence of survival to maturity. Comparison could not be made with data for the general population whose vital statistics begin at birth. The average duration of life for men whose work in part or in whole prior to the 20th century was in gerontology falls midway between the high level of 77 years for classical Greek authors and the low level of 51 years for revolutionary statesmen, and exactly between the levels of life duration for eunuchs and physical and medical scientists.
Left Ventricular Filling Pressures in Cardiac Patients†
Authors: Prakash Ravi , Aronow Wilbert S.
Published: April 2015

Pulmonary artery end‐diastolic pressure (PADP), pulmonary artery wedge pressure (PAWP), and pre‐“a” wave left ventricular diastolic pressure (LVDP) were correlated with post‐“a” wave left ventricular end‐diastolic pressure (LVEDP) in 51 patients with coronary disease and in 43 cardiac patients with non‐coronary disease, excluding mitral stenosis. In patients with coronary disease, the PADP was more closely correlated with PAWP (r = 0.83) and LVDP (r = 0.84) than with LVEDP (r = 0.62). In patients with non‐coronary disease, the PADP also was more closely correlated with PAWP (r = 0.82) and LVDP (r = 0.77) than with LVEDP (r = 0.70). In patients with coronary disease, the PAWP was well correlated with LVDP (r = 0.94) and with LVEDP (r = 0.84). In patients with non‐coronary disease, the PAWP was well correlated with LVDP (r = 0.81) and with LVEDP (r = 0.81). The PADP and PAWP may be helpful in evaluating left ventricular function at the bedside.
Challenging Residents to Assume Maximal Responsibilities in Homes for the Aged†
Authors: Rodstein Manuel
Published: April 2015

A program for activating residents of homes for the aged to assume maximal responsibilities is described. Promoting maximal physical and mental health through various modalities including activity programs, appropriate exercise and participation in democratic self‐government mechanisms, will result in a happier, healthier population of residents in institutions for the aged. The increased demands on staff time and patience will be compensated for by relief of the too‐frequent feelings of hopelessness and boredom endemic among the staff of long‐term care facilities. Such programs demand constant effort by all staff members, patients, volunteers and relatives because if they succumb to the usual human dislike of persistency, short‐term gains can easily be lost.
Communication for the Aphasic Stroke Patient: Assessment and Therapy†
Authors: Harrington Robert
Published: April 2015

Loss of communicative ability is one of the most devastating handicaps associated with stroke. The goals of therapy require continuous adjustment. Early ambulation facilitates breathing, chewing and swallowing, which are important factors in voice control. Hearing and vision should also receive concentrated attention. Formal speech therapy should begin when the patient shows an interest in regaining speech. Even before that, however, family members and friends can be of great help in laying the foundation for a good prognosis.
Changes in Elderly Welfare Hotel Residents During a One‐Year Period†
Authors: Plutchik Robert , McCarthy Martin , Hall Bernard H.
Published: April 2015

After a one‐year interval, a structured interview designed to assess the quality of life was again conducted with most of the tenants in a single‐room occupancy hotel in New York City. Comparisons were made between the two sets of findings. During the year, a program had been in effect to provide social, psychiatric, recreational, medical and other services to all the tenants at the hotel. Of the original 181 interviewees, 100 completed the second interview. Statistically significant changes occurred in 9 of the 35 variables assessed for the one‐year period. There was significant improvement in the self‐care index, but some negative mood changes were also found. The subgroup of identified alcoholics showed the most positive improvements of any of the subgroups.
Withdrawn, Apathetic Geriatric Patients Responsive to Methylphenidate
Authors: Kaplitz Sherman E.
Published: April 2015

A double‐blind randomized study showed that methylphenidate, as compared to placebo, was singularly effective in 44 withdrawn, apathetic geriatric patients. Study selection and exclusion criteria were rigidly enforced. Patients receiving methylphenidate in a dosage of 20 mg daily improved significantly over a period of six weeks as measured by results of tests for mental status, ward behavior (nurses' rating), target‐symptom response, and physician's and nurses' global evaluations. For this reason and because there were no side effects, this form of antidepressant therapy should be considered in the treatment of previously unresponsive or oversedated patients.
Progressive Deterioration of Glucose Tolerance in the Aged†
Authors: Grobin Wulf
Published: April 2015

This long‐term study of the natural history of glucose tolerance in the aged is now in its eleventh year. Of 411 nondiabetic persons screened on admission to the Jewish Home for the Aged (J.H.A.) since 1968, 15 per cent had abnormally elevated levels of postglucose blood sugar (PGBS) as compared with 25 per cent in the period 1964–1968. Fewer positive reactors were discovered with annual screenings and with the glucose tolerance test (GTT). Although the proportion of positive reactors and of diabetic‐type GTT curves was higher in subjects over age 80 than under age 80, there were 82 residents screened annually for five to nine years who retained normal glucose tolerance despite advancing age. The relatively lower rate of deterioration of glucose tolerance in the second period was attributable to: 1) the younger age of residents admitted since 1968, and 2) the diabetes‐oriented diet plus emphasis on exercise and prevention of obesity. The reactive hypoglycemia found in 6 per cent of the residents was asymptomatic, whereas iatrogenic hypoglycemia was usually symptomatic and often severe. This led to a deliberate policy of undertreatment. Dietotherapy induced a lasting remission in about 60 per cent of newly diagnosed cases of diabetes, often to the point of normal glucose tolerance. Early diagnosis of chemical diabetes, by postponing or obviating the need for antidiabetic therapy, reduced the incidence of iatrogenic hypoglycemia. Diabetes‐oriented measures are recommended for the aged in general, and for residents of homes for the aged in particular.
Uncontrolled Diabetes in Psychogeriatric Subjects†
Authors: Hontela S. , Müller H. F.
Published: April 2015

In a group of 20 long‐term psychogeriatric patients with uncontrolled diabetes, data on body weight, blood pressure and blood sugar concentration (fasting and postprandial) were correlated with the electroencephalographic (EEG) findings. The patterns were similar for the study subjects and for healthy subjects of the same age. The psychogeriatric patients with diabetes, in contrast to psychogeriatric patients with chronic hypoglycemia, showed an increase in body weight and blood pressure and an increase in blood sugar concentration with aging; they also showed a normal EEG whereas chronically hypoglycemic patients usually had an abnormal EEG. In terms of blood glucose levels and excess glucose in the urine despite treatment, the diabetes had to be considered uncontrolled. However, these patients were clinically asymptomatic. Apparently, in these particular circumstances, the diabetes may be an adaptive biologic phenomenon.
Evaluation of Isobaric Oxygenation for the Aged with Cognitive Impairment: Pilot Study
Authors: White Leonard , Crovello James N. , Rosenberg Samuel N. , Neiditch Jon A.
Published: April 2015

The effect of isobaric oxygenation on psychogeriatric subjects with mild cognitive impairment was assessed in a single‐blind controlled pilot study. Three of the 7 subjects were treated with a mixture of 97% oxygen plus 3% carbon dioxide, and 4 were treated with compressed air. The oxygen or air was administered during two 1.5‐hour sessions daily for fifteen consecutive days. Use of a miner's type mask ensured a closed system which permits the maximal partial pressure of oxygen. Psychologic and clinical observations did not indicate any advantage for the oxygenation therapy. Minimal side effects, which arose only in the oxygen group, may have involved some interaction between CO2 sensitivity and anxiety. Careful differential diagnosis and the control of motivational factors are of major importance in any study of the effects of oxygenation upon symptoms in psychogeriatric patients.
Senile Degenerative Brain Lesions and Dementia
Authors: Morimatsu Mitsunori , Hirai Shunsaku , Muramatsu Atsushi , Yoshikawa Masaki
Published: April 2015

In a study of senile degenerative lesions—including Alzheimer's neurofibrillary changes, senile plaques and amyloid angiopathy—the hippocampal area of the brain was examined by thioflavine T fluorescence microscopy in 146 consecutive autopsy patients over the age of 49. The incidence and quantity of neurofibrillary changes and senile plaques rose with age, and an approximate positive correlation in quantity was noted among the three kinds of degenerative change. The quantity of neurofibrillary lesions and senile plaques was significantly different between the demented and non‐demented patients, but not between the severely and less severely demented patients. The cause of dementia was studied retrospectively, based on the extent of morphologic changes in the brain, thus classifying dementia into three types: degenerative, vascular, and mixed. Clinically, the mixed type resembled the vascular type with regard to major neurologic signs, and there was some similarity to the degenerative type with regard to mental features.
Treatment of Trigeminal Neuralgia in the Aged by A Simplified Surgical Approach (Percutaneous Electrocoagulation)†
Authors: Tew John M. , Lockwood Pamela , Mayfield Frank H.
Published: April 2015

Trigeminal neuralgia can be excruciatingly painful. For aged patients, among whom trigeminal neuralgia most commonly occurs, medical therapy may often afford relief of pain. However, since this disorder is likely to become worse with increasing age, medical therapy eventually may fail because of increasing drug requirements and intolerable side effects. Major forms of surgical treatment requiring craniotomy may afford longstanding relief but are associated with significant side effects in 3–5 per cent of cases. For these reasons the authors began to test a new surgical approach, i.e., stereotaxic percutaneous electrocoagulation of the trigeminal nerve. More than 300 patients have been treated by this technique in the past five years. Successive radiofrequency lesions allow the production of a graded sensory deficit sufficient to relieve pain while preserving touch and motor function in the face. Unnecessary suffering from the severe pain of trigeminal neuralgia need not occur because of age or a debilitated condition which might ordinarily preclude surgical treatment. More than 100 patients over 65 years of age (4 of them older than 90) have been treated. Of this group, 93 per cent reported good to excellent results. Seven per cent have had some recurrent pain during the follow‐up period; however, recoagulation has been required in only 5 per cent of these patients. Recoagulation may be readily performed in any patient who shows evidence of fading of the sensory deficit. The electrocoagulation technique and the results in elderly patients are discussed.
Combination Drug Therapy for the Psychogeriatric Patient: Comparison of Dosage Levels of the Same Psychotropic Drugs, Used Singly and in Combination
Authors: Fracchia J. , Sheppard C. , Canale D. , Ruest E. , Cambria E. , Merlis S.
Published: April 2015

The dosage levels for a number of frequently prescribed psychotropic drugs, used singly or in combination, were determined in 902 long‐term psychogeriatric hospital patients. The data failed to support the hypothesis that physicians prescribe lower dosages when combination therapy is used. Rather, the tendency was toward higher dosages under these circumstances.
Treatment Goals in Geropsychiatry†
Authors: Gagliano Louis , Gianturco Daniel , Ramm Dietolf
Published: April 2015

Each geriatric patient has observable problems which can generate treatment goals implemented by a treatment plan. Extensive record keeping would be required to document this tripartite scheme. In practice, either problem‐oriented or goal‐oriented records are used. Problem records tend to drift toward a goal concept, since problems are usually stated in only sufficient detail to serve as a guide to treatment. The results of a problem‐oriented format are described for 143 state hospital patients whose mean age was 74 years. The most common number of problems was 5 per patient. Physical problems were the most frequent (N = 456), followed by behavioral (N = 203), thought‐related (N = 156), administrative (N = 99), affective (N = 69), and attitudinal (N=10). The authors’ experience with both systems leaves them with a preference for the problem‐oriented system with geriatric patients since physical problems are so numerous.
A Psychogeriatric Assessment Program. I. Social Functioning and Ward Behavior†
Authors: Dastoor D. P. , Norton S. , Boillat J. , Minty J. , Papadopoulou F. , Müller H. F.
Published: April 2015

Eighty newly admitted psychogeriatric patients were intensively investigated by a variety of disciplines — medical, laboratory, and psychologic‐psychiatric tests, including a Minimal Social Behavior Scale and an Integrative Social Functioning Scale. The sample of patients and methods of study for this 10‐month Geriatric Assessment Program are described. Assessment of present and past social functioning revealed good agreement between ratings made by different staff members. A decline in social functioning with time differentiated organic from functional psychiatric illness. Some of the scales employed may be of value for social screening purposes in the community.
The Use of Psychoactive Drugs in Elderly Patients with Psychiatric Disorders: Survey Conducted in Twelve Veterans Administration Hospitals
Authors: Prien Robert F. , Haber Paul A. , Caffey Eugene M.
Published: April 2015

A survey conducted at 12 VA hospitals included the collection of detailed information on the use of psychoactive drugs in 1,276 elderly psychiatric patients. On the day of the survey, 61 per cent of the patients were receiving psychoactive drugs. Prescription practices relating to the choice of drugs, prevalence of drug use, dosage, combination drug preparations, and antiparkinson agents are discussed in terms of such factors as the patient's age and the diagnosis. Also discussed is the literature on psychoactive drugs, particularly as it pertains to elderly populations.
Mass Screening for Coronary Risk Factors in 2,524 Asymptomatic Adults
Authors: Aronow Wilbert S. , Allen William H. , De Cristofaro Dominic , Ungermann Suzanne , Wan Maurice K. C. , Chun George M. H. , Leik Donald W. , Savitz Saul P.
Published: April 2015

The prevalence of coronary risk factors was assessed in 2,524 asymptomatic adults in Long Beach, California. Hypercholesterolemia (serum cholesterol level >250 mg/100 ml) was present in 725 subjects (28.8 per cent), hypertriglyceridemia (serum triglyceride level ≥150 mg/100 ml) in 497 (19.7 per cent), and an abnormal lipoprotein pattern in 813 (32.2 per cent). Of the 2,524 subjects, 233 (9.2 per cent) had a blood pressure above 140/90 mm Hg and 116 (4.6 per cent) has a blood pressure above 150/100 mm. There were 1,043 cigarette, cigar, or pipe smokers (41.3 per cent). Fifty subjects (2.0 per cent) had a fasting blood sugar level above 120 mg/100 ml, 48 (1.9 per cent) had abnormal triceps skinfold thickness, and 382 (15.2 per cent) weighed 20 per cent or more above the desirable weight. The electrocardiogram during rest was definitely abnormal in 183 subjects (7.3 per cent). On the basis of these data it is evident that in many asymptomatic adults, risk factors predisposing to coronary disease are not being detected or treated.
Effects of Relocation on Chronically Ill Geriatric Patients of a Medical Unit: Mortality Rates†
Authors: Zweig J. P. , Csank J. Z.
Published: April 2015

The entire general medical unit of Ste. Anne's Hospital for disabled elderly veterans was moved into a new modern building on July 13, 1971. Roughly, about 350 patients were involved. In anticipation of the move, a program of preparation of the patients was organized to prevent if possible the dramatic increases in the mortality rate reported in some earlier studies of relocated geriatric populations. The principal finding with regard to mortality was a significant decrease of 6.82 per cent after the relocation when compared with the mortality rate for the previous year. The highly appreciated air‐conditioning system in the new building, representative of modern improvements, may have helped to a minor degree. A much more important factor was the well organized program for preparation of the patients, skillfully carried out by a conscientious staff.
Sensory Deprivation in Geriatric Patients
Authors: OSTER CLAUDE
Published: April 2015

ABSTRACT: Sensory deprivation speeds up the degenerative changes normally associated with aging and enhances the loss of functional cells in the central nervous system. Since it connotes reduction or absence of stimulation of the five senses, it involves the patient's physical activity, social relationships, intellectual status and overall “value system.” Geriatric patients with various illnesses are particularly vulnerable to sensory deprivation, which becomes increasingly pronounced as physical or mental deterioration progresses. All cells require stimulation for continued growth and activity; lack of stimulation leads to atrophy, with secondary physical or psychosocial abnormalities. Depression acts as a negative reinforcement of stimuli, and anxiety acts as a blocking mechanism. The goal of rehabilitation is to maintain and strengthen the patient's social values and to preserve mental and physical motility. The recommended procedure involves assessment of medical, psychologic and social factors, and determination of whether organic disease is present. A specific treatment plan to meet the individualized needs of each patient is then established so as to minimize sensory deprivation and maximize physical and mental functioning. Re‐evaluation (physical and psychologic) at regular intervals establishes a pattern not only for individual comparison but for comparison with results in untreated control groups.
Upgrading Services in the Small Extended Care Facility
Authors: VEGA RAFAEL H.
Published: April 2015

ABSTRACT: The Extended Care Facility (ECF) has become an important part of the community's provision of health care for the aged. Appropriate services must be available for long‐term, intermediate, skilled, and short‐term medical care. This report describes a small ECF (180 patients) rendering these needed services for the elderly. A limited operating budget, a shortage of physicians, and demand for an increase in the patient‐load are some of the typical problems. In order that the important services can be rendered properly to the aged patients, participation by all the medical disciplines is essential. (The role of the Physical Therapy Department is discussed.) To upgrade services effectively, the interdisciplinary approach must involve a dual responsibility, i.e., the individual effort of the single discipline plus the group cooperative effort of all areas concerned.
Iron Deficiency Anemia in Postmenopausal Women*
Authors: BOYKIN LORRAINE STITH
Published: April 2015

ABSTRACT: In 90 postmenopausal women aged 55 or older residing in health care facilities, a survey was made of hemoglobin levels and food habits that reflected their consumption of iron‐rich foods. The reasons for inadequate dietary intakes of iron are discussed. There is need for better understanding of iron metabolism. Recommendations are made for the prevention of iron deficiency anemia in postmenopausal women and for achievement of the highest possible level of health as affected by the intake of iron and related nutritional factors.
Prediction of Short‐Term Outcome in Newly Admitted Psychogeriatric Patients
Authors: NEIDITCH JON A. , WHITE LEONARD
Published: April 2015

ABSTRACT: Thirty‐six consecutive admissions to a geriatric service recently reorganized to function within a community psychiatric framework were evaluated by means of a series of behavioral and psychologic measures. Assessments upon admission and at three, five and eight weeks and five months afterward, revealed that the greatest therapeutic responses and the most discharges occurred within the first few weeks after admission. Patients remaining for longer periods tended to stabilize at a lower level of functioning or to deteriorate. A combination of two simple measures used in evaluation upon admission and relating to physical and mental functioning was found to predict the patient's status at five months (still in the hospital, dead, or discharged) with 75 percent accuracy. Use of the lambda statistic for judging the predictive power of measures is suggested.
Immunobiology of Aging*
Authors: MAKINODAN T.
Published: April 2015

ABSTRACT: Normal immune functions can begin to decline shortly after an individual reaches sexual maturity. Although changes in cellular environment are partially responsible, the decline is due primarily to changes within the cells, especially the T cells and to some extent the stem cells. This is reflected in their inability to proliferate and differentiate efficiently. What needs to be resolved is whether the altered properties of T cells and stem cells are permanent or reversible and, if permanent, whether they are due to a stochastic or a genetically programmed event. The decline with age in certain normal immune functions is associated with an increase in the frequency of autoimmune and immune complex diseases, certain types of cancer, and viral and fungal infections. These diseases compromise normal immune functions in short‐lived strains of mice. In long‐lived mice and in humans, however, the decline in immune functions to threshold levels seems to predispose in‐individuals to illness.

Three general approaches recently have been used to improve the immune system of aging mice: a) dietary manipulation, b) drug therapy, and c) cellular therapy. Preliminary results of ongoing studies have been most encouraging. Future immu‐nopathogenic studies of aging mice with such an improved immune system should clarify the role of fidelity of the immune system in diseases of the aged. The immune system continues to serve as an excellent model for: a) the etiology of aging at the cellular and molecular levels, b) the pathogenesis of aging, and c) effective approaches to improve the quality of life for the aged.
Tumor Immunology, Autoimmunity and Aging*
Authors: YUNIS EDMOND J. , FERNANDES GABRIEL , GREENBERG LEONARD J.
Published: April 2015

ABSTRACT: Cell‐mediated immune function declines with aging, and may be associated with autoimmunity and malignancy. Humoral immune responses also decline with aging. The chief age‐related effect on the immune system is a decrease in T‐cell function. The “thymus clock” and immunogenesis are discussed in relation to aging. In animals, attempts at immunologic rejuvenation by cellular or hormonal means have not been as successful as the results attained by genetic manipulation.
Hormone Implants for Urinary Disorders in Postmenopausal Women
Authors: SCHLEYER‐SAUNDERS E.
Published: April 2015

ABSTRACT: Urinary disorders associated with the menopause were studied in 300 postmenopausal women between the ages of 45 and 85; 210 were multiparous and 90 nulliparous. The presenting urinary symptom was dysuria in 60 patients and incontinence in 100 patients. In the latter group, 25 had urgency‐incontinence, 45 stress‐incontinence, and 30 a combined form. The distal part of the urethra, being of the same embryologic origin as the genital tract, is estrogen‐dependent. Hormone replacement in the form of implants resulted in improvement in 70 percent of the patients and thus reduced the need for surgical intervention.
Thiothixene in the Treatment of Geriatric Patients with Chronic Organic Brain Syndrome*
Authors: RADA RICHARD T. , KELLNER ROBERT
Published: April 2015

ABSTRACT: Thiothixene was used in a four‐week double‐blind placebo‐controlled study of 42 geriatric patients with chronic organic brain syndrome (psychotic or nonpsychotic). The results, according to several rating measures, showed no significant difference between placebo and thiothixene. Side effects were mild and few. These data support the safety of thiothixene therapy for geriatric patients; however, there is no conclusive evidence of its efficacy in the treatment of chronic organic brain syndrome.
Treatable Aspects of the Dementia Syndrome
Authors: SNYDER BRUCE D. , HARRIS SANDRA
Published: April 2015

ABSTRACT: With attentive medical management, the elderly demented patient can live in greater comfort, dignity and independence. Errors in supervision can result in drug intoxication, misdiagnoses, and personal neglect. Many of the elderly have a chronic dementing illness, and disability often is accelerated by complications. However, some of these complications are treatable. Case histories are presented to illustrate pitfalls in the care of such patients.
Miles' Resection for Cancer of the Rectum
Authors: KRATZER GUY L.
Published: April 2015

ABSTRACT: Miles' resection is the optimal surgical operation for cancer involving the lowermost third of the rectum, although some surgeons question the wisdom of subjecting the patient to permanent colostomy and use fulguration as the alternative. In the author's series of 100 patients, the five‐year survival rate was 41.6 per cent. The operative mortality rate was 4 per cent. The median distance of the cancer above the dentate line was 3 cm and the average distance was 4.6 cm. Fifty patients had Dukes' C lesions. Of the 100 patients, 95 had adenocarcinoma, 3 had squamous‐cell carcinoma, 1 had a cloacogenic lesion, and 1 had melanocarcinoma. Complications were surprisingly few. Eleven patients had perineal recurrence. The relatively poor survival rate is attributed to anatomic limitations for radical surgical measures and to the spread of cancer cells by the time of operation. Regular check‐up examinations are most effective in the prevention of rectal cancer.
Internal Carotid Arterial Occlusion Simulating Extracerebral Hematoma: Relation to Diagnosis of Stroke
Authors: MELAMED ELDAD , RECHES AVINOAM
Published: April 2015

ABSTRACT: In 2 elderly male patients, a progressive neurologic deficit and alteration of consciousness developed following substantial head trauma succeeded by an asymptomatic “lucid” interval. The sequence of events and the associated electroencephalographic, echoencephalographic and cerebrospinal fluid findings strongly suggested the presence of an extracerebral hematoma. The cerebral angiographic study, however, disclosed complete occlusion of the extracranial portion of the internal carotid artery in both patients. This report stresses the diagnostic difficulties sometimes encountered in relation to stroke patients.
Community Intervention with the Elderly: A Social Network Approach
Authors: GARRISON JOHN E. , HOWE JO‐ANN
Published: April 2015

ABSTRACT: A technique is described for using the advantages of a social systems approach when working with elderly persons in psychiatric distress. The technique is based on the assumption that the solution to a variety of human predicaments lies within the collective instrumental and affective resources of the client's social network. The vehicle for accomplishing this objective is the “Network Session” during which a mental health professional meets with the elderly person and members of his/her social network to help resolve the difficulty. A case report demonstrating use of the technique is included.
Intrasynovial Steroid Therapy: Uses and Abuses†
Authors: Fitzgerald Robert H.
Published: April 2015

The indications and contraindications for use of intrasynovial steroid therapy are discussed. When properly used, the intrasynovial injection of steroids is a valuable method of treatment.
Examination of the Back in the Geriatric Patient†
Authors: Mayne John G.
Published: April 2015

Older people often complain of back pain, but it usually is not a major complaint except in the presence of serious disease such as malignancy, compression fractures from osteoporosis, or disc‐space infections. When back pain is a serious symptom in the elderly patient, the physician should look beyond the obvious evidences of degenerative joint disease for these other more serious conditions. Satisfactory examination of the back does not require an undue amount of time. It is important that it be done systematically. Simple, rapid, and adequate procedures are described.
Current Status of Total Joint Replacement in the Upper Extremity†
Authors: Beckenbaugh Robert D.
Published: April 2015

The principles of total joint arthroplasty recently have been expanded to the upper extremity, following the dramatic success with total hip and total knee replacement procedures. New problems have been encountered with the rebalancing of the soft tissues and the technical nature of joint mechanics in the upper extremities. Work on shoulder joint replacement is in the very early stages and of unknown success. Several prostheses are being used and tested. For elbow and wrist replacement, early and predictable success has been accomplished, enabling relief of pain and satisfactory motion. Total joint replacement in the fingers and thumb has provided excellent relief of pain but has been hindered by difficulties in rebalancing the soft tissues in patients with rheumatoid arthritis. It appears that total reconstruction of arthritic upper‐extremity joints will be commonplace in the not‐too‐distant future. Clinical trials are being expanded, with increasing success.
Physical Medicine and Rehabilitation in the Elderly Arthritic Patient†
Authors: Schutt Ann H.
Published: April 2015

The basic conservative therapy programs for elderly patients with arthritis include adequate physical rest and mental relaxation, analgesics, aspirin, and physical rehabilitation consisting of occupational and physical therapy with a good home therapy program providing appropriate balance between rest and activity. Proper protection from trauma and overuse of the involved joints, and appropriate nutrition can afford optimal improvement in health status and general resistance. Proper orientation of the patient regarding the nature of his disease and treatment program usually is required to obtain his full cooperation. A kind, encouraging, and understanding approach is most helpful in the elderly patient. Physical rehabilitation can help to relieve pain, decrease edema and deformities, improve muscle weakness and incoordination, and increase stamina. Difficulties with gait, transfers, and self‐care can be solved or improved. Physical medicine and rehabilitation measures are important components of the challenging treatment of patients of all age groups who are afflicted with severe arthritis. It is most important to tailor these components of the treatment program to the problem presented by geriatric arthritic patients.
Acquired Hemophilia: A Case Report
Authors: Seth H. K. , Frohnsdorff K. G. E.
Published: April 2015

A case of acquired hemophilia is presented. Widespread blisters and then ecchymoses developed in a 79‐year‐old woman who was severely demented. Laboratory studies revealed specific complete inhibition of factor VIII in the blood. In any elderly patient with a bleeding diathesis and an abnormality in intrinsic coagulation, the presence of inhibitors to factor VIII should be suspected.
Endometrial Screening of Asymptomatic Women by Irrigation Technique in the Private Gynecology Office
Authors: Casey Murray Joseph , Madden Thomas J.
Published: April 2015

A study was made of 201 asymptomatic women over age 40 (range, 40–74 years) who underwent uterine sounding and endometrial screening by the negative‐pressure jet irrigation technique, without anesthesia, in private gynecologists’ offices. Introduction of the irrigator was accomplished in 88 percent of these patients. In 97 percent of the successful irrigations, the specimens obtained were satisfactory for cytologic and histologic diagnosis of neoplasia. No occult endometrial carcinomas were discovered. The factors which interfered with endometrial screening by these methods are analyzed. Cervical stenosis prevented endometrial irrigation in 13 of the 24 unsuccessful attempts. Acceptance by the patients was high, in that 74.2 percent reported slight or no discomfort and only 4.7 percent complained of severe discomfort. Although 12.5 percent experienced pelvic cramping after irrigation, no other significant side effects were observed. The results of this investigation indicate the feasibility of using the endometrial irrigation technique for massive screening studies of asymptomatic women who are at risk for the development of endometrial carcinoma.
The Electroencephalogram in the Middle‐Aged and the Elderly
Authors: Roubicek J.
Published: April 2015

A survey was made of the electroencephalographic (EEG) changes during the human lifespan. It was found that the EEG changes during childhood and adolescent maturation continue even between the ages of 30 and 60 years. There is a decrease in the abundance of alpha activity, with a reduction in the fast part and a relative increase in the slow part of the alpha band. In the span of life between 60 and 90, there is an increase of slow waves with a progressive slowing during the aging process and a shift in the dominant frequency from 9 cps to 7 cps. Computerization of results in the beta band (above 13 cps) enables differentiation of the waves of the lower part (13–25 cps) from those of the upper part (above 25–30 cps). The lower part of the beta band decreases parallel to the alpha activity but the upper part of the beta band increases in amount during the aging process. The meaning of the divergent behavior of these sub‐groups of beta activity in the aged is discussed. The EEG seems to be an important factor in the study of aged persons.
Cyclandelate: Effect on Circulatory Measurements and Exercise Tolerance in Chronic Arterial Insufficiency of the Lower Limbs
Authors: Reich Theobald
Published: April 2015

Thirty‐nine patients with arterial insufficiency of the lower limbs were treated with cyclandelate or placebo in a double‐blind cross‐over study, to evaluate the effect of this drug on symptomatic and physiologic indicators of circulatory status. The following measurements were used: skin temperature of the big toe and dorsum of the foot; blood flow in the calf at rest and after exercise on a foot ergometer to the point of claudication; walking distance to the development of claudication; exercise tolerance on a foot ergometer; and reflex vasoconstriction on the skin of the toe in response to cooling of the upper extremities. During treatment with cyclandelate, significant improvement occurred in each of these measures of circulatory efficiency.
Aortic Medial Calcification in Progeria‐Like Syndrome†
Authors: Ishii Toshiharu
Published: April 2015

Aortic medial calcification was investigated in rats in which the progeria‐like syndrome (PLS) was evoked by administering dihydrotachysterol. In 35 experimental rats and 15 controls, calcification was studied morphologically by light and electron microscopy, and by enzyme histochemistry. Body weight, food intake and serum calcium levels were also determined. Calcification occurred along and on the elastic lamellae in association with the accumulation of ground substance. In the smooth‐muscle cells surrounding the calcified foci, the activities of various lysosomal enzymes increased concomitantly with a tendency toward transformation of smooth‐muscle cells to a modified form. From these observations, the role of ground‐substance formation by smooth‐muscle cells is postulated, and participation in the catabolism of ground substance by the lysosomal enzymes of these cells is suggested. It appears the increased activity of adenosine monophosphatase should be linked to the calcification. The etiology of weight loss, skin manifestations and aortic calcification in PLS rats seems to be different from that in human progeric diseases. Therefore, the PLS rat should not be readily accepted as an animal model for the study of progeric diseases.
Effect of L‐Dopa on Polycythemia
Authors: Herishanu Y. , Rosenberg P.
Published: April 2015

A patient with Parkinson's disease, in whom polycythemia vera was known to be present for several years prior to the onset of parkinsonian symptoms, received treatment with a preparation consisting of L‐dopa plus a decarboxylase inhibitor (Madopar). Improvement in the parkinsonian symptoms was associated with marked improvement in the polycythemia. A therapeutic trial of the same L‐dopa preparation in 2 other patients with polycythemia had similar effects. The cases are presented and the possible central therapeutic effect of L‐dopa is discussed.